Medical Hypnosis–Uses, Techniques, and Contraindications of Hypnotherapy
What is Hypnosis?
There is no definite dividing line between a normal waking state and a hypnotic or trance state. Examples of alterations in consciousness occur frequently and most people experience some of them. Both children and adults can become so absorbed in daydreaming that they lose track of what is going on around them. Some people consciously use daydreams to divert themselves from certain aspects of their existence. When someone is concentrating intently on a work project, the hyperfocusing that aids the work may also shut out noises and other distractions. Someone who is absorbed in an activity may, when the activity ends, need to take a moment to reorient to the external world.
What hypnosis is not: Sleep. Adults who are hypnotized often prefer to have their eyes closed. This is not necessary in order to have a deep trance state. In fact, many children prefer to have their eyes open and even to walk around during hypnosis. While in hypnosis, one’s attention and concentration is more focused. During sleep, this is not usually the case. EEG patterns during hypnosis and during sleep differ. Hypnosis is intense focused concentration, with the partial or complete exclusion of awareness of peripheral phenomenon. Some feel that individuals who are able to become intensely absorbed in an activity or daydreaming make the best hypnotic subjects. Hypnotic or trance states can occur spontaneously both inside the therapy room and in every day life.
Individuals may feel disappointed and say, “I didn’t feel like I was under hypnosis.” They expect their eyes to close automatically and expect to feel a floating or tired state. Despite this, within a few days, their target symptoms seem to get better. This may actually be good hypnotic treatment. Individuals experience trance in their own way. Many, particularly children, do not close their eyes or even remain seated, during the hypnosis. Some people may continue their work consciously or unconsciously after they leave the session. Other individuals consider medical hypnosis a failure because they have unrealistic expectations or goals. While hypnosis may be the primary treatment of choice for certain symptoms and disorders, it is often appropriate as an adjunct to other biological or psychotherapeutic techniques.
When I explain hypnosis to a new patient, I often have to explain how my procedures differ clinically and ethically from amateur stage hypnosis. Stage hypnosis depends on a certain amount of peer pressure and a given individual’s conscious or unconscious wishes to perform. Frequently it is not done with consideration for the subject’s needs or vulnerabilities. I see hypnosis as a specific medical or psychological procedure that should be done within the context of a therapeutic relationship.
Recently a clinician from another state asked for advice about branching out from clinical hypnosis to hypnosis for public entertainment. I advised her to avoid this completely. It is important for licensed mental health practitioners to use care in determining the appropriate venue for hypnosis.
Indications for Medical Hypnosis
Pain: Some patients worry that if hypnosis helps their pain that it means that the pain is “all in my head”. Actually, that is true because ALL pain is mediated through the brain. Pain related to surgery or medical conditions such as shingles can respond well to hypnosis. I usually work with the patient to build in safeguards so that he or she will be alerted to any change or increase in the pain.
Habit Disorders: Hypnosis has been shown to be effective bruxism (repetitive teeth grinding). I have used it successfully to help individuals stop smoking. For individuals with alcoholism or other chemical dependency, I strongly suggest that if they are seeing me for hypnosis, they also attend 12 step meetings.
Nausea and other Conditions in Pregnancy: I have had good results using hypnosis to attenuate nausea associated with cancer chemotherapy. An added benefit in one individual was the ability to learn to dilate small veins prior to a needle stick. “Morning sickness,” the nausea associated with pregnancy, can range from mildly annoying to medically dangerous. Pregnant women often wish to avoid medication unless absolutely necessary. I do not see hypnosis, in isolation, as a substitute for childbirth preparation classes such as Lamaze or Bradley. However, it can work in combination with these approaches. Women with anxiety disorders, who wish to avoid medication during early pregnancy, can often use these techniques to decrease anxiety and minimize panic attacks.
Relaxation: Almost by definition, hypnosis induces a state of relaxation. This can be short term, as when used to interrupt panic. When used with self-hypnosis, a motivated individual can often achieve longer-term results.
Anxiety states: Hypnosis can help anxiety disorders in more than one way. It can directly decrease anxiety and panic by inducing a state of relaxation. The therapist can also use the hypnotic state to help the patient focus more clearly on issues that might be causing the anxiety. Often the use of fictional stories, used as metaphors, can give the patient a new way of looking at his or her problems. Story telling is more permissive than direct suggestions. It gives the patient a chance to accept or reject the suggestion without feeling that he is being “non-compliant.”
Interruption of strong emotional state: Individuals in crisis are often more susceptible to suggestion. Susceptible individuals may actually dissociate spontaneously during a trauma or crisis. This tendency may be used therapeutically in emergency situations.
Psychotic Disorders: I do not use hypnosis as the primary treatment of schizophrenia or bipolar disorder. However, I occasionally will use hypnosis to interrupt an intense emotional state while waiting for other medical treatments to take effect. One must use caution when using hypnosis with these individuals, but hypnosis is not absolutely contraindicated.
Psychotherapy: Hypnosis can be a useful part of exploratory psychotherapy. The therapist often makes use of metaphorical stories to help the patient develop another way of looking at certain situations.
Some, such as the Speigels, feel that each individual has an innate capacity for achieving trance state. They see this capacity as relatively stable over time. They suggest that there may be inheritability of this capacity. Thus, they do not use deepening techniques as much as other clinicians. They do note that expectations and rapport with the therapist can influence the success of the hypnosis.
Milton Erickson emphasized less a biologically determined capacity for hypnosis. He attempted to find metaphors suitable for each individual. He also would use deepening techniques. He felt that individuals who seemed to have a limited capacity for trance could still achieve trance states with proper technique. Many clinicians approach their hypnotic work from a middle ground. It is useful to get a sense of the patient’s capacity to easily achieve trance. However, much can be done to deepen and enhance the trance state. Additionally, a great deal of productive work can be done while an individual is in a light trance state.
The induction is essentially a ritual that helps formalize a transition to a more focused state of consciousness. Deep or light trance states can occur spontaneously. The formal induction process serves to organize and structure the process so that the trance state can be more efficiently used in therapy. There are a wide variety of types of hypnotic inductions. Some therapists tend to use a particular type of induction most of the time. Others vary the type of induction depending on the personality type and preferences of the patient. Brief induction techniques can be more practical because the patient can often learn to use it himself in “real world” situations.
I will often teach patients how to use self-hypnosis so that they can gain more control over the process. They can use it between sessions as boosters. Often I teach them a long induction for when they have time and a shorter induction for quick use in crisis situations. Individuals who have difficulty doing the self hypnosis may benefit from hypnosis tapes. I will often make up custom tapes for certain patients.
Hypnosis and Children
Children are actually more easily hypnotized than adults. They may become bored with a slow adult-type progressive relaxation induction. If one expects to see a hypnotized child lie still with his eyes closed, one may conclude that the child is incapable of trance.
Pain: When children experience pain, they may not understand what is going on. Thus, the pain may be complicated by anxiety. Hypnosis along with sensitive, age appropriate explanations, can result in good pain relief. In severe or chronic pain, the psychiatrist may want to coordinate treatment with other medical specialists.
Anxiety Disorders: In separation anxiety, hypnosis can compliment a comprehensive approach which may also include specific family guidance, psychotherapy and sometimes medication. The hypnosis may help decrease the child’s anxiety during separation by helping him or her to carry an internalized representation of a parent with them. In reactive anxiety, (anxiety directly related to stress) hypnosis may be the treatment of choice and further treatment may not be necessary.
OCD: Cognitive psychotherapy can help a child or adolescent with OCD as it can an adult. Hypnosis can be an adjunctive treatment.
AD/HD: I do not use hypnosis as a primary treatment for AD//HD or learning disorders. Primary treatments for this condition include parent training, medication, educational intervention, psychotherapy, and the use of support groups. Hypnosis can sometimes augment these treatments by improving self-esteem, anxiety, and focusing.
Behavior disorders: When one is treating a child or adolescent, the goals of the parent and school may be different from those of the child. In such situations, control issues may be prominent. When I use hypnosis in such situations, I emphasize the permissive nature of the trance state. I do not try to use the hypnosis to make a child do things he does not want to do. I try to use the hypnosis to help the individual focus on the positive things he or she wants to achieve. The trance state may help the child or adolescent break out of an oppositional stance by encouraging him or her to think of creative solutions.
Contraindications for Hypnosis
This is a controversial subject. Different clinicians have varying opinions about the appropriate uses of hypnosis. I tend to be more conservative than some other experienced clinicians. Most licensed clinicians agree that they should not use hypnosis for public entertainment. It is not a good idea to try to induce hypnosis in a patient who does not want it. One should not use hypnosis to try to achieve goals other than the patient’s wishes. Generally, it would be difficult to use hypnosis in this way. However, there have been reports of manipulation of ambivalent patients in hypnotherapy and other forms of therapy.
There are a number of specific patients who I might feel would benefit more from another type of psychiatric intervention. In such cases, I will discuss a range of treatments and their potential risks and benefits. Hypnosis is one of a number of psychiatric treatment techniques. The person doing the hypnosis should first be a well-rounded clinician with knowledge of psychiatric diagnosis and treatment.