Photo by STEVE REED
[ continuing ed ]
Clinical
hypnosis:
what you
should know
BY TONY PATERNITI, PH.D., RN, NURSE EDUCATOR,
METHODIST HEALTH SYSTEM
Aging baby boomers generally have more
discretionary spending power than previous
generations and are better able to afford
nontraditional treatment modalities that may not be
covered by third-party insurers. As they consider
alternatives such as hypnosis, they often ask nurses
for advice about these treatment modalities.
They seek a knowledgeable response about the subject, even
though the nurse may not be directly involved in administering such
treatments. Since basic nursing textbooks include information about
alternative therapies (Perry & Potter, 2005), nurses are expected to
learn about nontraditional treatment modalities so that they can help
patients to better understand them.
Nontraditional modes of treatment are attracting a growing interest from health-care workers. Some acute health-care institutions
are even offering alternative therapies as a part of their treatment
regimens.
Because hypnosis therapy has long attracted the attention of many
health-care professionals, a group of clinicians formed the American
Society of Clinical Hypnosis (ASCH). Their work is organized under
one banner to conduct scientific studies, which are published in the
American Journal of Clinical Hypnosis, as well as in a variety of
other professional and refereed journals (Hammond, 1990).
Hypnosis techniques are used in such clinical applications as pain
management for surgical procedures or labor and delivery, as well for
the treatment of depression (Yapko, 2003). Responsible nurses must
be aware of such effective treatments as health care moves increasingly toward evidence-based practice — the standard for nursing care
in a multitude of settings.
At the most basic level, a nurse should have knowledge of the
many clinical and nonclinical applications for hypnosis, because a
patient may ask about its effectiveness for such problems as smoking
cessation or weight management. Addressing such health behaviors is
a vital part of the nurse’s role in educating the public. Nurses should
possess at least enough knowledge to be able to explain how hypnosis
does and doesn’t work and where to find a hypnotherapy clinician.
At a higher level, a nurse may be called upon to address the use of
hypnosis to manage the pain of cancer, or during labor and delivery
— hypno-labor — or at the dentist’s office — hypno-dentistry.
Upon completing this program, learners will have an understanding
of hypnosis and its use in clinical and nonclinical situations, and be
able to explain the nurse’s role in hypnosis in everyday practice.
HISTORY OF HYPNOSIS
Hypnosis began with Franz Anton Mesmer, who believed he could
magnetically unlock an invisible body fluid and cure individuals of
whatever afflicted them (Hathaway, 2003). Later, James Baird renamed Mesmer’s technique “hypnotism,” from the Greek word hypnos, which means “to sleep” (Hewitt, 2005). The medical profession
became interested when physician John Elliotson used hypnosis to
treat epilepsy, hysteria and asthma, as well as to perform more than
200 painless operations during the 1840s and ’50s (Hathaway, 2003).
Its use as an anesthetic before surgery waned with the discovery of
chemotherapeutic agents at the end of the 19th century, when it was
replaced by such drugs as ether, nitrous oxide and chloroform (Hathaway, 2003). Sigmund Freud was known to have used hypnosis, but
abandoned it as being authoritative, causing his patients to substitute
one symptom for another — known today as symptom substitution
(Ewin & Eimer, 2006).
The renewed use of hypnosis during the 1950s was inspired by an
Registrants who read this self-study article and score at
least 75 percent on the accompanying test will receive
EARN one continuing education credit certificate from the
Texas Nurses Association, District 4. For details, see
ONE
the
test on page15. This article is approved through
CREDIT
May 7, 2010. The author declares no real or
perceived conflict of interest that relates to this
educational activity.
[ MAY 2008 ]
PULSE 11
●
Objectives
●
●
●
●
●
Explain hypnosis to a client interested in
knowing more about it.
●
State two reasons nurses should be
knowledgeable about hypnosis.
List three uses of hypnosis for medical
conditions.
List two uses of hypnosis for nonmedical
conditions.
●
Define the phases of the hypnosis session.
interest in more holistic treatments. Practitioners began using hypnosis as a treatment
technique for a variety of physical and psychological problems.
Its modern use in medicine began with
the work of Milton Erickson, a psychiatrist
who dedicated the latter half of his career to
advancing hypnosis as a therapeutic entity
(Ewin & Eimer, 200). Dr. Erickson revolutionized hypnosis, taking it from a direct to
an indirect type of communication. He introduced and perfected the use of the indirect suggestion and metaphor as a means
of getting the patient “unstuck.” His techniques and strategies were based on information he received from the client, which
veered from the traditional protocol that was
authoritative and direct. Dr. Erickson developed a body of knowledge that is studied
throughout the world as Ericksonian Hypnosis. Some schools specialize in teaching his
techniques (Yapko, 2003).
CONTEMPORARY USES
Today, hypnosis is used to treat acute
and chronic pain, ranging from that which is
associated with dental procedures to the
refractory pain from cancer. Self-hypnosis
techniques that help women control labor
pain enable them to deliver their babies
without the use of drugs. Since their mental
processes are not chemically altered, they
maintain greater mental clarity. The work of
Ewin and Eimer (2006), a physician and
psychologist, might be of particular interest
to nurses, since they have written about
clients with a variety of problems commonly
understood by most nurses. The duo has
done extensive work in pain management
and developed a detailed protocol for conducting a history and carrying out the hypnotic session.
Because hypnosis has many health-care
applications, nurses must be prepared to
explain its uses as:
●
An adjunctive technique with cognitive
therapy to treat depression (Yapko,
2003);
An effective therapy for illnesses lacking
a well-defined etiology or originating
psychosomatically, such as headaches,
itching, spastic or irritable bowel syndrome, and asthma (Ewin and Eimer,
2006);
A treatment for conditions controlled
by the autonomic nervous system —
clients in hypnosis can alter their heart
rate, body temperature and blood pressure, which are physiologic functions
associated with autonomic activity; and
A method to alter or modify such detrimental health habits as smoking or
overeating.
Hypnosis even has been effective in removing warts. Other applications include
using hypnosis to help individuals:
●
●
●
●
●
Overcome fears;
Become better public speakers;
Enhance sports performance;
Reduce anxiety about taking exams; and
Improve study habits.
To formalize the hypnosis-related work of
physicians, psychologists, dentists, counselors, social workers and nurses with advanced degrees, Dr. Erickson founded the
ASCH, an organization that seeks to advance
the use of hypnosis through clinical and
experimental research and to provide a body
of knowledge that practitioners are encouraged to incorporate when using hypnosis.
The organization works to legitimize hypnosis as an effective treatment modality
when used adjunctively with clinical interventions. The group discourages the
practice of hypnosis by nonclinicians.
Nurses advising a patient about hypnosis
services should caution against hypnotists
who lack preparation in a clinically oriented
profession. Anyone trained over the Internet,
for example, or in a mass-production school
for hypnotists isn’t a good choice.
WHAT IS HYPNOSIS?
Hypnosis is erroneously associated with
the antics of stage hypnotists whose primary
objectives are to entertain and make money.
Hypnosis isn’t an altered state of mind, and
therefore, those who bark like a dog or quack
like a duck are doing so with complete
knowledge of what they are doing. The
relationship between the stage hypnotist and
the volunteer is well thought out and
planned prior to the performance (Hathaway, 2003).
Nurses must have a clear understanding
of hypnosis in order to objectively answer
client questions about its clinical use. Hypnosis is a daydream-like state of mind or
mode of communication when one individual
is exceptionally focused and attentive to the
suggestions of another individual — the
hypnotist. Self-hypnosis or auto-hypnosis
also is possible (Hewitt, 2005).
The communication occurs at two levels,
the first level being the conscious mind.
Consciously, the mind functions objectively and measurably with censors telling it
what is good or bad, right or wrong. The
conscious mind gets people through the day,
reminding them of activities and serving as a
gateway to the unconscious mind.
The second level of communication is the
unconscious mind, which is less concerned
with the objective world and is prone to
accept, rather than judge, and to store emotion as well as release it. The keeper of all
memories, it operates in the subjective domain and is capable of simultaneously managing multiple activities. Since the unconscious has a poor understanding of negative
statements, tending to interpret statements
about not doing something as a command to
do it, a hypnotist may say: “You remain
smoke free,” rather than “You do not smoke.”
Permanent change occurs in the subconscious mind, which can be accessed
through hypnosis.
A definitive model for hypnosis doesn’t
exist, although Dr. Erickson came closest to
defining a theory. Most practitioners agree
on these guiding beliefs or principles:
People tend to create their own beliefs (Hammond, 1990). A skilled clinical
hypnotist will listen for a client belief, which
usually surfaces during the history-interview
session, such as, “I always get a bad cold in
the winter,” or “The women in my family get
breast cancer.” The hypnotist understands
that the first client is self-programmed to get
a cold while the second client is doing the
same in relation to developing breast cancer.
The hypnotist accepts the well-known
relationship between thoughts and body
processes. (Consider that many surgical
nurses have put a hold on surgery for clients
who have stated the belief that they won’t
survive the surgery.)
Emotions often collide. When two
emotions are in contest, the more powerful
one tends to override the weaker one. The
powerful emotion generally originates in the
subconscious, with the discrepancy in feel-
The views expressed in Pulse are those of the authors and do not necessarily represent the opinions and views of Pulse magazine or of The Dallas Morning News, L.P.
12 PULSE [ MAY 2008 ]
ings revealed in the interview process. “I want to go to church and
know I should but something just keeps me from getting there.” The
hypnotist knows that the “should” statement comes from the judging,
conscious mind and the vague “something” statement is the undefined
unconscious emotion that acts more powerfully to keep the client
from going to church.
Less is better. A skilled clinical hypnotist will use the least
necessary means to accomplish the client’s objective.
The client is always right. This last principle is imperative if the
hypnotist is to establish a trusting relationship that will maximize the
client’s ability to enter into hypnosis.
The goal of clinical hypnosis is to assist clients in engaging their
own resources to bring about change. This requires accessing the
subconscious mind by speaking in a manner that makes sense to that
part of the mind. Although hypnosis lacks a clearly defined theory or
conceptual model, it is driven by principles universally accepted by
most hypnotists educated and trained in hypnosis.
HOW HYPNOSIS WORKS
Hypnosis involves several phases and processes, beginning with an
interview similar to those which nurses perform when admitting
clients to health-care settings. For the clinical hypnotist, the interview
is an information-gathering session to assist the client in defining the
problem or issue. The clinician is attentive to the client’s choice of
words, the use of metaphors in describing the problem and the feelings associated with a thought or events. These descriptors are meaningful to the client’s subconscious mind and are important for designing the hypnotic script to be used during hypnosis (Yapko, 2003).
History and interview: The history-interview session indicates
how the client processes information. Is the client’s dominant learning
mode visual, auditory or kinesthetic? The hypnotist uses this dominant learning mode when addressing the client during hypnosis,
encouraging a visually dominant learner to picture or see with the
mind’s eye. An auditory learner is encouraged to hear or listen.
Induction: To prepare for the induction phase, the client rests
comfortably in a recliner or similar type of chair — lying horizontally
is closely associated with sleep, and hypnosis cannot occur during
sleep. Induction directs the client’s attention internally, with particular attention paid to breathing and muscle relaxation — a slow,
progressive process. For clients who have difficulty relaxing, a quicker
orientation into the hypnotic state might involve a visual focal point or
other stimulus.
Deepening: The client focuses more attention internally, and is
taken metaphorically down a staircase, escalator or elevator as a way
of deepening the relaxation. The hypnotist avoids disturbing imagery
discovered during the interview — a staircase metaphor is likely to
disturb a client who has fallen down a staircase.
Special place: During a second type of deepening, the client may
be asked to describe a special place where everything is perfect with
nothing to do but relax. This special place belongs only to the client
and represents a safe haven from life’s stresses.
Working: The client’s primary problem is addressed in the working phase of hypnosis. Clinicians classically trained in hypnosis tend
to use direct suggestion, while those trained in Ericksonian hypnosis
tend to be indirect. Studies indicate that both work equally well, but
the client is the best information source for the most appropriate
method (Hammond, 1990). Generally, individuals from authoritative
and centralized settings — soldiers and police officers, for example —
tend to respond well to direct suggestion. Individuals who tend to
draw their structure intrinsically seem to respond better to indirect
suggestion (Yapko, 2003). Between 10 to 20 percent of the population
is so hypnotically prone that they respond well to all types of suggestion. Depending upon the client, the problem and the goal of the
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MAY 6-12, 2008
As your CNOs, we thank you for the gift of caring
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And congratulations to our DFW Great 10 0 Nurses
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• Racine Reid - Doctors Hospital at White Rock Lake
• Glenda Cox - Lake Pointe Medical Center
All the best,
Jim Murphy, CNO
Centennial Medical Center
Rusty McNew, CNO
Doctors Hospital at White Rock Lake
Debbie Moeller, CNO
Lake Pointe Medical Center
EOE
[ MAY 2008 ]
PULSE 13
hypnotic session, a variety of techniques may
be used, including regression in which clients
regress or go back in time to an earlier period in their lives. Some hypnotists prefer to
work in the present. The client’s primary
problem is addressed from a positive frame
of reference to circumvent the subconscious
mind’s lack of skill in processing negative
statements. Framing a negative thought in a
positive perspective, the hypnotist may say,
“Imagine that you are free from cigarette
smoke.” Such framing directs the subconscious to consider what life will be like after
the problem is resolved.
Termination: There are generally two
ways to end a hypnosis session. The hypnotist may count the client out of hypnosis
back into an alert state or take the client
from hypnosis into sleep. The sleep method
is useful if a recording of the session is given
to the client to listen to at bedtime.
IMPLICATIONS FOR NURSES
Nurses should know that every client who
seeks health-care services actually is in a
mild state of hypnosis. They are hypnoidal,
because they are generally mildly to moderately anxious when they enter the healthcare system. They are seeking assistance for
problems they are unable to resolve indepen-
dently. As a result, their attention is extremely focused, which causes them to be
open to suggestion. They are in need and are
attentively listening for a solution to their
problem. Doctors and nurses are authority
figures and, under such circumstances, tend
to have a great deal of influence over their
patients.
To illustrate this influence, consider the
typical nurse interview in which the nurse
asks a client to rate pain intensity on a scale
from zero to 10. For the client with chronic
pain, the nurse may ask about the client’s
pain goal. Because every nurse has been
taught to re-evaluate pain intensity after
giving medication in a hospital setting, the
nurse brings the patient the pain medication.
Everything about the language of the nurse
is directed toward the client having pain.
Every time the nurse makes reference to
pain the message to the client’s subconscious
level is, “I expect you to have pain.”
Compare that to a nurse, trained in hypnosis, who would request the client to
provide a comfort score, asking about the
client’s level of comfort. Medication would be
referred to as “your comfort medication.”
Many other clinical situations could similarly
assist the client toward a positive direction.
Language that directs the client away
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from pain and toward comfort requires a
level of understanding by the nurse acquired
through education and training.
Nurses who familiarize themselves with
hypnosis services will be much more helpful
to clients who are wondering whether hypnosis might be a helpful option.
CONCLUSION
More health-care workers are becoming
adept at using hypnosis as clients increasingly seek alternative therapies. Nurses often
are the primary information resource for
patients and, therefore, have a responsibility
to be knowledgeable about the use of hypnosis services. Many resources are available
to nurses, from local hypnosis groups in most
large metropolitan areas to national organizations that can provide speakers and other
forms of education. The Internet is a good
starting place for nurses to learn about such
sources. ■
EDITOR’S NOTE: Due to space limitations,
references will be made available upon request.
Call Jon Garinn at 214-977-8992 or e-mail
[email protected].
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14 PULSE [ MAY 2008 ]
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[ ce evaluation ]
TITLE: “Clinical hypnosis: what you should know”
(Please PRINT clearly)
PURPOSE: This self-study is designed to provide information about
hypnosis and its use as a nontraditional treatment modality.
NAME:________________________________________________________ TELEPHONE: __________________________________
To receive continuing nursing education credit, the registrant must:
1. Read the self-study.
2. Complete the post-test (score of at least 75 percent).
3. Complete the evaluation form.
4. Mail the Post-Test (with $10 payment) and Evaluation Form to TNA,
D–4.
Upon receipt of the required forms (the post-test with a score of at
least 75 percent, and evaluation form) by TNA, D–4, the registrant will
be mailed a CE certificate.
This activity provides 1.0 contact hours for the nurse. TNA, D-4
is an approved provider of continuing nursing education by the
Texas Nurses Association, an accredited approver by the
American Nurses Credentialing Center’s Commission on
Accreditation.
This activity meets Type 1 criteria for mandatory continuing
education requirements toward relicensure as established by
the Board of Nurse Examiners for the State of Texas.
EVALUATION FORM: “Clinical hypnosis: what you should know”
OBJECTIVE: To gain an understanding of hypnosis and its use in clinical and nonclinical situations, and to be able to explain the nurse’s role
in hypnosis in everyday practice.
ADDRESS: ____________________________________ CITY: ________________________ STATE:___________ ZIP:____________
E-MAIL (TO RECEIVE CERTIFICATE ELECTRONICALLY) _______________________________________________________________
BIRTH MONTH/YEAR: _________________________________________________________________________________________
PROGRAM EVALUATION:
Please rate how well objectives were met by circling the appropriate number:
1 — Not Met 2 — Partially Met 3 — Met 4 — Well Met
1. Explain hypnosis to a client who is interested in knowing more about it.
2. State two reasons nurses should be knowledgeable about hypnosis.
3. List three uses of hypnosis for medical conditions.
4. List two uses of hypnosis for non-medical conditions.
5. Define the phases of the hypnosis session.
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
Please rate the quality of teaching materials by circling the appropriate number:
1 — Strongly Disagree 2 — Disagree 3 — Agree 4 — Strongly Agree
1. The objectives were relevant to overall purpose.
2. The teaching/learning materials were effective.
3. The program was organized.
4. The program was easy to follow.
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
If you answered 1 to any of the above, please provide comments.
How long did it take to complete the program?_________________ Date completed:_____________________
MAIL the completed evaluation with your test results and $10 payment to: TNA, D–4, P.O. Box 35503, Dallas, TX 75235.
[ ce questions ]
Complete the following test questions:
1. Who is credited with first
using modern hypnosis?
a. Milton Erickson
b. Anton Mesmer
c. Sigmund Freud
d. John Elliotson
2. Who revolutionized hypnosis by introducing indirect
suggestion and the use of
metaphor?
a. Milton Erickson
b. Anton Mesmer
c. Sigmund Freud
d. John Elliotson
3. Which of the following is a
basic tenet of hypnosis?
a. Women go into hypnosis
more readily than men.
b. Children should never be
hypnotized.
c. What one tends to believe,
one tends to create.
d. Hypnosis is a state of sleep.
4. For which of the following
conditions is hypnosis
known to be effective?
a. Spastic bowel syndrome
b. Kidney stones
c. Angina pectoris
d. Myopia
5. The client states that she is
thinking about using hypnosis during her labor and
delivery. What is the best
response?
a. Hypnosis has not been
proven effective in labor and
delivery.
b. That is one way of managing
labor and delivery. It’s
important that you share
[ classified ]
that information with your
physician.
c. Do you have a backup plan
in case it doesn’t work?
d. Hypnosis isn’t for everyone.
Make sure it works before
you do it.
6. In what order is a hypnosis
session generally conducted?
a. Induction, deepening, special place
b. Induction, deepening,
termination
c. Deepening, induction,
termination
d. Deepening, special place,
termination
7. The client asks for information on how to select a hypnotist for weight management. Which of the following responses is most
appropriate?
a. Find a hypnotist who has
been doing weight management for many years.
b. Limit your search to a physician or health-care worker
trained in hypnosis.
c. The Internet is a great place
to find that type of information.
d. Think about it carefully
because it can be very
expensive.
8. The nurse should understand which of the following?
a. The relationship between
the conscious and subconscious minds.
b. How information travels
from the brain through the
body.
c. The relationship between
the central and peripheral
nervous systems.
d. How the autonomic nervous
system functions.
9. Which of the following
client statements demonstrates the principle that
individuals tend to create
what they believe?
a. “We have gone on vacation
to the Bahamas twice in the
past three years.”
b. “I never saw a Disney movie
I didn’t like.”
c. “I always get the flu in the
late spring.”
d. “My grandson insists on
hearing a bedtime story
before he goes to sleep.”
10. Which of the following
images is often used during
the deepening phase in
hypnosis?
a. A ladder
b. A staircase
c. An automobile
d. An ocean
11. The nurse is preparing to
administer a medication for
the client’s complaint of
pain at a level 8 on a scale
of zero to 10. Which statement would divert the
client’s attention from pain
toward comfort?
a. “I have your pain medication.”
b. “This medicine ought to
reduce your pain to a level 2
or 3.”
c. “I have your comfort medication.”
d. “These pills will take your
pain away.”
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[ MAY 2008 ]
PULSE 15