Resistance Shelly Johnson Gottsegen, LICSW Hypnovations April, 2010

Definition: “A force that works against the aims of treatment.”

Resistance According to Michael Yapko, PhD a preeminent psychologist, hypnotherapist, author and teacher: “Resistance is a real force to reckon with in treatment, and can be tied to one or both of the two main areas of treatment,: resistance to hypnosis, and/or resistance to therapeutic progress” (Yapco, p.527)

Resistance And: “…the responsibility of the clinician is to structure suggestions responsibly and competently to maximize the likelihood that they will be accepted and translated into a therapeutic change”.

“OK Boys we are going on the ice”…

Resistance “When a client reacts in unexpected ways, the person is choosing (at some level) to do so and your role is to be as supportive and helpful as possible.” The importance of allowing the client to feel accepted, understood, respected and likely to be helped cannot be over stated.

Refusing to go on the ice…

Resistance to Hypnosis or Treatment? Determine if: Fear of hypnosis Fear of treatment progress Fear of change All of the Above Collaborate with patient to address the resistance

Refusing to Come

Resistance Utilize resistance as an opportunity to deepen understanding and to provide direction for treatment. Example:And when you feel quite comfortable sitting, you might discover a growing curiosity about how it would feel to walk across the ice and when you are ready to do so….

Reasons for Patient Resistance Fear of change Misconceptions about hypnosis Symptom has secondary gain Dynamics in the therapeutic relationship Self -Protective Expectation of negative results Religious and Cultural beliefs

Resistance When resistance occurs, the clinician takes responsibility and uses the opportunity to adapt the treatment method. Adopt a permissive style that emphasizes flexibility in following the lead of the client.

Resistance Resistance is much less a debilitating factor when it is viewed as an acceptable response. Suggest possibilities in a way that encourages individual choice and control.

Adapt, Reassure, and Accept

Examples of Suggestions You can allow your eyes to close, if you would like. (eye closure) You may choose to uncross your legs. (Postural shift) You might be willing to let yourself relax even more deeply. (Deepening) It’s possible to experience your body differently. (Perceptual shift) Perhaps you can remember a time when you felt comfortable, (Age regression)

Use a Metaphor to address the Resistance Tell a story that reflects clients resistance and option for resolution Example: Like dropping a pebble in a lake and watching the ripples it takes time and patience to feel calm.

Unconscious issues causing resistance: (ASCH) Hidden client issues Dissociated issues Repressed issues Symptom has secondary gain Client came for different reason than stated reason Hypnosis Resistance – Hypnosis complications: Hypnosis brings up previously uncovered material which interfere with hypnosis process Trust in the unconscious

Make Hypnosis Safe (ASCH) Accept: “it is understandable…” Normalize: “Many people wonder…” Educate/demystify: “ hypnosis/trance is…”, “You are in control of your hypnotic experience…” Collaborate/Rebalance power: “We will find out together…” Negotiate: Would it be alright if…”

Utilizing Resistance (ASCH) Be permissive – all patient’s responses are ok Build a “Yes set”: “would it be alright to and would it also be ok if you…?” Use of negatives to obtain a positive: “you want/need to…do you not? Provide the illusion of choice for greater patient choice A patient’s hand won’t levitate say “And I don’t know whether it’s the left hand or the right hand that has gotten too heavy…”

Utilizing Resistance for induction: (ASCH) Offer easy to comply with Suggestions Foster a successful experience Pace suggestions for a positive and controlled response Monitor for signs of distress Communicate with the client, in and out of trance, about the hypnotic experience “Stay with the client” and adapt for a successful outcome

Utilizing Resistance during deepening: (ASCH) Offer neutral suggestions for increased comfort and relaxation Monitor depth Monitor body language for signs of distress and address the distress Validate, reassure and comfort Communicate with client during hypnotic experience

Utilizing Resistance during Re- alerting/terminating trance: (ASCH) Specify expectation for successful re- alerting Give permission to re-alert at own speed Be firm Ascertain full alert Process hypnotic experience together Plan for next hypnotic experience

Caveats- Patients that may not be suited for hypnosis, especially in the beginning of treatment:(ASCH) Severely depressed (Catatonic, psychotic) Suicidal Psychotic Organic brain injuries or syndromes Borderline Personality with thought disorders and/or psychosis (severe)

All’s well that End’s Well!