Teaching Clients Direct Self-Suggestion

Charles Holton, LCSW

HRC Forum 12 March 2003 :

Psychotherapy with Patients in Pain:  Clinical Implications and Treatment Approaches

Rationale:  Offers client direct experience of responsiveness to suggestion; clearly locates responsiveness and change within client, not from therapist; lowers resistance to hypnotic interventions by experience being directed by client; increases confidence in hypnotic abilities; can’t refute visible evidence of responsiveness (hand rising, or even minimal responses such as hand tingling).

Contraindications:  Some severely depressed patients could use failure as evidence of hopelessness (though this can be overcome by teaching attention to and building on minimal changes); some severely anxious patients have performance anxiety and social nervousness that inhibits response (though this can be overcome by suggesting they try it at home alone

Technique:  A thorough review of myths and misconceptions of hypnosis, discussion of hypnosis as a set of naturally occurring phenomena everyone has experienced; explanation of suggestion apart from trance phenomena; therapist demonstration of direct self-suggestion (“I’m asking my unconscious mind to lift my arm without me doing it on purpose.”); invitation to client to experience direct self-suggestion (and to ask the question in the way they believe will most likely elicit a cooperative response from their unconscious).

Results:  Vast majority of clients experience some degree of success, therapist helps by interpreting any response as a good beginning, and enthusiastically coaching client in discovering what their set of idiosyncratic hypnotic responses are.  Most clients are pleasantly surprised that they can achieve a satisfactory hand-levitation, and use increased confidence to move on to applications in other clinical areas.

Applications for pain:  Confident patients can begin to explore their responsiveness to direct suggestions that their “unconscious minds begin to search for ways to alter the pain experience.”  This is especially helpful when they understand the “gatekeeper” theory of pain, that the brain is interpreting a simple binary neurological signal “yes” as “pain” and then as “suffering, fear, sadness, anger,” etc.  Sometimes working on neutral body sites to develop confidence in directing the mind to alter physical experience (warmth, coolness, heaviness, lightness, numbness, sensitivity) is a good precursor to working with the area in pain.

See also article “Treating Somatic Symptoms with Hypnosis: Globus Hystericus and Migraine Headache” on his website.