Ejercicio: Desarrollando nuevas opciones y planes

The HIP was developed to provide a useful measure in the clinical setting. It evolved out of a need for a rapid induction and testing procedure that could be easily integrated into the clinical diagnostic interview, so that trance capacity might then be quickly used in treatment.

The HIP postulates that hypnosis is a subtle perceptual alteration involving a capacity for attentive, responsive concentration that is in-herent in the person and can be tapped by the examiner. The hypnotic induction becomes a deduction. A rapid procedure, the HIP takes 5–

10 minutes to administer. It is both a procedure for trance induction and a disciplined measure of hypnotic capacity standardized on a pa-tient population in a clinical setting.

The HIP assesses a single trance experience as it flows through the phases of entering, experiencing, and exiting the hypnotic state.

The test also establishes a structure for this sequence. The specific point in time at which the shift from customary awareness into trance takes place varies from person to person. However, the trance experience is punctuated, tapped, and divided into phases by the 10 individual items lettered A and D–L on the HIP score sheet.

Item D is the sum of items B and C (Figure 3–1). Six of these items (D, G, H, I, J, L) are used for rating the subject’s trance capacity

and for scoring the HIP according to the induction- or profile-scoring method. The remaining four items (A, E, F, K) round out the clini-cal picture and establish the procedures for entering and exiting trance as well as subsequent self-reporting. Scoring these four items is optional because they are not part of the original HIP summary scores. These optional items are scored on the more recent 16 scale (see Appendix). The 16-scale technique induces the subject to enter

FIGURE 3–1

the hypnotic trance quickly under observed, specified conditions and then to shift out of trance on signal. At the same time, the HIP teaches the subject to use his or her own cuing system for entering and exiting trance. Thus, as the examiner observes and measures trance capacity, the subject can learn to identify the trance experience to initiate and use it independently (self-hypnosis) in the service of relevant goals.

The trance experience can be divided into four phases for mea-surement (Table 3–1). The first is a pretrance or preinduction phase, which lasts until eye closure. The second is the induction or enter-ing phase, durenter-ing which instructions are given for the individual to shift into formal hypnosis. The shift may take place in response to the examiner’s directions and, as part of this induction ceremony, instructions are given for responsivity. The induction ceremonial phase and formal trance are terminated with the opening of the eyes, but hypnotic trance persists, and the third phase begins. The third is a postinduction or postceremonial phase, during which the person may or may not actually experience the following five re-sponses to the instructions given as part of the induction ceremony:

dissociation; signaled arm levitation; a discovery of a sense of dif-ferential control; response to the cut-off signal ending the hypnotic experience; and a sensory alteration involving floating, lightness, or buoyancy (see Figure 3–1, Items G–J and L). It is important to note that what are often called posthypnotic phenomena actually repre-sent the experience of hypnosis. Posthypnotic is a traditional label that can be confusing. A more appropriate label may be postcere-monial or postinduction.

Item J (cut-off) of phase three is the exiting procedure. Al-though the subject is out of formal trance and his or her eyes are already open, this period of postceremonial trance response must be terminated by the examiner touching the subject’s elbow. A fourth postexperiential, nontrance phase comprises self-reports by the subject.

Measurements of up-gaze (Item A), the eye-roll sign (Items B, C, and D), and instructed arm levitation (Item E) supply an evaluation of inherent potential or capacity for success in initiating and sustain-ing the trance experience. They also comprise the induction proce-dure. Actual success in maintaining the trance experience, once it has been effected through specific instructions, is tapped by dissociation (Item G), signaled arm levitation (Item H), control differential (Item I), cut-off (Item J), and float (Item L). These five measurements taken

together rate the degree to which the subject can attentively focus:

They constitute the induction score (Table 3–2). The profile score is a statement of the relationship between a person’s potential for trance and his or her ability to experience and maintain it. Exactly what this relationship means and how it is determined is discussed in Chapter 4, Administration and Scoring.

TABLE 3–1

Four Phases for Measurement of the Hypnotic Induction Profile

The 4 phases Items that tap the 4 phases 1. Preinduction Pretrance or

precere-monial; state of cus-tomary awareness

Up-gaze* (Item A)

2. Induction Ceremony for enter-ing formal trance with eye closure

Eye-roll sign (Items B, C, and D) Instructions for

post-ceremonial respon-sivity; exit the formal trance with eye

3. Postinduction Postceremonial trance with open eyes;

After trance; state of customary aware-ness; retrospective aspects of the trance experience

Amnesia* (Item K)

Float (Item L)

*Recording a score for this item is optional.

General Considerations

The HIP is best described as an objectively scored, interpersonal hyp-notic interaction that also serves as an induction technique. To obtain results comparable to the standardization data, momentum or rhythm must be established and maintained during the interaction:

There should be no long silences or pauses during test administration or conversation that diverts from the protocol of each item, and the pace should not be so rapid that the subject does not have a chance to attend to the experience. If administered correctly, the test requires 5–10 minutes.

The HIP requires that the operator have a degree of expertise and familiarity with the test, which is not required when using other tests of hypnotizability. The examiner is the instrument, and if he or she is not finely tuned, the HIP is not valid. Administering the HIP requires a stance of neutrality. Persons new to the HIP should not expect to be able to master the technique immediately. They should be aware that several—perhaps many—practice administrations are a requisite to TABLE 3–2

Items of the Hypnotic Induction Profile Scale

Dissociation “Spontaneous,” uninstructed. Score positive (1 or 2) if subject reports that the arm used in the preparatory levitation task feels “less a part” of the body than the other arm, or if that hand feels “less connected to the wrist” than the other hand.

Signaled arm levitation (Lev)

Score positive if on the instructed signal, the arm rises to upright position. Positive scores vary from 1 to 4, depending on the number of verbal reinforcements necessary.

Control differential

“Spontaneous,” uninstructed. Score positive (1 or 2) if subject feels less control over the arm used in the Lev item. The examiner’s questions do not indicate which arm is expected to be less controllable.

Cut-off Score positive (1 or 2) if, on instructed signal, subject reports normal sensation and control returning to arm used in Lev item.

Float Score positive (1 or 2) if subject reports having felt the instructed floating sensation during the administra-tion of the Lev item.

valid clinical or experimental application. At the same time, because the induction is standardized and is intended to instruct rather than convince the subject to respond, it can be effectively administered by clinicians with comparatively little experience with inducing hypno-sis. The object is to discover the subject’s biological capacity and psy-chological responsivity. The protocol may be read initially rather than recited from memory. Those more experienced in the use of hypnosis may find the HIP a rather different form of hypnotic induc-tion that is highly structured but less demanding of infinite variainduc-tion to formulate appropriate treatment strategies.

These qualities of the HIP have been preserved because the test is primarily a clinical instrument that was developed in the course of clinical practice. In the clinical setting, especially during the initial encounter in which the HIP is usually used, rapport is encouraged and nurtured by the attentive momentum of the examiner. Although the HIP items and even the wording of the test (insofar as this is pos-sible) should be the same in each case, the particular responses of the subject are acknowledged and woven into the fabric of the inter-change by the various items.

In Chapter 4, the administration and scoring of the HIP are pre-sented. Read the instructions given by the examiner for a single HIP item and the accompanying directions on scoring. When the connec-tions are clear between the administration of the test and the behav-iors and experiences to be observed, read the italicized administration instructions only without interruption. With the concurrent scoring by the examiner in mind, this uninterrupted reading should begin to communicate a sense of the rhythm of administration.

The physical setting can enhance the psychological one. Shifting into a state of peak responsiveness is in a sense “shifting gears,” and the physical arrangement may reflect this. For example, during an initial clinical interview, the clinician may be seated in his or her cus-tomary place across the desk from the patient (or subject) or in an armchair across the room. However, at the time of induction, the cli-nician shifts position, moving to another seat slightly forward and to the left of the patient. During the induction procedure, the clinician should be close enough to the patient to establish comfortable physi-cal contact, as shown in Figure 3–2. After completing the procedure, the examiner may return to his or her customary seat.

Throughout these instructions, it is presumed that the examiner will sit to the left of the subject, causing the subject’s left hand to lev-itate. If the examiner sits to the right of the subject, right should be

substituted for left in the examiner’s instructions. In general, the sub-ject should be seated comfortably with a place to rest his or her arms and legs. Some testers find that the use of a footstool enhances the initial floating sensation that many subjects experience during hyp-nosis. If an armchair is not available, have the subject sit next to a table with his or her arms placed on the table, legs relaxed, and feet flat on the floor. Another alternative would be to ask the subject to imagine that his or her elbow is resting on an imaginary air cushion.

Until the examiner is comfortable with the procedure, he or she may find it helpful to keep the book open to Chapter 4, Adminis-tration and Scoring. Because this is an interpersonal interaction, eye-to-eye contact helps sustain the subject’s attention even though the examiner may be referring to the instruction manual.

FIGURE 3–2

Subject’s

chair Operator’s

chair

Footstool

51

Administration