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Highlander Counselling
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ClinicalClinical
HypnosisHypnosis
Leonard McEwen
&
Lynn Lambert
Highlander Counselling& Mediation (c) 2007
FridayFriday
8:30-9:10 Definition History and Theories ofHypnosis
9:10-9:40 Myths and Misconceptions
9:40-10:00 Coffee
10:00-10:20 Assessment, Presenting Hypnosis
10:20-11:20 Hypnotic Phenomena
Highlander Counselling& Mediation (c) 2007
11:20-12:00 Induction and Realerting
12:00-1:00 Lunch
1:00-3:00 Induction and Realerting Cont'd
3:00- 3:15 Cof fee
3:15-4:15 Demonstrations of Inductions
4:15-5:15 Eliciting Hypnotic Phenomena
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8:30-9:30 Susceptibility, Stages of Hypnosis
9:30- 9:45 Cof fee
9:45-10:30 Self Hypnosis
10:30-11:30 Treatment Planning
11:30-12:15 Managing Resistance
SaturdaySaturday
Highlander Counselling& Mediation (c) 2007
1:15-1:45 Hypnotic Susceptibility Scales
1:45-2:15 Ethical Principles, Professional Conduct,Certification
2:15-3:00 Integrating Hypnosis Into Practice
3:00- 3:15 Cof fee
3:30-5:00 Integrating Hypnosis Cont'd
Highlander Counselling
& Mediation (c) 2007
9:00-11:30 Integrating Hypnosis Cont'd
11:30-12:30 Lunch
12:30-2:30 Experiential Sessions
2:30- 2:45 Cof fee
2:45-5:00 Experiential Sessions Cont'd
SundaySunday
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Leonard McEwen
&
Lynn Lambert
Your PresentersYour Presenters
V2
Highlander Counselling& Mediation (c) 2007
Please remember to sign in for each session
Sign InSign In
Highlander Counselling
& Mediation (c) 2007
Definitions, History &Definitions, History &
TheoriesTheories
Title Page
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Slide 7
V2 Handout our practice brochuresVIP, 11/09/2007
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MEDIA CLIPMEDIA CLIP
Highlander Counselling& Mediation (c) 2007
Hypnosis is a natural state of aroused, attentivefocal concentration with relative suspension of
peripheral awareness. It involves an intensity offocus that allows the hypnotized person to make
maximal use of innate abilities to controlperception, memory, and somatic function.
Spiegel & Maldonado, 1999
Hypnosis DefinedHypnosis Defined
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As a tool for health may have originated with Hindus of India
Sleep temples used suggestion to cure
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Swiss
1st to use magnetic healing
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Paracelsus (1493Paracelsus (1493--1541)1541)
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"the Great Irish Stroker"
Healed people by laying his hands on them and passingmagnets over their bodies
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ValentineValentine GreatrakesGreatrakes (1628(1628--1666)1666)
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Catholic priest
Believed that disease was caused by evil spirits and could beexorcised by incantations and prayer
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GassnerGassner (1727(1727--1779)1779)
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Used magnets to heal by applying steel plates to the naked body
Franz Anton Mesmer was a student
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Maximilian Hell (1720Maximilian Hell (1720--1792)1792)
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Dr. Franz Mesmer (1734Dr. Franz Mesmer (1734--1815)1815)
Physician from Austria
Had an effect he called "animal magnetism" or "mesmerism"
In Paris the medical community challenged him
The King put together a Board of Inquiry that included chemist
Lavoisier, Benjamin Franklin, and a medical doctor who was anexpert in pain control named Joseph Ignace Guillotin
Mesmer refused to cooperate with the investigation
The commission later declared that Mesmerism worked by theaction of the imagination
Mesmerism remained popular
Mesmer himself retired to Switzerland in obscurity, where he
died in 1815
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Indo-Portuguese priest
Revived public attention
Early 19th century
Introduced oriental hypnosis to Paris.
Gave exhibitions in 1814 and 1815
Faria claimed that it generated from within the mind by thepower of expectancy and cooperation of the patient
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AbbAbb FariaFaria
Highlander Counselling& Mediation (c) 2007
Concentration rather than animal magnetism
Involuntariness
Father of suggestion theory
Importance of the subject not the hypnotist
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Lucid SleepLucid Sleep
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Student of Mesmer
First described and coined the term somnambulism
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Marquis de PuysMarquis de Puysgurgur
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Rcamier was the first recorded use of hypnoanesthesia and operatedon patients under mesmeric coma (1821).
Carl Reichenbach 1840s and 1850s began experiments to find anyscientific validity to "mesmeric" energy, which he termed Odic force.Although his conclusions were quickly rejected in the scientific
community, they did undermine Mesmer's claims of mind control.
Mesmerism in its later guise of hypnotism contained a clear implicationthat many saints might be hysterics, leading The Roman CatholicChurch to ban hypnotism until the middle of the 20th century.
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RRcamiercamier
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Coined term hypnosis in 1842
Titled the "Father of Modern Hypnotism"
Rejected Mesmer's idea of magnetism inducing hypnosis
Ascribed the creation of the 'mesmeric trance' to a physiologicalprocessthe prolonged attention on a bright moving object orsimilar object of fixation. He postulated that "protracted ocularfixation" fatigued certain parts of the brain and caused thetrance, "nervous sleep"
Attempted unsuccessfully to use hypnotism to treat various
psychological and physical conditions
Others had better results, especially in the use of hypnosis inpain control
Braid is credited for writing the first book on hypnosis in 1843titled Neurypnology
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James Braid (1705James Braid (1705--1860)1860)
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English surgeon
Reported numerous painless surgical operations usingmesmerism in 1834
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Dr. JohnDr. John ElliotsonElliotson (1791(1791--1868)1868)
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Reported on 345 major operations performed using mesmericsleep as the sole anesthetic
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Dr. JamesDr. James EsdaileEsdaile (1805(1805--1859)1859)
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Neurologist
Endorsed hypnotism for the treatment of hysteria.
Led to a number of systematic experimental examinations ofhypnosis
Process of post-hypnotic suggestion was first described in thisperiod. Extraordinary improvements in sensory acuity andmemory were reported under hypnosis
From the 1880s the examination of hypnosis passed fromsurgical doctors to mental health professionals. Charcot had ledthe way and his study was continued by his pupil
Hypnosis as apsychopathological, hysterical process
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JeanJean--Martin Charcot (1825Martin Charcot (1825--1893)1893)
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Described the theory of dissociation, the splitting of mental
aspects under hypnosis (or hysteria) so skills and memory couldbe made inaccessible or recovered
Provoked interest in the subconscious and laid the framework forreintegration therapy for dissociated personalities.
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Pierre JanetPierre Janet
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JeanJean CharcolCharcol
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Decree from the Sacred Congregation of the Holy office(Roman Curia) declared that "Having removed allmisconception, foretelling of the future, explicit or implicitinvocation of the devil, the use of animal magnetism(Hypnosis) is indeed merely an act of making use ofphysical media that are otherwise licit and hence it is notmorally forbidden provided it does not tend toward an illicitend or toward anything depraved."
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July 28, 1847July 28, 1847
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Approval of hypnosis. He stated that the use of hypnosis by health careprofessionals for diagnosis and treatment is permitted. In an address
from the Vatican on hypnosis in childbirth.
The Pope gave these guidelines:
Hypnotism is a serious matter, and not something to be dabbledin
In its scientific use, the precautions dictated by both science andmorality are to be followed
Under the aspect of anaesthesia, it is governed by the sameprinciples as other forms of anaesthesia
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Pope Pius XII (1956)Pope Pius XII (1956)
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The first extensive medical application of hypnosis
Introduction of the hypodermic needle and the general chemicalanesthetics of ether in 1846 and chloroform in 1847 to America,it was much easier for the war's medical community to usechemical anesthesia than hypnosis
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American Civil WarAmerican Civil War
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Founder of the Nancy School
Wrote of the necessity for cooperation between the hypnotizerand the participant, for rapport
Emphasized, with Bernheim, the importance of suggestibility
Hypersuggestability Theory Nancy School with emphasis on hypnosis as a psychological
and not a psychopathological state
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AmbroiseAmbroise--AugusteAuguste LiLibaultbault (1864(1864--1904)1904)
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& Mediation (c) 2007
First International Congress for Experimental and TherapeuticHypnotism was in Paris.
Attendees included:
Jean-Martin Charcot
Hippolyte Bernheim
Sigmund Freud
Ambroise-Auguste Libeault
British Medical Association Approval, 1892
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18891889
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French pharmacist
Laws of Suggestion
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EmileEmile CouCou (1857(1857--1926)1926)
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Sigmund FreudSigmund Freud
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Milton EricksonMilton Erickson
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Modern TheoristsModern Theorists
Hilgard (1977)
Dissociatiion/divided consciousness
Ernest Rossi (1980s, current)
Stillness and tranquility - Biophysical theories
David Spiegel (1994)
Aroused, attentive focal concentration
S. Kosslyn (2000)
Psychological state of focused attention
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EndorsementsEndorsements
Clinical hypnosis endorsed by the:
British Medical Association (1955)
American Medical Association (1958)
American Psychiatric Association (1961)
American Psychological Association (1969)
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Neo-Dissociative
Social Pychological
Psychodynamic
Social Learning
Ericksonian Atheoretical Approach
Multidimensional Formulations
Theories of HypnosisTheories of Hypnosis
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Multidimensional & Multicausal
Hereditary
Physiology
Lymbic structures or the amygdala and hippocampus
Ultradian rhythms
Theta production and right hemispheric dominance
Dissocative Processes
Absorption in imagery (imagining as if) reduction in realityorientation
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Hypnotic ResponseHypnotic Response
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Cognitive, motivational and psychosocial variables (expectations,attidudes, motivations, compliance)
Interpersonal environmental variables (quality of relationship,
percieved competance, trust, conducive environment)
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MythsMyths
& Misconceptions& Misconceptions
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Loss of control
Surrender of will
Loss of consciousness
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Major Myths & MisconceptionsMajor Myths & Misconceptions
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M: The person being hypnotized will be under thecontrol of the hypnotist, and can be made to do orsay anything the hypnotist wants.
F: This is not true.
No matter how deeply hypnotized you become,you will remain in control throughout the session.You cannot be made to do anything you do notwant to do, or anything that you are uncomfortabledoing.
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M: Hypnosis is something that is done to people,rather than something that they can do forthemselves.
F: This is not true.
Hypnosis is a skill you can learn. It is a tool youcan use to help yourself feel better.
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M: People become trapped in hypnosis and cannotcome out of it when they want to.
F: This is not true.
People can end hypnosis whenever they want.
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M: People have to be very hypnotizable or suggestible or
gullible for hypnosis to work.
F: This is not true.
Research has indicated that the vast majority of people can
benefit from hypnosis. Furthermore, being hypnotizable or
choosing to be responsive to suggestions means only thatyou have the ability to use hypnosis effectively. It is not at all
related to being gullible or weak-willed.
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M: During hypnosis, people are unconscious.
F: This is not true.
During hypnosis, people are not asleep orunconscious. Although they may feel very relaxed,they are active participants in the hypnosissession.
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HypnosisHypnosis
vs. Relaxationvs. Relaxation
Title Page
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Hypnosis
Relaxation is not necessary for hypnotic induction.
Relaxation
Relaxation is being in a relaxed state.
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Hypnosis
Hypnosis can produce analgesia and anaesthesia.
Relaxation
Relaxation does not produce analgesia and anaesthesia.
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Hypnosis
Hypnosis can significantly reduce or abort acute pain.
Relaxation
Relaxation has no significant effect on acute pain.
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Hypnosis
Major surgery tolerated under hypnosis.
Relaxation
Major surgery cannot be tolerated under relaxation.
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Hypnosis
Hypnosis prevents inflammation and swelling in acuteburn cases.
Relaxation
Relaxation does not suppress inflammation and swellingin acute burn cases.
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Hypnosis
Hypnosis produces dissociation, hallucinations anddelusions.
Relaxation
Dissociation, hallucinations and delusions occur asepiphenomenon.
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Hypnosis
Hypnosis produces de-realisation and depersonalization.
Relaxation
Derealisation and depersonalization can occur.
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Hypnosis
Hypnosis induces dreams.
Relaxation
Dreams can occur.
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Hypnosis
Hypnosis produces trance logic.
Relaxation
There is no trance logic.
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Hypnosis
Hypnosis can easily produce amnesia.
Relaxation
Amnesia can occur by chance.
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Hypnosis
Somato-sensory changes easily produced under hypnosis.
Relaxation
Somato-sensory changes can occur as a function ofparasympathetic dominance.
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Its imperfect nature
Trauma memory
Accurate recall
Forensics
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Hypnosis & MemoryHypnosis & Memory
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Highly Hypnotizable subjects more prone
Prehypnotic and hypnotic suggestions must create a neutralatmosphere as to whether of not further or accurate information
will be revealed
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Hypnosis & Creation ofHypnosis & Creation of PseudomemoryPseudomemory
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Assessment,Assessment,
Presenting HypnosisPresenting Hypnosis
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Standard Psych/Medical evaluations and diagnostics should becompleted prior to using hypnosis
All hypnosis is really self hypnosis
Everyday trance
Everyday absorption experiences
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Name hypnosis dont use synonym
Discuss the imperfection of memory and the need to corroboratehypnotically obtained memory
Caution about the use of hypnosis and the ability to testify in
court
Handout
Informed ConsentInformed Consent
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HypnoticHypnotic
PhenomenaPhenomena
Title Page
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Media ClipMedia Clip
Highlander Counselling& Mediation (c) 2007
Research on phenomena associated with hypnosis
Suggestions for eliciting phenomena
Applications of hypnotic phenomena
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Hands moving together
Eye closure
Ideomotor signals
Arm catalepsy, levitation
Autonomic movements
Finger lock
Eye catalepsy
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IdeomotorIdeomotor PhenomenaPhenomena
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Dissociation
Analgesia
Anasthesia
Hypnotic dreams
Post hypnotic suggestions
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Ideosensory ActivitiesIdeosensory Activities
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Partial regression
Revivification
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HyperamnesiaHyperamnesia & Age Regression& Age Regression
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Hidden Observer (ego-state phenomena)
Negative and positive hallucinations
Olfactory
Gustatory
Kinesthetic
Auditory
Visual
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Amnesia & Time DistortionAmnesia & Time Distortion
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Difficulty of facilitating phenomena
Classic suggestion effect of experiencing phenomena
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FrequencyFrequency
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Induction, ReInduction, Re--AlertingAlerting
& Suggestions& Suggestions
Title Page
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Importance of removing suggestions and realerting clients
6 principles of induction and suggestion
4 types of suggestions
Handouts75
Steps In Facilitating InductionSteps In Facilitating Induction
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Preparing and educating the client
Fixation of attention and deepening of involvement
Facilitating involuntary or unconscious involvement
Realerting
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Facilitating InductionFacilitating Induction
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Media ClipMedia Clip
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Eliciting Hypnotic Phenomena
Highlander Counselling
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Hands moving together
Eye closure
Ideomotor signals
Arm catalepsy, levitation
Autonomic movements
Finger lock
Eye catalepsy
Hypnotic Phenomena DemonstratedHypnotic Phenomena Demonstrated
Dissociation
Analgesia
Anesthesia
Hypnotic dreams
Post hypnotic suggestions
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HypnotizabilityHypnotizability
Title Page
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Stages of HypnosisStages of Hypnosis
Advertising
Pre-Session
Waiting Room
Client Interview
Office Presentation
Induction
Deepening
Session
Alerting
Debriefing
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Intentional PracticeIntentional Practice
Set the stage for hypnosis
Feed the clients expectation
Call for an appointment
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Pre SessionPre Session
Advertisement - CSCH Membership
Use of Hypnosis as an adjunct
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Waiting RoomWaiting Room
Brochures
Receptionist distributes client information form which includeshypnosis related questions
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Client InterviewsClient Interviews
What was said to client when appointment was booked?
Are your colleagues aware that you use hypnosis and that you accept
referrals on that basis?
What forms were filled out in the waiting room?
What was learned in the first session?
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Office & PresentationOffice & Presentation
Comfort
Subdued lighting
Music
Bathroom
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InductionInduction
Your Chair
Comfort
Head support
Your Technique
Voice
Pace
Your Office Finishing
Color
Comfort
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DeepeningDeepening
Voice and timing
Image
Sound
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SessionSession
Directive
Metaphor use
Post hypnotic suggestion
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Removing suggestion effects and realerting
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ExampleExample
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Rapport and cooperative r elationship
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ExampleExample
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Creating positive expectancy
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ExampleExample
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EmileEmile CouCou and the Laws of Suggestionand the Laws of Suggestion
Cous Law
If imagination and will are in conflict, imagination always wins.
In other words you can not will yourself to do anything that youcan not imagine yourself doing.
The Law of Concentrated Attention
Whenever attention is concentrated on an idea over and overagain, it spontaneously tends to realize itself.
The Law of Reversed Effect
The harder one tries to do something, the less chance one hasof success.
The Law of Dominant Effect
A strong emotion/suggestion tends to replace a weaker one.
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The principle of using positive suggestions
ExampleExample
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Principle of trance ratification
ExampleExample
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Value of careful observation
ExampleExample
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Ericksons Principle of Individualization and utilization of clientsinterests, needs, talents and motivations
ExampleExample
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Direct vs indirect suggestions
Who wins... Neither
Truisms and contingent suggestions
Use of questions, implication covering all possible responses
Interspersing suggestions, use of analogies or metaphores
Double Binds
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Hypnotic InductionHypnotic Induction
Four basic induction techniques
Eye fixation
Arm drop
Hands moving together
Eye roll
Coin technique
Progressive relaxation
Imagery
Conversational
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Long Term Stability of Hypnotic Response
Genetic?
Trait involvement (dissociative)?
Situational and contextual variables
Burn victims
No one theory accounts for responsiveness
Hypnotic SusceptibilityHypnotic Susceptibility
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Is responsivity modifiable?
Do efforts produce only compliance but not increase responsivity?
Age and responsiveness
Two populations with above average responsiveness
ResponsivenessResponsiveness
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Personality FactorsPersonality Factors
No specific positive correlation exists between hypnotic responsivenessand scores on tests such as:
MMPI
Thurstone Personality Schedule
Rorschach
Thematic Apperception Test
California Psychological Inventory
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Hypnotizable person capable of deep imaginative involvement andalmost total immersion in the activity of:
Reading
Listening to music
Experiencing nature Engaging in absorbing adventures of body or mind
See Hilgards, Personality and Hypnosis (1970)
Imaginative Ability, Fantasy Proneness &Imaginative Ability, Fantasy Proneness &
HypnotizabilityHypnotizability
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As applied to developmental experiences such as:
Early deep involvement with a noncompetitive experience thatchallenges the imagination (reading)
Willingness to submit to impartial authority (history ofpunishment of parent)
Strong history of identification with opposite-sexed parent
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The capacity for absorbed and self-altering attention
Highly correlated with attention
See Tellegen and Atkinson, 1974
Absorption & HypnotizabilityAbsorption & Hypnotizability
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Erickson was a master at combining psych and physiologicalphenomena into expectancy
Expectancy & HypnotizabilityExpectancy & Hypnotizability
110
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No difference
Spiegel and Spiegel 2004
Gender & HypnotizabilityGender & Hypnotizability
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Peaks early and slowing declines
Images not relaxation with children
Age & HypnotizabilityAge & Hypnotizability
112
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Depends upon researcher/writer
Note Yapko
Mental Status & HypnotizabilityMental Status & Hypnotizability
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If you read Yapko Yes
If you read Spiegel and Spiegel set the context to allow forease of attainment
Spiegel and Spiegel or Yapko
Enhancing HypnotizabilityEnhancing Hypnotizability
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Hypnotizable Clinical PopulationsHypnotizable Clinical Populations
High (Affective/Mood)
Axis I
Dissociative/conversion
Dysthymia
MDD
Brief Psychotic
Axis II
Histrionic
dependant
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Medium (Mixed)
Axis I
Impulse Control
Dysthymia
MDD
Bipolar
Axis II Borderline
Antisocial
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Low (Cognitive)
Axis I
OCD
Schizophrenia
Axis II
Paranoid
Schizoid
Schizotypal
OCD
Narcissistic
Avoidant
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Openness to accept new ideas
Willingness to accept new information or perspectives
A focused capacity to translate ideas into suggested responses
Suggestibility In HypnosisSuggestibility In Hypnosis
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Therapist PowerTherapist Power
Coercive (derived from the ability to punish)
Reward (derived from the ability to give rewards psychological)
Legitimate (derived from position)
Expert (derived from knowledge)
Referent (derived from personal characteristics)
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Need for AcceptanceNeed for Acceptance
Client feels deficient or incomplete in some way
Given this, our clients are concerned about whether we willaccept them when they disclose their deficiencies
Reward and punishment and become a considerable forces inthe process
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Client ExpectationsClient Expectations
Self-fulfilling prophecy
The ideas that a person has about his future experiences willguide his or her current experiences in that direction
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Client Need for Internal HarmonyClient Need for Internal Harmony
Expectations and the need for cognitive consistency
Client who has been to every therapist in town and has not beenhelped. Expectation and cognitive consistency have client
believing that they are a hopeless case and that they will go togreat lengths to prove it
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Effects Upon SuggestibilityEffects Upon Suggestibility
Let clients know that you use hypnosis as an adjunct
Tell them that hypnosis often forms a part of your practice
Have hypnosis brochures in your waiting room
Discuss it in the first session
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ExamplesExamples
How many have had a positive hypnosis experience?
How many expected to experience hypnosis here?
How many considered their willingness to volunteer?
How many are willing to volunteer now?
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American Society for Clinical Hypnosis
More radical approaches Yapko
Some of the following is from Michael Yapko, PhD In the next section, some of the information is offered by Yapko
Need for Critical ThoughtNeed for Critical Thought
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Inconclusive no studies indicating that susceptibility is learnedor inherited
Poor subjects tend to remain poor subjects and good subjectstend to remain good subjects over time
Age and Hypnotizability Children can be and often are highly susceptible
Cannot apply traditional definitions of hypnosis
They often fidget and appear restless
Inactivity (catalepsy) as evidence of hypnosis not likely
Of minor value in determining susceptibility
Of consideration in choosing induction and utilization (ages andstages)
SusceptibilitySusceptibility -- Biology or LearningBiology or Learning
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IntelligenceIntelligence
No known correlation
Intelligence = hypnotizability if this exists it might be due to abilityto concentrate
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Mental StatusMental Status
Psychotics and hypnosis assumed in past to be poor but indirectwork can prove results if not rushed
Must allow for clients state and building of rapport
Bipolar in manic phase unlikely
Drug induced psychosis difficult to overcome Clients with senility can be worked with
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SelfSelf--EsteemEsteem
What you view as possible for your self
A major component
Seems to be learned
The conclusions which you draw from your experiences
Enhancing self-esteem is any usual goal of hypnosis
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Concrete or abstract
Concrete requires more detail
Factor in responsiveness
Factor in approach to use with the client
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Fantasy Proneness, Imagination & HypnosisFantasy Proneness, Imagination & Hypnosis
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Discover under what circumstances, internal and external, a person ismost responsive to new information and suggested perspectives
Building
Therapeutic Alliance
ClinicianClinicians Responsibilitys Responsibility
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Relationship Factors & HypnotizabilityRelationship Factors & Hypnotizability
Understanding and trust
Cooperative relationship
Collaborative relationship
Hypnosis can be viewed as a naturally arising
It responds within a special kind of relationship, one of mutual
responsibility and accountability
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High Hypnotic AbilityHigh Hypnotic Ability
Children (9-12)
Bulimics
PTSD
Dissociative disorders
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Slow deeper breathing
Progressive feelings of lethargy
Observable relaxation
Inhibition of voluntary movements
Eyelid catalepsy
Limb catalepsy
Light TranceLight Trance
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Glove anesthesia
Partial posthypnotic anesthesia
Partial amnesia
Partial age regression
Some degree of time distortion
Good mental imagery and ability to have dreamlike experience
Aware of external noises but they do not seem to matter
Medium TranceMedium Trance
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Full age regression(revivification)
Positive and negativehallucinations
Extensive anesthesia
Post-hypnotic anesthesia
Spontaneous amnesia
Responds to suggestionsfor amnesia
Ability to open eyes withoutaffecting the trance
Decrease in spontaneousmental activity
Very responsive toposthypnotic suggestion
Perceptual distortions andbody dissociation
Lip Pallor for about 1 cmbeyond themucocutaneous margin
Deep Trance (Somnambulism)Deep Trance (Somnambulism)
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Time ceases to be a meaningful concept
No awareness of physical body
Loss of awareness of ordinary identity and feeling the potentialto be anything or anyone
Feeling of oneness with the universe
Vary significant decrease in pulse and respiration rate
Spontaneous mental activity ceases
No awareness of the external world except the very distant voice
of the facilitator (Corydon Hammond, 1988)
Plenary Trance (Plenary Trance (StuporousStuporous))
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DeepeningDeepening
Title Page
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DeepeningDeepening
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What you learned in the client interview may be useful in deepening
What is the clients current relaxation practice?
Have they had previous positive experience with hypnosis?
What areas are there that are contraindicated because of
previous experience?
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Points to RememberPoints to Remember
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What to avoid if it has been associated with trauma
white light and rape
waves of relaxation drowning
down, down and falling
Others
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Points to RememberPoints to Remember
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Many of the deepening techniques can also be used for induction.
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MethodsMethods
of Deepeningof Deepening
Title Page
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Counting downwards (implying "going down" deeper into hypnosis)while offering suggestions of relaxation and come forward between
numbers
Miller, 1979
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CountingCounting
324
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Generally a good method for more difficult clients
No direct suggestion to client to respond in a particular way
Suggestion to act "as if" he or she were responding in the waysuggested
Suggesting that the client act "as if" he or she is comfortable,relaxed, thinking about a happy moments, paves the way for the
client to really experience the suggestions without any actualpersonal demands being made
Grinder and Bandler, 1981
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As IfAs If MethodMethod
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The client is told to imagine (that is, see, hear, feel) himself orherself at the top of a flight of "special stairs" or on a "specialelevator"
As he or she experiences herself going down the stairs at onerelaxing step at a time he or she can go down deeper intohypnosis
Or, as each floor is passed in the descending elevator, he or she
can experience himself or herself going deeper into hypnosis
(Smith and Wester, 1984)
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The Stairs/Elevator Going DownThe Stairs/Elevator Going Down
Highlander Counselling
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Tying of one suggestion to another according to the formula "as
you X, you can Y" (that is, "as you read this, you can begin tounderstand compounding")
Verbal compounding serves as a deepening or by continuallybuilding new responses on the framework of passed responsesthus intensifying the hypnotic experience
"Manual compounding" is the tying of verbal suggestions tophysical experience
As a deepening it can take the form of offering suggestions ofgoing deeper into hypnosis while experiencing physicalsensations that reinforce the suggestion (that is, "as your arm
drops slowly to your side, you drop more deeply into hypnosis")
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Compounding/ChainingCompounding/Chaining
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Useful for turning off the clients internal dialogue
Involves offering suggestions about the presence of the "minds
eye" as that part of the mind of that remains active in thinkingand imaging as the induction progresses. With suggestions forthe minds eye lids similar to the eye fixation suggestions ofthe eye lids getting heavy the client can slowly closeout straythoughts and images and experience a deeper state of hypnosis
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The MindThe Minds Eye Closures Eye Closure
Highlander Counselling& Mediation (c) 2007
you can now have some quiet time toenjoy the experience of hypnosis."
149
SilenceSilence
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Involves giving the client already in hypnosis a posthypnoticsuggestion that the next time that hypnosis is re-induced, he or
she can go into hypnosis both more deeply and more quickly
Clinician then guides the person in and out of hypnosis several
times within the same session (Gilligan, 1987; Warner, 1984)
good for those with short attention span (attention deficit
disorder, physical pain, depression, or other condition thatimpairs clients ability to focus)
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Posthypnotic Suggestions & RePosthypnotic Suggestions & Re--InductionInduction
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ClientClients Experiences & Office Situations Experiences & Office Situation
you may find yourself listening to the soundsoutside the office and with each sound you hear
you find yourself being drawn further into your
trance
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as the breeze from the fan touches you, youwill go deeper and deeper into relaxation...
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FanFan
Highlander Counselling
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with each ring of the phone, you will find
yourself drawn into your own special trance
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Ring of A PhoneRing of A Phone
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with each rock of the chair you will go deeper
and deeper into your own hypnotic trance
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Rocking ChairRocking Chair
Highlander Counselling& Mediation (c) 2007
Clients breathing
Each time you exhale you will feel yourself drawn into a moreand more relaxed state.
Other DeepeningsOther Deepenings
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Revolving Wheels FantasyRevolving Wheels Fantasy
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Patient Motivation & NeedsPatient Motivation & Needs
Motorcycle ExampleMotorcycle Example
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Visual ImageryVisual Imagery
you may choose to picture a pendulum swinging. Now you maynotice that with each stroke of the pendulum you are going further
and further into your own hypnotic trance.
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MetronomeMetronome
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Self Hypnosis
Highlander Counselling& Mediation (c) 2007
Benefits of Self HypnosisBenefits of Self Hypnosis
Between session change
Continuation of therapeutic f ocus
Long term maintenance
Situation or Crisis management
Highlander Counselling
& Mediation (c) 2007
YapkoYapko and Depressionand Depression
Give a sleep tape in the first session
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ApplicationsApplications
Pain
Asthma
Gastrointestinal problems
Wound healing
Anxiety disorders
Sleep disorders
Sexual dysfunction
Stress
Bereavement
Bruxism
Dental procedures
Childbirth
Flying and other phobias
Learning
Habit control
Smoking
others
Highlander Counselling& Mediation (c) 2007
Teaching SelfTeaching Self--hypnosishypnosis
In your office:
Post Hypnotic Suggestion for trigger
Two fingers
Eyes closing
Others
Practice
Highlander Counselling
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The clientThe clients 6 steps to selfs 6 steps to self--hypnosishypnosis
Plan the suggestion before going into hypnosis
Use your entry cue
Count backward from 100-95 slowly, dont think of suggestion100,99,98,97,96
Give the suggestion as you wrote it at 95
Count 94, 93, 92, 91, 90 dont think about or criticize the suggestion
When count reaches 90 give the exit or alert cue
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Treatment Planning
Highlander Counselling& Mediation (c) 2007
ApplicationsApplications
Pain
Asthma
Gastrointestinal Problems
Wound Healing
Anxiety Disorders
Sleep Disorders
Sexual Dysfunction
Stress
Bruxism
Dental Procedures
Childbirth
Flying and Other Phobias
Learning
Habit Control
Smoking
Others
16
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Work Environment Before meetings
Stressful situations
Performance related situations
Other Performance related (relationships, sports)
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Eyes Open ApplicationEyes Open Application
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Nail Biting
Smoking
Weight
Others
Habit ControlHabit Control
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Flying
Elevators
Others
PhobiasPhobias
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Anxiety, depression, shame, embarrassment
Reduce rubbing and scratching
Alleviation of warts
Pruritis
Acne, psoriasis
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Dermatological ConditionsDermatological Conditions
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Media ClipMedia Clip
Highlander Counselling& Mediation (c) 2007
Desensitization against anticipatory triggers, anxiety, panic
Suggestion of relaxation, ego-strengthening
Provoking and alleviating an attack (control training)
17
3
AsthmaAsthma
Highlander Counselling
& Mediation (c) 2007
Oesophageal spasm, swallowing problems
Desensitization against triggers
Gastric secretion reduced by imagery
Habitual reflex vomiting
IBS (Whorwell, IBS Treatment Unit)
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Gastrointestinal DisordersGastrointestinal Disorders
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Extremely effective
12 one hour sessions weekly for a three month period
Substantial improvement in symptoms and quality of life (81%
maintained improvement over 5 years), Gonsalkorale et al.(2003).GUT, 52(11), 1623-1629.
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GutGut--Directed HypnotherapyDirected Hypnotherapy
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17
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Erections & Irritable Bowel SyndromeErections & Irritable Bowel Syndrome
Highlander Counselling
& Mediation (c) 2007
Stop inflammation and swelling
Reduce pain and distress
Debridement of tissues and changing dressings
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BurnsBurns
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Media ClipMedia Clip
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Pain, anxiety, depression, feelings of hopelessness, side-effects
NIH study of 10-year follow-up of 86 patients with
metastatic breast carcinoma
Patients with self-hypnosis and group therapy had 50%less pain and survived 18 months longer, Kogan et al.(1997). Cancer, 80, 225-230
17
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CancerCancer
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Nobody wants to hurt, and pain interferes with healing, soit is no wonder that one of the most rewarding uses of
hypnosis is its ability to influence the perception of pain.
Barabasz & Watkins, 2005, p.231
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Chronic PainChronic Pain
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Shown to be efficacious with headache and migraine
Relatively brief and cost effective
Virtually free of the side effects, risks of adverse reactions, andongoing expense
Hypnosis should be recognized by the scientific, healthcare, and medical insurance communities as being an
efficient evidence based practice.
Hammond (2007)
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Headaches & MigrainesHeadaches & Migraines
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Esdaile (1957) reported 345 major operations performed inIndia with hypnosis
Hilgard and Hilgard (1975) reported 14 different types of
surgeries, hypnosis used as sole anesthetic
Multiple case studies (1955-1992: 24 cases reported)
Surgery Dental hypnosis (hypnodontia)
18
2
SurgerySurgery
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Media ClipMedia Clip
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PhobiaPhobia
Dentistry
Spaces
Birds
Injections
Highlander Counselling& Mediation (c) 2007
Media ClipMedia Clip
Highlander Counselling
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Meta-analytic review of 18 articles and 27 effect sizes
indicated that hypnotic suggestions relieve pain for 75% of933 subjects across different types of pain (Montgomery,DuHamel & Redd, 2000).
Lynn et al (2000) concluded that hypnosis can be
considered a well-established treatment for pain.
Hypnotherapy With PainHypnotherapy With Pain
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Review by Brannon & Feist (2004) indicated effectiveness withheadache, cancer pain, burn pain, childbirth discomfort, dentalpain, surgery pain, low back pain, experimental pain, and pain
from sickle cell disease.
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Elkins et al. (2007) reviewed 13 studies, excluding studies ofheadaches, that compared outcomes from hypnosis for thetreatment of chronic pain to either baseline data or a control
condition.
Hypnosis interventions consistently produced significant
decreases in pain associated with a variety of chronic painproblems such as:
Cancer
Low back pain
Arthritis pain
Sickle cell disease
Temporomandibular pain
Disability-related pain18
8
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Hypnosis is now the pain-control method of choice forinterventional radiological procedures at Harvard Medical
Schools Beth Israel Deaconess Medical Centre in Boston.Recoveries are faster, patients are more satisfied, and thehospital saves considerable sums of money while reducing
risk exposure.
Lang et al., 2000, Lancet, 355, 1486-1490
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YapkoYapko & Depression& Depression
Give a sleep tape in the first session
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Indications for HypnosisIndications for Hypnosis
Has requisite hypnotizability
Co-operative with procedure
Problem shown to be effective with hypnosis
Condition diagnosed/adjunct
No florid psychotic symptoms
Absence of mania
Not under the influence of illicit drugs or alcohol
Not actively suicidal
Not with certain personality disorders
19
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ContraindicationsContraindications
Low score on hypnotizability
Uncooperative with procedure
Problem shown not to be effective with hypnosis
Condition not diagnosed
Presence of florid psychosis
During mania
During intoxication with illicit drugs or alcohol
Actively suicidal
Borderline, narcissistic, and antisocial personalities
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Define self hypnosis
Teaching self hypnosis to clients
Therapeutic applications of self hypnosis in practice
193
Self HypnosisSelf Hypnosis
Highlander Counselling& Mediation (c) 2007
Establishing self hypnosis induction cues
Post hypnotic suggestion
In session practice
Recordings
The value of individualized audio tapes
Medical (pain, asthma, GI, wound, dermatological)
Psychiatric (Sleep, ego-strengthening, sexual dysfunction)
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Suggestive and insight oriented hypnotic approaches
Hypnosis indicated or contraindicated
Types of strategies or therapeutic goals
195
Treatment PlanningTreatment Planning
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Consider symptom complexity and intensity
Level of hypnotic talent and responsivity
Client expectations or preferences
Degree of psychological-mindedness and impulse control
Personality, dominant defence coping style
Diagnosis
Stage in change process
196
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Rapport
Degree of resistance
Locus of control
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Managing Resistance
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Enhancement of insight
Abreaction or emotional facilitation
Perceptual change
Reduction or alteration of affect
Facilitation of behavioral change
Facilitation of physiological change
StrategiesStrategies
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Sources of Resistance
Patient
Therapist
Environmental
Source of ResistanceSource of Resistance
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Education about myths and misconceptions
Separating hypnosis from the presenting problem
Creating healthy therapeutic alliance
Aligning patient/therapist goals
Accepting and using patient responses
Shifting to indirect permissive techniques
Exploring the resistance consciously and with insight oriented
hypnotic techniques
Resistance to HypnosisResistance to Hypnosis
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Obtain the clients feedback, critique and discussion of whatinterfered with responsiveness
Recall of previous successful induction
Modeling a successful subject
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Advantages
Objective method of evaluating responsivity to hypnosis and whois likely to benefit
Gain info about hypnotic talents and boost therapist confidence
Modelling for clinicians in how to elicit phenomena
AdvantagesAdvantages
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Disadvantages
Tend to be directive and may result in objections
Provide only one sample of responsiveness (not alwayspredictive)
DisadvantagesDisadvantages
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Hypnotic Susceptibility Scales
Highlander Counselling& Mediation (c) 2007
Barber Suggestibility Scale (Barber, 1976)
Carlton University Responsiveness to Suggestions Scale (Spanos,Radtke, Hodgkins, Stram and Bertrand, 1983)
Creative Imagination Scale (Wilson and Barber, 1977)
Davis-Husband Scale (Davis and Husband, 1931)Field inventory (Self-report) (Field, 1965)
Handouts
Hypnotic Susceptibility TestsHypnotic Susceptibility Tests
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"The debate continues over just how useful clinical scales are intreatment. Their value in research is beyond question. However, itis unclear how relevant and responsive to standardized, therefore
not individualized, a test item is to eventual clinical resultsobtained."
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Susceptibility Assessment ToolsSusceptibility Assessment Tools
Highlander Counselling& Mediation (c) 2007
Barber
Stanford Hypnosis Susceptibility Scale
Hypnotic Induction Profile
HIP Modified
Susceptibility Assessment ToolsSusceptibility Assessment Tools
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A measurement tool and an induction
Hypnosis Induction ProfileHypnosis Induction Profile
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Ethics
Highlander Counselling& Mediation (c) 2007
Ethical and Legal Issues and standards of professional conduct
Certification requirements in Clinical Hypnosis
The unfolding of CFCH
Handouts
EthicsEthics
212
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Informed consent
Adherence to guidelines and cautions
Memory work
Only using it to treat what one is qualified to treat with non
hypnotic methods
Professional registration requirements
Power imbalance in the counselling room
CFCH, ASCH, ASCEH
213
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72
Highlander Counselling
& Mediation (c) 2007
Integrating Hypnosis Into Practice
Highlander Counselling& Mediation (c) 2007
Examples
215
Highlander Counselling
& Mediation (c) 2007
Each person will have three opportunities to be a subject and a
therapist using hypnosis
Small group leaders will not demonstrate techniques or answer
questions during this time
Small group leaders will provide feedback and brief modelling of
alternate verbalizations
Small Group PracticeSmall Group Practice
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Highlander Counselling
& Mediation (c) 2007
Certificates Presented