NCSCH Spring 2003 Conference Preview

Expanding the Power of Therapy:

An Interview with Joan Murray-Jobsis, Ph.D.

 

Charles Holton, LCSW
Chuck Holton: Congratulations on your well-deserved lifetime achievement award from ASCH!

Joan Murray-Jobsis: Thanks, I feel really good about that.

Chuck Holton: How do you find hypnosis helps with routine therapeutic problems like anxiety and depression?

JMJ: It always helps people relax, and helps solidify the relationship, the therapeutic alliance with the patient. In addition to that, it helps people resolve issues of depression and anxiety quicker, because they can access emotional material with greater intensity, and they can access change processes with greater intensity. Everything works a little bit faster with hypnosis.

CH: A little deeper and a little faster, kind of amplifies the therapeutic processes. How does it apply differently with more severe psychopathology?

JMJ: Well, in some ways it's very much the same - it reaches people more deeply and helps them move along at a quicker rate. but it may also give us access to people who are more troubled, for whom regular psychotherapy wouldn't grant the access, or it might take years to get through, because what it does is help you connect in a very intense way with a patient. So if you can make that connection, especially with people for whom connecting is difficult, it's a tremendous step forward in making therapy work for these patients. You can do that with or without hypnosis, it's just harder with more troubled patients and hypnosis can help that process. If they can trust well enough to have that connection, then they can start doing the therapeutic work they need to do. In the case of psychotic patients, the whole difficulty is usually making the connection, period. 

It's partly a matter of understanding the patient's communication and what their underlying messages are, which frequently aren't on the surface or in the words they're presenting, the sentences they're saying, but rather in the feeling that comes through underneath. Then it's a matter of reaching that part of the patient and letting them know they're safe, they can temporarily drop their defenses, look at them, and maybe you can help work it out together. 

In a way, hypnosis gives us a modality, a technique, for reaching patients on a level that we can't quite access without hypnosis. And it also gives you access to imagery processes that are very similar to dream imagery, and symbolic material, and ways of communicating that you can't get at with an exclusively cognitive approach. You've got to be able to reach things in a different way, and hypnosis gives you that added tool, much like dream work or free association.

CH: I think it also helps with a sense of safety, and a stable container for the processing.

JMJ: Yes, it definitely helps produce a protective and limited environment for dealing with overwhelming affect, where you can contain things more readily and say, okay, we leave it in these sessions. And hypnosis contains better than regular therapy sessions, I think.

CH: Often clients who are new to hypnosis fear it because they think they'll be more vulnerable and less protected, when in fact it's just the opposite. 

JMJ: I think it depends a lot on the skill and integrity of therapist, the hypnotist. I advise clients that I would not get involved with stage hypnotists who don't have their best interests at heart. It's the therapeutic alliance, the caring of the relationship, that protects the patient. Plus their own ability to control. I always remind them that the bottom line is they're in control, they can always self-protect.

CH: How has your use of hypnosis changed over the years?

JMJ: When I first started I was simply using hypnosis with people trying to lose weight, change eating patterns, some smoking cessation, pretty much behavioral applications. I did my learning about hypnosis, how to use it, how to get comfortable myself with it , on those kinds of issues. Only later did I integrate hypnosis into the more deep psychoanalytic, psychotherapeutic kinds of work with personality disorders and dissociative disorders, post-traumatic stress problems, and also with psychotic patients. I found that they were patients that I liked working with that I did want to do therapy with, so I worked gradually at integrating hypnosis into working with those kinds of patients.

In the beginning, back in the early '70's, the literature generally said you couldn't use hypnosis with those kinds of patients. Some of my early publications were simply breaking down those barriers, saying, yes, they can use hypnosis, and it can be safe. It's all a matter of using techniques that build trust with the patient in both the therapist and in hypnosis, and in protecting the patient's need for defenses, not pushing through them, but letting the patient decide the pace themselves. 

So there's been a lot of change in how I have used hypnosis over the years, and basically I was developing techniques as I went, so that I could work with these patients with hypnosis.

CH: That's an enormous change, a real sea-change in the breadth and depth of applications, from a very narrowly proscribed behavior-change orientation to a broad set of approaches that can touch every client you work with.

JMJ: It expanded my use of hypnosis tremendously, and I think it had an impact on expanding the field's use of hypnosis.

CH: What do you think are the most important set of skills and principles for beginners to master when they're learning to use hypnosis in therapy?

JMJ: I think any beginner has to get some kind of a dialogue going that they're comfortable with, so they don't have to stop and think too much or read too much. Once they get past that initial tongue-tied period - and some people don't even struggle with that much, some are already past that when I do teaching sessions at the beginner workshops - it's getting comfortable with the idea of finding your own style. We tend to think in the beginning that we have to copy somebody else's approach or style, but what works best as a person inducing hypnosis is to have comfort and a style of your own. And then working with that, and adapting it to the patient's needs. But basically it's finding your own voice, your own style. 

CH: What can training in hypnosis offer seasoned clinicians who are already experienced psychotherapists?

JMJ: Oh, I think it's such a wonderful tool for expanding the possibilities of psychotherapy. People ask me if I use it much, I'm probably using it 80 or 90 percent of the time in my therapy work, because unless the patient doesn't want to use it, it's almost always helpful. It helps in any kind of behavior modification work, it speeds up the process and helps people make changes. And if they're struggling with life problems or depression you can immediately help them learn techniques for self-relaxation, ego strengthening - and almost everybody needs messages for ego strengthening! It helps with developing a sense of mastery, with self-acceptance. People don't have to be terribly disturbed to have developmental problems. The issues can be "Can I handle a separation?" or "Do I have unnecessary anxiety about death and dying?" or "Am I feeling like I can't cope with some of the stresses of my life?" Hypnosis automatically enhances any kind of therapy work we're doing. It's a wonderful tool for expanding the power of therapy.

CH: I couldn't agree more. Who were you teachers and mentors?

JMJ: The two big names that come to mind are Kay Thompson and Bob Pearson, two of the early disciples of Milton Erickson. Back when I was first starting with hypnosis in 1971 they taught almost every workshop that ASCH put on, 10 or 12 regional workshops a year plus the national workshop. That year they did a workshop here in Chapel Hill, and that was my first introduction to hypnosis.

CH: Yeah, Kay Thompson did was the very first NCSCH workshop back then, and she came again in '91.

JMJ: They taught that workshop,. And I was totally won over. I knew that this was a wonderful tool, it just felt right. At that workshop I let my two children who were pretty young at the time come in and be demonstration subjects, they were willing to be subjects, and they showed how children could work with hypnosis, and they didn't think it was scary, they thought it was okay.

I went to several of Kay and Bob's workshops around the country, and started using it in my own work and expanding how I could use it.

CH: You really took the ball and ran with it!

JMJ: I did, and it was easy, because at the time I was working on a joint appointment with the Psychiatry Department at UNC and Orange-Person-Chatham County Mental Health Center. There were funds for training and travel - the economic situation was very different - so it worked smoothly from my side and it fit well with my clinical interests. Later I taught with Kay and Bob before they retired, which was a big thrill.

CH: Kay Thompson was such a great person.

JMJ: She was an excellent teacher, a powerful personality, and they knew each other so well they did excellent tag-team work together.

CH: With the pressure for quick results in the managed care era, and so much emphasis on behavioral and cognitive approaches, how does that fit with your interests in the more psychodynamic and analytic traditions?

JMJ: I think I've always had my feet in two different camps. I can promote rapid change, and in fact hypnosis promotes that. I've always done some of that kind of therapy, so that even when managed care was even more strict that they are now about fast results, I could point out how hypnosis helps with fast results in behavior change. On the other hand, I never gave up doing the longer-term work. I think we've been fortunate in this area that there has always been some insurance funding for longer-term work, and also some private pay clients interested in that. It's probably my first love, probably always will be, doing insight-oriented work, interpretive work, and rebuilding, developmental repair work. Once the client repairs the gaps, gets something filled in that was missing, they just take off. It's wonderful to see and be a part of.

CH: It's great to be able to do both. And of course, having success with an initial behavioral presenting problem often establishes the sense of safety that opens the client's willingness to do deeper work.

JMJ: I think of clients who present with smoking cessation but they're really coming for major problems.

CH: It's a nice way to check out if the therapist is competent and safe. What are the most common mistakes you see practitioners of hypnosis make?

JMJ: What I hear about is practitioners who get too much ego involved in their work, that it's about them rather than about the patient, or not remembering to let the patient pace things. We always need to be respectful of the patient's need for defenses, and not push past them. Basically we need to help patients work with what they are able to work with, and not assume that we know where they have to go, or that we have all the answers. It's so important to be constantly assessing our own transference, our own reactions to the patient, keeping the patient's well-being at the forefront of the relationship.

CH: Not much different from general therapy errors.

JMJ: With hypnosis it's more important because the power balance tips a little bit in the relationship. You have to be more careful and more protective of the patient's interests and well-being. A lot of it is just avoiding becoming ego-involved, just keeping the patient's needs in the forefront. We're part of a process.

CH: With the emergence of evidence-based therapies and the growing emphasis on empirical validation of techniques, in what areas would you predict hypnosis will be shown to be most effective? I know it's a preferred modality for Irritable Bowel Syndrome, where else do you think we'll see similar results?

JMJ: I would expect research on migraine headaches would show hypnotic work to be effective. There's been some work with MRI images of brain changes with hypnosis.

CH: When Karen Olness was here, she cited research that teaching children self-hypnosis was more effective than any medication for juvenile migraine.

JMJ: It makes sense, since you can change blood-flow patterns with hypnosis. I've had experience with changing excessive blood-flow to an injury.

CH: I've had success with migraine sufferers who have auras learning to slow the rapid dilation of blood vessels and prevent full-blown migraines.

JMJ: Another place would be skin disease and skin irritation.

CH: That makes sense, since it's such a psychologically loaded organ system.

JMJ: And even if it's a physical cause, the psychological intervention can alter or reduce the symptoms, and it's an area that you could measure pretty readily.

CH: Well, Joan, I really thank you for your enthusiasm and time, and I'm excited about the Spring Conference. I can't wait to learn what you teach!

JMJ: It great talking to you!