U"lizing Clinical Hypnosis To Enhance Treatment: Make Your (Inevitable) Sugges"ons Count. with Michael D. Yapko, Ph.D.

Transcription

1 U"lizing Clinical Hypnosis To Enhance Treatment: Make Your (Inevitable) Sugges"ons Count with Michael D. Yapko, Ph.D. December 12,

2 The primary goal of this one day workshop is to acquaint you with some of the key principles of hypnosis and ways it can be used to deliver meaningful 2

3 Today s Agenda Part 1 (8:30 10:30) Overview of the field, what makes hypnosis effec@ve, the structure of hypnosis sessions, group hypnosis experience Part 2 (10:45 12:30) Watching it work: The Case of Mike Hypnosis in Trea@ng Comorbid Depression and PTSD; metaphor and meaning Lunch Part 3 (2:00 4:00) Age regression and empowering people; Exercise in accessing and contextualizing personal resources; Summary and closure 3

4 Part 1: Overview of the field, what makes hypnosis the structure of hypnosis sessions, group hypnosis experience 4

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6 Hypnosis in Modern Neuroscience has been increasingly used as an tool in a range of cogni@ve and social neuroscience research areas, such as hearing, vision, synesthesia, voli@on, pain, and azen@on and azen@onal conflict, including the ability to exert substan@al control over automa@c processes. 6

7 Hypnosis in Modern Neuroscience: The Intrinsic Focus The intrinsic focus as one area of research strives to acquire a bezer understanding of the nature of hypnosis and hypno@cally suggested phenomena. Intrinsic studies are largely concerned with what makes some people more responsive to hypno@c sugges@ons than others, the nature of hypno@c sugges@bility, whether suggested hypno@c phenomena are real or are simply imagined and whether hypnosis involves a special state of consciousness. (p.565) Oakley, D. & Halligan, P. (August, 2013). Hypno@c sugges@on: opportuni@es for cogni@ve neuroscience. Neuroscience, 14,

8 Hypnosis in Modern Neuroscience: The Instrumental Focus Instrumentally focused studies involve the use of experimentally and, increasingly, clinically informed to aspects of normal and abnormal psychological This more instrumental approach probes challenging issues such as the nature and neural basis of consciousness, brain mechanisms underlying visual or pain and the origins of clinical symptoms such as medically unexplained paralysis seen in some with conversion disorder (hysteria), delusions and in control over thought and in schizophrenia. p.565 Oakley, D. & Halligan, P. (August, 2013). for neuroscience. Neuroscience, 14,

9 Empirical evidence it works, i.e., hypnosis enhances treatment outcomes All therapy involves the use of Provides insights into experience Highlights the malleability of experience Enhances one s sense of personal control Mul@-dimensional applica@ons Enhances cogni@ve, behavioral and emo@onal flexibility 9

10 The salient clinical are, What do we want the client to focus on, and why? 10

11 Focus on past hurts rather than future Focus on what s wrong rather than what s right Focus internally and miss external cues 11

12 Hypnosis is about building frames of mind 12

13 Hypnosis is neutral, capable of either or experience. We re here to study the of course. 13

14 NO! It s what happens DURING hypnosis - the new and beneficial associa@ons the client forms that can be therapeu@c 14

15 Is NOT, Does hypnosis cure problem X? Rather, the salient is, If one applies therapy approach Y without hypnosis and applies therapy approach Y with hypnosis, will the addi@on of hypnosis to the process likely enhance the treatment outcome? The evidence suggests the answer is yes. 15

16 How do people generally regard hypnosis? It s a mixed reac<on from both professionals and the general public; a curiosity about hypnosis mixed with skep<cism and misapprehension based on commonly held misconcep<ons 16

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18 Hypnosis is caused by the power of the You ll say or do things against your will Hypnosis fosters dependency You can get stuck in hypnosis You re unconscious in hypnosis Hypnosis is simply Hypnosis bypasses thinking Hypnosis increases accurate recall 18

19 There are many different models of hypnosis, ways of thinking about both the process of doing hypnosis and the nature of the experience. One yet meaningful, way to divide them is as follows: Standardized (scripted) (Ericksonian) 19

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21 Let s consider a generic structure 21

22 To explore consciousness To explore spirituality To delineate individual differences To help people change To heal disease or mask pain To promote 22

23 Direct Indirect Process Content (PHS) 23

24 Permissive style Authoritarian style 24

25 And you can wonder if... I wonder if it will surprise you that... You already know how to... You might enjoy discovering that... I wonder whether you realize... Perhaps sooner than you might expect... 25

26 What are the of those who are termed highly (HH) to those who are termed low (LH)? 26

27 Personal Interpersonal Contextual 27

28 Involuntary 28

29 Anything can serve as an process as long as it serves to absorb and elicit meaningful responses 29

30 I d like to begin our hypnosis session by having you place both feet on the floor, let your hands rest on your thighs and when you re ready you can close your eyes so you can focus your acen<on on the ideas and images I m going to describe to you 30

31 You ve been so absorbed in feelings of distress, it would be helpful to start to get absorbed in a different and more comfortable way of experiencing yourself and to help yourself get absorbed in new possibili"es you can let your eyes close and why not take in a few deep, relaxing breaths 31

32 Orient to the idea of experiencing hypnosis Sit comfortably Take in a few deep, relaxing breaths Allow your eyes to close Focus your azen@on Allow yourself to relax 32

33 Hypnosis as a means of facilita@ng flow states Focus on what s right and amplify it Help people discover hidden resources and apply them in their own behalf Reinforce peoples ability to transcend self-limi@ng percep@ons 33

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35 Group hypnosis process 35

36 of focus involvement ( Trance logic ) Willingness to experiment Altera@ons of percep@ons Fluctua@ons in degrees of involvement Symbolic processing (metaphor, injunc@ons, implica@ons) 36

37 Age regression Age progression Amnesia Analgesia Anesthesia Catalepsy 37

38 Ideodynamic responses Sensory Time Value as building blocks: NEUTRAL 38

39 Orient the client to hypnosis procedure Build a response set Introduce therapeu@c Theme #1 Introduce metaphors on the theme, generally moving from less to more direct Interac@on regarding derived meanings 39

40 Introduce Theme(s) #2 (3...etc.) Introduce metaphors per theme regarding derived meanings (contextualize relevant learnings) Closure Permissive disengagement 40

41 for of resources Encourage a sense of comfortable comple@on Authoritarian style: Come out on the count of three Permissive style: Come out when you re ready 41

42 Using client interests Using client values Using client history Using client Using client responses Using environmental 42

43 Part 2: Watching it work: The Case of Mike Hypnosis in Comorbid Depression and PTSD; metaphor and meaning 43

44 THE CASE OF MIKE DEPRESSION S POWER TO ISOLATE 44

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46 The Inner Having an inner is normal. Believing it is 46

47 you employ hypnosis, it s for a clinically sound reason There s a specific type of associa@on you are trying to establish, a specific skill you re trying to facilitate the client azaining 47

48 All the things one would say to be helpful to someone can, of course, be said without hypnosis But hypnosis makes for a focused experience of mul"-dimensional experien"al learning 48

49 Goals for My Session with Mike 1. Establish rapport and a therapeu6c alliance 2. Deframe his viewpoint ( It s my past ) and reframe the salient issue ( It s the need for an effec@ve strategy to deal with nega@vity ) 3. Encourage the development of a discrimina6on strategy ( What is worth listening to? ) 4. of uncertainty, help Mike shiq his focus to future possibili6es rather than past abuse to guide his choices. 49

50 Goals for My Session with Mike 5. Re-associate Mike to his family, to them and with an in them as a source of op@mism and pride. 6. Introduce hypnosis/focusing techniques and encourage their development as skills for symptom management and empowerment 7. Reinforce cri6cal thinking by addressing his global and dichotomous thinking and personaliza@on of his parents limita@ons 50

51 Key Messages Given to Mike During Hypnosis You can develop the skills to cope The past doesn t predict the future You re more than your history You re more than your symptoms You have more resources than you realize and you can learn how to use them effec@vely 51

52 ANALOGIES AND METAPHORS Language devices used to describe a complex, usually abstract reality in concrete, familiar terms borrowed from another, simpler reality 52

53 Metaphor allows to be open-ended and ambiguous, allowing the client to explore new 53

54 The of Metaphors in Hypnosis Diagnosis Reframing meaning Building rapport Encouraging an Encouraging flexibility Embedding Contextualizing learnings 54

55 Metaphor encourages flexibility, challenging the client s one-dimensional cogni@ve rigidity in the symptom domain 55

56 Metaphors From Life Experience The important lessons of life take place around us all Be observant, considering the lesson(s) to be gleaned from the experience, and you ll always have a ready supply of relevant teachings. 56

57 Part 3: Age regression and empowering people; Exercise in accessing and contextualizing personal resources; Summary and closure 57

58 People rou"nely report the current problems are rooted in past experiences 58

59 Simple review of experience Accessing specific resources Resolving cri"cal incidents Rewri"ng personal history Amplifying differences between then, now and later 59

60 Hypermnesia (Dissociated regressionreviewing the past from the present) Revivifica<on (Associated regressionreliving the past as if it is the present) 60

61 That s why hypno@cally obtained tes@mony is generally excluded from court proceedings 61

62 I think I was abused but don t have any memories. Will you hypno@ze me to recover my memories? NO!!!! 62

63 When through someone s unconscious, you don t know where the land mines are 63

64 The goal is to make ongoing verbal interac"on during hypnosis comfortable for the client 64

65 An"cipa"on Signal Facilita"on Deepening 65

66 In just a moment, I m going to ask you to describe your experience out loud... 66

67 ... and you ll find that you can speak quite easily... 67

68 ... and as you speak, each word that you say can serve to deepen your in the experience... 68

69 Can you describe what you re aware of right now? Can you tell me what you re experiencing at this moment? Can you put into words what you re involved with internally at this "me? I wonder if you can verbalize what you re no"cing right now. 69

70 General Ways to Use Hypnosis Symptom management strategies (e.g., enhancing sleep, reducing anxiety) Skill-building/resource accessing (e.g., enhancing flexibility, building problem-solving skills) De-framing and reframing (e.g., It s not you, it s the way you go about it ) Associa"on and dissocia"on (e.g., shiqing focus away from feelings to ac@on, shiqing focus from past to future) 70

71 Clear for Using Hypnosis in Early Phase Treatment Acuteness of symptoms Severity of symptoms Stable style re: symptoms Rigidity; invariant nature of symptoms specific symptoms 71

72 An empowering strategy of empowerment by making dissociated resources available in desired contexts 72

73 procedure Build response set regarding memory (orient to general experience) Age regression to a specific context Ideomotor signal indica@ng context retrieved Sugges@ons to facilitate verbaliza@on 73

74 Verbal regarding memory specific resources in past context Consolidate resources Orient to future and extend resources into desired context for Closure and disengagement 74

75 I hope you ve started to discover the richness and merits of hypnosis 75

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77 Suggested Homework Find and read a good social psychology text Observe everyday examples of hypno@c phenomena in diverse situa@ons Become aware of and consider the sugges@ons evident in even your non-hypno@c work Consider crea@ng self-help recordings you can use on your own behalf for relaxa@on, sleep, etc. See the Things to Do sec@on at the end of each chapter in T-4 and do some of them 77

78 Suggested Homework Do as many sessions as you can with as many people as you can. Record and analyze. Read at least 2 current journal ar@cles in major journals re: your area of interest and analyze the scripts included for their structure and merits Get on the Erickson Founda@on NewsleDer mail list ( and my newslezer list ( both are FREE Prepare u@liza@ons for session interrup@ons Watch Vicki session with transcript 78

79 Michael D. Yapko, Ph.D. Website: Mailing address: P.O. Box 487 Fallbrook, CA , USA 79