Rich Faces

All communications between clinicians and patients involve embedded sugges-tions, whether direct or indirect. Even simple questions in the first evaluation session that are focused on the past may communicate the idea that the past holds the clues to the present and the future. This is a potentially hazardous message.

As Michael’s case (above) illustrates, an excessive focus on the past, especially in patients with a history of an unhappy childhood, can reignite and bring back images and experiences of sadness, hopelessness, and despair.

One of the pioneers of strategic therapy, Paul Watzlawick (1993), elaborated on the idea of how self-fulfilling prophecies may be a powerful force influencing

peoples’ choices and behaviors. He said, “It is the future, not the past, that determines the present; the prophecy of the event leads to the event of the prophecy” (p. 13). This philosophical stand is crucial in the practice of psycho-therapy because it puts a great responsibility on the behavior, speech, and com-munication of therapists toward their patients to orient people as much as possible to the best the future can hold. Blaming patients for their own misery under the guise of forcing them to accept responsibility for their feelings and actions is not necessarily a solution-oriented strategy. A focus on the future and its possibilities has the power of transforming the present with the force of second-order change (Watzlawick et al., 1974).

A special consideration and warning to therapists using future-focused hypnotically enhanced imagery is to be fully aware and knowledgeable of the patient’s abilities and limitations. Constructing future-focused imagery must take into account the present reality of the patient and the plausibility for change considering the patient’s intelligence, age, education, and economic reality. For example, a patient may have the fantasy of becoming the head of the neurosurgery department in a large general hospital; however, the reality is that this may be a person over the age of 50 who has never gone to college and is still working on getting a GED. It would be highly irresponsible for a clinician to engage the patient in a future-focused imagery involving the attainment of such unrealistic goals. No one wants to understate a patient’s potentials, but neither do we want to overstate them.

There are patients who refuse to participate in any therapy that involves formal hypnosis. Is it still possible to help these patients with a future-focused strategy?

My answer to this question is yes, it is possible to help them by using language that is focused on the future. Therapists can employ a solution-focused strategy by engaging the patient in future-focused language and imagery, thereby helping him or her to internalize a new future that involves a solution to his or her current depression.

For example, I had a patient who suffered from feelings of hopelessness and despair who felt disgusted, angry, and disappointed with himself for not being able to stop smoking. All his attempts in the past had failed even though he was successful in many other endeavors in his professional and personal life. He refused to participate in any therapy using formal hypnosis. We engaged in a dialogue whereby I asked him to assume that our work together produces a desirable result of his overcoming the habit of smoking. I further asked him to imagine himself a year from now having conquered his nicotine dependence.

I enhanced this image with ego-strengthening suggestions and asked him to carry on an imaginary dialogue with this person of the future who had already con-quered the habit of smoking. In this dialogue, he was instructed to ask his future self how he had conquered the habit of smoking, and then write an essay about what he learned and bring it in the following session for further discussion. The patient came in the following week and announced that he had stopped smoking

on his own and had no desire for any more cigarettes. This approach is not new and was described previously by Watzlawick (1985) and Yapko (1992, 2003).

The future holds all kinds of possibilities. This simple truth holds hope for the hopeless as an invaluable, even life-saving path out of depression.

EDITOR’S SUMMARY

• Hope for the future is a vital and motivating life force, one that is too often missing in depression sufferers.

• Hopelessness is an orientation to the future, albeit a negative one, that indicates a need for a positively future-oriented intervention.

• Hypnosis as a multidimensional approach catalyzes a more experiential shift in the direction of hopefulness than more single-dimensional interventions.

• The author presents a technique he calls “Back from the Future,” a hypnotic intervention for building realistic optimism and hopefulness.

Its rationale, structure, and method are detailed, and four case examples of its effective application are provided.

• A key distinction between realistic and unrealistic hope is made, empha-sizing the importance of any hopefulness generated through the use of the “Back from the Future” technique being identified as realistic.

• Suicidal or psychotic patients, and patients with dementia, are identi-fied as poor candidates for the “Back from the Future” intervention.

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Utilizing Hypnosis in