The Process of Hypnotherapy Stage 3 Planning a Change

In this chapter attention is focused on the process ofdeciding a strategy in Hypnotherapy for reducing the problem symptom. There is no one way of tackling a given symptom, or helping a given person. But there is a strategy which has a good chance of producing a short list of the most effective and efficient ways.

BY THE TIME we have completed the first two steps of diagnosis we should have a clear idea of the dynamics of the problem: we should know what systems are involved. Some of these are important when the central system becomes active; some of them are important when it is reduced in activity (and may act via a negative feedback loop to increase it again.) With all this information in mind we are in a position to begin to consider the strategy of how things are going to be changed for the better.

The claim of Hypnotherapy is that it IS possible for the therapist to intervene and to change things for the better. It is a well established fact that Hypnotic techniques CAN change things. We have just seen in the previous chapter HOW many of these changes are effected.

In this chapter the focus is more on the question of what exactly we should be aiming to change. The simplest approach is to find an answer to the question:

? > \C, i.e. is there a system which has as a direct result a reduction in the problem process?

The simplest answer to this is, "If we activate a system of belief in the Client that the symptom will disappear, then it will!" This is the hope and belief of many who come to a Hypnotherapist for help. And in many cases this will work.

A case in which it should always work is one in which our earlier steps have revealed that the only chain

Principles of Hypnosis (14) How to plan change in hypnotherapy involving C is C itself and the thought (T), "C will happen to me", and has the form: /T > /C > /T, i.e. a simple increasing positive feedback loop in which the more the Client thinks that a problem will arise the more it happens, and the more it happens the more he or she is convinced it will happen again.

If, in such a case, we can replace T by the thought T1= {"C is going to stop happening"}, then we will institute the loop:

/T1 > \C > /T1, which is a positive feedback loop which is increasing for T1, which therefore gets more and more ingrained, and decreasing for C which therefore gets less and less active until it disappears.

An example of the above loop might be provided by a case of stammering in which the belief, "I stammer" leads to stammering which reinforces the belief. In that case a Hypnotherapist could have a dramatic success if the old idea could be replaced by the new one, "I do not stammer". In practice, it would not be best to start with that suggestion for the following reason. There is a high chance that the old pattern will NOT be totally eliminated immediately, so that although the Client would be free from stammering for a few days, a stammer might start a little later. But if this were to happen it would immediately tend to replace the new thought by, "I am stammering again," and we are back into the old loop. It is therefore better practice to suggest a thought on the lines, "I am stammering less and less". This will establish a loop in which the less the stammering, the stronger the conviction that it is improving, which will feed back into reduced stammering, and so on. Then, at a second stage, the thought, "I do not stammer" can be introduced.

This example reinforces the idea we have observed, which is that Hypnosis is so very often about amplifying small changes into larger ones by means of a positive feedback loop. Here we are amplifying a small improvement into a greater one.

The recognition of the fact that what a person repeatedly thinks or believes can have the most profound effect on the whole of the mind and personality and feelings and body is one of the traditional cornerstones of Hypnotherapy. The emphasis on this fact is one of the features that contributes to distinguishing it from related disciplines. The trouble is that if this idea is made the sole defining characteristic of Hypnotherapy it can lead to the excessively simplistic view of things which amounts to the idea that Hypnotherapy consists solely of "placing the person in a trance", and then suggesting that the problem will disappear. Practising Hypnotherapists will have discovered that things are not always that easy, without perhaps being always clear about why it sometimes works and sometimes does not.

We have seen that such an approach will almost certainly work if there is only a simple feedback loop of the above form involved in maintaining the problem, and if the suggestion is appropriately worded. But it will often not (except perhaps for a short time) if the situation is more complicated.

Notice that the way in which we have diagnosed cases should make it clear when such complications exist and therefore when direct suggestion of the above form is almost certainly NOT the only treatment needed. We will have analysed all the causal chains involving C. In many cases these will be open-ended (e.g. blushing may be a direct result of "friends" making fun of the blusher in a deliberate attempt to arouse it) or involve other factors such as deep emotional responses. In such cases there is no guarantee that the simplistic approach is going to work and the exact way to tackle the problem is going to be less obvious and direct.

The central question for the Hypnotherapist in these more general problems is, " Where is the intervention going to be focused?". At times this may still be on the central system C, but it will often be on related systems.

As a simple example, Erickson is on record as having treated insomnia NOT by focusing on sleep at all, nor on the belief that, "I suffer from insomnia," but by putting his effort into establishing a new pattern of behaviour, which is that if sleep does not come then the sufferer should get up and polish floors for hours (Gordon & Myers-Anderson (1981)Bib pp. 149-150). Let us see how this works.

A typical insomnia problem involves an increasing positive feedback loop: /{Arousal} > /{Anxiety} > /{Arousal}.

In the simplest terms, Erickson has focused on the result of an increase in arousal and instituted: /{Arousal} > /{Polishing} > \{Arousal}.

He relies on the empirical fact that spending hours polishing in the middle of the night is in fact physically tiring, to produce the resulting lowering of the level of arousal. In this way he breaks the original positive feedback loop and creates a negative one. After this is repeated for a few nights, arousal will lead simply to the thought that polishing is on the agenda, which is such a tiring thought that arousal will drop until sleep supersedes: the "problem" is then over.

Another example, from my casebook, involved blushing. The basic process was the typical one for blushing: an increasing positive feedback loop of the following form:

/{Feeling of embarrassment} > /{Blushing} > /{Embarrassment}.

This stops being a positive feedback loop if we create a different resultant of the increase in blushing. In this case, which involved a man who had recently been promoted and so felt rather insecure in his new position, it was suggested that he feel and express anger as a result of the onset of blushing. He was to raise his voice and perhaps thump on the desk. It was explained that any redness would then simply be interpreted by others as a sign of anger. This would make him feel less embarrassed. He was quite happy to do this. We then had the new process:

/{Embarrassment} > /{Blushing} > /{Anger} > \{Embarrassment} > \{Blushing}.

This constitutes a negative feedback loop for the blushing and embarrassment. Once he had repeated this process a few times in real life he had no further problem. People responded quite well to his anger by backing off a bit and this gave him enhanced confidence in his new position, and so he seldom felt embarrassed at all, and if he ever did then he knew how to cope with it.

In choosing anger as a suitable resultant we may be guided by the notion that in the male at least, blushing can often be the result of suppressed anger. I have known a number of cases in which a young man had once freely expressed his anger, and went red in the face while doing so. Then, for one reason or another, he started to suppress the anger. Then the same redness remained, but now the associated feelings were of humiliation or embarrassment. In such cases the above intervention simply restores an earlier pattern of behaviour, but in a controlled way.

Although the point will not always be laboured, such a change should NOT of course be implemented without checking the consequences of the change in the way in which we have checked for the result of reducing the central symptom in Chapter 12. An increase in the expression of anger will affect people close to the Client. We would have to ensure that they will not react so strongly that the anger is again inhibited, i.e. that there is not a negative feedback loop for the anger of the form:

/{Anger} > /{Reaction} > \{Anger} > /{Embarrassment}.

We should also ensure that the expression of anger is kept within bounds, which is why a banging on the desk and raising the voice are specifically suggested. A general suggestion - "You will express your anger" - might lead to actions for assault!

In the above examples then, the focus of the intervention has NOT been on the presented symptom, but on other aspects of the loop involved.

Notice that no claim is being made that those are the ONLY ways of tackling the above problems. The problem of insomnia may be tackled in many ways. A common one is to give the sufferer a suitable tape which, typically, activates a non-rational part of the mind. This might be a generic, "Imagine yourself on a desert island" script or a more specific, "You like walking. You are now going to imagine yourself on an old familiar walk, and follow it every foot of the way..."

In this way we plan to inactivate the system of verbal thought which is so often involved in keeping the person awake, and instead to activate the daydreaming system, which at night can change so readily into normal dreams and hence sleep.

Note that the choice between the two approaches - the polishing or the tape -can be made on the basis of deciding whether the arousal has more to do with an active mind or an active body. If the arousal is more in the muscles, then Erickson's approach is likely to be better. If it is more in the (verbal) mind, then the tape may be the better choice. This illustrates the way in which a clarity of analysis of the systems involved in a problem leads to a clarity of understanding of the best approach to resolving a problem.

Blushing may likewise be tackled in many other ways. Simple suggestions that, "You will grow out of it" may be enough in a given case, particularly if the cause is a simple loop of the kind met at the start of this chapter.

Again the choice of the better technique will depend on our underlying analysis of the systems involved. If we have analysed a suppressed anger then the first method has clear advantages. If we have discovered an immature self-image - that criticism activates a childlike response - then the second can be recommended. Again notice that the approach is not determined by the SYMPTOM, but by the TOTAL PROCESS.

The difference between the skilled workman and the novice is often not that one can and the other cannot do the job, but rather in the quality and efficiency that the former brings to the job. A bookcase can be made in many ways, including holding it together by knocking nails in with a screwdriver. A Client's problem may be cured by many Hypnotic techniques, some of which are equally bizarre and liable to produce a result that could collapse in a short time. However, a professional Hypnotherapist should be constantly striving to achieve the best, smoothest and most efficient results.

In order to do this we study very carefully the person we are dealing with as well as the particular problem. In earlier chapters we have described a systematic way of approaching the analysis of the problem. Some examples of interventions have now been given. We now move on to see how we can proceed in a systematic way to plan possible changes, with a view to choosing and implementing the best.

The central difference between this process and the diagnostic process is that it is synthetic rather than analytic - it involves divergent rather than convergent thought, or lateral as opposed to linear thought. There is no ONE way, as we have seen above. Consequently there is no precise linear description of a process which is guaranteed to determine the best method of change for a given therapist and Client.

However, we can lay down some general principles to guide the creation of therapeutic interventions which will bring us as close as possible to such a description. The process is not, however, linear, but a loop. (They are everywhere!)

Step 1. Focus on a particular part (P) of one of the causal chains involving C. (This may be a named subprocess, or the link between two named subprocesses.)

Step 2. Think of a number of interventions (I) which can affect P in such a way as to lead to a reduction

Principles of Hypnosis (14) How to plan change in hypnotherapy in the activity of C. (The more the better.) This step is the creative one.

Step 3. Of each intervention ask, "How easy is this likely to be with this Client?"

Step 4. Of each intervention ask, "Does there exist a negative feedback loop which will act to eradicate the effect of this intervention?"

Step 5. Of each intervention ask, "Will the change that this intervention introduces create new problems?"

Step 6. Return to Step 1 and consider intervening at another point until all possible points of intervention on each chain have been examined.

As a result of going through the above process the Hypnotherapist should end up with a short list of possible interventions which will have the desired result of achieving a permanent improvement in the central process C, with no harmful side-effects, and which are (comparatively) easy to implement. It then remains simply to choose the better ones and to start making the changes.

That makes it sound very easy. Sometimes it is!

It does, however, leave open the question, "How on earth can one think of interventions out of the blue?" There are various answers to this. The first answer is that they are seldom created "out of the blue". A practising Hypnotherapist will have acquired an extensive list of possible ones from his or her training, reading and experience. An excellent source-book of Erickson's interventions (which tend to be more innovative than most) is O'Hanlon & Hexum (1990)Bib, but other books, journals, seminars and discussions with other practitioners can give the Hypnotherapist a familiarity with a wide range of approaches. With this background a "new" intervention is seldom more than a modification of an existing one.

The second answer is that the intervention may be "revealed" by the process of listening intelligently to the Client during a certain amount of open-ended discussion. If, as an example, it is found that a woman has trouble stopping herself eating the snack foods that all children love, while being quite firm with her own son in those matters, then it does not take too much lateral thinking to think of instituting the following resultant of eating such food: "You must be fair. Every time you indulge the little-girl-in-you with ice-cream, etc. you must give your son exactly the same." Notice that, as in the above examples, we are not seeking directly to change her eating habits, which were the central symptom, but rather introducing a change in the resultant. Since she has in fact tried very hard to reduce the eating directly with no success at all, we may presume that a direct attack will not be too successful. On the other hand this indirect approach, which still allows her to eat as much as she likes, will soon lead to the amounts being moderated by her motherly concern that it is not going to be good for her boy.

Equally, if while we were thinking about the precursor, we discovered that she mainly ate in that way at times when she felt alone in the evening because her husband spent all his time renovating cars, and we also discovered that she quite liked working on machines herself, then the following thought is obvious: "What if she were to be able to join him in the garage in some way at any time she felt that urge to nibble?" In just such a case things got a lot better when the husband bought an old car for her to renovate with him.

Notice how unique such a prescription must be! There can be very, very few women for whom an eating problem can be solved by their husband buying them a wreck to renovate! Yet, in this one case, it was a strategy which will improve the marriage, reduce her weight and improve her confidence (when she is able to drive her own car around), and all without further dependence on "therapy"! That is elegant. It is specific.

The ancient story of the Procrustean Bed comes to mind. Procrustes offered hospitality to passing strangers in the only house on a road through a wild land. But his standards of hospitality were demanding indeed. He only had one bed, but he was determined that every traveller should have a bed which fitted him perfectly. The solution? If the traveller was too short, Procrustes would stretch him on a rack until he was long enough. If he was too short, Procrustes would lop off whatever overlapped the ends.

Some therapies have a limited number of resources and have therefore to fit the patient to the remedies, rather than fitting the remedies to the patient. In reality many a General Practitioner, through no fault of his or her own, is limited to prescribing one of a limited number of drugs to deal with a very wide number of cases where there is no clear organic malfunction but some disturbance of emotional balance, or sleep, or digestive processes, and so on.

Systematic Hypnotherapy, far from being a non-scientific option, is in many ways a more scientific one than is open to the GP. It is aware of the complexity of the dynamical systems with which it deals. It diagnoses not in terms of simplistic, static, symptomatic categories but in terms of the precise dynamic processes involved, which may include external as well as internal systems. It has a great flexibility and there are an enormous variety of changes it may institute, so that over the range of problems to which it is best suited, it is in a far better position to fit the bed to the patient rather than the patient to the bed.

Now it may be thought that the types of interventions mentioned above, e.g. getting a woman to feed her son the same treats as she feeds herself, or getting her to work with her husband, are not Hypnotic. But notice that these, also, are changes in thoughts and/or habits. And it is NOT always the case that habits or thoughts can be changed simply as a result of saying that they could be. We will often have to bring to bear the full power of suggestion, amplified in the ways we have outlined, to start and maintain such a change in thought or habit. In this way, an actual session will often proceed in what looks a fairly normal way, with relaxation, visualisation, etc., but with the goal of changing one of the new, indirect processes rather than by a direct attack on the central or presented problem. Nevertheless such a method can often be a lot faster and more efficient than the direct attack because of its intelligent use of the real dynamics of the person's personality.

When it comes to implementing the above central process of determining the possible approaches to change, remember that, as in diagnosis, it is NOT being suggested that the Client be asked questions in a systems-oriented language. It is both common sense and courteous to talk in a language familiar to the Client, and the answers to the questions involved will normally be obtained as a result of informal conversation.

Thus we will not normally ask,

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