1. Presenting Hypnosis to Patients © Maureen F. Turner, RNBC, LCMHC, LCSW Co-Director, Hypnovations: Clinical Hypnosis Training and Education Programs Training and Education Programs April 9, 2009 April 9, 2009

2. Some Uses for Hypnosis www.motivationhypnosis.com   ADD/ADHD Fear   Allergies Focus   Anxiety Habit Control   Attention Healing   Concentration Infertility   Confidence Insomnia   Co-operation Memory   Compliance Pain Control   Diet Panic   Empowerment Performance   Exercise Prosperity

3. Some Uses for Hypnosis (P.2)  Regression Weight Control  Relationships Worry  Self Esteem  Sleep  Smoking  Sports Performance  Study Skills  Test Anxiety

4. Presenting Hypnosis to Patients Components to Include PHASE 1. EVALUATION PHASE 2. EDUCATION PHASE 3. HISTORY TAKING FOR HYPNOSIS PHASE 4. ASSESSMENT OF HYPNOTIZABILITY PHASE 5.TEACHING SELF HYPNOSIS

5. PR ESENTING HYPNOSIS TO THE PATIENT WHO IS: 1. A CURRENT PATIENT/CLIENT 2. A NEW PATIENT/CLIENT INFORMED CONSENT PR ESENTING HYPNOSIS TO THE PATIENT WHO IS: 1. A CURRENT PATIENT/CLIENT 2. A NEW PATIENT/CLIENT INFORMED CONSENT

6. ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 1. EVALUATION a. Current patient/client a. Current patient/client ► Clinician - Evaluate applicability of ► Clinician - Evaluate applicability of hypnosis in reaching clinical goals. hypnosis in reaching clinical goals. ► Clinician - Plan presentation to ► Clinician - Plan presentation to patient/client option of hypnosis as patient/client option of hypnosis as an aid or vehicle to achieve goals. an aid or vehicle to achieve goals. ► Clinician – Introducing the option of ► Clinician – Introducing the option of hypnosis- answering questions, hypnosis- answering questions, assessing and responding to beliefs assessing and responding to beliefs and fears. and fears.

7. ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 1. EVALUATION (Continued) b. New patient/client requesting Clinical Hypnosis treatment ► Evaluating appropriateness (often starting ► Evaluating appropriateness (often starting with initial phone call) with initial phone call) ► Addressing their questions re. hypnosis ► Addressing their questions re. hypnosis questions, assessing and responding to questions, assessing and responding to beliefs and fears. beliefs and fears.

8. ESTABLISHING THE HYPNOTIC RELATIONSHIP PHASE 2. EDUCATION TEACHING THE CONCEPT OF HYPNOSIS ► All hypnosis is self-hypnosis ► All hypnosis is self-hypnosis ► Hypnosis involves relaxing the Conscious Mind (about 3-10% of the mind’s activity from child to adult), in order to access the Unconscious Mind (estimated at 97-90% of the mind’s activity). ► Hypnosis involves relaxing the Conscious Mind (about 3-10% of the mind’s activity from child to adult), in order to access the Unconscious Mind (estimated at 97-90% of the mind’s activity).

9. PHASE 2. EDUCATION TEACHING THE CONCEPT OF HYPNOSIS ► Three Components of Hypnosis: 1. Dissociation (Involuntariness, Levels of Consciousness or Unconscious Response) Consciousness or Unconscious Response) 2. Absorption (or Imaginative Involvement 2. Absorption (or Imaginative Involvement 3. Suggestibility (or Suspension of Critical 3. Suggestibility (or Suspension of Critical Judgment) Judgment)

10. Phase 2. Education (Continued) EDUCATION FOR INFORMED CONSENT ► Hypnosis and the Courts of Law Many courts have had the mistaken idea that simply because hypnosis was used, memory must, therefore, have been contaminated. Therefore, patients/clients must be informed that there is a possibility that anything remembered once hypnosis begins will not be admissable in a court of law. The only way to protect potential rights to testify is to forego the use of hypnosis. Many courts have had the mistaken idea that simply because hypnosis was used, memory must, therefore, have been contaminated. Therefore, patients/clients must be informed that there is a possibility that anything remembered once hypnosis begins will not be admissable in a court of law. The only way to protect potential rights to testify is to forego the use of hypnosis.

11. PHASE 3. HISTORY TAKING FOR CLINICAL HYPNOSIS  Standard psychological or medical evaluations should be established prior to using therapeutic hypnosis. any  Standard psychological or medical evaluations should be established prior to using therapeutic hypnosis. (i.e. any traumas including accidents, deaths, diseases, disasters, phobias, physical and sexual abuse should be noted).  In addition, because many people seek hypnosis for belief change work, a more detailed hypnosis for belief change work, a more detailed Zero to Five history may be indicated. Many Zero to Five history may be indicated. Many beliefs are formed and stored in the Unconscious beliefs are formed and stored in the Unconscious Mind by age 5. Mind by age 5.

12. PHASE 3. HISTORY TAKING FOR CLINICAL HYPNOSIS (Cont.) PHASE 3. HISTORY TAKING FOR CLINICAL HYPNOSIS (Cont.) Routinely, interview for the presenting problem looking for the Cause-Effect clues. (Ex. If a person comes for being a “Chocoholic” – ask who gave them chocolate as a child and seek pertinent details, i.e.: “ my grandmother did.” ) Suggested Response: Clinician: “Is your grandmother still alive?” Client/Patient: “No, she died when I was five.” Clinician: “We often develop habits out of unresolved grief – this is something hypnosis can help you change.” And, continue, questioning re. any other early or later associations with chocolate.

13. PREPARING THE CLIENT FOR HYPNOSIS  Define and explain hypnosis  Dispel misconceptions, myths, and unrealistic goals  Explore client’s motivation and attitude of cooperation.  Explore previous hypnosis.  Explain re-alerting.

14. PHASE 4. ASSESSMENT OF HYPNOTIZABILITY  This phase is addressed informally throughout the presentation of hypnosis – noting the patient/client questions, fears expressed, beliefs about their own ability, cooperativeness in the interview, and body language. throughout the presentation of hypnosis – noting the patient/client questions, fears expressed, beliefs about their own ability, cooperativeness in the interview, and body language. Formal assessments are rarely done in clinical sessions now and have been relegated to use by researchers. Clinicians having found the assessments to have negative effects on the patient – clinician relationship setting up “a test” atmosphere of “pass-fail.”

15. Phase 5. Teaching Self-Hypnosis  All hypnosis is self-hypnosis (Milton Erickson)  There are many ways to induce hypnosis – both indirectly and direct.  The clinician is encouraged to present the method that they plan on using for the patient/client and inform them of the process and discuss the suggestions to be utilized for trance – usually, the more participatory – the better. This is the best way to truly establish a team approach to the clinician as guide and the patient/client as the one who is self-hypnotizing

16. Informed Consent Informed Consent

17. Concept of Informed Consent  I Information Definitions of Hypnosis Definitions of Hypnosis Multidimensional / multi-causal phenomenonMultidimensional / multi-causal phenomenon Altered state of consciousness Altered state of consciousness Narrowed focus of attention Narrowed focus of attention Cognitive variables (e.g. expectations) Cognitive variables (e.g. expectations) Imaginative variables (e.g. absorption) Imaginative variables (e.g. absorption) Context and interpersonal variables (e.g. role conception) Context and interpersonal variables (e.g. role conception)

18. Informed Consent Procedures Procedures Establish state of concentrated attentionEstablish state of concentrated attention Encourage use of focused imaginationEncourage use of focused imagination Suggestions compatible with patient goalsSuggestions compatible with patient goals Unconscious explorationUnconscious exploration Setting Setting OfficeOffice HospitalHospital Emergency situationsEmergency situations

19. Informed Consent (Cont.) Effectiveness of Hypnosis Effectiveness of Hypnosis Influences autonomic, physiological processesInfluences autonomic, physiological processes Influences behaviors, attitudes, cognitions, perceptions, emotionsInfluences behaviors, attitudes, cognitions, perceptions, emotions Symptom ameliorationSymptom amelioration

20. Informed Consent (Cont.) II Competency Licensed health care professional Licensed health care professional Advanced training in areas of expertise Advanced training in areas of expertise Hypnosis training Hypnosis training Course workCourse work Supervised practiceSupervised practice

21. Informed Consent (Cont.) III Voluntary Nature of Ethical Hypnosis Trance Collaborative effort - Formation of a new treatment paradigm– clinician/client team. Collaborative effort - Formation of a new treatment paradigm– clinician/client team. No influence against patient’s will No influence against patient’s will No loss of consciousness No loss of consciousness Ability to stop trance experience at any time Ability to stop trance experience at any time Self-control skill Self-control skill All hypnosis is self-hypnosis All hypnosis is self-hypnosis

22. Informed Consent (Cont.) IV Distinction IV Distinction - Conscious Mind - Conscious Mind - Unconscious Mind - Unconscious Mind V Experience of Hypnosis - Individual Talent - Individual Talent - Practice - Practice

23. Informed Consent (Cont.) VI Memories  Clarify expectations and beliefs about memory in / out of hypnosis  Clarify patient’s goals re memories in/out of hypnosis  Document verbalization of patient’s understanding  Document informed consent  Repeat over course of treatment

24. Informed Consent (Cont.) “Recovered memories” through “Recovered memories” through Hypnoprojectives Hypnoprojectives - Obtain Informed consent - Discuss court admissibility - No universal agreement about effects of Hypnosis on memory memory

25. Memories "recovered" in hypnosis or otherwise - Cannot be presumed to be true or false unless corroborated by another source - Vividness of recall does not equal veracity of memory of memory - Can be utilized as patient’s perceptions / symbols for psychotherapeutic exploration The effects on memory are no more likely to occur from the use of hypnosis than from many non-hypnotic interviewing and interrogative procedures (Hammond, D.C.,2008) The effects on memory are no more likely to occur from the use of hypnosis than from many non-hypnotic interviewing and interrogative procedures (Hammond, D.C.,2008)

26. Informed Consent VII Risks Use of Hypnosis by qualified professionals is safe and can be beneficial Use of Hypnosis by qualified professionals is safe and can be beneficial Use of Hypnosis by unqualified persons can lead to complications Use of Hypnosis by unqualified persons can lead to complicationsBenefits Symptom relief Symptom relief Cognitive self-control, mastery Cognitive self-control, mastery Alternatives Alternatives Treatment without hypnosis Treatment without hypnosis

27. Informed Consent Suggested Informed Consent Form Criteria in: Hammond, D., & Elkins, G. (2005). Standards of Training in Clinical Hypnosis. Des Plaines, IL: American Society of Clinical Hypnosis.

28. References Hammond, D.C. and Elkins, G. (2005). Standards of Training in Clinical Hypnosis. Illinois: American Society of Clinical Hypnosis Press. Hammond, D.C. and Elkins, G. (2005). Standards of Training in Clinical Hypnosis. Illinois: American Society of Clinical Hypnosis Press. Hammond, D.C., Garver, R.B., Mutter,C.B. et al. (2008). Clinical Hypnosis and Memory: Guidelines For Clinicians and For Forensic Hypnosis (Third Printing). American Society of Clinical Hypnosis: Education & Research Foundation, pp.48-49. Hammond, D.C., Garver, R.B., Mutter,C.B. et al. (2008). Clinical Hypnosis and Memory: Guidelines For Clinicians and For Forensic Hypnosis (Third Printing). American Society of Clinical Hypnosis: Education & Research Foundation, pp.48-49. Turner, M. (1995-2010). Private Clinical Hypnosis Practice, Case Presentations. (Unpublished). Turner, M. (1995-2010). Private Clinical Hypnosis Practice, Case Presentations. (Unpublished).