The Underlying Therapeutic Philosophy Integrative Hypnotherapy

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Certainly this edited work reflects some of my own philosophy of psychotherapy, which is one of broad spectrum, eclectic treatment. Reli ance on a limited range of methods and one approach appears to often be associated with inexperience as a therapist (Auerbach & Johnson, 1977; Fey, 1958; Parloff, Waskow, & Wolfe, 1978; Strupp, 1955; Wogan & Norcross, 1985). In fact, research has found that it is the most highly experienced therapists who ascribe to an eclectic approach (Norcross & Prochaska, 1982; Smith, 1982), refusing to be limited by adherence to only one orientation. Currently 30%-54% of psychotherapists from various disciplines identify themselves as eclectic (Norcross, 1986). It is my belief that not all patients need the same thing. Thus you will find a tremendous diversity in the suggestions represented in this book. In fact, when therapists tend to inflexibly use the same approach with all patients, there is evidence that destructive effects are much more likely to occur (Lieberman, Yalom, & Miles, 1973).

In the specialty area of hypnotherapy, we are beginning to witness an evolution similar to what has been seen in the broader field of psychotherapy where innumerable therapeutic schools and cults have sprung up. Various orientations to hypnosis have also begun to evolve. Unfortunately, we now see some clinicians who have begun to operate on the "one-true-light-assumption" that their specialized approach to hypnosis is the correct one. Similar to Erickson, I refuse to be limited by a unitary theory or orientation, either in psychotherapy or in my use of hypnosis. I value and encourage an openness to learning from all quarters. I am indebted to the work of many different master clinicians and hypnotherapists with highly divergent styles who have enriched my work in ways that would have never occurred if I limited myself to only one approach.

Thus I identify my approach to hypnotherapy as Integrative Hypnotherapy (Hammond & Miller, in press). This is an eclectic, multidimensional orientation that seeks to be comprehensive, incorporating methods from many hypnotic approaches. It is part of the emergent trend in psychotherapy, tracing its roots to pioneers like Thorne (1967), Wolberg (1954, 1967, 1987), Lazarus (1981), and more recently Beutler (1983), Prochaska and DiClemente (1984), Norcross (1986), and Hammond and Stanfield (1977). Depending upon the individual patient, direct, indirect, metaphoric, and insight-oriented techniques may be employed to alter behavior, affect, physiologic processes, imagery, perceptions, cognitions, and the internal dialogue of patients. Hypnosis is used to explore precon-scious and unconscious functions, resolve historical factors, and utilize unconscious resources.

This method of working builds on the general philosophy of technical eclecticism (Lazarus, 1981; Hammond & Stanfield, 1977), encouraging the prescriptive use of techniques according to indications and contraindications derived empirically and by experimental validation, rather relying on theories. Unfortunately, research on effectiveness is far too often lacking and experimentally validated criteria commonly do not exist on indications, contraindications and the matching of techniques with patient variables. Thus strategy and technique selection currently remain implicit and primarily guided by empirical evidence and clinical experience. Hypnotherapy, like psychotherapy, is still more of an art and only embryonic in scientific development. Tentative and yet systematic and explicit guidelines need to be published concerning strategy and technique selection with different patients, and this process is currently under development (Hammond & Miller, in press).

Stemming from this therapeutic philosophy, you will find that I have often included some suggestive guidelines and indications for the use of the hypnotic suggestions and metaphors that have been included in the book. I have indicated when these guidelines were mine. The titles and subtitles throughout the text are in most cases mine also. They have been provided to allow you to more easily identify "modules" of suggestions that have a different theme or focus.

A necessary limitation of this book is that it focuses primarily on what we call suggestive hypnosis. Sometimes suggestive hypnosis is all that is needed to successfully treat a clinical problem. However, there are times when problems and symptoms are related to historical factors (e.g., trauma) and/or serve adaptive functions and purposes that are beyond conscious awareness. In these cases, delivering hypnotic suggestions and metaphors will be most effective following uncovering and age regression (abreactive) work. A comprehensive, integrative approach to hypnosis thus includes the use of exploratory and insight-oriented hypnotic techniques. These interventions, however, are much more difficult to model in a limited amount of space and consequently are only rarely included in this book. These methods may be studied by consulting Hammond and Miller (in press), Rossi and Cheek (1988), Brown and Fromm (1986), and Watkins (in press).

Finally, I wish to emphasize that hypnosis is often most effective when it is combined with other (nonhypnotic) interventions. Hypnosis is like any other medical or psychological technique or modality: it is not uniformly effective with all problems or all patients. Thus it is vitally important that we do not identify ourselves as "hypnotists," but rather as psychologists, physicians, dentists, social workers, marriage and family therapists, nurse anesthetists, etc., who use hypnosis as one mode of intervention along with our other clinical tools.

Furthermore, ethical practice requires that we only use hypnosis to treat problems that we are qualified to treat with nonhypnotic techniques. If one has not received advanced specialty training and supervision in practicing with children or in doing sex therapy, it seems ethically inappropriate to use hypnosis to work in these areas. Hypnosis training alone does not qualify us to work in subspecialty areas beyond our expertise. Similarly, merely learning a few hypnotic inductions and then seeking to apply suggestions gleaned from a volume like this is likewise deemed to be inappropriate. The reader is encouraged to seek specialty training and supervision in hypnosis from your local university or the American Society of Clinical Hypnosis workshops, and to study comprehensive textbooks.

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