Cognitive Therapy With Hypnotherapy
Unlike the cognitive behavioural therapist the cognitive psychotherapist would acknowledge past traumatic events and try to change the client’s perception of them. The cognitive therapist may use hypnosis to help reinforce the client’s new thoughts and perceptions [14] “Hypnosis superficially resembles a sleep like state which is how it got its name” The first references to hypnosis can be traced back to ancient Egypt and Greece. Hypnosis is the Greek word for sleep. The father of modern hypnosis was Franz Anton Mesmer an Austrian physician who developed the theory of “animal magnetism” – the concept being that diseases were the result of magnetic forces stuck in the body. Mesmer would sweep his arms all over his client’s body in a showman like fashion in an attempt to get him to enter “an altered state of conscious awareness.” Although the author is aware of the differing schools of thought regarding hypnosis he will hold by the National College’s dictum that once the conscious mind has been put in abeyance by the client focusing on the therapists voice and words then the unconscious mind can be directly utilised.
Although there has been many great pioneers of hypnosis from John Elliotson, James Braid, James Esdaile, Ambrose Liebeault, Jean-Martin Charcot, Emile Coue and Sigmund Freud, Freud’s abandonment of hypnosis, describing it as “too capricious”, held up the development of hypnotherapy. In the 1930’s an American called Clark Hull produced a book called “Hypnosis and Suggestibility”. Hull was a lecturer on hypnosis, one of his students would later become arguably the world’s foremost hypnotherapist: Milton H Erickson. Erickson viewed the unconscious mind as a source of great creativity made up of experiences, ideas and memories [15] “Deep hypnosis frees subjects from the constrictions of the conscious model of reality and places them in direct contact with their unconscious knowledge, experiential learning histories, and abilities, all of which may be vilified into new experiential understandings.” While the author acknowledges the great successes Erickson had with resistant clients and his ability to cure by surprise, confusion and metaphor, for the purposes of this dissertation he feels it appropriate to agree with Erickson’s opinion of the unconscious as a source of creativity as opposed to Freud who viewed it as a seething cauldron of sexual energy and repressions. [16] “This leaves the unconscious area of mental life to contain all the more primitive drives and impulses influence our actions without our necessarily ever becoming fully aware of them.”
In the author’s experience insight orientated therapies has been successful with only a small number of clients. On these occasions the client has been comparably young and has not built up excessive memories of suffering and despair. For the greater majority who have successfully benefited from therapy they have played an active part in their own recovery. [17] “In my opinion, too much time is spent and too much unnecessary suffering caused today by frequently searching for deep-seated causes for nervous illness, when so often none exists … it is not so often a childhood cause as many believe – present sensitisation remains. The habit of fear is the important thing now. This must be cured.” Through counselling, the constraints and limitations of the conscious mind can be addressed, by using the ABC framework and disputing methods, which will presently be shown in detail, hypnosis as an adjunct can harness the creativity and power of the unconscious mind thus putting all parts of the psyche in synchronisation [18] “An injured or inadequate conscious/unconscious relationship can produce as much pain as a dislocated elbow or severed limb. Something is out of place, out of control, or not working properly … as a result that person’s ability to cope comfortably and sufficiently is compromised, symptoms develop, and pain or suffering is experienced.” Cognitive hypnotherapy can be used to track down an isolate N.A.T.’s and images which may not be uncovered through evocative imagery and self-monitoring.
By inducing hypnosis and helping the client achieve a reasonable level of relaxation which will help him to be more aware and at ease to confront anxiety producing thoughts or images [19] “The use of imagery procedures is endorsed by the finding that 90% of anxious patients report visual images prior to and concurrent with anxiety…indeed, some patients describe themselves as ‘imagers’ rather than ‘thinkers’ and find it much easier to report visual fantasies than automatic thoughts.” The client may be asked to visualise a time earlier in the week when his symptoms arose and by incorporating the use of ideo-motor signalling both therapist and client can achieve insight into disturbing symptoms. If the above methods fail to achieve insight into the thoughts, suggestions (with the client’s permission) to go into an anxiety situation whilst in reality, and to be ‘more aware’ of any negative thoughts and images so that he can write them down and at a later date both therapist and client can assess. This method should also overcome the problem of “the mind going blank” which will be discussed later as a secondary disturbance. In accordance with the rational-emotive theory that humans are happiest when they set up important life goals a time projection into the future using imagery of the end result will help motivate the client towards success.
As therapy progresses cognitive restructuring can begin in hypnosis with the client doing imaginal rehearsal by visualising themselves in problematic situations later that week and then using the new functional thoughts that the client has created thus breaking their negative self-hypnosis. Regarding dysfunctional images the author cites a case from his own experience of a fifty year old staff nurse who had a phobia about driving test examiners. Although “sufficiently efficient” in driving skills the woman would experience extreme nervousness, dry mouth, palpitations and an inability to concentrate just on seeing him. By using imaginal rehearsal the therapist asked her to see herself calmly meeting the examiner at the outset of the test and getting into the car after following the usual test procedures. As the test commenced she was asked to imagine – when appropriate – the examiner with ‘puffy’, good bagpipe blowing cheeks, wearing a long kilt and yellow wellington boots. She was then asked to imagine him drumming on his clipboard in time to Scottish country music. As the imaginal test proceeded she was then asked to visualise the examiner asking her to pull the car the over whilst he got out of the car and started doing somersaults. The lady in question who had failed three previous tests, passed. Her perception of driving examiners would never be the same again.
Hypnosis may also be helpful in allowing the client a greater awareness of how his problem began (roots of self image problems) thus being able also to isolate the belief that has arisen out of it. In hypnosis, priming the client before the regression may give his unconscious mind a clearer idea of what to find. The author favours the suggestions from The Handbook of Hypnotic Suggestions and Metaphors (pp128-129) and finds them specifically helpful. The therapist initially speaks to the client about the importance of high self esteem and then about the handicap and misery caused by low self esteem. The client is then asked to take a trip through his brain where perceptions of low self esteem will reside. The therapist specifying that the client’s experiences are not a depository of what happened but what was learned from the experience. A short story about a two year old who spills a glass of milk and interprets his parent’s response of chastisement very literally ends up believing that he is a bad boy in every other way and fails to realise that his parent was merely upset about the milk being spilled.
The client in then asked to imagine himself sitting in a train compartment feeling very safe, calm etc, the therapist then explains that he train will go back through his life times experiences and can stop at any incident the client favours. The client is given his own control switch to stop where and when he likes: the author favours an ideo-
motor response to indicate when he has “stopped” at something of relevance. Then the train is asked to come full circle and bring the client back to the present.
Direct suggestions are then used so that the client does not have to accept any negative messages from the past. [20] “Hypnosis may also be used to age regress patients to an experience immediately before they begin to feel anxious. This may aid in pinpointing the situations that illicit anxiety as well as the internal dialogue and imagery that evoke problematic responses”
Robin Thorburn ADHP (NC) MNRHP FNSHP UKCP (H)