Hypnosis in Psychotherapy

December 5, 2009 ChangeSeeker
Tags: Heart Centered Therapy, Hypnosis, Hypnotherapy, Psychotherapy, The wellness insititute, therapy using hypnosis

TREATMENT with HYPNOSIS

 

[The Wellness Institute]

Psychologists Steven Jay Lynn (Ohio University), Irving Kirsch (University of Connecticut), Jonathan Neufeld (doctoral candidate, Ohio University), and Judith W. Rhue (Ohio University College of Osteopathic Medicine) (1996) indicate the widespread acceptance of hypnosis and hypnotherapy today.

“Hypnosis is enjoying a wave of popularity (see Lynn & Rhue, 1991a). Not only do substantial numbers of mental health professionals use hypnosis regularly to treat a wide range of problems (Kraft & Rudolfa, 1982; Rhue, Lynn, & Kirsch, 1993), but also hypnosis has moved into the orbit of mainstream psychology. This latter observation is evidenced by the sharp increase in the number of hypnosis articles, spanning a wide range of disciplines, that has been published in recent years (Nash, Minton, & Baldridge, 1988). The cross-fertilization of the clinical and research domains can be seen in recent compendiums of hypnosis research (Fromm & Nash, 1992), hypnotherapeutic approaches (Rhue et al., 1993), and theories of hypnosis (Lynn & Rhue, 1991a), which all contain discussions of clinical work (see Lynn, 1994).

Clinicians have responded to the lure of seemingly powerful experiential techniques with a boom of interest in incorporating hypnosis into the treatment of an array of clinical problems, ranging from anxiety disorders to personality and schizophrenic disorders (Kraft & Rudolfa, 1982). Fortunately, clinical research indicates that hypnosis is more than a faddish addition to the clinician’s grab bag of psychotherapeutic tools. Meta-analyses (Kirsch, Montgomery, & Sapirstein, 1995; Smith, Glass, & Miller, 1980) have demonstrated that the addition of hypnosis to cognitive-behavioral and psychodynamic treatments substantially enhances their efficacy, and researchers have made important contributions to understanding hypnosis, assuring that clinical hypnosis can be more firmly grounded in scientific findings (see Lynn, 1994; Nash et al., 1988).

As the field of clinical hypnosis has matured, evidence exists that there is increasing agreement about what hypnosis is, what hypnosis is not, and how hypnosis can be used to modify experience and behavior (see Kirsch & Lynn, 1995). Perhaps the fundamental point on which there is virtual consensus is that hypnosis is not a treatment in itself. As Dowd (chapter 14, this volume) observes, hypnosis is a specialized technique that can be used as an adjunctive intervention integrated into a more encompassing psychological and perhaps medical treatment package.

Clinical hypnosis refers to a very wide variety of nonstandardized and changeable methods that can serve as a catalyst to an equally wide variety of psychotherapies (Barber, 1985). Thus, one can speak of psychoanalytic hypnotherapy, rational-emotive hypnotherapy, Ericksonian hypnotherapy, or multimodal hypnotherapy, as evidenced by the section of this book that discusses a single case from multiple therapeutic orientations. However, in many instances, the therapeutic use of hypnosis involves a blending of ideas and techniques from different theoretical perspectives, reflecting the tendency toward technical eclecticism that characterizes much of the field of contemporary psychotherapy (see Lynn & Garske, 1985). As it is practiced today, clinical hypnosis can be defined as the addition of hypnosis to accepted psychological or medical treatment. As such, it should be practiced only by professionals who have the appropriate training and credentials to provide the treatment that is being augmented by hypnosis.” Lynn, S. J., Kirsch, I., Neufeld, J., and Rhue, J. W. (1996).

References

Fromm, E., & Nash, M. R. (1992). Contemporary Hypnosis Research. New York: Guilford Press.1992

Kraft, W. A., & Rudolfa, E. R. (1982). The use of hypnosis among psychologists. American Journal of Clinical Hypnosis, 24, 249-257.

Kirsch, I., & Lynn, S. J. (1995). The altered state of hypnosis: Changes in the theoretical landscape. American Psychologist, 50, 846-858.

Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive behavioral psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 63, 214-220.

Lynn, S. J. (1994). The interface of hypnosis research and clinical practice. Guest editorial in the special issue of the American Journal of Clinical Hypnosis, 37, 81-83.

Lynn, S. J., & Garske, J. P. (1985). Contemporary Psychotherapies: Models and Methods (2^nd ed). Columbus, MO: Merrill Press.

Lynn, S. J., & Rhue, J. W. (Eds.). (1991). Theories of Hypnosis: Current Models and Perspectives. New York: Guilford Press.

Lynn, S. J., Kirsch, I., Neufeld, J., and Rhue, J. W. (1996). Clinical hypnosis: Assessment, applications, and treatment considerations. In S. J. Lynn, I. Kirsch & J. W. Rhue (Eds.), Casebook of Clinical Hypnosis (pp. 3-30). Washington, DC: American Psychological Association.

Nash, M. R., Minton, A., & Baldridge, J. (1988). Twenty years of scientific hypnosis in dentistry, medicine, and psychology: A brief communication. International Journal of Clinical and Experimental Hypnosis, 36, 198-205.

Rhue, J. W., Lynn, S. J., & Kirsch, I. (1993). Handbook of Clinical Hypnosis. Washington, DC: American Psychological Association.

Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The Benefits of Psychotherapy. Baltimore, MD: The Johns Hopkins University Press.

Citation of Selected Relevant Research

 

Gould, R. C., Krynicki, V. E., “Comparative effectiveness of hypnotherapy on different psychological symptoms,” Am J Clin Hypn, vol. 32, pp. 110-7, 1989.

Abstract:
In this study we measured a comprehensive set of symptoms before and after hypnotherapy to evaluate which symptom areas respond most and which respond least. The participants were 20 adults who sought hypnotherapy for such problems as stress, anxiety, and depression. There were two pretreatment measurements and one posttreatment measurement. Statistical analyses revealed significantly less symptomatology posttreatment in all measured dimensions. The greatest percentage decrease occurred in the anxiety dimensions; less of a decrease occurred in affective symptoms, and the least decrease appeared in ideational symptoms. The results are discussed in terms of the similarity of hypnosis to states of deep relaxation and its difference from the state of intense arousal which is a component of the fight-flight response. It is suggested that the symptoms most related to the fight-flight reaction respond most readily to hypnosis.

Kline, M. V., “Hypnosis with specific relation to biofeedback and behavior therapy. Theoretical and clinical considerations,” Psychother Psychosom, vol. 31, pp. 294-300, 1979.

Abstract:
Hypnosis as an intrapsychological and interpersonal experience is used as an integrative and amplifying procedure in relation to biofeedback mechanism and behavior therapy. The hypnotic capacity for linking cognitive to affective reactions within a feedback loop of sensory and motor imagery is presented as a dynamic approach to behavior modification during psychotherapy.

Kirsch, I., Montgomery, G., Sapirstein, G., “Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis [see comments],” J Consult Clin Psychol, vol. 63, pp. 214-20, 1995.

Abstract:
A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

Phillips, M., “Our bodies, our selves: treating the somatic expressions of trauma with ego-state therapy, ” Am J Clin Hypn, vol. 38, pp. 109-21, 1995.

Abstract:
Trauma activates primitive defenses which often involve somatic processes. In this paper, the author explores the use of somatic approaches to ego-state therapy, developed by John and Helen Watkins (1979), which has been shown in the literature to be an effective method of treating the internal fragmentation and dissociated response patterns related to early childhood trauma. Through the use of hypnotic techniques such as the somatic bridge, ideosensory signalling, and sensory awareness training, ego-state therapy can be directed to those parts of the self which are more connected to somatic expressions of traumatic experiences. Several clinical case examples are presented to illustrate the potential of this approach in the treatment of trauma. Specific benefits for patients who complain of psychosomatic symptoms are discussed, as well as for those with compromised body image and perception, and its usefulness as a hypnoanalytic tool for uncovering memories that may be more somatically based.

Steckler, J. T., “The utilization of hypnosis in psychotherapy: metaphor and transformation,” Psychiatr Med, vol. 10, pp. 41-50, 1992.

Abstract:
Hypnotic methods using suggestion and metaphor provide an economic and rapid means of facilitating rapid therapeutic change by the psychotherapist. Such methods circumvent normal conscious resistance to change by allowing the client to access his own inner resources in a therapeutically collaborative way. Metaphoric communications can serve numerous purposes, ultimately resulting in the transformation of conflict into new resource states for the client.

Winsor, R. M., “Hypnosis–a neglected tool for client empowerment,” Soc Work, vol. 38, pp. 603-8, 1993.

Abstract:
Clinical hypnosis is a valuable treatment modality that deserves to be more widely known and used by social workers. The author presents an overview of this growing clinical specialty, distinguishing between directive, Ericksonian, and permissive hypnosis. The latter, which is the most common style in use today, is based on a clear contract in which a hypnotherapist helps a client develop and use his or her own hypnotic abilities toward therapeutic goals. Characteristics of a hypnotic trance and the differing capacities of individuals in trance are presented. The article describes how permissive hypnosis is used in practice and identifies the types of clients for whom it is suitable. The author stresses the consistency of modern clinical hypnosis with social work aims and values.

Frischholz, E. J., Lipman, L. S., Braun, B. G., Sachs, R. G., “Psychopathology, hypnotizability, and dissociation [see comments],” Am J Psychiatry, vol. 149, pp. 1521-5, 1992.

Abstract:
The purpose of the study was to replicate and extend previous findings regarding the hypnotizability of different clinical groups. METHOD: The authors compared the differential hypnotizability of four psychiatric groups–patients with dissociative disorders (N = 17), schizophrenia (N = 13), mood disorders (N = 13), and anxiety disorders (N = 14)–and one normal group of college students (N = 63). Hypnotizability was assessed by four different measures: the eye roll sign and the induction score of the Hypnotic Induction Profile, the Stanford Hypnotic Susceptibility Scale, Form C, and two self-ratings of hypnotizability. RESULTS: As predicted, dissociative disorder patients had significantly higher hypnotizability scores on all measures than all other groups. Schizophrenic patients, on the other hand, had significantly lower scores than normal subjects on the eye roll sign and induction score but not on the other measures of hypnotizability. Some other unpredicted between-group differences were also found. Nevertheless, despite the between-group differences, the intercorrelations between the various hypnotizability measures within the normal group were very similar to those observed in the combined patient groups. CONCLUSIONS: The findings suggest that routine hypnotizability assessment may be useful in the differential diagnosis of patients with dissociative disorders.

Page, R. A., Handley, G. W., “Effects of deepening techniques on hypnotic depth and responding,” Int J Clin Exp Hypn, vol. 40, pp. 157-68, 1992.

Abstract:
The present study attempted to assess the effectiveness of commonly used deepening techniques and of surreptitiously provided stimulation on hypnotizability scores, in-hypnosis depth reports, retrospective realness ratings, and the Field Inventory of Hypnotic Depth (Field, 1965). High, medium, and low hypnotizables were assigned in equal numbers to 1 of 3 groups, each containing 54 Ss. Controls were compared to Ss receiving 2 deepening techniques or 2 suggestions for positive and negative hallucinations that were surreptitiously enhanced. Of the 4 dependent measures employed, the only significant difference between groups related to a change in depth reports for the manipulation items themselves, leading to the conclusion that the effect of the techniques was at best minimal and transient. Some methodological and conceptual issues are also discussed.

Putnam, F. W., “Using hypnosis for therapeutic abreactions,” Psychiatr Med, vol. 10, pp. 51-65, 1992.

Abstract:
Abreaction, the dramatic reliving of traumatic events under hypnosis, is a powerful therapeutic intervention useful in the treatment of victims of trauma. First systematically applied in World War I, abreaction coupled with psychotherapeutic processing of the recovered material is increasingly being used with victims of child abuse and chronic PTSD. Abreactions are helpful in recovering dissociated or repressed traumatic material, reconnecting missing affect with recalled material and for transforming traumatic memories. Although abreactions can be induced with medications, hypnosis is the method of choice except in acute situations where it is not possible to establish rapport. A variety of hypnotic techniques for the induction and management of abreaction are discussed, together with the indications and contraindications for their use.

Phillips, M., Frederick, C., “The use of hypnotic age progressions as prognostic, ego-strengthening, and integrating techniques,” Am J Clin Hypn, vol. 35, pp. 99-108, 1992.

Abstract:
Age progression as a hypnotherapeutic technique is mentioned infrequently in the literature when compared with its counterpart, age regression. In this paper we explore the use of progressions, or views of the future, as prognostic indicators of therapeutic progress and as valuable tools for ego strengthening and for the integration of clinical material. Age progressions vary in the types of suggestions given and can be used to promote growth on multiple levels, facilitating treatment goals and deepening the working-through process. We present six cases in which we used different types of age progressions, and we discuss the significance of the progressions used in each case, within the context of relevant clinical material. We conclude from our observations that the use of hypnotic progressions can be a sustaining, valuable aspect of hypnotherapy, particularly in providing an index of the current direction and progression of the therapy process itself.

 

Valente, S. M., “Clinical hypnosis with school-age children, ” Arch Psychiatr Nurs, vol. 4, pp. 131-6, 1990.

Abstract:
Despite the fact that nurses are in key positions to learn and use hypnosis to bolster a child’s symptom management, ability to solve problems, or self-esteem, they lack knowledge about the clinical effectiveness of hypnosis. Substantial clinical literature demonstrates that hypnosis effectively reduces anxiety, enhances coping, and has been used successfully to treat behavior disorders, school phobias, and sleep disorders. Hypnosis can effectively reduce a child’s anxiety and symptoms and has few side effects when used competently. With education and supervision, nurses can effectively use hypnosis to improve a child’s mastery and self-esteem and to reduce severe levels of anxiety.

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