What techniques are utilised

What techniques are utilised, and what’s the background on them

Definition

“Hypnotherapist” — Induces an hypnotic state in the client . Prepares client to enter hypnotic states by explaining how hypnosis works and what client will experience. Tests subject to determine degrees of physical and emotional suggestibility. Induces hypnotic state in client using individualized methods and techniques of hypnosis. He/she may train client in self-hypnosis.

“Clinical Hypnotherapist” – Clinical hypnosis is a procedure during which a qualified professional or therapist (the “hypnotist”) gives a patient carefully worded instructions to follow with the goal of helping the patient enter a state of deep relaxation. In this hypnotic state, the “hypnotized” client is aware of everything that is going on, but at the same time, becomes increasingly absorbed in using his or her imagination as directed by the hypnotist.

The hypnosis practitioner uses carefully worded language to help the patient enter into a state of highly focused, suggestible attentiveness in which the patient is able to clear away mental “clutter” and focus on his or her problem and solutions to the problem. Hypnosis practitioners employ a body of techniques to help their patients acquire the self-control, self-mastery, willpower and confidence to visualize, realize and achieve their goals. Frequently, hypnosis practitioners teach their patients self-hypnosis methods that they can employ on their own to reinforce and continue the process of positive change.

The hypnotist gives the patient suggestions to experience changes in behaviours, feelings, sensations, images, perceptions, thoughts, beliefs, and/or physical functions or symptoms. Suggestions are typically included for relaxation, calmness, confidence, increased self-control and well-being. Instructions typically include imagining or thinking about pleasant experiences.

Hypnosis is a relationship-based process of communication through which the therapist induces in the patient an alteration in consciousness and internal perception characterised by increased suggestibility. However, in the clinical setting, during the intake interview and evaluation process, an informal Waking Hypnosis State may develop before the formal induction of a Hypnosis Trance State. This Waking Hypnosis State has trance-like qualities that arise from the early experience of relaxation, which naturally develops during the patient’s comfortable interaction with the therapist. This comfort, the patient’s growing sense of trust in the therapist, and the patient’s expectation of eventually entering a formal trance, all help create the experience of relaxation which leads into the informal Waking Hypnosis State. The communication process that takes place during this Waking State is designed to start the process of change that is later further fixed in place during the Hypnosis Trance State.

People respond to hypnosis in different ways. Most people report that they were NOT asleep, but instead, felt very relaxed and could hear everything the hypnotist said. Some people describe hypnosis as a state of focused attention, in which they feel very calm and relaxed. Others describe the experience as being one in which they feel detached and deeply inwardly focused. Still others describe the experience as one in which their sensations and perceptions feel heightened and more vivid.

In the hypnotic state, which is an altered state of consciousness, awareness, and perception, suggestibility is heightened. Both parts of the mind (conscious and subconscious) are more receptive to acceptable, therapeutic suggestions than they are in an ordinary waking state. Even in a light hypnotic “trance”, with the patient’s permission, the “doorway” to his or her subconscious mind opens. This makes it possible for the hypnotist to provide information to the patient’s subconscious in a form that the subconscious can accept.

Hypnosis is a safe procedure when it is employed by a qualified, responsible and experienced professional therapist. It is NOT about “Zap, you are under my spell!” as in some sort of a master/slave or showman relationship. It is also NOT magic! Nobody can be hypnotized unless they want to be and unless they are willing to be a cooperative subject. No one can be hypnotized against their will. Lets make that clear.

In reality, all hypnosis is self-hypnosis. This is because in order for a person to enter the hypnotic state, he or she must follow the hypnotist’s instructions, and his or her conscious and subconscious minds must accept the hypnotist’s suggestions and make them his or her own.

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Anyone who can follow instructions and who wants to be hypnotised can be hypnotised. The subject/patient is simply asked to suspend his or her disbelief and critical, analytical mind, and to allow whatever happens to happen without trying to make anything happen. The patient is thus asked to imagine and visualise the things the hypnotist says. Hypnosis occurs without effort on the patient’s part. It is the therapist/hypnotist’s job to analyse what is happening—not the patient’s!

If the patient’s mind wanders, that is perfectly all right. Hypnosis is among other things a state of controlled daydream-type thinking—a state of believed-in imagination. Mind wandering is what happens when a person daydreams. The patient is told that even when his or her conscious mind wanders, his or her subconscious mind will hear everything that the hypnotist is saying.

Practitioners use clinical hypnosis in three main ways as outlined below:-

Encouraging the use of the imagination.
Under a focused state of attention, the human mind can use mental imagery to make the things we are imagining actually happen. For example, a patient with chronic back and sciatica leg pain may be asked to imagine what the muscles and nerves in his back and leg look like. If he imagines tight, twisted, knotted muscles and hot, pinched, inflamed nerves, he may be told in hypnosis to imagine this image changing to a more comfortable one.

Giving direct suggestions for therapeutic change.
Ideas are suggested to the patient in a form that the patient’s subconscious can accept. This is initially done in the waking state. Then, hypnosis trance is induced with the goal of fixing the suggestions in place in the patient’s subconscious. This is analogous to when an artist sprays a fixative on a painting to fix the colour in place and keep them from running.

Conducting subconscious exploration (or a Hypnoanalysis) to promote understanding and insight about the roots of the patient’s problem using a technique called ideomotor analysis.

A therapist trained in this method of hypnosis can help a patient uncover, reframe and resolve (a) underlying motivations for self-defeating behaviour, (b) subconscious inner conflicts, (c) key past experiences, and (d) subconsciously imprinted fixed ideas maintaining the patient’s problem and symptoms.

While individual responses vary, and no guarantees of a “cure” can be ethically made, clinical hypnosis is beneficial when a patient is motivated to change and overcome a problem.

Evidence from Systematic Reviews
In 1892, the British Medical Association (BMA) commissioned a team of doctors to undertake an extensive evaluation of the nature and effects of hypnotherapy, they reported,

The Committee, having completed such investigation of hypnotism as time permitted, have to report that they have satisfied themselves of the genuineness of the hypnotic state. (British Medical Journal, 1892)
Adding,

The Committee are of opinion that as a therapeutic agent hypnotism is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments [i.e., psycho-somatic complaints and anxiety disorders]. (Ibid.)
This report was approved by the general council of the BMA, thereby forming BMA policy and rendering hypnotherapy a form of “orthodox”, as opposed to complementary or alternative, medicine.

Subsequent research on hypnotherapy has tended to highlight three main areas in which its efficacy as a treatment has been demonstrated,

Anxiety.
Insomnia.
Pain management.
Psycho-somatic disorder, i.e., stress-related illness.

 

Hypnotherapy has many other applications but efficacy research has tended to focus upon these issues. More mixed results have been obtained for its efficacy in relation to the treatment of addictions, an area where high relapse is common with most treatments.

In 1955, the Psychological Medicine Group of the BMA commissioned a Subcommittee, led by Prof. T. Ferguson Rodger, to deliver a second, and more comprehensive, report on hypnosis. The Subcommittee consulted several experts on hypnosis from various fields, including the eminent neurologist Prof. W. Russell Brain, and the psychoanalyst Wilfred Bion. After two years of study and research, its final report was published in the British Medical Journal (BMJ), under the title ‘Medical use of Hypnotism’. The terms of reference were:

To consider the uses of hypnotism, its relation to medical practice in the present day, the advisability of giving encouragement to research into its nature and application, and the lines upon which such research might be organized. (BMA, 1955)
This is a much more thorough and extensive report, and constitutes one of the most significant documents in the history of hypnotherapy research. With regard to efficacy, it concludes from a systematic review of available research that,

The Subcommittee is satisfied after consideration of the available evidence that hypnotism is of value and may be the treatment of choice in some cases of so-called psycho-somatic disorder and Psychoneurosis. It may also be of value for revealing unrecognized motives and conflicts in such conditions. As a treatment, in the opinion of the Subcommittee it has proved its ability to remove symptoms and to alter morbid habits of thought and behaviour. […]
In addition to the treatment of psychiatric disabilities, there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations, and in suitable subjects it is an effective method of relieving pain in childbirth without altering the normal course of labour. (‘Medical use of hypnosis’, BMJ, April, 1955)
According to a statement of proceedings published elsewhere in the same edition of the BMJ, the report was officially ‘approved at last week’s Council meeting of the British Medical Association.’ (BMA Council Proceedings, BMJ, April 23rd, 1955:1019). In other words, it was approved as official BMA policy. This statement goes on to say that,

For the past hundred years there has been an abundance of evidence that psychological and physiological changes could be produced by hypnotism which were worth study on their own account, and also that such changes might be of great service in the treatment of patients. (Loc. cit.)
Soon afterwards, in 1958, the American Medical Association (AMA) commissioned a similar (though more terse) report which endorses the 1955 BMA report and concludes,

That the use of hypnosis has a recognized place in the medical armamentarium and is a useful technique in the treatment of certain illnesses when employed by qualified medical and dental personnel. (‘Medical use of hypnosis’, JAMA, 1958).
Again, the AMA council approved this report rendering hypnotherapy an orthodox treatment,

The Reference Committee on Hygiene, Public Health, and Industrial Health approved the report and commended the Council on Mental Health for its work. The House of Delegates adopted the Reference Committee report […]. (AMA Proceedings, JAMA, Sep. 1958: 57, my italics)
In 1995, the National Institute for Health (NIH), in the US, established a Technology Assessment Conference that compiled an official statement entitled ‘Integration of Behavioural & Relaxation Approaches into the Treatment of Chronic Pain & Insomnia.’ This is an extensive report that includes a statement on the existing research in relation to hypnotherapy for chronic pain. It concludes that:

The evidence supporting the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong. In addition, the panel was presented with other data suggesting the effectiveness of hypnosis in other chronic pain conditions, which include irritable bowel syndrome, oral mucositis [pain and swelling of the mucus membrane], temporomandibular disorders [jaw pain], and tension headaches. (NIH, 1995)
In 1999, the British Medical Journal (BMJ) published a Clinical Review of current medical research on hypnotherapy and relaxation therapies, it concludes,

‘There is good evidence from randomized controlled trials that both hypnosis and relaxation techniques can reduce anxiety, particularly that related to stressful situations such as receiving chemotherapy.
‘They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene).
‘A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety.
‘Randomized controlled trials support the use of various relaxation techniques for treating both acute and chronic pain, […].
‘Randomized trials have shown hypnosis to be of value in asthma and in irritable bowel syndrome […].
‘Relaxation and hypnosis are often used in cancer patients. There is strong evidence from randomized trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea, and vomiting, particularly in children.’ (Vickers & Zollman, ‘Clinical Review: Hypnosis & Relaxation Therapies’, BMJ, 1999)
In 2001, the Professional Affairs Board of the British Psychological Society (BPS) commissioned a working party of expert psychologists to publish a report entitled The Nature of Hypnosis. Its remit was ‘to provide a considered statement about hypnosis and important issues concerning its application and practice in a range of contexts, notably for clinical purposes, forensic investigation, academic research, entertainment and training.’ The report provides a concise (c. 20 pages) summary of the current scientific research on hypnosis. It opens with the following introductory remark:

Hypnosis is a valid subject for scientific study and research and a proven therapeutic medium. (BPS, 2001)
With regard to the therapeutic uses of hypnosis, the BPS arrive at much more positive conclusions.

Enough studies have now accumulated to suggest that the inclusion of hypnotic procedures may be beneficial in the management and treatment of a wide range of conditions and problems encountered in the practice of medicine, psychiatry and psychotherapy. (BPS, 2001)
The working party then provided an overview of some of the most important contemporary research on the efficacy of clinical hypnotherapy, which is summarised as follows (omitting their detailed references).

‘There is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain and in assisting in the alleviation of pain, discomfort and distress due to medical and dental procedures and childbirth.
‘Hypnosis and the practice of self-hypnosis may significantly reduce general anxiety, tension and stress in a manner similar to other relaxation and self-regulation procedures.
‘Likewise, hypnotic treatment may assist in insomnia in the same way as other relaxation methods.
‘There is encouraging evidence demonstrating the beneficial effects of hypnotherapeutic procedures in alleviating the symptoms of a range of complaints that fall under the heading ‘psychosomatic illness.’ These include tension headaches and migraine; asthma; gastro-intestinal complaints such as irritable bowel syndrome; warts; and possibly other skin complaints such as eczema, psoriasis and urticaria [hives].
‘There is evidence from several studies that its [hypnosis’] inclusion in a weight reduction program may significantly enhance outcome.’ (BPS, ‘The Nature of Hypnosis’, 2001)

Eye Movement Desensitization and Reprocessing (EMDR) is an approach developed by Francine Shapiro to resolve symptoms resulting from exposure to a traumatic or distressing event, such as rape. Clinical trials have demonstrated EMDR’s efficacy in the treatment of post-traumatic stress disorder (PTSD). It has shown to be more effective than some alternative treatments and equivalent to cognitive behavioural and exposure therapies (see effectiveness sections below). Although some clinicians may use EMDR for various problems, its research support is primarily for disorders stemming from distressing life experiences.

The theoretical model underlying EMDR treatment hypothesizes that EMDR works by processing distressing memories. EMDR is based on a theoretical information processing model which posits that symptoms arise when events are inadequately processed, and can be eradicated when the memory is fully processed. It is an integrative therapy, synthesizing elements of many traditional psychological orientations, such as psychodynamic, cognitive behavioural, experiential, physiological, and interpersonal therapies.

EMDR’s most controvercial aspect is an unusual component of dual attention stimulation, such as eye movements, bilateral sound, or bilateral tactile stimulation. The contention is the effective elements of cognitive behavioural therapy, desensitization and reprocessing, have been rebranded with eye movements as a novel therapy. As such some individuals have criticized EMDR and consider the use of eye movements to be completely unnecessary. However, more recent studies have found that the eye movement in EMDR correlate with decreases in heart rate, skin conductance, and an increased finger temperature. This is consistent with earlier research on physiological changes associated with EMDR. Also recent studies that have removed eye movement from the method have found the procedure less effective.

Neuro-linguistic programming (NLP) is an interpersonal communication model and an alternative approach to psychotherapy based on the subjective study of language, communication and personal change. It was co-founded by Richard Bandler and linguist John Grinder in the 1970s. The focus was pragmatic, modeling three successful psychotherapists, Virginia Satir, Milton H. Erickson and Fritz Perls, with the aim of discovering what made these individuals more successful than their peers. The theoretical foundations borrow from those disciplines related to language and the mind, including psychology, linguistics, cognitive science, and occupational therapy.

Today, variants and applications of NLP are often found in seminars, workshops, books and audio programs in the form of exercises and principles intended to influence change in self and others. There is also a great deal of difference between the depth and breadth of training and standards. While the field of NLP is loosely spread and resistant to a single comprehensive definition, there are some common principles and presuppositions shared by its proponents. Perhaps most generally, NLP aims to increase choice in the underlying representations so that the individual has more choice and flexibility in the world. Some of the main ideas include:

The way an individual thinks about a problem or desired outcome has an effect on the way he or she will deal with problems and choose a certain course of action. More specifically, mental representations of problems, wishes and desired outcomes, what people see, hear, feel, taste and smell in their mind, their representational systems is crucial to determining state and, hence, action necessary to achieve outcomes.
When communicating with someone, rather than just listening to and responding to what a person is saying, NLP aims to also respond to the structure of verbal communication and cues outwardly expressed in their nonverbal communication, such as voice tone, gesture, posture, facial expression and eye movements. It is claimed that these verbal patterns and non-verbal cues reveal information not typically available when distracted by preconceptions or expectations.

On the one hand, meta model questioning is intended to clarify what has been left out or distorted in communication, such as sensory specific evidence for a goal. On the other hand, the Milton model uses non-specific and metaphoric language. The generality of the Milton model allows the listener to fill in the gaps, making their own meaning from what is being said, finding their own solutions and inner resources. These are used in combination with reframing, which aims to challenge faulty thinking and irrational beliefs, helping someone see a problem in a new light.

The actual state someone is in when setting a goal or choosing a course of action is also considered important. A number of techniques in NLP aim to enhance states by anchoring resourceful states associated with personal experience or model states by imitating others. It is claimed that states can be enhanced through various techniques including manipulation of submodalities, adjusting the size, brightness and location of visual imagery or equivalent properties of representations in the other sensory modalities.

Emotional Freedom Techniques (EFT) is a psychotherapeutic tool based on a theory that negative emotions are caused by disturbances in the body’s energy field and that tapping on the meridians while thinking of a negative emotion alters the body’s energy field, restoring it to “balance.” There are two studies which appear to show positive outcomes from use of the technique.

EFT was created by Gary Craig in the mid 1990s, and is meant to be a simplification and improvement of Roger Callahan’s Thought Field Therapy techniques. Craig trained with Callahan in the early 1990s. In 1993, Craig was the first person Callahan trained in his most advanced procedure, a proprietary procedure known as Voice Technology. Craig found through his experience that the sequence of tapping points did not matter and that special proprietary procedures were therefore unnecessary, so by the mid 1990s he had simplified Callahan’s procedures.

Proponents of EFT claim it relieves many psychological and physical conditions, including depression, anxiety, post-traumatic stress disorder, general stress, addictions and phobias. More extreme claims have been made for multiple sclerosis and one proponent claims that “you can also use it for everything from the common cold to cancer.'” [1] The basic EFT technique involves holding a disturbing memory or emotion in mind and simultaneously using the fingers to tap on a series of 12 specific points on the body that correspond to meridians used in Chinese medicine. The theory behind EFT is that negative emotions are caused by disturbances in the body’s energy field and that tapping on the meridians while thinking of a negative emotion alters the body’s energy field, restoring it to “balance.”

The theory states that negative emotions are built in the following stages: A negative experience occurs; negative emotions are felt in response to this negative experience, leading to inappropriate programming inside the body; and then the body’s energy system gets disrupted due to these negative emotions. The contention of EFT is that in order to remove the negative responses, tackling the negative experience is not enough, because doing so cannot correct the energy imbalance. Rather, the energy imbalance must be restored along with curing the negative emotions.

The main difference between EFT and TFT lies not in principles, but in application. In TFT, a specific sequence of tapping points (known as an algorithm) is used for a particular problem. This sequence is determined using a procedure borrowed from applied kinesiology, called muscle testing.

In EFT, the order and sequence of tapping points is deemed to be unimportant, and therefore there are no individual algorithms for different problems. Instead, a comprehensive algorithm is used for all problems, and no diagnosis or muscle testing is required.