ALL
QUESTIONS AND ALL ANSWERS WITH LEARNING OUTCOMES
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Q1.1
Which one of the following is NOT
a leading
question?
[LO 1.8]
a)
If you eat that whole tub of ice-cream what will happen to your
weight loss goal?
b)
What do you think about restrictive dieting? Many people tell me
that they consistently fail when dieting.
c)
Do you want to stop smoking right now or next week?
d)
Do you want to stop eating chocolate?
Learning
outcomes: 1.8
An ability to recognise 'leading' questions.
Example
answer Student 1
Answer
D is not a leading question.
The
other questions have presuppositions or suggested outcomes built in
the question
1.2
Give three
examples
of loaded
questions and when
and why you
would use these.
Learning
outcomes: 1.7
An ability to recognise 'loaded' questions.
NOTES:
Loaded questions
imply a fact that has not been previously established. These facts
often have a negative implication and cause the client to defend or
confirm their position.
Example
answer Student 1
Loaded
Questions:
1/
How many times have you tried to stop smoking before you came to
me?
2/
Did you manage to lose the weight before?
3/
Have you always had a poor memory?
Loaded
questions can be used during the meta-questioning process, carried
out at the beginning of the consultation to pin down the issue which
the client needs help with because their answer causes the client to
question their line of thinking and potentially their previous
actions / behaviours allowing them to see other options.
Your
examples are correct. Loaded questions imply a fact that has not
been previously established. These facts often have a negative
implication. As you say, metaquestioning causes the client to
question their line of thinking and behaving, however loaded
questions particularly are used to provoke confirmation or
contradiction of the implied statement to bypass the polite rehearsed
responses and to gain access to the underlying emotions. Your
example of ‘Did you manage to lose the weight before?’ will cause
the client to either give much detail regarding previous dieting
attempts or clarification that she/he had never had cause to be on a
diet as they had never considered themselves overweight before.
Good.
Example
answer Student 2
“When
did you start to overeat?”- Assumes that the respondent overeats
and began to do it at some point that they can remember. We could use
this to determine the period or age that a client began over eating
and this would help the therapist to cut straight to the point and
put pressure on the client to take ownership of their behaviour
rather than trying to sugar coat it and not take responsibility.
Correct.
In leading the client in this manner, it invites resistance and
discussion. The client could protest that in fact their weight
condition has little to do with the amount of food they eat and
perhaps it is their metabolism at fault. Or they could agree that
they DO overeat and you can then explore the reasons as to why that
occurs. Good answer.
“Do
you still blame yourself for your childhood experiences?” - Assumes
that the respondent blames themselves for something that happened to
them as a child and that there was a specific point at which this
behaviour started to occur. We could use this question to help the
client to see that they have been blaming themselves for something
that was possibly out of their control, and to help us and them to
understand that they are still doing this to a certain extent.
Correct.
Having suspected that the client does in fact blame themselves in
this manner which could be to their detriment this gives the client
the opportunity to discount or agree and you can then explore both
avenues.
“Have
you quit smoking already then? or do you want to quit now?” –
This assumes that the person was or still is a smoker and that if
they haven’t already quit then they only have the choice to quit
right away. It would be useful in questioning a client who wants to
give up smoking and encourages them to make the decision to quit
straight away rather than delaying it and having a get-out-clause.
Correct.
Using the presumption that they may already have quit (in fact, it
is a technique to be utilised in that you are drawing attention to
the very notion that they are NOT smoking right now, so in actuality,
they are sitting in front of you as a non smoker!). They are lead to
explore the notion of what being a non smoker would be like and may
then volunteer
difficulties
and restrictions that having given up smoking would present. You
are also of course implying that if they have not already given up,
they will be doing so now. Well done.
Q2. Giving examples of classic
non-commitment language, identify a client lacking commitment to the
behavioural change they state they would like and discuss methods of
increasing motivation and inspiring desired change.
Learning
outcomes: 2.2
A demonstrable understanding of psychological theories of motivation
and behavioural change and an ability to apply this to clinical
practice.
NOTES:
This question breaks down specifically into four parts.
1
giving examples of classic non commitment language – What do they
say?
2
identifying a client lacking commitment to the behavioural change
they would like – How do you know?
3
discussing methods of increasing motivation – What would you
discuss with them to move them on?
4
inspiring desired change – How would you move them forward?
Do
not hesitate to simplify and use bullet points to ensure you have
broken down the question and that you do not spend too much time and
effort in one section.
Example
answer Student 1
A
weight loss client, when asked how they would like to change, may
say;
“I
have tried so many diets - but THEY don't work! I joined a local gym
for a while, but after waiting for the bus I was too tired, and it's
so boring! Then I went to a weight-watchers meeting, but it wasn't
for me - I do enjoy my food!
So,
my friend, Sally, she suggested that I might like to try this
hypnosis thing, to see why I can't seem to be able to lose any
weight, and I thought I may as well see if it might make me any
slimmer”.
Such
a client exhibits a distinct lack of commitment, and is seeking a
'magic charm' cure that will effect change with no effort or
sacrifice being necessary. This is evident in the language used, full
of excuses and reasons why nothing has worked to date.
She
claims to have “tried” many diets – but for how long and how
seriously?
She
joined a local gym “For a while” - and took the bus rather than
walking.
She
attended “A” weight watchers meeting – and instantly decided it
was not for her.
“I
do enjoy my food!” - self justification of her habits.
A
friend suggested hypnosis, and she “thought I might like to try”
it to see (prove) why “I can't seem to be able to lose any weight”
I
would first meta-question to discover if the weight loss was
something that she really desired, or was it to satisfy a friend or a
partner, or to meet some other criteria. Having uncovered the real
reason I would then elicit all her perceived advantages of having
lost the required weight, and as many desirable consequences, for
her, of being fitter and possibly slimmer. I would seek and find a
real desire to change, and then obtain from the client a firm
commitment to work as necessary to make and keep the change.
Having
arrived at a sensible and healthy target weight for this client, I
would motivate her with examples of all the advantages elicited
earlier. In hypnosis, I would have her imagine achieving all the
goals she had previously stated, and I would assure her that she
could still “Enjoy her food” and she could also enjoy feeling
fitter and she could also enjoy exercise. Most of all, she could
enjoy seeing herself and feeling proud of her achievement.
Q2.
Correct. A well structured answer with good examples and analysis.
Good to recognise that you would recognise her desire to still enjoy
food too. The only point I would make here is that seeing herself
and feeling proud of her achievement would of course be based on what
is the positive outcome of this particular client and her
representational system. Well done.
Example
answer Student 2
Examples
of non-commitment language include ‘I might want to stop eating
sugary foods’; ‘I want to lose weight but I don’t want to
change my diet’; ‘I want to make changes some of the time, like
during the week, but would like to have weekends off’; ‘I thought
I might like to lose some weight’; ‘I can’t understand why I
have gained so much weight’; ‘I can’t seem to be able to make
lasting changes to my diet’; ‘I’m not ready to make changes
straight away but would like to learn how I can be more ready in the
future’; ‘I just have so many problems and issues around this
whole “weight loss thing” I just don’t know where to start’.
Increasing
motivation can be achieved through actual post hypnotic suggestion,
and also through the line of questioning used. Using suggestions
within a hypnosis session could be achieved through the ‘control
panel’ method, asking the client to locate their internal control
panel then more specifically the dial/lever/switch for ‘motivation
to change [Specified behaviour]’ turning the motivation down,
looking for a physical response to indicate that the process has been
carried out- such as a finger movement (ideomotor response/reflex,
IMR), then adjusting the dial/lever/switch to increase motivation and
getting another IMR to signify that the change has taken place, also
looking for facial expressions and/or physical reactions (such as
sighing or smiling or relaxation of facial muscles) to indicate that
the client has made those positive changes.
It
is also possible to inspire motivation to change an unwanted
behaviour through questioning alone. People who are finding it hard
to make change are generally ambivalent about change, they are unsure
whether they want to change or whether they want to continue doing
the same things- they feel two ways about it. Resolving the
ambivalence and therefore increasing motivation to change can be
achieved through questioning and listening and building rapport in a
very short space of time. Using a mixture of open questions –‘when
do you think your issues with food started?’, ‘What do you think
is the root cause of your issues with food?’- and closed questions,
‘Do you want to make changes to your behaviour?’, ‘when will
you start?’- the therapist can guide a client towards being more
motivated and less ambivalent about making permanent change. Leading
and directing the client can take shape using questions such as ‘if
you make no changes at all then how can you see your life in 5 years
time? How about if you made those changes now? How will you be, then,
in 5 years? Encouraging the client to imagine their life without
addressing and making changes can help them to be more motivated to
change. It is very important to build good rapport with the client in
every situation as a hypnotherapist who does not have good rapport
with their client will yield poor results. The therapist needs to
instigate a number of different questioning techniques in order to
increase motivation and desire to change, such as future pacing (as
mentioned) and leading questions (“What
do you think about restrictive dieting? Many people tell me that
they consistently fail when dieting”); Loaded questions ‘Have you
already stopped overeating or do you want to stop that now?’.
I
had a client who had what she called ‘an addiction to sugar’. She
repeatedly chose foods that were high in sugar despite the fact that
they left her feeling tired and sick and made her gain weight. She
had had gastric surgery and lost a vast amount of weight in a very
short period of time and was in face now under the weight that her
surgeon had advised her to reach, though still a healthy weight. She
found that even though she knew the risks involved with eating sugary
foods- such as diabetes, she had had chronically uncontrolled type 2
diabetes prior to surgery though this was under control at the time
of her session, her weight had been fairly stable at her low end of
the range for several months though in the past few weeks she had
gained a couple of pounds, she felt physically unwell after having
what she called ‘a chocolate binge’. Despite all the alarm bells
that were ringing for her she reported feeling very demotivated when
it came to changing her behaviour and was finding that her own
version of ‘trying’ to cut down or have will power just wasn’t
working any more.
I
led her towards feeling more motivated by asking her questions about
how and where the behaviour had originated, how she felt about her
body, how she had come to terms with being a significantly smaller
weight and size, how she felt her relationship with food and with
herself and others had changed as she had changed and delving into
whether she believed that she was worthy of making lasting and
healthy changes to her behaviour. It turned out that she was
ambivalent about changing her behaviour and lacking in motivation in
part because she still felt like ‘the fat woman’ and like she had
no right to look and feel good. Her self-esteem and self-worth were
severely low and I was able to steer her thinking and attitude in the
direction of the root issue- that she felt unworthy of being slim and
healthy, without even going into too much detail about how that
attitude had manifested- eg her experiences as a child- she began to
see for the first time how much she had allowed that inappropriate
view of herself control her behaviour and how unnecessary it was to
live up to that out-dated view of herself and I could physically see
her thinking change and her motivation to change her behaviour
increase without ever having to address her original lack of
motivation whilst she was in trance.
From
your first section of this answer I would have advised you to be more
specific, in terms of taking each example you stated and then
addressing each one in turn, rather than generalising. However,
your very specific actual client experience addresses this and tells
me how you have not only understood the question but have had real
time experience of it. Additionally, the generalisations are valid
and true though and add much to communicate your understanding of the
question.
Example
answer Student 3
Non-commitment
language dilutes the power and intention of the stated desired
changes.
"Perhaps
I could try to start thinking about losing a bit of weight some time
soon"
A
client with full commitment to losing weight might say "I want
to lose weight and fit in my old clothes" which after
questioning can be improved to "I am going to eat healthy,
nutritional foods and increase my activity levels starring on Monday
and I will west my red dress to the Christmas party"
The
words "perhaps", " could", "try", "
start thinking about ", " a bit", "some time
soon" are all weak, "doubting" words that tell the sub
conscious that the client will be unsuccessful because there isn't
any real expectation of change.
The
lack of commitment may be because they have v come to you under
duress or because they have been told by friends or family or society
that they SHOULD wasn't those things but they themselves don't really
believe it or by into it themselves.
Alternatively
the client could be sabotaging themselves because they have tried in
the past and failed and do have that expectation of future failure,
or because of an underlying fear of what would happen if they were
successful and so they make sure that they will not be successful.
Being
aware of the client's body language and modality the first step is to
identify what change they would like to achieve. Starting with the
premise of "losing weight" what does this mean to the
client?
How
much weight do they want to lose? Have they been that weight before
or not? What was different in their life then and what we're they
doing differently (presuming that the client has a historical
reference point). What has changed? Is it possible to replicate that
now?
His
will they know when they have lost enough weight? What will that feel
like/look like/sound like? What will be different in their life? What
will they gain? What will they lose? What will their family fell
about the changes? And their friends? Will that have support or will
they be sabotaged?
What
is holding the client back from starting? What needs to change in
order for it to start and for the change to be successful? When will
that change be possible? Will there be any problems?
It
may be that the weight that registers on a number scale isn't really
what the client is aiming for (even if a number is mentioned). It may
be how they felt when they were that weight x number of years ago;
their social life; the job they were in; the life they had before
they had children; being on holiday and being able to wear a bikini
(rather than simply the size that the bikini was). The change may be
feeling healthier, or fitter or feeling confident in general.
So
:-
What does the client wasn't SPECIFICALLY.
When does the client wasn't it.
Is the client able to make the changes.
What has stopped those changes being made already.
How will the client know when they have achieved it.
When it is achieved what else will change.
Is the client happy with all of the changes.
What will happen if the change does not come about
Are the aims realistically achievable.
What does the client wasn't SPECIFICALLY.
When does the client wasn't it.
Is the client able to make the changes.
What has stopped those changes being made already.
How will the client know when they have achieved it.
When it is achieved what else will change.
Is the client happy with all of the changes.
What will happen if the change does not come about
Are the aims realistically achievable.
Presuming
that the desired loss of weight is achievable, measurable, had a goal
and does not cause conflicts the desire for making real change
possible to be a successful intervention has to be increased and made
concrete.
Where
the client days that they have never been their desired weight one
would ask the client if they had a role model or an image in their
mind (or on paper) of who they wanted to look like. To increase the
reality of this imagined end goal one would ask the client what that
person (or the historical them) would feel like, what they would be
doing, where they would be going, what they would see, who they would
see, what they would be wearing, what activities they would be doing,
where they would be eating and drinking, how they feel about
themselves and what they had achieved, what else they would be able
to achieve, what new things they would be able to try, making sure
that where the client is referring to an image of someone else that
they imagine that they are the other person and in all cases
encouraging the client to build up a tangible picture of what they
are aiming for and making it fully real and multi dimensional in full
color rather than a hypothetical, remote wish.
If
the client had been their target weight before one would ask the
client about that time (out times if they have been a yo-yo dieter).
What specifically were they doing, eating, driving, cooking,
exercise. What we're they doing in their spare time, where did they
go, who did they see, what did that wear, how did it make them feel,
what made them happy, what did they feel like,
In
either case the excitement and anticipating of the future state
should be enhanced and magnified, both to make the goal tangible and
a 3 dimensional complete reality, so that they know what they are
aiming for and also to make their stated desired change a strongly
attractive, desired outcome and a positive target for them to aim for
and work towards- - inspiration and motivation.
Next
comes the practicalities of achieving that goal.
What needs to happen for weight loss to be achieved (from their imagined solutions or from referring to past experiences) and evaluation if they are good choices to be replicated now. Depending on the client they may or may not have knowledge about healthy eating and dietary habits.
What needs to happen for weight loss to be achieved (from their imagined solutions or from referring to past experiences) and evaluation if they are good choices to be replicated now. Depending on the client they may or may not have knowledge about healthy eating and dietary habits.
"Maybe...."
and "I wonder if........" Ate good leading questions to
help clients find their own suggestions and solutions. "Perhaps
you could....." If they need more guidance. In any case though
it is important that the client feels that they are making their own
decisions rather than having them imposed otherwise the subconscious
still not accept you post hypnotic suggestions.
Ways
of increasing commitment to change is usefully done through future
pacing whereby they have achieved their goal and are acting as good
role models for their children etc. For example
"You see yourself sat at the kitchen table eating you mean. Your plate has a healthy mixture of vegetables and protein, you are drinking a glass of water and savouring every mouthful"
or
"You enjoy getting ready for the Christmas party, putting on make up and your favourite red dress that now for you perfectly and enjoying looking at yourself in the middle"
or
"You complete your first half marathon"
or
"You take part in your first mother's race at the schools sport's day and your children age cheering you on"
As appropriate for your client.
"You see yourself sat at the kitchen table eating you mean. Your plate has a healthy mixture of vegetables and protein, you are drinking a glass of water and savouring every mouthful"
or
"You enjoy getting ready for the Christmas party, putting on make up and your favourite red dress that now for you perfectly and enjoying looking at yourself in the middle"
or
"You complete your first half marathon"
or
"You take part in your first mother's race at the schools sport's day and your children age cheering you on"
As appropriate for your client.
You
give an excellent example here. You have identified some excellent
reasons as to why a client may be lacking in commitment in this
specific example.
You
have outlined future pacing as a way of increasing commitment to
change which could perhaps be seen as a motivating factor too, as
long as the future pacing detail directly corresponds to your
information gathering in the interview stage.
Q3.
What does
Hilgard’s Neodissociation
theory
propose with regards to trance?
- Hypnotic phenomena is produced through a disassociation within a high level control system
- Disassociation between imaginative processes and reality as it is perceived by the viewer
- A separation from past well established cognitive processes and the current interpretation of the view of the world
- Forming the intention to perform an action, without forming higher order thoughts about intending that action.
- Hypnotic behaviour is a social behaviour that can be explained without recourse to any special process.
Learning
outcomes: 2.1
Knowledge of the various theories on the nature of hypnosis.
Example
answer Student 1
Hilgard’s
Neodissociation theory proposes that a Hypnotic phenomenon is
produced through a dissociation with a high level control system.
Q4.
Which of the
following are NOT factors of 'pseudoscientific therapies/treatments'?
- Does not adhere to a valid scientific methodLacks supporting evidence
- Lacks plausibility
- Cannot be reliably tested
- Involves the use of sugar pills
- Vague, contradictory or improvable claims
- An over reliance on claims rather than evidence
Learning
outcomes: 5.6
An understanding of the term 'pseudoscientific therapies/treatments'.
Example
answer Student 1
E.
involves the use of sugar pills is NOT a factor.
The
other statements are an often used description of Pseudoscience
therapies and treatments.
Q5.
Clinical
studies have looked at how effective hypnosis is as a clinical
treatment for many conditions. For which condition is there NO
clinical evidence?
- Cancer remission
Learning
outcomes: 5.7
An understanding of the term 'empirically supported
therapies/treatments'.
Example
answer Student 1
Cancer
remission is the only subject listed for which clinical studies have
not provided evidence of effective treatment by hypnosis.
Q6.
In a maximum of 1500 words, explain what is meant by the term
extratherapeutic factors, how you would get to know about them from
the client and suggest an example that may impact on the outcome of
therapy.
Learning
outcomes: 1.9 An understanding of the nature and impact of
extratherapeutic factors.
Example
answer Student 1
The
term “Extra-therapeutic factors” refers mainly to that which
exists previous to and outside of the therapeutic scenario, those
such factors that accompany the client to therapy. These elements
include the clients own strengths / weaknesses, their abilities, any
specific fears, their faith and personal beliefs, also their life
experiences and their commitment and readiness to really change.
Many
other influences may be bearing upon the client, these can include
all the circumstances of their home and working environment, their
partner and other loved ones, and how much or how little support they
receive. It is estimated that approximately 40% of change is
attributable to client 'extra-therapeutic factors'. (Miller et-al:
1997).
The
existence and substance of such extra-therapeutic factors may be
elicited by careful meta-questioning, bearing in mind that each
client is unique and they will have obtained their own world view
which is, to them, perfectly reasonable. Care should be taken to
avoid directly challenging or refuting the clients position, while
guiding them to accept that further choices are available to them.
For
a particular presenting problem, possibly an irrational fear, or an
aversion to something innocuous, the therapist might decide that
'past life regression' is an appropriate course to take. However, the
client may be of a particular religion or belief that forbids or
distrusts any such thoughts regarding previous lives. Such a conflict
could result in the client “surfacing” from the state
prematurely, becoming upset, and no longer trusting the therapist.
Another
example where 'extra-therapeutic factors' could affect the outcome of
the therapy could be a client that is supported and encouraged in
making the desired change by those close to them. Conversely,
derision of or obstruction to the desired change by the clients peers
may be expected to impact badly upon the outcome.
A
client that wishes to stop smoking may be surrounded at home and work
by chain-smokers, or they may have lost someone close to them as a
direct result of smoking. Discovering such factors as these are
useful to the therapist, allowing the tailoring of suggestions to
suit, and may impact greatly upon a successful outcome.
Example
answer Student 2
Extratherapeutic
Factors are many and varied, they are an amalgam of components
external to the therapy itself. These will include the thoughts,
attitudes, life experiences and beliefs of the client, alongside this
are the strong impacts of their support systems and their personal
coping skills with the normal stresses of life. A sudden crisis
situation can be brought into the therapy situation and impact the
outcome. There may be a difficulty in the client re. their ability
and willingness to accept that change is indeed possible. Other
factors may include their religion or faith this can have a huge
impact on the way some clients respond to therapy. Motivation to
really commit to change and persistence in pushing through some of
these factors also has an impact on the outcome of therapy. It has
been estimated that circa 40% of the extratherapeutic factors
contribute to change.(Miller et-al: 1997 – Sprenkle and Blow et-al
2004 – Hubble et-al 1999)
Developing
solid rapport with the client thus eliciting their trust. Followed by
listening and hearing the answers to deep and careful
meta-questioning, without judging the clients view of their world,
which may well be very different to that of the therapist. From the
answers and being extremely careful not to openly oppose the answers
gained from the meta-questioning which may well cause a breaking of
rapport, advise and guide the client to understand that alternative
ways of dealing with their issues are available to them.
An
example of where the extratherapeutic factor may well impact therapy
is when a client states that they have been sent by a spouse or loved
one to quit smoking, but the client resents being forced into an
action that is not one they wish to commit to.
Unless
and until we understand the what and the how that our client
perceives themselves, their view of their world and importantly the
environment they inhabit it will make a successful outcome to therapy
difficult for the client as we will not be able to design and
organise the appropriate suggestions that will lead to a successful
outcome for both client and therapist.
Both
of the above are correct.
Q7.
What
approach would you take when hypnotising a child?
Learning
outcomes: 1.1
An understanding of advanced interventions.
Example
answer Student 1
...Those
therapists who work with children have to take into account certain
factors:
As
their client is under the age of consent they need written permission
of the parent / guardian as well as a current CRB certificate for
working with children, a a chaperone should be considered in many
circumstances.
The
formal style of hypnosis generally used today would not be
recommended for children as they struggle with their attention span
so are difficult to induce using the normal form of hypnosis. As
children are more imaginative than adults the preferred forms include
play therapy, Ericksonion metaphor story telling, a guided
visualisation such as between the child and the therapist making up a
story where the client is the central player and the therapist leads
the story feeding appropriate suggestions to bring about the required
changes.
Example
answer Student 2
To
work with children it would be best to adopt a permissive approach to
hypnosis. Depending upon the age of the child, a lack of cooperation
should be expected and allowed for. Lack of attention and fidgeting
could be a problem until the child's interest is secured. To this end
a “Play” scenario using their imagination may be useful, with
lots of encouragement and praise. Again dependant on the age and
personality of the child, a suitable induction should be utilized,
possibly based around a treasure trail , or a flying car.
During
the intervention, care should be taken to address only appropriate
issues, and to avoid any discomfort for them. After the session, fun
or funny post hypnotic suggestions could be used to reinforce the
desired goal or outcome. The whole experience should be made
enjoyable for the client, such that they relish the thought of
further sessions.
Q8.
Describe
a client scenario where you would choose to use Erickson’s
utilisation technique.
Learning
outcomes: 1.1
An understanding of advanced interventions.
Example
answer Student 1
A
client may well present an issue which they might be uncomfortable
discussing with a stranger, (the therapist), and hence appear
resistant. It could therefore be difficult to gain and maintain
rapport while endeavouring to uncover the root cause, and determine a
suitable intervention. In this instance I would attempt to apply
Erickson’s utilization approach; accepting the client – complete
with their issues – as they are, and working with whatever they
brought to the session. By agreeing and demonstrating a sincere
understanding and acceptance of their situation, I would hope to
forge a good therapeutic relationship on which to base any
intervention, negating any initial resistance and reinforcing their
trust in myself and the process.
Correct.
Yes, the Utilisation Technique is particularly useful with the
resistant client and that resistance may well be due to the subject
matter being uncomfortable for the client to discuss. This of course
is a matter of client perception, whether the client themselves
judges the matter to be so. Sexual matters, financial matters and
emotional discord are examples where the client may feel
uncomfortable discussing matters and where it is important to adopt a
matter of fact approach or, as you say, a sincere understanding and
acceptance of the situation, utilising whatever they bring to the
session to be helpful in the therapy.
It may be,
for example, that the client had been talking about difficulty in
parking when they arrived. If they later remarked that there was no
way to handle a situation or wanted to give up on a job or
relationship because they felt they did not know where it was going,
or it was impossible, the therapist could use the difficulty in
parking to assist. Such as, "There was an occasion when you did
not know where you were going and thought there was no way to get to
your destination or do what you wanted to do and yet you kept on
going until the perfect opportunity presented itself, not exactly how
you thought it would, but with creativity and patience you got there
in the end and can be pleased now that it all worked out so well...".
Q9.
State two
major theories of hypnosis. Outline and briefly discuss. Using the
Harvard citation method detail how you discovered this information.
Learning
outcomes: 2.1
Knowledge of the various theories on the nature of hypnosis. 3.3 An
ability to reference other authors' work properly, e.g. in 'Harvard'
and 'footnote' formats.
Example
answer Student 1
The
“Neodissociation theory” (Hilgard,1974) and the “Socio-cognitive
theory” (Spanos, 1986) are two competing theories regarding the
phenomena of hypnosis.
Neodissociation
is a “State” theory, that is to say that the hypnotized person is
thus in an altered state of mind. The hypnotists’ suggestions act
upon the dissociated part of the “Executive Control System” which
is shielded from the rest of the mind by an “amnesic barrier”.
Therefore the subject can be aware of the results of the given
suggestions, but remain unaware as to how they were achieved.
Hilgards theory arose from his experiments into the “hidden
observer” phenomenon whereby a “hidden” part of the mind can be
accessed to report on experiences that the subject is not aware of.
This concept of conscious and unconscious executive control systems
exhibited in hypnosis is controversial. (e.g Heap et al, 2004: Kirsch
& Lynn, 1998)
Spanos’
“Socio-cognitive” theory would appear to be the polar opposite of
dissociation, in that it is a “Non-state” theory. It argues that
subjects actively participate in the process, and that any phenomena
of involuntary experience is actually the result of normal
psychological processes such as beliefs, expectancies and motivation.
(Spanos et al , 1980) That is not to say that the client is
deliberately deceiving the hypnotist, or pretending to be affected
when they are not. Rather, their expectance of a phenomena or
particular result actually causes said results to be manifested.
Q9.
Correct, You have read the question well and I like the way you
compared the two models that you have chosen. You have a good
understanding of these models and have presented them clearly and
succinctly.
Example
answer Student 2
State
verse Non-State
“State”
theory
Hilgard's
Neodissociation theory of hypnosis is a classic 'state' theory. It
proposes that hypnotic phenomenon are produced through a dissociation
within high level control systems.
This
theory basically means that during the hypnotic induction the mind
(is split?) into two separate processes, the conscious part is aware
of the suggestions given, however the sub-conscious part accepts the
suggestion and then feedback the resulting action to the conscious
part. The conscious part takes no part in how the result was
processed.
This
is the process accepted by most direct hypnosis students, the client
must enter an altered state of being in order to accept the
suggestions, my original teaching proposed the Conscious and
Sub-Conscious minds were separate but interacting with a Critical
Factor (represented as a gatekeeper) between the two parts whose main
purpose was to keep the client doing what they always do, that which
is familiar, the Conscious mind and the gatekeeper had to be bypassed
in order for the client to accept the hypnotists new suggestions. The
Sub-Conscious is to be regarded as having the intelligence of a
bright 9yrs old child, (the approximate age children stop
automatically accepting such make believe things as the tooth fairy
and Santa Claus etc.) the hypnotist talks to the Sub-Conscious
stopping unproductive thought patterns and planting new more
productive thought patterns which are then run feeding into the
Conscious mind.
(Jonathon
Chase, Don’t
Look Into His Eye’s
1988)
“Non-State”
theory
Social-cognitive
theories form the 'non-state' end of the 'state-nonstate debate'.
State theories argue that processes such as 'repression' or
'dissociation' operate when subjects are given a suggestion, whereas
non-state theories view subjects as active "doers" and
observe the suggested effect as an enactment rather than a
happening (Spanos
et al, 1980).
This
process is both Ericksonian in that much of his work was by metaphors
and general story telling rather than the formal hypnosis of
Dissociated state hypnosis, Erickson would tell his clients long
rambling story’s with hidden threads of how they can change or
react to circumstances, the gentle rambling nature of these stories
allowed them to slip by the Critical Factor of the Conscious mind as
they appear to be just stories but the Sub-Conscious mind would pick
up on the meanings and take on board the lessons.
(Sidney
Rosen My
Voices Will Go With You: Teaching Tales of Milton Erickson:,1991
)
This is also how Dr Jonathon
Royal (a.k.a. Alex Smith) explains all hypnosis in his many training
books and seminars. He believes all hypnosis is fake and hypnotists
are merely giving their clients permission to do what they really
want, in the case of stage hypnosis, to perform and entertain without
feeling embarrassed, in the therapy room to make changes without
guilt or responsibility as “the hypnotist made me do it. Which is a
form of social compliance or peer pressure rather than any form of
altered state.
(Jonathon
Royal, "The
Encyclopedia of Hypnotherapy, Stage Hypnosis & Complete Mind
Therapy 2013)
Q9.
Correct, You have understood the question well and have compared the
two models that you have selected very effectively. Your answer
demonstrates a good understanding of these differing models
culminating in a demonstration of the varied approaches of the two
Jonathans.
Q10.
By reference
to the following article and further research, appraise, in a
professional, factual and non-emotive manner, the claim that
hypnotherapy could save the NHS money.
Learning
outcomes: 3.4 An ability to critically appraise, in a professional,
factual and non-emotive manner, claims made in the media, including
digital media such as websites, or those made by colleagues,
supervisors and trainers.
Hypnotherapy
'can help' irritable bowel syndrome
Greater
use of hypnotherapy to ease the symptoms of irritable bowel syndrome
would help sufferers and might save money, says a
gastroenterologist.Dr Roland Valori, editor of Frontline
Gastroenterology, said of the first 100 of his patients treated,
symptoms improved significantly for nine in 10.He said that although
previous research has shown hypnotherapy is effective for IBS
sufferers, it is not widely used.
This may be because doctors simply do not believe it works.
Widely ignored Irritable bowel syndrome (IBS) is a common gut problem which can cause abdominal pain, bloating, and sometimes diarrhoea or constipation.
Dr Valori, of Gloucestershire Royal Hospital, said the research evidence which shows that hypnotherapy could help sufferers of IBS was first published in the 1980s.He thinks it has been widely ignored because many doctors find it hard to believe that it does work, or to comprehend how it could work.He began referring IBS patients for hypnotherapy in the early 1990s and has found it to be highly effective.
"To be frank, I have never looked back," he said. He audited the first 100 cases he referred for hypnotherapy and found that the symptoms stopped completely in four in ten cases with typical IBS.
He says in a further five in 10 cases patients reported feeling more in control of their symptoms and were therefore much less troubled by them. "It is pretty clear to me that it has an amazing effect," he said.
"It seems to work particularly well on younger female patients with typical symptoms, and those who have only had IBS for a relatively short time."
Powerful effect He believes that it could work partly by helping to relax patients.
"Of the relaxation therapies available, hypnotherapy is the most powerful," he said.
He also says that IBS patients often face difficult situations in their lives, and hypnotherapy can help them respond to these stresses in a less harmful way. NHS guidelines allow doctors to refer IBS patients for hypnotherapy or other psychological therapies if medication is unsuccessful and the problem persists.
Dr Valori thinks that if hypnotherapy were used more widely it could possibly save the NHS money while improving patient care. Dr Charlie Murray, Secretary of the British Gastroenterology Society, said: "There is no doubt that hypnotherapy is helpful for some patients, but it depends on the skill and experience of those practising it.
This may be because doctors simply do not believe it works.
Widely ignored Irritable bowel syndrome (IBS) is a common gut problem which can cause abdominal pain, bloating, and sometimes diarrhoea or constipation.
Dr Valori, of Gloucestershire Royal Hospital, said the research evidence which shows that hypnotherapy could help sufferers of IBS was first published in the 1980s.He thinks it has been widely ignored because many doctors find it hard to believe that it does work, or to comprehend how it could work.He began referring IBS patients for hypnotherapy in the early 1990s and has found it to be highly effective.
"To be frank, I have never looked back," he said. He audited the first 100 cases he referred for hypnotherapy and found that the symptoms stopped completely in four in ten cases with typical IBS.
He says in a further five in 10 cases patients reported feeling more in control of their symptoms and were therefore much less troubled by them. "It is pretty clear to me that it has an amazing effect," he said.
"It seems to work particularly well on younger female patients with typical symptoms, and those who have only had IBS for a relatively short time."
Powerful effect He believes that it could work partly by helping to relax patients.
"Of the relaxation therapies available, hypnotherapy is the most powerful," he said.
He also says that IBS patients often face difficult situations in their lives, and hypnotherapy can help them respond to these stresses in a less harmful way. NHS guidelines allow doctors to refer IBS patients for hypnotherapy or other psychological therapies if medication is unsuccessful and the problem persists.
Dr Valori thinks that if hypnotherapy were used more widely it could possibly save the NHS money while improving patient care. Dr Charlie Murray, Secretary of the British Gastroenterology Society, said: "There is no doubt that hypnotherapy is helpful for some patients, but it depends on the skill and experience of those practising it.
"But
the degree to which it is effective is not well defined. "I
would support using it as one therapy, but it is no panacea."
|
Example
answer Student 1
Founded
in July 1948, funded by national insurance contributions, the
National Health Service was intended to provide access to health
care “Free at the point of delivery”.
The
funding of the NHS has been a massive problem to successive
governments ever since. As medical practices and techniques have
evolved, leading to newer and more expensive equipment for both
diagnosis and treatment, whole industries are now geared toward
researching, developing and supplying new drugs for each and every
malady imaginable.
Against
such a background, one might think that a safe and effective
alternative would be embraced by most medical professionals, both
for the economies involved and the comfort of their patients.
Unfortunately, it appears that many doctors choose to ignore the
results of the published research into the benefits of hypnosis.
Possibly viewed as a “Mystical” or “Eastern” practice, it
is shunned by the modern Western medical community in favour of
manufactured drugs and surgical solutions.
In
at least one field of medicine, published research has proved the
efficacy of hypnotherapy. Dr. Roland Valori of Gloucershire Royal
Hospital, editor of “Fronline Gastroenterology”, says that
symptoms of IBS (Irritable Bowel Syndrome) improved significantly
for 9 in 10 of his first 100 patients so treated. He began
referring patients as long ago as the 1990s and has found it to be
very effective. “It is pretty clear to me that it has an amazing
effect” “Of the relaxation therapies available, hypnotherapy
is the most powerful” he said.
Despite
research showing that hypnosis could help IBS sufferers as early
as the 1980s, it is still rarely offered as an option. Current NHS
guidelines allow for referral for hypnotherapy or other
psychological therapies if medication is unsuccessful or symptoms
persist. Doctor Valori thinks that the research may have been
overlooked because many doctors find it hard to believe that it
could possibly work, and cannot understand how it might work.
Two
other areas where hypnotherapy could prove cost effective and
beneficial are weight control and smoking cessation. According to
a report in August 2013 by the Health & Social Care
Information centre (HSCIC);
-
Over 2.2 million items were prescribed at a cost of over £58
million to help smoking cessation in England.
-
Around 462,900 adult hospital admissions were attributable to
smoking
According
to a study by Mckinsey Global Institute (MGI) in November 2014,
obesity has the second largest health impact after smoking. The UK
currently spends £47 billion every year on treatment of obesity,
and bringing just 20 percent of overweight individuals back to
“normal” weight within 5 to 10 years would save the NHS £766
million every year.
Dr.
Alison Tedstone, chief nutritionist at Public Health England (PHE)
said that tackling the problem required communication between
public and private sectors, and “There is no single ‘silver
bullet’ solution. Today 25 percent of the nation is obese and 37
percent is overweight. If we reduce obesity to 1993 levels, where
15 percent of the population were obese, we will avoid 5 million
disease cases and save the NHS alone an additional £1.2 billion
by 2034,”
As
more hypnosis techniques are utilized and further research is
conducted and published, still greater results may be obtained
across many more areas of treatment, to the point that
hypnotherapy and hypnosis could become a mainstream NHS offering.
Surely
further education and promotion of these techniques could be of
massive benefit to medical staff and the NHS as a whole, not to
mention the patients.
Correct.
I like the way you have, again, really read and understood the
elements of the question and answered accordingly, drawing on the
given article and also adding to its premise with further
research. This is a very interesting and informative answer.
Example
answer Student 2
The
doctor’s view that his small-scale study of 100 patients falls
short of what is widely accepted as a controlled scientific
experiment. A larger controlled study including double blind
testing of many more patients with measurable levels of IBS
discomfort and exactly what style of hypnosis as well as which
standard interventions are used verses the current standard
treatment of medication would be needed to provide conclusive
proof of the doctors’ claims.
Any
claim to save money would need clarification as to the duration of
such relief, the number of hypnosis sessions and a comparison of
the typical cost of drugs consumed for the same period of relief.
The
medical profession has a long held suspicion of Alternative Health
Treatments, mainly due to the limited scientific evidence as to
their effectiveness, hypnosis as well as several other alternative
treatments have been shown to assist some suffers but as each
individuals response to these sessions has been wide ranging from
excellent to no help it is difficult to produce consistent
repeatable empirical data on which to make an informed judgement.
IBS
is often regarded a stress related illness which should respond
well to hypnosis, however some IBS is not and to add to the
problem some IBS is of unknown origin. Each person responds
differently to stress so its impact on their particular episode of
IBS is virtually immeasurable due to the wide range of variables.
Whilst
many clients have stated hypnosis has helped sometimes when
medicine has been unable or has stopped being effective, the
scientific research and therefore data is not available due to
The
consultant responsible for developing the treatment plan for each
individual patient would have to take into account a huge range of
information about the patient including suggestibility testing to
decide if hypnosis was a viable treatment requiring further
training and understanding beyond that already held by medical
consultants.
Q10.
Correct. You have made some important points here and have
recognised the difficulties presented, giving a balanced and
detailed assessment.
Example
answer 3In
the current political climate, the NHS and funding is a political
‘hot potato.’ At a time when budgets are overspent and being
cut and the preference for traditional medication is losing some
of its dominance, alternatives are being sought and persuasive
arguments being made. One of these arguments can be made for the
treatment of Irritable Bowel Syndrome (IBS). NHS.uk defines this
as
“A common long term condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhea and/or constipation.” Figures from NHS.uk and the IBS network (www.theibsnetwork.org) indicate that up to one in five people may experience IBS at some point in their lives. There is a greater incidence for women than men (twice as many) with an onset of between 20 and 30 years old. Symptoms can be managed by making changes to diet (avoiding trigger food/drinks and increasing fiber levels) or lifestyle (reducing stress and increasing exercise) or symptomatic relief via medication can be provided, but there is no cure. The impact of not knowing when a bout may occur and the embarrassing nature of the symptoms often leads to an increased risk of depression and anxiety. These in turn have an impact on the economy and NHS- The Centre for Economic Performance’s Mental Health Policy Group report –How Mental Illness Loses Out In The NHS (2012) suggests figures of over £14 billion each year spent by the NHS on Mental Health (for all services/conditions) and extra physical healthcare for conditions caused or exacerbated by mental illness at an extra £10 billion/year. The report suggests for patients with anxiety conditions (roughly half of all mental illness) and for depression a series of CBT sessions with an approximate total cost of £750, has a result of a 50% recovery (mostly permanently for anxiety but depression has a higher relapse rate). When one adds the additional cost savings of being in employment, payment of taxes and contribution to spending, these figures are considered very cost effective and National programmes are and have been rolled out.
However not all cost saving
treatments are considered equal; whilst many
people experiencing IBS have reported relief by using
hypnotherapy, and published research supporting this has been
available since the 1980s, the scientific community are not widely
supportive of its use as a treatment. Dr Roland Valori, editor of
Frontline Gastroenterology, is unsure as to why but suggests
skepticism and lack of knowledge may be the reasons for the
reluctance. In the BBC article “Hypnotherapy 'can
help' irritable bowel syndrome” Dr Valori reports having
referred patients for hypnotherapy since the early 1990s. He
has conducted his own research where he has observed a 90% success
rate; broken down as 40% having symptoms cease and 50%
experiencing increased control over symptoms and reduction in
anxiety about them. In particular he reports the greatest benefit
for younger female patients and when treatment occurs sooner after
symptoms occur than for those who have experienced them for a
longer duration.
With
comparable savings and a growing body of support, perhaps its time
the scientific and medical community took another look at using
hypnotherapy to provide effective and cost efficient services for
its patients. And perhaps the current economic climate might
inspire this to take place sooner rather than later.
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|
Q11. Devise
and outline an appropriate psychological and hypnotherapy based
intervention for pain control, giving factors to be aware of during
the pre-talk and intervention.
Learning
outcomes: 1.2
An ability to devise an appropriate psychological intervention for a
medical condition.
Example
answer Student 1
Should
a client ask for help with pain control, it would be important to
determine the type of pain – Chronic or acute, and also the
perceived cause of the sensation. Bearing in mind that “Pain” is
actually a warning signal intended to protect the physical body, it
should be ascertained whether the cause of the particular sensation
of pain has been established. A referral from a GP would be
preferable.
Assuming
that it is deemed appropriate to proceed I would begin the pre-talk
explaining, with positive statements, that pain usually has a useful
function, and that they will certainly be able to control – but not
remove altogether- the sensation. I would ask when the pain is worse
and if anything particular exacerbates it.
Following
a suitable induction, deepener, and a convincer, I would guide them
to their own relaxing place where they could feel comfortable and
secure, and then anchor that feeling. From there I may ask them to
visualize a type of control, possibly a TV remote control, and
perhaps a bar-graph on a TV screen, similar to the volume. I would
have them notice that the control is labelled “DISCOMFORT” and
assure them that it actually varies the level of discomfort that they
feel. In order to convince them, having elicited their current level
of discomfort, I would ask them to very slightly increase the level
by means of the remote and notice the bar-graph respond as the
discomfort increased. I would hope to see a sign of this increased
dis-comfort, to be sure it was effective. Assuming that all was as
expected, I would ask them to use the remote control to lower their
discomfort to a manageable level. I would then have them set their
control to “AUTOMATIC” and assure them that it will maintain the
current level of sensation as necessary in all future circumstances.
I would ask them to test its response by imagining themselves in a
time or situation where they would previously have been in pain, and
have them notice their apparent comfort. I would ask them to repeat
this with further scenarios in which they might have previously
experienced dis-comfort, and now are comfortable, until I am sure
they are convinced of the effect. At that point I would have them
anchor their state of comfort, and tell them that triggering that
anchor at any time will instantly return them to their present
comfortable state.
I
may have them notice that the remote control has been mislaid, “The
way they often are…” but assure them that, should they need to
adjust it, they need only visualise it for it to become effective
again.
When
confident that the intervention has been successful, I would assist
them in returning to full consciousness, having them bring with them
any further helpful resources they might need.
A
comprehensive and clear answer, good. I particularly like your
definition of the pain experience and your approach with adaptation
of the classic control panel method with addition of powerful future
pacing.
My only
additional comment to you here is, where you say, "I would ask
when the pain is worse and if anything particular exacerbates it."
That you also maybe ask when it eases and maybe when it does not seem
to be an issue at all; what circumstances create more ease and
comfort... etc. This just helps to pre-establish the scale you are
introducing.
Also,
getting the sensation down to a manageable level is maybe what the
client has requested, though, having established that you may wish to
go further into comfort and ease.
Example
answer Student 2
The
most important factor to establish is that the patient has been or is
receiving medical treatment for the problem and their doctor is happy
for them to seek hypnosis for further assistance.
This
ensures you are not masking a serious medical problem potentially
making the condition or injury worse, also you may cause diagnostic
or treatment issues if the doctors are not aware the client is
undergoing hypnosis at the same time as medical treatment by changing
the response to the prescribed medications. I would remind them that
the pain is a signal something is wrong with their body and it is
usually there for a reason to get them to stop and if necessary seek
help.
The
intervention I would use would also need to be based on the
responsiveness of the client taking into account any effects of their
condition or medication, such as they may find it difficult to relax
due to pain or fall asleep due to the sedation effect of their
medication.
The
general intervention I would utilise would be based on changing the
perception of the pain into a noise response and give the client a
volume control by which they could adjust the volume, this would
allow them to vary the levels according to the stimulus they are
experiencing at any given moment.
During
the initial hypnotic session I would give the client the pain volume
control and make them turn it up one notch to notice the increase in
stimulus, then turn it down, this process convinces the client that
they can indeed influence the level of pain. I would also ensure the
client knows this method will only work on the targeted pain and if
any other pain is noticed they should see their doctor asap to
prevent them ignoring any other medical issues that may develop in
the future.
Correct.
You clearly understand the importance of the factors to be aware of
in relation to this condition and the necessity of vital information
gathering, plus ensuring the client is aware of the process. I like
your approach of using a volume control to parallel the body's pain
response too.
Q12.
Propose an ethically and therapeutically appropriate approach for
working with an adult whose presenting problem is weight control who
confides in you that they over use laxatives to control their weight
condition.
Learning
outcomes: 1.5
An ability to determine an ethically and therapeutically appropriate
approach for more complex cases where specific training may not be
available.
Example
answer Student 1
My
approach would be to firstly ascertain the type of laxative being
abused, fibrous or the more dangerous stimulant variety. Dependant on
this and my perceived severity of the abuse, I may consider referral
to a medical specialist due to the risk of damage already having
occurred to the clients’ organs. During my pre-talk, I would
explain the very real dangers of their over ingestion. I would then
positively assure the client that, following the necessary
intervention, they themselves would find that no further use of
laxatives would be considered necessary or acceptable. Indeed, they
would now find it easy to maintain a healthy and appropriate size and
weight simply by a balanced diet and healthy moderate exercise. By
these positive pre-suppositions I would reinforce the positive
outcome as a “done deal”.
Before during and after the actual intervention I would
consistently refer to their problem in the past tense, thereby
inferring that it was no longer an issue and had readily been dealt
with and overcome. As addiction to the laxatives would have to be
considered, the actual intervention would be based upon the “New
Behaviour Generator” with ‘dependency cessation’ woven into it.
This would consist of establishing communication with the clients’
subconscious mind, honouring it with praise for its good and positive
intentions, and then explaining that the current actions were not
actually beneficial. I would then ask it to conjure up new and better
ways to achieve the desired results of healthy size and weight, by
drawing upon its boundless resources, and ask it if it would be
willing to’ trial’ each new behaviour until it found a suitable
alternative. Following a positive communication from the
sub-conscious, I would ask it to adopt that alternative behaviour for
at least a fortnight, or until our next appointment, and again elicit
its agreement. Assuming a successful result, I would ask the client
to visualize a number of events in the near future, where they could
see themselves happily and confidently enjoying themselves, and have
them become aware of how positive and good they feel about their
appearance. I would anchor this and each subsequent positive feeling,
possibly to a commonly used word or colour. I would then repeat this
exercise until I felt that they had a firm grasp on the goal and
could realise that it was their future reality. I may include an
element of amnesia regarding their previous use of laxatives, and I
would include posthypnotic suggestions to reinforce their self-belief
and confidence.
In
conclusion, I would bring the client back to full waking awareness
and assure them of their success, making sure to ask them to contact
me with feedback.
Correct.
I like your approach and attention to the important factors involved
in this matter, together with how you propose you would deal with
such.
The future
pacing and powerful anchoring, together with confidence boosting is
also welcome, as is the assurance of follow up and feedback.
Example
answer Student 2
...Should
I encounter a client who is using laxatives for weight control I
would inform the client of the dangers of over using laxatives due to
the damage they can cause to the bowel function becoming impaired and
potential long term health issues which may develop.
I
would advise them to contact their GP for help and also offer to
refer them to an experienced hypnotist who does work with Weight
Control clients if they wished once their doctor has agreed.
I
would expect an ethical hypnotist would want to establish the
underlying cause of the laxative use verses reduced calorific intake
plus exercise routine and work on both aspects of the clients issues.
Stopping
the use of the laxatives as soon as possible to allow the bowels to
resume normal function, offering alternative forms of relieving
constipation if required, then work on the causes of the client over
eating with aversion therapy possibly a hypnotic gastric band
intervention. Finally providing the client with positive motivation
to lose weight and get fit and healthy which would ensure a long
lasting change.
Correct.
You have set out an ethically and therapeutically appropriate
approach for this most complex case. I applaud your recognition of
the necessity to establish the underlying root cause of the abuse of
laxatives, the appreciation of the medical dangers involved and the
interventions useful in such circumstances.
Q13.
Research the GHR Code of Ethics in relation to remote and online
therapy and other relevant materials and consider and discuss the
potential issues a therapist must consider before working online.
Learning
outcomes: 1.3
Sophisticated thinking, within the bounds of law and ethics, but
beyond the confines of unnecessarily dogmatic rules sometimes
asserted in training, supervision and reading.
Example
answer Student 1
The
GHR code of ethics, in relation to working remotely or online, is
clearly and concisely laid out in easy to follow terms. The code
appears to cover most issues that might arise from initial
consultation through to successful completion.
With
the advent of SKYPE and such technology a therapist can interact with
clients over almost any distance, making therapy available to anyone
with the necessary equipment. This can prove advantageous for both
therapist and client in terms of convenience and cost. However it can
be seen that, in comparison to a session conducted in a therapy room,
a number of additional factors apply to remote or online therapy.
Difficulties may include;
Obtaining
the necessary rapport between therapist and client, without personal
contact.
Recognising
important subtle signals that would be more apparent in a therapy
room.
Inability
to reinforce suggestions with physical contact. eg: Tapping forehead.
Technology
failure – at either end, or even power outage.
Any number of unforeseen interruptions.
Before
undertaking to conduct any remote or online therapy, it would be
advisable to gain real ‘hands on’ experience in a more
traditional setting.
Properly
accredited courses in conducting therapy online are available, and
the therapist should be properly trained in this discipline in
addition to their core expertise. Professional insurance for such
work should be obtained, and of course all safety measures should be
strictly adhered to. Even though the client remains at their own home
or chosen location, the therapist still has a duty of care and must
take all steps possible to protect the client from any harm. To this
end, the therapist should be satisfied that;
The
client has presented their true identity and location, and pertinent
medical history.
they
are in a sober and fit state to partake in the session to be
conducted.
The
clients full contact details, and those of their GP are known and
permission to contact their GP,
if so desired, should be obtained.
A
backup contact should be arranged for the event of any failure of the
communication technology.
Q13.
Correct. You have understood and processed well the requirements to
be aware of and put into practice when working with clients remotely
and have demonstrated the sophisticated thinking beyond the rules and
regulations and advisories of this practice.
Example
answer Student 2
Over
and above the standard procedures and practises of the GHR Code of
Ethics for therapists those that chose to work on-line or remotely
must comply with the following best practise to provide the best for
their clients and their practise.
The
therapist must ensure they understand the difference between
face-to-face treatment and on-line working, this includes the reduced
feedback from the client during both the assessment phase and the
actual treatment session itself.
The
therapist must be confident the client is who they say they are and
the contact details are correct. The therapist should be confident as
to the true nature of client’s issues prior to commencing any
sessions. They must have already agreed the standard personal
contract and paid the appropriate fees.
They
must be sure the client is not suffering from any relevant medical
conditions which could impact on the session and that they have
provided their GP’s details and phone number with authorisation in
case the therapist feels it necessary to make contact with the GP for
the wellbeing of the client, their family or the public.
The
therapist must be insured to work remotely or on-line, the therapist
and the client must have a suitable working environment a safe and
distraction free room, the therapist must be made aware of any other
persons present with the client and will have previously agreed if
the sessions are to be recorded in any way by the client.
The
client must also be aware and happy to work remotely or on-line,
including what to do in the case of technology failure issues, the
therapist must have a quality back up plan including a
landline/secondary phone number and if possible a third party
emergency contact number.
Ensure
all electronic transactions, emails, contract and fee scales etc. are
available to the client.
The
therapist must ensure the privacy and integrity of any material on
their computer systems prior to linking to any clients system and
deleting un-necessary material as soon as the clients contracted work
is completed.
Correct.
A well thought out answer with adherence to the advisories of the
Code and issues beyond its remit. You have understood and processed
well the requirements to be aware of and put into practice when
working with clients remotely and have demonstrated sophisticated
thinking beyond the rules and regulations.
Q14. Read
the following article and comment and discuss your views on Epilepsy
and Hypnotherapy.
Learning
1.3 Sophisticated thinking, within the bounds of law and ethics, but
beyond the confines of unnecessarily dogmatic rules sometimes
asserted in training, supervision and reading.
.
http://med.stanford.edu/news/all-news/2008/02/hypnosis-helps-doctors-zero-in-on-kids-seizures.html
Hypnosis
helps doctors zero in on kids' seizures
FEB 122008
02/13/08
BY KRISTA
CONGER
It was
no way for an 11-year-old to live. For a month the boy had endured
daily episodes of uncontrollable jerking and foaming at the mouth,
and his physicians at Lucile Packard Children's Hospital were
concerned that the boy had epilepsy. Before starting the boy on a
lifetime of antiseizure medications, though, they turned to an
unconventional diagnostic tool: hypnosis.
'Children
are highly suggestible and they have great imaginations,' said
Packard Children's child psychiatrist Richard Shaw, MD. 'We've found
that if we suggest that they are going to have one of their events
while they are in a hypnotic trance, they will usually have one.'
But
wait. Aren't physicians supposed to try to STOP seizures rather than
searching for new ways to cause them? In a word, yes. But in order to
treat seizures effectively, doctors must learn which parts of the
brain are causing the trouble. Many children who seem to be having
epileptic seizures are actually having an involuntary physical
reaction to psychological stress in their lives. These events require
a vastly different treatment than do true epileptic seizures.
The
only way to pinpoint the true cause is to monitor the child's brain
activity during an event. Connecting a panel of electrodes to a
child's scalp is relatively easy and painless. Conducting a 'seizure
watch' of indefinite length is another matter.
'It's
very difficult for parents to spend three or four days in the
hospital hoping their child has a seizure,' said Packard Children's
chief of pediatric neurology, Donald Olson, MD. 'It puts them in a
very uncomfortable place emotionally.' Furthermore, some hospitalized
children, removed from the very stressors that may be causing the
events, never have a seizurelike event.
Hypnosis
can speed the process considerably, said Shaw and Olson. Together
with former medical student Neva Howard, they tested the procedure on
nine children between the ages of 8 to 16 whose seizurelike events
included twitching, loss of consciousness, shaking, jerking and
falling. Their results were published online in January in Epilepsy &
Behavior. The physicians needed to know whether these were true
epileptic events, which are best treated by medication, or
nonepileptic events caused by psychological stress or other
neurological problems.
'We
can't always distinguish epileptic from nonepileptic events visually,
or through descriptions by family or friends,' said Olson, an
associate professor of neurology, of neurosurgery and of pediatrics
at the School of Medicine. 'But regardless of the cause, these are
disabling, life-altering events that need to be treated.'
The
authors believe that, although hypnosis may not work for every child,
the technique is an important tool that can speed proper diagnosis
and treatment for children suffering from seizurelike events.
To
hypnotize the subjects, Shaw, an associate professor of psychiatry
and behavioral sciences and of pediatrics at the School of Medicine,
first used a combination of deep breathing and progressive muscle
relaxation to induce a state of relaxation and deep focused attention
in the subjects. He then used a combination of imagery and suggestion
to induce one of their typical seizurelike events. Children typically
visualize being at one of their favorite places - for one teen, it
was on a beach in the Bahamas. After a hypnotic trance was
established, Shaw would then direct the child to recall the feelings
or events that usually precede a typical seizure. Electrodes on the
child's scalp recorded their brain activity during the session.
In
eight out of nine cases, Shaw could successfully trigger a
seizurelike event with this procedure. After an appropriate
monitoring interval, Shaw then directed the hypnotized child to
'return' to his or her favorite place and the episode would stop.
Using this technique, the physicians found that all eight of the
subjects were experiencing nonepileptic events.
'We had
a number of clues that these particular children might not have
epilepsy,' said Olson, 'but hypnosis helped us confirm our
suspicions.' Physicians begin to suspect causes other than epilepsy
if an individual has a variety of episodes, if the person's cognition
is unaffected despite frequent seizures or if the person has a
pre-existing psychiatric diagnosis.
Were
the kids in the study relieved to find they didn't have epilepsy?
'Yes and no,' said Shaw. 'It's important to explain very clearly that
although these events are psychologically based, they are completely
out of a child's control.' He and Olson compare the events, which are
a type of condition called conversion disorder, to other well-known
ways that stress and emotions affect other bodily functions, such as
migraines, ulcers and blushing.
Stanford
is part of an ongoing multicenter study of these nonepileptic events
to better understand their causes and possible treatments. For now,
Shaw often couples psychotherapy with self-hypnosis lessons to teach
children how to avoid the events.
'When
they're feeling out of control, this is a tool they can use. They
know that they were able to 'turn off' an event during the initial
hypnosis, and that gives them confidence to try it themselves,' said
Shaw.
In
general, people are growing more comfortable with the idea of
hypnosis in a medical setting, said Olson. 'The first reaction of
many people may be to equate hypnosis with some sort of black magic.
But once we explain the reasons and benefits, they're very
accepting.'
By
KRISTA CONGER
Krista
Conger is a science writer for the medical school’s Office of
Communication & Public Affairs.
Example
answer Student 1
The
article by Krista Conger illustrates how hypnosis proved to be useful
in differentiating between actual epilepsy and psychological stress
induced involuntary reactions (Seizures). Deliberately triggering
such a reaction may appear to be counter- productive, but in order
for the event to be observed in a suitable environment with brain
scanning equipment, the reaction must be made predictable. In those
cases that proved to be stress related rather than true epilepsy, a
more suitable treatment and management regime could be implemented.
Psychological
stressors are known to be complex and varied, but can often be
alleviated or moderated with hypnotherapy alone. This could be by
means of a suitable intervention conducted by a hypnotherapist, or by
fairly simple techniques of self- hypnosis. The avoidance of a
reliance on prescription drugs is a far better outcome for the
patient.
By
current best practice, treatment of actual epilepsy consists of
prescription drugs and regular monitoring. Hypnotherapy is not
recognised as a suitable treatment, indeed trainee hypnotherapists
are advised to refuse to accept clients with epilepsy in their
medical history. The accepted causes of epilepsy appear to be varied;
hereditary, injury, medical condition or quite often simply unknown.
Far more research is needed in this area, and until the answers are
found the various recognised Anti-Epilepsy Drugs will be prescribed
in order to try to control the condition.
It
would perhaps seem appropriate that such a debilitating condition
could be treated with hypnotherapy, and certain neurologists, such as
Dr Tim Betts of Birmingham University, have found it to be useful.
Dr
Betts uses hypnosis to induce intense relaxation and concentration,
so that the mind becomes detached from everyday concerns. In this
state, the subconscious is best able to respond creatively to the
hypnotist’s suggestions, and focus on aspects of the person’s
life where change is desired. (Canadian Epilepsy Alliance, 2008).
Unfortunately
the use of hypnosis in such cases is largely seen as “complimentary”
or “Alternative” and is not embraced by the mainstream modern
medical establishment. It can only be hoped that the work of Dr Betts
and his peers will further enlighten the medical community, and that
those suffering from epilepsy will become free of their condition and
hte drugs.
Q14.
Correct. Good comment and discussion on this topic and also
interesting additional information regarding the work of Dr Betts,
thank you.
Example
answer Student 2
Having
met several people who are diagnosed as Pseudo fitters, some have no
control over their seizures others are merely pretending for a number
of reasons (attention seekers or to avoid something or someone)
The
one’s who are deemed to have no control are not epileptic’s in
the normal sense of the word but as suggested in the article may be
subject to a stress reaction thou many are the result of other
medical conditions such as alcohol withdrawal or non prescription
drug use.
One
patient in particular stated he has seizures in response to pain from
nerve damage in his arm, he has claimed to fit for up to a staggering
3 hours, thou the length of time was not witnessed, his wife on
arrival back from a long shopping trip was able to talk him out of
his fit in a few minutes, giving credibility to the argument that the
patient can have some control over their seizures.
The
use of hypnosis to induce a seizure must be carefully scrutinised as
has been shown in many stage hypnosis shows, a good subject can be
persuaded to do and experience many things which could potentially
include reproducing a seizure from memory to please the physician but
not induce an actual epileptic fit which the patient might actually
suffer from but brought on by another trigger.
I
believe the subject should have further research and must include a
full brain scan of a patient undergoing both a hypnotic induced
seizure and a naturally occurring seizure to ensure both are produced
from the same parts of the brain and the hypnotic seizure is not just
a memory.
Such
a study must be carried out by highly trained individuals under
appropriately prepared conditions with full medical support as
seizures can be life threatening and no research is worth a death of
a patient.
Personally
I would be very reluctant to work with anyone suffering from Epilepsy
unless under strict medical supervision as it is almost impossible to
know what triggers a seizure and if, as the article suggests, it is
possible to induce a seizure under hypnosis it is not a certainty
that you could communicate sufficiently well with a patient in a
seizure to end the episode effectively before the patient sustains
harm.
Q14.
Correct. Your answer demonstrates the sophisticated thinking that
this advanced course promotes, within the bounds of law and ethics,
though also being beyond the confines of dogmatic rules, using your
personal experience to come to your conclusions. Having witnessed
the ceasing of a seizure in the manner described is a valuable
experience to share with other less experienced hypnotherapists and I
encourage discussion on this topic at peer support and on the online
forums. You make a good point also of the difficulties in
communication when a client is in trance and fitting is induced. The
brain scanning comparison is also a useful if not vital element to
bring into this scenario.
Q15.
If your client has an epileptic seizure advise the steps you would
take to care for the client.
Learning
outcomes: 1.11
Knowing how to take an appropriate course of action with a client who
is experiencing an epileptic seizure.
Example
answer Student 1
If
a client were to experience an epileptic seizure I would first ensure
that they did not cause themselves any injury, and would move any
objects away to prevent
such injury. I
would check that they were breathing and loosen
their clothing if necessary,
then monitor them and continue to calm and reassure them until the
seizure abated.
From
the client consent form I would know if they had previously
experienced a seizure, and if they had not, I would call
for an ambulance to
attend. If they were used to such seizures occurring, and seemed to
be no worse for the experience, I would ensure that they were fully
lucid and allow them to continue the session or to leave the therapy
room.
Q15.
Correct. Good answer. Yes, if collars or ties are restrictive it
would be advisable to loosen such, also when convulsions abate then
turning them onto their side may be advisable too. Take note of the
duration of the episode also. You have demonstrated knowledge of how
to take an appropriate course of action with a client who is
experiencing an epileptic seizure.
Example
answer Student 2
During
the initial interview you should have been made aware of the patients
medical conditions including epilepsy and at that point asked a few
more questions regarding how they manage their condition and made an
informed decision on whether or not you would actually use hypnosis
with them.
Should
a patient suddenly go into any form of seizure (known epileptic or
not) then I would use the standard medical process of
lead to the floor if necessary,
protects the head
using pillows loosen tight clothing around the neck etc.
and wait for the seizure
to pass. If seizure
last more than a few minutes or you become concerned for any reason,
consider calling for
an ambulance.
Once
past and the patient is recovered enough to answer questions (or
their companion if any) ensure whether they have single or multiple
seizures, have they any other medical conditions, have they taken
they regular medications and importantly ask if anything is different
about this last seizure, if so phone 999 and get them checked over
with the opportunity of transport to hospital if necessary.
Q15.
Correct. You have demonstrated your thorough knowledge and skill in
this arena, thank you.
Q16.
How would you address the following situation. A husband has paid for
his wife to have a stop smoking session. The wife does not want to
stop smoking however the husband is adamant because he discovered one
of their young children trying to smoke one of her cigarettes.
Learning
outcomes: 4.1
Advanced thinking around difficult ethical issues, particularly those
outside of codes of ethics and where an unambiguous and universally
agreed upon solution is unavailable.
Example
answer Student 1
I
would firstly advise the client that I would not conduct a smoking
cessation session with someone, unless the person receiving the
therapy actually wanted it for themselves, and not just to appease
another. I would question the client to determine their own
reluctance to cease smoking, and would try to understand exactly what
she gets from it and why she would choose to continue the habit. I
might mention, conversationally, some of the issues associated with
her continued smoking, especially regarding her children. By
reference to both research and the “Stop smoking” public health
campaigns, I would endeavour to have her agree that the benefits of
stopping smoking far outweigh the reasons for her to continue to
smoke. If I could have her agree this, I would continue and have her
suggesting the reasons why she should stop. If this continued and
she actually asked me to proceed with the session, I would get her to
state it a number of times, along with the reasons, to reinforce the
belief that stopping smoking really was her best option.
If
I was satisfied that she really had changed her mind and did indeed
now want to stop smoking, I would proceed with the session. However
if I detected, at this stage, any reluctance to leave the habit
behind, I would refuse to continue at that time and suggest that she
book a session at a later time, when she had resolved that she wanted
to stop.
Q16.
Correct and good answer. Inspiring and developing motivation is a
really good idea rather than a flat refusal to treat and this is
where you need your advanced thinking around difficult ethical
issues, particularly those outside of codes of ethics, comes into
play as is outlined in the learning outcomes. I would agree with
this approach and commend the action taken.
Example
answer Student 2
...The
problem with this scenario is that:
1) you
can not force someone to stop smoking on behalf of someone else,
2) the
child’s interest is already there, therefore the mother stopping
now will not change the child’s curiosity
3) the
parents have other issues such as poor communication to work on
rather than focusing on the wife’s smoking.
I
would suggest the wife looks at the reasons behind the husbands
position and suggest she might wish to consider stopping/reducing the
amount of smoking in front of the child, I would also request they
both had a talk with the child (dependant on the child’s mental
age), asking why they wanted to start smoking, also potentially
explaining that whilst smoking is bad for their health the mother is
trying to stop and how hard that is where as the child shouldn’t
start as that’s easier.
Q16. You
have demonstrated advanced thinking around this difficult ethical
issue and brought up some insightful and valid points.
Q17.
Criteria for empirically supported therapies have been defined by
Chambless and Hollon (1998). When is a therapy considered
efficacious in this context?
Learning
outcomes: 5.7
An understanding of the term 'empirically supported
therapies/treatments'.
Example
answer Student 1
The
criteria defined by Chambless and Hollon considers a minimum of 2
separate tests
showing superior results of experiments against medications, placebos
and previously accredited treatments. The experiments they evaluated
were for limited illness’s only:
Anxiety and stress, insomnia, pain management and
certain psychosomatic illness only.
They
went on to state further research was necessary to extend the range
of illness’s covered but this has yet to be carried out to a
satisfactory standard for full accreditation of hypnosis for use in
the treatment of other conditions.
Criteria
for empirical support are:
The
study must be replicated in two independent research settings and all
if any conflicts must be resolved to be efficacious and specific.
If
it effective in only one of the tests then it is classed as possibly
efficacious.
1.The
importance of independent replication before a treatment has been
established in efficacy is emphasised, and a number of factors are
elaborated that should be weighed in evaluating whether studies
supporting efficacy are sound.
2.
The therapy must be compared with a no treatment control group, an
alternative therapy, or placebo.
Must
be more beneficial than no therapy or placebo AND at least equivalent
to an alternative or established therapy.
3.
The empirical study must use sound scientific methods.
Q18.
Discuss how you would deal with a client who has become dependent on
you.
Learning
outcomes: 1.12
Knowing how to sensitively and firmly handle clients who breach
personal or professional boundaries.
Example
answer Student 1
Throughout
any sessions I would emphasise the progress they are making and the
growth as a person they have made. Re-enforcing how well they are
managing every situation they have encountered and will manage in the
future using the future pacing process.
This
positive re-enforcement should help the client to realise how they
have grown and changed as well how they are capable of coping with
life’s little trials as an individual reducing any dependence on
our sessions for answers to their problems and increasing their
confidence in their own ability to resolve their future issues.
After
an initial session I usually have a fairly closely spaced follow up
session to re-enforce and anchor their new thought patterns roughly
one week later with one further follow up session up to one month
afterwards if considered necessary, my normal block of sessions would
only be for 2 or 3 session with email support or possibly phone
support should they have a crisis.
Should
I consider the client becoming dependant on our sessions I would
ensure the next session included plenty of self empowerment
suggestions and acceptance of their new found abilities to cope, if
they still continued to make contact I would have to re-assess what
they wanted from the sessions by further meta-questioning and decide
if I was still able to assist them properly or refer them to another
therapist or doctor.
Q18.
Correct. This is a good answer, ultimately culminating in referral
to another therapist if attachment issues persist, after efforts to
address. You have demonstrated knowledge of how to sensitively and
firmly handle clients who breach personal or professional boundaries.
Q19.
Give the advantages and disadvantages of a
hypnotherapy treatment that is not supported by scientific research.
Learning
outcomes: 3.8
A demonstrable and respectful appreciation of both the advantages and
disadvantages of interventions that have, or have not, been
scientifically researched.
Example
answer Student 1
The
disadvantages are:
Not
empirically proven to assist with clients issue, may generate false
hope which may in turn cause the client to discontinue all treatments
both medical and alternative health.
May
actually mask symptoms and/or affect medical treatments by disguising
changes in their condition, possibly leading to a worsening of the
condition without the client being aware,
Having
no corroborating evidence to support use of hypnosis, having provable
support helps the client believe in the process increasing the
potency of the treatment, the placebo effect,
Without
research the medical profession is unlikely to support or promote the
benefits and therefore the future use of hypnosis.
Without
research there is little information to guide the hypnotist as to the
best way to assist the client and/or the doctors.
Hypnosis
is dependent on the practitioner being good at their job and the
clients have to be good subjects for the best results, these are not
measurable qualities using scientific methods.
The
Advantages are:
Hypnosis
is free from side effects,
Hypnosis
at the least effective level can lift the spirits of the client
allowing self healing to take place which will speed up recovery and
reduce problems,
Hypnosis
can be holistic and treat the client as a whole, your energy levels
are increasing, whilst when you need to, you can relax and sleep
peacefully in one carefully worded suggestion,
Hypnosis
could also if necessary be targeted where as medication rarely has
only one effect, so for example pain killers whilst reducing pain
makes the client sleepy and lethargic, hypnosis can relieve pain
without sedating the client.
Hypnosis
is almost instant in taking effect and if it doesn’t work for this
client/condition it can be stopped immediately, again no side
effects,
The
anecdotal list of conditions for which hypnosis has helped is growing
daily, there is nothing to lose in trying hypnosis for any and all
conditions you come across, if it fails the client has lost nothing
if it works they have gained everything.
Q19.
Correct. A good clear answer outlining your respectful appreciation
of both the advantages and disadvantages of interventions that have,
or have not, been scientifically researched, just as the learning
outcomes dictate. A thoughtful and well delivered answer.
Example
answer Student 2
Training
gives you the basics, hands on working with clients gives you
experience, however even if you have had many months of continuous
training or years of experience you are always likely to have a
client presenting with something you didn’t cover or forgot since
your course or just plain never heard of before. That’s where the
peer groups support is vital to ensure you are giving your best to
your clients, the one’s you find easy may be difficult for another
hypnotherapist and visa versa, sharing case notes (appropriately
censored) helps to broaden everyone’s knowledge and experience as
even the most comprehensive training manual could not possible cover
every potential clients situation, so being able to ask fellow
hypnotherapists is the best practical solution.
Hypnotherapy
is a solitary role with just a number of clients with problems
passing across your doorstep, this can lead to burn out if you do not
have the support and ability to off load some of the issues you are
presented with, talk therapy counsellors are required to have regular
meeting with supervisory counsellors themselves to prevent the
emotional overload that comes with listening to their clients,
hypnotists are just as likely to hear and take on some of their
clients issues and as such must have the facility to off load as
necessary and peer support and mentoring are all part of the process.
Also
each hypnotherapist can help their colleagues, for example you as a
hypnotist specialising in weight control may be approached by someone
with PTSD and that is a subject you do not normally work with but
through your peer group you know a fellow hypnotist who does, you can
refer the client safely knowing the client is in good hands and that
other hypnotist may well make referrals back on issues you are
specialising in.
Correct.
You have brought up some important points that show your
appreciation of peer support communication and attendance and you
have recognised the important advantages of continued contact with
peers and the sharing of information. Please look at the mechanics
of organising your own peer group sessions for a fuller answer in
line with the learning outcomes, otherwise a very appreciative and
appropriate answer, well done.
Example
answer Student 3
Alternative
therapies or approaches such as hypnotherapy often lack scientific
validation, and as a result their effectiveness is considered either
unproven or disproven. "There is no alternative medicine. There
is only scientifically proven, evidence-based medicine supported by
solid data or unproven medicine, for which scientific evidence is
lacking- P.B. Fontanarosa, Journal of the American Medical
Association (1998).
Scientific research has many advantages to bestow upon the treatments which fall within its remit. In order to qualify as scientific, or ‘evidence based,’ research must include a range of specifically designed scientific studies. Ideally performance on a given test or measure is taken before and after the intervention and participants randomly assigned to control or experimental groups. There must be measurable, sustained improvements in a defined area and with a large sample size – defined from past research and statistical analysis. An independent variable should be identified – one which is able to be manipulated in order to measure the effect on the dependent variable. External variables are controlled so that the relationship between the independent and dependent variable can be observed. The overall intention is to increase control and make accurate measurements of variables with an aim to increase objectivity and the ability to replicate.
There are advantages of hypnotherapy research attempting to comply with the scientific methodology even on a small scale. By doing so each study contributes to a body of research to build upon and develop; it is granted the ‘approval’ of the scientific community and is therefore easier to defend in terms of validity and ‘reliability. But people are not reliable and their effects are less easy to replicate - they vary from day to day, from moment to moment and session to session, especially if they know they are being observed. To avoid the participant effect, some scientific research is conducted as case study or case review in retrospect which in turn have their own disadvantages of memory and bias. These methods can be used just as easily for hypnotherapy research although with the same disadvantages. In the same way it is possible to measure effects before and after a hypnotherapy intervention, albeit via subjective responses- for example rating of pain before and after a session. Even if one took the most cynical attitude that hypnotherapy is a placebo- the fact that change exists is often the most important for the client, not what enabled it.
However even in tightly controlled scientific experiments, not all variables can be completely controlled. The creation of a scientific experiment can cause an artificial environment where people behave as they are expected to and these are then difficult to expand to be able to generalise to reality. Many hypnotherapists may argue that this is in fact similar to hypnotherapy – creating a condition to enable the participant to be open to suggestion. And as a wise psychology teacher of mine once drilled into us during statistics classes – correlation does not infer cause and effect. Her favourite example was the scientific causality link between eating ice cream and drowning; much more likely to be caused by sunshine behaviour at the beach than the ice-cream itself. This is a great example of the nature of the human condition – a factor which can be lost by using scientific research alone.
There are also
advantages of not using pure scientific methodology, one of which is
that if by doing so we prevent hypnotherapy from happening. Every
session we conduct cannot contribute to research but it can
contribute to the net total of knowledge. Whilst a session may not
meet the criteria, it will still have the practice methodology and
can have hypotheses – although not ones that can be tested for
statistical error. But we can use the principals for new and exciting
trials; subjective experience can be observed and recorded in the way
in which it was experienced; small numbers (as small as one) can be
part of something greater- for the client and hypnotherapy as a
whole. In addition costs to administer and develop may be smaller
without the scientific constraints and from here the only limitation
is imagination as to what hypnotherapy could be used for…
Hypnotherapy has no recorded side effects, there are no disadvantages
for trying it to assist new or less understood illnesses and unlike
many medical or scientific ‘treatments’ the administration of the
intervention is as therapeutic as the after effects.
Whilst it is true that without the backing of the scientific research it is harder for hypnotherapy to de-bunk the de-bunkers; there are many who will never accept alternative treatments with or without hard scientific ’proof’. It is also difficult to refute any accusations of harm caused – how can one prove you didn’t cause something if one cannot prove what you did do? But it is also important to remember that aspects of medical science such as surgery or anatomical dissection were once considered an abomination against nature – every part of a new science must start somewhere and build the mass of evidence which one day will reach a critical mass of acceptance. There is a balance to be struck between empirical evidence and scientifically principalled hypnotherapy; some things are so individual they are hard to express let alone to capture in a way that can be subjected to statistics. Any hypnotherapist who has had a client who cannot express how they feel after a session other than ‘yes’ will know the value of the smile that is lighting up the person’s face, or the lightness that appears throughout their body upon waking. It just doesn’t show up on a graph (unless it’s an inverted bell curve).
Q21.
Investigating related material sources on the internet, discuss how
bias can be avoided in scientific research.
Learning
outcomes: 5.3
An understanding of 'bias' in research.
Example
answer Student 1
The
internet is full of material covering every imaginable subject, the
vast majority of this information is unchecked or verified. Ranging
from phishing and hacking sites through aggressive sales sites to the
prestigious scientific community sites. Sales websites often pose as
official looking research sites in order to give an air of authority
to their work whilst glossing over the fact their research is, at
best, bias towards their product.
Wikipedia
is often the first reference site used by the public when researching
a subject, however Wikipedia is an open source site, which allows
anyone to post information about a subject, and allows others to
verify or report inaccuracies. The vast majority of the information
on Wikipedia is quite accurate however it should not be trusted
implicitly and further checks on its content must be undertaken
before accepting its information such as cross referencing with other
sites and sources.
Once
you have identified a reliable source of information you should look
to the following to give an indication as to the accuracy of the
content.
The
methodology of any research experiments must be open and transparent,
with a clearly defined purpose, they must also be carried out in a
scientific way in that they must be controlled conditions with
repeatable and clearly defined results which are measurable utilizing
scientific standards, the test size should also be statically large
enough to ensure a true representation of the effects (7 people out
of 10 selected volunteers doesn’t not truly reflect the efficacy of
a medicine or treatment etc. designed to be given to millions of
people) Check their case studies for validity and accurate recording
of results making sure the evidence is scientific and not anecdotal.
The
testing process must also include the use where possible of double
blind testing as well as the use of a control set to be in place to
ensure a true and accurate result to exclude the potential for human
bias on the part of the subjects or the researchers tainting the
results. Ensure the research has been validated and reviewed by other
experts in the field, checking on any referencing given.
These
methods are fairly standard in almost all research facilities,
however when surfing the internet for information it is always best
to obtain information from several sources where possible and also to
verify each source independently to ensure the quality of their
information.
Q21. More
information required. You have provided a clear understanding of
inaccuracies of information on the internet and warnings as to
anomolies encountered and also the idea of commercial bias, where a
salesperson may sway information towards a commercial end, however
please provide detail of a broader view of scientific bias.
Research
Bias
For
example, when using social
research subjects,
it is far easier to become attached to a certain viewpoint,
jeopardizing impartiality.
The
main point to remember with bias is
that, in many disciplines, it is unavoidable. Anyexperimental
design process
involves understanding the inherent biases and minimizing the
effects.
In quantitative
research,
the researcher tries to eliminate bias completely whereas,
inqualitative
research,
it is all about understanding that it will happen.
Design
bias is introduced when the researcher fails to take into account the
inherent biases liable in most types of experiment.
Some
bias is inevitable, and the researcher must show that they understand
this, and have tried their best to lessen the impact, or take it into
account in the statistics and analysis.
Another
type of design bias occurs after the research is finished and the
results analyzed. This is when the original misgivings of the
researchers are not included in the publicity, all too common in
these days of press releases and politically motivated research.
For
example, research into the health benefits of Acai berries may
neglect the researcher’s awareness of limitations in the sample
group. The group tested may have been all female, or all over a
certain age.
Selection/Sampling
Bias
Sampling
bias occurs
when the process of sampling actually introduces an inherent bias
into the study. There are two types of sampling bias, based around
those samples that you omit, and those that you include:
Omission
Bias
This
research bias occurs when certain groups are omitted from the sample.
An example might be that ethnic minorities are excluded or,
conversely, only ethnic minorities are studied.
For
example, a study into heart disease that used only white males,
generally volunteers, cannot be extrapolated to the entire
population, which includes women and other ethnic groups.
Omission
bias is often unavoidable, so the researchers have to incorporate and
account for this bias in the experimental design.
Inclusive
Bias
This
type of bias is often a result of convenience where, for example,
volunteers are the only group available, and they tend to fit a
narrow demographic range.
There
is no problem with it, as long as the researchers are aware that they
cannot extrapolate the results to fit the entire population.
Enlisting students outside a bar, for a psychological study, will not
give a fully representative group.
Procedural
Bias
Procedural
bias is where an unfair amount of pressure is applied to the
subjects, forcing them to complete their responses quickly.
For
example, employees asked to fill out a questionnaire during
their break period are likely to rush, rather than reading the
questions properly.
Using
students forced to volunteer for course credit is another type of
research bias, and they are more than likely to fill the survey in
quickly, leaving plenty of time to visit the bar.
Measurement
Bias
In
a quantitative experiment, a faulty scale would cause an instrument
bias and invalidate the entire experiment. In qualitative research,
the scope for bias is wider and much more subtle, and the researcher
must be constantly aware of the problems.
- Subjects are often extremely reluctant to give socially unacceptable answers, for fear of being judged. For example, a subject may strive to avoid appearing homophobic or racist in an interview.
This can
skew the results, and is one reason why researchers often use a
combination of interviews, with an anonymous questionnaire, in order
to minimize measurement bias.
- Particularly in participant studies, performing the research will actually have an effect upon the behavior of the sample groups. This is unavoidable, and the researcher must attempt to assess the potential effect.
- Instrument bias is one of the most common sources of measurement bias in quantitative experiments. This is the reason why instruments should be properly calibrated, and multiple samples taken to eliminate any obviously flawed or aberrant results.
Interviewer
Bias
This
is one of the most difficult research biases to avoid in many
quantitative experiments when relying upon interviews.
With
interviewer bias, the interviewer may subconsciously give subtle
clues in with body language, or tone of voice, that subtly influence
the subject into giving answers skewed towards the interviewer’s
own opinions, prejudices and values.
Any experimental
design must
factor this into account, or use some form of anonymous process to
eliminate the worst effects.
See
how to avoid this:Double
Blind Experiment
Response
Bias
Conversely,
response bias is a type of bias where the subject consciously, or
subconsciously, gives response that they think that the interviewer
wants to hear.
The
subject may also believe that they understand the experiment and are
aware of the expected findings, so adapt their responses to suit.
Again,
this type of bias must be factored into the experiment,
or the amount of information given to the subject must be restricted,
to prevent them from understanding the full extent of the research.
Reporting
Bias
Reporting
Bias is where an error is made in the way that the results are
disseminated in the literature.
With the growth of the internet, this type of bias is becoming a
greater source of concern.
The
main source of this type of bias arises because positive research
tends to be reported much more often than research where the null
hypothesis is
upheld. Increasingly, research companies bury some research, trying
to publicize favorable findings.
Unfortunately,
for many types of studies, such as meta-analysis,
the negative results are just as important to the statistics.
Q22.
How would you as a therapist assess the suitability of a technique,
its outcome and your own personal performance of delivering that
technique.
Learning
outcomes: 3.7
An ability to implement new techniques without direct supervision and
critically reflect on this, e.g. assessing the suitability of the
technique, outcome, and personal performance.
Example
answer Student 1
Generally
the suitability of a techniques depends on if it works for the client
sitting in front of you at the time of use, the outcome would be via
client feedback initially during the session i.e. are they responding
physiologically and hypnotically as expected, blushing, muscle
flaccidly etc. are they accepting the suggestions and do they come
out of trance in a good frame of mind, which would also lead to an
initial judgement on the delivery/performance of the therapist.
All
of these should be recorded in your client notes, how they felt, how
they responded etc. including how you felt the session went with
notes for improvements so as to improve your client's experience and
your performance overall as an informal reflective journal on each
client.
The
next phase of the judgement would be either at the next session or by
some other form of feedback off the client (verbal, phone or email)
stating how they felt after the session, how well the suggestions
have worked and what changes they have made to their lives since the
session.
It
is also very useful to keep a more formal reflective journal to
ensure you are working to your best and to help identify any areas
you should work on to provide the best for you and your clients,
which would then be used during mentoring and/or peer support
sessions.
Q22.
Correct. You have provided good strategies for assessing the
suitability of the technique, outcome, and personal performance, as
required by the learning outcome. I am marking this answer as
correct due to your previous answer regarding using a volume control
metaphor of your own devising, to deal with a client's pain response,
which has shown your ability to implement new techniques without
direct supervision and to critically reflect on it, which is also
part of the learning outcome to this question.
Q23.
Discuss the advantages of group hypnotherapy.
Learning
outcomes: 1.13
An understanding of the advantages and disadvantages of group
hypnotherapy.
Example
answer Student 1
Group
hypnosis is a great way of helping large numbers of people at the
same time.
Such
as a whole slimmer’s club of 20 – 30 people could be given
healthy eating/lifestyle suggestions in a single one hour session
rather than 20 – 30 individual sessions making it quick and
therefore cheaper for the individuals involved whilst the hypnotist
is able to make a living whilst providing a time/cost effective
session for the club.
Also
group hypnosis is a great form of advertising for inclusion in talks
to clubs and groups, such as Rotary clubs, health clubs etc. as well
as providing a good convincer for the participants of not only the
power of hypnosis but also the skill of the hypnotist.
Another
advantage of group working is peer pressure within the group of
subjects, there is a perceived pressure to follow the instructions
amongst the group assisting the hypnotist to work with the group more
effectively leading them into the hypnotic process.
The
group knowing they are safe as there is perceived safety in numbers
helping with the rapport building and the collective mind will pick
up and tend to follow everyone else into trance.
Q23.
Correct. You have demonstrated a good understanding of the
advantages to be gained by hosting group hypnotherapy sessions.
Also, bear in mind that often a client that may not have attended a
one to one session will come along with a friend to such an event and
then choose to experience a private session at a later date.
Q24.
Discuss what is meant by the term primary gain.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
Primary
gain is the initial reason for commencing a particular behaviour,
such as starting to smoke as all your friends smoke and you want to
be part of the group. This would normally be easily identified by the
initial meta questioning of the client, but further questioning must
take place to confirm this as still the only purpose for the
behaviour to continue or the session will be far more difficult than
necessary.
Q24.
Correct. You have provided an understanding of primary gain.
Q25. What
is meant by the term secondary gain and give an example.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
The
secondary gain is the reason a person continues a particular
behaviour beyond the initial reason or gain and may not have been
part of the reasoning for the client to have commenced this
particular behaviour but developed as time goes by, such as a smoker
now wishes to continue smoking as the act of smoking actually allows
them to take extra breaks from work or from a stressful situation,
they now find smoking relaxes them which is beyond the primary gain
of that the clients regular friends all smoke and the client wants to
continue to be part of that group, another secondary gain could be
that this group are also the works gossip corner and the client
wishes to continue smoking to hear the latest chatter.
The
hypnotist must understand and work with any secondary gains as well
as the primary gains in order to bring about the changes the client
requests or the secondary gains will undermine the potency any
suggestions given.
Correct.
Additionally, remember the interesting thing about secondary gains is
that the client is usually totally unaware of them and indeed often
insulted by the idea of them if presented unsympathetically.
Q26.
Discuss the term malingering as it relates to your client and offer
strategies to deal with this.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
Malingering
is often considered as intentionally (thou may be sub consciously)
exaggerating symptoms and conditions for the purpose of gaining some
external/secondary gains, such as if I’m too ill to do things for
myself my partner will do them for me or I’m unable to change my
life as its too difficult/stressful for me to do all these things
today.
By
getting the client to see and accept this is their strategy and then
they can take responsibility for their actions, which is the first
step to bringing about change.
To
show them the positives in doing things for themselves, growing self
confidence and self worth etc. or how each small step can build into
a massive change over time and that they are able to grow as a human
being with small changes on a daily basis.
Q26.
Correct. You have presented an understanding of malingering and how
to deal with such. Asserting that a person is malingering where the
complaint is of a subjective nature is a tricky area In the
Medicolegal arena steps are taken to attempt to determine whether the
individual 'should' be feeling pain, for example, to the extent that
they state they do when dealing with issues of compensation for
injury. Usually the term is used when the pain is not accompanied by
objectively demonstrable organic abnormalities. However, sensations
of pain are subjective and pain thresholds vary. As you say, this
can be an subconscious process though the pain sensations can be very
real. This often occurs in relation to complaints of pain in
situations where the person is entitled to receive pain contingent
compensation or is suing for damages. There are at present no valid
clinical methods for detection of malingered pain, though
hypnotherapy can often bring about significant relief with one's
perception of pain signals when the secondary gain and/or other
factors have been addressed.
Q27.
How would you prioritise the client and specific, localised,
contextual issues over inflexible, rule-based thinking? ie bottom up
versus top down thinking.
Learning
outcomes: 1.4
Prioritising the client and specific, localised, contextual issues
over inflexible rule-based thinking (i.e. 'bottom-up' versus
'top-down' thinking).
All
clients will have their own standard way of thinking and processing
their life, the hypnotist must identify which processes the client
utilises and ensure they use a hypnotic/therapeutic process that
compliments the client.
The
top down client sees the big picture/situation first and then has to
break it right down to understand the finer details/workings of the
situation whilst the bottom up thinking client sees the small details
first and builds upon them to create the bigger picture.
To
work with a top down client you would have to get them to accept more
generalised suggestions, a process which would work well for a top
down thinker is for general suggestions to be given and then to let
their sub-conscious mind make the changes necessary to bring about
the outcome they desire, utilising the Future paced process would
allow them to just focus on the bigger picture or end result and
allow the sub-conscious mind to work out the route to achieve the
desired overall changes.
Where
as the bottom up client would respond better to smaller suggestions
that lead to the overall required outcome such as slow your breathing
and notice how relaxed you become leading to a reduction in stress,
utilising the new behaviour generator would work well for them as
they do not need to be bothered with the end outcome consciously but
to concentrate on the small changes which eventually results in the
desired changes to the bigger picture.
One
of the first challenges for the hypnotist is to identify the clients
style of thinking and working out the best process for them, whilst
keeping in mind the stated outcomes the client has requested.
Q27.
Correct. Additional to this however, it is importance to recognise
the value of working with swapping these constructs around. For
example, when a client thinks themselves 'fat' at an identity level,
believing that fat is very difficult to shift after the age of forty,
this is an example of inflexible top down rule-based thinking
programmed into the client. Encouraging them to swap to bottom up
thinking could serve them well. For example, 'Yes, I understand you
are saying your particular body has built up some reserve of excess
energy at the moment and you would prefer that energy to be used up
and shifted from your body. Maybe a deeper level of thinking about
your own specific circumstances can encourage an experiment to change
to how you live your life every day and what you may be able to do to
use up some of that energy or reduce the amount of energy that is
ingested into the body so that this situation is addressed and is
more under your own personal control.'
Q28.
Locate a piece of hypnotherapy research on pain control. Include
statistical evidence and explanation. Explain the scientific
methodology used in this research and its advantages. Properly cite
your reference sources.
Learning
outcomes: 5.5
A demonstrable ability to locate hypnotherapy research.
Hypnotherapy
for the Management of Chronic Pain
Fibromyalgia
In
a controlled study, Haanen et al. (1991) randomly assigned 40
patients with fibromyalgia to groups that received either eight
1-hour sessions of hypnotherapy with a self-hypnosis home-practice
tape over a 3-month period, or physical therapy (that included 12 to
24 hours of massage and muscle relaxation training) for 3 months.
Outcome was assessed pre- and post treatment and at 3-month
follow-up. The hypnosis intervention included an arm-levitation
induction and suggestions for ego strengthening, relaxation, improved
sleep, and “control of muscle pain.” Compared with patients in
the physical therapy group, the patients who received hypnosis showed
significantly better outcomes on measures of muscle pain, fatigue,
sleep disturbance, distress, and patient overall assessment of
outcome. These differences were maintained at the 3-month follow-up
assessment and the average percent decrease in pain among patients
who received hypnosis (35%) was clinically significant, whereas the
percent decrease in the patients who received physical therapy was
marginal (2%).
Controlled
trial of hypnotherapy in the treatment of refractory fibromyalgia.
Haanen
HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP,
Hekster GB J Rheumatol. 1991 Jan; 18(1):72-5.
Int
J Clin Exp Hypn. Author manuscript; available in PMC 2009 Sep 25.
Published
in final edited form as:
Int
J Clin Exp Hypn. 2007 Jul; 55(3): 275–287.
doi:
10.1080/00207140701338621
The
above abstract includes the statistical data of how many patients
were selected for the trial, the period of the experiment and
follow-up assessments as well as a basic report on the findings, the
two basic methods of treatment are also reported.
A
random number of subjects from a selected pool of previously
diagnosed Fibromyalgia sufferers were given hypnosis and hypnotic
recordings to listen to over a 3-month period whilst another group of
subjects were given massage and muscle relaxation training.
At
the end of the initial experiment all the subjects were again
measured for any changes/improvements in their symptoms and measured
again after a 3-month period to monitor how these
changes/improvements had lasted.
The
results showed that hypnosis and hypnotic recordings were
significantly more effective in pain management and managing the
other symptoms of Fibromyalgia than simple massage and muscle
relaxation.
The
advantages of these experiments is that the subjects all have a known
medical condition which has measurable symptoms and as such can
provide a repeatable set of results. This experiment has been
repeated by several different research facilities utilising other
forms of treatment from pharmaceuticals to massage etc. verses
hypnosis as well as hypnosis in conjunction with these traditional
treatments and they have all found hypnosis improves the subject’s
condition.
Correct.
You have demonstrated your ability to locate hypnotherapy research
and to comment and evaluate on this particular subject of
fibromyalgia treatment with good citations throughout.
Q29.
You are setting up a peer group. Please describe, in a paragraph or
two, the benefits and how you would go about organising and promoting
it.
Learning
outcomes: 6.1 An appreciation for the benefits of peer groups and an
awareness of how to organise one.
Peer
groups are essential for growing the skill set and confidence of any
hypnotist as it exposes them to a range of client based issues and
solutions they would not normally see, the group can bring reflective
notes on past clients or potential clients and the group can work out
the how they would deal with each situation and then decide on the
best solutions between them, raising the knowledge of all in
attendance, as well as providing them with the support during the
early stages of their career on other matters of establishing a
successful therapy business not normally covered in classes or new
and innovative procedure and inductions etc.
To
set up a peer support group I would look to either the people in
class whilst I was studying or hypnosis forums such as Facebook, etc.
hopefully engaging with people from different training backgrounds
and certainly looking for different levels of skill and experience to
provide the greatest benefits to the group as a whole. Once a group
of people are agreeable to meeting up a suitable location should be
found for confidential discussions of anonymous clients issues but
with suitable facilities for social interactions such as light
refreshment and drinks to promote friendship amongst the group.
If
the group is too dispersed to meet physically then a private Facebook
group is an option but face to face meeting are preferable as they
are easier to share and support each other.
Correct.
A good answer with an appreciation of the process and practicalities
involved.
Q30.
Discuss the disadvantages of group hypnotherapy.
Learning
outcomes:
1.13
An understanding of the advantages and disadvantages of group
hypnotherapy.
The
group must either all want to be hypnotised or at least allow others
in the group to be, disruption such as chattering or getting up to
leave during the session would make it quite difficult for both the
hypnotist and the willing participants.
With
a group of people the hypnotist must monitor each and every
individual to ensure they are following instructions and the
hypnotist must pace the induction process to match everyone in the
group, this usually means to the slowest responder there as the
faster ones will wait for them to catch up but the slower ones will
get lost and come out of state if not coached correctly.
The
hypnotist should be utilising the correct form of induction for a
group situation, one in which they can easily see the current level
of each subject, a typical induction for groups being the magnetic
hands.
The
group must all be expecting the same style of suggestions i.e. not a
mix of smokers and slimmer’s wanting to change at the same time.
Time
is also a factor as the large number of the population who can be
easily hypnotised will not stay in hypnosis for too long without
direct intervention by the hypnotist which with a large group may be
challenging, something only a confident hypnotist should attempt.
The
hypnotist must also ensure they can be clearly heard by all of the
group which may require the use of a P.A. systems etc.
Correct.
Some well thought out and insightful observations of the
difficulties in hypnotising groups of people simultaneously.
Case
Study one:
You
have an appointment with a new client, Mark, who has booked in for
smoking cessation. Your client, Mark, enters the practice and you
engage in small talk about how he travelled there and you notice
there is no eye contact as he continues to look down most of the
time. The conversation then turns to the reason for his visit and
what you may be able to help them with and the reply comes back, “I
don’t really see the point anymore, I am too tired to carry on”,
or “everyone would be better off if I was not here”.
When
asked how long the client has been feeling this way, it transpires
that his wife recently left him and she has begun divorce
proceedings. It is likely to be a prolonged battle over assets and
child access. He volunteers that he feels he has not slept well for
weeks and is alternating between being tearful and irrationally
angry.
Discuss
how would you deal with this client and any associated issues.
Having
obtained a good level of rapport I would use meta-questioning get the
client to expand on their opening comments to establish a better
understanding of the client's current frame of mind as well as
identifying the right steps to assist him in the best way possible.
I
would look towards gaining permission to work with the client on his
other issues rather than the smoking during this session, I would
inform the client I felt stopping smoking at this time unproductive
due to all the other issues currently in his life, as I would
consider them more important.
If
the client is agreeable to continuing with this new direction of the
session I would want to work with his self-esteem and confidence
issues as well as stress release as he appears to be struggling with
these at this time and assisting with his poor sleep issues, which
should have a beneficial effect on him generally.
Utilising
the Control Room to adjust his Subjective Levels of Discomfort and
directing his sub-conscious mind to resolve his stress related issues
as best as possible with a strongly anchored quality sleep suggestion
incorporating Reframing of his future, possibly utilising Parts
Therapy if I discovered it to be appropriate during the
meta-questioning.
I
would request the client had at least another session preferably
within a week to monitor and support them whilst ensuring sustained
progress.
I
would closely monitor his behavioural changes (both during the
session and after) to make an informed decision as to the next step.
I
would strongly consider the client's true intent, bearing in mind his
comments of “too tired to carry on” and “ everyone would be
better off if I was not here”, should I consider these statements
to be more than a throwaway comment I would try and persuade the
client to contact his GP and discuss how he is feeling, if I felt it
necessary I would contact the GP myself to report my concerns as
required under the Code of Ethics.
A
good assessment of the situation here and a clear and concise plan of
action both of progressing with the therapy session and the various
implications. Though there really are no right or wrong answers
here, it is a good approach, as you say, to avoid dealing with the
smoking cessation at this initial stage, when it may be a supportive
mechanism necessary to his well being at present.
Case
Study two:
Mary
arrives at your practice for help losing weight. In your pre-talk
she comments angrily about the behaviour of her nine year old son,
Josh, who never does anything she asks. She has been a lone parent
for over a year since the breakup of her relationship which she
blamed on Josh’s bad behaviour. She says she is at her wits’
end and does not understand why he is so badly behaved. She
admitted that he angered her so much one night that she even threw an
empty bottle in Josh’s direction when he particularly upset her.
As you ask about her eating habits etc she volunteers that she and
her son live on a diet of fast foods which are delivered to the home
as she never has time to shop or cook properly because her job
involves long hours, where she is not home until late, and it is very
stressful. She then tells you that she cannot sleep unless she
drinks at least a whole bottle of wine every night.
Discuss
how would you deal with this client and any associated issues.
Having
obtained a good level of rapport I would use meta-questioning get the
client to expand on their opening comments to establish a better
understanding of their current frame of mind as well as identifying
the right steps to assist them in best way possible.
I
would look towards gaining permission to work with the client on her
other issues rather than the weight control during this session, as I
would consider them more important at this time.
If
the client is agreeable to continuing with this new direction of the
session I would want to work with stress release and anger management
as that appears to be the major issues at this time and also
assisting with her poor sleep pattern, which should have a beneficial
effect on her general life. I would consider use some Ericksonion
metaphors to work on her acceptance of her current position as I
would expect some issues around feeling guilty of her behaviour
towards her child which may help to move forward.
Utilising
the Control Room to identify and adjust her Subjective Levels of
Discomfort, directing her sub-conscious mind to resolve the stress
and anger related issues as best as possible with a strongly anchored
quality sleep suggestion incorporating Reframing of her future,
possibly utilising Parts Therapy or potentially Regression Therapy if
I discovered it to be appropriate during the meta-questioning.
I
would request the client had further sessions with at least another
preferably within a week to monitor and support them during this
vulnerable stage whilst the on-going work would ensure sustained
progress.
I
would closely monitor any behavioural changes (both during the
session and after) to make an informed decision as to the next step.
I
would try and persuade the client to contact her GP and discuss both
how she is feeling and possibly helping with her drinking dependant
on how dependant she believes she is on the alcohol, the GP could
also to identify any assistance there may be available with a
reference for her to social services for greater support with
bringing up a child under these circumstances.
If
I felt it necessary I would contact the GP myself to report my
concerns as required under the Code of Ethics as her child is
potentially at risk of harm should her situation continue un-changed
or deteriorate further.
A
good approach and due consideration of the implications of this
complex therapeutic situation with a good regard not only for the
well-being of the client, but for the child also. The therapeutic
structure of the session seems most appropriate and also the follow
up and timing of the other sessions. I particularly applaud your
recognition of the value of the sleep improvement as the initial step
toward an improved condition.
ALL
QUESTIONS AND ALL ANSWERS WITH LEARNING OUTCOMES
30….30
mins
29….30
mins finish 10:30
23….30
mins
20….30
mins finish 12:00
Lunch
12-1
4….15
mins finish 1:30
15…30
mins finish 2pm
14…1
hour finish 3pm
13…1
hour finish 4pm
8…1
hour finish 6pm
Q1.1
Which one of the following is NOT
a leading
question?
[LO 1.8]
a)
If you eat that whole tub of ice-cream what will happen to your
weight loss goal?
b)
What do you think about restrictive dieting? Many people tell me
that they consistently fail when dieting.
c)
Do you want to stop smoking right now or next week?
d)
Do you want to stop eating chocolate?
Learning
outcomes: 1.8
An ability to recognise 'leading' questions.
Example
answer Student 1
Answer
D is not a leading question.
The
other questions have presuppositions or suggested outcomes built in
the question
1.2
Give three
examples
of loaded
questions and when
and why you
would use these.
Learning
outcomes: 1.7
An ability to recognise 'loaded' questions.
NOTES:
Loaded questions
imply a fact that has not been previously established. These facts
often have a negative implication and cause the client to defend or
confirm their position.
Example
answer Student 1
Loaded
Questions:
1/
How many times have you tried to stop smoking before you came to
me?
2/
Did you manage to lose the weight before?
3/
Have you always had a poor memory?
Loaded
questions can be used during the meta-questioning process, carried
out at the beginning of the consultation to pin down the issue which
the client needs help with because their answer causes the client to
question their line of thinking and potentially their previous
actions / behaviours allowing them to see other options.
Your
examples are correct. Loaded questions imply a fact that has not
been previously established. These facts often have a negative
implication. As you say, metaquestioning causes the client to
question their line of thinking and behaving, however loaded
questions particularly are used to provoke confirmation or
contradiction of the implied statement to bypass the polite rehearsed
responses and to gain access to the underlying emotions. Your
example of ‘Did you manage to lose the weight before?’ will cause
the client to either give much detail regarding previous dieting
attempts or clarification that she/he had never had cause to be on a
diet as they had never considered themselves overweight before.
Good.
Example
answer Student 2
“When
did you start to overeat?”- Assumes that the respondent overeats
and began to do it at some point that they can remember. We could use
this to determine the period or age that a client began over eating
and this would help the therapist to cut straight to the point and
put pressure on the client to take ownership of their behaviour
rather than trying to sugar coat it and not take responsibility.
Correct.
In leading the client in this manner, it invites resistance and
discussion. The client could protest that in fact their weight
condition has little to do with the amount of food they eat and
perhaps it is their metabolism at fault. Or they could agree that
they DO overeat and you can then explore the reasons as to why that
occurs. Good answer.
“Do
you still blame yourself for your childhood experiences?” - Assumes
that the respondent blames themselves for something that happened to
them as a child and that there was a specific point at which this
behaviour started to occur. We could use this question to help the
client to see that they have been blaming themselves for something
that was possibly out of their control, and to help us and them to
understand that they are still doing this to a certain extent.
Correct.
Having suspected that the client does in fact blame themselves in
this manner which could be to their detriment this gives the client
the opportunity to discount or agree and you can then explore both
avenues.
“Have
you quit smoking already then? or do you want to quit now?” –
This assumes that the person was or still is a smoker and that if
they haven’t already quit then they only have the choice to quit
right away. It would be useful in questioning a client who wants to
give up smoking and encourages them to make the decision to quit
straight away rather than delaying it and having a get-out-clause.
Correct.
Using the presumption that they may already have quit (in fact, it
is a technique to be utilised in that you are drawing attention to
the very notion that they are NOT smoking right now, so in actuality,
they are sitting in front of you as a non smoker!). They are lead to
explore the notion of what being a non smoker would be like and may
then volunteer
difficulties
and restrictions that having given up smoking would present. You
are also of course implying that if they have not already given up,
they will be doing so now. Well done.
Q2. Giving examples of classic
non-commitment language, identify a client lacking commitment to the
behavioural change they state they would like and discuss methods of
increasing motivation and inspiring desired change.
Learning
outcomes: 2.2
A demonstrable understanding of psychological theories of motivation
and behavioural change and an ability to apply this to clinical
practice.
NOTES:
This question breaks down specifically into four parts.
1
giving examples of classic non commitment language – What do they
say?
2
identifying a client lacking commitment to the behavioural change
they would like – How do you know?
3
discussing methods of increasing motivation – What would you
discuss with them to move them on?
4
inspiring desired change – How would you move them forward?
Do
not hesitate to simplify and use bullet points to ensure you have
broken down the question and that you do not spend too much time and
effort in one section.
Example
answer Student 1
A
weight loss client, when asked how they would like to change, may
say;
“I
have tried so many diets - but THEY don't work! I joined a local gym
for a while, but after waiting for the bus I was too tired, and it's
so boring! Then I went to a weight-watchers meeting, but it wasn't
for me - I do enjoy my food!
So,
my friend, Sally, she suggested that I might like to try this
hypnosis thing, to see why I can't seem to be able to lose any
weight, and I thought I may as well see if it might make me any
slimmer”.
Such
a client exhibits a distinct lack of commitment, and is seeking a
'magic charm' cure that will effect change with no effort or
sacrifice being necessary. This is evident in the language used, full
of excuses and reasons why nothing has worked to date.
She
claims to have “tried” many diets – but for how long and how
seriously?
She
joined a local gym “For a while” - and took the bus rather than
walking.
She
attended “A” weight watchers meeting – and instantly decided it
was not for her.
“I
do enjoy my food!” - self justification of her habits.
A
friend suggested hypnosis, and she “thought I might like to try”
it to see (prove) why “I can't seem to be able to lose any weight”
I
would first meta-question to discover if the weight loss was
something that she really desired, or was it to satisfy a friend or a
partner, or to meet some other criteria. Having uncovered the real
reason I would then elicit all her perceived advantages of having
lost the required weight, and as many desirable consequences, for
her, of being fitter and possibly slimmer. I would seek and find a
real desire to change, and then obtain from the client a firm
commitment to work as necessary to make and keep the change.
Having
arrived at a sensible and healthy target weight for this client, I
would motivate her with examples of all the advantages elicited
earlier. In hypnosis, I would have her imagine achieving all the
goals she had previously stated, and I would assure her that she
could still “Enjoy her food” and she could also enjoy feeling
fitter and she could also enjoy exercise. Most of all, she could
enjoy seeing herself and feeling proud of her achievement.
Q2.
Correct. A well structured answer with good examples and analysis.
Good to recognise that you would recognise her desire to still enjoy
food too. The only point I would make here is that seeing herself
and feeling proud of her achievement would of course be based on what
is the positive outcome of this particular client and her
representational system. Well done.
Example
answer Student 2
Examples
of non-commitment language include ‘I might want to stop eating
sugary foods’; ‘I want to lose weight but I don’t want to
change my diet’; ‘I want to make changes some of the time, like
during the week, but would like to have weekends off’; ‘I thought
I might like to lose some weight’; ‘I can’t understand why I
have gained so much weight’; ‘I can’t seem to be able to make
lasting changes to my diet’; ‘I’m not ready to make changes
straight away but would like to learn how I can be more ready in the
future’; ‘I just have so many problems and issues around this
whole “weight loss thing” I just don’t know where to start’.
Increasing
motivation can be achieved through actual post hypnotic suggestion,
and also through the line of questioning used. Using suggestions
within a hypnosis session could be achieved through the ‘control
panel’ method, asking the client to locate their internal control
panel then more specifically the dial/lever/switch for ‘motivation
to change [Specified behaviour]’ turning the motivation down,
looking for a physical response to indicate that the process has been
carried out- such as a finger movement (ideomotor response/reflex,
IMR), then adjusting the dial/lever/switch to increase motivation and
getting another IMR to signify that the change has taken place, also
looking for facial expressions and/or physical reactions (such as
sighing or smiling or relaxation of facial muscles) to indicate that
the client has made those positive changes.
It
is also possible to inspire motivation to change an unwanted
behaviour through questioning alone. People who are finding it hard
to make change are generally ambivalent about change, they are unsure
whether they want to change or whether they want to continue doing
the same things- they feel two ways about it. Resolving the
ambivalence and therefore increasing motivation to change can be
achieved through questioning and listening and building rapport in a
very short space of time. Using a mixture of open questions –‘when
do you think your issues with food started?’, ‘What do you think
is the root cause of your issues with food?’- and closed questions,
‘Do you want to make changes to your behaviour?’, ‘when will
you start?’- the therapist can guide a client towards being more
motivated and less ambivalent about making permanent change. Leading
and directing the client can take shape using questions such as ‘if
you make no changes at all then how can you see your life in 5 years
time? How about if you made those changes now? How will you be, then,
in 5 years? Encouraging the client to imagine their life without
addressing and making changes can help them to be more motivated to
change. It is very important to build good rapport with the client in
every situation as a hypnotherapist who does not have good rapport
with their client will yield poor results. The therapist needs to
instigate a number of different questioning techniques in order to
increase motivation and desire to change, such as future pacing (as
mentioned) and leading questions (“What
do you think about restrictive dieting? Many people tell me that
they consistently fail when dieting”); Loaded questions ‘Have you
already stopped overeating or do you want to stop that now?’.
I
had a client who had what she called ‘an addiction to sugar’. She
repeatedly chose foods that were high in sugar despite the fact that
they left her feeling tired and sick and made her gain weight. She
had had gastric surgery and lost a vast amount of weight in a very
short period of time and was in face now under the weight that her
surgeon had advised her to reach, though still a healthy weight. She
found that even though she knew the risks involved with eating sugary
foods- such as diabetes, she had had chronically uncontrolled type 2
diabetes prior to surgery though this was under control at the time
of her session, her weight had been fairly stable at her low end of
the range for several months though in the past few weeks she had
gained a couple of pounds, she felt physically unwell after having
what she called ‘a chocolate binge’. Despite all the alarm bells
that were ringing for her she reported feeling very demotivated when
it came to changing her behaviour and was finding that her own
version of ‘trying’ to cut down or have will power just wasn’t
working any more.
I
led her towards feeling more motivated by asking her questions about
how and where the behaviour had originated, how she felt about her
body, how she had come to terms with being a significantly smaller
weight and size, how she felt her relationship with food and with
herself and others had changed as she had changed and delving into
whether she believed that she was worthy of making lasting and
healthy changes to her behaviour. It turned out that she was
ambivalent about changing her behaviour and lacking in motivation in
part because she still felt like ‘the fat woman’ and like she had
no right to look and feel good. Her self-esteem and self-worth were
severely low and I was able to steer her thinking and attitude in the
direction of the root issue- that she felt unworthy of being slim and
healthy, without even going into too much detail about how that
attitude had manifested- eg her experiences as a child- she began to
see for the first time how much she had allowed that inappropriate
view of herself control her behaviour and how unnecessary it was to
live up to that out-dated view of herself and I could physically see
her thinking change and her motivation to change her behaviour
increase without ever having to address her original lack of
motivation whilst she was in trance.
From
your first section of this answer I would have advised you to be more
specific, in terms of taking each example you stated and then
addressing each one in turn, rather than generalising. However,
your very specific actual client experience addresses this and tells
me how you have not only understood the question but have had real
time experience of it. Additionally, the generalisations are valid
and true though and add much to communicate your understanding of the
question.
Example
answer Student 3
Non-commitment
language dilutes the power and intention of the stated desired
changes.
"Perhaps
I could try to start thinking about losing a bit of weight some time
soon"
A
client with full commitment to losing weight might say "I want
to lose weight and fit in my old clothes" which after
questioning can be improved to "I am going to eat healthy,
nutritional foods and increase my activity levels starring on Monday
and I will west my red dress to the Christmas party"
The
words "perhaps", " could", "try", "
start thinking about ", " a bit", "some time
soon" are all weak, "doubting" words that tell the sub
conscious that the client will be unsuccessful because there isn't
any real expectation of change.
The
lack of commitment may be because they have v come to you under
duress or because they have been told by friends or family or society
that they SHOULD wasn't those things but they themselves don't really
believe it or by into it themselves.
Alternatively
the client could be sabotaging themselves because they have tried in
the past and failed and do have that expectation of future failure,
or because of an underlying fear of what would happen if they were
successful and so they make sure that they will not be successful.
Being
aware of the client's body language and modality the first step is to
identify what change they would like to achieve. Starting with the
premise of "losing weight" what does this mean to the
client?
How
much weight do they want to lose? Have they been that weight before
or not? What was different in their life then and what we're they
doing differently (presuming that the client has a historical
reference point). What has changed? Is it possible to replicate that
now?
His
will they know when they have lost enough weight? What will that feel
like/look like/sound like? What will be different in their life? What
will they gain? What will they lose? What will their family fell
about the changes? And their friends? Will that have support or will
they be sabotaged?
What
is holding the client back from starting? What needs to change in
order for it to start and for the change to be successful? When will
that change be possible? Will there be any problems?
It
may be that the weight that registers on a number scale isn't really
what the client is aiming for (even if a number is mentioned). It may
be how they felt when they were that weight x number of years ago;
their social life; the job they were in; the life they had before
they had children; being on holiday and being able to wear a bikini
(rather than simply the size that the bikini was). The change may be
feeling healthier, or fitter or feeling confident in general.
So
:-
What does the client wasn't SPECIFICALLY.
When does the client wasn't it.
Is the client able to make the changes.
What has stopped those changes being made already.
How will the client know when they have achieved it.
When it is achieved what else will change.
Is the client happy with all of the changes.
What will happen if the change does not come about
Are the aims realistically achievable.
What does the client wasn't SPECIFICALLY.
When does the client wasn't it.
Is the client able to make the changes.
What has stopped those changes being made already.
How will the client know when they have achieved it.
When it is achieved what else will change.
Is the client happy with all of the changes.
What will happen if the change does not come about
Are the aims realistically achievable.
Presuming
that the desired loss of weight is achievable, measurable, had a goal
and does not cause conflicts the desire for making real change
possible to be a successful intervention has to be increased and made
concrete.
Where
the client days that they have never been their desired weight one
would ask the client if they had a role model or an image in their
mind (or on paper) of who they wanted to look like. To increase the
reality of this imagined end goal one would ask the client what that
person (or the historical them) would feel like, what they would be
doing, where they would be going, what they would see, who they would
see, what they would be wearing, what activities they would be doing,
where they would be eating and drinking, how they feel about
themselves and what they had achieved, what else they would be able
to achieve, what new things they would be able to try, making sure
that where the client is referring to an image of someone else that
they imagine that they are the other person and in all cases
encouraging the client to build up a tangible picture of what they
are aiming for and making it fully real and multi dimensional in full
color rather than a hypothetical, remote wish.
If
the client had been their target weight before one would ask the
client about that time (out times if they have been a yo-yo dieter).
What specifically were they doing, eating, driving, cooking,
exercise. What we're they doing in their spare time, where did they
go, who did they see, what did that wear, how did it make them feel,
what made them happy, what did they feel like,
In
either case the excitement and anticipating of the future state
should be enhanced and magnified, both to make the goal tangible and
a 3 dimensional complete reality, so that they know what they are
aiming for and also to make their stated desired change a strongly
attractive, desired outcome and a positive target for them to aim for
and work towards- - inspiration and motivation.
Next
comes the practicalities of achieving that goal.
What needs to happen for weight loss to be achieved (from their imagined solutions or from referring to past experiences) and evaluation if they are good choices to be replicated now. Depending on the client they may or may not have knowledge about healthy eating and dietary habits.
What needs to happen for weight loss to be achieved (from their imagined solutions or from referring to past experiences) and evaluation if they are good choices to be replicated now. Depending on the client they may or may not have knowledge about healthy eating and dietary habits.
"Maybe...."
and "I wonder if........" Ate good leading questions to
help clients find their own suggestions and solutions. "Perhaps
you could....." If they need more guidance. In any case though
it is important that the client feels that they are making their own
decisions rather than having them imposed otherwise the subconscious
still not accept you post hypnotic suggestions.
Ways
of increasing commitment to change is usefully done through future
pacing whereby they have achieved their goal and are acting as good
role models for their children etc. For example
"You see yourself sat at the kitchen table eating you mean. Your plate has a healthy mixture of vegetables and protein, you are drinking a glass of water and savouring every mouthful"
or
"You enjoy getting ready for the Christmas party, putting on make up and your favourite red dress that now for you perfectly and enjoying looking at yourself in the middle"
or
"You complete your first half marathon"
or
"You take part in your first mother's race at the schools sport's day and your children age cheering you on"
As appropriate for your client.
"You see yourself sat at the kitchen table eating you mean. Your plate has a healthy mixture of vegetables and protein, you are drinking a glass of water and savouring every mouthful"
or
"You enjoy getting ready for the Christmas party, putting on make up and your favourite red dress that now for you perfectly and enjoying looking at yourself in the middle"
or
"You complete your first half marathon"
or
"You take part in your first mother's race at the schools sport's day and your children age cheering you on"
As appropriate for your client.
You
give an excellent example here. You have identified some excellent
reasons as to why a client may be lacking in commitment in this
specific example.
You
have outlined future pacing as a way of increasing commitment to
change which could perhaps be seen as a motivating factor too, as
long as the future pacing detail directly corresponds to your
information gathering in the interview stage.
Q3.
What does
Hilgard’s Neodissociation
theory
propose with regards to trance?
- Hypnotic phenomena is produced through a disassociation within a high level control system
- Disassociation between imaginative processes and reality as it is perceived by the viewer
- A separation from past well established cognitive processes and the current interpretation of the view of the world
- Forming the intention to perform an action, without forming higher order thoughts about intending that action.
- Hypnotic behaviour is a social behaviour that can be explained without recourse to any special process.
Learning
outcomes: 2.1
Knowledge of the various theories on the nature of hypnosis.
Example
answer Student 1
Hilgard’s
Neodissociation theory proposes that a Hypnotic phenomenon is
produced through a dissociation with a high level control system.
Q4.
Which of the
following are NOT factors of 'pseudoscientific therapies/treatments'?
- Does not adhere to a valid scientific methodLacks supporting evidence
- Lacks plausibility
- Cannot be reliably tested
- Involves the use of sugar pills
- Vague, contradictory or improvable claims
- An over reliance on claims rather than evidence
Learning
outcomes: 5.6
An understanding of the term 'pseudoscientific therapies/treatments'.
Example
answer Student 1
E.
involves the use of sugar pills is NOT a factor.
The
other statements are an often used description of Pseudoscience
therapies and treatments.
Q5.
Clinical
studies have looked at how effective hypnosis is as a clinical
treatment for many conditions. For which condition is there NO
clinical evidence?
- Cancer remission
Learning
outcomes: 5.7
An understanding of the term 'empirically supported
therapies/treatments'.
Example
answer Student 1
Cancer
remission is the only subject listed for which clinical studies have
not provided evidence of effective treatment by hypnosis.
Q6.
In a maximum of 1500 words, explain what is meant by the term
extratherapeutic factors, how you would get to know about them from
the client and suggest an example that may impact on the outcome of
therapy.
Learning
outcomes: 1.9 An understanding of the nature and impact of
extratherapeutic factors.
Example
answer Student 1
The
term “Extra-therapeutic factors” refers mainly to that which
exists previous to and outside of the therapeutic scenario, those
such factors that accompany the client to therapy. These elements
include the clients own strengths / weaknesses, their abilities, any
specific fears, their faith and personal beliefs, also their life
experiences and their commitment and readiness to really change.
Many
other influences may be bearing upon the client, these can include
all the circumstances of their home and working environment, their
partner and other loved ones, and how much or how little support they
receive. It is estimated that approximately 40% of change is
attributable to client 'extra-therapeutic factors'. (Miller et-al:
1997).
The
existence and substance of such extra-therapeutic factors may be
elicited by careful meta-questioning, bearing in mind that each
client is unique and they will have obtained their own world view
which is, to them, perfectly reasonable. Care should be taken to
avoid directly challenging or refuting the clients position, while
guiding them to accept that further choices are available to them.
For
a particular presenting problem, possibly an irrational fear, or an
aversion to something innocuous, the therapist might decide that
'past life regression' is an appropriate course to take. However, the
client may be of a particular religion or belief that forbids or
distrusts any such thoughts regarding previous lives. Such a conflict
could result in the client “surfacing” from the state
prematurely, becoming upset, and no longer trusting the therapist.
Another
example where 'extra-therapeutic factors' could affect the outcome of
the therapy could be a client that is supported and encouraged in
making the desired change by those close to them. Conversely,
derision of or obstruction to the desired change by the clients peers
may be expected to impact badly upon the outcome.
A
client that wishes to stop smoking may be surrounded at home and work
by chain-smokers, or they may have lost someone close to them as a
direct result of smoking. Discovering such factors as these are
useful to the therapist, allowing the tailoring of suggestions to
suit, and may impact greatly upon a successful outcome.
Example
answer Student 2
Extratherapeutic
Factors are many and varied, they are an amalgam of components
external to the therapy itself. These will include the thoughts,
attitudes, life experiences and beliefs of the client, alongside this
are the strong impacts of their support systems and their personal
coping skills with the normal stresses of life. A sudden crisis
situation can be brought into the therapy situation and impact the
outcome. There may be a difficulty in the client re. their ability
and willingness to accept that change is indeed possible. Other
factors may include their religion or faith this can have a huge
impact on the way some clients respond to therapy. Motivation to
really commit to change and persistence in pushing through some of
these factors also has an impact on the outcome of therapy. It has
been estimated that circa 40% of the extratherapeutic factors
contribute to change.(Miller et-al: 1997 – Sprenkle and Blow et-al
2004 – Hubble et-al 1999)
Developing
solid rapport with the client thus eliciting their trust. Followed by
listening and hearing the answers to deep and careful
meta-questioning, without judging the clients view of their world,
which may well be very different to that of the therapist. From the
answers and being extremely careful not to openly oppose the answers
gained from the meta-questioning which may well cause a breaking of
rapport, advise and guide the client to understand that alternative
ways of dealing with their issues are available to them.
An
example of where the extratherapeutic factor may well impact therapy
is when a client states that they have been sent by a spouse or loved
one to quit smoking, but the client resents being forced into an
action that is not one they wish to commit to.
Unless
and until we understand the what and the how that our client
perceives themselves, their view of their world and importantly the
environment they inhabit it will make a successful outcome to therapy
difficult for the client as we will not be able to design and
organise the appropriate suggestions that will lead to a successful
outcome for both client and therapist.
Both
of the above are correct.
Q7.
What
approach would you take when hypnotising a child?
Learning
outcomes: 1.1
An understanding of advanced interventions.
Example
answer Student 1
...Those
therapists who work with children have to take into account certain
factors:
As
their client is under the age of consent they need written permission
of the parent / guardian as well as a current CRB certificate for
working with children, a a chaperone should be considered in many
circumstances.
The
formal style of hypnosis generally used today would not be
recommended for children as they struggle with their attention span
so are difficult to induce using the normal form of hypnosis. As
children are more imaginative than adults the preferred forms include
play therapy, Ericksonion metaphor story telling, a guided
visualisation such as between the child and the therapist making up a
story where the client is the central player and the therapist leads
the story feeding appropriate suggestions to bring about the required
changes.
Example
answer Student 2
To
work with children it would be best to adopt a permissive approach to
hypnosis. Depending upon the age of the child, a lack of cooperation
should be expected and allowed for. Lack of attention and fidgeting
could be a problem until the child's interest is secured. To this end
a “Play” scenario using their imagination may be useful, with
lots of encouragement and praise. Again dependant on the age and
personality of the child, a suitable induction should be utilized,
possibly based around a treasure trail , or a flying car.
During
the intervention, care should be taken to address only appropriate
issues, and to avoid any discomfort for them. After the session, fun
or funny post hypnotic suggestions could be used to reinforce the
desired goal or outcome. The whole experience should be made
enjoyable for the client, such that they relish the thought of
further sessions.
Q8.
Describe
a client scenario where you would choose to use Erickson’s
utilisation technique.
Learning
outcomes: 1.1
An understanding of advanced interventions.
Example
answer Student 1
A
client may well present an issue which they might be uncomfortable
discussing with a stranger, (the therapist), and hence appear
resistant. It could therefore be difficult to gain and maintain
rapport while endeavouring to uncover the root cause, and determine a
suitable intervention. In this instance I would attempt to apply
Erickson’s utilization approach; accepting the client – complete
with their issues – as they are, and working with whatever they
brought to the session. By agreeing and demonstrating a sincere
understanding and acceptance of their situation, I would hope to
forge a good therapeutic relationship on which to base any
intervention, negating any initial resistance and reinforcing their
trust in myself and the process.
Correct.
Yes, the Utilisation Technique is particularly useful with the
resistant client and that resistance may well be due to the subject
matter being uncomfortable for the client to discuss. This of course
is a matter of client perception, whether the client themselves
judges the matter to be so. Sexual matters, financial matters and
emotional discord are examples where the client may feel
uncomfortable discussing matters and where it is important to adopt a
matter of fact approach or, as you say, a sincere understanding and
acceptance of the situation, utilising whatever they bring to the
session to be helpful in the therapy.
It may be,
for example, that the client had been talking about difficulty in
parking when they arrived. If they later remarked that there was no
way to handle a situation or wanted to give up on a job or
relationship because they felt they did not know where it was going,
or it was impossible, the therapist could use the difficulty in
parking to assist. Such as, "There was an occasion when you did
not know where you were going and thought there was no way to get to
your destination or do what you wanted to do and yet you kept on
going until the perfect opportunity presented itself, not exactly how
you thought it would, but with creativity and patience you got there
in the end and can be pleased now that it all worked out so well...".
Q9.
State two
major theories of hypnosis. Outline and briefly discuss. Using the
Harvard citation method detail how you discovered this information.
Learning
outcomes: 2.1
Knowledge of the various theories on the nature of hypnosis. 3.3 An
ability to reference other authors' work properly, e.g. in 'Harvard'
and 'footnote' formats.
Example
answer Student 1
The
“Neodissociation theory” (Hilgard,1974) and the “Socio-cognitive
theory” (Spanos, 1986) are two competing theories regarding the
phenomena of hypnosis.
Neodissociation
is a “State” theory, that is to say that the hypnotized person is
thus in an altered state of mind. The hypnotists’ suggestions act
upon the dissociated part of the “Executive Control System” which
is shielded from the rest of the mind by an “amnesic barrier”.
Therefore the subject can be aware of the results of the given
suggestions, but remain unaware as to how they were achieved.
Hilgards theory arose from his experiments into the “hidden
observer” phenomenon whereby a “hidden” part of the mind can be
accessed to report on experiences that the subject is not aware of.
This concept of conscious and unconscious executive control systems
exhibited in hypnosis is controversial. (e.g Heap et al, 2004: Kirsch
& Lynn, 1998)
Spanos’
“Socio-cognitive” theory would appear to be the polar opposite of
dissociation, in that it is a “Non-state” theory. It argues that
subjects actively participate in the process, and that any phenomena
of involuntary experience is actually the result of normal
psychological processes such as beliefs, expectancies and motivation.
(Spanos et al , 1980) That is not to say that the client is
deliberately deceiving the hypnotist, or pretending to be affected
when they are not. Rather, their expectance of a phenomena or
particular result actually causes said results to be manifested.
Q9.
Correct, You have read the question well and I like the way you
compared the two models that you have chosen. You have a good
understanding of these models and have presented them clearly and
succinctly.
Example
answer Student 2
State
verse Non-State
“State”
theory
Hilgard's
Neodissociation theory of hypnosis is a classic 'state' theory. It
proposes that hypnotic phenomenon are produced through a dissociation
within high level control systems.
This
theory basically means that during the hypnotic induction the mind
(is split?) into two separate processes, the conscious part is aware
of the suggestions given, however the sub-conscious part accepts the
suggestion and then feedback the resulting action to the conscious
part. The conscious part takes no part in how the result was
processed.
This
is the process accepted by most direct hypnosis students, the client
must enter an altered state of being in order to accept the
suggestions, my original teaching proposed the Conscious and
Sub-Conscious minds were separate but interacting with a Critical
Factor (represented as a gatekeeper) between the two parts whose main
purpose was to keep the client doing what they always do, that which
is familiar, the Conscious mind and the gatekeeper had to be bypassed
in order for the client to accept the hypnotists new suggestions. The
Sub-Conscious is to be regarded as having the intelligence of a
bright 9yrs old child, (the approximate age children stop
automatically accepting such make believe things as the tooth fairy
and Santa Claus etc.) the hypnotist talks to the Sub-Conscious
stopping unproductive thought patterns and planting new more
productive thought patterns which are then run feeding into the
Conscious mind.
(Jonathon
Chase, Don’t
Look Into His Eye’s
1988)
“Non-State”
theory
Social-cognitive
theories form the 'non-state' end of the 'state-nonstate debate'.
State theories argue that processes such as 'repression' or
'dissociation' operate when subjects are given a suggestion, whereas
non-state theories view subjects as active "doers" and
observe the suggested effect as an enactment rather than a
happening (Spanos
et al, 1980).
This
process is both Ericksonian in that much of his work was by metaphors
and general story telling rather than the formal hypnosis of
Dissociated state hypnosis, Erickson would tell his clients long
rambling story’s with hidden threads of how they can change or
react to circumstances, the gentle rambling nature of these stories
allowed them to slip by the Critical Factor of the Conscious mind as
they appear to be just stories but the Sub-Conscious mind would pick
up on the meanings and take on board the lessons.
(Sidney
Rosen My
Voices Will Go With You: Teaching Tales of Milton Erickson:,1991
)
This is also how Dr Jonathon
Royal (a.k.a. Alex Smith) explains all hypnosis in his many training
books and seminars. He believes all hypnosis is fake and hypnotists
are merely giving their clients permission to do what they really
want, in the case of stage hypnosis, to perform and entertain without
feeling embarrassed, in the therapy room to make changes without
guilt or responsibility as “the hypnotist made me do it. Which is a
form of social compliance or peer pressure rather than any form of
altered state.
(Jonathon
Royal, "The
Encyclopedia of Hypnotherapy, Stage Hypnosis & Complete Mind
Therapy 2013)
Q9.
Correct, You have understood the question well and have compared the
two models that you have selected very effectively. Your answer
demonstrates a good understanding of these differing models
culminating in a demonstration of the varied approaches of the two
Jonathans.
Q10.
By reference
to the following article and further research, appraise, in a
professional, factual and non-emotive manner, the claim that
hypnotherapy could save the NHS money.
Learning
outcomes: 3.4 An ability to critically appraise, in a professional,
factual and non-emotive manner, claims made in the media, including
digital media such as websites, or those made by colleagues,
supervisors and trainers.
Hypnotherapy
'can help' irritable bowel syndrome
Greater
use of hypnotherapy to ease the symptoms of irritable bowel syndrome
would help sufferers and might save money, says a
gastroenterologist.Dr Roland Valori, editor of Frontline
Gastroenterology, said of the first 100 of his patients treated,
symptoms improved significantly for nine in 10.He said that although
previous research has shown hypnotherapy is effective for IBS
sufferers, it is not widely used.
This may be because doctors simply do not believe it works.
Widely ignored Irritable bowel syndrome (IBS) is a common gut problem which can cause abdominal pain, bloating, and sometimes diarrhoea or constipation.
Dr Valori, of Gloucestershire Royal Hospital, said the research evidence which shows that hypnotherapy could help sufferers of IBS was first published in the 1980s.He thinks it has been widely ignored because many doctors find it hard to believe that it does work, or to comprehend how it could work.He began referring IBS patients for hypnotherapy in the early 1990s and has found it to be highly effective.
"To be frank, I have never looked back," he said. He audited the first 100 cases he referred for hypnotherapy and found that the symptoms stopped completely in four in ten cases with typical IBS.
He says in a further five in 10 cases patients reported feeling more in control of their symptoms and were therefore much less troubled by them. "It is pretty clear to me that it has an amazing effect," he said.
"It seems to work particularly well on younger female patients with typical symptoms, and those who have only had IBS for a relatively short time."
Powerful effect He believes that it could work partly by helping to relax patients.
"Of the relaxation therapies available, hypnotherapy is the most powerful," he said.
He also says that IBS patients often face difficult situations in their lives, and hypnotherapy can help them respond to these stresses in a less harmful way. NHS guidelines allow doctors to refer IBS patients for hypnotherapy or other psychological therapies if medication is unsuccessful and the problem persists.
Dr Valori thinks that if hypnotherapy were used more widely it could possibly save the NHS money while improving patient care. Dr Charlie Murray, Secretary of the British Gastroenterology Society, said: "There is no doubt that hypnotherapy is helpful for some patients, but it depends on the skill and experience of those practising it.
This may be because doctors simply do not believe it works.
Widely ignored Irritable bowel syndrome (IBS) is a common gut problem which can cause abdominal pain, bloating, and sometimes diarrhoea or constipation.
Dr Valori, of Gloucestershire Royal Hospital, said the research evidence which shows that hypnotherapy could help sufferers of IBS was first published in the 1980s.He thinks it has been widely ignored because many doctors find it hard to believe that it does work, or to comprehend how it could work.He began referring IBS patients for hypnotherapy in the early 1990s and has found it to be highly effective.
"To be frank, I have never looked back," he said. He audited the first 100 cases he referred for hypnotherapy and found that the symptoms stopped completely in four in ten cases with typical IBS.
He says in a further five in 10 cases patients reported feeling more in control of their symptoms and were therefore much less troubled by them. "It is pretty clear to me that it has an amazing effect," he said.
"It seems to work particularly well on younger female patients with typical symptoms, and those who have only had IBS for a relatively short time."
Powerful effect He believes that it could work partly by helping to relax patients.
"Of the relaxation therapies available, hypnotherapy is the most powerful," he said.
He also says that IBS patients often face difficult situations in their lives, and hypnotherapy can help them respond to these stresses in a less harmful way. NHS guidelines allow doctors to refer IBS patients for hypnotherapy or other psychological therapies if medication is unsuccessful and the problem persists.
Dr Valori thinks that if hypnotherapy were used more widely it could possibly save the NHS money while improving patient care. Dr Charlie Murray, Secretary of the British Gastroenterology Society, said: "There is no doubt that hypnotherapy is helpful for some patients, but it depends on the skill and experience of those practising it.
"But
the degree to which it is effective is not well defined. "I
would support using it as one therapy, but it is no panacea."
|
Example
answer Student 1
Founded
in July 1948, funded by national insurance contributions, the
National Health Service was intended to provide access to health
care “Free at the point of delivery”.
The
funding of the NHS has been a massive problem to successive
governments ever since. As medical practices and techniques have
evolved, leading to newer and more expensive equipment for both
diagnosis and treatment, whole industries are now geared toward
researching, developing and supplying new drugs for each and every
malady imaginable.
Against
such a background, one might think that a safe and effective
alternative would be embraced by most medical professionals, both
for the economies involved and the comfort of their patients.
Unfortunately, it appears that many doctors choose to ignore the
results of the published research into the benefits of hypnosis.
Possibly viewed as a “Mystical” or “Eastern” practice, it
is shunned by the modern Western medical community in favour of
manufactured drugs and surgical solutions.
In
at least one field of medicine, published research has proved the
efficacy of hypnotherapy. Dr. Roland Valori of Gloucershire Royal
Hospital, editor of “Fronline Gastroenterology”, says that
symptoms of IBS (Irritable Bowel Syndrome) improved significantly
for 9 in 10 of his first 100 patients so treated. He began
referring patients as long ago as the 1990s and has found it to be
very effective. “It is pretty clear to me that it has an amazing
effect” “Of the relaxation therapies available, hypnotherapy
is the most powerful” he said.
Despite
research showing that hypnosis could help IBS sufferers as early
as the 1980s, it is still rarely offered as an option. Current NHS
guidelines allow for referral for hypnotherapy or other
psychological therapies if medication is unsuccessful or symptoms
persist. Doctor Valori thinks that the research may have been
overlooked because many doctors find it hard to believe that it
could possibly work, and cannot understand how it might work.
Two
other areas where hypnotherapy could prove cost effective and
beneficial are weight control and smoking cessation. According to
a report in August 2013 by the Health & Social Care
Information centre (HSCIC);
-
Over 2.2 million items were prescribed at a cost of over £58
million to help smoking cessation in England.
-
Around 462,900 adult hospital admissions were attributable to
smoking
According
to a study by Mckinsey Global Institute (MGI) in November 2014,
obesity has the second largest health impact after smoking. The UK
currently spends £47 billion every year on treatment of obesity,
and bringing just 20 percent of overweight individuals back to
“normal” weight within 5 to 10 years would save the NHS £766
million every year.
Dr.
Alison Tedstone, chief nutritionist at Public Health England (PHE)
said that tackling the problem required communication between
public and private sectors, and “There is no single ‘silver
bullet’ solution. Today 25 percent of the nation is obese and 37
percent is overweight. If we reduce obesity to 1993 levels, where
15 percent of the population were obese, we will avoid 5 million
disease cases and save the NHS alone an additional £1.2 billion
by 2034,”
As
more hypnosis techniques are utilized and further research is
conducted and published, still greater results may be obtained
across many more areas of treatment, to the point that
hypnotherapy and hypnosis could become a mainstream NHS offering.
Surely
further education and promotion of these techniques could be of
massive benefit to medical staff and the NHS as a whole, not to
mention the patients.
Correct.
I like the way you have, again, really read and understood the
elements of the question and answered accordingly, drawing on the
given article and also adding to its premise with further
research. This is a very interesting and informative answer.
Example
answer Student 2
The
doctor’s view that his small-scale study of 100 patients falls
short of what is widely accepted as a controlled scientific
experiment. A larger controlled study including double blind
testing of many more patients with measurable levels of IBS
discomfort and exactly what style of hypnosis as well as which
standard interventions are used verses the current standard
treatment of medication would be needed to provide conclusive
proof of the doctors’ claims.
Any
claim to save money would need clarification as to the duration of
such relief, the number of hypnosis sessions and a comparison of
the typical cost of drugs consumed for the same period of relief.
The
medical profession has a long held suspicion of Alternative Health
Treatments, mainly due to the limited scientific evidence as to
their effectiveness, hypnosis as well as several other alternative
treatments have been shown to assist some suffers but as each
individuals response to these sessions has been wide ranging from
excellent to no help it is difficult to produce consistent
repeatable empirical data on which to make an informed judgement.
IBS
is often regarded a stress related illness which should respond
well to hypnosis, however some IBS is not and to add to the
problem some IBS is of unknown origin. Each person responds
differently to stress so its impact on their particular episode of
IBS is virtually immeasurable due to the wide range of variables.
Whilst
many clients have stated hypnosis has helped sometimes when
medicine has been unable or has stopped being effective, the
scientific research and therefore data is not available due to
The
consultant responsible for developing the treatment plan for each
individual patient would have to take into account a huge range of
information about the patient including suggestibility testing to
decide if hypnosis was a viable treatment requiring further
training and understanding beyond that already held by medical
consultants.
Q10.
Correct. You have made some important points here and have
recognised the difficulties presented, giving a balanced and
detailed assessment.
Example
answer 3In
the current political climate, the NHS and funding is a political
‘hot potato.’ At a time when budgets are overspent and being
cut and the preference for traditional medication is losing some
of its dominance, alternatives are being sought and persuasive
arguments being made. One of these arguments can be made for the
treatment of Irritable Bowel Syndrome (IBS). NHS.uk defines this
as
“A common long term condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhea and/or constipation.” Figures from NHS.uk and the IBS network (www.theibsnetwork.org) indicate that up to one in five people may experience IBS at some point in their lives. There is a greater incidence for women than men (twice as many) with an onset of between 20 and 30 years old. Symptoms can be managed by making changes to diet (avoiding trigger food/drinks and increasing fiber levels) or lifestyle (reducing stress and increasing exercise) or symptomatic relief via medication can be provided, but there is no cure. The impact of not knowing when a bout may occur and the embarrassing nature of the symptoms often leads to an increased risk of depression and anxiety. These in turn have an impact on the economy and NHS- The Centre for Economic Performance’s Mental Health Policy Group report –How Mental Illness Loses Out In The NHS (2012) suggests figures of over £14 billion each year spent by the NHS on Mental Health (for all services/conditions) and extra physical healthcare for conditions caused or exacerbated by mental illness at an extra £10 billion/year. The report suggests for patients with anxiety conditions (roughly half of all mental illness) and for depression a series of CBT sessions with an approximate total cost of £750, has a result of a 50% recovery (mostly permanently for anxiety but depression has a higher relapse rate). When one adds the additional cost savings of being in employment, payment of taxes and contribution to spending, these figures are considered very cost effective and National programmes are and have been rolled out.
However not all cost saving
treatments are considered equal; whilst many
people experiencing IBS have reported relief by using
hypnotherapy, and published research supporting this has been
available since the 1980s, the scientific community are not widely
supportive of its use as a treatment. Dr Roland Valori, editor of
Frontline Gastroenterology, is unsure as to why but suggests
skepticism and lack of knowledge may be the reasons for the
reluctance. In the BBC article “Hypnotherapy 'can
help' irritable bowel syndrome” Dr Valori reports having
referred patients for hypnotherapy since the early 1990s. He
has conducted his own research where he has observed a 90% success
rate; broken down as 40% having symptoms cease and 50%
experiencing increased control over symptoms and reduction in
anxiety about them. In particular he reports the greatest benefit
for younger female patients and when treatment occurs sooner after
symptoms occur than for those who have experienced them for a
longer duration.
With
comparable savings and a growing body of support, perhaps its time
the scientific and medical community took another look at using
hypnotherapy to provide effective and cost efficient services for
its patients. And perhaps the current economic climate might
inspire this to take place sooner rather than later.
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|
Q11. Devise
and outline an appropriate psychological and hypnotherapy based
intervention for pain control, giving factors to be aware of during
the pre-talk and intervention.
Learning
outcomes: 1.2
An ability to devise an appropriate psychological intervention for a
medical condition.
Example
answer Student 1
Should
a client ask for help with pain control, it would be important to
determine the type of pain – Chronic or acute, and also the
perceived cause of the sensation. Bearing in mind that “Pain” is
actually a warning signal intended to protect the physical body, it
should be ascertained whether the cause of the particular sensation
of pain has been established. A referral from a GP would be
preferable.
Assuming
that it is deemed appropriate to proceed I would begin the pre-talk
explaining, with positive statements, that pain usually has a useful
function, and that they will certainly be able to control – but not
remove altogether- the sensation. I would ask when the pain is worse
and if anything particular exacerbates it.
Following
a suitable induction, deepener, and a convincer, I would guide them
to their own relaxing place where they could feel comfortable and
secure, and then anchor that feeling. From there I may ask them to
visualize a type of control, possibly a TV remote control, and
perhaps a bar-graph on a TV screen, similar to the volume. I would
have them notice that the control is labelled “DISCOMFORT” and
assure them that it actually varies the level of discomfort that they
feel. In order to convince them, having elicited their current level
of discomfort, I would ask them to very slightly increase the level
by means of the remote and notice the bar-graph respond as the
discomfort increased. I would hope to see a sign of this increased
dis-comfort, to be sure it was effective. Assuming that all was as
expected, I would ask them to use the remote control to lower their
discomfort to a manageable level. I would then have them set their
control to “AUTOMATIC” and assure them that it will maintain the
current level of sensation as necessary in all future circumstances.
I would ask them to test its response by imagining themselves in a
time or situation where they would previously have been in pain, and
have them notice their apparent comfort. I would ask them to repeat
this with further scenarios in which they might have previously
experienced dis-comfort, and now are comfortable, until I am sure
they are convinced of the effect. At that point I would have them
anchor their state of comfort, and tell them that triggering that
anchor at any time will instantly return them to their present
comfortable state.
I
may have them notice that the remote control has been mislaid, “The
way they often are…” but assure them that, should they need to
adjust it, they need only visualise it for it to become effective
again.
When
confident that the intervention has been successful, I would assist
them in returning to full consciousness, having them bring with them
any further helpful resources they might need.
A
comprehensive and clear answer, good. I particularly like your
definition of the pain experience and your approach with adaptation
of the classic control panel method with addition of powerful future
pacing.
My only
additional comment to you here is, where you say, "I would ask
when the pain is worse and if anything particular exacerbates it."
That you also maybe ask when it eases and maybe when it does not seem
to be an issue at all; what circumstances create more ease and
comfort... etc. This just helps to pre-establish the scale you are
introducing.
Also,
getting the sensation down to a manageable level is maybe what the
client has requested, though, having established that you may wish to
go further into comfort and ease.
Example
answer Student 2
The
most important factor to establish is that the patient has been or is
receiving medical treatment for the problem and their doctor is happy
for them to seek hypnosis for further assistance.
This
ensures you are not masking a serious medical problem potentially
making the condition or injury worse, also you may cause diagnostic
or treatment issues if the doctors are not aware the client is
undergoing hypnosis at the same time as medical treatment by changing
the response to the prescribed medications. I would remind them that
the pain is a signal something is wrong with their body and it is
usually there for a reason to get them to stop and if necessary seek
help.
The
intervention I would use would also need to be based on the
responsiveness of the client taking into account any effects of their
condition or medication, such as they may find it difficult to relax
due to pain or fall asleep due to the sedation effect of their
medication.
The
general intervention I would utilise would be based on changing the
perception of the pain into a noise response and give the client a
volume control by which they could adjust the volume, this would
allow them to vary the levels according to the stimulus they are
experiencing at any given moment.
During
the initial hypnotic session I would give the client the pain volume
control and make them turn it up one notch to notice the increase in
stimulus, then turn it down, this process convinces the client that
they can indeed influence the level of pain. I would also ensure the
client knows this method will only work on the targeted pain and if
any other pain is noticed they should see their doctor asap to
prevent them ignoring any other medical issues that may develop in
the future.
Correct.
You clearly understand the importance of the factors to be aware of
in relation to this condition and the necessity of vital information
gathering, plus ensuring the client is aware of the process. I like
your approach of using a volume control to parallel the body's pain
response too.
Q12.
Propose an ethically and therapeutically appropriate approach for
working with an adult whose presenting problem is weight control who
confides in you that they over use laxatives to control their weight
condition.
Learning
outcomes: 1.5
An ability to determine an ethically and therapeutically appropriate
approach for more complex cases where specific training may not be
available.
Example
answer Student 1
My
approach would be to firstly ascertain the type of laxative being
abused, fibrous or the more dangerous stimulant variety. Dependant on
this and my perceived severity of the abuse, I may consider referral
to a medical specialist due to the risk of damage already having
occurred to the clients’ organs. During my pre-talk, I would
explain the very real dangers of their over ingestion. I would then
positively assure the client that, following the necessary
intervention, they themselves would find that no further use of
laxatives would be considered necessary or acceptable. Indeed, they
would now find it easy to maintain a healthy and appropriate size and
weight simply by a balanced diet and healthy moderate exercise. By
these positive pre-suppositions I would reinforce the positive
outcome as a “done deal”.
Before during and after the actual intervention I would
consistently refer to their problem in the past tense, thereby
inferring that it was no longer an issue and had readily been dealt
with and overcome. As addiction to the laxatives would have to be
considered, the actual intervention would be based upon the “New
Behaviour Generator” with ‘dependency cessation’ woven into it.
This would consist of establishing communication with the clients’
subconscious mind, honouring it with praise for its good and positive
intentions, and then explaining that the current actions were not
actually beneficial. I would then ask it to conjure up new and better
ways to achieve the desired results of healthy size and weight, by
drawing upon its boundless resources, and ask it if it would be
willing to’ trial’ each new behaviour until it found a suitable
alternative. Following a positive communication from the
sub-conscious, I would ask it to adopt that alternative behaviour for
at least a fortnight, or until our next appointment, and again elicit
its agreement. Assuming a successful result, I would ask the client
to visualize a number of events in the near future, where they could
see themselves happily and confidently enjoying themselves, and have
them become aware of how positive and good they feel about their
appearance. I would anchor this and each subsequent positive feeling,
possibly to a commonly used word or colour. I would then repeat this
exercise until I felt that they had a firm grasp on the goal and
could realise that it was their future reality. I may include an
element of amnesia regarding their previous use of laxatives, and I
would include posthypnotic suggestions to reinforce their self-belief
and confidence.
In
conclusion, I would bring the client back to full waking awareness
and assure them of their success, making sure to ask them to contact
me with feedback.
Correct.
I like your approach and attention to the important factors involved
in this matter, together with how you propose you would deal with
such.
The future
pacing and powerful anchoring, together with confidence boosting is
also welcome, as is the assurance of follow up and feedback.
Example
answer Student 2
...Should
I encounter a client who is using laxatives for weight control I
would inform the client of the dangers of over using laxatives due to
the damage they can cause to the bowel function becoming impaired and
potential long term health issues which may develop.
I
would advise them to contact their GP for help and also offer to
refer them to an experienced hypnotist who does work with Weight
Control clients if they wished once their doctor has agreed.
I
would expect an ethical hypnotist would want to establish the
underlying cause of the laxative use verses reduced calorific intake
plus exercise routine and work on both aspects of the clients issues.
Stopping
the use of the laxatives as soon as possible to allow the bowels to
resume normal function, offering alternative forms of relieving
constipation if required, then work on the causes of the client over
eating with aversion therapy possibly a hypnotic gastric band
intervention. Finally providing the client with positive motivation
to lose weight and get fit and healthy which would ensure a long
lasting change.
Correct.
You have set out an ethically and therapeutically appropriate
approach for this most complex case. I applaud your recognition of
the necessity to establish the underlying root cause of the abuse of
laxatives, the appreciation of the medical dangers involved and the
interventions useful in such circumstances.
Q13.
Research the GHR Code of Ethics in relation to remote and online
therapy and other relevant materials and consider and discuss the
potential issues a therapist must consider before working online.
Learning
outcomes: 1.3
Sophisticated thinking, within the bounds of law and ethics, but
beyond the confines of unnecessarily dogmatic rules sometimes
asserted in training, supervision and reading.
Example
answer Student 1
The
GHR code of ethics, in relation to working remotely or online, is
clearly and concisely laid out in easy to follow terms. The code
appears to cover most issues that might arise from initial
consultation through to successful completion.
With
the advent of SKYPE and such technology a therapist can interact with
clients over almost any distance, making therapy available to anyone
with the necessary equipment. This can prove advantageous for both
therapist and client in terms of convenience and cost. However it can
be seen that, in comparison to a session conducted in a therapy room,
a number of additional factors apply to remote or online therapy.
Difficulties may include;
Obtaining
the necessary rapport between therapist and client, without personal
contact.
Recognising
important subtle signals that would be more apparent in a therapy
room.
Inability
to reinforce suggestions with physical contact. eg: Tapping forehead.
Technology
failure – at either end, or even power outage.
Any number of unforeseen interruptions.
Before
undertaking to conduct any remote or online therapy, it would be
advisable to gain real ‘hands on’ experience in a more
traditional setting.
Properly
accredited courses in conducting therapy online are available, and
the therapist should be properly trained in this discipline in
addition to their core expertise. Professional insurance for such
work should be obtained, and of course all safety measures should be
strictly adhered to. Even though the client remains at their own home
or chosen location, the therapist still has a duty of care and must
take all steps possible to protect the client from any harm. To this
end, the therapist should be satisfied that;
The
client has presented their true identity and location, and pertinent
medical history.
they
are in a sober and fit state to partake in the session to be
conducted.
The
clients full contact details, and those of their GP are known and
permission to contact their GP,
if so desired, should be obtained.
A
backup contact should be arranged for the event of any failure of the
communication technology.
Q13.
Correct. You have understood and processed well the requirements to
be aware of and put into practice when working with clients remotely
and have demonstrated the sophisticated thinking beyond the rules and
regulations and advisories of this practice.
Example
answer Student 2
Over
and above the standard procedures and practises of the GHR Code of
Ethics for therapists those that chose to work on-line or remotely
must comply with the following best practise to provide the best for
their clients and their practise.
The
therapist must ensure they understand the difference between
face-to-face treatment and on-line working, this includes the reduced
feedback from the client during both the assessment phase and the
actual treatment session itself.
The
therapist must be confident the client is who they say they are and
the contact details are correct. The therapist should be confident as
to the true nature of client’s issues prior to commencing any
sessions. They must have already agreed the standard personal
contract and paid the appropriate fees.
They
must be sure the client is not suffering from any relevant medical
conditions which could impact on the session and that they have
provided their GP’s details and phone number with authorisation in
case the therapist feels it necessary to make contact with the GP for
the wellbeing of the client, their family or the public.
The
therapist must be insured to work remotely or on-line, the therapist
and the client must have a suitable working environment a safe and
distraction free room, the therapist must be made aware of any other
persons present with the client and will have previously agreed if
the sessions are to be recorded in any way by the client.
The
client must also be aware and happy to work remotely or on-line,
including what to do in the case of technology failure issues, the
therapist must have a quality back up plan including a
landline/secondary phone number and if possible a third party
emergency contact number.
Ensure
all electronic transactions, emails, contract and fee scales etc. are
available to the client.
The
therapist must ensure the privacy and integrity of any material on
their computer systems prior to linking to any clients system and
deleting un-necessary material as soon as the clients contracted work
is completed.
Correct.
A well thought out answer with adherence to the advisories of the
Code and issues beyond its remit. You have understood and processed
well the requirements to be aware of and put into practice when
working with clients remotely and have demonstrated sophisticated
thinking beyond the rules and regulations.
Q14. Read
the following article and comment and discuss your views on Epilepsy
and Hypnotherapy.
Learning
1.3 Sophisticated thinking, within the bounds of law and ethics, but
beyond the confines of unnecessarily dogmatic rules sometimes
asserted in training, supervision and reading.
.
http://med.stanford.edu/news/all-news/2008/02/hypnosis-helps-doctors-zero-in-on-kids-seizures.html
Hypnosis
helps doctors zero in on kids' seizures
FEB 122008
02/13/08
BY KRISTA
CONGER
It was
no way for an 11-year-old to live. For a month the boy had endured
daily episodes of uncontrollable jerking and foaming at the mouth,
and his physicians at Lucile Packard Children's Hospital were
concerned that the boy had epilepsy. Before starting the boy on a
lifetime of antiseizure medications, though, they turned to an
unconventional diagnostic tool: hypnosis.
'Children
are highly suggestible and they have great imaginations,' said
Packard Children's child psychiatrist Richard Shaw, MD. 'We've found
that if we suggest that they are going to have one of their events
while they are in a hypnotic trance, they will usually have one.'
But
wait. Aren't physicians supposed to try to STOP seizures rather than
searching for new ways to cause them? In a word, yes. But in order to
treat seizures effectively, doctors must learn which parts of the
brain are causing the trouble. Many children who seem to be having
epileptic seizures are actually having an involuntary physical
reaction to psychological stress in their lives. These events require
a vastly different treatment than do true epileptic seizures.
The
only way to pinpoint the true cause is to monitor the child's brain
activity during an event. Connecting a panel of electrodes to a
child's scalp is relatively easy and painless. Conducting a 'seizure
watch' of indefinite length is another matter.
'It's
very difficult for parents to spend three or four days in the
hospital hoping their child has a seizure,' said Packard Children's
chief of pediatric neurology, Donald Olson, MD. 'It puts them in a
very uncomfortable place emotionally.' Furthermore, some hospitalized
children, removed from the very stressors that may be causing the
events, never have a seizurelike event.
Hypnosis
can speed the process considerably, said Shaw and Olson. Together
with former medical student Neva Howard, they tested the procedure on
nine children between the ages of 8 to 16 whose seizurelike events
included twitching, loss of consciousness, shaking, jerking and
falling. Their results were published online in January in Epilepsy &
Behavior. The physicians needed to know whether these were true
epileptic events, which are best treated by medication, or
nonepileptic events caused by psychological stress or other
neurological problems.
'We
can't always distinguish epileptic from nonepileptic events visually,
or through descriptions by family or friends,' said Olson, an
associate professor of neurology, of neurosurgery and of pediatrics
at the School of Medicine. 'But regardless of the cause, these are
disabling, life-altering events that need to be treated.'
The
authors believe that, although hypnosis may not work for every child,
the technique is an important tool that can speed proper diagnosis
and treatment for children suffering from seizurelike events.
To
hypnotize the subjects, Shaw, an associate professor of psychiatry
and behavioral sciences and of pediatrics at the School of Medicine,
first used a combination of deep breathing and progressive muscle
relaxation to induce a state of relaxation and deep focused attention
in the subjects. He then used a combination of imagery and suggestion
to induce one of their typical seizurelike events. Children typically
visualize being at one of their favorite places - for one teen, it
was on a beach in the Bahamas. After a hypnotic trance was
established, Shaw would then direct the child to recall the feelings
or events that usually precede a typical seizure. Electrodes on the
child's scalp recorded their brain activity during the session.
In
eight out of nine cases, Shaw could successfully trigger a
seizurelike event with this procedure. After an appropriate
monitoring interval, Shaw then directed the hypnotized child to
'return' to his or her favorite place and the episode would stop.
Using this technique, the physicians found that all eight of the
subjects were experiencing nonepileptic events.
'We had
a number of clues that these particular children might not have
epilepsy,' said Olson, 'but hypnosis helped us confirm our
suspicions.' Physicians begin to suspect causes other than epilepsy
if an individual has a variety of episodes, if the person's cognition
is unaffected despite frequent seizures or if the person has a
pre-existing psychiatric diagnosis.
Were
the kids in the study relieved to find they didn't have epilepsy?
'Yes and no,' said Shaw. 'It's important to explain very clearly that
although these events are psychologically based, they are completely
out of a child's control.' He and Olson compare the events, which are
a type of condition called conversion disorder, to other well-known
ways that stress and emotions affect other bodily functions, such as
migraines, ulcers and blushing.
Stanford
is part of an ongoing multicenter study of these nonepileptic events
to better understand their causes and possible treatments. For now,
Shaw often couples psychotherapy with self-hypnosis lessons to teach
children how to avoid the events.
'When
they're feeling out of control, this is a tool they can use. They
know that they were able to 'turn off' an event during the initial
hypnosis, and that gives them confidence to try it themselves,' said
Shaw.
In
general, people are growing more comfortable with the idea of
hypnosis in a medical setting, said Olson. 'The first reaction of
many people may be to equate hypnosis with some sort of black magic.
But once we explain the reasons and benefits, they're very
accepting.'
By
KRISTA CONGER
Krista
Conger is a science writer for the medical school’s Office of
Communication & Public Affairs.
Example
answer Student 1
The
article by Krista Conger illustrates how hypnosis proved to be useful
in differentiating between actual epilepsy and psychological stress
induced involuntary reactions (Seizures). Deliberately triggering
such a reaction may appear to be counter- productive, but in order
for the event to be observed in a suitable environment with brain
scanning equipment, the reaction must be made predictable. In those
cases that proved to be stress related rather than true epilepsy, a
more suitable treatment and management regime could be implemented.
Psychological
stressors are known to be complex and varied, but can often be
alleviated or moderated with hypnotherapy alone. This could be by
means of a suitable intervention conducted by a hypnotherapist, or by
fairly simple techniques of self- hypnosis. The avoidance of a
reliance on prescription drugs is a far better outcome for the
patient.
By
current best practice, treatment of actual epilepsy consists of
prescription drugs and regular monitoring. Hypnotherapy is not
recognised as a suitable treatment, indeed trainee hypnotherapists
are advised to refuse to accept clients with epilepsy in their
medical history. The accepted causes of epilepsy appear to be varied;
hereditary, injury, medical condition or quite often simply unknown.
Far more research is needed in this area, and until the answers are
found the various recognised Anti-Epilepsy Drugs will be prescribed
in order to try to control the condition.
It
would perhaps seem appropriate that such a debilitating condition
could be treated with hypnotherapy, and certain neurologists, such as
Dr Tim Betts of Birmingham University, have found it to be useful.
Dr
Betts uses hypnosis to induce intense relaxation and concentration,
so that the mind becomes detached from everyday concerns. In this
state, the subconscious is best able to respond creatively to the
hypnotist’s suggestions, and focus on aspects of the person’s
life where change is desired. (Canadian Epilepsy Alliance, 2008).
Unfortunately
the use of hypnosis in such cases is largely seen as “complimentary”
or “Alternative” and is not embraced by the mainstream modern
medical establishment. It can only be hoped that the work of Dr Betts
and his peers will further enlighten the medical community, and that
those suffering from epilepsy will become free of their condition and
hte drugs.
Q14.
Correct. Good comment and discussion on this topic and also
interesting additional information regarding the work of Dr Betts,
thank you.
Example
answer Student 2
Having
met several people who are diagnosed as Pseudo fitters, some have no
control over their seizures others are merely pretending for a number
of reasons (attention seekers or to avoid something or someone)
The
one’s who are deemed to have no control are not epileptic’s in
the normal sense of the word but as suggested in the article may be
subject to a stress reaction thou many are the result of other
medical conditions such as alcohol withdrawal or non prescription
drug use.
One
patient in particular stated he has seizures in response to pain from
nerve damage in his arm, he has claimed to fit for up to a staggering
3 hours, thou the length of time was not witnessed, his wife on
arrival back from a long shopping trip was able to talk him out of
his fit in a few minutes, giving credibility to the argument that the
patient can have some control over their seizures.
The
use of hypnosis to induce a seizure must be carefully scrutinised as
has been shown in many stage hypnosis shows, a good subject can be
persuaded to do and experience many things which could potentially
include reproducing a seizure from memory to please the physician but
not induce an actual epileptic fit which the patient might actually
suffer from but brought on by another trigger.
I
believe the subject should have further research and must include a
full brain scan of a patient undergoing both a hypnotic induced
seizure and a naturally occurring seizure to ensure both are produced
from the same parts of the brain and the hypnotic seizure is not just
a memory.
Such
a study must be carried out by highly trained individuals under
appropriately prepared conditions with full medical support as
seizures can be life threatening and no research is worth a death of
a patient.
Personally
I would be very reluctant to work with anyone suffering from Epilepsy
unless under strict medical supervision as it is almost impossible to
know what triggers a seizure and if, as the article suggests, it is
possible to induce a seizure under hypnosis it is not a certainty
that you could communicate sufficiently well with a patient in a
seizure to end the episode effectively before the patient sustains
harm.
Q14.
Correct. Your answer demonstrates the sophisticated thinking that
this advanced course promotes, within the bounds of law and ethics,
though also being beyond the confines of dogmatic rules, using your
personal experience to come to your conclusions. Having witnessed
the ceasing of a seizure in the manner described is a valuable
experience to share with other less experienced hypnotherapists and I
encourage discussion on this topic at peer support and on the online
forums. You make a good point also of the difficulties in
communication when a client is in trance and fitting is induced. The
brain scanning comparison is also a useful if not vital element to
bring into this scenario.
Q15.
If your client has an epileptic seizure advise the steps you would
take to care for the client.
Learning
outcomes: 1.11
Knowing how to take an appropriate course of action with a client who
is experiencing an epileptic seizure.
Example
answer Student 1
If
a client were to experience an epileptic seizure I would first ensure
that they did not cause themselves any injury, and would move any
objects away to prevent
such injury. I
would check that they were breathing and loosen
their clothing if necessary,
then monitor them and continue to calm and reassure them until the
seizure abated.
From
the client consent form I would know if they had previously
experienced a seizure, and if they had not, I would call
for an ambulance to
attend. If they were used to such seizures occurring, and seemed to
be no worse for the experience, I would ensure that they were fully
lucid and allow them to continue the session or to leave the therapy
room.
Q15.
Correct. Good answer. Yes, if collars or ties are restrictive it
would be advisable to loosen such, also when convulsions abate then
turning them onto their side may be advisable too. Take note of the
duration of the episode also. You have demonstrated knowledge of how
to take an appropriate course of action with a client who is
experiencing an epileptic seizure.
Example
answer Student 2
During
the initial interview you should have been made aware of the patients
medical conditions including epilepsy and at that point asked a few
more questions regarding how they manage their condition and made an
informed decision on whether or not you would actually use hypnosis
with them.
Should
a patient suddenly go into any form of seizure (known epileptic or
not) then I would use the standard medical process of
lead to the floor if necessary,
protects the head
using pillows loosen tight clothing around the neck etc.
and wait for the seizure
to pass. If seizure
last more than a few minutes or you become concerned for any reason,
consider calling for
an ambulance.
Once
past and the patient is recovered enough to answer questions (or
their companion if any) ensure whether they have single or multiple
seizures, have they any other medical conditions, have they taken
they regular medications and importantly ask if anything is different
about this last seizure, if so phone 999 and get them checked over
with the opportunity of transport to hospital if necessary.
Q15.
Correct. You have demonstrated your thorough knowledge and skill in
this arena, thank you.
Q16.
How would you address the following situation. A husband has paid for
his wife to have a stop smoking session. The wife does not want to
stop smoking however the husband is adamant because he discovered one
of their young children trying to smoke one of her cigarettes.
Learning
outcomes: 4.1
Advanced thinking around difficult ethical issues, particularly those
outside of codes of ethics and where an unambiguous and universally
agreed upon solution is unavailable.
Example
answer Student 1
I
would firstly advise the client that I would not conduct a smoking
cessation session with someone, unless the person receiving the
therapy actually wanted it for themselves, and not just to appease
another. I would question the client to determine their own
reluctance to cease smoking, and would try to understand exactly what
she gets from it and why she would choose to continue the habit. I
might mention, conversationally, some of the issues associated with
her continued smoking, especially regarding her children. By
reference to both research and the “Stop smoking” public health
campaigns, I would endeavour to have her agree that the benefits of
stopping smoking far outweigh the reasons for her to continue to
smoke. If I could have her agree this, I would continue and have her
suggesting the reasons why she should stop. If this continued and
she actually asked me to proceed with the session, I would get her to
state it a number of times, along with the reasons, to reinforce the
belief that stopping smoking really was her best option.
If
I was satisfied that she really had changed her mind and did indeed
now want to stop smoking, I would proceed with the session. However
if I detected, at this stage, any reluctance to leave the habit
behind, I would refuse to continue at that time and suggest that she
book a session at a later time, when she had resolved that she wanted
to stop.
Q16.
Correct and good answer. Inspiring and developing motivation is a
really good idea rather than a flat refusal to treat and this is
where you need your advanced thinking around difficult ethical
issues, particularly those outside of codes of ethics, comes into
play as is outlined in the learning outcomes. I would agree with
this approach and commend the action taken.
Example
answer Student 2
...The
problem with this scenario is that:
1) you
can not force someone to stop smoking on behalf of someone else,
2) the
child’s interest is already there, therefore the mother stopping
now will not change the child’s curiosity
3) the
parents have other issues such as poor communication to work on
rather than focusing on the wife’s smoking.
I
would suggest the wife looks at the reasons behind the husbands
position and suggest she might wish to consider stopping/reducing the
amount of smoking in front of the child, I would also request they
both had a talk with the child (dependant on the child’s mental
age), asking why they wanted to start smoking, also potentially
explaining that whilst smoking is bad for their health the mother is
trying to stop and how hard that is where as the child shouldn’t
start as that’s easier.
Q16. You
have demonstrated advanced thinking around this difficult ethical
issue and brought up some insightful and valid points.
Q17.
Criteria for empirically supported therapies have been defined by
Chambless and Hollon (1998). When is a therapy considered
efficacious in this context?
Learning
outcomes: 5.7
An understanding of the term 'empirically supported
therapies/treatments'.
Example
answer Student 1
The
criteria defined by Chambless and Hollon considers a minimum of 2
separate tests
showing superior results of experiments against medications, placebos
and previously accredited treatments. The experiments they evaluated
were for limited illness’s only:
Anxiety and stress, insomnia, pain management and
certain psychosomatic illness only.
They
went on to state further research was necessary to extend the range
of illness’s covered but this has yet to be carried out to a
satisfactory standard for full accreditation of hypnosis for use in
the treatment of other conditions.
Criteria
for empirical support are:
The
study must be replicated in two independent research settings and all
if any conflicts must be resolved to be efficacious and specific.
If
it effective in only one of the tests then it is classed as possibly
efficacious.
1.The
importance of independent replication before a treatment has been
established in efficacy is emphasised, and a number of factors are
elaborated that should be weighed in evaluating whether studies
supporting efficacy are sound.
2.
The therapy must be compared with a no treatment control group, an
alternative therapy, or placebo.
Must
be more beneficial than no therapy or placebo AND at least equivalent
to an alternative or established therapy.
3.
The empirical study must use sound scientific methods.
Q18.
Discuss how you would deal with a client who has become dependent on
you.
Learning
outcomes: 1.12
Knowing how to sensitively and firmly handle clients who breach
personal or professional boundaries.
Example
answer Student 1
Throughout
any sessions I would emphasise the progress they are making and the
growth as a person they have made. Re-enforcing how well they are
managing every situation they have encountered and will manage in the
future using the future pacing process.
This
positive re-enforcement should help the client to realise how they
have grown and changed as well how they are capable of coping with
life’s little trials as an individual reducing any dependence on
our sessions for answers to their problems and increasing their
confidence in their own ability to resolve their future issues.
After
an initial session I usually have a fairly closely spaced follow up
session to re-enforce and anchor their new thought patterns roughly
one week later with one further follow up session up to one month
afterwards if considered necessary, my normal block of sessions would
only be for 2 or 3 session with email support or possibly phone
support should they have a crisis.
Should
I consider the client becoming dependant on our sessions I would
ensure the next session included plenty of self empowerment
suggestions and acceptance of their new found abilities to cope, if
they still continued to make contact I would have to re-assess what
they wanted from the sessions by further meta-questioning and decide
if I was still able to assist them properly or refer them to another
therapist or doctor.
Q18.
Correct. This is a good answer, ultimately culminating in referral
to another therapist if attachment issues persist, after efforts to
address. You have demonstrated knowledge of how to sensitively and
firmly handle clients who breach personal or professional boundaries.
Q19.
Give the advantages and disadvantages of a
hypnotherapy treatment that is not supported by scientific research.
Learning
outcomes: 3.8
A demonstrable and respectful appreciation of both the advantages and
disadvantages of interventions that have, or have not, been
scientifically researched.
Example
answer Student 1
The
disadvantages are:
Not
empirically proven to assist with clients issue, may generate false
hope which may in turn cause the client to discontinue all treatments
both medical and alternative health.
May
actually mask symptoms and/or affect medical treatments by disguising
changes in their condition, possibly leading to a worsening of the
condition without the client being aware,
Having
no corroborating evidence to support use of hypnosis, having provable
support helps the client believe in the process increasing the
potency of the treatment, the placebo effect,
Without
research the medical profession is unlikely to support or promote the
benefits and therefore the future use of hypnosis.
Without
research there is little information to guide the hypnotist as to the
best way to assist the client and/or the doctors.
Hypnosis
is dependent on the practitioner being good at their job and the
clients have to be good subjects for the best results, these are not
measurable qualities using scientific methods.
The
Advantages are:
Hypnosis
is free from side effects,
Hypnosis
at the least effective level can lift the spirits of the client
allowing self healing to take place which will speed up recovery and
reduce problems,
Hypnosis
can be holistic and treat the client as a whole, your energy levels
are increasing, whilst when you need to, you can relax and sleep
peacefully in one carefully worded suggestion,
Hypnosis
could also if necessary be targeted where as medication rarely has
only one effect, so for example pain killers whilst reducing pain
makes the client sleepy and lethargic, hypnosis can relieve pain
without sedating the client.
Hypnosis
is almost instant in taking effect and if it doesn’t work for this
client/condition it can be stopped immediately, again no side
effects,
The
anecdotal list of conditions for which hypnosis has helped is growing
daily, there is nothing to lose in trying hypnosis for any and all
conditions you come across, if it fails the client has lost nothing
if it works they have gained everything.
Q19.
Correct. A good clear answer outlining your respectful appreciation
of both the advantages and disadvantages of interventions that have,
or have not, been scientifically researched, just as the learning
outcomes dictate. A thoughtful and well delivered answer.
Example
answer Student 2
Training
gives you the basics, hands on working with clients gives you
experience, however even if you have had many months of continuous
training or years of experience you are always likely to have a
client presenting with something you didn’t cover or forgot since
your course or just plain never heard of before. That’s where the
peer groups support is vital to ensure you are giving your best to
your clients, the one’s you find easy may be difficult for another
hypnotherapist and visa versa, sharing case notes (appropriately
censored) helps to broaden everyone’s knowledge and experience as
even the most comprehensive training manual could not possible cover
every potential clients situation, so being able to ask fellow
hypnotherapists is the best practical solution.
Hypnotherapy
is a solitary role with just a number of clients with problems
passing across your doorstep, this can lead to burn out if you do not
have the support and ability to off load some of the issues you are
presented with, talk therapy counsellors are required to have regular
meeting with supervisory counsellors themselves to prevent the
emotional overload that comes with listening to their clients,
hypnotists are just as likely to hear and take on some of their
clients issues and as such must have the facility to off load as
necessary and peer support and mentoring are all part of the process.
Also
each hypnotherapist can help their colleagues, for example you as a
hypnotist specialising in weight control may be approached by someone
with PTSD and that is a subject you do not normally work with but
through your peer group you know a fellow hypnotist who does, you can
refer the client safely knowing the client is in good hands and that
other hypnotist may well make referrals back on issues you are
specialising in.
Correct.
You have brought up some important points that show your
appreciation of peer support communication and attendance and you
have recognised the important advantages of continued contact with
peers and the sharing of information. Please look at the mechanics
of organising your own peer group sessions for a fuller answer in
line with the learning outcomes, otherwise a very appreciative and
appropriate answer, well done.
Example
answer Student 3
Alternative
therapies or approaches such as hypnotherapy often lack scientific
validation, and as a result their effectiveness is considered either
unproven or disproven. "There is no alternative medicine. There
is only scientifically proven, evidence-based medicine supported by
solid data or unproven medicine, for which scientific evidence is
lacking- P.B. Fontanarosa, Journal of the American Medical
Association (1998).
Scientific research has many advantages to bestow upon the treatments which fall within its remit. In order to qualify as scientific, or ‘evidence based,’ research must include a range of specifically designed scientific studies. Ideally performance on a given test or measure is taken before and after the intervention and participants randomly assigned to control or experimental groups. There must be measurable, sustained improvements in a defined area and with a large sample size – defined from past research and statistical analysis. An independent variable should be identified – one which is able to be manipulated in order to measure the effect on the dependent variable. External variables are controlled so that the relationship between the independent and dependent variable can be observed. The overall intention is to increase control and make accurate measurements of variables with an aim to increase objectivity and the ability to replicate.
There are advantages of hypnotherapy research attempting to comply with the scientific methodology even on a small scale. By doing so each study contributes to a body of research to build upon and develop; it is granted the ‘approval’ of the scientific community and is therefore easier to defend in terms of validity and ‘reliability. But people are not reliable and their effects are less easy to replicate - they vary from day to day, from moment to moment and session to session, especially if they know they are being observed. To avoid the participant effect, some scientific research is conducted as case study or case review in retrospect which in turn have their own disadvantages of memory and bias. These methods can be used just as easily for hypnotherapy research although with the same disadvantages. In the same way it is possible to measure effects before and after a hypnotherapy intervention, albeit via subjective responses- for example rating of pain before and after a session. Even if one took the most cynical attitude that hypnotherapy is a placebo- the fact that change exists is often the most important for the client, not what enabled it.
However even in tightly controlled scientific experiments, not all variables can be completely controlled. The creation of a scientific experiment can cause an artificial environment where people behave as they are expected to and these are then difficult to expand to be able to generalise to reality. Many hypnotherapists may argue that this is in fact similar to hypnotherapy – creating a condition to enable the participant to be open to suggestion. And as a wise psychology teacher of mine once drilled into us during statistics classes – correlation does not infer cause and effect. Her favourite example was the scientific causality link between eating ice cream and drowning; much more likely to be caused by sunshine behaviour at the beach than the ice-cream itself. This is a great example of the nature of the human condition – a factor which can be lost by using scientific research alone.
There are also
advantages of not using pure scientific methodology, one of which is
that if by doing so we prevent hypnotherapy from happening. Every
session we conduct cannot contribute to research but it can
contribute to the net total of knowledge. Whilst a session may not
meet the criteria, it will still have the practice methodology and
can have hypotheses – although not ones that can be tested for
statistical error. But we can use the principals for new and exciting
trials; subjective experience can be observed and recorded in the way
in which it was experienced; small numbers (as small as one) can be
part of something greater- for the client and hypnotherapy as a
whole. In addition costs to administer and develop may be smaller
without the scientific constraints and from here the only limitation
is imagination as to what hypnotherapy could be used for…
Hypnotherapy has no recorded side effects, there are no disadvantages
for trying it to assist new or less understood illnesses and unlike
many medical or scientific ‘treatments’ the administration of the
intervention is as therapeutic as the after effects.
Whilst it is true that without the backing of the scientific research it is harder for hypnotherapy to de-bunk the de-bunkers; there are many who will never accept alternative treatments with or without hard scientific ’proof’. It is also difficult to refute any accusations of harm caused – how can one prove you didn’t cause something if one cannot prove what you did do? But it is also important to remember that aspects of medical science such as surgery or anatomical dissection were once considered an abomination against nature – every part of a new science must start somewhere and build the mass of evidence which one day will reach a critical mass of acceptance. There is a balance to be struck between empirical evidence and scientifically principalled hypnotherapy; some things are so individual they are hard to express let alone to capture in a way that can be subjected to statistics. Any hypnotherapist who has had a client who cannot express how they feel after a session other than ‘yes’ will know the value of the smile that is lighting up the person’s face, or the lightness that appears throughout their body upon waking. It just doesn’t show up on a graph (unless it’s an inverted bell curve).
Q21.
Investigating related material sources on the internet, discuss how
bias can be avoided in scientific research.
Learning
outcomes: 5.3
An understanding of 'bias' in research.
Example
answer Student 1
The
internet is full of material covering every imaginable subject, the
vast majority of this information is unchecked or verified. Ranging
from phishing and hacking sites through aggressive sales sites to the
prestigious scientific community sites. Sales websites often pose as
official looking research sites in order to give an air of authority
to their work whilst glossing over the fact their research is, at
best, bias towards their product.
Wikipedia
is often the first reference site used by the public when researching
a subject, however Wikipedia is an open source site, which allows
anyone to post information about a subject, and allows others to
verify or report inaccuracies. The vast majority of the information
on Wikipedia is quite accurate however it should not be trusted
implicitly and further checks on its content must be undertaken
before accepting its information such as cross referencing with other
sites and sources.
Once
you have identified a reliable source of information you should look
to the following to give an indication as to the accuracy of the
content.
The
methodology of any research experiments must be open and transparent,
with a clearly defined purpose, they must also be carried out in a
scientific way in that they must be controlled conditions with
repeatable and clearly defined results which are measurable utilizing
scientific standards, the test size should also be statically large
enough to ensure a true representation of the effects (7 people out
of 10 selected volunteers doesn’t not truly reflect the efficacy of
a medicine or treatment etc. designed to be given to millions of
people) Check their case studies for validity and accurate recording
of results making sure the evidence is scientific and not anecdotal.
The
testing process must also include the use where possible of double
blind testing as well as the use of a control set to be in place to
ensure a true and accurate result to exclude the potential for human
bias on the part of the subjects or the researchers tainting the
results. Ensure the research has been validated and reviewed by other
experts in the field, checking on any referencing given.
These
methods are fairly standard in almost all research facilities,
however when surfing the internet for information it is always best
to obtain information from several sources where possible and also to
verify each source independently to ensure the quality of their
information.
Q21. More
information required. You have provided a clear understanding of
inaccuracies of information on the internet and warnings as to
anomolies encountered and also the idea of commercial bias, where a
salesperson may sway information towards a commercial end, however
please provide detail of a broader view of scientific bias.
Research
Bias
For
example, when using social
research subjects,
it is far easier to become attached to a certain viewpoint,
jeopardizing impartiality.
The
main point to remember with bias is
that, in many disciplines, it is unavoidable. Anyexperimental
design process
involves understanding the inherent biases and minimizing the
effects.
In quantitative
research,
the researcher tries to eliminate bias completely whereas,
inqualitative
research,
it is all about understanding that it will happen.
Design
bias is introduced when the researcher fails to take into account the
inherent biases liable in most types of experiment.
Some
bias is inevitable, and the researcher must show that they understand
this, and have tried their best to lessen the impact, or take it into
account in the statistics and analysis.
Another
type of design bias occurs after the research is finished and the
results analyzed. This is when the original misgivings of the
researchers are not included in the publicity, all too common in
these days of press releases and politically motivated research.
For
example, research into the health benefits of Acai berries may
neglect the researcher’s awareness of limitations in the sample
group. The group tested may have been all female, or all over a
certain age.
Selection/Sampling
Bias
Sampling
bias occurs
when the process of sampling actually introduces an inherent bias
into the study. There are two types of sampling bias, based around
those samples that you omit, and those that you include:
Omission
Bias
This
research bias occurs when certain groups are omitted from the sample.
An example might be that ethnic minorities are excluded or,
conversely, only ethnic minorities are studied.
For
example, a study into heart disease that used only white males,
generally volunteers, cannot be extrapolated to the entire
population, which includes women and other ethnic groups.
Omission
bias is often unavoidable, so the researchers have to incorporate and
account for this bias in the experimental design.
Inclusive
Bias
This
type of bias is often a result of convenience where, for example,
volunteers are the only group available, and they tend to fit a
narrow demographic range.
There
is no problem with it, as long as the researchers are aware that they
cannot extrapolate the results to fit the entire population.
Enlisting students outside a bar, for a psychological study, will not
give a fully representative group.
Procedural
Bias
Procedural
bias is where an unfair amount of pressure is applied to the
subjects, forcing them to complete their responses quickly.
For
example, employees asked to fill out a questionnaire during
their break period are likely to rush, rather than reading the
questions properly.
Using
students forced to volunteer for course credit is another type of
research bias, and they are more than likely to fill the survey in
quickly, leaving plenty of time to visit the bar.
Measurement
Bias
In
a quantitative experiment, a faulty scale would cause an instrument
bias and invalidate the entire experiment. In qualitative research,
the scope for bias is wider and much more subtle, and the researcher
must be constantly aware of the problems.
- Subjects are often extremely reluctant to give socially unacceptable answers, for fear of being judged. For example, a subject may strive to avoid appearing homophobic or racist in an interview.
This can
skew the results, and is one reason why researchers often use a
combination of interviews, with an anonymous questionnaire, in order
to minimize measurement bias.
- Particularly in participant studies, performing the research will actually have an effect upon the behavior of the sample groups. This is unavoidable, and the researcher must attempt to assess the potential effect.
- Instrument bias is one of the most common sources of measurement bias in quantitative experiments. This is the reason why instruments should be properly calibrated, and multiple samples taken to eliminate any obviously flawed or aberrant results.
Interviewer
Bias
This
is one of the most difficult research biases to avoid in many
quantitative experiments when relying upon interviews.
With
interviewer bias, the interviewer may subconsciously give subtle
clues in with body language, or tone of voice, that subtly influence
the subject into giving answers skewed towards the interviewer’s
own opinions, prejudices and values.
Any experimental
design must
factor this into account, or use some form of anonymous process to
eliminate the worst effects.
See
how to avoid this:Double
Blind Experiment
Response
Bias
Conversely,
response bias is a type of bias where the subject consciously, or
subconsciously, gives response that they think that the interviewer
wants to hear.
The
subject may also believe that they understand the experiment and are
aware of the expected findings, so adapt their responses to suit.
Again,
this type of bias must be factored into the experiment,
or the amount of information given to the subject must be restricted,
to prevent them from understanding the full extent of the research.
Reporting
Bias
Reporting
Bias is where an error is made in the way that the results are
disseminated in the literature.
With the growth of the internet, this type of bias is becoming a
greater source of concern.
The
main source of this type of bias arises because positive research
tends to be reported much more often than research where the null
hypothesis is
upheld. Increasingly, research companies bury some research, trying
to publicize favorable findings.
Unfortunately,
for many types of studies, such as meta-analysis,
the negative results are just as important to the statistics.
Q22.
How would you as a therapist assess the suitability of a technique,
its outcome and your own personal performance of delivering that
technique.
Learning
outcomes: 3.7
An ability to implement new techniques without direct supervision and
critically reflect on this, e.g. assessing the suitability of the
technique, outcome, and personal performance.
Example
answer Student 1
Generally
the suitability of a techniques depends on if it works for the client
sitting in front of you at the time of use, the outcome would be via
client feedback initially during the session i.e. are they responding
physiologically and hypnotically as expected, blushing, muscle
flaccidly etc. are they accepting the suggestions and do they come
out of trance in a good frame of mind, which would also lead to an
initial judgement on the delivery/performance of the therapist.
All
of these should be recorded in your client notes, how they felt, how
they responded etc. including how you felt the session went with
notes for improvements so as to improve your client's experience and
your performance overall as an informal reflective journal on each
client.
The
next phase of the judgement would be either at the next session or by
some other form of feedback off the client (verbal, phone or email)
stating how they felt after the session, how well the suggestions
have worked and what changes they have made to their lives since the
session.
It
is also very useful to keep a more formal reflective journal to
ensure you are working to your best and to help identify any areas
you should work on to provide the best for you and your clients,
which would then be used during mentoring and/or peer support
sessions.
Q22.
Correct. You have provided good strategies for assessing the
suitability of the technique, outcome, and personal performance, as
required by the learning outcome. I am marking this answer as
correct due to your previous answer regarding using a volume control
metaphor of your own devising, to deal with a client's pain response,
which has shown your ability to implement new techniques without
direct supervision and to critically reflect on it, which is also
part of the learning outcome to this question.
Q23.
Discuss the advantages of group hypnotherapy.
Learning
outcomes: 1.13
An understanding of the advantages and disadvantages of group
hypnotherapy.
Example
answer Student 1
Group
hypnosis is a great way of helping large numbers of people at the
same time.
Such
as a whole slimmer’s club of 20 – 30 people could be given
healthy eating/lifestyle suggestions in a single one hour session
rather than 20 – 30 individual sessions making it quick and
therefore cheaper for the individuals involved whilst the hypnotist
is able to make a living whilst providing a time/cost effective
session for the club.
Also
group hypnosis is a great form of advertising for inclusion in talks
to clubs and groups, such as Rotary clubs, health clubs etc. as well
as providing a good convincer for the participants of not only the
power of hypnosis but also the skill of the hypnotist.
Another
advantage of group working is peer pressure within the group of
subjects, there is a perceived pressure to follow the instructions
amongst the group assisting the hypnotist to work with the group more
effectively leading them into the hypnotic process.
The
group knowing they are safe as there is perceived safety in numbers
helping with the rapport building and the collective mind will pick
up and tend to follow everyone else into trance.
Q23.
Correct. You have demonstrated a good understanding of the
advantages to be gained by hosting group hypnotherapy sessions.
Also, bear in mind that often a client that may not have attended a
one to one session will come along with a friend to such an event and
then choose to experience a private session at a later date.
Q24.
Discuss what is meant by the term primary gain.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
Primary
gain is the initial reason for commencing a particular behaviour,
such as starting to smoke as all your friends smoke and you want to
be part of the group. This would normally be easily identified by the
initial meta questioning of the client, but further questioning must
take place to confirm this as still the only purpose for the
behaviour to continue or the session will be far more difficult than
necessary.
Q24.
Correct. You have provided an understanding of primary gain.
Q25. What
is meant by the term secondary gain and give an example.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
The
secondary gain is the reason a person continues a particular
behaviour beyond the initial reason or gain and may not have been
part of the reasoning for the client to have commenced this
particular behaviour but developed as time goes by, such as a smoker
now wishes to continue smoking as the act of smoking actually allows
them to take extra breaks from work or from a stressful situation,
they now find smoking relaxes them which is beyond the primary gain
of that the clients regular friends all smoke and the client wants to
continue to be part of that group, another secondary gain could be
that this group are also the works gossip corner and the client
wishes to continue smoking to hear the latest chatter.
The
hypnotist must understand and work with any secondary gains as well
as the primary gains in order to bring about the changes the client
requests or the secondary gains will undermine the potency any
suggestions given.
Correct.
Additionally, remember the interesting thing about secondary gains is
that the client is usually totally unaware of them and indeed often
insulted by the idea of them if presented unsympathetically.
Q26.
Discuss the term malingering as it relates to your client and offer
strategies to deal with this.
Learning
outcomes: 1.10
An understanding of primary, secondary, and tertiary gain, and
malingering.
Example
answer Student 1
Malingering
is often considered as intentionally (thou may be sub consciously)
exaggerating symptoms and conditions for the purpose of gaining some
external/secondary gains, such as if I’m too ill to do things for
myself my partner will do them for me or I’m unable to change my
life as its too difficult/stressful for me to do all these things
today.
By
getting the client to see and accept this is their strategy and then
they can take responsibility for their actions, which is the first
step to bringing about change.
To
show them the positives in doing things for themselves, growing self
confidence and self worth etc. or how each small step can build into
a massive change over time and that they are able to grow as a human
being with small changes on a daily basis.
Q26.
Correct. You have presented an understanding of malingering and how
to deal with such. Asserting that a person is malingering where the
complaint is of a subjective nature is a tricky area In the
Medicolegal arena steps are taken to attempt to determine whether the
individual 'should' be feeling pain, for example, to the extent that
they state they do when dealing with issues of compensation for
injury. Usually the term is used when the pain is not accompanied by
objectively demonstrable organic abnormalities. However, sensations
of pain are subjective and pain thresholds vary. As you say, this
can be an subconscious process though the pain sensations can be very
real. This often occurs in relation to complaints of pain in
situations where the person is entitled to receive pain contingent
compensation or is suing for damages. There are at present no valid
clinical methods for detection of malingered pain, though
hypnotherapy can often bring about significant relief with one's
perception of pain signals when the secondary gain and/or other
factors have been addressed.
Q27.
How would you prioritise the client and specific, localised,
contextual issues over inflexible, rule-based thinking? ie bottom up
versus top down thinking.
Learning
outcomes: 1.4
Prioritising the client and specific, localised, contextual issues
over inflexible rule-based thinking (i.e. 'bottom-up' versus
'top-down' thinking).
All
clients will have their own standard way of thinking and processing
their life, the hypnotist must identify which processes the client
utilises and ensure they use a hypnotic/therapeutic process that
compliments the client.
The
top down client sees the big picture/situation first and then has to
break it right down to understand the finer details/workings of the
situation whilst the bottom up thinking client sees the small details
first and builds upon them to create the bigger picture.
To
work with a top down client you would have to get them to accept more
generalised suggestions, a process which would work well for a top
down thinker is for general suggestions to be given and then to let
their sub-conscious mind make the changes necessary to bring about
the outcome they desire, utilising the Future paced process would
allow them to just focus on the bigger picture or end result and
allow the sub-conscious mind to work out the route to achieve the
desired overall changes.
Where
as the bottom up client would respond better to smaller suggestions
that lead to the overall required outcome such as slow your breathing
and notice how relaxed you become leading to a reduction in stress,
utilising the new behaviour generator would work well for them as
they do not need to be bothered with the end outcome consciously but
to concentrate on the small changes which eventually results in the
desired changes to the bigger picture.
One
of the first challenges for the hypnotist is to identify the clients
style of thinking and working out the best process for them, whilst
keeping in mind the stated outcomes the client has requested.
Q27.
Correct. Additional to this however, it is importance to recognise
the value of working with swapping these constructs around. For
example, when a client thinks themselves 'fat' at an identity level,
believing that fat is very difficult to shift after the age of forty,
this is an example of inflexible top down rule-based thinking
programmed into the client. Encouraging them to swap to bottom up
thinking could serve them well. For example, 'Yes, I understand you
are saying your particular body has built up some reserve of excess
energy at the moment and you would prefer that energy to be used up
and shifted from your body. Maybe a deeper level of thinking about
your own specific circumstances can encourage an experiment to change
to how you live your life every day and what you may be able to do to
use up some of that energy or reduce the amount of energy that is
ingested into the body so that this situation is addressed and is
more under your own personal control.'
Q28.
Locate a piece of hypnotherapy research on pain control. Include
statistical evidence and explanation. Explain the scientific
methodology used in this research and its advantages. Properly cite
your reference sources.
Learning
outcomes: 5.5
A demonstrable ability to locate hypnotherapy research.
Hypnotherapy
for the Management of Chronic Pain
Fibromyalgia
In
a controlled study, Haanen et al. (1991) randomly assigned 40
patients with fibromyalgia to groups that received either eight
1-hour sessions of hypnotherapy with a self-hypnosis home-practice
tape over a 3-month period, or physical therapy (that included 12 to
24 hours of massage and muscle relaxation training) for 3 months.
Outcome was assessed pre- and post treatment and at 3-month
follow-up. The hypnosis intervention included an arm-levitation
induction and suggestions for ego strengthening, relaxation, improved
sleep, and “control of muscle pain.” Compared with patients in
the physical therapy group, the patients who received hypnosis showed
significantly better outcomes on measures of muscle pain, fatigue,
sleep disturbance, distress, and patient overall assessment of
outcome. These differences were maintained at the 3-month follow-up
assessment and the average percent decrease in pain among patients
who received hypnosis (35%) was clinically significant, whereas the
percent decrease in the patients who received physical therapy was
marginal (2%).
Controlled
trial of hypnotherapy in the treatment of refractory fibromyalgia.
Haanen
HC, Hoenderdos HT, van Romunde LK, Hop WC, Mallee C, Terwiel JP,
Hekster GB J Rheumatol. 1991 Jan; 18(1):72-5.
Int
J Clin Exp Hypn. Author manuscript; available in PMC 2009 Sep 25.
Published
in final edited form as:
Int
J Clin Exp Hypn. 2007 Jul; 55(3): 275–287.
doi:
10.1080/00207140701338621
The
above abstract includes the statistical data of how many patients
were selected for the trial, the period of the experiment and
follow-up assessments as well as a basic report on the findings, the
two basic methods of treatment are also reported.
A
random number of subjects from a selected pool of previously
diagnosed Fibromyalgia sufferers were given hypnosis and hypnotic
recordings to listen to over a 3-month period whilst another group of
subjects were given massage and muscle relaxation training.
At
the end of the initial experiment all the subjects were again
measured for any changes/improvements in their symptoms and measured
again after a 3-month period to monitor how these
changes/improvements had lasted.
The
results showed that hypnosis and hypnotic recordings were
significantly more effective in pain management and managing the
other symptoms of Fibromyalgia than simple massage and muscle
relaxation.
The
advantages of these experiments is that the subjects all have a known
medical condition which has measurable symptoms and as such can
provide a repeatable set of results. This experiment has been
repeated by several different research facilities utilising other
forms of treatment from pharmaceuticals to massage etc. verses
hypnosis as well as hypnosis in conjunction with these traditional
treatments and they have all found hypnosis improves the subject’s
condition.
Correct.
You have demonstrated your ability to locate hypnotherapy research
and to comment and evaluate on this particular subject of
fibromyalgia treatment with good citations throughout.
Q29.
You are setting up a peer group. Please describe, in a paragraph or
two, the benefits and how you would go about organising and promoting
it.
Learning
outcomes: 6.1 An appreciation for the benefits of peer groups and an
awareness of how to organise one.
Peer
groups are essential for growing the skill set and confidence of any
hypnotist as it exposes them to a range of client based issues and
solutions they would not normally see, the group can bring reflective
notes on past clients or potential clients and the group can work out
the how they would deal with each situation and then decide on the
best solutions between them, raising the knowledge of all in
attendance, as well as providing them with the support during the
early stages of their career on other matters of establishing a
successful therapy business not normally covered in classes or new
and innovative procedure and inductions etc.
To
set up a peer support group I would look to either the people in
class whilst I was studying or hypnosis forums such as Facebook, etc.
hopefully engaging with people from different training backgrounds
and certainly looking for different levels of skill and experience to
provide the greatest benefits to the group as a whole. Once a group
of people are agreeable to meeting up a suitable location should be
found for confidential discussions of anonymous clients issues but
with suitable facilities for social interactions such as light
refreshment and drinks to promote friendship amongst the group.
If
the group is too dispersed to meet physically then a private Facebook
group is an option but face to face meeting are preferable as they
are easier to share and support each other.
Correct.
A good answer with an appreciation of the process and practicalities
involved.
Q30.
Discuss the disadvantages of group hypnotherapy.
Learning
outcomes:
1.13
An understanding of the advantages and disadvantages of group
hypnotherapy.
The
group must either all want to be hypnotised or at least allow others
in the group to be, disruption such as chattering or getting up to
leave during the session would make it quite difficult for both the
hypnotist and the willing participants.
With
a group of people the hypnotist must monitor each and every
individual to ensure they are following instructions and the
hypnotist must pace the induction process to match everyone in the
group, this usually means to the slowest responder there as the
faster ones will wait for them to catch up but the slower ones will
get lost and come out of state if not coached correctly.
The
hypnotist should be utilising the correct form of induction for a
group situation, one in which they can easily see the current level
of each subject, a typical induction for groups being the magnetic
hands.
The
group must all be expecting the same style of suggestions i.e. not a
mix of smokers and slimmer’s wanting to change at the same time.
Time
is also a factor as the large number of the population who can be
easily hypnotised will not stay in hypnosis for too long without
direct intervention by the hypnotist which with a large group may be
challenging, something only a confident hypnotist should attempt.
The
hypnotist must also ensure they can be clearly heard by all of the
group which may require the use of a P.A. systems etc.
Correct.
Some well thought out and insightful observations of the
difficulties in hypnotising groups of people simultaneously.
Case
Study one:
You
have an appointment with a new client, Mark, who has booked in for
smoking cessation. Your client, Mark, enters the practice and you
engage in small talk about how he travelled there and you notice
there is no eye contact as he continues to look down most of the
time. The conversation then turns to the reason for his visit and
what you may be able to help them with and the reply comes back, “I
don’t really see the point anymore, I am too tired to carry on”,
or “everyone would be better off if I was not here”.
When
asked how long the client has been feeling this way, it transpires
that his wife recently left him and she has begun divorce
proceedings. It is likely to be a prolonged battle over assets and
child access. He volunteers that he feels he has not slept well for
weeks and is alternating between being tearful and irrationally
angry.
Discuss
how would you deal with this client and any associated issues.
Having
obtained a good level of rapport I would use meta-questioning get the
client to expand on their opening comments to establish a better
understanding of the client's current frame of mind as well as
identifying the right steps to assist him in the best way possible.
I
would look towards gaining permission to work with the client on his
other issues rather than the smoking during this session, I would
inform the client I felt stopping smoking at this time unproductive
due to all the other issues currently in his life, as I would
consider them more important.
If
the client is agreeable to continuing with this new direction of the
session I would want to work with his self-esteem and confidence
issues as well as stress release as he appears to be struggling with
these at this time and assisting with his poor sleep issues, which
should have a beneficial effect on him generally.
Utilising
the Control Room to adjust his Subjective Levels of Discomfort and
directing his sub-conscious mind to resolve his stress related issues
as best as possible with a strongly anchored quality sleep suggestion
incorporating Reframing of his future, possibly utilising Parts
Therapy if I discovered it to be appropriate during the
meta-questioning.
I
would request the client had at least another session preferably
within a week to monitor and support them whilst ensuring sustained
progress.
I
would closely monitor his behavioural changes (both during the
session and after) to make an informed decision as to the next step.
I
would strongly consider the client's true intent, bearing in mind his
comments of “too tired to carry on” and “ everyone would be
better off if I was not here”, should I consider these statements
to be more than a throwaway comment I would try and persuade the
client to contact his GP and discuss how he is feeling, if I felt it
necessary I would contact the GP myself to report my concerns as
required under the Code of Ethics.
A
good assessment of the situation here and a clear and concise plan of
action both of progressing with the therapy session and the various
implications. Though there really are no right or wrong answers
here, it is a good approach, as you say, to avoid dealing with the
smoking cessation at this initial stage, when it may be a supportive
mechanism necessary to his well being at present.
Case
Study two:
Mary
arrives at your practice for help losing weight. In your pre-talk
she comments angrily about the behaviour of her nine year old son,
Josh, who never does anything she asks. She has been a lone parent
for over a year since the breakup of her relationship which she
blamed on Josh’s bad behaviour. She says she is at her wits’
end and does not understand why he is so badly behaved. She
admitted that he angered her so much one night that she even threw an
empty bottle in Josh’s direction when he particularly upset her.
As you ask about her eating habits etc she volunteers that she and
her son live on a diet of fast foods which are delivered to the home
as she never has time to shop or cook properly because her job
involves long hours, where she is not home until late, and it is very
stressful. She then tells you that she cannot sleep unless she
drinks at least a whole bottle of wine every night.
Discuss
how would you deal with this client and any associated issues.
Having
obtained a good level of rapport I would use meta-questioning get the
client to expand on their opening comments to establish a better
understanding of their current frame of mind as well as identifying
the right steps to assist them in best way possible.
I
would look towards gaining permission to work with the client on her
other issues rather than the weight control during this session, as I
would consider them more important at this time.
If
the client is agreeable to continuing with this new direction of the
session I would want to work with stress release and anger management
as that appears to be the major issues at this time and also
assisting with her poor sleep pattern, which should have a beneficial
effect on her general life. I would consider use some Ericksonion
metaphors to work on her acceptance of her current position as I
would expect some issues around feeling guilty of her behaviour
towards her child which may help to move forward.
Utilising
the Control Room to identify and adjust her Subjective Levels of
Discomfort, directing her sub-conscious mind to resolve the
stress
and anger related issues as best as possible with a strongly anchored
quality sleep suggestion incorporating Reframing of her future,
possibly utilising Parts Therapy or potentially Regression Therapy if
I discovered it to be appropriate during the meta-questioning.
I
would request the client had further sessions with at least another
preferably within a week to monitor and support them during this
vulnerable stage whilst the on-going work would ensure sustained
progress.
I
would closely monitor any behavioural changes (both during the
session and after) to make an informed decision as to the next step.
I
would try and persuade the client to contact her GP and discuss both
how she is feeling and possibly helping with her drinking dependant
on how dependant she believes she is on the alcohol, the GP could
also to identify any assistance there may be available with a
reference for her to social services for greater support with
bringing up a child under these circumstances.
If
I felt it necessary I would contact the GP myself to report my
concerns as required under the Code of Ethics as her child is
potentially at risk of harm should her situation continue un-changed
or deteriorate further.
A
good approach and due consideration of the implications of this
complex therapeutic situation with a good regard not only for the
well-being of the client, but for the child also. The therapeutic
structure of the session seems most appropriate and also the follow
up and timing of the other sessions. I particularly applaud your
recognition of the value of the sleep improvement as the initial step
toward an improved condition.
