Читать книгу An Introduction to Hypnosis & Hypnotherapy - Damian PhD Hamill - Страница 3

“There were lots of invitations, I know you sent me some,

But I’ve been waiting for the miracle,

For the miracle to come.”

- Waiting For the Miracle, Leonard Cohen

In 1985, at the Evolution of Psychotherapy Conference in Arizona, the well-known therapist Rollo May estimated that there are over 300 distinct forms of psychotherapy currently being practiced (Zeig, 1987, p.212). If you think about it for a moment, this variety is bewildering. For each of these forms there is likely to be a theoretical underpinning, the satisfaction of which is necessary for that therapy to be viewed as having been ‘successful’ in its own terms. Even allowing for the probability that some of these therapies will share common elements of theory, this still leaves a staggering number of views on how people grow, function, develop problems; and what is necessary to resolve these problems.

Many of these therapies grew from early psychoanalytical models of human behaviour and bear their clear imprint. Even those that have developed a clear and unique identity of their own, such as Gestalt or Reichian therapy for example, were pioneered by disenchanted (or renegade, depending on your position) psychoanalysts - Fritz Perls and Wilhelm Reich, respectively. Despite the development of psychotherapy and its distancing in many cases from its psychoanalytical origins, there are several traits of the early psychoanalytical theorists that seem still to permeate many forms of therapy. The first of these is the insistence that the therapeutic model to which the therapist adheres is the only ‘correct’ model and that any other theories are necessarily ‘wrong’. The second is that therapeutic progress – human change - is a slow, laborious and often painful process.

The first of these traits brings with it a number of issues. If the adherents to a particular form of therapy believe that all other forms of therapy are ‘wrong’, then any change that these other therapies produce will be viewed as meaningless, transient or unsatisfactory in some other way. Furthermore, any change that a client experiences within the therapy of choice may also be viewed as meaningless, transient or unsatisfactory unless it fully adheres to and can be explained by the theoretical underpinnings of that therapy. Any change the client experiences that does not meet these criteria is often viewed as being temporary, superficial or, to borrow a psychoanalytical term, a ‘flight to health’. In considering the tendency of therapists to take this sort of position it is easy to come to the conclusion that the tail is wagging the dog – that the preservation of a theory of change blinds its theorists to evidence of change that does not fit the theory. Famous therapist and theoretician of change processes, the late Paul Watzlawick (Zeig, 1987, p.92), noted that a belief in possessing an ultimate truth about human affairs may encourage the holder to dismiss any evidence other than that which substantiates the ‘ultimate truth’ held. He characterised such ‘confirmatory bias’ as representing an apparent attitude that preserving a theory is more valuable than helping a client.

The situation outlined above inevitably raises the question of what exactly therapy seeks to achieve. Does a therapeutic encounter exist solely to provide ongoing confirmation of the therapist’s particular theoretical orientation, allowing the therapist to dismiss any developments that do not ‘fit’ this orientation; or is the goal of therapy to produce change within the client, in the direction that he or she wishes?

It is reassuring to realise, however, that many experienced psychotherapists across treatment modalities that were historically considered incompatible have moved away from such limiting perspectives. Rather than engaging in pointless ‘turf wars’ or unproductive arguments over whose therapy is the ‘best’ therapy, such practitioners are oriented more towards looking for commonalities between psychotherapies - those points where maps meet, intersect and overlap. These can be the most fertile grounds for collaboration, mutual sharing of experience and generation of new pathways of growth and development. Pamela Gawler-Wright (2009) has developed this collaborative framework within the context of Contemporary Psychotherapy and observes:

“Whenever we speak of psychotherapy we have to ask "which psychotherapy?" as the numerous and divergent modules of theory and practice are confusing even to the professional practitioner. The last two decades has seen a greater integration of various denominations of psychotherapy, resulting in a "post-schoolist" movement where positive similarities are embraced more than negative differences are fought over.”

Those who take this perspective, whatever their original clinical orientation (and however forbidding its own therapeutic lexicon may be to others), have come to realise that different therapeutic maps and models are merely differing metaphors describing common experience. The hazard into which the profession of psychotherapy drifted over decades was the reification of such metaphors, as if the elements of any particular metaphorical explanation really existed in tangible form and therefore excluded the possible existence of any other explanation.

The respected psychotherapist, Steve Lankton (1980, p.186), elucidated the metaphorical, rather than literal, nature of psychotherapeutic models and the perils of failing to recognise this distinction when he stated:

“Each school of psychotherapy is a metaphor designed to help expand the limitations of its client’s personal metaphors…Each has its own set of tools, conceptual labels, presuppositions and techniques. A lot of them have the same stated goals and intentions and yet are considered rival theories by their respective proponents. As we shall discover, though the content of these stories of personality may differ radically, the processes by which they effect change in their clients are formally identical.”

When it comes to filtering for similarities rather than differences, I believe that a common thread running through many of the different psychotherapies is the use of hypnosis and altered states. Once the essential characteristics and phenomena of hypnosis are recognised and understood, its de facto presence can often be detected in psychotherapeutic encounters where the word is not even part of the vocabulary, let alone regularly uttered. This is also despite the fact that some therapists who undoubtedly indirectly use trance in their practices would have an apoplectic fit if this were pointed out to them. I am reminded of a series of conversations I had with a therapist who practiced a form of humanistic psychotherapy, and who never missed the opportunity to decry hypnosis for various reasons which showed she had a fundamental misunderstanding of its nature. Due to the vehemence with which she held these views and my own desire at the time for an easy life, I did not avail myself of the opportunity to correct her misunderstanding. Some time later, however, she described working with a client using what she would have described as a creative visualisation method yet which I instantly recognised as being blatantly hypnotic in its structure, delivery and function. Had I pointed out that she was effectively using hypnosis she would almost certainly been horrified and denied it completely. Her inflexibility in championing her own therapeutic model to the exclusion of others meant that she could not recognise or acknowledge when her own therapeutic approaches borrowed heavily from formal hypnotic approaches which she claimed to revile. It also deprived her of the opportunity to learn how to use the hypnotic states she was eliciting more effectively.

This book, however, is designed to welcome those from diverse psychotherapeutic modalities who are open to acquiring new skills and also those who may have already developed a sneaking suspicion that they are utilising hypnotic patterns in their work and who want to check out whether that is the case. A clearer understanding of what hypnosis is and how it may already be present in your work can enable you to use it with greater flexibility, intent and grace, thereby enhancing your confidence and your clients’ results. It is this desire to create a broad church, which holds some common tenets of faith but also allows wide diversity of application, that has drawn to some of my training courses students from a wide variety of therapeutic orientations. I have taught hypnotherapy to clinical psychologists, CBT practitioners, humanistic counsellors, psychodynamic therapists, medical doctors, nurses and so on. Some of these have applied their hypnotherapeutic skills in the fairly pure form in which I taught them. Others have taken hypnotherapeutic approaches and blended them into their pre-existing therapeutic framework to enrich its potency. Still others have done a little bit of both. I believe that whatever medical or psychotherapeutic background you come from (or if you are a complete newcomer to the world of therapy) developing flexible skills in clinical hypnosis can be enormously beneficial to your work.

So what are the basic tenets of faith that I feel it is useful to bring to the study of hypnotherapy? Well, the practice of therapy advocated takes the view that the only meaningful way of determining whether or not change has taken place is through the experience of the client. Indeed, the therapist using brief hypnotic approaches may well need to get used to seeing clients change without having more than the vaguest notion of how the change was generated. If clients report therapeutic change that is meaningful to them and satisfies their wishes, I take this as sufficient evidence of change. What right, one might ask, has anyone to tell the client that his or her experience ‘doesn’t count’ as it doesn’t fit someone else’s theoretical orientation? The inclination to tell the client what he or she should be experiencing is also, in my view, a very quick route to damaging the rapport that is important for effective therapy.

This approach is different from some more traditional psychotherapies in which the clinician is often encouraged to assess progress or change in spite of the subjective feedback of the client. I submit that this approach, whilst very different from others, is actually profoundly liberating. Rather than the therapist having to ‘second guess’ the client’s experiences, we can allow the client to ‘own’ his outcome and respect his ability to assess progress towards it. This is empowering for both the client and the therapist.

It is important to realise, however, that this outcome-based or solution-focused approach does not mean that we abandon any form of theory and adopt the position that ‘anything goes’. Rather, it means that theory is the servant rather than the master of the therapeutic process and that no theory should be viewed as being immune from revision or scrutiny if it is contradicted by empirical evidence. Our first loyalty is to the client, not the theory, and the focus of our therapeutic approach is on helping the client to make change in an effective, humane, congruent and ethical manner. If we achieve this, we have done our job. We can view theories as being little more than tools to give us structure upon which to base our therapeutic interventions. The psychiatrist, Anthony Storr (1997, p.205), expressed this neatly with his words:

“Problems cannot be investigated or even perceived without some conceptual framework, but all such frameworks must be able to be overturned. There should be no articles of faith in science, unless it be the faith that no discovery, no law, is so absolute that it cannot be superseded.”

What else, then, typifies this approach? Well, there are a number of factors that I believe are likely to be useful in working with clients to produce therapeutic change. Bearing in mind that these are not written in stone they are, in no particular order, the following:

•Clients have within them the ability to resolve their own problems

•The responsibility of the therapist is to assist the client in changing him/herself

•The unconscious mind contains vast resources which can be harnessed to aid the client

•Problems often tend to be learnt behaviours and therapeutic change can be likened to a re-learning process

•Effective change can take place at a number of levels, both conscious and unconscious.

•People operate within interpersonal and intrapersonal systems and change will often only persist if it is supported by, or congruent with, these systems

•The mind and body are an integrated system - a change in one will often cause a change in the other

•Lasting change can happen extremely quickly and painlessly

•Labels are for packages, not people

•An eclectic approach gives the therapist the greatest flexibility to assist the client in changing. The proof is in the pudding – if it works use it

•If it ain’t broke, don’t fix it

•Therapy should aim to assist the client in living his/her life, it should not become his/her life

This last point relates back to the quotation from Leonard Cohen at the start of this chapter. One of the drawbacks of conventional therapies, such as the traditional ‘1000 hour analysis’ is that clients tend to put their lives on hold while they are in therapy. They are encouraged, either actively or tacitly, to believe that they are ’sick’, suffer some form of psychopathology and that they must endure some sort of therapeutic Odyssey before they can obtain absolution and return to a ‘normal’ existence. Therapy becomes their way of life. Nothing can be thought, said or done without having to be accounted for or investigated through the lens of the therapy they are undergoing. They become dependent upon their therapist. They ‘project’ and ‘transfer’ left, right and centre. Their diary revolves around their twice, thrice or four times weekly therapy sessions. They spend years in therapy, are just as unhappy as ever, yet are persuaded they have made progress because they now know why they are unhappy (or can at least quote their therapist’s explanation).

Respected therapist, Bill O’Hanlon, has light-heartedly compared this to the scene in the Woody Allen film, Annie Hall, in which Allen’s character, Alvy Singer, tells Annie that he has been seeing an analyst for fifteen years! When Annie expresses amazement at the length of time that the clearly still neurotic Alvy has been in therapy, he tells her that he is going to give it one more year and then, if he has not improved, he will go to Lourdes!

There is a risk that clients is such situations live their lives in a therapeutic limbo in the hope that one day they will experience a revelation, a ‘eureka’ moment, and that their therapist will declare them ‘cured’. I believe that this ‘waiting for the miracle’ is a waste of the human potential for happiness. It is existence rather than true living. The world is rich and full of wonderful experience and we should be committed to assisting our clients to enjoy a life of satisfaction and fulfillment.

It may sound as if I am dismissive of any therapeutic approaches that take any significant length of time but, as I hope I made clear earlier, this would be a misunderstanding of my position. A useful view of time considerations is that therapy should be as rapid as is consistent with the client achieving the results that he or she wants. My concern, however, is with protracted therapies that seem to have no connection with or regard for the life that the client is currently living, in the here and now. Even lengthy therapeutic approaches can strike an appropriate balance between longer-term work and assisting the client to live more fully and happily in the present and this is commendable. A brief hypnotherapeutic approach to therapy can be effectively blended with many other therapeutic orientations, allowing the therapist to offer rapid assistance to the client whilst still continuing to pursue other longer-term therapeutic approaches. It can often be the case that rapid therapeutic changes can generalise and be carried forward, creating momentum for further changes, both within therapy and the client’s life in general. Milton Erickson noted that effective therapy was often simply a matter of toppling the first domino! Many of my past students students who have trained in other psychotherapeutic models find that brief hypnotic approaches both augment their approach and also frequently enhance the speed and effectiveness of their methods. I welcome and encourage such cross-fertilisation of approaches, which can only benefit clients.

I also have regard for the concept of ‘demand characteristics’. Demand characteristics are the subtle, often subliminal expectations, or ‘rules’, that are communicated to any participant in a psychology experiment and which the participant may find himself perceiving and either adhering to or reacting against. In psychology they are viewed as being a ‘confounding variable’, which can impact upon the purity of the experiment. I suggest the concept can also be extended to interpersonal interactions such as psychotherapy. If a therapy client is told (or has it subtly implied) that change will be slow and painful, the client’s ongoing experience may well manifest these ‘characteristics’ that have been implicitly ‘demanded’ of them. What sort of message is a therapist communicating to a client if he tells her that therapy will take 1000 hours, over four sessions a week? What type of message does a therapist convey to a client if she tells him that his symptoms indicate repressed childhood sexual abuse and that the only way he will get better is to recall the abuse in vivid, excruciating detail? If the client is likely to fulfill the predictions of the therapist, is it not more humane and productive to make suggestions that therapy may well be swift and painless? (‘Suggestions’ - sounds a bit like hypnosis, doesn’t it?)

Even some early psychoanalytical practitioners began to realise these possibilities and famous psychoanalysts such as Sandor Ferenczi experimented with the technique of setting a date for the termination of therapy in order to focus the client’s mind and expedite therapeutic progress. He seemed to appreciate the well-known, everyday adage that the amount of work to be done will expand to fill the amount of time available to do it. If you create a context where therapy is perceived as being endless what motivation has the client to produce change?

Another important point worth noting at this stage is that I do not advise talking in terms of providing clients with ‘cures’. The very use of the word ‘cure’ implies that in some way the client who comes to a therapist is ‘broken’ or ‘sick’. With something as complex as human behaviour I suggest it is inappropriate to use these types of terms. Furthermore, as the client will often set his or her own outcomes in terms of the goals to be achieved, it is naïve to assume that there even exists such a thing as a universally recognised ‘cure’ for any particular problem. I prefer instead to think of clients as being people who are living or experiencing elements of their lives in ways that are problematic for them, or at least less than fully satisfactory. Consequently our role as therapists is to assist clients in finding ways to behave, think and feel that are more enjoyable, effective and life-enhancing. Often these changes can be so profound and radical that they can seem to represent a cure or a recovery from some terrible affliction but this is not the case.

In this book I will be setting out an introductory framework for creating therapeutic change in clients that is largely based upon the use of clinical hypnosis. The approach is eclectic and incorporates traditional hypnotic approaches and more contemporary ‘permissive’ approaches. I believe that effective therapists can respond flexibly to the client in front of them, rather than expecting the client to adapt to the therapeutic approach of the practitioner. The approach is described as brief, in as much as we attempt to make rapid, identifiable changes in the presenting symptom without concerning ourselves more than is necessary with the history or provenance of the symptom. It is strategic in the sense that the approach is designed to reach a defined, recognisable end point and the therapist and client devise a therapeutic strategy to get to that point as rapidly and effectively as possible. Brief strategic therapy is goal-oriented, solution-focused therapy and has a starting point and clear end point in sight. As such, defining the client’s outcome and establishing an evidence procedure to recognise when it has been achieved is important and will be addressed in the course of this book. I believe that hypnosis is an immensely powerful therapeutic tool and it is a natural human ability to access states of trance. In this book I attempt to sweep away the unnecessary and misleading mystique that has clung to the subject over many years and present it as what it is – a rapid, effective and empowering way of accessing the abilities and resources that we all possess within us. Rather than being a special ‘gift’ that one is born with, hypnosis is a skill that can be learnt like any other. Obviously, as with most skills, some people will be ‘better’ at it than others but it is a learnable skill nonetheless.

This book is written with the assumption that the reader knows virtually nothing about clinical hypnosis and is designed to introduce basic concepts and build upon these, introducing more advanced and sophisticated techniques as we progress. Although I take an inclusive and eclectic view of the field of clinical hypnosis, we will restrict ourselves to validated and credible approaches. There are many esoteric and rather eccentric approaches to hypnosis being touted, however the reader will not find such approaches here. Please note, however, that although I have attempted to make this book quite a comprehensive, introduction to the subject, it should not be viewed as a hypnosis training in its own right. Reading a book is not sufficient training to allow someone to practice as a hypnotherapist. Clinical hypnosis is a highly practical skill and anyone wishing to practice hypnotherapy should undertake training with a reputable organisation that provides extensive experiential, hands-on training in a classroom environment. I strongly advise against training in clinical hypnosis through correspondence courses of which there are many. Although often cheaper than a practical training, I strongly believe that they are a false economy and that nothing can substitute for the experience and close supervision obtained through practical training. Hypnotherapists who have already completed training with other organisations may, of course, find that they can incorporate some of the methods outlined directly into their own practices. Even experienced therapists may find unexpected gems and nuggets of gold hidden amongst these pages. I believe that you are never too old or too knowledgeable to learn new things.