The transition between evaluating the client (phase I) and educating the client (phase II) occurs as the clinician begins to determine the client's understanding of hypnosis. Research in the area of positive expectancies has taught us that the responsiveness of a client to any treatment will be affected by their expectations. Therefore, the preparation of our clients for hypnosis is a process of educating them and building positive expectations (Coe, 1993). Kirsch has interpreted the results of several of his studies as suggesting that, with sufficiently strong expectation, anyone is hypnotizable (Rhue, Lynn & Kirsch, 1993, p. 89). This parallels Hilgard's (1968) observation that laboratory studies of hypnotic ability and susceptibility are often unable to mirror the demands of the clinical setting where the client's expectations and motivation may render the results on the tests of hypnotizability less important.
An educational discussion about hypnosis prefaces any induction procedure. This pre-induction talk covers the myths, the misperceptions, the uninformed constructs that the individual may hold about hypnosis. Some of the common beliefs held about hypnosis include but are not limited to the following:
1 Hypnosis is something done to a person. The client may say 'Put me under, Doc.' This idea that the hypnotist has some power to control the client is partly rooted in the much larger sociopolitical view of the medical model as a non-egalitarian relationship. In addition, this notion of having something done to you is comparable to the surgical paradigm of the client who is unconscious on the operating table and literally in the hands of the doctor. It is important early in the educational process to clarify that all hypnosis is self-hypnosis and that client and clinician are partners in the endeavour. The client is thus encouraged to actively participate in the exploration of his or her own hypnotic abilities.
2 Hypnosis is sleep, loss of consciousness or amnesia. The client may ask 'How will you wake me up?', or 'How come I heard everything you said?' The origin of the word hypnosis is the Greek word for sleep. Many accounts of hypnosis describe it as similar to the early stage of sleep when one is drifting in and out of conscious awareness but still awake. Clients' confusion about hypnosis being a state of sleep is further compounded by their knowledge that sleepwalking occurs in the hypnagogic stage of sleep. Our semantic difficulties in describing the experience of trance, of hypnosis, have contributed to this misconception about hypnosis. Clients usually find it helpful when they can recall an experience of profound concentration or fixed attention. Such an experience can then be compared to their hypnotic trance. It is also helpful to share with clients that brain wave studies of subjects 'under hypnosis' show an alert brain wave pattern, and not that of a deep sleep state.
3 The trance will be irreversible. The client may ask 'Can I come out of this?' This fear that once in a trance state the client will be unable to terminate the trance is founded on the belief that something is being done to him or her. It suggests there is an external locus of control for the hypnotic process. It is useful to compare the hypnotic partnership to the roles of guide and pioneer. The hypnotist is a teaching guide, the client may choose whether and when to follow, and the client rapidly learns the terrain already familiar to the clinician.
4 The hypnotist will have power over the client, over their behaviour, their thoughts, over their wills. The client may fear that a suggestion will violate a moral or ethical code. 'Will I bark like a dog?' 'Will I talk about something I don't want to talk about?' These concerns often reflect the client's exposure to the portrayal of hypnosis in the entertainment industry. Lay hypnotists, unlike hypnotists in the professional health fields, lack clinical training and all too often lack concern for the subject's privacy, psychological well-being or moral codes. It is the clinician's responsibility to teach hypnosis adhering to the codes of ethics of his or her profession and to teach the client to discriminate between the ethical and unethical uses of hypnosis.
Each of these beliefs carries a concern about who is in control. This underlies the important clinical construct that all hypnosis is self-hypnosis. It is useful to teach this to clients and it may serve to lay the foundation for the later teaching of self-hypnotic procedures.
Some other valuable constructs which are important to explain to the client include defining and describing absorption, concentration, focused attention, and dissociation. The commonness of absorption or what is termed the 'everyday trance' can be illustrated by experiences of automaticity shared by many, such as automobile driving behaviours, tooth brushing and other repetitious behaviours. The focused attention or concentration of hypnosis may be compared to the state one experiences while at prayer, or while reading a highly absorbing novel. The state of shock one is in following an injury or accident can be likened to the experience of dissociation.
There is variability in hypnotic talent and skill. Discussion of this point is helpful in building positive expectancies that practice will make a difference in hypnotic responsiveness over time. Hypnotizability scales may be used to assess degree of hypnotizability.
Discussion about memory and hypnosis is an important requirement of the pre-induction talk. Memory is imperfect, productive, and reproductive both in and outside of hypnosis. Some hypnotic techniques metaphorically suggest that events in memory will be retrieved as they happened or were encoded (e.g. the TV screen or movie technique). It is important to distinguish between this metaphorical exploration of memory and what research tells us about the nature of memory. This is similar to the distinction that is made between narrative truth and historical truth. Educating the client about these distinctions will be beneficial.
A final area for consideration by the clinician is that of informed consent. The clinician will document the evaluation and treatment plan for a client according to the standards of care determined by his/her profession. In addition, if a case involves or may involve forensic testimony, clients need to know about any issues related to admissibility of testimony gathered with hypnosis.
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