D4 Clinical Hypnosis is Changing Our Minds

(Laurence Sugarman, MD, ABMH; David Alter, PhD, ABPH;

David Reid, PsyD)

Clinical Hypnosis is Changing Our Minds ASCH Annual Meeting and Workshops • 18 March 2018 • Orlando, FL

David S. Alter, Ph.D. Partners in Healing

10505 Wayzata Blvd #200 Minnetonka, MN 55305 drdavidalter@gmail.com

pih-mpls.com

David B. Reid, Psy.D. Augusta Psychological Associates

71 Wilson Boulevard Fishersville, Virginia 22939

dreid@drdavidreid.com drdavidreid.com

Laurence I. Sugarman, M.D. College of Health Science and Technology

Rochester Institute of Technology 180 Lomb Memorial Drive

Rochester, NY 14623 Laurence.Sugarman@RIT.edu

rit.edu/healthsciences/psychophysiology Teaching Objectives We will do our best to help participants learn:

1. What we mean by conversational hypnosis and hypnosis as a skill set. 2. What it means to be person- not problem/diagnosis-centered. 3. How to become comfortable with uncertainty, change, and being non-directive. 4. Use something from this workshop with your clients.

Table 1. Basic Skills for Conversational Hypnosis from Sugarman, Schafer, Alter & Reid, 2018.

Alter, Reid & Sugarman Changing Our Minds 2

Exercises to play with:

1. Practice mentioning embodied change (gestures, breaths, facial expression, posture) in your verbal responses to clients from the beginning of the encounter.

2. When the client describes a symptom or resolution in the course of a clinical encounter, (e.g., Then my stomach started hurting; Then it went away.”) be very curious and wonder out loud “How did you do that?” Be prepared for, “I don’t know.”

3. When the client is focused in the past or anticipating an imagined future, practice orienting them into the present the moment.

4. When the client is focused on a present worry or concern, use pro/regressive skills to source future or past abilities.

5. During your next clinical encounter, imagine all of the brain-body pathways that are “lighting up” with activation in both you and your client as you express your wonder and curiosity about their abilities to change.

References Alter, D. S., & Sugarman, L. I. (2017). Reorienting hypnosis education. American Journal of

Clinical Hypnosis, 59(3), 253-259. Csikszentmihalyi, M. (1997). Finding Flow: The Psychology of Engagement with Everyday Life.

New York, NY: Basic Books. Elkins, G. R. & Hammond, D. C. (1998). Standards of training in clinical hypnosis: Preparing

professionals for the 21st century. American Journal of Clinical Hypnosis. 41:1. 55-64 Erickson, M. (1958). Naturalistic techniques of hypnosis. American Journal of Clinical

Hypnosis, 1(1), 3-8. Erickson, M. H. (1986). Symptom based approaches in mind-body problems. In E. L. Rossi &

M. O. Ryan (Eds.), Mind-body communication in hypnosis: The seminars, workshops, and lecture of Milton H. Erickson (pp. 67-202). New York, NY: Irvington Publishers, Inc.

Erickson, M. H., & Rossi, E. L. (1979). Hypnotherapy: An exploratory casebook. New York, NY: Irvington Publishers, Inc.

Erickson, M. (2010). Experimental Demonstrations of the Psychopathology of Everyday Life. In E. Rossi, R. Erickson-Klein, & K. Rossi (Eds.), The collected works of Milton H. Erickson: Volume 5: Clinical hypnotic phenomena part 1 (pp. 177-190). Phoenix, AZ: The Milton H. Erickson Foundation Press

Hammond, D. C., & Elkins, G. (1994). Standards of training in clinical hypnosis. Chicago, IL: ASCH Press.

Hope, A. E., & Sugarman, L. I. (2015). Orienting hypnosis. American Journal of Clinical Hypnosis, 57(3), 212–229. doi:10.1080/00029157.2014.976787

Lindheim, M. Ø., & Helgeland, H. (2017). Hypnosis training and education: Experiences with a Norwegian one-year education course in clinical hypnosis for children and adolescents. American Journal of Clinical Hypnosis, 59(3), 282–291.

Mehrabian, A. (1971). Silent messages. Belmont, CA: Wadsworth Publishing. Pert, C. B. (1997). Molecules of emotion. New York, NY: Scribner. Reid, D. B. (2016). Hypnotic induction: Enhancing trance or mostly myth? American Journal of

Clinical Hypnosis, 59(2), 128-137. Rossi, E. L. (2002). The psychobiology of gene expression: Neuroscience and neurogenesis in

hypnosis in the healing arts. New York, NY: W.W. Norton & Company.

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Rossi, E. L., & Hill, R. (2018). The practitioner's guide to mirroring hands: A client-responsive therapy that facilitates natural problem solving and mind-body healing. Carmarthen, UK: Crown House.

Sugarman, L. I., Alter, D. S., & Reid, D. B. (2017, March). Reorienting hypnosis education: Relearning what you always knew that you didn’t know that you always knew. American Society of Clinical Hypnosis Annual Meeting and Workshops, Phoenix, AZ.

Sugarman, L. I., Schafer, P. M., Alter, D. S. & Reid, D. B. (2018). Learning hypnosis wide awake. American Journal of Clinical Hypnosis, (61), in press.

Teleska, J., & Roffman, A. (2004). A continuum of hypnotherapeutic interactions: From formal hypnosis to hypnotic conversation. American Journal of Clinical Hypnosis, 47(2), 103–115. doi:10.1080/00029157.2004.10403629

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press

Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit formation. Journal of Comparative Neurology and Psychology, 18(5), 459-482.

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RBUPChild&AdolescentHypnosisWorkshop2017ExperientialExercise2:BasicSkillsKEY:O=Operator.Thepersonidentifiedintheroleoftheclinician,directoroftheexperience.S=Subject.Thepersonidentifiedintheroleoftheclient/patient,receiveroftheexperience.V=Viewer.Thepersonwhoobservesbothoftheothers,keepingnotesandtime.Inallexperientialexercises,beyourselves.Donotrole-play.Donotwastetimepretendingtointroduceeachotherasifyouareinaclinicalsetting.Justassignstartingrolesanddotheexercises.Youneednotbeself-conscious,justconscious.Havefun!Forthisexercise,thetriadswitchesrolesaftereachepisodeaslongastimeallows.Thegoalistohavethelargestvarietyofindividualexperiences.1. Sstatesaproblemin1-2sentences,e.g.,“OnonehandIneedto_____andontheotherIwishI

could___.”2. EachOusesonebasicskillperepisodetorespond,startingwithkneading,thenwondering,

wandering,andfinallypro-orregression.Inotherwords,thefirstOuseskneading,thenthesecondO,thenthethird.Nextallusewondering,etc.Openinglanguageforthisexamplemayinclude:

a. Kneading“Thosehandscertainlyhaveasomethingtodo…”b. Wondering“Iwonderhowthey’regoingtohandle…”c. Wandering“…Sonowthatyouhavethissituationinhand,what’snext?”d. Progression“…Thosearebighands,Ibetyoucouldreallydoalotwiththem…”e. Regression“…Doyourememberwhenyoufirstlearnedwhichhandwaswhich?…”

3. WheneitherSindicatesresolutionorVindicatestimeisup,Oasksacontinuingquestion:e.g.,“Willyouletthis[learning/changing/discovery]continueafterthisexerciseinasatisfyingway?”

4. Vnotesverbalandnonverbalskillsforfeedback.5. Limiteachinteractionto3-4mins,thendiscussitfor5minutesbeforechangingroles.

Beforetimeforthissessionisover,summarizewhatlessonsyouhavelearnedtogether,whatyouwouldliketoimproveinthisexercise,andpreparetosharethiswiththeentiregroup.

Examplesofopeningphrasesfor:Kneading“Thatwasadeep/long/slowbreath…”“Whathappenswhenyoushiftpositionlikethat?”“Thatwasaslowblink…”“That[hand]gesturesaidsomething.”“That’sright…”“Yes…”

Wondering“Iwonder…”“…howyoudothat?”“…wonderful!”“imagine…”Wandering“What’sgoingtohappen…?”“…andthenwhat?”“What’syournextmove…?

Pro/regressionPrimarilynonverbal—prosody,tempo,facialexpression,gestures,posture—orientedtowardsanolderoryoungerpersonthanthesubject.Practicewithbothprogression(olderorientation)andregression(youngerorientation).

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RBUPChild&AdolescentHypnosisWorkshop2017ExperientialExercise7:FindtheTranceintheEncounter

Thisisalargegroup“live”interactioninwhichthepresenterrole-playsthepatientandtheentireparticipantgroupcollaboratesasclinicians,astheyareinspired.Theclinician-group’sroleistonotice,respondto,andencouragemanifestationsoftrance(psychobiologicalplasticity)inthepatient.Itisbesttoindicatereadinesstocontributebystandingup,ratherthanraisinghands,tomakefulluseofnon-verbalcommunication.

Forthisexercise,theclinician-groupneednotattempttodevelopacomprehensivehistory,diagnose,orcreateatreatmentplan.Youronlyresponsibilitytoaskquestions,buildrapportandtakeadvantageofbehavioralmanifestationsoftrancetolearnwhatwillhappennext.Thegoalistogetpastpatient’sdefensesand“stuck”behaviorbyutilizingtheirmomentsofplasticitytohelpthemchange.1. Presenterbrieflyprovidesacontextforthisencounter,thenassumetheroleofthepatient.2. Participantsthenaddressthepresenterintheroleofapatientbyaskingquestionsaboutthe

problem,usingbasicskills,orotherwiseexploringthecontextoftheencounter.3. When,inresponsetoaquestion,thepatientmanifestsbehaviorthatmightindicatetrance,the

clinician-groupneedstosayordosomethingthatcultivatesitorthepatientwillclosethatopportunity.

4. Thepatientwillonlyrespondtoquestionsandcommentsdirectedtohimincharacter.Hewillnotreacttothird-partyreferences(e.g.,“Iwouldaskhim…”“Heseemstobe…”).

5. Amaximumofthree“time-outs”canbecalledbytheparticipantsiftheyneedtodiscussandcollaborate.Thepresentercancallan“officialtime-out”ifhefeelsheneedstogivedirection,outofcharacter.

6. Thesessionendswhenthepatienthassuccessfullybeenhelpedtochangeor20minuteshaselapsed,whichevercomesfirst.

7. Iftimeallows,clinician-groupcancompose“continuingquestions,”“souvenirs,”or“anchors”forthepatient.

8. Afterthesession,thegroupreviewsthe“play”for10minutes.ExamplesofpotentialClinicalScenarios:

Evanisan18-year-oldfirstyearcollegestudentwhosemothermadeanappointmenttoseehisdoctoronthethirdFridayofOctober.Sheisconcernedabouthisreportsofrecurrentabdominalpain,decreasedappetiteandweightlosssincestartingcollege.Hehasmadethethree-hourdrivehome,hisfirsttripbacksincestartedcollegetwomonthsago,forthisappointment.Youarecoveringforhisregularphysician.

Thirteen-year-oldWendy“can’tfallasleepatall”becauseher“brainisreallybusy”andthenshebeginstoworrythatshewillnotgetenoughsleepandfailallofherclasses.Whenshedoessleepsheisawarethatsheisnotsleepingwell.Sometimesshehasveryscarydreamsthatawakenher.Herdoctorhastoldherparentstogiveherdiphenhydramineandmelatoninbutsherefusesbecause“theyaren’tnatural”andshe“doesn’twanttobecomeaddicted.”Shefeelstiredallthetimeandhassomemildstomachaches.Shehasrecentlydecidedtobecomeavegan.

Timothyissixandhasbeendiagnosedwithacutelymphoblasticleukemia.Hehas“always”beenafraidofneedlesandprocedures.Hismothersaysthatimmunizationsatthegeneralpractitioner’sofficeanddentalvisitshavebeen“nightmares.”Heoncekickedanurseandbrokehernose.Hisoncologyteam’suseofsedationforprocedureshasresultedinanticipatorypanic.Theywouldlikeyoutohelphim.