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In medical and scientific literature one often encounters the phrase: “Hypnosis was used…” This raises a whole host of questions. What sort of “hypnosis” was employed? How was it used? Who was using it? Such questions are often deemed irrelevant. Hypnosis is seen as a means to an end. Hypnotherapy is the use of hypnosis to administer therapy. Therefore the type of hypnosis – the hypnotic induction – is often taken for granted.

This is unsatisfactory. I have been a practicing hypnotherapist for some 15 years. I used to accept the statement that hypnosis is not a therapy, just a means by which therapy may be administered. The more experience I accrue, the more doubtful I become about a distinction which seem increasingly arbitrary. I think that the induction process has to be therapeutic if only because it induces a state of calmness, relaxation and openness of mind. As a therapist I find myself increasingly combining inductive and therapeutic suggestions. The distinction is becoming meaningless.

Having said that, it cannot be denied that the ways in which hypnosis can be induced are virtually countless. Each type of induction has its own properties, its own strengths and weaknesses. In a short series of articles I wish to examine some of the better-known types of hypnotic induction and discuss some of the strengths and weaknesses of each induction model.

It is absolutely not my intention to provide a do-it-yourself guide to hypnotic induction. I intend to describe and discuss methods, not provide scripts or methods a non-trained person can use to induce hypnosis for him or her self. People who have seen one or more hypnotherapists for treatment are often quite baffled not only by the difference of experience offered by different practitioners but also by the fact that the methods employed by various practitioners vary so greatly.

I hope to shed some light on the subject.

THE SIX STAGE METHOD

Before attempting any hypnotic induction the therapist will check for contra-indicators. As what follows is not a set of instructions for the induction of hypnosis I need not go into the matter of contra-indicators.

This was the method I learned at college. I imagine that most training establishments teach something similar. The six stages are:

i. Induction
ii. Trigger
iii. Deepener(s)
iv. IMR
v. Therapy
vi. Termination

INDUCTION

This will typically begin with a fixed-gaze technique. The subject can be seated or lying down but will be able to gaze straight ahead. The therapist will then ask the subject to look slightly upwards and to gaze steadily at a fixed point. While the subject is doing this, the therapist will offer eye-closure suggestions, suggesting that the subject’s eyes are growing tired etc. When eye-closure has been achieved, the therapist will offer a series of suggestions to relax the muscles of the body. The subject should now feel comfortable and calm.

TRIGGER

The therapist will choose a word – it can be any word – which will “trigger” the trance state. Suggestions to this effect are offered. The trigger word is repeated a few times. (The trigger need not be a word. It can be any sound, or a sensation).

DEEPENER

The therapist will now proceed with one or more state deepeners. These are quite simply direct or indirect suggestions intended to deepen the state of trance. The length of this stage of the session will depend upon how many deepeners the subject requires.

I M R (IDEO-MOTOR RESPONSE)

When a satisfactory trance depth has been achieved the therapist will direct the subject’s attention to his or her hand and suggest to the subject that the unconscious mind will take control of one of the subject’s fingers and show that it has done so by allowing the finger to become very light and to rise up from where it is resting. The I M R can then be used for purposes of communication or analysis.

THERAPY

These are the therapeutic suggestions which are suitable for the subject’s presenting issue. “You will stop smoking” or “you will not eat between meals” etc.

TERMINATION

The session is then formally “terminated”. The therapist says that (s)he will count from, say, 1 to 6 and then say “open your eyes”, returning the subject to full waking consciousness.

Strengths of the 6-stage method.

It is worth stressing that the effectiveness of any method will depend upon the level of knowledge and experience the person performing the induction is bringing to the session. Even the most sure-fire methods can be ineffective in the hands of someone inexperience or uncommitted.

The obvious advantage if this method is that it is clear and concise in its structure. It is time-efficient and comparatively easy for learners to master. A learner will not get bogged down in it or forget where they are. For therapists renting room in a clinic or elsewhere, where time is an important consideration or where a “50 minute hour” is used, this method is flexible, efficient and effective.

Weaknesses of the 6-stage method.

Some subjects are more suggestible than others. This method is fine or those of high or medium suggestibility. For those whose level of suggestibility is slightly lower it can cause problems. Learners, or inexperienced practitioners, often proceed too fast. Sometimes the subject doesn’t have time to settle before something else is happening to them. The subject may feel that he or she is being expected to respond too quickly. They may feel tempted to close their eyes before they are ready to do so or deliberately to lift a finger so as to produce the “IMR” response the therapist is looking for. If the session is over too quickly the subject may well feel that “nothing happened” or that “it didn’t work”.

In the hands of an experienced practitioner this method can be as effective as any other because the practitioner will have enough experience to pace the induction in a way which suits the particular subject.

I have to say that this is a method I rarely use. My own tried and trusted methods are more effective for me. But where appropriate I am happy to use the method I was taught at college. If people prefer being seated in a chair to lying down, if they have a tendency to nod-off and start snoring, or if they are used to these methods and prefer them then I’m always happy to oblige!

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One often encounters the assertion that hypnotherapy is the most ancient of the complementary therapies and that hypnosis was practiced in the ancient world. Hartland’s Medical and Dental Hypnosis actually begins with the statement that hypnosis emerged from “early history” to the present day as a powerful healing tool.

Making such statements is one thing. Backing them up is another. In Hidden Depths, a study of the history and development of hypnosis, Robin Waterfield takes a closer look at some of the evidence – and finds it surprisingly obscure and difficult to interpret. This is largely because he has to rely upon scholarly commentaries rather than examining the primary source evidence for himself.

Waterfield’s section on Greece and Rome begins with a very obscure source. Clearchus of Soli, a pupil of Aristotle, produced a dialogue known as Peri Hypnon (“On Sleep”) which has only come down to us in fragments quoted by other, later writers.

Clearchus is a shadowy figure. He flourished in the late 4th century and, like his master, produced work on a very wide range of subjects, from education to marine biology. None of his work survived in tact. The titles of his works are preserved in the works of writers such as Athenaeus and Diogenes Laertius. But two fairly substantial extracts from the dialogue on sleep have been preserved. There is an extract from it to be found in Contra Apionem (Against Apion), a defence of Judaism penned by the Jewish historian Flavius Josephus in the 1st century AD. Then there is an extract preserved in Proclus’ Commentary on Plato’s Republic, which is mentioned by Waterfield and seems to describe an act of hypnotism.

Before we turn to Proclus, let us consider the Josephus fragment for a moment. In Contra Apionem 1 177 – 181, Josephus gives a direct quotation from Clearchus’ Peri Hypnon in which Clearchus describes a meeting between Aristotle and an unnamed Jewish sage. Josephus wishes to establish that Greeks, from as early as the 4th century BC, had some contact with educated Jews. He also wants to stress that the Jewish sage in this case had some rather special knowledge. In the Clearchus extract, Aristotle mentions that he was living at the time in Asia Minor. We know that Aristotle spent some time away from Greece and founded a school in Assos, in north west Asia Minor. This, then, gives some credence to Clearchus’ account of the meeting. According to Aristotle (reported by Clearchus and quoted by Josephus) the Jewish sage claimed to speak of “wonders which are only comparable to dreams” (Contra Apion 1 177). Unfortunately Josephus only quotes enough of Clearchus to tell us about the actual encounter. We never get to learn what these dream-like wonders are. Could this teller of wonders be the “hypnotist” we encounter in Proclus?

Proclus is a little-known, seldom read Neoplatonist of the 5th century AD. His Commentary on Plato’s Republic, which contains the Clearchus quotation, has not been translated into English – or if any English translation does exist it is earlier than 1899 and I haven’t been able to track it down. The extract is short. I can’t give it in Greek as this system doesn’t like Greek fonts, so here is  my translation:

“He hit the boy with the stick and drew out his soul and led it from the body. He showed that the body was motionless and unharmed and was as unable to feel the blows as if it were lifeless. After the soul had been led by the stick back into the body it told what it had experienced. This convinced the spectators and Aristotle that the soul could leave the body”.

What’s actually going on here? The touch (or blow) with the stick must have served as some kind of hypnotic trigger. If the boy were unconscious from the start, the blow would be meaningless. The boy is then unable to experience sensation but when restored to consciousness is able to relate his experiences. This certainly looks like a plausible ancient account of hypnosis. But there are problems.

Firstly, did Clearchus actually write this? Can we rely upon Proclus? These questions are unanswerable, but let’s assume we can. Can we then assume that this incident, or something very much like it, actually took place? Waterfield’s view is that this is a work of fiction. But it cannot be wholly fictional. We know that Aristotle existed. We know he went to Asia Minor. As far as fact vs. fiction is concerned, the situation is pretty much the same as it is with the dialogues of Plato. Most of Socrates’ interlocutors were real people. Moreover, the philosophical content of such dialogues tends to move the fact vs. fiction argument onto another plane altogether. A “fictional” dialogue may express philosophical truth.

It is entirely possible that the whole “hypnosis” episode was invented to Clearchus or Proclus to illustrate a point (a “truth”) about the independence of soul and body. I’m inclined to think that it was based upon reality. But, if so, there is a further problem. In an article entitled Aristotle and the Jewish Sage Hans Lewy argues that the Jewish sage in Josephus’ extract from Clearchus and Proclus wand waving hypnotist were one and the same individual. And if that is true then Clearchus might be evidence for the existence of some kind of hypnosis in the ancient world but in the Middle East rather than in Greece.

References:

Kroll, W., (1901) In Platonis Rem publicam commentarii, Teubner

Lewy, H., (1938) Aristotle and the Jewish Sage, The Harvard Theological Review vol 31 no 3,

Thackery, J., Josephus vol 1, Loeb Classical Library, New York 1926

Waterfield, R., (2002) Hidden Depths: the Story of Hypnosis, Macmillan

Waxman, D ed., (1989) Hartland’s Medical and Dental Hypnosis, Bailliere Tindall

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Hypnosis is a means by which a person may be led to accept suggestions which may lead to some desirable outcome, whether physical or psychological. We sometimes say that it is a method of offering suggestions to the unconscious mind of a person requiring treatment or assistance. Unfortunately, the term “unconscious mind” carries with it a whole baggage of philosophical and psychological assumptions most of which do not concern us outside of the sphere of theoretical speculation. Suffice to say that the general public has some notion as to what is meant by the term “unconscious mind” and are happy to interpret this on their own terms.

Suggestion is the essence of hypnosis. The most popular, and obstructive, misconception surrounding hypnosis is that the most important element is something called a “trance”, which is supposedly some magical, metaphysical state somewhat akin to general anaesthesia! There cannot be a hypnotherapist in the land who hasn’t been told at some time or another that he or she has failed to “put” the client “under”. “You didn’t put me under”; “I could hear everything you said”, “I can remember everything” – one hears this said time and time again, even when one has taken some pains to explain that the purpose of hypnotic induction is not to render the subject unconscious or to put them to sleep. By “trance” we simply mean a shift in the quality of consciousness, from fully alert, rational consciousness to a quiet, passive condition in which the rational / critical faculties are lulled into a quiescent state. The trance state is induced by suggestion and the purpose of it is to impart suggestion. As said, suggestion is the essence of hypnosis.

Suggestion and the Placebo Effect.

Suggestibility is a highly complex and elusive quality. It is so intimately bound up with our interpretation of the world in which we live that it tends to be overlooked or taken for granted. Moreover, it tends to operate at a level somewhat below our “normal” levels of critical and rational awareness. Consequently, we are often far more suggestible than we think we are and are usually quite unaware of the extent to which suggestions of one sort or another influence our everyday lives.

One way in which suggestibility may be measured is through the placebo effect. In a recent study from the University of Hull, Kirsch et al conducted a meta-analysis on data submitted to the United States FDA and arrived at the conclusion that there was virtually no statistically significant difference between the effectiveness of SSRI antidepressants and placebos except at the deepest and most severe level of depression. These findings were misinterpreted by sections of the mass media as evidence of the ineffectiveness of SSRI antidepressants. In my opinion, however, what these findings show is the effectiveness of suggestion, both direct and indirect, in the context of the administration of placebos. Suggestion clearly works.

However, one curious feature of much of the scientific literature on the placebo effect is a certain reluctance to attribute its effectiveness to the power of suggestion.

One problem with most definitions [of the placebo effect] is their implication that the placebo effect is non-specific. Kirsch, however, pointed out that , whereas the ingredients of a placebo preparation may be totally non-specific, the effects of placebos can be very specific. The specificity of the placebo effect depends on the information given to the patient (ie, the expectation). For example, placebos can have opposite effects on heart rate or on blood pressure depending on whether they are given as tranquillisers or as stimulants. Thus, precise definition of “placebo effect” is difficult. (Fuente-Fernandez, R; Schulzer, M; Stoessl, A J; The Placebo Effect in Neurological Disorders, The Lancet Neurology Vol 1, June 2002, p 85 – emphasis mine.)

Still to this day, extensive examination leaves scientists and philosophers to conclude that “ the placebo concept as presently used cannot be defined in a logically consistent way and leads to contradictions”.(Gotzsche, P C; Is There Logic in the Placebo? The Lancet 1994; 344; 925 – 6). Confliction explanations – expectation, faith, classic conditioning, anxiety relief, symbolic processes, patient-doctor relationship, self-perceptions – vie for acceptance. The placebo effect has attributes of a neo-mesmeric energy. (Kaptchuk, T J; Powerful Placebo: The Dark Side of the Randomised Controlled Trial, The Lancet vol 351 June 1998 p 1723 – emphasis mine.)

The “contradictions” referred to above disappear when it is realised that suggestion does not always take the form of an imperative proposition. Suggestion can be indirect. For example, effective suggestion can depend upon the associations related to the actual appearance of a plaecbo. If a doctor were to attempt to administer a placebo in the form of a jelly baby or a sausage roll the patient’s suspicions would be alerted and the suggestions as to the effectiveness of the placebo would be undermined. On the other hand, the appearance of a shiny white pill would reinforce the suggestion of the efficacy of the placebo. To ignore the role of suggestion in placebo is to ignore the elephant in the room.

Hypnosis and suggestion.

The effect of hypnosis and hypnotherapy is similar to the placebo effect in that the efficacy of both is dependent upon direct and indirect suggestion. There are, however, two very significant differences. The effective administration of a placebo requires an element of deception. Hypnosis and hypnotherapy do not. The recipient of a placebo believes that he or she is taking some sort of effective medicine rather than, say, a bread-pill. But the suggestions administered in hypnotherapy are fully understood by both the therapist and the patient. The person undergoing hypnotherapy for smoking cessation will be told that he or she no longer smokes. The person having hypnotherapy for weight loss will be told that they will avoid certain foods in future. This is not to deny that both direct and indirect suggestion could be used to deceive a patient but I cannot think of a therapeutic context in which such deception would be essential to the improvement and well-being of the patient concerned.

The other significant difference is that, in hypnotherapy, suggestions are used to bring about a change in the quality of consciousness of the person undergoing treatment. What I am referring to here is the hypnotic “trance”, the phenomenon which causes more confusion and misunderstanding of hypnosis and hypnotherapy than almost any other. Therapists, and even leading experts in the field, disagree as to the nature and significance of trance. My own view is that the term “trance” can be applied to any healthy (i.e., non psychotic, non drug-induced etc) state of consciousness other than fully alert, wakeful consciousness. Daydreaming, drowsiness – states in which one’s state of consciousness is “lower” than it is during normal waking consciousness – all these are states in which the individual is rendered far more susceptible to suggestion than during fully alert, waking consciousness. Generally speaking, the deeper the “trance”, the greater the susceptibility to suggestion, though there are exceptions to this rule.

Scientific interest in suggestion and suggestibility goes back many years. In 1959, Weitzenhoffer and Hilgard devised the famous Stanford Scale of Suggestibility, a series of suggestibility tests to measure and quantify the receptivity of a given subject. But scientific research into suggestibility has never really gone beyond this and it is not hard to understand why. Suggestibility is what makes us truly human. It is the reason why we are moved by sunsets and mountains, why we are awed by Beethoven and moved to tears by Puccini. We could define great art as that which appeals to our innate suggestibility. But how do you study that which is so intimate a part of our perceptual apparatus? How do you step outside of the framework?

References:
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., and Johnston, B. T. (2008) Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration, PloS Medicine 26/02/08

Fuente-Fernandez, R; Schulzer, M; Stoessl, A J; The Placebo Effect in Neurological Disorders, The Lancet Neurology Vol 1, June 2002

Kaptchuk, T J; Powerful Placebo: The Dark Side of the Randomised Controlled Trial, The Lancet vol 351 June 1998

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1. Proteus.

In ancient times there was an island called Pharos, one day’s sailing from the coast of Egypt. Every day, at noon, a weird creature visited this island. He would emerge from the ocean and go ashore to find his beloved seals – his pets and companions. He would count his seals to make sure they were all present and safe. Then he would lie down and sleep. The name of the creature was Proteus – the Old Man of the Sea.

One day, a king called Menelaos, on his way home from Troy, landed on this island with his crew. But he couldn’t leave. There was no wind. Time passed. Food ran out. Menelaos became desperate. But then a goddess – a sea nymph – appeared to Menelaos and told him what to do. All he needed to do was to capture Proteus and hold him fast. If he were successful, then Proteus would tell Menelaos all he needed to know. Once captured and held fast, the Old Man always told the truth. Read the rest of this entry »

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