Fibromyalgia Hypnosis Study

Please find below a section from a brilliant student's workbook which cites an interesting clinical study you might be interested in.

Student Example Answer:  

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.

Q28. 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.

To be or not to be... hypnotised! In two minds?

In Two Minds?

Thank you for choosing to read this, I bet you were in two minds as to whether to read it or not weren’t you? I am very pleased to invite you into my training room to work with my wonderful clients who have taught me so much.

I have been a hypnotherapist and teacher for many years now and, before that, a corporate trainer for twenty years, training the minds of hundreds of individuals, including myself. This has led me to share with you my findings and experience which culminate now in the following.

The human mind is born into duality: the conscious and unconscious parts of the mind. Though it is of course the same mind and not physically divided into two distinct parts (although attempts have been made to do so) there is the generally accepted concept that these two aspects of mind have distinctly different functionality and purpose and that one cannot exist without the other.

The unconscious mind is all the memory, automatic behaviour, instinctive reactions, intuition, artistic inspirations, and much more that we shall be examining in depth, though it is also what quantum physicists refer to as the seat of the imaginal realm, ie the domain of all our imagination. This then gives us something of a dilemma. How are we to know what is real and what is imaginary when dealing with the representations from the unconscious mind, whether that be our own or another’s?

The perfect example to illustrate this is regression. I have experienced clients spontaneously regressing to help themselves regarding an issue. Sometimes this has been regression to an event within childhood or infancy and sometimes beyond that even. It must be pointed out here that the client’s consciousness would have not intended this regression to happen, or even have been willing to experience it if suggested by the therapist.

Of that information, it is sometimes difficult to separate what is real and can be investigated in concrete terms from what is seemingly designed from deep within the unconscious to maybe present the consciousness with an appropriate metaphor to deal with the presenting problem Does it indeed even matter, as long as the client benefits therapeutically from the experience?

Information from the mind can be made up, imagined, whether or not the conscious mind is aware of it being so. That information can also be ultimately truthful, real and the absolute expression of a situation that occurred involving the subject in their past.

It is my intention that this exploration will lead you into your own deepest ways of knowing and that it will invite you into the world of the client whilst giving you the tools to chart your escape.

This work is not a spiritual quest, has any political intention, or is involved in the advancement of any one isolated business or set of beliefs, it instead honours open-minded approaches and diverse methods which ultimately enhance the therapist’s understanding and ability to address imbalances within the mind and body. Hypnosis uses the unconscious mind and its relationship with the consciousness to bring about that balance. Often when problems present themselves it is due to the two parts of the mind being at war with eachother. Issues deep within the unconscious are then not heard or deliberately ignored. Communicating with the unconscious mind of the client is therefore imperative to bring resolution. Yes, resolution is what it's all about. Shall I stop smoking or not, shall I lose that weight or not, shall I endeavour to get over that fear of heights today, or not, shall I actively build up confidence to find a loving partner, or not, shall I .... shall I.... So, the worst thing for the human mind to deal with is being split: in two minds until procrastination or our internal arguing lead us long into old age where desires remain unexplored or fade into regret, or merge into the background of all our coping mechanisms. Therefore either go and experience hypnotherapy or ... not. Make that mind up. Though if you never did, you'd never know....

REFLECTIVE JOURNAL ENTRIES: ALCOHOL ABUSE

From Tracy Jones, with thanks

A client contacted me for help with moving on after a relationship had ended. She seemed desperate when I saw her and told me that she couldn’t see any future for herself without her ex partner. During the meta questioning it became apparent that she had become very reliant upon him for her every day living. She felt unable to go out on her own and avoided going anywhere but the local shops within the immediate area. She also disclosed that she had been drinking to help her deal with the strong negative emotions she was experiencing. She told me that drinking had been a problem for a long time and was part of the reason the relationship had ended as she was unable to control her alcohol intake when going out with her partner, then she would become short tempered and sometimes violent when she had consumed alcohol.

She seemed so desperate to move on from the relationship, telling me that she wanted to erase all memory of him from her mind as it was too painful to think about him at all, a painful reminder of what she had lost. I immediately told her that she may feel like that now but she didn’t really want to erase the memories as that was still a part of her life and had helped to make her who she was. Immediately I realised that I had lost rapport with her as I had failed to meet the client where they are. I knew that I had attempted to tell her how she should feel and straight away she began to defend herself telling me that she really did want to forget she had ever met him, even the good memories, she was desperate to remove. Thankfully, I managed to regain rapport through agreement with her that I could see how difficult this was for her and that I could understand the reasons why she felt she wanted to forget him altogether.

I worked on looking to the future, reassuring her that I could help her to become independent again by using hypnosis to help her overcome her anxieties. The work in the first session was based upon allowing her to see that she had a future without her ex partner and all the positive things in her life in the present.

In our second meeting, she told me that she’d had a good couple of days to begin with but things had gone downhill again and she had been using alcohol excessively in order to help her to cope. I decided that I would work on some practical ways to help her to go out, such as attending playgroups with her daughter and grandchild and arranging a shopping trip with her other daughter as I was concerned she was spending the majority of her time at home with her elderly mother, which was re-enforcing her anxiety issues. During the trance work, I again focussed upon moving forward and she told me after that she had decided she would redecorate her room and would ask her daughter to accompany her to visit the library as she enjoyed reading.

I also felt that we needed to address the drinking habit. I felt less than confident in this area, I’m not sure why! I decided to use a control panel intervention, increasing her strength resource as that is what she felt was needed in order to stop drinking alcohol.

We scheduled a third session and she emailed me before telling me that she didn’t feel that she needed to see me again as the relationship had been reconciled. I felt disappointed and slightly worried for her as it had been apparent that the relationship was volatile and she had been unhappy despite declaring deep love for him. I had been looking forward to helping her to move forward with her life independently as a more confident and happier person. I felt despondent, though realised and accepted that this was her decision and I had done my best in helping her, though I still had nagging doubts wondering if I’d really done enough and if a more experienced therapist could have helped her more.

A few months after our sessions, a mutual friend told me that she had seen my client, who told her that I had helped her immensely. She explained that she had not had any alcohol at all since our meetings and felt calmer and more in control. From this experience I have learned that even when from my perspective the therapy has failed to be effective, the client may have enjoyed benefits which I didn’t recognise or even know about as I had not had opportunity for a follow up appointment. This was a problem with my own thinking patterns as I had automatically assumed that I had not been effective in this instance without knowing the facts! I now realise that even if I don’t recognise the benefits of the therapy, the client may have a completely different experience of the therapy. Likewise, the from the client’s perspective, if they felt that the therapy hadn’t been effective, it’s likely that there will have been some benefit, even if the client doesn’t recognise it

REFLECTIVE JOURNAL: BEYOND CHOCOLATE ADDICTION

From Tracy Jones, with thanks

A friend asked me for help with weight control. During the meta questioning I found that she ate minimally through the day then in the evening she would begin to raid the chocolate and sweet cupboard. This was on a day which described as her ‘being good’. Other days would start with her getting up and thinking to herself that she would be good today, then almost immediately she would begin eating sugary foods. The client was overweight and slightly into the obese category. However she had already lost 4 stones over the course of a year but the weight loss had stopped, and she was beginning to put some weight back on. She told me that she enjoyed exercising and had a strict fitness regime which consisted of a 7 mile run first thing in the morning, every day, then she worked full time caring for children so was physically active all day, rarely taking a lunch break, then every evening she would do 2 or 3 exercise classes or around 2 hours in the gym. 

At the weekends she would complete her usual run, before spending around 4 hours at the gym, taking part in a variety of activities. Through the questioning she came across as feeling some guilt at the amount of time she spent at the gym, telling me that her husband complained that there was no family time. She told me that she justified it to him and herself as her accumulated lunch breaks that she didn’t get to take during the week. When she explained this to me, she was almost trying to convince me that she deserved to spend this time to herself as she was unable to have breaks while working as a childminder. I believe that she was also trying to convince herself of this!

I educated her about over exercising, explaining that unconscious mind was recognising that she was not having enough calories to sustain her body through her vigorous workout routine. This was especially apparent on the days where she woke up determined to ‘be good’, as her unconscious knew that on those days her body would receive no where near enough nutrition to keep her going, as on these days she was eating very little. Therefore the unconscious was immediately putting a stop to the lack of calories by sending the ‘eat’ signal. I also explained that her body needed rest days in order to recover, and this would actually aid her weight loss. She made it clear however that she was unwilling to reduce her exercise, as this was her time, doing something she enjoyed.

I conducted a new behaviour generator, then in subsequent sessions I used a control panel intervention and fork in the road. The fourth session was not arranged, and from speaking to her after I got the impression that she saw good results to begin with but she began to revert to her old behaviours after a while.

On reflection of this experience I think I know where the real root of the problem lies. During our sessions, she disclosed to me that her mother is, and has been for many years, addicted to prescription drugs. Her childhood was difficult and she described her mum as an attention-seeking hypochondriac. She told me that she never wanted to be like her mum and finds it difficult to take any kind of prescribed medication as she fears she will become addicted to it. She feels that addictions ‘run in the family’ and she was determined that she would be different. She also told me that she is addicted to exercise and as addictions go, it’s the best one she could have. From our discussions, I feel that she is convinced that she would follow in her mother’s footsteps and have some kind of addiction. I think that her unconscious mind has decided that as an addiction of some sort is inevitable it would choose one which is different to her mother (she made it very clear that she was determined not to be like her!) and one which is the lesser of the evils. It seems that if she is addicted to something then she has less chance of becoming addicted to drugs like her mother.

As a friend of the client, I found it difficult to confront her with this theory. Therefore, the therapy was not successful in the long term as the root cause of the problem had not been addressed. I did suggest to her that maybe a different therapist would be able to help her further, but as far as I know she has not perused any of the contacts I gave her.

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REFLECTIVE JOURNAL ENTRIES: CHILD SPIDER PHOBIA WITH SECONDARY GAIN

From Tracy Jones, with thanks

I had a child client who presented with a phobia of spiders. Her mother told me how she would scream hysterically if she spotted a spider, refusing to go to bed on the evening until she had seen that the spider had been completely removed from the house. The child also reported that she had nightmares about spiders walking over her face while she slept at night.

I used a heavy hand light hand induction and used language appropriate to her age. I used the fast phobia cure technique and found that the results were immediately very good. Her mother reported that she slept well that night and the next day there was a spider in the house, she shouted for her dad to get it out but rather than being hysterical, she was calm, watching her father remove the spider. She told her mum that she still didn’t like spiders but her mother told me that the difference in her behaviour around spiders was much more like she just didn’t like them rather than being terrified as she appeared before.

However, after a couple of months the problem returned. After discussion it became clear to me that I had not spotted and addressed secondary gain. The child told me that she became very scared of spiders again when there was a spider at school and her friends had all been screaming and running away from it. After some gentle questioning, it seems that she had felt that she no longer fitted in with her friends as most of them had a spider phobia!

She told me how they all tell each other stories about dangerous spiders and when they see one at school they all look after each other.

Having heard this I feel that in order to continue to fit in with her friends, the unconscious decided that having the spider phobia was a good way to ensure the friendships remained strong and without it there was danger of her losing the friendships if she no longer conformed to the normal. This made me realise the importance of identifying and addressing secondary gain in all instances, maybe something I’d overlooked as this was a child client.

ADVANCED: REFLECTIONS ON LEARNINGS AND PERSONAL DEVELOPMENT PLAN EXAMPLE

REFLECTION ON COURSE LEARNING

Reflection on course learning - this section is specifically mapped onto learning outcome 6.2. It requires the student to document how they feel their learning has developed over the duration of the course and how else you can improve your practice.

Reflection 1: What did you learn from the activity/experience/discussion? Something about yourself or others and/or new knowledge or skills? These reflections may well feed into your thoughts and comments on progress in your PDP, and help you to identify new priorities or learning opportunities.

Reflection 2: How will you use this learning to develop your practice as a hypnotherapist or as a reflective practitioner?

Reflection 3: How did you use this learning and what difference has it made to: Your awareness? Your perspective? Your practice? Your clients?

Reflection 4: What further learning needs do you have, or what actions do you need to take to further develop?

Reflection 1	Reflection 2	Reflection 3	Reflection 4
What did you learn? Use this column for personal thoughts/ reminders	How will you use this learning?	How did you use this learning? What difference has it made?	What further learning
The power of metaphor	I will be more able to recognise times when metaphor may be useful	I used it with a client who wouldn’t admit to a particular difficulty, so rather than addressing it directly when she obviously wasn’t comfortable discussing it, I used metaphor instead.	I would like to do some further reading on the subject of metaphor in order to become more creative in my approach to its use.
Using techniques tactfully in order to influence the clients thinking.	I will be more confident in tackling situations where a client might feel under pressure if I were to directly approach something. By using methods such as creating a past imaginary client who was in a similar position to the client and did things in a different way, the client would not feel offended as It would seen that I was simply sharing an experience of another client, though the unconscious and maybe conscious thinking may be influenced positively through this.	Opening up clients thinking while ensuring their comfort.	I would like to use this more in practice in order to gain more experience in this area.
The safe use of hypnotherapy for clients with epilepsy. I have learned that in some cases hypnotherapy can be used safely and effectively for some types of non epileptic fits.	Before studying for the advanced diploma I was under the impression that in no circumstances was it safe to work with clients suffering from epilepsy or fits. However I have learned that not all fits are caused by true epilepsy and that hypnotherapy can actually be useful in treating these types of fit.	I now feel confident in working with clients presenting with these problems. Having experience of dealing with children suffering from fits in the past, I feel confident that I know how to safely handle a client experiencing a fit during a therapy session and having a refresher of this information during the course, i am now more open to working with clients experiencing these difficulties.	I would like to converse with my peers more on this subject, especially those with more knowledge and experience than myself in this area in order to help more people with these problems.
The meaning of the term ‘malingering’ and how to recognise and deal with this withing the therapeutic setting.	I had a basic knowledge of malingering but on the advanced course I gained a much deeper insight into its meaning and ways in which I can help the client to look at their condition differently in order to understand it and move forward.	I am now able to more effectively recognise and manage a situation where a client is malingering. I have learned how to be tactful as to maintain rapport whilst doing this as this can be a sensitive area in which the client can easily be offended and the therapeutic relationship may be detrimentally affected.	Further experience will give me an even deeper understanding in this area, as will discussion and support from peers.

PERSONAL DEVELOPMENT PLAN (PDP)

Personal Development Plan (PDP) - this is where learning outcome 6.3 is realised. You are asked to create a plan of action for an area of practice that you wish to improve.

Your PDP represents your view of the key personal and professional priorities that you need to focus on, in order to develop as an effective Hypnotherapist.

Your PDP will be informed by your reflections in your Journal the outcomes of your time/discussions with your tutor, your own view of your skills and attributes and so on. It is likely that your PDP will be amended over the course of your learning journey.

Personal Development Plan

Objectives What do I want to be able to do or do better?	Success Criteria How will I recognise success? How will I review and measure my improvement?	Actions What methods will I use to achieve my learning objectives?	Implementation How will I practise and apply what I learn?
Use more efficient questioning techniques in order to reach the true cause of the problem.	The results of sessions would be a good indication, also the length of questioning time would tell me how concise the questioning was.	The knowledge I have gained from this course, further reading on the subject and through practical experience with clients.	During sessions, using questioning more effectively to pinpoint the cause of the issue.
Gain in confidence in promoting myself as a therapist.	By the number of clients that I am seeing gradually increasing over a period of time.	In gradually seeing more clients my confidence will grow as I become more experienced. Also by attending peer support groups, communicating with peers regularly, offering and asking for advice and support. Further reading and learning in the field of hypnotherapy.	I will build a successful hypnotherapy clinic, increasing in confidence as I do so.
Help clients who are experiencing difficulties with fertility.	Through client feedback.	I would like to widen my knowledge of fertility issues and take part in a course which is based upon the use of hypnotherapy for fertility issues. Also during peer support groups, learning from peers with more experience in this area.	I will see an increasing number of clients with these issues and be effective in helping them to conceive.
Effectively use hypnotherapy for children, including those with special needs.	Through feedback from both the clients and their parents/carers. Also from assessing the results gained, especially clients with special needs who have difficulty with expressive language who cannot verbalise how effective the therapy was.	I will gain experience from my using hypnotherapy with my own children, as well as friends children who have various difficulties. I will use my knowledge gained from working with children with special needs in order to devise effective and appropriate strategies to use. I can converse with previous colleagues whom I worked with in school settings. Also through wider reading on the subject of children and therapy, as well as further reading and research regarding various types of special needs.	I will use the therapy on my own children initially, before advertising that I work effectively with children. After carrying out the further learning stated regarding special needs, I will contact organizations such as special schools and support services to offer therapy to those clients with extra needs.

Thank you XXXXX, consider keeping your Journal and PDP going so that you consistently reflect on being the best you can be and what you next steps to achieving success in your terms are. Also, I value your recognition of staying in touch with your peers and on the Forum to continually engage with others who will inspire and support and who you can encourage and motivate too. See you on the Forum, great work all round XXXX, thank you again.

EXAMPLE ANSWERS: VIGNETTES MORE

(Student answer here) Ideas how you would proceed i.e. suitable intervention, ethical complexity, referral etc.

I would first ask if Mark had sought any medical advice. I would hope that he was already receiving medical attention, at least from his GP in the first instance. If he hadn’t seen a medical professional I would strongly advise him to see his GP. If I felt that Mark was in immediate danger of harming himself, I would be inclined to contact his GP myself to express my concerns. I may be inclined to offer contact numbers for further support, such as counsellors, Samaritans etc.

I would ask Mark more details about his current feelings and emotions, while assessing his unconscious communication too. I would ask questions surrounding his current motivation for smoking cessation, whilst assessing his commitment to change through the language used and unconscious communication. I suspect that at such a low point in his life, his motivation for the smoking cessation would be minimal, though I wouldn’t want to just presume this, not acknowledging it as this was the reason for his contact initially. It may be that Mark didn’t feel comfortable asking for help with his current emotions and difficulties, and as smoking cessation may be seen as being an ‘acceptable’ reason for seeking help, he used this as an excuse for seeking help.

Once Mark had explained more about his feelings and emotions I would begin to reframe his statements in order to encourage a more positive outlook for his future. I would ask him about his hopes for the future, encouraging him to think about ways to move on his life, focussing on a positive outcome. I would find out his views on the divorce he is going through, and again reframe this to encourage Mark to think about the positive aspects that the divorce may bring.

Once I had gained this information from him I could then incorporate this into the chosen intervention. I could use a control panel intervention. If he had told me for instance that he felt he needed self- belief in order to allow him to move forward from this point, I would work on increasing his self -belief through the control panel. I would ensure that the future pacing was a large part of the trance work, incorporating the aspects into it that he had disclosed during the meta questioning. For example, if he had told me that he wanted to make a decision regarding where he was going to live now that the relationship was over, I would include in the future pace that he see himself confidently choosing a new apartment, and in doing so, believing in his ability to make the right decision for himself. I would then build up the picture of him living there, how it may look (based upon the details he had given in the discussion), building up a very positive picture of how life will be in the future. I would also give suggestions about how he feels more able to relax and is sleeping well etc.

In order to ensure that he contacted his GP and to find out how he is, I would request a second session. If he seemed resistant to this, I may use the smoking cessation as an ‘excuse’ to check on him. For example, I may explain that because it was probably a good idea to address the issues around his current emotions in this first session (hopefully this would have been expressed by him early in the session during meta questioning), it would be beneficial for Mark to return for a further session in order to address the smoking cessation. During the second session, I would like to ask if he had contacted his GP and the outcome of this, and also whether the GP was happy for him to continue working with a hypnotherapist.

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table)

Correct. |There are no right or wrong answers here of course and whilst I applaud your practical considerations with regard to further support for your client, I would like to pick out a few strategic points here “and as smoking cessation may be seen as being an ‘acceptable’ reason for seeking help, he used this as an excuse for seeking help.” Your recognition of this is extremely valuable as we say we are so glad the world is full of people who smoke and want to lose weight as they may never enter into the hypnotherapy session. “I would begin to reframe his statements

a very positive picture of how life will be in the future” This again is so important as there is a grief involved in the demise of all relationships where the future that has been planned for with the partner has disintegrated with nothing there to replace it, intuitive insights on your part and an important point missed by some. “feels more able to relax and is sleeping well” Again this point is imperative and often overlooked, seeming insignificant to some in light of the comparison with such dramatic life changes, though it is important that the person maintains, or initiates, that ability to relax properly and to sleep peacefully, regardless of the trauma surrounding them, well done.

Also, you have set out a very clever and diplomatic strategy for ensuring that a follow up session takes place with your opportunity then to make sure benefits are continuing. Great work Tracy.

I would firstly ensure that I build a very strong rapport with Mary. I feel that this would be very important to ensure the success of the session. I would be checking that I had built and maintained rapport through pacing and leading.

Once rapport had been built and maintained for a while I would ask if Mary had sought any medical advice, from her GP or another medical professional. I would then sensitively explain that it is my duty as a professional practitioner to ensure that clients receive the appropriate support and that I feel that she currently needs more support than I can offer her as a hypnotherapist. Therefore I would like to contact her GP in order to ensure she receives the correct support, alongside the help I can offer her.

I would encourage Mary to realise that she has choices available to her, life doesn’t need to be this way. I would endeavour to open up her way of thinking, offering suggestions of different choices available to her. I maybe ask if it would be possible for her to cook a meal sometimes with her son in order to improve the diet and to strengthen their relationship. I may do this in an indirect manner such as using an imaginary client who was in a similar position to her and tell her how this had really worked for her.

Overall, I would be reframing to the positive. So by asking her if she is happy with how things are at present, and asking her how she would like things to be different, we could create small steps together in order to bring about positive change.

I would use the information gathered from these questions to devise a suitable intervention, such as new behaviour generator in order to reinforce the positive changes desired. Whilst addressing the obvious problems with her present situation, I would be including work based around weight control, as this was her motivation for seeking help, it would be good to include this, not only to help with the weight control issue, but as a motivator for change in other areas of her life.

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table)

Correct. It is necessary and professional to deal with this client in practical terms of advising other professionals etc and this has to be done tactfully so as not to break any sort of rapport, yes. I admire your reference to the indirect approach on this one particularly with regard to the mother and son cooking a meal together or doing some household tasks. A good answer here, though I add a few thoughts for helping in similar situations.

The recognition that the anger which is displayed at the son has its root elsewhere and is coming out inappropriately within the trance experience is helpful too. The information given is privileged and can be delivered to you either because you have created a rapport of yourself and environment to such an extent that she feels safe to deliver it (and therefore betrayed if you announce too early on your decision to report to authorities). Or it can be delivered to you as you are just someone who is standing still long enough as she volunteers her problems to all and sundry. It is a judgment call on your part as to which of these is more likely.