EXAMPLE ANSWERS: Q11

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

Student answer When working with pain it is important to establish the current position in terms of treatment – is the client currently under medical supervision or investigation? If so it may be advisable to provide therapy only if they are in a stable situation or are being referred by a GP as therapies could conflict or counteract each other. If they have not seen their GP I would be likely to advise them to do this. Within the pre-talk of an intervention for pain I would ensure that I explain that pain is the method by which the body provides feedback – a protection mechanism to reduce injury and it is important to explain that it would not be advisable to reduce pain to being totally absent as this may mask any other problems or injuries. Using metaquestioning I as the therapist can establish what, if anything, makes the pain worse and what, if anything, provides relief. A desired outcome can then be established e.g. reduction in pain to a level where the individual is able to walk, and sleep without the use of pain medication. I would confirm with the client what the intervention was going to be and establish on a scale the where they are now and where they want to be. I would be very clear as to which way the scale needs to go e.g. your level of comfort and ease in relation to your back is at a 2 and you wish to increase this to an 8. I would be specific so that they understand that pain from other areas of injuries will still be experienced if this is necessary for their body to alert them to a need. I would also ask them if they have ever seen a music sound mixing board and assuming that they have I would progress with the hypnotherapy session. I would then use an induction with ideomotor responses combined with a deepener and convincer to ensure that the client is in the therapeutic state. A relaxing place would be established and then I would ask them to imagine a control panel such as a music mixing board – with slides and toggles that turn volume, bass, treble etc up and down on a sliding scale. I would ask them to realise that each of the toggles is able to move and slide up and down within its track. I would ask them to identify the slide toggle marked ‘back comfort and ease’ and note where it is at this point (2). The client can then be directed to decrease the scale slightly- just a notch to level 1 to experience the change and then without lingering too long I would direct them to slide the slider up the scale, finding that it moves easily and with little effort. With each notch it moves the sense of ease and comfort increases until they are at the point where they are at or as close as 8 as they can be. I would then ask them to notice that the toggle itself can be removed – it can be pulled off so that the slider stays in place. They have control of the toggle and if they ever need to they can put it back on and adjust the scale, but unless they do, it will remain in place, fixed at that point. Next I would use future pace – imagining and experiencing scenarios in which pain was previously experienced and enjoying the comfort and ease they are now experiencing. After repeating several times with different scenarios I would return to the client to full waking awareness and ask how they felt now that their sense of comfort and ease had increased. (LO 1.2 An ability to devise an appropriate psychological intervention for a medical condition.

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table) Correct. A very comprehensive answer detailing your skills and understanding of the whole approach. Good to read and I look forward to you helping many in the future with this approach. Thank you.

Further Student Example Answer:  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.