Monday, 19 January 2015

Hypnosis, Metaphor and Guided Meditation

Hypnosis is focused attention, metaphor is story-telling, and guided imagery is mind games mainly used for healing. The common denominator is words the therapist uses, words to effect both mental and physical changes.
How is it possible for:
  1. the suggestions given in the suggestible state of trance; 
  2. the telling of interesting stories; 
  3. using internal imagery (all senses possible) to bring about change in a client?
Is the therapist an active/directive/causative agent, or is the therapist a facilitator who helps the client to find unique solutions based on their own life? In the old days therapists took most of the credit for change. Since we can never know a client in the way that they know themselves, then we are effectively limited to being guides.Although there is a place for traditional directive hypnotherapeutic work (as in, 'cigarettes will taste like shit from now on'), I believe that the most effective way to use the concentrated attention of a client is via the subtle and indirect use of language. It was said of Milton H. Erickson, MD, that he was a master of the precise use of vague language. 
Vague means that the words as is usually the case in poetry - provide opportunities for the listener to create/recall her own uniquely individual responses or memories. Rather than say, 'You are now going to figure out how to handle this by confronting your parents' you can say, 'just wonder what interesting, and perhaps surprising, ways have already come to mind to realistically resolve your concerns.' 
The first formulation restricts the client to the therapist-generated solution of confrontation. The indirect method is also more collaborative and respectful. Since everyone is unique, you have to tailor your approach to the client. It was also said of Erickson that he invented a new therapy for each client, and that his clients never knew what he was going to do when they entered his office. How predictable are you?
Everyone loves a good story. All cultures and religions have favourite stories and myths and legends that are told and re-told. Stories are entrapping. Stories are not just for children. Each of us is a unique and unfolding story - even those of us who live dull and routine lives - a dull story is still a story. White and Epston's 'Narrative Therapy' is an approach that makes use of the stories that people believe about themselves. 
When you meet a stranger and each of you responds to the unspoken question of 'Who are you?' you respond with your life story. At any rate, you report the highlights of how you got to be who you are - these are the key events as filtered through your present-day perceptions. Remember, memory is malleable, and what and how we recall past events are controlled by current needs and perceptions. Do you recall only good or only bad things about your growing up years, for example?
The intervention of Guided Metaphor makes use of personal stories to create a metaphor for change. The client is asked to summarize his life in a page, in a sentence, and in a descriptive word. Then, the client is asked to write a new story with the (realistic) ending they desire. This new story is told in a page, a sentence, and a descriptive word. 
The therapist can now construct a metaphor to deliver (in or out of trance) that incorporates the old story and how it has been transformed into a new story - all using the client's images and descriptive language. The client, in effect, tells you how his changes have been brought about. (This approach has parallels with Erickson's "pseudo-orientation in time', but is more structured.)
Of course, the traditional way of utilizing therapist-generated metaphor to suggest a variety of ways that the client can use to resolve her concerns is also useful. (Notice that I am picky about language and prefer 'concerns' to 'problems'.)
Guided imagery is primarily used with people who have life-challenging diseases, although it can also be used for psychotherapy. (The NLP 'swish' technique and the TimeLine Therapy approach can both be considered to be variants of guided imagery.) There is much evidence that body affects mind, and that mind affects body. Some depressions are biochemically related, as is their reversal or control by pharmaceuticals. Psychosomatic ailments are by definition mind-caused. Guided imagery uses the mind for healing, and with a surprising degree of concomitant physical improvement.
The most effective way to do guided imagery work is with client-generated 'images'. What do they feel, or have an inner sense, will work for them? Is it predators or angels? Mechanical devices like ray guns and pulverizers, or gentle persuasion? Biologically accurate things like enhancement of particular immune system components, or a healing presence? The healing metaphor, the healing agency, needs to fit the client's personal belief system and their unique life story. General imagery can be helpful if it is artfully vague. Yet, even with knowledge of the client's specific imagery, it is important to structure your language in as open-ended a way as is possible. The healing image may be an angel, but let the client fill in her own details about the angel- male or female or ... The healing work, after all, is done within the client's mind.
Is it all in the mind? Yes, if you use words. It is not necessary to belabour the point that words like 'red' and 'happy' are individually interpreted. Women, for example, can typically distinguish and name many more shades of red than men can. Yet, each woman experiences a particular red differently.
The placebo effect is always present when you use words since the words evoke individual belief systems. If you congruently believe, and project that belief, that whatever you are doing with a client will be helpful, then your belief tends to become the client's belief. When a treatment is 'new', it is invariably more effective than when it has been around for a while.
In 'talking' therapies words count, so choose them with care.

Rubin Battino
MS, Mental Health Counselling

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