The Handbook

Hypnosis is the oldest Western conception of a psychotherapy, yet generation after generation forgets and then rediscovers it.  Hypnotic techniques have been oddly dissociated from the canon of mainstream medicine, despite their efficiency and effectiveness.  The aura of purple capes and dangling watches haunts hypnotic history, and daunts practitioners.  Yet the phenomenon of hypnosis touches on something central in the healing arts:  getting the patient’s full attention, mobilizing an alteration in awareness, sensitizing the patient and doctor to the importance of clear and empathic communication, and honing therapeutic strategies.  Hypnosis is not a treatment, but rather a mental state that can facilitate a variety of treatment strategies. It is a form of highly focused attention coupled with an ability to dissociate – put outside of conscious awareness – things that would ordinarily be in consciousness.  Hypnosis is to consciousness what a telephoto lens is to a camera – what you see you observe in great detail, but you are less aware of the context.  This means a reduction in critical scrutiny and an emphasis on doing rather than thinking about what you are doing.  Such a state of mind offers special therapeutic opportunities – the patient is really paying attention.  But it also confers special responsibilities on the clinician using it – to assess the problem well, think through therapeutic strategies carefully, evaluate the patient’s response, be clear when the hypnotic experience is over, and teach the patient how to mobilize and make good use of their own hypnotic abilities. 

Thus the material in this book, written by leading clinicians and practitioners of hypnosis, is important to clinicians entering into and practicing with the uses of hypnosis in medicine and related disciplines. Hypnosis involves trust, and that trust is rewarded by clinicians who understand the phenomenon, its assets and limitations, and use it artfully to help patients master problems. There is widespread misapprehension that hypnosis poses a threat of losing control. Practiced appropriately, it is a powerful means of helping patients enhance control over symptoms like pain and anxiety, aspects of somatic function, and psychological distress. The chapters in this book provide a firm clinical basis for helping patients to help themselves.

There is a growing evidence base, including sizeable randomized clinical trials, demonstrating effects of hypnosis on problems such as chronic pain, procedural anxiety and pain, irritable bowel syndrome, migraine headaches, and asthma. The side effect profile for hypnosis is favourable compared to that of virtually any medication. So the risk/benefit profile is favourable.  Despite this, there remains concern that hypnosis is either ineffective or dangerous. We are accumulating more evidence that it works and how it works, with neuroimaging studies using event-related potentials, PET, and fMRI demonstrating changes in brain function associated with hypnotic instructions and symptom reduction. We have plenty of evidence, and should and will accumulate more.  What is needed now is educated use of hypnosis to help people suffering from pain, anxiety, smoking, and other medical and psychiatric problems.  Read this book and enhance your ability to help your patients. They will thank you. And remember, it’s a smart hypnotist who knows who is hypnotizing whom.

Preface
This book is the culmination of a decision made at the BSCAH Council meeting in February 2008 to produce a definitive textbook to assist in our teaching programme and as a basic reference for all health professionals and academics interested in hypnosis. The decision was easy, but producing the text has been hard work, not only for the contributors and ourselves as authors/editors, but for our families and colleagues who have had to endure our focused attention on this mammoth task over the last eighteen months.

There was a need for the book to be so much more than a comprehensive trawl of the literature and a subsequent regurgitation of what, in reality, is already in the professional domain. Notwithstanding the above, research findings are included, but the student is reminded that, by its very nature, hypnotherapy does not fit easily into the ‘controlled trial’ model of clinical evaluation. Consent and co-operation of the patient, the development of rapport, and the skill and experience of the therapists are a prerequisite of hypnotherapy and this cannot be reproduced with the use of set scripts or videoed programmes. Also, during therapy, the very nature of the diagnosis may change (e.g. from IBS to victim of childhood abuse) and this underlying problem may never have been uncovered in the control arm of a trial. Randomisation therefore, is likely to be at best, speculative.  It is reassuring however, that despite the above reservations, research evidence does exist and is of huge importance, especially in the area of neurophysiology, but in clinical trials it is likely to significantly undervalue the hypnotherapeutic intervention. Thus results of clinical outcome audits will be a better guide for health service commissioners.

The current obsession with evidence based medicine has inevitably led to the commissioning of restrictive, protocol driven, services in the mistaken belief that this will provide ‘cost-effectiveness’ for the health economy. As a consequence of this approach there has been a decline in the practice of treating a patient as an individual exhibiting a set of problems unique to their own genetic make-up and its interaction with the environment in which they grew up. We hope that this book will become a resource for commissioners who will be required to take a more holistic approach to service provision. It is eminently suited to integration with other aspects of health care being compatible with pharmacological, surgical, medical and psychological programmes of therapy in a time efficient manner.

Some sections are unashamedly clinical where the content is based on years of experience and observation in the clinical setting. Much learning of hypnotherapy however, goes on from a mixture of formal study and clinical discussion such that the experienced therapist evolves a methodology that is an amalgam of techniques and styles absorbed from a variety of, often forgotten, sources, which have been adapted to suit the specific personality and clinical orientation of that therapist. The text, therefore, will not be interrupted unnecessarily with a plethora of references and we hope our colleagues in the Society and worldwide will forgive us if they recognise their own ideas but without any due acknowledgement.

Throughout the book we have made repeated reference to the need for therapists to work within their field of competence and this competence relates to their background health professional status as much as it does to their hypnotherapy expertise.

Techniques, treatment regimes and verbatim scripts are included to give the student ideas and confidence to begin. They are not intended to imply that this is the ‘must do’ approach. There is no such thing as ‘the’ technique for any particular problem and the student must follow the ‘learn it, try it, adapt it’ approach to these different methodologies. Outcome audit and personal development are fundamentals of best practice.

What to include/exclude in a book on hypnosis has been difficult. The chapter on informal techniques demonstrates the usefulness of the hypnotic approach without formal induction and a reminder for us all to think ‘hypnotically’ in our ordinary consultations. Similarly, utilisation of the broader concept of ‘trance’ has enabled the inclusion of reference to areas such dance and art therapy. Overlap with other therapeutic areas is obvious and the student new to hypnosis will soon recognise that many of the ‘active ingredients’ of treatments have their true origins in hypnotherapy.

Permission has been obtained to use various case examples; all have been anonymised to avoid identification and all names given are fictitious.

Whilst we appreciate that there is a lot of academic debate about the exact definition of certain terms and concepts, throughout this book we have used the terms unconscious and subconscious synonymously and interchangeably. In the clinical sections this interchange equally applies to hypnosis and hypnotherapy. We have chosen to use ‘patient’ rather than ‘client’ and have used the masculine form where the gender could be either. Similarly where we have used the terms ‘medical’ and ‘clinical’ we intend these to refer to the wide ranging disciplines encompassed by medicine, psychology and allied health professions.

We have been privileged to have been entrusted by BSCAH to produce this work and thank the members of Council for their support and encouragement. We would like to thank, of course, all our contributors and apologise if at times we have been difficult to satisfy. Particular thanks are due to Karen Mackrodt and others who have helped with the proof reading. There are many others who, perhaps even unknowingly, have given help with this project and who deserve thanks – it would be impossible to list them all but we hope they will accept this global message of gratitude.

Les Brann     Jacky Owens   Ann Williamson

October 2010