Hypnotherapy Explained

Assen Alladin, Glenn Robert

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357386
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Hypnotherapy provides a powerful tool for utilizing the power of the mind to reduce distress and suffering. This concise guide provides readers with a rich source of ideas on starting hypnotherapy practice, and thinking seriously about hypnosis as a powerful adjunct to psychotherapy and medical interventions. With a clear definition of what hypnosis really is, readers can develop an understanding of the rationale for utilising hypnotherapy with particular disorders.As the medical community is progressively adopting a biopsychosocial model of healing, there is a serious move toward validating the scientific credibility of hypnosis, and hypnotherapy has become a well-established treatment. Unlike any other introductory text, "Hypnotherapy Explained" adopts a uniquely scientific approach among introductory texts; reviewing theories and offering practical ways to integrate hypnotherapy in medical, psychiatric and psychotherapeutic practice. It is enlightening reading for general practitioners, psychiatrists, psychologists and other healthcare professionals.

CHAPTER 1

Current Theories of Hypnosis

SUMMARY

This chapter reviews the neodissociation theory of hypnosis because it is the most widely accepted theory of hypnosis in the clinical domain. However, this focus on the neodissociation theory does not undermine the role of psychosocial factors emphasized by the sociocognitive theorists. Psychosocial factors can be judiciously utilized in the clinical setting to enhance compliance, positive expectancy and therapeutic alliance.

From the review of the brain-mapping studies of hypnosis and consciousness, it is apparent that it is unrealistic to expect a single physiological signature of hypnosis. The brain correlates of the hypnotic phenomena are determined by the quality (associated with imagery, relaxation or alertness) of the hypnotic induction, the trance level (hypnotic ability, degree of absorption and dissociation), and the nature (specificity and intensity of suggestions) of the hypnotic suggestions.

Just as we do not have a complete theory of hypnosis, we do not have a perfect definition of hypnosis. Several definitions are discussed, and finally a working definition of clinical hypnosis is presented. The chapter also highlights the strengths and limitations of hypnotherapy to provide the reader with a realistic view of the clinical potential of hypnotherapy.

INTRODUCTION

The aim of this chapter is to describe the neodissociation theory of hypnosis, which is one of the most dominant contemporary theories of hypnosis. Apart from having inspired – and still inspiring – extensive research, the theory provides a rationale for clinical work. Rather than reviewing the literature on the applications of hypnosis, the strengths and limitations of clinical hypnosis are reviewed to provide the reader with a critical perspective on the clinical applications of hypnosis to medicine and psychiatry. Finally, a contemporary working definition of hypnosis is provided.

Although hypnosis has existed as a treatment for medical and psychological disorders since time immemorial, as yet we do not have a clear definition or theory of hypnosis. Most of the theories advanced to explain hypnosis can be loosely classified under state and non-state, intrapersonal and interpersonal, or single and multifactor theories (Yapko, 2003).

State, intrapersonal and single theorists conceptualize hypnosis as a trance state or an altered state of consciousness (Barber 1969). The non-state, interpersonal and multifactor theorists, also known as sociocognitive theorists, suggest a social–psychological explanation of hypnosis. These theorists maintain that there is nothing unique about hypnosis and argue that most of the hypnotic phenomena can occur without a hypnotic induction or trance (Barber, 1979). The intrapersonal theories of hypnosis emphasize the subjective and inner states of the hypnotized person, whereas the interpersonal models attach more importance to the social context or relational aspects of the hypnotic interaction (Yapko, 2003). The single model of hypnosis stresses the importance of a single variable such as relaxation or dissociation that influences the hypnotic experience. The multifactorial approaches attach importance to the role of a variety of interactional forces, such as patient expectation and clinician demands, which combine to produce the hypnotic phenomena (Kirsch, 2000).

Although none of these theories have satisfactorily explained all the phenomena associated with hypnosis, the different formulations have certainly broadened our understanding of the subject. It is beyond the scope of this book to discuss the merits and controversies surrounding each theory (see Kallio and Revonsuo, 2003, for a review, and rejoinders in the whole issue of Contemporary Hypnosis, 2005; 22(1): 1–55). For the present purpose it is sufficient to restate the conclusions drawn by Rowley (1986, p. 23) from his review of the well-known theories of hypnosis 20 years ago:

None of them seem to be able to deal adequately with all the phenomena which come under the general heading of hypnosis. This is perhaps not surprising given the tremendous variety of phenomena. Accordingly the theories have different ways of dealing with this variety. Some redefine hypnosis, e.g. Edmonston (1981). Others reinterpret subjective experience, e.g. Spanos (1982) … Despite these inadequacies, each of the theories has something to offer, a new conceptualization of the issues, a methodological approach, a new synthesis of the evidence. Of course, in one sense it is impossible to produce a theory which is satisfactory to all researchers, for they are likely to have different criteria for evaluating theories.

A decade later, Yapko (2003, p. 61), from his review of the contemporary theories of hypnosis, came up with similar conclusions, especially when addressing the complexity and multidimensional nature of hypnosis:

With a subject as complex as hypnosis, the inadequacy of a single theory’s ability to explain the broad range of responses on so many different dimensions of experience becomes glaringly apparent. The complexities of the subject of hypnosis, and even greater complexities of the human being capable of hypnosis, are so great that it seems highly improbable that a single theory can evolve to explain its origin and character.

Academics and experimentalists have generally tended to adopt non-state, interpersonal and multifactorial views of hypnosis, whereas clinicians have taken the state, intrapersonal and single views of hypnosis, particularly the neodissociation theory of hypnosis, which is described below. However, proponents of both camps agree that hypnotic suggestions can produce altered states and that some subject variables such as co-operation (Spanos and Barber, 1974), expectations (Barber 1984, 1999), motivation (Araoz, 1981, 1985) and level of involvement in suggestion-related thoughts and images (Erickson and Rossi, 1979; Spanos and Barber, 1974) can influence the hypnotic performance.

For example, Kirsch (2005), a well-known sociocognitive theorist, points out that both state and non-state theorists agree that hypnotic suggestions can produce altered states such as amnesia, analgesia and involuntariness, although there is disagreement about whether these altered experiences depend on the prior induction of a trance state. Similarly, Spiegel (2005, p. 32), a well-known state theorist, underlines that:

Multilevel explanations are an absolute necessity in understanding human mind/brain/body phenomena because we are both neurally-based and social creatures who experience the world in mental phenomenal terms. To choose one of these domains as the complete explanatory context is to be by definition wrong.

Clinicians, who are mainly concerned with reducing patients’ distress, are not overly concerned whether hypnotic trance exists or does not exist, or whether trance induction is necessary or not necessary. To the clinicians, the clinical context and the skilful negotiation of subjects and other variables to maximize therapeutic gains are of paramount importance. Heap (1988, p. 3) regards this bidirectional relationship between the patient and the hypnotist in the clinical context as:

An interaction between two people characterized by a number of inter- and intra-personal processes of which the ‘essence of hypnosis’ only forms a part, if indeed it is present at all. These processes, which are not independent of one another (and which may apply to the behaviour and experience of both the subject and the hypnotist) include the following: selective attention, imagination, expectancy, social conformity, compliancy, role-playing, attribution, usually though not necessarily, relaxation, rapport, suggestion, and hypnotic or trance experience.

Moreover, clinicians emphasize the subjectivity of hypnosis and recognize that hypnotic techniques must be individualized for the patient, which can involve drawing upon techniques from more than one theoretical model. The treatment approach described in this book utilizes different therapeutic techniques derived from diverse theoretical conceptualizations. Golden et al., (1987) describe this approach as technical eclecticism. In this approach the clinician, in order to maximize therapeutic effects, borrows techniques freely from diverse therapeutic approaches without necessarily accepting the theories from which the techniques were derived. In this context, the therapist is more concerned with reducing the patient’s level of distress rather than adhering blindly to a particular theoretical orientation.

NEODISSOCIATION THEORY OF HYPNOSIS

The neodissociation theory of hypnosis is described in detail here because it (a) has inspired extensive research, (b) provides a rationale for clinical work (Kihlstrom, 2003; Lynn and Kirsch, 2006) and (c) continues to be one of the most influential contemporary theories of hypnosis. The focus on the neodissociation theory is not meant to discredit the contributions made by other competing or complementing theories of hypnosis. The aim here is to describe a theory that has been traditionally embedded within the clinical context. Indeed, the hypnotherapeutic techniques described in this book freely draw on other theories to enhance positive expectancy and treatment gains. For example, the cognitive hypnotherapy for depression described in Chapter 5 actively utilizes the subject’s variables and placebo effects (emphasized in the sociocognitive theories of hypnosis) to maximize treatment gains.

Hilgard (1973, 1974, 1986) describes hypnosis in terms of dissociation or divided consciousness. Dissociation is a psychological process whereby information (incoming, stored or outgoing) is actively deflected from integration with its usual or expected associations, producing alteration in thoughts, feelings or actions, so that for a period certain information is not associated or integrated with other information in the usual manner or in a logical way (West 1967). Such an experience can be regarded to be either normal or pathological.

Ever since Janet (1907), the close relationship between hypnosis and dissociation has been established. Janet (1889) held the view that systems of ideas can become split off from the main personality and exist as an unconscious subordinated personality, but capable of becoming conscious through hypnosis. The theory was applied to hypnosis and various other normal and pathological states such as automatism, amnesia, fugues and multiple personality. Hilgard, by deriving ideas and concepts from information processing, selective attention, brain functioning and the cognitive model of consciousness, reformulated the theory in contemporary terms and called it neodissociation theory.

In Hilgard’s reformulation, dissociation is seen as an extension of normal cognitive functioning. He posited that during ordinary consciousness information is processed at a number of levels by a hierarchy of cognitive operations and controls. Ordinarily these operations are integrated, but during hypnosis or dissociation the integration decreases, and certain aspects of experiences may not be available to consciousness. Within this model, dissociation or hypnotic involvement is not seen as an either/or phenomenon, but a cognitive process ranging on a continuum from minor or limited to profound and widespread dissociation. Hilgard also considered the role of self and will when formulating his neodissociation theory of hypnosis. He maintained that hypnosis and other dissociative experiences all involve som...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Foreword
• Preface
• About the Author
• Acknowledgements
• 1 Current Theories of Hypnosis
• 2 Stages of Hypnotherapy
• 3 Hypnotherapy as an Intervention in Medicine and Psychiatry
• 4 Hypnotherapy with a Medical Condition: Migraine Headache
• 5 Hypnotherapy with a Psychiatric Disorder: Depression
• 6 Training in Hypnotherapy
• Index