Philip Clayton y sus reflexiones…
7. Del “ser como sujeto” al panenteísmo
The structure of the hypnotic session for this approach to hypnosis is essen-tially the same as in the first approach. Likewise, the preparation of the patient, with regard to introducing hypnosis, describing what it is, allaying misconceptions, and so on, will be more or less the same. From then on, however, the two approaches diverge, the emphasis in the first being on absorption, the emphasis in the second approach being on suggestion and suggestibility.
At the beginning of the last chapter, we emphasised the importance of instilling a positive attitude to hypnosis and this may require, in some patients, the dispelling of misgivings and misconceptions. The significance of this is that Spanos and his co-workers (Spanos 1991) have demonstrated that, within limits, the more positive the person's attitude to hypnosis, the more responsive that person will be to hypnotic suggestions.
Another variable that enhances response to suggestion is the person's expectation that he or she is indeed a responsive subject (Kirsch 1991, Spanos 1991). Consequently, it will be useful for patients to be confident that they are responsive, however slight this may be. We can capitalise on this in the following manner.
Prior to the induction it is useful, when adopting this approach, to intro-duce patients to some suggestions that, with the incorporation of certain ploys, most of them will respond to in some way. One guiding principle (which is actually employed in the construction of most susceptibility scales) is the 'foot-in-the-door' effect. That is, one starts off with the easiest suggestions and gradually introduces more demanding ones. A useful way of doing this would be to administer a susceptibility scale such as the Creative Imagination Scale. One problem, however, is that the therapist does not have the required degree of control over the proceedings should the patient prove unresponsive.
A useful starter is a simple ideomotor suggestion. Postural sway may be used but many therapists will have misgivings about the nature of the physical interaction that this entails between them and the patient. Hence we recommend the arm lowering suggestion as described in Chapter 2.
Before you begin this, instruct the patient along these lines:
You have probably noticed that when you imagine something, you have some of the experiences that you would have in the real situation. For example, if you imagine something that you are really looking f o r w a r d t o , you feel some of the excitement. Or you might imagine something that you find really amusing and you find yourself smiling or even laughing about it. You might bring to mind an occasion when you were o u t in bitterly cold weather and you may feel as though you want to shiver. A n d , like everyone else, you are probably quite good at
making yourself feel anxious by imagining something that really worries you. You can use your imagination so well to change the way you are thinking and feeling -sometimes for the g o o d , -sometimes for the bad. Right now I want you to imagine this ... .
Administer the arm-lowering suggestion described in Chapter 2. (You are free to choose what you consider an appropriate image for a heavy object.) Now, what happens if the chosen arm fails to move? There is an obvious risk that the patient's confidence and expectations about the effec-tiveness of hypnosis will be compromised by this lack of response. Here, a tactic stemming from the work of Spanos and his colleagues may be used to good effect. Recall from Chapter 4 that these researchers consider that peo-ple do not respond to suggestions when they adopt too passive an attitude.
Instead of 'waiting for the response to happen', they should be 'making the response happen'. It is therefore legitimate to instruct the patient to delib-erately move the arm, but to try to move it in such a way that it appears to be being pressed down by a heavy weight. We suggest the following instructions:
It's OK to start to move your arm d o w n , but see how much you can do this so that your arm seems to be moving all on its o w n , pressed d o w n by a heavy book.
You will have to concentrate quite hard to do this, but just slowly move your arm d o w n so that it feels like it is being pressed d o w n hard ... that's fine ... keep concentrating ... good.
At the end of this, tell the patient to 'let go of the image and allow your arm and hand to feel perfectly normal again'.
Most people show some response to this suggestion, and again it is important to emphasise to patients how an idea or image can affect the way they feel and behave. In the case of patients with whom you have used the Spanos technique, they will nearly always report at least some success in having the feeling that, at times, the arm seemed to move on its own.
A useful suggestion to follow this with is the 'fruit' imagery described in Chapter 2. Remember to cover all modalities. The patient is to open the eyes at the end and then you can ask about the experiences. It is very important to be positive about any response the patient reports (the visual image of the fruit, the feel of the texture of the fruit in the hand, the smell, the taste, and so on). It is very good if the patient reports salivation, as this exemplifies an autonomic response that is clearly triggered by suggestion. Draw the patient's attention to how the ideas and images can affect the way he or she is behaving, thinking and feeling. Most people will report some experience from this exercise. If this is not so in the case of your patient, then this need not be a serious problem. It is useful and true to say to your patient that most people do not respond to all suggestions.
You may now proceed to do the 'arms coming together' suggestion described in Chapter 2. Once again, if the patient shows no response, intro-duce the 'Spanos method', asking the patient to deliberately move the arms together, but create the feeling that they are being drawn together automat-ically. (It is always a good idea, when giving such an instruction, to say something like, 'You will need to concentrate very carefully for this'.
Otherwise the risk is that patients may have the impression that the 'test has failed' and that you are now asking them to do something akin to pretending or cheating.)
If you sense that you have a very suggestible subject, you could do more suggestions, although you do not want to make the process too drawn out.
You may administer, for example, a suggestion for hand cooling or glove anaesthesia. You are at liberty to choose imagery that you feel suits the par-ticular patient. One ploy is to ask the subject to raise the hand by flexing the elbow. This may promote a slight cooling effect owing to a change in circu-lation, which may be amplified by your suggestions. You may test the per-son's response by gently pinching the backs of both hands for comparison.
(We suggest you seek the patient's permission for this.) This may not be necessary, as subjects often report some degree of cooling or numbness without the test. In Chapter 26, we shall discuss ways of potentiating this suggestion in patients who are not responsive to standard imagery.
Another suggestion one may use (in patients who have up to this point been very responsive) is the finger lock challenge. This can be a very con-vincing demonstration of the effectiveness of suggestion and hence a useful way of building on the patient's expectations for a good response to the treatment to follow. It comes with the risk of a very obvious demonstration of failure should the patient separate the hands with ease. This risk can be mitigated in the following way.
After asking the patient to squeeze the interlocking fingers together as tightly as possible, suggest an appropriate image. The one we recommend is that of the roots of a tree that have become so entangled that they are absolutely impossible to separate. You may now say, 'Now, holding that image and that idea firmly in mind, try to separate the hands'. There is one more trick to incorporate into this technique, but first note this. You have asked your patient to do something which the patient would normally have no difficulty whatsoever in doing, namely separating the two hands.
However, the patient has to do this while holding onto an image that would make separation impossible. If the patient is fully committed to doing this, then separating the hands would be inconsistent.
Some subjects will still separate the hands (although this is less likely to happen if your patient has thus far responded well to these suggestions).
We therefore advocate (as we do for challenge suggestions in general) that you use an indirect suggestion for the attempted hand separation.
(Indirect suggestions are discussed in Ch. 10.) In this case, a suitable
indirect suggestion may be as follows:
N o w , holding that idea and image firmly in mind, you may not be t o o surprised to find ... how difficult it can be ... when you t r y to pull your hands apart.
The purpose of the pauses here is to create a little suspense on the patient's part and this may enhance the impact of the communication. So, we allow for the possibility that the patient may indeed separate the hands, but, nevertheless (as is very likely under the circumstances), it requires more than the expected effort.
As with the previous suggestions, reinforce any aspect of the patient's response by indicating how an idea or image can automatically affect expe-rience and behaviour.
There are other suggestions you may use in the preparation phase.
Chevreul's pendulum is fairly failsafe and many patients are intrigued by it. Some practitioners also show a keenness for arm rigidity; our earlier comments on postural sway apply here. The ones we have mentioned are usually sufficient.
We have spent considerable time discussing this phase of hypnosis in treatment, but, in reality, once you have become practised, it only takes a few minutes and is only usually part of a first session of hypnosis. Always keep in mind the purpose, namely to build up the confidence and expecta-tion of patients in their responsiveness to the hypnotherapeutic procedures to come. You are also gaining a measure of the patient's inherent level of hypnotic susceptibility. Should you discern at this stage that the patient is not very responsive, press on. There is still much to be done and the rela-tionship between susceptibility and outcome is normally not sufficiently robust as to allow you to determine with due confidence whether or not treatment will succeed on the basis of these suggestibility tests alone.
Very occasionally, you will have a patient who gives you the strong impression of overplaying the lack of responsiveness to your suggestions by repeatedly emphasising an inability to respond. This should alert you to the possibility that there are some major problems that perhaps even your patient is not able to acknowledge fully and that make it difficult for this patient to accept treatment. Therapy can tolerate some disparity in the degree of optimism of patient and therapist, but too great a difference does not bode well.
Having thus prepared the patient, you are ready to move on to what may be more formally identified as the hypnotic induction. Say something like:
N o w , you've been doing very well and you are ready to experience a hypnotic induction. This is really m o r e suggestions that help you use your imagination so you can feel really relaxed. Remember you are always in c o n t r o l and you stay in touch w i t h my voice. Just allow your eyes to close now.
It is a good idea to spend a minute or so allowing the patient to become used to sitting in the chair listening to you with the eyes closed, so you may use the 'sensory-focusing' procedure described in the last chapter for the first approach to induction. There are several induction methods to choose from;
although they still encourage the experience of absorption, they place a much greater emphasis on suggestion and suggestibility than the first approach.