Clinical Hypnosis in Private Practice

This article appeared in The Maryland Psychologist – July/August 2007; Volume 52, Issue 6, Pp 9-11.

It was during a graduate school colloquium by T. X Barber, Ph.D.(1974 ), one of the early giants in hypnosis, that I first became mesmerized by hypnosis. His descriptions and demonstrations of hypnotic phenomena, (improved focusing, concentration and remembering, deep calmness and relaxation, ego and self-esteem enhancement, creative problem solving, anesthesia, body rigidity, and sensory alterations) fascinated me.

Though hypnosis is not magical, it does have an interesting blend of non-ordinary with ordinary. Like magic, there is an appeal to possibilities of what may be, if only... And for a clinician, there is appeal and satisfaction in having systematic ways to help people do what they need to do but are stuck believing they cannot.

This article is about the clinical and experiential aspects of hypnosis that I find useful and enjoyable in my private practice of psychology.

Naturalistic Phenomena

Barber’s research identified the natural psychological phenomena that could account for the effects of hypnosis. One of the most effective ways for me to enlist the cooperation of someone to use hypnosis is to de-mythologize it. I explain hypnosis as the intentional utilization of natural phenomena to achieve clinical objectives. The role of the hypnotist is to facilitate the capacity to utilize psychological abilities that the client already has, and to guide him or her to use these in new and creative ways.

Psychologist, Not A Hypnotist

Effective clinical hypnosis is grounded on good knowledge of psychological and psychotherapeutic concepts, effective psychotherapeutic skills, and the ability to work with unexpected reactions of the client before, during and after trance. Clinicians trained by the American Society of Clinical Hypnosis (ASCH) see hypnosis as an adjunct to psychotherapy 90+% of the time, and only use it to work with matters that they are trained to treat without hypnosis.

When I first talk with clients I tell them that I am a psychologist who uses hypnosis when it can facilitate the psychotherapeutic work. I charge for psychotherapy, rarely for hypnosis or hypnotherapy.

Requests For Hypnosis

When I get calls specifically for hypnosis or hypnotherapy the requests are often for “magic.” “I am having trouble getting an erection. Can you eliminate this problem in one session?” “My husband has been unfaithful to me. Can you help make this not bother me?” “I am obese and have never been able to stick with exercise or a healthy eating plan. Can you change that in one session?”

I take the time on the telephone to understand the prospective client’s expectations and am careful to explain how I work. I only accept those that understand, in advance, that we are likely to need multiple sessions.

I do agree to a single session approach for a few specific issues. These include situations where the client wants to: (1) retrieve information, such as a memory for the location of something they hid but cannot remember where, or the identity of a license plate or image of someone involved with a crime, (2) reduce performance anxiety that is clearly uncomplicated.

Facilitating The Therapeutic Process

A seasoned clinician at an ASCH workshop once described how hypnosis can reduce the time required to get results in psychotherapy by a third to a half. My experience is similar. Hypnosis seems to get at and effectively work with the unconscious components that I had been seeing in my initial years of practice.

These were the sticking points that regularly emerged while using traditional psychotherapeutic methods. I could see, hear, and feel the client’s dynamics, but talking, reflecting, explaining, interpreting, even confronting, seemed to have little impact on their repetitive troublesome patterns. If those methods did have impact, the process too often seemed to go on ad nauseam.

Non-specific Psychotherapeutic Tool

Clinical hypnosis is so much more than a technique. It is a way of listening with the third ear, and, a way to speak and work with the client’s entrapped and developmentally stuck parts. It provides a method for enlisting the client’s healthier ego functions, inner creativity, healthy narcissism, and wisdom to find better solutions and ways of being in the world.

Hypnotic principles guide the clinician to establish powerful rapport and a therapeutic alliance by listening to and joining with the person’s unconscious in conjunction with the usual therapeutic methods that work with the conscious mind. For example, by adjusting your physical posture and pace of speaking to match the client’s, you can build rapport in ways that language alone cannot.

Trance frees the client from the normal defenses, harsh inner critic, and the conscious mind’s requirements of logic, analytic thinking, time and geographical constraints. The client thereby gains access to the inner and deeper roots of his emotional traps and dysfunctional behaviors. The resulting self-empathy fosters the production of creative solutions that are congruent with one’s current needs, resources and realities. Then he can shift to using his conscious mind and traditional psychotherapeutic methods to make changes that are more self-respecting and fulfilling for him.

The use of trance to foster the generative capacity of the unconscious is nicely described in a book by Steven Gilligan, Ph.D.(1987) A well known chemist was frustrated by his attempts to create a model of the benzene molecule because it had components that logically did not – could not – go together. In a naturalistic trance state he could see how these components could blend together. He then used his conscious mind to translate this unconscious discovery into a practical model.

I enjoy the way clinical hypnosis facilitates the dance of clinical work. Training in hypnosis teaches how to recognize and utilize spontaneous alert trances that happen when the client drifts off in their own special way. Rather than seeing this as disengaging (from me!), I’ve learned to recognize these as some of the most important moments in therapy – times when clients are engaging their own inner meanings. My job is to know when to keep quiet and stay out of their way as well as when and how to say things to facilitate their inner discovery process.

Another effective and enjoyable process is the use of stories during conscious interactions as well as during trance. Again, there can be a nice flow between telling a story that induces an alert trance and then utilizing the inner absorption to go further into a deeper trance.

A common psychological challenge that thwarts the efforts of many clients is when they need to be strong and in control but are triggered into feeling weak, vulnerable and out of control. Rather then explore all the sources of feeling badly, one of my favorite hypnotic methods, anchoring, which I learned from Charlie Citrenbaum, Ph.D.(1983, 1985), enables clients to link their capacity to be strong, composed, and in control that is well established in one area of their life into the problem situation. The ego strength and composure they then bring to the problem situation enables them to generate multiple effective ways of handling it. This experience of being composed and resourceful readily spreads to other situations and results in feelings of competence and confidence. The generalization often happens spontaneously with minimal counseling.

Facilitating Self-directed Treatment

Clients come to us because they feel stuck, and, they may recognize the need for change but don’t know how to proceed or are not making progress. Hypnosis can enable them to discover and thereby take ownership for what they need in order to move the process forward. In this way, effort spent trying to leverage change by the therapist is redirected to the client.

Specific Interventions

The specific uses of hypnosis for difficulties like habit control, such as smoking and eating problems, are well known. Trance effectively enables the discovery of (a) the function(s) of these dysfunctional behaviors, (b) the awareness that the need is not the problem, but the way it is being “taken care of ”is, and (c) better ways to take care of the need.

Specific phobic reactions (e.g., flying, needle phobia) are treatable with hypnosis as it expedites the process of focusing on what enables them to feel calm and in control. Similarly, people suffering from insomnia, generalized anxiety, and panic disorder often can be helped quickly with hypnosis in combination with relaxation techniques and cognitive behavioral methods to regain control.

Hypnosis can be very effective in preparing for dental and medical procedures such as having blood drawn, chemotherapy, and surgery. Trance helps clients to (a) discover the steps needed to prepare for the procedure so as to feel more in control, (b) enter a state of mind and body that is free of worry, anxiety, and tension before and during the procedure, and (c) be more accepting of discomfort afterwards. There are research results demonstrating reductions in pain and use of pain medication, decreased blood loss, and shorter hospital stays when patients are prepared with hypnosis.

I’ve had good success using hypnosis with pain management to alter the sensations of pain and to reduce the negative meaning it has, a prime source of suffering. Because this is more of a complex specialty, I no longer promote this service.

Finally, there is an evidenced-based highly effective specialized hypnotic treatment for a specific ailment, Irritable Bowel Syndrome, which significantly reduces and sometimes eliminates the symptoms (see www.ibshypnosis.com). The seven-session protocol helps the client develop a deep relaxation in body and mind while multiple suggestions are made by the clinician, through direct statements and images, that the gastrointestinal system can remain calm and deeply relaxed regardless of any stress.

References available by request.

Michael H. Kahn, Ph.D. is a clinical and health psychologist and the co-director of Psychological Resource Associates in Severna Park. He has been in private practice for 30 years. He also coaches executives to manage the personal side of the success equation and is writing a book on the subject. He can be reached at 410-647-8840 or michael@mhkcoaching.com.