ADVANCED: SECTION FOUR WORKBOOK

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.

1. Learning outcomes: 1.3

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Q14. Read the following article and comment and discuss your views on Epilepsy and Hypnotherapy. .

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.

Learning outcomes: 1.3

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Q15. If your client has an epileptic seizure advise the steps you would take to care for the client.

Learning outcomes: 1.11

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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

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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

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ADVANCED: SECTION THREE WORKBOOK

Q8. Describe a client scenario where you would choose to use Erickson’s utilisation technique.

Learning outcomes: 1.1

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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, 3.3

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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.

http://news.bbc.co.uk/1/hi/health/8572818.stm

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. "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."

Learning outcomes: 3.4

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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

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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

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ADVANCED: SECTION TWO OF WORKBOOK

Q3. What does Hilgard’s Neodissociation theory propose with regards to trance? [LO 2.1]

1. Hypnotic phenomena is produced through a disassociation within a high level control system
2. Disassociation between imaginative processes and reality as it is perceived by the viewer
3. A separation from past well established cognitive processes and the current interpretation of the view of the world
4. Forming the intention to perform an action, without forming higher order thoughts about intending that action.
5. Hypnotic behaviour is a social behaviour that can be explained without recourse to any special process.

Learning outcomes: 2.1

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Q4. Which of the following are NOT factors of 'pseudoscientific therapies/treatments'?

1. Does not adhere to a valid scientific method
2. Lacks supporting evidence
3. Lacks plausibility
4. Cannot be reliably tested
5. Involves the use of sugar pills
6. Vague, contradictory or improvable claims
7. An over reliance on claims rather than evidence

Learning outcomes: 5.6

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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?

1. Pain
2. Depression
3. Smoking cessation
4. Cancer remission
5. Weight loss
6. Making surgery safer, quicker, and more comfortable

Learning outcomes: 5.7

(Student answer here)

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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

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Q7. What approach would you take when hypnotising a child?

Learning outcomes: 1.1

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ADVANCED: SECTION ONE OF WORKBOOK

GHSC Validated

The Unity Principal Ltd

Student Workbook / Portfolio for Advanced Practitioner Level

As part of the course we offer a support meeting once every 6 weeks so that students can talk to trainers about their assignments. You will be given five questions and six weeks to complete each set.

The questions must then be handed in by a set date to be advised. All questions must be passed before moving on to the next module.

If any questions are answered incorrectly the appropriate feedback and support will be provided until knowledge is attained and resubmission takes place.

Students are required also to carry out additional tasks of completing their Reflective Journal, give a short statement of how the course has developed them as a hypnotherapist and completion of the Personal Development Plan detailing continuing professional development that you will be planning to carry out in the future to develop yourself further as an advanced practitioner.

This workbook is made up of six sections

1. Learning Outcomes
2. Questions
3. Vignettes
4. Reflective Journal
5. Personal Development Plan
6. Info about how to complete etc.

Learning outcomes

The following learning outcomes must be met (in any order).

Important note: each question or task in the homework portfolio must be accompanied by the learning outcome/s that it substantiates.

1. Advanced clinical knowledge and skills

1.1 An understanding of advanced interventions.

1.2 An ability to devise an appropriate psychological intervention for a medical condition.

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.

1.4 Prioritising the client and specific, localised, contextual issues over inflexible rule-based thinking (i.e. 'bottom-up' versus 'top-down' thinking).

1.5 An ability to determine an ethically and therapeutically appropriate approach for more complex cases where specific training may not be available.

1.6 An understanding of what is meant by 'normalising' client experiences.

1.7 An ability to recognise 'loaded' questions.

1.8 An ability to recognise 'leading' questions.

1.9 An understanding of the nature and impact of extratherapeutic factors.

1.10 An understanding of primary, secondary, and tertiary gain, and malingering.

1.11 Knowing how to take an appropriate course of action with a client who is experiencing an epileptic seizure.

1.12 Knowing how to sensitively and firmly handle clients who breach personal or professional boundaries.

1.13 An understanding of the advantages and disadvantages of group hypnotherapy.

2. Theory and its application

2.1 Knowledge of the various theories on the nature of hypnosis.

2.2 A demonstrable understanding of psychological theories of motivation and behavioural change and an ability to apply this to clinical practice.

3. Academic thinking and argumentation

3.1 A demonstrable understanding of logic and academic argumentation.

3.2 A recognition of the problems associated with forming conclusions about other modalities based on small and biased data sets.

3.3 An ability to reference other authors' work properly, e.g. in 'Harvard' and 'footnote' formats.

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.

3.5 An ability to critique hypnotherapy literature in an academic and professional manner.

3.6 A forward-thinking appreciation of the potential consequences of scientific research and theorising on the future of clinical practice.

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.

3.8 A demonstrable and respectful appreciation of both the advantages and disadvantages of interventions that have, or have not, been scientifically researched.

4. Ethics

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.

4.2 A considered approach to professional responsibilities around public protection.

4.3 An awareness of the subtleties around protecting client confidentiality, especially regarding the ease with which identifying details can be released, e.g., bit by bit in supervision.

4.4 An ability to handle awkward challenges to the maintenance of confidentiality, demonstrating an awareness of the issues, sound judgement, and sensitivity towards client needs.

5. Research methods and application

5.1 An understanding of scientific methodology and its advantages.

5.2 An understanding of the term 'falsification' in science.

5.3 An understanding of 'bias' in research.

5.4 A basic understanding of statistical methods, sufficient to enable engagement with hypnotherapy research literature.

5.5 A demonstrable ability to locate hypnotherapy research.

5.6 An understanding of the term 'pseudoscientific therapies/treatments'.

5.7 An understanding of the term 'empirically supported therapies/treatments'.

6. Professional development

6.1 An appreciation for the benefits of peer groups and an awareness of how to organise one.

6.2 Effective personal reflection on the learning that has taken place on the course.

6.3 A recognition of, and demonstrable commitment towards, professional development needs as evidenced through a Personal Development Plan.

Important note: each question or task in the homework portfolio must be accompanied by the learning outcome/s that it substantiates.

QUESTIONS

Q1.1 Which one of the following is not a leading question? [LO 1.8]

1. If you eat that whole tub of ice-cream what will happen to your weight loss goal?
2. What do you think about restrictive dieting? Many people tell me that they consistently fail when dieting.
3. Do you want to stop smoking right now or next week?
4. Do you want to stop eating chocolate?
   Learning outcomes: 1.8

1.2 Give three examples of loaded questions and when and why you would use these.

Learning outcomes: 1.7

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Q2. 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

(Student answer here)

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Reflective Journal: Can I do this???!!

From Jim Skinner, with thanks

My reflections on the course in general are somewhat random and will not be in date order as like the course itself I found that I was using distraction techniques (my grass has never been cut so often, my car never so clean, etc. etc.) to avoid actually concentrating on the course work because I am not by nature the type of person that can sit and apply focus when left to my own devices. I clearly lack the discipline to study alone but sharing work space with others even though it was still my own work being done in my own way, works for me, and from conversations with other delegates I am not alone in this.

Many times I sat down to ‘just do one question’ which I would start and despite the fact that I have the knowledge within me, my mind would go blank or I would start writing and then find that I was deleting my work and starting again because I am hyper-critical and think I should do better work.

This was a recurring theme throughout the first months and as each week passed my avoidance was becoming tinged with cross-ness and a profound disappointment in myself for not just doing it !

I know I can actually do the work, and I have the knowledge, so why not do the work was the question I was beating myself up with.

The email I received from the course tutor Jennie Kitching suggesting that if enough people were interested she would arrange an intensive session to assist the completion of the course was to me an absolute relief, and I didn’t have to think twice. The response was not a surprise to me, there was rapid ‘yes please’ from many of the students wishing to get together and having a joint focus on completing the course.

Changes throughout my career so far that I wish to share here really focus on my levels of confidence and competence.

My confidence in my abilities as a Hypnotherapist have grown exponentially with each client and each issue that I have dealt with, I was definitely nervous and uncertain in the beginning and felt concern that the client would not enter trance, but because of my training and the advice to display confidence even if I wasn’t feeling it, has paid dividends for me. I now enter each session knowing that I have the ability to do the job and do it well and that I can and do help my clients.

My belief in my competence has grown as I get more and more positive feedback from my clients.

I have recently been doing group relaxation sessions for the staff at the local Hospice where I volunteer, one day a week. I had done very little group work prior and the little I had done was for 2/3 people, I had 12 people for my first session here and I soon realised that ensuring that my induction and deepener fitted so many people was somewhat more challenging than I had thought, as with that many people and the shortage of time available I couldn’t check individually if anyone was claustrophobic or suffered with hayfever etc. etc. and that what I was saying would work for them all. I changed the approach on my second session making it more generic, however on reflection I still haven’t got it quite right yet. 

The feedback has been positive and I may be making it more difficult for myself than is necessary.

Thinking about my reflective practice I now finally understand the true value particularly in relation to my own performances.

This is a pleasure to read Jim and we are so grateful that we are all a collective Unity presence that can affect each other and get things done! We all help each other and so long as we keep communicating I am sure we will achieve great things together. It is s delight to hear of your progressions and I will only reiterate that I think many of us would be wise to share our thoughts more often and get the support we know would be forthcoming rather than trying to go it alone. It is a common ‘side effect’ of the profession of being a hypnotherapist that we do wonders for folks every day and neglect ourselves and can give each other the very experience we all need to be brilliant therapists!

Reflective Journal Entries: Handling Grief

From Jim Skinner, with thanks

2. S. Grief

This client was in need of help with his grief following the loss of his father.

During our first meta questioning he disclosed that he also had huge anger issues with his siblings who were arguing and fighting over their inheritance and this was actually stopping him grieving properly.

We agreed that primarily we needed to have him relax and reframe what was going on around him as he was not sleeping and he could not concentrate whilst at work which was creating more stress.

I employed the empty chair (Gestalt) method allowing him a safe environment to firstly begin his farewells to his father and later return again to this method to say the things he needed to say to his siblings without the distress this would have caused his mother.

We had 3 sessions and he was able for the first time since the burial visit his father's grave.

Reflective Journal Entries: Skin Allergy

From Jim Skinner, with thanks

Reflective Journal of practice:

1. D. skin

This client is a nurse who has to use special antibacterial barrier skin gels and creams many times per day in the hospital, which had been causing the drying and cracking of the skin on her hands and between her fingers, this was both uncomfortable and itchy, it was also unsightly which caused her almost as much distress as the physical problems. 

She has suffered with eczema all her life and used expensive potions and lotions on her sensitive skin. An area of her skin that was particularly difficult for her was her eyelids, any time she was stressed – exams, driving test, etc she would suffer a break out which made matters worse for her. 

Her demeanour is one of confidence but she is actually shy and nervous and at our first meeting which was for help with a presentation she had to give to her superiors in management, during meta questioning she disclosed the above information. I decided and she agreed that whilst I was working on the presentation confidence I would also work on the self healing power of her mind.

Whilst in ‘trance’ and having covered the confidence work I suggested that her subconscious mind find alongside her, a white healing light that would enter her head and penetrate each cell of her body and that it would repair, replenish, restore and flush out any toxins and discomforts that she was holding onto and that in the future the barrier creams and gels would act as though they were the expensive lotions that she normally used to help her skin.

We met again two weeks later and she was delighted with the way she handled her presentation for which she was applauded for the first time in her life, but the thing she was most impressed with was that her skin particularly her eyelids were almost completely clear of any signs of eczema and even though she still had minor problems with her hands she considered them to be “at least 70% better to look at and the discomfort and itching was neglible”.

She booked another appointment for continued work on her skin and some help with weight control.