Scribd Logo
Upload

Welcome to Scribd!

  • 191 views

    Handbook of Hypnotic Suggestions and Metaphors by D. Corydon Hammond Ph.D.

    Uploaded by

    Carlita Shaw
    by D. Corydon Hammond Ph.D. (Editor) Designed as a practical desktop reference, this official publication of the American Society of Clinical Hypnosis is the largest collection of hypnotic suggestions and metaphors ever compiled. It provides a look at what experienced clinicians actually say to their patients during hypnotic work. A book to be savored and referred to time and again, this handbook will become a dog-eared resource for the clinician using hypnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Handbook of Hypnotic Suggestions and Metaphors by D. Corydon Hammond Ph.D.

    Uploaded by

    Carlita Shaw
    191 views610 pages
    by D. Corydon Hammond Ph.D. (Editor) Designed as a practical desktop reference, this official publication of the American Society of Clinical Hypnosis is the largest collection of hypnotic suggestions and metaphors ever compiled. It provides a look at what experienced clinicians actually say to their patients during hypnotic work. A book to be savored and referred to time and again, this handbook will become a dog-eared resource for the clinician using hypnosis.

    Original Title

    handbook of hypnotic suggestions and metaphors by D. Corydon Hammond Ph.D.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    by D. Corydon Hammond Ph.D. (Editor) Designed as a practical desktop reference, this official publication of the American Society of Clinical Hypnosis is the largest collection of hypnotic suggestions and metaphors ever compiled. It provides a look at what experienced clinicians actually say to their patients during hypnotic work. A book to be savored and referred to time and again, this handbook will become a dog-eared resource for the clinician using hypnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    191 views610 pages

    Handbook of Hypnotic Suggestions and Metaphors by D. Corydon Hammond Ph.D.

    Uploaded by

    Carlita Shaw
    by D. Corydon Hammond Ph.D. (Editor) Designed as a practical desktop reference, this official publication of the American Society of Clinical Hypnosis is the largest collection of hypnotic suggestions and metaphors ever compiled. It provides a look at what experienced clinicians actually say to their patients during hypnotic work. A book to be savored and referred to time and again, this handbook will become a dog-eared resource for the clinician using hypnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 610

    HANDBOOK

    of
    HYPNOTIC SUGGESTIONS
    AND METAPHORS

    EDITED BY

    D. Corydon Hammond, Ph.D.


    University of Utah
    School of Medicine

    W • W • NORTON & COMPANY • NEW YORK • LONDON


    Copyright © 1990 by The American Society of Clinical Hypnosis

    All rights reserved.

    Printed in the United States of America

    First Edition

    Library of Congress Cataloging-in-Publication Data

    Handbook of hypnotic suggestions and metaphors / edited by D. Corydon


    Hammond, p. cm. "An American Society of Clinical Hypnosis book." "A
    Norton professional book"—P.
    1. Hypnotism —Therapeutic use. I. Hammond, D. Corydon.
    RC495.H363 1990 615.8'512-dc20 90-31449

    ISBN 0-393-70095-X

    W . W. Norton & Company, Inc..500 F i ft h Avenue. N e w York. N Y1 01 10 W.


    W. Norton & Company Ltd. 10 Coptic Street. London W C 1 A 1 P U

    16 17 18 19 20
    CONTENTS
    Foreword by Harold B. Crasilneck vii

    1. Introduction 1

    The Underlying Therapeutic Philosophy: Integrative


    Hypnotherapy 2
    The American Society of Clinical Hypnosis 4
    Training Opportunities 5
    Eligibility for ASCH Membership 8
    Acknowledgments 9

    2. Formulating Hypnotic and Posthypnotic Suggestions 11


    Principles of Hypnotic Suggestion 11
    Types of Hypnotic Suggestions 27
    The Phrasing of Suggestions 38
    The Process of Suggestions in Facilitating Phenomena 42

    3. Hypnosis in Pain Management 45


    INTRODUCTION 45
    Techniques of Hypnotic Pain Management / Joseph Barber 50 • Altering
    the Quality of Discomfort: Example of Leg Pain / M, Erik Wright 52 •
    Transformation of Pain / William L. Golden, E. Thomas Dowd, and Fred
    Friedberg 53 • Erickson's Suggestions for Pain Control / Milton H.
    Erickson 54 • General Principles for Alleviating Persistent Pain / Ernest L.
    Rossi and David B. Cheek 56 • Religious Imagery of Universal Healing
    for Ego-Strengthening and Pain / M. Erik Wright 58 • The "Sympathetic
    Ear" Technique with Chronic Pain / Barry S. Fogel 58 • Reactivation of
    Pain-Free Memories: An Example of Intensifying and Relieving Pain / M. Erik
    Wright 59 • Chronic Pain Syndrome / Richard B. Garver 61 •
    Hypnotically Elicited Mystical States in Treating Physical and Emotional Pain
    / Paul Sacerdote 63 • Active Control Strategy for Group Hypnotherapy
    with Chronic Pain / Timothy C. Toomey and Shirley
    xii HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Sanders 66 • Pain Strategies by Hypnotizability Level / David Spiegel and


    Herbert Spiegel 67 • Reinterpreting Pain as Protection / Charles B. Mutter
    68 • Splinting Technique for Pain Control / Charles B. Mutter 68 •
    Erickson's Interspersal Technique for Pain 68 • The Setting Sun Pain
    Metaphor / Alexander A. Levitan 71 • Mexican Food: Metaphor of the Body
    Adapting to Pain / D. Corydon Hammond 71 • Metaphor of Callous Formation /
    D. Corydon Hammond 71 • Suggestions for Patients with Chronic Pain / Lillian
    E. Fredericks 72 • Pain Reduction / Beata Jencks 72 • "Body Lights"
    Approach to Ameliorating Pain and Inflammation (Arthritis) / Ernest L. Rossi and
    David B. Cheek 75 • Suggestions with Postherpetic Neuralgia ("Shingles") /
    Diane Roberts Stoler 76 • Suggestions to Reduce Pain Following
    Hemorrhoidectomies / Ernest W. Werbel 77 • Suggestions for Pain Control /
    Don E. Gibbons 78 • Hypnosis for Migraine / Lillian E. Fredericks 80
    • Suggestions with Migraine / J.A.D. Anderson, M. A. Basker, and R. Dalton 80
    • Diminution Rather Than Elimination of Headache / Irving I. Secter 81 •
    Suggestion for Symptom Substitution / Gary R. Elkins 81 • The Progressive
    Anesthesia Induction-Deepening Technique / D. Corydon Hammond 81

    4. Hypnoanesthesia and Preparation for Surgery 85


    INTRODUCTION 85
    Preparation for Surgery / Lillian E. Fredericks 90 • Suggestions for
    Anesthesia and Surgery / Bertha P. Rodger 91 • Hypnosis and the Anesthetist
    / John B. Corley 92 • Summary Steps for Preoperative Hypnosis to Facilitate
    Healing / Ernest L. Rossi and David B. Cheek 94 • Ericksonian Approaches
    in Anesthesiology / Bertha P. Rodger 94 • Examples of Preoperative
    Suggestions / Joseph Barber 98 • Preparation for Surgery / Sandra M.
    Sylvester 98 • Temperature Suggestion Following Chest/Abdominal Surgery / D.
    Corydon Hammond 101 • Suggestions for Insertion of Needles or Short
    Procedures / Esther E. Bartlett 101 • Switching Off the Senses / Bertha P.
    Rodger 101 • Rapid Induction Analgesia / Joseph Barber 102 •
    Surgical and Obstetrical Analgesia / Ernest L. Rossi and David B. Cheek 106 •
    Techniques for Surgery / William S. Kroger 107

    5. Ego-Strengthening: Enhancing Esteem, Self-Efficacy, and


    Confidence 109
    INTRODUCTION
    Ego-Strengthening / Moshe S. Torem 110 • An Example of Positive
    Suggestions for Well-Being / Sheryl C. Wilson and Theodore X. Barber 112 •
    Positive Suggestions for Effective Living / T. X. Barber 113 • Suggestions for
    Raising Self-Esteem / T. X. Barber 118 • Barnett's Yes-Set Method of
    Ego-Strengthening / Edgar A. Barnett 120 • Ego-Enhancement: A Five-Step
    Approach / Harry E. Stanton 122 • Suggestions for Modifying Perfectionism /
    D. Corydon Hammond 124 • Suggestions Derived from Rational-Emotive
    Therapy / Harry E. Stanton 126 • Suggestions for Raising Self-Esteem /
    Helen H. Watkins 127 • Suggestions to Facilitate Problem Solving / Don E.
    Gibbons 130 • The Serenity Place / D. Corydon Hammond 130 •
    CONTENTS xiii

    Ego-Strengthening Suggestions / Richard B. Garver 132 • The Inevitability of


    Change / Robert C. Mashman 132 • Change Is Necessary for Comfort /
    Robert C. Mashman 133 • An Abstract Technique for Ego-Strengthening /
    B. J. Gorman 133 • Learning to Feed Yourself: An Example of Age
    Regression to Experiences of Mastery / D. Corydon Hammond 135 • Ego
    Building / Joan Murray-Jobsis 136 • The Ugly Duckling Metaphor / Roy L.
    Rummel 139 • The Prominent Tree Metaphor / Alcid M. Pelletier 139
    • The Seasons of the Year: A Metaphor of Growth / Lawrence R. Gindhart 140
    • Confidence Building / H. E. Stanton 141 • Increasing Determination:
    The Snowball / H. E. Stanton 143 • Suggestions for Emotional Enrichment
    / Don E. Gibbons 143 • Stein's Clenched Fist Technique / D. Corydon
    Hammond 145 • Suggestions for Ego-Strengthening / John Hartland
    147 • Suggestions for Self-Reinforcement / Don E. Gibbons 149 •
    Visualization of the Idealized Ego-Image / Maurice H. McDowell 149 •
    Cycle of Progress / Douglas M. Gregg 150 • A Brief Ego-Strengthening
    Suggestion / William T. Reardon 151 • A Future-Oriented Suggestion / P.
    Oystragh 151

    6. Anxiety, Phobias, and Dental Disorders 153


    INTRODUCTION 153
    Hypnosis with Anxiety 156
    Progressive Relaxation Induction or Deepening Technique / D. Corydon Hammond
    156 • Hypnotic Treatment Techniques with Anxiety / David Spiegel and
    Herbert Spiegel 157 • The Private Refuge / Selig Finkelstein 158 •
    Imagery Scenes Facilitating Relaxation / H. E. Stanton 159 • Island of
    Serenity / Edwin L. Stickney 159 • Deep, Meditative Trance: The Approach
    of Ainslie Meares, M.D. 160 • Methods of Relaxed Breathing / Beata Jencks
    162 • The Autogenic Rag Doll / Beata Jencks 165 • Hypnotic
    Suggestion/Metaphor to Begin Reframing / Steven Gurgevich 167 •
    Rational-Emotive Suggestions About Anxiety / Albert Ellis 168 • Stress
    Reduction Trance: A Naturalistic Ericksonian Approach / Eleanor S. Field 170 •
    The Closed Drawer Metaphor / Brian M. Alman 172 • He Who Hesitates Is
    Lost: A Metaphor for Decision-Making / Michael D. Yapko 173 •
    De-Fusing Panic / Marlene E. Hunter 173

    Hypnosis with Phobias 175


    Paradigm for Flying Phobia / David Spiegel and Herbert Spiegel 175 • A Reframing
    Approach for Flight Phobia / Peter A. Bakal, M.D. 175 • Hypnosis with Phobic
    Reactions / Don E. Gibbons 177 • Suggestions for Simple and Social Phobias /
    Michael A. Haberman 177 • Example of Treating Phobic Anxiety with Individually
    Prepared Tapes / M. Erik Wright 180 • Treatment of Lack of Confidence and Stage
    Fright / David Waxman 180 • Overcoming Anxiety over Public Speaking / Don
    E. Gibbons 182

    Suggestions in Dental Hypnosis 183


    Suggestions with TMJ and Bruxism / Harold P. Golan 183 • Suggestions
    with TMJ / Ellis J. Neiburger 183 • Erickson's suggestions with Bruxism /
    Milton H. Erickson 184 • TMJ and Tension Heachaches / Dov Glazer
    184 • Suggestions to Promote Dental Flossing / Maureen A. Kelly,
    xiv HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Harlo R. McKinty, and Richard Carr 185 • Gagging / Harold P. Golan 185 • Imagery
    with Hypersensitive Gag Reflex / J. Henry Clarke and Stephen J. Persichetti 187 • Denture Problems
    and Gagging / Donald R. Beebe 188 • Suggestion with Gagging / Irving I. Secter 188 •
    Gagging Suggestion / William T. Heron 188 • Control of Salivation / Irving I, Secter 189 •
    Dental Phobias and Fears / Louis L. Dubin 189 • Illustrative Suggestions with Tooth Extraction /
    Selig Finkelstein 191 • Dental Hypnosis / Victor Rausch 192 • Suggestions for Operative
    Hypnodontics / William S. Kroger 193 • The Let's Pretend Game / Lawrence M, Staples 194 •
    Erickson's Approach with Bruxism in Children / Milton H. Erickson 195 • Use of Fantasy or
    Hallucination for Tongue Thrusting / Irving I. Secter 195 • Suggestions with Tongue Thrusting /
    Donald J. Rosinski 196

    7. Hypnosis with Cancer Patients 199

    INTRODUCTION 199

    Clinical Issues in Controlling Chemotherapy Side Effects / William H. Redd, Patricia H. Rosenberger and
    Cobie S. Hendler 200 • Suggestions and Metaphors for Nausea / Alexander A. Levitan 201 •
    Suggestions for Chemotherapy Patients / Alexander A. Levitan 202 • Suggestions and Metaphors
    for Support and Ego-Strengthening in Cancer Patients / Billie S. Strauss 203 • General Suggestions
    for Self-Healing / Joan Murray-Jobsis 203 • Hypnotic Suggestions with Cancer / Jeffrey Auerbach
    204 • Hypnotic Suggestions with Cancer Patients / Harold B. Crasilneck and James A. Hall 205 •
    Imagery to Enhance the Control of the Physiological and Psychological "Side Effects" of Cancer Therapy /
    Simon W. Rosenberg 206 • Breast Cancer: Radiation Treatment and Recovery / Diane Roberts Stoler
    209 « Hypnosis as an Adjunct to Chemotherapy in Cancer / Sidney Rosen 212 • Hypnotic Death
    Rehearsal / Alexander A. Levitan 215

    8. Hypnosis with Medical Disorders 217

    INTRODUCTION 217

    Hypnosis with Dermatologic Disorders 222


    Treatment of Pruritus / Michael J. Scott 222 • Erickson's Reframing Suggestion with Pruritus / Milton
    H. Erickson 223 • Suggestions for Itching / Beata Jencks 223 • Hypnotic Technique for
    Treating Warts / Harold B. Crasilneck and James A. Hall 223 • Suggestions for Warts [Modeled after
    Hartland] / Don E. Gibbons 224 • Suggestions for Vaginal Warts / Diane Roberts Stoler 225 •
    Suggestions with Condyloma Acuminatum (Genital Warts) / Dabney M. Ewin 226 • Suggestions for
    Immunodeficient Children with Warts / M. F. Tasini and Thomas P. Hackett 226 • Evoking Helpful
    Past Experiences and Medical Treatments: Example with Skin Rash / M. Erik Wright 226 •
    Suggestions with Pruritus / William S. Kroger and William D. Fezler 227 • Reducing Dermatologic
    Irritation / D. Corydon Hammond 228
    CONTENTS XV

    Hypnosis with Burns and Emergencies 228


    Suggestions with Burn Patients / Harold B. Crasilneck and James A. Hall 228 • Emergency Hypnosis for the
    Burned Patient / Dabney M. Ewin 229 • Hypnosis in Painful Burns / R. John Wakeman and Jerold Z. Kaplan
    231 • Ideomotor Healing of Burn Injuries / Ernest L. Rossi and David B. Cheek 233 • Direct Suggestions in
    Emergencies with the Critically 1 1 1 / Ernest L. Rossi and David B. Cheek 233 • Suggestions for Use of
    Spontaneous Trances in Emergency Situations / M. Erik Wright 234 • Painless Wound Injection Through Use of
    a Two-finger Confusion Technique / Steven F. Bierman 236

    Hypnosis for Healing, Psychosomatic Conditions and Autoimmune Diseases 238


    General Approach to Physical Symptoms Caused by Stress / Carol P. Herbert 238 • Symphony Metaphor /
    Marlene E. Hunter 238 • Healing Imagery / Marlene E. Hunter 239 • Suggestions with Autoimmune
    Disease / Jeffrey Auerbach 241 • Prolonged Hypnosis in Psychosomatic Medicine / Kazuya Kuriyama 242
    • Further Suggestions for Facilitating Prolonged Hypnosis / Stanislav Kratochvil 244 • Vascular Control
    Through Hypnosis / Emil C. Bishay and Chingmuh Lee 244 • Suggestion for Control of Bleeding / Milton H.
    Erickson 245 • Suggestions for Control of Upper Gastrointestinal Hemorrhage / Emil G. Bishay, Grant Stevens,
    and Chingmuh Lee 245 • Blood Perfusion Protocol / Lawrence Earle Moore 246

    Hypnosis with Neurological and Ophthalmological Conditions 247


    Teaching the Other Side of the Brain / Marlene E. Hunter 247 •
    Once Learned, Can Be Relearned / Marlene E. Hunter 248 • Hypnosis
    with Blepharospasm / Joseph K. Murphy and A. Kenneth Fuller 250 •
    Hypnotherapy for Lagophthalmos / Jean Holroyd and Ezra
    Maguen 251 • Suggestions for Involuntary Muscle Jerking / Valerie T.
    Stein 251 • Hypnosis with Bell's Palsy / Simon W. Chiasson 252
    Hypnosis with Sleep Disorders 253
    Suggestions with Sleep Disturbance / Richard B. Garver 253 • Suggestions with Sleep Disorders / Doris
    Gruenewald 253 • Visualization for Treating Insomnia / H. E. Stanton 254 • Hypnosis Techniques with
    Insomnia / David Spiegel and Herbert Spiegel 255 • Suggestions for Insomnia / Milton H. Erickson 255 •
    Snoring: A Disease of the Listener / Daniel A. Zelling 255

    Miscellaneous Medical Applications 256


    Hypnotic Techniques and Suggestions for Medical-Physical Complaints / Beata Jencks 256 • Paradoxical
    Self-Hypnotic Assignment for Chronic Urinary Retention or "Bashful Bladder" / Gerald J. Mozdzierz 262 •
    Hypnosis in Postoperative Urinary Retention / Simon W. Chiasson 263 • Hypnotic Paradigm-Substitution with
    Hypochondriasis / Thomas Deiker and D. Kenneth Counts 264 • Suggestions with Asthma / Don E. Gibbons
    265 • Suggestions for Prevention of Seasonal Allergies / Hans A. Abraham 265 • Erickson's Metaphor
    with Tinnitus / Milton H. Erickson 266 • Procedure with Difficulty Swallowing Pills / Irving I. Secter 266 •
    Suggestion for Alleviating Hiccups / Gerald J. Mozdzierz 267
    xvi HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    9. Hypnosis in Obstetrics and Gynecology 269


    INTRODUCTION 269

    Obstetrical Hypnosis: Childbirth Training 271


    Group Hypnosis Training in Obstetrics / Simon W. Chiasson 271 • Outline of
    Hypnotic Suggestions in Obstetrics / Bertha P. Rodger 273 • Suggestions for a
    Comfortable Delivery / Joseph Barber 275 • The Hypnoreflexogenous
    Technique in Obstetrics / A. Kenneth Fuller 277 • Childbirth Suggestions /
    Larry Goldmann 278 • Management of Antenatal Hypnotic Training /
    David Waxman 279 • Erickson's Childbirth Suggestions / Milton H. Erickson
    281 • An Ericksonian Approach to Childbirth / Noelle M. Poncelet 282 •
    Childbirth Script / Diane Roberts Stoler 286 • Preparation for Obstetrical
    Labor / William S. Kroger 293 • Suggestions with Untrained Patients in
    Labor / Nicholas L. Rock, T. E. Shipley, and C. Campbell 296

    Premature Labor, Miscarriage and Abortion 296


    Hypnotic Relaxation Technique for Premature Labor / Haim Omer 296 • Use
    of Immediate Interventions to Uncover Emotional Factors in Pre-Abortion
    Conditions / David B. Cheek 299 • Treating the Trauma of Prospective
    Abortion / Helen H. Watkins 301

    Hyperemesis Gravidarum and Miscellaneous Gynecologic


    Disorders 302
    Hypnotic Intervention with Hyperemesis Gravidarum / Ralph V. August 302 •
    Control Of Hyperemesis / Larry Goldmann 303 • Suggestions for Hyperemesis
    / William T. Heron 304 • Progressive Anesthesia Technique for Hyperemesis
    Gravidarum / D. Corydon Hammond 305 • Suggestions for Hyperemesis /
    Harold B. Crasilneck and James A. Hall 305 • Suggestions for Hyperemesis
    Gravidarum / David Waxman 305 • Suggestions with Psychogenic
    Amenorrhea / William S. Kroger 306 • Suggestions with Leukorrhea / F. H.
    Leckie 306

    10. Hypnosis with Emotional and Psychiatric Disorders 309


    INTRODUCTION 309
    Suggestive Techniques with Emotional Disorders 312
    Hypnotherapeutic Technique for the Reduction of Guilt: The Door of Forgiveness /
    Helen H. Watkins 312 • Dumping the "Rubbish" / H.E.Stanton 313 •
    The Red Balloon Technique / D. Corydon Hammond 313 • Edelstien's
    Fusion of Extremes Technique / D. Corydon Hammond 315 • Scenes for
    Facilitating Self-Understanding / H. E. Stanton 316 • Meeting an Inner
    Adviser / David E. Bresler 318 • Responsibility to a Fault: A Metaphor for
    Overresponsibility / Michael D. Yapko 320 • Different Parts: A Metaphor /
    Michael D. Yapko 321 • Enhancing Affective Experience and Its Expression /
    Daniel P. Brown and Erika Fromm 322

    Hypnosis with Severely Disturbed Patients 324


    Can Hypnosis Help Psychosis? / James R. Hodge 324 • Renurturing:
    Forming Positive Sense of Identity and Bonding / Joan Murray-Jobsis 326
    • Suggestions for Creative Self-Mothering / Joan
    CONTENTS xvii

    Murray-Jobsis 328 • Hypnotherapeutic Techniques with Affective


    Instability / Louis N. Gruber 328 • Hypnotic Suggestions to Deter Suicide /
    James R. Hodge 330 • Hypnosis with Bipolar Affective Disorders / A. David
    Feinstein and R. Michael Morgan 332
    Hypnosis with Post-Traumatic Stress Disorder and Multiple
    Personality Disorder 333
    Emergency Room Suggestions for Physically or Sexually Assaulted Patients / Carol
    P. Herbert 333 • Hypnotic Suggestions with Rape Victims / Bruce Walter
    Ebert 334 • Saying Goodbye to the Abused Child: An Approach for Use with
    Victims of Child Abuse and Trauma / Ronald A. Havens 334 • Reframing
    Dreams in PTSD / Charles B. Mutter 335 • Suggestions and Metaphors for
    Post-Traumatic Stress Disorder and Pain Control (in Spanish) / Marlene D. de Rios
    and Joyce K. Friedman 335 • A Fusion Ritual in Treating Multiple Personality /
    Richard P. Kluft 339 • Another Fusion Ritual / Richard P. Kluft 341 •
    Containing Dysphoria in MPD / Richard P. Kluft 342 • Modified
    Ego-Strengthening for MPD / Moshe S. Torem 343 • Corporate
    Headquarters of the Mind / Donald A. Price 343 • Metaphors with Multiple
    Personality and Trauma Patients / D. Corydon Hammond 346 • A Projective
    Ideomotor Screening Procedure to Assist in Early Identification of Ritualistic Abuse
    Victims / D. Corydon Hammond 347

    11. Hypnosis with Sexual Dysfunction and Relationship


    Problems 349
    INTRODUCTION 349
    Hypnotherapy and Sexual Dysfunction 354
    The Master Control Room Technique / D. Corydon Hammond 354 • Illustrative
    Suggestions in Sex Therapy / Bernie Zilbergeld 356 • Hypnotherapy with
    Psychogenic Impotence / Harold B. Crasilneck 356 • Suggestions for
    Spectatoring and Sensate Focus / D. Corydon Hammond 358 • Suggestions for
    Facilitating Sexual Fantasy / D. Corydon Hammond 360 • Changes in
    Preference Metaphor / D. Corydon Hammond 361 • Metaphors for Going Out
    to Dinner and Back Scratching / D. Corydon Hammond 362 • Organ
    Transplant Metaphor / D. Corydon Hammond 363 • The Pee Shyness
    Metaphor for Sexual Dysfunction / D. Corydon Hammond 364 • Metaphoric
    Suggestions and Word Plays for Facilitating Lubrication / D. Corydon Hammond
    364 • Suggestion for Ejaculatory Inhibition or Orgasmic Dysfunction / D.
    Corydon Hammond 365 • Suggestion for Erection or Lubrication / D.
    Corydon Hammond 366 • Suggestions for Impotence and Anorgasmia / Leo
    Alexander 366 • Suggestions for Induced Erotic Dreams / D. Corydon
    Hammond 367 • Suggestions with Sexual Dysfunctions / Don E. Gibbons
    368 • Suggestions for Premature Ejaculation / Milton H. Erickson 370

    Hypnotic Suggestions for Interpersonal Relationships 371


    Hypnotic Ego-Assertive Retraining / David Waxman 371 • "Fruits &
    Vegetables": A Simple Metaphor for Understanding People Better / Gerald J.
    Mozdzierz 372 • Suggestions to Increase Interpersonal Effectiveness / Don
    E. Gibbons 373 • Suggestions for Difficulties in Interpersonal Situations /
    Kermit E. Parker, Jr. 374 • The Symbolic Imagery Letter
    xviii HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Writing Technique / Mark S. Carich 374 • The Jazz Band Metaphor for
    Family Interaction / Philip Barker 375 • Golden Retriever Metaphor / D.
    Corydon Hammond 376 • The Pygmalion Metaphor / D. Corydon
    Hammond 377

    12. Hypnosis with Obesity and Eating Disorders 379


    INTRODUCTION 379

    Hypnosis with Obesity 380


    Examples of Suggestions for Weight Reduction / Sheryl C. Wilson and Theodore
    X. Barber 380 • Hypnotic Suggestions for Weight Control / T. X. Barber
    383 • Hypnotic Strategies for Managing Cravings / D. Corydon Hammond
    385 • Weight Control / David Spiegel and Herbert Spiegel 387 •
    Suggestions for Patients with Obesity Problems / Joan Murray-Jobsis 388 •
    Computer Metaphor for Obesity / Richard B. Garver 389 • Suggestions for
    Decreasing Food Intake / Harold B. Crasilneck and James A. Hall 390 •
    Historic Landmark Technique for Treating Obesity / William C. Wester, II 391
    • Hypnosis in Weight Control / Herbert Mann 393 • Weight Control
    Suggestions / Harry E. Stanton 395 • Miscellaneous Suggestions for
    Weight Control / William S. Kroger and William D. Fezler 395 • Further
    Suggestions for Management of Obesity / William S. Kroger 396 • Erickson's
    Suggestions with Obesity / Milton H. Erickson 397 • Negative Accentuation:
    Vivifying the Negative During Trance / M. Erik Wright 397 • Aversive
    Metaphor for Chocolate Eaters / Marvin Stock 399 • Symbolic Imagery: The
    Dial Box Shrinking Technique / Mark S. Carich 400 • The Attic of the Past /
    Eleanor S. Field 400

    Treatment of Eating Disorders 402


    Suggestions to Modify Body Attitude / Eric J. Van Denburg and Richard M.Kurtz
    402 • Altering Body Image / Hans A. Abraham 402 • Suggestions for
    Increasing Food Intake / Harold B. Crasilneck and James A. Hall 403 •
    Suggestions for Presenting Symptoms in Anorexia Nervosa / Meir Gross 403 •
    Metaphors for Bulimia and Anorexia / Michael D. Yapko 405

    13. Smoking, Addictions, and Habit Disorders 407


    INTRODUCTION 407

    Hypnosis with Smoking and Addictions 409


    Smoking Suggestions / Joseph Barber 409 • Hypnotic Suggestions for
    Smoking Cessation / T. X. Barber 411 • Hypnosis and Smoking: A Five
    Session Approach / Helen H. Watkins 413 • Smoking Control / David
    Spiegel and Herbert Spiegel 416 • Suggestions for Smoking Cessation /
    Harold B. Crasilneck and James A. Hall 416 • Smoking Cessation / Richard
    B. Garver 417 • Suggestions Regarding Smoking / Steven Gurgevich 418
    • Suggestions to Modify Smoking Behavior / Harry E. Stanton 419 •
    Suggestions Applicable for Smoking, Obesity and Other Addictive Behaviors / Doris
    Gruenewald 420 • Suggestions for Rational
    CONTENTS xix

    Self-Talk for Smoking and Other Addictions / D. Corydon


    Hammond 422 • Suggestions for Smoking Cessation / William C.
    Wester, II All • Aversive Metaphor for Smoking / Marvin
    Stock 423 • General Strategies for Overcoming Pleasure-Producing
    Habits / M. Erik Wright 425 • Illustrative Suggestions with Smokers /
    Paul Sacerdote 428 • A Posthypnotic Suggestion and Cue with Smokers /
    Brian M. Alman 429

    Hypnosis with Habit Disorders 429


    Hypnosis with Nailbiting / Harold B. Crasilneck and James A. Hall 429 •
    Erickson's Suggestions for Nailbiting / Milton H. Erickson 429 •
    Suggestions for Nailbiting / David Waxman 429 • Suggestions for
    Nailbiting / Don E. Gibbons 430 • Suggestions with Trichotillomania /
    Marianne Barabasz 431 • Suggestions for Scalp Sensitivity with
    Trichotillomania / T. J. Galski 431

    14. Concentration, Academic Performance, and Athletic


    Performance 433
    INTRODUCTION 433

    Enhancing Academic Performance 436


    Suggestions for Enhancing Academic Performance / Don E. Gibbons 436 •
    The Memory Bank / Douglas M. Gregg 437 • Academic Study Suggestions /
    Stanley Krippner 439 • Concentration Suggestions / William T. Reardon
    440 • Suggestion for Concentration / Brian M. Alman 440 • Suggestions
    and Success Imagery for Study Problems / Jeannie Porter 440 • Suggestions
    for Studying, Concentration and Text Anxiety / Richard B. Garver 445 •
    Erickson's Suggestions for Facilitating Speed of Learning / Milton H. Erickson
    446 • Alert Trance Suggestions for Concentration and Reading / E. R. Oetting
    446 • Alert Self-Hypnosis Technique to Improve Reading Comprehension /
    David M. Work 449 • Advanced Comprehension Suggestions for an Alert
    Trance / David M. Wark 450 • Improving Reading Speed by Hypnosis /
    Raymond W. Klauber 450 • Gorman's Ego-Strengthening Technique Adapted
    for Reading / G. Gerald Koe 452 • Suggestions for Foreign Language Study /
    Don E. Gibbons 457 • Suggestions for Mathematics or Statistics Performance
    / Robert M. Anderson 458 • Examination Panic / Milton H. Erickson
    459 • Suggestions for Concentration, Studying and Overcoming Test Anxiety /
    Alcid M. Pelletier 460 • Suggestions for Examination Phobia / David
    Waxman 461

    Suggestions for Aesthetic Refinement 461


    Suggestions for Artistic Expression / Don E. Gibbons 461 • Suggestions for
    Aesthetic Appreciation and Enjoyment / Don E. Gibbons 462 • Suggestions to
    Enhance Musical Performance / Don E. Gibbons 462 • Suggestions to Enhance
    Writing Ability / Don E. Gibbons 464

    Enhancing Sports and Athletic Performance 465


    Suggestions Used to Enhance Sport Performance / Keith P. Henschen
    465 • Sports Performance Enhancement / Richard B.
    XX HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Garver 466 • Metaphor for Athletics/Sports Competition / Richard R.


    Wooton 467 • Metaphor for Facilitating Cooperation and Teamwork in
    Athletics / Richard R. Wooton 469 • Suggestions for Concentration / Brian
    M. Alman 469 • A Cognitive-Hypnotic Approach to Athletic Performance
    with Weight Lifters / W. Lee Howard and James P. Reardon 470 •
    Suggestions for Sports Performance / Don E. Gibbons 471 • Endurance
    Suggestions with Distance Runners / J. Arthur Jackson, Gregory C. Gass, and E.
    M. Camp 472

    15. Hypnotic Suggestions with Children 475

    INTRODUCTION 475

    Helping Parents See Specific Advantages in Child Hypnotherapy / G. Gail Gardner


    All • Hypnosis with Children / Daniel P. Kohen 480

    Hypnosis with Pain 481

    Hypnotic Procedure for Pain Relief / Valerie J. Wall 481 • Techniques of


    Hypnoanalgesia / Karen Olness and G. Gail Gardner 484 • Pediatric Wound
    Injection —Using a Visual Distraction Technique / Steven F. Bierman 486 •
    Examples of Suggestions for Use in Pediatric Emergencies / Daniel P. Kohen 488

    Hypnosis with Enuresis 489

    A Hypnotherapeutic Approach to Enuresis / Daniel P. Kohen 489 • Imagery


    with Bedwetting / H. E. Stanton 493 • Induction and Ocean Metaphor for
    Bedwetting / Valerie J. Wall 494 • Suggestions with Enuresis / Franz
    Baumann 496 • Erickson's Suggestions with Enuresis / Milton H. Erickson
    497 • Enchanted Cottage Suggestions for Enuresis / Don E. Gibbons 497

    Suggestions for Thumbsucking 498

    Erickson's Suggestions for Thumbsucking / Milton H. Erickson 498 •


    Suggestions with a Four-Year-Old Thumbsucker / Lawrence M. Staples 499

    Miscellaneous Pediatric Problems 499

    Metaphor for a Boy with Behavioral Problems / Norma P. Barretta and Philip F.
    Barretta 499 • Hypnosis in the Treatment of Tourette Syndrome / David N.
    Zahm 501 • A New Hypnobehavioral Method for the Treatment of Children
    with Tourette's Disorder / Martin H. Young and Robert J. Montano 502 •
    Technique with Asthmatic Children / Harold B. Crasilneck and James A. Hall 504
    • Suggestions with Dyslexia / Harold B. Crasilneck and James A. Hall 505 •
    Hypnotic Suggestions with Stuttering / Harold B. Crasilneck and James A. Hall
    505 • Personalized Fairy Tales for Treating Childhood Insomnia / Elaine S.
    Levine 505 • Suggestions with School Phobia / David Waxman 506 • A
    Science Fiction-Based Imagery Technique / Gary R. Elkins and Bryan D. Carter
    506
    CONTENTS xxi

    16. Time Reorientation: Age Regression, Age Progression, and Time


    Distortion 509
    INTRODUCTION 509
    Age Regression and Abreaction 518
    Ideomotor Identification Followed by Partial Regression / D. Corydon Hammond
    518 • Imagery Methods of Facilitating Age Regression / H. E. Stanton 519
    • Improving the Quality of the Age Regression / Daniel P. Brown and Erika
    Fromm 519 • Suggestions to Facilitate Revivification / Eric Greenleaf
    521 • Erickson's Confusional Method for Revivification / Milton H. Erickson
    523 • Watkins' Affect or Somatic Bridge / John G. Watkins 523 •
    Facilitating a Full Abreaction / D. Corydon Hammond 524 • An Abreactive
    Technique / Richard P. Kluft 526 • A Vigorous Abreaction Technique /
    Richard P. Kluft 527 • The Fractionated Abreaction Technique / Richard P.
    Kluft 527 • The Slow Leak Technique / Richard P. Kluft 529 •
    Watkin's Silent Abreaction Technique / Helen H. Watkins 530 • Erickson's
    Age Regression Techniques / Milton H. Erickson 531 • Gradual Dissociated
    Release of Affect Technique / D. Corydon Hammond 534 • Sickness &
    Immunity Metaphors / D. Corydon Hammond 535 • Metaphor of an Injury,
    Scab, and Healing / D. Corydon Hammond 536 • Example of An Analytical
    Procedure for Reframing / E. A. Barnett 537 • Desensitization: An Example
    of Rapid and Repetitive Memory Evocation / M. Erik Wright 541 • Forensic
    Hypnosis Guidelines: The "Federal Model" / Richard B. Garver 542

    Age Progression 543


    Erickson's Time Projection Technique / D. Corydon Hammond 543 • Age
    Progression to Work Through Resistance / Richard B. Garver 545 • Suggestions
    Following Age Progression with Public Speaking / Don E. Gibbons 546 •
    Imagery of the End Result / Errol R. Korn and George J. Pratt 546 • Mental
    Rehearsal: The Protective Shield / Errol R. Korn and George J. Pratt 547 •
    Mental Rehearsal of Presentation and Sales Skills / Errol R. Korn and George J.
    Pratt 547 • Suggestions for Goal-Imagery / Alcid M. Pelletier 548 •
    End-Result Goal Imagery for Sales Productivity / Don E. Gibbons 549 •
    Erickson's Self-Suggestion Technique / D. Corydon Hammond 549

    Time Distortion Training 551


    Training Patients to Experience Time Distortion / Linn F. Cooper and Milton
    H. Erickson 551 • Summary of Suggested Steps in Time Distortion
    Training / D. Corydon Hammond 556

    References 559

    Credits 579

    Name Index 587

    Subject Index 592


    FOREWORD
    Hypnotherapy is the application of hypnosis in a wide variety of medical and
    psychological disorders. Adequate training in psychotherapy is a prerequisite for
    practicing hypnosis, regardless of whether the clinician is a psychologist,
    physician, social worker, or dentist. In fact, training in psychotherapy and
    hypnotherapy is a never-ending process.
    A text of this magnitude offers both the neophyte and the experienced clinician
    a tremendous, comprehensive reference. After receiving initial classroom or
    workshop training, additional training comes through reading, self-study and
    self-experience. This book represents a beacon for those desiring additional
    training in treating clinical problems. Having this reference available will give the
    new practitioner a very secure feeling.
    This is a book for clinical practitioners. In fact, it will undoubtedly become the
    practical companion volume and supplement to comprehensive textbooks and
    courses on hypnosis. It provides the reader with the "how to" suggestions that
    therapists use with their patients. Rather than intellectually discussing the topic of
    hypnosis, this book gives therapists, physicians and dentists a sampling of what
    experienced clinicians actually say to their patients during hypnotic work. At last
    we have a book that helps answer the common query from our students: "But
    what do I say now that the patient is hypnotized?"
    Every student and clinician who uses hypnosis will want to have this invaluable
    and comprehensive desktop reference. It represents the largest collection of
    therapeutic suggestions and metaphors ever assembled, with contributions from
    over 100 of the world's finest hypnotherapists. For those interested in the
    theoretical and research aspects of hypnosis, there are numerous other volumes
    that may be found in libraries. In my opinion, we are very fortunate in having this
    new text in which something so complicated has been made so much more
    understandable.
    However, Dr. Hammond rightly emphasizes that this is not meant to be a
    cookbook of suggestions to be routinely used with certain problems. And simply
    the extensiveness of the suggestions he has compiled will tend to discourage
    anyone from mechanically applying the same paragraph of suggestions to
    everyone with a problem. His inclusion of empirical indications

    vii
    viii HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    and contraindications for modules of suggestions is also intended to facilitate


    thoughtful treatment planning and the individualization of treatment.
    What you will find here is a resource book from which you will be able to pick
    and choose suggestions that you clinically judge to be compatible with individual
    patients and with your own personal style of doing hypnosis. It is an eclectic book
    that models a wide range of styles of practice in clinical hypnosis. The
    tremendous breadth of suggestions will also serve as a stimulus to your creativity
    in preparing hypnotic suggestions and metaphors of your own. Chapter 2 will
    enhance your skills further through outlining the principles and guidelines for
    formulating successful hypnotic and posthypnotic suggestions.
    Suggestions included in the book concern dozens of clinical problems. There
    are chapters and sections of suggestions on such medical topics as pain,
    hypnoanesthesia and hypnotic preparation for surgery, burns, emergencies,
    gastrointestinal disorders, cancer, chemotherapy, dermatologic complaints,
    obesity, smoking and addictions, childbirth training, obstetrical and gynecologic
    applications, insomnia, autoimmune diseases, and hemophilia.
    Psychotherapists will find practical suggestions concerning habit disorders
    (e.g., nailbiting, trichotillomania), anxiety and phobic disorders, sexual
    dysfunctions and relationship problems, concentration, academic performance,
    sports, ego-strengthening to increase self-esteem and self-efficacy, posttraumatic
    stress disorders, multiple personality disorder, severely disturbed (e.g.,
    borderline, schizophrenic) patients, and other emotional disorders. A chapter on
    hypnosis with children includes such clinical topics as pain and hypnoanesthesia,
    dyslexia, stuttering, enuresis, Tourette syndrome, school phobia, and asthma.
    Dentists will find useful suggestions concerning bruxism, TMJ, anxiety and
    phobic responses, pain control, thumbsucking, vascular control and gagging.
    There are also suggestions to be found on facilitating age regression, age
    progression, and time distortion. Each chapter represents the epitome of clinical
    expertise extant in our field.
    This Handbook contains a wealth of original and previously unpublished
    suggestions that Dr. Hammond solicited from many of our most experienced
    hypnotherapists. In these pages you will also discover many of the finest
    suggestions that have appeared in books, chapters and journal articles over the last
    30 years. For example, suggestions are included from throughout the back issues
    of the two most prestigious hypnosis journals in the world, the American Journal
    of Clinical Hypnosis and the International Journal of Clinical & Experimental
    Hypnosis. Dr. Hammond has done the work for us of reviewing tens of thousands
    of pages of books and journals, and then compiling in one place the practical
    clinical gems that he discovered.
    This book was a massive undertaking. Tasks of this kind require literally
    hundreds of hours of personal sacrifice and effort. Very few people possess this
    dedication and scholastic capability. The present text is literally Herculean in
    scope, volume and content. The book is also unique in that neither Dr. Hammond
    nor any of his contributors will receive royalties from its publication. The book
    was literally a labor of love by all those who
    FOREWORD ix

    have contributed. It was donated to and accepted as an official publication of the


    American Society of Clinical Hypnosis. All royalties from its sale will go to the
    American Society of Clinical Hypnosis to promote further research and workshop
    training in clinical hypnosis throughout the United States and Canada.
    Dr. Hammond is a master clinician of unusual breadth and talent who has
    become one of the giants in the field of clinical hypnosis. Part of his brilliance lies
    in the expertise that he has in integrating the practical contributions that are found
    in a great diversity of different orientations and approaches to hypnosis. Although
    he clearly makes scholarly and research contributions to the field, Dr. Hammond
    is primarily a clinician of the greatest magnitude, as exemplified by this text. Cory
    Hammond is one of the few people whom I know capable of authoring and
    compiling this type of text. People in the field will always be indebted for this
    yeoman challenge which he has completed in this magnificent presentation. His
    clinical breadth, extensive practical experience, and thorough knowledge of the
    field are truly reflected in this work. Dr. Hammond's book is destined to be a
    classic in the field that will be sought after for decades to come. It will rank as one
    of the greatest therapeutic contributions made in the fields of medicine,
    psychology, dentistry and allied fields.
    Harold B. Crasilneck, Ph.D.
    Past President, American Society of Clinical Hypnosis and the Society of
    Clinical and Experimental Hypnosis Clinical Professor of Psychiatry and
    Anesthesiology, University of Texas
    Health Sciences Center, Dallas
    INTRODUCTION

    HIS IS A PRACTICAL resource book for clinicians. Although it is a large


    compilation of therapeutic suggestions and metaphors, I wish to emphasize from
    the outset that it is not intended as a "cookbook" of suggestions to be routinely
    used with various clinical problems. My own personal philosophy of
    hypnotherapy is to encourage therapists to individualize hypnotic suggestions to
    the unique personality, expectations, motivations and problems of the patient
    (Hammond, 1988a).
    In the introductions to chapters I have often provided a scholarly overview of
    relevant research because I believe that it is important for clinicians to be aware
    of this literature. But this volume is not intended as a thorough text of the field of
    hypnosis. Rather, it is first and foremost a practical reference for clinical
    practitioners who are already trained in the use of hypnosis and a practical
    companion volume to comprehensive textbooks (e.g., Crasilneck & Hall, 1985;
    Hammond & Miller, in press; Watkins, 1987; Weitzenhoffer, 1989; Wester &
    Smith, 1984).
    The intent of this book is to provide clinicians with models of hypnotic
    suggestions and metaphors from seasoned hypnotherapists who have diverse
    approaches and styles. Verbalizations for hypnotic induction and deepening
    techniques have not been included because they may be found abundantly in the
    texts identified above, as well as in the American Society of Clinical Hypnosis
    course text, Hypnotic Induction and Suggestion (Hammond, 1988c).
    All too frequently we are only exposed to general descriptions of a therapeutic
    approach. As part of our training, we certainly need instruction in theory, history,
    assessment, guidelines and overall strategies. But if we are to function effectively
    as clinicians we also need exposure to the pragmatic nuts and bolts of what to say
    to patients. There is a deficit of such material in graduate education and students
    regularly complain that their training is not practical enough. This volume is
    designed to respond to that need and provide you with a look at what experienced
    clinicians actually tend to say to their patients during hypnotic work.
    You will find suggestions that are highly indirect, permissive and metaphoric,
    and ones that are also very direct, forceful and authoritative. I must admit to
    having occasionally included a suggestion that I, personally,
    2 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    would probably not use with a patient, despite considering myself very eclectic
    and flexible. But there may be some readers who will appreciate and find certain
    of these same suggestions both helpful and compatible with their own style. As
    therapists we are as distinctive as our patients. It is hoped, therefore, that as you
    treat patients with specific problems you will find that you can pick and choose
    different paragraphs and modules of suggestions from various contributors and
    adapt them to your individual patient. The variety of suggestions will often
    provide you with alternative ways of communicating with a patient about a
    particular problem. We cannot always know for sure which ideas will produce the
    desired motivation. As Erickson (Rossi & Ryan, 1985) said, "You provide a
    multiplicity of suggestions: the more suggestions that you give, and the more
    simply you give them, the greater the possibility of getting some of them
    accepted. Your task isn't to force a patient to accept suggestions. Your task is to
    present a sufficient number of suggestions so that he will willingly take this one
    and that one" (p. 213).
    In many ways hypnosis is the art of securing a patient's attention and then
    effectively communicating ideas that enhance motivation and change perceptions.
    There is nothing sacred about the phrasing of the suggestions in this volume. As
    Dr. Milton Erickson (Rossi & Ryan, 1985) taught, "I want all of you to be willing
    to disagree with my wording, because it's right for me but it may be wrong for
    you" (p. 216). You will undoubtedly find interesting ideas and concepts that
    appeal to you in the suggestions of many different contributors. But ofttimes you
    will probably find yourself wanting to convey the same idea a little differently, in
    your own way or in a manner that you believe will be more appealing to a
    particular patient. This is as it should be. In fact, this was another reason for
    compiling this volume —my belief that it will serve to stimulate your creativity in
    preparing your own suggestions and metaphors.
    Alexander Hamilton once said, "Men give me some credit for genius, but all of
    the genius I have lies in this. When I have a subject in mind, I study it profoundly,
    day and night it is before me. 1 explore it in all its bearings. My mind becomes
    pervaded with it. The result is what some people call the fruits of genius, whereas
    it is in reality the fruits of study and labor." Part of the genius that was attributed
    to our Society's founding President, Dr. Milton H. Erickson, stemmed from this
    same kind of hard work and study. His sophistication and polish evolved from his
    discipline in carefully writing and rewriting suggestions and thoughtfully
    planning treatment (Hammond, 1984a, 1988b). He did this regularly for several
    decades of his life. Although this book will undoubtedly contain suggestions that
    you will find useful with patients or clients, it is also hoped that these materials
    will provide you with ideas and encouragement to thoughtfully prepare your own
    suggestions and metaphors.

    The Underlying Therapeutic Philosophy:


    Integrative Hypnotherapy
    Certainly this edited work reflects some of my own philosophy of
    psychotherapy, which is one of broad spectrum, eclectic treatment. Reli-
    INTRODUCTION 3

    ance on a limited range of methods and one approach appears to often be


    associated with inexperience as a therapist (Auerbach & Johnson, 1977; Fey,
    1958; Parloff, Waskow, & Wolfe, 1978; Strupp, 1955; Wogan & Norcross,
    1985). In fact, research has found that it is the most highly experienced therapists
    who ascribe to an eclectic approach (Norcross & Prochaska, 1982; Smith, 1982),
    refusing to be limited by adherence to only one orientation. Currently 30%-54%
    of psychotherapists from various disciplines identify themselves as eclectic
    (Norcross, 1986). It is my belief that not all patients need the same thing. Thus
    you will find a tremendous diversity in the suggestions represented in this book.
    In fact, when therapists tend to inflexibly use the same approach with all
    patients, there is evidence that destructive effects are much more likely to occur
    (Lieberman, Yalom, & Miles, 1973).
    In the specialty area of hypnotherapy, we are beginning to witness an
    evolution similar to what has been seen in the broader field of psychotherapy
    where innumerable therapeutic schools and cults have sprung up. Various
    orientations to hypnosis have also begun to evolve. Unfortunately, we now see
    some clinicians who have begun to operate on the "one-true-light-assumption"
    that their specialized approach to hypnosis is the correct one. Similar to
    Erickson, I refuse to be limited by a unitary theory or orientation, either in
    psychotherapy or in my use of hypnosis. I value and encourage an openness to
    learning from all quarters. I am indebted to the work of many different master
    clinicians and hypnotherapists with highly divergent styles who have enriched
    my work in ways that would have never occurred if I limited myself to only one
    approach.
    Thus I identify my approach to hypnotherapy as Integrative Hypnotherapy
    (Hammond & Miller, in press). This is an eclectic, multidimensional orientation
    that seeks to be comprehensive, incorporating methods from many hypnotic
    approaches. It is part of the emergent trend in psychotherapy, tracing its roots to
    pioneers like Thorne (1967), Wolberg (1954, 1967, 1987), Lazarus (1981), and
    more recently Beutler (1983), Prochaska and DiClemente (1984), Norcross
    (1986), and Hammond and Stanfield (1977). Depending upon the individual
    patient, direct, indirect, metaphoric, and insight-oriented techniques may be
    employed to alter behavior, affect, physiologic processes, imagery, perceptions,
    cognitions, and the internal dialogue of patients. Hypnosis is used to explore
    precon-scious and unconscious functions, resolve historical factors, and utilize
    unconscious resources.
    This method of working builds on the general philosophy of technical
    eclecticism (Lazarus, 1981; Hammond & Stanfield, 1977), encouraging the
    prescriptive use of techniques according to indications and contraindications
    derived empirically and by experimental validation, rather relying on theories.
    Unfortunately, research on effectiveness is far too often lacking and
    experimentally validated criteria commonly do not exist on indications,
    contraindications and the matching of techniques with patient variables. Thus
    strategy and technique selection currently remain implicit and primarily guided
    by empirical evidence and clinical experience. Hypnotherapy, like
    psychotherapy, is still more of an art and only embryonic in scientific
    development. Tentative and yet systematic and explicit guidelines need to be
    published concerning strategy and technique
    4 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    selection with different patients, and this process is currently


    under development (Hammond & Miller, in press).
    Stemming from this therapeutic philosophy, you will find that I have often
    included some suggestive guidelines and indications for the use of the hypnotic
    suggestions and metaphors that have been included in the book. I have indicated
    when these guidelines were mine. The titles and subtitles throughout the text are
    in most cases mine also. They have been provided to allow you to more easily
    identify "modules" of suggestions that have a different theme or focus.
    A necessary limitation of this book is that it focuses primarily on what we call
    suggestive hypnosis. Sometimes suggestive hypnosis is all that is needed to
    successfully treat a clinical problem. However, there are times when problems
    and symptoms are related to historical factors (e.g., trauma) and/or serve adaptive
    functions and purposes that are beyond conscious awareness. In these cases,
    delivering hypnotic suggestions and metaphors will be most effective following
    uncovering and age regression (abreactive) work. A comprehensive, integrative
    approach to hypnosis thus includes the use of exploratory and insight-oriented
    hypnotic techniques. These interventions, however, are much more difficult to
    model in a limited amount of space and consequently are only rarely included in
    this book. These methods may be studied by consulting Hammond and Miller (in
    press), Rossi and Cheek (1988), Brown and Fromm (1986), and Watkins (in
    press).
    Finally, I wish to emphasize that hypnosis is often most effective when it is
    combined with other (nonhypnotic) interventions. Hypnosis is like any other
    medical or psychological technique or modality: it is not uniformly effective with
    all problems or all patients. Thus it is vitally important that we do not identify
    ourselves as "hypnotists," but rather as psychologists, physicians, dentists, social
    workers, marriage and family therapists, nurse anesthetists, etc., who use
    hypnosis as one mode of intervention along with our other clinical tools.
    Furthermore, ethical practice requires that we only use hypnosis to treat
    problems that we are qualified to treat with nonhypnotic techniques. If one has not
    received advanced specialty training and supervision in practicing with children
    or in doing sex therapy, it seems ethically inappropriate to use hypnosis to work in
    these areas. Hypnosis training alone does not qualify us to work in subspecialty
    areas beyond our expertise. Similarly, merely learning a few hypnotic inductions
    and then seeking to apply suggestions gleaned from a volume like this is likewise
    deemed to be inappropriate. The reader is encouraged to seek specialty training
    and supervision in hypnosis from your local university or the American Society of
    Clinical Hypnosis workshops, and to study comprehensive textbooks.

    The American Society of Clinical Hypnosis


    PURPOSE AND DESCRIPTION
    The American Society of Clinical Hypnosis (ASCH) was founded in 1957,
    with Milton H. Erickson, M.D., as the first president. Numbering
    INTRODUCTION 5

    almost 4,000 members, the ASCH is a nonprofit professional organization. Its


    purpose is to establish and maintain the foremost society in North America of
    professionals in medicine, psychology and dentistry dedicated to informing the
    public about the therapeutic effects of hypnosis and educating qualified
    professionals in the use of hypnosis for the benefit of humanity and themselves.
    A central objective of the society is to provide and encourage educational
    programs to further, in every ethical way, the knowledge, understanding and
    acceptance of hypnosis as an important clinical tool. Thus, almost monthly,
    ASCH conducts beginning, intermediate and advanced training workshops at
    different locations throughout the United States and Canada, as well as an annual
    workshop. Approximately four dozen local Component Sections of the American
    Society of Clinical Hypnosis also provide ongoing professional interaction and
    educational programs.
    Another key purpose of the society is to stimulate research and encourage
    scientific publication in the field of clinical hypnosis. Thus we also sponsor an
    annual scientific meeting, held in conjunction with the annual workshops. The
    American Journal of Clinical Hypnosis is published quarterly by the society. In
    addition to the professional papers and book reviews, the journal also includes
    abstracts of the worldwide hypnosis literature. A comprehensive computer search
    of references to worldwide publications is also included in each issue of the
    Newsletter, which is published five times a year. The ASCH Education and
    Research Foundation was established to encourage and promote both education
    and research.

    Training Opportunities
    REGIONAL WORKSHOPS
    Eight or nine regional workshops are held yearly in different cities throughout
    the United States and Canada. This training is available to licensed psychologists,
    physicians, dentists, social workers, marriage and family therapists, and masters
    degree level registered nurses with advanced subspecialty training and
    certification. Medical residents and doctoral students in medicine, dentistry and
    psychology are also eligible to attend. Students, residents, interns, ASCH
    members, and full-time faculty members are eligible for discounted registration
    rates.
    The regional workshops generally are conducted at three levels simulta-
    neously: beginning, intermediate and advanced. A course text is available to
    participants and the workshops include the opportunity for several hours of
    supervised practice. The faculty is changed for each regional workshop,
    providing participants with models of a variety of styles of practice. Workshops
    generally begin Thursday evening and conclude at noon on Sunday. You may
    write for information at the address listed below.

    ANNUAL WORKSHOPS AND SCIENTIFIC MEETING


    Held in late March or early April each year, the annual meeting consists of two
    and one-half days of workshops and a two-day scientific meeting. A
    6 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    beginning and intermediate workshop is part of the program, and there is an


    extensive range of advanced workshop offerings. The 50-60 faculty members for
    the annual workshops include many of the finest teachers in the world.
    Professional papers in the scientific meeting cover a broad range of topics.

    AMERICAN JOURNAL OF CLINICAL HYPNOSIS

    Published quarterly, the American Journal of Clinical Hypnosis contains both


    experimental and clinical papers, book reviews, and abstracts of worldwide
    hypnosis literature that is in English or has English abstracts. Yearly subscriptions
    are available for $30. Subscription and advertising inquiries should be sent to the
    Business Manager, ASCH, 2200 E. Devon Ave., Suite 291, Des Plaines, IL.
    60018, USA.

    VIDEOTAPE LIBRARY AND AUDIOTAPES

    Dozens of audiotapes of past workshops and scientific meeting presentations


    are available for purchase to professionals. In addition, the ASCH Videotape
    Library contains over 80 high quality videotapes of recognized authorities in the
    field demonstrating techniques. These videotapes are available for rental to
    members or Component Sections of the society.

    BOOK SALES

    For the convenience of members and attendees at workshops, ASCH maintains


    an inventory of many of the most respected volumes on different aspects of
    clinical hypnosis. In addition, the following three publications are available
    exclusively from ASCH:

    1. Hypnotic Induction and Suggestion, edited by D. Corydon Hammond, Ph.D.,


    is the ASCH course text for beginning and intermediate level workshops. This
    134-page monograph is highly practical in nature and ideally suited for use in
    courses and seminars. A free instructor's copy is included with each class
    order of 20 or more books. It includes: verbalizations for 12 induction
    techniques; principles of induction and suggestion; a checklist assessment
    instrument for individualizing hypnosis; over 20 deepening techniques;
    guidelines and questions for rapid unconscious exploration through ideomotor
    signaling; 19 strategies for managing resistant patients; an annotated
    bibliography describing the contents of 135 books on hypnosis; preparing the
    patient; phenomena of hypnosis; stages and depth of hypnosis; self-hypnosis;
    adverse reactions; hypnosis and children; types of suggestions; and
    hypnotizability scales. It is available from ASCH for $15.00/copy plus $2.00
    postage and handling.
    2. The ASCH Manual for Self-Hypnosis, by D. Corydon Hammond, Ph.D. This
    40-page manual is designed to provide your patients with the essential
    principles for using self-hypnosis. It will save you time in the
    INTRODUCTION 7

    office, and patients who won't read a lengthy book will be willing to read this
    manual. Sections include: What is Hypnosis? Preparing for Self-Hypnosis;
    Preparing Hypnotic Suggestions; The Process of Self-Hypnosis; Deepening
    Your Hypnotic State; Spectatoring and Dealing with Distractions; Imagination:
    The Catalyst for Change; Having a Dialogue with Your Symptom; The Council
    of Advisers Technique; The Inner Adviser Technique; Mental Rehearsal and Age
    Progression; Erickson's Method of Self-Hypnosis; References for Further
    Reading. The cost is $5.00 (plus $2.00 shipping and handling on single orders),
    and quantity discounts are available to encourage its use with your patients. 3.
    Learning Clinical Hypnosis: An Educational Resources Compendium. "A unique,
    up-to-date volume on the methods and teaching of therapeutic hypnosis by D.
    Corydon Hammond and the acknowledged authorities of the American Society
    of Clinical Hypnosis. This is the standard reference text that belongs in the
    libraries of all medical, dental, and nursing schools, as well as graduate
    departments of Psychology and Social Work. Students and mature clinicians of
    all specialties will find an excellent orientation to the therapeutic art and leading
    edge of modern hypnosis right here!" Ernest L. Rossi, Ph.D.
    This 393-page volume includes 265 pages of practical handouts and
    summaries of clinical techniques, 28 handouts on induction and deepening
    techniques, and 34 inductions for children. It includes sections on:
    foundations of knowledge, an overview of modules for teaching hypnosis and
    model course outlines, numerous alternatives for teaching demonstrations,
    many experiential learning exercises, formulating hypnotic suggestions,
    methods of unconscious exploration, age regression, methods of
    ego-strengthening, hypnotic strategies for pain management, specialized
    techniques and metaphors, resistance, and a comprehensive overview of
    commercially available audiovisual aids and resources. It is available for
    $37.50 (add $3.50 for shipping and handling).

    COMPONENT SECTIONS

    Approximately four dozen local component sections of ASCH provide


    support, professional interaction, and further training opportunities to members.
    Many component sections also allow masters degree practitioners membership
    status. Foreign affiliated societies offer still further opportunities for international
    exchange.

    THE ASCH NEWSLETTER

    Published five times a year, the Newsletter provides members with timely
    information about latest developments in the field and training opportunities.
    Clinically relevant information is frequently included, as well as a current
    literature computer search update.
    8 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Eligibility for ASCH Membership


    To be eligible for membership, the applicant must have:

    a. An M.D., D.D.S., D.M.D., D.O. or a Ph.D., or an equivalent degree


    (e.g., Ed.D. or D.S.W.) with psychology as the major study. (Doctoral
    level social workers and doctoral level marriage and family therapists
    frequently meet these requirements);
    b. a doctorate from a university or college accredited by its appropriate
    regional accrediting body;
    c. a license to practice in the state or province;
    d. membership or eligibility for membership in a professional society
    consistent with his/her degree;
    e. 40 hours of appropriate professional training and experience in clinical
    or experimental hypnosis.

    To be eligible for associate membership, the applicant must have:

    a. An M.D., D.D.S., D.M.D., D.O. or a Ph.D., or an equivalent degree


    (e.g., Ed.D. or D.S.W.) with psychology as the major study;
    b. a doctorate from a university or college accredited by its appropriate
    regional accrediting body;
    c. a license to practice in the state or province;
    d. membership or eligibility for membership in a professional society
    consistent with his/her degree;
    e. an associate member shall have two years' time allotted for acquiring the
    prerequisite clinical experience and training for full membership require
    ments.

    To be eligible for student affiliate membership, the applicant must be:

    a. A full-time student with a minimum of 45 completed graduate semester


    hours or 60 completed graduate quarter hours; and shall be (1) enrolled
    in a graduate program in active pursuit of a doctorate in medicine (M.D.
    or D.O.), dentistry or psychology, or (2) enrolled in a doctoral program
    where psychology is the major field of study;
    b. pursuing his/her doctoral degree at a university or college fully accred
    ited by the appropriate regional accrediting body to give such a degree.

    For further information concerning membership, training, tapes or publications,


    please contact: The American Society of Clinical Hypnosis
    2200 East Devon Ave., Suite 291
    Des Plaines, Illinois 60018
    (312)297-3317

    All royalties from the sale of this book have been donated to the American
    Society of Clinical Hypnosis to promote further training and research in hypnosis.
    INTRODUCTION 9

    Acknowledgments
    This book represents the compilation of many different people's styles and ways
    of working. Appreciation is extended to the dozens of master clinicians who freely
    contributed their work to ASCH for publication in this volume and in the 1973
    Handbook of Therapeutic Suggestions. The finest suggestions from the 1973
    volume have been retained in this book.
    Thanks are also in order to Dr. Louis Dubin, past president of the American
    Society of Clinical Hypnosis, and to my colleagues on the Executive Committee of
    ASCH for encouraging this massive undertaking. I am also appreciative for the
    assistance of Drs. Michael Yapko, Valerie Wall, and Daniel Kohen for reviewing
    and providing feedback on some of the original material that was submitted. Most
    of all, I appreciate the sacrifices of my loving wife and companion, Melanie, who
    provided encouragement, endured this project along with me, and thoughfully
    helped proofread this volume.
    FORMULATING HYPNOTIC AND
    POSTHYPNOTIC SUGGESTIONS

    INinvolved in formulating effective


    THIS CHAPTER WE WILL overview the major principles and guidelines
    hypnotic suggestions. Afterwards, we will
    discuss different types of suggestions that may be constructed and how to phrase
    suggestions. Finally we will examine the process of how you may present a series
    of suggestions in order to production different hypnotic phenomena. Keep in
    mind that hypnotic suggestions may be directed toward behaviors, emotions,
    sensations and physiologic processes, cognition, imagery, and relationships
    (Hammond & Miller, in press; Hammond & Stanfield, 1977). Suggestions may
    also focus on producing immediate responses within the hypnotic session or
    posthypnotic effects.

    Principles of Hypnotic Suggestion

    ESTABLISH RAPPORT AND A COOPERATIVE RELATIONSHIP


    Establishing a relationship with the patient must always be considered the first
    and most vitally important prerequisite for suggestions to be effective. Relating
    to the patient in a warm, understanding, caring and respectful manner reduces
    defensiveness and creates the trusting kind of climate that is necessary for
    hypnosis to be maximally effective. Because hypnosis is a cooperative venture,
    rather than something we do to the patient, it is crucially important to devote time
    to the human relationship dimension and not to simply concentrate on technical
    expertise in hypnosis alone.

    C RE ATE POSITIVEEXPECTANCY
    Experienced hypnotherapists are probably more effective than new students, at
    least in part, because they act utterly expectant and confident that their
    suggestions will occur. This inspires confidence in patients. Act and speak
    confidently.
    11
    12 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    There are times, as we will discuss shortly, when it is wise to phrase


    suggestions in a more permissive and indirect way. Exercise caution, however,
    that you do not speak in such a laissez faire manner that you are perceived as
    lacking confidence. This is a mistake common among hypnotherapists with
    limited experience and confidence, or who are trying to be overly permissive. Be
    careful about using words such as "perhaps," "maybe," "can," or "might" (Brown
    & Fromm, 1986). For instance, listen to the lack of conviction and confidence
    conveyed by these suggestions: "One of your hands might begin feeling lighter."
    "Maybe (Perhaps) your hand can float up." "Perhaps a numbness will develop in
    your hand." Compare the difference when you change the words to "will" and
    "is." "One of your hands is beginning to get lighter, and will begin to float up,
    lighter and lighter." As we will discuss under the principle of successive
    approximations, you can be permissive concerning the time required to develop a
    response, and still convey confidence. It is important to make the distinction
    between being confident and authoritative versus authoritarian and dominating.

    THE LAW OF REVERSED EFFECT


    The principle of reversed effect primarily applies to making suggestions to
    produce physiological effects. This "law" refers to the fact that the harder one
    consciously endeavors to do something, the more difficult it becomes to succeed.
    Have you ever tried to consciously will an erection or an orgasm? Or, how many
    times have you retired to bed too late and tried to help yourself to go to sleep, only
    to find yourself more wide awake? Just as we are unsuccessful at trying to will
    ourselves to perspire or salivate, we are generally unsuccessful in applying
    conscious willpower to produce therapeutic changes, especially physiologic
    changes.
    As you formulate suggestions, emphasize imagination and imagery rather than
    appealing to the conscious will. For example, instead of simply verbally
    suggesting that a hand is becoming numb, you may have patients imagine putting
    their hand into the snow or into an icy cold stream, while simultaneously
    suggesting anesthesia. Alternatively, seek to evoke memories and images of life
    experiences where the phenomenon was experienced in the past. For example:
    "And one of the things that you don't know that you know, is how to lose the
    ability to feel. (This is a confusional statement that creates a sense of
    wonderment.) And yet you've experienced that many times —like when you've
    fallen asleep on a hand or an arm, and awakened to find it numb, or like when
    you've gone to a dentist and had novocaine or lidocaine injected —and I'm sure
    you know what those numb, leathery sensations feel like, do you not?" (These are
    truisms that evoke memories of the desired phenomenon.)

    LAW OF CONCENTRATED ATTENTION: REPETITION OF


    SUGGESTIONS
    This refers to the principle of repetition of suggestions. When we concentrate
    attention repeatedly on a goal or idea, it tends to be realized.
    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 13

    Thus, a classic principle in formulating important hypnotic suggestions is to


    repeat them several (e.g., three or four) times. Repetition of suggestion may be
    accomplished through using somewhat synonymous words and phrases.
    However, one of Milton Erickson's (1954/1980) contributions to hypnosis was
    his model of giving both direct verbal suggestions and also using metaphoric
    examples as an indirect method of repeating suggestions. Thus, Erickson often
    told a metaphor or two to "seed" an idea. He would then make a bridging
    association, identifying the relevance of the stories to the patient's problem, and
    finally, he would offer the patient direct suggestions.

    THE PRINCIPLE OF SUCCESSIVE APPROXIMATIONS


    In formulating hypnotic and posthypnotic suggestions, it is essential to not
    expect your patients to immediately produce various hypnotic phenomena. As
    therapists we often err in the same way as our patients: we hold magical
    expectations that hypnosis will produce instant results. We, like our patients,
    often want immediate gratification. But most clients do not "leap tall buildings in
    a single bound." Be patient as you seek to facilitate hypnotic phenomenon, and
    allow the client time to develop the desired response. It may be helpful, when
    responses are slow in coming, to mentally break the desired task down in your
    mind into intermediate steps to be facilitated. When you expect positive results,
    exude confidence, and are persistent in working to produce one the hypnotic
    phenomenon, the little bit of extra time will usually be rewarded.
    Adjust your pace to your patient's rate of response. Thus you will want to avoid
    the authoritarian suggestions reminiscent of lay hypnotists and stage hypnotists:
    "You will immediately...," "In five minutes you will...," "By the time you
    awaken your pain will be completely gone." Respect the individuality of your
    patient and realize that different persons will require more time to respond to a
    suggestion. When giving suggestions for new patients, where you are not yet
    aware of their response potentials, it is, therefore, desirable to phrase the
    suggestions in more a fail-safe and permissive manner (Erickson & Rossi, 1979).
    We will discuss this further as we talk about different types of suggestions.
    We should add, however, that you can be permissive concerning time, and yet
    still convey a confidence that patient's will, in their own time, respond to the
    suggestions. Some of the following types of words are permissive concerning
    time, but still contain the implication that the patient will respond: "soon,"
    "before long," "yet," "beginning to notice," "shortly," "in its own way." For
    example: "And do you begin to notice the tingling and numbness beginning yet?"
    "Soon you'll sense a lightness starting to develop in that hand. And you can begin
    to wonder just when you'll first sense a twitch and sensation of movement in one
    of the fingers. And that hand's becoming lighter."

    THE LAW OF DOMINANT EFFECT


    This principle states that stronger emotions tend to take precedence over
    weaker ones. Thus, once again, rather than appealing to the conscious will,
    14 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    you will find it more effective to connect your suggestions to a dominant emotion.
    The famous defense attorney Clarence Darrow once described his prime
    courtroom strategy. He would seek to stir the emotions of the jury so that they
    wanted to decide the case his way, and then he would look for a technicality to
    give them to justify it. We as therapists may similarly be more influential by
    seeking to stir the emotions of patients and connect suggestions to them. It is my
    belief that this strategy is probably most effective with those patients who tend to
    emphasize their heart and emotions more than their intellect and rationality in
    decision-making. Related to this concept, you may at times seek to arouse an
    internal state of tension and anticipation in the patient that can be resolved only
    through producing the desired hypnotic response.

    THE CARROT PRINCIPLE


    As therapists we sometimes, in effect, try to push our patients from behind,
    toward a goal. But, like trying to push a mule toward our chosen destination, we
    find that some of our patients dig in their heels and resist our influence. Instead of
    pushing people from behind, we should be seeking to motivate them from in front,
    toward a goal. Therefore, as you formulate suggestions, interject comments about
    the patient's goals.
    This principle encourages us to link the patient's motivations and goals with our
    suggestions, just as the Law of Dominant Effect encourages us to tie suggestions
    to strong emotions of the patient. By way of illustration, as part of a suggestion for
    deepening, you may state: "And you will sink deeper and deeper in the trance as
    that arm floats up toward your face, because you want to live to raise your
    children, and you want to become a nonsmoker." Along the same vein, when you
    work with a patient who gives more importance in his life to logic and reasoning
    (as contrasted with emotion), provide him with logical reasons (or even
    pseudo-rationales) for accepting your suggestions.

    THE PRINCIPLE OF POSITIVE SUGGESTION


    Rather than seeking to override existing motives or attitudes, create positive
    motivation and attitudes in your patients. This can sometimes be difficult to do,
    and in actuality, there is no research evidence to validate this principle. Thus you
    will notice that occasionally a contributor to this book resorts to a negative
    suggestion. Nonetheless, based on clinical wisdom, I recommend that whenever
    possible you should seek to change negative suggestions to positive ones. When
    this cannot be done, you may wish to precede the negative suggestion with an
    easily performed or accepted positive suggestion (Weitzenhoffer, 1989).
    By way of illustration, instead of suggesting to a weight control patient, "You
    will not be hungry," (an unlikely, and even undesirable proposition), you may
    suggest: "And you'll be surprised to discover, how really comfortable you will be,
    because you'll simply become so absorbed in the things you're doing, that time
    will go by very rapidly, and suddenly, to your
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 15

    surprise, you realize that it's time for another meal." As another example, rather
    than suggesting, "You won't eat sweets or foods that are bad for you," you may
    suggest: "You will protect your body, treating it with kindness and respect, as if it
    were just like your precious, innocent little boy that you love, totally dependent
    upon your care and protection. You will protect your body, just as you protect and
    take care of your son." In talking to a child with a bedwetting problem, you talk
    about having a "dry bed" rather than about not wetting the bed.

    THE PRINCIPLE OF POSITIVE REINFORCEMENT


    Reinforce and compliment the patient both in and out of trance. "You're doing
    that very nicely." "Good. You're doing very well." "Umm hmm. That's right. And
    really enjoy the weightlessness of that hand, as it continues to float all the way up
    to your face." "You've worked very hard today, and I hope that your unconscious
    mind will take a real pride in how hypnotically talented you are, and in how much
    you've accomplished." As a further model of how you may compliment the
    hypnotized patient, note what Erickson (Erickson & Rossi, 1989) told a patient on
    two different occasions: "Also, after you awaken, I want you to have a very
    thorough appreciation of how very capably you have worked tonight." "I want
    you to know that I thank you for your generosity, your kindness, in permitting me
    to do things in my way. I appreciate it tremendously. It was very kind of you ..."
    Social psychology research certainly suggests that compliments or praise will
    generally enhance patients' rapport and liking of us, and, therefore, their
    compliance to suggestions.
    Certain suggestions may also be reinforced nonverbally. For example, in
    facilitating levitation, limb heaviness, or glove anesthesia, the hypnotherapist
    may reinforce verbal suggestions through very lightly stroking the patient's arm
    or hand two or three times: "And as I stroke that hand, you'll notice how the
    anesthesia begins to spread and flow through that hand." Similarly, you may
    "prompt" a patient who is slow in developing levitation, gently using an upward
    stroking motion under the forearm during inhalations, or lightly lifting the
    fingertips.

    CREATING AN ACCEPTANCE OR Y E S - S E T
    For many years human relations experts and sales people have known the
    importance of obtaining an initial "yes" response from someone you are trying to
    influence. A powerful orator will seek to immediately obtain affirmative
    responses from the audience to create an acceptance set mentally. As early at
    1936, Dale Carnegie emphasized this principle, referring to it as "the secret of
    Socrates." "His method? Did he tell people they were wrong? On, no, not
    Socrates. He was far too adroit for that. His whole technique, now called the
    'Socratic method,' was based upon getting a 'yes, yes' response. He asked
    questions with which his opponent would have to agree. He kept on winning one
    admission after another until he had an armful of yeses. He kept on asking
    questions until finally, almost
    16 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    without realizing it, his opponent found himself embracing a conclusion that he
    would have bitterly denied a few minutes previously" (Carnegie, 1966, p. 144).
    One particular type of hypnotic suggestion is particularly effective at eliciting a
    "yes-set": truisms. The truism, which will be discussed more fully later, is an
    undeniable statement of fact. For instance, "All of us have had the experience of
    walking along on a cold, winter day, and feeling the cold against our skin." Using
    suggestions in the form of truisms creates an acceptance set. This may be
    enhanced even further by interacting with the hypnotized patient. For example,
    continuing with the suggestion we just gave: "And I'm sure you've felt how cold
    the winter wind can be against your skin, have you not?" Most patient's will nod
    their head "yes." If an overt response was not immediately forthcoming, you could
    simply add, "You can simply gently nod your head up and down for yes, and back
    and forth for no. And you can remember how cold the winter's wind can feel
    against your face, can you not?" (Following a nod for "yes":) "And you remember
    how you can see your breath, like fog, in the cold air, don't you? (Patient nods.)
    And the longer you walk with your face or your bare hands exposed to that cold
    air, the more numb they feel, don't they? And so your mind remembers what that
    feeling of numbness is like." This type of sequence of undeniable experiences,
    where patients think or nonverbally indicate, "Yes, yes, yes, yes," makes it more
    difficult for them to not continue responding affirmatively to the suggestions that
    follow.

    INTERACTIVE TRANCE AND CONFIRMING THE


    ACCEPTABILITY OF SUGGESTIONS

    It is common for new hypnotherapists to expect that the patient should basically
    remain in a silent and passive role, while the therapist assumes full responsibility
    for single-handedly formulating suggestions and controlling the patient's
    experience. This is an error. We observe students frequently suggesting various
    types of internal (e.g., imagery, regression) experiences without any idea whether
    the patient is actually experiencing what was suggested.
    You may involve the patient as an active participant in hypnotherapy in at least
    three ways. First, prior to hypnotic work, obtain patients' input and ideas about
    their interests, preferences, suggestions and the approach that they deem most
    likely to be effective. When your style of hypnotic work is congruent with the
    patient's expectations, you may anticipate a greater likelihood of success.
    Second, you may obtain nonverbal feedback from the patient in the form of
    head nods, ideomotor finger signals, or even levitation as a signal to monitor
    progress. This type of suggestion has been called the implied directive. After
    giving posthypnotic suggestions, for example, you may suggest: "And if your
    unconscious mind is willing to accept this idea [or, "all of these ideas"], your 'yes'
    finger will float up to signal me." If a response is not forthcoming within the next
    20 seconds or so, you may add,
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 17

    "Or, if your unconscious mind isn't willing to accept all of these ideas, your 'no'
    finger can float up to signal me." In this manner you will be able to determine the
    acceptability of suggestions and whether resistance is present. Personally, I
    would rather know if there is resistance immediately so that we can work it
    through, rather than discovering it a week later.
    Neophyte hypnotists too often practice what we might call, "When I wish upon
    a star therapy"—giving hypnotic suggestions and then hoping that they will
    magically have an impact on and be accepted by the patient. It seems far more
    desirable to regularly track patient progress, the acceptability of your suggestions,
    and the success of internal therapeutic work. Thus, after giving a hypnotic or
    posthypnotic suggestion, you may ask the patient: "Would that be all right?" "Is
    that acceptable to you?" "Do you understand?" "Do you understand this clearly?"
    "And is that all right?" "Would you be willing to do that?" This was a common
    practice of Dr. Milton Erickson. Once a suggestion is accepted, it commits the
    patient to a course of change and therapeutic movement.
    The "unconscious" mind may also be consulted, as modeled two paragraphs
    above, to obtain a more involuntary commitment about the acceptability of
    suggestions. This is a regular practice in my therapeutic work. Once such
    confirmation is obtained, it is no longer necessary to be overly permissive or
    indirect in presenting suggestions to the patient. You have confirmed that
    resistance is not present, and you can, therefore, deliver the suggestions in a more
    positive, confident and forceful manner.
    Obtaining commitments in hypnosis, whether conscious or unconscious, is a
    powerful therapeutic tool for increasing the effectiveness of suggestions. The
    reason seems to be that most people experience an internal pressure and need to
    feel and look consistent. Considerable social psychological research indicates
    that when someone makes an initial commitment, he is subsequently more
    willing to accept ideas related to the prior commitment (Cialdini, 1988). In fact,
    obtaining any kind of commitment at all seems to increase the likelihood of
    accepting subsequent ideas. This is the basis for the well-known sales strategy
    referred to as the "foot-in-the-door technique." Sales people usually start with a
    small, often seemingly innocuous request, realizing that a domino effect will
    often result once the change process is under way. Once inertia has been
    overcome, further movement is much easier to obtain. This is also the basis for
    the "yes-set" that we have already discussed.
    Nonverbal responses may also be requested to determine when internal
    processes are being experienced or have been completed. Some examples will
    illustrate this process: "When you become aware of the numbness beginning to
    develop in your right hand, just gently nod your head up and down for yes." "And
    when your unconscious mind has identified a time in your past when you felt
    calm and confident, your 'yes' finger will float up to signal me." "And as you walk
    along in the mountains, the path will eventually lead you down by a creek or
    stream. And when you're walking along by that creek, just gently not your head
    up and down to signal me." Other illustrations will be given later as we discuss
    the implied directive as a type of suggestion.
    18 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    Let's model the manner in which nonverbal signaling might be used in


    exploratory or abreactive work. Suppose that we have a female patient who was a
    victim of incest as a child, and that you have had the patient regress to the age of
    four, relive the experience and abreact the feelings. Some therapists might just
    assume that feelings have been resolved at this point, and simply give some
    posthypnotic suggestions. However, following abreaction and refraining, I
    consider it a more careful and thoughtful approach to interact with the patient and
    check concerning the resolution and acceptance of suggestions: "And now that
    you've released all those old, outdated feelings, is your unconscious mind now
    willing to let go of all those old, out-of-date feelings, so that they'll no longer
    influence you?" If an ideomotor signal for "yes" is obtained, you can more
    confidently suggest: "You can now let go of all those old feelings of anger, and
    hurt, and fear, and guilt. Just let go of all those outdated feelings, and when your
    unconscious mind can sense you letting go of them, your 'yes' finger will float up
    again." (Following a positive response:) "That's right. And your unconscious
    mind can finish letting go of all those old feelings, so that you will now be free of
    the effects of that experience. It will no longer influence how you think, or act, or
    feel. And I want to ask, can your unconscious mind now sense that all men are not
    like your father?" (After a positive response:) Good. You can now understand that
    all men are not like your father. And do you realize that your husband is not like
    your father?" (Again, following a positive response:) That's right, you can now
    appreciate that all men are not like your father. And you will begin to see men as
    individuals now, perceiving them as distinct individuals. All men are not like your
    father, and your husband is not like your father. And you are free now; free to
    relate to men as individuals, and free to relate to your husband as an individual.
    And those events that we've worked through will no longer influence how you
    think or act or feel. You are free now."

    Finally, at times the patient may also be asked to verbally interact during
    hypnotic work. It is commonly believed that verbalizing "lightens" a hypnotic
    state, and, therefore, nonverbal signals often seem preferable. There are
    situations, however, when information is needed that cannot be conveniently
    conveyed through nonverbal ("yes" or "no") responses. When verbal interaction
    only occurs occasionally during hypnosis, it will not significantly alter the depth
    of trance. Furthermore, suggestions may be offered to minimize the "lightening"
    of the trance. For example, you may suggest: "You can speak in a hypnotic state,
    just as you can speak in the dreams of the night, without awakening. And
    remaining very deep in a hypnotic state, I want you to just verbally tell me, what
    are you experiencing right now?" Or, "And in a moment, I'm going to ask you to
    speak to me. And as you speak, simply the sound of your voice will take you into
    a deeper and deeper hypnotic state. So that as you speak, with every sound of your
    voice, and with every word that you speak, you'll go deeper and deeper into the
    trance."
    Sometimes interactive trance is useful during induction and deepening. You
    may simply ask the patient to occasionally describe what he is hearing
    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 19

    or seeing during an imagery experience. This allows you to tailor your input,
    rather than "operating blind." Similarly, in working to produce certain hypnotic
    phenomena, it may be useful to obtain interaction, and then accept and utilize
    whatever the patient offers you.

    THE PRINCIPLE OF TRANCE RATIFICATION

    In hypnosis it is vitally important to create a sense of positive expectancy in the


    patient. Trance ratification refers to the process of providing the patient with a
    convincer, that is, an experience or experiences that ratify for patients that they
    have been in an altered state of consciousness. It is interesting that sometimes
    even highly talented hypnotic subjects do not believe they have been hypnotized
    until they have a ratifying experience.
    Trance ratification is a basic, yet often neglected, hypnotic principle. Through
    eliciting various hypnotic phenomena, patients may come to realize that they
    have undiscovered potentials beyond their conscious capacities. This realization
    increases patients' sense of self-efficacy and confidence that they have the inner
    resources needed to change (Bandura, 1977). It is recommended, therefore, that
    you provide from time to time a trance ratification experience for your patients.
    For example, with a weight control patient, you might facilitate a glove
    anesthesia. Then, with the patient's permission, press on the hand with a sharp
    object, clamp a hemostat on the fleshy part of the hand below the little finger, or
    put a sterile needle through a fold of skin on the back of the hand. After inserting
    a needle or attaching a hemostat, ask your patient to open her eyes to briefly look
    at the hand. The suggestion may then be forcefully given: "I have had you do this
    to demonstrate to you the power of your own mind over your body. You have now
    witnessed the incredible power of your unconscious mind to control your feelings
    and your body. And you can know that, when your unconscious mind is so
    powerful that it can even control something as fundamental and basic as pain, that
    it can control anything having to do with your feelings and your body. You have
    far more potentials than you realize. And because of this power of your
    unconscious mind, your appetite and cravings will come under your control."
    Such an experience instills hope, belief and positive expectancy.
    Some of the following hypnotic experiences are recommended as having value
    for providing trance ratification:

    1. Glove anesthesia or analgesia.


    2. Time distortion.
    3. Limb catalepsy.
    4. Arm levitation.
    5. Limb heaviness.
    6. Amnesia.
    7. Ideomotor signaling.
    20 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    8. Response to posthypnotic suggestion (e.g., for an itch; to not be able to stand up).
    9. Recall of forgotten or even insignificant memories.
    10. Ideosensory phenomenon: warmth, taste, smell.
    11. Olfactory hallucination.

    EXAMPLE OF SUGGESTIONS FOR TRANCE RATIFICATION. As I have stated, the pro-


    duction of hypnotic phenomena serve to convince patients that they are in an altered state.
    In addition, successful response to such suggestions also appears to increase the patient's
    subsequent depth of trance. In the following suggestions for the treatment of warts,
    Crasilneck and Hall (1985) model for us, in a single treatment procedure, the use of a wide
    variety of trance ratification procedures: ideosensory phenomenon (heat, coolness); arm
    levitation; eyelid heaviness; response to posthypnotic suggestions for eyelid catalepsy and
    limb rigidity; glove anesthesia; and olfactory hallucination.

    Please cup your right hand on your right knee. . . . That's it. . . . Now look at the knuckles
    of your hand and as you are doing so, your entire body will begin to relax thoroughly. . . .
    Pay no attention to other sounds . . . just concentrate on your right hand and my voice,
    realizing that nothing is beyond the power of your mind . . . and of the body. As I continue
    talking to you and as you continue staring at the back of your cupped hand, you will begin
    to notice things like the heat in the palm of your hand . . . and perhaps movement in one of
    the fingers. ... As this occurs, slightly nod your head . . . yes . . . very good . . . and now you
    will notice that your hand is becoming very, very light . . . like a feather coming up toward
    your forehead . . . Good . . . Your hand starts to move upward . . . and as your hand
    continues to rise, keep looking at the back of your hand . . . but notice your eyelids are
    getting very heavy, very drowsy, and very relaxed. . . . Now when your hand touches your
    forehead . . . your eyes will be closed . . . you will be tremendously relaxed and capable of
    entering a deep level of trance. Your hand and arm comes up, up, up towards your
    forehead. . . . Now, your hand touches your forehead . . . your eyes are closed. . . . You can
    let your hand rest comfortably in your lap and normal sensation is returning to your right
    hand and arm. . . . Notice that your eyelids feel heavy ... so heavy that even though you try
    to open your eyes for the moment . . . you can't. . . . Go ahead and try . . . but you cannot. .
    . . Try again . . . but the eyelids are shut tight. . . . Normal sensations return to the eyelids. .
    . . Now you will enter a much more sound and relaxed state. . . . Now I want you to raise
    your right hand. . . . That's it. . . . Extend it in front of you, and as I count to three, your arm
    will become rigid . . . hard . . . like a board soaked in water . . . like steel . . . so tight ... so
    rigid . . . those muscles become steel. . . . One, tight . . . two . . . very rigid, and three, the
    whole arm, each finger . . . yes . . . become steel. . . . There . . . nothing can bend that arm or
    the fingers [as a further demonstration, at this point Crasilneck often has the patient use the
    other arm and feel the arm rigidity and their inability to bend it. Ed.] . . . showing you the
    power of your mind and body. . . . Now relax the arm and hand. . . . Normal sensation
    returns and still a much deeper and sounder state of relaxation.

    1 now give you the hypnotic suggestion that your right hand will develop the feeling
    that a heavy thick glove is on your right hand ... as your hand has
    FORMULATING HYPNOTIC A N D POSTHYPNOTIC S U G G E S T I O N S 21

    developed this sensation, move the forefinger of the right hand. . . . Good. . . .
    Now you will note some pressure in the forefinger . . . a dull sensation of pressure.
    . . . Open your eyes. . . . Now you see that in reality I'm sticking your finger
    severely with my nail file . . . but you are feeling nothing . . . correct? . . . Fine. . . .
    Normal sensation is returning to your hand. . . . I am now going to stimulate the
    middle finger. . . . As you feel this . . . nod your head, yes. . . . You see you pulled
    your hand back, which is an immediate and normal response. You are now aware of
    the tremendous control that your unconscious mind has over your body. . . . Now
    close your eyes again. . . . I now suggest that you can smell a pleasant odor of your
    choosing. . . . As you smell this, nod your head yes. . . .Good. . . . And now a very,
    very deep level of trance. . . . The pleasant odor leaves and still a more relaxed and
    deeper state of trance. . . . Nothing is beyond the power of the unconscious mind
    and these warts are going to leave completely and your skin will be void of them. . .
    . The area that I touch with this pencil . . . this area of warts now begins to feel very
    cool . . . cool . . . slightly cold. . . . As you f e e l this, nod your head. . . . Good. . . .
    Think the thought as I continue talking. . . . The area is cool. . . . The warts are
    going to leave. . . . The area is cool, and the warts will leave my body because of the
    power of my mind over my body. . . . Now just relax your thoughts . . . just
    pleasant, relaxed, serene thoughts. . . . Listen to me . . . my every word . . . These
    warts are going to leave. . . . We have demonstrated the control of your mind over
    your body, and these warts will be gone very shortly. . . . Your skin will feel slightly
    cool around the area of the warts for a day or so, and as the coolness fades, the warts
    will also begin to fade. And so, as I slowly count from ten to one, you will be fully
    awake . . . free from tension, tightness, stress and strain. These warts are going to
    fade out (pp. 374-375, reprinted with permission).

    TIMING OF SUGGESTIONS AND DEPTH OF TRANCE

    The timing of suggestions is something that is guided by clinical wisdom but


    which lacks research support at this time. Many leaders in the field have taught
    that you will have more impact by giving your most important suggestions last.
    Although depth of trance has been discounted as unimportant by some, many
    senior clinicians have believed that when suggestions are given in a deeper
    hypnotic state, they will have more influence. Erickson (Erickson & Rossi,
    1974/1980) certainly believed that it was important to devote sufficient time to
    adequately produce certain hypnotic phenomena and he instructed Rossi in this
    regard. "Erickson rarely gives therapeutic suggestions until the trance has
    developed for at least 20 minutes, and this only after hours of previous hypnotic
    training" (p. 89). Erickson often treated patients in time extended sessions where
    the patient might be in hypnosis for hours, and a large proportion of his famous
    case reports involved work in deep trance. In fact, his widow informed me that his
    favorite paper that he ever wrote was his chapter on deep trance (Erickson,
    1954/1980). It is my own personal belief that subjects often tend to be more
    responsive in deeper trances.
    22 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    THE PRINCIPLE OF INTERSPERSING AND EMBEDDING


    SUGGESTIONS
    Suggestions may be subtly interspersed within stories, anecdotes, or
    "deepening" techniques. Words or phrases may be included, set apart by very
    brief pauses or changes in voice tone, that convey additional meanings and
    suggestions.
    For instance, I was working with a woman for both obesity and marital
    problems. She had a noxious habit of interrupting rather than listening during
    interactions. Therefore, the following suggestions were given (and recorded on
    cassette tape for use in self-hypnosis). Notice where commas indicate very brief
    pauses. "It will be interesting for you to learn to listen, to your body. And as you
    listen, to your body, you can notice how you feel satisfied. And rather than
    interrupting, the natural balance of things, you can listen respectfully to feelings,
    and sensations of your body, noticing how soon you feel comfortably full and
    contented." Two problems were being addressed at once.
    Personally, I find it useful to brainstorm ideas and phrases that convey the
    desired suggestions, and then to consult a comprehensive thesaurus to identify
    additional synonyms. What words and phrases convey attitudes, perceptions,
    feelings or qualities that are desirable for the patient? Then I contemplate how
    these words and phrases may be interspersed within an analogy, example,
    metaphor, or deepening technique. You are encouraged to read Erickson's (1966)
    example of the interspersal technique in the chapter on pain and to consult
    Erickson's collected papers (1980) for other masterful examples of this technique.

    ERICKSON'S PRINCIPLES OF INDIVIDUALIZATION AND


    UTILIZATION

    Milton Erickson emphasized the need to individualize hypnotic procedures.


    But many lay hypnotists and even some legitimate professionals assume that
    hypnotic response is only a trait and that individualization is, therefore,
    unnecessary. Thus, they mass produce popularized self-hypnosis tapes,
    presenting everyone with the same induction and suggestions. There is limited
    evidence, however, suggesting that hypnosis may be more effective when it is
    individualized (Holroyd, 1980; Nuland & Field, 1970) and takes into account the
    unique motivations, personality, interests and preferences of the patient.
    Furthermore, there is evidence in psychotherapy outcome research that failure to
    individualize therapy not only may result in poor outcome, but may be associated
    with psychological casualties (Lieberman, Yalom & Miles, 1973). Therefore, 1
    have many of my patients take home a paper and pencil checklist of life
    experiences, interest and values (Hammond, 1985, 1988a). The checklist rapidly
    provides information to use in individualizing the induction, metaphors and
    suggestions.
    As one example of individualization, we can determine by brief questioning
    (during or after hypnosis) which sensory modalities a patient is
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 23

    primarily able to imagine (visual, auditory, kinesthetic, olfactory). We may then


    tailor the imagery that we suggest accordingly. I also recommend questioning
    your patients after an initial hypnotic experience to obtain their feedback about
    how you can make the experience even more effective.

    MYTH OF THE SUPERIORITY OF INDIRECT SUGGESTIONS. As clinicians begin to study


    hypnosis, they commonly ponder over the question, "Should 1 be direct or
    indirect in my approach?" In recent years this has become one of the most
    controversial areas in hypnosis, particularly among workshop presenters and
    non-research-oriented writers; therefore, we will examine in some detail the
    existing evidence.
    Some authors, particularly some of those identifying themselves as
    "Ericksonian," have assumed that indirect, permissive suggestions are always
    superior to direct suggestions. Some have even been so bold as to make
    statements like these: "Direct suggestion will bring only temporary relief, will
    intensify the transference relationship toward authority, and will increase
    repression of the conflict that led to the symptomatology" (Lankton & Lankton,
    1983, p. 150), and "An Ericksonian hypnotist strives to be artfully indirect in all
    suggestions and interventions" (Lankton & Lankton, 1983, p. 251). "He
    [Erickson] noticed that direct suggestions were useful only to the extent that
    clients knew what they wanted, were congruent about wanting to accomplish it,
    and had the resources necessary to change available and organized. Clients
    seeking therapy rarely meet these criteria" (Lankton, 1985). Are indirect and
    permissive suggestions always superior?
    Alman (1983) experimentally tested this assumption and to his surprise found
    that response to direct versus indirect suggestions was normally distributed
    —some patients responded better to very direct suggestions, and others were
    more responsive to permissive, indirect suggestions. Very similarly, McConkey
    (1984) found subjects were heterogeneous in their response to indirect
    suggestions —half were responsive to this type of suggestion and half were not.
    He speculated that "indirection may not be the clinically important notion as
    much as the creation of a motivational context where the overall suggestion is
    acceptable, e.g. by making the ideas congruent with other aims and hopes of the
    patient" (p. 312).
    There have been some studies and uncontrolled case reports (Alman & Carney,
    1980; Barber, 1977; Fricton & Roth, 1985; Stone & Lundy, 1985) that have
    reported superior effects for indirect suggestions, but several of these studies
    (e.g., Barber, 1977) had serious methodological flaws. The indirect condition that
    was used by Matthews, Bennett, Bean and Gallagher (1985), for example, was
    34% longer than the direct condition, which appears to have accounted for the
    greater depth reported.
    In contrast to the studies claiming greater potency for indirect suggestions,
    many other studies have failed to find a difference in effectiveness (e.g., Lynn,
    Neufeld, & Matyi, 1987; Matthews et al., 1985; Murphy, 1988; Reyher &
    Wilson, 1976; Spinhoven, Baak, Van Dyck, & Vermeulen, 1988). For instance,
    Barber's (1977) superior results with indirect suggestions have
    24 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    not been replicated with dental procedures (Gillett & Coe, 1984), with foot
    surgery (Crowley, 1980), obstetrical patients (Omer, Darnel, Silberman, Shuval,
    & Palti, 1988) or with pain in paraplegic patients (Snow, 1979). Furthermore, Van
    Gorp, Meyer and Dunbar (1985) used his procedure with experimental pain and
    found that traditional hypnotic suggestions were significantly more effective than
    indirect suggestions. Still other studies have likewise found that direct
    suggestions produce better posthypnotic response (e.g., Stone & Lundy, 1985).
    Matthews and Mosher (1988) entered their study anticipating a superior
    response with indirect suggestions, and expecting that it would decrease
    resistance as hypothesized by Erickson and Rossi (1979). Subjects not only did
    not respond differently to either indirect inductions or indirect suggestions, but
    subjects receiving indirect suggestions were actually found to become more
    resistant! Lynn et al. (1988) likewise did not find that resistance was minimized
    by using indirect suggestion. Further testing the "Ericksonian" belief that indirect
    suggestions are superior with resistant and more independent patients, Spinhoven
    et al. (1988) examined the relationship of locus of control to preference for direct
    or indirect suggestions. Locus of control did not predict response to either direct
    or indirect approaches.
    Sense of involuntariness of response to suggestions has also been discovered to
    be the same for direct and indirect suggestions (Matthews et al., 1985; Stone &
    Lundy, 1985). Furthermore, Lynn et al. (1988) actually found that sense of
    involuntariness and of subjective involvement was greater when direct
    suggestions were used. The later finding replicated the carefully controlled results
    of Lynn, Neufeld, and Matyi (1987).
    Research (Matthews, Kirsch, & Mosher, 1985) has now carefully examined the
    Bandler and Grinder (1975) and Lankton and Lankton (1983) contention that
    using two-level communication and interspersing suggestions in a confusing dual
    induction produces superior results. If anything, they found the opposite. Not only
    was a double induction not more effective than a traditional induction procedure,
    but when it was used as the initial induction experienced by a subject, it was less
    effective and appeared to have a negative impact on later hypnotic experiences.
    Even Erickson (1964) would have probably predicted this, however, since he
    designed confusional procedures for primary use with consciously motivated but
    unconsciously resistant subjects.
    So, let's return to our initial query, "Are indirect suggestions superior to direct
    hypnotic suggestions?" The weight of existing evidence clearly requires a
    response of "No." Indirect suggestions do not seem more effective than direct
    suggestions; in fact, direct suggestions may possess some advantages. Several
    studies (Alman, 1983; McConkey, 1984; Spinhoven et al., 1988) seem to indicate
    that some individuals will respond better to each type of suggestion, but most
    people fall in the middle of the distribution and may well respond equally well to
    either type of suggestion. The furor of the past decade over the belief that "indirect
    is always better" is rather reminiscent of the extensive research literature that has
    now failed to replicate the creative, but nonetheless unfounded tenets of NLP.
    As
    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 25

    mental health professionals we may stand too ready to adopt unproven theories as
    truth.
    It is thus my recommendation, in the light of current evidence, that we should
    keep our therapeutic options open and maintain the flexibility to use both direct
    and indirect suggestions. In light of the research, the debate over the preferability
    of one type of suggestion over the other may be "much ado about nothing." We
    are probably well advised to not spend so much time worrying about it. Erickson
    certainly felt free to use both highly directive and even authoritarian suggestions
    with some patients, and to use very permissive and indirect suggestions with
    others (Hammond, 1984).
    We have no validated indications or contraindications for the type of
    suggestions to use. In fact, some of the widely accepted indications for when to
    use indirect suggestions (e.g., with resistant and more independent subjects) that
    evolved from clinical beliefs may be nothing more than folklore, since they have
    not received research support thus far. Hypnosis — like so much of
    psychotherapy —is still more art than science. We must therefore remain open
    and appropriately humble about what we actually know, rather than becoming
    prematurely entrenched in untested theories that may limit our options for
    intervention and learning.
    What I am going to express now is only my tentatively held clinical belief,
    which may or may not prove to be accurate. In my own clinical work I tend to be
    more direct, straightforward, and forceful in giving hypnotic suggestions under
    the following circumstances: 1) When a good therapeutic relationship and rapport
    have been established with the patient; (2) When the patient seems motivated and
    nonresistant; (3) When the patient seems able to accept direction and authority, or
    is more dependent and used to accepting authority; (4) When the patient seems
    more highly hypnotically talented and is in a deeper hypnotic state; (5) When I am
    familiar with the hypnotic talents and capacities of the patient and am thus aware
    of the hypnotic phenomena she or he can manifest; and (6) When, upon ques-
    tioning the patient, I learn that he or she seems to prefer and respond more
    positively to a direct approach. (In other words, a "work sample" of how the
    patient responds to different styles of suggestion is probably more valid than
    drawing inferences from unsubstantiated "personality" characteristics.)

    UTILIZING PATIENT LANGUAGE PATTERNS. Another method for tailoring hypnosis


    to patients is to incorporate their idiosyncratic syntax and styles of speech into the
    suggestions you give. Listen for phrases and words that the patient tends to use.
    For instance, during the initial evaluation a patient with relationship problems
    described himself as "very intelligent," and indicated, "I have a lot of common
    sense." He also used the phrase, "Take my own destiny in my own hands."
    The phrases and concepts of this patient were incorporated into the following
    suggestions: "Now you are an intelligent person, an astute person, who can very
    level-headedly size up situations. And you can begin to realize that you have even
    further mental resources, beyond your conscious intellect. Your unconscious
    mind is very perceptive, and within you there is
    26 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    a great deal of intuitive common sense. Your unconscious mind perceives what
    needs to be done. And your unconscious mind will use these aptitudes, and will
    begin to give you spontaneous impressions about your relationships. As you
    interact with people, and as you observe other people interact, impressions,
    recognitions will spontaneously come into your mind, about what you do that's
    self-defeating in relationships. And you can trust that your unconscious mind has
    the common sense to recognize how you've been turning people off, without fully
    realizing it consciously. Your unconscious mind isn't about to let you just drift
    along, leaving your future to chance. It will bring images and impressions about
    your relationships into your mind, so that you can make intelligent decisions and
    changes. And rather than leaving your relationships to chance, you will find that
    you will begin to take your destiny into your own hands, realizing changes that
    need to be made."
    When we are able to incorporate the patient's own language into suggestions,
    the ideas may feel more compatible and congruent to the patient. We are literally
    speaking the patient's language and thus the suggestions may conform more to the
    patient's pattern of thinking and make a more profound and lasting impression.

    UTILIZATION. Another facet of individualization is Erickson's principle of


    utilization. Erickson used this term to convey the importance of utterly accepting
    whatever occurs with the patient, and then seeking to use, displace, and transform
    it. In hypnosis, this is essentially the parallel of using empathy and respect to
    establish rapport in psychotherapy.
    Thus if a patient yawns in a tired way, one may comment, "Have you ever
    noticed, how after a yawn, your whole body relaxes more deeply?" If a patient has
    some muscles jerk slightly in one leg during the process of induction, the therapist
    may say, "And you notice the little muscles jerk in your leg, which is a good sign
    that the tension is really flowing out of you, as your muscles relax." This intense
    observation and focus on the patient, in and of itself, creates rapport. But
    suggestions may then also reframe nonverbal behavior, making the attribution
    that it is evidence of hypnotic responsiveness. Patient behavior, even if it might be
    interpreted by some as problematic, is thus accepted and suggestions are
    connected to it.
    A new patient complained that, in hypnotic attempts with a previous therapist,
    he could only enter a light hypnotic state because his mind kept wandering.
    Therefore, the following suggestions were offered during the induction: "And as
    we continue, undoubtedly your mind will begin to wander to thinking about other
    things [accepting his "resistant" behavior]. And different images may run through
    your mind. And that's perfectly all right, because for the next little while, your
    conscious mind doesn't have to do anything of importance. Just allow your
    unconscious mind to wander in whatever way it wants, because the only thing that
    matters, is the activity of your unconscious mind." The patient went into a
    profound, deep trance and experienced spontaneous amnesia for almost the entire
    session.
    In individualizing hypnosis, you may also consider taking into account and
    utilizing the personality styles and needs of patients. In a highly competitive
    patient, for example, one might choose a dual levitation
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 27

    induction, while suggesting an attitude of curiosity about which hand will reach
    the face first. You are encouraged to thoroughly study the literature on utilization
    (Erickson, 1959; Erickson, 1980; Erickson & Rossi, 1979; Haley, 1973;
    Hammond, 1985).

    THE LAW OF PARSIMONY


    Finally, I wish to strongly encourage you to use the most parsimonious method
    and style of suggestion to accomplish the therapeutic task. Today, many
    hypnotists seem to be trying to make hypnosis much more complicated and
    difficult than it needs to be. This often stems from misinterpretations of
    Erickson's work (Hammond, 1984, 1988b). Esoteric, multiply embedded
    metaphors and confusional techniques are unnecessary with most patients, are
    often perceived as condescending, and usually meet the therapist's needs far more
    than the patients.

    Types of Hypnotic Suggestions


    Many of the types of suggestions we will discuss were conceptualized by
    Erickson and Rossi (1979). Some types were original with Erickson and some
    have been used for centuries. As I have indicated, there is no outcome research to
    suggest the superiority of any of these styles of suggestions. It is recommended,
    however, that you familiarize yourself with all of these types of suggestions to
    broaden your available repertoire for intervention.
    In general, almost every one of the 14 types of suggestion may be used to
    facilitate any of the hypnotic phenomena (catalepsy, levitation, amnesia,
    dissociation, anesthesia, hyperesthesia, ideosensory activities, positive or
    negative hallucinations, hypermnesia, age regression, age progression, time
    distortion, depersonalization, induced dreams). One way to refine your skills in
    using the various suggestion types is to practice writing out several suggestions of
    each type for facilitating each one of the different hypnotic phenomena.

    IMPLICATION
    Implication is a difficult to define but important method of indirect suggestion.
    Rather than directly suggesting an effect, you may merely imply or assume that it
    will take place. For instance, in deepening a trance, you may ask, "What color are
    the flowers?" This implies and assumes that the patient is capable of visualizing.
    Similarly, a patient may be told, "When you're aware of noticing some of the
    sounds of nature around you, like the wind in the trees and the birds singing, just
    nod your head." This implies that the patient will be capable of auditory
    imagination; the only question is "when" he will notice the sounds, not "if he will
    hear them.
    The hypnotherapist is well advised to be very cautious about the use of the
    words "if and "try." "If your right hand is getting light, nod your
    28 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    head," implies that the patient may fail to obtain the desired response. Instead you
    may ask, "Which one of your hands feels lighter?" This implies that one hand
    does, in fact, feel lighter. "You can begin to wonder which one of your hands your
    unconscious mind will cause to develop a lightness, and begin to float up?" This
    implies that one hand will lift. The question has been shifted from "will one lift,"
    to "which one will lift."
    Contrast the prehypnotic suggestion, "Well, let's try to hypnotize you now,"
    with the implications in the following suggestions by Erickson (Erickson & Rossi,
    1975). "Would you like to go into trance now or later?" "Would you like to go
    into a trance standing up or sitting down?" "Would you like to experience a light,
    medium or deep trance?" "Which of you in this group would like to be first in
    experiencing a trance?" "Do you want to have your eyes open or closed when you
    experience trance?" (p. 152, emphasis added, reprinted with permission). These
    are therapeutic double binds, which will be elaborated in more detail later, but
    which change the question from "if to "when" or "how." I have on occasion
    similarly asked a phobic patient, "Would you prefer that we get you over this
    problem with a rapid method that is more intense, or with a more gentle method
    that takes a little longer?" This offers the patient a double bind in that both
    alternatives are desirable and therapeutic, but it also assumes and implies that he
    will get better.
    "And the numbness will begin to spread slowly at first," implies that later it will
    eventually begin to spread more rapidly. "Don't go into a trance quite so rapidly,"
    implies that the subject is already entering trance. "We won't do anything to get
    you over your problem today [implication: we will in the future], but will simply
    give you the opportunity to experience hypnosis and see how soothing and
    calming it is" [implication: you will experience hypnosis]. Suggesting to a
    terminally ill or chronic schizophrenic patient that they send you a recipe when
    they return home implies that they will leave the hospital. "Have you ever been in
    a trance before," suggests through implication that they are about to enter a
    hypnotic state.
    Consider the implications of the following double bind suggestions of Erickson
    (Erickson & Rossi, 1975), "Do you want to get over that habit this week or next?
    That may seem too soon. Perhaps you'd like a longer period of time like three or
    four weeks." "Before today's interview is over your unconscious mind will find a
    safe and constructive way of communicating something important to your
    conscious mind. And you really don't know how or when you will tell it. Now or
    later" (p. 153, reprinted with permission).
    Another example of using implication by changing "if to "when" may be found
    in my suggestions for induced erotic dreams in the chapter on sexual dysfunction
    and relationship problems.
    Before moving on to discuss other types of suggestions, it may be instructive to
    listen to the words of Rossi (Erickson & Rossi, 1975) as he described the work of
    a master hypnotherapist:

    Erickson does not always know beforehand which double bind or suggestion will
    be effective. He usually uses a buckshot approach of giving many suggestions but in
    such an innocuous manner (via implications, casualness, etc.) that the patient does
    FORMULATING HYPNOTIC A N D POSTHYPNOTIC S UGGESTIONS 29

    not recognize them. While watching Erickson offer a series of double binds and
    suggestions, Rossi frequently had the impression of him as a sort of mental
    locksmith now gently trying this key and now that. He watches the patient intently
    and expectantly, always looking for the subtle changes of facial expression and body
    movement that provide an indication that the tumblers of the patient's mind have
    clicked; he has found a key that works much to his mutual delight with the patient.
    (P. 151)

    TRUISM
    A truism is a statement of fact that someone has experienced so often that they
    cannot deny it. These statements may be focused on motor, sensory, affective or
    cognitive processes, or on time. For example: "Most people enjoy the pleasant
    feeling of the warmth of the sun on their skin, as they walk along the beach."

    TYPES OF PHRASING. The following types of phrases are often used with a truism.
    "Most people . . .; Everyone . . .; You already know . . .; You already know how to
    . . .; Some people . . .; Most of us . . .; It is a very common experience to . . .;
    Everybody . . .; You've known all along how to . . .; There was a time when you
    didn't . . .; Sooner or later . . .; Sooner or later, everyone. . . .; In every culture . . .;
    It gives everyone a sense of pleasure to. . . ."

    NOT KNOWING AND NOT DOING


    Suggestions of this type facilitate unconscious responsiveness rather than
    conscious effort. They assist patients to not try too hard (in accord with the Law of
    Reversed Effect), encouraging autonomous responding and dissociation. Here is
    an example of this type of suggestion: "You don't have to think, or reply, or try to
    do anything at all. In fact, it isn't even necessary to listen carefully to what I'm
    saying, because your unconscious mind will just inevitably hear everything I'm
    saying, without any effort on your part at all."

    TYPES OF PHRASING. Some of the following phrases are commonly used with this
    type of suggestion: "You don't have to . . .; It isn't necessary to . . .; It isn't
    important . . .; You don't need to . . .; Without knowing it, you've . . .; You don't
    need to be concerned if . . .; Just allow it to happen . . .; Without really trying, it
    will just happen all by itself. . . ."

    COVERING ALL POSSIBILITIES OF RESPONSE


    Giving a suggestion that covers all the possible types of response that a patient
    may make is most valuable when you wish to focus patient responsiveness in a
    certain direction. This is a fail-safe approach because virtually any response is
    defined as successful and hypnotic. This is especially valuable when you don't
    know the patient well and are initially exploring his responsiveness and
    identifying his hypnotic talents. Here is an
    30 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    example of this type of suggestion: "Shortly your right hand, or perhaps it will be your left
    hand, will begin to get light and lift up, or perhaps it may develop a heaviness and press
    down, or maybe it won't even move at all, I can't really be sure. But you can simply notice
    very carefully what begins to happen [implication]. Perhaps you'll notice something in
    your little finger, or maybe it will be in your index finger that you first sense a movement or
    sensation, I really don't know. But the most important thing isn't even how it begins to
    move, but just to become fully aware of what begins to happen to that hand."

    QUESTIONS

    Suggestions in the form of questions may be used to focus attention and awareness,
    stimulate associations, facilitate responsiveness, and to induce trance. This type of
    suggestion is particularly valuable when the question is one that cannot be answered by the
    conscious mind. Questions, however, should not be used in a rigid manner, but should
    utilize ongoing patient behavior. Each question, for example, may suggest an observable
    response. Questions are, again, a fail-safe approach that you will want to use when you do
    not yet know the responsiveness and hypnotic talents of your patient, or perhaps when you
    anticipate resistance. Be careful, however, to avoid asking questions that communicate a
    lack of confidence and doubt. It is counterproductive, for example, to ask, "Is your hand
    getting numb?"
    Several examples will illustrate this type of suggestion: "And the numbness, do you
    notice that beginning?" "And will that hand remain floating right there, or does it float up
    toward your face?" "Can you enjoy relaxing and not having to remember?" "Do you begin
    to experience the numbness in the fingers, or on the back of the hand first, or does it spread
    out from your palm?"
    This type of suggestion, like the others we are discussing, may be used in producing any
    of the hypnotic phenomena, in induction or deepening, or as part of the treatment of almost
    any clinical problem. The following suggestions, reprinted with permission from Erickson
    and Rossi (1979), demonstrate the use of questions in doing an eye fixation induction and a
    levitation induction. Ordinarily we would use this type of suggestion occasionally and not
    exclusively as it is done here for illustrative purposes.

    Would you like to find a spot you can look at comfortably? As you continue looking at
    that spot for a while, do your eyelids want to blink? Will those lids begin to blink together
    or separately? Slowly or quickly? Will they close all at once or flutter all by themselves
    first? Will those eyes close more and more as you get more and more comfortable? That's
    fine. Can those eyes remain closed as your comfort deepens like when you go to sleep? Can
    that comfort continue more and more so that you'd rather not even try to open your eyes?
    Or would you rather try and find you cannot? And how soon will you forget about them
    altogether because your unconscious wants to dream? (p. 29)
    Can you feel comfortable resting your hands gently on your thighs? [As therapist
    demonstrates.] That's right, without letting them touch each other. Can you let those hands
    rest ever so lightly so that the fingertips just barely touch your thighs? That's right. As they
    rest ever so lightly, do you notice how they tend to lift up a bit
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 31

    all by themselves with each breath you take? Do they begin to lift even more lightly and
    easily by themselves as the rest of your body relaxes more and more? As that goes on, does
    one hand or the other or maybe both continue lifting even more? And does that hand stay
    up and continue lifting higher and higher, bit by bit, all by itself? Does the other hand want
    to catch up with it, or will the other hand relax in your lap? That's right. And does that hand
    continue lifting with these slight little jerking movements, or does the lifting get smoother
    and smoother as the hand continues upward toward your face? Does it move more quickly
    or slowly as it approaches your face with deepening comfort? Does it need to pause a bit
    before it finally touches your face so you'll know you are going into a trance? And it won't
    touch until your unconscious is really ready to let you go deeper, will it? And will your
    body automatically take a deeper breath when that hand touches your face as you really
    relax and experience yourself going deeper? That's right. And will you even bother to
    notice the deepening comfortable feeling when that hand slowly returns to your lap all by
    itself? And will your unconscious be in a dream by the time that hand comes to rest. (pp.
    30-31)

    As you begin to experiment with using this type of suggestion, you may find the following
    format beneficial in helping you initially generate suggestions.

    Question Format For


    Suggestions: CAN YOU (R) . . . DO
    YOU (R) . . .
    (they) AND WOULD YOU LIKE TO . .
    .
    notice
    sense
    feel
    (your) unconscious
    hear
    taste
    smell
    listen
    remember
    imagine
    see
    experience
    pay attention to
    wonder
    choose
    let your
    let yourself
    DOES _________________
    WILL (it; you) __
    ARE YOU AWARE OF . . .

    CONTINGENT SUGGESTIONS
    Contingent suggestions connect the suggestion to an ongoing or inevitable behavior.
    This is a highly useful suggestion that has been used for well
    32 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    over a hundred years. Contingent suggestions may be used with both suggestions
    given during hypnosis and with posthypnotic suggestions where a trigger or cue
    for the suggestion is identified.
    Here are some examples: "And as your hand lowers, you will find
    yourself going back to a time when _____________ " "And when you feel the
    touch of his body in bed, you will be surprised at the flood of erotic, intimate
    memories that come to mind."
    Contingent suggestions are also closely related to the concept of "chaining"
    suggestions together, in a sense, making them contingent upon each other. It is
    commonly believed that suggestions may be made more effective by connecting
    them, as the following illustration demonstrates. [To a subject with an arm
    floating cataleptically:] "And as you become aware of the numbness beginning to
    develop in that hand, it will begin to float up even lighter toward your face, and
    your mind will begin drifting back through time to the beginning of that problem,
    and as the arm floats up higher, you drift further and further back through time." It
    is popularly believed that when two or more suggestions are linked together, it is
    more difficult to reject them.

    TYPES OF PHRASING. You will find some of the following types of phrases are
    often a part of contingent suggestions: "And when . . .; As . . .; As soon as . . ."
    You will also often use the words "until" and "then" as part of
    contingent suggestions: "If__________ then__________ " In using this type
    of suggestion to trigger posthypnotic behaviors (or feelings, or thoughts), you will
    also need to identify inevitable cues or triggers. For examples: lying down in bed;
    tying a shoelace; brushing your teeth; seeing your house; hearing a song.

    Contingent suggestions may also take the following forms:


    "While you _________ you can "
    "When you _________ please__________ "
    "Don't _________ until you___________"
    "You won't __________until __________ "
    "Why don't you _________ before you __________ "
    "The closer you get to __________ the more you can___________ "
    "After _________ you can __________ "
    "As you feel _________ you recognize___________"
    "The feeling of __________will allow you to ___________ "
    "And as__________occurs, _________ may occur more than you'd expect."
    "And when you__________ ., you'll __________ "

    As soon as: your arm feels numb


    you can no longer feel your legs
    your unconscious knows __________
    you have gone back in time to . . .

    THEN, your arm will lower.


    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 33

    THE IMPLIED DIRECTIVE

    The implied directive usually has three parts (Erickson & Rossi, 1979): (1) a
    time-binding introduction; (2) an implied suggestion for an internal response that
    will take place inside the patient; and (3) a behavioral response that will signal
    when the internal response or suggestion has been accomplished. This type of
    suggestion is particularly used for tracking progress during hypnosis.

    FORMAT The implied directive often conforms to the format: "As soon as [the time
    binding introduction] your inner mind has identified the circumstances when that
    problem developed [the internal process that is desired] your 'yes' finger will float
    up" [the behavioral signal].

    PHRASING Here are some illustrations, within the format that was just
    introduced, of how this type of suggestion may be phrased. "As soon as . . . (your
    entire hand feels very numb and anesthetized; you can no longer feel
    your legs; you can see ___________; that memory has faded from your
    conscious mind; you know __________ ; your unconscious senses that your
    trance is deep enough to accomplish ___________ ) . . . then . . . (your arm
    will float down; your finger will lift; you will awaken).

    APPOSITION OF OPPOSITES

    This type of suggestion, probably originated by Erickson in the 1930s, contains


    a balancing of opposites or polarities. For example: "As that right arm becomes
    more tense and rigid, the rest of your body becomes more and more relaxed." "As
    your right arm floats up, your left floats down." "As your forehead feels cooler,
    you'll feel your hands getting warmer." In this type of suggestion, you may also
    mention or suggest a physical metaphor, and then a psychological one.

    PHRASING. In formulating this kind of suggestion, you may find it helpful to


    consider some of the following polarities or opposites: warmth — coolness;
    tension —relaxation; anesthesia — hypersensitivity; wet —dry; floating
    —heaviness; light —heavy; full —empty; more—less; difficult (hard)—easy;
    older —younger.

    NEGATIVES TO DISCHARGE RESISTANCE

    Erickson (Erickson & Rossi, 1979) believed that the use of negatives could
    serve as a "lightning rod" to discharge minor inhibitions and resistance. He had
    begun using this type of suggestion by the 1930s and he believed in its clinical
    utility, but thus far we have no experimental validation for its effectiveness.
    Nonetheless, this type of suggestion is commonly used by many clinicians. Some
    examples will illustrate this type of suggestion.
    34 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    "You will, will you not?"


    "And you can, can you not?"
    "You can't stop it, can you?"
    "You can try, can't you?"
    "You do, don't you?"
    "And why not just allow that to occur?"
    "And you really don't have to do until ."
    "And you won't until
    "You don't need to ."
    " are you not?"
    " doesn't it?
    " don't you?"

    THE BIND OF COMPARABLE ALTERNATIVES


    This is a bind that appears to give a patient a free choice between two or more
    alternatives. However, both of the choices are essentially comparable and they
    will both lead the patient in the desired therapeutic direction. The choices offered
    in this type of suggestion may sound different, but are virtually the same, simply
    giving illusion of choice.
    Here are several examples of a bind of comparable alternatives. The first three
    examples actually model prehypnotic suggestions. I have identified the hypnotic
    phenomena that some of the suggestions seek to elicit. "Would you rather go into
    trance sitting up or lying back in the recline?" "Would you prefer to go into a
    trance gradually or more rapidly?" "Would you rather go into a light trance, a
    medium trance, or a deep trance?" Levitation: "And perhaps your left arm, or
    maybe it will be your right arm that will float up toward your face." Age
    Regression: "And you may remember a happy experience that happened when
    you were five years old, or perhaps you'd rather recall one from slightly later."
    Analgesia or Anesthesia: "You may choose to feel the pressure, or nothing at all."
    Negative Hallucination: "You can just be aware of the sound of my voice, or you
    can simply ignore everything else." Time Distortion: "Time may seem to pass
    quickly, or you may simply be unaware of its passing." Anesthesia: "Do you begin
    to experience the numbness more in the right hand, or in the left hand?"

    CONSCIOUS-UNCONSCIOUS DOUBLE BIND


    This type of suggestion seeks to utilize the patient's unconscious mind (or,
    depending upon one's theoretical frame of reference, uses the metaphor of the
    unconscious mind), bypassing conscious, learned limitations. Responses to this
    type of suggestion require patients to focus inwardly and initiate unconscious
    processes that are beyond their conscious control. In a double bind, behavioral
    possibilities outside the patient's usual range of conscious alternatives and
    voluntary responses are offered.
    Here are several examples: "And if your unconscious mind is ready for you to
    enter trance, your right hand will begin to get light and float up. If
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 35

    your unconscious mind is reluctant for you to enter trance, your left hand will lift
    up." "And the unconscious mind can continue working on that problem and
    preparing you for our next session after you leave. And the really interesting,
    really curious thing, is that your conscious mind may or may not really be aware
    or even understand what's going on, depending on the preference of your
    unconscious mind. And as your unconscious mind is preparing you, and doing its
    work, your conscious will remain free to carry on all the many other things that
    you need to attend to each day."

    CONFUSIONAL SUGGESTIONS

    It is popularly believed that confusion will "depotentiate conscious mental sets"


    (Erickson & Rossi, 1979), allowing unconscious processes to occur more readily.
    Erickson (1964) believed that this type of suggestion was particularly indicated
    when a patient was consciously motivated but seemed unconsciously resistant to
    experiencing hypnosis. We will briefly introduce suggestions of this type.

    SHOCK AND SURPRISE Shock and surprise may be used to facilitate creative
    moments, stimulating the patient's unconscious mind to conduct an inner search
    and capturing the patient's attention. This may be done through interspersing
    certain shocking or surprising words and/or through the use of strategically
    placed pauses. For instance, after leaving a patient's hand floating cataleptic, the
    facilitator may suggest: "And what that hand is going to do next will surprise
    you," while then waiting expectantly. This method may be used for a surprise
    reinduction of hypnosis in a patient recently realerted: "Are you awake? Are you
    sure? And what do you begin to notice about your eyes ... as they begin to flutter .
    . . and get heavier . . . and close, all by themselves." Another suggestion with a
    shock element would be to say, "It would be a disaster, if you didn't change
    directions, and arrived at where you are going."

    DOUBLE DISSOCIATION DOUBLE BIND This type of suggestion may include various
    other types of suggestions, and creates overload and confusion, depotentiating
    conscious sets. Careful observation and noting of patient responses to the
    alternatives may alert you to the hypnotic talents and tendencies of the patient.
    This type of suggestion may take some of the following formats: "(In a
    moment) you can __________ but (you don't need to; even though; when;
    without knowing) __________, or, you can______ (do the opposite)_____ , but
    (or any of the other phrases above) ____________ "
    Here are a few illustrative examples. "In a moment you can awaken as a person,
    but it isn't necessary for your body to awaken. Or, you can awaken along with
    your body, but without being aware of your body." "In a moment you will open
    your eyes, but you don't need to wake up; or you can come fully awake when you
    open your eyes, but without an awareness of what transpired while they were
    closed." "You may choose not to remem-
    36 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    ber, or you may choose just to forget, but choosing to forget is your choice in the
    same way as choosing not to remember that which you've chosen to forget." "As
    you remember to forget what it was that you were going to remember, you can
    just as easily forget what you were going to remember to forget."

    PHRASING FOR A DOUBLE DISSOCIATIVE CONSCIOUS-UNCONSCIOUS DOUBLE BIND


    This
    type of confusional suggestion may take the following format: "Your
    conscious mind _________ , while (or, and, since, as, because, at the same
    time) your unconscious mind ____________ , or perhaps your unconscious
    mind ________ , while your conscious mind _____________" Explained an
    other way, the format may take either of two forms: (1) Conscious
    ________ , unconscious __________, while (or, since) conscious __________ ,
    unconscious___________ (2) Unconscious _________ , conscious _________ ,
    while unconscious __________ , conscious__________
    Here are some examples: "Your conscious mind may think about solutions,
    while your unconscious mind considers their implications, or perhaps your
    unconscious mind will generate some solutions, while your conscious mind
    wonders what the results may be." "Your conscious mind may remember the
    details of those events, while your unconscious mind perceives the feelings, or
    your unconscious mind may recall what happened, while your conscious mind is
    only aware of strong feelings and not the reason for them." "Your conscious mind
    may be aware of the time available to complete the test, while your unconscious
    mind seems to have all the time it needs, or, your conscious mind may enjoy a
    relaxed pace without concern for time, while your unconscious monitors the time
    you have left and the speed of your work." "And when you open your eyes you
    can consciously see your mother sitting in front of you while your unconscious
    mind is aware of your feelings toward her, or perhaps your unconscious mind will
    hold the image of her while your conscious mind is encompassed in the feelings
    you have about her."
    Do not be concerned if confusional suggestions initially seem overwhelming
    and too complex to master. They are by definition confusing, and are probably the
    least important type of suggestions to become skillful in using.

    INTERSPERSAL OF SUGGESTIONS AND METAPHORS


    This refers to bringing up topics and using words or phrases that "seed" ideas,
    focus attention, and indirectly influence the patient. Metaphors or anecdotes may
    serve to illustrate a point or tag a memory, to indirectly suggest or model
    solutions, to foster self-reflection and insight, to increase positive expectancy or
    motivation, to bypass resistance, to reframe or redefine a problem, and to
    intersperse suggestions while bypassing defenses (Zeig, 1980). Metaphors may
    be used, just like hypnotic suggestions in general, to facilitate behavioral,
    affective or cognitive-perceptual changes.
    By way of illustration, you may describe to a patient the process, following an
    injury, of a scab forming for protection, while natural and
    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 37

    internal healing processes take place. A scar may remain later, perhaps as a small
    reminder of a hurt, long ago, but which doesn't have to remain painful. This
    metaphor may be used to communicate ideas to a patient who has experienced
    trauma, incest, rape, or divorce.
    Metaphors are another way of conveying suggestions, and they may be of
    particular value as a method of accomplishing repetition of suggestion without
    using identical words or phrases. When metaphors are delivered prior to giving
    more straightforward suggestions, this process has been popularly referred to as
    "seeding" an idea.
    We may think about three basic styles of metaphors. Some hypnotherapists tell
    metaphoric stories out of their background of experience — for example,
    concerning previous patients or personal experiences. Another type of metaphor
    is the truism metaphor. These metaphors are commonly about nature or types of
    life experiences that are so universal that the patient cannot deny them. They thus
    establish a yes- or acceptance-set in the patient. Several of these types of
    metaphors that I use may be found in the sections of this book on sexual
    dysfunction and trauma.
    Finally, some therapists (e.g., Lankton & Lankton, 1983; Gordon, 1978) make
    up metaphoric stories to fit a patient situation, often seeking to create characters
    and components that are parallel to aspects of the patient's circumstance.
    My personal preference is clearly to utilize the first two types of metaphors, but
    no research exists to indicate that one is more effective than another. Making up
    stories seems to me, however, the opposite of therapist genuineness or
    authenticity —qualities which are consistently found to be important
    "nonspecific" factors in successful therapy and relationships (Hammond,
    Hepworth, & Smith, 1977; Truax & Carkhuff, 1967). Making up tales of the
    "once upon a time" variety may also seem condescending and, therefore,
    offensive to some patients. The use, and particularly the overuse, of such stories
    may thus run the risk of impairing the therapeutic alliance with the patient.
    Erickson, who usually serves as the model for those who emphasize a
    metaphoric orientation to hypnosis, seems to have almost always used the first
    two types of metaphors. Furthermore, close colleagues who actually observed his
    therapy, as well as patients, have emphasized that metaphors were only
    occasionally used by him (Hammond, 1984). In fact, metaphors were estimated
    to represent no more than 20% of Erickson's hypnotic work (Hammond, 1988b).
    Metaphors have their place in our therapeutic armamentarium, but we must keep
    a balanced perspective and realize that therapy is more than storytelling.
    A metaphoric story may be introduced by simply saying, "And let me give you
    an example," or "You may remember," or "Can you remember a time when . . .?"
    Also, and importantly, metaphors do not always have to be long and involved to
    make an important point. Consider, for example, this brief metaphor by Barker
    (1985): "Fleming's discovery of penicillin was serendipitous. He was working in
    his laboratory with some disease-causing bacteria. These were growing on a
    culture plate which became contaminated by a mold. Some investigators would
    probably have thrown the contami-
    38 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    nated plate out, but Fleming took a look at it and noticed that the bacteria were
    dying where the mold was growing. This proved to be due to a substance
    produced by the mold, later named penicillin. So things should not always be
    taken at their face value" (p. 105, reprinted with permission). This metaphor
    makes a point, albeit briefly.
    You will have an opportunity to review a variety of metaphoric styles in the
    chapters that follow and to determine the extent of your comfort with them. If you
    are particularly interested in refining this type of suggestion, you may wish to
    consult authors who have emphasized metaphors (Barker, 1985; Lankton &
    Lankton, 1989; Mills & Crowley, 1986; Witztum, Van der Hart, & Friedman,
    1988; Zeig, 1980). You should also consult the section on Erickson's Interspersal
    Technique in the chapter on pain.

    SYMBOLIC AND METAPHORIC IMAGERY


    The term suggestions usually refers to verbal statements. The effects of
    imagery seem so powerfully in hypnosis, however, that it is my belief that we
    should acknowledge suggestions for imagery as a category of suggestion. The
    Law of Reversed Effect is a principle that encourages the use of imagery,
    particularly to bring about physiologic effects. For instance, having patients
    imagine what their pain looks like and then modify the imagery may produce
    analgesic relief. Imagining an agitated acid stomach and then modifying the
    imagery to images (and sounds, sensations and smells) of cool comfort often
    reduces gastric secretions. Imagery modification is a powerful hypnotic
    technique. Symbolic imagery may also be used to treat emotional problems, as
    you will see illustrated in the Silent Abreaction technique and others later in the
    book.
    Finally, metaphoric imagery should also be noted. A patient's situation or
    idiosyncratic speech often suggests metaphoric imagery experiences. For
    instance, a patient may say, "I feel like I'm in a cave," or "I'm blocked and I don't
    know how to get past it," or "I'm trapped." Suggesting that the patient imagine
    himself in such a circumstance may be a valuable therapeutic method of evoking
    deeper emotions, clarifying situations, and facilitating the working through of
    conflicts.

    The Phrasing of Suggestions


    Hypnosis is essentially a refined way of communicating with a patient who is in
    a state of concentration. Becoming proficient with hypnosis requires that you
    master a new way of speaking and communicating, a hypnotic "patter." For this
    reason, as you study and watch hypnosis demonstrations, you are encouraged to
    write down phrases and suggestions that appeal to you. You will find it valuable to
    tape record workshops and demonstrations and subsequently study the language
    and phrasing of suggestions.
    Some writers and teachers have emphasized the concept of going into a trance
    oneself, and simply "trusting the unconscious" to formulate sugges-
    FORMULATINGHYPNOTIC ANDPOSTHYPNOTICSUGGESTIONS 39

    tions and conduct hypnotherapy. This admonition stems from Erickson's


    discussing a particularly fascinating case where he did precisely this. However,
    before we can trust that something brilliant will flow out of our unconscious
    mind, we have to put something into it!
    After 40 years of experience in compulsively writing, rewriting and carefully
    preparing suggestions (Hammond, 1984, 1988b), Erickson could certainly trust
    his unconscious mind to spontaneously contribute suggestions and ideas for
    intervention. This is the case with all experienced clinicians. Rollo May (1958)
    once said: "The therapist's situation is like that of the artist who has spent many
    years of disciplined study learning technique; but he knows that if specific
    thoughts of technique preoccupy him when he actually is in the process of
    painting, he has at that moment lost his vision ..." (p. 85, emphasis added).
    After thorough, careful study of the technique of hypnosis and of formulating
    suggestions, you will increasingly find that you can trust yourself to innovate
    spontaneously. In fact, as you progress you will undoubtedly be delighted with
    some of the creative and valuable suggestions that flow into your mind. However,
    the concept of "trusting the unconscious" should not be used to justify sloppy
    clinical work and a lack of thoughtful preparation or treatment planning.
    1 want to encourage you to invest considerable time in writing out suggestions
    and metaphors. Take concepts and ideas in this book that appeal to you and
    rewrite them and make them your own. Carefully consider where to put pauses
    and painstakingly examine the implications of your suggestions. Tape record
    your hypnotic work and listen afterwards to what you are actually saying and
    implying.
    This kind of thorough study and preparation is crucial to becoming skilled at
    the art of hypnosis. It is my experience that many of the most highly polished
    hypnotherapists who seem to be "silver tongued" simply have the appearance of
    spontaneity. In most cases they have actually spent many long hours carefully
    formulating the suggestions and metaphors they use, and have then, in many
    cases, committed them to memory. This was certainly the case with Erickson,
    who for many years compulsively wrote and rewrote suggestions and metaphors
    to use with patients.

    RHYTHM AND PAUSES Most experienced practitioners speak with a rhythm and
    cadence when they do hypnosis, essentially speaking in phrases. This seems to
    encourage hypnotic response. A common error among new students is that they
    will tend to speak continuously, in a lecturing or conversational manner, without
    pauses.
    It not only seems beneficial to speak in a rhythmic manner, but during the
    process of induction it is helpful to gradually slow down the rate at which you are
    speaking. Thus you will speak slower and in a more relaxed manner as the
    induction proceeds. There is an exception, however. Occasionally you may be
    working with an obsessional or resistant patient who is overanalytical of
    everything you say. With this type of patient it may be helpful, at least with
    important suggestions, to speak more rapidly so that they have less time to pick
    apart or resist suggestions.
    40 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    EXAMPLES OF INTRODUCTORY HYPNOTIC PHRASING

    In an effort to speed up your learning process, I will provide you with a list of
    many types of introductory phrases that are often used by hypnotherapists,
    particularly those with a more "Ericksonian" orientation. Repeated study of these
    phrases and the types of suggestions identified above will undoubtedly assist you
    to become smoother in your delivery of inductions and suggestions. It may be
    helpful to tape record these phrases and listen to them repeatedly. This will assist
    you in internalizing this new way of speaking.

    And you can wonder . . .


    Can you notice . . .?
    And you can be pleased . . .
    And you begin to wonder when . . .
    With your permission . . .
    Now I'd like you to have a new experience.
    . . . In a way that meets your needs.
    I want you to enjoy this experience.
    And you will be surprised at . . .
    Now of course I don't know for sure what you're experiencing. But perhaps
    you're . . . It's going to be a pleasure to .
    . . And I'd like to have you discover . . .
    Perhaps even taking a special kind of enjoyment (in your ability to) . . . And
    sooner or later, I don't know just when . . . And I wonder if it will surprise you
    when . . . I wonder if you'll be curious, as you notice . . . You already know how to
    . . . Perhaps you wouldn't mind noticing . . . I would like you to discover
    something . . . One of the things I'd like you to discover is . . . And I want you to
    notice something that's happening to you. At first . . ., but later . . . Have you
    begun to notice that yet?
    And I think you're going to enjoy being surprised that . . .
    And I want you to notice something that's happening to you.
    I wonder if you'll enjoy how naturally, how easily . . .
    I wonder if you'd like to enjoy . . .
    I wonder if you'll be surprised to discover that . . .
    And I wonder if you'll be curious about the fact that you . . .
    Perhaps noticing . . .
    Perhaps beginning to notice . . .
    And maybe you'll enjoy noticing . . .
    I wonder if you've ever noticed . . .
    Maybe it will surprise you to notice that . . .
    I'd like you to let yourself become more and more aware of . . .
    FORMULATING HYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 41

    I'd like you to begin allowing . . .


    And your unconscious mind can enable you to . . .
    1 wonder if you'll decide to . . . or . . .
    In all probability . . .
    Very likely . . .
    And would you be willing to experience . . .?
    You don't need to be concerned if . . .
    It's so nice to know . . .
    And do you notice the beginning of . . .?
    It may be that you'll enjoy . . .
    At times like this, some people enjoy . . .
    One of the first things you can become aware of is . . .
    And it appears that already . . .
    Give yourself the opportunity (to see if). . . .
    Perhaps sooner than you expect . . .
    And if you wish . . .
    And you can wonder what . . .
    And, in an interesting way, you'll discover . . .
    And its very rewarding to know that . . .
    And, Chris, you know better than anyone that . . .
    It's very positive and comforting to know . . .
    You'll be fascinated and feel a strong compulsion to . . .
    And that will probably remind you of other experiences, and other feelings
    you've had. I would like you to appreciate the fact
    that . . . I wonder if you'll be reminded . . . I wonder if
    you'll be pleased to notice . . . . . . by just noticing. I
    wonder if you've ever noticed . . .
    And while you wonder that, I want you to discover that . . .
    I'd like you to begin allowing . . .
    What's important, is the ability of your mind to . . .
    I want to remind you of something that you probably already know, which
    is . . . And as that occurs, you really can't help but notice . . .
    So that it's almost as if . . . Almost as if . . . Almost as though . . .
    Kind of like . . . And that's just fine . . . And that's all right . . .
    That's okay.
    All that really matters . . .
    All that's really important . , .
    I don't know if you're aware of these changes, and it doesn't really matter.
    I wonder if you'll be interested, in learning how, to . . .
    It may be that you're already aware of . . .
    The really important thing is just to be fully aware of . . .
    42 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    The Process of Suggestions in Facilitating


    Phenomena

    I have adapted and modified (Brown & Fromm, 1986) eight steps that may be
    useful in conceptualizing how to structure a series of hypnotic suggestions that are
    designed to produce one of the hypnotic phenomenon.

    1. Focusing Attention. It is recommended that a sequence of suggestions


    begin with something that captures or focuses the patient's attention.
    This may be done indirectly by simply speaking in a manner that
    compels or captures attention. For example, "Something is beginning to
    happen to one of your hands, but you don't know what it is yet." Such
    a suggestion creates a sense of wonderment, depotentiating conscious
    mental sets and focusing attention through evoking curiosity. After all,
    how often does anyone say something like that to most people?
    Attention may also be focused through a more direct suggestion. For
    example, in the case of formulating suggestions to facilitate arm levitation,
    one may say: "Concentrate on the sensations in your hands." Another
    illustration of a straightforward directive to focus attention prior to giving
    more important suggestions is to say, "I want the deepest part of your
    unconscious mind to listen very carefully. And when the deepest part of your
    mind is fully listening, your 'yes' finger can float up to signal me." Erickson
    often said, very simply, "Now I want you to listen very carefully."
    2. Enhancing Awareness of Immediate Experience. Particularly when seeking to
    facilitate an immediate action or sensory hypnotic phenomenon (e.g.,
    ideomotor or ideosensory activity, anesthesia), it can be valuable to increase
    the patient's awareness of his or her current experience. As a next step in arm
    levitation, for example, one may continue: "And you can simply tell me,
    which hand feels lighter?" or, "And notice the texture of your slacks, and the
    sensations that you notice in your fingers." This step, popularly referred to as
    "pacing," does not suggest an activity or experience, but simply points out or
    seeks to increase current awareness.
    3. Noting and Accepting Any New Aspect of the Experience or Leading the
    Subject. Next, a suggestion is given to create an expectation and anticipation
    of a new experience. The therapist will now have an opportunity to note the
    patient's response to suggestion. Several suggestions will illustrate this step:
    "And one of your hands will begin to feel lighter than the other." "And a
    lightness will begin to develop in one of your hands, [pause] And you'll begin
    to notice a tendency to movement in one hand. And then a finger will begin to
    twitch or move, [pause] and then to float up." "You will begin to notice a
    numbness and anesthesia beginning to develop in your right hand. And when
    you notice the anesthesia beginning, just nod your head to let me know. [If no
    response is forthcoming, after 20 seconds, further suggestions may be given:]
    And I don't know if you'll begin to notice the numbness in your fingers,
    FORMULATINGHYPNOTIC AND POSTHYPNOTIC SUGGESTIONS 43

    or your palm or on the back of the hand first. But when you notice the
    numbness beginning, just nod your head. [If necessary, after another 30
    second pause, you may ask:] Do you notice the numbness yet?"
    4. Introducing the Immediate (Process) Goal of the Suggestion. The behavioral
    response or desired goal for the near future is next noted to the patient. "And as
    that lightness increases, soon that entire hand and arm will begin to float up,
    off your lap" [the immediate goal]. "And notice how that numbness begins to
    flow and spread through that entire hand ["that" is dissociative language, in
    contrast to saying "your hand."]. Before long that entire hand will become very
    numb, and leathery, and anesthetic. And when that entire hand feels very
    numb and anesthetized, just nod your head to let me know."
    5. Repetition of Suggestion and Reinforcing Partial Responses. It is often
    important to be patient in seeking to obtain a hypnotic response. Use repetition
    of suggestion focusing on the intermediate responses that are needed to
    produce the full response you desire. "And that hand is getting lighter and
    lighter [said during inhalations], lifting, lifting, that's right [reinforcing a small
    twitching movement]. And that index finger twitches and lifts [further
    reinforcing the partial response to suggestion], and the other fingers will
    develop a lightness also, almost as if large helium balloons were being
    attached to each fingertip and the wrist with strings." Naturally, more
    significant responses to suggestion are also deserving of reinforcement.
    "That's right, and up it comes. And you can really enjoy the way it's
    effortlessly floating up."
    6. Encouraging Dissociation and Involuntary Response. As the suggestive
    sequence continues, as modeled under step 4, it is important to shift to using
    dissociative language that will encourage a feeling of automatism and of
    responding involuntarily. For example: "And the hand is lifting; it's floating
    up, lighter and lighter. And just allow that hand to continue floating up all by
    itself at its own pace and speed." The following suggestions illustrate this
    process in producing glove anesthesia: "Notice, with a sense of curiosity, how
    that numbness and anesthesia begin to flow and spread, all through that hand.
    Spreading and flowing in its own way, without really trying, just allowing
    it to happen."
    7. Building Anticipation and Expectation. Occasionally in the process of giving
    suggestions to facilitate a phenomenon, it is helpful to create expectancy and
    build a sense of anticipation of a response that will soon occur. For instance:
    "And soon you'll become aware of the tendency to movement, and first one
    finger, and then another, will begin to develop a lightness. And before long
    you'll sense a finger twitch or move, and then it will begin to lift." "And
    something's beginning to happen to one of your hands, and soon you'll become
    aware of what it is."
    8. Accepting the Patient's Pace of Response. Adjust to the patient's rate of
    response, whether it is rapid or slow. Begin by "pacing" the behavioral
    response, adjusting, accepting and commenting on it. Then, suggestions may
    be introduced to accelerate or slow down ("lead") the speed of response.
    When a levitation is beginning to occur very slowly, for example, be patient
    and continue to focus on and reinforce small,
    44 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    minimal movements. Later, leading suggestions may be given. For instance,


    "And now it's as if some other force begins to push or pull that arm up. As if
    there's a large helium balloon under the palm, or attached with strings to each
    fingertip and to the wrist, and that hand and arm will begin to float up more
    rapidly, lighter and lighter [as the therapist very lightly strokes up the
    underside of the forearm, or very gently lifts the fingertips while the patient is
    inhaling.]."

    HANDLING FAILURE TO RESPOND TO SUGGESTIONS


    What do you do when there is no response to a suggestion? One option is to be
    accepting (e.g., saying "That's all right.") and then simply move on to something
    else, possibly with the suggestion that they will respond more fully next time. But
    perhaps the best strategy that I have discovered is to interact with the patient in
    trance. You may ask, "Remaining deep in trance, just tell me verbally, what are
    you experiencing?" You may discover that your suggestion was not clear to the
    patient or that he misinterpreted the suggestion. On the other hand, you may
    discover that some type of response has occurred that may then be accepted and
    utilized for therapeutic gain. For instance, after failing to obtain an ideomotor
    signal in response to suggestions, the inquiry may reveal that the patient feels a
    sensation in one finger, but that "it doesn't seem to want to float up." This may be
    accepted and utilized in the following manner: "That's just fine. Many people
    experience sensations instead of feeling a finger move. So whenever your
    unconscious mind creates a distinct sensation in that finger, it can represent a
    signal of 'yes,' you can then voluntarily lift it up to let me know." Be open to
    patient feedback when you make inquiries. You may learn something you need to
    modify, change or suggest to facilitate a successful response. Also, remember to
    be patient and reinforcing of partial responses.
    It is also vitally important to accept that many patients seem to be natively
    talented at experiencing certain phenomenon, and may have difficulty
    experiencing others. It may be interpreted in this way to the patient, as a normal
    phenomenon, and this reduces perceptions of failure.
    HYPNOSIS IN PAIN
    MANAGEMENT
    INTRODUCTION

    Evaluation and Assessment of Pain

    THICAL PRACTICE requires that we have the technical knowledge to


    adequately evaluate patient needs. This means that the nonphysician treating pain
    patients must become familiar with medical evaluation and treatment
    alternatives. Pain patients should be required to obtain a physical examination
    and appropriate diagnostic studies prior to psychological intervention.
    Similarly, it is vital for physicians and dentists to learn to evaluate more than
    the biophysical aspects of pain. Particularly with chronic pain patients,
    multidimensional assessment is required (Hammond & Stanfield, 1977), taking
    into account the physical-sensory, behavioral, affective,
    interpersonal-environmental, and cognitive (and adaptive function) components
    of the pain experience.
    Interview evaluation may include: a description of the pain; history of the pain
    and whether it is acute or chronic; prior treatments, surgeries and medications and
    their effects; the impact of the pain problem on relationships, vocation, leisure
    activities, sexual activity, etc.; level of premorbid functioning; potential benefits
    of the pain ("If I could magically take away your pain today, how would your life
    be different? What would you be able to do that you can't do now?"); antecedents
    (environmental, temporal, emotional, cognitive) associated with exacerbation
    and improvement of pain; and level of depression.
    We must remain aware that lifestyle variables such as bruxism, postural habits
    (e.g., from lengthy telephone use and video games), and environmental
    chemicals (Hall, 1980) may all contribute to pain problems. Last year a
    53-year-old female patient consulted me with a 40-year history of severe, daily
    migraines. She had undergone almost every kind of medical

    45
    46 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    and dental evaluation. But during the first interview it became apparent that her
    migraine headaches were usually present upon awakening in the mornings.
    Although she had no evidence of tooth abrasion from grinding, I asked her to
    consciously relax her jaw before retiring during the next week. The next week she
    had four migraines instead of seven. She was then taught self-hypnosis with
    suggestions for bruxism. The following week she only experienced one mild
    headache and she reported that it was the most comfortable week in 40 years! Her
    relief has continued. Despite the many intensive medical and dental evaluations,
    this behavioral factor that is responsive to hypnotic intervention had been
    overlooked.
    Other cases may be cited, however, in which medical causes for pain were
    discovered that required medical treatment, not hypnosis. For instance, a large
    proportion of the women referred to me for the psychological treatment of
    dyspareunia (pain with intercourse) are said by their gynecologists to have no
    organic pathology. Experience has taught, however, that most gynecologists (who
    usually happen to be men) have not learned to do a detailed enough pelvic
    examination to identify organic causes of dyspareunia (Abarbanel, 1978; Kaplan,
    1983). In my practice, when we have a specially trained gynecologist evaluate
    these patients, we find organic causes for dyspareunia in 70%-80% of the cases.
    The message is that we must not neglect thorough medical or psychological
    (behavioral, cognitive, environmental, affective) evaluation with pain patients.
    Pain is a complex disorder.

    OBTAINING A SENSORY DESCRIPTION OF THE PAIN

    Hypnotherapy with pain is facilitated by a detailed description of the following


    sensory aspects of the pain: (1) thermal sensations (e.g., degree of heat versus
    cold); (2) kinesthetic sensations and pressure aspects of the pain (e.g., dull, sharp,
    binding, itching, heavy, twisting, drilling, penetrating, stabbing, pounding); and
    (3) imagery of the pain (size, shape, color, texture, sound). One method for doing
    this is to obtain a detailed verbal description of the sensory components of the
    pain. This may be done in an interview in a manner that establishes rapport with
    the patient and leaves him or her feeling empathically understood. For example, I
    typically ask the patient to tell me which of the following adjectives describes an
    aspect of their pain:

    Aching, beating, binding, biting, burning, caustic, cool, corroding, cramping,


    crushing, cutting, drilling, dull, flashing, flickering, gnawing, grinding, gripping,
    heavy, hot, itching, lacerating, nagging, nauseating, numb, penetrating, piercing,
    pinching, pounding, pulsing, rasping, searing, sharp, shooting, smarting, spasming,
    splitting, squeezing, stabbing, stinging, tearing, throbbing, tingling, twisting.

    A detailed sensory description of the pain not only establishes rapport but also,
    more importantly, provides you with clues that may be valuable if techniques are
    used for replacement or substitution of sensations or for hypnotic reinterpretation
    of the pain experience. In addition, many of the pain descriptors listed above
    suggest imagery to both patient and therapist that may subsequently be used with
    the technique of imagery modification.
    HYPNOSIS IN PAIN MANAGEMENT 47

    The qualitative aspects of pain may also be assessed through paper and pencil
    instruments such as the McGill Pain Questionnaire (Melzack, 1975) and the Low
    Back Pain Questionnaire (Leavitt, Garron, Whisler, & Sheinkop, 1978). It may
    likewise be enlightening to have patients draw their pain or at least to imagine in
    hypnosis what their pain looks like. Drawings may usefully assess the location of
    pain and will naturally also suggest images for later modification during hypnosis.
    Drawings to determine location of pain may particularly be facilitated by giving
    the patient a page with a line drawing of the front and back of the body, with
    instructions to identify or shade areas where pain is experienced.

    OUTLINE OF HYPNOTIC STRATEGIES AND TECHNIQUES FOR


    MANAGING PAIN
    In this chapter you will find a large number of hypnotic techniques discussed
    and modeled for you. You may find the following conceptualization of major
    hypnotic pain control strategies and the techniques that fall under these strategies
    to be useful in understanding these methods.

    I. Unconscious Exploration to Enhance Insight or Resolve Conflict


    A. Ideomotor Signaling
    B. The Inner Adviser Technique
    C. Guided Imagery
    D. Hypnoprojective Techniques
    II. Creating Anesthesia or Analgesia
    A. Direct or Indirect Suggestion
    B. Imagery and Imagery Modification
    C. Ideomotor Turn-off of Pain
    D. Gradual Diminution of Pain
    E. Interspersal Technique and Use of Metaphors
    F. The Clenched Fist Technique
    G. Increasing and Decreasing Pain
    III. Cognitive-Perceptual Alteration of Pain
    A. Body Dissociation
    B. Symptom Substitution
    C. Displacement of Pain
    D. Replacement or Substitution of Sensations
    E. Reinterpretation of Sensations
    F. Unconscious Exploration of Function or Meaning of Pain
    G. Amnesia
    H. Time Distortion
    I. Massive Time Dissociation
    J. Increasing Pain Tolerance
    1. Posthypnotic Suggestions for Internal Dialogue
    2. Mental Rehearsal of Coping with Triggers and Pain
    3. Desensitization to Triggers that Exacerbate Pain
    K. The Inner Adviser Technique (to explore meaning and triggers of pain)
    48 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    IV. Decreasing Awareness of Pain (Distraction Techniques)


    A. Time Dissociation
    B. Imagining Pleasant Scenes and Fantasies
    C. Absorption in Thoughts
    D. External Distraction Through Enhanced Awareness of the Environ
    ment
    E. Eliciting Mystical Experiences

    STRATEGY AND TECHNIQUE SELECTION How does one select which one of the
    strategies to use? My personal preference is to first determine with a technique
    from strategy I (e.g., ideomotor exploration) that an unconscious dynamic or past
    event is not a part of the problem. This can generally be assessed in one part of a
    single session, although if factors are uncovered they may require an interview or
    two to resolve. One problem with conventional pain assessment strategies (e.g.,
    Karoly & Jensen, 1987) is that they neglect the possible role of unconscious
    variables as a potential cause of a pain problem. There are occasions when a pain
    problem, or part of a pain problem, may be associated with past trauma (e.g.,
    incest) or serve unconscious purposes (e.g., for self-punishment). We may
    hypothesize that this may particularly be the case when the cause of the pain is
    unknown and cannot be causally related to any pathophysiologic process, where
    the pain seems more intense than would ordinarily be anticipated, and/or when
    pain lasts longer than is appropriate.
    Hypnotherapy for pain should include a brief routine check (e.g., with
    ideomotor signaling) to determine if unconscious factors contribute to the
    problem (Hammond & Cheek, 1988; Rossi & Cheek, 1988).
    When it has been determined that psychological and unconscious factors do not
    play a role in the problem, suggestive hypnosis may then be introduced. Thus it is
    next recommended that you determine whether strategy II techniques (e.g.,
    suggestions for anesthesia, ideomotor turn-off of pain, imagery modification) are
    successful in alleviating or managing the distress. When these more
    straightforward techniques are not entirely effective, we may then experiment
    with the more complex techniques that fall under strategies III and IV. These
    techniques will be particularly beneficial when pain is chronic and where several
    pain sites are identified. Certain techniques (e.g., time dissociation, imagining
    pleasant scenes) are primarily useful with patients who can be inactive, at least for
    segments of the day. For instance, if a patient is imagining a future or past time
    when they were not in pain, this inward absorption precludes simultaneous
    interaction with people or the performance of vocational tasks. When working
    with more difficult, chronic pain patients who have several sites or types of pain,
    you may also find it helpful to begin by working with their least difficult or
    intense problem first. Begin with the problem where you anticipate the highest
    probability of success. Successful management of one pain area or problem will
    enhance patient self-efficacy and their belief that success may be anticipated with
    other problems (areas) as well. Success breeds success.

    When time permits, it is also valuable to determine the hypnotic pain


    management techniques that the patient is most skilled in using and which
    HYPNOSIS IN PAINMANAGEMENT 49

    techniques are most potent for them individually. You will probably find it most
    helpful initially to demonstrate pain control techniques to manage acute pain that
    is therapist-induced; for example, begin by creating glove anesthesia to block pain
    that is induced through the use of a hemostat or nail file.
    There are a variety of suggestive hypnotic strategies for pain management that
    will be reviewed in the first part of this chapter. In successfully controlling
    organic pain, however, it is extremely important to have frequent reinforcement
    sessions early in treatment. In particular, it has been recommended (Crasilneck &
    Hall, 1985) that we should reinforce pain control as quickly as possible after the
    patient becomes aware of the return of pain. Thus, in the first 24-hour period it
    may be necessary to see the patient several times (e.g., every four hours) and
    self-hypnosis should be learned as rapidly as possible.
    We should also not neglect the role of ego-strengthening as part of hypnotic
    work with chronic pain patients. Patients with chronic pain customarily also
    develop feelings of low self-esteem and self-worth that may be responsive to
    hypnotic suggestion. Furthermore, self-hypnosis provides such patients with an
    active self-management strategy that can return some sense of control and
    mastery to their lives.
    Most of our patients are not capable of creating a complete anesthesia and
    removing all of their pain through hypnosis. However, even for those patients
    who are this hypnotically talented, we should only remove all pain in a small
    number of conditions: (1) dental anesthesia; (2) childbirth; (3) terminal illness
    (e.g., cancer pain); (4) when hypnosis is being used for surgical anesthesia; (5)
    phantom limb pain; and (6) possibly for treating shingles or arthritis attacks
    (Crasilneck & Hall, 1985). In other cases, we must remain cautious to leave some
    "signal" pain so that the patient will not injure himself and so that pain from the
    development of new symptoms or a worsening of the patient's condition will be
    perceived and reported.
    Very importantly, as clinicians treating pain we must assume a realistic posture
    concerning the role of hypnosis. Hypnosis is like any other medical or
    psychological technique: it is not effective with every patient. Some patients
    obtain tremendous pain relief with hypnosis; others find it clearly helpful but are
    in need of still other methods of relief; some find that it reduces the affective
    components of pain (Price & Barber, 1987), making the sensory pain more
    tolerable; and some patients receive no benefit from hypnosis. Consequently we
    must also be familiar with nonhypnotic treatment options such as medications,
    nerve blocks and trigger point injections, physical therapy, transcutaneous
    electrical nerve stimulation (TENS), and biofeedback. When it comes to the
    treatment of pain, the hypnotherapist should not work in a vacuum. A
    multidisciplinary team is ideal, and interdisciplinary cooperation is vitally
    important.

    CHAPTER OVERVIEW

    The first part of this chapter will introduce you to a variety of hypnotic
    techniques for pain management and models of verbalizations for these
    techniques. Later, suggestions specific to several conditions such as migraine,
    arthritis, cancer and shingles will be presented.
    50 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    Techniques of Hypnotic Pain quently enable a patient to tolerate some


    persistent feeling in the area but not to suffer
    Management from it. A sensation of stabbing pain may be
    Joseph Barber, Ph.D. substituted with a sensation of vibration, for
    Los Angeles, California example: "The stabbing needles might become,
    in a surprising way, somehow more dull, not
    Though there are many ways of conceptualizing quite so very hot, so that, at some point in the
    techniques of hypnotic pain management, and future, maybe in two minutes, maybe in two
    while different clinicians will certainly apply hours, you can notice the peculiar buzzing, or
    techniques differently, it is helpful to consider four vibrating feeling of the blunt, warm needles."
    basic methods of achieving hypnotic pain control: For some patients, substitution is easier when
    the substituted feeling is not thoroughly
    pleasant; a burning neuralgic pain may become
    1. Analgesia or anesthesia can be created in the
    an irritating itch, for instance, or a tickle; a
    hypnotized individual by simply suggesting
    patient who needs for some reason to continue to
    that the perception of pain is changing, is
    be aware of the stimulus of the pain, for
    diminishing, or that the area is becoming
    instance, may be better with this technique.
    numb, so that the pain is gradually disap
    pearing. It may be easier for a patient to 3. Displacement of the locus of pain to another area
    notice growing comfort rather than dimin of the body, or, sometimes, to an area outside
    ishing pain; thus a specific feeling of com the body, can again provide an opportunity for
    fort such as that associated with anesthesia the patient to continue experiencing the
    can be suggested specifically, for example: sensations, but in a less vulnerable, less painful
    "You may remember the feeling of anes area. The choice of the area is usually based on
    thesia from the past, and begin already its lesser psychological vulnerability, and
    imagining that such numbing comfort is suggestions can leave the choice to the patient;
    beginning, just barely, to become more and for example: "As you continue to pay careful
    more apparent." Alternatively, the patient attention to the discomfort in your abdomen, let
    can be given a specific focus to notice me know when you first begin to notice the very
    diminishing pain. For instance, it may be slight movement of that feeling. . . . That's right,
    helpful to ask the patient, before treatment, now just notice, as the movement continues, in
    to rate his or her pain on a scale from 0 to perhaps a circular way, to increase . . . is it
    10, "0" representing no pain at all, and "10" moving clockwise, or counterclockwise? . . .
    representing the most pain imaginable. (Patients That's fine, now just continue to be curious as
    can rate their pain quite reliably, as Sternbach you notice how the feeling can continue to move,
    [1982] describes.) Following induction, the in an ever-increasing spiral, moving round and
    hypnotized patient may be told, "Earlier, you round your abdomen, and notice which leg it
    were able to rate your pain, using numbers. I'd begins to move into ..." and so on, as the feeling
    like you to look up, in the corner of your mind, is suggested to move into a limb, perhaps even
    right now, and notice what number you see, and to center in a single toe or finger, or to move
    notice that number beginning to change." outside the body altogether.
    Further suggestions can be given for associating
    the number with the perception of pain, and for 4. Dissociation of awareness can be created when
    perceiving progressively diminishing magni- the patient does not need to be very functional
    tude of the numbers. (e.g., during a medical or dental procedure) or
    when some condition renders
    2. Substitution of a painful sensation by a
    different, less painful sensation can
    fre-
    HYPNOSIS IN PAINMANAGEMENT 51

    the patient virtually immobile (e.g., during the you might, more quickly than you expect, begin to
    last stages of a terminal illness). The patient can have the impression of a lovely white swan, gliding
    be taught simply to begin to psychologically along, the graceful long curve of its neck
    experience himself or herself as in another time, reminding you very, very distinctly of a "2." Or is it
    place, or state, as in a vivid daydream. For that, seeing a "2," you are reminded of a swan. And
    instance, one can suggest that the patient not only reminded of a swan, but, somehow, begin
    experience himself or herself as floating, and to feel almost as if you, too, are gliding gently
    that "your mind, your awareness, can just float along, the smoothness and grace more and more a
    easily outside your body, and move over by the part of your awareness. . . . And any time that you
    window, so you can watch the world outside . . want to feel more comfortable than you do, all you
    have to do is look up in the corner of your mind and
    ."or one can suggest that the patient float outside
    see the number you feel. And the number you feel
    the room, and travel to any place he or she
    is the number you see, and the number you see is
    would enjoy.
    the number you feel. And then just watch . . . just
    watch, as the numbers, and your feelings, begin to
    change. And a beautiful swan, or is it only the
    EXAMPLE OF SUGGESTIONS FOR coolness of a "2," is so very much more easy to live
    with, is it not?
    DECREASING NUMBERS TO CREATE
    COMFORT [The patient was thus given a posthypnotic
    suggestion for coping with future pain. However,
    A while ago, you were able to very accurately in order not to lead the patient to expect too much
    rate your pain, using a number from 0 to 10. Any from this new experience, no suggestion was given
    time in the future that you would like to feel more for complete pain relief (no "0" was suggested, for
    comfortable, you can do so. All you have to do is to instance), and further caution was added:]
    look up in the corner of your mind, and notice what Now, I really don't know you very well, and you
    number is associated with the level of pain you feel. certainly don't know me well yet at all . . . so I
    Then, just watch . . . just watch as the number really don't know how much relief you can expect,
    begins to change. I don't know exactly what that really expect, to feel when you leave my office. It
    will be like. Maybe it will begin to quite slowly may be that sometime later today, and I really don't
    fade from your visual awareness, and as it does so a know what time, maybe 10:30 this morning, or
    smaller number will begin to emerge from the maybe just one second after noon, or maybe 6:18
    background. For instance, if you feel and see an this evening ... I really cannot say what time it will
    "8," you may begin to notice the lines of the "8" be ... I cannot predict the future . . . but maybe it
    begin to fade, and "7" will become more apparent. would be interesting to you, or even enjoyable for
    Or maybe the curves of the "8" will begin to you, to notice, at some time later today, but I don't
    straighten and relax, and become more like the know what time exactly, to just suddenly notice
    angles of the "7," until, after a while, the angularity how much more comfortable you feel than you
    of the "7" will take on the graceful curves of the thought you might. But I don't know what to
    "6." And maybe the "6" will, like the pages of a expect. I'd be really very surprised if you left here
    calendar in a movie, be blown by the wind, off into feeling much relief; I wouldn't be very surprised to
    the darkness, leaving a "5." And maybe the "5" will later find out that you felt better later today. But
    begin to open, ever so gradually, and the line at the listen . . . even if you feel better late today, either
    top will fade until you notice that there is no longer later this morning, or this afternoon, or even
    really a "5" there but rather a "4." Or, maybe some tonight, just before getting ready for bed, there is
    numbers will be skipped altogether, and no reason to assume that this has
    52 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    anything at all to do with anything you and I may your eyes closed, your body relaxing more and
    have done today. There is really no need to know more with each breath you take. Whatever relief
    how or why something happens in order to enjoy you might feel, either now, or later today, or
    the fact of it. So there is no reason at all to assume tomorrow morning when it's time for you to
    any cause in particular. In fact, whatever relief you awaken, that relief is just something that happens,
    feel may be so very pleasing, so very enjoyable to and I don't know why, and I don't know how. You
    you, you may not even care why it happens. may have some idea about it, either while it's
    [The purpose of such suggestions was to obviate happening, or just after you discover feeling better,
    any expectations the patient may have had about or maybe next month or next year. I don't know.
    my own expectations, as well as any doubts the After all, time is not only relative, but it is
    patient may have had about the efficacy of sometimes very confusing. Your mom is going to
    hypnosis, and to diffuse issues of control or power drive you home today, and when she does, while
    which might have otherwise inhibited relief] she is driving, and while you sort of daydream
    about what I've said to you, while this is happening,
    it is today, and you know what day this is. But
    tomorrow, today will be yesterday, and tomorrow
    ILLUSTRATIVE DISSOCIATIVE will be today, and what was once today will be just
    SUGGESTIONS WITH A RESISTANT that much farther in the past of your comfort, your
    CHRONIC PAIN PATIENT relief, your hopes, your curiosity about what can be
    done for you, and better yet, what you might do for
    I wonder, even as you continue to lie on the yourself. Now, as I leave the room, I want you to
    treatment table, if you would enjoy remembering take whatever time you need to get up, after your
    some time, long ago, when you didn't hurt very mind has cleared and your eyes have opened, to get
    much. Or maybe you can remember what it was up, get your clothes on, go find your mom and do
    like when the nerve block stopped the pain. That whatever else is necessary to get yourself gone to
    was really a great experience, and, though it might the comfort of your home. The receptionist will
    happen again, I really doubt that it could happen make an appointment for you to see me in a few
    today. In fact, if you do feel better later today, on days, and when I see you again, I will be really
    your way home, after you get home, while you're eager, really curious, to hear you tell me about the
    standing in the kitchen, or just as you're getting into things you've been wondering about. Goodbye.
    your bed, it is unlikely that it is the result of
    anything we've done for you today. We're just
    getting to know you, and it seems unlikely that
    someone with a problem as complex as yours is
    going to experience much relief today, or, even if
    you do, it is probably just a lucky break, just a Altering the Quality of
    fluke. Who knows how much comfort you can Discomfort: Example of Leg
    have? I don't. Well, at least I don't know for sure.
    I'm sure you can have some relief. Who couldn't. Pain
    But just how much is really as unclear to me as it is
    to you. I don't know you, I don't understand you, I M. Erik Wright, M.D., Ph.D.
    don't feel your pain, I don't really understand your
    pain, so it would be really dumb for me to stand The following illustration shows how guided
    here and tell you that you're going to feel better imagery can be used to assuage discomfort by
    today just because you're lying there listening to me reinterpreting its nature. It is taken from a case
    with where it was important for the intensity of pain to
    become tolerable so that healing could be
    HYPNOSIS IN PAIN MANAGEMENT 53

    facilitated. Trance induction had already taken Transformation of Pain


    place. The therapist continued:
    You have described this pain in your leg shin as William L. Golden, E.
    being sharp and piercing, like a knife point sticking Thomas Dowd, and Fred
    into the bone ... A very distressing and Friedberg
    uncomfortable experience ... It would become more
    tolerable if this sudden, intense, sharp pain were In physical transformation of pain, the pain is
    replaced by a pain that did not come so moved to a part of the body that is less central to
    unexpectedly, that gave you time to adjust yourself the individual's activities or to a location that is so
    so that when it occurred, even if the new pain were ridiculous that the person is enabled to treat it in a
    not exactly comfortable. . . . humorous fashion, thus making it easier to view
    [The therapist begins to develop imagined the pain in a more detached manner. For example,
    conditions for modifying the pain:] Now visualize lower-back pain could be transferred to the big toe,
    the left leg as being covered by thick layers of where it interferes less with daily activities. Or a
    cotton . . . going around and around that part of the headache could be moved to the little finger of the
    leg where the pain is most often experienced . . . right hand or, more humorously, the left earlobe.
    See this cotton secured to your leg so that it won't This procedure is especially valuable in cases of
    slip off . . . The cotton is so thick and matted that chronic, intractable, benign pain, where there is
    nothing would be able to pierce through it, no often a need to retain the pain for psychological
    matter how sharp it might be . . . [The therapist reasons. The client is thus not asked to give up the
    paces the process according to cues from the pain, but only to transform it. Often it is helpful to
    client:] Signal with your finger when you see this ask clients where they would like to move their
    clearly . . . Good . . . pain, in order to involve them in the process.
    [The therapist continues building pain-reducing Physical transformation of pain is accomplished
    imagery:] Now see a sharp knife thrusting at the as follows. After the subject is placed in a trance,
    cotton layers, but it absolutely cannot penetrate he or she is instructed to touch the painful part of
    through the cotton protection . . . You may sense the body with (usually) the right hand and to
    the pressure transmitted through the cotton ... It transfer the pain to another part of the body by
    may feel like a dull pain, but it is mostly pressure touching it with that hand. If desired, suggestions
    and you are much better able to stand the amount of can also be made for a reduction of the pain in the
    discomfort . . . When you have reached the toler- new location. An instruction such as the following
    ance level for this dull pain, see the knife being could be used:
    withdrawn from the cotton batting . . . The pressure
    is relieved, and the dull pain drops immediately. . . .
    You can slowly allow your right hand to move so
    [The therapist gives control to the client for pain that it touches your back at the most painful spot. ...
    reduction and healing:] Now that your body does As it touches your back, you can be aware of the
    not have to prepare for the shock of the sharp pain, painful sensations flowing from your back into
    you will be able to use that spared energy to speed your hand. . . . Now slowly allow your hand to move
    up the healing process . . . When the pain recurs, toward your left shoulder, feeling the pain lessen as
    you can gradually build up the thickness of the it does so. ... As your hand touches your left shoulder,
    cotton wadding so that the pressure becomes more you can feel the pain move to your shoulder, but
    somewhat less than before. Now remove your hand
    tolerable and the dull pain continues to decrease. In and let it slowly drop to your lap, relaxing as it goes.
    time, you may feel only a sensitive area on the skin
    as the healing underneath continues.
    Pain can also be transformed into other sensations,
    and this procedure is likewise useful
    54 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    in cases of chronic, psychogenic pain. In addition, TRUISMS FOR DEVELOPING


    the signaling function of pain is retained, while the ANESTHESIAS
    suffering and incapacitation associated with it are
    reduced. For example, suggestions can be given Erickson discussed "the tremendous amount of
    that the individual will experience an itching, learning you have acquired during your lifetime of
    tingling, or warm sensation in the place of and at experience in developing anesthesias throughout
    the site of the pain rather than the pain itself. To your entire body. For example, as you sit and listen
    some extent, this technique is based on the to me now, you've forgotten the shoes on your feet .
    common observation that the label we attach to . . and now you can feel them; you've forgotten the
    something might in part determine how we respond glasses on your nose . . . and now you can feel
    to it (a rose by another name might not smell as them; you've forgotten the collar around your neck .
    sweet), because the meaning of an event or object is . . and now you can feel it . . . You listen to an
    partly a function of its name. For example, we entertaining lecture, and you forget about the
    might respond quite differently to a behavior hardness of the chairs. But if it happens to be a very
    labeled aggressive than to one labeled forthright, boring lecture, your chair feels so utterly
    although the actual behavior could be the same in uncomfortable. You sense those things. We've all
    both cases. The client might be instructed as had tremendous experience in developing
    follows: anesthesias in all parts of our bodies" (Erickson,
    1985, p. 228). "So how did you get that anesthesia
    for the shoes on your feet? Not because there is a
    As you pay close attention to the sensations in drug put into the nerve; not because you were told
    your back (the location of the pain], you can become to have the anesthesia; but because in your lifelong
    aware of a feeling of warmth, it will gradually learning you have acquired the automatic ability to
    replace all other feelings so that all you feel in that turn off sensations and to turn them on again"
    area is warmth. And you can allow that feeling of (Erickson, 1986, p. 120).
    warmth to remain for as long as you have need of it.

    Erickson's Suggestions for ANTICIPATION AND UTILIZING THE


    UNCONSCIOUS
    Pain Control
    A number of things may develop, some of which
    Milton H. Erickson, M.D. I have not mentioned. I hope you will notice and
    appreciate them, and then fit them into the goal that
    you wish to achieve. And I'd like to have you
    INTRODUCTION interested in the way these unexpected things can
    fit into the goal you wish to achieve (Erickson,
    These practical suggestions were compiled from 1985, p. 180).
    throughout the published papers and lectures of Dr.
    Erickson. They have been compiled according to
    technique. Although sometimes Erickson simply REPLACEMENT, SUBSTITUTION OR
    describes a technique, often his actual suggestions REINTERPRETATION OF SENSATIONS
    are provided. 1 believe that many of these
    suggestions will provide you with a valuable model You tell your patients in the trance state to think
    for many of the more complex methods that we over their pain. Maybe they can't cut out the
    must occasionally resort to when more nagging quality of the pain, but maybe they can cut
    straightforward techniques are not successful. the burning quality; maybe they can cut out the
    {Ed.) heavy quality. Or maybe they can keep
    HYPNOSIS IN PAIN MANAGEMENT 55

    the heavy, dull aspect of the pain, and lose the patient's subjective experience of pain is going to
    burning, the cutting, the lancinating, shooting lessen that pain . . ." (Erickson, 1983, p. 228).
    qualities of the pain. And what have you done? You And I explained to her with profound apologies
    have asked your patients to take the total that even though I had relieved the pain of her
    experience of pain and to fragment it into a variety cancer by this numbness, I would have to confess
    of sensations; and as surely as your patients that I was going to be an absolute failure in one
    fragment their pain, . . . they have reduced it regard. I would not be able to remove the pain from
    (Erickson, 1986, p. 81). the site of the surgical scar. Instead of removing
    absolutely all of the pain, the best, the very best,
    ALTERATION OF SENSATIONS. You have aching that I could do would be to leave the scar area with
    pains in your legs that distress you very greatly; you an annoying, disagreeable,
    are suffering from arthritis. But if you will examine great-big-mosquito-like feeling. It would be
    something awfully annoying; something she would
    those sensations, you will find, perhaps, a feeling of
    feel helpless about; something she would wish
    warmth; perhaps a feeling of coolness; perhaps a
    would stop. But it would be endurable, and I
    feeling of coldness; and now how about extending impressed that point on Cathy's mind. It took me
    some of those sensations? (Erickson, 1986, p. four hours to accomplish everything (Erickson,
    104). 1983, p. 172).
    I asked my patient to tell me whether I should
    take care of the cutting pain next —or should it be
    the burning pain, or the hard, cold pain, or the
    lancinating pain? What does the patient do in
    DISPLACEMENT OF PAIN
    response to such a question? He immediately
    divides his pain experience, psychologically, into a
    great variety of separate kinds of pain . . . Now, you've got cancer pain. Why not have
    (Erickson, 1983, p. 223). another kind of pain also? Why not have pain out
    here in your hand? You have cancer pain in your
    There are certain transformations that can be body. It is very, very troublesome; it is very, very
    brought about here. You know how that first
    threatening; it is going to kill you. You know that.
    mouthful of dessert tastes so very good? And even
    the second mouthful still tastes good; but by the You wouldn't mind any amount of pain out here in
    time you reach the sixty-sixth mouthful, it doesn't your hand, because that wouldn't kill you. It is the
    taste so good. You have lost the liking for it, and pain in your torso that is going to kill you, and if
    the taste of the dessert has changed in some you only had pain out here you could stand any
    peculiar way. It hasn't become bad; it has just "died amount." You can teach your pain to displace the
    out" in flavor. Now, as you pay attention to these pain from the torso out into the hand where it is
    various sensations in your body that you have gladly experienced, because it has lost its
    described to me, I would like you to name the threatening quality. (Erickson, 1986, pp. 80-81).
    particular sensation that you want me to work on
    first (Erickson, 1983, pp. 225-226).
    I want to know if that grinding pain is a rapid AMNESIA FOR PAIN
    grinding pain or a slow grinding pain. Or, I can
    suggest an addition to the grinding: "If you will just One of the ways of dealing with unpleasant
    pay attention to that grinding pain you will notice sensations is to forget them —like when you go to
    that it is a slow grinding pain." I have added my the movies and get all absorbed in the suspenseful
    own adjective of slow to the patient's grinding pain, drama on screen, and meanwhile you forget about
    and if the patient does not accept slow I can slip your headache. You may not
    over to rapid grinding pain. Why? Because
    anything that I do to alter the
    56 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    remember until three days later that you had a because [the left hand] was the only hand that was
    headache when you went into the cinema left to write with! . . . What was my technique? I set
    (Erickson, 1983, p. 226). up a body disorientation by teaching the patient to
    get very confused about the site of the pain, about
    the part of the body involved in the pain, and about
    GRADUAL DIMINUTION OF PAIN the direction of the pain. You disorient the patient
    to the point where he simply does not know which
    I can't take away all of your pain. That is asking side is which, and then you provide him with the
    too much of me; it is asking too much of your body. orientation that you want for him. If you can move
    And if you lose 1 percent of that pain you would the pain to a place in the body where there is no
    still have 99 percent of it left; you wouldn't notice organic cause for it, then you are in a position to
    the loss of 1 percent, but it would still be a loss of 1 produce hypnotic anesthesia for the pain at its
    percent. You could lose 5 percent of that pain. You actual site. You move the patient's subjective
    wouldn't notice the loss of 5 percent, because you experience of the pain to the wrong area, bodily,
    would still have 95 percent of the pain; but you because you can correct it more easily there; the
    would still have a loss of 5 percent. Now you could patient has little resistance to accepting suggestions
    lose 10 percent of the pain, but that really wouldn't in the healthy area (Erickson, 1983, p. 235).
    be noticeable because you would still have 90
    percent of it; but you nevertheless would have a
    loss of 10 percent of your pain. [You continue to
    diminish the pain —down to 85 percent, 80 percent, PAIN METAPHOR
    75, 70, 65, 60,and so on. Then you say:] You might
    even lose 80 percent of your pain, but I don't think . . . You can also cut down organic pain by
    that is quite reasonable, yet. I would be willing to minimizing your response to it. You see, in organic
    settle for a loss of 75 percent. [And the patient is pain situations you have neurosynapses that are
    going to agree with you, regretfully. Then:] What is transmitting the pain. Through hypnosis you can
    the difference between 75 and 80 percent, and spread those synapses apart — like sparks jumping
    sooner or later you can lose 80 percent, and maybe a gap—until you have your synapses spread so wide
    85 percent; but first, let us settle for 80 (Erickson, apart that you get a jumping of the thing. At that
    1983, p. 236). point a certain maximal pain stimulation is
    necessary in order for the person to sense the pain
    (Erickson, 1985, p. 26).

    DISORIENTATION AND CONFUSION


    TECHNIQUE WITH PAIN
    General Principles for
    "Let us see, is that pain in your right leg, or your
    left leg? . . . Let us see, which is your left leg and Alleviating Persistent Pain
    which is your right leg?" And you can get as
    Ernest L. Rossi, Ph.D. and
    confused as you get the child confused on this
    subject of where the pain is, and which leg is which. David B. Cheek, M.D.
    "And now is it on the outside side of your leg, or is Malibu, California, and Santa Barbara, California
    it on the inside side of your leg?" . . . I discussed
    Tightness and leftness, and centrality and Therapy for persistent pain states must be elastic
    dextrality, and so on, until the girl was so confused and must conform to the understandings and needs
    that she thought this hand was her right hand [her of the patient and the patient's relatives. Often it
    left hand], and this hand was her left hand must also fit into the needs
    [her right hand] —
    HYPNOSIS IN PAIN MANAGEMENT 57

    and understandings of prior medical and surgical know how to turn pain off by first learning
    attendants in whom the patient has continued faith. how to turn it on. (Prior experience with
    It is best judgment to listen carefully to what the uncontrolled fear of uncontrolled pain, a fear
    patient thinks can be done and what he or she of the unknown.)
    expects the hypnotherapist to use as an approach to 8. As soon as the patient has developed con-
    the problem. The patient is often in a hypnoidal fidence in being able to turn the pain on and
    state during the first moments of interview and may off, it is helpful to have him select a cue word
    have insights of utmost value to impart. If the or thought which will automatically turn off
    therapist can weather the initial critical interview the pain. This is rehearsed several times in the
    and can have free rein, these are the general steps office, but the patient is told to avoid trying it
    which have proven helpful: on his own until the instructor knows it is
    going to be successful. (There are several
    implications to this bit of instruction. Most
    1. Be sure the patient is unconsciously willing to
    important is the implied confidence that such
    be helped.
    a day will come. Next in importance is the
    2. Discover when and what caused the illness or
    warning that simple experiences in the office
    pain to be important in the very beginning
    setting do not indicate that the task is now
    [through ideomotor signaling]. This may
    finished.)
    relate to the distress of another person rather
    than to a personal experience with pain. 9. A pseudo-orientation into the future is
    3. Determine the first moment at which the requested and the patient is asked to have the
    patient experienced the pain. Discover yes finger lift when he is forward to the time
    whether the patient was awake or asleep at the when there is good health and total freedom
    time. (Sleep means either natural sleep or a from pain. (Refusal to select a time may
    period of unconsciousness as from indicate discouragement or resistance which
    chemo-anesthesia.) have not previously been apparent.
    4. Discover what reinforced the importance Acceptance of a date commitment reinforces
    of that initial pain. This may have been the the other placebo elements of optimistic
    statement of a doctor or the consternation hope.)
    of relatives at the time of initial illness or 10. Train the patient carefully with auto-hypnosis
    injury. induction and simple use of brief periods for
    5. Ask if the patient now, at the time of complete relaxation. This should be restricted
    interview, believes cure is possible. Orient tc to three minutes, at the most, from onset of a
    the moment when this conclusion was drawn, medium trance to the moment when the eyes
    regardless of the answer. Points of origin are feel like opening. The author insists that the
    significant whether optimistic or pessimistic. patient stick to the time limits rather than
    6. Have the patient turn off all pain at an drifting off into natural sleep or prolonged
    unconscious level and have a yes finger lift reverie. If too much time is lost during these
    when this has been accomplished. Ask for a exercises, the patient will tend to discredit
    verbal report when it is known consciously that results and will give up the rehearsals as a
    all pain is gone. needless waste of time. The two- or
    three-minute exercises should be repeated
    7. Ask the patient to turn the pain back on again
    after each meal and at bed time, four times a
    but to make it twice as strong as it was at first.
    day. This is no more time than might be taken
    The patient may balk at this until it is made
    in smoking five cigarettes during the day.
    clear that the pain will again be turned off, and
    that it is helpful to
    It may suffice to make office appointments for one
    hour once a week if the patient is first seen
    58 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    during an interval of relative comfort. If the patient for healing and for relief from pain . . . You must let
    is in severe pain, the author usually arranges for yourself come closer to its essential meaning . . .
    admission to the hospital for a period of two or Forgiveness and love are parts of this universal
    three days. This separates the patient from healing spirit . . . that release the inner tensions . . .
    unrecognized triggering stimuli at home, permits free your body and your spirit from pain . . . Let
    more than one visit a day if necessary, and allows your thoughts focus upon your feelings of
    use of pain-relieving drugs to augment effects of forgiveness and love . . . Forgiving yourself . . .
    suggestion. forgiving others ... releasing the stresses within
    yourself that generate tension through anger,
    hatred, resentment . . . And as the spirit of
    forgiveness grows within you . . . these tensions are
    Religious Imagery of Universal released . . . opening up the healing life forces . . .
    permitting you to connect with the love of others
    Healing for Ego-Strengthening and love of self . . . and love of God ... As you open
    and Pain up to this healing love ... the awareness of the pain
    becomes distant . . . moving further and further
    M. Erik Wright, M.D., Ph.D. away . . . diminishing in importance and in
    consequence ... as the healing love flows through
    you. . . .
    INTRODUCTION
    It is commonly believed that anger, resentment
    COMMENTARY. Those who identify themselves
    and guilt take up a great deal of energy and may
    with a particular religious group may invoke
    inhibit healing, as well as causing emotional significant hypnotherapeutic images associated
    turmoil. In fact, some research (Pennebaker, with their deep religious convictions. The client is
    Kiecolt-Glaser, & Glaser, 1988) implies that encouraged to activate religious imagery that will
    releasing such feelings may produce both evoke the most intense religious involvement,
    immediate and long-lasting effects on immune including religious ecstasy, with a consequent
    function. distancing from the ongoing pain experience. The
    In Wright's technique, you may also use procedures may not only emphasize relief from
    ideomotor signals to have patients indicate when pain but also may provide considerable religious
    they feel they can forgive themselves. They may be solace for the individual.
    asked to identify specific individuals they need to
    forgive, and to work inwardly on forgiving them
    and even praying for them, giving a signal when
    they feel they have let go of their negative feelings The "Sympathetic Ear" Technique
    and resentments toward the person. It may then be
    suggested that they visualize the empty spaces
    with Chronic Pain
    where the guilt and resentment were, and imagine Barry S. Fogel, M.D.
    them being filled with love. It may be further Providence, Rhode Island
    suggested that they sense and feel the energy,
    which was wrapped up in keeping the resentment
    and guilt inside, being released and becoming INTRODUCTION
    available for healing. (Ed.) Comprehensive approaches to the management
    of chronic pain attempt to reduce psychological
    SUGGESTIONS rewards for pain behavior, of which secondary
    gains are a part. Commonly used methods include
    There is a deep universal healing spirit within environmental manipulation in an inpatient
    you and in the world that you can draw upon setting, marital and family
    HYPNOSIS IN PAIN MANAGEMENT 59

    therapy to reduce interpersonal rewards for pain have to say —thoughts, feelings, complaints,
    behavior in important relationships, formal ideas. . . . It wants to listen, and listens with perfect
    instruction in alternate coping skills, and attention, without fatigue or judgment. Tell the ear
    insight-oriented psychotherapy. all that concerns you now. . . . Each day take time
    When a clinician is presented with an unre- to put yourself in a trance and talk to the
    stricted invitation from a patient to treat pain by sympathetic ear. As you talk to the sympathetic
    whatever means are necessary, the clinician often ear, you feel your concerns are fully and
    will opt for some combination of the above completely heard.
    methods to deal with the operant aspects of pain;
    hypnosis might be used to directly reduce the
    intensity of the pain or to promote relaxation.
    However, the patient specifically requesting
    hypnotherapy of pain may be open to hypnosis, yet Reactivation of Pain-Free
    be relatively resistant to the introduction of other Memories: An Example of
    management approaches, particularly if they Intensifying and Relieving Pain
    appear to be costly or to require the involvement of
    other individuals.
    M. Erik Wright, M.D., Ph.D.
    The seeker of self-hypnosis may be seeking
    individual mastery of the situation, through a
    mutative technique or experience, rather than INTRODUCTION
    seeking a program which requires ongoing sub-
    mission to environmental manipulation suggested Another approach to pain control is based on the
    by another person. With patients who have settled following premises: People typically retain
    upon hypnosis as their treatment of choice for memories of a pain-free period in their lives, with
    psychological or ideological reasons, it may be its concomitant physical and emotional feelings of
    useful for the therapist to use hypnosis itself to well being. A persistent pain experience, however,
    promote a cognitive restructuring that may mitigate can submerge these memories. The
    the effect of secondary gain in sustaining pain psychotherapeutic premise is that clients who can
    behavior. Following such a restructuring, the recall these and intensify their chronic pain can
    patient may initiate a discussion of secondary gain also learn to diminish that pain perception, even to
    with the therapist, eliminating the need for the the point of eliminating it. The imagery invoked
    therapist to confront the patient, possibly during hypnotic trance is based on this premise.
    intensifying resistance or even leading to a The therapeutic process can proceed along the
    defection from treatment. following lines.
    Once the issue of secondary gain can be
    comfortably discussed directly, the therapist has
    the option of blending hypnosis with individual
    ILLUSTRATIVE SUGGESTIONS
    psychotherapy . . ., or making use of behavioral or
    family therapy techniques to directly reduce the
    Therapist: You are familiar with your own
    operant reinforcers of the patient's pain behavior.
    signal for entering trance ... So give yourself your
    signal to relax ... to let yourself go all over ... to feel
    yourself becoming light and free . . . Take the time
    THE "SYMPATHETIC LISTENER" you need to bring about a most comfortable feeling
    SELF-HYPNOTIC ASSIGNMENT of calm and quietness within yourself ... of the
    freeing up within yourself of muscle tension and
    [Following hypnotic induction and deepening] inner tension . . . Raise your right index finger
    Imagine a sympathetic listener, a sympathetic ear. when you have reached that point . . . [The client
    The ear is eager to hear whatever you does so shortly.] Fine. . . .
    60 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    From what you have told me . . . you know that is okay . . . [The therapist reassures the client:] No
    there was a time in your life when you felt well — matter how intense the pain may become . . . you
    physically, emotionally, and in every other way . . . will be able to manage it . . . Observe what images
    when you knew what it meant to feel glad to be are in your mind as the pain begins . . . Tell me
    alive . . . when your body functioned easily and what you are thinking of . . . what you are feeling . .
    freely . . . [The therapist seeks permission to . [Pain intensification is suggested:] Let this pain
    proceed:] Let's check with the inner part of your become stronger and more intense . . . Feel it in all
    mind to see if it will be okay to go back to that time its typical ways . . . Let the part that is with me in
    ... to let the awareness of what it felt like to feel the here and now describe it, while the part that is
    well return to you . . . Would the inner part of the going through the pain episode feels it in all its
    mind use the finger signals in the way it has used usual intensity ... If you wish, now make that even
    them in the past? [The client lifts finger.] The "yes" more stressful than the usual experience . . . This is
    finger went up slowly but definitely and remained a bad episode . . . [Pain moderation begins:] When
    up . . . Okay. . . . you have the full awareness of pain . . . start the
    turnoff . . . [Pain is supplanted with well being:] Let
    [The therapist invites age retrogression in
    the inner well being flow into your body and clear
    recalling wellness:] Drift yourself back through
    out the pain sensations . . . quietness, calmness, the
    time to before the pain was part of your life . . .
    muscles letting go . . . turning off the pain . . .
    before the pain was in the picture . . .
    leaving it in the past ... the images of relief filling
    [Observer-participant dissociation is suggested:]
    you. . . .
    Let part of you continue to remain with me in the
    here and now, while the other part of you goes back [Posthypnotic suggestions are offered:] The
    in time . . . Going back . . . going back . . . going conscious part of your mind and the inner part of
    back . . . When you are at that good time ... let me your mind will remember the importance of what
    know by your right index finger . . . [The therapist has just taken place . . . Not only were you able to
    encourages elaboration of the feeling of well permit the pain to flow into your body in its very
    being:] Describe yourself . . . Tell how you feel in typical way, but you were also able to clear the
    each part of your body . . . how it feels to feel good body of this pain, to have relief replace it and the
    . . . Enjoy every moment of this feeling of well well being feeling come back . . . [Homework is
    being . . . Let every cell of the body restore the suggested:] This is an exercise that you will
    awareness of this capacity to feel well, which is practice in between the pain episodes . . . Your skill
    part of that cell but which has been submerged by at shutting off pain will increase . . . and then you
    stress feelings . . . This feeling is still a part of you . will find yourself shutting off pain right in the early
    . . Nourish it . . . bring in colors . . . sounds ... or any stages of your pain episodes . . . You will bring the
    other sensations you wish to strengthen that feeling . pain into limits of feasibility that permit you to go
    . . Let yourself feel very comfortable . . . Now count on with your life . . . You can turn it off more and
    from one to five slowly . . . and let all the more as you gain confidence, and your life will
    psychological time take place that will revive these expand once again. . . .
    feelings of well being strongly in your mind . . .
    signal when you reach the count of five . . . [Soon
    the client signals.]
    CONCLUDING COMMENTARY
    [The therapist seeks permission for the pain In the reactivation model illustrated above, three
    experience:] Is the inner part of your mind ready to phases are evident: the reactivation of pain-free
    move up in time to the beginning of a typical pain memories, the reactivation and intensification of
    episode? . . . [The client responds with the finger the chronic pain, and then the quieting of the pain
    signal] The "yes" finger says it experience.
    HYPNOSIS IN PAIN MANAGEMENT 61

    Chronic Pain Syndrome these that are more acceptable to you." [See the
    section on cancer patients below for further
    Richard B. Garver, Ed.D. suggestions about reinterpreting sensations.]
    San Antonio, Texas

    It is important, first, to help newly referred


    GATE CONTROL THEORY METAPHOR
    chronic pain patients to understand why they have
    been referred by a physician who determined that
    conventional medical treatment resources have "The more sensations that your unconscious
    been exhausted. In fact, the patient has often been mind has options to produce, the more likely these
    told, "There is nothing more I can do for you; you other sensations are to occur. Your unconscious
    have to learn to live with the pain." Although it is mind can relax all the nerve and muscle fibers in
    not meant to be so, this is often a negative the area of your body where there is tension or
    suggestion. pain. It can also interrupt the pathways which
    travel from the site of the injury, to the spinal cord,
    I let patients know that I believe they are in pain,
    that they feel the pain, and that they are not seeing up the back of the spinal cord, through the brain
    me because they are crazy or imagining things. But, stem and into the pain reception area. There are
    I indicate that I am here to help them to change this many, many gates which these pain impulses must
    pain pattern and that pain is a behavior like all other pass through, and your unconscious mind can close
    sorts of behaviors, and that we learn behaviors that many of these gates, reducing the number of nerve
    are both productive and non-productive. Pain is impulses that will finally reach the pain reception
    sometimes a productive behavior when it protects area, and so, you simply will be aware of less
    us, but when it is reinforced and perpetuated by pain."
    negative emotions such as anxiety and fear, it
    becomes self-perpetuating. Pain produces negative
    emotions. Negative emotions produce tension, and
    CONTROL SWITCH VISUALIZATION
    tension produces more pain. 1 also indicate that
    there is within the unconscious mind an established
    "Your unconscious mind can also help you
    program of pain, which is reinforced by many
    visualize this pain reception area, perhaps as a
    things (primary and secondary gain), and this
    compartment or a lighted room. When there is a lot
    memory of pain adds to the perceived pain.
    of pain being reported there, the light can be very,
    One of the first things that I do is to have patients very bright; but you have a rheostat, a dimmer
    produce a glove anesthesia and help them switch, which you can turn down. As you turn the
    understand that they are really doing this, not I. light down, dimmer and dimmer, you will
    They have produced this analgesic effect in their experience less and less pain. Perhaps you will
    hand. This, of course, can be transferred to the even want to rate it on a scale of 1 to 10, with 10
    affected areas. Other useful pain metaphors and being the most pain that you would ever be in. And
    suggestions follow. the number that you feel will be the number you
    can see in your mind and in this pain reception
    area. If you feel an 8, you will see an 8. So the
    SUGGESTIONS REINTERPRETING PAIN number you feel is the number you see, and the
    SENSATIONS number you see is the number you feel. So see the
    number 7, and the number 6. As you lower the
    "You will experience other sensations that are numbers, you will lower the pain. Remember the
    more acceptable than pain, perhaps a gentle number you feel is the number you see, the number
    coolness or warmth, a lightness or heaviness, you see is the number you feel."
    tingling, even numbness, or any combination of
    62 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    TIME DISTORTION ical diagnosis. My emphasis with all of these pain


    patients is to emphasize and reinforce the fact that
    "Your unconscious mind can also distort time. they are gaining more and more control of the pain,
    You can tell your unconscious mind that the time and that the pain is less and less in control of them.
    that you feel pain will be perceived as the shortest
    amount of time. Perhaps an hour can even be like a
    minute, and the time of comfort can be much HEADACHE PAIN
    longer. So, whenever you do feel pain, you know
    that it will be over a very short period of time." I use more relaxation of the nerve and muscle
    fibers in the area of the pain for tension headaches,
    and have found cooling the head and warming the
    DISSOCIATION OF PAIN hands useful for migraine headache pain. To help
    patients learn this feeling of cooling the head and
    "Also, if you like, you can leave the pain here warming the hands, I tell them to actually put
    and you can go somewhere else. You can leave themselves in that situation, to imagine putting ice
    your pain here, and go somewhere else where you packs around the head, and to place their hands in
    are comfortable, and you can stay there for any warm water and memorize the sensations.
    amount of time that you would like. And, while you Self-hypnosis will thereby enable them to
    are gone, nothing will strengthen your pain; and so reproduce this at another time.
    perhaps it will grow weaker and weaker, and by the
    time you return, there will be very little, if any, pain
    left at all." SUGGESTIONS WITH CANCER
    PATIENTS
    COMPUTER PROGRAMMING Many of the same pain strategies apply with pain
    METAPHOR patients. However, for coping with the side effects
    of chemotherapy or radiotherapy, I suggest that the
    The computer metaphor of programming out all unconscious mind will potentiate the therapeutic
    pain-related behaviors and programming in all effects of all treatment and minimize the adverse
    comfort and control-related behaviors is a useful side effects. It is suggested that, in fact, "you can
    one. All the behavior that the patient associates experience any number of different sensations
    with pain will be programmed out, and all instead of nausea or pain. A feeling of tingling,
    behaviors that the patient associates with being which often accompanies nausea, is one that you
    comfortable and in control, both physically and can focus on, and you will experience more
    emotionally, will be programmed in. A very good tingling than nausea."
    posthypnotic cue can also be used to reinforce this
    Some other very specific posthypnotic sug-
    so that while the patient is in a normal waking state
    gestions are also helpful. First, an environmental
    he may use a cue such as touching his right ear,
    cue is established, for example, that when the
    which tells his unconscious mind to program in that
    patient enters the hospital or the treatment room or
    positive comfortable behavior. If the situation he is
    smells a particular odor, that will produce another
    in produces pain, tension or discomfort, he can
    effect (or several other effects) rather than any
    touch his left shoulder, which is the unconscious uncomfortable effects or sensations. A second very
    cue for the unconscious mind to remember to valuable suggestion is to establish a symptom
    program that behavior out. The exception to this, of awareness cue that is always present. It is
    course, is to always remind the patient that the suggested, "If you begin to feel even the slightest
    unconscious mind will allow him to have pain that effect of an unwanted symptom, whether that be
    will keep him safe from injury, or that might prove pain or
    beneficial for med-
    HYPNOSIS IN PAIN MANAGEMENT 63

    nausea, that will be a feedback cue to the ods seem contraindicated, or should at least be used
    unconscious mind, to instead produce other with utmost caution, with borderline or psychotic
    behavior, other sensations that are acceptable." patients. Elicitation of mystical states will be useful
    This is very important because the symptoms will primarily with deep trance subjects and with
    often be there in one form or another unless all patients who are judged to have the capacity and
    suggestions work perfectly, which they often won't. security to temporarily suspend reality. Sacerdote
    But, if the symptom occurs, the patient usually primarily used these techniques after having a
    expects more of that symptom. It is very valuable couple of hypnotic sessions with patients to
    when the symptom can be used instead to produce determine their hypnotic talent and to provide them
    other sensations which are more comfortable. with experiences in primary process thinking
    The third suggestion is for a physical action cue. through guided imagery and the use of induced
    For example, by touching the forefinger and thumb dreams. {Ed.)
    together or touching the right ear, that will signal
    the unconscious mind to produce another sensation
    rather than the unwanted symptom. I tell the patient INTRODUCTION
    that this is very much like pushing the play button
    on a tape recorder so that the tape that you want For the purpose of this paper, mystical states are
    played will begin to run. The physical action cue is defined and operationally described as states of
    the play button on that recorder. ecstasy, rapture, and trance. The experiencing
    subject finds himself perceptually, emotionally,
    and cognitively immersed in oceanic, universal
    feelings; i.e., in direct intuitive or supernatural
    Hypnotically Elicited Mystical States in communion with the universe or with a superior
    being. Visual (lights, colors, shapes), auditory
    Treating Physical and Emotional Pain
    (music), olfactory, and other sensations are often
    part of the experience, but the mystical states
    Paul Sacerdote, M.D., Ph.D.
    bypass ordinary sensory perceptions and logical
    Riverdale, New York
    understanding. Therefore, they cannot easily be
    described in terms of everyday reality. They are, by
    INDICATIONS AND definition, ineffable—beyond verbal expression. In
    CONTRAINDICATIONS spite of these "inborn" difficulties of
    communication, patients usually attempt and
    Sacerdote, expanding on the work of Fogel, partially succeed in giving some ideas of
    Hoffer and Aaronson, provides us with two unique perceptual, emotional, and cognitive experiences
    perceptual change techniques for eliciting mystical which can only be described as mystical.
    states. These methods are intended for patients
    suffering with protracted or recurrent physical pain As this is a clinical paper, no useful purpose
    and with accompanying emotional pain (anxiety, would be served by attempting to catalogue
    depression). They may hold particular value for hypnotically elicited, mystical experiences along
    patients with severe chronic pain problems, for Fischer's (1971) continuum in his interesting "A
    example, from cancer and migraine. It is cartography of the ecstatic and meditative states:
    recommended that these techniques only be used The experimental and experiential feature of a
    by highly experienced hypnotherapists, after perception-hallucination continuum are
    establishing a trusting rapport with the patient, with considered." (Incidentally, this cartography does
    patients without severe psychopathology. These not include hypnotic states!) Nor would the
    meth- methods which I am about to describe or my
    patients' experiences be clarified if I were to
    spell them out in terms of Zen
    64 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Buddhist or other religious or philosophical ination" or "expansion" of space elicited


    terminology. comparable alterations of perception, emotion,
    I find it of some use, however, to accept mood, and cognition. These changes were dra-
    Aaronson's (1971) distinctions between an matically illustrated by one S through drawings and
    "introvertive mystical experience" and an paintings of the same scene, seen under different
    "extrovertive mystical experience." The former posthypnotically suggested time conditions or
    culminates in the subjective experience of space conditions.
    "nothingness"— the absolute void. The latter tends I have found it feasible to apply the above
    to expand the person's awareness to unlimited, observations to the clinical area. The patient's
    universal experiences. To facilitate introvertive conscious and subconscious needs, as well as our
    mystical experiences, Aaronson (1971) developed
    own understanding of such needs and our ability to
    a progression of deepening verbalizations aimed at
    follow and to guide him, determine the results: a
    guiding trained Ss into abandoning identification of
    schizophrenic-like experience, or a "conversion"
    the senses, relinquishing ego-identification, and
    dispensing with usual logical categories of occurrence, or a mystical state. For instance, an
    distinction. To achieve extrovertive mystical states, excellent S and superb student became
    he used techniques aimed at expanding the ego belligerently paranoiac when she emerged from
    across barriers of space and time. hypnosis; the opening of her eyes was the cue for
    the posthypnotic suggestion that, "upon coming out
    The techniques which I have evolved and will of hypnosis, distances would seem very short,
    describe were inspired by the original observations people and objects would be close, clear, and
    and experiments conducted by Fogel and Hoffer distinct." Upon opening her eyes to this radically
    (1962), and by the more recent experiments of changed space, she had felt terribly closed-in and
    Aaronson (1968). In Fogel and Hoffer's threatened. The same student was given the
    experiment, a talented and well trained S was led posthypnotic suggestion that, upon opening her
    into deep hypnosis and made to listen to an eyes, she would find herself in a gently expanding
    oscillator with the belief that its speed was space, with people and objects shining in mar-
    constant. When, unknown to her, the speed was
    velous luminosity. Upon emerging from hypnosis,
    progressively increased, S became progressively
    she seemed to radiate ethereal serenity. She later
    more manic. When the speed was gradually
    described her experience as soothingly unreal,
    decreased, depression set in, until, at speeds near
    zero, she retreated into a catatonic state. This ineffable, without end or beginning, a wonderful
    experiment suggested that a person's behavior, universe without problems.
    mood, emotion, and cognition can be altered very
    radically through basic manipulations of the
    dimensions of time. SUGGESTIVE VERBALIZATIONS
    Aaronson (1968) gave to his trained, deep I will give some of the verbalizations which I
    hypnotic Ss various posthypnotic suggestions. For currently utilize. It should be kept in mind that
    instance, posthypnotic suggestions of a "restricted these are modifiable according to the patient's
    present" generally produced evidence of capabilities, needs, responses, and degree of
    depression; suggestions of total absence of the hypnotic talent and training. Transference and
    present elicited a schizophrenic-like catatonic
    countertransference obviously play an important
    state. On the other hand, posthypnotic suggestions
    role.
    of "expanded" time —especially expanded present
    and expanded future— led his Ss to experiences of
    INTROVERTIVE MYSTICAL EXPERIENCES. Usually
    supreme serenity, during which the strictures and the
    anxieties connected with passage of time patient has been previously induced to a medium
    disappeared. Similar suggestions involving
    level of hypnosis by my method of "reversed hand
    "restriction" or "elim-
    levitation," which is based largely on
    concentrated attention with detachment.
    HYPNOSIS IN PAIN MANAGEMENT 65

    The reversed hand levitation has generally the yond it another chain of mountains . . . and then
    advantage, when compared with traditional lev- beyond, more and more valleys and more and more
    itation, of implicitly suggesting relaxation, mountains and plains, and rivers, and lakes and
    oceans extending and expanding further and further
    deepening, and "letting go" (Sacerdote, 1970). The
    out in every direction to receding horizons. ... As the
    patient who has responded well to previous view continues to expand, your ears rejoice in the
    inductions will already be able to experience natural music of the wind, the rustling of grasses and
    dissociative phenomena and deep relaxation. When leaves and tree branches, the singing of birds, the
    there is evidence for both, I repeatedly, patiently, chirping of crickets, the tolling of bells; your nostrils
    and monotonously suggest: smell all the fragrances of the trees, and the grasses,
    and the flowers . . . and your eyes watch in wonder-
    Now, as every word travels from my lips to your ment the continuously "expanding" view of the ex-
    ears to reach your brain, your body progressively panding future. . . .
    enjoys more and more complete relaxation in every
    muscle and cell; and your mind delights in calm,
    clear, peaceful serenity. . . . You are now sur-
    rounded by a soothing atmosphere of absolute calm- WHY AND HOW SHOULD MYSTICAL
    ness . . ., protected from danger, disturbance, and STATES HELP TO RELIEVE PAIN?
    fear. And while relaxation and peaceful serenity
    penetrate deeper and deeper to every cell of your The idea of eliciting extrovertive mystical states
    body, we are safely surrounded in every direction by came to me while I was dealing with advanced
    wider and wider transparent, concentric spheres of
    luminous serenity, of cheerful calmness . . . [The cancer patients; they were raked with pain, beyond
    transparency which 1 explicitly mention communi- the reach of any further palliative treatment. I was
    cates to the patient that he can see and be seen; that familiar with the effects that the perception of
    he is not emotionally isolated.] You are safely expanded present, expanded future, and expanded
    bathing and comfortably breathing in the center of space could have on the mood and reality
    these transparent spheres, while luminous calmness perceptions of normal individuals. It seemed
    all around you penetrates even more deeply within worthwhile to see if patients in pain, guided into
    your body and permeates your mind. . . . All volun- symbolic, multisensory imagery, could be led to
    tary and involuntary reactions and responses gradu-
    experience perceptions of expanding time and
    ally fade and disappear. . . . Little by little, you
    become free of fears, of anxieties, of thinking, of space. Such experiences might "free" them from
    feeling. the limits of time, from the restrictions of activity;
    death itself could become merely the completion of
    life, rather than an event to be feared. In the
    EXTROVERTIVE MYSTICAL EXPERIENCES. The expanded present and future, people and objects
    pa t i en t could appear to the patients as bathed in luminous
    who has similarly been led to a state of increasing reflections. Synesthesias of colors, music, and
    dissociation and body relaxation is first guided by fragrances would further distance them from the
    me through an imaginary climb to the top of a "reality" of pain, desperate illness, dependency,
    symbolic mountain: and depression. Mystical states could enable the
    patient to deal in entirely new ways with problems
    Now finally you are at the top and you are able to of guilt and punishment, of life and death. They
    look towards the sunny side of the mountain. . . . might also encourage him to come to terms with
    You notice the blue of the sky and the brightness of these problems on a philosophical or theological
    the sun. You enjoy the warmth of the sunshine on basis.
    your shoulders and your back, on your arms and
    hands, on your legs and feet. You breathe in slowly
    and deeply the clean, pure, cool air. ... In front of The other approach, leading to "introvertive"
    your eyes under the quiet blue sky you see the mystical experiences, is based upon progressively
    beautiful green valley; and beyond the valley a deeper states of muscular relaxation and increasing
    picturesque chain of mountains . . . and beyond that psychological calm and serenity. The gradual
    first chain, you distinguish another valley; and be- restrictions of perceptions and re-
    66 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    sponses suggested to the patient are also sym- Patients were given the following suggestions
    bolized for him with the image of his body fully following the hypnotic induction:
    relaxed at the quiet center of concentric, luminous,
    serene spheres of wider and wider radius. Thus, a Allow yourselves to imagine a scene of comfort and
    kind of sensory and emotional isolation is relaxation. A place where you can feel really secure
    established which, in itself, can facilitate and peaceful. You may see yourself alone or with
    psychological and physiological dissociation of another person or in a familiar or unfamiliar place. Let
    the loci of pathology from the thalamic and the scene present itself to you and allow yourself to
    see, smell, hear, touch, or taste anything of special
    conical centers of pain perception.
    interest to you. After a time, as you continue to
    experience your special place, with your eyes
    remaining closed, we will ask you to describe your
    scene to the rest of the group. You will retain a clear
    Active Control Strategy for image of your special scene and will be able to recall it
    with ease anytime you like, especially when you begin
    Group Hypnotherapy with to experience the onset of any pain. . . .
    Chronic Pain
    Timothy C. Toomey, Ph.D. and Shirley
    ENCOURAGEMENT OF IMAGES AND FANTASIES
    Sanders, Ph.D. Chapel Hill, North Carolina
    THAT EMPHASIZE CHOICE AND ALTERNATIVES

    INTRODUCTION As a common feeling elicited from


    the chronic pain patients in the group was that of being
    "locked in" and overwhelmed by the pain, the use of a
    The following strategies and suggestions were
    technique that emphasized choices and alternatives
    used in a group hypnotherapy treatment format for
    seemed important. Thus, patients were encouraged to
    working with chronic pain patients. Although
    have a dream while in trance of two roads, one leading
    only five subjects were used, the treatment was
    to health, the other to sickness and disability.
    successful in reducing pain levels. (Ed.)
    They were asked to image both roads, to describe
    them, to image choosing the road to health and what
    that entailed. Patients were given the following
    PRODUCTION OF PLEASANT, RELAXING suggestion:
    IMAGES AND FANTASIES

    Patients were encouraged to produce images of You are able to experience yourself at an intersection
    relaxation and comfort and to share these with the and can clearly see two paths leading from familiar to
    group. The responses frequently involved unfamiliar terrain. You know that both of these paths
    simple images of scenes which the patients are meant for your steps alone. One of these paths is a
    reported when encouraged by the therapists and healthy path and contains clues and directions for your
    recovery. While on this path some of you may
    other group members. In contrast with experience a particular image or vision which is a clue
    traditional relaxation procedures which to your healing and recovery. Allow yourself to be
    impose a technique on the patient, the therapists open to such an image. The other path is a sickness
    strove to employ the utilization methods described path and has sights and signs of the future should you
    by Erickson (1959) which emphasize starting choose this direction. Allow yourself to ask questions
    where the patient is and gaining of any one you meet along both of these paths. After a
    gradual control over the symptom to demonstrate time, we will ask each of you to share your journey
    that change is possible. with the rest of the group.
    HYPNOSIS IN PAIN MANAGEMENT 67

    Frequently the "healthy path" generated images of ENCOURAGEMENT OF PRACTICE AND


    people, activity, and interesting sights and sounds. ACTIVE EMPLOYMENT OF COPING
    The "sickness path" was usually dark, dreary, and STRATEGIES
    isolated. While in trance, patients were encouraged
    to attend to the characteristic features of the healthy In addition to incorporation in the patient's
    road as a way of obtaining cues for restoration schedule of a time period each day for relaxing and
    —including people or activities they may have enjoying pleasant images following self-induction
    forgotten or neglected during their illness. of an hypnotic trance state, patients were
    encouraged to make active use of coping strategies
    DETERMINATION OF SIGNALS OR CUES during periods of pain or when they needed an
    extra boost to accomplish a difficult task. They
    ASSOCIATED WITH ONSET OF SEVERE
    were encouraged to view novel or difficult tasks,
    PAIN e.g., a new exercise-activity program or taking a
    Patients were encouraged to recall, while in plane trip, in a stepwise fashion and to use
    trance, the feelings and thoughts associated with trance-induced coping strategies and images as
    pain onset and disability behaviors. For one, it was means of simplifying complex tasks and
    a feeling of cramping and burning in the back; for reinforcing successful performance of each step.
    another, it was a dull throbbing in the head. Patients Although the approach described here is
    were given the suggestion that such signals could structurally very similar to techniques developed
    be reinterpreted as reminders or cues for use of a by self-control theorists and cognitive behavior
    coping strategy, e.g., pleasant imaging, deep modifiers (Meichen-baum, 1971; Turk, 1980), the
    breathing, muscle relaxation, instead of producing emphasis on assisting the patient via the hypnotic
    the usual cycle of self-depreciatory thought environment to discover appropriate coping
    patterns and disability behaviors. Thus an effort strategies is different. For example, "Imagine
    was made to establish novel signal values for pain walking down the healthy path as you begin to
    stimuli. Patients were given the following walk the mile of prescribed exercise." "Focus on
    suggestion: the pleasant and interesting sensation of air rushing
    past your limbs as you stand up, leave the house,
    You are starting to experience an episode of pain. and take your daily walk." Indeed, the patient
    Be very attentive to any beginning clues that pain is actively participates in finding his own solutions.
    coming. Some of you may feel a burning, others may
    feel cold, others a throbbing sensation. Imagine that
    your pain clues are changing to interesting, even
    pleasant, sensations. The burning becomes the
    warmth from a comforting fire; the cold becomes a
    refreshing breeze on a hot summer's day; the throb- Pain Strategies by
    bing slows as your breathing becomes slow and Hypnotizability Level
    regular and you imagine the ocean waves gently
    ebbing, and flowing on the shore. Now, as you
    become more comfortable and relaxed, no longer David Spiegel, M.D., and
    concerned with your pain, you have time to use any Herbert Spiegel, M.D.
    of the approaches you have learned in the group. Stanford, California, and New York, New York
    You may wish to enjoy your special scene or allow
    your image of healing to do its work. Others may
    just want to enjoy deep regular breathing and deeper Instructions for pain control differ depending
    and deeper levels of relaxation and comfort. Take upon the hypnotizability of the subject. High
    your time and enjoy the experience. You will be able hypnotizables are given instructions to use
    to clearly recall this exercise and use it regularly self-hypnosis to simply make the painful or
    whenever you notice any beginning clues of pain. affected area numb, or to imagine themselves
    68 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    floating above their body or even getting up and know . . . that you have all the protection you need .
    walking to another room while they are in pain. . . that if your red light goes on . . . you can cool it
    Mid-range subjects are instructed to experiment down.
    with changing temperature of the affected body
    part, making it warm or cold by imagining that they
    are in a warm bath or rolling in snow, for example.
    Or, they may imagine that they are in the dentist's Splinting Technique for
    office receiving a shot of novocaine and that this Pain Control
    numbness which they first experienced in the
    mouth can now be spread with their hand to the Charles B. Mutter, M.D. Miami, Florida
    affected part of the body.
    Low hypnotizable subjects are encouraged to use INDICATION
    distraction techniques, focusing on competing
    sensations elsewhere in their body, for example, This technique is used to protect patients with
    rubbing their fingertips together. All of these use chronic pain from overexerting or hurting
    the hypnotic state to focus on some competing themselves. It follows techniques given for pain
    sensation or image which involves teaching them to control with patients who have chronic
    filter the hurt out of the pain rather than fighting the musculoskeletal disorders. These suggestions are
    pain, at the same time producing a sense of floating used when the patient is in hypnosis.
    relaxation.
    SUGGESTIONS
    Your unconscious mind has a sacred trust to
    Reinterpreting Pain as protect your body. It knows the capacity of every
    cell, every organ, every system . . . and it will
    Protection protect you by causing you to turn and twist or
    bend only within your physical capacity .. . and not
    Charles B. Mutter, M.D. Miami, beyond ... so that when you attain comfort . . . you
    Florida can move and keep that comfort for longer periods
    of time. As your body becomes stronger, your mind
    [Various metaphors may be used with a patient will then allow you to turn, twist, and bend to a
    in hypnosis to reinterpret pain as a protective greater degree . . . but only within those limits ... so
    mechanism rather than a debilitating one. The that when you gain comfort, you need not fear
    following metaphor is used while the patient is in reinjuring yourself. Should you have any dis-
    hypnosis]. comfort, it is merely your body protecting you ... by
    When you drive a car and it overheats, a red light giving you a signal that you have gone beyond
    signal goes on the dashboard . . . that signal tells those limits.
    you to pull the car over . . . to check the fan belt, the
    water pump, or radiator . . . because you know that
    if you continue to drive the car when it is hot, you
    can damage the motor. It is good to know that your Erickson's Interspersal
    car has a protective signal so that you know when
    to . . . cool it down . . . to avoid further damage.
    Technique for Pain
    Think of your body as your car . . . that gets you
    through a lifetime . . . and it is good to Particularly in cases of resistance and when he
    did not know a patient well, Milton Erickson would
    "seed" ideas through interspersing words
    HYPNOSIS IN PAIN MANAGEMENT 69

    or phrases within the context of a story or discussion. you can listen to me, Joe, so I will keep on talking and
    These embedded suggestions were typically set off by you can keep on listening, wondering, just wondering
    the use of a slightly different voice tone or a very brief what you can really learn, and here is your pencil and
    your pad, but speaking of the tomato plant, it grows so
    pause.
    slowly. You cannot see it grow, you cannot hear it grow
    Erickson (1966) masterfully used embedded [suggestions for negative hallucinations], but grow it
    suggestions in treating the cancer pain of a patient named does —the first little leaflike things on the stalk, the fine
    "Joe." Joe was a retired farmer who had turned florist. little hairs on the stem, those hairs are on the leaves, too,
    Facial cancer had resulted in the loss of much of his face like the cilia on the roots, they must make the tomato
    and neck due to surgery, ulceration, maceration and ne- plant feel very good, very comfortable if you can think of
    crosis. He experienced intolerable pain for which a plant as feeling, and then you can't see it growing, you
    can't feel it growing, but another leaf appears on that little
    medications were not very effective. A relative was
    tomato stalk and then another. Maybe, and this is talking
    urgently requesting that hypnosis be used, but Joe like a child, maybe the tomato plant does feel
    disliked even the mention of the word hypnosis. The comfortable and peaceful as it grows. Each day it grows
    patient was unable to speak and could only communicate and grows and grows. it's so comfortable, Joe, to watch a
    through writing. We will now pick up on Erickson's plant grow and not see its growth, not feel it, but just
    account. know that all is getting better for that little tomato plant
    that is adding yet another leaf and still another and a
    Despite the author's unfavorable view of possibilities branch, and it is growing comfortably in all directions.
    there was one thing of which he could be confident. He
    [Much of the above by this time had been repeated many
    could keep his doubts to himself and he could let Joe
    times, sometimes just phrases, sometimes sentences.
    know by manner, tone of voice, by everything said that
    Care was taken to vary the wording and also to repeat the
    the author was genuinely interested in him, was
    hypnotic suggestions. Quite some time after the author
    genuinely desirous of helping him. . . . The author began:
    had begun, Joe's wife came tiptoeing into the room
    Joe, I would like to talk to you. 1 know you are a carrying a sheet of paper on which was written the
    florist, that you grow flowers, and I grew up on a farm in question, "When are you going to start the hypnosis?"
    Wisconsin and 1 liked growing flowers. I still do. So I The author failed to cooperate with her by looking at the
    would like to have you take a seat in that easy chair as I paper and it was necessary for her to thrust the sheet of
    talk to you. I'm going to say a lot of things to you, but it paper in front of the author and therefore in front of Joe.
    won't be about flowers because you know more than I do The author was continuing his description of the tomato
    about flowers. That isn't what you want. [The reader will plant uninterruptedly, and Joe's wife, as she looked at
    note that italics will be used to denote interspersed Joe, saw that he was not seeing her, did not know that she
    hypnotic suggestions which may be syllables, words, was there, that he was in a somnambulistic trance. She
    phrases, or sentences uttered with a slightly different withdrew at once]. And soon the tomato plant will have a
    intonation.] Now as I talk, and I can do so comfortably, I bud form somewhere, on one branch or another, but it
    wish that you will listen to me comfortably as I talk about makes no difference because all the branches, the whole
    a tomato plant. That is an odd thing to talk about. It tomato plant will soon have those nice little buds —I
    makes one curious. Why talk about a tomato plant? One wonder if the tomato plant can, Joe, feel really feel a kind
    puts a tomato seed in the ground. One can feel hope that it of comfort. You know, Joe, a plant is a wonderful thing,
    will grow into a tomato plant that will bring satisfaction and it is so nice, so pleasing just to be able to think about
    by the fruit it has. The seed soaks up water, not very much a plant as if it were a man. Would such a plant have nice
    difficulty in doing that because of the rains that bring feelings, a sense of comfort as the tiny little tomatoes
    peace and comfort and the joy of growing to flowers and begin to form, so tiny, yet so full of promise to give you
    tomatoes. That little seed, Joe, slowly swells, sends out a the desire to eat a luscious tomato, sun-ripened, it's so
    little rootlet with cilia on it. Now you may not know what nice to have food in one's stomach, that wonderful
    cilia are, but cilia are things that work to help the tomato feeling a child, a thirsty child, has and can want a drink,
    seek grow, to push up above the ground as a sprouting Joe, is that the way
    plant, and
    70 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    the tomato plant feels when the rain falls and washes You know, Joe, I could talk to you some more about
    everything so that all feels well. [Pause.] You know, Joe, a the tomato plant and if I did you would probably go to
    tomato plant just flourishes each day just a day at a time. sleep, in fact, a good sound sleep. [This opening
    I like to think the tomato plant canknow the fullness of statement has every earmark of being no more than a
    comfort each day. You know, Joe, just one day at a time casual commonplace utterance. If the patient responds
    for the tomato plant. That's the way for all tomato plants. hypnotically, as Joe promptly did, all is well. If the
    [Joe suddenly came out of the trance, appeared disori- patient does not respond, all you have said was just a
    ented, hopped upon the bed, and waved his arms; his commonplace remark, not at all noteworthy. Had Joe not
    behavior was highly suggestive of the sudden surges of gone into a trance immediately, there could have been a
    toxicity one sees in patients who have reacted variation such as: "But instead, let's talk about the tomato
    unfavorably to barbiturates. Joe did not seem to hear or flower. You have seen movies of flowers slowly, slowly
    see the author until he hopped off the bed and walked opening, giving one a sense of peace, a sense of comfort
    toward the author. A firm grip was taken on Joe's arm and as you watch the unfolding. So beautiful, so restful to
    then immediately loosened. The nurse was summoned. watch. One can feel such infinite comfort watching such a
    She mopped perspiration from his forehead, changed his movie."] (p. 207)
    surgical dressings, and gave him, by tube, some ice
    water. Joe then let the author lead him back to his chair.
    After a pretense by the author of being curious about
    Joe's forearm, Joe seized his pencil and paper and wrote, Joe's response was excellent and during the following
    "Talk, talk."] Oh, yes, Joe, I grew up on a farm, I think a
    month he gained weight and strength. Only rarely did he
    tomato seed is a wonderful thing; think, Joe, think in that
    experience enough pain to need aspirin or demerol. A
    little seed there does sleep so restfully, so comfortably a
    beautiful plant yet to be grown that will bear such month later, Erickson visited again and after much casual
    interesting leaves and branches. The leaves, the branches conversation, "Finally the measure was employed of
    look so beautiful, that beautiful rich color, you can really reminiscing about 'our visit last Oct ob er. ' Joe did not
    feel happy looking at a tomato seed, thinking about the realize how easily this visit could be pleasantly vivified
    wonderful plant it contains asleep, resting, comfortable, for him by such a simple statement as, 'I talked about a
    Joe. I'm soon going to leave for lunch and I'll be back and tomato plant then, and it almost seems as if I could be
    I will talk some more. (pp. 205-206) talking about a tomato plant right now. It is so enjoyable
    to talk about a seed, a plant"' (p. 208). As a result of these
    two extended sessions, Joe lived comfortably until his
    death over three months after the first contact.
    Erickson (1966) indicated that despite his "absurdly
    amateurish rhapsody" about a tomato plant that Joe had One would be incorrect to assume that Erickson's
    an intense desire for comfort and to be free from pain. primary therapeutic method was the use of interspersed
    This meant that Joe "would have a compelling need to try suggestions within metaphors. Close long-term
    to find something of value to him in the author's colleagues have estimated that not more than 20% of
    babbling" (p. 207) which could be received without his Erickson's work consisted of the use of metaphors
    realizing it. "Nor was the reinduction of the trance (Hammond, 1984, 1988b). Erickson flexibly used both
    difficult, achieved by two brief phrases, 'think, Joe, think' very direct and very indirect suggestions, depending on
    and 'sleep so restfully, so comfortably' imbedded in a the clinical situation. However, the clinician should be
    rather meaningless sequence of ideas" (p. 207). Joe was aware that the patient's unconscious mind has the
    impatient and anxious to resume the talk after lunch. capacity to perceive meaningful suggestions offered in
    "When it was suggested that he cease walking around seemingly casual conversation or metaphoric stories.
    and sit in the chair used earlier, he did so readily and Metaphoric communication offers us one more avenue
    looked expectantly at the author. for therapeutic intervention.
    HYPNOSIS IN PAIN MANAGEMENT 71

    The Setting Sun Pain Metaphor METAPHOR


    Alexander A. Levitan, M.D. New I remember the first time that I ever ate Mexican
    Brighton, Minnesota food. I ate chili stew at Isleta Indian Pueblo in New
    Mexico. It contained so much red chili, that the
    [This metaphor is particularly indicated when broth of the stew was bright red. My nose started
    the patient has described the pain as a flaming red running, my eyes watered, and my mouth kept
    sphere.] hurting and kept burning, no matter how much cold
    See yourself sitting on a tropical beach at sunset. water I drank. I couldn't imagine how anyone could
    Notice the bright red sun as it descends on the far eat such hot chili. I was almost unaware of the
    horizon. See the colors begin to change from taste, because the pain was so great.
    orange to crimson, and then a deep, dark But I spent the next year and a half living in New
    red-orange. Notice that as the sun approaches the Mexico. And I'm not sure exactly when, or how,
    water, there actually seems to be two suns, one in but my body changed and adapted. Or perhaps in
    the sky and one in the water. See the sun gradually part it was my mind that changed. Because, before
    sink into the ocean. See the colors change from red long, that sensation of the hot chili in my mouth
    to purple and then to blue. Notice the magical seemed different. Almost as if somehow, my
    stillness that pervades everything just at sunset mouth had developed a callous. Somehow my
    when the ocean is as smooth as glass and sounds mouth adapted, so there was no longer pain, and I
    seem to travel forever. Enjoy that delicious feeling could just enjoy the taste. I had in a sense become
    of tranquility. Realize that that tranquility is avail- callous to the pain, and yet remained pleasantly
    able to you whenever you need it, on a moment's sensitive to the delicious flavor of the hot tamales
    notice, merely by giving yourself your own or enchiladas or stew.
    personal signal to relax! Perhaps you might enjoy And you really should be willing to allow the
    letting your finger and thumb come together to nerves in the painful part of your body, to adapt,
    make a magic "O.K." sign and that can be your and develop callouses, just as I did in order to eat
    signal to experience immediate relaxation chili and Mexican food.
    whenever you choose to employ it.

    Metaphor of Callous Formation


    Mexican Food: Metaphor of the
    D. Corydon Hammond, Ph.D. Salt Lake
    Body Adapting to Pain City, Utah

    D. Corydon Hammond, Ph.D.


    It's interesting every spring when I begin to play
    Salt Lake City, Utah
    golf again. After a long winter of not playing golf,
    in about early April I go up to the driving range and
    INDICATIONS hit a bucket of balls. Before I'm done with a large
    bucket of balls, my hands are getting sore. And by
    This metaphor and the one that follows were the time I've hit a large bucket of balls, I have a few
    designed for use with chronic pain patients. They blisters on my hands. If the weather is rainy and
    were inspired by a metaphor by Milton Erickson cool the next week, it may be two weeks before I go
    (1983, p. 112) where he used a conceptualization back to the driving range to practice. And if I hit a
    that may be useful for patients, despite not being large bucket of balls again, I'll develop blisters on
    medically sound, of developing a callousness to the my hands again.
    pain.
    72 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    But if I go to the driving range for a short time on WARMTH AND METAPHOR OF
    Monday afternoon, and share a small bucket of MELTING BUTTER OR CREME
    balls with my son, and then go back on Wednesday
    and share another small bucket, and again for a You can change the sensation of discomfort to
    short time on Friday and Saturday, blisters don't warmth [or cold if appropriate], and feel a warm
    develop. When I gradually increase what 1 do, comfortable tingling in your . . . [area of pain]. Let
    callouses gradually form. My body gradually the sun shine on your [area of pain] and feel how
    adjusts. And before long I can play nine holes of the warmth penetrates the skin, the subcutaneous
    golf, and my hands are only a little sore, and I don't tissues, the muscles and all the way down to your
    have any blisters. And then before long, I can play bones. You can visualize a pad of butter or some
    eighteen holes of golf, comfortably, because my soothing creme on your skin, and as it melts, so will
    body has adjusted, and callouses have formed. your discomfort melt away. So good, so relaxing,
    so comforting. You can be very proud of your
    And in this same way, you can gradually allow success and your ability to change your sensations
    callouses to form in your pain nerves, allowing at any time you wish, and to any degree you desire.
    your body to adapt gradually. And if And when you use self-hypnosis several times a
    I had a painful __________ , I'd be willing to day, you will notice that with practice you will be
    spend just as much time allowing callouses to able to go deeper, and it will take less and less time
    develop around those nerves, as I do allowing my to change and control your sensations. During the
    hands and fingers to develop callouses. rest of the day you need not pay any attention to . . .
    [area of pain]. Your body knows how to make you
    breathe, and your heart to pump your blood around
    [etc.] completely, without your help. Pay all your
    attention to your work, your play, and your sur-
    Suggestions for Patients with roundings. You have learned a new skill and you
    Chronic Pain can use it to see and hear and taste and touch in a
    new way. In a way which will be very pleasing to
    Lillian E. Fredericks, M.D. Palm you.
    Beach, Florida
    When you walk through the woods, you will
    come to a fork in the road, and you can choose
    [After appropriate induction of trance and deep whether you want to go to the right or the left. Up to
    relaxation, I use behavior modification with now you went unconsciously to the left. You did
    positive suggestions]: not know how to choose. Now you have the skill
    You are so deeply relaxed and comfortable right and the power to choose the right road, the road of
    now that you will be able to follow my suggestions comfort and to a productive and happy life.
    with ease. You know with the use of hypnosis that
    you can alter perception, experience and memory,
    and you can regain control over your sensations.
    With this newly learned tool, you will be able to Pain Reduction
    alter the course of events. Just like the person
    Beata Jencks, Ph.D.
    steering a sailboat can turn the rudder in such a way
    that the wind catches the sails, and the boat turns Murray, Utah
    around and goes the opposite direction; so are you
    steering your boat of life and you can turn around INTRODUCTION
    and go the opposite direction. You can be relaxed, The best approach for coping with pain is first to
    comfortable, and in control of your sensations. try to analyze its peculiar characteris-
    HYPNOSIS IN PAIN MANAGEMENT 73

    tics, differentiating it from other possible pains; out by concentrating exclusively on relaxing the
    then to decide what might change or alleviate it; body during exhalations in places which are not
    and finally to experiment with appropriate imagery, affected by the cramp. This has proven very
    relaxation, diversion, dissociation, or physical helpful for getting rid of cramps without changing
    treatments like heat, cold, or massage. the position during yoga practice and for
    continuing swimming with a cramp. Lymph
    ALLEVIATION OF DIVERSE PAINS drainage massage is good for prevention.

    It must be remembered that all the following LOCAL WARMTH Warm a hand, for instance on the
    suggestions work with some, but not with others. abdomen or chest, and then put it on the painful
    Different exercises should be tried, and those which area. Imagine during inhalations inhaling the
    bring relief should be conscientiously practiced. warmth into the painful area and pain streaming
    out through it and away from it during exhalations.
    DULL ACHES. These have been relieved by imag-
    ining during exhalations a hot water bottle which COOLNESS. Coolness or warmth can be attributes of
    warms and relaxes, or by treating the aching area one kind of pain and may be remedies for another
    with warm water or alcohol, or even by imagining kind. Usually the opposite is required for relief.
    receiving a painkiller shot into it. Thinking of Experiment while remembering that coolness,
    softening the area or feeling the pain "evaporate" rigidity, and tensions are enhanced by inhalations,
    during exhalations also proved helpful. the opposites by exhalations.

    SHARP PAIN AND STABBING PAIN. These have been ANESTHETIC Imagining strongly having a body part
    partially relieved by imagining that the painful area immersed in ice water or snow, or having been
    was icy and very rigid, or by imagining that it was injected with a numbness-producing anesthetic,
    very soft, like foam rubber, so that the stabbing met can evoke an effective anesthesia in dentistry and
    with no resistance. This has not worked for otherwise.
    stabbing pains so strong that they halted the breath.
    ARTHRITIC PAINS AND STIFFNESS. Arthritic pains
    BURNING PAIN AND PAINS FROM BURNS. T h e s e Can can be eased by imagining a warm shower over the
    be relieved by thinking coolness and soothing shoulders and neck during exhalations, or a warm
    lotions being applied during inhalations, and blanket over the knees. Cupping a painful area
    relaxation during exhalations. However, thinking with a warm hand increases the effect. Imagine
    coolness for burnt soles of feet may make it further that the afflicted area loosens up and
    possible for the burn victim to walk, but the tissues becomes soft and warm during exhalations.
    will suffer additional damage. Common sense must Before any movement, imagine moving the
    always be a guiding factor for deciding whether body parts involved in the movement, be it an arm
    pain reduction is beneficial or not. for reaching or the legs for walking. Limber up the
    body in the imagination before getting up in the
    CRAMPS. These can be handled in at least three morning. Invigorate the limbs during inhalations
    ways: relax as much as possible, tense as much as while making imagined movements and relax
    possible, or relax and tense alternately. Time the during exhalations. Only then attempt to move in
    tensing with inhalations and the relaxing with reality. Move then only during exhalations, since
    this avoids unnecessary body tensions and
    exhalations. A cramp can also be waited
    increases limberness. Inhale between movements.
    Hold the breath
    74 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    during movements only if the pain is excruciating. cially with conditions such as chest and abdominal
    Lymph drainage massage is also helpful before pain, prior to providing hypnotherapy. {Ed.)
    getting out of bed. Also, get up from sitting and Start the relaxation at the throat. Exhale a few
    climb stairs during the exhalation phase. Halt times slowly and deeply and imagine making the
    during inhalations. throat wide and open. Relax and think during
    For bending, as for instance for tying shoelaces, exhalations "soft, gentle, wide, open," and so on,
    bend as far as possible during one long exhalation. with respect to places inside the throat, chest, and
    Wait and relax during several breathing cycles abdomen. Do any or all of the following exercises
    while the body adjusts to the position it reached. according to need.
    Then stretch a little further during another long
    exhalation. By thus bending stepwise, one may OPENING FLOWER Feel whether and where there is
    extend the reach a great deal. narrowness or tension in the throat. Imagine a
    Anticipation of relief is also helpful. If a hot bath flower bud opening in it, as in a time lapse film.
    or a hot whirlpool can ameliorate the pain, imagine Repeat this during two or three exhalations. Feel
    going to the hot water. Imagine the anticipation what happens to that throat region during the next
    very vividly during exhalations. Then imagine two or three exhalations. Is there a widening?
    being in the hot water. Softening? Moisture flowing?
    HEADACHES. Distinguish the features of the INVERTED FUNNEL. Imagine an inverted funnel,
    headache. It can be in different places and have narrow above, wide and open below. Imagine this
    different qualities. It may be general, frontal, or funnel starting at the mouth-throat junction. Feel
    one-sided, pressing, stabbing, nagging, dull, or during exhalations a widening, softening, and
    pounding. Next, find body areas which are tense. opening up toward the lower, wide open end of the
    Tension headaches can be due to tensions in the funnel. Ascertain the place down to which the
    head itself or in the neck and shoulders, the spine, throat or chest opened up. Then start the narrow top
    the small of the back, or even the legs. Do of the funnel about an inch or two above that place,
    appropriate relaxation exercises and experiment to and repeat the widening, softening, and opening up
    see if relaxation of certain body areas will reduce during exhalations. Imagine that some liquid of
    the headache. pleasant temperature and consistency streams
    For pressure headaches try the following. If the down the funnel. Relax in this manner the throat,
    pain feels like a "board before the forehead," think chest, and abdominal cavity.
    of the area softening and becoming relaxed or
    warm during exhalations. During inhalations think
    GUIDE ROPE. Imagine the exhalation to be a
    that the bony walls of the skull expand or that
    coolness streams into the head. The thought of guide rope along which you can glide, slide, or feel
    opening the head at the crown to "let fresh air in" your way down into the chest cavity. Repeat this
    also allayed or ameliorated pressure headaches. for about three consecutive exhalations. Relax
    Experiment whether this works better for you while going down. Continue down into the
    during exhalation or inhalation. It differs. Also abdominal cavity along the guide rope of the
    experiment whether coolness or warmth is better to exhalation.
    ameliorate headaches.
    ELEVATOR Imagine riding down an elevator within
    yourself from the throat into the chest during
    exhalation. Make a stop at the place the elevator
    RELIEVING DISCOMFORT IN THE has reached at the end of the exhalation. Allow the
    CHEST AND ABDOMINAL AREA inhalation to stream in passively. Then descend
    further during the next exhalation. Repeat,
    The nonmedical clinician is reminded to always starting and stopping as
    obtain careful medical evaluation, espe-
    HYPNOSISINPAIN MANAGEMENT 75

    necessary, and go down through the chest into the a. "See yourself standing in front of a
    abdomen. full-length mirror. See tiny [colored]
    lights in different parts of your body.
    KNOT DISSOLVES. Remember the feeling of a The colors represent the feelings of those
    "knot in the stomach," or actually create it by parts. When you can see the total pic
    holding the breath and tensing inside. Then gently ture, your yes finger will lift to let me
    release the tenseness, or, for that matter, tenseness know."
    which was there without creating it, during
    b. Scan the body, getting the color of each
    successive exhalations by thinking "the knot
    light and what that color represents to
    dissolves." If no relief is felt, check if the jaw or
    the patient. The process starts with un
    base of the tongue are tense. Such tension is often
    important parts of the body, ending with
    related to stomach discomfort. Release these
    exploration of the organ or extremity
    tensions.
    suspected of having problems. For ex
    ample, with rheumatoid arthritis, in
    SETTING SUN. Internal tensions can be reduced which multiple joints are involved but
    in the chest as well as in the upper and lower some are more painful than others, one
    abdominal area by thinking of a setting sun during might proceed as follows, selecting the
    exhalations. Feel the gentle warmth, the red glow, least painful for the first therapeutic
    the slow sinking, and allow the "inner space" to approach. Confidence builds with each
    expand like a horizon, while the body walls seem to success from least to most painful.
    soften and expand elastically.
    "Look at the entire image of yourself
    and let your unconscious mind select the
    RELAXING THE LOWER ABDOMEN. Repeat first the joint you know to be the least inflamed,
    widening of the chest and abdominal cavity. Then the least painful. When you know what it
    observe passively where discomfort makes itself is, your yes finger will lift to tell me
    known. Give such places a gentle, but deep finger which joint and what color."
    pressure massage during deep exhalations. Wait
    passively, but attentively, until the body reacts. The 2. Therapeutic Reframing
    abdomen usually "makes known" its reaction by air a. "Let your inner mind shift back to a time
    movements and pressure changes. Wait passively when there was a light that represents
    and then massage again where necessary. comfort and flexibility. When you are
    there, your yes finger will lift. [Wait for
    the signal.] Now come forward to the
    RELIEF OF HEARTBURN. Think "cool" during inha- first moment that color (light) was put
    lations and "calm and relaxed" during exhalations, there in place of the comfortable light.
    or imagine drinking soothing cool milk with the When your yes finger lifts, please tell me
    thought of coolness during inhalations. how old you are and what is happening."
    b. "Now, is there any good reason why you
    should continue with pain in that joint?"
    "Body Lights" Approach to 3. Ratifying Therapeutic Gain
    Ameliorating Pain and a. "Now that you know what has been
    happening, is your inner mind willing to
    Inflammation (Arthritis) let you turn off that unconscious pain
    Ernest L. Rossi, Ph.D., and and continue the process of healing?" [If
    David B. Cheek, M.D. the answer is no, it will be necessary to
    orient to whatever factor is standing in
    Malibu, California, and Santa Barbara, California
    the way, as in Step 2.]
    1. Accessing and Transducing Symptoms into b. "Go forward now to the time when you
    "Lights" will not only be free of the pain in that
    joint, but will have turned off the pain in
    76 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    all the joints that have been troubling SUGGESTIONS FOR PAIN CONTROL
    you —a time when you are no longer
    afraid of pain returning, when you are You are peaceful, calm, relaxing deeper and
    really well in every respect. When you deeper, deeper and deeper, deeper and deeper. As I
    are there, your yes finger will lift and talk to you, you continue to go into an even deeper
    you will see a month, day, and year, as state of relaxation. In the past you have had feelings
    though they were written on a black- of anxiety, doubts, fear, panic, and the sense of loss
    board." [This is done as a measure of the of control arises from flashbacks of reliving aspects
    patient's confidence level.] of the shingles or from other past experiences
    which have evoked those kinds of feelings. All of
    these feelings and behaviors have interfered with
    your growth, sense of oneness, and natural healing
    processes and you acknowledging your uniqueness
    Suggestions with Postherpetic and goodness. If you experience any of those
    Neuralgia ("Shingles") negative feelings as we're talking, either you can
    allow yourself to choose to look at what is causing
    Diane Roberts Stoler, Ed.D. those feelings at that time when you experience
    Boxford, Massachusetts them, or you can imagine putting them into my
    locked file cabinet in my office. They will remain
    in the file cabinet in my office where they will be
    INTRODUCTION stored. These feelings will not surface and cannot
    be touched unless you choose to retrieve them to
    This script was developed for an 86-year-old work on them yourself or in therapy, to help you
    man who had a severe case of shingles on his scalp learn to live and enjoy life. You will always know
    which continued down to his left eye. He had been where they are because you have the control and
    on pain medication for over six months with no you have chosen to place them there. By knowing
    relief and the physician was concerned about this, if a flashback occurs, you have a way of
    addiction and side effects of the drugs. He loved having power to control those feelings and you no
    the ocean and was an ex-auto mechanic. The longer need to stuff them inside, but rather have a
    suggestions were given following induction and way of dealing with them to resolve them and help
    extensive deepening techniques. you to have greater control over your own life.

    As you allow yourself to go deeper and deeper,


    SUGGESTIONS FOR SELF-HYPNOSIS you are realizing, perhaps for the first time, that you
    can allow yourself to take control over your body
    [The following suggestions for self-hypnosis through your mind. You can become more relaxed
    were given during the induction-deepening pro- and with this relaxation your body's healing
    cess.] Each morning upon rising you can permit mechanism can function appropriately and
    yourself to allow your body to become relaxed and normally. And as your body responds in this deeply
    in balance, then you will permit yourself to take relaxed way, you are becoming aware that you can
    one long deep breath in through your nose and out permit yourself, when needed, to take greater
    through your mouth while using the thumb and control over your body than you ever thought
    index technique. This will be a signal to go into the possible. You are acquiring confidence in yourself.
    deepest level of hypnosis whereby you will feel You feel a realization growing within you of the
    your strength and confidence and knowledge that fact that you have the ability to make changes, and
    you can control the pain from the shingles and have these
    the ability to heal the shingles all together.
    HYPNOSIS IN PAIN MANAGEMENT 77

    changes make your body healthier, and you can With your relaxation and concentration, which
    assist your body's normal healing functions with activates your natural healing process, you will
    your relaxation and concentration. allow yourself a sense of strength and confidence
    You can allow yourself to activate the antiviral which will fill your body. You have the ability to
    mechanism via the Mystery Oil, to attack and kill cleanse your body and help heal it, and with this
    all herpes virus, along with activating your white knowledge comes a sense of calm, peacefulness
    blood cells to attack and kill all bacteria on the and serenity. You permit yourself to enjoy the
    turtle's back. The warmth of the sun will allow the sounds of the birds and you become even more
    scabs to heal, and with this awareness you can relaxed. As you listen to the sounds of the gulls and
    permit yourself to change the various dials on the the sound of the ocean, you allow yourself a sense
    alt meters to help you heal and to adjust the level of of joy and happiness which fills your body, and
    discomfort related to the pain in the various parts of you can allow yourself to become even more
    your face and head. You can allow yourself to relaxed.
    adjust these various meters so that you may achieve
    Relaxation will give you that peace of mind and
    a comfortable level and by putting your thumb and
    inner tranquility which will enable you to cope
    index fingers together. This will be a signal to go
    with the tensions and stresses of everyday living.
    into a deeply relaxed state, a deeply relaxed state.
    You will be able to tolerate the persons, places or
    As long as there are any signs or sensations of things that used to disturb you and annoy you. You
    the pain near your eye, face or head you can allow will be there for you in all circumstances.
    yourself to adjust the various dials to produce a No one can bother you here. You have no cares
    comfortable level for yourself, whereby you will or worries. You feel safe, secure, calm, peaceful
    feel pressure and no discomfort. And you will be and relaxed. There is a sense of peace with the
    aware of the causes and reason for the discomfort, environment around you. This spot is peaceful and
    but you need not feel a greater sensation than serene. You feel calm, peaceful, confident. This
    discomfort unless you do injury to that area, spot is a safe, secure spot. No one can bother you
    whereby you will feel pain. here. You are peaceful, calm, relaxed; you go
    As you turn the dial on the alt meter you will deeper and deeper, deeper and deeper and as I talk
    produce the feeling of pressure and by adjusting the to you. You continue to go into an even deeper
    volume control you can adjust the level of intensity state of relaxation. Everything but my voice is
    from sharp, to dull, to total numbness. You will be becoming remote now, quite remote; nothing else
    able at all times to adjust and control the level of but my voice seems important, nothing else is im-
    sensation to obtain the appropriate level for you to portant, nothing else but my voice.
    maintain comfort, whereby you feel sensation but
    no pain, pressure but no pain.
    As the night settles in and the sun is setting in the
    west, your ability to take greater control of your life Suggestions to Reduce Pain
    and the discomfort will increase, day by day, as you
    learn to concentrate your mind and relax more and Following Hemorrhoidectomies
    more. If there is a psychological and/or physical
    reason for the pain you have been experiencing, this Ernest W. Werbel, M.D. San
    knowledge will come up through images, thoughts Luis Obispo, California
    and dreams. With this information, you will be able
    to share it either with me or the necessary medical
    INTRODUCTION
    doctor.
    The following suggestions were used before
    surgery and were reinforced the day following
    78 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    surgery. Eight of eleven patients receiving hyp-


    nosis reported no pain post-surgically, while three Suggestions for Pain Control Don E.
    experienced moderate pain. In contrast, only two of
    Gibbons, Ph.D.
    eleven nonhypnotically treated patients reported no
    pain, four reported moderate pain, and five reported
    severe pain. Note Dr. Werbel's use of trance DIRECT SUGGESTIONS FOR
    ratification procedures along with the suggestions. ALLEVIATION WITH SIGNAL PAIN
    It is anticipated that when something like catalepsy,
    levi-tation, or glove anesthesia is used for After the trance has been concluded, you will
    find that your pain is almost completely gone.
    ratification, that the success rate will be greater.
    There will still be a little discomfort remaining, just
    (Ed.)
    to serve as a reminder for you to take it easy; and
    you will still continue to let up as much as you need
    to for the healing to proceed properly. But the extra
    SUGGESTIONS pain, which serves no useful purpose, is going to be
    completely taken away. And you are going to be
    You are now in a relaxed state. An individual greatly relieved at how much better you will feel.
    who is as relaxed as you are does not feel pain as
    acutely as a person who is tense. In fact,
    sometimes, he feels no pain at all. [Then one of the
    SUGGESTIONS FOR HEADACHES
    patient's hands is elevated. It usually remains in
    that position.] Please open your eyes and look at
    INTRODUCTION. I have had excellent results with
    your elevated hand and note how perfectly
    the following suggestions, which use vestigial
    motionless it remains, just as if you were a statue.
    remnants of the diving reflex to alleviate the
    Now close your eyes again. Your extremity
    discomfort of migraine and other stress-induced
    remains motionless because you relax so well that
    headaches. By slowing the heartbeat and
    your muscles are in equal tone and are not pulling
    decreasing blood pressure by means of this
    against each other. [I then request the patient to technique, circulatory congestion in the head may
    look again at his motionless uplifted hand to be alleviated and the headache symptoms gradually
    convince him thoroughly that he is in a trance.] cease. (Of course, suggestion also plays an
    You relax wonderfully well. You are an excellent important —and perhaps the most important—part
    subject. Therefore, there is no need for you to feel in enhancing the effectiveness of this underlying
    pain following surgery. I want you to remember physiological rationale.) [These suggestions will
    that there is no need for you to feel pain. You may undoubtedly be most effective for patients who are
    feel pressure. familiar with and enjoy skin diving. (Ed.)]
    [Dr. Werbel then demonstrated glove anes- The effect of the following suggestions may be
    thesia, after which he continued:] This shows that enhanced by requesting the subject to assume a
    you need have no pain following surgery. sitting position prior to the induction, and, as the
    Remember you need have no pain following "diving" suggestions are given, handing him a
    surgery. If you have any pain at all it should be cloth moistened in cool water to hold against his
    minimal. . . . When you have your first bowel face as he bends forward slightly and puts his head
    movement be relaxed just as you are now and you down.
    need feel no pain. Remember, when you move your
    bowels following surgery, be relaxed as you are
    SUGGESTIONS. Picture yourself now as a dolphin,
    now and your bowels may move just as easily and
    comfortably as they did prior to surgery. swimming lazily along just below the surface of the
    sea. Feel the water above you gently warming your
    back; and feel the cooler
    HYPNOSIS IN PAIN MANAGEMENT 79

    water beneath you, as you swim lazily along. Just that the subject is slowly rising back to the surface,
    let yourself continue to swim slowly along, followed by suggestions that the scene is fading
    concentrating on the images and the sensations and that the subject is becoming fully aware of
    which you feel as you continue to listen to my himself as a person once more, still in trance and
    voice, and soon you will be able to experience still retaining the feelings of relaxation,
    everything I describe to you just as if it were peacefulness, and well-being which were part of
    actually happening. his undersea experience. The trance may then be
    You think how refreshing it would be to dive terminated in the usual manner, together with
    down, all the way to the bottom. Let yourself begin suggestions that the subject will continue to feel
    to dive now, diving easily and gently, all the way peaceful and relaxed, with no further trace of
    down to the bottom. Feel the cooler currents against discomfort.
    your face as you angle your body toward the At the conclusion of the trance session, the
    bottom, and feel yourself beginning to adjust to the subject may be instructed to repeat the foregoing
    increasing depth and the pressure of the water imagery at the appropriate intervals by means of
    around you as you continue to descend. autosuggestion, either to ward off an oncoming
    Any previous discomfort you may have felt is headache or to alleviate one which has already
    fading away now, as you feel the cool, soothing begun. More responsive subjects should eventually
    currents rushing by as you sink deeper and deeper, be able to experience similar sensations merely by
    and your system continues to slow down in closing their eyes and silently repeating to
    response to the increasing pressure and cold. The themselves the word dive.
    water continues to grow even colder now, as you
    continue to sink, but your body adapts to it easily
    and comfortably. You continue to drift down and SUGGESTIONS FOR A PAINFUL
    down, sinking past seaweed forests and deep coral CONVALESCENCE
    canyons, sinking all the way down to the bottom,
    almost there. INTRODUCTION AND INDICATIONS. The
    following
    Now you find yourself drifting slowly along,
    suggestions may be helpful in assisting a subject to
    exploring the bottom of the sea. Just savor the
    get through a particularly stressful period, such as a
    experience for a few moments and enjoy the cool
    painful convalescence, which is not unduly
    freshness as you swim along.
    exacerbated by underlying personality conflicts or
    In just a short while, I'm going to return you to by various "secondary gain" factors. . . . These
    your normal sense of time and place; but after you suggestions may also be employed, together with
    return, this feeling of peace and well-being will directly suggested sleep ... to assist a seriously or
    remain with you, and all traces of your previous terminally ill patient in coping with intervals of
    headache will have vanished. Even after you have unusually severe discomfort. In the case of
    returned to your normal sense of time and place, terminal illness, however, such suggestions should
    you will continue to feel just as good as you do usually not be relied on to the extent that they may
    right now. So just continue to let yourself explore deny the patient sufficient time to accept and to
    this undersea world for a moment or two, come to terms with the fact of his own impending
    experiencing all the enjoyment and pleasure that death; and other patients who may learn to use such
    goes with it; and soon it will be time to return you techniques by means of autosuggestion should be
    to the environment from which you left. cautioned not to employ them to avoid having to
    cope with problems which ought to be dealt with
    COMMENTARY. After a moment or two has elapsed, instead of merely being endured, such as the
    suggestions may be given to the effect periodic drinking bouts of an alcoholic spouse.
    80 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    TIME DISTORTION SUGGESTIONS. As a result


    Of making your temples colder and colder and colder.
    what I am telling you now, your awareness of the It feels as though you were holding an ice cube
    passage of time is going to be changed, so that the against your temples. It feels just like your hand
    days (or hours) will just seem to be flying past, and feels when you hold a glass with your favorite drink
    you are going to be pleasantly surprised at how in it. Do it right now, and feel how it gets colder,
    swiftly they have gone. You will be able to carry and colder, and colder, it gets tingly and numb, and
    out all of your routine activities in the usual sometimes even anesthetic so you cannot feel it
    manner, for this will have no effect on the speed anymore."
    with which you do things; but just as a few minutes If the patient loves to take a bath: "You are now
    can seem like an hour at times, and an hour seem taking a bath, immersing yourself into this
    like only a few minutes, your perception of the wonderfully warm and soothing water. You feel
    passage of time is being changed now, so that every cozy and warm and comfortable all over. The only
    minute that passes is going to seem much, much part of your body outside of the water is your head.
    shorter than it actually is. As you turn the hot water faucet on to renew the
    water and make it even warmer, you notice that
    COMMENTARY. As with other techniques, it may be your temples are getting colder and colder and
    necessary to repeat the foregoing suggestions at colder. As you feel your body getting hotter, notice
    appropriate intervals (or to teach the subject to do your temples getting colder. A very good and
    so by means of autosuggestion) for them to remain comfortable feeling in your head. It becomes
    effective for the desired length of time. But is clearer, more lucid, and all the congestion
    should also be made clear to the subject that these disappears. The discomfort gradually drains out
    suggestions are only intended to be effective for a with the rest of the water in your tub, and you can
    limited period of time. This can most easily be just stay there and enjoy this comfortable feeling all
    accomplished by adding the following sentence over you.
    each time the suggestions are administered, [Never tell a patient, "You will just have to live
    whether by the subject himself or by another: with your pain." Subconsciously the patient will
    "These suggestions will be effective retain his/her pain because if there is no pain,
    only he/she is not alive.]
    until ------------- ,at which time your
    normal
    sense of the passage of time will be fully restored."
    Suggestions for time condensation may also be Suggestions with Migraine
    used in conjunction with suggestions for emotional J.A.D. Anderson, M. A. Basker, and R.
    enrichment as a means of counteracting unpleasant
    Dalton
    or negative affect by directly suggestion the
    London, England
    opposite sensations (Sacerdote, 1977).

    INTRODUCTION

    Hypnosis for Migraine Using hypnotherapy, Anderson, Basker and


    Dalton (1975) obtained complete remission with 10
    Lillian E. Fredericks, M.D. of 23 patients (in comparison with only three of 24
    Palm Beach, Florida patients on prochlorperazine). Patients were taught
    self-hypnosis. They were provided with a simple
    I dissociate my patients to a cold place (in the explanation of migraine both in and out of
    winter to go skiing or walking in the mountains in hypnosis, including an emphasis that migraines
    result from abnormally swollen blood vessels in the
    the snow, etc.). I suggest that "the icy wind and
    scalp. They
    snow is touching your forehead, and is
    HYPNOSIS IN PAIN MANAGEMENT 81

    were also asked to visualize the arteries in the head Suggestion for Symptom
    and neck. The following suggestions were given.
    Substitution
    SUGGESTIONS Gary R. Elkins, Ph.D.
    Temple, Texas
    Migraine is caused by . . . and always made
    worse by tension . . . thus making the arteries in the When you are ready to begin to resolve your
    head congested and large. I want you to visualize problems, it may be possible to let go of the tension
    the arteries in the head . . . picture them large and and pain. When you are ready, you can have some
    throbbing . . . now, as you relax and become less other symptom to replace the pain. The pain can
    tense . . . each day . . . your arteries become smaller fade and become less and less as you become more
    . . . smaller and smaller . . . more normal. The aware of another sensation that replaces it.
    arteries stay normal . . . and your head feels
    comfortable, (p. 51)

    The Progressive Anesthesia


    Diminution Rather Than Induction-Deepening Technique
    Elimination of Headache D. Corydon Hammond, Ph.D.
    Irving I. Secter, D.D.S., M.A. Salt Lake City, Utah
    Southfield, Michigan
    INDICATIONS AND INTRODUCTION
    [In accord with my findings on other comparable
    patients, I considered that permitting retention of a This method, a modification of Watkins (1986)
    small amount of the illness, with instruction to have procedure, may be valuable with medical, cancer
    it at times when it is least disturbing, could be an or burn patients who are experiencing considerable
    effective measure of therapy. Accordingly, after pain, as well as in hypnotic preparation for surgery.
    this patient appeared to be in a satisfactory trance, I It may be more confidently used when the
    told him to take a few minutes time and if he so practitioner has facilitated glove anesthesia in the
    desired he could go into a deeper state of relaxation patient previously. In a talented subject, it may be
    by breathing more slowly. I always give the patient used as the initial induction; in other cases,
    sufficient time to become as deeply relaxed as induction and deepening may precede the use of
    desired. When I believe this has been accom- this method. There are several other options in
    plished, I give the following suggestions]: using this technique. When a prior induction has
    been done and the anesthesia has spread through
    the entire body except the head, the patient may be
    Every time you are in bed ready to go to sleep, you given the following suggestions as part of his
    will get the feeling you are getting a headache; as
    training: "Would you like to have a pleasant,
    soon as you experience this feeling, you will breathe
    slowly, regularly, and deeply, as you are doing now; surprising experience? In a moment, I'm going to
    with each slow, regular, deep breath, the feeling that have you awaken from trance, but you will only
    you are getting a headache will begin to subside, and awaken from the neck up. Would that be all right?
    then leave you completely. You will then go into a So that in a moment, as I instruct you to, you will
    normal, natural, deep sleep; you will sleep the night only awaken from the neck up, and the rest of your
    through, and awaken refreshed at the correct, proper body will remain asleep in a deep trance. You will
    time, feeling very good, sound in body, sound in only awaken from the neck up." After
    mind.
    82 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    experiencing this for a minute or two, the patient is like feeling has spread all the way up to your
    instructed to close his/her eyes and go into an even elbow, your head can begin to nod again. [Pause]
    deeper state. The technique of having the patient's [Repetition of suggestion may be used occasionally
    body remain in trance while the patient awakens as needed.]
    may also be used with only one limb that is painful Would it be all right for that comfortable
    and which may also be made cataleptic. Watkins numbness to continue to spread? [After affirmative
    prefers to have each part of the body become rigid reply] All right. [Lightly stroking from the elbow to
    as it is anesthetized, removing only the rigidity the shoulder] Gradually that numbness and
    after the entire body is numb. immobility continues spreading upward, at its own
    pace and speed, through your elbow and into your
    upper arm. Flowing into your biceps, and your
    SUGGESTIONS triceps, and then it will flow into your deltoid
    muscle. So that soon, it begins to feel as if that arm
    is asleep, [pause] almost as if the arm is detached
    Please concentrate on your right hand, and as
    somehow, [pause] as though it's no longer a part of
    you do so, a feeling of heaviness will begin to
    you, but just resting motionless, there. When that
    develop. As you notice that feeling of heaviness,
    feeling has spread through the entire arm up to your
    please nod your head. [Pause] Good, and now as
    shoulder, your head can nod again. [Again,
    you keep focusing on that hand, and as I stroke it,
    following pauses, use repetition as needed. The
    you will begin to notice a numbness developing.
    anesthesia may then be transferred across the
    [Lightly stroking the one hand, and pausing until a
    shoulders and subsequently down the other arm,
    response is given.] Nod your head when you
    reinforced with light strokes. Then, without any
    become aware of the numbness starting to develop.
    further stroking (which could be construed as
    [Pause] Um hmm. And I'd like you to notice, with a
    having sexual connotations), the anesthesia and
    kind of sense of curiosity, how that numbness and
    sense of detachment are moved down through the
    anesthesia begin to spread all through your hand,
    rest of the body. Throughout this procedure, if it is
    through the fingers, the palm, the back of the hand,
    being used as the initial induction, observe the
    all through the entire hand. [Pause] Notice how that
    patient's eyelids and utilize any heaviness or
    numbness deepens more and more, and as it does
    blinking that is noted. Thus eye closure may be
    so, it's such a pleasant feeling that it feels as if it's
    facilitated at any time, or one may wait until the last
    really too much bother to move even a finger. That
    part of the procedure when the anesthesia spreads
    hand just feeling a kind of heavy, relaxed,
    to the head and face.]
    immobility, almost as if, it's going to sleep. Almost
    as if, it's beginning to sleep now, almost as though
    it's no longer a part of you. And as you're aware of Now feel that comfort, that still, quiet, rest and
    that, your head will nod again. [Pause] comfort spreading from your shoulders down,
    [pause] through your chest, [pause] through your
    Now as I stroke your forearm, the numbness back, [pause] A still, passive, comfort, spreading
    begins spreading into it too, as though something is into your stomach, [pause] your lower back,
    flowing into it, bringing this feeling of numbness, [pause] your abdomen. Bringing a sense of rest, a
    and immobility to your forearm. [As this is being sense of comfort and immobility, and stillness.
    said, lightly stroke from the back of the hand Resting so quietly, that it's as if parts of your body
    through the upper forearm two or three times.] And are beginning to sleep now.
    you feel that numbness beginning to spread, do you [Progress at the approximate pace the patient
    not? And you can be rather fascinated by that. And required through the earlier parts of their body, or
    when that anesthesia and kind of heavy, almost ideomotor signals may be requested at different
    wooden- points in the progression. Use repetition
    HYPNOSIS IN PAIN MANAGEMENT 83

    as required. Facilitate the spread of anesthesia through the trunk, "feeling increasingly detached, almost separate from your
    the right leg and foot, and then the left leg and foot. Continue body." Further suggestions may finally be given for the
    using terms like: "quiet," "still," "motionless," "immobility," anesthesia to flow up the neck, across their head, and down
    "wooden-like," "as if it's going to sleep," through the patient's face.]
    HYPNOANESTHESIA AND
    PREPARATION FOR SURGERY

    INTRODUCTION

    Role of Presurgical and Intraoperative Suggestions

    HERE ARE A VARIETY of encouraging studies indicating that presurgical


    hypnotic suggestions and suggestions delivered while the patient is under
    anesthesia or in the recovery room may reduce postoperative pain and
    complications and speed recovery (Bonello et al., 1960; Bonilla, Quigley &
    Bowen, 1961; Doberneck, McFee, Bonello, Papermaster, & Wangensteen, 1961;
    Evans & Richardson, 1988; Goldmann, Shay, & Hebden, 1987; Kolough, 1962;
    Werbel, 1960).

    AWARENESS UNDER CHEMICAL ANESTHESIA. Milton H. Erickson (1963) made the


    pioneering observation in 1932 that anesthetized patients could perceive
    conversation at some" level of awareness, and it was David Cheek (1959) who
    published the first paper on this topic. Since that time there have been numerous
    case reports of memories of both events and conversation that took place while
    the patient was under chemical anesthesia (e.g., Brunn, 1963; Goldmann, Shay, &
    Hebden, 1987; Hilgard, Hilgard, & Newman, 1961; Hilgenberg, 1981; Kumar,
    Pandit, & Jackson, 1978; Levinson, 1969; Rossi & Cheek, 1988; Saucier, Walts,
    & Moreland, 1983), some of which were confirmed as accurate by individuals
    who were present during the surgeries. Particularly impressive have been some of
    the reports about what we may call "fatty" comments where a surgeon made an
    insulting remark in reference to someone's weight during surgery (Bennett, 1988;
    Halfen, 1986). It is particularly impressive that such comments, unconsciously
    registered, seem capable of causing continuing psychosomatic problems
    (Rossi &
    86 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    Cheek, 1988) and can be traumatic enough to cause postsurgical complications,


    depression and vegetative responses (Bennett, 1988; Goldmann, 1986). A lawsuit
    has now been settled out of court concerning a "beached whale" comment made
    by a surgeon around an anesthetized patient, which was recalled several days later
    by the patient and confirmed by a nurse who was present (Bennett, 1988).
    Early case reports of awareness under anesthesia quickly led to recom-
    mendations to exercise caution about making derogatory remarks or inadvertently
    verbalizing negative suggestions in the presence of anesthetized patients.
    Furthermore, some anesthesiologists and surgeons began giving positive
    suggestions for speedy recovery, free of complications and pain, with positive
    results (Bonello et al., 1960; Bonilla et al., 1961; Doberneck et al., 1961; Evans &
    Richardson, 1988; Kolough, 1964; Werbel, 1960).
    Wolfe and Millet (1960) reported on 1,500 patients where positive suggestions
    were delivered, and half of the patients required no postoperative pain
    medication! Hutchings (1961) described positive results from using positive
    intraoperative suggestions with 200 patients. He believed that children seemed
    even more responsive than adults, and indicated that 140 of the 200 patients
    required no pain medication after surgery and that 12 of 88 abdominal surgery
    patients needed no postoperative pain medication. Unfortunately, both studies
    lack control groups.

    FAILURE TO REPLICATE STUDIES. Such reports led to some investigations of


    memory retrieval that, in an effort to obtain experimental rigor, used recall of such
    things as unrelated nonsense syllables, poetry, music, or common words as their
    outcome measures. The memory for such information was often assessed a short
    time following surgery (Brice, Hetherington, & Utting, 1970; Browne & Catton,
    1973; Dubovsky & Trustman, 1976; Eich, Reeves, & Katz, 1985; Lewis,
    Jenkinson, & Wilson, 1973; Loftus, Schooler, Loftus, & Glauber, 1985; Millar &
    Watkinson, 1983; Stolzy, Couture, & Edmonds, 1986). In general, these studies
    failed to find that surgical patients could recall what they heard during surgery.
    These results led reviewers (Dubovsky & Trustman, 1976) to conclude that
    surgical personnel need not curtail their operating room talk and that attempts to
    promote healing through suggestions delivered during surgery were not
    successful.
    However, there were some serious methodological flaws in these studies
    (Bennett, 1988). For instance, these studies generally used information for recall
    that was not the least bit meaningful or relevant to the surgical patient. When
    more meaningful information has been used as a criterion measure, patients tend
    to recall far more (Bennett, 1988). Furthermore, as indicated above, some studies
    tested postsurgical patients relatively soon afterwards, but it has been found that,
    when there are longer periods (e.g., several days to several weeks) between
    surgery and postsurgical testing, there is greater recall of what occurred or was
    said during surgery (Adam, 1979; Bennett, 1988). Some failure to replicate
    studies have also used tape
    HYPNOANESTHESIAANDPREPARATIONFORSURGERY 87

    recordings, often of a voice unfamiliar to the patient (e.g., Abramson, Greenfield,


    & Heron, 1966; Bennett, Davis, & Giannini, 1984, 1985; Bonke & Verhage,
    1984; Pearson, 1961). Prerecorded tapes have generally not produced positive
    results in enhancing recovery from surgery. Finally, some studies have asked for
    verbal recall of intraoperative suggestions, but this has been found to be more
    difficult to obtain. In contrast to verbal recall measures, when behavioral
    measures are utilized, significant results are generally found, as will be cited
    shortly.

    CONSCIOUS RECALL OF SURGICAL EVENTS. Hypnosis has proven effective in some


    cases in facilitating conscious patient recall of events or comments in surgery that
    were meaningful to the patient (Bennett et al., 1985; Cheek, 1959, 1966, 1981;
    Goldmann, Shay, &Hebden, 1987; Rossi & Cheek, 1988). For example, in an
    impressive study, Levinson (1965) staged a "surgical crisis" with ten dental
    patients under deep (stage 3) ether anesthesia. Four of the ten patients were able to
    recall the event under hypnosis. Thus, at least part of the time, hypnosis may
    promote recall of comments made during surgery. In particular, Cheek's (Rossi &
    Cheek, 1988) belief that a deeper level of consciousness is tapped through using
    the method of ideomotor signaling (Hammond & Cheek, 1988) to obtain
    recognition of disturbing events has received independent experimental
    validation (Bennett, 1988; Rath, 1982).

    EFFECTS OF SUGGESTIONS UNDER ANESTHESIA. Despite difficulty in recalling


    information consciously, even with the use of hypnosis, there is compelling
    evidence that suggestions delivered personally under surgical anesthesia do
    produce behavioral responses, even though there is conscious amnesia (e.g.,
    Bennett et al., 1984, 1985; Goldmann, 1986). This validates that auditory
    messages are in fact perceived at some level of consciousness under anesthesia,
    despite the lack of conscious ability to remember. Furthermore, when an
    anesthetist addresses the patient by name and asks him or her to remember
    something, it may facilitate responsiveness even further (Bennett, 1988; Millar &
    Watkinson, 1983; Stolzy et al., 1986). Interestingly, in studies using tapes that
    also gave posthypnotic type suggestions for a behavioral response to a cue that
    would be presented later, significant levels of behavioral responses were still
    obtained (Bennett et al., 1984, 1985; Goldmann, Shay, & Hebden, 1987). The
    effectiveness of these personalized suggestions validates that messages are
    perceived, even though taped suggestions usually did not facilitate improved re-
    covery.
    Barber, Donaldson, Ramras, and Allen (1979) have also documented that
    subjects breathing 20%-40% concentrations of nitrous oxide had better response
    to posthypnotic suggestions than control subjects breathing oxygen. Mainord,
    Rath, and Barnett (1983) and Rath (1982) found fewer postsurgical complications
    in subjects receiving positive suggestions under deep surgical anesthesia. In fact,
    Rath (1982) found that patients receiving suggestions required less pain
    medication, had lower pain ratings, and were
    88 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    discharged from the hospital sooner, confirming other less rigorous studies (e.g.,
    Kolough, 1964). Bensen (1971) reported on results of utilizing positive
    suggestions in the recovery room immediately following surgery. In 100 cases
    (primarily involving hemorrhoidectomies, dilettage and curettement,
    tonsillectomies, and some surgeries for removal of growths or tumors), 72%
    reported little or no postoperative pain, 98% experienced normal appetite and
    thirst, and bleeding was 90% controlled.
    On a related note, it is also fascinating that studies have shown that suggestions
    delivered to sleeping subjects (Stage 1 REM sleep) may also produce behavioral
    responses to a cue (Evans, 1979; Evans, Gustafson, O'Connell, Orne, & Shor
    1966, 1969; Perry, Evans, O'Connell, Orne, & Orne, 1978). As is usually the case
    in studies of suggestions given under surgical anesthesia, subjects were amnestic
    for the suggestions given during sleep, but the suggestions were nonetheless
    effective in producing the suggested behavioral responses.

    HYPNOSIS WITH CHILDREN. Collaborating the positive findings of Hutchings


    (1961), cited earlier, it should also be noted that hypnosis has often been
    successfully used as an adjunct to chemical anesthesia with children (Antich,
    1967; Bensen, 1971; Betcher, 1960; Crasilneck, McCranie, & Jenkins, 1956;
    Cullen, 1958; Daniels, 1962; Jones, 1977; Kelsey & Barron, 1958; Marmer, 1959;
    Scott, 1969; Tucker & Virnelli, 1985; Wiggins & Brown, 1968). In fact, in a
    controlled study of the effects of hypnosis on anxiety and pain in children (ages
    5-10), those receiving hypnotic preparation were found to be significantly less
    anxious and more cooperative, and they only required one-fifth as much
    postoperative pain medication as controls (Gaal, Goldsmith, & Needs, 1980).
    In summary, the evidence seems unequivocal that presurgical hypnotic
    suggestions or verbal suggestions made while the patient is under chemical
    anesthesia (that are meaningful to the patient) will influence physiological,
    behavioral, and unconscious processes of the patient.

    HYPNOANESTHESIA

    It is well documented that hypnosis may actually be used as the sole anesthetic
    for both minor and major surgeries (August, 1960, 1961; Bowen, 1973; Elliotson,
    1843; Esdaile, 1846/1976; Finer & Nylen, 1961; Lait, 1961; Marmer, 1959;
    Minalyka & Whanger, 1959; Monteiro & de Oliveira, 1958; Rausch, 1980;
    Steinberg, 1965; Tinterow, 1960). Some of these operations have included mitral
    commissurotomy, coarctation of the aorta, hysterectomy, thyroidectomy,
    hemorrhoidectomy, transurethral resection, dilation and curettage, mammaplasty,
    amputations, cesarean sections, tonsillectomies, and cholecystectomy. It should
    be noted, however, that the use of hypnoanesthesia as sole anesthetic is seldom
    necessary except under extenuating circumstances. Also, perhaps only 10%-20%
    of patients are sufficiently talented hypnotically to accomplish this.
    HYPNOANESTHESIAANDPREPARATIONFORSURGERY 89

    Crasilneck and Hall (1985) cited the following indications for hypnosis in
    anesthesiology:

    1. In situations where chemical anesthetic agents are contraindicated because of


    allergic reaction or hypersensitivity.
    2. For certain surgical procedures during which it is desirable for the patient to
    be able to respond to questions or commands and when it is important to
    observe the patient's state of consciousness during surgery (e.g., stereotactic
    neurosurgical procedures, therapeutic embolizations of carotid and vertegral
    arteries, and for monitoring intraoperative spinal cord function).
    3. With patients where fear and apprehension of general anesthesia are so
    significant that they may contribute to anesthetic risks.
    4. When organic problems increase the risk of using chemical anesthetics and
    interfere with diagnostic or surgical treatment.

    More commonly, hypnosis may be used in combination with chemical anesthesia.


    There is evidence that when hypnosis is used to augment chemoanesthesia, less
    general anesthesia is required (Bartlett, 1966; Crasilneck et al., 1956; Fredericks,
    1980; Van Dyke, 1970). Hypnosis may also be very helpful in combination with
    local anesthesia (Crasilneck & Hall, 1985; Golan, 1975; Lewenstein, Iwamoto, &
    Schwartz, 1981).

    SUMMARY
    Hypnosis and positive suggestions may thus be used in the following capacities
    with surgical patients:

    1. To reduce presurgical fear and apprehension, while simultaneously creating


    feelings of calm, optimism, motivation and increased cooperation.
    2. To create hypnoanesthesia as the sole anesthetic for surgery in the rare
    instances when this is indicated.
    3. Giving positive suggestions during surgery and in the recovery room to
    maintain calm, reduce complications, minimize pain (and the need for
    postoperative medication), facilitate appetite, reduce bleeding, enhance
    healing and speed recovery.
    4. For analgesia or anesthesia to be used in combination with lower levels of
    chemical anesthetic agents.

    In this section of the chapter you will have an opportunity to review the finest
    available suggestions and approaches that are used in the hypnotic presurgical
    preparation of patients, as well as suggestions to be used during and immediately
    following surgery. You will also find illustrations of suggestions to promote
    healing and for hypnoanesthesia. The reader interested in applications of hypnosis
    with burns and emergencies should also consult Chapter 8.
    90 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Preparation for Surgery awaken from a peaceful, natural sleep. You will be
    relaxed and pleased to feel so good, so happy, and
    Lillian E. Fredericks, M.D. so comfortable. All your physiological functions
    Palm Beach, Florida will return promptly and you will feel thirsty and
    hungry, and will look forward to your next meal.
    After your surgery, you will do all the prescribed
    INTRODUCTION breathing exercises, and you will be a good and
    cooperative patient. You may feel some sensations
    Obviously you have to adapt the basic sug-
    in the operative area which will tell you that you are
    gestions that follow according to each patient and
    healing well. You will have a dry and comfortable
    the type of surgery the patient underwent. You
    wound and you will heal very promptly. Let these
    obviously will not suggest that the patient is thirsty
    and hungry if he/she had a gas-trectomy or bowel sensations be a signal to you to let that area go limp
    surgery, etc. Also, please never say to a and loose, soft and relaxed. You will have time to
    rest and restore; so much time to enjoy all the care
    postoperative patient, "You are finished," since the
    you are getting. You will enjoy your visitors and
    patient may take this literally, resulting in
    the planning for the return to your home. You will
    considerable anxiety or negative effects.
    be able to eradicate from your mind any pain or
    problem you might have had prior to surgery. Just
    like sailboats going forward only, and enjoy all the
    THE PREOPERATIVE VISIT things you can do again to make life more
    productive, more interesting, and more to your
    [After reading the chart and introducing myself liking. You also will be surprised and pleased to see
    to the patient]: What do your friends call you, how short the hospital stay will seem to you.
    Mr./Mrs . . .? May I call you . . .? [First name only]
    Where would you rather be right now? . . .
    [Patient's favorite place] . . . Would you like me to
    show you a way to go through tomorrow's surgery POSTOPERATIVE SUGGESTIONS IN
    and anesthesia with comfort and safety? [Pause] THE RECOVERY ROOM
    Just close your eyes and let all your muscles go Your operation has been completed and you are
    limp and loose and relaxed, from the top of your doing very well. You are healing and your immune
    head to the tip of your toes. That is very good. Now system is working at full speed to prevent any
    let's go to that lovely place of your choice, and infection. You are nicely relaxed and comfortable,
    thoroughly enjoy every minute. While you are thinking happy and pleasant thoughts. Your body
    there, feeling good and comfortable and happy, I and mind work together; your body reacts to the
    will explain to you what will happen tomorrow, way you think and feel. You can breathe easily and
    and how I will prepare you for a relaxed sleep so deeply and with great comfort. You can cough and
    the surgeon can perform the operation to the best of clear your throat any time you want to. You will be
    his ability. Pay attention to my voice only. All other thirsty and hungry, and as you swallow, let that be a
    noises are unimportant to you; they are just like signal to your digestive tract to relax and function
    background music. [Tell the patient on his/her level normally. Your wound will be dry and comfortable.
    of understanding, briefly, what you will do.] Your body knows how to do all that, and you will
    I will be with you all the time, watch over you be surprised how easy it will be to empty your
    and make sure that you are comfortable and safe. bladder and move your bowels at the appropriate
    When you are as nicely relaxed as you are now, time. Feel good and happy knowing all is well.
    you will need less anesthesia and you will awaken
    at the end of the operation as you
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 91

    Suggestions for Anesthesia and your throat as needed and go on breathing


    gently, easily, deeply and comfortably.
    Surgery 8. You have time now to rest ... to think of
    pleasant things like how nice it will be to feel
    Bertha P. Rodger, M.D. like yourself again . . . Time to enjoy all the
    Palm Harbor, Florida T.L.C. of the doctors, nurses and others
    working with you to help you get better fast.
    9. You will be quite calm, comfortable and
    PREOPERATIVE SUGGESTIONS cooperative throughout, following all the easy
    instructions given to help you.
    10. You can be pleasantly surprised to find it
    1. From the moment your medication is given, much easier than you anticipated . . . and be
    until you are back in your room again, you pay very thankful!
    attention only to the voice that speaks directly
    to you. All other sounds seem pleasantly far
    away, a lulling, soothing sound . . . like SUGGESTIONS DURING OPERATION
    background music ... or the sound of waves
    gently lapping on the shore. That drowsy,
    1. As the patient is placed on the table, blood
    dreamy, sleepy feeling increases with each
    pressure is taken, etc., repeat preoperative
    sound . . . making you more comfortable.
    suggestions.
    2. Your medication can be the signal to start a 2. Intubation: "I'm going to slip in a soft airway
    pleasant daydream going of some pleasant while you take a deep breath."
    activity in a special place where you feel safe, 3. Added relaxation: "Make the operative area
    secure and contented. soft, limp and comfortable."
    3. The whole operative area remains soft, loose, 4. At closing of incision:
    limp and comfortable throughout the a. The operation is completed . . . your
    operation and afterward until completely condition taken care of (relieved).
    healed. b. You can look forward to getting better
    4. You awaken in the recovery room as if from a fast.
    restful, peaceful sleep, refreshed and c. The body is made to heal . . . and can do
    pleasantly surprised to find your operation so quickly, comfortably, completely.
    completed, your condition relieved, and d. All body functions return rapidly as the
    healing already well under way. anesthesia wears off.
    5. The sensations you feel are those of healing, a e. You awaken smoothly, enjoy a rest pe
    little pulling that tells you the area is well put riod, respond to the voice speaking di
    together again . . . slight cramping .. . a little rectly to you.
    heaviness or tingling reminds you that healing f. You breathe easily, deeply, clear your
    is already begun and acts as a signal to let the throat and go on breathing easily, rhyth
    area become soft, loose and comfortable again mically, naturally.
    . . . and to keep it that way.
    g. You can be glad that little soft tube is
    6. You can recover quickly, completely, com- there doing work for you so function is
    fortably. rapidly restored.
    7. You can be pleased to find how easily you can 5. Intra-operative suggestions for cancer pa
    pass water, move bowels, enjoy meals, tient
    breathe deeply. You can cough to clear a. The tumor has been removed. Now the
    immune system goes to work to complete
    healing. It can take care of any
    92 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    remaining cells just as it knows how to take SPECIAL NEEDS


    care of infection.
    b. You can look forward to feeling much 1. You may feel some little discomforts . . .
    better, to getting better, to enjoying life occasional cramping or pulling, a heaviness in
    fully. the operative area from time to time. You can
    c. Nothing need disturb you . . . nothing welcome these as part of the healing process
    need bother you. and relax in response.
    d. You can live all the rest of your life, 2. There may be a soft tube in your bladder
    making the most of it. (nose/mouth etc.) to keep it drained so it can
    function easily as soon as the tube is removed.
    You can be glad to know it is there working for
    POSTOPERATIVE VERBALIZATIONS you. It conforms to the contours of the area so
    you are aware only of a slight fullness.
    1. You are now in the recovery room. Your 3. You can keep your arm (with the I.V.) still so
    operation is completed and healing is already that the fluid you are getting can speed healing.
    well underway, your condition taken care of, 4. Whenever dressings need to be changed, you
    you can get better now. can keep the area soft, and limp like a Raggedy
    2. Pay attention only to the voice speaking directly Andy doll so it will remain comfortable. You
    to you. All other sounds seem very far away, have time then for a pleasant daydream that
    soothing and lulling, like distant TV. makes it seem like a very short time and the
    3. You can now recover quickly, completely, time passes rapidly.
    comfortably.
    4. All body functions return rapidly as the
    anesthesia wears off. You can look forward to
    enjoying that good food and finding it so
    Hypnosis and the Anesthetist
    satisfying to drink fluids. John B. Corley, M.D.
    5. The sensations you feel will be those of the
    healing process . . . setting everything right ... The anesthetist visits the patient preop-eratively.
    so you need not mind them. They remind you to In a casual but personally conversational fashion
    keep the area soft, limp and comfortable. he/she addresses the patient. He communicates
    6. You can breathe deeply and easily and swallow those understandings and attitudes that he/she
    to clear your throat. This is the signal to your knows as an experienced anesthetist will be of most
    digestive system, "One-way — go straight on value in effecting within the patient that state of
    down." So it becomes more and more well-being most conducive to successful surgery
    comfortable. and a favorable postoperative course. This
    communication is made slowly, thoughtfully, with
    7. Your body knows how to bring enough blood
    pauses of varying length to meet the patient's needs
    to the area to bring the raw materials for healing
    . . . not enough to spill over nor to interfere with in understanding. These pauses are indicated in the
    carrying away waste products. following material by the indicated spacing in the
    words employed.
    8. Notice with pleasure how soon your body
    functions all return to normal . . . how easily
    I am Dr. Smith. . . . 1 am going to give you an
    and fully you regain control of your bladder
    anesthetic tomorrow .... I wanted to meet you. I
    and bowels . . . how much more comfortably
    wanted to check ... a few simple things . . . myself
    you function than you anticipated.
    ... to make sure . . . everything goes smoothly .. .
    tomorrow morning.
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 93

    The anesthetist then examines the patient exactly as especially when you feel my hand . . . upon your
    he/she would under other circumstances, continuing the shoulder . . . just like this . . . [demonstrating] . . . you will
    remarks: be surprised . . . how very easy it will be . . . to recall how
    comfortable . . . you are now. . . . And you will be
    inclined ... if you will allow yourself ... to take a deep,
    Everything is fine. ... I suppose everybody ... is a little deep breath . . . and become most comfortable . . . and
    apprehensive . . . before an operation. . . . But you need very content ... to leave everything to me. ... It is pleas-
    not be. . . . You are in very good condition . . . for an ant, isn't it ... to just lie there and relax . . . with your eyes
    operation . . . and you have an excellent surgeon. . . . You closed . . . feeling warm and comfortable . . . and very
    could not be in better hands . . . and, of course I'll be there safe . . . just letting yourself relax? . . . Just be indolent
    too. ... I promise I'll look after you . . . very carefully. . . . and lazy. ... I will leave you ... for a few minutes now. ...
    Everything, you will find . . . will go very smoothly. .. . I have to see another patient. . . . But I will be back . . .
    Tonight the nurse will give you a sedative ... to make sure very soon. . . . While I'm gone ... be comfortable . . . very
    you will relax . . . and have a good sleep ... it always comfortable . . . and just relax all over.
    helps, doesn't it . . . to just relax . . . and not to worry
    unnecessarily? . . . Actually ... it is much easier to relax . .
    . than most people ever realize. . . . Here ... let me show
    you something . . . useful . . . and very pleasant. . . . Just The anesthetist then leaves the room in accord with his
    close your eyes . . . for a moment . . . take a deep breath . statement to the patient. When he returns:
    . . and make yourself more comfortable . . . That's very
    good. . . . Now open your eyes . . . and let me place your
    I'm back. . . . I'm glad to see . . . you were able ... to
    hand . . . like this . . . [demonstrating] in front of your
    relax so well. ... It is very pleasant, isn't it?. ... I just
    face. . . . Is that comfortable? . . . Good . . . now all you
    wanted to remind you . . . that everything is well in hand
    have to do . . . is to choose some spot . . . upon your hand
    ... for tomorrow morning. . . . You have an excellent
    . . . like that furrow there . . . and deliberately concentrate
    doctor. . . . He is very good ... as you already know . . .
    ... on that spot . . . and just let your hand ... do what it
    and you're very fit for the surgery. . . . And don't forget. .
    wants to do. . . . That's very good. . . . Notice how the
    . .I will be there myself ... to give your anesthetic . . . and
    fingers separate . . . how light appears between the fingers
    to make sure . . . that everything . . . goes smoothly. . . .
    . . . how the fingers spread . . . spread far apart . . . just like
    After the operation . . . you'll be pleasantly surprised ...
    a fan. . . . That's very good. . . . See how the hand itself . .
    to find how well you'll really be. . . . You'll be able to
    . has now begun to move . . . towards your face. . . . Just
    breathe easily. . . . You will be able to pass your water. .
    let it. . . . As the hand comes closer .. . to your face . . .
    . . You will be able to be remarkably relaxed . . . and very
    how comfortable . . . you begin to feel. . . . And actually,
    pleased to find it is all over. . . . Operations today . . . are
    when the hand does touch your face . . . several pleasant
    very different . . . from what they used to be . . . I'm
    things will happen. . . . Your hand will feel very
    going to awaken you now. . . . Remember . . . when we
    comfortable . . . against your face ... it will feel . . . as if it
    meet in the operating room . . . and you recognize my
    is stuck . . . with glue . . . very comfortable. . . . And your
    voice . . . and especially . . . when I touch you on your
    eyes will be so tired . . . you will find it very pleasant ... as
    shoulder . . . just like this . . . [demonstrating] . . . you
    they close . . . and you take a deep, deep breath . . . and
    will find it very easy . . . if you wish ... to take a deep,
    begin to relax all over. . . . That's very good ... so pleasant
    deep breath . . . and be very comfortable. . . . 1 will count
    ... so comfortable . . . Just for a moment now . . . notice
    to 3. . . .When
    how pleasant it really is . . . when I touch you gently ... on
    your shoulder . . . like this . . . [demonstrating]. Now the 1 do . . . you will awake. . . .completely awake and rested
    gentle pressure ... of my hand . . . makes it so very easy ... . . . very relaxed. . . . And when the nurse . . . tonight . . .
    to take another deep, deep breath . . . and begin to let brings you your sedative . . . you will take it . . . and find
    eoperating room . . . and you recognize my voice it very easy ... to drift off to sleep . . . and sleep a very
    . . . and restful sleep. . . .1 . . .
    2 . . . 3 . . . That's excellent. . . . Good night. . . . I'll see
    you in the morning.
    94 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Summary Steps for Preoperative comfort in the surgical area after you have
    regained consciousness?" (If the answer is
    Hypnosis to Facilitate Healing no, it is time to check on possible
    Ernest L. Rossi, Ph.D., and resistance; but it may be only that more time
    and rehearsals are necessary.)
    David B. Cheek, M.D.
    Malibu, California, and Santa Barbara, California b. "Elimination of postoperative pain with
    hypnosis allows the most rapid healing
    1. Initial training in anesthesia and to occur because inflammation is mini
    well-being mized. Is your inner mind willing to
    a. Ideodynamic signaling for exercises in work on this for the sake of yourself and
    anesthesia and/or analgesia: the people who love you?" (A no answer
    "Your yes finger can lift when you can feel indicates an unconscious need to suffer
    the numbness (coldness, stiffness, etc.)." or to punish someone else. The source
    b. Ideodynamic exploration and correction must be found and removed.)
    of misconceptions and fears about sur c. "Does your inner mind know you can go
    gery. home as soon or even sooner than sur
    2. Accessing and utilizing inner resources gical patients who have had no prepara
    a. "After surgery of this kind, most pa tion such as you have had?" (This
    tients are well and ready to go home in X projects your confidence in the patient's
    days. Does your inner mind know it can ability to do well. It strongly suggests
    facilitate healing so you may do even that the patient will live through the
    better than that?" surgery and will be going home.)
    b. "Let your inner mind now select a time
    when you've gone on a vacation. Your
    yes finger will lift when you are leaving;
    your no finger will lift when you are
    back in your home again. The injection Ericksonian Approaches in
    you receive before surgery will be your
    ticket to leave on that trip. Your yes
    Anesthesiology
    finger can lift when your unconscious
    knows this. All the sounds of the oper Bertha P. Rodger, M.D.
    ating room will translate into back Palm Harbor, Florida
    ground noises associated with your
    trip."
    c. "Your yes finger can lift when your EMERGENCY ROOM VERBALIZATIONS
    unconscious knows it can ignore all con
    versation in the operating room unless I You won't mind being comfortable while we
    speak to you using your first name. I will work, will you? You know anything hurts less when
    keep informed about the operation but I you can relax even a little bit, or when you begin to
    want you to pay all your attention to the distribute some of your attention elsewhere. [No
    things you see, the people you are with, one can argue with this. The truism initiates
    and the enjoyable food you eat during positive response, the important "yes-set" of mind.]
    that trip. As you do this, you will be You know the pleasant sensation of warmth on your
    using all the normal biological processes skin when you stretch out in the sun in a favorite
    for healing your body." spot. You have time now to think about such things,
    3. Ratifying postoperative healing to let your mind wander . . . and wonder . . . as you
    a. "Does the inner part of your mind know that
    you can ignore sensations of dis-
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 95

    wander. You don't even have to pay attention to tuning out everything else. You may even get so
    what I am saying. The deep part of your mind can absorbed in what is going on that it seems as if you
    listen to the voice speaking directly to you. All are really there, participating in the action. This is
    other sounds can deepen that sense of comfort that called 'dissociation.' It is just a matter of degree. So
    comes as you relax and rest so pleasantly. you have the choice of concentrating on the hurting
    —or turning to something more interesting. The
    more you do the latter, the less anything bothers
    PREPARATION FOR you."
    HYPNOANESTHESIA This falls within the realm of setting the stage for
    increasing collaboration. To go on with
    The following verbalization is a mosaic which demonstrating a point is vastly more effective than
    also illustrates a number of Erickson's teachings. remonstrating. It gives a firm basis upon which to
    Most ideas are drawn directly from Seminars on build: "Tightening muscles seems to set nerves on
    Hypnosis [led by Erickson and others in the 1950's, edge so that discomfort increases. Tension always
    leading to the founding of the American Society of aggravates pain and can even cause it. Yet as much
    Clinical Hypnosis] or other workshop notes. Many as 40% of pain is relieved by simple relaxation.
    have filtered through the lectures of others trained You can test this out for yourself. Double up your
    by him. It is no longer possible to sort out the fist and hold it very tightly. Pinch the back of your
    sources of such contributions. Words, phrases, and hand to discover how sharp it feels. Now make
    approaches come spontaneously into use after long your hand go as limp and floppy as a Raggedy Ann
    steeping in them. doll and note how little a pinch bothers it now."
    A patient referred for learning hypno-anesthesia It's a little difficult to record on paper the
    was somewhat diffident and apprehensive about grimace that accompanies the first pinch and the
    hypnosis. Hence it seemed best to separate trance smile that goes with the second. Both are
    development from its use, as Erickson so important. With the fact verified that helpful
    characteristically did: "I really cannot hypnotize information is indeed being supplied, it is easier to
    you. But at some time in the future when you are proceed. This time a certain vagueness is
    ready to learn to go into a trance, I can help you do introduced, producing slight confusion. Com-
    so. Then you can learn to use it . . . and go on doing munication techniques use multiple levels of
    so all the rest of your life." verbal content, voice variance, and nonverbal
    demonstration. All of these reinforce the changes
    It made clear that the patient, not the facilitator,
    in awareness and provide guidance.
    "does the hypnotizing," retaining control.
    Appearing to put it off to the nebulous future To continue: "Turn your attention to the wealth
    decreases its threatening aspect. Yet it leaves the of sensations you can sense in your hand . . . and to
    matter open for change as readiness for it comes. their changes. Just which part is the heaviest? Is it
    The anesthesiologist continues: "Meanwhile, in the fingers? In the palm? Near the wrist? Where
    there are some very interesting things you can learn does it feel lighter? As if it might like to lift? To
    that will help you. You can forget about hypnosis float upward? Does that tingly feeling start first in
    until you understand more about it and want to your fingers? Or the back of your hand? Is there a
    work with it. . . . There are certain things you bubbly feeling along with this? Or does it feel stiff
    already know about dealing with discomfort or ... as if it is made of wood . . . feeling only a slight
    pain that you can put to use right now —like the vibration . . . if anything? Notice where it feels
    distraction that occurs when you give your full most comfortable of all . . . where nothing bothers
    attention to a TV program, it . . . nothing disturbs it. And that feeling of
    comfort is so pleasing . . . you wonder . . . how long
    it really needs to take ... to
    96 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    spread even further . . . and deeper . . . through that and breathe in little spasms . . . deeper . . . faster . .
    whole area . . . and even beyond . . . for an extra . get that blood pressure up higher. .. . It's so very
    margin . . . and how well it can remain ... to keep uncomfortable, isn't it? So why don't you stop
    you entirely comfortable. The comfort can stay as halfway0. Wouldn't you really rather just let your
    long as normal healing is going on. Your body eyes close? And snuggle down . . . just listen ... to
    knows how to heal. As you keep yourself comfort- the voice that speaks directly to you ... to tell you
    able ... all the energy goes to the healing process. just what to expect . . . and how to respond ... so as
    It's so good to be able to work so nicely with your to keep yourself quite comfortable. . . ."
    body." "You can let the time of the contraction seem to
    Numerous techniques are effected including: go by like a flash ... so fast you hardly notice it
    conviction of her ability to develop and retain except for timing it. The time between contractions
    control; raising her expectation of something can seem like a nice long time. So you have plenty
    desirable happening; showing her the creative of time to rest, relax and enjoy whatever you wish."
    choices; and focusing on the goodness of her body.
    All lead her to an experience of better functioning
    ALTERING PERCEPTIONS OF PAIN
    by her own skills.
    "Erickson pointed out that when a child is hurt, it
    is in his entirety. Narrowing down the area to where
    STRUCTURING EXPECTATIONS
    the pain is actually felt and recognizing that all the
    It is essential to pay attention to the patient's, rest of the body is free from pain enables easier
    expectations. One who expects to feel nothing management. Now a desensitization process can
    during treatment may be quite upset to feel whittle away at it further. It is more readily
    something, interpreting any sensation as pain. accomplished a bit at a time, dimming sharpness,
    Anticipating this is part of paying adequate turning 'dull misery' into a 'wonderful weariness,'
    attention to detail. It might be explained in this even a 'lovely lassitude' as that feeling is slowly
    way. "Analgesia is like turning down the rheostat, attenuated. The 'red hot poker' effect can be cooled
    the dimmer, to where sensation is tolerable, even through 'real hot' to 'still too warm,' which is like
    comfortable. Anesthesia is like turning off the moving away from the hot fireplace until it
    switch. It's possible you might feel a little becomes 'comfortably warm' or 'pleasantly cool' or
    something. If you were able to feel the incision, it even 'numbingly cold'."
    would feel like a fingernail drawn lightly across the
    skin —a tickle or a trickle." Demonstrating this so
    lightly as to tickle makes it clear. SOLILOQUY ON PAIN
    "Give your full attention to your pain. Try not to
    let your mind wander from it —even for a moment.
    SUGGESTIONS FOR THE PATIENT IN
    Find out exactly where it is located, exactly how it
    LABOR feels. Keep your mind fixed on it so you won't miss
    A frightened patient just admitted to labor room anything significant about it." [Starting with what
    was on the verge of panic, becoming the patient is already doing, giving full attention to
    unmanageable. Grasping both her hands in the his pain, the task is made more difficult by the
    manner of a handshake, I spoke firmly to her, "If effort it takes to keep such intense concentration. A
    you really have to panic, you ought to do a good point of no return is soon reached, after which the
    job of it! Come on . . . I'll help you. . . . Get your harder one tries, the less he succeeds. Erickson long
    heart beating faster . . . pumping harder . . .
    much harder . . . and faster . . .
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 97

    ago observed that when he spotted an acquaintance than burning your fingers. ... It cools in the process
    walking ahead of him, he could catch up, get in enough to be handled comfortably."
    step, then as he slowed his steps, speeded them, "You tell me you have pain . . . and I know you
    turned right or left, the other would go along with really do have pain . . . and you know it hurts less
    his assumption of leadership quite out of when you relax. You know how to hurt. No one has
    awareness. Such minute observation fostered his taught you how not to hurt. I can do that. Simple
    unique communication by indirect ways which relaxation can deal with as much as 40% of pain.
    avoid resistance.] That's almost half. As you learn to let the area go as
    [Now mental imagery is introduced.] "There is a soft, limp and floppy as a Raggedy Ann doll and
    building in Boston containing a circular room with keep it that way, you can have the pain or you can
    a bridge across its center. Standing on the bridge is
    halve it!"
    like being on the inside of a globe, with colored
    [Thus the patient is led away from being steeped
    maps of the world on the surrounding walls.
    in negative thinking and responses with
    Imagine walking into such a globe with a map of
    your pain on its walls, lighted from outside so you alternatives couched in broad enough terms to
    get a really good look at it. The color in the area of allow for individual adaptation. He can learn to
    pain shows the intensity and concentration as well part with pain a little at a time or to trade it for a
    as the exact area covered." [A vivid picture, painted sensation less disturbing, less restrictive of
    in "living color" is easily held, easily changed with function. While this re-education is going on, he
    the speed of thought to stir helpful associations. It has the option of having or halving the pain.]
    allows a search for meaning or causation without
    bringing material to consciousness unless the
    patient is ready to do so. Mental energy is thus PLAY ON WORDS
    accumulated and directed usefully.]
    [To a cancer patient whose family was adamant
    "Watch what happens now, as a diluting color is that she not be informed of the diagnosis.] "You
    put into the one representing pain. It begins to fade know you have pain . . . and many painful feelings
    a little, turn paler. Some neutralization seems to be too. And this pain . . . and the painful thoughts that
    occurring, as if it's being suctioned out, washed out go with it . . . can so fill your mind ... as to drive out
    further, rendered more harmless. It looks better. all other thoughts. You know you have pain . . . and
    You can see more clearly what was beside it, you know that you know it . . . and no one can tell
    beneath it, behind it, around it, within it. You can you any different. What you do not know ... is that
    also see relationships of timing . . . when it began . . you also have areas of no pain . . . and you can
    . when it recurs ... in relation to what . . . and to know this no-pain . . . and the time of no-pain . . .
    whom." [Putting the picture into a different frame can get longer and longer. . . . The area of no-pain
    allows broader vision, possibly the taking of a new can get larger and larger ... so you have more and
    road instead of continuing in the same old rut. Yet more no-pain . . . until you are entirely free!"
    this is done without meddling. The patient can find
    his own meaning when he is ready, encouraged by "You would like so much to say no to all pain. . .
    this understanding support.] "You wonder how . You want your no to be a good no . . . the right no.
    long its duration really needs to be . . . to fulfill its There are many things you know . . . and you know
    purpose as an alerting signal . . . that something is others know them . . . and sometimes they do not
    going on that might need attention . . . some care. want you to know they know them. So you do not
    It's like when a hot potato is tossed to you, you find let them know that you know them ... to protect
    that tossing it back is better their feelings. There may be one person with
    98 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    whom you can share what needs to be shared . . . Preparation for Surgery
    without distress to anyone. There are so many
    things you do know that will help you to say the Sandra M. Sylvester, Ph.D.
    right no . . . and let you become more and more Tucson, Arizona
    aware of no-pain . . . until you consistently feel no
    pain!"
    INTRODUCTION

    The following suggestions may be used in


    hypnosis with the patient, and may be tape
    recorded for the patient to use in tape-assisted
    Examples of Preoperative self-hypnosis for reinforcement of the suggestions.
    Suggestions (Ed.)

    Joseph Barber, Ph.D.


    SUGGESTIONS
    Los Angeles, California

    INTRODUCTION AND INDUCTION. Hello, this is Dr.


    1. You can enjoy an undisturbed, restful night's Sandra Sylvester and I am here to help you prepare
    sleep. for your surgery. What I am going to do at this time
    2. You can awaken in the morning with feelings is to speak to you a little about surgery and the
    of calm and the anticipation of being well taken healing process and also give you some
    care of, and just let everyone else take complete instructions that will help you become more
    care of you. comfortable and more relaxed as you prepare for
    3. You can daydream as fully as you would like, your surgery.
    with no need to pay attention to all the goings Now, would you please lie in a position which is
    on in the hospital; you can ignore the noise and very comfortable for you. Take time to arrange
    lights, and just be delighted (if not surprised) your body, position your pillows, so that you feel
    that there is really nothing to bother you, and poised and balanced and very comfortable and at
    nothing to disturb you. ease. Take a few moments to do this. Adjust your
    4. During the comfort of anesthetic sleep, you can head so that you are comfortable . . . your back . . .
    continue to let the doctors take care of you, but your arms . . . your feet . . . and legs. As we
    know that you can also do anything you need to continue, if you would like to change your position
    do to increase your comfort. to become even more comfortable, please feel free
    5. Upon wakening, you can still let yourself to do so.
    daydream, without having to be clearly aware The process of coming into the hospital for
    of anything except questions and requests surgery is a very common and routine procedure
    directly made to you. for all of us here at the hospital. But for you it may
    6. [If appropriate] You can enjoy comfortable, be a once in a lifetime experience. And so, if I may,
    satisfying, deep breaths; free, effortless, I would like to talk with you about what we have
    urination; appropriate control of bleeding; learned about the healing process so that you can
    uneventful healing. prepare yourself in the best possible way for your
    7. You can be pleased to surprise the nurses when surgery.
    they don't get to give you medication for pain, And so to begin: As you are lying in this
    and to enjoy noticing that there are no feelings comfortable position, look up at the ceiling and
    to bother you or disturb you. find a spot which is easy for you to see. Just any
    spot on the ceiling will do. Please continue to look
    at that spot while 1 continue to speak with
    HYPNOANESTHESIA A N D PREPARATION F O R S U R G E R Y 99

    you. Already as you are looking at that spot you inhale and exhale, your chest goes up and down in a
    may begin to perceive some very subtle changes in comfortable, easy rhythm. An interesting thing about
    your vision. For example, you may notice that that your breathing is that you breathe day and night every
    spot becomes very easy to see. And you may also moment of your life without having to think about it.
    notice that the periphery of your vision surrounding Your auto-nomic nervous system directs and controls
    that spot may begin to get hazy, so that as you keep your breathing in a comfortable way; in a way that is so
    that spot in focus, the rest of your vision moves out much better than you could ever do consciously; in a way
    of focus. You may also notice that your eyes begin that occurs without any effort on your part. Your body, in
    to tire and fatigue . . . and sometimes your eyes will a sense, breathes by itself. As you continue to breathe,
    indicate that by tearing. So you may notice your you may notice that each time you exhale, you can relax
    eyes watering a bit. You may notice that as your more and more. Each time you exhale you can feel as if
    eyes blink, you sense a feeling of comfort come you are sinking deeply into the support of the mattress.
    over your body in that brief moment when your Each time you exhale you can feel as if you are letting go
    eyes are closed. And as your eyes continue to tire, of more and more muscle tension. So that each time you
    and they continue to blink, you will find more and breathe out, it is as if you are letting go of tightness and
    more comfort and pleasure as your eyes are closing. you feel your muscles becoming soft and loose. You may
    And soon you will notice that it is more experience this as a comfortable feeling of heaviness, so
    that each time you exhale, you feel your body becoming
    comfortable for you to just allow your eyes to close.
    soft and loose and heavy. If you notice that there is any
    When you notice that it is more comfortable for you
    part of your body which is still tense, which is holding on
    to allow your eyes to close, let them close, so that
    to tension, imagine as you exhale, that you breathe out
    you can notice the changes which occur when you
    through that body part which was holding tension and let
    have turned off your sense of vision.
    your breath melt the tension so that, as you breathe out,
    those muscles too become soft and loose and
    FOCUSING ATTENTION AND UTILIZING HOSPITAL SOUNDS.
    comfortable. Take a few moments to make a tour of your
    One thing you may notice almost immediately is how
    body, taking time to notice if there is any tension
    easy it is to hear the words that I speak directly to you. It anywhere within your body. If you notice any tension in
    is also easy to hear and continue to hear all of the sounds your body, take a few moments of extra care, letting
    around you. And yet, those sounds which are not yourself breathe out through that part of your body and
    important to you at this moment can fade into the back- melt the tension away.
    ground, and even though they are still there, they need
    not disturb you in any way. You can hear pages in the
    You may also notice that your heartbeat assumes a
    hallway and know that you do not need to listen to them.
    regular, even, rhythmical pattern, which is most
    You may hear talking or sounds from your neighbor, the
    beneficial for you at this time. You know again that your
    television set, snatches of conversations. While these go
    unconscious mind directs the beating of your heart day
    on, notice how pleasant it is to know that you need not
    and night, every moment of your life whether you con-
    bother to respond to anything unless it is directed sciously think about it or not. It is the circulation of
    specifically at you. oxygenated enriched blood throughout your body which
    aids very much in the healing process. And so for these
    AUTOMATICTY,TRUSTINGTHEUNCONSCIOUS,ANDDEEP- few moments, just feel the rhythm of your heartbeat.
    ENING. You may also notice how easy it is to begin to You may notice somewhere within your body a pulsing,
    tune in to the rhythm of your breathing, noticing that
    when you are still, your body takes a rhythm of breathing
    which is most beneficial for you at this
    moment. As you
    100 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    regular, even rhythm. Sometimes your heartbeat right now is to feel and experience the rhythms
    may be so subtle that perhaps the only way to feel it going on within your body —feeling a sense of
    is on a cellular level, for every single living cell in comfortable stillness, feeling a sense of quiet deep
    your body feels the regular influx of nutrients with within you, allowing your unconscious mind to
    every beat of your heart. This process also cleanses work freely and easily in this process of healing.
    away all waste products in each and every cell in
    your body. And, as mentioned earlier, this process SUGGESTIONS FOR HEALING AND REFRAMING
    goes on automatically whether you think about it or PAIN.
    not. One of the ways that your body heals itself is by
    Your blood pressure lowers to a level which is circulating rich oxygenated blood to every single
    best for you right now. Because you are lying down living cell in your body, filling that cell with
    in a position of relaxation and comfort and you feel nourishment and carrying away waste products and
    a certain sense of stillness, your blood pressure can poisons, and filtering them outside of your body.
    lower. If you were to get up and move around, your This process is a process that you can participate in
    blood pressure would rise so that you could carry and facilitate. One of the ways that you can
    on that activity. So the important thing about your facilitate this process is to keep in mind that your
    blood pressure is that it be flexible, rising when you body is constantly healing itself, sloughing off dead
    need it to rise and lowering when you are not doing cells, nourishing that area, and growing new cells
    anything which places a demand on your body. all of the time. As part of your healing process you
    will experience many different kinds of physical
    sensations. You may feel the sensation of
    UTILIZING INTERNAL DIALOGUE. You may also notice
    stretching and shrinking as tissues join together and
    that as I continue to speak with you, thoughts mend themselves. You may experience sensations
    continue to drift through your mind, as if your of warmth as the healing process continues, or
    thoughts are like drops of water in a river. And you sensations of pressure as swelling begins to
    know, sometimes those drops of water move very subside. It is important to know that, as your body
    quickly in the form of white water rapids, bubbling heals itself, changes do occur and those changes
    over rocks, moving very quickly downstream. Yet, may be perceived by you. You can cooperate with
    in the very same river, if you walk downstream far the work of your body by remaining calm, as you
    enough, you will come to a spot in the river where are now, continuing to breathe in a rhythmical easy
    the water is so deep that it is almost impossible to rhythm, letting your breath enrich your blood
    detect any movement at all. In fact, perhaps you supply, which in turn will carry nutrients to your
    cannot see the water move until you wait and watch cells, allowing your blood pressure to go to a level
    a leaf detach itself from a branch of a tree, begin to which is most beneficial to you now. If you are
    drift downward toward the surface of the water, feeling any sense of discomfort, breathe in and out
    touch the surface of the water, pause for just a through that area so that your warm breath can
    moment and then begin its journey downstream. soothe those muscles and allow them to feel soft
    Feel the rhythm of your thoughts without bothering and warm and relaxed. So let yourself rest and let
    to pick out any one thought to think about. Just feel your body take its time to heal.
    the gentle drifting rhythm of your thoughts as they
    drift through your mind like drops of water.
    Now, leaving you with these thoughts, allow
    yourself to continue to breathe, relaxing more and
    DEPOTENTIATING CONSCIOUSLY TRYING. Know more with each breath, fully enjoying that feeling
    that of deep comfort and peace. Allow the drifting of
    at this moment there is nothing special for you to your thoughts to match the easy rhythm of your
    do, there are no demands being placed upon you, breathing as you inhale and exhale. Then, give to
    no expectations. There is no one to please, no one your unconscious the task of directing your healing
    to satisfy. The only thing for you to do process with the same
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 101

    efficiency that it directs your respiration, digestion, I'm going to wash the skin [or mucous mem-
    and circulation —knowing that your unconscious brane] off with some cold, wet fluid that will wash
    can direct your healing process, whether or not you away most of the feeling . . . right here [rubbing the
    consciously think about it. area briskly and thoroughly with alcohol or any
    antiseptic], so that what I do is not a bit important
    REALERTING. In a few moments, you will begin to to you . . . [giving the skin a few flicks of the
    rouse yourself and reorient yourself to this room. fingernail to complete the anesthesia, washing
    You can begin to do so when, and only when, you again with the antiseptic and rapidly inserting the
    are ready to do so, taking all the time you need; needle].
    allowing yourself to retain that feeling of comfort
    and a sense of well-being. As you do begin to move
    around a bit, you may feel sensations returning to
    your hands and feet. Be curious as you open your
    eyes, and notice how bright the colors can appear.
    Switching Off the Senses
    You can feel refreshed as if you have just awakened
    from a long and restful sleep.
    Bertha P. Rodger, M.D.
    Palm Harbor, Florida
    I invite you to play this tape as often as you wish
    so that you can use it to help put yourself in the best
    possible mind-set for your surgery and for the 1. Assume a COMFORTABLE and BALANCED
    healing process, which for the next few days and position. Allow your body STAY STILL and
    weeks will be your full-time job. Thank you. NOTICE how much quieter and more
    COMFORTABLE you become as the sense of
    MOVEMENT, is SHUT OFF.
    Temperature Suggestion Following 2. REST your EYES, on a spot or GAZE into space,
    NARROWING the FIELD of VISION,
    Chest/Abdominal Surgery decreasing DISTRACTION, with less
    D. Corydon Hammond, Ph.D. stimulation from OUTSIDE your body, you
    Salt Lake City, Utah CENTER it more and more on INNER
    REALITIES. You become MORE QUIET. Your
    You will begin to get pleasantly warm now. We body KNOWS HOW when you SET THE
    have placed a heat lamp over you, which will STAGE for it and ALLOW the quietness to come
    rapidly warm your body back to normal to you and ALL THROUGH you, very, very
    temperature, almost as if you were snuggled up pleasantly. NOTICE these feelings. They are
    warmly in bed, or resting comfortably in a warm UNIQUE to you.
    bath. 3. Let you eyes CLOSE and STAY closed. You
    begin to feel a familiar DROWSY, DREAMY,
    SLEEPY feeling. Yet you are neither asleep nor
    Suggestions for Insertion of in the process of going to sleep. You are ALERT
    Needles or Short Procedures to whatever is IMPORTANT, UNDISTURBED
    by the unimportant. It is a PURPOSEFUL
    Esther E. Bartlett, M.D. FOCUSING of attention. DISCOVER how
    Quincy, Massachusetts infinitely more COMFORTABLE it is.
    4. Pay attention to the WEIGHT of one ARM . . .
    [These suggestions may be used as waking perhaps your DOMINANT one. SENSE the
    suggestions with effectiveness, or with hypnosis heaviness of its bones, muscles, soft tissue,
    for even greater effectiveness.] blood vessels. NOTE the pleasant feeling that
    it is really TOO MUCH
    102 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    BOTHER to move even to lift a little finger! as you BREATHE IN . . . "UP' . . . and
    You feel a LOVELY LASSITUDE, perhaps even return FULL of VIGOR.
    a WONDERFUL WEARINESS!
    5. Note that BOTH ARMS are ACTUALLY
    HEAVY. Are they EQUALLY so? Which is
    heavier? Which is LIGHTER? Perhaps you
    LIKE the LIGHTNESS better? Pay atten
    Rapid Induction Analgesia
    tion to ALL the feelings of lightness. RE
    MEMBER a time you felt a DELIGHTFUL
    Joseph Barber, Ph.D.
    lightness ... of FLOATING . . . like a Los Angeles, California
    FEATHER on a gentle breeze ... a LEAF
    on the water ... a BIRD on the wind,
    INTRODUCTION AND INDICATIONS
    soaring EFFORTLESSLY.
    6. While you rest and relax so comfortably, NO [Elicitation of cooperation] I'd like to talk with
    FEELING need DISTURB you. You can you for a moment to see if you'd like to feel more
    RECOGNIZE any feeling but need not pay comfortable and relaxed than you might expect.
    ATTENTION to it . . . nor REACT to it UNLESS Would you like to feel more comfortable than you
    it is REALLY important to do so. You can do do right now?
    whatever is NEEDFUL in response without I'm quite sure that it will seem to you that I have
    being bothered by any feeling, physical or really done nothing, that nothing has happened at
    emotional. all. You may feel a bit more relaxed, in a moment,
    7. NO SOUND need DISTURB you. There is no but I doubt that you'll notice any other changes. I'd
    interference with hearing. You need not REACT like you to notice, though, if you're surprised by
    to it UNLESS it is important. Many can sleep anything else you might notice. OK, then . . . the
    through a thunderstorm but awaken to the cry of really best way to begin feeling more comfortable is
    a tiny baby. ANY SOUND can be the SIGNAL to to just begin by sitting as comfortably as you can
    go more deeply into the STATE OF right now ... go ahead and adjust yourself to the
    COMFORT. most comfortable position you like [Initiation of
    8. NOTICE that your BREATHING becomes more deep relaxation] . . . that's fine. Now I'd like you to
    CALM, DEEP AND EASY. Your HEART beat notice how much more comfortable you can feel by
    becomes CALM, STRONG, and REGULAR. just taking one very big, satisfying deep breath. Go
    Measurements would show your BLOOD ahead . . . big, deep, satisfying breath . . . that's fine.
    PRESSURE coming TOWARD NORMAL You may already notice how good that feels . . .
    where it STABILIZES, responding how warm your neck and shoulders can feel. . . .
    appropriately to changing needs. A pleasant Now, then ... I'd like you to take four more very
    feeling of WARMTH pervades your entire being deep, very comfortable breaths . . . and, as you
    ... as if your personal THERMOSTAT is turned exhale, notice . . . just notice how comfortable your
    to exactly the right temperature. COMFORT shoulders can become . . . and notice how
    FLOWS through your whole being. You feel comfortable your eyes can feel when they close . . .
    CALM . . . CONTENTED . . . SAFE . . . and when they close, just let them stay closed [Eye
    SECURE. These feelings STAY with you even closure] . . . that's right, just notice that . . . and
    when you return to another state of notice, too, how when you exhale, you can just feel
    ALERTNESS. that relaxation beginning to sink in. . . . Good, that's
    fine . . . now, as you continue breathing,
    9. As a way of REORIENTING yourself quickly comfortably and deeply and rhythmically, all I'd
    and pleasantly . . . WHEN you are READY . . . like you to do is
    you can say to yourself as you BREATHE OUT
    . . . "WAKE" . . . and
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 103

    to picture in your mind ... just imagine a staircase, ning, perhaps, to really, really enjoy your re-
    any kind you like . . . with 20 steps, and you at the laxation and comfort . . . SIX ... six steps down the
    top. . . . Now, you don't need to see all 20 steps at staircase . . . perhaps beginning to notice that the
    once, you can see any or all of the staircase, any sounds which were distracting become less so . . .
    way you like . . . that's fine. . . . Just notice yourself, that all the sounds you can hear become a part of
    at the top of the staircase, and the step you're on, your experience of comfort and relaxation . . .
    and any others you like . . . however you see it is anything you can notice becomes a part of your
    fine. . . . Now, in a moment, but not yet, I'm going to experience of comfort and relaxation . . . SEVEN . .
    begin to count, out loud, from one to 20, and ... as . seven steps down the staircase . . . that's fine . . .
    you may already have guessed . . . as I count each perhaps noticing the heavy, restful, comfortably
    number I'd like you to take a step down that relaxing feeling spreading down into your
    staircase . . . see yourself stepping down, feel shoulders, into your arms . . . [confusingly,
    yourself stepping down, one step for each number I permissively eliciting arm heaviness]. I wonder if
    count . . . and all you need to do is notice, just you notice one arm feeling heavier than the other . .
    notice, how much more comfortable and relaxed . perhaps your left arm feels a bit heavier than your
    you can feel at each step, as you go down the right . . . perhaps your right arm feels heavier than
    staircase . . . one step for each number that I count . your left ... I don't know, perhaps they both feel
    . . the larger the number, the farther down the stair- equally, comfortably heavy. ... It really doesn't
    case . . . the farther down the staircase, the more matter . . . just letting yourself become more and
    comfortable you can feel . . . one step for each more aware of that comfortable heaviness . . . or is
    number ... all right, you can begin to get ready . . . it a feeling of lightness? ... I really don't know, and
    now, I'm going to begin. . . . [saying each number it really doesn't matter . . . EIGHT. . . eight steps
    with the initiation of subject's exhalation, watching down the staircase . . . perhaps noticing that, even
    for any signs of relaxation and commenting on as you relax, your heart seems to beat much faster
    them] ONE . . . one step down the staircase . . . TWO and harder than you might expect, perhaps noticing
    . . . two steps down the staircase . . . that's fine . . . the tingling in your fingers . . . perhaps wondering
    THREE . . . three steps down the staircase . . . and about the fluttering of your heavy eyelids . . . [Each
    number, each suggestion of heaviness enunciated
    maybe you already notice how much more relaxed
    as though the hypnotist, too, is becoming intensely
    you can feel. ... I wonder if there are places in your
    relaxed] NINE . . . nine steps down the staircase,
    body that feel more relaxed than others . . . perhaps
    breathing comfortably, slowly, and deeply . . .
    your shoulders feel more relaxed than your neck . . .
    restful, noticing that heaviness really beginning to
    perhaps your legs feel more relaxed than your arms.
    sink in, as you continue to notice the pleasant,
    ... I don't know, and it really doesn't matter ... all
    restful, comfortable relaxation just spread through
    that matters is that you feel comfortable . . . that's your body . . . TEN . . . ten steps down the staircase
    all. . . . FOUR . . . four steps down the staircase, . . . halfway to the bottom of the staircase, won-
    perhaps feeling already places in your body dering perhaps what might be happening, perhaps
    beginning to relax. ... I wonder if the deep relaxing, wondering if anything at all is happening
    restful heaviness in your forehead is already [Integration of sighing with enunciation is helpful ..
    beginning to spread and flow . . . down, across your . watch for responsiveness] . . . and yet, knowing
    eyes, down across your face, into your mouth and that it really doesn't matter, feeling so pleasantly
    jaw . . . down through your neck, deep, restful, restful, just continuing to notice the growing,
    heavy . . . FIVE . . . five steps down the staircase ... a spreading, comfortable relaxation . . . ELEVEN . .
    quarter of the way down, and already begin- . eleven steps down the
    104 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    staircase . . . noticing maybe that as you feel deeper relaxed . . . heavy . . . comfortable . . . restful
    increasingly heavy, more and more comfortable, . . . relaxed . . . nothing really to do, no one to please,
    there's nothing to bother you, nothing to disturb no one to satisfy . . . just to notice how very
    you, as you become deeper and deeper relaxed . . . comfortable and heavy you can feel, and continue to
    TWELVE . . . twelve steps down the staircase. ... I feel as you continue to breathe, slowly and
    wonder if you notice how easily you can hear the comfortably . . . restful-ly .. . NINETEEN . . .
    sound of my voice . . . how easily you can nineteen steps down the staircase . . . almost to the
    understand the words I say [Suggestion to pay bottom of the staircase . . . nothing to bother,
    attention] . . . with nothing to bother, nothing to nothing to disturb you as you continue to feel more
    disturb . . . THIRTEEN . . . thirteen steps down the and more comfortable, more and more relaxed,
    staircase, feeling more and more the real enjoyment more and more rested . . . more and more
    of this relaxation and comfort . . . FOURTEEN . . . comfortable . . . just noticing . . . and now . . .
    fourteen steps down the staircase . . . noticing TWENTY . . . bottom of the staircase . . . deeply,
    perhaps the sinking, restful pleasantness as your deeply relaxed . . . deeper with every breath you take
    body seems to just sink down, deeper and deeper ... as I talk to you for a moment about something you
    into the chair, with nothing to bother, nothing to already know a lot about . . . remembering and
    disturb ... as though the chair holds you, forgetting [Amnesia suggestions] . . . you know a lot
    comfortably and warmly . . . FIFTEEN . . . fifteen about it, because we all do a lot of it . . . every
    steps down the staircase . . . three-quarters of the moment, of every day you remember . . . and then
    way down the staircase . . . deeper and deeper re- you forget, so you can remember something else . . .
    laxed, absolutely nothing at all to do . . . but just you can't remember everything, all at once, so you
    enjoy yourself [More and more directly suggesting just let some memories move quietly back in your
    enjoyment of the experience . . . more taking for mind ... I wonder, for instance, if you remember
    granted the fact of the relaxation] . . . SIXTEEN . . . what you had for lunch yesterday ... I would guess
    sixteen steps down the staircase . . . wondering that, with not too much effort, you can remember
    perhaps what to experience at the bottom of the what you had for lunch yesterday . . . and yet ... I
    staircase . . . and yet knowing how much more wonder if you remember what you had for lunch a
    ready you already feel to become deeper and deeper month ago today ... I would guess the effort is really
    relaxed . . . more and more comfortable, with too great to dig up that memory, though of course it
    nothing to bother, nothing to disturb . . . SEV- is there . . . somewhere, deep in the back of your
    ENTEEN . . . seventeen steps down the staircase . . . mind ... no need to remember, so you don't . . . and 1
    closer and closer to the bottom, perhaps feeling wonder if you'll be pleased to notice that the things
    your heart beating harder and harder, perhaps we talk about today, with your eyes closed, are
    feeling the heaviness in your arms and legs become things which you'll remember tomorrow, or the next
    even more clearly comfortable . . . knowing that day ... or next week ... I wonder if you'll decide to let
    nothing really matters except your enjoyment of the memory of these things rest quietly in the back
    your experience of comfortable relaxation, with of your mind ... or if you'll remember gradually, a bit
    nothing to bother, nothing to disturb [18-20 said at a time . . . or perhaps all at once, to be again
    more slowly, as though in increasing anticipation of resting in the back of your mind . . . perhaps you'll
    being at the bottom] . . . EIGHTEEN . . . eighteen be surprised to notice that the reception room is the
    steps down the staircase . . . almost to the bottom, place for memory to surface . . . perhaps not . . .
    with nothing to bother, nothing to disturb, as perhaps you'll notice that it is more
    you continue to go deeper and
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 105

    comfortable to remember on another day altogether ate . . . whenever [doctor's name] touches your right
    ... it really doesn't matter . . . doesn't matter at all . . . shoulder, like this ... or whenever I touch your right
    whatever you do, however you choose to remember shoulder, like this . . . you'll experience a feeling ...
    ... is just fine . . . absolutely natural . . . doesn't a feeling of being ready to do something
    matter at all . . . whether you remember tomorrow or [Posthypnotic suggestion for a variety of
    the next day, whether you remember all at once, or behaviors, but with purpose of developing a trance
    gradually . . . completely or only partially . . . . . . and with implication for analgesia] . . .
    whether you let the memory rest quietly and whenever I touch your right shoulder, like this ... or
    comfortably in the back of your mind . . . really whenever [doctor's name] touches your right
    doesn't matter at all . . . and, too, I wonder if you'll shoulder, like this . . . you'll experience a feeling ...
    notice that you'll feel surprised that your visit here a feeling of being ready to do something . . .
    today is so much more pleasant and comfortable perhaps a feeling of being ready to close your eyes .
    than you might have expected [Analgesia . . perhaps a feeling of being ready to be even more
    suggestions] ... I wonder if you'll notice that comfortable . . . perhaps ready to know even more
    surprise . . . that there are no other feelings . . . clearly that there's nothing to bother, nothing to
    perhaps you'll feel curious about that surprise . . . disturb . . . perhaps ready to become heavy and
    surprise, curiosity .. . I wonder if you'll be pleased to tired. ... I don't know . . . but whenever I touch your
    notice that today . . . and any day . . . whenever you right shoulder, like this . . . you'll experience a
    feel your head resting back against the headrest feeling .. . a feeling of being ready to do something
    [Direct posthypnotic suggestion for analgesia] . . . ... it really doesn't matter . . . perhaps just a feeling
    when you feel your head resting back like this . . . of being ready to be even more surprised ... it
    you'll feel reminded of how very comfortable you doesn't really matter . . . nothing really matters but
    are feeling right now . . . even more comfortable your experience of comfort and relaxation . . .
    than you feel even now . . . comfortable, relaxed . . . absolutely deep comfort and relaxation . . . with
    nothing to bother, nothing to disturb ... I wonder if nothing to bother and nothing to disturb . . . that's
    you'll be reminded of this comfort, too, and fine. . . . And now, as you continue to enjoy your
    relaxation, by just noticing the brightness of the comfortable relaxation, I'd like you to notice how
    light up above . . . perhaps this comfort and very nice it feels to be this way . . . to really enjoy
    relaxation will come flooding back, quickly and your own experience, to really enjoy the feelings
    automatically, whenever you find yourself your body can give you . . . [Preparation for end to
    beginning to sit down in the dental chair . . . / don't this comfortable experience] and in a moment, but
    know exactly how it will seem ... I only know, as not yet . . . not until you're ready . . . but in a
    perhaps you also know . . . that your experience will moment, I'm going to count from one to 20 . . . and
    seem surprisingly more pleasant, surprisingly more as you know, I'd like you to feel yourself going
    comfortable, surprisingly more restful than you back up the steps . . . one step for each number . . .
    might expect . . . with nothing to bother, nothing to you'll have all the time you need . . . after all, time
    disturb . . . whatever you are able to notice . . . is relative . . . feel yourself slowly and comfortably
    everything can be a part of being absolutely going back up the steps, one step for each number I
    comfortable [Every sensation creates the analgesic count . . . more alert as you go back up the steps,
    experience (nothing detracts from it)] . . . and I want one step for each number I count . . . when I reach
    to remind you that whenever [doctor's name] three, your eyes will be almost ready to open . . .
    touches your right shoulder, like this . . . whenever it when I reach two, they will have opened . . . and,
    is appropriate, and only when it is when I reach
    appropri-
    106 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    one, you'll be alert, awake, refreshed . . . per feel the cold, your yes finger will life
    haps as though you'd had a nice nap . . . alert, unconsciously. Tell me when you are
    refreshed, comfortable . . . and even though feeling cold from your knees down."
    you'll still be very comfortable and relaxed, b. "When you are in cold water, you soon
    you'll be alert and feeling very well . . . perhaps get used to it. It is no longer cold.
    surprised, but feeling very well . . . perhaps You are about half as sensitive as you
    ready to be surprised ... no hurry, you'll have usually are. If you stubbed a toe or
    all the time you need, as you begin to go back bumped your shin, you would feel a
    up these restful steps. [Numbers on inhala bump but there would be no pain. Your
    tion . . . lilting, arousing intonations . . . more no finger will lift to let you know when
    quickly at first . . . watch for responsiveness] you are half as sensitive as you were at
    TWENTY . . . NINETEEN . . . EIGH- first."
    TEEN . . . that's right, feel yourself going back up
    c. "Now walk in until you feel the cold
    the steps . . . ready to be surprised, knowing what
    water up to your ribs. When you feel
    you had for lunch yesterday, and yet . . . cold from your ribs to your knees, your
    SEVENTEEN. . . SIXTEEN . . . FIFTEEN... a yes finger will lift. When you are numb
    quarter of the way back up, more and more alert ... from your ribs down to your toes, your
    no rush, plenty of time . . . feel yourself becoming no finger will lift."
    more and more alert [If no apparent arousal, slow
    down, inject more suggestion for arousal] . . . d. "Now press your left thumb and index
    FOURTEEN . . . THIRTEEN . . . TWELVE . . . finger together. This associates instant
    ELEVEN. . . TEN . . . halfway back up the stairs . . . coolness and numbness, and you will be
    more and more alert . . . comfortable but more and able to do this with increasing speed
    more alert . . . NINE . . . that's right, feel yourself every time you repeat this exercise."
    becoming more and more alert . . . EIGHT. . . e. "Now loosen your pressure on the left
    SEVEN . . . SIX . . . FIVE [After 5, increasingly hand, and press the index finger and
    slowly .. . repeat suggestions for arousal and pos- thumb on your right hand to bring back,
    itive experience] . . . FOUR . . . THREE . . . that's instantly, all the feelings that have been
    right . . . TWO . . . and ONE . . . That's right, wide cool and numb."
    awake, alert, relaxed, refreshed . . . that's fine. How f. "Practice this at home until you know
    do you feel? Relaxed? Comfortable? you can reproduce these sensation
    changes any time you wish."
    2. Therapeutic facilitation
    a. Have patient repeat exercise until con
    fidence is assured.
    Surgical and Obstetrical b. Explain that making labor more like the
    work of sawing wood than like a long
    Analgesia arduous experience will allow the baby
    to be born feeling welcome and free of
    Ernest L. Rossi, Ph.D., and guilt.
    David B. Cheek, M.D. c. "By turning off unconscious, painful
    Malibu, California, and Santa Barbara, California stimuli, you will heal without inflamma
    tion and will be able to go home
    1. Accessing unconscious control of analgesia sooner."
    a. "Walk into an imaginary, cold lake until 3. Ratifying and extending new ability
    the water reaches your knees. When you "Learning this skill will not only make your
    immediate task easier, but also will aid you
    in meeting unrelated tasks with confidence
    in the future."
    HYPNOANESTHESIA AND PREPARATION FOR SURGERY 107

    Techniques for Surgery are relaxed, and, with every breath you take, you
    will find yourself going deeper and deeper relaxed.
    William S. Kroger, M.D. You are doing just fine. Just relax all the muscles
    Palm Springs, California of your abdomen and chest. You are breathing
    slower, deeper, and more regular. That's right. In
    REHEARSAL TECHNIC FOR SURGERY and out ... in and out. Going deeper and deeper
    relaxed. You feel nothing except a little pressure.
    [During a typical rehearsal session for ab-
    The more relaxed you are, the less tension you
    dominal surgery the patient is told:] Now your skin
    have, the less discomfort you will have.
    is being sterilized." [At this time the abdomen is
    [Frequently there is a slight trembling of the
    swabbed with an alcohol sponge.] I am now
    eyelids. This often is indicative of deep hypnosis.
    stretching the skin and making the incision in the
    One can use this objective sign to deepen the
    skin. [The line of incision is lightly stroked with a
    hypnosis, as follows:] I notice that your lids are
    pencil.] Now the tissues are being cut. Just relax.
    now trembling. That's a good sign. And, as they
    You feel nothing, absolutely nothing. Your
    continue to tremble, you will go deeper and deeper
    breathing is getting slower, deeper and more
    relaxed. You will feel yourself falling, falling,
    regular. Each side of the incision is being separated
    deeper and deeper relaxed with every breath you
    by an instrument. [The skin and the muscles are
    take. Remember, if you want to open your eyes at
    being pulled laterally from the midline.] Now a
    any time, you may. Voices won't bother you.
    blood vessel is being clamped. [A hemostat is
    clicked shut.] You will feel absolutely no [Production of catalepsy by light stroking of the
    discomfort. You are calm, quiet and relaxed. Your skin frequently minimizes capillary bleeding,
    breathing is getting slower, deeper, and more probably as the result of vasospasm. Here the law
    regular. Just relax! Now I am going deeper and of dominant effect is put to use: a psychological
    entering the abdominal cavity." [For the suggestion is enhanced by a physiological effect.
    peritoneum, suggestions of relaxation and As the region that is going to be operated on is
    assurances of complete pain relief are repeated stroked light, I remark:] This area is getting very
    several times.] Just relax. You are getting deeper stiff, cold and numb. Think, feel and imagine that
    and deeper relaxed: your heartbeat is getting slower there is an ice cube on your skin. Now it is getting
    and more regular. Just relax. You feel nothing, more numb and colder. Numb and cold. Very, very
    absolutely nothing. [The viscera are relatively cold. [This verbalization and the stroking are most
    insensitive to cutting. One does not have to worry advantageous where bleeding from the skin is ex-
    about pain. However, the patient has to be prepared pected. If the hypnosis fails during surgery, one can
    for the discomfort produced by pulling and torsion easily switch to intravenous or inhalation
    of the abdominal organs.] anesthesia. It is always advisable to have these
    available for prompt use.]
    [The steps for closure of the peritoneum,
    muscles, fascia and skin are also described in a
    similar manner. There are really only three times
    when pain can be expected: when the skin is POSTOPERATIVE VERBALIZATION FOR
    incised, when the peritoneum is incised, and when DEHYPNOTIZATION
    one is tugging on the viscera.]
    [Patients are dehypnotized as follows:] You will
    MAINTENANCE OF feel just as if you have awakened from a deep
    sleep, but, of course, you were not asleep. You will
    HYPNOANESTHESIA DURING
    be very, very relaxed. Any time in the future when
    SURGERY I touch you on the right shoulder, if I have your
    [The following is a verbalization for main- permission, you will close your
    taining hypnosis:] All the muscles in your body
    108 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    eyes and let your eyeballs roll up into the back of not hesitate to eat the food given to you, and as a
    your head. Then you will count backward from 100 matter of fact, you will relish every bite. You will
    to zero slowly, and you will go deeper and deeper be very, very hungry. The more nutritious food you
    relaxed with every breath you take and every are able to consume, the faster your tissues will
    number you count. You will find that the period heal. I am going to count to five and you will open
    after your operation will be a very pleasant one. your eyes. [Dehypnotization should be done
    Should you have any discomfort in and around the slowly:] You will feel completely alert, refreshed,
    wound, you may use the glove anesthesia which and wonderful after you open your eyes. One, you
    you learned to develop to "knock it out." You will are feeling fine. Two, more alert. Three, still more
    be able to relax and sleep soundly. Should you alert. Four, sound in mind, sound in body, no
    require medication for sleep, it will make you very headache. Five, open your eyes. You feel
    sleepy. You will wonderful.
    EGO-STRENGTHENING:
    ENHANCING ESTEEM,
    SELF-EFFICACY, AND
    CONFIDENCE

    INTRODUCTION

    HE CONCEPT OF "ego-strengthening" was popularized by John Hartland


    (1971). His ego-strengthening approach, reprinted later in this chapter, simply
    consisted of generalized supportive suggestions. Their purpose was to increase
    the patient's confidence and belief in him or herself, enhance general coping
    abilities, and minimize anxiety and worrying. It was his common practice to give
    ego-strengthening suggestions as part of almost every induction, seeking to
    reinforce self-reliance and a positive self-image.
    Although not a practitioner of hypnosis, Bandura (1977) and others (e.g.,
    Marlatt & Gordon, 1985) have emphasized the concept of self-efficacy: the
    expectation and confidence of being able to cope successfully with various
    situations. This has come to be a key concept in the emerging field of relapse
    prevention. Individuals with high self-efficacy perceive themselves as being in
    control.
    In the helping professions we have a relatively limited number of interventions
    available to us for increasing self-esteem and self-efficacy. We may give patients
    positive feedback and compliment them, but they often discount such comments.
    Cognitive therapists of various persuasions have provided us with some methods
    for helping patients examine assumptions and irrational thinking patterns that
    undermine esteem. Traditional insight-oriented approaches to therapy examine
    the historic roots of one's self-image, and can be effective but sometimes rather
    time-consuming. Behav-iorists (Bandura, 1981) emphasize that self-efficacy is
    increased by engineering success experiences for patients, but this is often quite
    difficult to accomplish. Roleplaying and mental rehearsal techniques which may
    also
    109
    110 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    enhance coping abilities, have more recently been emphasized by behavior-ists


    (Marlatt & Gordon, 1985) as methods for increasing self-efficacy expectations for
    specific situations.
    Hypnotic techniques offer the clinician an abundance of other options for
    enhancing self-esteem and self-efficacy: rapid unconscious exploration and
    working through of the roots of self-image problems; obtaining unconscious
    commitments from the patient (as modeled by Barnett's approach); direct
    suggestions and indirect suggestions and metaphors; positively-focused age
    regression to successful and happy life experiences; age progression and mental
    rehearsal; hypnotic conditioning techniques (e.g., the clenched fist technique);
    symbolic imagery techniques; methods for altering imprinted ideas (as modeled in
    one of T.X. Barber's contributions); the use of trance ratification procedures to
    convince the patient of the power of his own mind and inner potentials; the use of
    personalized self-hypnosis tapes to provide regular reinforcement of suggestions;
    learning self-hypnotic self-management skills for coping with anxiety, anger or
    other emotions; hypnotic reinforcement of cognitive (e.g., rational-emotive)
    therapy concepts; and hypnotic reinforcement and facilitation through
    posthypnotic suggestions of positive internal dialogue and self-talk.
    The enhancement of feelings of esteem and self-efficacy has been found to be a
    powerful tool in working with a great diversity of patients and problems:
    depression, low self-esteem, overemotionality, substance abuse, posttraumatic
    stress disorder and victimization; patients with developmental deficits, anxiety
    and phobic disorders, grief reactions, coping with chronic illness; athletes,
    business executives, students, children, and patients with eating and habit
    disorders. In this chapter you will find a tremendous diversity of options for
    increasing esteem and efficacy.

    Ego-Strengthening gery is performed. At times his condition


    strengthens to the point that an infection is cured
    Moshe S. Torem, M.D. due to the strengthening of the patient's immune
    Akron, Ohio system. At times just the mere teaching of
    self-hypnosis for relaxation and calmness and the
    use of ego-strengthening techniques may be
    INTRODUCTION enough so that a patient's symptoms spontaneously
    disappear.
    John Hartland pointed out that only a few In my opinion, ego-strengthening is a technique
    patients will let go of their symptoms before they that is indicated for all patients who come to us
    feel confident and strong enough to do without looking for an alleviation of their suffering
    them. Hartland's ego-strengthening techniques are regardless of what their symptoms are. It is like
    comprised of positive suggestions of self-worth saying that healthy and good nutrition is helpful to
    and personal effectiveness. I view all patients regardless of what their diagnosis or
    ego-strengthening as analogous to the medical illness is. After I teach the patient self-hypnosis, I
    setting in which a patient is first strengthened by then introduce ego-strengthening suggestions.
    proper nutrition, general rest, and weight gain Later, I ask the patient to repeat after me specific
    before a radical form of sur- statements of
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 111
    ego-strengthening. The following is a verbatim memories of the past, you know that you don't have
    example of suggestions given, following induction, to be the memories themselves. That's right. You
    to a patient recovering from depression. can be free of the past and live better in the present,
    more adaptively, coping more effectively with the
    tasks of daily living .. . knowing that every day, in
    SUGGESTIONS every way, you are continuing to get better and
    better, to see things more clearly, knowing that you
    With each breath as you exhale, this calmness are moving forward. Becoming stronger, wiser,
    becomes stronger and stronger, spreading all the improving your understanding of life and the
    way from your head down to your toes, from top to purpose of living in your special role in your family
    bottom, inside out and outside in, immersing you in and society.
    an ocean of calmness. An ocean of calmness . . . You continue to strive for accomplishments, but
    that's right. And as that continues, peace and at the same time, strike a very special balance
    serenity are taking you over, inside and outside, between your career, life, and your family life. You
    thus putting your mind and body in sync with each strike a very special balance between time and
    other. Creating a special state of internal harmony, energy you spend in accomplishing your goals, and
    and peace, and serenity. That's right. That's right. the time and energy you spend in protecting and
    As you continue to sit here and listen to me, there is improving your relationships with other people. In
    this center core within your unconscious mind doing that, you learn to accept yourself as you are,
    that's logical and rational, cool and collected, calm respect your thinking, your feelings, your
    and relaxed, clever and wise . . . the one that wants emotions, and develop a sense of pride and
    you to heal and recover and get well as a whole self-worth. You become more authentic and
    person. That's right, very intelligent and very develop greater courage to assertively express your
    knowledgeable. In fact, it knows so much that your needs in an adaptive way, as you relate to other
    conscious mind doesn't even know how much it people in the workplace and in the family. You
    doesn't know. develop a new sense of balance and moderation
    between leading a life of structure and commit-
    This center core within your unconscious mind ment, and a life of playfulness and spontaneity. As
    has always been there with you, since the time you you continue to move forward, you learn to accept
    were a little child. It has helped you survive yourself with grace and ease, viewing yourself in a
    difficult predicaments in the past, and will continue positive light, developing greater confidence, your
    to help you in the future. People refer to this center talents, your gifts, your skills, and your attitudes
    core in your unconscious as the inner guide or the and abilities.
    internal adviser. Some refer to it as the higher self,
    and others as the guardian angel. But regardless of You have the capacity to visualize yourself in
    the name of what it is or how you call it, it has this the future, living up to your dreams with a sense of
    very special function of guiding you from within, joy and accomplishment. Now, all of the things I
    to continue to find your own way for have said, you do not have to fully remember if you
    self-actualization, your own way to learn the don't want to, or you don't need to remember them,
    difference between the past and the present. This but your unconscious mind and the center core will
    will allow you to remember what you need 10 continue to guide you like an internal coach, even
    remember about the past and what happened to when you are asleep at night. This will continue
    you. And once you do remember, in fact, you have every moment of the hour, every hour of the day
    been an ingenious survivor, rather than a victim of and night . . . every day and night of the week . . .
    unfortunate circumstances. That's right, and now every week of the month . . . every month of the
    you can let go of these memories. And know year, every year for the rest of your life.
    that you have
    112 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    And as you continue to move forward, you begin The key to your success is confidence . . .
    to realize that life is a journey, and that the goal of confidence in yourself . . . confidence in your
    living is not traveling to a specific destination, but ability to do . . . whatever you truly want to do . . .
    the journey itself becomes your destination, and the confidence that you can and will accomplish your
    quality, grace, and form in which your travel on goals through the power of your own mind ... the
    this journey we call life, is in itself the goal of power of your own thoughts. What you tell yourself
    living, and in doing so you are writing the book of has the greatest of power over your life. . . . What
    your own journey. you tell yourself determines whether you feel
    Now take a deep, deep breath again. Let the air cheerful, or gloomy and worried . . . and the way
    out slowly, that's right, and 1 want you to know that you feel, whether you feel joyous, or sad and
    you have the capacity to use this specific technique worried, determines, to a great extent, the health
    for self-hypnosis on your own, anytime you want and well-being of your physical body. When you
    to. In doing so, you will reinforce again and again are bothered and unhappy, your body simply
    this specific technique, boosting your ego and your cannot function properly. What you tell yourself
    whole self, as a whole person. And now 1 will has an enormous impact on your life. . . . What you
    slowly count together with you from three to one, tell yourself ultimately determines what you are
    and when we get to one, your eyes open and they and are not able to do.
    come back to focus. You will be fully alert, awake, Now, tell yourself that your life is just starting,
    and oriented, knowing exactly where you are and and that from this day on you will begin to live
    what you need. You will know what you want to do fully, moment by moment, and really appreciate
    after the session to function adaptively in the tasks and enjoy being alive each moment. Tell yourself
    of your daily living, knowing that you have the that you will no longer worry unnecessarily, either
    capacity to do this again on your own as you come about things that happened in the past or about what
    out of this exercise of hypnosis. might happen in the future, unless there is
    [The patient is then realerted. This technique is something constructive you can do to change them .
    followed by a brief discussion of the patient's . . because the past and the future exist only in our
    experience and what it was like. This will allow thoughts . . . life exists only in each moment. If you
    him to ask questions or clarify certain issues.] spend your moments worrying about the past or the
    future, these moments, which are your life, pass
    you by. So, let yourself become deeply involved in
    each moment . . . deeply involved in everything that
    is happening around you . . . less conscious of
    An Example of Positive yourself—and more at peace with yourself and
    Suggestions for Well-Being with the world. Tell yourself that with each passing
    day, you will feel happier, more content, more
    joyous, more cheerful, because you choose to feel
    Sheryl C. Wilson, Ph.D., and
    this way by controlling your thinking. And because
    Theodore X. Barber, Ph.D. you feel this way, life will be more fun. . . . you will
    Framingham, Massachusetts, and Ashland, enjoy each day. . . . and you will become more and
    Massachusetts more healthy, as your body functions easily in a
    tension free environment.
    [The illustrative suggestions, as presented
    below, are an example of the kinds of positive Day by day, let yourself feel more alive, more
    energetic, and at the same time, less tense, less
    suggestions that we have used in conjunction with
    nervous, less worried or anxious. Tell yourself that
    many other suggestions in the treatment of smoking
    your mind and body are relaxed, calm, and
    and obesity.]
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 113

    you are at peace with the universe. And because always somewhere in the sessions, we give some
    you are calm and at ease, you will have greater of these kinds of suggestions. We make a tape for
    energy and your mind will be clearer, and sharper, each client which includes these suggestions,
    and more focused. Consequently, you will be able tailoring the tape to fit that person's needs. It
    to see problems in perspective and handle them should be clear that these are by no means the only
    easily, efficiently, effectively, and confidently, kind of suggestions that we use in our therapeutic
    without becoming bothered or tired out. endeavors. We use a wide variety of suggestions
    Above all, stop telling yourself that you can't do and a wide variety of procedures and techniques.
    something which you want very much to do [such
    as stopping smoking or losing weight]. As long as
    you tell yourself you can't do it, you can't. Instead, POSITIVE SUGGESTIONS F O R
    tell yourself that even if it is difficult, you will be EFFECTIVE LIVING
    able to do it. When you tell yourself that you can
    and will, you have taken the first step towards [We begin by asking the client to sit quietly,
    accomplishing what you want to accomplish. And close the eyes, and begin to relax. Then we go on
    you will find that you can and will accomplish your somewhat as follows.]
    goal. These things that you will now be telling Let yourself begin to relax and feel calm, with
    yourself will begin to affect your life more and peace of mind. Just feel yourself at ease, tranquil, at
    more. They will affect the way you feel about peace, relaxed. Take a deep breath, just take a deep
    yourself, and the way you feel about your life, and breath, and as you let out the breath, feel all the
    consequently will affect every aspect of your life. tensions leaving, you feel at peace, calm, and at
    ease. All bothers, worries, anxieties, just fading
    away, just gone far away. There's lots of time, feel
    your mind at peace, calm, at peace, relaxed and at
    ease—that your mind becomes calm, your mind
    Positive Suggestions for and body are at ease, peaceful and relaxed. Become
    Effective Living more and more ready to retain those ideas that I
    will give you, as you will let them go deep in the
    T. X. Barber, Ph.D. back of your mind, and you will use them as you
    Ashland, Massachusetts wish throughout your life. Every day, beginning
    now, you'll feel this way, calm, and at peace, while
    you're interacting, while you're working, while
    INTRODUCTION you're doing, you'll still feel peaceful, calm and at
    ease. Be able to enjoy life now, with peace of mind,
    I'm going to present positive suggestions for at peace with the universe, a feeling of peace and
    effective living that we use with a wide variety of tranquility. And a feeling of it's so good to be alive,
    clients. These suggestions are especially made to with peace of mind. At peace with everyone around
    emphasize that life can be a little different, that you, relaxed and calm and at ease, and enjoying
    people can live more effectively; they can enjoy every moment of living. Starting now, a feeling of
    more, they can see things in a better way, they can underlying happiness, and peace of mind can be
    feel better about themselves. We have found these with you, can be with everyone in the universe,
    kind of general suggestions to be useful with a wide because we make it ourself, as we let our mind be
    variety of individuals. We use them when we're calm, and relaxed. As we become more calm, and
    trying to help someone stop smoking, when we're relaxed, you feel a kind of underlying energy also.
    trying to help someone lose weight, when we're The relaxation and calmness fits in
    trying to help somebody who's depressed.
    Almost
    114 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    with energy, vitality, being fully alive, at all times over the years will no longer be stale for you, as
    and in all situations. More and more, starting today, you become aware again that we can be the way we
    you'll feel more and more calm, at ease, and at were once, looking at each thing as miraculous, as
    peace, feeling so good to be alive. So good to be beautiful, as wonderful as the first time we ever
    vibrant, energetic, vital, healthy, and strong, alive saw them, when we were children.
    and vibrant, able to flow with everything around As if we're here now, again, for the first time. As
    you, every day, and to enjoy every day, more and if we're here from another planet. We've just landed
    more, to enjoy every aspect of every day, as you and we see the wonders of the earth, and we see the
    feel peaceful, and calm, and at ease, with energy, people on the earth, and we see their hair, and their
    with vitality, feeling the strength and energy in face, and their nose, and their skin, and the wonders
    your being, feeling the flowing and vibrations and of their being and their mind. And we see each
    energetic flow of your life. person as if we've never seen this person before.
    We see them fresh and new, and we see all the
    wonderful aspects of their being. And we look
    again at every cloud and we feel every breeze. And
    SEEING AND APPRECIATING THE
    we begin to feel the air around us, and we become
    WORLD ANEW more aware of the oxygen we breathe, and we
    With peace of mind, calm, and at ease, being become more aware of the colors and the details of
    the flowers and the trees, and the people, and the
    able to look out at every part of the universe, at
    buildings, and the grass, and the books, and
    every person around you, at every flower and tree
    and plant, grass and children, and in a new way, as everything that surrounds us, every day, every
    you begin, starting now, to see the world in a new person, every child, every adult, every person,
    way, with a freshness, and wonder, and awe of a every animal, every plant —we see it anew.
    little child. You begin now to see the world again as Experiencing each moment in a new way, starting
    now, as if a fog has been lifted, as if everything is
    you once did when you were an unspoiled child,
    becoming sparkling clean, as if we've come from
    and you can regain that capacity again, to see and
    appreciate everything freshly, and naively, in a another planet and we look around, and we see, and
    simple way as you can begin once again to see we feel, and we experience in a new way, starting
    things anew, fresh, wonderful, clean. Now you can now, and every day. And this feeling will grow
    begin to look at every sunrise as if it's the first more and more as time goes on — you will be able
    to feel more and more at ease and calm and
    sunrise you've ever seen, and every sunset, and you
    peaceful with vibrant energy, enjoying every aspect
    will see the colors, and the wonder, and the beauty
    surrounding you again, as if it's the first time you've of your being, feeling strong, healthy, with peace of
    ever seen it. mind, calm mind, body at ease, and yet very vibrant
    and energetic, looking at everything in a new way,
    Starting now, every bird that you see will be as if as if you've been here now, just a short time. You're
    you've never seen a bird before, as if you're a new beginning to experience the world again, fresh,
    child, and you're beginning again to look with clean, sparkling new, new perceptions, aware of
    wonder and amazement at the world around you. everything around you freshly, once again. And
    You see every bird in a new way, and every tree, this will grow every day.
    and the leaves on the tree, and the seeds on the tree,
    and the bark on the tree, and the green leaves and
    With this new way of looking at life, you'll find
    the sun shining, and the grass around you, you'll be
    every day that your energy will increase and you'll
    able to see it in a new way, fresh, with wonder and
    feel so healthy, and you feel healthy, and free,
    awe. As you gain the capacity to appreciate
    you'll feel all the tensions will leave. You'll feel at
    everything as you once did. Everything that's
    ease and calm, and free as you
    become stale
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 115

    become more aware of the blood circulating in your remember how to play and to have fun, by your
    body, and the strength in your muscles, and the own creativity and imagination, using your own
    wonders of your strong, healthy being. You begin ingenuity, able to regain your lost spontaneity,
    to feel that you're living, you're beginning to live your naturalness, your freshness —it will come out
    more and more, growing every day, becoming and you will feel at ease with it.
    more aware, more filled with energy, more vibrant.
    Starting today, you'll begin to feel that life is just
    beginning, that your potential for living a very good CREATING HAPPINESS THROUGH
    life is there, and it will increase and you'll become
    CHANGING YOUR THINKING
    more aware of the potential, and you'll become
    aware of how you can enjoy life more and more
    Starting now, more and more, you will realize
    every day. And you'll look forward to every coming
    that happiness, and unhappiness, are due to your
    day as another exciting day that you can live fully,
    own thoughts, the way you think about situations.
    growing, changing, maturing, healthy, strong,
    You will be able to shift your thoughts, the way
    vibrant, and energetic. You will realize that you
    you think about situations. You will be able to shift
    have the potential to be happy, strong and much
    your thoughts to the positive aspects, and look at
    greater than you thought. That you have vibrant
    the positive aspects of living, enjoy every day. You
    energy, that you're able to flow with everything
    will become more and more aware that if life's
    around you, to be able to flow and move with every
    situations are not the way you always want them,
    person, every individual you meet. You'll be able to
    you will work to change them, without frustration,
    feel with them, be able to feel with every animal,
    without anger, without being bothered. You will
    and every plant, and every part of the earth.
    work to change things that are not the way you
    want them, but you will do it with a calm, peaceful
    From this day on, you'll begin to live fully,
    mind, being at ease and at peace with the universe.
    moment by moment, every day. You'll get so much
    out of every day, more and more, starting now, You will become more and more aware that
    every day, every hour, every second, will become everyone has problems in living, but you will also
    more and more exciting, full, enthralling, amazing. be aware that as you become more mature, that you
    You'll become more and more aware of the can face problems with a calm mind, with strength
    wonders of your being, yourself, the earth, and and determination, to work to improve them. When
    everything around you. You'll become more and you cannot change things, you will accept them
    more deeply involved in everything that is calmly, you will be aware that anger and frustration
    happening around you, the people you meet, the do not help. You'll realize that life is too precious
    tasks you meet, and the children that you see, and and too wonderful to waste it in being bothered
    everything that comes into your life. You'll be over little things, little annoyances. Starting today,
    aware, and become more and more involved, like a you will work to change anything that is
    child, living fully, enjoying every moment, being changeable that you can change with peace of
    unself-conscious, feeling free. You'll be able to mind, without being bothered, without frustration,
    make more and more activities, and something like without anger. You will be less and less worried
    an enjoyable game, that you can play, and dance, about the future, problems of the future, dangers of
    and move, and enjoy. And your activities will be the future which will never occur anyway. Most of
    the way they were when you were a child, free and the things you worry about won't happen anyway.
    unspoiled, at ease, enjoying, able to get into things, You'll let the worries go, you'll enjoy the day,
    more and more, as you were once able to be you'll let yourself go, you'll enjoy yourself, as
    creative, ingenious, able to make everything into a worries drop out of your life.
    fun game. You'll again
    116 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    LIVING WITH EMPATHY, RESPECT, AND desires to be kind, to be good, to do things for
    HARMONY others also.
    You'll feel with other individuals. You'll become
    more and more empathic as time goes on. You'll be
    And day by day, you'll find yourself more and able to help others, to help others to feel good, to
    more successful in living at peace with the help others enjoy life. And as you help others enjoy
    universe, with yourself, with everything around life, you'll be able to enjoy it yourself, more and
    you, with no unnecessary worries. As each day more as time goes on.
    passes, you will feel more and more at peace, more
    and more lively, feeling alive, enjoying each
    moment, living now, today, enjoying every day GENERAL SUGGESTIONS FOR
    more and more as you let these thoughts go to the WELL-BEING
    back of your mind. They will be more and more this
    way, as you let them guide your life. You'll become And each day, as you wake up in the morning,
    increasingly able to meet the responsibilities of you'll have an inner feeling of excitement, a feeling
    your life, and will be able to determine for yourself of energy and underlying joy, eager to get up from
    what the truly necessary activities are in life. bed and to get going. You feel so good, refreshed,
    With ever increasing frequency, you'll become awake, relaxed, with energy, an inner feeling of
    more and more deeply interested and aware of joy, and well-being, when you wake up in the
    other people, seeing that other people have morning. And throughout the day, a feeling of joy
    problems, and you will be aware of their problems, of living, of vibrant energy, and as you wake up in
    able to help them, as you become less and less the morning it will be so good to begin to plan for
    concerned about yourself, and more concerned the new day ahead. You'll feel refreshed, strong and
    about others, more and more aware of the beauty of healthy, as you'll have slept calmly and at peace,
    other individuals around you. As each day passes, knowing that each day as life goes on, you will
    you'll find yourself more aware of and concerned enjoy it more and more as you mature and become
    with the feelings of others. You'll be deeply more and more aware of every beauty, and every
    interested in the people around you, more and more mystery and amazing thing that surrounds you, as
    forgetting yourself, not concerned especially about you become more and more aware of the amazing
    yourself, not self-conscious, giving others your nature of the universe and life.
    undivided attention, really interested in them, their
    life, what they think and say, feeling good, and
    relaxed, and happy, and natural.
    SUGGESTIONS FOR S L E E P
    You'll realize that everyone around you is more
    or less insecure, and doesn't feel perfectly secure And each night when you go to bed, you'll be at
    with others. And you'll realize more and more that ease and relaxed, you'll feel relaxed and calm
    others want you to like them, they want to feel that knowing that every day is another adventure. Even
    they matter, that they're important. And once you though some days will have problems and things
    realize this, it becomes more and more a part of we don't like, every day will be an adventure.
    your being, to be able to help others to feel good Starting now, as you go to bed every night, you'll
    about themselves. You'll realize more and more be calm, and at ease, your mind and your body will
    that they're struggling to be happy, to love, to feel be calm, tranquil and relaxed. You'll be able to
    good about themselves, and you'll be able to sleep calmly, at peace, able to sleep the way you
    empathize and feel with other individuals, to feel did when you were a baby —so calm, so relaxed, so
    with their feelings and insecurity, with their completely at peace. You'll sleep so well. You'll be
    able to
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 117

    sleep soundly, knowing in the back of your mind, potentials for living beautifully that are there all the
    that day by day you're beginning to live more fully, time, you'll be able to have more and more calm,
    more deeply. As time goes on, you will live with peace of mind, awareness, and a feeling of strength
    more and more wisdom, and you'll let yourself and health and energy, that will grow as the days
    sleep the way a baby does, when a baby feels good pass. Your mind will be at peace and calm. You'll
    and very secure. You'll sleep very well, and very feel strong and healthy, and very vibrant and alive,
    calm, and when you wake up in the morning, you'll and that feeling will pervade your being. You'll
    be fully rested, very refreshed and at peace. become more aware of it, but it will be there, at the
    back of your mind, starting now, every day.
    SUGGESTIONS ABOUT WORK Every day will be as if it's the first day in your
    You'll be at ease with your life and everything life. You'll be able, more and more, to feel as if it's
    so wonderful, as you see things again in a fresh
    around you. You will be so glad and so happy to
    new way, experiencing everything in a fresh new
    have another day to live and enjoy, every day. And way—the way you may have experienced it when
    when you're at work, you'll be able to focus on a you were a child, as you begin to look at the grass
    task, and become absorbed and involved in the task and the flowers, and the trees and the birds. You
    at hand. You'll be able to also become absorbed and become aware of their delicate textures. You
    involved with the people around you. When you become aware of the details of their being. You
    work, you'll be able to work well, and efficiently, become aware of the breeze every time it touches
    able to concentrate, able to enjoy your work and you. You become aware of everything you do with
    able to enjoy the task. your hands, and the strength of your hands, and the
    wonderful manipulative ability of your hands, and
    ENHANCING PRESENT AWARENESS the wonderful abilities of your body. You become
    more and more aware of so many things that you've
    And able to enjoy everything you do —the
    taken for granted, and you begin to see them in a
    people around you, the food as you eat moderately
    new way, no longer stale, no longer something that
    and with peace of mind. Able to enjoy the water you're used to, no longer something that you just
    you drink, with peace of mind, calm and at ease, don't even notice— fresh as if you've just come to
    enjoying every aspect of the beautiful, wonderful this earth. Starting anew.
    earth. You'll be able to enjoy everything you see
    and touch, and you'll become more aware of touch And you begin to meet the challenges of life
    and the beauties of touching. You'll become more every day with a calm mind, a calm, peaceful mind.
    and more aware of the fragrances and the aromas, So good to be alive, and with this calmness, and
    and everything around you. And you become more feeling the strength of your being, the vitality and
    aware of all the beauties of your senses, as you see, health flowing through your being, you'll be able to
    and hear, and touch, and smell, and feel. And you change those things that can be changed every day.
    become more and more aware of people around But those things that can't be changed, you will
    you. You become more and more aware of their accept with calmness and peace of mind, knowing
    amazing nature, of the depths of their being, of their that life can be so beautiful, no matter what
    strivings and hardships and problems. problems you may face.
    You'll become more and more absorbed in your
    REINFORCEMENT OF EARLIER work, in the people around you, consumed very
    SUGGESTIONS much about the wonders of being able to think, and
    feel, and talk, and plan, and imagine, and in the
    And as you become more and more aware that
    wonders of your mind and
    your life is only beginning, and of the
    118 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    your being, and being able to use them in your work difficulties [misfortunes, illnesses, rejec-
    and with people around you. Loving every tions, deaths of loved ones].
    individual and every creature that you see, and • You have helped many people in your life.
    being more and more aware of nature. Living more • You did well in a very difficult situation.
    and more fully, more and more deeply, every day, • You really care about people.
    starting now. And as you let these thoughts enter • You have much empathy and love for others
    the back of your mind, you'll feel, starting now, that you have not been able to express.
    more and more at peace, calm, and at ease, with • You are a kind person.
    peace of mind. Vibrant, strong, and energetic body, • You have so much that you haven't begun to
    and peace of mind. You begin to feel more and use —so much more love, so much more
    more at ease and calm and alive, and you see competence, so much more ability to be at
    everything in a fresh, new way, new, beautiful. ease, to enjoy life, to live fully.
    Your life will become more and more wonderful
    In addition to interspersing these kinds of
    and exciting. You'll be able to fulfill the many,
    statements in our discussions, I also include them
    many potentials that you have starting now, so let
    as suggestions in the hypnosugges-tive procedures;
    these thoughts now go to the back of your mind. Let
    for example, after the client has been given
    them guide your life as you wish. Let them guide
    repeated suggestions of deep relaxation, he or she
    your life, starting now, as you wish. Let them go to
    may be given a series of suggestions on various
    the back of your mind, and now, as you wish, you
    topics, interspersed with suggestions that "Starting
    can become more and more alert to everything
    now, you can begin to focus more on your strengths
    around you, more and more ready to begin to live
    and positive aspects . . . you can become more
    with vibrant energy, and with peace of mind, as you
    aware of your ability to overcome obstacles . . .
    become now more alert and ready to open your
    your caring and love for people . . . your growing
    eyes, beginning now to open your eyes.
    ability to be at ease and to enjoy life," and so on. 2.
    A second hypnosuggestive approach that aims to
    enhance self-esteem derives from the fact that
    clients with low self-regard have typically been
    criticized by parents or other significant individuals
    in their early lives, and they have incorporated the
    Suggestions for Raising criticisms into their self-images. In the therapy
    Self-Esteem sessions, we trace back the destructive criticisms
    the clients have received from parents, siblings, or
    T. X. Barber, Ph.D. other important people "You're dumb, stupid, ugly,
    Ashland, Massachusetts clumsy, rotten, no good," etc.). After we have
    uncovered some or many of the origins of the low
    self-esteem, I proceed as follows in a
    1. First, I look for and emphasize all of the manifest hypnosuggestive session. I first give to the client
    and latent positive characteristics that I can (and indirectly to myself) suggestions for deep
    observe about the client. I am always able to relaxation and then, when the client and 1
    find many such attributes, and I sincerely tell are both relaxed with eyes
    the client about them at intervals in our
    discussion, using statements such as the
    following:
    • You have done so much [or worked so hard
    or struggled so much] in your life.
    • You have been able to overcome so many
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 119

    closed, I speak to the client from my "inner self"-- themselves relax deeply, and to let the ideas "go
    for instance, somewhat as follows: deep into your mind." Although these tapes are
    individualized for each client, they typically
    We understand now why you have felt you were emphasize positive aspects of the client that have
    unattractive, unintelligent, and not likable. It is clear been neglected or suppressed and that can be
    now that your mother had a tremendous amount of released and expanded. Examples of the kinds of
    resentment and anger and was unable to love you or
    suggestions that are included in the hypnosuggestive
    anyone else because of her own father, who
    degraded her and made her feel totally unlikable and tapes are as follows:
    worthless. It's clear that you were too young to
    understand why your mother constantly put you You have much caring and concern and love for
    down and screamed at you and made you feel there others that you hold down and keep within
    was something wrong with you. You can now see you . . . You can begin now to let out these good
    how your negative feelings about yourself were due feelings . . . allowing the kind, caring, good feelings
    to negative suggestions you received constantly from to flow out to others . . . You can begin
    your mother, who was negative about everything and more and more to be your true self as you release
    everyone because of her own misery. Now you can your warmth and empathy toward others.
    begin breaking through the negative suggestions you
    Starting now, you can be more and more aware
    have received, you can begin coming out of the nega-
    of your true self that is being released, and you can
    tive hypnosis you have been in for so many years,
    stop criticizing yourself . . . You can stop blaming
    and you can begin to be your true self that has been
    yourself for what you did that you should not have
    held down for so long. You can see more and more
    done or what you did not do that you should have
    clearly that as long as you were negatively
    done, and you can forgive yourself as you forgive
    hypnotized and believed you were stupid, ugly, and
    others . . . You can be as kind to yourself as you are
    no good, you reacted to events and people around
    to others ... as loving to yourself as you are to
    you in a nonconfident, afraid way, which tended to
    others . . . You can stop criticizing and blaming
    confirm your own beliefs. You can now begin to let
    yourself, and you can be free — free, more and
    go of these negative suggestions and begin to be
    more, to be your true self.
    your own true self, realizing more and more each
    day that you are a good, kind, loving, and lovable Starting now, you can more and more allow
    person. Each day you can become less and less yourself to be the person you can be . . . ap-
    afraid, more and more at ease, more and more able preciating again and grateful again to be able to see,
    to enjoy life and to be your true self, [emphasis to hear, to smell, to touch, to be alive . . .
    added] Appreciating again as if it's your first day on earth,
    as if you've never felt the sun before, never heard a
    bird sing, never smelled a flower before . . .
    Grateful to be able to touch the rain and a stone, to
    As part of the hypnosuggestive approach to raising
    hear the laughter of children and the sound of the
    self-esteem, I make additional cassette tapes for the
    sea, to smell the grass and appreciate tasty food, to
    clients. These tapes, which are made when the client see the colors of the earth and the stars . . .
    and I are in my office, begin with suggestions for Appreciating again the strength and power in your
    deep relaxation, followed by specific suggestions body . . . Feeling the energy and health vibrating
    that aim directly or indirectly to enhance self-esteem and flowing through your being . . . Feeling again
    by guiding the clients to focus on their underlying the excitement and enthusiasm and the feeling of
    strengths, virtues, and positive qualities. The clients aliveness that has been suppressed for so long . . .
    are asked to listen to the cassette tape at home once a more and more ready to enjoy, to have fun, to play
    day during the forthcoming week, to and laugh and sing . . . More and more feeling good
    let to be you and to be alive, (emphasis added]
    120 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Barnett's Yes-Set Method of When the patient answers "yes," ask: "Is there
    any part of your inner mind that does not entirely
    Ego-Strengthening agree with me?" [This is a double check for a
    hidden ego state or part of the personality that is
    Edgar A. Barnett, M.B., B.S. still negative. If such a part exists, undiscovered, it
    Kingston, Ontario, Canada may sabotage the ego-strengthening suggestions.]

    STEP THREE. Help the patient to accept his/her


    INDICATIONS feelings, and establish a yes-set. Then, let go of old,
    negative feelings.
    "I know that all human beings have uncom-
    This method of ego-strengthening is recom- fortable feelings as well as comfortable feelings,
    mended following the use of other methods to and I know that you have had feelings that are
    enhance the patient's esteem; otherwise, patients uncomfortable. I know that you have had feelings
    with minimal self-esteem will usually fail to of sadness, like any other human being. If you
    respond positively to step two and further work will agree with that, your 'yes' finger will float up to
    be required. This method may be valuable in signal me. And you have had feelings of happiness,
    facilitating greater acceptance of one's own feelings like any other human being. If you agree with that,
    and in promoting assertiveness and self-regard. again your 'yes' finger can lift. And you have had
    Ideomotor finger signals should be established feelings of anger, just like any other person, have
    prior to using this method. (Ed.) you not? And feelings of love, just like any other
    human being. [Wait for signal, and if necessary,
    STEP ONE. State a belief in humanity's worth and ask, "Have you not?" or "Haven't you?"] Feelings
    importance, seeking the patient's affirmation of this of fear, just like any other human being. And
    belief. feelings of safety and security, just like anybody
    "Now, I want your unconscious mind to listen else."
    very carefully. And when the deepest part of your "Now, all of those feelings are normal, human
    mind is listening carefully, your 'yes' finger can lift feelings and you don't need to feel ashamed or
    to signal me. [Pause] Good. And keep listening guilty or embarrassed about any of them. I believe
    very carefully. that you have the right to all of your feelings,
    "I believe that every human being is unique and whether or not they are unpleasant. Do you agree?"
    important. Do you agree?" [If the patient answers [If the answer is "no," seek to determine the reason.
    "no," exploration about this may be done with For example, perhaps anger is regarded as an
    ideomotor signaling. Another approach is to say, unacceptable feeling. Reason with the patient,
    "Even though you do not agree with me, do you justifying the value of any type of feeling he or she
    believe me when I say that / believe that every regards as problematic]
    human being is important and unique?"] "I believe that you have as much right to your
    feelings of sadness as any other human being. If
    STEP TWO. Persuade the patient to accept himself you agree, your 'yes' finger will float up again.
    (herself) as an important and worthwhile human [Pause] And you have as much right to your
    being. feelings of happiness as any other human being, do
    "I believe that you, (patient's name), are unique you not? [Pause] And you have as much right to
    and special—just as unique and important as any your feelings of anger as anyone else; as much right
    other human being. Do you agree?" [This question to your feelings of love; as much right to your
    will typically be met with considerable thought and feelings of fear and to your safe feelings. Do you
    delay.] agree?"
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 121

    "It is your privilege to have those feelings, and No one has the right to put him/her down, so
    you don't need to feel guilty, ashamed or protect him/her from anybody who wishes to do
    embarrassed about any of your normal human that. Take care of him/her at all times. In fact, I
    emotions. You have a right to keep them for as long want you to take care of him/her, but also to care
    as you need them. But you also have a right to let for him/her. Care for (patient's name), love
    them go when you don't need them any more. And him/her. If your unconscious mind is willing to do
    if you agree with all of this, your 'yes' finger will all these things, your 'yes' finger will lift."
    float up again." [Pause] "And as you do all of these things, some
    "And any of these old, out-of-date, uncom- wonderful things will happen: you feel very safe,
    fortable feelings that you've been carrying around very secure. It feels like you have the answer to so
    and which you no longer need can be let go. And if many things which used to puzzle you. You will
    you feel that you are letting go of them right now, feel so safe, so secure, that you will no longer let
    your 'yes' finger will float up. [Pause] And you can things get you down because you know how to
    stay free of those old, out-of-date, uncomfortable handle them. You always did know, but you did
    feelings. You can finish letting go of them now. not know you knew. And use the knowledge. You
    [Pause] You have a right to those feelings of hurt if can use it to the best of your ability. And with that
    you need them back; you have a right to have your good knowledge, you can do the things that you
    feelings of anger back if you need them back at really want to do. You will be able to do them
    some time; you have a right to have your feelings of because you feel friends with yourself. It's a nice
    fear back any time you need them. But, when you thing to feel good friends with yourself. And if you
    don't need them any longer, you can feel happy, are feeling friends with yourself right now, your
    you can feel loving, and you can feel safe and 'yes' finger will lift." [pause]
    secure."
    "Continue to be friends with yourself. Continue
    "Now, I would like your unconscious mind to to listen to yourself, hear yourself, and give
    make a commitment that you will respect (patient's yourself good advice. And take the good advice
    name) always. By that, I mean that you will respect that you give yourself. And as you feel very good
    his/her feelings. And if your unconscious mind is about yourself, I am going to ask you, please, to
    willing to do that, your 'yes' finger will float up. know that you don't need to put anybody else
    [Wait for 'yes' signal] You'll like him/her because down. You don't have to put anybody else down,
    he/she has human feelings and a right to those because you feel that you can respect other people,
    feelings. And because you like him/her, you will and respect them as having their problems and
    listen to his/her feelings and not put him/her down being human, just like you."
    for having them. He/she has a right to have them. "And because you are feeling so good, today can
    And you will find ways of helping him/her to feel be a very good day. I would like you to see yourself
    comfortable — good ways that are helpful. Never having a very good day. When you can see that, let
    put him/her down for having uncomfortable your 'yes' finger lift. [Pause] Good. You feel so
    feelings, for he/she has a right to them. Listen to good. There's a nice, calm, relaxed, smiling feeling
    them, respect them, like them. I want you to always all through you. And keep that feeling. Keep it
    protect him/her, as you have been doing in the best each day. Feel good about (patient's name), being
    way that you could; but now, you have better ways the person you are, liking (patient's name), and
    of protecting him/her. Listen to his/her feelings. taking care of him/her."
    You've got better ways. You've found better ways.
    Always look for better ways to take care of "I want you to know that you can remember
    (patient's name)." what you need to remember at all times, and forget
    what you need to forget, because your
    "And don't allow people to put him/her down.
    He/she is just as good as anybody else.
    122 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    unconscious mind will always remember every- THE GENERALIZED


    thing that we have talked about. If that is EGO-ENHANCEMENT
    understood, your 'yes' finger will lift. [Pause] It will TECHNIQUE
    keep all of the suggestions that we have agreed
    upon, so that your conscious mind does not have to The technique embraces the following steps:
    bother with trying to remember all the many things
    that we have discussed. Your conscious mind can 1. Physical relaxation induced by concentration
    leave all of the remembering to your deep, inner, upon the breath, following it as it flows in and
    unconscious mind, so that when your open your out, letting go tension, tightness, and
    eyes, your conscious mind can be free, to think discomfort with each breath out. Patients are
    about other things." [Awaken and distract the encouraged to develop a detached attitude, as if
    patient.] they are watching someone else breathing.
    The simple following-of-the-breath physical
    relaxation technique permits patients to "let go"
    specific problems, unwanted thoughts, and
    physical discomforts which have been
    Ego-Enhancement: A Five-Step discussed before induction is commenced.
    Approach Thus, it serves as both the first step in trance
    induction and the commencement of therapy.
    Harry E. Stanton, Ph.D. 2. Mental calmness encouraged through imagining
    Hobart, Tasmania, Australia the mind as a pond, the surface of which is
    completely still, like a mirror. Thoughts are
    watched in a detached way, being allowed to
    INTRODUCTION drift through above the water, attention then
    being brought back to further contemplation of
    Opportunities to tailor the approach to handle the water's stillness.
    specific problems occur within each of these five In the "pond" mental relaxation step, patients
    steps. Due to its flexibility, this approach to may be encouraged to imagine the area above
    ego-enhancement may be used to help patients with the water as their conscious minds and that
    a wide variety of presenting problems. below as their unconscious minds.
    Approximately 85% of my patients find that the Accordingly, they have the power to "drop
    ego-enhancement approach affords considerable into" the pond of their mind anything they
    relief. This is true whether they want to learn how desire. This may be formulated in terms of a
    to relax, overcome anxiety, sell more insurance, trance-deepening suggestion, with the patient
    kick a football farther, or let go of habits such as imagining a beautiful stone representing, say,
    smoking, overeating, and alcohol abuse. As it is mental calmness sinking down and down,
    basically gentle and nonintrusive in nature, deeper and deeper, until it comes to rest at the
    ego-enhancement is a technique unlikely to cause bottom of the pond. It is then suggested that the
    harm and would seem capable of effective use with patient's mind locks around this calmness, a
    most patients finding difficulty coping with their calmness which is to become a permanent part
    life situations. However, as I have not employed of his or her life. The same procedure may be
    the approach with patients suffering with severe followed with other stones, each one repre-
    character disorders, I am unable to comment on senting a specific suggestion relevant to the
    whether it would be similarly helpful and particular patient, and each one assisting
    noninjurious in such a context.
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 123

    the deepening of the trance as the stone sinks patients find their special place, it is suggested
    "down and down, deeper and deeper." As a that they think of themselves as they want to
    normal practice, mental calmness, physical be, imagining themselves behaving the way
    relaxation, confidence, and happiness comprise they want to behave, and "seeing" themselves
    the "stones," but these may be replaced with achieving the success they wish to achieve.
    others such as concentration, mental control, Sometimes particular images to meet the
    and healing where it seems appropriate. The expressed needs of patients will be suggested;
    "pond," then, provides a basic framework on other occasions patients may generate their
    within which considerable flexibility is own material.
    possible. The "special place" visualization is a
    3. Disposing of "rubbish" as subjects imagine common aspect of many hypnotherapeutic
    themselves "dumping" mental obstacles, such treatments. One particularly useful pattern is to
    as fears, doubts, worries, and guilts, down a have patients imagining themselves going
    chute from which nothing can return. Physical through a door which they can shut behind
    obstacles, such as cigarettes and excess weight, them to exclude the rest of the world.
    may also be disposed of in this way. Suggestions may then be made that, in this
    4. Removal of a barrier representing everything place, they will be able to get into contact with
    that is negative in the lives of subjects. the unconscious part of their minds which will
    Embodied in this barrier are self-destructive then solve any problems they might have. One
    thoughts, forces of failure and defeat, mental aspect of such solutions will be that things
    obstacles, and self-imposed limitations, which have worried or upset them in the past
    everything which is preventing subjects from will simply drop out of their lives as if they
    employing their lives as they would like. This never existed. Because these things have now
    barrier is destroyed through use of the become so unimportant, patients will probably
    imagination. forget they were ever disturbed in this way. At
    this point, use may be made of an Ericksonian
    The corridor, rubbish chute, and barrier approach to the encouragement of amnesia by
    metaphors may also be used to meet individual reminding patients of the frequency with
    needs. Smokers may wish to discard their which, in the past, they have forgotten people
    cigarettes, alcoholics their alcohol, and the and possessions that, at one time, were very
    obese may care to strip away their unwanted important to them. Once this importance has
    weight. Patients may also generate their own faded, so too does memory, a process that can
    variations, this being one of the main benefits of take place with those things which used to
    the approach. . . .Similarly, they often put into worry and upset them.
    the barrier negative aspects of their
    personalities which they have not mentioned in As it is usually preferable for patients to be
    pre-trance discussion. However, because they left free to choose their own special place, they
    feel these are holding them back, they decide for can be told that when they pass through the
    themselves that they should go into the barrier. door, a place will be waiting. This could be
    Other specific negative influences which appear somewhere from their childhood where they
    to be interfering with individuals' enjoyment of enjoyed themselves while growing up, or
    life are placed in the barrier by the therapist. perhaps a fantasy place, maybe even a
    5. Enjoyment of a special place where subjects comfortable emptiness. Wherever it is, beach,
    feel content, tranquil, and still. In this place garden, lovely room, or a comfortable bed, in it
    they "turn off the outside world. Once the patient will feel happy, content, tranquil,
    and still.
    124 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Suggestions for Modifying perfection, we will just automatically feel inad-


    equate, because we can't reach such a goal.
    Perfectionism I think, however, that you can be pleasantly
    relieved, when you change your goal from
    D. Corydon Hammond, Ph.D. perfection, to being competent and making a
    Salt Lake City, Utah contribution. Life can be so much more enjoyable,
    so much more rewarding, when our goal is simply
    INDICATIONS to do things well, and just keep gradually
    improving. I want you to appreciate the value, the
    Perfectionism may be a part of many clinical benefit, of accepting yourself as imperfect, but in
    syndromes, including depression (and low esteem), the process of growing, in the process of gradually
    anxiety disorders, obsessive-compulsive disorder learning and getting better and better.
    and personality, and type-A behavior. These are
    direct and cognitively oriented suggestions aimed
    at modifying perfectionistic tendencies. Cognitive, PATIENCE WITH GRADUAL
    Adlerian and rational-emotive therapists may find IMPROVEMENT AND CREDITING
    these suggestions particularly compatible with ONESELF
    their approaches. Many of these suggestions are for
    patients who are caught up in overcompetitiveness The natural process of change is generally a
    and striving for perfection. Those with a birth order process of taking a series of steps. We roll over and
    as the oldest child and who feel that they must be learn to crawl before we learn to walk, or run, or
    first, best or superior, and second children who are ride a bicycle. We learn addition before we
    caught up in the Avis Complex ("We're second, so progress to multiplication or algebra. The natural
    we try harder.") may benefit from such order of things, is gradual growth and
    suggestions. Some of the other suggestions may improvement. We don't have to be perfect, and
    foster self-acceptance of one's humanness, despite certainly not overnight. We change by gradually
    making mistakes. walking up a series of steps; no one can leap up a
    whole staircase, far less leap a tall building in a
    single bound. We are human, and it is unrealistic to
    expect ourselves to be superhuman. And different
    PERFECTIONISM, SUPERIORITY, AND people make progress in different ways. So I'd like
    OVERCOMPETITIVENESS to suggest that you be patient with yourself,
    because you're unique, and you have your own
    I wonder if you may be one of those people who unique process of growth. And I'd like you to really
    feel that they can't settle for less than perfection, enjoy, each small improvement, each small change.
    and perhaps even that you may as well not even try Experience changes fully, and take credit for the
    if you can't do something perfectly. Many people improvements and gains you make. I'd like you to
    make themselves miserable by striving to be just appreciate how you make changes, and not
    superior, the best, the first, or perfect. They become become impatient with how fast those changes take
    enslaved, striving for the mistaken goal of place.
    perfection and superiority. They mistakenly believe
    that the only thing worth being in life is a star
    —above other people, the best, the first, or perfect.
    That is a belief that will bring misery. Expecting CHANGING YOUR GOAL TO
    perfection from yourself and others leads to disap- COOPERATION AND CONTRIBUTING
    pointment and depression because we are all
    And as you accept the goal of being competent,
    human and imperfect. When we have a goal of
    and making a contribution, instead of
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 125

    being perfect (superior), your relationships with scious mind has altered this inward, basic goal, you
    people will become more gratifying, more har- will find that all this will occur so easily, without
    monious. People who strive to be the best or your even thinking. And you can celebrate your
    superior to others come to view the world as an humanness, and enjoy having the courage to be
    unpleasant, competitive, dog-eat-dog jungle. imperfect.
    People dislike them.
    When your goal is to be better than others, you're
    forever competing, and continually insecure, REFRAMING MISTAKE MAKING
    because it's impossible to measure who's the best.
    But you can free yourself, from the tyranny of We've all made mistakes. And I'm sure that you
    trying to be better than others. It can be so can recall a time when you made a mistake—a
    gratifying, so refreshing, to simply have the goal of mistake that taught you something. Even though it
    making a contribution to other people. When you may have been unpleasant, you can recall making a
    simply strive to improve, and make a contribution mistake that you learned something valuable from,
    in life, people become friends, allies and can you not? [Negative to discharge resistance]
    confederates, instead of threatening competitors; [Assuming you get an affirmative head nod, you
    we feel a fraternity and bond with people. The goal can proceed. Otherwise, you may enlist an
    is now cooperation, not competition. And if your unconscious search for such a time, with an
    unconscious mind is willing to change your inner ideomotor signal when such a memory is
    goal to growing, improving and making a identified.]
    contribution, instead of perfectionism and
    competitiveness, your "yes" finger will float up to And as you recall that memory, I want you to
    signal me. [Await a response, and after 20 seconds begin to appreciate the fact, that without having
    if an affirmative response has not occurred, add, made mistakes like that, you would have never
    "Or your 'no' finger can float up if your unconscious learned and progressed. As a kid, did you ever
    mind is not willing to change your inner goal." If touch a light plug and get a shock that really kind
    the latter is the case, ideomotor exploration may be of jolted you? Many of us had that experience, and
    employed concerning roadblocks to letting go of we learned something very important from that,
    old, mistaken goals.] even though it was a very unpleasant jolt! And
    similarly, it's because you've had the pain of a
    What a relief! To be free of the burden of trying burn, that you learned to be cautious with fire.
    to be the best, or perfect (or superior). It's so much Your imperfect mistakes, have been perfect
    easier, so much more satisfying, so natural, to opportunities for a wealth of learnings, that have
    accept yourself as human, and in the process of formed an indispensable foundation to build on.
    improving and growing. No need to compete with So don't be mistaken about mistakes; the more
    anyone —there's no way to measure who's the best unpleasant it is, the more pleasant will be your
    anyway. learning.
    And I wonder if you'll be surprised, at how And yet so many people are afraid to try, for fear
    attracted you will now become, how enthusiastic they'll make mistakes. And when they do make a
    you'll become, about the goal of cooperating and mistake, they try to cover it up for fear people will
    working together and making a contribution, think less of them, or think they're weak or stupid.
    instead of trying to be perfect (or superior). And I But I'd like you to appreciate the fact, that mistakes
    wonder if you'll notice how spontaneously, how are not only tolerable, but are actually desirable,
    automatically you can find yourself cooperating because we learn through making mistakes.
    with people, and thinking in terms of making a Have you ever been around someone who was
    contribution. It will feel like such a relief—like afraid to admit they had made a mistake? [Brief
    becoming a member of the human family. And
    pause for response] They're very tense
    because your uncon-
    126 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    and defensive, so they find it hard to grow and rational-emotive therapy. Individual paragraphs
    improve. What I'd like you to consider is the (themes) may be regarded as modules for use with
    benefit, of having the courage to be imperfect. I patients who have particular difficulties. (Ed.)
    wonder if you've had the experience, I certainly
    have, of finding that when you see people make an
    error or mistake, that you can actually feel relieved, SUGGESTIONS
    to see that they're human too. Most people feel Day by day you will increasingly do what you
    more willing to have a relationship with someone enjoy doing rather than what other people think you
    who seems human, rather than perfect. And if ought to do in life. It would be nice if other people
    someone does criticize you for making an honest approved of what you do, but it is not necessary to
    mistake, it's probably because they are insecure. your happiness for you to be loved and approved of
    I wonder if you might even find it an interesting by almost everyone for almost everything you do.
    growth experience, to tell friends about some You know what it is that makes you happy, that
    mistakes you make, or about mistakes that you makes life enjoyable and this is what you should
    have made, instead of trying to hide and cover them do.
    up. In fact, wouldn't it be fascinating, as a way of As each day passes, you will become increasingly
    giving you practice allowing yourself to be human competent as you try to better your own
    and imperfect, if your unconscious mind were to performance. Do things because they bring pleasure
    arrange for you to make some minor mistakes? and rewards, but give up the notion of trying to be
    And while your unconscious mind may take a kind thoroughly competent, adequate and achieving. Try
    of pleasure in letting you be human, I don't know at to do rather than do perfectly. Accept failures as
    first, if it will make you a little nervous, or if it will, undesirable but not dreadful. You are a worthwhile,
    in some strange sort of way, seem more fun and valuable person because you exist as a human being,
    almost amusing, to find that you can make an not because of how well you do something. You are
    occasional silly mistake. Or maybe it will just give worthwhile in yourself, quite apart from your
    you the feeling of, "Welcome to the human race." performances.
    But deep inside, you can begin to get the feeling,
    that it really is all right to be human, and to make Day by day you will find it easier and easier to
    some mistakes, so that you can learn and grow accept that you are a fallible human being, and
    more rapidly. therefore, likely to make mistakes. You will be able
    to learn from your mistakes and be increasingly
    successful as a result. Because you can accept that
    as a human being you are fallible, you will find it
    completely unnecessary to blame yourself for
    Suggestions Derived from anything, for self-blame is completely unhelpful
    and destructive.
    Rational-Emotive Therapy
    When conditions are not as you would like them
    Harry E. Stanton, Ph.D. to be, you will be able, wherever possible, to
    Hobart, Tasmania, Australia change them for the better. When for the moment,
    things cannot be changed, you will be able to
    accept them calmly, realizing that anger and
    INDICATIONS frustration would be making you miserable for
    nothing. It would be nice if things were going the
    These suggestions may facilitate way you want, but if they are not, it is not terrible,
    cognitive-perceptual changes and be particularly horrible or catastrophic. You will be able to accept
    helpful with patients who operate on the kinds of the situation and determinedly work to improve it.
    irrational assumptions targeted for change in
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 127

    Day by day you will become more and more sorbed in some persons or things outside yourself.
    successful in feeding positive, happy thoughts into To make our lives happy and fulfilling we need a
    your mind. You will accept more and more strongly purpose, and you will be able to find such a
    that you are responsible for your emotions, that you purpose for yourself.
    decide whether to be happy or miserable. It is not
    external events that make you happy or sad, but the
    attitude you take to these events. Your misery is
    caused by your irrational thinking and the negative
    sentences you speak to yourself. Suggestions for Raising
    Gradually you will find less and less need to Self-Esteem
    worry about future problems and dangers, many of
    which are quite imaginary. You will be able to Helen H. Watkins, M.A.
    determine the real dangers about the things you fear Missoula, Montana
    and see what the probabilities are of their actually
    occurring. Most of the things we worry about never
    happen, so we make ourselves miserable for INDICATIONS
    nothing. Day by day you will find yourself
    becoming more and more successful in overcoming The following suggestions were prepared for use
    such pointless worry. with patients with low self-esteem. The
    As each day passes, you will become increas- suggestions should be given following hypnotic
    ingly able to face up to the difficulties and induction and deepening. These suggestions may
    responsibilities of life. You will be able to be used in an office setting. It is also recommended
    determine for yourself what the truly necessary that the session be tape recorded for later use by the
    activities of life are, and, no matter how unpleasant patient at home. The suggestions labeled as "night
    they may be, you will be able to perform them tape" are for use by the patient immediately before
    unrebelliously and promptly. As you do so, you going to sleep. It may be helpful in the "night tape"
    will feel an ever growing sense of happiness and to use a lengthier induction-deepening process that
    accomplishment. may include such things as progressive relaxation
    and going down a long staircase for deepening.
    With every passing day, the irrationalities of the During the deepening process, the author also
    past will influence your life less and less. You will suggests, "For the present, you will not fall asleep,
    reject more and more strongly the idea that the past but will listen to the sound of my voice until the
    is all important and you will realize very tape is finished." The "day tape" suggestions are
    powerfully that just because something once for use in tape-assisted self-hypnosis during the
    strongly affected you, there is no reason why it day. (Ed.)
    should continue to do so indefinitely. You are a
    different person now from the one you were in the
    past and you can now successfully cope with things
    which may have previously upset you.
    NIGHT TAPE SUGGESTIONS
    With ever increasing frequency, you will be able
    to accept people and things as they are, seeing that THE SAFE ROOM. You can see that in front of us is a
    compromise and reasonable solutions are hallway. And as you look down the hallway, you
    necessary. You will be able to give up the notion can see a door. That door is a door to a room of
    that it is catastrophic if perfect solutions to life's your own choosing, in which you will feel safe and
    problems are not found. comfortable. [Pause] As we come closer to the end
    As each day passes, you will find yourself of the hallway, you can see the door more clearly.
    making definite attempts to become vitally ab- This door will keep out all the negative messages,
    the words, the behav-
    128 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    iors, that you perceived from your world as a child, entity, that exists because it becomes a kind of
    which made you feel bad about yourself. There's no spokesman, for that life energy, for that healing
    room here for such negative messages. energy, for that essence, which is you. That
    Look at the door very carefully, [pause] even the nurturing part of you is capable of healing, both
    doorknob. And know that this is a room of your mind, and body. It is capable of helping, healing
    own choosing, in which you will feel safe, and those parts of you that are not happy, that don't feel
    comfortable. Early positive messages and good about themselves. And it is possible for that
    experiences enter, but all negative messages must nurturing self, to seek out other parts of you, that
    stay outside. And now I want you to open that door, are not happy, and help them, help them become
    and then close the door behind you. And look happier, help them become more worthwhile in
    around that room, this safe room, that you can visit their own eyes, and most of all, help them to feel
    any time you wish, by just closing your eyes. Look loved from the inside, not from the outside world.
    around, and enjoy what you see there, [pause] To help this process, it is worthwhile for you to
    Now I'd like you to sit, or lie down someplace in think about that nurturing part within you, and
    that safe room, wherever you will be comfortable. perhaps to visualize that process going on, as you
    And listen carefully to whatever I say to you. There go about your daily business. Visualize the process
    is a life energy inside of you. It is unique to you. It of that nurturing part helping out those, that are not
    is your life energy, not anyone else's. It is the so happy inside, in a way that comes naturally to
    energy from whence you came. Life energy has you, in your mind's eye. And as you continue to do
    only one purpose: to help you reach your potential this, thinking about the nurturing part, you will
    as an organism. It is protective; it is healing. And stimulate that aspect of you, and it will become
    since it is healing and protective, it is therefore stronger within you.
    loving. I want you to experience that life energy of As you go to sleep tonight, you will have a
    yours, by feeling a light above your head, a light healing dream, [pause] a healing dream to heal
    from which issues warm streams of energy, warm mind, body and spirit. And that healing, nurturing
    streams of energy, that surround you like an part will know, what you need in a healing dream.
    imaginary cocoon, soft and pliable, that lets you And that healing dream will not only have an effect
    move about, that protects you, like a cocoon. tonight in your dream, but will affect you during
    Feel that life energy also penetrating every cell the day as time goes by. And as healing progresses,
    of your body, surrounding you, and penetrating you will come to feel better about yourself,
    you. This is your life energy. It represents your true stronger, more self-confident, and therefore
    self, your natural self, your essence — whatever happier. And when you feel happier and better
    you wish to call it. It belongs to no one but to you. about yourself, the world will respond to you in
    It is protective; it is healing, and therefore loving. more positive ways.
    Within that life energy are no negative messages; And now, in a moment I'm going to sign off, and
    they cannot exist there. Feel that positive life you will find that you will drift into a natural sleep
    energy, coursing through every cell of your body, pattern, and when you awaken in the morning, you
    surrounding and protecting you. That life energy will be aroused just naturally from this sleep
    has sometimes been expressed within you, perhaps pattern. I'm signing off now. Sweet dreams.
    as a still inner voice, that many of us ignore; words [Silence. Tape is left open-ended, allowing the
    of wisdom inside of us that we don't always listen patient to drift off to sleep.]
    to, but are really there to protect us. That still inner
    voice is a nurturing part of you. And that
    nurturing part is an DAY TAPE SUGGESTIONS
    Allow yourself to drift and float, drift and float.
    And listen to the sound of my voice, and
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 129

    what I'm going to be saying to you. Self-esteem is little bit, while you check out those messages from
    the way you think and feel about yourself. The the past. [Pause for about one minute.]
    more positive the feelings, the higher your Now let's take a trip into your past, and find out
    self-esteem; the more negative the feelings, the what faces go with those messages. Imagine that
    more negative your self-esteem. Self-esteem affects you are sitting in a pink compartment on a train,
    the quality of your life. A high self-esteem can looking out the window. As you look around your
    make you feel productive, capable, lovable, happy. compartment, for you are the only person sitting
    Low self-esteem makes you feel unproductive, there, you notice that the compartment is pink all
    miserable, worthless, incompetent, unlovable. With the way around, the ceiling, the walls, the
    low self-esteem, you may even be outwardly jovial, furniture, so that you can almost feel the pinkness.
    or you may act confident to the world, or you may The pinkness is strangely relaxing. That train will
    be highly successful in your work. But inside, you take you on a round trip into your past, all the way
    cringe and say to yourself, "Boy, if that world out back to your birth, and then return to the present.
    there only knew what I'm really like, they wouldn't
    Now the train begins to move along, and pick up
    want to get to know me. They'd probably just go
    speed. But you have a control switch in front of
    away." And so you carefully polish up your cover,
    you, and by moving that switch, you can control
    your facade, and stay on the alert, for fear you will
    the speed of that train. You can even stop if you
    be found out. What a miserable way to live. How do
    wish, to get a better view of some incident you
    people get this way?
    want to study more carefully. Perhaps you want to
    Well, let's take a trip, through your brain, where look at the people in those scenes, and understand
    all of those notions are stored. Think of an area in them better, and yourself. See them as human
    your brain, containing all the experiences you have beings, with human faults, limitations and
    ever had in your lifetime. That area is not exactly a emotions. No one can be perfect, neither you nor I,
    depository of what happened, but of what you nor any of the people in those scenes. In a while, I
    will sign off, so that you can go on this trip at your
    learned from those experiences; that is, how you
    own speed. When the train reaches birth, take in a
    perceived them. For example, suppose at the age of
    deep breath, and get in touch with the energy from
    two you spilled a glass of milk and you heard
    whence you came. That energy from whence you
    someone say, "Bad girl or bad boy!" From this
    came is your essence. It is protective, it is loving, it
    experience, you might get the idea that you are bad,
    is your life energy, and it belongs only to you. Feel
    even though the person saying that did not mean
    its power, its warmth, its protec-tiveness. Feel it as
    that exactly. They were just upset at having to clean
    warm streams of energy, surrounding and
    up the milk, and didn't want you to do it again. penetrating you. It will give you strength on the
    But as a child, you can't help but think con- trip back.
    cretely; that is, literally. You conclude, "I am bad,
    or worthless, or I can't ever make it," or whatever From birth, the train will head back on its return
    that negative idea is. Therefore, the brain is always trip over the same scenery. However, on the return
    full of distortions from child thinking, which is just trip, you will be able to change your attitude
    normally concrete and literal. toward these scenes, if you wish. You can even
    open a window and do something to change the
    Check out that brain right now. Maybe you can event, [pause] because on that return trip, you are
    see, or hear, or sense the messages that are there. full of life energy, which helps you to be more
    They may not all be negative, but they are always a confident and self-assured. Take the time you need
    product of child thinking; that is, the perception of for your trip; make it meaningful to you.
    the child. I'll be silent for a Remember, you don't have to accept any more of
    those negative messages from the past, [pause]
    You can leave
    130 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    them back there. [Pause] When you return to the to base any final decisions, and you will always
    present, take a deep breath, and slowly open your want to check out these new ideas to make sure that
    eyes to become alert. Have a good, meaningful trip they are practical, just as you would check out
    for yourself. Remember, you deserve it. This is information from any other source. You will also
    [therapist's name] signing off. [Stop speaking and continue to be aware that sometimes the best
    leave the tape open-ended.] decision is a decision to wait or to secure additional
    information before acting. But nevertheless, you
    are going to be surprised and pleased at how much
    more clearly and creatively you are going to be able
    Suggestions to Facilitate to think, and at how much more confidently and
    effectively you will be able to deal with the issues
    Problem Solving and problems which lie before you.
    Don E. Gibbons, Ph.D.

    INTRODUCTION
    The Serenity Place
    It is my own belief that the process of incubation
    may be facilitated by direct suggestion—if only D. Corydon Hammond, Ph.D. Salt
    because the subject is thereby made more confident
    Lake City, Utah
    that an effective solution will be forthcoming. At
    the conclusion of an induction, the following
    suggestions may be given.
    INDICATIONS

    SUGGESTIONS This is a permissive, indirect ego-strengthening


    method designed to increase patient coping
    In the coming days and weeks, your thoughts abilities. It is useful with anxious patients, for
    will often turn to the consideration of important patients with premenstrual syndrome, and with
    decisions you have to make, and important patients who are bright, insightful and
    problems for which you have as yet found no self-directed. Along with induction and deepening,
    solution. Even when you are not consciously this procedure may be tape recorded for use in
    thinking about these topics, your mind will con- tape-assisted self-hypnosis. The open-ended
    tinue to deal with them so that, when your attention conclusion allows the patient to remain in a deep
    returns to them once more, you are going to be trance for as long as needed, which can often
    surprised and delighted at how many potentially produce profound feelings of calm and tranquility.
    useful ideas you are able to come up with; and Encourage the patient to allow the image to
    some of these ideas are even likely to catch you by spontaneously appear, rather than searching
    surprise at times, emerging into your awareness consciously for the most ideal place. The process
    while you are thinking of something else. They for arriving at the serenity place may be
    might even enter your dreams at night, or you individualized, for example, through taking an
    might wake up with some of these new ideas in elevator down and finding the special place when a
    mind; but regardless of how they make their door opens, floating there on clouds, or simply
    appearance, they are going to be very helpful and finding oneself there. Present the suggestions
    beneficial to you. slowly and restfully. Commas are placed to suggest
    brief pauses.
    Of course. You will always try to make sure that
    you have sufficient information on which
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 131

    SUGGESTIONS can be aware of actual feelings, with a correct


    sense of proportion, free from the distortions of a
    Now, as you continue to relax, more and more mood or set of circumstances. [Pause] As you rest
    deeply, just allow yourself to float across time and in this place, things come into proper perspective.
    space. And in a moment, your unconscious mind is [Pause] And in this special place, independent of
    going to suddenly take you, to a very special place, anything that I say, you can receive what you most
    that's associated with tremendous feelings of need right now. Your unconscious mind knows
    peacefulness, and tranquil-ity, and safety, and what you most need. And I don't know exactly how
    happiness. It may be a place you've been before, or you'll receive that. It may be that you gain a new
    some special place that you find yourself in for the perspective, or just find yourself feeling
    first time. And you can just allow such a place to differently. [Pause] Or maybe, before awakening,
    spontaneously come into your awareness now. And you'll receive from your unconscious, a special
    as you find yourself there, give yourself the gift, of an experience or a memory that gives you
    opportunity, to experience all the refreshing the understanding or the perspective or the feelings
    feelings of calm, and contentment, and security, that you most need right now. [Pause] Or perhaps,
    and happiness, associated with this wonderful you may hear, what you need. It may be that you
    place. And I'm not really sure whether you'd rather hear a still voice, maybe a voice in your mind, or
    just sit and rest back, and look at everything around seeming to come from deep inside you, saying
    you, or if you'd rather walk around some, and what you most need to hear, giving you the
    explore this special place, that's here right now, just suggestions you most need to receive right now.
    for you. And I don't know for sure, the things that [Pause]
    will stand out most for you —whether it will be the
    sounds in this special place, or the beauty of it. And in a moment now, I'm going to stop talking.
    Perhaps you'll especially enjoy the sensations and And you can remain in this special place of yours,
    feelings as you touch things, and maybe even the for as long as you need. You can remain in this
    smells will be unusually pleasant. place of contentment, and happiness, and
    tranquility, for as long as you need, recharging
    And I wonder if you've already begun to notice your batteries, and soaking up these feelings,
    the fact, that as you just experience, and enjoy this receiving what you need. And there's something
    special place, you soak up and absorb these tranquil that's going to be embedded and remain in your
    feelings. And you can just allow these feelings of mind: you will know, that you can return to this
    deep contentment, and peace, and calm, to flow, all special place of yours, whenever you need or want
    through you, to all parts of you, allowing all of you to. You will know, that whenever you need to rest,
    to experience these soothing feelings. And as each or replenish your strength and energy, that you can
    moment passes in this special place, these put yourself into a deep and peaceful hypnotic
    wonderful, invigorating feelings increase, and state, and return to this place.
    become more a part of you. And you can savor this And when you're ready to awaken, you can drift
    place, and your enjoyment of it can be heightened, back across time and space, bringing these
    with every moment that you spend here. And as you wonderful feelings, and this sense of perspective
    rest here, and recharge your batteries, this experi- with you. And you'll awaken feeling well;
    ence may remind you of other places and expe- refreshed, alert and clear-headed. And what you
    riences, where you've felt happy, and contented, have experienced can remain with you, after you
    and filled with peaceful feelings. [Pause] have awakened. Now, as I stop speaking, you can
    And in this place of serenity and security, things continue in this place, receiving what you need, for
    can come into perspective. [Pause] You as long as you like.
    132 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Ego-Strengthening Suggestions The Inevitability of Change


    Richard B. Garver, Ed.D. Robert C. Mashman, Ph.D.
    Del Mar, California
    San Antonio, Texas

    I know you have a conscious memory of what INDICATIONS


    you have experienced and learned, but your
    unconscious mind has a much more complete These are nonspecific suggestions for change
    record of everything that you have ever learned or intended to activate the client's own abilities in
    experienced of any significance since you were selecting and implementing a necessary change.
    born. I want to ask your unconscious mind to They are intended to potentiate the effect of
    review all of that material, and it can do that much subsequent suggestions. These suggestions define
    more quickly and completely than you could do it change as pervasive, positive, and unconsciously
    consciously. Review all of your learning and determined. In addition, they redefine feelings of
    experiences; scan all of them and select only anxiety and confusion as signs of positive
    positive experiences and feelings. Review them, unconscious activity. Discomfort is reframed as an
    and strengthen them, and begin to make them epiphenomenon of natural, normal unconscious
    available to you as your inner strength to cope with work.
    whatever you need to cope with now. And although
    you won't be aware of most of this consciously, it
    will be going on beneath the surface, just as your SUGGESTIONS
    unconscious mind works on problems and con-
    tinues to operate beneath your awareness most of Now change is something that exists throughout
    the time. Perhaps you will be more aware of some the universe and it is particularly characteristic of
    of this, a small sample of it surfacing into your biological life. You may or may not know that
    conscious awareness — perhaps an experience, a every seven years almost all of the molecules that
    positive experience, that gives you a good feeling. make up your body are cycled through. So that
    It may be one that happened last week, last month, every seven years you are actually a completely
    last year, or many years ago, but the thought of it new person. There are certain patterns that remain
    makes you feel good about yourself. Then, perhaps and that is why you are still recognizable to
    occasionally a good feeling will surface, just a yourself and others.
    positive feeling, a feeling perhaps of being secure,
    Psychological change usually begins below
    confident, happy; or perhaps this feeling may be
    awareness . . . from what might be described as a
    unattached to any particular experience, just a good
    seed of change, a potentiality for change. A seed
    feeling and you can enjoy it again, a feeling of inner
    can be planted in our early or late childhood or
    strength. You'll begin to feel much better about
    perhaps even today, or it can be inherited as part of
    yourself, and you will have the inner strength it
    the genetic wisdom of our species. Up until
    requires to pursue some positive strategies that we
    recently developmental psychologists have paid
    have talked about, and where some of these may
    attention mostly to childhood and adolescence, but
    have been threatening before, now they will
    it is now documented and recognized that adults go
    represent a challenge to you, and you will feel
    through developmental stages as well . . .
    positive about taking a bit of a risk in meeting this
    throughout their entire lives. And there is
    challenge, and feeling good about it.
    remarkable consistency across people as to what
    the developmental stages are . . . and the order in
    which they appear, although each individual mani-
    fests the developmental issue differently.
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 133

    This remarkable consistency in terms of adult SUGGESTIONS Understanding, more and


    development suggests that these particular more, that it is your ease and
    changes come about as a result of a potentiality that comfort that are important
    is inherited, a seed that we inherit from our parents [said as the client readjusts his/her physical
    and even the species that preceded us. And when position], and in order to get more comfortable,
    the conditions and the timing are correct, these you will shift your position when you would like. It
    seeds can develop and germinate below our is important to recognize that when you go through
    awareness in our unconscious mind . . . and when life, you will arrive in a certain situation, and you
    that happens we may have a sense that something is will find the most comfortable position for
    going on below the surface. yourself, the most comfortable point of view, the
    In the days, weeks and months that follow, you comfortable understanding, and then you will feel
    may have a strange feeling, a sensation, an good for a period of time.
    experience. If that should happen, you can take But at some point the situation will change a
    pleasure in knowing that your unconscious mind is little bit, or you will change yourself, and it will
    working for you, that there is a necessary and require an adjustment to remain comfortable.
    useful change developing . . . and after that change There is no one position, no point of view, there is
    is completed and has become part of your mental no one understanding that will allow comfort
    processes, that change will emerge into forever . . . And so what is necessary to maintain
    consciousness in the form of a new feeling or a your comfort as you proceed through your life is
    changed behavior and you can understand —yes the ability to adjust your position from time to time
    —that's what's been going on all along. ... to see things a little bit differently, or to hear
    things in a way that is particularly useful, and to
    notice that your feelings can evolve and that, even
    though the same situation may present itself, the
    Change Is Necessary for feelings that you have in response will be
    evolutionary.
    Comfort
    Robert C. Mashman, Ph.D.
    Del Mar, California
    An Abstract Technique for
    Ego-Strengthening
    INDICATIONS
    B. J. Gorman, M.B., Ch.B.
    These are further nonspecific suggestions for
    change intended to activate the client's own abil-
    ities in selecting and implementing a necessary INTRODUCTION
    change. Intended to potentiate the effect of sub-
    sequent suggestions, these suggestions utilize the One means of circumventing . . . critical faculty,
    client's own experience of a need for a physical which seems to be operative to some degree under
    readjustment in the hypnotic session as a metaphor all therapeutic situations, is to give suggestions in
    for the process of readjustment in life. It is an indirect or abstract manner, in such a way that
    discomfort that informs us of the need for change. no direct suggestion is made, and therefore, the
    The suggestions redefine discomfort as a useful, critical faculty is less likely to be activated. I have
    unavoidable, and periodic part of life, and found that a modified form of Dr. John Hartland's
    encourage flexibility and adaptability. excellent ego-strengthening (1971), delivered in
    this ab-
    134 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    stract manner, has been very effective. The general cess fat or flesh; greatly increased resistance to all
    technique which I have used, altered, of course, to forms of infection or disease and an increasingly
    suit each patient, is as follows. . . . This approach great measure of control of both the au-tonomic
    was first initiated when a patient commented upon nervous system and the hormone glands which,
    the fact that certain words which I had used, such as between them, control all the functions and
    "exactly" or "precisely" [e.g., from Hartland's conditions of the body.
    ego-strengthening suggestions] had made him feel Good health means not only physical health but
    that I was setting too high a standard for him. I also a healthy attitude of mind in which the nerves
    therefore dropped the authoritarian approach and are stronger and steadier, the mind calm and clear,
    now, almost exclusively, allow the patient to more composed, more tranquil, more relaxed, more
    choose from the material which 1 present to him confident.
    that which he needs. According to the It can mean a greater feeling of self-esteem, a
    circumstances, 1 may also soliloquize about such greater feeling of personal well-being, safety,
    words as autonomy, wealth, happiness, etc. I have security, and happiness than has ever been felt
    given in some detail the wording for "health," before.
    "success," and "motivation" to illustrate the mode
    It can mean complete control of the thoughts and
    of presentation which I have found most
    emotions, with the ability to concentrate better and
    successful.
    utilize all the vast resources of the memory and the
    full intellectual powers of the subconscious mind.
    It can mean the ability to sleep deeply and
    THE TECHNIQUE refreshingly at night and to awake in the morning
    feeling calm, relaxed, confident and cheerful —and
    You are now so deeply relaxed that your mind ready to meet all the challenges of the new day with
    has become very receptive. In this state of deep boundless energy and enthusiasm.
    relaxation the critical part of your conscious mind The words good health can mean to you any or
    is also very deeply relaxed so that you can accept all of these things and more. These words have
    any ideas you wish to accept for your own good. tremendous power. I want you to let them sink
    Because I wish you to remain in this uncritical deeply into your subconscious mind, which always
    state, I am not going to give you any direct does reproduce in you your dominant thoughts.
    suggestions with regard to any of your particular The next word I would like you to think about is
    problems; I am only going to ask you to think about success. It may mean a sense of recognition,
    certain words and their meanings and associations satisfaction and achievement in your chosen field
    for you. I want you to think lazily of these words, to in life; a happy, fulfilling sex life; a closely-knit,
    turn them over in your mind, to examine them, to loving family circle; the ability to make firm
    let them sink deeply into your subconscious mind friends and mix easily in a social setting, or the
    until they become woven into the very fabric of confidence and skill to speak well in public.
    your substance and of your self-image. It may mean the ability to set and achieve goals
    The first word I wish you to think about is the in life which are realistic, worthwhile and
    word health, and I want you now and always to progressive, and the motivation and determination
    couple it with the word good. What can the words to achieve those goals. It may mean the confidence
    good health mean? They can mean a sense of to enable you to throw off your inhibitions, to be
    superb physical well-being, with strong heart and spontaneous, to express your feelings without fear
    lungs, perfect functioning of all the organs, nerves, or hesitation.
    glands and systems of the entire body; firm, strong Success may mean wealth in terms of money
    muscles, bones and joints; smooth, healthy, elastic and the things that money can buy, or security
    skin and the absence of any ex-
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 135

    for yourself and your family. It can also show itself to ego-strengthening is to utilize experiences,
    in the attitude of mind which gives inner happiness particularly of mastery, in the personal life history
    regardless of material possessions or of the patient. We may view the patient as having
    circumstances. internal resources waiting to be tapped and
    It could mean the ability to overcome some utilized. This more indirect and experiential style
    particular problem; perhaps even some problem was characteristic of Dr. Milton H. Erickson's
    about which I do not know. method for enhancing esteem and self-efficacy.
    Whatever the word success means to you, I want The example modeled here is one of moving from
    you to use this word as an emotional stimulus to dependence to independence, as well as gaining
    produce in you all the feelings which go with mastery. Other early life experiences that may
    success. serve as a source of positive age regression include
    Finally, I want you to think of the word learning to walk, to talk, to read, to ride a bike, to
    motivation. What can it mean? It can mean the roller skate, to swim, to drive a car, to skip rope,
    desire, determination and driving force to achieve a and to multiply and divide. The next contribution
    certain objective. It can mean a gradual but by Dr. Murray-Jobsis provides an excellent
    progressive strengthening of one's desire to be in example of this approach in her suggestions about
    charge of one's life; to destroy the old recordings of learning to crawl and walk. Hypnotic induction
    habit patterns; to play new music instead of old; to and trance-deepening should have been done prior
    cease being a puppet of one's early conditioning to facilitating these experiences.
    and to become a creator of a new, healthy, happy,
    successful script in the play of life.
    It can mean the gradual but progressive building LEARNING TO FEED ONESELF
    of a stronger and stronger desire to stop [e.g.,
    overeating or smoking, etc.] until the desire is so It might be interesting to allow your mind to
    great that it is much stronger than the desire to [e.g., drift back through time, as if you're growing
    eat, smoke, etc.], and there is therefore no younger and smaller, and smaller and younger.
    difficulty, hardship or discomfort in [e.g., losing Allowing yourself to orient back to when you were
    weight, giving up smoking, etc.]. a small infant. Just imagining as if you were a very
    We have all been conditioned since birth to small infant again, who still has to be fed by other
    associate words with feelings. Words are therefore people. And I'm not sure if you'll actually
    the tools which we are going to use to produce the remember it exactly as it was, or if you'll only
    feelings and results which we want. And these imagine it as if you were a baby again, and it
    words are health, success, and motivation. doesn't really matter.
    But I'd like you to find yourself in a high chair,
    or sitting and being fed. You are so small that
    someone else is feeding you. And it can be a very
    Learning to Feed Yourself: An nice experience, to be fed. But when you're
    completely dependent on someone else, it can also
    Example of Age Regression to be rather frustrating. Sometimes they may feed you
    Experiences of Mastery too fast, and you really haven't had a chance to
    swallow the last bite before the next bite is already
    D. Corydon Hammond, Ph.D. Salt Lake being put into your mouth. And your cheeks fill up
    City, Utah with the food. And it's frustrating because you
    really can't tell them, except to push it out with
    your tongue. And at other times you feel full, and
    INTRODUCTION AND INDICATIONS
    you really don't want any more, but they keep
    One method of ego-strengthening is through the
    use of direct suggestions. Another approach
    136 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    trying to feed you, even though you keep turning beginning to explore and understand ourselves
    your head away. At other times, the person who is more fully. And in that understanding an ac-
    feeding you can get distracted with something. And ceptance of self, coming to know and understand
    you're really hungry, and you want that next bite and accept our strengths and our limitations.
    that's sitting out there in the spoon, but it's not Coming to access our strengths and our sense of
    moving toward your mouth. And it's so frustrating power without apology or fear, without worrying
    to not be able to get it. [Pause]. whether our strengths please or displease others.
    And a little later, as you get a little bigger, you And acknowledging to ourselves our right to
    begin trying to feed yourself. And you take hold of achieve our own personal best self. And at the same
    that spoon or food, and maybe at first you thought it time acknowledging our need to accept limitations.
    would be easy. But you quickly find that it won't go Learning to discriminate between those limitations
    where you want it to go. It looked so easy. You that can be changed through growth and learning,
    want to get that food into your mouth, but and those limitations that may be an inevitable part
    somehow your hand won't do exactly what you of human existence. And coming to an acceptance
    want it to do. And you really can't quite figure out of our total selves with our strengths and our
    how to do it, how to get it there. You keep missing, limitations. Knowing that we have a right and an
    and dropping the spoon, and you really can't get it obligation to be our best self. But also knowing that
    up to your mouth. Sometimes it almost gets there, no one should ask us to be or do more than our best
    and then oh, it missed again! And finally someone self.
    helps you, and takes over and feeds you, and it
    must have seemed like such a relief. And I'm sure at
    first, that you must have felt very discouraged. You
    must have thought you'd never be able to feed EXPANDING MASTERY
    yourself, like you saw other people do. But you
    really wanted to do things for yourself. And you And perhaps beginning to explore and expand
    didn't give up, and other people encouraged you. the possibilities of competency and mastery that are
    And before you knew it, you could do it yourself. available to us, continuing to explore and expand
    And what a feeling that is, to master things that our boundaries for competency and mastery. And
    seemed impossible, and be able to do things for perhaps traveling back into past experiences,
    ourselves, without depending on others. There was traveling back to some of the earliest times in
    a time when it seemed impossible to be able to do childhood and infancy, to some of our earliest
    that for yourself, and now you don't even think attempts at growth and mastery.
    about it. [A bridging association may now be made
    to the patient's problem.] LEARNING TO CRAWL AND WALK Perhaps remem-
    bering and re-experiencing some of those early
    months of existence, of first beginning to crawl.
    Crawling across the floor. Feeling the excitement
    and the wonder of lifting the body off the floor and
    Ego Building beginning to move. Feeling the strength and the
    Joan Murray-Jobsis, Ph.D. Chapel power and the mastery of finally beginning to be
    Hill, North Carolina able to move, not having to simply lie there waiting
    for someone to come. But being able to move,
    physically moving about, beginning to be able to
    GENERAL MESSAGES
    explore things. And perhaps seeing the patterns
    And it begins to become easier to imagine beneath the fingers as the hands move across the
    traveling through time and space in trance, floor crawling, the pattern of the carpet or the floor.
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 137

    And feeling the excitement, the challenge, the cuss METAPHOR. And most of us remember the
    mastery of being able to move about for the first story of the glass filled to the halfway mark, and
    time. And then perhaps reaching up to a chair or a how one person can look at that glass with great
    table and pulling ourselves upright and standing for sadness and dismay, saying, "Oh, how awful, the
    the very first time on two feet. And feeling once glass is already half empty," and another person
    again that sense of mastery and excitement, struggle can look at that same glass with a great sense of joy
    and accomplishment. And then still later taking that and happiness and say, "How wonderful! The glass
    very first step, and wavering, and falling, but is still half full." And of course in both cases, the
    getting up again, and taking another first step, and glass and the liquid are exactly the same, but the
    falling. And so many steps and so many falls and perceptions are dramatically different. And since
    failures. But always finding within ourselves the how we feel about our existence is influenced by
    strength, the determination, to persevere, to endure how we perceive our existence, then isn't it
    all those falls and hurts and failures. And always reasonable always to choose to perceive the
    getting back up and trying again. And from those fullness and satisfactions of life, and to distance
    first wavering steps we learned eventually to walk, from whatever losses, discomforts, or
    and skip, and run, and jump, and after a while we dissatisfactions may be an inevitable part of our
    hardly had to think about it at all. existence? And in so many ways we can add to our
    sense of joy in life by choosing to perceive the
    And in those early months of existence, we were fullness of life, perceiving all of the positives that
    still free, not yet weighed down with those later are sent to us throughout our days, all of the
    fears of failure and of humiliation. And somehow positive responses, the compliments, the
    as infants we knew instinctively that struggle and affirmations, all of the kind words and the smiles.
    failure are a natural part of life and growth. And we Allowing ourselves to perceive them and perhaps
    knew that it is not avoidance of failure that leads to distancing away from whatever inevitable nega-
    competence and growth; but rather it is learning tives there may be. And most of us have in the past
    from our failures, and perseverance, and placed far too much emphasis on whatever
    willingness to take risks that allow us to grow and negative or critical comments we've received in our
    succeed. And even as the child learned to walk with daily lives. And most of us have been trained in a
    steadier and steadier gait, so also can we as adults false sense of modesty to dismiss the positive
    learn to walk through life —steadier and steadier, comments that have come to us. And isn't it better
    less fearful of our missteps and setbacks. So also wherever possible to help ourselves really focus on
    can we as adults enhance our capacity for those positive messages and to dismiss or take less
    persevering our failures and expand our capacity seriously some of the inevitable negative messages
    for taking risks. And in so many ways, we can we get in our daily lives.
    rediscover our capacity for growth, perseverance,
    risk-taking, allowing ourselves to move more
    freely and positively toward enhancing And perhaps also beginning to allow ourselves
    competency, mastery, growth, development. to perceive the joys in nature more fully, really
    noticing when there is a beautiful blue sky and
    high white clouds, or really noticing the scenery on
    the way in to work as we drive. Or when we take a
    EXPANDING JOY walk, really noticing the trees, and the sky, and
    And in similar fashion, beginning to explore and everything in nature. Seeing the beauty that is
    expand our capacity for joy in living. Beginning to around us, beginning to allow ourselves to expand
    explore all the ways in which we can experience our capacity to see, and feel, and hear the beauty in
    nature. And in our personal interactions, seeing,
    joy in our everyday lives.
    and hearing, and feeling the beauty in our
    associations with loved
    138 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ones, family, close friends, all of the good messages ning is worthwhile, and we set our own standards
    that come our way, perceiving them fully, of approval.
    expanding our capacity to perceive the joy in And similar to freeing ourselves from de-
    everyday living. structive competitions, we also can expand the
    possibilities of freeing ourselves from destructive
    forms of anxiety. Again as we begin to examine the
    FREEDOM FROM DESTRUCTIVE past, looking at the origins of our anxiety, we
    COMPETITION AND ANXIETY discover that anxiety hangs on us as if it were a
    weight around our neck, weighing us down and
    THE COMPETITIVE GAMES IN OUR FAMILY OF making it difficult for us to function.
    ORIGIN.
    And in addition to expanding our capacity for joy, MOUNTAIN METAPHOR And one of the ways we can
    for experiencing joy in living, we can also begin to begin to help free ourselves from these destructive
    explore the possibility of freeing ourselves from anxieties is to begin to see our anxiety as if it were a
    destructive forms of competition and destructive mountain. And when we stand close to that
    forms of anxiety. And very often we learn our mountain, it seems overwhelming. But we can
    patterns of competition in our early years, in our imagine getting into a car and driving some
    early years with our family. And sometimes we distance from that mountain. And when we are far
    learn that we must always lose. Sometimes we enough away, we can stop, get out of the car, and
    compete for mother's approval and discover that turn around and look back, and from this distance
    mother's approval costs us father's love. Or that mountain seems much less overwhelming.
    sometimes we compete for father's approval and And from this distance we can begin to imagine
    discover that in winning his approval we lose different ways of getting beyond that mountain.
    mother's love. And so we begin to discover that we Perhaps we discover a path around one or the other
    lose by whatever action we take. And sometimes side of the mountain. Or perhaps we discover a
    we compete with brothers and sisters for parents' tunnel through the base of the mountain. We might
    love. And sometimes we discover that in winning even discover that we can fly over the mountain.
    our parents' love, we lose the love of our brother or But in any event, from this distance that mountain
    sister. And again there's the feeling of somehow of anxiety seems much less overwhelming. And we
    always losing. And in some families things are so begin to discover that some of the anxieties become
    destructive and mixed up that everyone competes, insignificant; some even disappear. And those that
    and no one wins. remain become much more manageable from this
    perspective. Everything does indeed become
    And we begin to notice that the rules of easier.
    competition are unfair, that the rules of the game
    are loaded. And the only way to deal with this
    destructive kind of competition is to step out of the REFRAMING ANXIETY. And then we may notice
    game, refuse to play the game, and instead of that anxiety consists of several component parts.
    seeking approval from others, we begin to set our And some of these component parts of anxiety are
    own standards of approval. We learn to step out of really quite positive, consisting of excitement and
    the destructive game, and set our own standards of challenge and interest and energy, the kind of
    approval. We begin to get a sense of self, and to be energy that gets us "up" for a performance. And
    able to define values, and to set our own standards. when we think about it, we begin to realize that life
    And then we begin to let go of the old habit of would be very boring if we had no challenge, and if
    automatically competing, and we begin to judge we had no anxiety at all. Even as children we
    whether the competition is fair. And we begin to sought challenge and excitement: riding roller
    discriminate, and select the competitions that are coasters, learning to ride a bicycle. And without
    meaningful, and to determine whether win- these challenges life
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY. AND CONFIDENCE 139

    would be dull and boring. So it's really only the with such grace and beauty it made his sad heart
    excessive levels of anxiety that we experience as flutter. He thought, if only I could be just a little
    destructive, the excessive levels of anxiety that beautiful with just a fraction of that loveliness.
    interfere with our performance. And these ex- Then all of a sudden, he happened to look down
    cessive levels of anxiety can be managed by into the water beside him and behold! There was a
    distancing, while at the same time beginning to mirror-image, a reflection, of himself. No longer
    allow ourselves to experience and even enjoy the was he the ugly duckling; he too was a swan, a
    healthy, moderate levels of anxiety —to enjoy the creature of stately elegance.
    challenges. Redefining the moderate levels of The ugly duckling, transformed into a beautiful
    anxiety as energy, and interest, and excitement. swan, can symbolize the growth and changes in all
    And then with this new perspective, everything of us. When there are emotional hangovers of
    becomes easier. ugliness from the past, when we might have been
    like an ugly duckling at least to ourselves in some
    ways, through loving care and affirmations we also
    change, and we become transformed. . . . Our
    The Ugly Duckling Metaphor destiny is to be fully and completely alive, full of
    loving ourselves and loving others, and we grow
    Roy L. Rummel, Ph.D. and develop toward that destiny. . . . Now relax,
    Dayton, Ohio and let this picture of the ugly duckling trans-
    formed into a beautiful swan inspire and energize
    Once upon a time a mother duck sat hatching her you toward a richer, more abundant life, as you
    eggs. One egg was larger; it was the last to hatch. take a few moments of silence to reflect about the
    Her duck friends said, "Be careful about that egg; growth and transformations taking place inside
    it's probably a turkey. Turkeys'll give you nothing yourself. . . . That moment of silence begins . . .
    but trouble. Why not spend your time and energies now.
    mothering your new babies that are hatched. Forget
    that big, old turkey egg." The mother duck was
    determined to follow her best instincts, however,
    and she kept sitting on it, and it finally hatched.
    There it was, not a baby turkey, but a big, gangly The Prominent Tree Metaphor
    duckling.
    Alcid M. Pelletier, Ed.D.
    Now she's got this big, awkward kid, along with Grand Rapids, Michigan
    all her beautiful brood! In the barnyard her friends
    continued to make many a snide remark about this
    peculiar and ugly creature, but like God, with INDICATIONS
    nurturing devotion in her heart, she kept loving
    them all, giving her mother duck's best. Time went A metaphor like this may be subtly disguised as
    on. Her big fellow got bigger and bigger, but so a "deepening" technique ("to help you go still
    often he felt like an outcast. His ugly appearance deeper"). During trance "deepening," before
    was shunned by all his peers, and the gangs and therapeutic work is usually done, patients are less
    cliques in the barnyard shot him down with many likely to engage in the defensive monitoring and
    slings and arrows of adversity. . . . editing of suggestions. This type of metaphor may
    be particularly useful with patients who have been
    Finally, one spring day, after what seemed an through trauma, deprivation, and difficult life
    eternity, he was moving around the pond near the circumstances. In such cases you could also discuss
    castle, and over across the way he spotted this the early process of the tree's growth from a seed,
    magnificent, regal-looking swan floating encountering the hot
    140 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    sun, learning to bend before the strong winds, being thesis. Imagine the energy going through the
    weighed down by the rains and snow, the animals cambium layers of the tree to the roots which obtain
    that may try to devour it, learning to grow around nitrates from the soil. Imagine, the whole being,
    obstacles, the process and periods of growth and exchanging within itself, to give life, strength and
    latency, and the development of a hard outer bark health to the whole being. Nineteen . . . twenty, as
    to protect the tenderness within. (Ed.) you admire that tree, imagine yourself like that tree,
    tall and strong, firmly rooted and grounded. You,
    like that tree have been made stronger by the
    INTRODUCTION vicissitudes of life. Like the tree's branches you
    reach out for help and energy. You too, can offer
    One should discuss which fantasized scenes shelter and help to others. Within you, are the
    most relax a patient. This method avoids using various functional systems to make the whole you
    guided imagery which may exacerbate patient stronger and healthier. But now, think deeply, you
    phobias or allergies. A prominent tree can be are more than that tree. You can think, you have
    introduced in any nature scene. For the present mobility, you can be discreet, you can make
    example let us say a fairly intelligent patient has decisions, you can love and be loved, you can do so
    selected a walk through a field of moderately tall many, many things that tree cannot do. Sense your
    grass. . . . The therapist counts 20 steps, pausing power, your strength, your abilities. Be grateful for
    occasionally to call attention to tall blades of you. Think of all you are! Now please, relax deeper
    waving grass, colors, gentle breezes, etc., to deepen and deeper as you contemplate your strength. [At
    the trance. this point, if it is necessary, the therapist may utilize
    other ego-strengthening suggestions.]

    THE METAPHOR
    . . .Ten . . . eleven . . . twelve, now see to your
    right or your left stands a tail strong tree. Thirteen . The Seasons of the Year: A
    . . fourteen, the tree is so fascinating that you walk
    around admiring it. Fifteen . . . sixteen, hear the
    Metaphor of Growth
    birds singing in the tree. The sound of the birds
    singing along with the sound of the wind through Lawrence R. Gindhart, Ph.D.
    the leaves and the wind through your clothing is so
    relaxing. Seventeen . . . eighteen, see the tree, how
    fascinating, how tall and strong. Examine it
    INTRODUCTION AND INDICATIONS
    carefully. Notice the outcropping of the roots This metaphor was designed for a patient who
    reaching out across the soil and disappearing into wanted to "grow up," and may serve as an indirect
    the ground. Imagine the roots spreading deep into method for facilitating personal "growth."
    the ground to firmly anchor the tree. See how tall the
    Repetitions have been excluded from the written
    trunk is with a few twists and turns, the scars and
    version, but should be included in presenting this to
    rough edges that are the result of the tree's struggle
    a patient. (Ed.)
    to survive against the wind, the hail and the storms
    of life. The struggle to survive made it stronger.
    Notice how high and far the branches reach into the THE METAPHOR
    sky. Imagine the branches offering shelter to the
    birds and shade to man. You know the leaves obtain March is now, [patient's name], the time for
    energy from the sun through the process of beginning the growth that has ceased for so long
    photosyn- —through the long cold winter. As you wonder, as
    you understand, as you listen to my
    EGO-STRENGTHENING:ENHANCINGESTEEM,SELF-EFFICACY,ANDCONFIDENCE 141

    voice, and as you hear every word I say, you can comes early in spring— especially in March. Of
    feel more and more relaxed as you listen to my course, it is very comforting to know that growth,
    voice. More and more relaxed —and com- especially this special kind of rapid growth which
    fortable—even warm—as you listen —and relaxed, always takes the right amount of time—just the right
    as you listen, as you understand — as you become amount of time— sometimes very fast —
    aware. And you can hear, you can listen, you can sometimes slower—against odds—often very
    understand, and be aware as you relax and feel very rapidly — sometimes slower — it perseveres and it
    comfortable — even as we talk about some things can and will take all the time it needs. That rapid
    that won't seem to make much sense at first. growth occurs along with the budding— along with
    You know, [patient's name], in winter so much the unfolding of leaves — until all is just right—
    stays dormant for such a long time. The growth that when so much is in bloom. And the blooming of
    once was, just had to stop, and wait —a long time flowers, and the unfolding of leaves, tells you all is
    waiting for the growth and the warmth of spring. growing—at just the right rate — in just the right
    You know, [patient's name], we could talk about amount of time. When so much is in full bloom you
    trees—about how they must feel after waiting for will have the very satisfying feeling of confidence
    such a long time —without growing. Just waiting that growth is just as it should be. The things that
    for the right time — for springtime— to grow. And grow always do, [patient's name] , you know, they
    you know, [patient's name], about the cold and the always do — and they don't forget what they
    barrenness and the aloneness and the misunder- learned when they had to stop growing — for a
    standing those trees must endure before they greet while. It took a lot to endure the misunderstanding
    the long awaited springtime and especially March. of winter. Yes, it seems odd to talk about growth,
    Now, [patient's name], March is a special time. trees, springtime and March — but, growth occurs,
    You can feel the comfort of knowing about the [patient's name] , and you can feel it, especially in
    strength from the fluid of growth that begins to March, even now.
    build and builds deep in the roots of that which has
    been dormant for so long. Do you know, [patient's
    name], you can feel so good, so comfortable, so
    warm, as you sense the feelings of growth —
    beginning deep in those roots— and you can
    continue to feel it — beginning deep in those roots. Confidence Building
    And you can continue to feel it beginning deep,
    comfortable and strong— and strength, [patient's H. E. Stanton, Ph.D.
    name], comes from knowing it begins soon. Soon, Hobart, Tasmania, Australia
    of course, can be any time —an hour from now — a
    day from now. Certainly, during that time-even in a
    moment — especially in March. Can you imagine THE CLOUD
    —can you see clearly — and feel how peaceful you
    feel — as you see the growth building deep in those Visualize a normal white, soft, fluffy cloud
    roots — as you become increasingly aware, as the hovering over your head into which you will be
    energy of growth moves ever upward from deep in able to place all the reasons, direct and indirect,
    the roots. And can you — now—[patient's name] — which you think have contributed to your lack of
    feel the special sense of pride that growing things confidence. These reasons are the unconscious
    feel in springtime. You can then— feel that special "computer" programs which are maintaining your
    way as you notice the very budding of growth unwanted behavior. Thus, they need to be erased.
    that Let your mind drift in a pleasantly relaxed way
    and, whenever any reason for your lack of
    confidence, no matter how trivial, comes into
    142 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    your mind, put it into the cloud. As you do so, your Some force is preventing you, a force emanating
    unconscious mind will put in other reasons of from a huge black statue in the center of the room.
    which you are unaware, causing the cloud to This statue, powered by a brilliant jewel embedded
    become increasingly dark. When you have put in in its forehead, is the embodiment of all the
    every reason you are able to think of, it will be inky negative forces of failure and defeat within you. It
    black. has been placed in the room as the guardian of the
    Look at the black cloud containing all these treasure, making all other guardians unnecessary.
    negative programs and, as you do so, somewhere To free this vast storehouse of your potential so
    behind it you will see a source of light. At first that you can become the person you are capable of
    quite dim, it will become increasingly bright. That being, you must first overcome the negative
    light is really a sun, the sun of your own desire to tendencies, the forces of failure and defeat, within
    be free of everything that has been preventing you you which are acting to prevent this, these
    from living life to its fullest. tendencies being personified and embodied in the
    The light grows stronger and brighter until it guardian statue.
    begins to burn away the black cloud. As this is Go to the statue and knock the jewel from its
    happening, you will become increasingly aware of forehead. As it lies on the ground, its lustre fades,
    the warmth of the sun so that, as the cloud burns so that it looks dark and ugly like a piece of coal.
    away completely, leaving no trace of either cloud This can be stepped upon and crushed into black
    or anything it contained, you will be able to bask in dust. Its power gone, the statue may then be pushed
    this warmth, feeling the sun's rays penetrating so that it falls and breaks into many pieces.
    every cell of your body, bringing a wonderful sense You are now free to gather up as many of the
    of self-assurance and self-confidence. treasures as can be carried, taking it with you as you
    retrace your steps up the passage to the entrance.
    There is no need to attempt to take all the treasure,
    THE PYRAMID for you will be able to return to this treasure room
    whenever you want to. No matter how much you
    Imagine yourself back in ancient Egypt, standing may take, or how many times you return, the room
    in the desert before the cave-like entrance to a large will never be empty.
    pyramid. As you enter, you find yourself in a Step outside into the warm sunshine, and return
    downward sloping passageway, well lit with to the world of your everyday life with the
    torches. Feeling a sense of security and confidence, treasures you have gathered. These treasures,
    you follow this passageway as it takes you deeper which can be anything you want them to be, will
    and deeper into the heart of the pyramid. reveal themselves in new habits, new ideas, and
    At the very end of the passage is a vast storeroom new directions.
    filled with treasures of all descriptions. This is the On any occasion when you feel a lack of
    storehouse of all the vast untapped resources, all confidence in your ability to do something, think of
    the potential for good and for achievement, which the pyramid and the treasures it contains. As you
    you have not yet turned to your advantage. All of do, you will feel a sense of confidence, strength,
    this treasure is rightfully yours, for it has been and power surging through you, filling you with the
    stolen from you through force of circumstance. certainty that you are capable of accomplishing the
    However, unless you carry it back into the world task about which you were doubtful.
    outside to enjoy and to share with others, it will
    eventually be sealed up within the room and lost
    THE LAKE
    forever.
    Naturally, you attempt to gather this treasure, for INDICATIONS. This image may feel more com-
    it is rightfully yours. Yet, you cannot. patible to a patient who enjoys the mountains
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 143

    and certain leisure activities like swimming, has brought you as far as this mountaintop, further
    canoeing or rowing. Imagery of walking in the progress towards your objective is blocked, for all
    mountains may be used for deepening before using along the mountainside are numerous barriers and
    this symbolic imagery experience. The patient may obstacles. These represent everything standing
    be asked to give a head nod or ideomotor signal between you and the attainment of your goals.
    when he/she is engaging in using some method to Bend down and pick up a handful of snow.
    get across the lake, and when the other side is Examine this. You will find it to be soft and
    reached. Patients may also be asked to verbalize powdery, comparable, in a way, to your own
    which activity they have selected for crossing the determination which has, at times, lacked firmness
    lake. (Ed.) and strength.
    Add more snow, packing it more tightly in your
    SUGGESTIONS. See yourself standing on the hands, compressing it into a snowball which is
    shore of a lake, looking out over the water. Where firm, round, and hard. As you do so, feel your own
    you stand, it is a dreary and depressing scene, the assertiveness and determination becoming stronger
    water rough and treacherous, whipped into waves and firmer too, as hard and as firm as the snowball
    by wind and rain. Yet, the other side of the lake is being prepared for its trip down the mountainside.
    quite different, with people enjoying the bright Walk over to a very steep incline at the side of the
    sunshine and lively atmosphere. This is the shore of mountain and gently roll the snowball down it,
    health and normality. straight at the obstacles below. Quite slowly the
    Visualize yourself crossing the lake in some way snowball rolls down the mountainside, growing in
    that requires considerable effort. Rowing a boat, size as it does so, until it attains the proportions of a
    paddling a canoe, or even swimming would be large boulder. It then becomes an avalanche,
    possibilities. Not only are the waves and wind to be sweeping everything before it as it continues on its
    combatted. Other obstacles will attempt to impede journey to the bottom.
    your progress from the shore of dreariness to the The way is now clear. As all obstacles have been
    shore of brightness, but these you overcome. If the swept away, you can begin to descend the
    distance seems too great, or your efforts are mountainside where your courage and determi-
    exhausting, you can use the islands dotting the nation have gone before to clear a path. As you
    surface of the lake as temporary resting places. imagine yourself striding purposefully down the
    When you finally reach the bright shore, as you mountain, you will know that, in your own mind,
    will, you feel a tremendous surge of confidence, a your determination is continuing to grow, as did
    belief in your ability to live your life as you want to, the snowball, until it will become sufficiently
    coping effectively and happily with whatever your strong to sweep away every obstacle in its path.
    environment provides. You will then be able to attain whatever goals in
    life you have set, just as easily as you can now
    imagine yourself descending that mountainside.
    Increasing Determination: The
    Snowball
    Suggestions for Emotional
    H. E. Stanton, Ph.D. Enrichment
    Hobart, Tasmania, Australia
    Don E. Gibbons, Ph.D. INTRODUCTION
    Picture yourself standing at the top of a tall
    snow-covered mountain, looking down into a AND INDICATIONS
    valley below. In this valley is the place you have Many people consistently go at life with such an
    been attempting to reach. Though your journey air of grim determination that they eventu-
    144 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ally lose, or at least severely blunt, their capacity to beginning to breathe more rapidly in anticipation of
    experience joy and a zest for living— not merely the joys which will soon be yours; for soon your
    abandoning their sense of childlike wonder, but entire body will be quivering with pleasure and
    also the deeper, richer experiences of fulfillment tingling with delight. As you continue soaring
    which are characteristic of the fully functioning farther and farther into trance, your ability to
    adult. . . . respond to experience of every kind is becoming
    The following postinduction suggestions are not infinitely keener. Your entire body is becoming
    designed to induce excessive or inappropriate exquisitely more sensitive and more responsive
    affect, nor are they intended to elicit strong with every breath you take.
    emotion merely for its own sake. Rather, they are You are beginning to breathe even faster now, as
    designed for use as a set of "toning up" exercises your capacity for experience multiplies itself over
    for sufficiently suggestible subjects who are and over. And the higher you climb, the higher you
    familiar with their aims and purposes: as a means want to climb and the stronger the effects of my
    of strengthening and heightening the capacity for words become.
    positive emotional response, and as a method of And as your entire body continues to grow more
    counteracting occasional tendencies toward sensitive and more responsive with every breath
    depression when such tendencies are primarily the you take, you are also becoming more free, more
    result of habit or of failure to maintain a open, and more accepting of every type of
    sufficiently optimistic outlook on life. When experience. You are becoming totally and
    combined with appropriate suggestions of time completely free, as your responsiveness continues
    expansion, these suggestions may also be useful as to grow and your breathing comes still faster in
    a means of providing a temporary substitute for anticipation of the joys which will soon be yours.
    persons who are presently addicted to mood- And the higher you go, the higher you want to go
    altering drugs. They may also be used as a method and the stronger the effects of my words become.
    of pain control by allowing the subject to experi-
    ence the opposite emotions. A similar approach has And now, as your responsiveness and sensitivity
    been employed for this purpose by Sacerdote continue to increase within an atmosphere of total
    (1977). freedom, we are beginning to release all of the vast,
    untapped resources of feeling and emotion which
    lie within you. Probing the depths of your
    innermost self, and releasing every wonderful,
    SUGGESTIONS positive emotion for your exquisitely tuned body to
    savor and experience to the fullest.
    Now, as you continue to listen to my words, you And the higher you go, the higher you want to go
    find yourself being mentally transported to the and the stronger the effects of my words become.
    center of a large, green meadow which lies at the Great waves of pleasure, ecstasy, and delight are
    foot of a tall mountain. But this is no ordinary gushing forth from the innermost depths of your
    mountain looming up before you; for this is a being like water from behind a bursting dam,
    mountain of pure joy, and you are about to climb all overwhelming you completely as your breathing
    the way to the top of it. comes still faster and your heart begins to pound.
    Now you are beginning to climb the mountain of But there is never any sense of strain or fatigue;
    joy. And as you climb, you can feel this joy for the heights which you are able to achieve in
    coursing through every fiber of your being, as the trance are truly without limit. And the higher you
    level of joy within you continues to rise. go, the higher you want to go
    Now, you are about to be transported to greater
    heights of pleasure than you ever dreamed possible.
    As you continue soaring farther and farther into
    trance, you are already
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 145

    and the stronger the effects of my words become. Each time you climb this mountain of joy, you
    You are being guided all the way to the peak of will be able to tap into more of this vast potential,
    the mountain by the sound of my words alone; and and the joy which you are able to experience in
    as I continue, you will feel wave after wave of your everyday life will be correspondingly
    ecstasy building up from the depths of your being enhanced.
    and rolling endlessly forth like breakers upon an
    ocean shore. Each successive wave, as it comes
    crashing forth, will carry you still higher, leaving
    you ever more sensitive and more responsive to the Stein's Clenched Fist Technique
    one which is to follow.
    And the higher you climb, the higher you want to D. Corydon Hammond, Ph.D. Salt Lake
    climb and the stronger the effects of my words City, Utah
    become.
    The waves of joy will come faster and faster INDICATIONS
    until they finally blend together into one vast tide.
    And when they finally fuse together and become This is an ego-strengthening and hypnotic
    one, they will carry you up to an ultimate peak of conditioning technique that can give patients a
    joy which is the fulfillment of all existence. And valuable coping method for altering problematic
    then you can sink back, happy and fulfilled, and emotional states. Unconscious resources within the
    able to experience joy more fully in your everyday patient (e.g., feelings of confidence, happiness,
    life. calm, spontaneity) are accessed and then
    And each time this exercise is repeated, your conditioned, so that they may be evoked by the
    capacity to experience joy will become greater, and patient whenever needed. This technique may be
    your ability to live joyfully will be correspondingly used for coping with anxiety, anger, cravings
    enhanced. (smoking, food, alcohol, drugs), with compulsive
    Now, as you continue climbing on and on, you disorders, in nailbiting, and with psychosomatic
    begin to sprint; for you are determined to reach the disturbances. In a sense, this method is like the
    peak as soon as you can. And with every step, your behavioral methods of thought stopping and
    speed increases. Running and running, breathing thought substitution, which can often be made
    faster and faster, nearly bursting with delight as the more powerful and automatic through hypnotic
    level of joy within you continues to rise. And when conditioning. Failures may occur if this technique
    you finally sink down upon the peak, a final burst is used when unconscious adaptive functions are
    of joy will explode within you like a rocket. Now being served which need to be examined through
    you are very near the peak. Almost there. Now! exploration techniques (e.g., ideomotor signaling),
    or when strong hostility requires exploration and
    And as you sink down upon the peak and the joy
    abreaction. The verbalizations modeled below are
    begins to subside, it is followed by a boundless
    mine, but they are modeled after Dr. Calvert Stein.
    feeling of peace and tranquility, confidence and
    calm. You feel just as secure as a little baby nestled
    in its mother's arms. And as a result of having
    tapped into this vast potential for experiencing joy, THE TECHNIQUE
    you will be much more able to respond joyfully in
    everyday life situations; and each new day will [First, identify the resource and feeling state
    contain new treasures of joy for you to discover and needed by the patient. Following induction and
    to experience. deepening, the patient may be told:] Now I want
    your unconscious mind to search through your
    memories and identify a time when you
    146 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    felt (e.g., confident, happy, peaceful and calm, to experience these feelings again, all you
    healthy, needed, accepted, competent, strong). Just need to do is clench your dominant hand into a
    allow your inner mind to identify a time fist, and this same kind of memory and feelings,
    when you felt _________ , no matter how brief will come back into your experience.
    the experience, or how long ago, and no matter [Identify two other experiences where the
    how intimate or personal the experience, because it patient felt these same types of feelings, going
    isn't necessary to tell me anything about it if you through the same procedure and suggestions.]
    don't want to. And when your unconscious mind And now you can feel pleased, and feel a sense
    has identified that experience, just allow your of confidence in knowing, that you have learned a
    "yes" finger to float up. method for recapturing these feelings, whenever
    [After an ideomotor response:] Good. Now you need them. Your unconscious mind has
    I'd like your unconscious mind to take you back memorized these feelings, these experiences, and
    through time to that experience. Just allow they will remain just beneath the surface, as inner
    yourself to drift back to that experience, and resources. And because of this conditioning, they
    when you are there, allow your "yes" finger to will be readily available, whenever you need them.
    float up again. [Following an ideomotor re All that you'll need to
    sponse:] Good. And as you enjoy that experi do is to clench your __________ hand into a fist,
    ence again, you can begin to sense those feel as these memories, and positive feelings, wash
    ings associated with it —feelings of ___________. back over you.
    And when you're aware of experiencing those And I'd like you to demonstrate this for yourself
    feelings again, allow your "yes" finger to float up now. In a moment, I want you to squeeze that
    to signal me. [Pause for response] That's right. And (right, left) hand into a confident fist. And as you
    notice how those feelings get stronger, as you do so, notice, just notice how one of these same
    enjoy that experience again, in complete privacy. wonderful memories, and these same feelings,
    [Pause] come back into your experience. Go ahead.
    And now as you feel these feelings, I'd like you [Pause] And enjoy this experience. [Pause] And
    to close your dominant hand into a tight fist, and as the stronger you clench that fist, the more vivid
    you do so, these positive feelings become even the feelings become, do they not? [A double
    stronger. That's right, just close your dominant check] And I'd like you to appreciate, your own
    hand into a tight fist, as a sign and symbol of ability, to recapture these feelings, whenever you
    confidence and determination. This is the hand that wish, knowing that they are always there, just
    you trust and depend on. And as you clench it beneath the surface for you.
    tightly, feel the feelings of Now allow that fist to relax, and allow yourself
    ________becoming even stronger. And when to drift into an even sounder, and deeper hypnotic
    you're aware of feeling those feelings even more state. [Deepen the trance.]
    strongly, just nod your head to let me know. And now you're going to have an opportunity,
    That's right, and just continue enjoying that to learn another method, which will allow you to
    experience, and these good feelings, allowing them even more effectively neutralize the
    to fill you, and to flow all through you. And as you feelings of__________ , and replace them with
    continue experiencing these feelings, take several feelings of__________and__________ . In a mo
    deep, refreshing breaths, while your unconscious ment, I'd like you to permit yourself to re
    mind memorizes, all of these wonderful feelings. member an unpleasant experience, that made
    Because in the future, whenever you close your you feel____________It doesn't have to be so
    dominant hand into a tight fist like this, you will unpleasant that it makes you miserable. I don't
    feel once again, these want you to be that uncomfortable. But allow
    feelings of _________ and _________ , flowing just enough of an unpleasant memory to come
    back over you and filling you. Whenever you want back, so that you begin to feel some of those
    feelings of __________ . [Pause] And when
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 147

    you're experiencing some of those unpleasant remain with you, far longer than you might expect.
    feelings, signal me with your "yes" finger. You now have a method for controlling your
    All right. And now I want you to enjoy own feelings, and for creating this same sense of
    discovering something, very interesting. I want well-being, whenever you need to. So whenever
    you to notice, how these negative feelings can you feel (negative feelings), just close your
    be transferred and displaced, into your (nondominant) hand into a fist. As you do so, you'll
    nondominant, (left, right) hand, as you close it feel all
    into a fist. Close your (left) hand into a fist, and those unpleasant feelings and sensations
    as you do so, be aware of how those unpleasant flowing, and funneling, and concentrating into
    feelings and sensations funnel down, through your _________ hand. And after a short time,
    your shoulder, your arm, your forearm, down when it feels as though all those unpleasant
    into your (left) fist. Allow all those unpleasant feelings are locked up in that hand, then you can
    feelings and sensations, those negative emo neutralize them. You can get rid of them, and then
    tional and physical knots, to flow down into replace them with positive feelings, by simply
    your _________ fist, condensing and concen squeezing your (dominant) hand into a
    trating there. Lock them up tightly in that fist,
    tight fist, while you open your _____
    keeping them there until you're reasonably sure
    that all of them, or the majority of them, are in hand, and let go of all the unpleasant feelings and
    that fist, where you yourself have displaced and sensations. And I want you to really enjoy, all the
    transferred them. You may not always be able positive feelings, and wonderful memories that
    to keep unpleasant feelings from appearing in flow over you, and that will increase,
    your mind or body, but you'll be able the tighter you squeeze that___________fist.
    to And after a minute of two of clenching that fist,
    you'll discover that those pleasant, good feelings,
    transfer them into your____________ fist, will remain with you. Almost as if, by
    where clenching that ________ fist, you've
    you can control them. And when it feels as if all infused
    those unpleasant feelings, are collected into that your whole being with so many, good feelings,
    fist, just nod your head to signal me. with so much of those natural endorphin substances
    Good. Now, since you're the one who put those from your brain, that for a long time, there's just
    feelings into that (left) fist, you're the person who nothing to bother you, and nothing to disturb you.
    can remove and neutralize them. And I want you to
    observe how easy it is, to get rid of those feelings,
    and replace them with positive feelings. I want you
    to squeeze your (dominant) hand into a strong,
    confident, happy fist. And as you do so, allow your
    Suggestions for
    (nondominant) hand to relax, letting go of all those Ego-Strengthening
    unpleasant feelings. That's right. Just move those
    fingers around, allowing all those unpleasant John Hartland, M.B.
    feelings to flow out of your hand, as if they were
    just evaporating, or falling onto the floor. And
    you'll discover that the unhappy memory INDICATIONS
    disappears, and is replaced by a positive one. And
    you can enjoy that happy memory again, in The suggestions that follow are the original
    complete privacy, with that happy fist tightly ego-strengthening method, pioneered by the late
    closed, as a symbol of confidence, and strength, John Hartland. Although they are extremely
    and determination. Enjoy taking several extra deep, general, highly directive and authoritarian, they
    relaxing breaths, as you just luxuriate in these may nonetheless be useful with patients who are
    positive feelings for a while. [Pause] And these dependent and submissive to
    good feelings will
    148 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    authority. Clinicians may also find certain concepts fatigued . . . much less easily discouraged . . . much
    and ideas useful to adapt for individual patients, less easily depressed. Every day . . . you will
    and to modify into a more permissive form. (Ed.) become so deeply interested in whatever you are
    doing ... in whatever is going on around you . . . that
    your mind will become completely distracted away
    SUGGESTIONS from yourself. You will no longer think nearly so
    much about yourself. . . you will no longer dwell
    nearly so much upon yourself and your difficulties .
    You have now become so deeply relaxed . . . so
    . . and you will become much less conscious of
    deeply asleep . . . that your mind has become so
    yourself. . . much less preoccupied with yourself .
    sensitive . . . so receptive to what I say . . . that
    . . and with your own feelings.
    everything that I put into your mind . . . will sink so
    deeply into the unconscious part of your mind . . . Every day . . . your nerves will become stronger
    and will cause so deep and lasting an impression and steadier . . . your mind calmer and clearer . . .
    there . . . that nothing will eradicate it. more composed . . . more placid . . . more tranquil.
    Consequently . . . these things that I put into your You will become much less easily worried . . . much
    unconscious mind . . . will begin to exercise a less easily agitated . . . much less easily fearful and
    greater and greater influence over the way you apprehensive . . . much less easily upset.
    think . . . over the way you feel . . . over the way you You will be able to think more clearly . . . you
    behave. will be able to concentrate more easily. You will be
    And . . . because these things will remain . . . able to give up your whole undivided attention to
    firmly imbedded in the unconscious part of your whatever you are doing . . . to the complete
    mind . . . after you have left here . . . when you are exclusion of everything else. Consequently, your
    no longer with me . . . they will continue to exercise memory will rapidly improve . . . and you will be
    the same great influence . . . over your thoughts . . . able to see things in their true perspective . . .
    your feelings . . . and your actions . . . just as without magnifying your difficulties . . . without
    strongly . . . just as surely . . . just as powerfully . . . ever allowing them to get out of proportion.
    when you are back home ... or at work ... as when Every day . . . you will become emotionally much
    you are with me in this room. calmer . . . much more settled . . . much less easily
    You are now so very deeply asleep . . . that disturbed. Every day . . . you will become . . . and
    everything that 1 tell you that is going to happen to you will remain . . . more and more completely
    you . . . for your own good . . . will happen . . . relaxed . . . and less tense each day . . . both
    exactly as I tell you. And every feeling . . . that I tell mentally and physically . . . even when you are no
    you that you will experience . . . you will experience longer with me.
    . . . exactly as I tell you. And these same things will And as you become . . . and as you remain . . .
    continue to happen to you . . . every day . . . just as more relaxed . . . and less tense each day . . . so . . .
    strongly . . . just as surely . . . just as powerfully . . . you will develop much more confidence in
    when you are back home ... or at work ... as when yourself. . . more confidence in your ability to do . .
    you are with me in this room. . not only what you have ... to do each day . . . but
    more confidence in your ability to do whatever you
    During this deep sleep . . . you are going to feel
    ought to be able to do . . . without fear of failure . . .
    physically stronger and fitter in every way. You
    without fear of consequences . . . without un-
    will feel more alert . . . more wide awake . . . more
    necessary anxiety . . . without uneasiness. Because
    energetic. You will become much less easily
    of this . . . every day . . . you will feel more and
    tired . . . much less easily
    more independent . . . more able to
    EGO-STRENGTHENING:ENHANCINGESTEEM,SELF-EFFICACY,ANDCONFIDENCE 149

    'stick up for yourself . . . to stand upon your own gave you a strong sense of pride and accom-
    feet . . . to hold your own ... no matter how difficult plishment, and meant a great deal to you at the
    or trying things may be. time. It may have been graduation from high
    Every day . . . you will feel a greater feeling of school, or the day you got your first driver's
    personal well-being . . . a greater feeling of personal license, or almost anything else you can think of, as
    safety . . . and security . . . than you have felt for a long as it was something you really felt good about
    long, long time. And because all these things will when it happened. Take your time, and as soon as
    begin to happen . . . exactly as I tell you they will you have thought of a situation which fits this
    happen . . . more and more rapidly . . . powerfully . . description, you can signal me by raising the index
    . and completely .. . with every treatment I give you . finger of your right [or left] hand.
    . . you will feel much happier . . . much more [After the subject has responded:] All right.
    contented .. . much more optimistic in every way. Now let yourself get in touch with the feelings of
    You will consequently become much more able to achievement and satisfaction which you were
    rely upon . . . to depend upon . . . yourself . . . your feeling when you were actually in that situation.
    own efforts . . . your own judgment . . . your own Let yourself go back and experience those feelings
    opinions. You will feel much less need ... to have to once more, and feel them growing even stronger as
    rely upon ... or to depend upon . . . other I speak. Growing and growing, and becoming
    people. clearer and stronger and more intense with every
    passing second. And all the time I am speaking to
    you, until the trance is over, these feelings are
    going to continue growing stronger by themselves.
    Suggestions for And when the trance is ended, your normal,
    Self-Reinforcement everyday mood will return. And of course, you will
    have no need to balance things out by feeling bad,
    Don E. Gibbons, Ph.D. just because you have been allowing yourself to
    feel so good. But because you have been able to
    INTRODUCTION AND INDICATIONS recapture and to strengthen these feelings of pride
    and accomplishment, and the sense of deep
    The following suggestions are designed to assist personal satisfaction that goes with them, it will be
    an individual in developing a greater capacity for much easier for you to feel good in the future over
    self-reinforcement so that he will be less dependent all the things you do that you ought to feel good
    on external sources of reward—and hence, better about, and to give yourself a pat on the back
    able to determine the course of his own conduct. Of whenever you have it coming.
    course, numerous concrete applications are
    possible.
    Visualization of the
    SUGGESTIONS Idealized Ego-Image
    Now I would like to help you to experience the Maurice H. McDowell, Th.D.
    feelings of satisfaction and achievement which Salem, Oregon
    come with the attainment of an important goal, so
    that you can learn to practice and strengthen these
    INTRODUCTION
    feelings and apply them to the attainment of other
    goals in your life. First of all, I would like you to Normally, I ask patients to read the first four
    think of a time in the past when you had just chapters of Maltz's Psycho-Cybernetics. If they
    achieved something that was very important to
    you —something that
    150 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    read the first four chapters, they normally will Cycle of Progress
    continue to read the rest of the book, and this makes
    an excellent background for therapy. After deep Douglas M. Gregg, M.D.
    hypnosis has been obtained, the following San Diego, California
    suggestions are given to each patient.
    As you continue to relax, just letting yourself
    drift down deeper and deeper relaxed . . . you relax
    SUGGESTIONS
    completely throughout every fiber of your being;
    Each person has several self-images. Your relaxing physically, emotionally, mentally and
    obvious, conscious self-image is largely a reflected spiritually. And as you relax so completely in this
    image of how you feel significant people have fashion, concentrating your mind, listening to each
    reacted to or treated you. If you have felt that they word that 1 say, you let each suggestion take
    treated you as a just, honorable, and decent person, complete and thorough effect to help you, deeply
    you will tend to think of yourself in those terms. If, and automatically, on both the conscious and
    on the other hand, you have felt that they regarded unconscious levels of mind activity. You extend
    you as a bad, lying, thieving, untrustworthy person the principles of relaxation and concentration
    of little value, you will tend to think of yourself in which you now experience into your everyday life
    those terms. so that in every situation, and in every circumstance
    in which you find yourself, whether alone or with
    You also have precise self-images: How you feel others, you relax and you concentrate your mind,
    that your father feels toward you. What your automatically; no matter what you are doing, you
    mother would say about you if she were present find that more and more, day by day, you relax and
    now. Or, how would your favorite teacher evaluate you concentrate your mind. If you are doing
    you? How do you think the teacher you most something for fun or relaxation, you relax and you
    dislike would evaluate you? What would your best enjoy it more . . . you concentrate your mind
    friend say about you? [These various images were casually and comfortably and get more out of what
    sometimes discussed with the patient for you are doing. If you are doing something that
    clarification. If any traumatic materials were involves work or some serious project or activity,
    elicited, a temporary amnesia was often instilled you relax and apply yourself more thoroughly,
    for follow-up at a later time.] more effectively; you concentrate and do a better
    Now I want you to go way deep into your own job. And so, every day in every situation and in
    mind and visualize the real you, the kind of a every circumstance in which you find yourself, you
    relax and you concentrate, more and more and
    person you really are and can really become. I want
    more. As you relax and concentrate, you evaluate
    you to look at it very carefully and to study it
    everything thoroughly and completely; you reach
    thoroughly and lock it into your conscious mind so
    decisions easily and readily; you act efficiently and
    that we can discuss it when I alert you.
    effectively; and you build your self-confidence,
    I shall count to three, and the visualization will your self-reliance, your self-acceptance, and your
    immediately appear in your mind. As soon as you self-esteem. You become a stronger individual; you
    have completed the visualization, please lift your become self-sufficient. As this occurs, you feel
    right index finger to signal me that you have more relaxed and you are capable of greater
    completed your part of this project and are willing concentration.
    to be alerted. . . .
    [This technique has been used with over one Just drifting down now . . . way down . . . deeper
    hundred college students in their search for
    relaxed. And you realize that as you are more
    identity. It has been very helpful to a majority of
    relaxed and as you are capable of greater
    the students.]
    concentration, you evaluate things even more
    EGO-STRENGTHENING: ENHANCING ESTEEM, SELF-EFFICACY, AND CONFIDENCE 151

    thoroughly and completely; you reach decisions concentrate your mind more and more. Helping
    even more easily and readily; you act even more you as you learn to relax, deeper and deeper
    efficiently and effectively and you continually relaxed ... as you learn to concentrate your mind
    build your self-confidence, self-reliance, more and more intensely, more and more
    self-acceptance, and self-esteem . . . growing completely, just drifting deeper relaxed.
    stronger and more capable every day in all situa-
    tions. As you do this, you feel even more relaxed
    and you are capable of even greater concentration.
    As you drift down deeper relaxed, you let all of A Brief Ego-Strengthening Suggestion
    these suggestions seat themselves deeply,
    permanently in your unconscious mind. And as you William T. Reardon, M.D.
    apply these principles in your life automatically Wilmington, Delaware
    every day, in every situation and in every
    circumstance in which you find yourself, whether You will be able to tolerate the persons, places,
    alone or with others, you relax more and more or things that used to disturb you and annoy you.
    deeply, you concentrate your mind more and more You will be able to adjust yourself to your
    sharply and intensely, you evaluate thoroughly and environment, even though you cannot change it.
    completely, you reach decisions easily and readily,
    you act efficiently and effectively, and you
    continually build your self-confidence,
    self-reliance, self-acceptance, and self-esteem. And A Future-Oriented Suggestion P.
    you continually find that you are capable of more
    relaxation and greater concentration and so on in a
    Oystragh
    cycle of progress that grows, that deepens, Bondi, N.S.W., Australia
    strengthens and reinforces itself every day as you
    grow and become that person that you have always . . .and as this begins to happen, every day you
    admired; the person you have always wanted to be: will find yourself better able to . . . [include
    self-sufficient. relevant suggestions] . . . and achieve for yourself
    that picture of yourself that you have in your
    mind's eye. As you want to be, as you can be, and
    All of these suggestions are now implanted
    as you will be.
    deeply, firmly and permanently in the deepest
    reaches of your unconscious, and they are part of You will be able to stand up for yourself, stand
    your entire being to be used automatically by you on your own feet and state your opinion or
    to make your life more effective, more productive, suggestion without embarrassment, without fear
    more useful and happier as you learn to relax more and without anxiety.
    and more, as you learn to
    ANXIETY, PHOBIAS, AND
    DENTAL DISORDERS

    INTRODUCTION

    Anxiety and Phobic Disorders

    HERE ARE MANY METHODS for working hypnotically with anxiety disorders.
    Occasionally, direct suggestions for relief of anxiety or phobias prove effective
    (e.g., Horowitz, 1970; Marks, Gelder, & Edwards, 1968; Naruse, 1965). When
    direct suggestions are ineffective, there are many other suggestive hypnotic
    techniques that may be productive. The patient may be taught to dissociate from
    anxiety-provoking circumstances. This may be accomplished through imagining
    floating away to a tranquil setting, feeling distant from tension-producing
    situations, or through age regression or age progression to more peaceful scenes
    and times (temporal dissociation). Contributions by the Spiegels, Stanton,
    Finkelstein, and Stickney model variations of such dissociative methods.
    Hammond's serenity place technique found in the ego-strengthening chapter is yet
    another example of scene visualization and dissociation for anxiety management.
    Simply the process of induction and deepening generally relieves anxiety. Thus
    verbalizations for a progressive relaxation induction have been included as part of
    this chapter, although many other induction methods may produce anxiety
    reduction. Meares' contribution on the use of deep meditative trance, primarily
    facilitated through nonverbal methods, provides another option for anxiety
    management. This method is similar to the technique of prolonged hypnosis
    discussed in Chapter 8.
    Hypnotically-facilitated systematic desensitization and mental rehearsal of
    successfully coping with tense situations are yet other methods for treating
    anxiety and phobic disorders (Clarke & Jackson, 1983). Advan-
    154 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    tages of hypnotic desensitization over traditional behavioral desensitization


    include enhanced scene visualization (Deiker & Pollock, 1975; Glick, 1970) and
    the ability to give posthypnotic suggestions to encourage behavioral responses to
    the situations that were imagined (Deyoub & Epstein, 1977; Gibbons, Kilbourne,
    Saunders & Castles, 1970).
    Cognitive factors may be another important etiologic component of anxiety and
    phobic responses. When low self-esteem is determined to be an aspect of the
    problem, ego-strengthening methods may be employed. Any cognitive therapy
    interventions that are used at a conscious level may also be reinforced
    hypnotically. Thus in this chapter you will find Gurgevich modeling one of his
    methods for cognitive refraiming. Rational-emotive therapy suggestions such as
    those found in this chapter and in the chapter on ego-strengthening may likewise
    be offered to anxious patients to modify their underlying assumptions and internal
    dialogue. Hypnosis may also be used to age regress patients to experiences
    immediately before they began to feel anxious (Crasilneck & Hall, 1985). This
    may aid in pinpointing the situations that elicit anxiety as well as the internal
    dialogue and imagery that evoke problematic responses. Age regression to times
    prior to the development of the phobia, when the patient was coping successfully,
    has also proven effective (Logsdon, 1960).
    There are times, however, when a phobic response or generalized anxiety is
    caused by more than simply conditioning or irrational cognitions. In these cases
    unconscious exploration, through ideomotor signaling (Hammond & Cheek,
    1988), ego-state therapy (Van der Hart, 1981), or hypnoprojective techniques
    (Gustavson & Weight, 1981; Schneck, 1966; Wolberg, 1948), has successfully
    identified conflicts, functions, purposes or past experiences that are beyond
    conscious awareness. When traumatic events are found to be associated with
    phobic reactions, it may be profitable to facilitate an age regression and abreact
    the feelings associated with the experience.
    Finally, it should additionally be reinforced that hypnotic interventions may
    (and often should) be used in conjunction with more traditional
    psychotherapeutic and medical interventions. In the treatment of phobias or panic
    disorder, for example, hypnotic methods may be combined with medication,
    in-vivo desensitization, cognitive therapy, bibliotherapy, marital or systems
    therapy, imaginal desensitization, and assertiveness or social skill training to
    produce a broad spectrum treatment package (e.g., Barlow & Cerny, 1988;
    Lazarus, 1989). The suggestions by Ellis in this chapter are illustrative of how
    hypnosis may be used to reinforce nonhypnotic therapies.
    There has been a tremendous amount published on hypnosis with phobic
    disorders, including a theme issue of the American Journal of Clinical Hypnosis
    in April 1981 and one book (Clarke & Jackson, 1983) focused on hypnotic
    treatment of anxiety and phobic disorders. We will not attempt in this introduction
    to provide a thorough review of an area as broad as anxiety, phobias and panic
    disorder. However, it seems important to note that, despite the fact that hypnosis
    is often useful in the treatment of anxiety and phobic disorders, careful evaluation
    and treatment are still essential (Crasilneck, 1980). At least 76 different phobias
    have been identified (Laughlin, 1967), and thus, the seemingly unitary category
    "phobic disor-
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 155

    ders" is far from a homogeneous grouping. Patients with phobias or anxiety


    disorders should not all automatically receive the same treatment. For instance,
    Fermouw and Gross (1983) emphasized the importance of considering the
    subtypes of social phobias, taking into account the difference between patients
    with high physiological arousal alone versus those with high cognitive and high
    physiological arousal.
    The first section of this chapter will overview a variety of suggestions for
    facilitating anxiety relief. Suggestive procedures for the treatment of phobic
    disorders will be the next topic of this chapter.

    DENTAL HYPNOSIS

    There are many applications of hypnosis in dentistry. A large percentage of


    patients are anxious and fearful concerning dental work, some to the point of
    being phobic. Hypnotherapy prior to dental work, self-hypnosis training, and
    naturalistic (informal) hypnotic procedures may all prove calming for the patient.
    Suggestions that are found in other chapters of the book on pain, anesthesia,
    healing and working with children are certainly relevant to dentistry. Use of
    dental analgesia will reduce the need for chemical anesthetic agents, along with
    their risks and side effects. Hypnotic analgesia will prove particularly beneficial
    when medical conditions and allergies preclude the use of chemical anesthetic
    agents. Dentists will also want to consult Chapter 8 for suggestions to promote
    vascular control, for example, to control bleeding among hemophilia patients.
    Hypnotic suggestions may also be extremely effective in working with bruxism,
    temporomandibular joint syndrome, gagging, thumbsucking, nailbiting, tongue
    thrusting, and in adjusting to dentures. Hypnotic suggestions can additionally
    facilitate compliance to suggestions for brushing, flossing, adjusting to dentures,
    and wearing dental appliances. Finally, hypnosis can be of particular value in
    pediatric dentistry to facilitate cooperation, minimize misbehavior, and reduce
    pain and anxiety. Research (Barber, Donaldson, Ramras, & Allen, 1979) also
    suggests that the combined use of hypnosis with nitrous oxide may prove
    unusually effective, potentiating the effects of suggestions.

    INDICATIONS AND CONTRAINDICATIONS FOR HYPNOSIS WITH TEMPOROMANDIBULAR JOINT


    SYNDROME AND BRUXISM Temporomandibular Joint Syndrome (TMJ) may cause
    symptoms of jaw pain, joint and muscle tenderness, abrasion of teeth (secondary
    to bruxism), and joint dislocation and/or sounds. TMJ, jaw clenching and bruxism
    may be an undiagnosed cause of headaches, particularly when the patient
    awakens with headaches. Clinicians who are not dentists should have potential
    TMJ problems evaluated by a dental or a maxillofacial specialist. Occlusal
    problems may result from abnormal malocclusion, and tooth grinding may stem
    from neoplasms, degenerative joint disease, congenital anomalies or trauma. The
    meniscus may also be displaced, worn down or torn.
    Patients should be cautioned, however, that some dental specialists almost
    routinely suggest surgery without first trying more conservative
    156 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    treatments. Teflon joint implants that break down over time and require further
    surgery are also still being used. Nonhypnotic and nonsurgical treatments also
    include the use of removable splint and jaw appliances. However, placebo
    treatments often (40%-64%) provide lasting remissions and stress seems to be a
    prominent etiologic variable in both bruxism and TMJ. Thus hypnotic suggestions
    and self-hypnosis training may provide lasting relief for many patients. In this
    regard, many of the suggestive procedures included in the first part of this chapter
    for treatment of anxiety may be beneficial. Hypnotic approaches to TMJ and
    bruxism may include abreaction of emotions (e.g., anger), self-hypnosis training,
    and suggestive hypnosis. The final section of the chapter will present suggestions
    that have been used successfully by various clinicians for managing various
    dental problems, along with an overview of the areas in which hypnosis may be
    used in dentistry.

    HYPNOSIS WITH ANXIETY

    Progressive Relaxation breathing easily and comfortably, and deeply, you


    may become aware of the sensations as you breath,
    Induction or Deepening noticing for example that the sensations are
    Technique different when you breathe in [timed to inhalation],
    and when you breathe out [timed to exhalation].
    D. Corydon Hammond, Ph.D. Salt Just notice those feelings as you breathe in [timed
    Lake City, Utah to inhalation], and fill your lungs; and then notice
    the sense of release, as you breathe out [said while
    FIXATION ON BODY AND BREATHING exhaling simultaneously with the patient].

    I'd like you to begin by just resting back, very PROGRESSIVE RELAXATION
    comfortably, and closing your eyes. Just rest back
    in the way that is most comfortable for you right And now I'd like you to concentrate particularly
    now, just resting your hands on your thighs, or on on the feelings in your toes and feet. Just allow all
    the arms of the chair. And as you just settle back the muscles and fibers in your toes and feet, to
    comfortably, this will be an opportunity for you to become very deeply relaxed. Perhaps even
    become even more comfortable, and to experience picturing in your mind's eye what that would look
    a hypnotic state, very easily, and very gently, and like, for all those little muscles and tissues to relax,
    very comfortably. loosely and deeply. Allowing yourself to get that
    And as you rest back, you can begin noticing the kind of feeling you have when you take off a pair of
    feelings, and sensations in your body right now. tight shoes, that you've had on for a long time. And
    Just notice some of the sensations, that you can be you can just let go of all the tension in your toes and
    aware of right now. For instance, you may become feet, and feel the relaxation spread. [Brief pause]
    aware of the feel of the shoes on your feet; or you And now imagine that this comfort and
    may notice the sensations in your hands as they rest relaxation, is beginning to spread and flow, like a
    there; or perhaps you may be aware of how the gentle river of relaxation, upward, through your
    chair supports your body. And as you continue ankles and all through your calves. Letting
    listening to me, and
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 157
    go of all the tension in your calves, allowing them scalp, and all out across your scalp, as if it's just
    to deeply, and restfully, and comfortably relax. bathing your head, with waves of comfort, and
    And when it feels as if that comfort has spread all relaxation. And that relaxation can flow down, into
    the way up to your knees, gently nod your head to your forehead, and like a gentle wave, down across
    let me know. [Pause] [After a response:] Good. your face, into your eyes, your cheeks, your mouth
    [This signal is a double check that the patient is and jaw. Just let go of all the tension in your face,
    responding adequately and it also allows the your mouth, your jaw, allowing those tissues and
    facilitator to gauge the amount of time needed for muscles to sag down, slack and relaxed.
    purposes of timing the rest of the induction. A And now allow that comfort to flow back down
    signal may also be given when the comfort has your neck, and across your shoulders, and down
    reached the top of the thighs.] into your arms. Letting that comfort flow down
    And allow that comfort to continue, flowing your arms, through your elbows, [pause] through
    upward, into your knees, and behind your knees your wrists, through your hands and fingers, right
    and through your knees, and into your thighs, down through your fingertips. Letting go of all the
    letting go of all the tension in your thighs. Perhaps tension, and tightness, letting go of all the stress,
    once again imagining what that might look like, for and strain, all through your body. Just allowing
    all those large muscles and tissues, to become soft your body to rest, and relax.
    and loose, and deeply relaxed. Perhaps already
    noticing that sense of gentle heaviness in your legs,
    as they just sink down, limply and comfortably.
    And when you notice that sense of heaviness in
    your legs, gently nod your head again. And
    Hypnotic Treatment Techniques
    continue to allow that comfort, to flow and spread with Anxiety
    upward, at its own pace and speed, into the middle
    part of your body. Flowing into your pelvis and David Spiegel, M.D., and
    abdomen and stomach, [pause] through your hips Herbert Spiegel, M.D.
    and into your lower back. Letting that soothing, Stanford, California, and New York, New York
    deep comfort spread, inch by inch, up through your
    body, spreading from muscle group to muscle
    group. Gradually, progressively flowing into your Anxiety patients are taught to concentrate on
    developing a physical sense of floating relaxation,
    chest, [brief pause] into your back, [brief pause],
    a sense of floating in some setting they associate
    between your shoulder blades, and into your
    with comfort, such as a pool, a bath, a lake, or a hot
    shoulders. Just allow all the tension to loosen, and
    tub. They are then instructed to picture an
    flow away. As if somehow, just the act of breathing
    imaginary screen in their mind's eye, with the
    is increasing your comfort. As if somehow, every
    picture on that screen initially a pleasant scene.
    breathe you take, is just draining the tension out, of
    They are thus taught that they can use their
    your body, taking you deeper, [timed to exha-
    reservoir of memories and experiences to produce
    lations] and deeper, into comfort, with every breath
    psychological relaxation and physical comfort
    you take. And allow that comfort to flow into your rather than anxiety. They are then taught to picture
    neck and throat. Perhaps imagining once again what concerns them on this imaginary screen,
    what that would look like, for all the little fibers and using the center of the screen as a problem or
    muscles in your neck and throat, to deeply, softly, receiving screen where they choose what particular
    comfortably relax. Let that relaxation sink deep anxiety-related problem they wish to work on.
    into your neck. And it can gradually flow up your Then they are instructed to move some particular
    neck, up into your problem on which they wish to do further
    mental work
    158 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    onto the left, or sinister, side of the screen, where upper legs, through your knees, into your lower
    they picture their problem in greater detail. They legs, ankles and feet. Bring the feeling of
    then use the right side of the screen as a comfortable relaxation from your shoulders into
    problem-solving screen, where they try out your neck and let it move into your head, until it
    possible solutions. In this way, they are instructed fills your entire head with a comfortable, relaxed
    to focus on particular aspects of the problem, feeling. Take a deep breath and, as you breathe out,
    making it possible to conceptualize solutions. relax very deeply. [You can gently press the
    Throughout this instruction, patients are patient's shoulder as he/she exhales.]
    interrupted if necessary to help them maintain a Just imagine you are on the fifth floor of a very
    physical sense of floating comfort, thereby lovely building. This building has the interesting
    dissociating the psychological experience of stress property that permits you to double your relaxation
    from the physical experience of stress. each time you descend to a lower floor. There are
    three ways of descending for you to choose from.
    There is a lovely elevator with very comfortable
    chairs to support you comfortably. There is an
    The Private Refuge escalator, which has a comfortable chair for you to
    sit on as it goes down from floor to floor. There is a
    Selig Finkelstein, D.D.S. wide, carpeted stairway, that is brightly lit with
    Pleasantville, New York lovely pictures on the walls. Through the windows
    you can see a lovely day outside.
    As we descend, enjoy the increase in feelings of
    INDICATIONS
    comfort and relaxation, which you can double with
    This technique consists of a progressive re- each successive floor. Now, we reach the fourth
    laxation procedure followed by downward floor and continue down, reaching the third floor,
    movement and imagery of a safe place. These and continue down as the relaxation intensifies,
    suggestions may be used for induction and reaching the second floor, with relaxation
    deepening, and to assist patients where symptoms deepening even more, and continue to the first
    of anxiety and fearfulness are present. A variant of floor.
    this technique is also valuable with multiple You leave the building and enter an absolutely
    personality patients. (Ed.) wonderful place, which is wherever you want it to
    be, and which you can change whenever you wish.
    In it are the things, and only the things you want,
    SUGGESTIONS and you can change these also, as you wish. With
    you are the people, and only the people, you want,
    Relaxation is a mental process. You can begin and you can change them any time you choose, and
    by closing your eyes, but it helps to have you can even be by yourself, if you like.
    something physical with which to work. Just Enjoy your special place, in a safe and lovely
    wiggle your shoulders a little bit. That can give you manner. This is your refuge, and now that you
    a comfortable feeling of relaxation. Move that know where it is and how to get there, you can
    feeling of comfortable relaxation into your upper return to it any time you need to or want to.
    arms, through your elbows into your forearms, When you wake up, you can feel refreshed and
    wrists, and hands, so that you have a comfortable, very good, and when I count to three, you can wake
    relaxed feeling from your right hand, up your right up, feeling terrific, because you are. One . . . two . .
    arm, through your shoulders to your left arm and . three.
    left hand. Move the feeling of comfortable
    relaxation from your shoulders into your chest,
    stomach, hips and
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 159

    Imagery Scenes Facilitating your breath, feeling that, with each step, you let go
    more and more. This sense of ever-growing calm
    Relaxation has completely enfolded you by the time you reach
    H. E. Stanton, Ph.D. Hobart, the garden. [Pause]
    Tasmania, Australia And what a beautiful garden it is. You can see
    masses of multicolored flowers, an ornamental
    fountain, superb shrubs, and graceful trees.
    THE POOL Perhaps you can smell the flowers, hear the songs
    Imagine you are standing on a ledge overlooking of the birds and the sound of the water from the
    a quiet pool, lifting a heavy rock high over your fountain splashing into the pool at its base, and feel
    head. Watch the rock as you drop it into the water, the gentle warmth of the sun soaking into your
    observing, in slow motion, the splash and way it body.
    settles, sinking to the bottom of the pool. As it does
    so, imagine the water closing in above it,
    generating rippling circles spreading out all over
    the pool's surface. Continue to observe these
    ripples as they wax and wane until, finally, they Island of Serenity
    fade away completely, returning the water to its
    initial state of mirrorlike calm. Edwin L. Stickney, M.D. Miles
    City, Montana

    THE CLOUD
    INDICATIONS
    Feel that a warm cloud is bathing the entire
    center of your body. As it touches any part of you, This metaphor may be particularly indicated
    it engenders a wonderful feeling of warmth and with anxious patients who feel threatened,
    relaxation. Gradually the cloud spreads out from overwhelmed, or intruded upon by others. It may
    your center, touching every part of your body in be helpful in reducing patient defensive-ness
    turn, bringing a sense of energy, warmth, release of preparatory to exploration or in facilitating
    all tension, and peace. Once you are completely self-exploration and insight. (Ed.)
    engulfed by the cloud, feel your body becoming
    increasingly light, so that it seems to float
    effortlessly, drifting upwards into the blue sky.
    SUGGESTIONS
    Cushioned safely within this cloud, you can go to
    some special place where you feel at peace.
    Now I want you to imagine that you are going to
    take a trip to an island. I am going to count to ten,
    THE GARDEN and as I do, you will be able to make this journey. I
    don't know whether you will make it by plane, by
    Imagine yourself standing on the patio of a boat, or by swimming as Donna Nyad did.
    lovely old house, enjoying the warm sun and the And now you begin the journey—One . . . going
    gentle breeze which fans your cheeks. From this
    into a deeper and more relaxed state with each
    patio, you notice that there is a flight of ten steps
    count.
    leading down into a beautiful sunken garden.
    Two. . . . etc.
    Go down these steps, one at a time, linking your
    downward movement to an exhalation of Six . . . And now I need to tell you something
    about this island to which you are going. This
    island is your island of serenity. It is very deep
    within you.
    160 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Seven . . . going deeper and deeper. . . . This American Journal of Clinical Hypnosis. If you find
    island is so deep within you that it cannot be this approach interesting, you will probably also
    invaded. want to consult the two contributions on prolonged
    Eight . . . deeper and deeper yet. . . . It cannot be hypnosis in Chapter 8 (Hypnosis with Medical
    invaded by anyone, it cannot be invaded by Disorders). (Ed.)
    anything.
    Nine . . . deeper and more relaxed ... so that when I believe that the giving of specific hypnotic
    you are on this island you are safe. Most of the time suggestions is poor quality hypnotherapy. This
    we need to guard ourselves, but you are so safe on opinion is based on the experience of 1,130 patients
    this island that you may allow any feelings you wish treated by hypnosis. Of these, approximately 420
    to come out in the open and be recognized and patients were treated primarily by hypnotic
    deeply felt. suggestion and approximately the same number by
    Ten . . . now you are on your island of serenity, hypnoanalytic techniques, including both
    and in the next few minutes you will be able to hypnography and hypnoplasty as well as verbal
    spend a whole day on that island. hypnoanalysis. The remaining 710 patients have
    [Further visualizations and/or ego-strengthening been treated simply by deep relaxing hypnosis
    suggestions may now be incorporated into this without any specific suggestions or hypnoanalysis
    metaphor as needed.] at all. In this method, hypnosis is used to show the
    patient how to reduce his own anxiety. The
    rationale of the method is that symptoms are only
    maintained by anxiety. If the patient can reduce his
    Deep, Meditative Trance: The anxiety, symptoms either disappear spontaneously
    Approach of Ainslie Meares, or can be easily controlled by the patient. Thus the
    patient who wants to give up smoking or overeating
    M.D. becomes anxious when put to the test. This is
    shown by his restless, agitated apprehension. If he
    INTRODUCTION AND INDICATIONS can be shown by relaxing hypnosis how to control
    this disquiet of his mind, he becomes master of his
    The late Dr. Ainslie Meares was heavily own destiny and is in a position to control his
    influenced by Eastern meditative traditions. His symptomatic behavior with little effort.
    distinctive approach was one of facilitating deep,
    meditative hypnotic states. He did this primarily So, as I see it, the only therapeutic suggestions
    through using nonverbal techniques and a that we should use are those to help the natural
    minimum of verbal suggestions that would require mechanisms of the patient's mind to alleviate his
    conscious analysis. Concerning his use of touch, anxiety. For this to be effective, the suggestions
    however, it must be remembered that Meares was a cannot be given by means of a logical verbal
    physician. Caution is urged with regard to the communication, as this would keep the patient alert
    extent and nature of the touch utilized to minimize and so prevent the essential atavistic regression. So
    possible misinterpretation, transference or the suggestions must be conveyed by the
    countertrans-ference reactions. Meares believed para-logical use of words, by unverbalized
    that facilitating an extended state of profound phonation and by touch.
    quietness and stillness was very healing. He
    particularly utilized this approach with medical At the beginning of the session, it is necessary to
    patients (e.g., cancer patients). The editor believes use a few words to allay the patient's immediate
    it is also a valuable technique that is indicated with anxiety. But these words must be used in a way
    anxiety states and premenstrual syndrome. which does not evoke any critical thought in the
    patient, as such would keep the patient alert and so
    The following material was compiled and edited prevent the atavistic regression of true hypnosis.
    from Dr. Meares' contributions in the 1973 ASCH
    Syllabus and from his article in the
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 161

    So I say to the patient, "Good Easy Natural our mind is not still. It is important that this
    Letting yourself go Effortless All effortless and stillness of mind should develop in the absence of
    natural All through us Deeply All through our body drowsiness and in the absence of physical comfort.
    All through out mind." At first, when the patient is learning this type of
    These verbal suggestions have very little logical meditation, the stillness will not be complete.
    content, but on the other hand they carry a There will come moments of stillness followed by
    significant para-logical meaning. They are said periods of mental activity, and then stillness again,
    slowly. There are pauses between the phrases, and which is experienced as a kind of ebb and flow in
    the pauses lengthen out into silences. From this the naturalness of it all. Any attempt on the part of
    there is an easy transition to suggestion by the patient to try to induce the stillness destroys the
    unverbalized phonation. "Ah Umm Umm." This whole process. Many patients find that capturing
    continues into the sound that comes when I breathe the effortless quality is the most difficult part of the
    out slowly in relaxed fashion. I do this, timing it whole procedure. While all this is going on, other
    with the natural rhythm of the patient's breathing. suggestions of relaxation are communicated by
    touch. I let my hands rest on the patient's
    The absence of any direct logical communication shoulders, on his forehead, or on his abdomen
    is very important. Any logical communication that where my hand moves easily but firmly with the
    I might make alerts the patient's critical faculties to patient's respiratory rhythm.
    evaluate what I have said, and so defeats the
    purpose of the procedure, which is to lead the These nonspecific suggestions reduce the level
    patient to stillness of mind. Even such simple, but of the patient's anxiety and no specific suggestions
    logical, ideas as, "Your arms are relaxed," have this are given at all. By this means the patient learns to
    effect, as the patient immediately thinks about the reduce his anxiety himself, and retains full
    relaxation of his arms. Communication must be personal responsibility for his better way of life.
    made in such a way that it does not provoke any If it is practicable, the cancer patient attends for
    intellectual activity in the patient. This is achieved a session of meditation each weekday morning for
    by nonverbal phonation and by touch, and a month and then less frequently. Besides these
    sometimes by single words or simple phrases which sessions with me, the patient is required to practice
    are merely reassuring and do not evoke critical daily at home. Meditation in a position of comfort
    mental activity in the patient. Thus the word, produces a kind of drowsy numbness which is
    "Good," spoken slowly in a long exhalation, has quite different from the crystal clear stillness of
    this effect. Again, the phrase, "That's right," has a intensive meditation. So the patients are
    similar effect if spoken in a slow exhalation. Again, encouraged to practice their meditation in a posture
    unverbalized phonation, a long natural, "Ummm," of slight discomfort. Then, as the meditation
    has meaning to the patient in the way of comes, the slight discomfort is transcended and the
    reassurance, and the knowledge that I am close by. patient is no longer aware that he is in a potentially
    The "Ummm" does not evoke any intellectual uncomfortable or even painful posture. At the start
    response. However, the main and most significant I lead the patients into meditation while they are
    means of communication is by touch as something sitting in a comfortable chair. When they have
    very natural, reassuring and helpful. The touch learned the feel of it, they practice at home sitting
    must never be tentative, or it will make the patient on an upright chair or stool. This is enough to
    anxious. provide some very slight discomfort. They start to
    meditate. Then as the meditation comes they are no
    The mind is simply allowed to be still. If we longer aware of the slight discomfort. Then they
    want our mind to be still, it is obvious that we proceed to lying on the floor, kneeling, squatting
    cannot keep repeating a mantra. It is equally on their buttocks or squatting cross-legged sitting
    obvious that we cannot be aware of our breathing. on a cushion or
    If we are aware of our breathing, of course
    162 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    book and then to squatting without any aid. The rhythms; (2) use minimal real stimulation, but
    only purpose of the posture is to provide a degree of maximal involvement of the imagination; (3)
    discomfort which is commensurate with the observe a pause-for-feeling, or "creative pause," to
    meditator's ability to transcend it. allow time for the imagination to work and the body
    The length of time spend in meditation depends to react.
    on the patient's ability to do it. At the start, 10 Experimentation should not be continued when
    minutes three times a day may be all the patient can the desired results are not obtained after a few
    manage. On the other hand, some patients who trials. In this case other images should be
    have been successful in bringing about a regression substituted. However it should be kept in mind that
    of their cancer have gotten into the way of different exercises and images may be effective at
    meditating for two or three hours a day or more. . . . different times or under different circumstances.
    Those patients who come to like meditating do
    best.

    TABLE
    Physical, Physiological, and Psychological
    Methods of Relaxed Breathing Feelings, Actions, and Images Related to the
    Breathing Rhythm
    Beata Jencks, Ph.D. Holding the
    Murray, Utah Exhalation Inhalation Breath
    Physical and Physiological
    INTRODUCTION
    Relaxation Increase of Maintenance
    tension or increase of
    Dr. Jencks has created a variety of innovative
    tension
    respiration techniques that may be beneficial in
    facilitating greater relaxation. She believes that Heaviness Lightness Unstable
    utilizing imagination, along with suggestions in the equilibrium
    form of single words or phrases, is particularly Calmness Stimulation Restlessness
    powerful when linked with the appropriate phases
    of the breathing cycle (see the Table below for Warmth Coolness Variability
    details). The techniques may be used in the office
    setting, or recommended for use in self-hypnosis. Darkness Brightness Variability
    These are also methods that may serve to focus Softness Hardness Rigidity
    attention and may be used for deepening
    techniques. (Ed.) Moisture Dryness

    Weakness, Strength, Momentary


    weariness invigoration, conservation
    INSTRUCTIONS refreshment of strength

    While you are trying out or practicing many of


    the following exercises, keep in mind the effects Psychological
    listed in the Table. The instructions for the
    Patience, en- Speed, being Anxiety,
    exercises should be modified by experimentation
    durance startled oppression
    according to personal needs. For such
    experimentation the following instructions are Contemplation Ready Strained
    helpful: (1) Do or imagine something only two or attention attention
    three times during consecutive breathing (continued)
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 163

    TABLE LONG BREATH


    (continued)

    Holding the Imagine inhaling through the fingertips, up the


    Exhalation Inhalation Breath arms into the shoulders, and then exhaling down
    Equanimity Courage Cowardice the trunk into the abdomen and legs, and leisurely
    out at the toes. Repeat, and feel how this slow, deep
    Deep thought, Open- Closed-
    breathing affects the whole body, the abdomen, the
    concentration mindedness, mindedness flanks, and the chest. Do not move the shoulders
    creativity
    while doing the long breath.
    Introversion Extroversion

    Boredom Excitement Keen interest


    STONE INTO WELL
    Satisfaction Curiosity Uncertainty
    Imagine a deep well in your abdomen. Then
    Depression Cheerfulness Nervous imagine that you are dropping a stone into this well
    tension during a relaxed exhalation. Follow its fall. How
    Comfort Exhilaration Uneasiness
    long did the fall last? How deep did it fall? Where
    did it come to rest? Repeat.
    Generosity Greed Stinginess

    Actions BELLOWS
    Relax, release, Tense, bind, Hold on Breathe as if the flanks were bellows which are
    let go, loosen tighten grasp
    drawing in and pushing out. Inhale while the
    Release pres- Increase pres- Maintain or bellows are drawing in the air, exhale while the
    sure, stream, sure, stream, increase bellows contract and expel the air. Imagine that the
    or flow out or flow in pressure air streams through the flanks freely.
    Liquify Solidify Maintain
    consistency
    HOLE IN THE SMALL OF B A C K
    Expand, Contract, Dimension
    widen, open narrow, close unchanged or Sit or lie comfortably and breathe normally and
    congestion relaxedly. Disregard the chest and throat
    Sink, descend, Ascend, Maintain level completely for a moment and imagine a hole in the
    fall asleep levitate, rise,
    small of the back, through which the breathed air
    wake up flows in and out comfortably. Breathe deeply and
    Lengthen Shorten Maintain
    relaxedly through the hole for three or four
    length breathing cycles. Then just close the eyes for a
    moment, let the mind drift, and enjoy the feeling of
    Move or swing Move, draw, Stop, stand, or deep relaxation.
    forward, strike, pull, or swing hold still
    kick, punch, backward,
    reach out haul in SWING
    Send, give, Receive, take, Keep, interrupt
    Lie on your back and imagine a swing swinging
    help, offer demand
    with your respiration. Push the swing during one
    Laugh, sigh, Sob, gasp Smile, frown
    exhalation. Let it swing in its own rhythm. Do not
    giggle push the swing all the time.
    164 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Permit it to swing by itself. Feel tensions swinging BREATHING THROUGH THE SKIN
    out during exhalation. Feel energy streaming in
    during inhalation. Concentrate on the forehead or any other body
    surface area and imagine inhaling and exhaling
    through the skin there. Exhale and feel something
    going out. Inhale and feel something coming in.
    PENDULUM
    Exhale through the skin and permit it to relax.
    Inhale and halt the breath momentarily. Exhale Inhale through the skin and feel it refreshed and
    and imagine that this sets a pendulum in motion. invigorated.
    Permit the breathing to find its own rhythm. Allow
    it to swing or flow as it wants to do. RELAXING THE DIAPHRAGM
    The release of tensions will result spontaneously
    WAVES OR TIDES and unconsciously in slower, deeper exhalations.
    Such relaxed breathing is similar to that during
    Lie on your back and imagine ocean waves or sleep and during the waking state may be felt as
    tides flowing with your respiration. Allow them to "being breathed" rather than active breathing. The
    flow out passively. Allow them to return passively. respiration is deepened when the tendons of the
    Do not push. They flow by themselves. Feel the neck and shoulders are relaxed, the mouth-throat
    passive flowing in and out of the waves or tides. junction is felt as a wide open space, and
    Observe where you feel movement. Feel to where exhalations are felt throughout the whole trunk,
    the waves are flowing. Feel from where the waves especially in the flanks and in the small of the back.
    return. Do not prolong this exercise beyond two or Also imagining making movements with the joints,
    three respiratory cycles. Then feel what happened as in calisthenics, or using the vocal mechanism by
    in the body during the next two to three cycles. Get humming, chanting, sighing, or growling will relax
    up from the lying position first to a sitting and then the diaphragm.
    to a standing position during consecutive exhala-
    tions. This preserves the relaxation and prevents
    dizziness after deep relaxation. LOOSENING JOINTS
    Stand relaxedly, arms hanging easily at the Work on the joints is especially effective for
    sides, inhale and feel what is set in motion by the relaxing the diaphragm, since nerve cells which
    rising wave of inhaling. Then allow the wave of the deepen the breathing rhythm reflexively are located
    breath to decline and fade, as if into a great around and in the joints. Allow any yawning,
    distance. Repeat, and allow the arms to move sighing, or changes in the breathing rhythm to
    easily with the breathing waves. occur naturally during joint exercises.
    The following exercise is similar to F. M.
    Alexander's technique, and it is especially effective
    IMAGINED DRUG for the head-neck-shoulder region, which was the
    location with which he worked.
    Imagine that you are inhaling a broncho-dilator Sit in an armchair with a high back to rest the
    agent, which relaxes and widens the walls of the air head, the arms well supported, the feet squarely on
    passages in bronchi and lungs. Allow them to the floor with the knees bent at right angles, or lie
    become soft like rags and relaxed, collapsing on the floor on the back, with the legs drawn up, the
    during the exhalations, and allow them to become feet on the floor. Then think each of the following
    phrases during an exhalation, disregarding the
    widely expanded during the inhalations, while the
    inhalations, or letting
    air streams in easily.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 165

    the air stream passively into the lungs as if a The Autogenic Rag Doll
    vacuum were filling gently. Use any or all and
    repeat as needed: Tell the shoulders to let go of the Beata Jencks, Ph.D.
    neck. . . . Tell the neck to let go of the head. . . . Tell
    Murray, Utah
    the head to let go of the jaw. . . . Tell the throat to let
    go of the tongue. . . . Tell the eye sockets to let go of
    the eyes. . . . Tell the shoulders to let go of the upper INDICATION
    arms. . . . Tell the elbows to let go of the lower arms.
    . . . Tell the wrists to let go of the hands. . . . Tell the This may be used as an induction or deepening
    hands to let go of the fingers. . . . Tell the spine and
    technique. It incorporates all the aspects of
    sternum to let go of the ribs. . . . Tell the lower back
    Schultz's autogenic training, but uses imagery
    to let go of the pelvis. . . . Tell the hip joints to let go
    instead of Schultz's intellectual formulas. It has
    of the upper legs. . . . Tell the knees to let go of the
    lower legs. . . . Tell the ankles to let go of the feet. . proven valuable with anxiety, with children as well
    . . Tell the feet to let go of the as adults, and in preparation for childbirth training.
    Individuals will respond best who can use visual
    and kinesthetic imagery. The procedure may be
    Similar to this are some instructions in A. D. used on a self-hypnosis tape, and it may be
    Read's (1944) relaxation method for natural presented in segments: introducing only the limb
    childbirth. The practitioner is instructed to imagine, heaviness procedure first, and adding other
    for instance, that the shoulders "open to the components every few days. (Ed.)
    outside," the arms fall "out of the shoulder
    sockets," the back "sinks through the couch to the HEAVINESS OF THE LIMBS. Make yourself comfort-
    floor," the legs, knees, and feet "fall by their own able and allow your eyes to close. Then lift one arm
    weight to the outside," the head "makes an a little, and just let it drop. Let it drop heavily, as if
    indentation in the pillow," the face "hangs from the it were the arm of a Raggedy Ann [Andy] doll, one
    cheekbones," and the jaw "hangs loosely." All of of those floppy dolls or animals. Choose one in
    these involve the loosening of joints and are your imagination. Choose a doll, an old beloved
    effective, especially if done during relaxing soft teddybear, a velveteen rabbit, a bean bag toy,
    exhalations. or even a pillow or a blanket. Choose anything soft
    which you like. Lift the arm again a little and drop
    it, and then let is rest for a moment. . . .
    FILLING AND EMPTYING THE BOTTLE Now think of your arm again, but don't lift it in
    reality, just in the imagination. Lift it in imag-
    This is a German version, taught to actors and ination and think that you are dropping it again,
    singers, of a yogic exercise to relax and deepen and do this while you breathe out. Let the arm go
    breathing. Remember that, when liquid is poured limp like a rag while you breathe out. . . .
    into a bottle, the bottom fills before the middle and And now work with the other arm. Use either
    the top. When the liquid is poured out, the bottom your imagination or really lift it at first. It does not
    will empty before the top. Imagine that the trunk is matter. But do not lift it too high, just enough to
    a bottle. Fill it with inhaled air, first the bottom and feel its heaviness, and let it drop, but gently and
    then higher and higher. During exhalation imagine relaxedly. Learn to do it more and more in
    the bottle tipped and the breath flowing out, imagination only. And when you breathe out again,
    emptying first the lower abdomen, then the upper, drop it, let it go soft, let it go limp and relaxed. . . .
    and finally the chest. Repeat, but no more than Next lift both arms together, and allow them to
    three times consecutively. Then resume normal drop, simply relax them, allow them to be limp and
    breathing. soft. . . .
    166 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Then lift one leg. Lift it only a little, just enough And just as you walk or run, sometimes a little
    that you can feel its heaviness, and allow it to drop, faster, sometimes slower, and sometimes skip
    limp and relaxed, limp and soft. . . . Do this always along, just so that little motor in you sometimes
    when you breathe out. Don't lift the leg too high, so goes a little faster, sometimes slower, and
    that it does not hit too hard. Or better yet, lift it only sometimes skips. That is quite normal. And now
    in imagination. Do this a few times in your just feel, if you can, the rhythm of your heart. It
    imagination only, and just let it become heavy and does not really matter whether you can feel it or
    relaxed. . . . only imagine it, but think of your heart and say
    Now do the same with the other leg. Lift it a "thank you" to it. This organ works all the time for
    little, and while you breathe out let it relax. Let it you, whether you think of it or not. So now just stay
    go soft like a rag. Let it drop like the leg of a giant with it for a while, and say "thank you." . . . Thank
    rag doll. . . . your heart that it does such a good job for you. . . .
    Feel free to move your legs or any part of your
    body to a more comfortable position any time you RESPIRATION. Next, for a moment, pay attention to
    want to do so. your breathing. The breathing rhythm, just like the
    And now both legs together, lift them in your heart, sometimes goes fast and sometimes goes
    imagination, and let them relax, limp and soft, like slow. Allow it to go as slow or as fast, as shallow or
    a rag or a bean bag. . . . as deep as it wants to. If you have to sigh, that is
    And finally all limbs together, both arms and fine. If you want to inhale deeply, that is fine. Just
    both legs, breathe out and allow them to be limp follow the breathing. . . . And then, for a moment,
    and relaxed, heavy and comfortable, like a giant just imagine that the air which you breathe streams
    rag doll, well supported by the chair, the sofa, or in at the fingers while you breathe in, up your arms,
    and into your shoulders and chest; and then, while
    the floor.
    you breathe out, down into your abdomen, down
    into your legs, and out at your toes. And repeat this
    WARMTH OF THE LIMBS. Next imagine that you put
    for two or three breaths. . . . Then imagine that you
    your rag doll into the sun. Let it be warmed by the
    are floating, floating on an air mattress on the
    sun. The giant rag doll is lying very relaxedly. Feel
    ocean, a big river, or a swimming pool. Let slow
    how the sun is shining on it. Feel it on one arm first,
    and gentle waves carry you up and down in the
    and then on the other. See to it that the head of the
    rhythm of your breathing.
    rag doll is in the shade and kept cool, but all the
    limbs are sprawled out in the sun. Feel your arm,
    warm, soft, and relaxed. . . . And then feel the other INTERNAL WARMTH Now breathe into the palm of
    arm, warm, soft, and relaxed. . . . And then let one your hand and feel the warmth of your breath. Such
    leg be nicely warmed by the sun. . . . And then the warmth is within you all the time. Repeat it, and
    other leg, nicely warmed, soft, and relaxed. . . . then put the hand down again and imagine. Imagine
    Remember, you are the giant rag doll, and you are that you breathe this same kind of warmth into your
    lying in the sun; all your limbs are nice and warm, own inside. . . . While you breathe out, imagine that
    but your head is lying in the shade and is you breathe that warmth down into your throat,
    comfortably cool. . . . down into your chest, down into your abdomen. . . .
    Just become nicely warm inside. . . . Or you may
    HEARTBEAT. And now that you are such a nicely imagine that you are drinking something which
    relaxed rag doll, imagine you have within yourself really warms you nicely inside, or even that
    something like a warmly glowing ball is
    something that is like a little motor, which makes
    rolling around within you.
    you go all the time, and that is your heart. It just
    keeps you going all the time, day and night,
    whether you keep track of it or not.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 167

    Allow it to warm your inside, so that it becomes all sponses to trance-deepening so that the
    soft and relaxed. communicative rapport between therapist and
    subject remains clear and intact.
    COOLNESS OF T H E FOREHEAD. Bring one hand to the
    mouth and lick two fingers. Then stroke the moist
    fingers over your forehead. Just stroke your
    forehead and feel the coolness of the moisture. If SUGGESTIONS
    you want to moisten the forehead again, feel free to
    do so. . . . And then, while you breathe in, feel the There were times in the past when you felt
    refreshing coolness of your forehead, and imagine worried and frightened. Can you remember the
    again that giant rag doll or rag animal, lying with its feeling of being worried, the feeling of being
    head in the cool shade. . . . frightened by your own thoughts? [Pause] Now, let
    yourself remember what followed that feeling. Can
    Now just lie there and relax completely for a
    you remember the feeling of relief you experienced
    while, and think of the rag doll with its body each time you began to think that everything is
    warmed comfortably, relaxed in the sun. Feel again going to be fine — a feeling, a thought that
    the gentle cradling of the waves of the breathing everything is working out well, a feeling that
    rhythm. And while breathing in feel the cool shade, everything is going to be fine. Such a wonderful
    the coolness on your forehead, and while breathing feeling of relief and release from worry.
    out feel your comfortably relaxed body.
    Each point in time is like a lens through which
    ENDING THE ALTERED STATE OF CONSCIOUSNESS.
    you see your world. The first day in school was
    In different than the semester's end. The first time
    time, become more and more aware of being behind the wheel of an automobile felt different
    refreshed during the inhalations. And when you from the relaxing drive today. Some of your
    decide it is time to end the state in which you are greatest pleasures today may have been first
    now, yawn and breathe in deeply and refreshingly experienced with apprehension or tension. Now
    while you stretch and flex arms and legs. And then you may choose how you would like to feel about
    open your eyes, look around and breathe in once any past or present condition. As you relax more
    more. deeply, your unconscious mind selects the proper
    lens and the most comfortable frame. Sometimes
    you can tell your imagination what you are ready to
    begin enjoying. I don't know if your thoughts will
    change after your feelings, or if your feelings will
    Hypnotic Suggestion/Metaphor to follow more relaxing thoughts. But I know you are
    Begin Reframing ready to enjoy a pleasant change, a wonderful
    feeling of release.
    Steven Gurgevich, Ph.D.
    Tucson, Arizona

    COMMENT
    INTRODUCTION
    At this point, you would begin focusing upon
    The following is spoken to the patient who is
    specific events or conditions to reframe with the
    already in trance as a prelude to focusing on
    patient in trance. Also, at this point, suggestions
    specific events that will be the focus of reframing
    can be offered for uncovering what events or
    or unbinding of affect. It is important to have
    circumstances need to be reframed in order to
    already established ideomotor signaling and
    remove symptoms.
    observation of physiological re-
    168 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Rational-Emotive Suggestions want to hear — the sound of my voice. And you're


    going to do what I tell you to do, because you want
    About Anxiety to, you want to do it. You want to stay in this
    relaxed state and be fully aware of my voice and do
    Albert Ellis, Ph.D. New what 1 tell you to do because you want to do it, you
    York, New York want to be relaxed. You want to rid yourself of your
    anxiety and you know that this will help you relax
    and listen, relax and listen, go into a fully free and
    INDICATIONS AND
    relaxed state.
    CONTRAINDICATIONS
    You're only focusing on my voice and you're
    These suggestions were excerpted from a going to listen carefully to what I'm telling you.
    published case with an anxious female patient. The You're going to listen carefully to what I'm telling
    case illustrates how any ideas that may be you. You're going to remember everything I tell
    conveyed in a conscious state may also be you. And after you awake from this relaxed,
    reinforced in a hypnotic state. These suggestions hypnotic state, you're going to feel very good.
    may be of particular value with anxious and Because you're going to remember everything and
    overemotional patients, who catastrophize and are use what you hear— use it for you. Use it to put
    very demanding of themselves and others. They away all your anxiety about your anxiety. You're
    will also be reinforcing when a cognitive therapy going to remember what I tell you and use it
    approach is being used for part of treatment. Some everyday. Whenever you feel anxious about
    aspects of the suggestions may be offensive to anything, you're going to remember what I'm telling
    religious patients, but could be modified for use you now, in this relaxed state, and you're going to
    with such individuals. The suggestions are also fully focus on it, concentrate on it very well, and do
    somewhat authoritarian at times. Some patients exactly what we're talking about, relax and get rid
    will like the forcefulness; but when working with of your anxiety, relax and get rid of your anxiety.
    someone who is very reactive to authority, you may
    want to phrase the suggestions more permissively. Whenever you get anxious about anything,
    The suggestions were tape recorded for use in you're going to realize that the reason you're
    self-hypnosis, and were given following a pro- anxious is because you are saying to yourself,
    gressive relaxation induction. (Ed.) telling yourself, "I must succeed! I must succeed! I
    must do this, or I must not do that!" You will clearly
    see and fully accept that your anxiety comes from
    your self-statement. It doesn't come from without.
    SUGGESTIONS It doesn't come from other people. You make
    yourself anxious, by demanding that something
    Your eyes are getting heavier and heavier and must go well or must not exist. It's your demand that
    you want to let yourself sink, you're trying to let makes you anxious. It's always you and your
    yourself sink, into a deeper, deeper, relaxed state. self-talk; and therefore you control it and you can
    You want to let your whole body, especially your change it.
    eyes, go deeper and deeper and deeper into a totally
    You're going to realize, "/ make myself anxious.
    free, warm, nice, flexible, relaxed state. And now
    I don't have to keep making myself anxious, if I
    you're letting yourself go deeper, deeper, deeper.
    give up my demands, my musts, my shoulds, my
    You want to fully relax and get your body out of
    oughts. If I can really accept what is, accept things
    your way and go deep, deep, down deeper, down
    the way they are, then I won't be anxious. I can
    deeper, into a fully, fully, fully free and easy
    always make myself unanxious and tense by giving
    relaxed state. You're only listening to the sound of
    up my musts, by
    my voice, that's all you're focusing on, and that's all
    you
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 169

    relaxing— by wanting and wishing for things, but "And even if I get very anxious and go crazy,
    not needing, not insisting, not demanding, not that isn't too terrible. If I tell myself. 'I must not go
    musturbating about them." crazy! I must not go crazy!' then I'll make myself
    You're going to keep telling yourself, "I can ask crazy! But even if I'm crazy, so I'm crazy! I can live
    for things, I can wish. But I do not need what I with it even if I'm in a mental hospital. I can live
    want, 1 never need what I want! There is nothing I and not depress myself about it. Nothing is terrible
    must have; and there is nothing I must avoid, even when people don't like me, even when I'm
    including my anxiety. I'd like to get rid of this acting stupidly, even when I'm very anxious!
    anxiety. I can get rid of it. I'm going to get rid of it. Nothing is terrible! I can stand it! It's only a pain in
    But if I tell myself, "I must not be anxious! I must the ass!"
    not be anxious! I must be unanxious!" then I'll be
    Now this is what you're going to think in your
    anxious.
    everyday life. Whenever you get anxious about
    Nothing will kill me. Anxiety won't kill me. Lack anything, you're going to see what you're anxious
    of sex won't kill me. There are lots of unpleasant about, you're going to realize that you are
    things in the world that I don't like, but I can stand demanding something, saying "It must be so! I
    them, I don't have to get rid of them. If I'm anxious, must get well! I must not do the wrong thing! I
    I'm anxious —too damn bad! Because / control my must not be anxious!" And you're going to stop and
    emotional destiny — as long as I don't feel that I say, "You know —I don't need that nonsense. If
    have to do anything, that I have to succeed at these things happen, they happen. It's not the end
    anything. That's what destroys me—the idea that I of the world! I'd like to be unanxious, I'd like to get
    have to be sexy or I have to succeed at sex. Or that I along with people, I'd like to have good sex, but if I
    have to get rid of my anxiety." In your regular life, don't I don't! Tough! It is not the end of everything.
    after listening to this tape regularly, you're going to I can always be a happy human in spite of failures
    think and to keep thinking these things. Whenever and hassles. If I don't demand, if I don't insist, if I
    you're anxious, you'll look at what you're doing to don't say, 'I must, I must!' Musts are crazy. My
    make yourself anxious, and you'll give up your desires are all right. But, again, I don't need what I
    demands and your musts. You'll dispute your ideas want." Now this is what you're going to keep
    that "I must do well! I must get people to like me! working at in your everyday life.
    They must not criticize me! It's terrible, when they
    criticize me !" You'll keep asking yourself, "Why You're going to keep using your head, your
    must I do well? Why do I have to be a great sex thinking ability, to focus, to concentrate on ridding
    partner? It would be nice if people liked me, but yourself of your anxiety just as you're listening and
    they don't have to. I do not need their approval. If concentrating right now. Your concentration will
    they criticize me, if they blame me, or they think get better and better. You're going to be more and
    I'm too sexy, too damn bad! I do not need their more in control of your thoughts and your feelings.
    approval. I'd like it, but I don't need it. I'd also like to You will keep realizing that you create your
    be unanxious but there's no reason why I must be. anxiety, you make yourself upset, and you don't
    Yes, there's no reason why I must be. It's just have to, you never have to keep doing so. You can
    preferable. None of these things I fail at are going always give up your anxiety. You can always
    to kill me. change. You can always relax, and relax, and relax,
    and not take anyone, not take anything too seri-
    "And when I die, as I eventually will, so I die! ously.
    Death is not horrible. It's a state of no feeling. It's
    This is what you're going to remember and work
    exactly the same state as I was in before I was born,
    at when you get out of this relaxed state. This idea
    I won't feel anything. So I certainly need not be
    is what you're going to take with you all day,
    afraid of that!
    everyday: "I control me. I don't have to upset
    myself about anything. If I do upset
    170 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    myself, too bad. I may feel upset for a while but it and vigorously disputing my irrational beliefs, 'I
    won't ruin my life or kill me. And I can be anxious must do well! I must not be disapproved.'"
    without putting myself down, without saying 'I
    must not be anxious!' At times I will make myself
    anxious, but I can give up my anxiety if I don't
    demand that I be unanxious." And you're going to Stress Reduction Trance: A
    get better and better about thinking in this rational
    way. You'll become more in control of you. Never
    Naturalistic Ericksonian
    totally in control, because nobody ever is totally Approach
    unanxious. But you'll make yourself much less
    anxious and able to live with it when you are Eleanor S. Field, Ph.D.
    anxious. And if you live with it, it will go away. If Tarzana, California
    you live with it, it will go away. Nothing is terrible,
    not even anxiety. That's what you're going to INTRODUCTION
    realize and to keep thinking about until you really.
    really believe it. The following induction procedure utilizes the
    Now you feel nice and free and warm and fully following process:
    relaxed. In a few minutes I'm going to tell you to
    come out of this relaxed, hypnotic state. You will 1. Focusing attention inward — inner approach.
    then have a good day. You will feel fine when you 2. Evoking pre-existing associations and mental
    come out of this state. You will experience no ill processes.
    effects of the hypnosis. You will remember 3. Utilizing natural absorption and natural
    everything I just said to you and will keep working processes.
    at using it. And you will play this tape every day for 4. Utilizing natural resources.
    the next 30 days. You will listen to it every day 5. Subconscious learning process (educational
    until you really believe it and follow it. Eventually experience).
    you will be able to follow its directions and to think 6. Use of dissociation, anticipation, confusion,
    your way out of anxiety and out of anxiety about exploration, double binds, universal
    being anxious without your tape. experiences — the separation of the conscious
    You will then be able to release yourself from and unconscious minds, metaphors.
    anxiety by yourself. You can always relax and use
    the antianxiety technique you will learn by
    listening to the tape. You can always accept
    SUGGESTIONS
    yourself with your anxiety and can stop telling I would like for you to take a few minutes to get
    yourself, "I must not be anxious! I must not be yourself comfortable. Possibly you may want to
    anxious!" Just tell yourself, "I don't like anxiety, I'll take off your shoes, and you can do that too. And ...
    work to give it up. I'll conquer it. I'll control myself, I really DON'T KNOW . . . just what your eyes
    control my own emotional destiny. I can always want to do at this moment. You MIGHT want to
    relax, make myself feel easy and free and nice, just find a spot on the wall to look at, comfortably —not
    as I feel now, get away from cares for a while and staring at anything—but just allowing it to occupy
    then feel unanxious. But I can more elegantly the center of your visual field ... and WONDERING
    accept myself first with my anxiety, stop fighting it what is going to happen next. . . . You MIGHT feel
    desperately, and stop telling myself it's awful to be more comfortable just . . . closing . . . your eyes in a
    anxious. Then I can go back to the original anxiety peaceful sort of way — and either way you do it, I
    and get rid of it by refusing to awfulize about would just like for you ... to let yourself . . . zero in
    failing on the idea of just . . .
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 171

    being comfortable —and there have been many being said ... as it is doing now — and your
    TIMES - many PLACES - many SITUATIONS SUBCONSCIOUS mind is HERE WITH ME -
    where you have felt so COMFORTABLE that AND IT CAN HEAR ME - and RESPOND in ITS
    nothing else mattered except that comfort — and OWN TIME - IN ITS OWN . . . COMFORTABLE
    you might think of them now — and let your WAY.
    SUBCONSCIOUS mind . . . present to you . . . You CAN ENJOY whatever it is you are
    ONE SUCH SITUATION . . . where you really experiencing and —right now . . . you can enjoy
    experienced the sense of physical and mental whatever sensations — heaviness or light-
    comfort. ness—warmth or coolness —and let them become
    And you CAN . . . recall . . . and part of your relaxation and comfort. You can ... go
    RE-EXPERIENCE all the sensations - the as deeply as YOU need to— at this time - for
    sights-the sounds— the feelings . . . which go with WHATEVER it is your SUBCONSCIOUS mind
    being extremely comfortable— and you CAN wants to do to help you . . . ENJOY this experience.
    RECALL where you FIRST EXPERIENCED . . . And you MIGHT ENJOY that experience of going
    feeling profound relaxation . . . covering your body so deeply into trance that it seems to you that you
    — the feeling of every muscle in that part of your are just . . . ALL MIND without a body — a mind
    body just loosening up — and just letting go — and floating in space and time— completely free —
    lying flat like a limp rubber band — very deeply able to move whenever and wherever it wants to go
    relaxed — and very LIKELY that part of your body — THAT'S RIGHT.
    that needed the relaxation most will re-experience And I WONDER what your subconscious mind
    it first — and the feeling of every nerve in that part wants to EXPLORE right now — what doors it
    of your body becoming . . . very quiet — peaceful wants to open — perhaps taking a look through the
    — not doing any more than is absolutely necessary FILE CABINETS in the corner of that marvelous
    — and you can WONDER . . . what direction that DATA PROCESSING SYSTEM that is your
    relaxation is going to move through your body — mind. Searching through the files and examining
    whether you experience it all at once . . . like a flow things that . . . stay the way they are— things that
    of comfort peacefully moving through you. And need to be updated—what needs to be erased —
    soon you get the feeling that . . . you don't even what items can be eliminated — and it is very
    have to be aware of it anymore. You can simply comforting for YOU TO DISCOVER for yourself .
    allow . . . yourself to become part of that relaxation . . that . . . you CAN really ... let go . . . of what you
    . . . as it . . . becomes part of you. don't need — and your SUBCONSCIOUS mind
    can do this in ITS OWN TIME ... and ... IN ITS
    And it will be very interesting for you to
    OWN WAY - and you can continue to rest even
    DISCOVER for yourself that you . . . don't even
    more comfortably . . . just knowing . . . you CAN
    need to listen to me . . . because what your
    rely on your SUBCONSCIOUS mind to do the
    CONSCIOUS mind does now is not at all
    things that need to be done.
    important. . . . Maybe . . . your CONSCIOUS mind
    just wants ... to curl up in a corner and go to sleep You CAN BEGIN TO EXPLORE . . . your
    for a while — or go as far away as it likes — the CAPABILITIES . . . that you never had suspected
    way you did as a kid in SCHOOL when you sat in you had — which have been there all the time—
    the CLASSROOM and looked out the window . . . and find out for yourself a . . . very . . . deep . . .
    and allowed your mind to drift as far away from the sense of just who and what you are— and what you
    CLASSROOM as it could get — some place you'd are . . . capable of . . . doing all those things —
    rather be — and you lost track of what was being perhaps you just weren't aware of them before - but
    said — and it didn't matter because your your SUBCONSCIOUS MIND CAN MAKE
    SUBCONSCIOUS mind was picking up THEM AVAILABLE TO
    everything which was
    172 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    YOU ... at the time that you need them. THAT'S PLISHED . . . something of tremendous im-
    RIGHT - and you can continue drifting along . . . portance — just for you — and you won't do it . . .
    very comfortably wherever you are in TIME AND until your subconscious mind is ready for you ...
    SPACE - just enjoying the restfulness of not having to do so.
    to do anything in particular right now.
    And I WONDER if you might begin to notice
    some change in the atmosphere around you —
    perhaps becoming more luminous — more trans-
    parent—spinning all around you in all directions ... The Closed Drawer Metaphor
    as far as you can see— and that atmosphere around
    you seems to be radiating a calmness you can Brian M. Alman, Ph.D.
    experience with every one . . . of your senses — a San Diego, California
    calmness . . . moving all around you . . . and all over
    you . . . softly . . . moving itself into every fiber of
    Don is a salesman for a large printing company.
    your being . . . until you get the feeling that's all
    His tensions and stress arise from a number of
    there is — nothing . . . else exists . . . for you . . .
    sources through the day. "I'd really like to go into a
    except that calmness — deep sense of peace -
    trance about eight or ten times on some days," Don
    WEIGHTLESS SUSPENSION and you feel all the
    reported. "Most of the problems hit me when I'm in
    pressures dissipate— nothing to think about . . . and
    the office. Now I have this drawer on the lower left
    absolutely nothing to do except let yourself be —
    of my desk for those problems."
    and on an even deeper level, experience a sense of
    your own being — who you are — what you are What Don has done is given himself cues while
    capable of— becoming more AWARE of your own in self-hypnosis that, whenever a problem comes
    INNER RESOURCES - and now you can up that stresses him, he will put his stress in that
    ANTICIPATE the JOY of DISCOVERING those drawer. "I write down the name of the person or
    RESOURCES and WHAT YOU CAN DO -to account or the supplier or sometimes just a word
    make use of them to help yourself . . . and other that describes the problem. Then I take two deep
    people as well. . . . breaths, open the drawer, and put away both the slip
    of paper and the feelings of tension. Sometimes I
    And now, for the next few minutes — you CAN also put away the throb I feel in my head that means
    ALLOW yourself to relax — even more deeply - as a headache is on its way," Don said. "When I close
    your SUBCONSCIOUS MIND CONTINUES the the drawer I leave it all in there."
    important work it has started for you — working to Once a week he throws out the old slips of paper
    reach an even deeper understanding — and and makes room for new calm and relaxed
    whenever your subconscious . . . mind is finished . . reactions. He also has a folder in his briefcase for
    . with what it needs to do at this time — it will find situations that occur when he is in the field.
    its own way of letting you know — and in your
    You may want to adapt this technique for
    own time— at your own pace— and only when
    your subconscious mind is ready for you to do so yourself. Choose a drawer in your dresser at home
    — you can begin to drift back quietly — easily — or in your desk at work. Make it a place to deposit
    from wherever it is you have been — reorienting your tensions and stress, and when you close the
    yourself to . . . this time— this place — and become drawer, you leave your unnecessary stress there.
    aware of feeling . . . very refreshed — alert — Use your imagery and visualization to reinforce the
    comfortable — and with a very deep sense ... feeling of distance between you and the stress. [The
    of having ACCOM- patient may also imagine putting stresses in a
    drawer in self-hypnosis. (Ed.)]
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 173

    He Who Hesitates is Lost: A and there comes a time to take action . . . before the
    chance slips away . . .
    Metaphor for Decision Making
    COMMENTARY. Any strategy that turns the de-
    Michael D. Yapko, Ph.D. San
    Diego, California pressing paralysis of ambivalence in a positive
    direction will also facilitate the recognition of one's
    abilities to make decisions in one's own behalf. In
    INTRODUCTION AND INDICATIONS the above metaphor, the man loses an opportunity
    because of paralysis, not incompetence. The
    An indirect strategy for facilitating message is one that also addresses a global thought
    decision-making and escape from ambivalence pattern, i.e., overwhelming oneself with all of what
    involves the use of metaphors that illustrate the is involved. The client may thus learn that instead
    truism, "He Who Hesitates Is Lost." The metaphor of focusing on the frightening aspects of what there
    is used as a vehicle to encourage making an internal is to lose by moving on, he or she can look at what
    decision to act before external circumstances will be lost by staying put.
    interfere. The following is an example of such a
    metaphor.

    METAPHOR De-Fusing Panic


    A friend of mine recently went through an Marlene E. Hunter, M.D. Vancouver,
    experience that really was most instructive . . . on a British Columbia, Canada
    number of levels. ... He had wanted to get a new job
    . . . one that paid more and afforded him great
    prestige ... He applied for a job . . . one that INTRODUCTION
    involved moving to another city. . . . He wanted it
    very badly . . . but was uncertain about moving to Many hypnotherapists are reluctant to interact
    make things happen . . . and he asked for a week to with patients in trance. With techniques like this
    think the offer over . . . and they politely agreed he one, however, an interactive trance allows the
    could take a week to decide . . . and a week of going therapist to obtain information about each part of
    back and forth in his feelings went by . . . and when the symptom complex. Thus the feedback obtained
    they called him a week later .. . he asked if he could from interaction will permit greater
    have three more days in order to decide . . . and individualization to the patient. (Ed.)
    when they called him three days later, he asked if he
    could have another day to decide . . . and they po-
    litely agreed he could have another day to decide . .
    . and when they called him the next morning and SUGGESTIONS
    asked for his answer, he asked if he could tell them
    later that day . . . and they impolitely told him they I am going to describe for you a way in which
    gave the job to someone else apparently more you can have some tools immediately available to
    enthusiastic about the opportunity . . . and he was you for relieving an anxiety attack. ['Immediately
    quite upset because he wanted that job, but he made available' sounds good to any panic sufferer!]
    himself afraid . . . thinking of too many things to do You know how miserable it is to all of a sudden
    at once . . . instead of knowing he could move and feel that coming on, so to have some sort of
    work and live one day at a time . . . bandaid, as it were, that you could immediately use
    to relieve that feeling — that is
    174 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    very, very comforting. I'm going to describe such a When your breathing is comfortable again, wait a
    situation. little longer; and when your heart rate feels
    In order to learn how to do that, I suggest that comfortable again, then choose the next one—
    here, now, while you are very safe here in my maybe that fidgety feeling in your hands, or maybe
    office in hypnosis, you allow yourself to feel what releasing the knot in your tummy — that's the idea;
    one of those attacks feels like; but you can limit the in the back of the neck there now— that's right,
    feeling to just however much is okay for you to feel releasing each one by itself in turn until everything
    at this time. [Arranging the safe framework.] is back to normal again. See? You know exactly
    Hypnosis is wonderful, you know, because you where to put your hands. That's it. When everything
    can make those restrictions. You're safe here in my is easy again, take a deep breath and settle back
    office; just let yourself feel what one of those panic down comfortably in the chair. [This patient moved
    attacks feels like, knowing that you can limit those her hands to her neck for comfort. Always utilize
    feelings to just whatever is okay, whatever feels whatever the patient does, in a positive way.]
    manageable. That's right. Just think of what you have learned in these last
    But whatever feels okay, let yourself feel that few minutes. You've learned at least two very
    amount to the fullest, and take particular note of important things: one is that you know exactly what
    what happens first. Maybe the first thing you feel is to do with your hands, exactly where to put them,
    a little fluttering in your chest, or your tummy; and exactly where that place is in your neck; you
    perhaps you notice your breathing is changing or know exactly what to do, where to focus your
    your heartbeat is changing. Some people feel a attention. [Ego-strengthening.] The second thing
    little tension in the head, or your tummy is you have learned is that you can do ft! You have
    growling; maybe your hands become moist. [All reversed each part of the symptom complex. Isn't
    people with panic attacks have some, if not most, that wonderful! I knew you could, and you've just
    of these symptoms; this reassures the subject that proven it. [Positive reinforcement— the subject is
    you do know how he or she feels.] doing it right.]
    Just let yourself feel your own personal complex Now just to reinforce that, go through it again,
    of feelings for those situations, remembering that again restricting the feeling to only what is okay to
    you can limit it to just whatever feels okay for you feel this morning right here in my office in
    to feel here, knowing that you are safe. But hypnosis. You may feel comfortable about feeling
    whatever is okay, let yourself feel that much to the a little more this time, because you know you can
    fullest. do it, but whatever is okay with you, limit it to that,
    Then when you reach the fullest of that amount, that's right, and whatever is okay, let yourself feel
    whatever it is, hold that— just hold that to the fullest, yes, that's right, that's right, that's
    it ------ ahh, good for you. Now, bit by bit and it-hold it there. . . . [Once done, the subject will be
    one at a time, reverse EACH SYMPTOM. Start more comfortable (and trusting) about doing it
    with your breathing. Breathing is something that again.]
    we can deliberately change and regulate, so it is Then, when you are feeling it to the fullest once
    perhaps the best place to start. [Watch your subject again, one by one, reverse each part in turn, usually
    carefully—your timing is important.] Let your starting with the breathing because it is something
    breathing ease back, just concentrate on your that we can have such definite control over;
    breathing— that's the idea, you know how to do it, breathing comes first, then you yourself know how
    that's right. to proceed— the back of your neck, right in the pit
    As your breathing comes back into the of your stomach, that's right. One by one, it is
    comfortable zone again, you'll notice that your impor-
    heartbeat is already beginning to do that too,
    because breathing and heartbeat go together.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 175

    tant to do it one by one. [She again used her hands but it is so comforting to know that you have
    — on her neck, then her abdomen.] something that you can do immediately— just like
    That's it. Then, when everything is back to having that bandaid handy. [Positive
    normal again, you can settle comfortably back in reinforcement. Bandaid in place!] Something you
    the chair, taking a deep breath. That's right. Just can do right away, wherever you may be; one by
    take care of that last feeling in the pit of your one, reverse each part of that symptom complex,
    stomach. It's interesting, isn't it? — the way the usually starting with the breathing because it is
    feelings have a sort of a pattern. That's right, that's something that we can deliberately control.
    better — that shimmering feeling just letting you [Reassurance of further work.] And then, within a
    know that your muscles are relieving their tensions. very short time (as you can tell), the symptoms ease
    That's good. [The patient gave a little movement.] away and you are back in perfect control again —
    And then, when you are ready, breathe a very in fact, YOU ARE IN CONTROL THE WHOLE
    deep breath. What a relief! And just settle right TIME THAT YOU ARE REVERSING THAT
    back down. That's right. [Taking a deep breath and SYMPTOM COMPLEX! Isn't that wonderful!
    letting it out always relieves muscle tension.] Yes, you can regain control that quickly. That's
    marvelous. [Handing the control back to the
    Congratulations! You see, you've done it twice
    subject.]
    and you've done it extremely well. And now you
    know that you have something you can do Next time we'll talk about preventing it from
    immediately, if ever you get stuck. happening. In the meantime, you know now that
    Next time, of course, we are going to be talking there is always something that you can do, right
    about preventing it happening at all, away. That's good.

    HYPNOSIS WITH PHOBIAS

    Paradigm for Flying Phobia fied times at some regular repeated interval or
    throughout the trip.
    David Spiegel, M.D., and
    Herbert Spiegel, M.D.
    Stanford, California, and New York, New York

    A Reframing Approach for Flight


    Patients are taught to concentrate on three
    points: (1) to think of the plane as an extension of Phobia
    their body, very much like a bicycle or a car; (2) to
    float with the plane, so that they have a physical Peter A. Bakal, M.D.
    sensation of comfort associated with the experience Schenectady, New York
    of flying; (3) to concentrate on the difference
    between a probability and a possibility.
    Thus anxieties about the flight can be processed INTRODUCTION
    from the point of view of putting them into the
    proper perspective rather than experiencing every Dr. Bakal uses a three-session, individual
    adverse possibility as a probability. Patients are hypnotherapy approach that is unique in that he
    instructed to choose when to do this exercise but to addresses and reframes the negative suggestions
    use it in preparation for the flight, and during the about flying that are so prevalent in flight
    flight either at speci-
    terminology. In his original article (Bakal, 1981),
    he reported excellent results with a series
    176 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    of 21 patients followed up for three years, and one and the engine slows down. Also, veteran fliers will
    qualified "success" with a patient who had only remember that the stewardess usually announces,
    two sessions in two days before a flight to Hawaii. "We are on OUT final approach and we will be on
    (Ed.) the ground in a few moments. Please stay in your
    seats until we arrive at the gate." After the patient
    has consciously addressed the fact that he is
    REFRAMING SUGGESTIONS AND constantly exposed to all these suggestions,
    PROCEDURE hypnosis is induced. Although I use Ericksonian
    techniques, any technique would suffice. The
    In the first session, prior to hypnosis, I point out patient is then led through a "night." I like the
    all the wrong words used, unintentionally, by "My-friend-John" approach. On the first session, I
    airlines to condition people to fear flying. take "John" step-by-step through the flight, each
    Examples of such expressions include "terminal" time bringing to his subconscious attention these
    for the airport building, "departure lounge" and the suggestive expressions so that he can address them
    "last and final call" for the boarding call. I also and cannot deny that they exist. Then I take John on
    remind patients that when they board a flight, one the plane after hearing, "last and final call." Finally,
    of the first messages they encounter is how to cope the plane moves, takes off. The following features
    with a crash and how to use oxygen in case of an are pointed out to the patient:
    emergency. If all the wrong suggestions are
    combined, the patient gets the following picture: 1. A lack of sensation of height.
    they arrive at the "terminal," see the "insurance 2. The beauty of the city and countryside, night or
    desk," are asked if the place they are going is their day.
    "final destination," and they are told this is the "last
    3. The slant of the airplane.
    and final call" for flight 146, "terminating at
    4. The statements made by the stewardess about
    Kennedy Airport."
    crashing.
    I remind patients to anticipate the noise of the 5. The sound of the gear retracting and the loud
    gear going up and the flaps moving up and assure noise it makes when the holding bolts lock in.
    them that these are safe sounds to expect when the 6. The noise of the flaps and their purpose to aid
    plane takes off. . . . The patients are taught to be in lift, and the sound when the plane reaches
    critical of remarks from airline personnel —such as altitude and levels off and when the engines
    the pilot stating, "We are going to have some slow a bit, similar to the noise we expect with a
    turbulence," and learn not to connect that with the car when it reaches the plateau at the top of a
    image of air pockets, wings falling off, and planes hill.
    crashing. They also learn what turbulence is and are 7. The pilot talking to them to warn of turbulence
    encouraged to make the analogy to a bumpy road, a
    and thunderstorms.
    known condition which the patient could expect to
    8. The angle of the luggage racks in level flight
    handle in his own life experience. In another
    example, patients are warned that the pilot might (slightly upward).
    say something like, "We have a thunderstorm on 9. The banking and tipping of the plane, similar to
    our radar and we will try to fly around it," thus a car on a banked road.
    evoking fears of thunderstorms, severe weather
    conditions, icing and such other situations. John is now encouraged to settle down and enjoy
    the flight. When the plane starts its descent, the
    The patients are told that, when the plane starts patient is taught to notice:
    to descend, the change in the sound of the engines
    is similar to that of an automobile going downhill 1. The luggage racks have now leveled off, the
    as the driver eases up on the gas sound of the engines which have been slowed
    further. This is the same as an
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 177

    automobile when it is ready to go downhill; the car REHEARSAL SUGGESTIONS WITH


    slants down, you take your foot off the accelerator FEAR OF FLYING
    and decrease speed. 2. The stewardesses tell people
    to buckle their seat belts, put out cigarettes, and to First of all, I want you to make yourself quite
    put seats in the upright position, that they are on comfortable and relaxed; and when you are feeling
    "the final approach" and will be "on the ground" thoroughly peaceful, and completely comfortable
    shortly. in every way, you can signal me by raising the
    Each "wrong word" is pointed out. The index finger of your right [or left] hand. So just let
    landing is described. The flaps go down and the yourself relax completely now, and soon your
    gear goes down with the usual loud sound. The finger will rise.
    plane lands and the pilot races the engine in [After the subject has responded:] That's fine. Just
    reverse thrust to slow the plane down so that the continue to relax even deeper now; and with every
    brakes will become effective. Then the plane word that I utter, you will find yourself able to
    taxis up to the airport building known as the follow my suggestions more easily. Just let your
    "terminal." imagination drift along with my words, and let
    On the second visit, the patient again enters yourself flow with the experience I describe, and
    the state of hypnosis, is taken through the same soon you will be able to feel everything I suggest to
    situation. But this time, ideomotor responses you, just as if it were really happening.
    are used as each situation is encountered. On Now, as you continue to relax more and more, I
    the third trip, the patient verbalizes as he hears want you to picture yourself at home, getting ready
    or sees each item on the flight. to go to the airport. But the relaxation you are
    feeling now will remain with you, and if you
    should happen to feel any tension later on, you can
    just raise your index finger again, and I will take
    Hypnosis with Phobic Reactions you back to an earlier part of the trip and we can
    proceed more slowly. So just picture yourself here
    Don E. Gibbons, Ph.D. at home, feeling very relaxed as you begin to pack
    and to make all the other preparations for your trip.
    And as you do, just notice how relaxed you are,
    INTRODUCTION and how calm you have become.
    Systematic desensitization may easily be Now you are taking your luggage out to the car
    adapted for use within a trance induction format and putting it into the trunk. And now you are
    (Gibbons, Kilbourne, Saunders, & Castles, 1970; getting into the car, ready to go to the airport, and
    Gibbons, 1971), as a means of alleviating phobic still feeling perfectly calm. All the details of the
    responses which are not due to unconscious trip have been taken care of up to this point, and
    symbolic substitutions or emotional displacements, you can just relax and enjoy the drive.
    and which are not primarily instrumental in the You will be able to answer yes or no to my
    satisfaction of other needs. As an illustration of the questions by shaking your head in the appropriate
    manner in which this may be accomplished, the manner. You are still feeling very calm and relaxed
    following suggestions are designed to alleviate a now, aren't you?
    fear of flying which is simply the result of [Pause. If answer is yes:]
    inappropriate past experience, or lack of That's fine. Now if you should happen to feel
    appropriate experience, with flying itself. [Note: any anxiety at any time, you can just signal me by
    Clinicians may also obtain head nods or signals raising your index finger, and we can go back to an
    from the patient throughout such a rehearsal to earlier stage in your journey and let you relax a
    monitor their comfort level. (Ed.] little more deeply before going on.
    178 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    But 1 doubt that you will need to do this, because you enjoy your meal thoroughly before returning to
    you are still feeling so very deeply relaxed and your book.
    calm. So absorbed in your book have you become once
    Now you are pulling up to the airport and getting again that you are surprised to discover that the
    out of your car in order to give your luggage to an plane has landed and is taxiing up to the ramp.
    attendant who will see that it is checked onto your You leave the plane, feeling relaxed and happy.
    flight. You get back into your car and proceed to You have had a very enjoyable flight, and you have
    the parking area. You park your car and calmly remained perfectly calm during the entire trip. And
    stroll into the waiting room, feeling perfectly calm now that you have seen how pleasant flying can
    every step of the way. Now you are waiting in line actually be, you know that whenever you fly again
    at the ticket counter, picking up your ticket, looking in the future, you will have a similar relaxing and
    at it, and now you are walking to the gate where enjoyable experience in store for you.
    you are to board your flight.
    On the way to the gate, you pass a newsstand,
    where you notice a paperback book which looks
    extremely interesting. You stop a moment to Suggestions for Simple and
    purchase the book to take along with you on your Social Phobias
    flight. Now, still deeply relaxed, you are going
    through the security check on the way to the gate. Michael A. Haberman, M.D.
    You remain deeply relaxed as you think about the Atlanta, Georgia
    book you have just purchased, and about how
    interesting it appears to be. Phobic panic responses, as opposed to true panic
    Now you have completed the security check and disorder, occur following a psychological stressor.
    you are approaching the gate. You give your ticket Usually, the anxiety response builds in anticipation
    to the attendant, who stamps it and gives you your of the event, which might vary from entering an
    seat number. You take a seat in the waiting area and elevator, airplane, or high place to giving a speech.
    begin to thumb through the book, becoming more The sine qua non of panic disorder is the onset of
    and more interested in it with each passing second. the panic attack without clear precipitant and then
    It looks like it is going to be one of the most later the gradual onset of anticipatory anxiety and
    interesting books you have ever read. progressive limitation of activity. On the other
    As your flight is called, you rise from your chair hand, simple or social phobia has a clear and
    and prepare to board the plane along with the other reproducible precipitant (e.g., entering an elevator
    passengers, still feeling very deeply relaxed and or giving a talk) that leads to avoidance of a specific
    thinking about the fascinating book you have just behavior. Panic disorder is treated with medication
    started to read. but phobias can respond to hypnosis and
    psychotherapy.
    Now you enter the plane and make your way to
    your seat, still feeling perfectly calm and relaxed. The essence of an anxiety response is that it is
    You sit down and fasten your seat belt and open the based on fear. A phobia concretizes that fear. Once
    book once more, quickly becoming so absorbed in established, the reinforcer to the avoidance is the
    your reading that you scarcely notice the takeoff. reduction in anxiety when one moves away from
    You interrupt your reading long enough to enjoy the feared situation. Therefore, the person develops
    the meal which is brought to you, and you are a conditioned response. Normal ego defenses erect
    pleased to discover how good everything tastes. walls to protect the personality from undue fear.
    You are still deeply relaxed and Usually the origin of the phobia is unknown.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 179

    Hypnosis can approach these anxiety responses based more on the unique logic of hypnosis. A
    through a search of the unconscious using Watkins' general theme in phobias is a fear of being trapped
    affect bridge technique or by a more directly in a situation over which you have no control and
    behavioral technique, such as relaxation coupled which can be destructive to the self. This applies to
    with systematic desensitiza-tion. The latter airplanes or giving speeches. One needs to identify
    technique is extremely easy for a hypnotic operator. metaphors that the patient can use to concretize the
    It involves only an induction and the suggestion for concepts of freedom and control and power that
    developing skill at self-hypnosis and relaxation of they can use in hypnosis. Here is an example of
    muscle tension coupled with suggestions that such how to apply the principles outlined above.
    relaxation (experienced as heaviness or a floaty
    feeling in the limbs, for example) indicates a CASE 1. Joseph is a 35-year-old salesman who
    lessening of fear and an increase of comfort. must travel to both coasts in his job. After a few
    You then use a fractionation technique during weeks of uneventful flying, a flight he is on
    the first session. This technique involves helping experiences severe turbulence during which pas-
    the person alternately and repeatedly enter the sengers are instructed to stay in their seats and
    hypnotic and waking state ana is usually fasten their seat belts. Joseph becomes frightened
    experienced as going deeper each time, which you and notices his heart racing and his breathing
    also suggest to them. becomes more labored. After the flight lands and
    Prior to inducing hypnosis the patient develops a he gets off the plane, he feels better but the next
    hierarchy of situations gradually approaching the time he gets on a plane he is hypervigilant and
    actual phobic situation, such that the first situation consciously concerned over safety issues that he
    is the least anxiety-provoking (such as reading a took for granted before. Over the next few weeks
    travel magazine), to a bit more anxiety (thinking of he flies four times and begins having anticipatory
    taking an airplane), and then more anxiety before leaving for the airport. He has
    anxiety-provoking (making a reservation). anxiety attacks on the plane. Over the next few
    Gradually his visualizations then take him onto the weeks, insomnia develops and he is anxious during
    plane itself, and then into the air. These form the the day, consciously afraid he will have to fly. He
    basis of images. You can repeat the patient's own fears someone will find out and he will lose his job.
    words during hypnosis. He has no formal psychiatric history and he says, "I
    have always been able to handle things before. I
    As scenes are imagined, the therapist may obtain don't know what to do."
    ideomotor finger signals when the patient is
    experiencing anxiety. At that point, the patient You decide to use hypnosis. Joseph tells you he
    should be told to stop imagining the scene and to is fond of bicycling as a hobby. Joseph enters
    imagine a neutral stimulus. The anxiety response trance quickly and you might say: "I wonder if you
    diminishes as you have the person take can recall when you first learned to ride a bicycle.
    himself/herself deeper into trance before imagining You may be thinking of a bike with training wheels
    the anxiety-provoking scene again. As you or even a tricycle because that is how most people
    reintroduce the troubling scene, the anxiety re- begin to learn how to control themselves. At first a
    sponse recurs but hopefully lessens. grownup needed to walk next to you and steady the
    In this manner, you gradually "desensitize" the bike and you were very aware of your fear, but also
    individual to his fear in vitro. This must be of your excitement and your desire. A new world
    followed by in vivo techniques (e.g., actual trips to was opening up for you and you reached out for it.
    the airport using self-hypnosis at appropriate times Remember how you practiced and practiced until
    during the journey). somehow you forgot that you were afraid, forgot
    that there was ever a time you didn't
    If the patient is less phobic and only gets
    anxious, for example, during the landing of an
    airplane, you can use a very different technique
    180 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    know how to ride. You were in control. And all it bilitating anxiety at the thought of going to a doctor
    took was practice and you learned to ride a bike as or dentist, a store or restaurant, and so forth. When
    well as you could walk. the anticipated anxiety became too great, she was
    "And remember then when you first learned to able to calm herself sufficiently to carry out these
    drive a car, how scary it was to get behind the activities by listening to the tape. She routinely
    wheel and have to hit the gas and the brakes, and kept the tape in her purse so that it would be
    steer and watch the road. Remember there was a available to her as needed. If she was in a situation
    time you didn't want anybody to talk while you that required privacy, she used earphones. She had
    were driving, didn't want your concentration practiced trance induction and relaxation
    broken. Then suddenly you were driving and you procedures with the therapist in the past, and had
    couldn't remember how not to drive. You were in described a number of reassuring scenes. These are
    control. And you can learn to control your fear imbedded in the relaxation process on the tape.
    again just as you learned how to enter this relaxed
    state, just as you learned how to ride a bike and how
    to drive a car. You can permit yourself to be in
    control again. Just like you began to feel
    ILLUSTRATIVE TAPED SUGGESTIONS
    excitement instead of fear. And suddenly you
    weren't limited anymore in where you could go.
    You could travel far away from home knowing that [The therapist's voice is recorded on tape.] While
    you were in control, that you are in control now, of sitting in a chair, as comfortably as you can, you
    the depth of your relaxation, of the attention that can let your eyelids close, blinking a few times . . .
    you pay to the sound of my voice and the meaning and then very gently let them close. ... As they
    of my words to your unconscious mind. If you close, let your whole body gradually begin to have a
    choose you can achieve this state whenever you feeling of lightness ... a feeling of lightness with the
    need to. Whenever you would like you can enter a weight and heaviness going out of your shoulders
    deep state of relaxation, a state in which you are in and your chest, and then out of your abdomen . . .
    control and you can permit yourself to go deeper just letting go . . . letting your hands rest com-
    and deeper as you breathe slowly and deeply. [Be fortably . . . feeling the air going in and out, from
    sure the patient is doing this —otherwise, use what your abdomen, from your chest . . . Then feel the
    he is doing.] Whenever you need to you can enter lightness in your hips, thighs, and legs . . . Just let
    this state of relaxation, deeply, easily, comfortably go.
    and always in complete control. Always in [The therapist introduces the idea of relaxing in a
    complete control." bath, a soothing experience for this client:] Let your
    thoughts take you to your bath where you are so
    very comfortable . . . just the right temperature . . .
    and relaxing very comfortably . . . with the same
    Example of Treating Phobic lightness of your body just floating and yet resting
    there . . . Very gently, quietly, letting go . . . Going
    Anxiety with Individually deeper and more relaxed . . . [The therapist
    Prepared Tapes mentions a particular sensation that had been
    referred to by the client in the past:] Letting your
    M. Erik Wright, M.D., Ph.D. stomach growl when it wants to . . . It has a right to
    make its own statement . . . Just feeling yourself
    INTRODUCTION getting lighter and freer . . . Very light and free. . . .
    The following tape recording was prepared for a
    middle-aged woman who experienced de-
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 181

    [The therapist introduces the idea of Wendy, the Treatment of Lack of Confidence
    client's dog, a source of great pleasure and
    comfort:] And then, after a while, when you are out and Stage Fright
    of the bath . . . feeling warm and relaxed . . .
    perhaps feeling Wendy near you, resting on your
    lap, or wherever she fits nicely .. . Just a sense of David Waxman, L.R.C.P., M.R.C.S.
    quiet peacefulness and letting go . . . Feeling secure London, England
    ... A sort of gentle peacefulness . . . Going deeper
    and deeper with each breath.
    As you practice, two or three times a day, The restoration of self-confidence is one of the
    wherever you are, just feeling this free, and quiet, easiest and most rapid results that can be achieved
    and secure feeling each time . . . then when you're by hypnotherapy. The full ego-strengthening
    very relaxed and quiet, you can go somewhere you routine, suitably reinforced by specific suggestions
    want to ... or take a trip . . . You can do some of the appropriate to each individual case, has proved
    things that you need to do ... or want to do . . . and invaluable in the treatment of this condition.
    enjoy the sneer pleasure of moving your body. . . . [Begin with this, then proceed in the following
    Whenever you choose, you can spend ten min- manner:] "As you become . . . more relaxed and
    utes or twenty minutes or even longer, just letting less tense, each day . . .so . . . you will remain more
    go . . . feeling your shoulders easing up . . . listening relaxed . . . and less tense . . . when you are in the
    to your quiet breathing . . . sensing the lightness and presence of other people ... no matter whether they
    freedom of your body . . . There is no rush . . . There be few or many ... no matter whether they be friends
    is no pressure . . . Just letting go . . . gently and or strangers.
    quietly ... So good to let go and not have any "You will be able to meet them on equal terms . .
    pressures or any tensions . . . Feeling good and . and you will feel much more at ease in their
    whole. . . . presence . . . without the slightest feeling of
    And as you relax, the inner mind is focusing your inferiority . . . without becoming self-conscious . . .
    energy toward healing and mobilizing your health without becoming embarrassed or confused . . .
    forces . . . not only for the health of your eyes and without feeling that you are making yourself
    teeth, but for whatever else is needed ... to heal, to conspicuous in any way.
    recover your energy, to restore your sense of "You will become . . . so deeply interested . . . so
    well-being and joy of living . . . Very quietly, very deeply absorbed in what you are saying . . . that
    relaxed as you listen to my voice . . . going a step you will concentrate entirely upon this to the
    further each time that you practice going into this complete exclusion of everything else.
    quiet space of your own . . . You can choose what-
    "Because of this . . . you will remain perfectly
    ever images you want to . . . Wendy when you want
    relaxed . . . perfectly calm and self-confident . . .
    her with you ... or she may romp off when you want
    and you will become much less conscious of
    to be free . . . Very deeply relaxed, as long as you
    yourself and your own feelings.
    need to be. . . .
    " You will consequently be able to talk quite
    When you are ready to come back to the here and freely and naturally . . . without being worried in
    now, give yourself a signal . . . then very gently feel the slightest by the presence of your audience.
    yourself coming back to the here and now . . . the "If you should begin to think about
    calmness and good feeling persisting even when your-
    you are totally awake and going about your
    business.
    182 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    self . . . you will immediately shift your attention Overcoming Anxiety over
    back to your conversation . . . and will no longer
    experience the slightest nervousness . . . discomfort Public Speaking
    . . . or uneasiness."
    Don E. Gibbons, Ph.D.
    [When the patient is likely to be called upon to
    appear upon the stage, to make a speech or to
    deliver a lecture, the above may well be modified in INDICATIONS
    the following manner:] "The moment you get up to
    speak . . . all your nervousness will disappear These suggestions were prepared for use when
    completely . . . and you will feel . . . completely the patient has already begun to overcome anxiety
    relaxed . . . completely at your ease . . . and and self-consciousness concerning public
    completely confident. You will become so deeply speaking. Once the patient begins to have
    interested in what you have to say . . . that the successful speaking experiences, these suggestions
    presence of an audience will no longer bother you may foster a more permanent diminution of
    in the slightest . . . and you will no longer feel anxiety. A very positive element of these
    uncertain . . . confused . . . or conspicuous in any suggestions is the acceptance, utilization and
    way. reframing of a modicum of anxiety, which research
    "Your mind will become so fully occupied with has demonstrated may enhance performance.
    what you have to say . . . that you will no longer (Ed.)
    worry at all as to how to say it.
    "You will no longer feel nervous . . .
    self-conscious . . . or embarrassed . . . and you will SUGGESTIONS
    remain throughout . . . perfectly calm . . . perfectly
    First of all, I would like you to allow yourself to
    confident . . . and self-assured."
    express your fear of public speaking freely and
    Whenever a speech or talk has to be given, or a openly for a moment, allowing it to escape like
    stage appearance made, the patient must be steam escaping from a safety valve, to relieve the
    impressed with the importance of making thorough pressure. So just picture yourself up there giving
    preparation. The feeling that he has mastered his your talk, and let yourself feel all the anxiety for a
    subject or become word perfect in his lines will moment, just as strongly as you can. Let your
    help him enormously. It is always essential to imagination go, and let yourself feel all the anxiety
    rehearse it thoroughly before the actual you have been holding back. Feel it surging to the
    performance. He should be instructed to speak surface. Let yourself feel it all and experience it all.
    slowly, clearly and deliberately, and to concentrate Now!
    entirely upon what he is saying.
    And as I continue to speak, your fear is
    At every session, following the ego-strength- beginning to leave; for you have allowed most of it
    ening phase, the subject is desensitized, as in other to escape by permitting yourself to express it
    phobic problems, to the next situation along the openly. Your fear has been considerably weakened,
    hierarchy in which he is liable to feel the focus of and what little is left of it is going away completely.
    attention. It's almost gone. Now your fear is completely gone,
    The teaching of self-hypnosis, whenever pos- and you can feel a great sense of relief.
    sible, can prove invaluable in these cases. Not only
    And whenever you are about to give any kind of
    can the patient be taught to visualize himself
    public speech, you will be able to feel and
    addressing an audience without difficulty, but he
    experience all the anxiety that the speech may
    can also suggest to himself, during hypnosis, that
    cause you; but this anxiety will always be felt
    he will gradually be able to do this without
    before you are about to begin, so that by the time
    nervousness, self-consciousness or apprehension in
    you actually start to speak, most of the anxiety will
    real life.
    already have been released. And any remaining
    tension will be well within the
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 183

    range that is helpful— just enough to add liveliness you will soon become so engrossed in what you
    and sparkle to your delivery, but not enough to have to say that you will forget about yourself
    detract from it or prevent you from doing your very completely.
    best. When your speech is concluded, you will be full
    Because you are able to express all your of the warm feeling of accomplishment which
    unnecessary anxiety ahead of time, you will be able comes from the certain knowledge that you have
    to concentrate completely on what you have to say done well. And as time goes on, this realization of
    as soon as your speech begins, without worrying how well you are actually doing will cause your
    about how you may look or sound to others. And as anxiety to become less and less, until it disappears
    your talk progresses, completely.

    SUGGESTIONS IN DENTAL HYPNOSIS

    Suggestions with threaten to occur in the future and replays them


    many times during the night.] During the night the
    TMJ and Bruxism abnormal touch of your teeth will waken you,
    Harold P. Golan, D.M.D. you'll smile, realize that your subconscious is
    Boston, Massachusetts
    protecting you, turn over and go right back to
    sleep, losing no sleep at all.
    You will do this whole exercise with a sense of [Glove anesthesia and temperature change may
    humor, sort of laugh at yourself and the rest of the then be produced for trance ratification. Following
    world, knowing that you have this secret weapon to production of glove anesthesia and insertion of a
    use whenever necessary. You may even smile at 25-gauge needle through the skin on the back of the
    your teeth, jaws, tissues, realizing that they are hand, the following suggestions may be given:]
    going to be helped by what you are learning. You You are really wonderful at this. You have just
    may use this knowledge for any medical or dental demonstrated to me and to yourself that you have
    situation, injections, examinations, whatever. control over one part of your body. The only reason
    I chose the right hand is that it is visible and
    [An explanation may be given to the patient that
    accessible. If you can control one part of your
    stressful situations occur every day which cause us
    body, you can control any part of your body
    to grit our teeth.] Whenever one of these
    including your mouth. This is a big concept,
    anxiety-producing events happen or is going to
    control of your body rather than your body
    happen, such as an extremely hard examination, a
    controlling you. You should be proud of yourself
    difference of opinion with a friend or parent, a
    that you are so good at this modality. I'd like you to
    difficult decision, you unconsciously grit your
    keep this feeling in your hand for five full minutes
    teeth. Now you have a way of handling the
    following this state of relaxation as a further sign
    situation by keeping just enough nervous energy to
    that something physical can happen from this
    do the task superbly well and spilling off the excess
    marvelous mental process of yours.
    tension. When you go to sleep at night you will
    practice, saying something like this to yourself,
    "Nothing is important enough in life for me to eat
    myself up."
    [Further instruction may explain that most Suggestions with TMJ
    gritting or bruxism happens during the night. The Ellis J. Neiburger, D.D.S.
    cause is that the subconscious mind remembers the
    stressful or anxiety-producing situations which The jaw clenching-muscle cramping-pain cycle
    have occurred during the day or of the temporomandibular joint syndrome
    184 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    can be reduced or eliminated by relaxation obtained small child you can reinforce these suggestions by
    by slightly opening the mouth. Inserting the tongue tying a sponge rubber in the hand and endowing
    between the teeth tends in general to act as an that sponge rubber with nice properties: "It will
    accurate measure of interocclusal distance, and help your fingers to open and enable you to get a
    serves as a reminder of unconscious mandibular very strong arm."
    closure. Suggesting to the patient that whenever he [An alternative suggestion is for the bruxism
    clenches his jaw he will automatically insert his patient to awaken whenever he grinds his teeth.] ...
    tongue between his teeth, averts the initialing state he can go to sleep with gum tucked in between his
    in the muscular tension-pain cycle. cheek and his teeth. You explain that he must learn
    "Whenever you grind your teeth or tighten your to sleep that way so that every time he grinds his
    cheek muscles, you will want to keep your mouth teeth he will slip that gum in between his teeth,
    slightly open, wide enough to place your tongue chew it for a while, then carefully tuck it back
    between your back teeth. This will help your against his cheek and go back to sleep. [Transforms
    muscles to become loose, loose. . . . This will stop bruxism into a gum-chewing habit, and who wants
    your muscles from cramping. The longer your to do this ordeal in the middle of the night.]
    tongue stays between your teeth, the more your
    muscles will become loose, limp, like wet cotton."

    TMJ and Tension Headaches Dov

    Erickson's Suggestions with Glazer, D.D.S.


    New Orleans, Louisiana
    Bruxism
    Milton H. Erickson, M.D. INTRODUCTION
    For the next five minutes, experience a uniquely
    Don't give the suggestion "when your head hits
    effective technique to enjoy a hypnotic trance.
    the pillow," because many people sleep without
    pillows. Instead, trigger it by "when you put your Simply listen to the suggestion, follow the
    head down." Talk about "how nice it is to fall instruction and be pleasantly surprised by the
    asleep instantly when you put your head down experience.
    —the instant you are ready to go to sleep it is so
    delightful to go sound asleep into a deep INDUCTION
    physiological sleep. And whenever you go into a
    sound physiological sleep, there is the possibility TENSION. Focus attention on your hands. Put the
    that this night or the next night, that this week or the
    heels of the hands together and let the fingers touch
    next week, you will grind your teeth. But from now
    each other. Raise the hands to the height of the jaw,
    on, whenever that does occur . . ." [Then make the
    elbows away from the body. Press the hands
    bruxism inconvenient and unpleasant].
    together. Press tight enough to feel the tension in
    [The suggestion can also be to awaken whenever the fingers, hands, arms, shoulders, neck, feel the
    the teeth grinding occurs. Point out:] "It is a very tension around the jaw, face, head. Squint the eyes,
    nice thing to have a good grip of the hand, and wrinkle the forehead. Press tighter. Feel that
    people are so lazy about exercising — they always tension!
    skip their calisthenics. Every time you grind your
    teeth, you exercise your grip until you get a really RELAXATION Now relax: hands down, eyes closed.
    good grip." [This is particularly effective for Take a deep breath through the nose and hold it,
    children]. With a now gently release the air. Nice and comfortable,
    pleasantly relaxed. Lips together, jaw loose, limp
    and relaxed.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 185

    With eyes closed, arms and legs in a comfortable 67% of patients, as compared with 15% of a
    position, let the body sink gently into the chair. As control group, were found to have improved
    the tension drains from the top of the head to the gingival health. The groups were given the
    tips of the fingers, become aware of relaxed following types of suggestions.
    muscles around the head, temples, forehead, (1) "Suggestions involving oral health which
    eyebrows, eyes, nose, cheeks, lips, chin, jaw, ears, explained the need for routine dental flossing to
    neck, shoulders, arms, hands, fingers. prevent periodontal disease and interproximal
    caries; (2) suggestions involving personal ap-
    pearance which cited healthy looking gums, clean
    SUGGESTIONS
    teeth, and the benefit of avoiding interproximal
    Sense the relaxation throughout. Feel warm, safe decay; and (3) suggestions dealing with social
    and secure. Float with the feeling, and once again, desirability which mentioned better smelling
    take a deep, deep breath through the nose and hold breath and a cleaner, more well-kept appearance."
    it, now gently release the tension. Nice and
    comfortable, pleasantly relaxed. More deeply
    relaxed.
    Feel good and confident that relaxation is always
    Gagging
    just a breath away. Want it to happen, expect it to Harold P. Golan, D.M.D.
    happen, it will happen. Enjoy the calmness, the Boston, Massachusetts
    tranquility and the serenity.
    INTRODUCTION
    ALERT
    Gagging is an abnormal response of mouth and
    Now as though waking up from a pleasant throat muscles to a normal stimulus either physical
    relaxed rest, feel naturally bright, alert and or psychological. It has been a problem in
    refreshed. Sound in mind, sound in body, sound in professional practice for persons who cannot
    health. Eyes open, bright, alert and refreshed. swallow food or pills, brush their teeth, wear dental
    Ready to proceed. appliances, or react excessively to chemotherapy.
    [Now that the muscles have been mentally Authorities have mentioned various methods of
    relaxed, to further enhance relaxation, it is controlling this habit. They include authoritative
    waking suggestion, symptom removal by
    suggested that the patient follow the same path of
    hypnotherapeutic suggestion, and brief
    relaxation by massaging the muscles from the top
    hypnoanalysis (Erickson, Hershman, & Secter,
    of the head to the tip of the fingers. The results are 1961), as well as anesthesia (Hartland, 1966),
    quite rewarding.] ideomotor questioning and anesthesia (Cheek &
    LeCron, 1968), and direct suggestion (Hilgard &
    Hilgard, 1975). The following technique uses
    relaxation, temperature change and anesthesia for
    Suggestions to Promote adults, and relaxation, temperature change and arm
    Dental Flossing catalepsy relaxation for children.

    Maureen A. Kelly, D.D.S., Harlo R.


    McKinty, and Richard Carr THE TECHNIQUE
    Lincoln, Nebraska
    After an adequate physical and emotional
    These authors found that eight months following history (Golan, 1987), hypnosis is explained as
    suggestions to promote dental flossing, being a normal, natural physiological function,
    186 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    an altered state of awareness during which the patient piece of food like a fish bone. It can be psychological,
    will hear everything, be in control, and not be asked to do such as an emotional situation which is frustrating,
    anything contrary to his or her wishes. Once patient irritating, nauseating, connected with work, family,
    permission is granted, induction consists of asking the health, having teeth removed. You will be taught to
    patient to close his eyes, take a deep breath, hold it, and control it whatever the cause may be.
    as he exhales slowly, let out all of the anxieties about this
    moment and problem. At the very beginning, you may At this time it is suggested to the patient that in order to
    briefly touch or raise the wrist to signal to the patient that test their creative imagination, they are being given a
    some sort of change is happening. The following pseudo-injection in the back of the right hand with the
    suggestions may then be offered: blunt end of a pen:

    You will know that feeling of numbness, pins and


    Your body is your most prized possession. Only you needles, cold which happens with an injection of
    can take care of it. You owe your body the respect of novocaine. Allow this to spread across the back of your
    good health. Self-preservation is the first rule of life. hand as though you have a glove of anesthesia, and stop
    With your new dentures, you'll look well. All those it at the wrist.
    people surrounding you will see you smile. You'll eat
    well, being able to swallow everything, helping your
    digestion. Remember that adequate food is necessary for The doctor, by observing, can see the veins begin to raise
    life itself. and stand out, and can also feel the temperature change.
    Notice how good you feel right now, how your When he senses the area is anesthetized, he can insert a
    breathing rate has slowed. [The pulse is taken as this is 25 or 27 gauge needle through the skin and leave it in
    being said.] Every muscle from the tip of your toes to the place.
    top of your head is relaxing, comfortably and easily.
    [Name the muscle systems.] You'll practice this in the Remaining in this state of relaxation, in a few
    privacy of your room or home, in the beginning, at least moments you may open your eyes, look down at the back
    six times a day until it becomes second nature to you. It of your right hand, smile at what you see there, close
    can be a moment, a minute, several minutes, or you can your eyes and go even deeper into this lovely state of
    even put yourself to sleep this way. You'll be able to do relaxation, remembering what you saw.
    this after a while with your eyes closed or open, because
    you'll have to eat or do what we have suggested here for
    treatment with your eyes open. You'll be in control even For those who cannot legally insert a needle, you may
    when you practice, because if there is any legitimate suggest to the patient that he notice how cold his hand is,
    interruption such as the phone or someone calling you, having him signal the change to you with an ideomotor
    you can open your eyes, capable of carrying out any of signal, and then having him open his eyes in the same
    your daily activities perfectly well and cheerfully, just as way described above, and notice how pale his hand is
    you will at the end of this visit. compared to the operator's hand and how his veins have
    You'll be able to carry this out for any medical or raised because of the vaso-constriction from the cold. It
    dental reason whenever you need it. For the first time is important for the patient to realize that he or she can
    you'll be in control of your body, rather than your body cause a physical change by a mental process (Golan,
    controlling you. You'll smile, realizing an immense 1986).
    feeling of confidence and pride in yourself. You'll smile
    After removing the needle, suggest that the patient
    not only at the outside world, but at the tissues of your
    keep the anesthesia during the trance and for five minutes
    mouth and throat, using the new control you will learn.
    This relaxation is the most complete a body can following hypnosis as a further sign that something
    experience. physical can happen from the marvelous power of his or
    her mind. At this time, suggest that the patient transfer
    Let's now mention the reasons gagging occurs. It can
    be a physical cause, such as being conditioned to gag by the anesthesia to his mouth, every
    a physician's throat stick or choking on a
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 187

    portion of his mouth —hard palate, soft palate, vessel, and muscle will be vibrant and alive. The
    throat, floor of the mouth, gingiva, and cheeks. whole day will take on a rosy glow.
    Then, with a gloved finger, touch each portion.
    Have the patient emulate your touch. It will give Repeat the suggestion of retention of the anesthesia
    him great confidence to be able to touch an area of for five full minutes after trance, assuring the
    the mouth, an action which previously caused him patient the he can use the hand for any purpose
    to gag. during this time. Using a rising voice, make certain
    In working with children, an arm catalepsy that the patient is completely aroused from trance
    [rigidity] is suggested for trance ratification during some of the repetition of dehypnotization.
    purposes. They may make an arm rigid, strong, We then proceed at the patient's own pace after
    tight, and then relax it. Explain to them that this is hypnosis, whether it be for x-rays, prophylaxis,
    what they do when they gag, tightening their throat operative procedures, surgery, or denture
    muscles and forgetting to relax them. Now that construction. As treatment proceeds, the need for
    they know how to tighten and relax one part of their formal induction and hypnosis decrease. Simple
    body, they can learn to do it to any part of their reinforcement may be necessary at crucial stages.
    body, including their mouth. They, too, may open
    their eyes when you test their arm.
    Control is mentioned again: if she can control her
    hand, she can control any part of the body, Imagery with Hypersensitive Gag
    including the mouth. Whatever the original reason, Reflex
    physical or psychological, it can be controlled. If
    the reason was physical, the anesthesia or J. Henry Clarke, D.M.D., and Stephen J.
    temperature change can do it; if psychological, the Persichetti
    relaxation and anesthesia take care of the problem. Portland, Oregon
    You may repeat some of the steps mentioned
    above which you consider important, since INTRODUCTION
    repetition of suggestions will enhance the total
    result. Motivation is increased by repeating Some dental patients have difficulty tolerating
    suggestions about the wonderful, new appearance dental treatment because of a hypersensitive gag
    and function of dentures for this kind of patient, and reflex. Direct suggestion has been used by some
    the ability to eat properly for patients with dentists. Desensitization may prove beneficial
    problems swallowing. Suggestions may also be when anxiety and fear are the underlying etiology
    given for proper brushing and oral hygiene for of the problem. Clarke and Persichetti, however,
    patients who were not able to tolerate objects in the devised an imagery procedure for the treatment of
    back of their mouths. Suggestions are tailored for a highly sensitive gag reflex in the absence of
    each patient, taking into account the emotional significant fear. (Ed.)
    history which was taken at the beginning. Finally,
    the trance may be ended by suggesting that the
    patient will have no feelings of tiredness or SUGGESTIONS
    heaviness when he arouses himself:
    The patient may be asked to imagine "breathing
    through an opening in the neck (cricothyroid
    You will be rested and refreshed, as though you region). Our rationale is that it is difficult for these
    had a very pleasant nap. You'll feel happy that you patients not to focus on the pharyngeal area. The
    have found this medium, proud that you have the image of an opening below that region allows them
    intelligence to do this, cheerful. Every nerve, blood to focus on breathing, bypassing the 'gagging' area.
    It im-
    188 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    plies that the pharyngeal area is not so critical and gagging, discomfort and pain will have faded
    need not be a problem. The image is related to the away.
    patient's primary concern with breathing, and One, your gagging and discomfort is starting to
    therefore is easy for them to maintain. We also fade away. Two, it is fading more and more. Three,
    suggested cool, fresh air flowing in and out with no less gagging and discomfort. Four, gagging and
    effort. . . . discomfort fading more and more. Five, it is half
    "We have encountered some patients who gone. Six, gagging, discomfort and pain still
    disliked the image of breathing through 'a hole in fading. Seven, all of your dental difficulties are
    the neck,' and we have then explored images such almost gone. Eight, your gagging problems are
    as a 'numb throat,' or breathing in some other nearly gone. Nine. Ten, everything connected with
    creative way. The home use of audiotape, practice your denture problems are normal. You no longer
    denture, and impression trays (or other practice need to gag. I am going to count from one to three
    techniques) is a form of desensitiza-tion—relaxing and at the count of three you will be wide awake,
    while simulating procedures that are usually feeling refreshed and rested. Remember, your
    anxiety-provoking. This also familiarizes the gagging problems will be gone as well as your
    patient with the procedures for the next other denture problems. One, coming awake. Two,
    appointment. The patient goes through several eyes starting to open. Three, wide awake.
    rehearsals of the actual procedures. Acrylic [The patient was instructed to return to my office
    practice dentures should be as thin and stable as in one week and told that she would be
    possible; otherwise they may trigger the gag reflex. rehypnotized in the same manner and the same
    Combining the desensitization with the dental suggestions reinforced. The patient returned one
    treatment reduces the number of appointments week later and reported that she no longer had a
    needed." problem with gagging. However, I rehypnotized
    her and reinforced the suggestions that had been
    given previously. Seven years later, this patient has
    never been troubled with gagging due to her
    Denture Problems and Gagging denture.]

    Donald R. Beebe, D.D.S.


    Mentor, Ohio Suggestion with Gagging
    Irving I. Secter, D.D.S., M.A.
    INTRODUCTION Southfield, Michigan

    These suggestions were given to a patient who The following is now frequently used. After the
    complained of problems with gagging the day after patient has learned to develop hypnoanesthesia on
    eight teeth were extracted and a denture made. cue, he is told: "In the past the x-rays [or
    (Ed.) toothbrush, or whatever stimulus it may have been]
    Mrs. L., your new denture is gagging you has caused you to gag. From now on instead of
    because it feels bulky and strange, and your recent causing you to gag it will cause an anesthesia to
    extractions are causing you some discomfort and develop, which will prevent the gagging."
    pain. You will no longer be troubled with these
    strange and bulky feelings, nor the discomfort and
    pain. For as I am talking to you these feelings and Gagging Suggestion
    gagging difficulties will slowly fade away, you will
    find that when 1 wake you from this trance, that the William T. Heron, Ph.D.
    denture will feel comfortable and that you will not
    Mr________ , you are having trouble toler
    gag anymore. Now I am going to count slowly
    ating x-ray film in your mouth. You know, of
    from one to ten and when I reach ten all of your
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 189

    course, that it is necessary to take the x-rays in you to visualize a large calendar that has the years
    order that the dentist may know how to proceed. on it, in addition to the months and days. And I
    That is the case, isn't it? [Pause for head response.] want your mind to replicate a bear-cat scanner, and
    When you are hungry, you enjoy food in your continue to scan the inner recesses until it lights up
    mouth, correct? [Pause for response. Of course on the period of time and the incident that
    everyone gives a positive response.] precipitated the problem. [Pause for identification
    All right. Now, when you have food in your of event.] I would now like to have you
    mouth it touches your tongue, the inside of your superimpose over this experience the type of
    cheeks, the roof of your mouth, but all of these experience that it can be, with modern techniques
    touches are pleasant, aren't they? [Pause for and skills, coupled with the kind of clinician you
    positive response.] All right. Now, as the x-ray film would enjoy, the way it can be — comfortable,
    touches your tongue and inside of your mouth, secure and rapid. Whenever faced with any
    think of those touches as if it were food. Is that all external or invasive technique, this new
    right with you? [The dentist may now proceed with superimposed image will prevail, and a new
    work, usually without too much difficulty.] security will embrace you.

    PARESTHESIA FROM INDUCED


    Control of Salivation ANESTHESIA OR NERVE DAMAGE BY
    MANIPULATION
    Irving I. Secter, D.D.S., M.A.
    Southfield, Michigan I would like you to go back to that early time to
    recall the period when your lip had full sensation
    The flow of saliva increases when there is food in and functioned as intended. Now overlay this
    the mouth to be eaten. This is the beginning of the normal sensation over the unnatural feeling and
    digestive process. There is now no food present to feel how the change has returned you to comfort.
    be digested. Therefore your excessive salivation is [An ideomotor signal may be requested for when
    not useful and is undesirable. Visualize in your this internal response has occurred.] When either
    mind's eye a water faucet turned on full. Then see the chemo agent begins to dissipate or the nerve
    yourself turning the handle of the faucet until there begins to regenerate, the hypnotic superimposition
    is no more water coming through at all. Swallow will begin to recede and the natural feeling will be
    the saliva which is in your mouth, and notice how reestablished. Thus during all the periods, there
    dry your mouth becomes. Then turn the faucet on will never be anything but a natural feeling.
    only enough for your mouth to become just moist
    enough.
    SUGGESTIONS FOR GAG REFLEX

    1. While casually going about preparatory


    Dental Phobias and Fears activity prior to a procedure, the clinician cat-
    Louis L. Dubin, D.D.S., Ph.D. egorically and definitively states that it is im-
    Philadelphia, Pennsylvania possible to gag while holding one's breath because
    of the physiologic and anatomic relationship of the
    human race. "Let me show you by introducing
    EXPLORATION TECHNIQUE FOR DENTAL
    what has always troubled you: an x-ray film; a
    FEAR FROM A TRAUMATIC EXPERIENCE tongue depressor; or even an impression tray.
    [Following an appropriate evaluation of the [Each is used with the patient while he holds his
    patient and hypnotic induction:] I would like breath, while the following suggestion is given.]
    And note how comfortable you feel, the loss of the
    troubled
    190 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    sensation and the marvelous tolerance to the ning's sleep, the subconscious will discipline the
    previous irritant. conscious to keep the teeth slightly ajar. Just as the
    2. [This procedure utilizes technical jargon and subconscious can alter the mental and physical
    creates expectation of positive results from a response upon seeing or hearing a traumatic
    "medical procedure." It is a naturalistic hypnotic experience, so will it be effective here. All of this
    procedure, assuming that the patient in the dental can be supplemented with a night guard con-
    chair is already highly fixated and focused in structed by your clinician.
    attention. (Ed.)] [First note the severity of the gag
    by testing with no comment.] I am starting a
    process of tape that causes the shields on the
    receptor cells in the brain to drop, thereby not ANESTHESIA AND ALTERATION OF
    permitting awareness of the gag. I shall begin the PAIN AWARENESS
    tap through the occipital, parietal, temporal and
    frontal area on the left side of your head only,
    The following steps are used by the author in
    where the light pressure activates the dropping of
    producing anesthesia/analgesia: (1) dissociation,
    the shield. [Following the application of pressure.]
    (2) increased tolerance, (3) roleplaying, (4) recall.
    Now note the complete absence of any sensation of
    gagging. This may last permanently or have to be
    INTRODUCTORY SUGGESTIONS. Take whatever
    reinforced from time to time. So effective is it, that
    I can touch any portion of your throat and it is no number of deep breaths that you believe you
    more responsive than touching the skin on your require to return to that comfortable state that you
    hand. enjoyed before. You will feel yourself descending
    or ascending several plateaus more than the
    previous time, and fully enjoying what you selected
    to experience; where and with whom, is your
    choice — either the experience you've had or would
    BRUXISM AND CLENCHING like to have, or in a location you've been to, or
    DURING SLEEP would like to be, either alone or with someone of
    your choice. It isn't necessary for you to be
    [Following appropriate evaluation and hypnotic concerned about hearing my voice or listening for
    induction:] Be aware of that comfortable feeling suggestions; enjoy your experience at the
    that you experience when there is an appropriate subconscious level.
    amount of space between your teeth — no contact.
    The intense pressure sets up a reaction in the DISSOCIATION. If you are frank and are truly
    temporomandibular joint which involves the nerves enjoying an experience you've selected with all
    serving each entire side of the face and the head. your senses involved, then all that transpires here
    The resultant symptoms mimic many other will be of no consequence to you. If you are not
    physical and anatomical abnormalities, resulting here, all that happens here will not impact you. You
    many times in excruciating pain and loss of will also have no recall back in the alert stage of
    function. Also, the premature wear of the facets of what happened here, and only recall, if you wish, of
    each tooth alters the occlusion, and if observed
    the marvelous experience you selected.
    professionally, appears to have been caused by an
    aging process.
    INCREASED TOLERANCE. Note the degree of dis-
    However, a mental protective mechanism will comfort, on a scale of 0-10, that you are
    now be activated and constantly functioning. experiencing. Also note that if you would like to
    Whenever your teeth make contact while asleep, it reduce it, you can participate in the resolu
    will feel as if high powered stimuli suddenly
    appeared and you will be aroused from your sleep.
    Obviously, if you wish to enjoy an eve-
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 191

    tion of the problem. You can, to whatever degree Illustrative Suggestions with
    you wish or are capable, reduce it by "X" amount
    on the scale, therefore, noting the difference in
    Tooth Extraction
    comfort. Again, with your participation, you may Selig Finkelstein, D.D.S.
    do this on several occasions until you can go no Pleasantville, New York
    further, noting, however, the obvious difference.
    Now, taking whatever number of breaths you
    require to arrive back at that comfortable secure RAPID RELAXATION INDUCTION
    state, picture yourself on a merry-go-round,
    Mrs. M, before we start, I'm going to teach you
    passing that gold ring on each swing. Reach out, how to relax. As you know, everything is easier
    grasp and pull the ring, and depending on how when you are relaxed. While relaxation is a mental
    effectively you pull it in, the tolerance that you've process, it does help to have something physical to
    already achieved that is registered on the scale of work with, so shrug your shoulders a little. That's
    0-10 will alter considerably. You may be able to very good and that is all the actual physical
    eliminate it completely or retain a tolerable level. movement you need to make. Mentally, move this
    feeling of relaxation from your shoulders into your
    RECALL Do you recall the last time you experienced upper arms, through your elbows into your
    the comfort of the local anesthetic, the feeling of forearms, wrists and hands, so that you have a
    numbness of your lip to the midline, the loss of comfortable relaxed feeling from your right hand
    control and the inability to expectorate without up your right arm, across your shoulders, down
    dribbling down your chin? Do you also recall that your left arm to your left hand. It's all right to close
    whatever the doctor did, you had only awareness your eyes now. Move the feeling of comfortable
    and no discomfort but only sensations of touch. All relaxation from your shoulders into your chest and
    of this can also be experienced just as vividly. stomach and hips . . . into your upper legs and
    Visualize taking off your glove on a sub-freezing through your knees into your lower legs, ankles
    day in the winter, and immersing your hand in the and feet. Now move the feeling of comfortable
    newly fallen snow. Feel the cold permeating from relaxation from your shoulders into your neck and
    the tip of your fingers until it reaches your wrist, let it spread up into your head, until it fills your
    becoming colder and more intense, in fact, so entire head with a comfortable relaxed feeling.
    intense that it is becoming intolerable, wanting to Take a deep breath and as you breathe out, relax
    find relief. very deeply. You have noticed how relaxing it is
    One of your hands will float up toward your face when you breathe out, so you can become more
    now, and the index finger will touch the area that is deeply relaxed and comfortable each time you
    to be anesthetized. When all of the anesthesia exhale.
    leaves the finger and hand, and drains into your
    face, the hand will return to your lap and the
    intensity of the cold will have completely
    ANESTHESIA SUGGESTIONS FOR
    anesthetized the gums, the teeth, tissues, both
    anterior and posterior, to he selected area. This TOOTH EXTRACTION
    area, like when it was previously anesthetized with
    We do have a very effective surface anesthetic,
    a chemical and an injection, will have the same
    which I am now applying to your tooth and gums.
    protective mechanism that frees you from all
    I'm squeezing it into the gum tissue and now, to
    discomfort. It will last the same length of time that
    make sure we have complete anesthesia, I'm going
    it always lasts when injected, and return to a natural
    to push it under the gum around the tooth. Notice
    feeling free of any post-discomfort, bleeding or
    how the numbness increases as I push it firmly
    swelling.
    down further and further around the tooth. I'm
    now going to
    192 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    exert even more pressure to push the anesthetic out of trance. The trance state is a very comfortable
    material under the gum and down around the root and enjoyable state, and it is wise to give the
    of the tooth. The anesthesia has now become so subject an incentive to terminate it.
    profound you will not be able to feel the tooth
    being removed . . .

    Dental Hypnosis
    VASCULAR CONTROL, CLOTTING, Victor Rausch, D.D.S.
    AND NORMAL HEALING Waterloo, Ontario, Canada

    The tooth is out, and you can let the socket fill
    with blood and clot normally. You can be INTRODUCTION AND INDUCTION OF
    pleasantly surprised at how little discomfort and HYPNOSIS
    swelling there will be as the tooth socket heals
    rapidly in a normal manner. When you open your To determine the appropriate formal induction
    eyes, you will feel refreshed and very good and technique suitable for a particular patient, let us ask
    very pleased with yourself, and when I count to ourselves one question: "At this time, is the patient
    three, you will open your eyes and feel terrific, experiencing acute physical pain or severe
    because you are. One . . . two . . . three. psychological distress?"
    If the patient is not in immediate severe pain or
    distress, more permissive techniques such as
    progressive relaxation enhanced with
    COMMENTARY ego-strengthening phrases are usually sufficient to
    produce the relaxation necessary to make the
    The suggestion for eye closure was made when procedure comfortable for the patient.
    she started to blink and seemed to be keeping her Instructing the patient in a direct manner to take
    eyes open with an effort. The suggestion of a deep breath, let the eyes close and let the whole
    powerful new topical anesthetic was made to give body go limp as the breath is forcibly blown out
    her trance logic a handle for interpreting any produces a rapid relaxation response. The
    sensation as comfortable. The perceptual distortion suggestion that "with each breath you take and with
    was reinforced constantly as the elevator was each word I say you relax deeper and deeper until
    applied to the tooth and finally as the tooth was nothing bothers, nothing disturbs" sets up an
    removed. Until the tooth was removed, all the automatic deepening technique paced by the
    suggestions were to the effect that the anesthesia patient's breathing and the dental surgeon's voice.
    was being instituted and intensified. When the Specific suggestions can now be incorporated into
    patient was told that it was so numb that she would the verbalization.
    not feel the extraction, the tooth had already been
    If the patient is in acute pain or experiencing
    removed, so there was nothing that she could
    severe psychological distress, the short, rapid,
    possibly feel.
    authoritarian instructive induction techniques are
    The posthypnotic suggestion that the socket will usually the most successful. For a patient in pain,
    fill with blood and clot and heal normally is readily the top priority is relief as quickly as possible. The
    accepted in the trance state, even though the exact patient's mind-set is such that he is less critical and
    physiological mechanism that makes this happen is readily accepts suggestions and commands which
    unknown at the present time. Giving a subject the may under normal circumstances seem to be
    feeling of being refreshed and feeling good and irrational.
    being terrific when she opens her eyes gives her an The patient's need for the relief of pain or mental
    incentive to come distress dictates the rapidity with which he or she
    will accept hypnotic suggestions and respond to
    them.
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 193

    VERBALIZATION FOR TREATING A "As I touch your teeth and the surrounding
    PATIENT IN SEVERE PAIN tissues, those areas become completely numb. Let
    this finger [indicate a specific finger by touching
    "I realize you are in extreme discomfort and I can it] move by itself. It moves by itself when the areas
    help you. For me to do that you must help me. I am touching are completely numb. [Stroke the
    Listen very carefully to what I say and follow my area until the ideomotor signal is activated.] Good!
    instructions. Do you understand? [Let the patient [Teeth at this point may be surgically removed.]
    commit himself.] Good. Now, look at me and put Let the sockets fill and the bleeding stop. Turn it
    your finger on the tooth that is hurting. Now, as I off! [The denture may be fitted and inserted.]
    touch the area [place a finger on an area adjacent to
    the tooth where there is no inflammation and gently EGO-STRENGTHENING AND TEACHING
    press], feel the pressure of my finger. The pressure SELF-HYPNOSIS.
    feels good. As the pressure increases, your eyelids "You have done extremely well. Enjoy a feeling
    become heavy and close. Concentrate only on the of well-being and accomplishment. You now
    pressure. In a few moments you will feel only the become aware of how good you are at hypnosis.
    pressure. When that happens let this finger [touch After you leave here today, you can use
    and indicate a particular finger on one of the hands] self-hypnosis for your benefit anytime it is
    twitch. It will move by itself to indicate to me when appropriate for you. Go through the same
    you feel only the pressure. [Wait for the ideomotor procedure we used today and you will respond as
    response.] That's good! effectively and easily as you did today. Do you
    "The more pressure you feel, the more com- understand? Good."
    fortable the tooth feels. Now, relax very deeply and
    become aware only of the good feeling of the POSTHYPNOTIC SUGGESTION. "In a few moments, I
    pressure." will ask you to allow yourself to come to complete
    At this point the tooth can be surgically removed. alertness. After you do, your mouth remains
    completely comfortable. Your mouth heals rapidly.
    The unacceptable feeling of pain has been
    The denture feels good. You speak clearly.
    integrated into the acceptable, pleasant feeling of
    Nothing bothers, nothing disturbs. Do you
    pressure. Trust the ideomotor signal. Do the
    understand? Good."
    procedure. Often, as the forceps are engaged on the
    tooth in question, the pressure produced by the
    forceps acts as a deepening cue and causes the
    patient to go into very deep hypnosis.
    Suggestions for Operative
    Hypnodontics
    OTHER DENTAL SUGGESTIONS
    FOLLOWING INDUCTION AND William S. Kroger, M.D.
    Palm Springs, California
    DEEPENING

    ANESTHESIA AND BLEEDING CONTROL. PRODUCTION OF ANESTHESIA


    "Nothing
    bothers, nothing disturbs —you are doing just fine [One should never assume that anesthesia is
    — you are safe, comfortable, enjoying the feeling. present, even though a patient may be in deep
    Your body is safe, comfortable, totally relaxed, hypnosis. Always include this step to produce
    working automatically. You now let yourself flow anesthesia first; then test before operating. The
    with that feeling of relaxation so deeply that you procedure is to take hold of the tooth to be treated
    need pay no attention to your body anymore. between the index finger and the thumb, rocking it
    and at the same time depressing it in the socket,
    gently at first but gradually more firmly. While
    doing this say:] As I press down
    194 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    on this tooth, you will find that it is getting numb listen to what I am going to say, and it will be just
    and losing all its feeling. It is beginning to feel as so much fun.
    though you've had an injection. You will feel a "I want you to pretend —make believe—that is
    tingling sensation . . . cold and numb . . . what the 'pretend game' is. You make believe that
    you are at home in your own living room and lying
    TEST FOR ANESTHESIA. [Take a sharp explorer and down looking at television. It can be just as real as
    gently press into the gingival area around the tooth, can be. When you see the television screen you can
    saying:] I am pricking your gum with this point, nod your head so that I may know that you see the
    but, you see, you feel absolutely no discomfort. TV screen all lighted up, and your bestest TV
    [Stop, and say:] I shall do the same to the other side program is coming on. . . . There it is now . . . and it
    is getting clearer and clearer. I want you to see
    of your mouth, but you will feel a sharp pain there.
    every bit of the picture, and it can be just as good as
    [Then prick the gingival tissues on the normal side
    it ever was when you saw it at home. I want you to
    very lightly. Almost always, the patient will react tell me all about the picture . . . what people or
    with a sudden start. Now go back on the first side animals, just what you saw, later, after I tell you to
    and indicate the difference to the patient. If there is awaken. And all of the time that you are watching
    any doubt in the operator's mind, either the hyp- the television program, I'll be working on your
    nosis should be deepened and the above words teeth. You will hear some noise, and feel some
    repeated, or the patient should be given procaine pressure, but you will be having so much fun
    and further tests should be made.] watching the picture that you will not mind
    anything that I do. Nod your head to let me know
    that you are having fun." [Kathy nods.]

    The Let's Pretend Game I occasionally make some remark, such as: "I
    want you to tell me all about what you saw, and you
    Lawrence M. Staples, D.M.D. know you can always close your eyes and see your
    favorite television program whenever you come to
    Some of my young patients like to play a game the dentist. . . . You will always want to have your
    called "let's pretend" when they have to have their dentistry done like this. Going to the dentist can
    dental care. They shut their eyes when I tell them always be fun because you have learned the game
    to, and they at first just pretend that they are at of 'let's pretend.'"
    home, watching their favorite TV program, and Then I said to Kathy: "In a moment I am going to
    they have fun while I am caring for and working on say the letters . . . A..B..C..and the next time I say
    their teeth. the letter C, you will open your eyes smiling and
    "Would you like to play a game like that," I feeling very happy that you have had two cavities
    asked Kathy, and she thought that would be fun. cared for and a little old root removed . . . and it has
    "All right, Kathy, I will draw a 'funny face' on your been a lot of fun . . . A . . . The picture is about over
    thumbnail. . . . Here are the eyes, and here is the and it will just fade away . . . B . . . The picture has
    mouth . . . and right between them will go the nose, gone and the TV screen is dark, and now, smiling
    and now a dimple in the chin. Hold your thumb in and happy . . . C . . . Your eyes will open and, oh
    front of you and just look at that funny face so that boy, did you ever have fun!?"
    is about all that you see . . . Just that funny face on My records show that later, as Kathy grew older,
    your thumb. Pretty soon your eyes will be water skiing on one of the New Hampshire lakes
    tired-like, and your eyelids will begin to feel so took the place of the television, and Kathy told me
    VERY HEAVY and tired-like, that they will feel like how she learned to water ski one summer, and so I
    they do when you are tired. That is fine, just let said: "Suppose you shut your eyes as you have
    them stay closed until I tell you to open them. You done many times before when you were having
    will not go to sleep, for you will want to dental care ... let yourself
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 195

    become limp and loose and lazy-like, just as you the feelings in his mouth, and the question of how
    have done before . . . sleepy-like and drowsy-like. . the mouth works. Once you get the child interested
    . . And suppose you see and feel yourself water in his own bruxism movement, sooner or later he
    skiing up on Merrymeeting Lake. . . . Imagine that will show it to you. You ask him to really
    you are in the water. .. . Daddy and his boat are in memorize those feelings, and then you express the
    front of you and as you hold the rope, Daddy starts very pious hope that he won't awaken when he
    the motor and up you go on your skiis . . . just the makes that bruxism movement during sleep. And
    way you did last summer. . . . And now Daddy you express this hope so nicely and so genuinely
    makes the boat go a little faster, and away you go and so suggestively that you actually condition him
    down the lake. ... Be careful now, you are going to to awaken by your subtle negative suggestion.
    cross up over the waves that the boat is making. [As You can also suggest that he will be able to hear
    I said this, Kathy slightly lifted her toes as she the bruxism; that he will awaken when he hears it;
    would when going over a wave.] And now you are
    and that he will immediately comfort himself with
    down near the end of the lake. Daddy is going make
    the realization that he has a good pattern of going
    a turn." [And Kathy slightly moves her shoulders as
    back to sleep whenever he awakens. But how many
    she would do in balancing herself for making a
    times does a person want to awaken in the middle
    change of direction.]
    of the night just to prove to himself that he can hear
    I chatted as I did her dental work, suggesting that his bruxism, and that he can go right back to sleep!
    she was going over the waves and making other
    turns, etc. At one point I suggested that one of her
    friends was out water skiing also, and I said:
    "Mary, over there has just taken a tumble . . . but Use of Fantasy or Hallucination
    you, Kathy, are such a good water skier that you
    don't fall. [This remark of praise brought a slight
    for Tongue Thrusting
    smile on Kathy's face.] Water skiing is so much fun Irving I. Secter, D.D.S., M.A.
    up on Merrymeeting Lake, and it is also a lot of fun Southfield, Michigan
    to close your eyes and daydream that you are
    waterskiing whenever you come for dentistry. You
    [First the hypnotized patient is asked to imagine
    can always have your dentistry done this way. . . .
    (or hallucinate) an unpleasant, negative theater
    And now, Kathy, your dentistry is finished for
    scene or a negative experience with the associated
    today, so I'll say A . . . B . . . C . . . and you will
    unpleasant feelings. Then he or she imagines a
    awake smiling and happy .. . A . . . Daddy's heading
    very happy scene or experience with the
    for the shore . . . B . . . you drop the rope; you are in
    accompanying positive feelings. The patient is
    shallow water now . . . and C . . . the daydream is all
    asked to signal with a head nod when he or she is
    over —eyes open and you smile because that was a
    experiencing the suggested scenes.]
    lot of fun."
    Let the theater scene disappear for the time
    being. Be aware of the fact that you are sitting
    comfortably and relaxed in this chair.
    Now we can talk about your tongue thrusting
    Erickson's Approach with and how much nicer it will be for you when your
    Bruxism in Children teeth are straightened. Listen carefully. Every time
    you thrust your tongue into an improper position,
    Milton H. Erickson, M.D. you can re-experience the bad feelings that you had
    during that bad scene in the theater a short time
    I think as soon as the child is old enough you ago. You can immediately put your tongue in a
    really ought to take up with him the question of proper position, and the bad feelings can be
    immediately replaced by the wonderful
    feelings. Are you
    196 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    willing for this to happen? [Patient nods.] Would with the proper place for the tongue to be during
    you be willing to try this a few times right now for swallowing.
    practice? You remember, Paul, that in proper swallowing,
    the tongue is supposed to make contact with a spot
    on the soft tissues of your palate directly behind the
    two front teeth. Now, Paul, allow your tongue to
    Suggestions with find this place, and to feel it, and to become
    Tongue Thrusting comfortable with the way it feels. Notice
    particularly how well the tongue fits to this spot.
    Donald J. Rosinski, D.D.S. Notice how much more relaxed your entire body
    New York Mills, New York becomes as your tongue becomes more familiar
    with this spot.
    Now, Paul, allow the tongue to remain in contact
    INTRODUCTION with this special place, while your teeth and lips
    close together in preparation for swallowing.
    [Following hypnosis and a thorough education
    Notice how easily you can accomplish this when
    of the nature of the problem.] At this point, the
    all of the muscles in and around your face and
    patient being in a very relaxed state and giving
    mouth are completely relaxed.
    signs that he is willing to continue with the
    instructions, an explanation of the swallowing Pay close attention, now, Paul, to just how easy
    pattern is given. He is informed that the particular it is to complete the swallowing action while you
    pattern which has brought him to our office is a are so completely relaxed. Notice that the tongue is
    holdover from infancy which has been allowed to able to maintain its contact with the palate during
    become a habit for reasons in which we are not swallowing — without any extra stress on any of
    really interested. He is given the freedom to resolve the muscles of your mouth — the lips are able to
    for himself this aspect of the problem in the light of remain closed gently together without any need to
    his intelligent adult evaluation of the explanation fight the thrust of the tongue which you have had
    which is given. Assuming the strong motivation for all of these years.
    which has brought this patient to our office for Please continue to relax in this fashion, Paul,
    assistance with his swallowing pattern, he is while you repeat this action a few times so that it
    informed that we strongly believe that he wants and becomes very completely imprinted in the memory
    is willing to accept and act upon the re-education of banks of your subconscious mind—so that each
    his swallowing pattern. and every time you swallow from now on [this is
    said slowly and repeated two or three times to
    ensure that the patient truly grasps its significance
    SUGGESTIONS as a posthypnotic instruction] your subconscious
    mind will activate the nervous pathways which will
    Now, Paul, while your body is completely enable you to swallow in this same relaxed fashion.
    relaxed, and your mind completely free to You will find that this activity by the subconscious
    concentrate upon the way in which you swallow, mind will replace very soon the past mode of
    we can review for you the steps in swallowing. In swallowing.
    doing this while the mind is completely attentive to You will also, Paul, become consciously aware
    the steps to be followed, we can be quite certain of this progress, although only very dimly at first.
    that these steps will be fed into the program of As the newly learned pattern of swallowing
    swallowing, and replace this troublesome way of becomes more comfortable, you will find this
    swallowing which has been a holdover from awareness growing in your consciousness, so that
    infancy. We can allow the nerves in the tongue to you will feel proud that you have been able to do
    become acquainted such a good job on
    ANXIETY, PHOBIAS, AND DENTAL DISORDERS 197

    yourself when the orthodontist compliments your instructions which also reinforce previously given
    progress in treatment. But, most of all, Paul, you posthypnotic instructions for swallowing and
    will have a feeling of accomplishment in knowing well-being in this regard.]
    not only that you were able to learn this new pattern Now, Paul, since you fully understand what you
    of swallowing, but also that you will have been able must do to learn this new way of swallowing, we
    to do such a good job that there will not be any can end the appointment. I should like you to rouse
    sliding back into this former pattern — you will yourself from this very relaxed state with a feeling
    have learned it well, and for good. of well-being that everything is normal. Also, you
    Paul, before we bring this trance to a close, I will feel refreshed from having relaxed in this
    would like to know whether there is anything about fashion, and feel good in knowing that each and
    the instructions which is not clear. Do you every time you swallow, the subconscious mind
    will take over to help you to swallow more easily,
    understand everything? [Upon ascertaining that the
    and without the problem tongue thrust.
    patient does understand the instructions, he can be
    roused from his state with
    HYPNOSIS WITH CANCER
    PATIENTS
    INTRODUCTION

    CANCER PATIENTS HAVE a variety of psychological and medical needs that


    may be addressed through hypnosis. Cancer and chronic illness may certainly
    have a negative impact on self-esteem and feelings of confidence. Thus hypnotic
    ego-strengthening methods that were discussed in Chapter 5 may be of value with
    these patients. In addition, simply the use of self-hypnosis to control symptoms
    provides the patient with a sense of mastery and counters feelings of helplessness
    and powerlessness. Pain is a prominent issue for some patients, and thus the
    suggestions in Chapter 3 may likewise be of benefit. The side effects of
    chemotherapy are popularly regarded as being almost as terrible as cancer itself.
    Certainly the side effects of anticipatory nausea, vomiting, diarrhea and loss of
    appetite may be successfully addressed through hypnotic suggestion (Walker,
    Dawson, Pollet, Ratcliffe, & Hamilton, 1988). You will find a variety of
    suggestions and metaphors in this section for treating these symptoms.
    Anxiety and fear, discussed in the last chapter, are also important symptoms of
    many patients. Professionals in the fields of hypnosis and behavioral medicine
    widely believe that producing feelings of calm and tranquility allows the immune
    system to function at a maximal level, aiding the fight against cancer. For these
    reasons, self-hypnosis and approaches like Meares' deep meditative hypnosis or
    the method of prolonged hypnosis may be valuable therapeutic tools.
    Although research evidence is anecdotal and limited, many health professionals
    similarly believe that hypnotic imagery may enhance the functioning of the
    immune system (Rossi, 1986; Simonton, Matthews-Simonton, & Creighton.
    1978). We truly hope that this is the case and there is encouraging research about
    our ability to enhance cellular immunity (Hall, 1982-83). The field of
    psychoneuroimmunology (Ader, 1981) has experienced an explosion of exciting
    research that is beginning to identify

    199
    200 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    factors like stress, depression (versus laughter), and loneliness (versus social
    support) that seem linked to diseases like cancer (Borysenko, 1987).
    However, we must await further, more definitive evidence about the potentials,
    limits and active ingredients of hypnotic approaches with cancer. We very
    honestly don't know what works. Thus most of us use very different hypnotic
    approaches like those of both Meares and the Simontons, in the hope that they will
    be beneficial to at least some of our cancer patients. Assisting the patient in letting
    go of strong, unresolved feelings may also prove to be a key in enhancing the
    body's ability to fight and prevent cancer (Pennebaker, Kiecolt-Glaser, & Glaser,
    1988).
    I believe that we must strike a balance in our approach to cancer patients. We
    must remain optimistic, offering hope and treatment options that we believe may
    prove beneficial, and yet we must remain cautious not to make exaggerated claims
    to the public that imply that hypnosis is a cure for cancer. Historically,
    enthusiastic proponents of hypnosis have too often made grandiose claims, and
    then, when hypnosis has failed to live up to the false advertising, it has fallen into
    disrepute and disuse. We hope that we possess some keys, undoubtedly in need of
    refinement, that will open locks to free bodily responses that serve preventative
    functions and assist in the fight for life. At a minimum, hypnotic techniques will
    offer many of our patients' symptomatic relief from nausea, vomiting, pain,
    suffering, depression, and loss of self-worth— thus providing a higher quality of
    life during the time they sojourn with us. Later in this chapter you will also find
    that Levitan's Hypnotic Death Rehearsal Technique offers an alternative for
    assisting terminal patients to come to grips with their own impending death.

    Clinical Issues in Controlling on drugs. Hypnosis not only enables the patient to
    alleviate his or her experience of nausea, but also
    Chemotherapy Side Effects potentially benefits the patient in other areas.
    Finally, as a general relaxation technique, a patient
    William H. Redd, may use hypnosis to reduce stress and anxiety. Its
    Patricia H. Rosenberger, and benefits extend beyond the control of nausea.
    Cobie S. Hendler In spite of the many benefits hypnosis offers, we
    frequently encounter an initial reluctance on the
    We believe the control of chemotherapy patient's part to employ this technique. We find that
    nausea/emesis through hypnosis offers several many patients have the preconception that
    advantages. Hypnosis during chemotherapy hypnosis is a mysterious technique allowing the
    treatment makes the experience less stressful and therapist to influence or control the individual's
    the time pass more quickly. It requires no thoughts or actions. Straightforward explanations
    equipment unless a patient uses hypnosis tapes, and of hypnosis alleviate many patient fears. In our
    then only a tape recorder and audiotapes are introduction to hypnosis, we emphasize that
    required. Unlike antiemetic drugs, it does not patients control their hypnotic experience and that
    produce aversive side effects. As a skill which they become hypnotized only to the extent they
    patients can learn, it gives patients a personal sense allow themselves. Furthermore, we stress that it is a
    of mastery and control over their problem, rather skill that individuals can master with practice,
    than an increased sense of helplessness resulting rather
    from further dependency
    HYPNOSIS WITH CANCER PATIENTS 201
    than a state which just "happens" every time they A final issue is the patient's dependence upon the
    are hypnotized. To those patients searching for a therapist's presence during chemotherapy such that
    technique which eradicates post-chemotherapy the patient resists progressing to self-hypnosis. Our
    nausea with little effort on their part, this is a research to date suggests that the presence of the
    disappointment. To those patients who desire therapist may be crucial to successful
    control over their acute nausea, this technique is nausea/emesis control. However, it should be
    eagerly embraced. understood that in our initial work we included no
    In addition to a general wariness toward formal training in self-hypnosis nor did we
    hypnosis, some patients believe that a psycho- encourage the patients to use any methods of
    logical intervention implies a psychological eti- self-control. We are now investigating ways of
    ology of their problems. That is, if nausea can be maximizing patients' involvement in their nausea
    controlled through hypnosis, the nausea must be control by stressing patient independence from the
    psychological in origin, not the result of the toxic outset, teaching patients to use audiotape
    drugs. This suggests to some patients that they are recordings of hypnotic inductions during
    emotionally and/or mentally "weak." In turn, they chemotherapy treatments, and training nurses to
    believe they should either "tough it out" or
    assist patients in nausea control.
    somehow gain psychological control over the
    nausea on their own. In response to this attitude, we
    discuss with patients the very real aversive side
    effects of chemotherapy and point out that
    psychological interventions can be useful in the Suggestions and
    treatment of physical problems.
    Metaphors for Nausea
    Some patients are reluctant to devote the time
    necessary to practice hypnosis. It represents Alexander A. Levitan, M.D.
    another interruption in a schedule already New Brighton, Minnesota
    interrupted by physicians appointments and
    chemotherapy treatments. Some patients prefer to LAKE METAPHOR See yourself watching a lake
    live with the nausea until it becomes unbearable high in the mountains. Notice that there is a storm
    rather than make a commitment to learning this raging. There are whitecaps and the skies are dark
    technique. In addition to the inconvenience in their and cloudy. Then watch carefully as a solitary
    schedule, hypnosis serves as another reminder that sunbeam penetrates the clouds. Soon others follow
    they have cancer. For individuals actively seeking it and the dark storm clouds part to allow the
    normalcy, any such reminder is not welcomed. sunshine to come streaming through. Soon there is
    The importance of good rapport between bright sunshine everywhere. The surface of the
    therapist and patient cannot be underestimated. lake is now tranquil and serene.
    Hypnosis is an interpersonal event: both therapist
    and patient are active participants. This TURN OFF THE LIGHT. See yourself as a house with
    interpersonal element seems critical; we have many rooms. Find the room that contains the
    found that patients must initially work with unpleasant feeling that you are experiencing now.
    someone and be trained in hypnosis before [Pause] Turn off the light in that room. Tiptoe out
    hypnosis tapes are effective. Patients report they of the room and quietly close the door and lock it
    prefer to experience hypnosis with a therapist so that those feelings don't bother you anymore.
    several times; it is only when they have identified
    and become comfortable with their hypnotic
    SUGGESTION. Whenever you practice relaxing,
    experience that they can "transfer" to audiotapes.
    you will have the pleasant taste of mint in your
    202 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    mouth and it will replace any undesirable taste or being taken up by the bloodstream and excreted
    feeling you may have. from your body, expelled from your body in your
    urine and your stool. See the inside of your
    MAGIC MIRROR See a magic mirror pass through abdomen, healthy, clean, free of any hints of cancer
    your body at your upper abdomen such that all the cells. All of this is within your power. All of this
    nausea is below the mirror, and it doesn't bother you can do for yourself. It is a good feeling to be in
    you at all. control. It's nice to be in charge. It's nice to be the
    captain of the ship.
    RESTAURANT METAPHOR. See yourself planning to Now, while you are relaxing and enjoying the
    visit a new restaurant, one you've been looking peaceful place you have chosen, I want you also to
    forward to for a long time. See yourself dressing, know that you can control the other feelings you
    then leaving the house with the person you'd most have. Just as your learned to turn the pain switch off
    like to be with. See yourself arriving at the to your hand [when glove anesthesia was
    restaurant, being escorted to the table where performed] so that you need not have any
    everything is just as you hoped it would be. See discomfort when the IV is set, you can turn off the
    yourself opening the menu, noticing all the switch that controls any unpleasant feelings in your
    stomach. Any hint of nausea can be turned off. Find
    wonderful things there are to eat. Be aware of that
    the switch on the switchboard which controls that
    pleasant anticipatory hunger. Take an emotional
    and turn that switch off. Let the light go out over
    snapshot of that feeling. That's the feeling you'll
    the switch, let that feeling extinguish itself. Some
    have whenever you practice relaxing, and it will people even like to think about a house, a house
    substitute for any negative feelings you might have with all the rooms lighted. Find the room in the
    at the time. house that controls the stomach, and turn the light
    off. Let that feeling leave you totally and
    completely. Replace it instead with a comfortable,
    peaceful, pleasant feeling. Almost as if that part of
    Suggestions for the body didn't belong to you any longer. Almost as
    Chemotherapy Patients if you didn't even have to think about it. That's
    good. Enjoy that feeling and keep it there as long as
    Alexander A. Levitan, M.D. you want. Know that it is available for you
    New Brighton, Minnesota whenever you wish. You are in control, you can
    turn that switch off anytime you wish, and you can
    And I want you to take a moment to see the set the timer to leave it off as long as you like.
    drugs helping you. You know that we are all here
    working together for your benefit. You're on the And if there ever should be any little hint of
    team, too. You are a member of our group. Feel the discomfort, any little hint that something isn't quite
    medicines going into your system. See them right, all you have to do is take a deep breath, let
    searching out any remaining cancer cells that might yourself relax and it will disappear. It will be
    be anywhere in the body, anywhere in your replaced with the same feeling of peace and
    abdomen. See them attacking those cells and contentment you have now. And now, why don't
    destroying them. See the cancer cells dying. See you decide which hand you would like to numb up
    the battle raging as one blow is delivered from one and, when you have fully numbed it up, that's fine,
    drug, then another blow from the other drug. just let it become heavy, free of discomfort, free of
    Knocking out the cancer cells, destroying them painful sensations. Let the veins in the back of the
    totally. Then see your own defense mechanisms, hand dilate up. Let them become like swollen, full
    your own white cells, your own antibodies going in rivers. Let the needle go in prop-
    there administering the final blows, cleaning up the
    breakdown products, the trash, the residue. See it
    HYPNOSIS WITH CANCER PATIENTS 203
    erly into the vein when the IV is set. Let the vein were younger. Putting together a puzzle reflects
    and the skin wrap themselves tightly around the mastery; the implication is that the child has
    needle so that there will be no chance of any mastered one situation, the puzzle and can in the
    leakage, there will be no black and blue marks, no same way, master another and cope with his or her
    bleeding, and certainly no discomfort. That's fine. present situation.
    Just let that happen. OK. And when you're ready, A suggestion used with adults who are strug-
    let us know by raising the finger and we will set the gling to cope with diagnosis or recurrence of
    IV. [There is no need to confine suggestions to cancer is as follows:
    anatomically or physiologically known functions.
    The mind has influence far beyond what we can You'll find you have some strengths that you
    accurately describe and explain. Glove anesthesia didn't know you had.
    does not correlate with neuroanatomy and neither
    need these suggestions.]
    These adults were previously bright,
    well-functioning, and had considerable strength, so
    the suggestion "have some strengths" is
    ego-syntonic. The suggestions "You'll find" and
    Suggestions and Metaphors for "you didn't know you had" imply that the patient
    Support and Ego-Strengthening in need not be aware of the strengths at present, but
    may experience them in the future.
    Cancer Patients
    Billie S. Strauss, Ph.D.
    Chicago, Illinois
    General Suggestions for
    Metaphors and suggestions must be such that Self-Healing
    they are meaningful to the patient at the particular
    time they are given. The patient must be able to Joan Murray-Jobsis, Ph.D. Chapel Hill,
    relate to suggestions from the context of his or her North Carolina
    previous experience, and suggestions must be
    ego-syntonic. Suggestions of mastery often are
    INTRODUCTION
    most effective when they reflect a previous time
    when the patient was competent and effectual. These suggestions for self-healing are appli-
    A metaphor used with young adolescents with cable with other medical disorders besides cancer,
    cancer to help them deal with depression around but they have been included in this chapter because
    weakened functioning and the vast changes made of their particular relevance to cancer. (Ed.)
    in their lives is as follows:

    Imagine a picture, broken into a thousand pieces. SUGGESTIONS


    Now begin to pick up the pieces and put them back
    together again. And perhaps beginning to remember that inner,
    central core of existence, that place deep within the
    These children, metaphorically, felt that their lives central part of mind and body, that place of inner
    were "broken into pieces" by the effects of the harmony and inner calm, quiet stillness, a place of
    disease. They, often correctly, saw their lives as inner healing powers and life force. And
    being devastated and felt helpless to continue with remembering that from the very beginnings of
    their daily routines. These children had worked existence, the mind and body have known how to
    picture puzzles when they heal themselves. The body knows how to heal over
    scrapes and wounds
    204 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    and injuries, how to generate new cells and new be included to allow time for the development of
    tissue whenever needed. And the body knows imagery. Patients may also be asked to interact and
    equally well how to regulate its own healthy describe their experience and imagery, allowing
    functioning; regulating heart rate and breathing, suggestions to be more closely tailored to the
    and body temperature and blood pressure, all patient's experience. (Ed.)
    effortlessly, unconsciously, automatically
    maintained at moderate healthy levels. And the
    body knowing how to maintain its own healthy
    blood chemistry, maintaining the necessary
    SUGGESTIONS
    hormonal and chemical components for a healthy
    functioning mind and body; maintaining and A cancer cell is a weak and confused cell. If it
    regulating the serotonin levels, the potassium, the reproduces rapidly it may form a tumor. Normally
    endorphins, all the necessary hormonal and cancer cells are quickly destroyed by the immune
    chemical components that allow for an active, alert system. Recent research is demonstrating that
    mind and body, but without overexcitation, imagery can assist immune system functioning. It
    overstimulation. And in similar fashion, the body is important for patients to communicate to the
    maintaining an immune system effortlessly, clinician their spontaneous imagery to the
    automatically, warding off invading organisms suggestions. This is important in terms of
    before they have a chance to gain a foothold. prognosis and also to help illuminate healing
    Building resistance, maintaining resistance, psychotherapeutic work that may be needed.
    building antibodies, the white blood cells Allow yourself to become very warm and
    surrounding the invading viruses or bacteria, like comfortable. Let any fear fade away ... becoming
    white knights on white chargers. And the body very warm and relaxed . . . safe and secure. Begin
    knows how to regulate its metabolic system; the your healing journey by first making yourself very
    metabolism being designed to help us stabilize our small, as small as a drop of water, and then slip
    bodies at a normal, moderate, healthy level. And in inside yourself through your mouth and down your
    every way, mind and body working for health, throat. You can be inside a clear bubble that will
    healing, maintenance of healthy functioning. And protect you and supply you with everything you
    somehow knowing of these inner resources, the need. Allow yourself to become even smaller now
    strength, the growth, the healing, the life force, and enter your bloodstream.
    making everything easier.
    Circulate through your body and tell your
    immune system to release stronger and more
    effective white blood cells into your bloodstream.
    Let these white blood cells be represented by an
    animated or symbolic form. Watch them stream
    Hypnotic Suggestions with through your bloodstream, full of energy and sure
    Cancer of their purpose—to dissolve any unhealthy growth
    that they find. If you would like you can transmit
    Jeffrey Auerbach, Ph.D. messages of encouragement or direction to your
    Los Angeles, California immune system. . . . You might want to thank your
    immune system for the good job it is doing in the
    INTRODUCTION face of a challenger ... or ask your immune system
    if there is anything you can do to help speed your
    The following suggestions, like the Simon-tons' healing.
    approach, encourage the patient to actively fight From a safe vantage point, see any tumors being
    the cancer through the use of imagery. Naturally, dissolved as your white blood cells
    such suggestions may be individualized to the
    patient, and pauses may
    HYPNOSIS WITH CANCER PATIENTS 205
    surround and overcome any unhealthy growth. See intake the doctor has ordered for you. . . .
    the area being completely healed and then watch Discomfort, anxiety, and tension will be minimal
    your immune system cells patrol through your body and under control most of the time . . . you will be
    in a loving and protective way. See and feel relaxed and at ease. . . . You can rest well, secure in
    yourself being restored to a state of ideal health and the knowledge that your unconscious mind will
    appreciate and love yourself for taking the time to allow you to be free of excessive tension and any
    love and heal in this way. physical or psychological discomfort.
    [These suggestions may be reinforced as often
    as necessary with periodic and frequent
    self-hypnosis.]
    Hypnotic Suggestions with Cancer
    Patients
    TYPES OF SUGGESTIONS TAUGHT IN
    Harold B. Crasilneck, Ph.D., and James A. SELF-HYPNOSIS
    Hall, M.D.
    Dallas, Texas
    I will be virtually free of pain. ... I will eat as
    much as I can, enjoying my food. ... I will sleep as
    CONTROL OF CHEMOTHERAPY SIDE often as I wish, going to sleep easily and
    awakening calm and refreshed. ... I will be free of
    EFFECTS
    fear, calm and unafraid, with little anxiety or
    Time will go by rapidly, your anxiety and fears tension. ... I can review as I wish the pleasant
    will be much less . . . you can sleep for long periods experiences of my past life, my family's affection,
    of time during and following treatment . . . nausea the warmth of my friendships . . . and past
    and vomiting will be minimal; however, if you have problems will fall into place, no longer of any great
    to vomit you can . . . should you be asleep when you concern. . . . My body will respond maximally to
    need to vomit you can awaken, vomit, and any medical treatment that will prolong my life or
    immediately go back to a deep, restful, peaceful increase my comfort. ... I am calm and at ease . . .
    sleep . . . time will pass by quickly . . . hours will knowing that the immense power of my uncon-
    seem like minutes . . . there will be little discomfort scious mind can help me both mentally and
    and vomiting will grow less with each treatment. physically.
    I have a built-in immune system ... my immune
    system can block and destroy the cancer cells in my
    SUGGESTIONS WITH TERMINAL body. ... I have a powerful built-in psychological
    PATIENTS immune system . . . and nothing is beyond the
    power of my unconscious mind. . . . My powerful
    You will be free of tension, tightness, stress and built-in immune system can . . . and will destroy
    strain, you will be relaxed and at ease, and your these cancer cells that have invaded my body. . . .
    body will be relatively free of discomfort. You will My immune system can and will contain the tumor
    have a minimum of discomfort. . . . You will be . . . arresting the growth . . . and finally destroy this
    relaxed ... at ease. . . . You will have a feeling of invader of my body. ... I can and will destroy these
    well-being . . . sleeping when you desire . . . and cancer cells because of the omnipotent power of
    reinforcing these suggestions yourself ... as my immune system and . . . my unconscious mind.
    frequently as you desire. . . . You can eat well and ... I will recover ... I will get well. ... I will get well.
    enjoy the food ...
    206 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Imagery to Enhance the Control of kept in mind that these suggestions were tailored to
    the individual patient, whose interests included
    the Physiological and snowmobiling, bowling, being outdoors in winter
    Psychological "Side Effects" of and at the beach in the summer. (Ed.)]
    Cancer Therapy
    PAIN CONTROL FOR MOUTH, THROAT AND
    STOMACH.
    Simon W. Rosenberg, D.M.D.
    New York, New York Now picture the following: A winter scene at
    dawn in a safe, secure home or cabin in the woods.
    Have a relaxed, easy breakfast in front of a
    INTRODUCTION fireplace. A warm drink and nourishing food to
    remove the night's chill. So good to feel
    The selection of a variety of imagery from the comfortable. Being warmly dressed, step outside
    patient's abundant garden of experience and fantasy feeling tip-top, into the invigorating air. Look
    can aid in controlling physiological processes. around you. See each of the objects before you. Let
    Analgesia or pain control may be obtained through them take on shape, dimension, texture. See each of
    a reduction of individual components of pain — their colors. Feel the warmth of the clothing—the
    i.e., experiential, anticipatory or actual pain stimuli. refreshing coolness of the air. Hear the sounds of
    Local anesthesia obtained by hypnosis becomes the woods— if only to allow the room noises of the
    useful for venipuncture, spinal taps, bone marrow nurses working or the intercom announcements to
    aspiration or biopsy, injections, etc. An ability to drift off— Perhaps all you can hear is the sound of
    maintain body rigidity is required for wound care quiet or even a dog's bark in the distance. Try to
    and therapeutic or diagnostic radiology; body smell the fragrances of the woods in winter — a
    flaccidity may be required for examinations or little more and a little bit more. Note how good it
    diagnostic tests. The surgical patient often is aided feels.
    by stimulation/suppression of appetite, gag reflex,
    salivation, bowel movement, urinary bladder If you were to take off your glove, in your mind's
    function, etc. In addition, hemorrhage control may eye, your hand might get numb. If you went on a
    be crucial. Nausea and vomiting from cancer warmed-up, well-tuned snowmobile through the
    chemotherapy is often uncontrollable with woods, your cheek might feel a cool numbness
    medication. Hypnotic imagery for control of these with the wind and light snow flurries going
    physiological processes is used with consistent refreshingly by. When they put in the central
    success. . . . The goals of ego-strengthening, faith venous line this afternoon, and when they do the
    enhancement, and reduction of secondary gain bone marrow tap, it will be interesting to think
    result in increased patient autonomy and coop- about that cool, comfortable numbness right in the
    eration. Experiencing a decreased sense of fear and area they're working. Wouldn't be surprised if you
    anxiety, the patient reacts with less antagonism and could make it numb even before they put the
    resistance to the necessary, optimal therapy. anesthesia in. George, you'll surprise yourself. I'm
    sure of it, George! Make it numb before they begin,
    if you want.

    EXAMPLES OF SUGGESTIONS
    TIME DISTORTION. [Time distortion was introduced
    [The following suggestions, excerpted from an as part of an undirected, open-ended use of the
    individual case report, illustrate types of image used thus far.] I enjoy thinking about a
    verbalizations that may be used. Induction and snowmobile ride, down a new trail. One that can
    deepening had already occurred. It should be become a very familiar one. While you think about
    that snowmobile trail, I'd like
    HYPNOSIS WITH C A N C E R PATIENTS 207
    to talk to you. You can control the speed and where or dryness. Hear the sounds. Smell the fragrances.
    you wish to go. Could even go in slow motion, like
    the old-time movies, or speed it up or go in reverse. POSTHYPNOTIC SUGGESTIONS. George, you will re-
    As you take that ride, you can still listen to the member everything you need to. You will practice
    things I'll say. it four or five times a day and be able to achieve
    deeper relaxation each time more easily and
    MOTIVATION AND EGO-STRENGTHENING. Body quickly. You will feel better about yourself—a
    and sense of accomplishment and mastery. Now you're
    health are our most prized possessions. You're now able to control feeling instead of them controlling
    working toward restoration of complete health. By you. Feel just tip-top! Allow the day to take on a
    mastering this technique, which you're so good rosy glow. Feel the benefits of deep relaxation. As
    with, George, you are regaining self-control. Just as if having had a good night's rest. You will be able
    you control how fast you snowmobile, you control to go through the day more relaxed, more
    your anxiety with relaxation. comfortable and secure in one's feelings. Look
    There is no longer a need to worry about forward to the next session and think about
    procedures. You can put it out of your mind if you reorienting to the room in a few moments.
    like, until it's time. You'll be able to relax over it.
    Able to control the sting of needles, to take the hurt
    POSTHYPNOTIC PHASE. [After the patient was
    right out of it —pressure, but nothing more. No
    reoriented, he was encouraged to talk by saying:]
    longer need to wait for pain pills or nausea meds.
    Once you've told the nurses or doctors, and only if Any questions? [After any needed clarification,
    it's appropriate, you can bring relaxation into that reassurance and "waking" hypnotic suggestions
    part of your body. You've become part of the were given.] George, you're such an excellent
    treatment team. No need to be patient, or tolerate person for this. You did so well! I know you will
    anything unpleasant. Not fighting the nurses or practice what we've done and you'll benefit greatly
    doctors anymore. Not delaying taking meds from applying this when it is appropriate. I'll see
    because now you're learning to handle each you tomorrow. We can do another session, if you
    situation. Now unified to fight the disease and wipe want. May not even need it.
    out the bad cells.

    INSTRUCTIONS FOR SELF-HYPNOSIS. Now I've been


    IMAGERY AS A THERAPEUTIC
    talking a lot. You probably weren't paying MODALITY
    complete attention but you heard everything. Now
    you're paying attention! You'll remember what we Images do not intrinsically evoke specific
    did so you can practice it four or five times a day. effects; the practitioner's verbalization must
    You're just an excellent patient and I know you will include imbedded therapeutic suggestions. While
    be able to master this thing so you can turn it on there are no restrictions as to which images to use
    quickly, at a moment's notice. Remember to for a given desired result, the prehypnotic
    assume a comfortable position with arms and legs interview will often disclose which experiences of
    uncrossed. Take three slow, deep breaths. Hold. the patient might be revivified or what situations
    Feel the tension. Say "relax" and let the tension might be fantasized. Patients' likes and dislikes, as
    flow with each breath. Think about some safe, well as what things make them feel "good" or what
    secure, comfortable place —might be the winter they would really like to be doing, are important
    scene we talked about or any other scene. Perhaps clues. Specific treatment goals should be elicited
    the beach. See the objects — their shapes, texture, by asking the reason(s) hypnosis is desired. The
    colors. Feel the warmth or coolness, moisture winter woods
    208 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    scene used with this patient was carefully inter- tion, space and time contraction, transfer of
    woven with both direct and indirect suggestions of analgesia/anesthesia to the area or transfer of the
    "safe, secure; relaxed, easy breakfast; so good to pain to another locus. Imagery of a cool,
    feel comfortable; refreshing coolness; cool, comfortable fog or light rain touching the cheeks,
    comfortable numbness; regain self-control; control being breathed in and pleasantly numbing the
    anxiety with relaxation; not fighting nurses or tongue, mouth, throat, stomach, etc. has been
    doctors; fight disease (pronounced ambiguously: particularly helpful and is expanded to a "fog of
    disease); wipe out bad cells; rosy glow; etc." anesthesia" (as proposed by Andrew St. Amand,
    M.D.). This image can be adapted to induce local
    SPECIFIC IMAGES. Relaxation and anxiety control anesthesia, body rigidity or flac-cidity, nausea and
    can be evoked with almost any trance induction or emesis control, stimulation or suppression of
    deepening imagery. The broad, green leaf appetite, salivation, or bowel movement, urinary
    detaching from the tree top, gently drifting on a bladder release or retention, and even healing
    breeze, as if in slow motion, and finally settling so enhancement and tumor shrinkage/destruction.
    easily it doesn't bend a single leaf of grass beneath The psychological goals of ego strengthening,
    the tree (per Albert Forgione, Ph.D.) can be motivation to recover, and reduction of secondary
    modified to a colorful fall leaf, a winter snowflake, gain are obtained by including suggestions within
    a speck of dust on a drop of water in a rainbow or the imagery. Visualizations of increased
    the mist of a waterfall. Expansion to full self-control, mastery of physiological control and
    vivification involving sight, sound, smell, taste and autonomy are encouraged. Within the image the
    touch hallucination can easily introduce patient is in control of the sailboat, snowmobile,
    suggestions of time distortion (patient controls magic carpet, etc., or gains mastery of mountain
    speed as in slow motion), dissociation (patient climbing, swimming, running, etc., and this is
    separates from the restraints of time, body, linked with any control gained over the patient's
    ideation, rumination or obsession), and selective physiological complaint.
    amnesia (patient experiences the imagery instead
    of something perceived as painful or unpleasant). Revivification of past accomplishments such as
    Other scenes of seashores, mountains, underwater success with school, job, family, community or
    or outer space are equally valid and widely used. recreation shows previous ability to succeed.
    Karen Olness' flying blanket . . . deserves special Abreaction may occur if the patient perceives this
    mention for use with children. This author often image as confirming the loss of some ability that
    utilizes the imagery of a mare and its colt (or other was important to him. However, this can be a
    animal/offspring pair). This image is readily valuable therapeutic event to get the patient beyond
    accepted by children and serves the purpose of a the mourning stages of denial, anger and
    strong metaphor (as the colt engages in its activity, depression to acceptance and continuation of life.
    the mother is near to make sure that all is well). Imagery of value with this task involves regression
    back to early grade school when promotion to a
    Analgesia and pain control involve reduction of new classroom meant chairs and tables seemed
    larger than life. The idea of looking through adult
    the components of experiential (remembered or
    eyes at the same scene (with all of the
    previously imagined), anticipatory or real
    accomplishments since grade school) is
    (physically stimulated) pain. The first two of these
    introduced. Thus the patient gains the perspective
    are generally approached through relaxation,
    dissociation or behavioral desensitiza-tion. The that, viewed from today, the obstacles of the past
    actual pain may be reduced by removing the "hurt" have been overcome, although they seemed
    insurmountable then. Childhood experiences of
    from the "unbearable" through reinterpretation or
    playgrounds, trips to relatives, vacations, etc., are
    suggestions of direct reduc-
    HYPNOSIS WITH CANCER PATIENTS 209
    variations on this theme (suggested by Harold When you enter the hospital setting and during
    Golan, D.M.D.). the holding period, you can allow your body to
    Perhaps the most useful aspect of the imagery become relaxed and in balance. Then you will
    technique involves giving permission to experience permit yourself to take one long deep breath in
    all of the images that will allow the patients through your nose and out through your mouth
    themselves to resolve any issues they need to, at the while using the thumb and index technique. This
    point in their "therapy" when they are ready. Within will be a signal to go into the deepest level of
    the image, patients interact with some "significant hypnosis, whereby you will feel your strength and
    other" and are told what they need to hear to resolve confidence and knowledge that you are a winner
    their inner conflict. A related approach involves and can succeed. This one long deep breath will be
    spiritual "awakening" or contact from which the a signal to give yourself the strength and
    patient gets the feeling of strength to survive and confidence to reach the goal you have set for
    carry on. yourself. The time in the hospital and at home is for
    recovery and healing. The more you allow your
    mind and body to relax, the more rapidly this
    recovery will occur. You can permit yourself to
    Breast Cancer: Radiation allow your body to become relaxed and in balance.
    Treatment and Recovery Your relaxation will allow your body to nurture
    itself and adjust, and thus come into balance to
    Diane Roberts Staler, Ed.D. enhance your body's natural healing process. Your
    Boxford, Massachusetts desire to recover, heal and return to an active life
    enables you to gain the inner strength and energy
    INTRODUCTION within you. With one long deep breath this will be a
    This script was developed for inclusion on a signal to give to yourself the strength and
    self-hypnosis tape for a middle-aged woman with confidence to reach the goals you have set for
    inflammatory breast cancer who had to have yourself, to enhance the healing process. Your
    radiation implanted into her breast. The script was relaxation will enhance your healing process and
    designed in two sections. The first part was receptivity to the words
    designed to be used prior to the operation, in the
    waiting area, and during the operation. The second spoken by your physician, Dr. _____________He
    part was designed for use during the several days will be speaking to you while you are under
    she needed to remain in the hospital with the general anesthesia, and his words which will be
    radioactive implant inside and for her recovery at technical language will be easily understood by
    home. She worked with computers as part of her you to enhance your healing process and your
    employment and loved the ocean.* body's acceptance of the radiation. As the radiation
    is absorbed into your body, all healthy cells will be
    protected by a special coating, while all cancer
    SUGGESTIONS cells anywhere in your body, whether you use the
    experimental medication or not, will be
    [These suggestions followed an imagery in-
    hypersensitive to the radiation and will be killed
    duction utilizing a beautiful, tranquil seashore, off. Not a single cancer cell will survive. Your love
    followed by deepening suggestions.] and acceptance of your own strength will allow
    you to mobilize your natural healing process to re-
    *Special thanks and acknowledgment must be given to Dr. cover quickly.
    John C. Curnutte, M.D., Ph.D., The Scripps Institute, La Jolla,
    California, for his support, expertise and technical assistance in
    the area of oncology, especially for the current dynamics of how
    Pay close attention to my voice. You have no
    the immune system works for the destruction of cancer cells. cares, fears, worries or other negative thinking.
    Right now, all your cares, fears, worries and
    210 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    negative thinking will just drift away. They will go healthy cells will be protected by a special coating,
    so far that you can barely feel or see them. Notice a while all cancer cells anywhere in your body,
    boat off in the distance. You can put the thought whether you use the experimental medication or
    and feelings of self-doubt, being scared, your not, will be hypersensitive to the radiation and will
    excessive worry about the cancer, feelings of be killed off. Not a single cancer cell will survive.
    helplessness, being overwhelmed, not believing in Time will pass quickly and pleasantly during
    yourself, and feelings of frustration onto that boat your operation and your stay in the hospital. Each
    and allow it to drift off into the distance, off further day that you are in your room will pass quickly and
    and further away; so far and so distant that you will be a signal to go into an even deeper hypnosis
    barely notice it. Allowing it to be just a dot on the where your relaxation and concentration will
    horizon. However, you do not let it totally enhance your healing process and your body's
    disappear because you may choose to retain these acceptance of the radiation.
    feelings and retrieve them if you need them. But
    right now you have no need for them. As you let Relaxation will give you that peace of mind and
    them go, you gain a sense of peace and calm inner tranquility which will enable you to cope with
    flowing within your body. your stay in the hospital and will enable you to
    enhance your healing process and your body's
    You can allow yourself the pleasure of watching acceptance of the radiation. As the radiation is
    those feelings drift further and further away into the absorbed into your body, all healthy cells will be
    horizon. Notice that you do not allow them to protected by a special coating, while all cancer cells
    entirely disappear, so that if you want those anywhere in your body will be killed off.
    feelings, they will be there. But right now, you have
    Just imagine a mini computer screen which can
    no need for those feelings, so allow them to go off
    monitor and have control over all sensations and
    towards the horizon. These feelings will be there if
    control the poison to search and kill the cancer. If
    you want them back or want to be in touch with
    you want to monitor any sensation in your breast or
    them.
    any part of your body, you need only to turn on the
    When you are entering the hospital setting and screen. And if the sensation is due to radiation, the
    during the holding period, you can permit your word or color violet will appear on the left hand
    body to become relaxed and in balance. Relaxation side of the screen, with the level of intensity in
    will give you that peace of mind and inner words or numeral from 1-10. This left side is the
    tranquility which will enable you to cope with the input side. You can allow yourself to change the
    tensions and stresses of everyday living. It is numerals to a comfortable level.
    possible there will be other noises in the waiting
    area, operating room or outside your room in the If the sensation is due to cancer in the body, the
    hospital. These noises will not disturb you; instead word or color black will appear on the left hand
    they will act as a signal to deepen your hypnosis. side of the screen, with the word or numeral of
    You will be able to adjust yourself to your intensity from 1-10. On the right hand side of the
    environment, even though you cannot change it. screen you can type instructions to search and find
    the cancer, for the white cells and other immune
    If there are people who are discussing something systems to kill and release the needed poison to kill
    that is not beneficial to you, this will be a signal to off the cancer cells, while adjusting the intensity
    go into an even deeper state and their voices will level. Lastly, if the sensation is due to any reason
    only be muted, white noise to your ears. You will other than stated, the word or color red will appear
    remain calm, poised and relaxed. on the left hand side of the screen with its intensity
    You will only attend to what Dr._____________is level in numeral or word from 1-10. You can
    saying to you to enhance your healing process and make the appropriate adjustment
    the body's acceptance of the radiation. As the
    radiation is absorbed into your body, all
    HYPNOSIS WITH CANCER PATIENTS 211
    needed for complete comfort on the right hand side calm and strength will help in the healing process
    of the screen. In addition, by saying to yourself, and your recovery time. Your concentration,
    "relax, calm, poise, courage" [conditioned cues for relaxation, wisdom, and understanding, along with
    induction of self-hypnosis], you will allow yourself the support and love of your family and friends,
    to relax, remain calm, and gain the inner strength helps you to activate your inner light, which is your
    and control to achieve your goal. energy, and your inner goodness, which is your
    During your stay in the hospital, you will not strength. You can allow yourself to harness their
    need to feel any pain in your arms, legs, or breast, energy to help your body's receptivity to enhance
    only pressure and some minor discomfort. Your your healing process and your body's acceptance of
    ability to control your threshold of discomfort is the radiation.
    under your control. You may feel pressure and As you allow yourself to feel the calmness
    some minor discomfort but no pain. If for any within you and the awareness of the sun, you will
    reason the medical staff does not do a procedure allow yourself to feel a complete sense of peace
    correctly, your body will be aware of it and it will and oneness within yourself. This calmness and
    register on your mini computer screen, so that you relaxation will allow your body and mind to
    can inform them. Once you have told them, this function more effectively. You feel a sense of joy
    will be a signal to allow yourself to go into a very and life within your soul. Allow yourself to settle
    deep state of hypnosis to enhance your healing back and listen to the sound and smells of the sea
    process and body's acceptance of the radiation. As and shore. Listen to the waves rolling onto the
    the radiation is absorbed into your body, all healthy shore line. You feel at peace. Let yourself sink
    cells will be protected by a special coating, while deeper and deeper, deeper and deeper. Notice the
    all cancer cells anywhere in you body will be warmth of the sun, experience the strength of the
    hypersensitive to the radiation and will be killed ocean surrounding you; within you a sense of
    off. Not a single cancer cell will survive. control, comfortable peace and tranquility. You
    feel a sense of power, control, inner strength.
    You are peaceful, calm, relaxing deeper and
    deeper, deeper and deeper, deeper and deeper. As I As you let yourself drift along deeper and
    talk to you, you continue to go into an even deeper deeper, you are becoming more and more relaxed,
    state of relaxation. If feelings of fear or a sense of and as you are allowing yourself to become more
    loss of control arises from a flashback or other past relaxed, you permit your body to become limp and
    feelings that might interfere with your feeling alive, loose, and feel a sense of freedom and oneness
    you can choose either to look at what's causing with nature and the environment surrounding you.
    those feelings or to put them into your file in my You know that you can put yourself into
    office where they will be stored. These feelings will hypnosis any time and any place where there is no
    not surface and cannot be touched unless you danger to you or others; thus never while driving a
    choose to retrieve them to work on them in therapy, car or cooking. Otherwise you can put yourself into
    to help you learn to live and enjoy life. You will hypnosis very quickly and with each trial and each
    always know where they are because you have the time you will be able to go into hypnosis more
    control and you have chosen to place them there. rapidly that ever before. And the suggestions here
    By knowing this, if a flashback occurs, you have a or that you give yourself will last longer with each
    way of having power to control those feelings and trial. You will always find hypnosis refreshing and
    you no longer need to stuff them inside. Rather, you relaxing. No one can put you into hypnosis without
    have a way of dealing with them to resolve them your agreeing to it. Otherwise you will always find
    and help you to have greater control over your own hypnosis helpful in reaching your goal of taking
    life. When you return home, your sense of peace, greater control of your life.
    212 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Now allow yourself to go deeper and deeper than can begin the procedure for bringing yourself back
    you have ever felt before. If for some reason you to your usual state of awareness. When you do, you
    need to put yourself into hypnosis where it is not will feel alert, refreshed and relaxed, calm, and
    feasible to close your eyes, such as at work or in the refreshed, bright, sharp, physically better,
    middle of a stressful situation, by taking one long emotionally better, mentally better and spiritually
    deep breath through your nose and breathing out better than you have felt in a long, long time. The
    through you mouth, you will permit yourself to go feelings of well-being will remain with you longer
    into a very deep state of hypnosis. At that point you and longer with each trial and each time you listen
    will allow yourself to focus your mind on your to this tape. When you are ready, you can bring
    body, picture the ocean, and repeat to yourself in
    yourself back to your usual state of awareness.
    your mind, "relax, calm, poise, courage." And you
    will be able to help yourself. You will remain calm,
    poised, and will respond more effectively to take
    care of and help yourself.
    Hypnosis as an Adjunct to
    You will permit time for yourself and to take Chemotherapy in Cancer
    naps when your body feels fatigued. By taking two
    five- to ten-minute relaxation periods a day to Sidney Rosen, M.D. New
    picture yourself in the ocean or some other scene York, New York
    that brings inner peace, and a breather from the
    inner stress and turmoil, you will enhance the
    reaching of your goal of peace and calmness in INDICATIONS AND
    your life and feelings of being in control. CONTRAINDICATIONS
    Each time you listen to this tape, each time you Dr. Rosen models for us his approach to assisting
    reaccept the suggestions that are contained on this cancer patients who are undergoing chemotherapy.
    tape, they become more and more a part of you. As 1 point out in Chapter 16, there have been
    Even though you may not consciously remember suggestions of caution expressed about using age
    them, they will remain there in your unconscious, progression techniques with seriously depressed
    and they will work better and more effectively than patients lest they project themselves into a very
    ever before. You will permit yourself to accept the negative future that exacerbates feelings of
    suggestions on this tape because you want to be hopelessness. This could be iatrogenic and increase
    cancer-free, and to be able to control various suicide potential. Thus you are cautioned to use age
    sensations in your body and to know what they progression thoughtfully in working with cancer
    mean. You will allow yourself to accept these patients, assessing their level of depression and
    suggestions because you want to feel stronger, suicide potential prior to intervention. (Ed.)
    more in control, relaxed, healthier and vigorous.
    Your desire to be cancer-free, to be strong, and to
    take control of your life is so great that it easily
    allows you to accept the suggestions contained on SUGGESTIONS FOR HEALING,
    this tape. COMFORT AND NAUSEA
    Now you can allow yourself sink deeper and [Following induction using Erickson's Early
    deeper, deeper and deeper. You can choose at this Learning Set.] You can become a bodiless mind.
    point either to fall asleep or to begin the procedure And as a bodiless mind you can travel anywhere at
    for bringing yourself back to your usual state of all in time or space. You can be three years old, or
    awareness. If you choose to fall asleep you will ten years old. You can enjoy comfort at any age.
    disregard the rest of this side of the tape; otherwise, [Sometimes I will have the patients signal to me,
    when you are ready, you with automatic movements, when they are
    comfortable. Then 1 may
    HYPNOSIS WITH CANCER PATIENTS 213
    suggest:] Today's date is not 1983. Today is not July 18, Wordsworth said, "Into every life some rain must fall,
    1983. And you are not in New York City, in Dr. Rosen's some days will be dark and dreary." There were some
    office. This is 1993 and I don't know where you are. You times when things were not so hot. There were times
    when you thought that you were not going to be able to
    could be at home, you could be on a vacation trip. You
    make it, to get through another hour, another day. But
    could be with friends, your children, your grandchildren. you got through those times, didn't you [again looking
    I don't know where you are, or what you are doing. But back from age 83]?
    you are comfortable, aren't you? You do feel good, don't
    you? DISCUSSION. After the general approach, outlined
    above, I might have the patient hypnotically review the
    CASE EXAMPLE entire chemotherapy treatment, using imagery, when
    possible.
    After I get a positive response to age progression I The progression into the future has three possible
    may go even further into the future. For example, with effects:
    one hospitalized woman, age 43, who had both breasts
    removed, I said during my first contact with her: 1. It implies that the person will survive and thereby
    adds to a sense of hope. Hope has been associated
    You are 80 years old — 83 years old. And you can
    with greater survival rates and greater longevity
    look back 40 years, seeing yourself at age 43. And you
    (Newton, 1982-3).
    can realize that the period around age 43 was really a
    very important time in your life — a watershed, the time 2. It is an indirect way of requesting the unconscious
    when you really began to understand the meaning of your mind to devise ways of dealing with the side effects
    life, the value of your life. A very important time for you. of therapy and with the psychological and
    You can't say that you were actually lucky to have gotten physiological impact of the cancer.
    cancer but, in a way, you feel that it was lucky for you. 3 Patients are left with some sense of mastery and a
    feeling of process as they preview responses over
    1 will then play with time: the immediate future and through the next few
    months of therapy. . . .
    You are age 83, looking back at yourself, at age 43.
    And you see what happened after you saw Dr. Rosen.
    How did you go through that period? How did you go ILLUSTRATIVE SUGGESTIONS
    through the chemotherapy? Was the chemotherapy
    upsetting to you? Did it take one week, did it take two [The following suggestions were given to a
    weeks after you saw Dr. Rosen, before the chemotherapy
    63-year-old woman who had undergone a radical
    was accepted as a matter-of-fact treatment? As a helper?
    Or did it take only one session before you felt better? Did mastectomy and was soon to begin chemotherapy
    it take a month? two weeks? treatments. She had previously had fears that she might
    develop cancer, and associated her cancer with a kind of
    dirtiness or contamination. She believed the letter "c"
    As I offer different times, I watch for responses and note
    was associated with negatives, e.g., cancer, calamity,
    them. Then I progress the patient, in the same way as I
    contamination, chemotherapy. After a con-fusional
    might bring her back from an early childhood regression:
    induction, she was given time distortion and disorienting
    suggestions. Note the trance ratification procedures that
    And that young woman of 43 grows older, hour by
    hour, day by day, week by week, month by month, year Dr. Rosen utilizes. (Ed.)]
    by year — and really enjoys her life, doesn't she? Life
    has become very meaningful. She appreciated the You know that St. Patrick's Day came last year and
    value of every moment. Of course, as that it probably rained, as it always seems to do on St.
    Patrick's Day, this year, in 1981, just as it will
    214 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    in 1982 and as it did in 1979. You know that, a year or so You can sense that force that is working inside you
    ago, back in 1980, you were impelled to call Dr. Rosen, now. And that unconscious force that is working against
    hoping that working with him would help you in dealing you, too, can you not? That last force will become
    with some severe anxieties. When he didn't answer the weaker and weaker as you become stronger.
    telephone you decided that it wasn't the right time to do You can have some understanding now of the question
    this. You don't know now, that two years from today you that was asked a long time ago. "What is the source of
    will actually be seeing Dr. Rosen, after some of your this unconscious part of you that is working against you
    worst fears have materialized. You have a lot of now?" You can talk in words and tell me about it, if you
    conscious awareness of the importance of fantasy, the like. [Patient: The source is fear. But it's not going to win
    importance of listening to your own unconscious mind. —because fear is no good.]
    When you do see Dr. Rosen, in March of 1982, you will Can you take that fear and wrap it up? Where is it
    want to be prepared to use whatever you have learned located — in your left hand? Rather than try to fight
    throughout your life so that you can redirect, not only against it, can you dispense with it, in some other way?
    your conscious thoughts, but your unconscious activity Right now, when your hand becomes clenched so tightly,
    as well. You can do this by tapping that vast reservoir of you can try to hold that fear in. The fingers and joints
    unconscious learnings and extracting from it some of the become locked tight. If you try to open that fist, the more
    most positive, the most helpful, the most creative you try to open it the tighter the fingers clench. That's
    experiences and moments. You can find yourself right. Try to open it, finding that you can't. That's right.
    inspired, when the occasion arises, to lift yourself above You can really feel the tightness, the tension. Locate all
    yourself, or to take yourself outside of yourself, at times, the tightness, all the tension from your body into that left
    or to go inside of yourself, in order to oversee or to direct hand; all of the despair. [A loud car horn is heard,
    those powerful healing forces which you know are persistently blowing outside the window.] And that
    present. You don't have to force those forces. damned irritating horn can make you feel more frustrated
    and angry, can't it — till you feel like smashing
    You don't have to force yourself to concentrate. All something — with that left fist . . . and when you've had
    you need to do is make gentle requests of your as much of it as you can stand for now . . . yes, let it build
    unconscious mind. "I would like to ask my unconscious up further . . . there are times when we are in severe pain,
    mind to help me to go through this experience that we naturally and instinctively hold onto something,
    comfortably and effectively." Once you have made that just as you are holding on now ... in that left fist . . until
    request you can let yourself go into a deeper trance, the fist itself becomes painful . . . the hand becomes achy.
    knowing that you have all the resources that you need. . . . When you don't want to stand it for another moment,
    You can call on resources from inside and from just nod your head, once. . . . Now lean back and take a
    outside—from your friends. You can allow them to deep breath, and let the fist relax and open, letting out the
    nurture you, temporarily, putting aside your pride for a fear, letting out the tension. Letting it out of your body.
    while, the feeling that you have to take care of Letting it leave your mind . . . like that . . . yes. . . .
    everything, for yourself and for others. You can allow
    yourself to be sick, for a while, not needing to feel sick,
    You focus on your breathing for a moment or two,
    but knowing that there is a cleaning up job to be done
    letting yourself go into a more relaxed state, a deeper
    there, and that it will be done, as efficiently, as
    trance. Enter into your cocoon . . . and you are not alone
    effectively and as comfortably as possible.
    here. You become more and more relaxed . . . and as you
    You know, deep down inside, do you not, that this will relax, more and more, you can listen to your unconscious
    be done. It is not just a wish fulfillment, is it? You are messages . . . You've heard the negative ones. You have
    going to be well very soon, are you not? I'm waiting for a seen them ... in your dream . . . but you can tune up the
    signal. Yes! Like that! If you are wondering if that is just positive messages now, too ... so that they become not
    a wish fulfillment, that you are deliberately moving that only messages from your conscious mind, not only the
    thumb, try to stop it from going up, finding that the more grim determination of a very strong woman, to overcome
    you try to stop it the higher up it wants to go. That's right! this illness ... it will become a voice from a very very
    Like that! deep source, which just quietly knows that you will
    HYPNOS1S WITH CANCER PATIENTS 215
    become well . . . and safe . . . and able to proceed with the throw something up, in despair, wasn't there? Were you
    living of your life again . . . very, very soon. I don't know able to let go of that despair, in some other way? ... to
    what images are going to come to you ... to represent this focus on feeling relaxed and comfortable . . . and safe . . .
    very positive feeling . . . but I do know that you will come during the treatment and after the treatment? [Patient
    up with some images that are meaningful to you . . . nods "yes."]
    corrective images, clean, clear, perhaps celestial . . .
    certainly comforting. [Note the "good c's."] Can you see
    them, or hear them now? [She shakes her head "no."]
    Would you like me to supply some? All right . . . you
    have a vast repertoire of music . . . much more vast than
    Hypnotic Death Rehearsal
    mine. 1 do not want to limit you. You could think of "The Alexander A. Levitan, M.D.
    Ode to Joy" ... or a Schubert Mass ... or even some
    New Brighton, Minnesota
    Mozart . . . just scan through your repertoire . . . until you
    hit on some small piece of music that you can sense is a
    healing music for you. You can hear that, in your mind,
    INTRODUCTION
    more and more vividly, more and more clearly. You can
    see the orchestra. You can pick out various parts of the In response to the needs of certain patients and their
    orchestra. . . . So, you will remember these and they will
    families in our practice, a technique has been developed
    come back automatically. And they can be so vivid and
    which has proven useful for those imminently facing
    so clear that you will be not quite sure — is there really an
    orchestra, or is it a record that I hear, or is it just in my death and in those manifesting marked anxiety about
    own head? And it really doesn't matter. All that matters is death. This technique has proven effective in defusing
    that you know that you're creative, your healing forces anxiety and correcting misconceptions regarding the
    are liberated, more and more. . . . death experience and the effect of death upon both the
    patient and the patient's family. This technique has been
    You can go into a deeper trance and can take a look called death rehearsal. The approach varies according to
    into your future, if you like. You are with your family, the type of problem for which it is being employed and
    your husband, and everything is back to normal, isn't it? essentially represents a projection of the patient into the
    Or, are you involved in newer projects, that interest future with direct interaction and involvement of the
    you? I [your husband] is well, is he not? You had fears, therapist in the scene being visualized by the patient.
    back in 1982, that he might not be. And he is 74 years old
    now, isn't he? No? How old is he? [Patient: 72.] Yes, but
    now it's 1984. He's 74. Can you see him being well, this
    year? And you are just a youngster— 10 years younger. THE TECHNIQUE
    And that chemotherapy is behind you. And that is a
    A representative application of the death rehearsal
    relief, isn't it? [Patient: Yes.] How did you go through it?
    Was it uncomfortable for you? Or were you able to technique might be for a cancer patient manifesting
    utilize some of the things that you were working on with significant fear and anxiety over the actual mechanics of
    Dr. Rosen and others, to make it more comfortable? Did his or her own death. Characteristic anxieties expressed
    your hair fall out? That was not a serious problem, include the fear that the experience will be ex-
    anyway, was it? You had the wig— a whole series of traordinarily painful, extremely disruptive for the family,
    them, if you needed them . . . and what about the nausea or that the patient will manifest cowardice during the
    that people talk about? Did you have much nausea? Or terminal stages. A major associated fear is that of
    were you able to just take a deep breath, whenever you rejection and of dying alone and uncomforted because of
    felt it beginning, and let that feeling go out of you . . . the characteristic uneasiness manifested towards death
    blow it out . . . instead of having to throw it up . . .
    by our society. Few patients have ever heard of the
    remembering that there was a desire at one time to want
    concept of "helping someone to die."
    to
    216 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Under these circumstances we have found it that the events described may be reframed in the
    useful to ask the patient whether he or she would most favorable fashion. If the patient's concept of
    like to learn a little about what it is like to die. death is integrated into his religious beliefs every
    Almost universally the patients respond effort is made to support his visualization of the
    affirmatively if the question is posed in a caring death experience as long as it is not anxiety
    and solicitous fashion. A hypnotic trance is then provoking. Reassurance is given to the patient that
    induced by whatever method seems mutually he will be kept comfortable at all times and will be
    acceptable to the therapist and the patient. attended by a group of loving and concerned family
    Once in a satisfactory state of relaxation, the members or care providers according to his
    patient is asked to project himself into the future preference.
    and to visualize a point in time when his or her own Should the patient visualize events that are
    death is immediately inevitable. He is then totally inconsistent with reality, a gentle effort is
    requested to give the therapist an ideomotor signal made to direct his imagery to a more realistic
    indicating that he or she has a visualization of that circumstance. Where multiple interpretations of
    point in time. A suggestion is then given that the events are possible the patient is directed to the
    patient will be able to speak in a comfortable more favorable alternatives. If the spouse is
    fashion and that each word spoken will serve to visualized as being overwhelmed with grief or
    deepen the trance, thereby countering the normal emotion it is suggested that it is helpful for a person
    tendency for a trance to lighten when the patient is to express these feelings rather than keep them
    asked to speak. locked within.
    The patient is then asked to describe the Alternatively, if a relative is visualized as
    circumstances of the scene visualized. He is showing little or no emotion, it can be pointed out
    encouraged to be as concrete as possible and to that many people can experience deep feelings of
    describe in minute detail not only the physical love and affection without expressing them
    setting in which he finds himself but his thoughts outwardly. In this fashion every effort is made to
    and feelings as well. The hypnotherapist assists the enable the patient to experience his own death in a
    patient by inquiring about specific details. setting of comfort and security while adhering to
    Representative questions might be: Where are the realities of his particular circumstances. The
    you? Who is there with you? Are you afraid? Can death process is thus demystified and understood as
    you tell you are dying? Do you feel alone? Is there a natural biologic event common to all mankind. . .
    any pain? What is it like to die? What are those .
    persons around you feeling? What are they saying? Frequently, a death rehearsal will enable a
    How do they react to your death? Is there an patient to approach his own demise with equa-
    obituary in the newspaper? What does it say? Who nimity, security, and control. The patient will often
    is with your spouse after your death? Who visits also express gratitude in having shared the death
    you at the funeral home? What do they say? Who experience with the hypnotherapist and will take
    attends the funeral? What do they say or do? Who comfort in knowing that the hypnotherapist will be
    sends flowers? Who comforts or assists your available for the actual experience as well should
    family? What happens over the year after your this be required.
    death? Does anyone visit your grave on the In order to be of maximal assistance to the dying
    anniversary of your death? What do they do or say? patient the hypnotherapist must become
    What has been the effect of your death upon your comfortable with his own mortality and the fact
    family, friends, business, etc.? that he, too, will someday die. The act of "helping
    These questions are posed in a sympathetic, someone to die" must be clearly distinguished from
    understanding, and accepting fashion. Where the act of "causing someone to die." Death need not
    necessary, direction is given to the patient so be perceived as a defeat for the therapeutic process
    but rather as a natural conclusion to a biologic
    chain of events.
    HYPNOSIS WITH MEDICAL
    DISORDERS

    INTRODUCTION

    HERE ARE A TREMENDOUS number of conditions and specialties in medicine


    where hypnosis may be beneficial. Thus Chapter 3 has focused on hypnosis with
    pain, Chapter 4 concentrated on hypnotic preparation for surgery and
    hypnoanesthesia, Chapter 7 centered on uses of hypnosis with cancer patients,
    Chapter 9 examines obstetrical and gynecologic applications of hypnosis, sexual
    dysfunctions are the focus of Chapter 11, and Chapters 12 and 13 elaborate
    hypnotic approaches with obesity, eating disorders, smoking and addictions.
    Medical conditions in children (e.g., pain, enuresis) are discussed in Chapter 15.
    This chapter contains suggestions for use with other medical conditions such as
    dermatologic conditions, burns, emergencies (e.g., accident victims, critically ill
    patients, wound injection), vascular control (e.g., hemophilia, GI bleeding), sleep
    disorders, urinary problems (urinary retention, "bashful bladder"),
    ophthalmologic problems (e.g., lagophthalmos, blepharo-spasm), and neurologic
    complaints (stroke, involuntary muscle jerking, Bell's Palsy). The contribution by
    Jencks provides imagery and brief suggestions that may be used with a great
    diversity of conditions, including pulmonary complaints, nose and throat
    problems, ophthalmologic complaints, dermatologic conditions, and procedures
    to increase energy and facilitate feelings of invigoration and alertness. There are
    also a variety of suggestions concerning miscellaneous medical conditions that
    are included in this chapter: autoimmune disease, general suggestions for healing
    imagery, hypochondriasis, allergies, the use of prolonged hypnosis for
    psychosomatic disorders, asthma (suggestions for this may also be found in
    Chapter 15, Hypnotic Suggestions With Children), tinnitus, and difficulty
    swallowing pills. Before presenting suggestions that may be used in working
    218 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    with these various medical problems, a few introductory remarks will be made
    concerning some of these areas.

    Hypertension, Gastrointestinal Disorders,


    Premenstrual Syndrome, and Psychosomatic
    Disorders
    There are some conditions where hypnosis has proven particularly beneficial.
    While suggestions were not submitted in some of these areas, you should be aware
    of the potential benefits of hypnosis with these problems. One of these areas is
    hypertension. Hypertension has been benefited by deep muscle relaxation (e.g.,
    Taylor, Farquhar, Nelson, & Agras, 1977), meditation (e.g., Benson, Rosner,
    Marzetta, & Klemchuk, 1974; Benson & Wallace, 1972) and hypnosis (Barabasz
    & McGeorge, 1978; Crasilneck & Hall, 1985; Deabler, Fidel, Dillenkoffer, &
    Elder, 1973; Friedman & Taub, 1977, 1978; Maslach, Marshall, & Zimbardo,
    1972). Hypnotic procedures for control of hypertension include self-hypnotic
    training in relaxation and finger or hand warming. Consistent practice of
    self-hypnotic procedures several times each day is vitally important for success,
    and hypnosis may need to be combined with cognitive therapy, weight reduction,
    smoking cessation, and a regular exercise program for maintenance of change to
    occur.
    Another particularly valuable area for the application of hypnosis is with
    gastrointestinal problems such as ulcers, irritable bowel syndrome, ulcer-ative
    colitis and Crohn's disease. Klein and Spiegel (1989) documented the ability of
    hypnosis to both stimulate and inhibit gastric acid secretion. When compared to
    no-hypnosis controls, for example, with hypnosis there was a 39% reduction in
    basal acid output and an 11% reduction in pentagastrin-stimulated peak acid
    output. Colgan, Faragher, and Whorwell (1988) studied the possible benefits of
    hypnotherapy in relapse prevention with duodenal ulcer patients. In a carefully
    controlled study, on one-year follow-up, 100% of control patients (who received
    medication until after ulcers were healed) had relapsed. But for patients who also
    received hypnotherapy, only 53% had relapsed.
    A variety of studies have also impressively documented the value of
    hypnotherapy with irritable bowel syndrome (Byrne, 1973; Kroger & Fezler,
    1976; Whorwell, Prior, & Faragher, 1984; Whorwell, Prior, & Colgan, 1987).
    Whorwell's group have now found long-term (mean 18 months) follow-up
    response rates on 50 patients with 95% success with classical cases, 43% with
    atypical cases, and 60% with cases exhibiting significant psychopathology.
    Patients over age 50 responded poorly (25% success), but patients below age 50
    with classical irritable bowel syndrome were 100% successful. Gastrointestinal
    conditions appear to be stress-related illnesses (Fava & Pavan, 1976-77;
    Gerbert, 1980; Walker, 1983; Zisook & DePaul,
    HYPNOSIS WITH MEDICAL DISORDERS 219

    1977) and anecdotal evidence suggests the possible involvement of other


    emotional factors (e.g., repressed hostility and anger) (e.g., Walker, 1983) that
    may be responsive to hypnotherapy.
    It should also be noted that premenstrual syndrome (PMS) patients may be
    benefited by self-hypnosis training (Hammond, 1988d). Hypnosis may assist
    these patients to reduce such primary symptoms as anxiety, overemotionality, and
    anger (Hammond, 1988e). PMS patients commonly feel "out of control," and
    experience diminished esteem and depression. Self-hypnotic techniques offer
    PMS patients a self-management skill that allows them to regain feelings of
    control, and it may be used to increase ego-strength and feelings of self-efficacy.
    Hypnosis may further assist such patients to cope with premenstrual cravings for
    sweets and salt, which seem to exacerbate the condition, and to cope with fatigue
    and insomnia.
    A latter section of this chapter will introduce suggestions that may prove
    beneficial in promoting healing, and in treating other psychosomatic conditions
    and autoimmune diseases.

    PHYSICAL MEDICINE, REHABILITATION AND NEUROLOGY. Crasilneck and Hall (1985)


    emphasized four prominent uses of hypnosis in neurology: (1) for differential
    diagnosis of functional versus organic problems; (2) to maximize functional
    ability even when full recovery is not possible; (3) for management of discomfort
    and pain; and (4) for enhancing motivation for rehabilitation (e.g., physical
    therapy) and recovery. They found that hypnosis may still be used with patients
    suffering from stroke and cerebrovascular accident, with the following
    modifications. The therapist should speak very slowly, use simple vocabulary,
    use increased repetition of suggestion, and persevere with the patient in spite of
    minimal response or negative countertransference. Hypnosis has been used with a
    variety of physical medicine, neurologic and musculoskeletal problems: phantom
    limb pain, spasticity (cerebral palsy, stroke, neurodegenerative conditions),
    movement disorders (e.g., tic, tremor, torticollis, blepharospasm, whiplash),
    seizures, hyperkinetic disorders, and problems with speech and swallowing.

    Dermatologic Disorders
    There are a variety of dermatologic disorders in which hypnosis may contribute
    to positive treatment outcome, including pruritus (excessive itching), acne,
    psoriasis, eczema, neurodermatitis, warts and herpes simplex.
    Hypnotic interventions may include posthypnotic suggestions to reduce
    picking and scratching in acne, pruritus, eczema, and neurodermatitis. When
    suggestions are ineffective, exploration of unconscious dynamics may prove
    beneficial. This has particularly been found to be the case in patients with
    neurodermatitis. Hypnotic imagery of applying soothing and healing ointments or
    solutions (or in the case of Dr. Wright's contribution
    220 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    to this chapter, a soothing bath with cornstarch) is commonly beneficial with


    irritating conditions. Practicing self-hypnosis to reduce stress may likewise
    benefit conditions that are exacerbated by anxiety (e.g., herpes, acne, eczema,
    psoriasis). Warts and herpes may be positively affected through production of
    ideosensory changes (e.g., warmth, coolness, tingling) both in the office and
    through practice several times daily in self-hypnosis. Studies (e.g., Scott, 1960;
    Sinclair-Gieben & Chalmers, 1959; Surman, Gottlieb, & Hackett, 1972; Surman,
    Gottlieb, Hackett, & Silverberg, 1973; Tasini & Hackett, 1977) have shown
    particularly impressive effects in applying hypnosis to the treatment of warts. The
    successful impact of words and imagination on warts is of particular import
    considering the increasingly widespread routine use of powerful chemotherapy
    agents to treat warts.

    Sleep Disorders
    A small proportion of sleep disturbance is associated with sleep apnea or
    medical problems and will not be amenable to treatment by psychological
    techniques. The largest proportion of sleep disorders are associated with
    psychiatric disorders, or alcohol or drug dependence that will require
    broad-spectrum interventions with these disorders along with symptomatic
    disturbance. It is thus vitally important to carefully evaluate sleep disorders to
    assess the etiologic contributors. Depression, medical conditions (e.g., apnea,
    myoclonus), substance abuse, and overuse of caffeine or nicotine should all be
    ruled out prior to considering intervention with hypnotherapy .
    There are, however, a proportion of insomnia patients whose sleep is disturbed
    by (1) cognitive overactivity and conditioned habit patterns incompatible with
    sleep (e.g., presleep patterns of worrying, rumination, compulsive analysis of the
    day's activities or planning for future events, reading, watching TV), (2) central
    nervous system excitation (anxiety, tension), and (3) underlying (unconscious)
    conflicts or fears that disrupt sleep. These patients may receive substantial benefit
    from hypnotherapeutic intervention.
    Basic hypnotherapy strategies may involve: (1) self-hypnosis training to
    facilitate deep muscle relaxation; (2) use of additional self-hypnotic techniques to
    control cognitive overactivity (e.g., self-hypnosis tapes with monotonous
    activities such as hearing repetitive suggestions, listening to a metronome,
    walking down a long staircase, engaging in boring activities after becoming
    deeply relaxed); and, when the first two strategies are not successful within four
    or five interviews, (3) unconscious exploration of underlying functions or
    conflicts associated with the sleep disturbance.
    Because use of the behavioral technique of stimulus control (Bootkin, 1977)
    has proven even more effective than relaxation procedures in treating insomnia, it
    is also recommended that this technique be routinely used in conjunction with
    hypnosis. Stimulus control instructions request that the
    HYPNOSIS WITH MEDICAL DISORDERS 221

    patient: (a) Only sleep or make love in bed. Other activities, such as watching TV,
    reading, reviewing the day, planning activities of the next day, or eating must not
    occur in bed. If the patient begins to engage in these activities, he must decide if
    he wants to continue them, and if so, get up and go into the other room to engage
    in them, (b) If the patient is awake 20 minutes after retiring, she must get up and
    engage in a constructive activity. (c) The patient should only go to bed when he
    feels tired, never take naps during the daytime, and should set the alarm to awaken
    at the same time every morning.
    Garver's contribution to this chapter emphasizes the recall of positive
    memories about sleeping, which may both relax and distract patients from other
    mental activities. Gruenewald's and Stanton's suggestions emphasize the use of
    imagery to promote relaxation and occupy mental attention. The Spiegels'
    approach encourages the patient to relax through experiencing floating feelings
    and then to distance themselves from thoughts by putting them on an imaginary
    screen. Zelling's contribution is unrelated to insomnia but offers an interesting
    approach for coping with snoring.

    Burns and Emergencies


    Crasilneck and Hall (1985) outlined five problem variables that may be
    addressed in hypnotherapy with burn patients: (1) the constant pain, (2) loss of
    appetite, (3) the necessity for repeated painful procedures, such as debridement,
    (4) contractures that result from lack of exercise due to pain, and (5) negativism
    and severe psychological regression that may slow rehabilitation. Their
    suggestions, along with those of several other experts in this area are presented
    later in the chapter.
    There is widespread belief that trauma is trance-inducing, whether it stems
    from a serious automobile accident, burn, or myocardial infarction. Several
    suggestions have been reproduced in this chapter that may be offered to critically
    ill or emergency patients, acting on the assumption that they are already in a
    trance-like state and will not require a formal hypnotic induction.

    Vascular Control Through Hypnosis


    A variety of studies have documented that vascular flow and bleeding may be
    influenced and controlled through the use of hypnosis (e.g., LeBaron & Zeltzer,
    1985; LaBaw, 1970, 1975; Bishay & Lee, 1984). This may be valuable in working
    with hemophilia patients, surgical and dermatologic procedures (e.g.,
    dermabrasion), and in dental work. Several illustrative suggestions for this have
    also been included in this chapter.
    222 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    HYPNOSIS WITH DERMATOLOGIC DISORDERS

    Treatment of Pruritus Regardless of any itching sensations you feel, you will
    note that they no longer bother you in any way. You may
    Michael j. Scott, M.D. still feel itchiness but you will no longer have any desire
    Seattle, Washington or need to scratch.

    In general, I use permissive suggestions and almost If a history reveals that a patient has his itchy spells when
    invariably gradually decrease the symptom over the he arrives home from work at 5:30 p.m. and that they last
    course of several visits rather than at one session. I until bedtime at 11:00 p.m., I may employ any of the
    respect the patient's need for a symptom, such as following:
    functional pruritus. Only very rarely, when I am
    thoroughly convinced that a symptom is purely psychic Until the next session you will note that the sensation
    in origin and the individual has no further need for it, do I of itchiness will last only from 5:30 p.m. to 8:00 p.m.,
    employ dogmatic or authoritative suggestions such as, and you will be completely free of symptoms for the last
    "Once this session is terminated you will no longer have three hours of every evening.
    any sensation of itching or any desire to scratch."
    In dermatologic conditions, pruritus is the most At each subsequent session the times can be altered
    frequently encountered complaint, so I will confine my accordingly. You could use a different approach and alter
    reference to this particular symptom. The patient's the intensity of the pruritus, suggesting that it will
    scratching, in order to relieve the itchy symptom, is what become "progressively less severe every day" without
    invariably produces the undesirable side effects of changing the duration each night. You could similarly
    excoriations, infections, etc. If we can eliminate or change the frequency by having it occur every other day
    decrease the patient's desire to scratch, we can then instead of daily. With such techniques a previously
    shorten the course of many cutaneous disorders and intolerable pruritus may be decreased in intensity and
    frequently allow the natural healing processes to occur frequency to a tolerable and comfortable level without
    more readily. With this in mind, I often allow the patient depriving the patient of the symptoms entirely.
    to retain the symptom of itching, but decrease his desire
    Instead of direct suggestion, one may recommend
    or need to scratch through the use of several available
    symptom substitution as follows:
    methods. I may use hypnosis to gradually decrease the
    duration, intensity, or frequency of the pruritic attacks or
    his desire to scratch. I may offer symptom substitution, Immediately upon coming home and changing
    for example, suggest the sensation of pressure or dull, clothes, you will go to the recreation room and devote
    tolerable pain for the pruritus. I may hypnotically suggest three-quarters of an hour to the strenuous use of a
    punching bag. You will resume this activity for an
    other activities instead of scratching (such as physical
    additional half-hour later in the evening. You will then
    exercises, verbal aggressiveness, painting, etc.).
    note that the sensation of itchiness will completely
    disappear and will no longer bother you.
    With the above brief and incomplete background in
    mind, you can realize how my actual suggestions may
    vary considerably depending upon the patient, the In cases of generalized neurodermatitis, one may
    situation, resistances, etc. However, some typical suggest:
    suggestions would be as follows:
    Instead of scratching all over your body, you will now
    discover that by limiting your scratching to only your
    thighs, you will obtain the same relief and satisfaction
    you formerly derived from scratching all over your body.
    HYPNOSIS WITH MEDICAL DISORDERS 223
    In this way, with each visit we may gradually Hypnotic Technique for
    diminish the area involved and aid considerably in
    obtaining a cure. Merely changing the location of a
    Treating Warts
    visible, unsightly, functional derma-tosis to a Harold B. Crasilneck, Ph.D., and
    covered, invisible area of the body is often James A. Hall, M.D. Dallas, Texas
    desirable and beneficial.

    INTRODUCTION

    Following hypnotic induction and deepening,


    Erickson's Reframing Suggestion Crasilneck and Hall (1985) lightly touch the area
    with Pruritus around a wart with a pencil while instructing the
    patient that he/she will feel a coolness or coldness
    Milton H. Erickson in the area. It is suggested that this sensation will
    persist for approximately a day as the warts begin
    "You're troubled by this itch. Naturally I don't to diminish. These suggestions are reinforced in
    know exactly what it is. I'm certain that you want each subsequent session. The following
    your itch for accomplishment to be kept. Your itch suggestions model the authors' technique. Note the
    to do things can be kept. In fact, there are a number extensive use of hypnotic phenomena for purposes
    of itches that you want to keep. Any itch that you of trance ratification. (Ed.)
    want to keep— be sure to keep it! Also let's be sure
    that you get rid of any itch you are willing to lose
    but no more than you are willing to lose."
    LEVITATION INDUCTION

    Please cup your right hand on your right knee. . .


    . That's it. . . . Now look at the knuckles of your
    Suggestions for Itching hand and as you are doing so, your entire body will
    begin to relax thoroughly. .. . Pay no attention to
    Beata Jencks, Ph.D. other sounds . . . just concentrate on your right hand
    Murray, Utah and my voice, realizing that nothing is beyond the
    power of the mind . . . and of the body. As I
    Itching may be controlled by imagining continue talking to you and as you continue staring
    breathing through the afflicted skin area with the at the back of your cupped hand, you will begin to
    thoughts of "cool" or "still" during inhalations and notice things like the heat in the palm of your hand .
    "calm" or "relaxed" during exhalations. This has . . and perhaps movement in one of the fingers. ...
    worked for heat rashes and certain allergic As this occurs, slightly nod your head . . . yes . . .
    conditions. It may take considerable concentration very good . . . and now you will notice that your
    to control bad allergic reactions in this manner. An hand is becoming very, very light . . . like a feather
    additional aid is to involve the imagination coming up toward your forehead. . . . Good. . . .
    generally for counteracting a skin condition, as for Your hand starts to move upward . . . and as your
    instance by thinking, "I am [exhalation] resting in a hand continues to rise, keep looking at the back of
    [inhalation] cool and refreshing, yet [exhalation] your hand . . . but notice your eyelids are getting
    relaxing and comforting, [inhalation] relieving very heavy, very drowsy, and very relaxed. . . .
    bath." Also thoughts of floating in the ocean, or Now when your hand touches your forehead . . .
    even diving into cool water in a diving bell, were your eyes will be closed . . . you will be
    useful images evoked by trainees for reducing tremendously relaxed
    itching of skin areas.
    224 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    and capable of entering a deep level of trance. Your middle finger. ... As you feel this . . . nod your head,
    hand and arm comes up, up, up towards your yes. . . . You see you pulled your hand back, which
    forehead. . . . Now, your hand touches your is an immediate and normal response. You are now
    forehead. . . . Your eyes are closed. . . . You can let aware of the tremendous control that your
    your hand rest comfortably in your lap and normal unconscious mind has over your body. . . . Now
    sensation is returning to your right hand and arm. . . close your eyes again. ... I now suggest that you can
    . smell a pleasant odor of your choosing. ... As you
    smell this, nod your head yes. . . . Good. . . . And
    now a very, very deep level of trance. . . . The
    TRANCE RATIFICATION PROCEDURES pleasant odor leaves and still a more relaxed and
    deeper state of trance. . . .
    EYELID CATALEPSY. Notice that your eyelids feel
    heavy ... so heavy that even though you try to open IDEOSENSORY SUGGESTIONS FOR
    your eyes for the moment . . . you can't. . . . Go WART REMOVAL
    ahead and try . . . but you cannot. . . . Try again . . .
    but the eyelids are shut tight. . . . Normal sensations Nothing is beyond the power of the unconscious
    return to the eyelids. . . . Now you will enter a much mind and these warts are going to leave completely
    more sound and relaxed state. . . . and your skin will be void of them. . . . The area that
    I touch with this pencil . . . this area of warts now
    begins to feel very cool . . . cool . . . slightly cold. ...
    LIMB RIGIDITY. Now I want you to raise your right
    As you feel this, nod your head. . . . Good. . . . Think
    arm. . . . That's it. . . . Extend it in front of you, and
    the thought as I continue talking. . . . The area is
    as 1 count to three, your arm will become rigid . . .
    hard . . . like a board soaked in water . . . like steel ... cool. . . . The warts are going to leave. . . . The area
    so tight ... so rigid . . . those muscles become steel. . is cool, and the warts will leave my body because of
    . . One . . . tight . . . two . . . very rigid, and three, the the power of my mind over my body. . . . Now just
    whole arm, each finger . . . yes . . . become steel. . . relax your thoughts . . . just pleasant, relaxed,
    . There . . . nothing can bend that arm or the fingers serene thoughts. . . . Listen to me . . . my every word
    . . . showing you the power of your mind and body. . . . These warts are going to leave. . . . We have
    . . . Now relax the arm and hand. . . . Normal demonstrated the control of your mind over your
    sensation returns and still a much deeper and body, and these warts will be gone very shortly. . . .
    sounder state of relaxation. Your skin will feel slightly cool around the area of
    the warts for a day or so, and as the coolness fades,
    the warts will also begin to fade. And so, as I slowly
    GLOVE ANESTHESIA I now give you the hypnotic count from ten to one, you will be fully awake . . .
    suggestion that your right hand will develop the free from tension, tightness, stress and strain. These
    feeling that a heavy thick glove is on your right warts are going to fade out.
    hand ... as your hand has developed this sensation,
    move the forefinger of the right hand. . . . Good. . . .
    Now you will note some pressure in the forefinger
    ... a dull sensation of pressure. . . . Open your eyes. Suggestions for Warts
    . . . Now you see that in reality I'm sticking your
    finger severely with my nail file . . . but you are
    (Modeled after Hartland)
    feeling nothing . . . correct? . . . Fine. . . . Normal Don E. Gibbons, Ph.D.
    sensation is returning to your hand. ... I am now
    going to stimulate the Now I am going to stroke your hand, and as I do,
    you will gradually begin to be aware of
    HYPNOSIS WITH MEDICAL DISORDERS 225
    feelings of warmth flowing from my hand into SUGGESTIONS
    yours and flowing all through your hand, as these
    feelings of warmth continue to grow stronger and You know that part of becoming healthier and
    stronger with each passing moment. As 1 stroke happier is to allow yourself to enjoy only foods that
    your hand now, you will soon begin to notice these are good for you. In this garden, if you become
    feelings of warmth flowing into your hand from hungry there are all types of fruit trees growing
    mine, and as soon as you do, you can signal me by here and vines, especially raspberries,
    nodding your head. [After the subject has nodded strawberries, mangoes, pineapples, and oranges.
    his assent:] That's fine. Now, as the warmth The water is pure and cool; there are ponds which
    continues to grow stronger, you are going to feel it are spring fed. The water in one of the ponds is
    becoming concentrated in the warts themselves. only for drinking and it has very special properties
    And soon the warts will begin to feel warmer than that allows your antiviral and immune system to
    the rest of your hand. As I stroke the warts now, work at it best, to maintain and support your
    you can feel the warmth flowing into them from the healing process so that you can remain free from
    rest of your hand. And as soon as you can feel the illness and the vaginal warts. It is important that
    warmth in the warts themselves, you can signal me you drink 8-10 glasses of water per day to help
    by nodding your head once more. your body remain free from the warts.
    [After the subject has nodded his head once If any warts ever appear, your body will
    more:] Very good. Now, as you continue to feel the automatically search and find them, and will
    warmth flowing out of my hand and concentrating activate your anti-viral mechanism in your brain,
    itself in the warts while I continue to stroke them, along with decreasing the blood supply to any
    the warts are going to start to heal. And this healing wart, anywhere on your body. Lastly you will
    process is going to continue until the warts are gone permit yourself to feel the warmth of the sun and its
    completely. Over the coming days, your warts are heat in any area where the warts may appear and
    going to become flatter and smaller, and soon they the warmth of the sun will dry them out
    are going to disappear completely. Before very immediately.
    long, they will be completely gone. Within a very
    There are also other types of special ponds in
    short time, your warts will be gone completely.
    this garden. You can go to any of these special
    ponds daily as part of your ongoing pursuit of
    health. They are ponds of positive emotions and
    strength—such as ponds of patience, humor,
    Suggestions for Vaginal Warts perseverance, calmness, kindness, endurance, high
    energy, wisdom and others. These ponds are warm,
    Diane Roberts Stoler, Ed.D. soothing and moss-lined, about the size of a bath
    Boxford, Massachusetts tub, and you may take a dip in any of them when
    you need to replenish your supply of energy or
    positive emotions.
    INTRODUCTION
    Another very special pond is the golden glitter
    This script was written for a 26-year-old woman pond. This pond is there for whenever you need to
    with recurring vaginal warts. She loved the ocean deal with warts or other bodily ailments, whether
    and was into holistic health. Imagery was used for the causes are physical or emotional. You may take
    extensive induction and deepening prior to giving out this special clay and put it on whatever part of
    the following suggestions. The last imagery scene your body needs healing. The pond is warm, but
    was of a lush garden with a mountain stream not hot, and its healing energy penetrates through
    flowing down through it. your skin and flesh to heal and rejuvenate your
    entire body with a soothing pleasant tingle.
    226 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    There are no other people in the garden unless your skin becomes normal in every way. You can
    you want them there. No one can bother you here. forget about the warts and turn your conscious
    You have no cares or worries. You feel safe, thoughts to other things, because your natural
    secure, calm, peaceful and relaxed. There is a sense healing processes will cure the warts without your
    of peace with the environment around you. This having any further concern about them.
    spot is peaceful and serene. You feel calm,
    peaceful, confident. This spot is a safe, secure spot.
    No one can bother you here. You are peaceful,
    calm, relaxed. You go deeper and deeper, deeper Suggestions for
    and deeper, and as 1 talk to you, you continue to go Immunodeficient
    into an even deeper state of relaxation. Everything
    but my voice is becoming remote now, quite Children with Warts
    remote; nothing else but my voice seems important, M. F. Tasini and Thomas P.
    nothing else is important, nothing else but my
    voice. [Further deepening suggestions are now Hackett, M.D.
    offered.]
    "Let yourself feel relaxed and tired all over.
    You can come anytime to this special garden and Imagine doing something you like to do. Think of
    you can enjoy the fruit, the water, the various ponds doing it now and how much fun it is. Take a few
    to replenish your strength and positive energy, deep breaths —in and out —and imagine that as
    along with the very special golden glitter pond. you let your breath out you get more and more
    This pond is there for whenever you need to heal relaxed. Feel your hand, the hand you write with,
    bodily ailments. If there are any underlying begin to tingle. Now it will start to get real
    imbalances that any ailments are symptomatic of, light—like a feather. Imagine your hand is so light
    you will allow yourself to become aware of the it will begin to rise up. Let it go. As it rises you will
    reason for that ailment. begin to feel very relaxed and good. Let it stay up
    for a while and then let it come down. As it comes
    down you continue to feel very relaxed and good."
    While in the trance state, the patients were told the
    Suggestions with Condyloma following, "the warts will feel dry, they will then
    Acuminatum (Genital Warts) turn brown and fall off. They will not trouble you
    anymore." [Patients were seen for an average of
    Dabney M. Ewin, M.D. three sessions.]
    New Orleans, Louisiana

    Your body has the capacity to overcome the wart


    virus and heal this infection. Focus your attention Evoking Helpful Past
    on the involved area and soon you will notice a Experiences and Medical
    sensation of warmth in the surrounding skin as the Treatments: Example with
    blood vessels dilate to bring in more antibodies and
    white blood cells to fight the infection, and more Skin Rash
    protein and oxygen to help build the new and
    normal tissue when the wart has gone away. When
    M. Erik Wright, M.D., Ph.D.
    you feel the increased warmth, your left index
    finger will rise . . . [finger rises] . . . good. . . . Now INTRODUCTION
    your inner mind will lock in on this and maintain [The following example is that of a client who
    this warmth until the warts are healed and
    was beset with a recurring, highly irritat-
    HYPNOSIS WITH MEDICAL DISORDERS 227
    ing skin rash:] When you had this skin rash three pleted. Give yourself the signal for arousal,
    years ago, you used to get great relief from soaking feeling refreshed and comfortable.
    in a lukewarm bath in which you had dispersed half
    a box of cornstarch. Of course, when you are able to
    get into the bath water, you can truly enjoy the good
    feeling on your skin. However, there are many Suggestions with Pruritus
    times, such as at work, when you cannot get into a
    bath to reduce the distress of the rash. When you William S. Kroger, M.D., and
    find that your tolerance for the distress is becoming William D. Fezler, Ph.D.
    shaky, close your office door and give yourself an Palm Springs, California, and
    intense irritation-relief treatment. Beverly Hills, California

    RAPID INDUCTION AND SUGGESTIONS. [The therapist IMAGERY OF SOFT COTTON. You are enveloped in a
    draws upon the client's ability to enter trance:] layer of cotton which acts as a protective coating.
    Close your eyes and give yourself the cue to relax This wonderful feeling will remain for several
    and become quite drowsy. . . . Feel your body hours (or all day): your skin will feel fine until your
    becoming lighter with each breath that you take . . . next visit.
    until you get the feeling of your body floating in
    your bathtub . . . and the water is at just the right NEGATIVE SENSORY HALLUCINATION [The hypno-
    temperature and you can see and feel the cornstarch tized patient is asked to imagine how the skin looks
    dispersed throughout the water. . . . When you have and feels in an area without lesions.] Look at your
    reached that point . . . signal with your right index right wrist; you can begin to speculate on whether
    finger. . . . Very good. . . . or not that area will look like your left wrist, which
    Feel the smooth, cool particles touch and coat does not have any involvement. Now, keep looking
    your skin at every point where there is any irritation at the left wrist; notice the texture of the skin —it
    . . . and as the skin is coated by these particles, feel also feels perfectly normal, does it not? [The
    the coolness and the relief as the particles draw out patient nods his head in agreement.] Every time
    the tenderness and irritation from each of the rash you look at this wrist you will observe that this area
    bumps. As the discomfort leaves, the skin energy is on your right wrist is becoming as normal-looking
    left to continue the healing. . . . Feel the active as your left wrist. You may also close your eyes,
    healing as the new cells on the surface of the skin and in your "mind's eye" see or imagine that the
    replace the injured, irritated cells. . . . See, below lesions have disappeared —the skin is normal in
    the surface of the skin, how the blood is actively appearance. However, you may keep just as much
    nourishing the healthy tissue growing on the skin . . of the itching on the involved area of the wrist as
    . and the skin irritation subsides and becomes you wish to retain. You do not have to get rid of
    readily tolerable. . . . this itching all at once, but rather, allow it to
    disappear slowly. [The patient is given another
    [The therapist then offers a posthypnotic healing posthypnotic suggestion such as:] You might raise
    suggestion:] Let this cooling and healing continue the question whether you wish this lesion [on the
    even after you open your eyes, for as long as wrist] or that lesion [one near the elbow] to
    possible. . . . Each time that you repeat the exercise, disappear first. Also, you might begin to consider
    the postexercise effect of cooling and healing the possibility of just when this will occur. Will it
    regrowth will continue a bit longer. Soon you will be tomorrow, a week from tomorrow, or several
    not need the exercise at all, because the healing will weeks from now? At any rate, the more you keep
    have been com- thinking about this under auto-hypnosis, the more
    likely the rash will go away.
    228 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Reducing Dermatologic duces comfort . . . that promotes healing . . . that
    turns off the sensations in the affected skin areas,
    Irritation allowing more rapid healing to take place. And as
    this comforting, healing solution gently spreads
    D. Corydon Hammond, Ph.D.
    over all the affected areas, you'll notice the
    Salt Lake City, Utah
    underlying texture of the skin changing, softening,
    becoming more and more normal. Your skin
    INDICATIONS changes to a comfortable, relaxed, normal color
    and consistency. Continue letting that soothing,
    These suggestions are intended for use following healing ointment sink in, and allowing more to be
    induction and deepening with conditions like spread on until there is a sense of complete
    pruritus, eczema, neurodermatitis, and herpes comfort, and relief. And when your unconscious
    simplex lesions. In the case of herpes lesions, the mind knows that this has influenced your skin
    suggestions should be for the solution to produce a sufficiently so that you will be able to maintain
    drying effect, to comfortably dry up the lesions. several hours of comfort, it will cause the index
    finger on your right hand to develop a lightness,
    and float up all by itself, as a signal to you. [Pause
    SUGGESTIONS until the signal is given.] And within another
    minute or two you will become consciously aware
    And as you remain deeply relaxed, I want you to of the comfort, and then you may awaken, realizing
    imagine that a cooling, healing salve or ointment is that you can apply this salve again in self-hypnosis,
    being gently spread over the affected areas of your whenever you need to.
    skin. It is an ointment that pro-

    HYPNOSIS WITH BURNS AND EMERGENCIES

    Suggestions with Burn Patients doing you are going to get well ... a very deep and
    sound level. ... As you are aware of this . . . nod
    Harold B. Crasilneck, Ph.D., and your head. . . . Good . . . a deeper and a sounder
    state. . . . Now the finger that I touch will lose all
    James A. Hall, M.D.
    feeling. . . . Now as that finger feels and is numb . .
    Dallas, Texas
    . nod your head, yes. . . . Good . . . Now open your
    eyes. . . . You will note that I am stimulating that
    finger very hard with the point of my nail file, but
    SUGGESTIONS
    you have absolutely no sensation of pain. Pressure,
    but no pain. Now normal sensations return to your
    I am going to ask you to stare at this coin that I'm finger. As you feel the file just barely stimulating
    holding and as you do so, pay no attention to any your finger, pull it away. . . . Good . . . relax . . . now
    other sounds or noises. You are aware that you are you can realize the power of the mind over the
    breathing more rapidly and also that as you stare body and if you can block pain . . . real pain . . .
    intensively at this coin, your eyelids are beginning then, you can allow your body to respond to other
    to blink and to feel heavy. As you feel them getting suggestions equally well. You are now in a very
    heavy and drowsy, just let them close . . . that's it . . deep state of relaxation. . . . You are going to hear
    . they are fluttering .. . closing and closed . . . some soft music that is pleasurable to you . . . and
    closing and closed . . . and as I continue talking, as this
    you will enter a very deep level of hypnosis ... for
    in so
    HYPNOSIS WITH MEDICAL DISORDERS 229
    occurs, nod your head, yes. . . . Good . . . and now a second degree for the first four hours. . . . The
    very deep and relaxed state of mind and body. deeper dermal layers are not immediately killed by
    Because of the power of your mind over your body the heat, but rather later by the body's
    . . . you are going to be able to definitely increase inflammatory response.
    your food intake. This food intake is going to help Chapman, Goodell, and Wolff (1959a,b)
    you to get well ... it is an integral part of your showed that inflammation is mediated through the
    rehabilitation, and you will eat all the food central nervous system by release of a
    prescribed by your doctor. The food will taste good. bradykinin-like substance which is released during
    . . . You will enjoy your food . . . realizing that with the first two hours after the burn stimulus, but that
    every mouthful you digest you are improving your the release of this enzyme is held in abeyance by
    physical and mental state. . . . Food intake is going icing the wound. They also showed that hypnotic
    to help you get well. . . . You will be hungry much suggestion can produce a blister (response without
    of the time and you will eat not only the regular a true stimulus), and can prevent blistering when
    meals, but also the supplemental food ordered for an experimental burn is placed on a hypnotically
    you. You will be hungry and your appetite will def- anesthetized arm (true stimulus without a
    initely increase . . . you will have a craving for each response). Thus, the damaging inflammatory
    reaction can be blocked by early hypnosis,
    meal because in your case food intake is an
    attenuating the ultimate depth and severity of the
    absolute necessity to health and you will eat every
    burn (Ewin, 1978, 1979).
    meal with enjoyment . . . knowing this food is
    making you get well very rapidly. As I slowly count During the first two days after a severe burn,
    from ten to one backwards, you will fully awaken . . inflammation causes large amounts of fluid to
    . relaxed, at ease, and hungry- exude into the burned tissues from the blood-
    stream, requiring intravenous replacement to
    prevent shock and kidney shut-down. Since much
    of this fluid is later reabsorbed and can overload
    Emergency Hypnosis for the the cardiovascular system, standard fluid formulas
    Burned Patient aim at giving the least amount of fluid that will
    maintain both blood pressure and minimal urine
    Dabney M. Ewin, M.D. output of 25 cc to 50 cc per hour (600-1,200 cc per
    New Orleans, Louisiana 24 hrs.). Margolis, Domangue, Ehleben, and
    Schrier (1983) have shown that, in every case
    hypnotized before ten hours, the urine output on
    INTRODUCTION the second day was significantly elevated,
    averaging 3501 cc as opposed to 1,666 cc in
    The acutely burned patient arrives in the
    matched controls. With the inflammatory edema
    emergency room in a state of frightened anxiety,
    limited, the calculated fluid was too much, and the
    seeking prompt relief of the burning pain, and in a
    extra had to be cleared through the urine.
    hypnoidal state that makes him highly susceptible
    to both good and bad suggestions. The body's When a newly burned patient arrives in the
    response to the thermal injury is inflammation, emergency room, his mind is concentrated and
    causing progressive pathologic worsening hypnosis is usually easy to induce. Since he may be
    (Hinshaw, 1963) of the injury. In sun burn, the first a stranger to the physician, the first communication
    degree burn (redness) present on leaving the sun is an introduction and suggestion.
    progresses to second degree (blister) in the ensuing
    8-12 hours. The "standard" third degree VERBALIZATION
    (full-thickness) burn was shown by Brauer and
    Spira (1966) to be only Doctor: I'm Dr ___________ and I'll be taking
    care of you (pause). Do you know how to treat
    230 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    this kind of burn? [This question is to bring to his patients are aware of this phenomenon in
    immediate attention that he doesn't, and that he light-skinned people.]
    must put his faith in the medical team. Precise Patient: Yes.
    wording is important because if you ask, "Do you Doctor: Well, you know that nothing has
    know anything about treating burns?" he may know happened except a thought, an idea, and all of the
    something and tell you about butter, Solarcaine, or little blood vessels in the face have opened up and
    kiss-it-and-make-it-well, which is a complete turned red, or clamped down and blanched. What
    avoidance of recognizing the dependence.] you think is going to affect the blood supply to your
    Patient: No. [The standard reply. In the rare skin, and this affects healing, and you can start right
    instance of a physician or nurse who actually does now. You should have happy, relaxing, enjoyable
    know about burns, you simply use that knowledge thoughts to free up all of your healing energy. Brer
    to say, "Then you already know that you need to Rabbit said "everybody's got a laughing place," and
    turn your care over to us, and that we will do our when I tell you to go to your laughing place, I mean
    best."] for you to imagine that you are in a safe, peaceful
    Doctor. That's all right, because we know how to place, enjoying yourself, totally free of
    take care of this and you've already done the most responsibility, just goofing off. What would you do
    important thing, which was to get to the hospital for a laughing place?" [The patient needs
    quickly. You are safe now, and if you will do what I something he perceives as useful to occupy his
    say, you can have a comfortable rest in the hospital time. The laughing place may be the beach, TV,
    while your body is healing. Will you do what I say? fishing, golfing, needlepoint, playing dolls, etc. It
    [This exchange lets the patient know that he is on becomes the key word for subsequent rapid induc-
    the team and has already done his biggest job, so he tions for dressing changes, etc., to simply "go to
    can safely lay aside his fight or flight response (he's your laughing place."
    already fled to the hospital) which mobilizes
    Patient: Go to the beach . . . or . . .
    hormones that interfere with normal immunity and
    Doctor: Let's get you relaxed and go to your
    metabolism. It includes a prehypnotic suggestion
    laughing place right now, while we take care of the
    that he is safe and can be comfortable if he makes a
    burn. Get comfortable and roll your eyeballs up as
    commitment. His affirmative answer has made a
    though you are looking at the top of your forehead
    hypnotic contract that is as good as any trance.]
    and take a deep, deep, deep breath and as you take it
    Patient: Yes, or, I'll try. [Frightened patients in, gradually close your eyelids and as you let the
    tend to constantly analyze each sensation and new breath out, let your eyes relax and let every nerve
    symptom to report to the doctor. By turning his and fiber in your body go [slow and cadenced]
    care over to us (the whole team), he is freed of this loose and limp and lazy-like, your limbs like lumps
    responsibility and worry. Next, his attention is of lead. Then just let your mind go off to your
    diverted to something he hadn't thought of before.] laughing place and . . . [visual imagery of laughing
    Doctor: The first thing I want you to do is to turn place]. [This short bit of conversation does not
    the care of this burn over to us, so you don't have to ordinarily delay the usual emergent hospital care.
    worry about it at all. The second thing is for you to Most often, when the patient arrives in the
    realize that what you think will make a great deal of emergency room an analgesic is given, blood is
    difference in your healing. Have you ever seen a drawn, I.V. drips are started, and cold water
    person blush, or blanch white with fear?" [Even applications are applied by the time the doctor
    dark-skinned arrives. If not, these can proceed even while the
    conversation takes place. A towel dipped in ice
    water produces immediate
    HYPNOSIS WITH MEDICAL DISORDERS 231
    relief of the burning pain that occurs right after a laughing place is and to record it, because he may
    fresh burn. Since frost bite is as bad an injury as a enhance it later with some visual imagery. This
    burn, the patient should not be packed in ice, but ice simple, rapid induction usually produces a
    water towels are very helpful. In fact, Chapman et profound trance almost immediately. By this time,
    al. (1959a,b) showed that applying ice water to a the patient has iced towels on and the analgesic is
    burn holds the inflammatory response in check for taking effect so that he actually is cool and
    several hours, so there is ample time to call for the comfortable. It is much easier hypnotically to
    assistance of a qualified hypnotist if the primary continue a sensation that is already present than it is
    physician is not skilled in the technique of to imagine its opposite. The suggestion "cool and
    hypnosis.] comfortable" is anti-inflammatory, and if he
    Doctor: Now while you are off at your laughing accepts it he cannot be hot and painful. From now
    place, I want you to also notice that all of the on, the word injured is substituted whenever
    injured areas are cool and comfortable. Notice how possible for the word burn, because patients use the
    cool and comfortable they actually are, and when word "burning" to describe their pain. (Do not
    you can really feel this, you'll let me know because specify a particular area, hands, neck, etc., because,
    this finger (touch an index finger) will slowly rise while these areas will do well, some spot you forgot
    to signal that all of the injured areas are cool and may do poorly.)
    comfortable." I just leave the patient in trance and go ahead
    Doctor. [After obtaining ideomotor signal:] Now with his initial care, get him moved to the Burn
    let your inner mind lock in on that sensation of Unit, and often he will drop off to sleep. On
    being cool and comfortable and you can keep it that subsequent days, "Go to your laughing place," is
    way during your entire stay in the hospital. You can all the signal the patient usually needs to drop off
    enjoy going to your laughing place as often as you into a hypnoidal state and tolerate bedside
    like, and you'll be able to ignore all of the procedures, physical therapy, etc.
    bothersome things we may have to do and anything
    negative that is said. ... Go to your laughing place.
    In burns under 20%, the single initial trance
    generally suffices, while in larger burns, repeated Hypnosis in Painful Burns
    suggestion helps control pain, anorexia, and
    uncooperativeness. R. John Wakeman, Ph.D., and Jerold
    Since a thought can produce a burn (vide supra), Z. Kaplan, M.D.
    continued feelings of guilt or anger can prevent
    healing and should be dealt with during emotional
    countershock a day or two after admission. If the INTRODUCTION
    patient is guilty, I stress the fact that it was
    unintentional and that he has been severely BURNS WITH CHILDREN. A burn injury is a
    punished and has learned a lesson he will never devastatingly traumatic experience for anyone,
    forget or repeat. If he is angry, I point out that the regardless of age. The younger child often has
    goal is healing, and it does not interfere with his greater difficulty in adjusting to routine (painful)
    legal rights to get the best healing possible or to procedures. He/she may have problems
    forgive the other person of evil intent. There is no understanding why he/she must be submitted to
    place for anger at his laughing place, and he is torturous procedures and cannot easily project into
    instructed to postpone that feeling until healing has the future with knowledge that it will all end soon.
    occurred. For these reasons, hypnosis utilization became a
    It helps for the doctor to know what the highly demanded and reinforcing alternative for
    the children, their par-
    232 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    ents, and the staff of our unit. Hypnotic training on what new . . . and exciting experiences lie ahead
    with younger children included such procedures as . . . more and more hope and positive anticipation . .
    the "television screen" induction, dissociation to a . about your return home . . . your seeing friends . . .
    "favorite place," and posthyp-notic suggestions for and your renewed energy to get as much out of life
    "letting the body take a nap" when feeling as possible in the years to come . . . and so on. . . .
    discomfort.

    SUGGESTIONS PRIOR TO
    SUGGESTIONS DEBRIDEMENT

    [Ego-strengthening suggestions for improved [An example of a typical dissociation discourse


    self-esteem, body-image acceptance, hope, and after deepening has been achieved just prior to
    coping skills for transition back into their families, debridement is as follows:] . . . and as you continue
    homes, and communities were found to be quite to go deeper . . . and deeper . . . into that
    effective in making the patient recovery period comfortable . . . relaxed state ... as each moment
    more positive. After the patient had achieved his or goes by . . . you may be surprised at how easy it is
    her deepest level of hypnosis, suggestions were for you to experience ... the calmness, . . . comfort, .
    included such as:] . . . and as the days go by . . . you . . and pleasant relaxation . . . felt at your . . . special
    will find that your attention ... is less and less place [individual's scene—e.g., "boat races in San
    focused on your liabilities . . . your disabilities ... or Diego"] . . . enjoying the surroundings . . . and
    your changes of appearance . . . and more and more going even deeper . . . letting your body relax . . .
    focused ... on your assets . . . your strengths . . . and more and more completely . . . feeling the warm
    your inner resources . . . such as appreciation and breeze . . . the gentle rocking of your boat . . . back
    pride in . . . your self-control . . . cooperation . . . and forth . . . back and forth . . . with each breath . .
    intelligence . . . and inner fortitude . . . never . you see all of the beautiful colors of each racing
    allowing you to quit ... or give up . . . and becoming boat . . . counting the boats as they speed by . . . and
    more . . . and more . . . fully aware in attitudes . . . going deeper . . . now feeling perfectly at ease . . .
    beliefs . . . and feelings . . . that despite your body's nothing to distract you . . . nothing to interrupt your
    differentness from the way it was . . . you know that pleasant experience . . . and knowing at all times . .
    differentness is never a measure of worth . . . and . that all you have to do to return to this place ... is
    although you may now be somewhat different . . . raise your hand and arm . . . and as they grow heavy
    you are still . . . and will always be as worthwhile . . . . . you become deeply relaxed . . . deeply relaxed .
    . as a human being . . . and driven to find new . . completely comfortable . . . and can remain
    strengths . . . new abilities . . . and interests ... in comfortable for a long time . . . even after leaving
    your life to come . . . accepting yourself more and the beautiful scene . . . deeply comfortable . . . when
    more ... as really the same person . . . that you were exercising . . . when eating . . . when moving . . .
    before . . . just stronger .. . with some differences . . you will find that sleeping is no longer a problem . .
    . which do not detract from your worth ... as a . you will be surprised at how much stronger you
    person . . . more and more able to understand other's grow . . . each day . . . little by little . . . stronger and
    failures in accepting "differentness" . . . more and more relaxed . . . completely comfortable . . . even
    more supportive of your family ... in every way . . . when you are no longer with me . . . even when you
    finding it quite interesting that you seem to be less are not at this beautiful place . . . feeling better and
    and less concerned . . . about how you have better . . . without flaws . . . without
    changed . . . about how you will live . . . and more apprehensions . . . only relaxation . . .
    and more focused
    HYPNOSIS WITH MEDICAL DISORDERS 233
    calmness . . . comfort . . . and self-confidence . . . fingers will lift to let you know how well you
    and so o n . . . . are doing."
    3. Ratifying and maintaining healing
    a. "That coldness and numbness will re
    main there for at least two hours. Then
    Ideomotor Healing of it may be necessary to repeat the exer
    Burn Injuries cise. You will get better each time you
    do it, and the result will last longer
    Ernest L. Rossi, Ph.D., and and work more effectively as you go
    David B. Cheek, M.D. along."
    Malibu, California, and Santa Barbara, California b. Any difficulty with this procedure may
    indicate a need to work through emo
    tional problems.
    If a patient is seen hours or days after
    experiencing a burn, proceed as follows, explaining
    the process as a means of eliminating inflammation
    and allowing healing to occur rapidly.
    Direct Suggestions in
    1. Accessing inner healing resources Emergencies with the
    "Remember a time when you walked into Critically I II
    cold water. It felt cold for a while until a
    time when you got used to it. That represents Ernest L. Rossi, Ph.D., and
    a degree of numbness. When you are feeling David B. Cheek, M.D.
    cold at an unconscious . . . level, your brain Malibu, California, and Santa Barbara, California
    will shut down the messages that cause
    inflammation and interfere with healing. 1. The critically ill are already in a state of
    "Imagine standing in cold water up to hypnosis. Learn to recognize and utilize the
    your knees. When you are feeling that un- spontaneous expressions of hypnotic behavior.
    consciously, your yes finger will lift. When 2. Avoid conversation and actions that might
    you are half as sensitive as normal, your no suggest pessimism. Suggest hope and opti-
    finger will lift. mism, but do so sincerely since the threatened
    "Now, walk in further until the cold water human is canny in recognizing reassurance that
    is up to your hips. Your yes finger will lift is phony.
    when you are cold from your hips to your 3. Collect your thoughts and marshal a plan of
    knees, and your no finger will lift when you action before touching or speaking directly to
    are numb from your hips to your toes. Your the patient. You may be breathless in your
    right hand wrist will be below the water level hurry to get to the patient; you may not know
    and will also feel numb." [This will happen exactly what to do. Take a few moments to give
    without explanation, even though the patient is directions to bystanders. Your voice will be
    lying in bed.] confident with them because you know more
    2. Self-testing of hypnotic analgesia than they do. The quality of your voice will
    "Now you know how to make parts of your then give confidence to the patient in accepting
    body alter sensations. Please place your cold, reassurance from you. You also have gained
    numb right hand over the burned area and time to control the expressions of your haste.
    experience the coldness and numbness flow 4. Tell the patient what has happened and that he
    into the burned area. When you know the will be all right. Outline what you are doing
    burn is cold and numb, your yes and no now and what your reason is for so
    234 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    doing. This implies that you respect his healing source (mind, brain, etc.) carries
    knowledge and his ability to understand your out the following:
    actions. Allow time to outline what steps to c. "Your inner healing source can let this
    take as you plan for the patient tomorrow and in finger lift when the bleeding (and/or
    the future. There is no better reassurance than pain, etc.) has been turned down by
    the tacit suggestion that you expect a future for half."
    which to plan. d. "That finger can lift again when your
    Instruction and promise of a future should be comfort can continue getting better and
    given to unconscious people, even when they better in every way."
    show no pupillary reflex to light. Congratulate 2. Therapeutic facilitation
    the unconscious person for being so relaxed, a. "Your inner mind knows exactly what it
    and tell him specifically how long you expect needs to do to continue recovery by
    him to remain in this relaxed state before returning your blood pressure (or what
    awakening with feelings of hunger and ever) to normal. It can lift a finger to
    thoughts of food. indicate that healing is continuing now
    5. Give medication for pain if possible. This is a all by itself."
    form of communication showing that you are b. Congratulate the patient for being so
    interested in taking constructive action. Tell relaxed and doing so well in allowing the
    him what you are giving and for what purpose. healing to take place.
    The patient will know that it takes a little time c. Outline a series of steps (signs) by which
    before medication works; he will be able to the healing process will continue in the
    focus attention better on your actions during the immediate future.
    interval. The time taken in giving an injection 3. Ratification with posthypnotic suggestion
    allows you time to collect your thoughts and "You will feel yourself going into a deep,
    control any outward signs of alarm. comfortable sleep for four hours and then
    6. If he is able to talk, get the patient talking about awaken feeling refreshed and alert with a
    work, hobbies or his family. The human mind good appetite." (Appropriate suggestions for
    can be taught to ignore pain and sources of each patient's particular situation are added at
    shock if it is directed to concern itself with this point.)
    times and places where pain and fear did not
    exist.

    Suggestions for Use of


    SUMMARY OF DIRECT HEALING Spontaneous Trances in
    SUGGESTIONS IN EMERGENCIES Emergency Situations
    M. Erik Wright, Ph.D., M.D.

    All injured, frightened, hemorrhaging, shocked,


    and unconscious people may be considered INTRODUCTION
    critically ill. They enter a hypnotic state
    In crisis or life-threatening situations (e.g.,
    spontaneously and need no formal induction.
    cardiac trauma, automobile accidents), patients
    typically enter spontaneous trances, fixated in their
    1. Accessing healing sources attention on their body and immediate
    a. Outline simply and briefly what you are environment. Unfortunately, negative suggestions
    going to do for them now. are often made in emergency situations by
    b. Designate a finger (by touching it light bystanders, ambulance attendants, police and
    ly) to lift all by itself when the inner medical personnel. For instance, patients may
    HYPNOSIS WITH MEDICAL DISORDERS 235
    hear: "You'd better hurry, this guy may not make [Other, similar suggestions were modeled by
    it!" "Is this guy going to make it?" "Wow, look at Dr. Wright in his scientific meeting talk:] Let your
    that blood all over the place. This woman's a mess." body concentrate on repairing itself and feeling
    At an annual scientific meeting of the American secure. Let your heart, blood vessels, everything,
    Society of Clinical Hypnosis, Wright presented bring themselves into a state of preserving your
    results of an experiment where patients were life. Bleed enough so that it will cleanse the
    randomly assigned to experimentally trained wounds and let the blood vessels close down so
    ambulance attendants versus untrained attendants. that your life is preserved; your body weight, your
    Crews trained to give positive suggestions had body heat, everything is going to be maintained,
    significantly fewer patients who were dead on and things are being made ready at the hospital.
    arrival and their patients had a quicker recovery We are getting there as quickly and as safely as
    rate. This is a vitally important topic for further possible. You are now in a safe position. The worst
    confirming research. is over. We are now taking you to the hospital.
    We believe that emergency personnel should be
    trained in giving positive suggestions, even to
    uncommunicative, stuporous patients. SUGGESTIONS FOR CARDIAC
    These suggestions, the first paragraph of which EMERGENCY PATIENTS
    are reprinted from Dr. Wright's book, illustrate
    This has been a terrible thing that has happened,
    suggestions used in his study. (Ed.)
    but it is over and now it is time for the body to
    make use of itself and begin recovering. There are
    many things that will be able to be attended to later.
    SUGGESTIONS FOR AMBULANCE Now the main thing is to let your body heal itself,
    ATTENDANTS relax, and begin to think in terms of what tomorrow
    may bring, of how good it is to be alive, and to be
    [Ambulance attendants may be taught to give the
    able to breathe and to be able to know that even
    following types of suggestions, speaking in a rather
    with the tubes in your nose, there is life, and there
    low-key manner, close to the ear of the patient.]
    You are in good hands now. You will be at the is hope.
    hospital shortly. Everything there is being made
    ready to help you. Let your muscles relax, let your SUGGESTIONS AFTER STABILIZATION
    mind begin to feel more secure and quiet. . . .
    AT THE HOSPITAL
    Wherever this may be needed, let your blood
    vessels adjust to keep the blood circulating inside [Focusing on the body movements that are still
    your blood vessels and to seal off leaks if they there:] How good it is that you can focus and listen
    occur. . . . Wherever your skin is tight and tense, let to me. There are a lot of things that we'll be able to
    it relax and permit the body's healing processes to talk about in the next week of learning when you
    begin to work. . . . As you listen to my voice, you can begin exercising, when you can begin to . . .
    will find yourself gradually becoming calmer. . . . [you lay out a program of future action, rather than
    Your breath will move in and out of your chest a focus on the debit, the losses that have taken
    more freely and more regularly. . . . Your body has place. Now what you are offering is very limited
    already begun to mobilize its healing powers and and realistic in terms of what will be done.]
    started to repair your hurt. . . . Everything that can
    be done to help you right here is now being done. [By setting a framework of anticipation, the
    Soon you will be at the hospital. The medical team individual first detaches himself from the anxiety
    has been told that you are on your way in. The team about the self and the number of secondary assaults
    will take over with the hospital's resources to help so that the aftershock is lessened because you
    you. . . . suggest that the heart, through learning how to
    make use of itself, is like it is
    236 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    shedding a load:] The attack has been a heavy load of a vasoconstricting effect would argue against the
    and it may shiver a little bit, but that is all right. likelihood of promoting infection. Nevertheless,
    [Thus, whatever may happen, you anticipate it so results with both proparacaine and TAC have been
    that you do not give rise to a new set of fears.] imperfect.
    Work with hypnosis led to the development of
    the present technique. No additional drugs are
    COMMENTARY required, nor does the procedure require additional
    time. Instead, the patient's attention is focused
    Dr. Wright encouraged emergency personnel to
    away from the wound and distributed elsewhere. A
    translate to the patient the body experiences
    discrimination task is assigned, and confusion is
    happening to him or her, such as the sense of
    engendered by giving instructions ambiguously.
    pressure that comes and goes. He recommended
    talking with postcardiac recovery patients and with The patient's consciousness is thus sufficiently
    emergency physicians to learn about the subjective preempted to permit injection without the
    body experience of cardiac patients. The trained perception of pain.
    professional may then comment on the [It is recommended by the author that you draw
    symptomatology and feelings of the patient a picture of a wound on a piece of paper and
    (pacing), and then make comforting suggestions practice this technique with the paper to promote
    about it (leading). (Ed.) mastery. (Ed.)]

    METHOD
    Painless Wound Injection A sterile field is prepared around the wound, and
    Through Use of a Two-finger the patient is instructed that it would be best to
    direct his or her vision elsewhere. The physician,
    Confusion Technique who usually engages in small talk while setting up,
    then says: "Now here's a distinction you can learn,"
    Steven F. Bierman, M.D. emphasizing the italicized words. One finger of the
    physician's left hand is then placed to one side of
    INTRODUCTION the wound, a second finger to the other side.
    (Where the wound is long, a finger is placed on
    Injection of local anesthetic into an open wound, either side of the wound and gradually moved along
    in preparation for suturing, is in some ways like its length as the injection proceeds.) With the
    adding insult to injury. The procedure is painful physician using the right hand, the wound is then
    and generally dreaded by patients. In recent years, injected. All the while, the physician is delivering
    physicians have turned to topic preinjection the following instructions and questions so as to
    solutions in hopes of eliminating such discomfort maintain the state of distraction (notice that the play
    (Pryor, Kilpatrick, Opp, et al., 1980). Although is on two words: "one," referring to finger #1 and to
    these solutions are often effective, especially in one finger— as opposed to two fingers — and
    shallow wounds, their efficacy is limited in deeper "two," referring to finger #2 and to both fingers:)
    wounds that require extensive debridement and
    layered closure. There is also the suggestion, albeit
    from animal studies, that Now, I'm going to place finger #1 here [on one
    tetracaine-adrenaline-cocaine (TAC) solution may side] and finger #2 here [on the other side]. And you
    predispose to wound infection (Barker, can feel finger #1 [wiggle finger] and finger #2
    Rodeheaver, Edgerton, et al., 1982). This author [wiggle finger], can't you? Now when I say feel, I
    mean the light touch, not the wiggle, so that whether
    has achieved reasonable success in this regard by 1 am moving finger #1 [wiggle #1] or finger #2 [wiggle
    using topical proparacaine, 0.5% solution. Here, #2] or two [wiggle both] or just moving one [wiggle
    the absence
    HYPNOSIS WITH MEDICAL DISORDERS 237
    #2], you can still sense the touch of #1 [wiggle 1] or two often effect some measure of numbness under either or
    [wiggle both]. Now at some time either one [wiggle #2] both. So the target phenomenon will actually occur.
    or both [wiggle both] will go numb, and what I want you Therefore, the physician can, and should, be earnest in
    to pay attention to is when one [wiggle #1] or two his or her directions; the patient, sensing this, will be
    [wiggle #2] begins to feel less. And it's kind of like the attentive and gratified upon discovering the effect.
    old one [wiggle #1]— two [wiggle both].
    To ensure success, the physician should attend
    scrupulously to three additional considerations. (1) The
    At this point, the injection usually begins. The physician
    word needle is never volunteered: unless the patient asks
    tries to keep the patient in a mild state of confusion while
    specifically, the word is not used. Instead, one might ask
    simultaneously directing the patient's attention to the side
    for "a 30 gauge," a truncated phrase which always
    of the wound not being injected. It is best, therefore, to
    communicates the need sufficiently. (2) The needle is
    alternate the side one is injecting, being careful to do so never shown. Lidocaine is drawn up into the syringe
    unpredictably. For example, while injecting side #1, the with the physician's back to the patient, thus concealing
    physician may say: the dreaded point. These simple measures eliminate the
    verbal and visual cues that would otherwise recall
    Now I know you can feel the movement of finger #2, previous unpleasant experiences and thus incite
    and I also know that if I stop moving one [stop #2] so that
    anticipation of the same. (3) The physician must be
    both one [wiggle—stop #1] and two [wiggle —stop #2]
    are still, you can still feel the touch of two [wiggle #2]; is careful to avoid such negative suggestions as "now this
    that correct? Now what I don't know, and what I need you is going to hurt," or "just a little prick now." As Erickson
    to tell me, is which finger, #1 or #2, is beginning to and Rossi (1976) have pointed out, "Every suggestion . .
    become more numb? . requires that [the patient] act it out for himself to some
    degree." The suggestion, however well-intentioned, that
    A similar tack may be taken when injecting side #2, with pain is about to occur is self-fulfilling.
    emphasis on the sensation under the contralateral
    finger. DISCUSSION
    At this juncture, the patient will generally comment.
    Thorough evaluation of the two-finger confusion
    Whatever is said, the physician should respond sincerely
    technique would, of course, require a prospective,
    and honestly. Common remarks by the patient are:
    randomized, controlled experiment. Proparacaine 0.5%
    "I'm sorry, which is number one and which is number (or TAC) alone, for example, could be compared as
    two?" The physician should respond by reiterating the preinjection anesthesia to proparacaine 0.5% (or TAC)
    initial instructions, more or less. plus the confusion technique. Initial results, however,
    "Neither is becoming numb, I think." The physician warrant this preliminary report, for I have found that
    should respond: "Neither is becoming numb, and yet you when administered in earnest, the two-finger method
    can feel finger #2 [wiggle #2] and two [wiggle both] and rarely allows for even the barest perception of the
    finger #1 [wiggle #1 . . ." and so on. injection. In well over 50 cases where the technique has
    "I'm feeling something else. . . ." The physician might been used, no patient has ever described the injection of
    respond: "You're feeling something else, yes, and yet local anesthetic into a wound as painful; the vast majority
    what I want you to do is pay attention too to exactly have felt nothing and have been surprised to learn that an
    when one of these fingers, #1 [wiggle #1] or #2 [wiggle injection has been given. Thus, whereas an exact
    #2] or two [wiggle both], is beginning to go numb. Now comparative study of available techniques would be nice,
    which finger [wiggling one after the other alternately] is
    there is no question that use of the two-finger confusion
    beginning to feel less?
    technique can result in painless wound injection.

    Any two-point discrimination of this sort will eventually


    accommodate to the perception of a single point.
    Moreover, instillation of local anesthetic in proximity to
    the two fingers will
    238 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    HYPNOSIS FOR HEALING, PSYCHOSOMATIC CONDITIONS A N D


    AUTOIMMUNE DISEASES

    General Approach to Physical This approach takes four one-half hour visits and
    is practical in a family practice office setting. I use
    Symptoms Caused by Stress this approach for conditions from insomnia to
    migraine. I may superimpose specific suggestions
    Carol P. Herbert, M.D., CCFP, FCFP V a n c o for particular symptoms, but have found that this
    u v e r , British Columbia general approach results in spontaneous remission
    of many symptoms, which is very powerful
    feedback to the patient to keep practicing. The
    A permissive approach to self-hypnosis which patient is seen in follow-up at one month and two
    emphasizes positive experiences of physical months, and then reinforced on routine visits for
    changes acts to reframe a negative self-image or medical care.
    previously confusing symptoms. I begin by briefly
    outlining the "fight or flight" response, then
    contrast the physical and emotional changes of the
    relaxation response. I ask the patient to choose a
    pleasurable visual or auditory image to focus Symphony Metaphor
    his/her awareness.
    Marlene E. Hunter, M.D. Vancouver,
    "Take a couple of deep breaths in . . . and out . . .
    and on the out breath, notice a sense of comfortable British Columbia, Canada
    heaviness beginning in one hand and arm. Repeat
    to yourself, 'My hand and arm are comfortably
    heavy,' several times. [Pause] Then allow your INTRODUCTION
    attention to pass to the other hand and arm and
    repeat, 'My hand and arm are comfortably heavy. This metaphor is obviously particularly apropos
    Both my hands and both my arms are comfortably for the musically inclined subject, but may be
    heavy.'" appreciated by many others also. There are many
    The same suggestions are given for the lower metaphoric concepts that may be included in such a
    limbs, ending with, "Arms and legs, hands and feet, metaphor, depending upon the concerns and
    comfortably heavy. Feeling quiet inside." problems of the patient: harmony and discord,
    1 do not use terms like "try" or "relax." In fact, I orchestrating, rehearsal, leading and following,
    tell the patient that this is training in "how not to try cooperation with each other and the importance of
    hard to relax." I end the exercise by suggesting that the different parts to each other, balance, tune and
    the patient practice 5-10 minutes, three times daily, not in tune, fine tuning, the automaticity that comes
    with complete alerting unless it is bedtime, by after lengthy practice, picking up the tempo, etc.
    flexing and stretching the arms, inhaling sharply, (Ed.)
    and then opening the eyes. I encourage the patient
    to give positive self- suggestions during the last
    minute of the exercise. SUGGESTIONS
    I teach "warmth," "heartbeat," and "respiration"
    over the next three weeks, emphasizing Sometimes I like to think of the body as a
    self-awareness and encouraging reports of positive symphony orchestra. A symphony orchestra makes
    experiences of the physical self, [see Jencks, 1979). beautiful music; but it is made up of many sections
    and each section is made up of
    HYPNOSIS WITH MEDICAL DISORDERS 239
    many instruments. As you know, sometimes an Healing Imagery
    instrument gets out of tune: a violin may break a
    string, or one of the reeds may need to be cleaned. Marlene E. Hunter, M.D. Vancouver,
    [There are many possible problems.] Something British Columbia, Canada
    needs to be done so that that instrument can
    produce beautiful music again. Or sometimes,
    when working on some composition, a whole INTRODUCTION AND INDICATIONS
    section might be having trouble with the rhythm or
    with a difficult chord or harmonic, or the timing Dr. Hunter's suggestions may facilitate healing
    might be off. in psychosomatic disorders (e.g., ulcers, colitis) or
    following accidents or surgery. The last sections
    But despite the fact that an instrument may need describe images that may be suggested for use with
    to be tuned or repaired, or a whole section might patients whose clearest imagery capacity is visual,
    need to work on timing or rhythm, there is nothing auditory, or kinesthetic. (Ed.)
    wrong with the orchestra. [By implication, nothing
    is wrong with the person.] The orchestra is still as
    strong and vital as ever. It is simply that that
    SUGGESTIONS
    instrument needs to be fixed, or that section has to
    practice more, and when they have done that, then All living things in the plant and animal world
    the orchestra is once again harmonious, rhythmic, have one thing in common: all have within them,
    attuned to itself. the most incredible capacity to HEAL. If you
    Well, the body is rather like that. If we think of simply think of a wounded animal, or a damaged
    the body as being composed of many "sections"— plant, you can affirm that statement for yourself.
    the digestive system, the respiratory system, the The animal — man included — recovers from
    reproductive system, the cardiovascular system, the wounds and illness; the plant grows new leaves or
    muscular system — all of these systems make up branches, and sometimes even has scars to remind
    the symphony that is the body. And within each the observer that once, it was wounded.
    system, there are the various "instruments": in the [Universality of the capacity to heal]
    digestive system there are the teeth and the mouth, You also have this wonderful capacity. You also
    and the esophagus where you swallow, and the have this miraculous healing energy within you.
    stomach and the sphincter at the end of the stomach, [Invitation to go deeper into trance.] Go now,
    and the various parts of the bowel; and then there deep within yourself: to the very center of yourself,
    are also the auxiliary organs like the liver. [One to the source of that healing energy within you. Go
    may change which system is described to suit a to the very source of that healing energy; be aware
    patient's symptomatology.] And all of these of that energy that comes from the very center of
    "instruments" make up that "section," just like the yourself. Gather up that energy, and direct it to that
    instruments in the sections of the orchestra. part of your body where you instinctively know it
    So, although attention may need to be paid to must be directed! [You can trust your intuition.]
    one section or one instrument, yet the symphony— Each one of us has his or her own personal
    the body— is still wonderful, and still has all the concept of that energy. [Everyone's concept is right
    potential for making beautiful music. for them.] For me, it is a source of light — a source
    Think to yourself, "My body is like a sym- of healing light, like the sun, a light that can be
    phony"— and feel the wonderful rhythms of your directed to the part of the body which needs
    body pulsing softly to their own special beat within healing, and suffuse that part of the body with its
    you, and harmony being restored. healing glow. It is a golden
    240 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    light, that surrounds and bathes the ill or wounded cence, of recovery. It is the image of what your
    part of the body with that healing golden energy. body will be like — will look like, feel like, sound
    Discover YOUR own concept of what your like when you are well again; restore harmony to
    healing energy is. Locate it deep within you, and your body, and power. Fill in all of THAT
    direct it to wherever your body needs it. wonderful detail, in whatever kind of image is right
    Now FEEL, sense the healing that is already for you, remembering that the image can be
    beginning within you. You can actually FEEL that realistic or symbolic, two- or three-dimensional,
    healing. That's right. Direct that energy through whatever you instinctively know is congruent with
    your body, to wherever you intuitively know it is your deep sense of self. [Ego-strengthening.]
    needed — knowing that you may even be surprised Place this image beside the earlier one. Your
    at the part of your body which you have intuitively task now becomes very simple: you simply need to
    chosen! [Positive suggestion for healing.] But evolve the first image into the second. [Simple
    knowing, also, that the subconscious mind has so expectation of success.]
    much more information than the conscious mind Some people like to do this in a way similar to
    has, the subconscious mind may know that some rifling through those little pictures in the upper
    other part of the body, different from where your corners of comic books — flipping the pages
    conscious mind would have thought, may need that quickly so that the cartoons seem to move; some
    healing first. Trust your subconscious mind to choose to make a video or movie of the process;
    direct that energy; trust your intuitive response. some draw immediate images — short-term goals,
    [But generally it is better to let the subconscious do as it were; some just sense the evolution of one into
    that itself.] the other. [Triggers for the imagination.]
    Now let your wonderful, creative imagination In your own hypnosis every day, reinforce this
    formulate an image, in your awareness, of what healing imagery. The more frequently you do that,
    that ill or wounded part of your body is like — the stronger the message that you are giving to your
    what it looks like, or feels like (kines-thetically or subconscious mind and thence to your body: I
    tactilely), or indeed even sounds like— discordant, CAN BE WELL: I AM ALREADY ON THE
    harsh, hoarse, a grating sound perhaps, or thin and ROAD TO RECOVERY! [Affirmations in
    reedy with little substance. [Emphasizing the imagery.]
    importance of self-trust.]
    [Formation of images using all the senses;
    images must have personal meaning to be ef- HEALING IMAGERY - OTHER
    fective.] This image could be pictorial, as if you TECHNIQUES
    were looking at an anatomy book; or in three
    dimensions, like a piece of sculpture. It could be 1. COLOR. Another type of imagery uses color
    entirely symbolic, or graphic. Use your own talents extensively and gives it priority. Some people paint
    to devise an image that has meaning for YOU. a picture in their imaginations — a picture in the
    Use all of your sensory awarenesses to formulate colors of illness and disease. The healing imagery,
    that image. Fill that image with all the detail you then, involves painting a new picture, using the
    possibly can — what you see, hear, feel, touch, colors of health, or in changing the existing (in the
    taste, smell. Remember color, and strength. mind's eye) picture as convalescence and healing
    Then place that image, in your inner awareness, ensue.
    on one side. Now, begin to create another image: A variation is to simply perceive colors — in the
    this image is of healing, of convales- shades and tones of woundedness or ill health —
    swirling about in various patterns; gradually the
    colors change, merging into the vibrant colors of
    full recovery. One thinks of
    HYPNOSIS WITH MEDICAL DISORDERS 241
    this type of imagery with the artistically inclined metaphor very carefully. A good history is the first
    (not necessarily artists). essential, rapport a close second.
    Healing imagery has an infinity of variation. Use
    2. MUSIC. For those who use auditory imagery your own creative imagination to present
    more extensively, music can be used to great wonderful options to your patients.
    advantage. The music of disease may be per
    ceived as jarring and discordant — each subject
    will have his or her own ideas about that; many
    will hear (with their inward ear) a specific piece Suggestions with
    of music that fits their interpretation. The
    music may change suddenly or gradually, "let
    Autoimmune Disease
    ting it happen" or deliberately ending one and Jeffrey Auerbach, Ph.D.
    beginning another.
    Los Angeles, California
    Pain which is perceived in auditory terms —
    e.g., throbbing — may be altered in this way,
    changing the image of the pain as the music INDICATIONS
    changes. Personally, I have changed Heavy Metal
    In autoimmune diseases, like rheumatoid ar-
    (a throbbing ankle with torn ligaments) to a Mozart
    thritis and lupus, the immune system attacks the
    opera with great success! Similarly, musical
    representations of illness may change to those of body— the joints, internal organs or skin. In effect,
    health and happiness. These musical metaphors the immune system is misguided or "confused."
    may be combined with the frequent use of words Hypnotherapeutic work may help stimulate healthy
    such as harmony, rhythm, attuned, tempo, etc. immune system functioning, where only foreign
    [Also see the Symphony Metaphor above.] invaders or mutant cells are attacked. A general
    understanding of how autoimmune diseases
    operate will be helpful to the patient, and
    3. WIND, BREEZES. The image of a soft breeze sometimes pictures of what the disease process and
    wafting away illness, bringing strength and a the immune system look like will help to facilitate
    sense of well-being, is very pleasant. A brisk the internal changes that are required for healing or
    wind, blowing disease away, is more active and remission.
    invigorating for some.
    Alternatively, the concept of a storm, even a
    raging gale, as the terrifying or devastating illness, SUGGESTIONS
    subsiding to a warm, healing breeze bringing peace
    and comfort, may describe some patients' situation Allow an image of yourself to become very,
    more vividly. very small. Begin your healing journey by seeing
    yourself shrinking smaller and smaller until you're
    4. HEALING WATER This could be, figuratively, as small as a drop of water, and slip inside yourself
    swimming in a magic pool or immersing oneself through your mouth and down your throat. Then
    in some sort of healing water. We sometimes allow yourself to shrink even smaller until you are
    talk of "taking the waters," referring to a spa or not much larger than a single cell, but fully
    health resort. In that case the healing water is protected by a sturdy and transparent bubble
    taken "within," rather than "without." around you. Then slip into your bloodstream and
    Healing water also has some reference to the travel to an area that is in need of healing. [Pause]
    safety of the womb, floating in the warm amniotic What do you see? [Pause] From a very safe vantage
    fluid. The link to baptism or being "born again" is point, you can observe your immune system in
    another possibility to explore with some patients. action. What are your white blood cells doing?
    Obviously one chooses the [Pause] If any white blood cells are disturbing part
    of
    242 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    your body as opposed to only subduing foreign THEORY, TECHNIQUE, INDICATIONS,
    invaders or mutant cells, they will need educating. AND CONTRAINDICATIONS
    You may want to have a dialogue with your
    immune system. "Why are you attacking me? . . . The method is based on the following as-
    Let's live in peace. . . . What do we have to do to sumptions:
    live in harmony? . . ."
    Send a message from your safe vantage point to
    1. The human organism is endowed with spon-
    a wise, experienced and healthy white blood cell
    taneous healing power with which to restore
    that understands the importance of not harming the
    healthy mind and body.
    joints, organs or skin. Watch this wise old cell
    2. The so-called hypnotic trance serves the
    explain effectively to the misguided cells how to
    functions of enhancing the healing force in the
    recognize what not to attack, [pause] See the
    organism.
    immune system leaving any damaged areas in
    3. Especially in prolonged hypnosis, the
    peace, and watch, as in time lapse photography,
    self-recovering force is reinforced and the or-
    those areas healing completely, and then watch ganism is set free from the strains of mind and
    yourself using that part of your body effectively body caused by the stress of the inner and outer
    and with pleasure. world, and is helped to restore health.
    4. Prolonged hypnosis stimulates the patient to
    develop an attitude to accept therapeutic
    approaches, such as suggestions and hypnotic
    Prolonged Hypnosis in working relationships, and respond to them in
    Psychosomatic Medicine an active and self-regulatory manner.
    5. The first assumption presupposes our basic
    Kazuya Kuriyama, M.D.
    belief in the human organism. This belief
    Japan underlies any therapeutic endeavor, be it for
    physical or psychological disorders. The
    INTRODUCTION second assumption brings forward the nature of
    trance. Clinically speaking, we encounter many
    Time-extended or prolonged hypnosis is not cases in which the so-called trance seems to
    even mentioned in comprehensive textbooks on exert strong therapeutic effect upon the human
    hypnosis. Therefore, although there is only limited body. For example, in many cases mere
    experimentation with this approach (Kratochvil, induction into hypnosis can bring out marked
    1970; Kuriyama, 1968; and two non-English improvement or more or less disappearance of
    publications from Germany and Czechoslovakia), symptoms without any therapeutic suggestions
    it is being included in this volume to introduce a or interpretations being given. Often simply
    unique treatment option deserving of further being in a trance seems to be very therapeutic.
    investigation. Of possible relevance to this method
    are the studies of Barabasz and Barabasz (e.g.,
    1989), who in several reports have documented the As stated in the third and fourth assumptions, in
    ability to increase hypnotic susceptibility after only prolonged hypnosis, which keeps the patient away
    a few hours of REST: restricted environmental from the stimuli and disturbances of the outer
    stimulation therapy. These results suggest that world and eliminates the tension state created by
    Kuriyama's approach may, at a minimum, enhance wrong learning, the inherent self-recovering force
    responsiveness to suggestion. There are also and the effect of the trance will be enhanced to an
    similarities between Kuriyama's approach and the optimal level. Also, the feelings of security and
    independent method of the late Dr. Ainslie Meares satisfaction
    reviewed in Chapter 6. (Ed.)
    HYPNOSIS WITH MEDICAL DISORDERS 243
    that come from the fact that the patient is treated well and things under hypnosis. Also, the environmental
    long enough add to more favorable results. manipulation needs to be arranged so that there should
    be no visitors during the treatment. The following is an
    THE METHOD. After having induced the patient into example of suggestive words:
    deep hypnosis by ordinary inductive techniques, the
    following methods are in order. From now on you will be on the bed hypnotized for a
    long time. You are lying on the bed with your mind and
    1. Short-term prolonged hypnosis: Maintain the trance body so relaxed, and comfortable. If you want to go to
    for two or three hours. the bathroom or drink water, you will have no trouble
    2. All-night prolonged hypnosis: Hypnotize the patient doing so under hypnosis. And after coming back to bed,
    at night and maintain the trance, with which he goes you will automatically go into a hypnotic state which is
    into natural sleep, until the following morning when much deeper than when you left the bed. You are so
    comfortable that you will never feel that you woke from
    he wakes up from the hypnosis after washing his
    hypnosis, but rather that you wish to go into deeper
    face.
    hypnosis.
    3. All-day prolonged hypnosis: Maintain the trance as
    long as possible on the second day following the
    If the inpatients are to be hypnotized at night, the
    above all-night hypnosis.
    following suggestions need to be added.
    4. Long-term prolonged hypnosis: Maintain the trance
    all day long, and, moreover, preserve it as long as the
    You will be under hypnosis for a while, and then, you
    subject wishes; that is until he feels confident that he
    will gradually go into deeper and deeper sleep. You will
    will recover. If necessary, the trance is to be
    never wake up until tomorrow morning when you will
    continued for a few days or even for several weeks.
    wake up from hypnosis only after you have washed your
    face. At that time, your head is clear and you will feel
    Method 1 is applied to some inpatients and outpatients by very good. You will enjoy breakfast very much.
    letting the patient lie down on the bed or sit relaxed in an
    easy chair. Some patients relax better themselves with In addition, depending on any special condition, proper
    the therapist close enough to be heard. Others do not do suggestions or support need to be given.
    well unless the therapist visits them to help reinforce the
    trance occasionally. The other methods (Methods 2-4) TYPES OF DISEASES AND TREATMENT RESULTS. Pro-
    are applied only to inpatients. Method 2 has turned out to longed hypnosis can be used mainly for the following
    be most practical and effective, apparently because the two situations: (a) cases from which a favorable
    patients are not disturbed by day-time noises or visitors. outcome is expected by using prolonged hypnosis,
    In regard to method 3, it is important to take into and/or (b) when treatment has reached a deadlock with
    consideration such factors as the patient's habits and no further improvement, after the patient has improved
    personality traits and to maintain the trance according to to a certain stage by ordinary hypnotherapy.
    the rhythm of his life. Method 4 is for specific conditions
    Treatment results: The eight cases of bronchial
    and needs very careful preparations.
    asthma had suffered from severe attacks every day for
    When the individual is induced into prolonged several years with no noticeable improvement with
    hypnosis, the therapist needs to give a thorough various types of medical treatment, and thus had to be
    explanation as to what it is like to be in the trance; that is, hospitalized. Five of them, persistent users of steroid
    that there is no danger whatsoever, he can drink water or hormone, were able to set themselves free from it in a
    tea, go to the bathroom, and do any other relatively short time.
    necessary In some cases, only by keeping the patients in a
    so-called trance for many hours was marked
    244 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    improvement was observed. In others, the ther- eryday activity, talk with other people, eat and
    apeutic effect was reinforced by proper sugges- sleep normally at night, so that nobody will be
    tions during the course of treatment. At any rate, able to find anything strange in your behavior;
    the author was able to observe marked you won't be aware of any change, either.
    improvement in many of the patients who had not With me you will be able to speak quite
    responded to pharmacotherapy or standard normally, too. My words will act upon you as a
    hypnotherapy. direct command only if I change the intensity
    of my voice, i.e., if I whisper or speak more
    INDICATION AND CONTRAINDICATION. This m e t h o d loudly than usual. As long as you remain in
    is applicable to all cases where hypnotherapy is hypnosis, you won't be oriented in time. You
    indicated. However, it seems to be of particular use will answer each question concerning the date,
    in the following cases. by the answer "January 1," being convinced
    that this is true. This is the only date you know
    1. Bronchial asthma, organ neurosis and anxiety from this moment in your hypnotic state.
    neurosis, which attacks during every day
    particularly during the night.
    2. Angina pectoris, chronic stomach ulcer in
    which no immediate psychogenic factors are Vascular Control Through
    detectable, and where a good balance of mind Hypnosis
    and body seems to play an important role at
    present in bringing about favorable therapeutic Emil G. Bishay, M.D., and
    outcomes.
    Chingmuh Lee, M.D.
    3. Cases of chronic anxiety or tension, and those Torrance, California
    whose psychosomatic symptoms are
    perpetuated.
    4. Cases where no effect can be expected by drug INTRODUCTION
    therapy or ordinary hypnotherapy.
    The following suggestions were used success-
    fully in a study (Bishay & Lee, 1984) that
    documented the reduction in regional blood flow to
    the hands through production of hypnoanesthesia.
    Further Suggestions for
    Similar suggestions may facilitate vascular control
    Facilitating Prolonged Hypnosis in other parts of the body.
    (Ed)
    Stanislav Kratochvil, Ph.D.

    [The following suggestions were given to SUGGESTIONS


    subjects following hypnotic induction, deepening,
    and the production of a variety of hypnotic [Following induction utilizing relaxation, im-
    phenomena. (Ed.)] agery, and a 20-step staircase for deepening:] Now
    you are so deeply relaxed, your whole body feels
    1. You will remain in hypnosis until 1 repeat three very relaxed, and very heavy. You have relaxed so
    times the word "zero." You cannot return to well that you did not pay attention to the fact that
    your normal state without this signal. Another you can feel your left hand getting heavier and
    person would be able to bring you back to your heavier. You can feel it pressing on your left thigh .
    normal state only by repeating this word ten . . and you can't even move it. Your right hand, at
    times. the same time, is feeling as if it is being pulled up ...
    as
    2. You will behave and live in the hypnotic state
    in the same way as if you were not in hypnosis.
    You will be engaged in your ev-
    HYPNOSIS WITH MEDICAL DISORDERS 245
    if there was a helium balloon attached to it with a you could also control salivary glands, or you
    strap and pulling it, very slowly, and slightly up. could stimulate those glands. You can say a single
    As your right hand leaves your thigh, it is not word to someone that will produce tears. Those
    going to go higher. It will feel cold and numb. You tears require an alteration of the flow of blood in
    are going to actually start immersing your right the tear glands, and you don't even know how those
    hand in a bucket full of ice-cold water. It is getting tear glands are supplied with blood. There is a
    colder and colder, more and more numb. You can wealth of knowledge that exists in your body, of
    hardly feel it. The tips of your fingers are very, very which you are totally unaware, and that will
    numb. . . . They are almost painful. The dorsum manifest itself when given the right psychological
    [back] of your right hand is very numb and cold. or physiological stimulation.
    Move a finger on your right hand when you feel it
    really cold and very numb . . . That's nice . . . It is
    already pale and its veins are very collapsed. You
    can open your eyes, if you wish, and see how pale Suggestions for Control of
    your right hand is . . . and remain in your deep Upper Gastrointestinal
    trance.
    Hemorrhage
    Emil G. Bishay, M.D., Grant
    Stevens, M.D., and Chingmuh
    Suggestion for Control of
    Lee, M.D.
    Bleeding Torrance, California
    Milton H. Erickson, M.D.
    INTRODUCTION
    In your present type of thinking, you do not
    believe . . . that you could control the flow of blood; Bishay, Stevens, and Lee (1984) used the
    that you could cut down on bleeding. Yet you know following suggestions in an emergency room
    that the utterance of one single word right now setting. The patient had a history of upper GI
    could bring a flush to the face . . . And that is right, bleeding for three years and was admitted to the
    because your body has had a lot of experience in surgical ECU with a diagnosis of "recurrent peptic
    controlling the flow of blood, and it is so easy and ulcer disease vs. stomach ulceration, incomplete
    so simple. And if you can control the flow of blood vagotomy." After the patient was reassured that
    in your face, well, why shouldn't you be able to nothing would hurt her and no one would do
    control it in your neck; and your neck does turn red anything to her against her will, she was told that if
    and your forehead does turn red, and why not a she could relax, her unconscious mind would help
    little bit below. And consider the way in which your control the bleeding. The following suggestions
    body has had experience in turning pale at the were then given, which successfully controlled
    thought of something terrifying, and consider the bleeding without surgical intervention. (Ed.)
    way your body has had many experiences in
    turning red under heat and turning white under
    cold. Your body has had a lot of experience; there is SUGGESTIONS
    a tremendous wealth of actual physiological
    experience that warrants the expectation that one As you lie comfortably in bed, all that you need
    could build up a hypnotic situation to control to do is to close your eyes and take a series of real
    capillary flow of blood; and with that capillary flow deep breaths . . . and as you exhale let your body
    of blood relax as deeply as you can. ... At the same time . . .
    imagine how it would feel if you were now lying on
    your back in some place
    246 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    in which you had pleasant memories ... a beach STEP 2. HYPNOTIC INDUCTION. Typically this pro-
    perhaps. . . . Feeling the pleasant, cool sand under ceeds with a formal and direct induction procedure.
    your back . . . and the lovely cool breeze on your Eye fixation is preferred because it establishes a
    face . . . enjoying an ice-cold drink which you are precedent for the patient's narrowing focus of
    sipping slowly with great pleasure. . . . Listen to the attention (later to be on a particular part of the
    calming waves . . . and the joyous laughter of kids body). This may be followed by progressive
    playing far away. . . . The feeling that you can attain relaxation. Trance deepening is not necessary
    in your body is of complete and total relaxation. . . . because a very light trance is sufficient for blood
    Good! You are listening to my voice . . . and perfusion.
    drifting into a very pleasant state of mind and body.
    You know now that your "unconscious" is STEP 3. IMAGERY FOR PERFUSION. After the patient
    controlling your breathing . . . watch how deep and has achieved an adequate trance, he/she is in-
    slow it is now. . . . Your unconscious mind is also structed as follows: "Picture your strong normal
    controlling your pulse . . . your blood pressure and . blood . . . flowing from your strong, normal heart . .
    . . your skin vessels ... as I can see, these vital signs . through a system of canals* to the desired area** .
    . . . have already been controlled by your . . calm and comfortable . . . canals are expanding to
    unconscious mind . . . which is already taking very facilitate the increased flow . . . pleasurable
    good care of your body. You can allow it to control sensations . . . blood rushing to the desired area . . .
    your bleeding completely. It will cool down and you may already feel that area becoming warmer . .
    close all the bleeding points in your stomach and . comfortable . . . nothing to distract you now . . . en-
    esophagus effectively and safely ... as if it is healing
    joying the warmth and sensation of your healing
    you while you are slowly sipping this refreshing
    blood flowing . . . your blood carrying all the
    ice-cold drink in your hand. . . . Notice how relaxed
    building blocks of healing; protein, amino acids,
    . . . comfortable and . . . secure you feel right now
    when you allowed your unconscious to help you. vitamins, etc. . . ." [These suggestions are repeated
    Your entire body is free from tension . . . and you over and over, with the possible introduction of
    feel so good! You are doing great! . . . and you have time distortion.]
    learned how to relax . . . whenever you need the
    help ... of your unconscious ... to make you feel safe STEP 4. POSTHYPNOTIC SUGGESTIONS. These are
    . . . secure and happy. [Instructions for given for comfort, motivation, and increased ease
    self-hypnosis were then given.] and depth in subsequent hypnotic sessions. The
    desire for continued perfusion can be ac-
    commodated by suggesting that something com-
    monly encountered in the patient's environment
    will trigger said perfusion. For example, the patient
    Blood Perfusion Protocol can be instructed to watch TV for some hours per
    day with the perfusion occurring and being
    Lawrence Earle Moore, Ph.D. maintained each time a commercial appears on the
    San Francisco, California
    TV screen (clearly she must be prohibited from
    watching public or non-commercial channels).
    Hospital personnel (e.g., nurses or technicians) can
    STEP 1. PRE-INDUCTION TALK This is designed to
    also be a trigger.
    facilitate the hypnotic induction by establishing
    rapport with the patient, correcting his miscon-
    ceptions about hypnosis, and allaying his anxieties. *Here is an excellent place for utilization, e.g., a burned truck
    driver was told to view his arteries as freeways, a plumber as
    pipes, etc.
    "The "desired area" is usually specified, e.g., left hand, right
    foot. Caution: the patient takes your suggestions
    literally.
    HYPNOSIS WITH MEDICAL DISORDERS 247

    HYPNOSIS WITH NEUROLOGICAL AND OPHTHALMOLOGICAL


    CONDITIONS

    Teaching the Other Your doctor has explained that the stroke
    affected the left side of your brain, the side where
    Side of the Brain the speech center is located. That is why you are
    having trouble with your words. However, the
    Marlene E. Hunter, M.D.
    right side of your brain is fine. [Opening up
    Vancouver, British Columbia, Canada
    another possibility.]
    Here is an interesting challenge for you, then —
    INTRODUCTION AND INDICATIONS teach the right side of your brain to do what the left
    side used to do! [Often they are longing for a
    These suggestions are designed for use in stroke dramatic approach — here is one.]
    patient rehabilitation, particularly where the This will be all the more interesting because the
    damage has been to the left hemisphere, to facilitate right side of the brain seems to be more active in
    recovery of function and feelings of hope. We do the realm of imagery, music, and creativity, even
    not presently have research validation that hypnosis though we know that both sides of the brain can
    can facilitate enhanced recovery of function, perform all the various functions, and there is a
    despite the clinical belief that this may be possible. tremendous cross-over in activity.
    Until we have evidence to the contrary, however, it
    seems that at worst the clinician has only wasted a [Spoken very gently, but very intensely.] But
    few words while simultaneously instilling hope, this is just what you need! Think of the
    motivation, and a sense on the part of the patient of possi-bilities-the right side of the brain has all the
    being able to do something for himself. (Ed.) potential that it needs to learn the various speech
    functions, and it has great powers of creativity, too!
    [Affirming the validity of the approach. Right side
    specifically designed for such a challenge.]
    SUGGESTIONS
    Because brain activity is physiological as well as
    You know that you have been able to perform mental, you will also need to focus very
    many functions throughout your life — things like determinedly on mind/body communication. All
    walking and talking and writing and feeding the information about biochemistry and
    yourself. These became second nature to you many, neurophysiology must be fully accessible to your
    many years ago. [You already have the subconscious mind, and the information that the
    information.] Then, three months ago when you subconscious holds must be accessible to the body.
    had your stroke, you found that very suddenly you So ask your subconscious mind and your body
    were unable to do those very things that you have to get into strong communication, in order to
    done automatically for decades. [Calmly stating cooperate and collaborate fully in this venture. The
    the fact.] project, then, is this: the left side of your brain must
    So the past three months have been very teach the right side of your brain what to do, in
    confusing and difficult, because of this strange and order for you to find the words you want and speak
    frustrating situation. [Acknowledging the feelings, clearly and freely again. [Restating the original
    reassuring that they are normal.] In particular, you suggestion in a new way: inner learning through
    have had a hard time speaking, because you seem inner teaching.]
    to lose the words that you are looking for. This has Did you know that you have a bridge from one
    been all the more exasperating and depressing side of your brain to the other? You have.
    because you have always been so articulate.
    248 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    [The concept of a bridge is reassuring —bridges another opportunity for mind/body communication
    ARE transportation routes.] It is called the corpus and collaboration.
    callosum. It is a very strong bridge connecting the And then there will be possibilities that only the
    two hemispheres of the brain. How wonderful that deepest part of your subconscious mind knows
    you have a bridge already there! It can be one of the about or has access to; so in your own hypnosis
    routes that information can take as it is transferred every day, remember to ask your subconscious to
    from the left side to the right. use ALL the information that it has, to help you in
    [Combining fact and imagery.] In your own this challenging project. [Covering all bases.]
    way, create the image of this bridge in your mind, You know more than you know that you know.
    and envision or feel or hear or have the very And learning what you already know is a
    strongest sense of information traveling across this wonderful experience. [Several words with
    bridge, from the left side of the brain, to the right. multilevels of meaning are reiterated throughout,
    When it gets to the right side, let it find the exact e.g., bridge, cross-over, creativity, "right side" etc.]
    place to settle — somewhere accessible, where
    other information coming in, can find it easily and
    add to it. [The "right side" is symbolic]
    Then, when the information is safely lodged in Once Learned, Can
    the right side of the brain, again invoke that
    wonderful mind/body communication as you direct Be Relearned
    your right brain to begin to use that information!
    You can be very, very curious about how that will Marlene E. Hunter, M.D. Vancouver,
    happen. Will you feel like speaking, and find that British Columbia, Canada
    some promising sound comes forth? Will you say it
    all in your mind first, and then find the way to make
    your mouth and tongue work properly? How will it INTRODUCTION
    come about?
    These suggestions were also prepared for use in
    We know that this will probably take a very stroke patient rehabilitation. A similar approach
    concerted effort over some period of time— after may also be used for the aphasic patient for
    all, it took you some period of time to learn how to relearning language and how to speak. These
    speak in the first place, so it is reasonable that it suggestions may also be combined with the
    will take some length of time for your right brain to previous ones. (Ed.)]
    learn to do what your left brain has been doing.
    [Preparing for long effort.]
    Stay patient, then — in the long run, this will be SUGGESTIONS
    the shorter way. Stay patient and calm, and let the
    left side of your brain, teach the right side what to Today I'm going to talk about learning. But I'm
    do. [Mildly confusing statement.] going to talk about it in a rather different way. I'm
    Remember, too, that there are other ways of going to talk about learning how to do something
    transferring information besides sending it across a you already know how to do! [Catching attention
    bridge. [More creative imagery.] Send that with an unusual statement.]
    information to catch a ride on a passing hormone, [Setting the background for the statement.]
    for instance. There is great hormone involvement in When you were very small, just a baby boy, you
    any learning process. This is had to learn how to walk; to get yourself up on your
    feet, standing straight, put one foot ahead of the
    other and take steps to get yourself to somewhere
    else from where you were.
    HYPNOSIS WITH MEDICAL DISORDERS 249
    Your conscious mind hasn't thought about that you can learn how to do it once (and when you
    for decades. Walking came to be such an automatic were a baby, at that), you can learn how to do it
    thing, thinking about it was quite unnecessary. again, when you have all that previous experience
    Your subconscious mind recognized, "I want to go about learning. [Reflecting the opening
    over there . . .," your body took over, and you went. statement.]
    [Invitation to realize all the ingredients.] Yes. You have already learned how to learn how
    However, a lot of learning, of trial and error, of to walk. ["Learned how to learn how to . . ." —
    finding out about the relationship of objects to hypnotic emphasis and further emphasizes the
    other objects and most of all, of motor skills, were "learn" throughout the script.] Therefore, you can
    dedicated to learning to walk, for quite a long time relearn what you already have learned, calling on
    before you were able to walk steadily and safely, to your subconscious to search out that previous
    stop and start just when you wanted to and to go in learning and learn to put it to new use.
    the precise direction that you wanted to go. In order to do that searching, go further into
    Over the years, you have walked and walked and hypnosis now. [Placing my thumb on his forehead
    walked. Your body and your brain and your mind again — deepening.] Use my thumb as a focusing
    have collaborated so often on that activity called point, and go "way down" into hypnosis, as far as
    walking, that you know all there is to know about you need to go to achieve what you need to
    it. You even know how to walk backwards! achieve. That's right. Good.
    [Curious ability!] Now, let your subconscious mind go back to the
    Six months ago a sudden, confusing and time when you were a small baby, just learning
    distressing thing happened to you: you had a how to walk. [Regression.] Go back to the
    stroke. [Acknowledging fact.] And that stroke beginning of those lessons — and that beginning
    affected the part of your brain that was involved in may even have been before you were born, when
    walking. Now your muscles apparently refuse to do you were experiencing what it was like to move
    what you tell them to do, and they are weak and within the ocean of the amniotic fluid. Ask your
    flabby. You have been going to physiotherapy subconscious mind to REVIEW ALL THAT
    [physical therapy] diligently to regain your muscle LEARNING, and find out what you need to know
    strength in your legs and arms. [Reassuring that he again, as you relearn what you have already
    has been doing his best.] learned so many years ago. [Further emphasis,
    referring to earlier phrases.]
    Yet, still your feet and ankles and knees and hips
    are obstinately staying put instead of going where Feel again what it is like to learn how to walk.
    you want them to go. [Recognizing frustration.] Let all your senses be clear as you re-experience
    This has been very frustrating; and you know from that— the muscle tone, the awareness of something
    some of our previous sessions, when we find that you would later call strength, and sense of
    something to be very frustrating, that indicates that position, and of how you know your feet are on the
    we must look for a different approach. [A problem ground; the exquisitely complicated movement of
    is an opportunity to do something different.] the foot as it lifts in a step and swings forward —
    all there for your subconscious mind and your
    Let us explore, then, a new avenue. We can do
    body, together, to review and re-explore.
    that by putting the whole situation into a new
    [Kinesthetic imagery.]
    framework. [Reframing.]
    When you were a baby, you learned how to do Ask your subconscious mind to review all that
    something you had not done before. Then how old information many times a day, for as many
    about — again learning to do ill [The invitation.] days as it needs to, and then to redirect that
    Now, THAT makes sense. After all, if information to the present. [The information is
    needed NOW.]
    250 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    At the same time as your subconscious mind is uation' from the past. . . . Go back to a pleasant time
    reviewing that previous learning, you are regaining in your life before this eye problem began and
    muscle strength through your therapy, so that soon experience what it is like to blink normally —
    the two approaches can merge, and you will begin naturally — remember what it feels like not to need
    to learn again what you have already known for to rub your eyes— enjoy knowing that at this time
    many decades. [More mind/body communication.] you have no need to open your eyes with your
    Once learned, skills can be relearned. [Reinforce- hands . . . [three-minute pause]. . . . It would be
    ment.] wonderful to bring back this feeling, this
    This new approach calls for the greatest possible understanding, this ability to blink naturally and
    normally, would it not?"
    collaboration between mind (conscious and
    subconscious) and body. Reinforce that They found that the patient was able to remain in
    collaboration every day in your own hypnosis, hypnosis for an extended period without spasms,
    reminding yourself that you already know what manual eye opening or eye rubbing. At that point,
    you are now learning, and you are putting that the patient was told, "Congratulations on your
    knowledge to good use as you approach this ability to control
    worthwhile endeavor in this renewed and your eyelid movements. See, Mr.___________
    worthwhile way. ["You already know what you are you are in control — your eyes are opening and
    learning" — referring again to the opening closing [timed to lid movements] — Now you are
    statement.] having no problem with spasms. . . . I'm curious to
    find out when you'll actually begin to notice that
    your eyes are opening and closing [again,
    suggestions paired with lid movements] naturally
    Hypnosis with Blepharospasm in your everyday life. ... I hope that you will look
    forward to feeling confident in your ability to relax
    Joseph K. M u r p h y and A. and to control your eye movements naturally. What
    I'd like to have you do is this: Why not avoid trying
    Kenneth Fuller
    to force open your eyes. When you notice your
    attention being focused on eye spasms — why not
    INTRODUCTION — let that be a signal to RELAX [pause] - RELAX
    and wait for your eyes to open spontaneously — on
    Blepharospasm consists of an involuntary spasm their own . . . Just like you have done so well in
    and closure of the eyelids associated with today's session."
    involuntary contraction of the orbicularis oculi
    muscles due either psychological or organic In another session the patient was taught
    causes. A variety of symptomatic treatment self-hypnosis. He was also given repetitive
    procedures have been followed, including med- post-hypnotic suggestions for spontaneous eye
    ication, behavior modification, surgery, opening, for relaxation, and for improving
    bio-feedback and hypnosis. function. In still another session some of the
    following types of suggestions were given.
    "You have shown exceptional ability to use
    HYPNOTHERAPY hypnosis to RELAX. . . . You have shown good
    ability to use self-hypnosis. . . . You have
    The authors used both hypnosis and demonstrated your ability to blink normally and
    bio-feedback in successfully treating a case. They naturally for extended periods of time using
    age-regressed the patient to an enjoyable scene and hypnosis. ... I want you to really realize that you
    "he was asked to see, feel, hear and experience can continue to use these abilities in everyday life
    himself 'functioning confidently, comfortably with — even when you are no longer with me."
    natural blinking in a pleasant sit-
    HYPNOSIS WITH MEDICAL DISORDERS 251
    Hypnotherapy for you sleep. You will sleep very deeply, comfort-
    ably, with your eyes completely closed, like your
    Lagophthalmos cats.
    Jean Holroyd, Ph.D., and When you are deeply relaxed your body
    functions optimally. Your eyes can produce more
    Ezra Maguen tears, just like actors and actresses. Tears will flow
    Los Angeles, California more liberally. They can be happy or neutral tears;
    they don't have to imply unhap-piness. Your body
    INTRODUCTION takes in a lot of liquid, which goes into producing
    urine, sweat, blood, tears; it can secrete more tears.
    Holroyd and Maguen (1989) reported the only Your eyes will be very comfortable with the tear
    known successful treatment through hypnosis of a ducts producing more fluid. The ducts will become
    patient who was unable to close her eyelids at more active, alive, youthful; will produce more
    night. This condition caused corneal irritation and fluid like when you have a happy emotion —
    erosion. Lagophthalmos consists of incomplete seeing a baby, a little kitten or a little puppy. The
    eyelid closure, most commonly associated with ducts will produce more and more liquid, day and
    thyroid ophthalmopathy, but also occurring with night, and that will feel very comfortable to you.
    ectropion, conjunctival cicatricial diseases, facial Your eyes will float very comfortably in that
    nerve palsy, tumors involving the seventh nerve healthy liquid. When your eyes move during
    nucleus, and orbital space-occupying lesions. dreaming they will be bathed in fluid.
    Nonhypnotic treatment for nocturnal
    lagophthalmos includes patching the eye to protect [Permissive amnesia suggestions were usually
    the cornea, use of lubricants and therapeutic soft given:] You don't have to pay conscious attention
    contact lenses. to what I'm saying because what I say is taken in by
    your unconscious mind. As this material drifts into
    The patient was trained in self-hypnosis and it the back of your mind, you may forget it in your
    was suggested that "she could sleep very conscious mind. As you forget with your conscious
    comfortably all night long with her eyelids mind, you'll know that it's in your unconscious
    completely closed" (p. 266). During the course of mind. You may or may not remember what I have
    her treatment a self-hypnosis tape was also made said; I have been talking to a deeper part of
    for the patient to use nightly with "suggestions for yourself.
    relaxation, permissive suggestions for time and
    space dissociation, permissive amnesia
    suggestions, and the direct suggestion that her
    eyelids would be comfortably closed while she
    slept" (p. 266). The following types of suggestions Suggestions for Involuntary
    were reinforced in about eleven appointments. A Muscle Jerking
    meaningful image for this particular patient was of
    her cats sleeping. (Ed.) Valerie T. Stein

    INTRODUCTION
    SUGGESTIONS
    These suggestions were formulated and suc-
    Your eyes can be completely closed while cessfully used by Stein (1980) in treating a case of
    sleeping; they can close completely when you action (intention) myoclonus. The suggestions
    blink. Your eyelids can be comfortably closed all were used in four hypnotic sessions after
    night, with your lids as if they were sealed. That induction, deepening, and suggestions for qui-
    part of your brain (or back of your mind) that takes
    etness, relaxation, calmness and internal peace. An
    care of your body (for eating, drinking, urinating)
    audiotape to facilitate self-hypnosis was
    will keep your eyes closed while
    252 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    also made. Sessions were framed as "quiet time" of hypnosis with Bell's Palsy, Dr. Chiasson's
    and as a time for healing. Although only the subject experience is included for its potential benefit to
    of one case report, perhaps hypnosis may hold clinicians. Furthermore, it is hoped that this report
    promise in working with this difficult disorder. I may encourage experimental evaluation of
    hope the inclusion of these suggestions will hypnotic intervention with Bell's Palsy. (Ed.)
    encourage such experimentation. {Ed.)
    THE TECHNIQUE
    SUGGESTIONS
    My results with hypnosis in the treatment of
    Imagine, now, that hovering over your body Bell's Palsy have been most rewarding and
    there is a globe of bright light; a sphere of warm exciting. Bell's Palsy, along with other
    energy that sends out rays of warmth and healing neuropathies, is fairly common in obstetrics. One
    that penetrate every fiber of your being; body, of my friends, a neurosurgeon, claims that it is
    mind, and spirit. Each ray enters into and merges impossible to close the eye affected by Bell's Palsy
    with the very essence of your being. You can feel or, otherwise, we must be dealing with something
    the warmth spreading throughout the totality of else. However, you can use an eye closure hypnotic
    your body/spirit/mind. This sphere of light and technique and tell subjects to close their eyes and
    warmth and healing has been sent to you from that relax the eyelids so much that even if they try they
    which has created and maintains the universe. cannot open them. Then by really trying they can
    These rays are warming you, healing you, open their eyes. It does not take any effort to close
    penetrating and joining with all that is you. Now the eyes, but it takes a definite muscular effort to
    imagine that these deeply warmly relaxing rays are open the eyes. Therefore, I maintain that in Bell's
    tapping the powers of the universe and are healing Palsy the eye is kept open by muscle spasm and that
    and soothing your spirit, mind, and body. Imagine when the patient relaxes, the muscle spasm
    also, that the sphere itself slowly descends upon disappears and the eye closes passively. When the
    and into your being, merging with and becoming hypnosis is discontinued the spasm returns and the
    part of every aspect of your being, such that now eye remains open.
    the rays radiate outward from you, forming a
    I merely give the explanation to the patient that
    glowing shield, encircling your essence. It is
    the nerve is swollen and as the circulation improves
    warming, relaxing, and healing at the deepest levels
    the swelling will disappear and the nerve will come
    of your being. [Suggestions for relaxation,
    back to normal. I also mention taste in my
    calmness, and quietness were continually repeated.
    suggestions because in some patients the capacity
    Posthypnotic suggestions for calmness were to taste is impaired on part of the tongue. A
    given.] paresthesia is often experienced as the nerve is
    revitalizing. Therefore, I offer the explanation that
    the feeling of pins and needles is an alarm
    mechanism and that it is a good sign and means that
    the nerve is returning to normal. It would be
    Hypnosis with Bell's Palsy inappropriate to have the patient create an analgesia
    again through hypnosis because that is what we are
    Simon W. Chiasson, M.D.
    working to overcome. I simply tell the patient that
    Youngstown, Ohio
    since we know that normal function is returning,
    she might as well be comfortable while this is
    INTRODUCTION happening.

    Although we have only anecdotal, uncontrolled These explanations may not be physiologically
    reports about the potential contribution accurate, but they seem to be reasonable
    HYPNOSIS WITH MEDICAL DISORDERS 253
    explanations that are accepted by the patient, and Palsy. However, I hope that others will pursue the
    they have produced effective results with five use of hypnosis with this condition, although I also
    cases. I cannot infer from only five cases that charge you not to neglect any traditional method of
    hypnosis is the answer in treating Bell's treatment.

    HYPNOSIS WITH SLEEP DISORDERS

    Suggestions with Sleep ally wants to accept a more positive, comfortable,


    efficient, and effective program, so long as it does
    Disturbance not cover up a problem or coerce a symptom away.
    Richard B. Garver, Ed.D.
    San Antonio, Texas SUGGESTIONS TO POTENTIATE MEDICATION. [If it has
    been deemed beneficial for the patient to be taking
    Your unconscious mind has a memory for a sleep medication for a brief time, another useful
    virtually everything you do, and this includes your strategy is to give hypnotic suggestions to
    sleep behavior. It has a memory for good, high potentiate that drug:] Your unconscious mind will
    quality sleep, and it has a memory for sleep make the best use of these medications, directing
    disturbance. Your unconscious will be selective in them, using them to help you experience a very
    reviewing your sleep behavior, and will focus on good quality of rested, continued sleep, until
    the memory, the very positive memory, of good awakening refreshed in the morning. And your
    quality sleep, sleeping deeply and continually unconscious mind will memorize the therapeutic
    through the night and waking up refreshed in the effect of this, and perhaps even the chemistry
    morning. behind it, so that when you taper off the sleep
    [Always include the protective suggestion:] If medication, your unconscious mind will continue
    you need to awaken through the night for an to produce the therapeutic effects of that
    emergency or any physiological need, of course medication.
    you will do so, but otherwise you will sleep
    through the night with good, comfortable sleep.
    Any memories of disturbed sleep will be ignored,
    and unless there is anything that's important that we Suggestions with
    need to know about that's keeping you from
    sleeping, you can sleep comfortably. If it is Sleep Disorders
    important that we need to know something that is
    interfering with your sleep, which is known by Doris Gruenewald, Ph.D.
    your unconscious mind, I suggest that it will Laguna Hills, California
    surface into your conscious awareness before we
    meet again, so that you can tell me about it. Or, if
    we need to at another time, we can ask your
    INTRODUCTION
    unconscious mind exactly what it is that is
    Following preliminary history gathering and
    interfering.
    assessment, the induction should be geared toward
    a relaxed, dream-like state, but always taking the
    EXPLORATION OF UNCONSCIOUS DYNAMICS. I t h i n k it is patient's personality and defenses into account.
    important to explore unconscious dynamics only if Avoid motor tasks and emphasize fantasy, even if
    necessary, and not just because the patient is very the patient has not shown much talent for it.
    curious to know what might be interfering. I
    believe the unconscious mind usu-
    254 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    IMAGERY Visualization for
    Imagine yourself walking leisurely along a path Treating Insomnia
    that winds through . . . [choose the kind of scenery
    likely to appeal to the patient]. Feel the springy, H. E. Stanton, Ph.D.
    soft ground under your feet . . . enjoy the green Hobart, Tasmania, Australia
    foliage ... the light, gently weaving through
    openings . . . the increasing darkness as you enter 1. Visualize a soft, black velvet curtain which has
    deeper . . . deeper . . . [etc.]. Soon you see a fork in a warm, comfortable feeling about it. As
    the path . . . one side leads to a place of deep thoughts enter your mind, allow these to drift
    relaxation, the other side leads more directly to across the curtain and disappear out of the other
    sleep [adapt suggestions to the patient's needs]. side of your mind, then return to a
    You can choose which side you want to enter. [This contemplation of the curtain. [Pause]
    choice is important for those who have trouble 2. Then imagine yourself on the veranda or patio
    giving up control.] You want to enter the side of of a lovely house which has 10 steps leading
    sleep. Soon you will feel even more drowsy than down to a beautiful garden below. For each step
    you already are . . . drowsier and drowsier .. . you descend, allow yourself to let go more and
    sleepier and sleepier. Soon you will drift off into a more so that, when you reach the foot of the
    deep, natural, healthful sleep. [Repeat "sleep." The steps, you feel a sense of peace and relaxation.
    patient may actually fall asleep, in which case it is Enter the garden, noticing the colors of the
    well to allow a brief period before awakening.] flowers, the drifting clouds, the sound of birds
    singing, the rustle of leaves in the trees, and the
    pleasant warmth of the sun. [Pause]
    STAIRCASE IMAGERY 3. Continue to visualize the garden, picturing
    yourself lying on the grass, enjoying the
    Imagine yourself going down a softly carpeted warmth of the sun on your face. As you lie
    stairway . . . slowly . . . step by step . . . you count there, watch the leaves as they fall slowly from
    each step until you are all the way down. [Therapist the trees nearby, reminding you that it is
    counts slowly to 10 or 20.] At the bottom of the possible to let go of old problems and worries,
    steps you see a room, and you know that this room allowing them to drop away, just as old leaves
    is there for you ... for you alone. You enter this drop away from trees, to make way for new
    room. It's the most comfortable room imaginable growth.
    and it looks exactly as you want it to be. [Describe
    if indicated.] There is a wonderfully inviting bed in
    this room. You realize immediately that it is there THE TROPICAL ISLAND
    for you. [The patient's own bedroom may be used.]
    You lie down in the bed and enjoy the comfortable In this tropical island fantasy, you visualize
    firmness [or softness] of the mattress, the silky feel yourself standing beside a jungle pool into which a
    of the sheets, the pillow adapting itself to the waterfall is splashing. You slide into the pool,
    contours of your head. You sense, you know, that finding the water warm and inviting. This warmth
    this is where you can sleep, as much as you want. begins at your feet and calves, then your thighs,
    Feel the pleasant drowsiness taking over more and body, arms, and neck as you wade in further,
    more. Before long, you drift off into a natural, immersing yourself completely.
    relaxing, restoring sleep . . . [etc.]. [If a tape is made As you swim towards the waterfall, you notice a
    of these suggestions, instruct the patient to arrange flat rock, large enough to stand upon. This you do,
    for automatic shut-off of the recorder.] allowing the warm water from the waterfall to
    cascade over your body, massaging it and soothing
    away all worries, tensions, and problems, leaving
    behind a wonderful sense of
    HYPNOSIS WITH MEDICAL DISORDERS 255
    serenity. Every muscle, nerve, and fiber in your allotment of energy? You've got to direct it
    body is at peace. elsewhere [rather] than in keeping yourself awake.
    Move out from under the waterfall and stretch That nice rest each night is going to replenish your
    out on the smooth, sun-warmed rock which is energy. How are you going to use it?
    surprisingly comfortable. The warmth flows into
    your body from the rock and, together with the
    fresh air, the sunshine, and the soft jungle sounds in
    the distance, creates a comfortable, drowsy feeling
    within you, a feeling that becomes more and more Snoring: A Disease of the
    all-encompassing as you drift off into the realms of Listener
    sleep.
    Daniel A. Zelling, M.D. Akron,
    Ohio

    Hypnosis Techniques with


    Insomnia INDICATIONS AND
    CONTRAINDICATIONS
    David Spiegel, M.D., and
    Herbert Spiegel, M.D. Where snoring is a serious problem, clinicians
    Stanford, California, and New York, New York may want not only to treat the spouse as Zelling
    creatively suggests, but also to be alert to the
    [The Spiegels use a technique similar to their possibilities of sleep apnea. Referral to a sleep lab
    method with anxiety, experiencing floating while will be necessary for accurate diagnosis of this
    viewing an imaginary screen. (Ed.)] Patients are condition. The suggestions that follow will
    instructed that they cannot stop the flow of their undoubtedly prove most beneficial with patients
    thoughts if they are having trouble sleeping, but who enjoy the ocean and sailing or ocean cruises.
    what they can learn to do is dissociate physical from (Ed.)
    psychological tension. They are instructed to use a
    screen to act as a traffic director for their own
    thoughts, projecting them out onto the screen rather
    than experiencing them within their body and INTRODUCTION
    thereby maintaining a high state of physical arousal
    that makes sleep more difficult. The myth is that snorers can or should be
    treated; the truth of the matter is: snoring is a
    disease of the listener and only the listener should
    be treated. A qualified medical hypnoanalyst can
    treat the listener not to be bothered by his or her
    Suggestions for Insomnia spouse's snoring. After all, the engineer on an
    Milton H. Erickson, M.D. ocean liner, with all the noise of the engine room,
    can sleep when he is off duty. And with
    self-hypnosis and proper imagery, the listener can
    You use an awful lot of energy staying awake.
    learn to ignore the noise or incorporate it into his or
    You resort to every conceivable measure of
    her own mental imagery. The imagery that I have
    preventing sleep. Now, if you sleep and rest
    found to be very effective is for the listener, in
    yourself thoroughly, you will have an over-supply
    self-hypnosis, to imagine that he or she is on a
    of energy. What would you really like to do with
    large, wooden sailing vessel, falling asleep on the
    that energy? What constructive or instructive or
    deck.
    developmental project would you like to undertake
    to use up that extra daily
    256 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    SUGGESTIONS mind's eye. The sounds of the ocean, the creaking
    of the mast, the sounds and sensations of a voyage.
    Have you ever been on a beautiful, oceangoing Hear the clatter of the rigging, hear the cries of the
    sailing vessel with the sting of a salty spray on your distant gulls. All the tension leaves your mind as
    face? I want you to imagine, to picture in your the boat gently rocks you to sleep; floating . . .
    mind's eye, or to just pretend that you're on a drifting . . . dreaming. So relaxed, so peaceful . . .
    beautiful, large sailboat: The hull is knifing through Just sailing away . . . Sailing away . . . See the sun
    a surging breaker. You hear the gulls and the getting lower and lower on the horizon as the gentle
    creaking of the wooden mast under a full load of rocking motion of the sailboat lulls you to sleep . . .
    canvas: the clatter of the rigging; the squeak of the Peaceful and tranquil . . . The creaking of the mast:
    boom — all the sounds of the ocean and the so peaceful, so comforting. The buoys in the
    sailboat. And you feel yourself lulled asleep on a distance, the clanging of the bells on the buoys, as
    beautiful sailing vessel. You listen to the creak of you continue your voyage, hear the bells, feel the
    the wooden mast. It is so relaxing ... so peaceful ... rocking motion. Feel, hear and experience this
    the wind in your face; the salt spray from the ocean; pleasant voyage as you rest . . . really rest. And you
    and you are lulled to sleep . . . can get back on board anytime you want. See what
    you're seeing now. Feel what you're feeling now, as
    You can use this image at night. At night when the sounds fade and you drift. Peaceful and
    you go to sleep, the noises that surround you can fit tranquil.
    into this image. Some of the noises of the house,
    some of the noises from other people can fit into Always allowing yourself time to rest on your
    this beautiful image, as you're on this large, old voyage of life, on the sea of life. The reassuring
    rigging sloop. So peaceful and tranquil. A quality sounds of Mother Ocean that people have listened
    ship on the high seas. to since the beginning of time. Solid wood under
    And you can let this ship take you wherever you your feet and a tall mast, swaying in the wind as
    want to go. Whether this is a pleasure trip on a you drift and float and dream, allowing the vessel
    Sunday afternoon to Cape Cod or the Bahamas, or to take you wherever you want to go as you
    yachting on the Riviera. Just close your eyes and continue to float and drift and dream.
    allow yourself to be there in your

    MISCELLANEOUS MEDICAL APPLICATIONS

    Hypnotic Techniques and training, yoga, mazdaznan, acupressure, massage,


    meditation, T'ai Chi, Zen, and other Eastern
    Suggestions for Medical-Physical therapeutic measures. There is a simplicity about
    Complaints many of Jencks' procedures. For example, she
    emphasizes the use of breathing rhythms and often
    Beata Jencks, Ph.D. has patients repetitively think suggestions in the
    Murray, Utah form of single words or phrases as they inhale
    and/or exhale. She has thoughtfully provided us
    with elegant therapeutic methods for working with
    INTRODUCTION
    a variety of medical conditions not commonly
    The following suggestions and methods reflect addressed in standard texts. Some of her
    Jencks' tremendous breadth of experience with suggestions are suitable to be given directly to
    not only hypnosis, but with autogenic patients, in the
    HYPNOSIS WITH MEDICAL DISORDERS 257
    form of posthypnotic suggestions. Many specific during inhalations, or disregard the inhalations.
    suggestions for imagery are also provided. (Ed.) A cough or a tickle in the throat may be
    controlled by using both exhalations and inha-
    lations. Thoughts like "calm," "warm," "moist,"
    NOSE AND THROAT DISORDERS "comfortable," or "relaxed" should accompany
    exhalations, and "fresh," "cool," or "very still,"
    GATE. Swallow hard and feel the place in the throat inhalations.
    where the constriction during swallowing occurs.
    Imagine at that place a gate which can be opened OPHTHALMOLOGIC PROBLEMS
    and closed at will. Feel the gate closing when
    swallowing. Allow the gate to open wide during an EYE COMFORT. Close the eyes and note how they
    exhalation. Imagine again the Lake in the Mouth feel. Are they tense? Dry? Burning? Is there
    [that the mouth is like a dark, warm cave with a movement? Think of the hollows which surround
    lake at the bottom], and then imagine during the eyes. Are the eyes comfortable in their sockets?
    exhalations opening a water gate at the place where Consider what might do the eyes good in their
    you imagined the gate. Feel during exhalations the present condition and choose from the following.
    water from the imagined lake stream downward For removing tensions, think "let go," or "loose"
    through the throat. Feel how far down into the chest during exhalations. Also, the following should be
    it may flow during consecutive exhalations. thought or imagined during exhalations. To
    counteract dryness, imagine the eyeball swimming
    SHOWER OR WATERFALL IN THROAT. Imagine a in a warm saline bath. For calming disturbing
    warm waterfall or shower running down inside the movements, think "calm and still," "a calming
    palm cups my eye," or "dark and comfortable."
    wide open throat during exhalations, or just think
    During inhalations, on the other hand, think "cool
    "warmth and moisture are flowing down." This is
    air streams through my eyelids," or "light and
    good for soothing sore or dry throats.
    cool," or use both phases of the breathing rhythm
    by thinking for burning eyes "moist" during exha-
    NOSE AND SINUSES. Relax the jaw, throat and lations and "cool" during inhalations, or imagine
    tongue. Think of the mucous membranes of the the eyes "floating . . ." during exhalations, and add
    nose and sinuses during exhalations. Feel the air "... in cool water" during inhalations.
    stream down. Disregard the inhalations for the
    present. Feel the spaces become wider during Sit back comfortably and work slowly. Exhale
    exhalations; feel them become moist; feel them gently and close the eyes. Feel coolness gently
    warming. streaming up the nose during inhalation. Exhale
    Compare the effect of exhalations versus gently and relax the tissues around the cheekbones
    inhalations in the nose and sinuses. Feel the and above the eyes. Permit the eyes to move under
    warmth and moisture during exhalations; feel the the closed lids. Relax completely during a deep
    coolness and drying effect during inhalations. Feel exhalation. Imagine during an inhalation that the
    widening, softening, and relaxation in the whole inhaled air streams in through the closed eyelids,
    mouth-nose-eye area during exhalations. Feel and think "my eyes are getting cool." Relax with an
    constriction during inhalations. exhalation and repeat. Feel the forehead widen and
    For a running nose think "cool and dry" during expand above the eyes during inhalation. Relax
    inhalations and "calm" during exhalations, or during exhalation. Repeat. Sit back, relax for a
    disregard the exhalations. For a stuffy or dry nose moment, and allow the breathing to resume its
    think "warm, wide, and moist" during exhalations natural rhythm.
    and "light" or "opening up"
    258 H A N D B O O K OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Follow the above routine as close as possible, and according to the previous question, "What does the
    incorporate whatever feels best from the following list of restriction feel like, and what, just in your imagination,
    thoughts to be used during inhalations and exhalations could counteract this particular kind of restriction?"
    respectively. The items in the two columns are Success is highly individual.
    interchangeable according to individual needs. Use any
    or all. SIEVE. The diaphragm may be imagined as being
    permeable, so that whatever can be imagined to flow
    through it can do so. The movement during a relaxing
    Thoughts During Inhalations "letting go" of the breath during exhalation may be felt as
    My eyes are getting cool. a streaming or flowing downward into the lower
    My eyeballs shrink. abdomen or down and out of the body. It can be felt
    The space inside my forehead expands. while lying down, sitting, or walking and will always
    have a very relaxing effect. Just imagine the diaphragm
    My eyes feel light.
    to be a sieve. Feel during exhalations that something
    The space between my eyelids and my eyeballs
    streams downward and outward or downward and in-
    increases. My eyesockets expand.
    ward. Relax deeply with the streaming and allow the
    My eyelids become light and thin. My
    abdomen to stay relaxed during the following passive
    eyelids float. The visual center in the back
    inhalation.
    of my head seems refreshed. The top of
    my head seems to become wide and open.
    TENNIS COURT. If there is a feeling that not enough air
    can be inhaled, this exercise is helpful. Imagine that if the
    Thoughts During Exhalations surface space of all air sacs of the lungs was spread out, it
    My eyes are getting warm. would cover an area approximately as large as a tennis
    The pressure around my eyes feels relieved. court. Breathe, and imagine doing it "with the whole
    The space behind my eyes seems to enlarge. tennis c ou r t. "
    My eyes become soft.
    Moisture fills the space between my eyelids and VERTICAL BREATHING. This exercise works espe-
    my eyeballs. My eyeballs are floating. My cially well for real physical restrictions, such as body
    eyelids become soft and warm. My eyes sink back casts or corsets, but also for being very still and calm for
    softly. My eyes become very relaxed. My chest and a long period of time as is necessary for an actor on stage
    abdomen relax comfortably. when he plays being dead. Breathe very slowly and
    relaxedly while imagining that the breath moves up and
    down a vertical tube inside you. This tube can be
    PULMONARY DISORDERS between throat and pelvis, extend from the crown of the
    head to the toes, or even extend along the vertical axis of
    MANAGING REAL AND APPARENT BREATHNG RESTRIC the body out into space.
    TIONS. Work with the imagination is especially
    important for easing restricted breathing. Imagining RELIEVING SHORTNESS OF BREATH. For
    anything that will remove a barrier or block, make relieving

    something impenetrable permeable, soften a hard shortness of breath or the feeling of suffocating, press
    resistance, or change the direction of a movement may firmly under the nostrils with two fingertips. Breathe
    work. Greatest success is attained if the exercise is through the nose while moving the pressing fingers
    constructed outwards toward the cheekbones.
    HYPNOSIS WITH MEDICAL DISORDERS 259
    TRAP DOOR. To relieve a restricted feeling in the flooding out, or flowing out all slag, sludge, and
    region of the diaphragm at the end of an exhalation, foul air. Then inhale and imagine fresh, cool,
    give the diaphragm a little push with the last breath, vitalizing, invigorating air streaming in. Repeat as
    and imagine that the bottom were dropping out of necessary.
    the diaphragm, or that it were opening up like a
    lowering trap door to a room below. BODY ALERTNESS. Make a short, quick, alert
    survey of your body and ask: Do the shoulders
    allow alertness? Are the eyes alert? Are the ears
    INVIGORATION EXERCISES FOR fully awake and attentive? What about the chest,
    ALERTNESS the arms? Drive out drowsiness where it lingers.
    Do groins, hips, and buttocks interfere with the
    [Jencks invigoration exercises are designed to alertness of the upper body? Are feet and legs
    produce alertness, a "lightness of the spirit," and aware and awake? Check once more the
    feelings of being alive. Although many of the head-neck-shoulder region. Inhale and then resume
    exercises involve imagery, some of the exercises your activity.
    may be done with the eyes open, performed in a
    short period of time, and do not involve hypnosis. ENERGIZING WALK. Do this in reality or in the
    (Ed.)] imagination. Walk rhythmically, about four steps
    during inhalation, hold the breath for about four
    SIMPLE INVIGORATION. Imagine stretching the arms steps, and exhale during the next four steps. Adjust
    and legs and feel very much alive during the speed of the steps to your physical and mental
    inhalations. Also just inhale with an invigorating condition. However, take more steps during
    thought, such as "alive and anew," "aware and exhalations and/or holding the breath than during
    awake." inhalations. Adjust the vigor of the inhalation to
    the need of the body. Very consciously end the real
    ENERGIZING. Stretch and flex the limbs during or imagined walk with a deep, refreshing,
    inhalation while imagining energy rising up along energizing inhalation.
    the spine. Relax, and repeat.
    CLEAN AIR. Imagine walking through fog or
    ALERTNESS. If the attention lapses during mental smog during a long, slow exhalation. Then, during
    work, inhale and imagine that oxygen comes as inhalation, imagine coming up and out of the fog
    energy into body and mind, and that it sweeps away or smog into clean, clear, snowy, sunny, cold
    all tiredness and "cobwebs of the mind." mountain air.

    AWAKE BREATHING. If you are not alert enough to JOGGING. Imagine jogging leisurely on a good
    be adequate to an occasion or job at hand, your surface in a place which is pleasant and enjoyable.
    breathing may be too shallow. Allow the breathing Let it have the right temperature, the right surface
    to become as awake and aware as the task or on which to run, the right landscaping. Breathe in
    situation demands, but at intervals revert to your rhythm with the imagined jogging.
    natural rhythm, allowing sighing or yawning to
    occur naturally. Again and again enliven your MANHOLE. Imagine jogging happily along or
    breathing with refreshing inhalations. walking rather fast. Suddenly step into an open
    manhole. Let this surprise take away the breath.
    SWEEPING OUT TIREDNESS. Exhale forcefully and No harm was done, but you are really stirred up
    deeply and imagine that you are sweeping out, and awake.

    COUNTERSTRETCHING. Strengthen and energize


    the head and neck region by turning the head
    260 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    slowly right or left, the chin toward the shoulder, to warm every vertebra and melting any tensions.
    inhaling while turning the head and lowering it Then let it ascend during consecutive inhalations,
    toward the shoulder and exhaling while bringing it filling the spine with energy and invigoration.
    back to the starting position. Do this so slowly that
    the motion is barely visible. Breathing in this FINGER AND ARM INVIGORATION. Invigorate the
    exercise is opposite to that for relaxing the head fingers with about five small, strong, flexing
    and neck and is invigorating. movements during a stepwise inhalation. Exhale
    while letting the hand relax, then repeat. Initiate
    DOUBLE DOOR. For invigoration of the shoulder and movement of the arm, hand, and fingers from the
    neck region, imagine a double door in the region of shoulder blade region and imagine that the
    the shoulder blades. Allow its two parts to swing forearms or fingers, like those of a string puppet,
    open widely during inhalations. Let them close are supported and moved by means of strings from
    during exhalations. Imagine that a cool, fresh an outside force. Remember that lifting and
    breeze enters while it opens. Become calm and lightness are associated with inhalations. Permit the
    self-possessed while it closes. fingers to be soft, light, liquid, and sensitive, or
    heavy, precise, and hard like little hammers
    FACE TREATMENT. Imagine an invigorating mas- according to the work they must perform.
    sage of the skin of the face. Imagine drumming on Experiment with the breathing while doing this, so
    it with the fingertips. Feel a water massage from a that it aids the actions.
    refreshing shower or raindrops, or feel little
    hailstones bouncing on different parts of the face. INTEGRATION BREATH Imagine or do the follow-
    Feel the deeper tissues massaged during ing. Hold the arms straight down in front, hands
    exhalations. Feel the fast, vibrating, exhilarating folded, palms down. Raise the outstretched arms
    impact on the skin while inhaling in small,
    slowly above the head during inhalation. Feel the
    interrupted, almost gasping steps. End with a deep,
    invigoration. Bring the folded hands behind the
    refreshing inhalation.
    head and press the palms together about five times
    while holding the breath. During exhalation raise
    ICE PLUNGE. Imagine diving into a pool cold the arms with the folded hands to full height and
    enough to stop the breath. Imagine coming out of slowly lower them to the starting position. Repeat
    the pool and relax. Inhale for new vigor and three times.
    energy.
    MENTAL INVIGORATION. Try any or all
    COLD SHOWER Inhale deeply in short steps and of the
    imagine the cold water of a shower beating on following. Imagine during an exhalation "shaking
    shoulders, head, chest, and neck. Feel the vi- water off the fur," or "shaking dust off the mind."
    brations and the sting of the cold water jets. End Then, during the following inhalation, allow
    with a deep, invigorating inhalation. clarity, order, and invigoration to enter body and
    mind.
    CLIMBING TO AWARENESS. Imagine climbing stairs Imagine during inhalations that coolness and
    or a mountain during inhalations. With each step vitality flow into the head. Relax the body during
    imagine climbing into greater and greater exhalations. End on a refreshing inhalation.
    wakefulness and alertness. Keep the exercise short Relax completely during an exhalation. Allow
    to prevent overventilation. the limbs to become heavy and the mind empty and
    floating. Then, during the ensuing inhalation,
    LIGHT BULB. Imagine a little glowing, warm light imagine or feel vibrations and think
    bulb on top of your head. Make it float down the
    back of the head and along the spine during
    consecutive exhalations while allowing it
    HYPNOSIS WITH MEDICAL DISORDERS 261
    of physical and mental invigoration and renewal. tion. Inhale and exhale while imagining charging a
    Repeat about three times. battery there, or filling a reservoir with energy.
    Do the Long Breath [see this exercise in Chapter
    6]. Then after an exhalation, inhale deeply and RESERVOIR OF ENERGY. Create a reservoir for
    "send the invigoration up into the mind." conserving and holding energy in the lowermost
    abdomen, in the region of the navel, or in the chest.
    AWAKENING. For awakening after sleep, or for Get energy during inhalations. Hold it, and
    coming out of a relaxed altered state of con- possibly increase it while holding the breath. Think
    sciousness, inhale and make small stretching of endurance during long, slow exhalations.
    movements with fingers and toes. Either move Imagine during inhalations that something starts
    several times during one long inhalation, or inhale glowing within you, or imagine a beam of light in
    stepwise while moving the fingers. Relax during the reservoir. Relax those parts of the body which
    exhalation. Lengthen the spine during inhalation. are not involved in the building of the energy
    Feel it stretch and become longer. During reservoir during exhalations. Use the reservoir as a
    exhalation relax again, but in a more refreshed place from which to draw energy in an emergency.
    manner. Then, during the next inhalation, imagine Energy can thus be built up and "preserved" for
    plugging yourself into your new battery for several days before some event, in order to reach a
    recharging. Repeat this for several inhalations. peak of energy for a game day, a contest, or in a
    Then stretch and flex the limbs, inhale, and start special event.
    getting up. If young and healthy, get up with an
    inhalation to increase vigor and vitality. If weak
    and not so healthy, get up during an exhalation in CALM BASE. For being still and calm, inhale and
    order to preserve strength and avoid wasting exhale a few times deeply. Then find a comfortable
    energy. balance between relaxation, tension, and real or
    imagined support for the limb, the whole body, or
    the mind, whatever is to be the "calm base." From
    this base let well-aimed aggression proceed, be it in
    CONSERVING AND INCREASING pistol shooting or in an argument.
    ENERGY
    PUMPING STRENGTH. Breathe in and out sharply
    [In addition to the following exercises for and imagine pumping energy and strength directly
    enhancing energy level, Jencks advocates building into any body part or limb which needs it. End the
    as many rest periods as possible into one's daily pumping with an inhalation. If an exertion follows,
    routine and keeping the body as relaxed as hold the breath for this.
    possible. (Ed.)]
    ATHLETIC WARM-UP. The efficiency of a warm-up
    GOLDEN THREAD. For being calm and relaxed, yet is increased and muscles remain more relaxed and
    feeling alive, imagine a golden thread through the invigorated if movements are consciously made as
    crown of the head and down the spine. Imagine that follows. For greater flexibility make forward
    this thread is your center of calmness. movements and stretch, or overstretch, during
    exhalations. For invigoration make forward
    SOLAR PLEXUS OR STORAGE BATTERY. The movements and stretch, or overstretch, during
    solar inhalations. Mix the two consciously during the
    plexus is a network of nerve fibers, located at the warm-up. Inhalation also develops tension, and
    level of the sternum, behind the stomach, in front stretching during inhalation should alternate with
    of the spine. Its fibers radiate like a sun. The solar relaxation during exhala-
    plexus region is a very good place for storing and
    conserving energy in the imagina-
    262 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    tion, so that the proper balance between the two is COUNTERACTING NAUSEA
    maintained.
    Imagine inhaling "coolness" into the stomach
    PARTIAL RELAXATION AND INVIGORATION. Relax- area and exhaling through a place in the body as far
    ation or invigoration alone may not be appropriate. removed from the stomach as possible. Then try to
    Learn to combine invigoration of one part of the talk to the stomach and tell it to relax and calm
    body, or tension of one part of the body, with down. Nausea is evoked by the parasympathetic
    relaxation of other parts. Remember that exhalation nervous system. Do anything possible to divert the
    produces relaxation and inhalation produces mind at the same time as stimulating the
    invigoration or tension. Learn to bring a specific sympathetic nervous system.
    part of the body to the required state of invigoration
    or tension, and then relax the rest of the body. For
    example, relax shoulders and neck during GENITOURINARY DISORDER
    exhalation, and during inhalation invigorate an arm
    for special movement, such as playing an instru- EXCRETION. The excretion of urine, feces, and
    ment or a throw in athletics. Unnecessary tension in menstrual flow can be influenced by the imag-
    shoulders and neck hinders the freedom of the arm ination and the breathing rhythm. The general rule
    for easy, yet controlled, movement and must be is that increased excretion is evoked by thoughts of
    released with exhalations. warmth, relaxation, or flow during exhalations.
    Decrease is effected by thoughts of tension,
    stoppage, or cold during inhalations. Depending on
    ENDURANCE. Endurance may be increased by alternate
    the purpose, inhale, tighten the muscles, and think
    relaxation and invigoration. If, for instance, an arm
    "hold!" or "cold!" or relax during repeated
    must be held for a prolonged time in a raised
    exhalations and think "warm and comfortable" or
    position, feel it light and invigorated during
    "movement and flow are easy."
    inhalations, feel it relaxed and easy during
    exhalations. Design your own exercises for
    increasing endurance using the entries in the table
    [found in Chapter 6].
    Paradoxical Self-Hypnotic
    EFFICIENT HANDS. TO prevent tension while writing Assignment for Chronic Urinary
    or working with the hands, imagine initiating the Retention or "Bashful Bladder"
    movements from the shoulder blade region or the
    elbows, not from the forearms or hands. Let the Gerald J. Mozdzierz, Ph.D.
    shoulders sink and relax the arms and hands Mines, Illinois
    repeatedly while working. Invigorate the fingers
    periodically by making small flexing and stretching [This approach was utilized in a case report,
    movements. following self-hypnosis training through an
    eye-roll technique with the patient.] The patient
    DELEGATING ENERGY. Imagine the Rubber Joints was also given an "assignment" to go to the ladies'
    [an exercise where ankle, knee and hip joints are room at work every 45 minutes, preferably when
    imagined as flexible rubber] for relaxation and others would be present. She was then instructed to
    balance. Then, during an inhalation, gather the full "drop her drawers," position herself on the toilet
    breath and imagine during the next strong seat, ready herself to void and then to roll her eyes
    exhalation forcing all the inhaled oxygen into back, upward and "let it happen." But, she was told that
    arm, fingers, or wherever energy is needed, for the purpose of the exercise was not to have her
    forethought, energetic action. urinate but to have her more relaxed and
    accustomed to the
    HYPNOSIS WITH MEDICAL DISORDERS 263
    restroom setting. She was to wait only a brief hand. At this moment the verbalization is begun:
    period for the relaxation to take effect (perhaps a "Watch your hand and, as your fingers begin to
    minute or so), then leave. She was not to expect any separate, your hand will feel lighter and will
    urine output immediately. gradually float down towards your face. When
    your hand touches your face, your eyes will close if
    they are not already closed, and you will become
    completely relaxed. [This is repeated until the
    Hypnosis in Postoperative desired effect is initiated.]
    Urinary Retention "As your hand comes closer and closer, your
    eyelids will get heavier and heavier. It doesn't
    Simon W. Chiasson, M.D. matter which part of your hand touches your face:
    Youngstown, Ohio it may be your thumb, the back of your hand or
    your fingers, but when your hand touches your
    face, you will feel deeply relaxed.
    INTRODUCTION
    "That's fine. Now that your hand has touched
    There is not one gynecologist or surgeon who your face, let it move slowly down to your side and
    has not been plagued by the vexing problem of as you do so you can become even deeper and
    urinary retention, especially following extensive deeper relaxed. [The patient is then given
    anterior colporrhaphy; however, it may occur suggestions to relax all muscles from the tip of the
    following abdominal surgery or a toes to the top of the head.]
    hemorrhoidectomy. The problem may occur "To help you get more deeply relaxed, imagine
    seldom or often, depending on the surgery that you are standing at the top of a nice wide
    performed or the individual involved in the stairway with soft carpeting on the stairs, and as
    procedure. I believe that the most frequent reason you come down the stairs you go deeper and
    for the problem is the discomfort in the operative deeper into relaxation.
    area, causing reflex bladder spasm. The only "You step mentally on the first step and the
    genuine anatomical obstructions are due to carpeting is soft and thick, and the padding is thick
    incorrect estimation in a sling procedure or underneath it. This gives you such a nice, pleasant,
    overcorrection of the suburethral area with comfortable feeling that you want to transmit it to
    resulting spasm and edema. your whole body, and you feel more comfortable
    This technique is not very time-consuming. It and more relaxed.
    takes only about 10 to 15 minutes, time well spent "You make every muscle in your body twice as
    in patient-physician relationship. I am reporting relaxed as it was a moment before [each such
    here the verbalizations used in successfully treated suggestion for various muscle groups is timed with
    cases. the patient's breathing and is given as she exhales].
    Let your toes relax — feet — ankles — heels — legs
    — knees — thighs — hips — all the muscles in your
    PROCEDURE AND SUGGESTIONS pelvis — your abdomen (from your chest margin
    down to the middle of your thighs, inside and out,
    CHIASSONS INDUCTION. The patient is lying in bed, front and back) — all your chest muscles, and with
    as comfortable physically as possible. She is each breath you go deeper and deeper — all your back
    properly oriented in understandings of hypnosis, muscles — your shoulders and arms — elbows and
    and any special questions about hypnosis are wrists — hands and fingers — all your neck muscles
    answered. She is told to put her hand in front of her — every muscle in your face and even the muscles of
    face, about 8 to 10 inches away, with the forearm your scalp and forehead. Nice and loose and relaxed,
    parallel to the body. The fingers are held together twice as relaxed as they were a moment ago.
    and the hand is turned so that the patient is looking
    at the back of the
    264 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    "You get on the second step and the carpet is the relaxation in the pelvic muscles. The circulation
    thicker and the padding is thicker and you feel more will be better, your healing will progress more
    comfortable and more relaxed, and again you let rapidly. When you feel the pressure building in
    every muscle become twice as relaxed as it was a your bladder and all the muscles around the neck of
    moment ago. the bladder relaxing, raise your right index finger.
    "You get on the third step and the carpeting is so [Alternately, an involuntary ideomotor signal may
    thick that it feels almost like sponge rubber. You go be called for. {Ed.)]
    deeper, deeper and deeper, and again you let every "That's fine. Now when 1 count to three and you
    muscle become twice as relaxed as it was a moment become completely alert you can retain the
    ago. relaxation in your pelvis, and you will be able to
    "When you get on the fourth step, the carpeting empty your bladder, and each time you will do it
    is so thick it feels as if you were walking on three to more and more easily."
    four inches of sponge rubber, and you feel more
    comfortable and more relaxed. You go deeper and
    deeper, and again you let every muscle be twice as
    relaxed as it was a moment ago.
    "On the fifth step the carpeting is so thick it feels Hypnotic Paradigm-Substitution
    as if you were walking on air. You go deeper, with Hypochondriasis
    deeper and deeper — and again, you let every
    muscle be twice as relaxed as it was a moment ago.
    Thomas Deiker, Ph.D., and D.
    "On the sixth step it is as if there was no step at
    Kenneth Counts, Ph.D.
    all, just as if you were walking on air. You feel
    more comfortable and more relaxed, no tension and
    no resistance. You go deeper, deeper and deeper.
    "You get on the seventh step and it is just as if INTRODUCTION
    you were floating on a cloud — a nice soft, white,
    billowy cloud, and you feel more relaxed and go These suggestions were used successfully in a
    deeper, deeper and deeper. single-subject design study (three sessions) in
    "On the eighth step just imagine it pulling out treating a 59-year-old woman with
    wide like a big foam rubber mattress and your hypochon-driacal neurosis. Her symptoms included
    whole body melts right into it, right into it, and you weakness, low energy, nausea, diarrhea, and dizzi-
    get a pleasant, heavy feeling throughout your ness in the absence of medical ailments.
    whole body. You go deeper and deeper. Importantly, she also stated, "I haven't got any
    "On the ninth step it is as if there were no step family or personal problems." She spent a great
    and no mattress, just as if you were floating along deal of time lying on the sofa. "The experimental
    on 'Cloud Nine' with a pleasant, heavy, paradigm-substitution sessions consisted of
    comfortable feeling and you go deeper, deeper and providing detailed cognitive beliefs relating to
    deeper. general mental health concepts, which were
    "When you reach the tenth step you have suggested to be incorporated amnestically between
    reached the spot where, with every breath, you can sessions." Although these illustrative suggestions
    go deeper and deeper until you reach the deepest were from only one session and are specific to the
    point of relaxation for you at this particular time. case, they illustrate a technique that may have
    potential benefit with hypochondriasis and that
    provides an alternative to uncovering and
    SPECIFIC THERAPEUTIC SUGGESTIONS. "As you con-
    insight-oriented treatment methods. Since
    tinue to relax you will become aware of all of psychophysiologic complaints may both cover
    serious psychopa-thology or stem from organic
    conditions, how-
    HYPNOSIS WITH MEDICAL DISORDERS 265
    ever, clinicians are encouraged to do careful another reason that physical problems, even
    psychological and medical evaluation prior to though they are still there, will not seem as
    using such techniques. (Ed.) important, you won't spend as much time and effort
    thinking about those problems, not even important
    enough to spend time thinking or talking about.
    SUGGESTIONS

    When you wake up you will feel as relaxed as


    you feel now, but there will be a change, an Suggestions with Asthma
    important change that will affect your daily life.
    The change will be in your mind, the way in which Don E. Gibbons, Ph.D.
    your mind works, the things that your mind thinks
    about. It's not that you will have no more problems, If you ever feel any more attacks coming on, or
    just the kind of problems you have, the kind of even if one has already started, you will be able to
    problems your mind thinks about, will be different. place yourself in trance very rapidly, just by
    When you wake up you will think of yourself as a closing your eyes and silently repeating the
    person with "problems in living." Everyone has necessary suggestions to yourself. Then you will be
    problems in life. Problems in living. Sadness or able to drive away the symptoms completely by
    nervousness bother most people at times. These slowly counting to fifty, with each count taking a
    feelings could have many sources, problems with deep breath and clenching your fists, and then
    family or friends. Feelings of loneliness or lack of unclenching your fists and letting your body relax
    purpose are other problems in living, or feelings as much as possible each time you let a breath out,
    that the future has little to offer. These are the silently repeating to yourself the word calm each
    problems that bother many people. Maybe some of time you exhale. And when the count is completed,
    these bother you. Maybe it's something else. You you can terminate the trance in the usual way,
    haven't had time to think about these important feeling fine once more.
    problems because of your other concerns. Now you
    will have time to do so, because your mind will be
    very curious to discover such problems in living in
    your own life, and you will be very eager to discuss
    them and solve them, because one of the changes in
    Suggestions for Prevention of
    your mind will be much greater confidence in being Seasonal Allergies
    able to solve these problems with hard work. Your
    other problems won't have gone away, but they will Hans A. Abraham, M.D.
    seem less important than these problems of living. Palm Beach, Florida
    You will feel good about yourself, proud of your
    courage and honesty in dealing with important The vast expanse of the United States has some
    problems in life. These problems will be just as blooming or pollinating plants at all times. There
    important as your other problems, just as serious, will be some pollens in the air at all times, not
    interfere with your life just as much, will bring you enough to cause symptoms. Nevertheless these
    the sympathy of those around you, but will be ones minute amounts of pollens enter the system and
    that you can solve, that hard work will overcome. will act similarly as the desensitizing injections
    Your other problems, your physical problems, from the allergist. There will be a gradual increase
    worrying about physical problems has prevented of the airborne pollens, desensitizing your body.
    you from being able to devote your energy to these When the pollen season in your area is upon you,
    more important problems in living. That is you will be prepared, and although there may be
    some symptoms in the first year, they will not be
    266 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    enough to cause any disability. And season after of times this afternoon when you stopped hearing
    season, the symptoms will be negligible until they the ringing. It is hard to remember things that don't
    have disappeared completely. occur. But the ringing did stop. But because there
    was nothing there, you don't remember it. . . . Now
    the important thing is to forget about the ringing
    and to remember the times when there was no
    Erickson's Metaphor with ringing. And that is a process you learn. I learned in
    Tinnitus one night's time not to hear the pneumatic hammers
    in the boiler factory — and to hear a conversation I
    Milton H. Erickson, M.D. couldn't hear the previous day. ... I knew what the
    body can do automatically. [Pause] Now rely upon
    Now I am going to give you a story so that you your body. Trust it. Believe in it. And know that it
    can understand better. We learn things in a very will serve you well.
    unusual way, a way that we don't know about. In my
    first year of college I happened to come across that
    summer a boiler factory. The crews were working
    on twelve boilers at the same time, and it was three Procedure with Difficulty
    shifts of workmen. And those pneumatic hammers
    were pounding away, driving rivets into the boilers. Swallowing Pills
    I heard that noise and I wanted to find out what it Irving I. Secter, D.D.S., M.A.
    was. On learning that it was a boiler factory, I went
    Southfield, Michigan
    in and I couldn't hear anybody talking. I could see
    the various employees were conversing. I could see
    the foreman's lips moving, but I couldn't hear what I want you to visualize someone other than
    he said to me. He heard what 1 said. I had him come yourself, who has the same problem you have.
    outside so I could talk to him. And I asked him for Signal that you can see this person sharply and
    permission to roll up in my blanket and sleep on the clearly as if on a TV or motion picture screen, by
    floor for one night. He thought there was something letting your right index finger come up. [Patient
    wrong with me. 1 explained that I was a pre-medical signals.]
    student and that I was interested in learning Notice this person is trying to swallow a pill. He
    processes. And he agreed that I could roll up in my chokes on it. His throat muscles tighten and he fails
    blanket and sleep on the floor. He explained to all to swallow the pill. You know how he feels, don't
    the men and left an explanation for the succeeding you? Signal "yes" with your finger. [Patient
    shift of men. The next morning I awakened. I could signals.]
    hear the workmen talking about that damn fool kid. Is this person male or female? [Patient re-
    What in hell was he sleeping on the floor there for? sponds.] Observe now, our friend has been given
    What did he think he could learn? During my sleep the signal to "relax." He [or she] does so
    that night I blotted out all that horrible noise of the completely, mentally and physically. His throat
    twelve or more pneumatic hammers and I could muscles relax and he feels good all over. Note that
    hear voices. I knew that it was possible to learn to you can share these feelings with him, too.
    hear only certain sounds if you tune your ears Acknowledge this with the finger signal. [Patient
    properly. You have ringing in your ears, but you signals.]
    haven't thought of tuning them so that you don't
    hear the ringing (p. 104). . . . And you think back; Now let our friend disappear from the picture
    there are a goodly number and see yourself there in his place. OK? [Patient
    responds.] Now see yourself on the screen getting
    the signal to "relax." Do so completely, mentally
    and physically, both on
    HYPNOSIS WITH MEDICAL DISORDERS 267
    the screen and in person. See yourself swallowing a THE TECHNIQUE
    pill without any difficulty and take pleasure in your
    success. From now on, whenever you need to
    The technique begins with the common practice
    swallow a pill or anything else that has given you
    of eliciting the patient's permission. Thus the
    difficulty, the touch of the pill to your tongue can
    patient is asked if he/she would like to be rid of the
    be a signal for complete relaxation, and the pill can
    hiccups. Most often the person will respond
    go down without any difficulty. Are you willing for
    affirmatively. It is always better to elicit
    this to happen? [Patient responds.] Shall we
    permission for such simple procedures since it
    practice this in the alert state?
    demonstrates respect for the patient and greatly
    facilitates cooperation and therapeutic efficacy.
    Next, the person is asked, "Please stare in my
    eyes and make every effort not to blink. That is all
    Suggestion for that is required. Breathe normally . . . that's right . .
    Alleviating Hiccups . just continue to stare in my eyes and breathe
    normally. That's right."
    Gerald J. Mozdzierz, Ph.D. The suggestion above may be repeated over and
    Mines, Illinois over with simple variations. I have usually found
    the suggestion to be successful within one minute. I
    INTRODUCTION have no idea why the procedure is effective; I only
    know that it is very effective. One can speculate
    This suggestion pertains to helping children and that the patient is completely distracted and, hence,
    adults to rid themselves of a case of simple hiccups. relaxed by the eye fixation and attempting not to
    This distressing symptom can interfere with a blink, so that normal breathing is returned.
    clinical interview or physical exam, and yet I have The therapeutic effectiveness of the procedure
    found that it can be quickly relieved. I have no can greatly enhance the credibility of the therapist
    knowledge of the derivation of this technique or if for helping the patient to be relieved of this
    it has ever been described in publication form. I discomfort. Of course, the therapist should politely
    only know that I have used this approach to help give credit to the patient for effecting the "cure."
    any number of people to rid themselves of this
    oftentimes distressing spasming of the diaphragm
    which results in an abortive attempt to inhale.
    HYPNOSIS IN OBSTETRICS
    AND GYNECOLOGY

    INTRODUCTION

    Hhypnotic childbirthwidely
    YPNOSIS HAS BEEN used in obstetrical care, particularly in
    training. August (1960a), for example, performed more
    than 1,000 deliveries using hypnosis as the sole anesthetic. There are a variety of
    advantages that may result from the use of hypnosis in obstetrics. Hypnosis may
    be successfully used to reduce pain in delivery, reducing the need for medications
    and chemo-anesthesia, thereby eliminating its risks and post-delivery effects for
    both mother and child. It may additionally facilitate comfort in suturing the
    episiotomy. Hypnosis has proven successful as the sole anesthetic for childbirth
    in between 58% and 79% of cases (August, 1960, 1961; Fuchs, Marcovici,
    Peretz, & Paldi, 1983; Mody, 1960; Mosconi & Starcich, 1961), with an average
    among studies of 69%. Another potential advantage of hypnosis is seen in the
    widespread reports suggesting that it may reduce the average duration of labor by
    two to four hours (Abramson & Heron, 1950; Callan, 1961; Davidson, 1962;
    Fuchs et al., 1983; Mellegren, 1966).
    Hypnosis has also proven extremely effective in the treatment of hyperemesis
    gravidarum, vomiting in the early stages of pregnancy. Success rates of 75% and
    greater are common with this problem (Fuchs, 1983; Fuchs, Brandes, & Peretz,
    1967; Fuchs, Paldi, Abramovici, & Peretz, 1980; Henker, 1976).
    Another important area of hypnosis application is in the care of patients with
    problems of premature labor. The incidence of premature labor has not decreased
    significantly in recent years (Caritis, Edelstone & Mueller-Heubach, 1979),
    despite advances in technology; hypnosis has the potential to enhance patient care
    and minimize risks and expenses for such patients. Hypnosis and self-hypnosis
    training may modify negative attitudes, anxi-
    270 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    eties and fears concerning childbirth. Zimmer, Peretz, Eyal and Fuchs (1988)
    recently found that mothers who used hypnosis for anxiety and stress management
    had fetuses who moved in a much more active manner than a control group.
    More impressively, Omer (1987) and Omer, Friedlander and Palti (1986) have
    documented that brief hypnotic interventions produced significantly greater
    prolongation of pregnancy in women with premature labor than a medication
    treatment group, confirming earlier case reports (Lugan, 1963; Schwartz, 1963).
    Omer's approach to managing premature labor is presented later in this chapter.
    Finally, it should be noted that hypnosis has also been used to promote and to
    suppress lactation (August, 1961; Cheek & LeCron, 1968; Kroger, 1977) in
    obstetrical patients.
    Like any other therapeutic method, hypnosis has limitations. Obstetrical
    hypnosis requires that the patient have some hypnotic training prior to delivery,
    and, of course, not all patients will be adequately responsive to hypnosis.
    However, group hypnotic training is often conducted in a way that enhances
    rapport and satisfaction with patients and requires minimal time.
    Hypnosis has also been used to treat a variety of gynecologic complaints. I have
    personally found hypnosis to be of considerable benefit in evaluating and treating
    dyspareunia (painful intercourse), and I have successfully treated (with long-term
    follow-ups) several chronic and resistant vaginitis (vaginal infection) cases.
    Hypnosis has been successfully used in the treatment of dysmenorrhea (painful
    menstruation) (Leckie, 1964), amenorrhea (Crasilneck & Hall, 1985; Erickson,
    1960; Van der Hart, 1985), leukorrhea (vaginal discharge) (Leckie, 1964),
    pseudocyesis (false pregnancy), and post-menopausal symptoms (Crasilneck &
    Hall, 1985).
    In approximately 50% of infertility cases the cause cannot be determined. It is
    widely believed that a proportion of these cases result from psychological factors
    —a belief that is reinforced by the common experience of couple's finally
    adopting a child out of frustration, only to conceive a child of their own a few
    months later. Unfortunately, we only have uncontrolled and anecdotal case
    reports (e.g., August, 1960b; Leckie, 1965; Muehleman, 1978; Wollman, 1960) of
    the potentially positive impact of hypnosis with resistant infertility. This is an area
    of potentially fruitful research.
    We should also be aware that there is a variety of painful gynecologic
    procedures for which hypnotic analgesia may be helpful. Finally, there are several
    well-done investigative reports (Stalb & Logan, 1977; Willard, 1977; Williams,
    1973) documenting that hypnosis may be used to induce breast growth. We do not
    yet know whether this phenomenon is mediated through vascular flow changes,
    endocrine effects, or a combination of the two, but it illustrates the power of
    mind-body interaction.
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 271

    OBSTETRICAL HYPNOSIS: CHILDBIRTH TRAINING

    Group Hypnosis problems amenable to hypnosis. If I were to take


    time with each patient referred or asking for help
    Training in Obstetrics with hypnosis, I would have to give up obstetrics
    and gynecology. However, I can accommodate a
    Simon W. Chiasson, M.D.
    great number of these patients by teaching them
    Youngstown, Ohio
    hypnotic techniques in the group situation and then
    spending a short period of time with them on an
    INTRODUCTION AND OVERVIEW individual basis.
    I make no effort to induce my patients to use
    When I initially began using hypnosis, I treated hypnosis. However, because of past patients who
    patients on an individual basis. But after the have used hypnosis and referrals for hypnosis, I
    original fascination wore off, I discovered that I still have a great many who choose this modality.
    was using up too much time. Therefore, I adopted a Because of the understanding of hypnosis that the
    group training model with which I have been very teachers of Lamaze have in our area, they no
    pleased. longer resist the use of hypnosis. At one time they
    I consider the following aspects most important: felt that if a woman was using Lamaze she was
    controlling the situation, but if she was using
    1. Group hypnosis training saves time for me. hypnosis she was under someone else's control. I
    2. I spend one and a half hours twice a month with was able to demonstrate to them that their use of
    the group and this allows a larger number of methods like eye fixation and breathing and
    patients to achieve a greater depth in the counting were actually self-hypnosis. I helped
    hypnosis and to be exposed to a greater variety them realize that no one actually hypnotizes a
    of techniques. patient, but that we are teaching women how to go
    3. The patients are able to exchange experiences into a hypnotic state and use it for their own
    in the group. benefit.
    4. The answers to questions by any member of the I use a permissive approach with my patients.
    group help the entire group. They are invited to come in and observe at least
    5. The spirit of competition helps some pa one class. At this time every effort is made to
    tients to attain a greater depth. correct any misconceptions they may have con-
    6. Group preparation is stressful for some cerning hypnosis and to give them a basic
    patients. However, if patients who are rather understanding of how hypnosis can be beneficial
    anxious in groups are still able to achieve a for them. It is explained that only 20%-35% of
    hypnotic state under these conditions, they will patients are able to go through labor and delivery
    have a better chance of achieving it in labor, using hypnosis alone. However, it is explained
    which is another stressful condition. that, if they do need medication or anesthesia, less
    7. The classes give a much better chance to will be required than without hypnosis. They are
    educate the patient about the misconceptions informed that if they do not feel completely
    that make labor and delivery such an ordeal. relaxed they may ask for medication to help them.
    They are told that they never have to feel that they
    are letting me down if they do not use hypnosis all
    I use a permissive technique that also enables me to
    through the delivery. After all, they are using
    help patients from outside my obstetrical practice.
    hypnosis for their benefit, not mine.
    Many patients are referred to me with
    I no longer use any one particular induction
    technique; rather, I seek to fit the technique to
    272 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    the individual. But, since I am using a group While the patients are deeply relaxed they are
    approach with about 20-25 patients, I have them told about the "breakthrough periods," and how to
    close their eyes and I tend to use a counting use them to their advantage. First, when they are
    technique, counting backwards from 100 to 0. I go 6-7 cm. dilated, they may feel discouraged and that
    from 100 to 80 in increments of 1, and then from 80 they are not getting anywhere or that no one is
    to O in increments of 5. I also offer suggestions paying much attention to them. They may even feel
    after each count of 20. After counting down to 0, I nauseated. It is explained that if they are checked at
    ask them to picture themselves doing something this time and found to be 6-7 cm. dilated, then they
    they would find particularly enjoyable. It is should know that within a half an hour or less they
    suggested that, as this becomes more and more will be completely dilated.
    vivid, they can go deeper and deeper.
    The second "breakthrough period" is just before
    I no longer use dissociation to imaginal scenes they are completely dilated. They feel like pushing
    during delivery. I used that technique in the very and if they push they feel uncomfortable because
    beginning. However, it seems silly to me to have a they are pulling down the whole uterus. It is not
    woman taking an imaginal trip 1,000 miles away helpful to tell them not to push; instead they are
    on a beach, or even imagining sitting in a chair told to take in a big breath and let it all out, or pant
    observing the birth process, while she is delivering. like a puppy, and then they cannot push. The last
    I believe that she should know that she is having a "breakthrough" is when the head comes through the
    baby but that it does not have to be painful. cervix. Sometimes this occurs suddenly and with
    Nevertheless, dis-sociational procedures are great force. They are told that this is what they were
    valuable when repairing an episiotomy, although waiting for. If they have had a baby before, they
    even in this situation I give patients a choice of will be ready to deliver in three or four
    technique. I ask, "Do you want to simply picture contractions. If this is their first baby, they can use
    yourself doing something enjoyable or do you want the contractions. "By pushing down, the more you
    me to use a local anesthetic?" push, the better it feels. And with each contraction,
    you can relax more and more, and make all the
    muscles in your bottom nice and numb, and loose
    TECHNIQUES AND SUGGESTIONS and relaxed."
    The verbalizations I use for obstetrical patients Patients are also told that when their contractions
    vary with the problems. I usually give the are 10 minutes or less apart, they should get ready
    following suggestions at every 20 number interval to go to the hospital. "And when you get in the car,
    (e.g., at 80, 60, 40, 20, and 0) during the counting you can feel just as if you are sitting in this chair.
    technique. And by merely putting your right hand on your left
    "The remainder of your pregnancy will be so shoulder, and closing your eyes, picturing a color,
    much better. Your labor will be shorter, easier and and taking a deep breath, as you gradually let that
    safer. Your stay in the hospital will be so much breath out, and that hand sinks all the way to your
    better. When you are in labor and when you are in side, you will be deeply relaxed." Patients are told
    the hospital, you can use your contractions to get to repeat the self-hypnotic induction again in the
    more and more relaxed, and to make every muscle prep room to make the prepping and examination
    in your bottom nice and numb, loose and relaxed. comfortable. "And each contraction and each
    [These are the muscles that have to relax when the background sound or noise will simply help you
    head is coming down and delivering.] If I put my stay more relaxed." They are further told, "The
    hand (or if the nurse or your husband puts a hand) remaining part of your pregnancy will be so much
    on your shoulder, you can use this as a signal to go better. Your labor will be shorter, easier and safer,
    deeper and deeper." and your stay in the
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 273
    hospital will be so much better." They are also HEADACHES. "As the muscles relax, the circula-
    instructed to practice self-hypnosis. tion improves on the inside and outside of the
    I stress relaxation primarily, but glove anesthesia body, especially through the brain. And since the
    may be produced during a group session and circulation is normal, the vessels will not dilate or
    transferred to the chin with suggestions to keep the constrict; therefore, there should be no headaches."
    numbness in the chin for five minutes after alerting
    from trance. This serves the purpose of providing
    trance ratification. It is pointed out that they can
    transfer the numbness anywhere. Outline of Hypnotic
    I seek to see the patient in labor when she is Suggestions in Obstetrics
    21/2-3 cms. dilated. If I am delayed, however, our
    nurses and residents are familiar with supportive Bertha P. Rodger, M.D.
    measures and are very helpful. If the patient is Palm Harbor, Florida
    having difficulty relaxing, the resident usually asks
    what method she uses to relax, and during the ADVANTAGE S
    process of explaining her self-hypnotic technique,
    the patient will usually induce a hypnotic state. If • Versatility, flexibility, adaptability to indi-
    the patient needs medication it will usually not be vidual and situation.
    until shortly before delivery, and then in most cases • Reduces or eliminates drugs for sedation,
    she will only require 25 mg. IV of Demerol. analgesia, anesthesia, anxiety and pain con-
    trolled without interference with physiology of
    SUGGESTIONS FOR HYPEREMESIS. "You can replace the mother/child.
    dirty metallic taste in your mouth with a minty taste • Answers dependency need, fostering mother's
    or the taste of your favorite toothpaste. And as you maturity as she learns to pursue goal despite
    relax more and more, all your muscles will be twice suffering or difficulty. Satisfaction and joy in
    as relaxed and your circulation improves on the participating, whatever the circumstances.
    inside and outside of your body, especially through
    your intestinal tract. As the circulation improves,
    PREPARATION
    all the peristaltic waves, the waves that move the
    food along the intestine, will be nice and smooth,
    • Weekly classes of 10-20; question and dis-
    beginning with the esophagus, the tube from the
    cussion save time.
    back of your throat to your stomach. And the food
    will go down nice and easy, and be broken up in the • Present as natural, inborn ability to control
    stomach and passed to the small bowel to be input for purpose of controlling output
    digested and absorbed. All the peristaltic waves (behavior).
    will be nice and smooth. Each time you brush your • Methods of induction and deepening taught as
    teeth, you will reinforce the nice relaxed feeling autohypnosis.
    and have this pleasant taste in your mouth." • Stages of labor explained, special approaches
    suggested.
    • Posthypnotic suggestions with a copy to take
    E X C E S S FLUIDS. "As the muscles relax more and home. Rapport established with person of
    more, the circulation improves on the inside and choice for reinforcement prn.
    outside of the body, bringing the fluid back into
    circulation from the tissues, and helps the kidneys
    LABOR
    to work more effectively."
    • Normal, psychological act (as such, does
    not have to cause pain!).
    274 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    • Does not have to be learned. Body knows howl each procedure (enema, IV, etc.). Report
    Made to perform appropriately. unmistakable change to next stage. Stage 2. Need
    • Done unconsciously so the less attention to it, to be doing something active. Counting
    the better. Muscles of arms, legs, digestive Techniques, especially pendulum (e.g., counting a
    tract, uterus, contract and do their work. pendulum swinging from 1 to 100, or 2 to 99) or
    Recognize the pleasant sensations of counting time in seconds, starting with 100, 99.
    hardening: the feelings of accomplishment and Can notice how pressure actually does numb birth
    strength. canal. Increasing anticipation of seeing baby . . .
    • Contractions = powerful mechanism by which look forward to holding it. . . . Watch what is going
    baby will be born into world. Hard work gives on in the mirror.
    greatest satisfaction. Look forward to this Stage 3. Attention focused on baby, bath,
    result. Parents truly co-creators with God, footprinting, etc. Time to review with crystal
    bringing new life into the world. clearness all the interesting and delightful
    • Term "labor pain" common. Transpose to sensations and experiences connected with
    "contraction." True meaning = a most useful having a baby so as to share when you wish.
    device, a tightening and hardening which = Walking upright (as if with book on head) and
    motor part. sitting squarely numbs area of episiotomy
    • Welcomed as each brings goal nearer. Stirs nicely. (Minimizes irritation of rubbing
    emotions of placidity. buttocks).
    • Calmness and pleasant anticipation of ful Own doctor will tell you what signs to watch
    fillment. Use as a signal to go into trance as for, appraise you of what to expect, interpret
    needed, relaxing excess tensions so energy what is happening and how you can help.
    goes where it's needed. Come out of trance as if
    from a pleasant nap, refreshed and happy. As
    POSTHYPNOTIC SUGGESTIONS FOR
    cervix dilates from 1-10 cms., can go deeper
    and deeper and be more and more comfortable. LABOR AND DELIVERY
    (Saves both psychic and physical energy as
    1. Each contraction can be considered as a
    both cervix and perineum relax in readiness for
    pleasing occurrence, drawing you nearer to
    delivery.)
    your goal . . . bringing a new love for your
    • Full dilation: Familiar sensation as head enjoyment.
    moves into birth canal. Signal to notify at 2. You can feel it as a hardening, a tightening, a
    tendant. Important step forward. Now any wonderful power working for you. You can
    discomfort in sacral area and thighs disap welcome it, using it as a signal to go deeper into
    pears spontaneously. Strong desire to push is the state of comfort (trance).
    controllable according to instructions. Pres 3. The moment it starts to go, you can forget it
    sure of descending head numbs unpleasant completely. It has passed.
    sensation (like elastic band on finger).
    4. You need pay attention only to the voice
    speaking directly to you.
    5. You can be quite calm, confident and coop-
    CONDUCT OF LABOR erative throughout.
    6. A pleasant sense of anticipation can replace any
    Stage 1. Free to enjoy resting, relaxing, reverie of apprehension.
    all the happy experiences leading up to your 7. You can recuperate quickly, completely and
    becoming a co-creator with God; all love in comfortably.
    your life . . . whole mosaic. Can go into
    trance with each contraction, even
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 275
    ADDENDA Dissociation to another place, can "sit over there
    and watch." 9. Posthypnotic Suggestions
    provide helpful mind-set. Reinforce by reading
    • You can feel your contractions to the point of
    at home in trance.
    satisfaction of your own curiosity, enabling you
    10. Feel sensation through wall of numbness.
    to share the experience with the rest of the
    female population who have had babies, 11. As cervix dilates 1-10 cms, go deeper into
    assured thereby that you are really dealing well. comfort to count of 10.
    12. Counting especially. Pendulum to occupy
    • You may feel it necessary to pay for this joyful attention prn.
    experience with some pain, or need some TLC
    after it. Turn on your abdomen, relax into a
    lovely lassitude while gravity aids in draining
    all congested areas and realize you don't need Suggestions for a
    those pills after all! Comfortable Delivery
    • Prolonged contraction of muscle in fear or in
    splinting causes it to ache just because of Joseph Barber, Ph.D.
    interference with its circulation. Los Angeles, California
    • The odds are tremendously in favor of having a
    When a woman wants to learn hypnosis for a
    healthy, normal child, and doing it easily!
    comfortable delivery without chemical anesthesia,
    • Teach patient to deepen trance to count of 10 it is my practice to request that her husband
    with the number 10 as the "deepest trance you participate in the process (as many husbands now
    can imagine." And then reports of the dilating participate in the delivery). At the outset I indicate
    cervix in cm. implies or can be given as a signal to the couple that our goal is to enable them, as a
    to deepen trance in a like manner.*
    team, to create as much comfort, excitement, and
    joy as possible during childbirth. I generally begin
    by hypnotizing the husband, asking that the wife
    DEVICES TO AID COMFORT pay close attention to the process. During hypnosis
    1 suggest to the husband that while in the hypnotic
    state he is well able to know how to hypnotize his
    1. Simple relaxation; trance prn: Can double the wife, since he can better empathize with her needs,
    effect of medication, halve pain. for example:
    2. Reverie: Passes time quickly, pleasantly,
    sends messages to body to perform efficiently, "Now you know the comfort of this state, and,
    heal rapidly. even though you remain in this state, feeling
    Time distortion: Time of contraction passes comfortable, you can enjoy watching your eyelids
    "like a flash" leaving plenty of time between begin to open, and as you look over at your lovely
    to rest and enjoy. wife, you can begin, even as you sometimes pay
    4. Deliberate redirection of attention from attention to me, you can begin to say things to her
    discomfort to comfort. that you feel will help her to feel more of what you
    are feeling. You can begin now to share this
    5. Reinterpretation of sensations in terms of
    experience with your wife."
    familiar and pleasant.
    6. Teach glove anesthesia and transfer (can do it As the husband begins, I serve as coach,
    mentally to difficult spot). providing additional cues and suggestions when
    7. Revivify saddle block (epidural), tuning out needed, attempting to develop a state of mutual
    any unpleasant part, trance. hypnosis for the couple. As this process continues,
    the husband is coached to provide suggestions to
    *This suggestion comes from Belinda Novik, Ph.D.
    his wife for analgesia during labor and delivery,
    for example:
    276 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    "You'll be doing hard work, but you've done hard create analgesia on her own. The couple is
    work before. And there will sometimes be such a encouraged to practice daily and to return in a
    lot of pressure, maybe more than you can week, at which time their experience is discussed
    remember feeling before, but you don't need to be and any difficulties are explored and remedied.
    surprised by it. You can just notice how easily your Generally, there are four such appointments.
    mind seems to somehow ease the pressure, letting it A couple's relationship obviously plays a
    spread and flow, without blocking, knowing that significant role in determining the pace and
    there are no other feelings to bother you or disturb ultimate success of such a technique. In couples
    you. And your physician can talk to you, and the looking forward to the birth of their child and in
    nurse can talk to you, and you can easily pay women motivated to handle their delivery with
    attention to whatever you need, all the while letting hypnosis, this approach generally leads to quite
    the pressure come and go, sometimes feeling so happy results. Difficulties arise when the couple
    excited that you're soon going to get to see your does not really want a child or if other aspects of
    baby. And since you're preparing for this ahead of the situation create fear or resentment. If, for
    time, training your nervous system so that this instance, a woman wants her husband's support but
    natural experience can be quite comfortable he is unable or unwilling to give it, this issue must
    enough, you can also know that you are preparing be faced before going further. A woman may learn
    for any eventuality. So that, no matter what to use her independence and autonomy in this
    situation might occur, no matter if there are delays situation; she may be able to locate an obstetrician
    or surprises, or whatever, you still have the freedom willing to assist her in her use of her own
    and ability to do whatever is necessary for your psychological abilities, without the need to use her
    comfort. And I'll be there with you, reminding you husband's help. Other difficulties arise if a woman
    of what we're doing, if you forget. And you don't has difficulty allowing her husband to help her, as
    even have to pay attention to me if I'm distracting was the case with one patient who initially giggled
    you. You can just do whatever you need. The noise, whenever her husband attempted to offer her
    the lights, the unfamiliar feelings are all just a part suggestions; subsequent discussion revealed that
    of what is for you the most natural experience in the the woman did not seriously believe her husband
    world. And you might sometimes find yourself capable of any intellectual or emotional help to her
    thinking, as the work goes on, and as the pressure in any situation. Our work became reoriented
    builds, you might sometimes enjoy thinking about toward the wife's learning and practicing
    later, either in a few minutes, or a few hours, about self-hypnosis and allowing the husband to "just
    holding our baby outside your body, not inside, and share the experience," although by the time
    getting to look at our baby. And whenever I delivery occurred the couple had been able to move
    squeeze your hand, like this, you can just let go and into the roles we originally attempted, and 15 hours
    remember how really far away and quiet and of labor were experienced with little effort and no
    comfortable you can feel, and how nice it is to be discomfort.
    able to rest between work."
    Advance training in pain control is easier than
    The husband is also taught how to provide using hypnosis when pain is already being felt
    noxious stimulation, such as squeezing the skin of because learning to feel and maintain comfort is
    his wife's inner thigh, for the purpose of their easier when pain, anxiety, and fatigue are not
    practice outside the office, so that the wife can interfering. Certainly clinicians can help untrained
    experience analgesia in advance of labor and patients during labor or other potentially painful
    develop confidence in her ability to experiences with hypnotic techniques, but in such
    cases attention needs to be
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 277
    paid initially to the fact of the discomfort and then that at any time during labor and delivery, you can
    to how it might change. readily have whatever medication you want, when
    you want it. This serves to help overcome your past
    fears. Probably medication will not be necessary,
    and if required will be only a small amount. In
    The Hypnoreflexogenous regard to the time of onset of labor, the uterus does
    not break the harmonious, hypnotic, relaxing calm
    Technique in Obstetrics of your body. When labor begins you will
    A. Kenneth Fuller, M.D. experience little or no discomfort. You may ask
    yourself, or your doctor, whether you may be in
    Gainesville, Florida
    labor; the important thing is this: Your only symp-
    toms are the natural contractions manifested only
    INTRODUCTION by periodic hardening of your womb. In some
    cases, where a complete blocking of discomfort is
    Fuller's suggestions are adapted from the work not obtained, women find discomfort so distributed
    of Werner, Schauble and Knudson (1982). They that it is felt mainly at the level of the lower back as
    use a verbal conditioning technique to (1) a discomfort similar to that during your period, or a
    overcome fear of delivery with positive feelings heavy aching in both thighs. The back and upper
    that reframe maternity as a special experience, (2) thigh discomfort stops quickly and spontaneously
    substitute the concept of contraction for pain, and when the dilation of the cervix is complete. You
    (3) presumably reduce the excitability of the cortex may look forward to this because it is a positive
    through psychological sedation. You are referred to sign, indicating that the time of delivery is near.
    Werner's original article for further details con-
    cerning the rationale for these suggestions. (Ed.) After delivery you may vividly remember these
    words: "In the next few days you will pass your
    water without being catheterized; you will move
    SUGGESTIONS your bowels without enemas; you will have a good
    appetite; the food will appeal to you; the nursing
    In the hypnoreflexogenous technique you may staff will appeal to you; you may have a few
    notice that we exalt maternity and enliven you with sutures, but they are not going to bother you — you
    the emotion which the happy waiting and the will hardly know that they are there; the entire stay
    precious moment of birth represent. You, through in the hospital will seem like a pleasant vacation."
    your own conscious and active participation, can The effectiveness of your calm, fearlessness,
    maintain this emotion throughout labor. Each motivation and training provided your child with
    contraction can be considered as a pleasing the opportunity to be born without feeling any guilt
    occurrence which draws you constantly nearer to for causing you any pain during labor and delivery.
    the goal of delivery, closer and closer — with you
    being able to actually see your baby and hold your You may benefit by entering hypnosis at some
    baby, because a contraction is a motor part point — it is your right, your privilege to do so, if
    necessary in order for you to have your baby. you wish, to stay in this state of pleasant
    expectation throughout labor and delivery.
    I want you to fully understand that this method However, you will probably not need to enter
    works even for women who have had previous bad hypnosis during labor, since you will not be
    experiences and who may believe that drugs and uncomfortable. During the training sessions, you
    anesthesia are the only ways to stop pain. You have are being taught three techniques
    the chance to understand
    278 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    which produce the absence of pain and discomfort. Childbirth Suggestions
    First, you should understand and really understand
    that if at any time during labor or delivery you
    experience discomfort from an intense contraction Larry Goldmann, M.D.
    of the uterus, automatically, without thinking, you Fort Myers, Florida
    will lapse into the deepest hypnotic state you can
    attain and remain in it as long as the contraction 1. Labor is a normal, physiologic process.
    lasts, after which you will be completely 2. The contractions of the uterus are no different
    comfortable again. Or, if the labor has gone on for from the contractions of any other muscle of
    quite a while and you would like a little nap, you
    the body.
    may remain in the hypnotic state through several
    contractions or even through the rest of the labor 3. Surely you will feel the power of your
    and delivery. contractions, but they are nothing more than
    muscular contractions.
    Second, you can use the technique of allowing 4. Remember that each contraction carries you
    yourself to go to a pleasant place in your mind's closer and closer to the delivery of your baby
    eye. Really have a sense that you are there, that you through a normal vaginal delivery.
    are seeing the things that you see there, you are 5. Each contraction will be perceived as you
    feeling the things that you feel there, you are desire, not as others would have you perceive
    hearing the things that you usually hear when you them.
    are at this place, enjoying yourself, being pleasant 6. Your unconscious mind will cause you to
    and comfortable. Continue to fully experience this become relaxed with each contraction — the
    and while you are there you may notice that you're stronger your contractions become, the deeper
    noticing different sensations while you are in this will be your relaxation.
    place, this comfortable, pleasant, tranquil place 7. Your husband's voice will be as relaxing to
    where you can relax. While you are at this place you as mine.
    nothing seems to bother you, you are just enjoying
    8. Your confidence in yourself and your partner
    the moment there.
    will grow with each contraction.
    Third, why not learn to use a technique whereby 9. You will look forward to each contraction,
    you divide your body into two parts, an upper and a realizing that each one carries you closer and
    lower half. Now, I want you to include the uterus in closer to the delivery of your baby.
    the lower half. When you have done this, then you 10. Labor and delivery are exciting, enjoyable
    can awaken the upper half and learn to permit the experiences that you can share with your
    lower half to remain asleep. . . . You may use these partner in a relaxed, comfortable setting.
    techniques in any stage of labor but usually, if
    11. Remember that while you are in labor you are
    needed at all, it will be at the end of the first stage
    always in control.
    for the lower backache type discomfort; during the
    second stage to push the baby out or to produce 12. You can have your baby your way—relaxed
    pain control for an episiotomy or any tear that and completely in control.
    might have occurred. The fact is you may not find it 13. You will find your husband's touch and voice
    necessary to use any of these techniques at all. Now to be relaxing and reassuring to you.
    emphasis throughout hypnosis training in obstetrics 14. You will find that when your husband places
    is that you are not preparing to undergo a surgical his right hand on your left shoulder, you will
    procedure, but you are preparing to perform a become very deeply relaxed, when
    normal, natural, physiological act. appropriate, without any effort on your part.
    15. Just as you experience no discomfort when the
    muscles of your heart, intestine, or bladder
    contract, you will experience no discomfort
    when the muscles of your
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 279
    uterus contract — for these are all normal takes time. They will cause so little discomfort to
    physiologic functions. begin with, that the only thing you will need to do
    is to sleep as much as possible, and to relax. You
    will be able to do this by putting yourself to sleep
    and relaxing in hypnosis as you have been taught.
    Management of Antenatal Because of this, you will feel the contractions
    merely as pressure in your stomach, and they will
    Hypnotic Training not distress you at all. If anything, or anyone
    David Waxman, L.R.C.P., M.R.C.S. disturbs you, you will immediately put yourself
    London, England straight off to sleep again, as a result of which your
    labor will progress more steadily and easily. You
    will remain perfectly calm and unworried, and not
    SUGGESTIONS in the least bit afraid.
    In every confinement [labor], there are three Later, as the passages open up, the contractions
    separate and distinct stages. The first and longest of will become stronger, heavier and more frequent.
    these is concerned with the necessary preparation You will not become frightened or try to resist this,
    for the birth of the child. This could not occur because this is perfectly normal and helps the baby
    unless time were given for all the muscles to relax, to be born. This is a sign that your labor is
    and the passages to widen and dilate sufficiently to progressing well. You will be able to stay in your
    permit the passage of the baby. Once these are wide trance and remain relaxed by taking a series of
    open, the second and more active state occurs. deep, rapid, rhythmic breaths. With each of these,
    During this, the child descends through the you will relax more and more completely. All
    passages, and eventually emerges and is born. tension will disappear and you will feel only the
    When this has happened, there is still the final discomfort of heavier pressure from each
    stage, which is not completed until the afterbirth contraction. You will not lose control, and will
    [placenta] has come away. remain perfectly passive, allowing the contractions
    to do their own work, without trying to assist in
    Now, probably the first sign that you will have
    any way.
    that labor has started is a slight show of blood,
    almost as if a monthly period were beginning. With A short pause may occur, after which the
    this you will feel some weak contractions of the contractions will recommence with increased
    womb, with long intervals between them. strength. About this time, the membranes will
    Sometimes, the show does not occur, and the only rupture and the waters escape. There is no need to
    sign of commencing labor is the presence of these become worried or alarmed about this, it merely
    weak, infrequent, but regular uterine contractions. means that you have entered into the second stage
    When you first feel these, look at the clock and of your labor, and the actual birth ... of your child is
    time them. No matter how long elapses between about to begin. Although the contractions become
    them, if they are occurring at regular intervals, you much heavier and more frequent, they will not
    have probably started in labor, so either send for frighten you, because soon it will be necessary for
    the midwife, or go straight into the hospital ac- you to cooperate and help in getting your baby
    cording to your previous arrangements. You must born. As the contractions continue, you will begin
    not induce any hypnotic trance until this has been to feel an almost irresistible desire to assist by
    done. bearing down. No matter when this occurs, you
    During this first stage, you will find that the must not give way to it, until you are told to do so.
    contractions will be weak, and will not occur very If you do, you will delay the birth of your child,
    often. They will gradually cause the passages to render it more difficult, and wear your-
    open up, but this is a slow process and
    280 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    self out unnecessarily, without doing a scrap of sleepy and drowsy to become disturbed. You will
    good. As soon as you feel this urge, tell the midwife carry out faithfully every instruction that you are
    or nurse, but do not give way to it until she tells you given, just as effectively as if I had given them,
    to. When she does, take a deep breath, hold it as myself.
    long as you can, and push down as hard as you can
    as long as each contraction lasts. If you have to
    breathe out before the contraction is over, take EXPLANATION OF TRAINING
    another deep breath as quickly as possible and
    continue to hold it and push down, since it is The main object of subsequent antenatal
    usually the last part of the contraction that produces hypnotic training sessions is to condition the
    most progress. You will find that this will greatly patient to become completely relaxed, both
    reduce the discomfort. Remember, as you bear mentally and physically, whenever she enters the
    down and push, how much you are helping to bring trance state, to remove fear and apprehension, and
    your baby into the world, because this could not be to instill suggestions of confidence and general and
    done without some hard work and physical physical well-being. This conditioning is more
    exertion. It will be well worthwhile. In each effective if the patient is taught self-hypnosis and
    interval, between the contractions, you will be able practices it regularly at home, thereby gaining
    to relax completely, and sleep. much more confidence in her own power to control
    her reactions during the confinement.
    As the baby's head descends, and appears at the
    outlet, the final process of delivery is about to When teaching self-hypnosis and in the course
    begin. At this point, you will be able to obey all of each ordinary hypnotic induction, it is always
    instructions implicitly. Whenever you are told to advisable to couple suggestions of increased
    stop pushing, you will stop pushing immediately, relaxation with deep, rhythmic breathing. Once this
    and indulge in rapid deep breathing instead. As a technique has been mastered by the patient, it will
    result of this you will relax more and more prove invaluable in the alleviation of pain and
    completely, and as the head presses down harder distress during her actual labor.
    and harder on the outlet, the whole area will The suggestions to be impressed upon the
    become quite numb and insensitive. You will patient's mind at each training session can easily be
    experience a feeling of stretching, and the sensation constructed from the detailed description of labor
    of something passing through the outlet. under hypnosis which has already been given to
    Although you will probably require no extra her. These should be selected and phrased to suit
    help, suitable drugs or anesthetics will be available each individual case, in accordance with certain
    if you feel the need of them. They will not be given general principles:
    to you unless you request them. You have only to
    ask. If, on the other hand, you wish to remain 1. Suggestions that the patient will continue to
    awake as your baby is born, you have only to say keep fit and well throughout her pregnancy.
    so. When you have seen the baby, and the afterbirth
    2. That she will look forward to her confinement
    has come away, you will fall into a deep refreshing
    with pleasure and happiness, and not with
    sleep. You will wake up from this feeling really fit
    dread and apprehension.
    and well, and remembering very little of what has
    occurred. Throughout the whole of your labor, you 3. That everything is perfectly normal (provided,
    will be able to talk, or answer questions if of course, that this fact has been clinically
    necessary, without waking up from your deep, established).
    relaxed, hypnotic sleep. You will be able to 4. That, during her labor, she will fall into a deep
    cooperate in every way, but you will feel far too hypnotic sleep whenever she is told to do so, or
    upon a prearranged signal she gives herself to
    induce self-hypnosis, and all
    HYPNOSIS IN OBSTETRICS AND GYNECOLOGY 281
    subsequent suggestions will be both transferred fully informed as to the
    accepted and acted upon. correct method of conducting a labor under
    5. That each contraction of the womb will be felt hypnosis.
    as a not altogether unpleasant sensation. Even
    during the second stage, the feelings
    experienced will be simply those of increasing
    pressure, comparable in every way to ordinary Erickson's Childbirth
    physical exertion. Care must be taken not to Suggestions
    abolish all her sensations, otherwise labor
    might well commence without the patient's Milton H. Erickson, M.D.
    becoming aware of the fact.
    6. That every time she puts herself into a deep Since you are a pregnant woman, you are
    hypnotic sleep, she will be able to relax her expecting a baby, and you would like to have that
    muscles and relieve tension so completely that baby in the way that is most comfortable to you. I
    she will feel much less, and the delivery of the want you to be sure to have it in the way that is
    baby will become much easier. most pleasing and most comfortable to you. If that
    7. That subsequently her breasts will more likely means that you have to get a cramp in your arm
    produce plenty of milk, so that she will be able from holding on to that grip, be sure to get that
    to breast feed her child should she so wish, cramp because, you see, I don't know what kind of
    without difficulty. This last suggestion is likely pain or distress you might want to have during the
    to be successful since the commonest causes of labor. All I know is that you want to have a very
    deficient lactation are worry and fear. Hypnosis happy, very agreeable labor. You want to look
    seems to abolish these by inducing an attitude upon the arrival of this child as a completely
    of positive expectancy. pleasing thing. Therefore, you might want a cramp
    in the right arm, a cramp in the left arm; you might
    8. That once the confinement is over, and she has want an itch on your leg; you might want to feel a
    slept, she will wake up feeling perfectly fit and labor contraction here and there. If you do want to
    well, and may, if she so desires, remember little feel a labor contraction I would like to suggest the
    or nothing about it. following. You know that labor comes in three
    stages. The first stage gives you much more time to
    These specialized suggestions should be preceded feel a labor contraction than the second or third
    by the usual ego-strengthening routine on every stage. So if you really want to feel a labor
    occasion. During the last six weeks of pregnancy, contraction, do it in the first part of the first stage;
    special emphasis is placed upon those suggestions because that gives you more time to study and to
    relating to the patient's reactions and behavior, and experience and to feel it. But, of course, you can
    the instructions she is to follow during her also have a contraction that you feel in the second
    confinement. or the third stage, if you want to. In case you do
    If the practitioner, by any chance, will be unable wish to feel a labor contraction, I just want you to
    to be present at the confinement, the patient must be feel it in the most adequate way possible.
    placed posthypnotically en rapport with some other
    individual — doctor, nurse or midwife— with Being a medical man, I suggest the first stage,
    whose instructions she will comply as if they had and the first part of the first stage; because that is
    been issued by the hypnotist. For this procedure to the best time . . . to feel a labor contraction. But . . .
    succeed, the deeper stages of hypnosis will have to [you can also] feel it in the second stage, or in the
    be attained, and the individual to whom rapport is third stage. But in the third stage, you are going to
    be busy with a lot of other things. There is that
    impending question: What sex is the baby going to
    be?
    282 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    An Ericksonian Approach to and to determine if they are accepted to any extent
    by the couple (Poncelet, 1983). Particular attention
    Childbirth is paid to metaphorical "organ" language. I
    question each spouse sequentially and treat them
    Noelle M. Poncelet, Ph.D. equally. Similarly, I question what their needs will
    Menlo Park, California
    be before, during, and after labor and delivery.
    Most often the woman is quick to identify
    THE SETTING general needs, e.g., love and support from her mate
    and relief from pain. There is usually a pause when
    The couple is seen in the third trimester of I ask her, "How will you recognize his love and
    pregnancy when labor and delivery are immediate support? What form do you wish his love and
    concerns. An audiotaped two-hour session usually support to take?" I help her to identify whether she
    suffices. I make clear I need not be present during wants him to look at her, talk to her, touch her.
    labor and delivery. I am available for "booster" What exactly does she want to hear? Where does
    sessions or by phone if necessary. I request she want to be touched? When? How much
    follow-up contact after the baby is born. pressure? As I encourage her to create a totally
    I send the woman's physician a letter that satisfying sensory experience, I frequently am
    explains the nature of hypnosis and helps him or amazed at how specific many women can be,
    her recognize trance behavior. I make suggestions especially when invited to exclude some
    for ways the obstetrician can reinforce the trance, disagreeable behaviors.
    including a hand on the woman's shoulder, and/or
    simple sentences such as: "You are doing fine [first It is delightful to observe the appreciative look
    name]." I recommend lower trials of analgesic of her husband as he sighs deeply and
    medication, if that is necessary, to avoid acknowledges the relief of knowing specifically
    oversedation. I indicate that hypnotic training how to be helpful. Many suggestions are elicited
    includes suggestions for appropriate and the husband is then asked to state sincerely
    responsiveness to interactions with the medical and which behaviors he is willing to offer and which he
    nursing staff. would rather not. I will express disbelief at
    "blanket" acquiescence and will state that any need
    met out of obligation is poison to the relationship
    while those met out of desire are fertilizers. Helpful
    THE INFORMATION-GATHERING behaviors he agrees to are immediately rehearsed
    INTERVIEW and anchored.
    The information-gathering interview consists of The process is then reversed and the husband is
    two phases: (1) the identification of needs and asked what his needs will be and how he would like
    "anchoring" of need fulfillment; and (2) fostering his wife to best meet them. Stupefaction is a
    an understanding of hypnosis. common response. Men have told me they do not
    need anything; this is not their time; all they want is
    ANCHORING. In order to tailor the hypnotic training to help their wife and make sure she is all right. I
    to the unique characteristics of the couple, I respectfully disagree and wonder aloud about their
    proceed by first asking detailed information personal concerns and their isolation from the
    regarding: (1) their assumptions about the physical experience between their wife and child
    childbirth experience or their expectations if this is during the pregnancy. Tentatively first-time fathers
    not their first pregnancy, and (2) their needs. begin to tune inward. Men who already have a child
    have less difficulty stating
    Questions about assumptions and expectations
    allow me to hear facts and myths transmitted by
    significant others and the health staff
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 283
    their inner experience. Needs can now be fortable than they already are. They are encouraged
    formulated, agreement elicited from the woman, to readjust their body positions any time they wish
    and their needs can be anchored. Encouraging to increase their comfort and relaxation. This is
    husbands to voice their concerns provides two especially important because the pregnant woman
    crucial points of relief for the woman: It is a may need to move if only in response to her baby
    validation and explanation of a worried look on her shifting position. In fact, some pregnant women
    husband's face or perceived concern in his voice. exhibit active trance behavior similar to that seen
    She is less likely to interpret these behaviors as in hypnotized children; the main clue that a trance
    rejection or criticism. Moreover, it prompts her to state has been experienced is the reorientation
    get away from her preoccupation with herself, and behavior seen as the trance is terminated (Poncelet,
    attend to his needs. . . . 1982).
    Mutual anchoring of needs can occur at the
    visual, auditory, and kinesthetic levels in a way that EYE FIXATION. Both are invited to focus on a "spot"
    is unique to each couple's needs. Anchoring is on the ceiling in anticipation of the many ceiling
    rehearsed in the office. It is a natural posthypnotic fixtures they will see at home and in the hospital.
    suggestion for a satisfying interaction and for Thus an orientation to the future is suggested.
    personal comfort and relaxation during labor and Experienced subjects are invited to recall their
    delivery. Furthermore, clarifying and negotiating most satisfying trance, meditation, or relaxation
    needs clear the way for privacy to be respected by training experience, while untrained subjects are
    each, since such withdrawal no longer is specifically led toward eye closure. Other trance
    interpreted as rejection and abandonment. inductions may be used to meet the specific needs
    of either partner.
    KNOWLEDGE ABOUT HYPNOTIC EXPERIENCE. The
    last DISSOCIATION. Dissociation is suggested to a
    part of the information-gathering interview focuses "favorite place filled with happy memories, where
    on the couple's knowledge of, and previous you have felt so relaxed, so comfortable, so safe.
    experience with, hypnosis. Successes, failures, You can be by yourself or with each other, it does
    myths and fears are carefully identified, again in not matter." They are encouraged to use the power
    behavioral terms. Experience with Lamaze and of their imagination and to step into this place.
    natural childbirth training, meditation, prayer and Ideomotor finger signaling ratifies that this step
    relaxation are acknowledged as useful and has been accomplished and that trance is
    overlapping with the hypnotic state. Needs to be in deepening.
    control of the experience and complete
    responsiveness to the medical and nursing staff are
    RELAXATION Relaxation is suggested in a variety of
    stressed as being compatible (and in fact enhanced)
    in the hypnotic experience. ways. Always added is an invitation to "focus on
    the most comfortable part of your body . . . and
    Such attention to the hypnotic experience is in with each breath in, increase and spread the
    itself the beginning of a naturalistic induction and, feeling of relaxation, with each breath out, let go of
    most often, signs of light trance behavior become unnecessary tensions and concerns. They can be
    evident at this point. put on hold and dealt with later, just like dirty
    dishes in the sink sometimes need to wait for an
    appropriate time to be washed." Thus, anxiety is
    HYPNOSIS TRAINING not discounted but postponed.

    The partners are invited to enjoy the trance TRANCE DEEPENING. Deepening is achieved by
    together, to make themselves even more com- the use of learning sets, suggestions about
    conscious and unconscious processes, truisms,
    284 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    and double binds. Many observations on the mind observes and enjoys the experience." To
    couple's trance behavior and appreciation of their maximize comfort, the metaphor of a switchbox in
    accomplishments are also given. the mother's inner mind is offered. She is invited to
    identify the wires that connect every organ and the
    PARTIAL AMNESIA FOR PREVIOUS CHILDBIRTH EXPERIENCE. muscles involved in childbirth and to connect each
    At this point, suggestions are given to multi-para one with a switch of a specific color. She is alerted
    couples for retrieving the positive aspects of, and to the light above the switch which goes on at the
    the lessons learned from, their previous childbirth start of a contraction. This signal gives her the
    experience and for forgetting what was "uniquely pleasure to recognize how well her body is
    negative about those events." working. She then can turn the switch off or lower
    it so that all she needs to feel is a dull pressure, a
    numbing, cramping sensation, massaging her
    PSEUDO-ORENTATION IN TIME. The couple is in-
    baby.
    vited to "think of the time soon in the future, the
    appropriate time only, when the baby will be ready
    to be born." It is important in orientation to the AMNESIA. She is encouraged to appreciate the work
    future to stress that the rehearsal is for the future of each contraction and to recognize it as completed
    only and not an invitation to go into labor now. and therefore ready to be forgotten as she
    Perhaps she will recognize a contraction, the immediately becomes absorbed in other activities:
    rupture of her membrane. There will be signals for preparing herself to go to the hospital, enjoying
    her to feel very joyful, excited, curious, relieved leisure, conversation, rest, dreaming, sleep.
    that the time has come . . . and to go into a very
    soothing and comfortable trance. Therapeutic POSTHYPNOTIC SUGGESTIONS. The woman is en-
    suggestions can be added: " Your body knew how to couraged to remain active during the first stage of
    learn to walk; how can childbirth not be the most labor, to follow her physician's advice on the
    satisfying, pleasurable experience when it is linked proper time to go to the hospital, and to use the
    to your love for one another now and several breathing and focusing techniques learned during
    months ago?" childbirth training. She is invited to notice her
    As her husband learns from his wife that labor trance and relaxation deepen with each contraction
    has started, he is invited to use her message to go (or as she gets in the car, or at each traffic light, or
    deeply into an active trance which will enable him as she approaches the hospital, talks to the
    to help himself, his wife, and the obstetrical team. insurance clerk, as she is greeted by the medical
    He is invited to tap within himself the ancient and nursing staff, as she sees uniforms, or when her
    genetic primary knowledge that he has about the physician and assigned nurse examine her, etc.)
    childbirth experience. He is reminded that he is the She is alerted to fluctuations of trance level as a
    product of one sperm and one egg, that he started as normal phenomenon, especially in the lighter
    a female embryo before differentiating as a man. . . trance level necessary for verbal communication.
    . Both are reminded of ways to meet the needs they
    have agreed upon and that are now available to REFRAMNG PAIN. Both partners are invited to
    them so that each can be maximally comfortable, recognize that if contractions are one minute long,
    confident, and present to the other. for example, in one hour there will be twelve
    minutes of work for forty-eight minutes of comfort.
    ANALGESIA Contractions are described as "the Therefore, boredom and fatigue are identified as
    long abdominal muscles contracting while the unnecessary enemies and the couple is encouraged
    cervix opens and the vaginal walls stretch. Your to play, move, listen to favorite music, dissociate to
    body knows what to do; your body leads, your favorite places and rest.
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 285
    REFRAMING ANXIETY. Anxious feelings are wel- stronger and more powerful [rather than more
    comed because "if you can say hello to them, you painful]; they are closer to one another. Trust your
    obviously will be able to bid them. ..." I encourage body; it will know how to breath and flow with the
    the couple to observe their anxiety, to recognize its pressure, if you let it use all it knows and has
    appropriateness, e.g., the contraction/release practiced." Suggestions are given for time
    mechanisms of the body, fear of the unknown, distortion so that in between contractions, time is
    concerns about the baby, doubt about parenting experienced as relaxing and resting: "Take a few
    abilities. I suggest they seek information if it is moments . ... all the time your unconscious needs to
    needed. "An A + for your childbirth performance is feel rested, regenerated with energy and
    not necessary; all that matters is to enjoy and fully refreshed." Dissociation is particularly encouraged
    experience a special shared moment. If you feel you at this time.
    need medication, trust yourself and take some; you
    can be pleased to know you need less because you REFRAMING THE STRAINING. The straining, the
    are using hypnosis." Another metaphor is offered: panting, the buildup of tension are linked gently to
    "Anxiety is like driving down the highway and preorgasmic experience (when one can look and
    coming to a railroad crossing. The light is flashing sound in pain and not experience it as such). Low
    red and so, naturally, you stop, and listen. Before vocalizing is a natural vehicle that can help push
    long you see the train coming from one side as you the baby down. She can use her energy as a
    feel the ground tremble beneath you. You watch it powerful drive (Peterson calls it aggressive [1981])
    crossing the highway and disappear out of your that will massage the baby down the stretched and
    awareness as you proceed safely and cheerfully on flexible passage without any harm to her or the
    your journey." baby (see Peterson, regarding the woman's fear that
    she will be ripped open and her baby's head be
    REFRAMING HOSPITAL LANGUAGE. In the h y p n o t i c crushed). I prepare the woman for the possibility of
    state, any sentence is a potential positive or negative experiencing the orgasmic-like pleasure, the "rush"
    suggestion. At this point, with humor in my voice, I and "joyful shaking" at the moment her baby
    direct the couple's attention toward the peculiar way rotates its head through her cervix and down her
    some people have of expressing themselves. For vagina. I reinforce that it will be a private and
    example, if a nurse comes in and says: "Are you in enormously satisfying experience.
    much pain, honey?" or "You don't look
    uncomfortable yet!" or "How bad are your Her husband is encouraged, if she so desires, to
    contractions?" or "You are only six centimeters fondle her breasts during contractions (Gaskin,
    dilated," I tell the couple to immediately adjust such 1978), to massage her back and apply
    a potentially negative suggestion with tolerance counterpressure, to squeeze her shoulders, her
    and delight to: "How comfortable am I?" or "I am ankles with an intensity that parallels the con-
    already six centimeters dilated with four more to traction, using his own intuition and responding to
    go." Similarly, in response to the well-meaning her direction.
    physician saying, "This is your last chance to It follows naturally to talk about the joy of
    receive medication before your baby is born, the actively bringing her baby into the world as the
    woman is invited to think, "I have a choice: do I couple focuses next on the pleasure of seeing the
    want medication?" baby's head, hearing its sounds, feeling him/her in
    one's arms, on one's belly, close to one's breast.
    TIME DISTORTION. " Welcome to the second stage of
    REFRAMING THE NURSING EXPERIENCE. I describe the
    labor [or "transition," if such terminology is used],
    baby licking the nipple before suckling, the
    your baby is near! Your contractions are familiar sexual pleasure that facilitates vaginal
    contractions. I talk in general about the plea-
    286 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    sure for their baby of enjoying both the feeding INTRODUCTION
    breast, full of milk, and the empty breast, the one
    that pacifies. I explain the delight for the baby of The childbirth script for labor, delivery and
    experiencing two different sensations. Here I offer recovery was developed as part of the Stoler
    the possibility for the man to consider comfortably Program for Pain-Controlled Childbirth. It was
    giving in to his natural yearning for the nursing based on previous childbirth scripts used in
    experience, if he so desires as some men do, and if hypnosis, which have been revamped and re-
    structured over a 10-year research period. The
    social mores have not inhibited his capacity to
    result of that research period is the present script,
    recognize this need and to act upon it.
    which provides women with a consistent, reliable
    and effective means of achieving the type of
    BLEEDING CONTROL. As the couple is absorbed in
    childbirth they have chosen to experience.**
    the trance state imagining the pleasure of dis-
    covering their newborn, it is easy to slip in some
    rather direct suggestions for prompt expulsion of
    the placenta, bleeding control, comfortable CHILDBIRTH SCRIPT
    stitching of the episiotomy, if necessary, quick and
    [The script presented here was for a 36-year-old
    effective contracting to pre-pregnancy shape, and
    speedy and smooth healing and recovery. woman for her first pregnancy. She loved being at
    her grandmother's house near the ocean. The
    suggestions begin following an imagery induction
    POSTHYPNOTIC SUGGESTIONS. Husband and wife to facilitate dissociation and deepening
    are asked to share their unconscious experience of suggestions.]
    childbirth with their conscious mind upon
    awakening from the trance in the hospital. DISTANCING FROM FEELINGS. Pay close attention to
    Both are encouraged to appreciate what they my voice. You have no cares or worries; right now,
    have accomplished in this office and to take time to all your cares and worries will just drift away.
    practice going into a trance with or without the Notice one of the fluffy clouds above you floating
    audiotape of this hypnotic training session, with in the sky. You can allow yourself to put your
    heightened confidence that they will plea-surably nervous feelings, fear about the baby's health, fear
    experience the birth of their baby. of what people think, doubts about complications,
    loss of control, concern about your husband and all
    TERMINATION OF TRANCE. Suggestions for re- other negative scanning to be placed on that cloud,
    orientation to the office are given. Comments, and allow it to drift away off into the distance, off,
    questions and clarifications are welcomed at the off, further and further away. So far and so distant
    end of the session. Joyful anticipation is shared and that you barely notice it. Allowing it to be just a dot
    my availability for "booster" sessions, if necessary, in the horizon, however, you do not let it totally
    is made clear. disappear because you may choose to retain these
    feelings and retrieve them if you need them. But
    right now you have no need for them. You let them
    go and as you do you gain a sense of peace and
    Childbirth Script calm flowing within your body.
    Diane Roberts Stoler, Ed.D. You can allow yourself the pleasure of watching
    Boxford, Massachusetts those feelings drift further and further away into the
    horizon. Notice that you do
    Although this script is lengthy, it has been
    included to illustrate the manner in which rep- **For further information, write to Childbirth Inc., RFD#2,
    etition of suggestion is often included in actual Boxford, MA 01921
    work with patients. (Ed.)
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 287
    not allow them to entirely disappear, so that if you mental or emotional. You can control your entire
    want those feelings, they will be there. But right body with your mind. Your are relaxed and you
    now, you have no need for those feelings, so allow have the ability to deliver your child in peace and
    them to go off towards the surface of the water. relaxation. The act of bearing your child will be as
    These feelings will be there if you want them back natural and as easy as any other process of your
    or want to be in touch with them; they are close at body, like breathing in and out, breathing in and
    hand, but for the time being you can let them flow out, in and out, in and out, in and out. You will
    and be just within your grasp. allow your body to flow rhythmically like the
    You are peaceful, calm, relaxed; you go deeper rhythmic flow of the breeze through the trees.
    and deeper, deeper and deeper, and as 1 talk to you, Notice the leaves going back and forth, back and
    you continue to go into an even deeper state of forth. You are relaxed and courageous. You know
    relaxation. Everything but my voice is becoming you are relaxed and courageous. You know the
    remote now, quite remote; nothing else but my birth of your child is a joyful event in your life.
    voice seems important, nothing else is important, You are courageous. You are relaxed. You are
    nothing else but my voice. What I say to you right relaxed. You will be alert to hear your baby's first
    now seems of interest, even though my voice may cry. You are relaxed and peaceful. You are
    come to you from a dream, or it may change in courteous. You are relaxed and peaceful. You are
    quality, as you relax more and more, as you sink composed. You are confident.
    deeper and deeper into this lethargy. As you relax
    There is joy in you, and you feel strong,
    more and more, you allow yourself to sink deeper
    courageous, and there is an inner strength in your
    and deeper and deeper, deeper and deeper into this
    entire being. It is the birth of your child, and as you
    lethargy. As you relax more and more, more and
    feel this strength and confidence, and vitality, you
    more, more and more, you allow yourself to sink
    deeper and deeper, deeper and deeper, into a deeper allow yourself to sink into an even deeper state of
    state of relaxation. Just relax now. Relax. [Still relaxation. When you are ready to go to the
    further deepening suggestions are given.] hospital after talking to your physician, you will
    notice that by saying to yourself, "Relax, calm,
    numb." You will be able to control and maintain
    CHILDBIRTH SUGGESTIONS. You are bearing a child, the harmony within your body.
    child is developing, growing, preparing for entry
    into this world. You will give birth to the baby with IMAGERY FOR CONTROL OF COMFORT. YOU
    joy and relaxation. You have felt the movement of permit
    your child within you, growing, developing and yourself to numb various areas just by picturing a
    preparing for entry into this world. switchboard with lights, heat sensors, dimmer
    You will give birth to the baby with joy and switches, and on and off switches. Each light has a
    relaxation. The process is a natural, effortless, and heat sensor under it, along with a dimmer switch
    automatic one in which you will be relaxed and you and an on and off switch. This gives you complete
    know that you are courageous. Saying this will be a control to adjust your body, your comfort level and
    reminder to yourself to do your visualization and sensation level. You have complete control to
    keep your mind active and to concentrate on the adjust the heat level and to adjust the dimmer
    ocean and your visualization to enhance your switch. Thereby, by focusing on the various lights
    ongoing health and healing process of your body. and adjusting the dimmer switch to any area on
    You will be able to adjust yourself to your your body, you have complete control to adjust
    environment, even though you cannot change it. both the level and intensity of comfort you want.
    You can do everything better when you are relaxed, You have complete control for specific comfort
    whether it be physical, and sensation levels. This ability, along with your
    thumb and index fingers together, will be a signal
    to go into a deeply relaxed state, a deeply relaxed
    state.
    288 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    You will be able to control and regulate the degree happiness and this will encourage you to gain all
    of dullness, whereby you will feel pressure but not your strength to go deeper and deeper into
    discomfort. This will allow you to be able to time hypnosis to help yourself and your baby.
    your contractions. When you notice the sun setting in the west and
    At the onset of your labor you will dull all the the temperature drop, you know this will be a sign
    nerves from just above your knees, front and back, that you will be fully dilated, and you can gain
    to your pubic area, buttocks area, abdomen, lower more energy and the enthusiasm to push your baby
    back, upper back, chest cavity, just below your into the world. At this point you can see your labor
    breast. If you can visualize an area like a barrel coming to completion. You will be aware to push
    —from just below your breast to just above your your baby into the world. You can allow yourself to
    knees, encircling your body — by adjusting the go into a very relaxed state, deeper than you have
    dimmer dial to the appropriate level of comfort, you ever experienced before. By allowing yourself to
    will make it dull, where you will feel pressure and go into this state, you permit your body to flow in
    movement, but no sharp pain; pressure and its natural rhythms, and help and assist the natural
    movement, but no sharp pain. You have the ability movement of your muscles to gently, just like the
    to adjust tne level of dullness in this area of your natural gentle rhythm of movement of the distant
    body throughout your labor. With the touch of your ocean and the breeze through the trees surrounding,
    husband's hand (or the support person), on any part allow yourself to go deeper and deeper, and
    of your body, this will produce the required and become more and more relaxed, and limp and loose
    desired amount of dullness. You will feel pressure like a Raggedy Ann Doll. At that point you will
    and movement but no sharp pain, pressure and permit yourself to go deeper into this deep state of
    movement but no discomfort. You notice your relaxation, whereby you can push your baby into
    contractions will be increasing and you will be able the world with peace and tranquility.
    adjust the level of dullness by adjusting the dimmer
    switch to the level of intensity of sensation to the
    various parts of your body, to achieve the amount of TIME DISTORTION. You allow yourself to drift back
    sensation needed to feel the pressure and movement into a wonderful deep state of relaxation. You
    in a comfortable level, so that you can help the baby allow yourself to go deeper and deeper, deeper and
    come out. deeper than ever before. Time will pass quickly and
    pleasantly (within 4-10 hours or maybe longer),
    and there will be no fatigue, nausea, or exhaustion
    DEEPENING AS LABOR PROGRESSES. YOUwill because of your relaxation. As labor advances,
    know each contraction will be represented in the gentle
    how far dilated you are by the rotation of the sun in movement of the ocean in the distance, going back
    the sky and the coolness of the air. At 1 cm., you and forth, back and forth, allowing you to sink
    notice the air becoming cooler, and by 10 cm. you deeper and deeper. And each contraction means
    will know that you are in transition when you may you are reaching your goal, allowing you to go
    have a desire to go inside the house. But you will deeper and deeper.
    allow yourself to notice the setting sun in the west
    and choose to settle back in the grass and enjoy the
    PERMISSION FOR AMNESIA You will remember only
    beautiful sight. You allow yourself to go into an
    the things about labor and delivery that are
    even deeper state of relaxation so that you may help
    pleasant; when the delivery is over, you will
    yourself and your baby to arrive safely. At this
    remember those things clearly and all other aspects
    point you feel of the gentle movement of the wind
    of your labor and delivery will fade, with you
    over your body and you allow yourself to settle
    coming closer and closer to the setting of the sun.
    comfortably in the grass cave which is safe and
    protected. This will fill your souls with joy and
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 289
    SUGGESTIONS FOR SOMNAMBULISTIC push the baby into this world, this will be a signal
    BEHAVIOR.
    to go deeper and deeper, deeper and deeper, and
    You'll be able to move around the birth or labor
    with each contraction, you will go deeper and
    room, use the bedpan or toilet, and still stay deeply deeper, deeper and deeper.
    hypnotized. In fact, you will go deeper and deeper,
    As you relax you will permit yourself to go
    deeper and deeper, deeper and deeper during the deeper and deeper. You will feel control to adjust
    process of delivery, than ever before. Opening your the amount of numbness during labor and delivery,
    eyes will not bring you back to your usual state of so that you can feel pressure and movement, but
    awareness, but rather it will allow you to sink even not pain.
    deeper and deeper, deeper and deeper, deeper and During labor and delivery you allow yourself to
    deeper into this state of relaxation, concentration enjoy the movement of your baby. And with your
    and peacefulness. It is possible there will be other eyes closed, you say to yourself, "Relax, calm,
    noises, such as women moaning or other noises at numb, courage." You let yourself sink deeper and
    the hospital or on the way to the hospital. These deeper, deeper and deeper, deeper and deeper into
    noises will not disturb you; instead they will act as hypnosis during labor than ever before. As the
    a signal to deepen your hypnosis. circular muscles relax and the long muscles push
    the baby into this world, this will be a signal to go
    COMFORT WITH CONTRACTIONS. In the process of deeper and deeper, deeper and deeper, and with
    natural delivery, there will be no nausea, no each contraction, you will go deeper and deeper,
    sickness or pain, during or after labor. In childbirth deeper and deeper. You will be able to go deeper
    the circular muscles of the lower part of the uterus into hypnosis during labor than ever before, and
    relax and allow the longitudinal muscles of the each easy, gentle releasing breath and every uterine
    upper part of the uterus to contract and push the contraction will be a signal for you to go deeper
    baby down the birth canal. and deeper, deeper and deeper. You will remain
    numb where you feel pressure and movement but
    SUGGESTIONS FOR CONTROL AND SELF-EFFICACY.
    no pain, pressure and movement but no pain.
    As
    When you will notice the sun starting to set and
    you relax you will permit yourself to go deeper and
    the sky colors becoming darker and deeper, you
    deeper. You will feel control to adjust the amount
    will allow yourself to realize that your positive
    of dullness during labor and delivery, so that you
    energy will bring you strength and calmness to
    can feel pressure and movement, but not pain. Your
    rejoice in the birth about to arrive. During labor
    desire to take control and to make these
    and delivery you allow yourself to enjoy the smells
    adjustments is so strong because of two main
    and sounds of the flowers, the grass and the distant
    reasons — you want to take control of your life and
    sea, and to feel of the warm sun over your body. As
    to help yourself and your baby. Therefore you
    the sun is setting, you gain a sense of peace and
    desire to be able to control and adjust the dullness,
    harmony with the world around you and your body
    so that you will permit yourself to feel only
    becomes more and more relaxed.
    pressure and movement and no discomfort.

    THEFINALSTAGEOFLABOR.Andasyourelax,the
    ENJOY THE MOVEMENT OF BABY. During labor and
    circular muscles relax and the long muscles push
    delivery you allow yourself to enjoy the movement
    the baby into this world. This will be a signal to go
    of your baby. And with your eyes closed, you say
    deeper and deeper, deeper and deeper, and with
    to yourself, "Relax, calm, dull, courage." You let
    each contraction you will go deeper and deeper,
    yourself sink deeper and deeper, deeper and
    deeper and deeper. You will be able to go deeper
    deeper, deeper and deeper into hypnosis during
    into hypnosis during labor than ever before, and
    labor than ever before. As the circular muscles
    each breath and every
    relax and the long muscles
    290 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    uterine contraction will be a signal for you to go the delivery room or to have a cesarean birth
    deeper and deeper, deeper and deeper. You will because of some medical need for you or your
    remain numb where you feel pressure and baby, this will be a signal to reach an even deeper
    movement but no pain, pressure and movement but state, and by doing so, you will be helping yourself
    no pain. [Repetition of previous suggestions is now and your baby. You will only feel and continue to
    given.] feel pain if it is needed to help you and your baby;
    however, as soon as the appropriate person acts to
    COMFORT EXCEPT FOR SIGNAL PAIN. You will be able alleviate the problem, you will immediately go into
    to respond appropriately, to help yourself and your a very deep state of relaxation, calm and total
    child. Until the time when you need to push, you numbness. You will remain calm and act appropri-
    will allow your body to feel pressure and ately to help yourself and your baby.
    movement, but no pain, except if there may be
    damage to you or your baby. If you feel pain you COPING WITH ANXIETIES OR FEARS.
    [Following
    will be able to report it to the nurse or some other
    deepening comments:] If during labor a scary
    person on the delivery team. They may need to
    anxiety arises regarding the hospital, from the
    know where the pain is located, so that they may
    memories of having your miscarriage, fears of not
    help you. Then, once they have helped you, this
    being able to bond with your baby, or fears that
    will be a signal to allow yourself to become relaxed something will go wrong or any other flashback
    and to remain in a very deep state of hypnosis. that might interfere, you can choose to put them
    After they have helped you, you will not need to into a box. Then tie a rope around it and place it at
    feel the pain, but only pressure. You will remain the bottom of the well, not too far away. This well
    calm and act appropriately to help yourself and has a very heavy lid that cannot be opened by
    your baby. anyone other than yourself. These feelings will not
    surface and cannot be touched unless you choose to
    EDITING OUT NEGATIVE SUGGESTIONS. If there are retrieve them. You will always know where they
    people who are discussing you or your child's are because you have placed them there and only
    progress, in a way that is not beneficial to you, this you can retrieve them. These feelings cannot
    will be a signal to go even deeper, and their voices surface unless you choose to retrieve them, to work
    will only be a muted, white noise to your ears. You through the feelings in your therapy to help you
    will remain calm, poised, and relaxed. You will, if make your life more productive and happier and
    needed, be able to instruct the labor and delivery healthier. You will always know where they are
    team through your ability to separate body from because you have the control and you have chosen
    mind, so that your body will feel totally heavy and to place them there. Allow yourself to settle back
    limp, in a deep state of numbness, in order that you and listen to the sound, and movement, of the deep
    can respond in a very logical and appropriate and the wonderful feeling of lying in the spring
    manner to help you and your baby. grass. Allow your body to feel heavy and limp, and
    Once this has been accomplished you will be to listen to the breeze through the trees and the
    able to go and concentrate on the safe place in the distant ocean going back and forth, back and forth,
    grass near the house, ocean, the shore, the sky, or back and forth in a melodious rhythm. You feel the
    concentrate on the movement of your baby. You warmth of the sun over your body. You feel at
    will permit yourself to take greater control by peace.
    saying to yourself, in your mind, "Relax, calm,
    poise, numb." This will permit you to go back to a
    very deep state of relaxation, whereby you will feel THE DELIVERY. Opening your eyes will not bring
    pressure and movement but no pain, pressure and you back to your usual state of awareness; rather, it
    movement but no pain. If there is a need to be will allow you to sink even deeper and
    transported into
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 291
    deeper, deeper and deeper in this state of relaxation and breasts. You can turn the valves to produce more milk
    peacefulness. When the delivery team announces that the quickly, and turn off the switches for any discomfort in
    baby is coming out, you will be able to open your eyes, the area. However, if an infection such as mastitis should
    and will be able to touch and assist your baby coming out occur, you will feel discomfort in order to inform your
    into this world. Watching the birth of the baby, and physician. But if there is no infection or major problem
    seeing the blood and secretions will have no negative with the breast, other than general irritation, you will not
    effect on you. Rather, you will watch in interest. feel pain or discomfort. When you have chosen to stop
    breast-feeding, you will be able to dry up the milk easily
    C ONTROL OF B L E E D ING AND PAIN. By turning off and comfortably by slowly turning off the valves to that
    your valves, you will be able to decrease the flow of area over the period of several days.
    blood, and by relaxing the perineum, you will be able to
    push through and stretch the perineum with little or no further
    FURTHER SUGGESTIONS FOR SELF-EFFICACY. [ A f t e r
    tearing. If you need to have an episiotomy, you can numb deepening comments:] Within you is a sense of control,
    and decrease the flow of blood to the area. And the area comfortable peace and tran-quility. You feel a sense of
    will remain numb until the stitches are healed. After your power, control, inner strength.
    delivery, the perineum will return to its size before the
    birth of your child so that you may enjoy an active and ONSET OF LABOR When labor begins the contractions may
    enjoyable sex life. hurt; at that point, you will start timing the contractions.
    When they are continuous for a half-hour, coming every
    SUGGESTIONS FOR POST-DELIVERY COMFORT AND seven minutes, you will call the doctor. Based on what
    WELL-BEING. If hemorrhoids appear, you will keep you are told you may choose to call the answering
    them numb in that area until they have gone. With your service if you want me or my support person to be with
    relaxation and concentration the flow of blood in the you at your delivery, so that she or I will be able to meet
    veins in your legs will virtually eliminate any and all you at the hospital. When you start to dial the office
    varicose veins. After labor is over, you will feel only number of the doctor, you will say to yourself, "Relax,
    pleasantly tired, so you can relax and be able to void the calm, courage, numb." This will be a signal to adjust the
    urine in your body. You will sleep easily at any time in dimmer switch to numb those parts of your body just
    the hospital or at home. During and after delivery you below you breasts to just above your knees, in a
    will be happy, courageous, confident, proud, and you barrel-like area that will surround that area. You will
    will have a wonderful feeling of accomplishment allow yourself to maintain the needed level of numbness
    because you will be relaxed and happy. There will be no whereby you will feel pressure and no discomfort.
    need for maternity blues. You will be able to calmly deal
    Upon reaching the hospital, you will be able to
    with your new baby at home, and the activities of your
    maintain the needed level whereby the admitting nurse
    home life. You will feel only calmness, happiness,
    or a doctor agrees that you are in active labor. At that
    contentedness, a relaxed feeling, a feeling of
    point, you will allow yourself to become even more
    accomplishment. If after delivery, after-contractions may
    numb, whereby you feel pressure and movement, but no
    occur, or if rectal discomfort develops, you will
    discomfort.
    automatically be able to numb the areas of discomfort
    until those areas are healed. If there is a traffic jam on the way to the hospital you
    can deepen your state by putting your thumb and index
    fingers together and taking one long, deep breath. This
    SUGGESTIONS FOR LACTATION. Your relaxation will act as a
    will allow the milk to develop quickly in your
    292 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    signal to allow you to go into a very deep state can choose to do so by saying to yourself that you
    whereby you will achieve a very deep state of want to experience the sensation. Once this has
    numbness, calm, and relaxation. You realize that been accomplish, this will be a signal to allow
    by focusing your mind on your hand held monitor, yourself to dull the area and relax, and obtain a
    and adjusting the dimmer switch, you can control comfortable level to permit a comfortable level of
    the level of sensation and intensity you wish. You pressure but no discomfort, and to allow yourself to
    have complete control over how much dullness you go even deeper into hypnosis than you have ever
    want to have at any given time. Also, you may been before.
    choose to have your husband or someone who is
    driving the car put his/her hand on your body, and COMFORT FOR MEDICAL PROCEDURES. If at any time
    by doing so you will achieve specific dullness to in the process there is the need for any kind of
    the area where he has touched. injection, for example, to place an intravenous
    If for some reason you are unable to leave your tube, you can numb that area by focusing your
    home and your husband is not with you and you are mind and picturing the area. You may feel
    alone, by taking one long deep breath through your pressure, but no discomfort; pressure, but no
    nose, and breathing out through you mouth, you discomfort. If for any reason the medical staff do
    will permit yourself to go into a very deep state of not do a procedure correctly, your body will be
    hypnosis. At that point you will allow yourself to aware of it, so that you can inform them; for
    focus your mind on your body and picture what example, if they do not put on the fetal monitor
    areas you need to dull. With this focus and with correctly or put in the IV correctly. Once you have
    picturing your scene, and repeating to yourself in told them, this will be a signal to allow yourself to
    your mind, "Relax, calm, courage, numb," you will go into a very deep state of hypnosis and to help
    be able to help yourself and your baby. You will yourself and your baby appropriately.
    remain calm and poised, and know that you have
    the ability to make decisions wisely to help you and
    SUGGESTIONS FOR POST-DELIVERY CARETAKING. After
    your baby.
    labor and delivery are over, and you have returned
    You will be able to visually go within yourself to home, your sense of peace, calm, and strength will
    monitor the progress of your baby, and your labor help in your recovery time and help you sleep,
    and delivery. You will be able to make, if possible, whether you have a vaginal or cesarean birth. Your
    all the necessary phone calls to obtain assistance in inner strength, relaxation and desire will shorten
    your labor and delivery. You will feel relaxed, the recovery period and help you to cope with the
    calm, and will maintain the needed level of dullness newborn's needs. You will remain relaxed and at
    to deliver your baby, if necessary, in good health ease.
    and tranquility. During this period you will allow
    You will eat only foods that are good for your
    yourself to focus on the movement of your baby,
    body, such as complex carbohydrates, fruits,
    your body, and to picture yourself in your safe spot
    vegetables, and lean meat, while eliminating fats,
    in the grass and how wonderful this feels. This
    sugar, and white flour. You will eat only when your
    calmness and relaxation will allow your baby to
    body needs, not your emotions need, to be fed and
    enter the world with an Apgar of possibly 9 or 10.
    nurtured. Therefore, you will eat only when your
    You feel a sense of joy and life within your soul.
    body is hungry, and only in small quantities. You
    will eat slowly and enjoy your food. You will
    YOU MAY F E E L DESIRED SENSATIONS. At a n y p o i n t gradually go back to a full exercise program that
    during your labor you may wish to feel the actual will bring health and contentment to you. This
    labor and the strong contractions. You will help you
    reach your goal of______ pounds that you have
    set for yourself. You will allow yourself to engage
    in activity —mentally, emotionally, and
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 293
    physically — that will bring to you health, lon one long deep breath through your nose. And as
    gevity, and peace —mentally and physically and you breathe out through you mouth, you will
    emotionally. You will permit time for yourself permit yourself to go into a very deep state of
    and time to take naps when your body feels hypnosis. At that point you will allow yourself to
    fatigued. Your desire to achieve this goal in life focus your mind on your body, picturing your
    will provide the strength and endurance for scene, or any other peaceful and secure scene, and
    you to be able to reach your desired weight repeating to yourself in your mind, "Relax, calm,
    of ____ pounds. poise, courage," you will be able to help yourself.
    By eating only when you are hungry, eating only You will remain calm and poised and respond
    the foods that are good for your body, eating small more effectively to take care and help yourself.
    quantities, eating slowly and enjoying each and [Suggestions are now repeated.]
    every morsel of food that you put into your mouth, Because you and I have worked on the various
    and by exercising appropriately every day for a suggestions, along with the script I have developed
    minimum of one 30-minute period, you will to help you take greater control over your life, each
    achieve your desired weight. time you listen to this tape, each time you reaccept
    This calmness and relaxation will allow your the suggestions that are contained on this tape, the
    body and mind to function more effectively. You suggestions become more and more a part of you.
    feel a sense of joy and life within you soul. Let Even though you may not consciously remember
    yourself sink deeper and deeper, deeper and deeper. them, they will remain there in your unconscious,
    Notice the warmth of the sun and the wonderful and they will work better and more effectively than
    feeling of the world surrounding you. Within you is ever before. You are letting yourself sink deeper
    a sense of control, comfortable peace and and deeper, deeper and deeper.
    tranquility. You feel a sense of power, control,
    inner strength.

    SUGGESTIONS FOR SELF-HYPNOSIS. YOU know that Preparation for


    you can put yourself into hypnosis any time and Obstetrical Labor
    any place except where there is danger to you or
    others, such as driving or cooking, where there William S. Kroger, M.D. Palm
    could possibly be danger to you or others. Springs, California
    Otherwise you can put yourself into hypnosis very
    quickly, and with each trial and each time you will VERBALIZATION FOR GLOVE
    be able to go into hypnosis more rapidly that ever
    ANESTHESIA
    before and the suggestions here, or that you give
    yourself, will last longer with each trial. You will [Glove anesthesia is produced as follows:] And
    always find hypnosis refreshing and relaxing. No now you will go into a deep, hypnotic state, way
    one can put you into hypnosis without your down, deeper and deeper! You are going to
    agreeing to it. Otherwise you will always find produce glove anesthesia. As I stroke this hand, it is
    hypnosis helpful in reaching your goal of taking going to get numb, heavy, and woodenlike. When
    greater control of your life. you are sure that this hand has become numb, just
    If, for some reason, you need to put yourself into as your gums would be after your dentist has
    hypnosis where it is not feasible to close your eyes, injected procaine, you will then transfer this
    such as at work, or when dealing with the baby, or numbness to your face. With every movement of
    in the middle of a stressful situation, you can put your hand toward your face, it will get more numb
    yourself into this wonderful feeling of calm and and woodenlike. [The hand moves to the side of the
    relaxation by taking
    294 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    face.] When it touches your face, press the palm of The following is an actual verbalization taken
    your hand close to your face [The hand lifts and is from a tape recorder for the conduct of labor.
    pressed to the face], and when you are certain that
    that numbness has transferred from your hand to SUGGESTIONS DURING LABOR Now, Mary, you have
    your face, drop your hand and your arm. You are been able to enter a deep state of relaxation through
    going deeper and deeper relaxed with every breath autohypnosis. Also, you have demonstrated that
    you take. You can just feel that numbness being you can produce glove anesthesia and transfer this
    transferred from your hand to your face. That's fine. numb, heavy, wooden feeling to either side of the
    Just fine. Excellent. Now, after you are certain that face. Now that you are in active labor, you will be
    the area on your face is numb, you can remove your able to develop the same anesthesia in both hands
    hand and it will be normal but your face will be and transfer this numb, heavy, wooden feeling to
    anesthetized. the abdomen, in order to cut down the discomfort
    [The glove anesthesia can be transferred to the produced by your contractions [the word 'pain' is
    abdomen by one or both hands. A posthyp-notic never used]. You will also develop anesthesia of
    suggestion can be given that the anesthesia can be any other area of the body that I pick out. such as
    transferred to the perineum at the appropriate time. the area between the vagina and the rectum. This
    As each site is anesthetized, the sensory proof of area will be without any feeling for a considerable
    anesthesia can be demonstrated to the patient. length of time. Each time you practice producing
    However, one should remark:] Remember, you will the glove anesthesia, you will be able to maintain it
    know what I am doing, but you will feel no pain as for long intervals. When labor starts, you will first
    I test for the degree of anesthesia. [This is feel an ache which will begin in the back and then it
    consistent with what is known of the phylogenesis will move around to the side of your belly. At this
    of the nervous system. Since pain is the most time, you will be able to use the autohypnosis and
    primitive of all sensations, it does not have as much place yourself in a deep state of relaxation.
    cortical representation as the other senses. Remember, you need have no more discomfort
    Discriminatory sensations such as touch, having than you are willing to bear. Your labor
    been acquired later, have more representation in the contractions will get stronger and longer, and that is
    cortex.] a good sign that you are making progress. Even
    though you know that the labor contractions are
    there, you will not be able to feel them. If the glove
    MANAGEMENT OF LABOR anesthesia does not relieve your discomfort
    completely, please do not feel guilty about asking
    INTRODUCTION. When labor actually begins, the for drugs, which will be available.
    patient induces autohypnosis. The physician also
    can induce hypnosis over the phone or through
    another physician to whom he has transferred the
    rapport. An assistant, such as a nurse, can do it by
    handing the patient a written order to go into a deep
    HELPFUL SUGGESTIONS
    state of relaxation. How it is done depends on the DURING LABOR
    kind of conditioning and the cues the patient
    received during her training program. If the patient INTRODUCTION It takes years to become adept with
    has not mastered autohypnosis, the doctor's forceps or to be a good vaginal operator. Likewise,
    presence is necessary for maintaining the hypnosis. the ability to be adept in producing, maintaining,
    Suggestions are given for complete anesthesia of and controlling the applications of hypnosis to
    the abdomen, the perineum, and other hypersensi- obstetrics requires much practical experience.
    tive areas. The most useful suggestions
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 295
    are given below. Misdirection of attention is used [Backache in the sacral area causes considerable
    to mitigate the forcefulness of the labor discomfort, especially if the fetus is in an occiput
    contractions, as follows. posterior position. Here, too, the husband's aid can
    be enlisted:] I want you to place the palm of your
    SUGGESTIONS. I want you to breathe deeply in the hand, with your fingers fanned out, over the small
    same manner in which you were trained during the of your wife's back. You will press firmly over this
    prenatal classes. You will count the number of deep area. You will start this at the beginning of each
    breaths or pants that you take with each contraction and release the pressure only after the
    contraction. In other words, as soon as you feel the contraction has disappeared. [This maneuver often
    contraction, start panting and keep a record of the helps patients who complain bitterly of low back
    number of breaths required for each contraction. pain.]
    Perhaps it might be 28 for the first one. In about 10 If you do have more discomfort than you are
    minutes, you should have another contraction able to tolerate, do not feel embarrassed if you
    which may last for 30 or 40 seconds; this one may have to moan. It will help relieve some of the
    require 30 deep breaths or pants. Keep an average tension. Also, if you wish to open your eyes, you
    between the first and the second by adding the total may do so without interfering with the relaxed
    and dividing by two, which, in this case, would be state you are in. As soon as you close your eyes,
    29. I want you to keep this average for all of your you will drop even deeper relaxed. You will not be
    contractions. As they get closer and closer, you will bothered by any noises or sounds around you. As a
    notice that the average number of breaths will matter of fact, you will become more and more
    increase, indicating that labor is progressing nicely. concerned with your breathing and counting, and,
    [The idea is to keep the patient's attention so as you become more involved in these, the sounds
    concentrated on the addition and the division that around you will fade into the distance. As the head
    she doesn't have time to think of the painful uterine of your baby descends down the birth canal, you
    contractions. Such a procedure can potentiate the will notice more of a desire to push. I have taught
    use of hypnosis. This preoccupation undoubtedly you how to breathe. You can grunt and bear down.
    explains to a degree the success of the natural Every contraction will be a signal for you to bear
    childbirth method in which the woman spends a down harder. And, because you will be completely
    considerable amount of time thinking about relaxed, you will obtain the maximal effect from
    whether or not she is carrying out this or that each contraction. You can go through the rest of
    exercise correctly.] your delivery without any trouble. Remember, if
    you should require an anesthetic agent, it will be
    Finally, when you are in the last stages of labor, given to you. And, even if this is necessary, you
    you will push down when requested to do so. will find that having a baby will be an exhilarating
    Naturally, the more you relax, the more effective experience, especially if you are deeply relaxed.
    each push will be. If you follow these suggestions
    you will get the most out of each contraction. [For the actual delivery, the patient can transfer
    [Another way to deepen the hypnosis is to the glove anesthesia to the perineum before it has
    employ the husband's participation and been "prepped" or sterilized. She is instructed:]
    post-hypnotic suggestions:] I am going to instruct This area will remain completely numb and
    your husband that each time you develop a anesthetic. As you push down, with each deep
    contraction, he will squeeze your wrist with his breath you take this area will become more and
    forefinger and thumb. And, as he squeezes your more anesthetic. [One can also produce anesthesia
    wrist, this will be a cue, or a signal, that you will by commenting:] As I stroke this area with my
    drop deeper and deeper relaxed with each deep fingers, it will become numb and anesthetic,
    breath you take. completely numb and anes-
    296 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    thetic, just as if this area had been injected with traction. See how you tense up and fight these
    procaine [Iidocaine]. It will become just as numb contractions? Now I am going to show you how
    and anesthetic as your jaws become after the you can relax your whole body by breathing
    dentist has blocked off a nerve. This area is getting correctly so you will be able to be more
    very numb, heavy, and woodenlike. comfortable and endure the contractions and
    [One can enhance the anesthetic effects of the perhaps even sleep until your baby comes. It is very
    above methods, after the vagina has been sterilized easy to do. All you have to do is cooperate and fix
    and the patient is ready for delivery, by the your eyes upon this target. . . . [At this point a fairly
    following suggestions:] I am now freezing all the prominent object in the line of vision of the patient
    skin between my thumb and forefinger. [Con- was used.] Keep your eyes on this target and no
    siderable pressure is exerted at this time.] Ev- matter what happens do not move them away. If
    erywhere I touch my thumb and forefinger you do, bring your eyes back to the target and you
    together, you will notice a numb, heavy, will find it will make you much more comfortable.
    woodenlike sensation that will get more numb with This whole procedure is very much like your
    each breath you take. [This, together with the everyday activities; for example, when you watch
    delivery of the head, produces a considerable TV and are interested in the program, people come
    amount of pressure anesthesia which, in some and go and you are not aware of them. Also, you
    patients who have a high pain threshold, is suf- may have experienced cutting your finger while
    ficient for the performance of an episiotomy.] cooking and not have noticed the pain or that it had
    been cut until afterwards. Or perhaps you might
    have seen a baby fall and hurt itself and cry but
    when the mother held it and kissed away the pain,
    S u g g e s t i o n s with U n t r a i n e d the baby stopped crying. All this is a normal
    reaction of the human body; that is, by listening to
    Patients in Labor my voice, watching the target, and trying to
    experience the things I tell you to, you will be able
    Nicholas L. Rock, M.D., to relax your whole body, become more
    T. E. Shipley, and C. Campbell comfortable, and eventually fall asleep.
    New Orleans, Louisiana

    You seem uncomfortable and nervous about


    your labor, especially when you have a con-

    PREMATURE LABOR, MISCARRIAGE AND ABORTION

    Hypnotic Relaxation Technique In a control group study, Omer documented that


    this hypnotic procedure combined with standard
    for Premature Labor medication was clearly superior (p < 0.002) to a
    group receiving medications alone. Treatment was
    Haim Omer
    generally begun within three hours of
    Jerusalem, Israel
    hospitalization and lasted an average of three
    hours: one hour and a half on initial contact, and
    INTRODUCTION another hour and a half during the following days.
    Each patient also received an audiotape recorded
    Premature labor is the major cause of infant especially for her with instructions to use it twice
    death and also results in costly hospitalization. daily. (Ed.)
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 297
    THE TECHNIQUE uterus, calming everything down slowly, as the sun
    relaxes and softens your muscles when you lie on a
    [Following brief education about the nature of beach. This calmness may grow with every minute that
    hypnosis:] An explanation of the physiological effects of goes by, with every breath you take.
    hypnotic-relaxation was given as follows:
    These images were elaborated as the counting
    When you imagine a car accident your body reacts progressed to 15. At this point, suggestions were
    with signs of fright: Your heat beats faster; your muscles interspersed for trance deepening and further
    get tense; your blood pressure rises and so on. When you suggestions for uterine relaxation were given:
    imagine a relaxed situation, for instance, a warm bath,
    your body also relaxes. The same is true with more Maybe it is somewhat funny, but I may talk to your
    specific images. When someone imagines that he is womb, and your womb . . . [here the women's name is
    eating ice cream, the blood vessels in his stomach inserted] can hear everything I say. Your womb . . . [the
    contract; when he imagines he is sipping hot tea from a woman's name] hears me deeper and deeper, deeper than
    cup, the blood vessels in his stomach dilate. It is thus your conscious mind, your womb . . . [the woman's
    possible to influence many bodily reactions in a desired name] listens and understands everything that I say and
    manner. The goal of this hypnotic-relaxation exercise is may carry out those things that I am asking you to do.
    to relax your whole body and your uterus in particular. Your womb . . . [the woman's name] may rest so deeply,
    just as in a deep sleep and it . . . [the woman's name] can
    listen only to my voice and may know how to react so
    The therapist told the patient that the use of deeply to everything I say. The baby inside you may
    hypnotic-relaxation did not imply that contractions were slowly become more comfortable, free; it has lots of
    due to psychological problems. The hypnotic-relaxation space and nothing disturbs it; nothing presses upon it. Its
    technique may influence physiological processes of small hands may float so freely, and you are so close to
    physical as well as psychological origins. your baby that what happens to you passes over to your
    baby, and what happens to your baby passes over to you.
    If no other questions were asked, the therapist asked
    You are so close to the baby that you can have a foggy
    the patient if she was ready. If so, she was told to take a feeling of the baby's foggy feelings and sensations. As
    deep breath and close her eyes. ... In what follows, the the baby's hand becomes free and light it may start
    therapeutic procedure is described (schematically, floating and moving [the therapist touches the woman's
    whenever usual hypnotic techniques were used; in detail, wrist and carefully raises it and moves it about, matching
    whenever special interventions designed for this project his motions to what he is saying. If catalepsy appears, the
    were used). depth of hypnotic involvement can thus be checked]. It
    may get farther and farther away from the body, so
    A relaxation induction was utilized in which the
    lightly, so freely, so full of the open space surrounding it,
    therapist counted from 1 to 20 concentrating on various
    and it may remain poised, floating, effortless, and it may
    parts of the body. At the count of 10 the following slowly go down and rest, so deeply, so restful.
    suggestions were given:

    I will now lay my hand lightly over your belly, and I The counting progressed until 20 and a finger
    will ask you to pay attention to the feeling of warmth questioning procedure now took place:
    which will develop under my hand. Now, pay attention
    to this warmth under my hand and imagine it slowly Now I will ask you some questions about how your
    reaching your uterus. You can imagine this warmth pregnancy will go on. You don't know the answer to
    spreading over your uterus, softening up every single these questions in any conscious way, but your body,
    corner and cell of your deep inside you, knows the answers. The knowledge to
    answer these questions is there inside you, for
    298 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    your unconscious mind is very close to everything that stronger and prettier. Another day and another day and
    happens to your body. You won't answer by speech, your some more and, look, another week has passed. Your
    body will show us the answers; your fingers will move baby's skin gets smoother, rosier, silk-like; another week
    and give us the answers. This finger [the index finger of goes by, and the line of his eyes and lips becomes more
    the right hand was touched] will be the "Yes" finger, and and more clear and beautiful. He gets stronger and
    this finger [the left hand index] will be the "No" finger. I bigger. One more week, and one more week, and the
    will count to 30, and you can sink deeper and deeper, and baby has all the space he needs and all the calm and time
    with each count let your fingers become lighter and in the world. Somewhere in the middle of the ninth month
    lighter as if they wished to rise all by themselves [the you may look backwards and remember with your
    therapist counted to 30, giving suggestions for increased imagination how you have gone through all of those
    finger lightness and responsiveness]. The first question weeks, how you have succeeded in overcoming that
    that I will ask you is whether deep inside your body and crisis, how everything went on so smoothly, how your
    mind there is a readiness that the baby may go on womb grew quiet and comfortable, how you found a
    growing inside you, inside your womb, until at least the funny kind of deep patience within you, the patience of a
    beginning of the ninth month of pregnancy, until the 37th tree filling up its fruit with sweetness, a patience which
    pregnancy week? [There is a short silent interval.] filled up your body and mind. A feeling of timeless-ness,
    Slowly your fingers start to get that feeling, and they of having plenty of space around you, just like a tree
    begin to move, that's right, lifting, more and more allowing its fruit to ripen, to grow, to become full, to get
    clearly, wonderful! [In 34 of 38 cases a positive answer its color, its sweetness, its juiciness, as if you had all the
    was readily obtained, in two cases a negative one, and in time in the world to allow your fruit to get totally ripe.
    three cases a no answer.] Now I will ask another And when you reach your day of delivery, somewhere by
    question: Whether there is a readiness deep inside you to the end of the ninth month, everything is ready for an
    allow the baby to grow within you until the middle of the easy delivery. Surely you know how hard it is to pluck an
    ninth month, say, the end of the 38th week? [There is a unripe fruit from a tree, a green fruit, how stubbornly the
    short silent interval. When a positive answer was fruit refuses to be plucked, how much you have to pull at
    obtained a third question was asked.] Now, maybe there it. Whereas a ripe fruit, when its time is come, when it is
    is really a readiness deep inside you to let the baby already beautiful, and full with its sweet scent, it is
    remain and grow inside you to the very end of the ninth enough to give it a slight pull and it is out, for this
    month? [There is another silent interval.] happened at the right time. [If changes have appeared in
    the monitor as generally was the case, the therapist
    Let us now ask another question: Is there a readiness complimented the patient's womb for the achievement.]
    deep inside you for your body to do everything to protect Now I am going to count backwards, from 30 to 1, and
    your pregnancy? For your body to learn how to move with each count all of the things I've said will slowly sink
    softly, to keep from making unnecessary efforts, to care in your mind, like rain which slowly sinks into dry earth.
    for yourself slowly, softly, delicately? [There is a short
    interval.]
    Dehypnotization proceeded by backward counting.
    After this finger questioning procedure, a time During this process, suggestions were given to the effect
    progression was undertaken: that the patient would be influenced by the therapeutic
    messages even when not thinking about it. She was told
    Please imagine that time is beginning to pass, a few that this influence would lead her to move around in a
    hours have gone by, and you are now in the women's mild and self-protective way and that she would be able
    ward, away from the delivery room, and you may
    to remain calm even in the face of thoughts or events
    remember your hospitalization as something which took
    which would otherwise be disturbing. . . .
    place a while ago, so that you are already used to it.
    Morning, noon and evening look very much alike as you After the therapist had reviewed with the patient her
    rest in the hospital; a day has gone by, and you can feel reactions to the exercise, he tried to keep her mind
    calmer and better, and another day has gone by. Little by involved associatively in the
    little a week has passed, and after while you go home,
    and with every hour that goes by and every day, your
    baby becomes
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 299
    hypnotic process by telling her some therapeutic quent. Tzirrr, Tzirrr . . . Tzirrr . . . Tzirrr ... [in Hebrew
    anecdotes. These anecdotes are actually indirect the word Tzir means also a uterine contraction], slowly
    suggestions for a continuation of pregnancy, and are weakening, diminishing, fading out until it completely
    based on similar procedures by Erickson (Zeig, 1980). disappears.
    Here are two examples of such anecdotes:
    After a few anecdotes, the therapist decided according to
    (a) Natural scientists have long known that fe the uterine conditions whether to do another
    males of many species are capable of influencing the hypnotic-relaxation exercise. If contractions had
    liming of their delivery. The African wildebeests (a disappeared, he would perform a similar exercise on the
    species of buffalo), for instance, live in large herds, following day (without the finger questioning part)
    sometimes consisting of hundreds of animals. This is which he would record on cassette. If contractions were
    a wandering animal, the wandering being a part of still present he would perform a second exercise on the
    their defense against predators. spot. In this manner all women received at least two
    The female wildebeests are in heat for about one and a personal exercises. About half of them had the second
    half months every year. This period is common for the exercise in the initial session, and another half had it the
    whole herd. Pregnancy lasts for 11 months so that the following day. These differences were not found to be
    calves should be delivered within a one and a half month
    related to outcome.
    period. Here a problem arises: Will the whole herd wait
    for each cow to deliver? This is a dangerous solution After the end of the woman's hospital stay (generally
    since the herd will then be liable to predation. Is it one week), the therapist contacted her by phone about
    possible that the cow about to deliver will leave the herd once every two weeks to check how she was feeling and
    and stay by itself? Of course this would leave her and her
    whether she was listening to the cassette.
    calf totally unprotected. The solution which nature
    devised for this problem is amazing. In a manner which is
    not well understood, all the cows deliver on the same
    day. In a few hours' time all of the calves are standing on
    their feet! The early ones . . . [the woman's name is Use of Immediate Interventions to
    inserted] postpone the delivery, whereas the late ones
    deliver earlier. This could be a story about wildebeests
    Uncover Emotional Factors in
    alone, but the fact is that their hormonal processes seem Pre-Abortion Conditions
    to be extremely similar to human ones. Everything a
    wildebeest can do with its uterus, it is quite possible that David B. Cheek, M.D.
    a woman can do as well. Only you don't know yet that Santa Barbara, California
    you know how to do it. You just don't know consciously
    how it is that you are now calming your uterus, how your
    In a retrograde study of abortion sequences some
    body is changing its timetable, postponing things, letting
    years ago, I found that more than half of the women
    time go by.
    started their bleeding and expulsive contractions during
    (b) In some areas of South America there are some the night, usually between one and four in the morning.
    kinds of crickets which stay buried for 13 years as The majority of those who started during the day
    larvae deep inside the earth. Every 13 years they revealed, during age regression, their belief that the pro-
    become crickets for one day and they go out of their cess really originated with troubled dreams repeated for
    holes for a giant honeymoon. The noise they make several nights prior to the abortion.
    can be heard from enormous distances; the whole
    jungle is filled up with it. Sometimes a cricket comes Fortunately, thought sequences capable of causing
    out before its time. Something was wrong and it abortion very rarely do so the first time around. They
    comes out something like a year or two too early. It occur on repeated cycles of sleep and on successive
    gets out and starts chirping with great enthusiasm. nights of sleep. This gives the
    The time, however, is still not ripe, and no answer
    comes. Slowly its chirping grows less and less fre-
    300 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    patient an opportunity to recognize that her sleep started ten weeks ago, that this is a planned
    has been disturbed and to report this change in pregnancy but she has had five previous
    behavior to her doctor or midwife. Early miscarriages of planned pregnancies, and she
    intervention can prevent loss of a normal hopes that she might be able to carry this one. She
    conceptus. The physician should know how to act is 30 years old and has been happily married for six
    at once during the first telephone call of alarm. In years.
    the case of a woman with a history of habitual This is an emergency and you must act quickly if
    abortion, it is far better to check out the emotional you are to be of help to her. You need not be
    background before the patient begins the concerned about her past history. She is frightened
    pregnancy. and is therefore already in a hypnoidal state. This
    Even if the process of bleeding and consciously enables her to respond strongly to positive, hopeful
    perceived uterine contractions has already begun, suggestions given honestly and authoritatively. We
    there is usually time to expose the emotional cause should use hypnosis permissively under peaceful
    and help the patient stop the progress toward circumstances, but authoritative commands are
    abortion or delivery of a dangerously premature necessary during an emergency.
    infant. But intervention must begin at once and Explain that you will show her how to stop this
    should not be delayed by admission of the patient to process but that you need to know what has started
    a hospital. It can be handled over the telephone, any this trouble. Say to her, "Let the unconscious part of
    time, at home or even long distance when the your mind go back to the moment you are starting
    patient is on a vacation trip. the bleeding. When you are there, you will feel a
    All pregnant women, regardless of previous twitching sensation in your right index finger. Don't
    history, should know how to recognize that their try to recall what is going on. Just say 'now' when
    sleep has been troubled and be shown how to check you feel that finger lifting up from where it is
    resting."
    their own unconscious reactions to threatening
    dreams and deep sleep ideation. Their first line of There is a double reason for this approach. Your
    correction is to ask for an ideomotor response to the words tell the patient that something can be done
    question, "Is there an emotional cause for this?" If right now to prevent what has happened regularly
    the answer is a yes with a finger signal or before. The request for an unconscious gesture
    movement of a Chevruel pendulum, they can ask, when reaching the moment that bleeding started
    "Now that I know this, can I stop my bleeding (or centers her attention on what her finger might do
    cramps) and go on with this pregnancy?" and diminishes her acute attention to the
    contractions of her uterus and the fact that she is
    If the answer suggests an organic beginning or
    bleeding.
    inability to stop the process, there is still time to
    make a telephone call to the doctor or midwife who It may take less than 30 seconds before she says,
    is capable of inducing hypnosis over the telephone, "Now." You will probably notice that her voice is
    searching for the causal experience, and permitting subdued, indicating that she has slipped into a
    the patient to make her corrections for the sake of deeper trance state. Say to her, "Let a thought come
    her baby. to you about what your unconscious knows has
    started your bleeding. When you know it, your yes
    Consider this example: A woman who has not
    finger will lift again, and when it does please tell me
    been to your office but has been referred to you for
    what comes to your mind."
    obstetrical care calls at 3 p.m. on Sunday to say that
    she has an appointment next week but started to There may be another 30-second pause before
    bleed slightly this morning and is now having she responds. Be quiet until she reports something
    cramps. She would have called earlier but she did such as: "I'm asleep after lunch. I'm dreaming that
    not want to bother you. She reports that her last the doctor is saying he doesn't think I will be able to
    period carry my baby because of
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 301
    all the other ones I have lost. He says we can try the cause will permit correction of the problem.
    some hormones to see if that will help." This diverts her total attention from the bleeding
    You answer, "That index finger can represent a and uterine cramps to the more constructive area of
    yes answer to a question. Your middle finger on the what she can do to stop the trouble and get on with
    same hand can represent a no answer. This is like the pregnancy.
    nodding your head unconsciously when you agree The questions and the unconscious review of
    with someone or shaking your head if you disagree. significant events have led the patient further away
    I want to know, is the dream occurring after you from the thought that she might lose this
    have started bleeding?" pregnancy.
    She answers, "My no finger is lifting." A marvelous protective action takes place by
    "All right. This is a dream and your unconscious virtue of entering a hypnotic state at a time of crisis.
    knows the dream is the cause of your bleeding. Coagulation mechanisms return to a normal
    Sadness and fear can make a uterus bleed even balance and all vegetative behavior is improved.
    when a woman is not pregnant. Is your inner mind There is no need to command bleeding to stop or
    willing now to stop the bleeding and let your baby the uterus to remain quiet, but it helps the patient to
    go on developing normally?" make better use of these protective functions when
    The patient will usually find her yes finger lifting you show respect for this phenomenon by saying:
    for this question, but if she gets a no, or some other "Now this is something you dreamed. Would you
    finger, that might mean she does not want to agree that this dream does not need to threaten the
    life of your baby, and that you have a right to stop
    answer; then you must ask her yes finger to lift
    your bleeding and get on with your pregnancy?"
    when she knows why she feels this way. It is
    usually some feeling of guilt or defeatist belief
    system at work. Simple recognition permits her to
    remove that factor.
    You conclude the telephone call with a deep- Treating the Trauma of
    ening series of suggestions and directions to relax Prospective Abortion
    her abdomen, stop the irritability of her uterus, and
    fall asleep for about 10 minutes after hanging up. Helen H. Watkins, M.A.
    You ask her to call you back in one hour with a Missoula, Montana
    report. Do not say any more about bleeding. Just
    ask her to call you in one hour. The statement often
    INDICATIONS AND OUTLINE
    used by doctors is, "Give me a call if your bleeding
    continues or gets worse." Such a statement is This is a technique for use with newly pregnant
    interpreted as meaning the doctor expects her to women who are struggling with a decision
    bleed, and she will do so. She has shown five concerning whether or not to have an abortion.
    previous times how well she can bleed and abort.
    You explain that this does not mean she has to FIRST SESSION. Explore the pros, cons, facts, data,
    miscarry again. Bleeding occurs in 30% of feelings, consequences, attitudes and beliefs.
    pregnant women at some time during their
    pregnancy and has nothing to do with prognosis SECOND SESSION Explore the patient's feelings and
    unless they become frightened. attitudes with hypnosis.
    This presentation is easily understood by a
    frightened patient. The statement of a way for THIRD SESSION Following hypnotic induction, I
    communicating unconscious information is also have her visualize the fetus and speak to the fetus
    telling the patient tacitly that discovery of silently, expressing her conflict about the
    302 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    pregnancy. Then wait for a response, whether it is a It is surprising how often a response is forth-
    feeling, something heard, or something seen. The coming. I let the patient come to her own
    patient repeats this process at home, usually by just interpretation. No matter what happens physically,
    closing her eyes, breathing to enter a relaxed state, the patient finds emotional release in this
    focusing on her abdomen and stroking her procedure, and with emotional release comes a
    abdomen gently. reduction of guilt.
    Spontaneous miscarriages sometimes result.
    CONSECUTIVE SESSIONS. If the patient decides to Women who experience this react with a sense of
    have an abortion and a medical appointment is awe, respect for another energy system, and a sense
    made, then (first in my office and then at home) I of love by the fetus in agreeing to end its existence.
    have her speak to the fetus silently, explaining why It is a profound experience.
    she cannot give it birth and expressing her feelings Perhaps these women experience the grief
    to the fetus. If the woman senses a response of syndrome before the loss of the fetus, so that when
    agreement from the fetus, then I have her begin the the abortion is done the whole experience is
    process of visualizing the fetus leaving her body in finished. Many find a deeper sense of self, even
    any way that comes to her. If the patient receives no deeper respect for life, looking forward to
    response, then she makes the decision as to when pregnancy in the future when the time is more
    the visualization of the abortion is appropriate. appropriate. It is as if a force beyond their own
    Sometimes the upcoming surgical procedure comprehension understands their grief, their
    presses her for time; sometimes she simply senses sorrow, and their desperation. Instead of potential
    the appropriate time. tragedy, this process becomes a healing experience
    in their lives.

    HYPEREMESIS GRAVIDARUM AND MISCELLANEOUS


    GYNECOLOGIC DISORDERS

    Hypnotic Intervention with front of the training group to a beginning subject


    who was also suffering with hyperemesis
    Hyperemesis Gravidarum gravidarum. (Ed.)

    Ralph V. August, M.D.


    SUGGESTIONS

    INTRODUCTION You just concentrate your mind on my voice as I


    talk with you, as I make suggestions which will be
    The late Dr. August used group training with beneficial to you. And as you count each breath,
    obstetrical patients, and his groups included both you will find with each deep breath, you relax
    experienced and new hypnotic subjects. He deeper . . . and deeper . . . and so now you may be
    believed that by watching experienced subjects ready to concentrate your mind on your heart, and
    who entered hypnosis more quickly and easily, notice how, with each heart beat, you can feel
    yourself relaxing . . . deeper .. . and deeper . . . and
    beginners learned self-hypnosis more quickly. He
    deeper. So you can keep your mind on each heart
    learned that hypnosis followed by suggestions for
    beat, using each one to help you to go deeper . . .
    continuing comfort, "Just like you feel now," would
    and deeper. And you may notice by now that your
    control hyperemesis for two to ten days, and heart beats seem slower, more comfortable,
    sometimes permanently. The following suggestions more
    model those given in
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 303
    relaxed, more at ease. While you keep on relaxing, Gail, that practice makes perfect, and you can
    getting sleepier . . . and sleepier. And by now you practice doing this every day, as many times a day
    may be ready for that which for you, Gail, is most as you wish. And of course you, Gail, are also
    important of all. Everyone else is aware of this . . . welcome to make your appointments for each week
    because, by now, you can concentrate your mind on with our group; and when you have started gaining
    your abdomen. Notice how your abdomen feels weight again, then you can go to your regular
    warm, relaxed, at ease. Feels so good that it feels visits, which would be at the time of your regular
    like you could eat and drink anything you want . . . obstetric visit, because it will be once a month for a
    and I know you can. It feels so good now ... it feels while yet, until possibly about the eighth month . . .
    better than it's felt for quite some time. And some and of course today is December 18th. So each one
    women may at this point be aware of the baby's of you is aware now of how comfortable you feel,
    movement or not, depending on what the baby and each one of you is aware of how easy it is to
    happens to be doing. You will notice, Gail, that help yourself. Remember always that hypnosis is
    your abdomen and stomach just feel good . . . and never what I do. It is never what anybody else or
    that's all, because it is very, very early in your any other doctor does. It is what you do that counts.
    pregnancy. And you will notice now, it feels so Where I fit into the picture is that 1 am a teacher
    good that you can ignore your abdomen and showing you how.
    stomach altogether. You don't need to pay attention
    to them anymore because you know they feel good This will help you to help yourself; and this, of
    now, and you can continue to keep them feeling course, will be my pleasure to help you to help
    good, as I know you want to, and as now you can yourself; and any time you want to, you count to 3,
    and will . . . while you keep on being as feel good, and are wide awake.
    comfortable as you wish.

    And by now you might feel as though your mind


    is floating on a cloud. Floating along . . . at ease . . . Control Of Hyperemesis
    with your forehead cool, so that you can ignore
    everything down below. You don't need to pay Larry Goldmann, M.D. Fort
    attention to anything else in your body now . . . you Myers, Florida
    just keep your mind in the clouds, and notice how
    good it feels. And you can do so, whenever you PRE-INDUCTION DISCUSSION
    want to. All you need to do, Gail, is always just to
    sit back comfortably in a chair and say to yourself, 1. Routine discussion of misconceptions about
    "Gail, sleep." And every woman in this room hypnosis.
    knows all she ever needs do is to address herself by 2. Discussion of power of unconscious mind to
    her own given name . . . when she does, just using control all body systems, i.e., respiration rate,
    the word sleep, she can relax completely .. . she heart rate, flight or fight responses, and
    knows that this sleep is a hypnotic sleep; in which alimentary function.
    you are just as aware as you want to be of the things 3. Discussion of physiology of alimentary tract,
    around you, and you can ignore as much as you i.e., peristaltic motion, gastric empty,
    want to of everything else about you; in which you swallowing, etc.
    know that whenever you want to, all you need to do 4. Discussion of vomiting control center in brain.
    is to count to 3, and feel good, and you will be wide 5. Discussion of nutrition and its effect on
    awake. And you can do so whenever you wish, and pregnancy.
    continue feeling good. Remember also, 6. Find out from patient what her favorite food is,
    how she likes it prepared, and where she likes
    to eat it.
    304 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    SUGGESTIONS ONCE IN TRANCE it goes down into your relaxed stomach, and
    does not cause any nausea or urge to vomit.
    1. The normal peristaltic motion of your bowel 10. Feel how satisfying it feels to eat and digest
    and esophagus move food down into the your favorite meal, and know that you are
    stomach then into and through the intestine for giving vital nutrition to your normally
    absorption of nutrients. developing infant — nutrition which cannot be
    2. The unconscious mind controls the direction obtained through IV feeding.
    of peristalsis. The unconscious mind knows 11. Now, at your own rate, finish your meal, and
    the path food is supposed to take. see how there is no sign of nausea or vomiting.
    3. The unconscious mind also knows how Once you have finished your meal, please
    important nutrition is to the proper growth and signal me.
    development of your baby. 12. Now, I would like you to begin to become
    4. The unconscious mind also knows there are more awake and aware, feeling very confident
    many times when the vomiting center of the in your ability to eat and digest meals without
    brain needs to be stimulated, i.e., in case of any significant nausea and no vomiting,
    food poisoning or intestinal flu, and it does knowing that your unconscious mind will not
    this automatically. But during a normal allow you to vomit, because vomiting deprives
    physiologic state, like pregnancy, it knows both you and your baby of needed nutrition.
    that this center should be suppressed, because 13. As you return to the awake, aware state, you
    vomiting and nausea are counterproductive to will look forward to eating and enjoying your
    good nutrition, which the unconscious mind meals.
    knows is vital to a normal pregnancy outcome.
    5. There may be times during the pregnancy
    when the unconscious mind feels there is a
    need for nausea, but these times will be Suggestions for Hyperemesis
    short-lived, lasting 30 seconds or less, and will
    not interfere with your ability to eat, digest, William T. Heron, Ph.D.
    and absorb your meals in a normal, profitable
    fashion, assuring you and your baby proper INTRODUCTION
    nutrition throughout the pregnancy.
    The late Dr. Heron, working with Milton
    6. Your unconscious mind knows that your
    Abramson, M.D., developed the following sug-
    pregnancy is a normal, physical state and does
    gestions for "morning sickness." They trained
    not and will not have any need for vomiting.
    patients in a group, but these suggestions were
    7. Your unconscious mind knows that good given only to those suffering with hyperemesis.
    nutrition is essential to the normal progress of (Ed.)
    your pregnancy, and will work to assure you
    of this.
    8. Now, I would like you to picture, very clearly, SUGGESTIONS
    your favorite food, prepared as you like it.
    And see yourself with this food in a relaxed Now, Mrs. C, you are resting comfortably and
    atmosphere, where you feel comfortable, safe, relaxed. Sometimes you have a little nausea and
    and secure. When you can vividly see and you would like to escape this difficulty. Let us
    smell the food, please signal me. point out that your physiology is under some strain
    9. Now, begin to eat your favorite food. I wonder because it is really taking care of two people— you
    how good it tastes, and how easily and the baby. This increased strain does sometimes
    result in nausea. Now, after this if you should feel
    nauseated, all you
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 305
    need do is to sit or lie down for a few minutes. This Suggestions for Hyperemesis
    resting your body will also rest your physiology,
    and the nausea will pass. All you need to do is to Harold B. Crasilneck, Ph.D., and
    rest a few minutes, and the nausea will pass. Soon, James A. Hall, M.D.
    as your physiology becomes accustomed to the Dallas, Texas
    increased load, the morning sickness will disappear
    completely. [After the patient is induced into a moderately
    deep hypnotic state, the authors demonstrate glove
    anesthesia for purposes of trance ratification. After
    removal of the anesthesia, the following
    Progressive Anesthesia suggestions are given. (Ed.)]
    The nausea and the vomiting will simply
    Technique for Hyperemesis discontinue. . . . You can and will digest foods
    Gravidarum easily without fear or excessive tensions or
    anxieties. . . . You simply will be relaxed and at
    D. Corydon Hammond, Ph.D. ease; your mind and your body relaxed. . . . You
    Salt Lake City, Utah can and will ingest and digest foods easily, with
    little or no nausea or discomfort.

    INDICATIONS
    Suggestions for Hyperemesis
    The progressive anesthesia induction, the
    verbalizations for which are in Chapter 3 on pain Gravidarum
    management, may prove helpful with hyperemesis
    David Waxman, L.R.C.P., M.R.C.S.
    when other procedures have not met with complete
    London, England
    success in treating hyperemesis. The disadvantage
    of this technique is that it will require the patient to
    remain immobile for a period of time. However, in INTRODUCTION
    cases of severe hyperemesis it is desirable to have
    periods of bed rest rather than continuing to vomit. Waxman uses hypnosis, sometimes combined
    In hypnotically talented and experienced subjects, with other medical measures, routinely in the
    it may be used as the induction, combining it with a treatment of hyperemesis. Exploration of
    progressive relaxation technique. In other cases, psychological-emotional factors is recommended
    the procedure may follow induction and deepening in resistant cases. (Ed.)
    by other methods. An alternative to this method is
    to ask the patient, after induction and deepening,
    "Would you like to have a pleasant, surprising SUGGESTIONS
    experience? In a moment, I'm going to have you
    awaken from trance, but you will only awaken As you focus your attention on your stomach . . .
    from the neck up. Would that be all right? So that in you will begin to experience a feeling of warmth,
    a moment, as I instruct you to, you will only spreading into your stomach. That feeling of
    awaken from the neck up, and the rest of your body warmth is increasing . . . with every word that I
    will remain asleep in a deep trance. You will only utter, warm and comfortable . . . warm and
    awaken from the neck up." Refer to Chapter 3 (pp. comfortable. ... As soon as you feel that warmth . . .
    81-83) for the complete verbalizations of this please raise your index finger. That's right. Now,
    technique. put it down again.
    And as your stomach feels warmer . . . it is
    beginning to feel more normal. . . more and more
    comfortable. All feelings of sickness are
    306 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    passing away completely . . . you no longer feel at of the exact place where you have discomfort and
    all sick. Your stomach feels perfectly normal . . . pressure. Perhaps you might even imagine how
    and comfortable, in every way. 'jumpy' and irritable you felt just before your flow."
    And in a few moments . . . when I count up to [In this technique, a "dry run" or a rehearsal of the
    seven . . . you will open your eyes, and be wide onset of menstruation under autohypnosis helps to
    awake, again. You will wake up . . . with your reinforce the appropriate posthypnotic suggestions.
    stomach completely comfortable . . . without the
    slightest feeling of sickness or discomfort . . . and AGE REGRESSION. Another technique is to utilize
    you will find that . . . when you wake up, each hypnotic age regression. The patient is regressed to
    morning . . . you will not feel the slightest trace of her last period and asked to recall the specific
    sickness whatever . . . your stomach will remain sensations associated with it; if she wishes, she can
    perfectly normal. . . without the slightest discomfort choose the approximate date for the establishment
    of any kind. And, with every one of these treatments of the menses. Suggestions must be made in a
    . . . this trouble is going to disappear . . . more and confident manner. However, the physician should
    more quickly . . . more and more completely. never get himself "out on a limb" by guaranteeing
    that the menses will occur on a specific date.
    Rather, he can preface his remarks by saying, "If
    you are able to feel the sensations associated with
    Suggestions with Psychogenic your period, you have a good chance of having your
    period. Or, perhaps, you can begin to wonder
    Amenorrhea whether it will be a day or two before the date you
    chose, or maybe the period will come on a week
    William S. Kroger, M.D. afterward."
    Palm Springs, California

    REHEARSAL
    Although this method does not always work, the Suggestions with Leukorrhea
    author has on several occasions dramatically
    induced the menses by hypnosis. . . . Bleeding F. H. Leckie, M.D.
    seldom can be initiated by direct suggestion.
    Rather, the technique is to ask the following INDICATIONS AND
    questions: "Do your breasts get hot and heavy just CONTRAINDICATIONS
    before you are due to have your period? Do you
    feel like jumping out of your skin at this time? Is Leukorrhea, a non-bloody vaginal discharge,
    there any pain connected with the onset of the may be responsive in some cases to hypnotic
    flow? If so, where is it? So you have a backache, or suggestion. However, at present we lack research
    a feeling of pressure in the pelvic region? Are there evidence for this. Thus it is vitally important to
    any other symptoms associated with the onset of obtain a gynecologic evaluation to rule out such
    the flow?" causes as chronic cervicitis, ever-sion, erosion,
    If the answers to the above questions are fed genital infection, tumors, fistulas, and estrogen
    back to the hypnotized patient, one has an excellent deficiency. (Ed.)
    chance of reestablishing the menses by this type of
    sensory-imagery conditioning. The verbalization SUGGESTIONS
    used is as follows: "In about 2 weeks, you will find
    it most advantageous to feel all the sensations that Deeply asleep — happy — calm — confident —
    you previously described and associated with your relaxed. In the neck of the womb there are little
    periods. Think
    HYPNOSISINOBSTETRICSANDGYNECOLOGY 307
    glands which produce a slippery, clear secre- normally and your discharge clears. You feel
    tion—this is normal and healthy. But various better, more and more confident, and in control of
    emotions, such as excitement, worry, fear, can your emotions. You are able to face all your
    make these little glands more active so that they problems and worries calmly and confidently. By
    produce more secretion; this excess secretion counting up to four, slowly and confidently to
    becomes noticeable as a discharge. You know that yourself, when you feel excited and tense, you
    you have been examined and have been found to be become calm and relaxed, and all your fears and
    normal; especially your womb, your ovaries, your worries fall away from you. You are now able to
    front passage are normal. Because you are worried, relax for sexual intercourse with your husband, and
    anxious, tense, the little glands in the neck of your from now on you are able to have and enjoy full,
    womb are producing more secretion. You can now normal sexual intercourse with him, free from all
    learn to relax and control your feelings and pain or discomfort, and you are able to achieve
    emotions to free yourself from tension; in so doing, complete satisfaction and relief. Your discharge
    the little glands in the neck of the womb work now clears.
    HYPNOSIS WITH EMOTIONAL
    AND PSYCHIATRIC DISORDERS
    INTRODUCTION

    THIS CHAPTERis into three sections. The first section consists of


    DIVIDED
    suggestive techniques that may be used with a variety of emotional disorders.
    Some of the contributions model "symbolic imagery techniques" that may be
    valuable in working through problems like guilt, anger, depression, fears, doubts,
    and anxieties. This section also includes two insight-oriented contributions for
    furthering self-insight. Stanton demonstrates how guided imagery techniques may
    facilitate self-understanding. Bresler's model of the inner adviser technique
    illustrates how this method may be used for self-exploration as well as
    symptomatic relief. Brown and Fromm's contribution demonstrates how
    suggestions may be used to enhance affective expression in emotionally
    underexpressive patients. Two metaphoric interventions are also included in this
    section.
    The second section of the chapter models hypnotic suggestions that may be
    useful with severely disturbed patients, such as borderline, schizophrenic, bipolar,
    suicidal and emotionally labile patients. The final section of the chapter focuses
    on hypnotic interventions with post-traumatic stress disorder and multiple
    personality disorder patients.

    Symbolic Imagery Techniques: Indications and


    Contraindications
    There is a category of hypnotherapy techniques that I refer to as "symbolic
    imagery" techniques. It appears that a hypnotic state allows a suspension of our
    "generalized reality orientation" so that imagination may be used to powerfully
    influence thoughts and feelings. These techniques seem most effective with
    individuals who are responsive to both visual and, secondarily, kinesthetic
    imagery.

    309
    310 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    Thus, in hypnosis, imagery experiences that might otherwise seem superficial


    and silly may often produce potent therapeutic change. Watkin's (1980) silent
    abreaction procedure (see Chapter 16), in which a patient imagines demolishing a
    large boulder to safely vent resentment and anger, is an example of this category
    of techniques. Another clinically useful method is the red balloon technique
    (Walch, 1976). Some symbolic imagery techniques that were formulated by Dr.
    Harry Stanton may be found in this volume in the sections on ego-strengthening,
    anxiety, and sleep disorders. Hammond's master control room technique in the
    chapter on sexual dysfunctions is yet another example of a symbolic imagery
    procedure.
    These methods are particularly suited for reducing problematic emotions, such
    as anger, resentment, guilt, pathological jealousy, compulsive cravings (e.g., for
    alcohol, drugs, cigarettes), and obsessional worries. Guided imagery techniques,
    as illustrated by Stanton's methods for facilitating self-understanding, may also be
    used for self-exploration and enhancement of insight. Working with emotional
    disorders, however, is all too frequently not as simple as suggesting them away or
    imagining them disappearing. Clinicians are advised to engage in careful
    assessment and history-taking prior to using hypnosis or any other therapeutic
    technique. Furthermore, training in hypnosis itself is insufficient preparation for
    treating psychological disorders. You should not use hypnosis to treat a condition
    you are not trained to treat with other, nonhypnotic methods.
    Clinicians who work with emotional disorders will find, in many cases, that
    exploration (e.g., through ideomotor signaling or hypnoprojective techniques) of
    the underlying dynamics and abreactive work may be crucial preliminary steps
    that will increase the effectiveness and lasting benefits of these methods.
    Technique selection (Hammond & Miller, in press) will be dependent on: (1) the
    extent to which the emotional problems seem long-lasting versus recent and more
    delimited in scope; (2) the degree to which specific historical events and factors
    seem implicated; (3) the extent to which the preliminary history and assessment
    suggest secondary gains and adaptive functions may be involved in the emotional
    disorder; and (4) the initial expectations of the patient. When patients have
    expectations for the facilitation of insight or working-through (abreaction) of past
    events, and when problems seem more diffuse in origin, longer-term, and linked
    to internal dynamics and adaptive functions, more exploratory hypnotic
    techniques seem indicated initially. Insight-oriented hypnotherapy may
    sometimes require time, but in other cases may only take one, two or three
    sessions. Afterwards, symbolic imagery techniques may be very powerful and
    facilitative.

    Hypnosis with Severely Disturbed Patients


    Scagnelli (1976) noted three special problems and challenges for clinicians
    using hypnosis with schizophrenic patients:

    1. The problem of control wherein these patients are intensely concerned with
    maintaining control and fear of loss of control. This fear may be
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 311

    managed through allowing the patient to keep his eyes open, emphasizing
    self-hypnosis for self-control, and using a permissive hypnotic style.
    2. Fear of closeness between patient and therapist, which necessitates the
    therapist's allowing the patient maximal freedom and independence, including
    freedom to reject the therapist and hypnosis.
    3. Fear of giving up a negative self-concept for a more positive one, which may
    create resistance to ego-strengthening techniques.

    Despite these unique challenges, patients with developmental deficits may be


    treated with the aid of hypnosis. There is such an increasingly large body of
    literature on the use of hypnosis with seriously disturbed patients that it is beyond
    the scope of this introduction to survey these articles. However, reviews of this
    area of treatment may be found in Murray-Jobsis (1984), Brown and Fromm
    (1986), Baker (1983a, 1983b, 1983c), and Copeland (1986). In addition, Hodge's
    contribution to this section provides a practical clinical overview on the topic of
    using hypnosis with psychotic patients.

    Post-Traumatic Stress Disorder and


    Multiple Personality Disorder
    Through the years there have been a variety of published works concerned with
    the psychotherapeutic treatment of the effects of traumatic stress. Following
    World War I, hypnosis and abreactive therapy became popular for rehabilitating
    troops suffering from "shell shock" (Shorvon & Sargant, 1947). Similarly, the
    impact of traumatic events in World War II encouraged a variety of publications
    on treatment of "war neurosis" (Grinker & Spiegel, 1943, 1945; Kardiner &
    Spiegel, 1947; Sargant & Slater, 1941; Watkins, 1949), as did the psychological
    casualties of the war in Vietnam (Figley, 1978; Van der Kolk; 1984). Our society
    has also grown more violent with the passage of time. Violent crimes and rape
    have increased, and we have now begun to recognize, believe in, and more
    accurately diagnose incest and childhood sexual abuse (Courtois, 1988; Russell,
    1986). These events have lead us to more thoroughly appreciate the need for the
    treatment of post-traumatic stress disorders, whether they stem from war, child
    abuse, spouse abuse, cult abuse, terrorist actions or calamities of nature. It is the
    rare therapist who is not confronted with victims of some type of trauma.
    Ever since the earliest work with PTSD, hypnosis has appeared prominently in
    the treatment literature as a modality that often produces beneficial results.
    Fascinatingly, as research has accumulated, we have discovered that childhood
    trauma and severity of punishment in childhood are related to both multiple
    personality disorder (a type of post-traumatic stress disorder) (Bliss, 1980;
    Coons, 1980) and high hypnotizability (Hilgard, 1970; Nowlis, 1969; Nash,
    Lynn, & Givens, 1984). Providing further support for these studies, Cooper and
    London (1976) learned that parents of high hypnotizable subjects rated
    themselves as more strict and impatient than parents of low hypnotizable
    subjects.
    312 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    Thus it appears that trauma, especially early childhood trauma, encourages the
    use of dissociative processes, often leaving victims with higher hypnotic talent
    and capacity. This provides further suggestive evidence that hypnosis may often
    be an effective treatment modality with PTSD, and even more so in the treatment
    of multiple personality disorder —the most severe form of PTSD.
    The selections in the latter part of this chapter will first provide you with
    illustrative suggestions that may be used with traumatic stress victims other than
    MPD patients. Herbert's contribution presents suggestions for use with assault
    victims in an emergency room setting and Ebert's material focuses on rape
    victims. Suggestions for the reframing of traumatic dreams, a common PTSD
    symptom, are provided by Mutter, and Havens' models an intervention with adult
    victims of abuse. A unique contribution by de Rios and Friedmann provides you
    with Spanish language suggestions for PTSD victims, along with the English
    translation of the suggestions.
    The final part of this chapter concentrates on suggestions that may be useful
    with MPD patients. Kluft models for us fusion rituals and suggestions for
    containing the turmoil and dysphoria that are so often present in MPD patients
    undergoing therapy. Torem illustrates how ego-strengthening suggestions may be
    adapted for this population, and Price demonstrates his approach to exploration
    with MPD patients. Finally, I have provided some brief examples of metaphors
    that I use in selected circumstances with multiple personality patients. For a
    systematic, thorough study of the use of hypnosis with MPD, you are encouraged
    to refer to the following sources: Braun, 1984a, 1984b; Kluft, 1982, 1983, 1985,
    1986; Putnam, 1989; Putnam, Guroff, Silberman, Barban, and Post, 1986.

    SUGGESTIVE TECHNIQUES WITH EMOTIONAL DISORDERS

    Hypnotherapeutic Technique for to go first?" After the patient answers, we walk to


    the door and I ask the patient to describe the door.
    the Reduction of Guilt: The Door of Then I ask, "Have you ever seen this door before?"
    Forgiveness The answer gives the patient a possible focus of
    where to go. I continue, "Would you open the door
    Helen H. Watkins, M.A. while we stand at the doorway looking in, and tell
    Missoula, Montana me what you see?" At this point, the patient
    I hypnotize the patient, deepening by walking becomes the observer and experiences as object
    down stairs, and then suggest the following: "In whatever he or she sees in the room. If the patient
    front of us is a hallway at the end of which is the walks into the room and participates in the scene,
    Door of Forgiveness. However, before you can then the event is experienced as subject. The
    reach the Door of Forgiveness, there may be other purpose of entering the room is to resolve some
    doors you may need to pass through. Look on either experience, some relationship out of the past which
    side of the hallway and tell me if you see any involves guilt. An emotional abreaction, therefore,
    doors." may be involved. I am a supportive guide, but not
    If the patient perceives doors on either side of an active participant. Whenever the patient feels
    the hallway, I ask, "To which door do you wish
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 313
    finished, we close the door and come to the next closer and closer to the ground level. When you
    one. reach the ground level you feel very much at ease,
    When there are no more doors to be seen, we yet you can go still deeper, for on the indicator
    walk to the Door of Forgiveness, and I say, "We are there remain three basement levels, Bl, B2, and B3.
    now at the Door of Forgiveness. As I open the door, As the elevator passes each of these floors you are
    walk to the middle of this place while I remain able to let go still more, so that when you reach
    inside by the closed door. If you wish, let me know basement level 3, and the doors open, you are
    what happens." I am no longer a guide; I am simply feeling a wonderful sense of ease and comfort.
    a silent listener. In that way, the patient may share In this state, you leave the elevator and, crossing
    the forgiveness with me, but I am not the forgiver. a hallway, open the door to a room which you
    The patient finds his or her own self-forgiveness. enter. This is a beautifully furnished room with a
    This technique may span several sessions. deep pile carpet and superb drapes. In this room is
    a large stone fireplace with a fire burning. Perhaps
    you can see the flames licking around the logs,
    hear the crackle and hiss, smell the smoke, and feel
    Dumping the "Rubbish" the glorious warmth soaking into every cell of your
    body.
    H. E. Stanton, Ph.D. Things you may not wish to keep in your life,
    Hobart, Tasmania, Australia such as fears, doubts, anxieties, hostilities, re-
    sentments, and guilts, can be imagined lying on a
    THE LAUNDRY small table, in the form of accounts which have
    been paid. As there is no longer a need to keep
    Imagine yourself going into your laundry, filling these settled accounts around, you can pick them
    the sink with water, opening a trap door in your up and drop them onto the fire, one at a time,
    head, pulling out the unwanted rubbish such as feeling a sense of release as they are transformed
    fears, doubts, anxieties, and guilts, and "dumping" into ashes.
    it in the water, which becomes blacker and blacker
    as you do so. Finally, imagine yourself pulling out
    the plug and letting the inky water vanish down the PROTECTION AGAINST NEGATIVE
    sink. INFLUENCES
    Imagine yourself putting on a beautiful golden
    ROOM AND FIRE helmet and closing the visor. Within this helmet
    you are safe from the negative influences of others.
    Imagine yourself on the tenth floor on an Their damaging suggestions, unable to penetrate
    apartment building, waiting for the elevator. When this protection, simply bounce off harmlessly.
    it arrives, you enter and turn to face the door. To the
    right hand side of the door is a vertical indicator
    showing the floor numbers. At the moment, the
    number 10 is illuminated. The elevator begins its The Red Balloon Technique
    descent, smoothly, quietly, comfortably. As it
    D. Corydon Hammond, Ph.D. Salt
    reaches the ninth floor, the number 9 is illuminated,
    but the elevator continues on smoothly and Lake City, Utah
    effortlessly for this is yours alone; it will not be
    stopping to pick up anyone else. The numbers INTRODUCTION AND INDICATIONS
    illuminate in turn as each floor is reached, your
    This symbolic imagery technique, adapted
    feelings of relaxation and comfort increasing as
    from suggestions by Walch (1976), may panic-
    you approach
    314 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    ularly be helpful in reducing problematic emotions gondola underneath, and it is moored and tied
    like anger, resentment, and guilt, as well as down with large ropes. Walk over to it, and inside
    cravings. It will be primarily effective with patients the gondola you'll notice a large basket or container
    who are responsive to both visual and kinesthetic of some kind, which you can unlatch, and which is
    imagery. The following verbalizations illustrate empty inside.
    how I use this technique. Now, take off the heavy back pack, and drop it
    onto the ground. Are you tired of carrying around
    in your life that heavy burden of those feelings,
    ILLUSTRATIVE SUGGESTIONS which you've been carrying for so long? [Pause] Do
    you feel ready to get rid of those old, outdated
    I'd like you to imagine that you're walking along feelings? [Pause] Good. Then, in a moment, I'm
    a path in a beautiful mountain setting. And as you going to ask you to open that pack, and inside you'll
    walk, allow your comfort to increase, as you sink find some kind of objects or containers, that have
    deeper and deeper into trance. And I really can't been infused with all of those excessive feelings of
    know for sure all the things you'll be noticing. (e.g., guilt, anger), that have been weighing you
    Perhaps you'll particularly enjoy the contrasting down. Open the pack, and see what kind of objects
    shades of colors, or be aware of the tall trees, you find, that contain all that (e.g., anger). What
    silhouetted against the blue sky, with peacefully are they? [Pause].
    drifting, fluffy clouds. I wonder if you'll notice a Okay. Now, I'd like you to take those objects,
    nearby mountainside, with interesting patterns of slowly, one at a time, and toss them into that large
    rocks and trees. basket in the gondola. And I think you're going to
    Many people enjoy the sounds of nature, like the be pleased to notice, that with each object that you
    sound of the wind in the trees, or of a nearby throw away, those feelings
    stream, or of birds singing. [Pause] Perhaps you'll of _________ can decrease. And that will be
    notice the warmth of the sun against your skin, or such a relief! It's as if you're filling that basket up
    the texture of things you touch along the way. As with all those feelings. As though you're cleansing
    you walk, just take time to notice the things that yourself of all those excessive feelings, feeling
    interest you, as you drift deeper, and deeper into increasing peace and comfort, increasing relief and
    trance. [Pause] freedom, with every object that you throw into that
    And I'd like you to imagine that you're carrying a basket in the gondola. And by the time you've
    large pack on your back. Feel the weight and thrown away all of those objects, I think you're
    burden of it, and imagine that as you're walking, the going to be surprised, or perhaps just enjoy, how
    pack is growing heavier with each step. That pack free, how peaceful you can feel within yourself.
    is filled with objects of some kind, objects that Now go ahead, and take the objects out of the
    contain and have been infused with the heavy pack and begin throwing them, one at a time, into
    burden of all your excessive (e.g., anger, guilt) that basket. And you can enjoy getting rid of those
    about (e.g., your divorce). feelings. When you've thrown the last object into
    And now the path begins leading up a rise, up a that basket, so that the basket is filled with all of
    slight hill. And the pack is feeling even heavier. But those excessive feelings, allow the index finger on
    you sense that a short distance ahead that you will your right hand to float up to signal me.
    come to the top of the hill. As you reach the top, the [After the signal:] Good. Now close and latch
    path leads into a large, open meadow, with the lid of the basket. And you can either untie those
    beautiful green grass and wild flowers. And you ropes or use a big knife or axe that you'll find
    can walk out into the meadow, noticing the beauty. nearby on the ground to cut those ropes. [Pause]
    In the meadow you can also see a large, colorful, And as you release that balloon, you can
    helium or hot air balloon, with a
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 315
    rest back on the comfortable grass, and watch it it were a dream, almost as if you were really
    float up, into the sky, carrying away the basket, observing it, And in a dream, you can see, and feel,
    and all those excessive feelings of ___________ and hear things, and they can seem very real, even
    that have burdened you. And with each movement though you're just lying there, very quietly,
    and motion of the balloon up into the sky, you can sleeping. And in a similar way, you can experience
    feel an increasing sense of release, and relief. Free what I'm going to describe."
    of those feelings, so that they will no longer have to Now, present the patient with a visualization of
    influence your thoughts, or moods, or actions. Free the two extreme individuals. For example, one who
    of those feelings. Watch as the wind begins to carry is aggressive, and another who is passive and
    the balloon farther, and farther away. Soon it will dependent. Describe each of the persons and their
    be out of sight, and when it's gone you can take a behavior in some detail, as the two individuals
    big deep breath, and then you can really enjoy the respond to the same setting or situation.
    Afterwards, have the patient see one of the
    freedom, and relief, and peacefulness, of being rid
    individuals walking over, possibly taking the other
    of those feelings. And this relief, and peace, can
    person by the hand, and standing side by side.
    flow and circulate all through you. And you'll be "And as they stand beside each other, a fascinating
    delighted to discover, that these feelings of free- thing begins to occur. A bright light begins to shine
    dom, and comfort, and well-being, can remain with on both of them, a warm, comforting kind of light.
    you." [Another option some patients enjoy is to And as the light shines on them, their details begin
    leave the feelings behind on the mountain, climb in to be obscured, and you sense them beginning to
    the gondola, and float away themselves] . blend and merge together. Blending, and inte-
    grating, and fusing together into one person, a
    healthy, strong person."
    Edelstien's Fusion of
    Extremes Technique Now describe this new person's characteristics,
    and how he/she is different from the two previous
    D. Corydon Hammond, Ph.D. ones. "And she has the best qualities and
    Salt Lake City, Utah characteristics of both of them. She is strong, and
    yet sensitive and considerate. She can be assertive
    INTRODUCTION and forceful when necessary, and yet
    This method of Edelstien's (1981) is very similar compassionate and not overbearing," etc. The
    to the gestalt therapy method of "integration of patient may now observe this model, prompted by
    polarities." He advocates its use with reaction the therapist, responding very positively to the
    previous situation.
    formations, "which cause us to behave in one way
    because we are afraid of behaving in the opposite "And as you think about the one person who is
    way" (p. 121). In this technique, the patient the integration and blending of the two, you can
    visualizes two different individuals responding in realize that this person is really very much like
    opposite ways to a situation, and then visualizes you. You can appreciate that you have these
    these two persons merging into one, with the qualities, and the capacity to be this way,
    responding with the best qualities of each of those
    integrated person having the best characteristics of
    persons. It isn't necessary to act like either one of
    each. I have added some unconscious checks and
    them alone. You have the best qualities of both.
    commitments as elaborations to the technique.
    "Now I want to ask your unconscious mind
    THE TECHNIQUE something, and please allow it to respond
    through your fingers, all by itself. Is your un
    "In a few moments, I will describe a scene, and
    conscious mind willing to allow you ________ to
    as I do so, you can experience it as though
    identify with that composite person, taking on
    316 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    the best characteristics, both the___________ and self-exploration and insight. Such exploration
    the (specify the qualities)!" [Pause for a response] techniques may initially be introduced innocuously
    "Good. Now I want the deepest part of your mind by presenting the imagery as a deepening technique
    to listen to me carefully, and when the deepest part that will seem nonthreatening. In using guided
    of your unconscious mind is listening very imagery (Hammond, 1988f), patients should be
    carefully, your 'yes' finger can float up." [Pause] encouraged to "just let it happen," to allow it to
    "Good." [This step assumes that ideo-motor signals happen "spontaneously." As an alternative to the
    have already been established.] structure that Stanton provides, the hypnotherapist
    "Now your unconscious mind has made a may simply serve in an evocative role, offering
    commitment, to allow you to identify with the best implications and open-ended suggestions. For
    characteristics of this composite person. And so in example: "When you enter this particular room,
    interesting ways, your conscious mind will notice you'll find something very meaningful and sig-
    how you're beginning to respond differently. Your nificant there." "And soon you will discover
    conscious mind may doubt; it may question; but something or someone relevant to what you're
    you will be unconsciously impelled to respond struggling with." When symbolic blocks are
    differently from the way you have in the past. And I encountered, the therapist may suggest symbolic
    wonder if you'll be curious, as you notice that solutions. Guided imagery settings for exploration
    you're beginning to feel more and more like the may also seek to incorporate interests of the patient
    combination, like that integration of those two (e.g., caves, mountain trails, scuba diving beneath
    persons, and that you're finding it easier and easier the sea, cross-country skiing, using computers,
    to act as he/she would. And as that occurs, your music), or historic settings such as the patient's
    conscious mind really can't help but notice — childhood home. If you are interested in other
    fascinated at how you're responding to these hypnotic techniques for facilitating insight you
    situations (specify) as if you were that combined should refer to Brown and Fromm (1986), Freytag
    person. At first, you may discover that these new (1961), Hammond and Miller (in press), Rossi and
    responses happen suddenly and unexpectedly, Cheek (1988), Sacerdote (1978), Stein (1972),
    before you have any opportunity to even think or Watkins (in press), Wolberg (1964), and Wright
    resist. But after you've surprised yourself, by acting (1987). (Ed.)
    in these new ways, there will be a sense of deep
    inner satisfaction, of unconscious joy, and perhaps
    even amusement and delight. And soon, you'll
    begin to enjoy how naturally, how easily, you begin GANDOR'S GARDEN
    to act like the composite of the two
    women Imagine walking down a forest path. The sun is
    shining, the birds are singing, and there is a feeling
    men: _________, and__________ , and (specify of warmth in the air. Without prior warning, you
    the characteristics)." come upon a large mound of freshly dug earth on
    one side of which is a round, partly open, wooden
    door. Curious, you approach the door. Looking
    inside, you see a downward sloping tunnel which,
    Scenes for Facilitating though dark, does have a glimmer of light
    Self-Understanding emanating from the far end.
    H. E. Stanton, Ph.D. You enter the tunnel, following it as it takes you
    down and down, deeper and deeper in the earth. As
    Hobart, Tasmania, Australia
    you do so, the light at the far end grows steadily
    brighter. Suddenly you emerge from the tunnel
    INTRODUCTION and, much to your surprise,
    Stanton's techniques illustrate the manner in
    which guided imagery may be used to facilitate
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 317
    you find yourself in a garden flooded with light phasizing that great insights will grow out of your
    coming from an ingenious system of skylights. experiences. He bids you farewell with an
    High-pitched laughter comes from behind you and, invitation to return as often as you desire to the
    turning, you see a smiling elf who, after magic garden. Taking your leave of Gandor, you
    introducing himself as Gandor, the owner of the retrace your steps along the tunnel, returning to the
    garden, invites you to walk around and explore. outside world with the wisdom you have received.
    The first thing you notice is a tiny reflecting
    pool. As you gaze into it, you see an image of
    yourself as you would like to be, staring back at JIGSAW
    you. This idealized image then speaks, giving you
    some information about yourself of which you had Imagine that you are sitting at a table, a number
    been unaware. [Pause. A head nod may be of boxes before you. There are no pictures on their
    requested after this information has been received, lids, but inside each one is a complete set of jigsaw
    and remaining in trance, the patient may be asked pieces. Choose a box, empty out the contents onto
    to discuss the message received. If appropriate, the table and put the jigsaw together. As you put
    further interaction may be promoted with Gandor. the pieces together, a picture will form, normally
    (Ed.)] one which has some meaning for you, telling you
    something about yourself. Then go onto the other
    After absorbing this message, you continue boxes, assembling the pieces found in each one,
    walking along a pathway winding its way through and create further pictures. These may be related to
    the garden until you come upon a small child the first one, elaborating upon a single theme.
    skipping rope. The child welcomes you with a Alternatively, they may indicate quite different
    smile, and, as you bend down to her, she whispers concerns. [Feedback about each puzzle may be
    in your ear, telling you something about yourself obtained as each picture is being put together,
    that you had virtually forgotten. This is something following each completed puzzle, or after the
    relating to your own early years which needs to be trance experience. (Ed.)]
    remembered now to help you enjoy your present
    life more fully. [Pause. The patient may be asked if
    he/she would like to share what he/she has learned.
    (Ed.)] THE THEATRE
    You continue on your way, arriving at a small Imagine yourself sitting in the stalls of a theatre
    clearing where three butterflies are dancing waiting for the performance to begin. As you wait,
    joyfully in the air. They are humming a tune about you notice someone standing off to one side of the
    happiness and what constitutes the true secret of stage looking behind the closed curtain. Although
    being happy. You stop and listen to their song, then you cannot see what is going on behind the curtain,
    resume your walk. [Pause] this person is able to do so, and it is making
    When you have almost reached the end of the him/her look very frightened, very unhappy.
    path, you see an old man [or woman] sitting Slowly the curtains open, revealing to you the
    cross-legged on the verge. Though he appears to be cause of this negative reaction.
    sunk deeply in a meditative trance, he opens his Because of your tendency to project your own
    eyes at your approach, as if he had been expecting fears and problems onto this imaginary person, you
    you. Slowly and deliberately he begins to speak, are likely to gain increased insight into them. To
    conveying some especially wise advice on a matter focus on problems in particular, you could imagine
    about which you have been concerned. [Pause. A the person looking very puzzled, then smiling
    head nod may be obtained after the message has happily as he/she found the solution to his/her
    been received.] problem by looking
    Thinking about this advice, you return to your
    starting point. Gandor awaits you, em-
    318 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    behind the curtain. Similarly, you could have the work" with patients and, in several instances, of
    person looking very happy, or very confident, or how to work when there seems to be resistance and
    very relaxed, as he/she looked behind the curtain. the adviser dialogue is not progressing smoothly.
    In this way you could gain further self-awareness. His dialogue does tend to favor an animal adviser.
    When you interact verbally with the patient and
    find that the adviser is a person, you will want to
    avoid suggesting that the patient sprinkle food or
    Meeting an Inner Adviser pet the adviser. For further information concerning
    other techniques with advisers, you may refer to
    David E. Bresler, Ph.D. Bresler (1979), Rossman (1987) or Hammond
    Santa Monica, California (19880. If you are interested in the concept of using
    a council of advisers with a patient, you will find
    INTRODUCTION AND INDICATIONS Napoleon Hill's (1963) description of his personal
    use of this technique fascinating. (Ed.)
    Working with inner advisers or guides is a
    popular therapeutic technique used by many
    therapists (Miller, 1977; Rossman, 1987; Samuels INDUCTION
    & Bennett, 1973; Zilbergeld & Hammond, 1988).
    This is primarily an insight-oriented hypnotherapy This tape contains a guided imagery exercise
    technique for uncovering information related to which will help you to make contact with an inner
    physical or psychological symptoms. Essentially, adviser who resides in your mind's eye. . . . Before
    this method gives form and voice to the beginning, take a moment to get comfortable and
    "unconscious" mind or inner wisdom of the patient. relax. ... Sit upright in a comfortable chair, with
    It is rather reminiscent of an "empty chair" your feet flat on the floor, and close your eyes. . . .
    technique that Perls (Fagan & Shepherd, 1970)
    Take a few slow, deep, abdominal breaths . . .
    used with dependent patients and patients about to
    inhale . . . exhale . . . inhale . . . exhale. . . . Focus
    terminate treatment. He had patients put their ideal
    your attention on your breathing for a few minutes .
    therapist in an empty chair and interact with the
    . . and recognize how easily slow, deep breathing
    "therapist," moving back and forth between chairs
    alone can induce a nice state of deep, gentle
    to play both roles. This method helped patients to
    relaxation. . . .
    understand that they know more than they know
    that they know, to use a phrase of Erickson's. The Let your body breathe itself . . . according to its
    inner adviser technique similarly assists patients to own natural rhythm . . . slowly . . . easily .. . and
    elicit information that is already inside. It may also, deeply. . . .
    however, be used to remove or control symptoms. Now take a signal breath ... a special message
    For instance, sometimes an "adviser" may remove that tells the body you are ready to enter a state of
    pain for the patient for varying periods of time. deep relaxation . . . exhale. . . . Breathe in deeply
    through your nose . . . and blow out through your
    Proper use of this technique requires an mouth. . . .
    interactive trance in which you periodically Remember your breathing . . . slowly and
    question patients about who their adviser is and deeply. ... As you concentrate your attention on
    what their adviser says or does. This is not fully your breathing, imagine a ball of pure energy or
    evident from the following script, but should be white light that starts at your lower abdomen and,
    incorporated in clinical work. However, the as you inhale, it rises up the front of your body to
    following verbalizations by Bresler are a very fine your forehead . . . and, as you exhale, it moves
    model of how to begin doing "adviser down into your spine, down your legs, and into the
    ground. . . .
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 319
    Again . . . imagine this ball of pure energy or Don't be alarmed if your advisor becomes quite
    white light rise up the front of your body to your excited and starts jumping up and down at this
    forehead as you inhale . . . and as you exhale, it point. . . . Often, advisers have been waiting a long
    goes down your spine, down your legs, and into the time to make this kind of contact. . . . Until now,
    ground. . . . Circulate this ball of energy around for your adviser has only been able to talk to you
    a few moments . . . and allow its circulation to sporadically through your intuition. . . . Tell your
    move you into even deeper states of relaxation and adviser you're sorry you haven't listened more in
    comfort. . . . the past, but that you'll try to do better in the future.
    Each time you inhale and exhale, you may be ... If you feel silly talking in this way, tell your
    surprised to find yourself twice as relaxed as you adviser that you feel silly . . . that it's hard for you
    were a moment before . . . twice as comfortable . . . to take this seriously . . . but if you sincerely want
    twice as peaceful. . . . For with each breath, every your adviser's help, make that very, very clear. . . .
    cell of your body becomes at ease ... as all the Tell your adviser that you understand that, like in
    tension, tightness, pain or discomfort drains down any friendship, it takes time for feelings of mutual
    your spine, down your legs and into the ground. . . . trust and respect to develop. . . .
    Continue to circulate this ball of energy around for
    Although your adviser knows everything about
    a few minutes. . . .
    you — since your adviser is just a reflection of
    As you allow yourself to enjoy this nice state of your inner life — tell your adviser that you won't
    deep, peaceful relaxation, return in your mind's eye push for any simple answers to important questions
    to your personal place. . . . Let your imagination that you may be dealing with. . . . Rather, you'd like
    become reacquainted with every detail of this to establish a continuing dialogue ... so that
    beautiful spot. . . . Sense the peaceful beauty all anytime you need help with a problem, your
    around you. . . . Stretch out . . . relax . . . and enjoy adviser can tell you things of great importance . . .
    it. [Long pause] things that you may already know, but you may
    have underestimated their significance. . . .
    If there's a problem that's been bothering you for
    MEETING THE ADVISER a while, ask your adviser if he or she is willing to
    give you some help with it . . . yes or no? . . . Your
    As you relax in your favorite spot, put a smile on adviser's response is the first answer that pops into
    your face . . . and slowly look around. . . . your mind. . . . Pose your questions as you exhale .
    Somewhere, nearby, some living creature is . . and the first response that comes into your mind
    waiting for you . . . smiling and waiting for you to as you inhale is your adviser's reply ... an inspira-
    establish eye contact. . . . This creature may tion . . . ask your questions now. [Pause]
    immediately approach you or it may wait a few
    What did your adviser reply? . . . Ask any other
    moments to be sure that you mean it no harm. . . .
    questions that are on your mind. [Pause] Continue
    Be sure to look up in the trees or behind bushes,
    your dialogue for a few moments . . . asking your
    since your adviser may be a bit timid . . . but even if
    questions as you exhale . . . and listening to the
    you see nothing, sense his or her presence and
    response that pops into your mind as you inhale.
    introduce yourself. . . . Tell your adviser your
    [Pause].
    name, and that you mean no harm, for you've come
    with only the friendliest intentions. Find out your Remember, your adviser knows everything
    adviser's name . . . the first name that comes to your about you, but sometimes — for a very good
    mind . . . right now. . . . reason —he or she will be unwilling to tell you
    something. . . . This is usually to protect you from
    Sprinkle some food out before you . . . and ask information you may not be ready to deal
    your adviser if he or she is willing to come over and
    talk with you for a few moments. . . .
    320 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    with. . . . When this occurs, ask your adviser what the next time you meet? ... If so, find out what
    you need to do in order to make this information this is. [Pause]
    available to yourself. . . .Your adviser will usually See if your adviser will allow you to establish
    show you the way. [Pause]. physical contact. . . . This is very important. . . . Just
    If there is something that you'd like your adviser about every animal on the face of the earth loves to
    to be thinking about between now and the next time have its face stroked and its back scratched. . . . See
    you meet, tell this to your adviser now. [Pause] If if your adviser will allow you to make this contact
    there is anything your adviser would like you to now. [Pause] While making this contact, find out if
    think about between now and the next time you there's anything else that your adviser would like to
    meet, find out what it is now. [Pause] tell you ... If so, what is it? [Pause]
    Set up a time to meet again ... a time that's Is there anything you would like to tell your
    convenient for you and a time that's convenient for adviser before you leave? ... If so, do it now.
    your adviser. ... Be specific as to exact time and [Pause]
    place. . . . Tell your adviser that, although these In a moment, you will take the signal breath to
    meetings are important to you, part of you is lazy or return from this meeting ... but before you do, tell
    even reluctant to follow through. . . . yourself that each time you make contact with your
    One way your adviser can help motivate you to adviser the communication will flow more and
    continue to meet periodically is by giving you a more smoothly . . . more and more easily . . . more
    clear demonstration of the benefits you can gain ... and more comfortable. . . .
    a demonstration so powerful that you will be Tell yourself that when this experience is over,
    moved to work even harder in getting to know you will feel not only relaxed, rested, and
    yourself. ... If you are in pain, for example, ask comfortable, but also energized with such a
    your adviser if he or she is willing to take away that powerful sense of well-being that you will be able
    pain completely . . . right now, just for a few to respond easily to any demands that may arise. . . .
    moments, as a demonstration of power. . . . If so, To end this exercise for now, take the same
    tell your adviser to do it . . . now. [Long pause] signal breath that you used to begin it . . . exhale . . .
    Notice any difference? If you're willing to do breathe in deeply through your nose . . . blow out
    your share of the work, by relaxing yourself and through your mouth . . . and be well.
    meeting periodically to set things straight, there's
    no limit to your adviser's power. . . . Ask for any
    reasonable demonstration that will be undeniably
    convincing to you of this power. .. . Responsibility to a Fault: A
    You might be, for example, somewhat forgetful .
    . . and although you want to continue these Metaphor for
    meetings with your adviser, you might forget the Overresponsibility
    exact time and place that you agreed to meet. ... If
    so, ask your adviser to help you by coming into Michael D. Yapko, Ph.D.
    your consciousness just a few moments before it's San Diego, California
    time to meet, to remind you of the meeting.
    Before leaving, tell your adviser you're open to INTRODUCTION AND INDICATIONS
    having many different kinds of advisers . . . and
    that you will leave this totally up to your adviser's This metaphor was used to enhance awareness in
    discretion. ... Is there anything your adviser would an adult woman of how she inappropriately took
    like you to bring along with you responsibility for her parents' actions. The theme of
    metaphors given to her was
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 321
    of someone being overly conscientious to such a gift of all on another, more important one . . . and I
    degree that others were rendered powerless. know of no recorded instances of an insecure
    (Ed.) mother bear preventing her cubs from becoming
    independent. . . .

    METAPHOR
    COMMENTARY
    The world of nature is enjoyed by almost
    If the client has issues surrounding abandon-
    everyone . . . people like the beauty and the
    ment, is feeling uncared for by others, or is
    diversity of animals, for example . . . but people do
    assuming too much responsibility for others'
    not realize that animals of all shapes, sizes, colors, feelings, the above metaphor can be useful, as can
    and temperaments have to face certain realities . . . others with a similar theme.
    just as people do . . . animal families are not unlike
    human families in some ways ... the establishment Guilt and self-blame are closely related.
    of a territory in which to live that is all one's own ... Whereas the underresponsible individual tends to
    the bonding of a family ... the anticipation and be a blamer (extropunitive), the overres-ponsible
    finally the arrival of an offspring or two . . . the individual tends to be martyrish and intropunitive.
    proud parents . . . the protective parents . . . and love The intensity of the self-blaming can be so great
    takes a lot of different forms in the animal that it becomes the focal point of the person's
    kingdom. . . . Consider the bears as an example of mental energy, precluding awareness of other
    the wisdom of animals ... a mother and her cubs are interpretations or perspectives. Guilt can be an
    inseparable in their earliest weeks and months of incredibly profound agent of paralysis in an
    life ... if you really want to anger a bear ... get near individual's life, and disrupting the overresponsible
    her cubs . . . she protects them fiercely ... as she person's tendency to wallow in it is a key goal of
    teaches them how to hunt for food . . . how to treatment.
    survive in the wilderness . . . how to live . . . and
    how to grow . . . and the cubs have time to play and
    be young . . . but they also know the seriousness of
    what they must learn ... in order to be on their own Different Parts: A Metaphor
    eventually . . . and then one day, the mother will
    chase her cubs up a tree . . . and then abandon them Michael D. Yapko, Ph.D.
    . . . she leaves them on their own ... to live for them- San Diego, California
    selves ... to grow and change and learn as their lives
    go on . . . and a huge part of her responsibility ... is
    to reach a point of no longer having to be INDICATIONS
    responsible for others . . . their lives are their own to
    This metaphor may be useful prior to the
    live . . . and she knows she can't live it for them no
    matter how much she cares for them . . . and it may initiation of unconscious exploration, ego-state
    seem cold and callous on the surface . . . especially therapy, or unconscious negotiation with un-
    when one sees the desperate search of the cubs for conscious parts of a patient. It "seeds" the concept
    their mother . . . but she has a greater wisdom ... a of unconscious parts or polarities of the self and
    broader perspective . . . and an intuitive sense that that there can be motivations beyond our conscious
    each life is valuable in what it allows its bearer to awareness. It may be especially useful in working
    do . . . and what seems cruel on one level ... is with children or teenagers. (Ed.)
    actually the greatest

    METAPHOR
    And I can tell you about a young boy I saw not
    long ago . . . who had been a model fourth
    322 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    grader . . . good grades, hard-working little fellow . client, as has the concept of being able to
    . . and toward the end of the school year he selectively amplify or diminish parts of his or her
    underwent a transformation ... he stopped doing his experience in order to achieve a higher purpose.
    schoolwork ... he stopped being nice to other
    children ... he grew sullen and withdrawn . . . and
    nobody knew why . . . and then 1 saw him . . . and
    found out things of great importance to him . . . and
    he loved his teacher so much that he wanted her to Enhancing Affective Experience
    be his teacher again . . . and he was trying to fail in and Its Expression
    school in order to stay with that teacher . . . and
    sometimes what seems odd on the surface, or even
    crazy, may make sense at a deeper level . . . but it Daniel P. Brown, Ph.D., and Erika
    became apparent that a part of him wanted to stay Fromm, Ph.D.
    firmly put another year . . . but 1 also discovered a Cambridge, Massachusetts, and
    part of him that would be proud to be a big fifth Chicago, Illinois
    grader . . . and I found a part of him that was quite
    curious about what fifth grade would be like . . . and
    I found another part of him that was excited about it Hypnosis has been used to induce specific
    being near the end of the school year . . . looking emotions in normal subjects (Hodge & Wagner,
    forward to a summer away from school . . . when 1964). In the clinical situation the hypnotherapist's
    there's lots of time to think and change one's mind . task is not to suggest specific emotions to the
    . . and another part that was sad at saying good-bye patient but rather to bring the patient's current
    to friends for the summer . . . and there were lots of emotional experience into full awareness. Patients
    are often only dimly aware of the emotional
    parts to this boy . . . and I wonder which part of him
    undercurrent in interactions with others; the
    you would have talked to if you wanted to know
    psychotherapy process is no exception. They
    that lots changes are part of growing . . . the curious
    become aware of emotions only at discrete
    part? ... All I know is . . . when I talked about
    moments in the ongoing exchange. Apart from
    different parts of growing up . . . he listened very
    these moments, they have little conscious
    closely . . . and he's doing very well in fifth grade,
    awareness of the continuous affective experience.
    you'll feel better knowing The therapist can help patients bring these
    underlying emotions to the point of consciousness
    (Rosen, 1953) and also help them to recognize the
    specific emotions accurately. To ease the entry of
    COMMENTARY underlying emotions into awareness, the
    hypnotized patient is told, "Notice now what you
    In the above metaphor, the idea is seeded that feel as you experience this scene" or "When I count
    seemingly strange behavior can be purposeful, that from one to five ... by the time you hear me say,
    change involves letting go, that there are different 'five' . . . you will begin to feel whatever emotion is
    parts of self, and that the quality of one's associated with the [name symptom or problem]."
    experience is determined to a significant degree by
    which part(s) one focuses upon. The metaphor Bringing the undercurrent of feeling to the point
    implies that one can focus on whichever part of of consciousness is only the first step. Many
    oneself is best able to catalyze successful patients have difficulty in accurately recognizing
    adjustment. The language of "parts" has now certain affects and in verbalizing them. To enhance
    been introduced to the recognition and verbalization, the hypnotist says:
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 323
    A specific feeling will become clear to you. ... It will Another technique used by the hypnotherapist is
    become clearer . . . and clearer. . . . You will be able to affect intensification (Rosen, 1953). The hypnotist says:
    recognize exactly what this particular feeling is . . . and
    you will be able to describe it to me. . . . Now, what is it
    When I count slowly from one to five . . . with each
    that you are now feeling?
    number you will begin to feel "x" more and more
    intensely . . . with each number you hear, the feeling will
    It is especially important to give an open-ended grow stronger and stronger. . . . By the time I reach five,
    suggestion — not to suggest a particular emotion to the you will feel it in your body as strongly as it is possible to
    patient but to amplify the patient's awareness of the bear. . . . Now . . . one . . . two . . . three . . . four . . . five.
    emotion of the moment. Usually the patient will report Notice what you feel, and you will be able to describe it
    to me.
    experiencing a particular emotion. Should the patient
    continue to have difficulty finding words for the feeling,
    the hypnotist says: This technique is especially useful when a patient
    spontaneously reports a feeling emerging in the course
    of the therapy session. The therapist uses hypnotic
    I will count slowly from one to five ... by the time I
    reach five, a word or two will come into your mind suggestions to help the patient recognize the feeling
    spontaneously ... a word or two which exactly express within certain limits. To safeguard the patient from
    what you are now aware of feeling . . . [Therapist being overwhelmed, the therapist can use an ideomotor
    counts]. . . . Now, tell me what it is you are feeling. signal:

    The hypnotherapist also helps the patient to experience If at any point in the counting the intensity of the
    feeling seems too much to bear, the index finger of your
    the affect fully so that its visceral, cognitive, and motor
    hand will lift all by itself, and that will be your way of
    (expressive) components are well integrated:
    signaling to me not to count beyond that point.

    As the feeling becomes clearer and clearer to you,


    Hypnosis can also enhance affects the patient has
    notice more carefully exactly how you experience this
    discovered. Affects are expressed through certain
    feeling in your body . . . notice what sensations you
    experience in your body as you feel [x] . . . notice where defined groups of facial muscles, supplemented by the
    in your body you hold this feeling . . . notice the muscles limbs, through visceral responses largely mediated
    in your face, and you will see just what muscles hold this through the auto-nomic nervous system, and through
    feeling . . .now, notice what goes through your mind as complex behavioral patterns. The experience of an affect
    you feel [x]. . . . You will discover certain thoughts, is not the same as its expression. It is not always
    images, or memories spontaneously passing through necessary to encourage expression of the affect in
    your mind about this feeling. behavior, though encouraging its communication in
    words is usually therapeutic. For example, the
    hypnotherapist should not say, ". . . and as the feeling
    Those instructions are standard procedure and can be
    gets stronger and stronger, you will find yourself
    employed whenever the patient describes a symptom or
    compelled to do something." This kind of suggestion
    a behavioral problem, is involved in a fantasy
    encourages discharge in the form of abreaction or
    production, or experiences some sort of shift in the
    acting-out. When the suggestion is worded this way, the
    psychothera-peutic process. By using this procedure
    expression of rage, sexual acting-out, or panic states is
    strategically during the course of the therapy session, the
    commonly observed (Rosen, 1953). The patient is likely
    therapist helps amplify a variety of affective experiences
    to cry or laugh or have violent emotional outbursts,
    associated with the psychothera-peutic process.
    which are not
    324 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    themselves therapeutic. A better way to word the standing. Emphasis is on the therapeutic rela-
    suggestions is to say, ". . . and as the feeling gets tionship, not on discharge itself. When suggestions
    stronger and stronger, you will find an appropriate are worded as we advise, the patient finds effective
    way to communicate it." This kind of suggestion ways to communicate to the therapist the affective
    encourages appropriate channels for expression, experience of the moment and to elicit an empathic
    communication, and under- response.

    HYPNOSIS WITH SEVERELY DISTURBED PATIENTS

    Can Hypnosis Help Psychosis? 3. Are special treatment techniques necessary?


    Hypnosis by itself, like the passage of time,
    James R. Hodge, M.D. does nothing. What is done with and within
    Akron, Ohio hypnosis is what really matters. Treatment
    techniques should be designed for the indi-
    vidual patient. Many special techniques have
    INTRODUCTION been offered (Baker, 1981, 1983c; Brown,
    This is primarily a book of therapeutic sug- 1985; Scagnelli, 1976; Scagnelli-Jobsis, 1982).
    Hodge (1980) and Hodge and Babai (1982)
    gestions. However, many misconceptions exist
    have offered a general categorization of
    concerning whether hypnosis may be utilized with
    strategies and tactics of hypnotherapy,
    schizophrenic and psychotic patients. Therefore, I
    including some specialized techniques for
    have decided to include Dr. Hodge's excellent, yet psychotic patients. Scagnelli-Jobsis (1982)
    brief, introduction to this subject. (Ed.) reports a number of cases in which hypnosis
    has helped when other methods were
    A French philosopher is reported to have stated unsuccessful, "the use of hypnosis in
    that everything worth saying has already been said, psychotherapy requires three attributes in the
    but that because nobody was listening it has to be therapist: experience in hypnosis and in
    said again. Fortunately, new material may develop psychotherapy, imagination, and courage to try
    between the retellings. both accepted and innovative techniques"
    To answer the title question, an additional series (Hodge, 1980).
    of questions must be asked and answers from the
    literature must be provided: 4. Can hypnosis be dangerous to the patient?
    There are always dangers in any procedure, but
    1. Can psychotic patients be hypnotized? For these are greatly lessened if the therapist will ".
    many years it was felt that they could not be, . . always practice within his area of
    but recent evidence indicates that at least some competence — that is, he should use hypnosis
    can be (Baker, 1981, 1983c; Eliseo, 1974; only for conditions he would be willing and
    Murray-Jobsis, 1985; Pettinati, 1982; able to treat without the use of hypnosis"
    Scagnelli-Jobsis, 1982; Spiegel, Detrick, & (Hodge, 1982). Conn (1972) and
    Scagnelli-Jobsis (1982), in her review of the
    Frischholz, 1982).
    theoretical and clinical literature, agree with the
    2. Are special induction techniques necessary?
    above. However, Kleinhauz and Beran (1984)
    Probably not (Baker, 1983c; Eliseo, 1974;
    report six cases of subjects who experienced
    Scagnelli-Jobsis, 1982). Both permissive and trauma or psychopatho-logical symptoms
    authoritarian approaches have been successful. following the misuse of hypnosis, particularly
    for stage performances; and Smith and
    Kamitsuka (1984)
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 325
    report a case in which the spontaneous use of their adult ego roles to themselves. At such
    self-hypnosis was misinterpreted as central times their self-monitoring ego would most
    nervous system deterioration. Interestingly, likely be more prominent," and that ". . . ego
    when each of these cases came to the attention receptivity (i.e., depth of altered states of
    of experienced hypnotherapists, the problems consciousness) would be greatest when the
    were quickly resolved. Scagnelli-Jobsis (1982) subject trusts either the strength of his own
    has reviewed the issues of concern about overall ego, or the therapist's or both combined,
    hypnosis with psychotic patients, and Watkins to allow lowering of defenses, adaptive
    (1986) lists and describes the general dangers in regression, and receptive access to previously
    the use of hypnosis. Complications are not defended material." Several of my own patients
    always dangerous and can be handled by have reported unwilling ness to use
    competent therapists. Actually, therapy with self-hypnosis, often (even when clearly
    hypnosis generally tends to make the patient necessary) for fear of becoming addicted to it
    stronger and more effective (Scagnelli, 1976; ("I might like it too much"), for fear that it will
    Scagnelli-Jobsis, 1982), and this is the ultimate wear out, or simply for fear that it won't work.
    goal. Others have said, "I can just do it better in the
    presence of authority," and this is compatible
    5. Is a special relationship necessary? Yes. with the above hypothesis, especially if we
    Specifically there must be trust, a therapeu accept that all hypnosis is ultimately
    tic alliance, and ego receptivity self-hypnosis. In any case there is a tendency
    (Baker, for self-hypnosis to become more effective
    1983c; Scagnelli-Jobsis, 1982). Hodge (1980) with reinforcement of successes, though not
    emphasizes that "The effective use of hypnosis always.
    depends upon a positive therapeutic
    relationship; failure to develop this relationship 7. Is the state of the illness important? Cases of
    is the primary contraindication to the use of treatment of acute psychosis, chronic
    hypnosis as well as the primary reason for its psychosis, and organic brain syndromes have
    failure." Even if the patient has the ability to been reported (Baker, 1983c; Brown, 1985;
    enter the trance, he must also have the Eliseo, 1974; Scagnelli, 1976;
    willingness to enter it and the trust in the Scagnelli-Jobsis, 1982).
    therapist to have the hypnotic and therapeutic
    8. Is it necessary or desirable to limit the depth of
    experiences.
    trance? Probably not (Baker, 1983c; Eliseo,
    6. Is self-hypnosis effective? It is not only 1974; Scagnelli-Jobsis, 1982), but the depth of
    effective but desirable (Baker, 1983c; trance should be selected for the specific
    Scagnelli, 1976; Scagnelli-Jobsis, 1982). patient depending upon the goals to be
    However, experience has shown that many achieved. Regression in the service of the ego,
    patients either do not think to use it, do not as well as other projec-tive techniques (Hodge,
    use it, or find that it is less effective than 1980; Hodge & Babai, 1982) that can only be
    when done with or by the therapist. I have accomplished by deeper levels of trance, has
    found no really satisfactory explanation for been helpful.
    this, but a hypothesis for further study 9. Are there any special problems with hypnosis
    comes from the words of Kleinhauz and with schizophrenics? In terms of the patient,
    Beran (1984) that, "During hypnosis the Scagnelli (1976) reports three issues: control,
    subject agrees to permit the hypnotist to fear of closeness, and fear of releasing negative
    become the sole channel of communication self-concepts. In terms of the therapist, he
    and source of interpretation of all internal should always practice within his limits of
    and external stimuli impinging upon him competence with hypno-
    self," and of Scagnelli-Jobsis (1982) that
    subjects are ". . . probably holding more of
    326 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    sis and with the illness he is treating. In terms of arms. The feeling of being held snug and secure,
    hypnosis itself, Scagnelli-Jobsis (1982) lists tightly held against the warm soft breast. Feeling
    four common concerns about the use of the rise and fall of the breast with the rhythm of the
    hypnosis with psychotics: hypno-tizability, breathing, much like the rhythm of the ocean,
    decompensation, preference for fantasy over constant, steady, always there. And the sound of the
    reality with refusal to terminate trance, and heartbeat, again like the rhythm of breathing,
    excessive dependency. She states that all of constant, steady. And the rhythm of the rocking,
    steady, soothing. And perhaps an awareness of the
    these concerns have been able to be discounted
    smell of the warmth of that nurturing body, and the
    when hypnosis is properly used for the
    taste of the warm sweet milk. And the feelings of
    appropriate patient. fullness, and satisfaction, and well-being. And the
    feelings of loving and being loved, and warmth and
    security, and ease and well-being. And from these
    early experiences and memories comes a sense of
    Renurturing: Forming Positive self that is secure, and loved, and loving. And in
    Sense of Identity and Bonding this beginning are the very beginnings of the sense
    of self: of well-being, comfort, ease, security,
    Joan Murray-Jobsis, Ph.D. loving and being loved, and everything being well.
    Chapel Hill, North Carolina And then everything does become easier.

    INDICATIONS
    DISCOVERING THE PHYSICAL BODY
    These suggestions, offered from an object
    relations framework, are designed for severely AND BOUNDARIES
    disturbed patients suffering with developmental And it becomes easier, from this sense of
    deficits. The approach is basically one of facil- wholeness and wellness and well-being, to move on
    itating age regression and providing the patient to those later weeks and months when we begin to
    with nurturing early life experiences that may have discover this physical body that contains the sense
    been missed. (Ed.) of self. We begin to discover the sense of
    boundaries and limits of this physical being, this
    body that we exist within. We begin to discover an
    SUGGESTIONS awareness of the skin that contains this body, and
    And then perhaps traveling back to some of the physical movement that defines our body. The
    fingers, and the toes, and the face, that set the
    those earliest memories of existence, those early
    boundaries of this body. We discover the sensations
    weeks and months of existence, and beginning to
    of the skin, the sensations of touch, and holding,
    create within our imagery and within ourselves a and stroking, and caressing. And we discover the
    positive sense of living and loving, a positive sense sensations of movement, of reaching and
    of self that should have been, could have been, and stretching, and rocking, all the good sensations of
    would have been if we could have been there the body. And we begin to discover the sensations
    together. If I could have been there with you, the of the internal body, sensations of food going into
    infant you, it would have been and should have the mouth, and down into the stomach, and feelings
    been all of the good feelings. And we can create of satisfaction. We begin to know and identify the
    these feelings now, at least in part, in imagery. physical being, the physical body that contains our
    sense of self, whole, satisfied, well-being, being
    loved, loving, wanted, secure.
    THE EXPERIENCE OF BEING HELD
    And we can begin to imagine the feelings of
    being held, feeling the arms, the warm strong
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 327
    RENURTURING: SEPARATION AND reality where enough of our needs are met, where
    INDIVIDUATION there is enough care, enough protection, enough
    loving concern. And where our feelings of anger
    And then gradually we begin to understand and and sadness and loss are allowed expression in a
    identify the boundaries and the limits containing holding, loving, supportive, accepting
    this sense of self, and the separations between environment. And so we experience our feelings,
    ourselves and that external environment. As we absorb them, grow beyond them, come to accept
    reach out and touch objects and let them go, we the realities of the imperfect world, giving up the
    begin to discover the separateness between fantasy of that perfect union of perfect care,
    ourselves and those objects. And we begin to everything, every need being cared for and met.
    discover the separateness between ourselves and
    other physical beings. Discovering our physical
    being as separate from that other holding, BEGINNING TO ENJOY SEPARATENESS
    protective, nurturing physical being, the holding,
    protective arms. And gradually we begin to discover, perhaps to
    And even as we begin to discover a sense of our surprise, that we may even begin to enjoy our
    separateness, of the boundaries and limits of our sense of separateness. Perhaps we begin to
    physical and emotional self, we also discover that discover that we may not really need that nurturing
    our sense of separateness is experienced within an caretaker as much as we thought we did. We begin
    awareness of our earlier bonding and to develop capacities, competence, and mastery far
    connectedness. And there is always an awareness beyond what we might have imagined. Because in
    and a memory of those early experiences of the normal developmental process we seem to
    bonding and connnectedness, and of the well-being continuously grow and expand in our capabilities
    and the wholeness, loving and being loved and and mastery. And so we discover that we may not
    secure. Always an awareness of the bonding and really need that nurturing parent quite as much as
    connectedness, even as we begin to understand the we once thought we did. And in similar fashion, we
    separateness. begin to discover, that perhaps we may not even
    want that nurturing parent as much as we once
    thought we did. We begin to discover that in our
    ACCEPTING THE IMPERFECT WORLD developmental growth and process of evolving, we
    begin to move toward curiosity and exploration,
    But in the beginning, the awareness of that and challenge and growth, in ways that would have
    separateness can seem so painful. It can seem such been so terribly limited by the old, fantasied,
    a loss, and such an angry thing. Because it means symbiotic union. A union so tight it would have
    the loss of that fantasy, the loss of the perfect, prevented us from growing, and developing, and
    caring, nurturing parent, the symbiosis of being as discovering all the potential of our individual
    if bound together, as if one. And it means the loss identity. And in the normal course of development
    of the fantasy of the perfect world where all of our we begin to discover satisfactions in evolving and
    needs are met all of the time, whenever we need developing our own individual unique
    them, and where everything is exactly as we want separateness. And we begin to discover strength
    it to be. And gradually we come to accept the loss from our experience of our original sense of
    of the fantasy, the loss of the perfect caretaker, connectedness and bonding. And the combination
    nurturer. Gradually we come to accept the realities of strength and freedom that results from our
    of the imperfect world, and the imperfect nurturing bonding and the separateness begins to open a
    caretaker. We begin to accept the "good enough" world of growth and satisfaction to us. And
    nurturer, the "good enough" caretaker, and the
    "good enough" world that is the reality we are
    beginning to experience. A
    328 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    then it does begin to become satisfying to move When you look at that little girl Lisa, you know
    into this "good enough" world with the "good very well that she really was lovable and that she
    enough" nurturing, caretaking parent. And we deserved all the love that every little girl has always
    begin to grow in experience, and evolve into all of deserved. If you had been there to be her mother,
    the satisfactions of developing into our own you would have done all of the things that a mother
    unique, very special human abilities, our own should do. You would have held her and cradled
    unique, special combination of abilities and her and rocked her and sung songs to her and
    capacities, and strengths and talents. maybe talked to her of all of the love of poetry, of
    And gradually we begin to discover all sorts of words, and music. You would have shared with her
    adventures in that outside world. And we begin to all of the happiness of running and playing,
    discover other people, other children, other adults, swinging and moving, all of the fun of living and
    who provide some of our needs and wants and care, learning and growing, and all of the fun of growing
    alternative sources of solace and care and support. up strong and healthy and well loved. And little
    And alternative sources of interest and growth and Lisa can still get some of those feelings of love
    excitement. And so we begin to move toward our from you, all of the feelings that you can give her,
    natural evolution and development, discovering all the mothering and the loving that she always de-
    of the other possibilities of bonding in the outside served. The little girl Lisa was truly lovable, just as
    world that go beyond that original nurturing, the grownup Lisa is now lovable.
    caretaking, loving parent. And then things do seem
    to become easier, satisfying.

    Hypnotherapeutic Techniques
    with Affective Instability
    Suggestions for Creative
    Louis N. Gruber, M.D.
    Self-Mothering
    Joan Murray-Jobsis, Ph.D. INTRODUCTION
    Chapel Hill, North Carolina There are many patients in psychiatry whose
    most characteristic feature is affective instability. . .
    In this hypnotic method, the patient is asked to . Diagnostically, these patients are often labeled as
    imagine himself or herself as an infant or baby, and having "borderline personality disorder," or
    then to experience himself/herself mothering the "cyclothymic disorder" or a major affective
    little child. Dr. Murray-Jobsis believes that patients disorder, alone or in combination. . . . The basic
    will usually perceive the infant as lovable and that principle of my psycho-therapeutic approach using
    this will help facilitate the process of beginning to hypnosis can be found in Melitta Schmideberg's
    love and reparent themselves. It provides some injunction concerning the "borderline" patient, "to
    restitution for the lack of nurturing and mothering be aware that the patient is dominated by . . .
    that some patients experienced, and it helps to contrasts, because he can only be influenced
    foster self-love and self-acceptance. The sug- therapeuti-cally if both sides are reached almost
    gestions that follow were taken from an actual case. simultaneously" (Italics mine) (1959). This is
    (Ed.) feasible with the hypnotic approach. Effective
    treatment of patients with affective instability must
    recognize:
    SUGGESTIONS
    If you could have been the mother of that little —their suggestibility
    girl, you would have loved her as she should have —their sense of vulnerability to external influences
    been loved, could have been loved.
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 329
    — their defensive clinging to negative mental childhood experiences were. Life has not worked out
    states for you as you hoped. You have had much suffering
    — their creativity and disappointment. In fact, your rage and anger
    — their desire for balance, stability, and self- can even be of value in certain situations. Sometimes
    even a little flash of that anger is all it will take for
    control (even more than "feeling better"). you to be left alone, or treated with greater respect.
    Now I want you to ponder those feelings, and then I
    Before the specific techniques are given, the patient want you to begin to focus and concentrate those
    must begin associating treatment with self-control feelings in one of your arms. That will be your anger
    and mastery. One must forcefully interrupt arm, and as you now squeeze the fist on that side,
    you can feel those angry and bitter feelings growing
    regressive behaviors (whining, weeping, slumping stronger, under your complete control. . . . Now I
    in the chair, diffuse hostility, sarcasm), and thus want you to release that fist and consider for a few
    break up the negative mental set often associated to moments another kind of feeling. I want you to think
    therapy. At the same time one gives recognition to of a situation in which you feel comfortable, confi-
    the negative states and their validity. I may speak, dent and at peace . . . begin to feel the strength and
    for example, of the patient's "dark side" and "bright comfort of that situation . . . and begin to focus and
    concentrate those feelings in your other arm. That
    side," and the need to bring both of them into will be your "strength and comfort arm," and as you
    balance, "so that you can have more and more now squeeze your fist tighter and tighter you can
    control over the working of your mind." experience that feeling of strength and comfort
    Patients are prepared for hypnosis by learning growing stronger under your complete control. . . .
    that it is a form of increased awareness which will
    give them greater control over their mental
    She left the session feeling greatly encouraged, and
    processes. I compare it to being so absorbed in a
    book or movie that one doesn't hear one's name practiced the two evoked feeling states regularly as
    called. Most patients are eager to get started. instructed. Improvement was noted in her daily life
    and she began to enjoy her therapy sessions.
    Although continuing to show instability, she was
    A KINESTHETIC TECHNIQUE able to handle my departure from the area as well
    as her father's death over the next six months,
    I stumbled on this technique in desperation after stresses that would previously have been
    more than ten years' work with a young woman. catastrophic for her.
    She had been phoning me almost daily
    complaining of depression, hopelessness, visual AN IMAGERY TECHNIQUE
    hallucinations, fantasies of committing mass
    murder, and warnings that "you're making me A visual imagery technique embodying the same
    angry" in response to any therapeutic intervention. basic principle (balanced evocation of two mental
    She responded immediately to the following states) can be offered to patients who are
    technique and later asked why I had waited so long outwardly in control but continue to swing
    to teach it to her. between bouts of depression and giddy, unpleasant
    After gaining her total attention I brought her "highs."
    into trance by telling her a metaphorical story and A thirty-six year old man had been called
    announcing that she would now be receiving manic-depressive and had a long history of
    "special instructions." I then told her more or less erratically shifting symptom pictures. He was
    as follows: found to be quite suggestible and was interested in
    learning to regulate his own moods without drugs.
    You undoubtedly have good reason to feel anger He went easily into trance and was then instructed
    and bitterness. No one can really know how bad your in the following two images:

    First he was told to imagine, tied to one wrist, a


    bunch of large, brightly colored, powerful balloons,
    330 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    pulling him upward. Slight spontaneous arm carefully by experienced therapists in working with
    levita-tion was ignored, and he was further told to depressed patients (e.g., Terman, 1980; Waxman,
    imagine himself being lifted off the ground, slowly 1978) or in manic-depressive illness (Brown &
    floating into the air, a few feet off the ground, then Fromm, 1986) because the severity of depression
    to window height, rooftop height, the height of the may be exacerbated through uncovering of
    treetops, or high into the sky, "as HIGH as you
    emotion-laden material. Nonetheless, in skilled
    comfortably wish to go," to look down from a
    comfortable height on the various scenes of his life hands and with patients who are depressed but not
    with detachment and serenity. severely so, hypnosis may facilitate a rapid
    uncovering of vitally important etiologic factors.
    When he signaled full experiencing of this image
    and its accompanying euphoria, he was instructed in Hodge (1972) has found that suggestions to deter
    the second image: "In your other hand, now, imagine suicide have seemed effective. He indicated:
    a heavy rope, that is tied to a heavy iron anchor on "Patients accept these suggestions quite easily,
    the earth below you. Now as you pull that rope you almost as if they do not believe them. They may or
    can slowly come down, controlling your height, may not recall the suggestions before, during, or
    down to the height of the tree-tops, or the height of
    the ceiling, or a few feet from the ground, as low as after a suicidal impulse; and they are frequently
    you wish. And as you pull on that imaginary rope perplexed or even angry that something will
    you can come down lower and lower and lower . . ." happen to prevent their carrying out their suicidal
    attempts or that they will feel a need to contact me
    before carrying out such an attempt. Some remarks
    The patient was instructed to place himself in that patients have made have been of the nature of,
    trance and practice these visualizations on a regular 'I was getting all my pills ready to take them, but
    basis, and he did so with enthusiasm. On one somehow I felt that I just had to call you,' or 'I was
    occasion, while practicing in bed, he went into a all ready to get in the car and go away to kill
    prolonged trance and "woke up" several hours later, myself, but I felt I had to call you first.'
    "hanging on to my balloons" and feeling exhausted Occasionally a patient will, while feeling suicidal,
    but euphoric. He let himself down with the ask to be released from the obligation of the
    imaginary rope and went to sleep. Therapy now suggestion, but has invariably accepted the refusal"
    proceeded rapidly with little "insight" but with an (p. 22).
    increasing sense of stability and self-confidence,
    and with active, realistic problem solving. As with Suggestive hypnosis certainly seems to possess a
    the previous technique, evoked feeling states can much lower risk of untoward effects than utilizing
    be conditioned or "anchored" to various cues intense uncovering techniques or a method such as
    (Bandler & Grinder, 1978). age progression. In the latter technique, the patient
    may imagine that the future continues to be
    negative and subsequently experience even greater
    feelings of hopelessness. Suggestions such as those
    Hypnotic Suggestions to recommended by Hodge (1972), however, seem to
    have little risk and may yield positive benefits. This
    Deter Suicide is particularly the case when they are part of a
    broad-spectrum approach to the treatment of
    James R. Hodge, M.D. depression (e.g., medication, cognitive behavior
    Akron, Ohio therapy, etc.) and when Hodge's own excellent
    guidelines below are followed. The suggestions are
    INTRODUCTION, INDICATIONS, AND very direct, and this clearly seems indicated in this
    type of situation. (Ed.)
    CONTRAINDICATIONS
    Some hypnotherapists have suggested that
    hypnosis is contraindicated or only to be used
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 331
    RATIONALE to suicide: Get an appointment with the
    psychiatrist.
    Most suicidal impulses are temporary and many
    are actually brief, especially if the problem can be
    identified and if there is someone available with SUGGESTIONS
    whom the patient can discuss his problems and/or
    break up the suicidal ruminations. If the suicidal In the future, though you may have some
    pattern of thought can be interrupted or if the suicidal thoughts and feelings and impulses, you
    patient can be given a "face saving way out," the will not be able to carry out an actual suicide
    suicidal danger may lapse. My main premises, attempt until you have discussed it with me, in
    then, in the wording of this suggestion are: advance, and in my office. I do not know how you
    will prevent yourself from carrying out the suicidal
    1. Hypnosis can and should only have a temporary impulse, but you will find a way. Do you
    deterring effect on a suicidal impulse. understand? [The patient almost invariably agrees,
    Ultimately the psychodynamics of the patient's but if he does not, I ask him what he does not
    suicidal tendencies should be worked out in understand and then explain it further.] Now, one
    psychotherapy so that such tendencies should other thing. I want you to agree with me that you
    not remain a way of life for him. will enter a trance at any time I insist on it even if
    2. A direct and permanent you do not want to at that time. Will you agree to
    confrontation-challenge to the patient that he that? [Patients are sometimes reluctant to make
    cannot ever commit suicide would be bound to such a promise, but I have had none of them refuse,
    fail. The "cannot ever" implies a challenge and and they have kept their promises quite well]
    control that the patient must test regardless of [An alternative wording of suggestions to deter
    the other dynamics of his suicidal tendencies; it suicide attempts is modified from the suggestions I
    is quite possible that he may overcome the made to the patient described in my article on the
    effectiveness of such hypnotic suggestions. treatment of dissociative reactions (Hodge,
    3. A temporary deterrent is often all that is 1959):]
    necessary to prevent a given suicide attempt In the future while you may have some suicidal
    permanently, especially if it gets the patient to thoughts and feelings and impulses, you will be
    the psychiatrist's office. At least it gives the unable to carry out a suicide attempt unless you are
    psychiatrist a chance to work with the patient in a hypnotic trance. The suicidal thoughts and/or
    and to consider and arrange hospi-talization if feelings will serve as an alert to the possibility that
    necessary. In case the suicidal pattern cannot be you may be about to enter the trance, but you will
    interrupted by discussion and analysis in the not actually enter it unless (a) the feelings become
    office, the patient has already agreed to enter very strong and you feel unable to handle them, (b)
    the trance event though he may wish to commit you actually begin to make preparations for a
    suicide instead. Discussion and analysis in the suicide attempt. In either of these situations you
    trance may be effective even when it is not will enter the trance, will begin to feel better and
    effective outside the trance. If this is not more relaxed; and in any case you will be unable to
    effective, however, it may be easier to protect commit suicide until you have actually contacted
    the patient and to arrange for hospital-ization me and informed me that you are in a trance and
    while the patient is in a trance. have been planning suicide. If I am not available,
    you will continue to relax and to feel better in the
    4. It gives the patient a realistic, logical, ac-
    trance and you may remain in it as long as is
    ceptable, and semi- compulsory alternative
    necessary to protect yourself until I am available.
    However, when you are
    332 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    aware that you are no longer suicidal, your trance possess documentation that their suggestions lead
    will automatically terminate ten minutes later. to hemispheric changes (e.g., similar to lithium),
    Being in a trance will not prevent you from although they propose that this is a hypothesis
    carrying out the necessities of your life. To worthy of investigation. This, however, is not
    summarize: The more suicidal you are, the more meant as a commentary on these authors; it is a
    you will be compelled to enter a trance and to commentary on the pre-scientific status of
    contact me. In the trance you will be unable to psychotherapy in general and hypnotherapy in
    commit suicide unless I give you permission; the particular. We must also keep in mind that it is
    trance itself may be just the factor you need to possible that a metaphoric technique may produce
    break up your suicidal thoughts and to help you to beneficial behavioral change even if it does not
    produce hemispheric alterations. (Ed.)
    relax and find better ways to handle your problems.

    INTRODUCING SUGGESTIONS FOR


    Hypnosis with Bipolar ELECTROCHEMICAL REGULATION
    Affective Disorders Before formulating suggestions for electro-
    A. David Feinstein, Ph.D., and R. chemical hemispheric balance, suggestions for
    Michael Morgan overall physical-emotional balance are introduced.
    Ashland, Oregon, and San Diego, California Particular emphasis is placed on lifestyle
    imbalances that cause difficulties for the patient,
    INTRODUCTION such as relentless work activity or relationship
    patterns that swing from intensive involvements to
    Feinstein and Morgan (1986) described a no involvements at all. . . .
    program for treating bipolar affective disorder General suggestions for electrochemical balance
    patients with hypnosis. The five stages of their precede the introduction of specifically tailored
    program include: (1) determining relevant medical suggestions and imagery. A transcription taken
    and psychosocial parameters; (2) establishing from a typical session reads:
    rapport and a positive response set to the therapy;
    (3) introducing suggestions for electrochemical Your brain chemistry is balancing itself at the ideal
    regulation; (4) teaching self-hypnosis; and (5) level for you, for happiness, for attaining your goals
    addressing self-concept. One innovative technique in life. As each organ of your body continues to
    that they described is reprinted here. A number of relax, you notice a new sense of balance between the
    studies, summarized by Feinstein and Morgan, two sides of your body, a balance which you can feel
    have implicated electrochemical asymmetry in in your legs, your arms, your chest, your face, and
    hemispheric lateral-ization in several major now you sense it in your brain. As you notice this
    sense of balance, you may become aware of the
    psychiatric disorders, including bipolar affective circulation of your blood, seeing your blood pick up
    disorder. In addition, hypnosis has been found to oxygen, feeling your blood circulate through your
    spontaneously effect changes in hemispheric body and bringing even greater balance to your brain
    asymmetry (Frumkin, Ripley, & Cox, 1978). and to all the other organs of your body.
    Feinstein and Morgan's technique encourages the
    development of balance through metaphoric
    Specific suggestions and images for electro-
    suggestions for electrochemical balance.
    chemical balance are formulated based upon the
    We must bear in mind with this disorder, and patient's responses to these general suggestions.
    many other conditions discussed in this volume, Tailoring these images to the patient's system of
    that we do not have research to document that internal representation is critical to the
    hypnosis may make a positive contribution to effectiveness of the imagery. The images which
    treatment outcome. Neither do these authors were the most effective differed for each of the five
    subjects. The essential differences
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 333
    fell along a continuum from concrete, literal, BLENDING RIVERS IMAGE. The imagery suggested
    kinesthetic imagery to abstract, symbolic, visual by the therapist is, to the greatest possible extent,
    images. A kinesthetic image is apparent in the derived from the patient's internal world. For
    following instructions: instance, the second patient, a naturalist, had
    described a favorite spot where two rivers merged
    You will be imagining a chemical balance taking into one. Under hypnosis she was told to imagine
    place in your brain. Direct your awareness to your herself lying in the grass next to two mountain
    brain; perhaps one part seems heavier than another streams watching a brown leaf floating down one
    part; perhaps one part seems warmer. As the of the streams and a yellow leaf floating down the
    chemical balance begins to take place, such feelings other: "The streams are flowing toward one another
    of warmth or heaviness may equalize throughout like streams of vital life chemicals in your brain.
    your brain. Allow this natural balance to occur now, When the two streams merge, the leaves swirl
    knowing that the feelings of warmth or heaviness together, becoming a single color, and the energies
    will fade away when the chemical balance is
    and chemicals in your brain blend in a natural
    complete. As those feelings fade away, the balance
    remains. harmony." In another instance, where several
    earlier images had not been effective, the therapist
    noted the patient's comment that her brain was
    CONTROL ROOM MAGE. An image that was on the "like a sponge that absorbs things" and had her
    abstract and symbolic end of the continuum was formulate an image of one side of the brain being a
    formulated for the male patient who had difficulty sponge soaked in a liquid of one color, the other
    yielding control. He was taught to visualize himself side being a sponge soaked in a liquid of another
    on a swivel chair in a master control room which color, with suggestions of the two liquids flowing
    had dials, switches, and meters for every function together to become a blended color.
    of his being. [See Hammond's master control room
    technique in Chapter 11.] Two meters in particular The imagery finally arrived at for a given patient
    revealed electrochemical status of the sides of his often combines both kinesthetic-literal and
    brain. He used imagery to adjust the dials, which visual-symbolic modes, such as seeing a balance
    brought the electrochemical status of both sides of scale with beakers containing vital life chemicals
    the brain to their ideal, symmetrical levels. He later on each end and sensing the scale coming into
    learned to use the control panel to influence other perfect balance as necessary chemicals are added
    conditions such as physical pain. to the beakers.

    HYPNOSIS WITH POST-TRAUMATIC S T R E S S DISORDER AND


    MULTIPLE PERSONALITY DISORDER

    Emergency Room Suggestions for or sexual assault. In such situations,


    direct suggestion is helpful as follows:
    Physically or Sexually Assaulted
    Patients 1. "You did everything you could — now let me
    do what I can to help you."
    Carol P. Herbert, M.D., CCFP, FCFP 2. "Your body is healthy and strong" (for
    Vancouver, British Columbia children: "You will grow up to be a healthy,
    strong man/woman.")
    It is essential to recognize that many patients 3. "What happened is not your fault."
    spontaneously enter trance following physical 4. "It is a good thing that you told (someone)."
    334 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    5. "You may find yourself remembering more and Saying Goodbye to the Abused
    more details about what happened to you over
    the next few days. You may also dream about
    Child: An Approach for Use with
    your experience. That is your inner mind's way Victims of Child Abuse and Trauma
    of coping. Write down what you remember or
    tell someone." Ronald A. Havens, Ph.D.
    Springfield, Illinois

    It is important not to give inadvertent suggestions


    CONTRAINDICATIONS
    as to the identity of the assailant. Given the current
    legal climate, induction of hypnosis is not This metaphoric procedure is not recommended
    recommended in the emergency setting. However, for use with borderline personality disorder or with
    it is permissible to encourage progressive muscle schizophrenic patients.
    relaxation during physical examination or
    procedures (e.g., venupuncture). Under no
    circumstances should patients be touched without SUGGESTIONS
    explicit permission, as patients with a history of
    abuse may spontaneously dissociate or regress, And now, as you sit there with your eyes closed,
    especially if touch is perceived as sexual or as and begin to continue to allow your body to relax,
    similar to the behavior of a past abuser. your mind to relax, and experience the awareness
    of many different things, you may begin to wonder,
    as you drift down into a light trance or a deeper
    trance, exactly how deeply relaxed you might
    become later on.
    Hypnotic Suggestions with But there really is no need to make an effort to
    try to be aware of exactly how deeply relaxed an
    Rape Victims arm or a leg might be, because you can continue to
    relax even more deeply later on while your
    Bruce Walter Ebert Beale Air Force unconscious mind does those things needed for
    Base, California you.
    And so, as you continue to relax and to
    The following suggestions were adapted from experience the peaceful calmness of a comfortable
    Ebert (1988) for use with rape victims. After state of increasing relaxation, I can say many
    teaching a patient self-hypnosis, the following different things, including those things needed to
    suggestions may be offered: "Take your time with help you discover the abilities and capacities you
    this growing sense of power, control, and comfort have to allow yourself to experience many
    because you will discover that, the more you relax different things.
    with the techniques, the more the fears will simply And one of the things you may experience is an
    fade away." awareness that there are many different ways to
    Another technique utilized by Ebert (1988) was heal a wound, a wound from long ago that never
    to have the patient find the image that most healed but remained behind to change the way you
    represented strength to her. In one case a patient think and feel. Kind of like a woman I know who
    imagined her grandmother. She may then be always wondered why she was the way she was
    instructed to take the strength she needs from this until one day when she discovered a child within
    image/person, and told that this "is stored deeply — a sad child, an unhappy child, an angry, hurt
    inside and does contain your strength and power. child from long ago. A child she always heard in
    You can utilize it whenever you choose by the background, a child she protected and did
    recalling this image when you need to feel strong, everything for today, a child who made her feel
    in control, and powerful."
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 335
    so sad and she would do anything to keep that child think about, and see, and feel things, things that
    quiet, to keep that child happy, to give that child you wouldn't dare in the ordinary state.
    what it wanted and needed. It is hard for any person to think that he can be
    And I asked her what needed to be done and she afraid of his own thoughts, but you can know that
    said she needed to say goodbye to that child, she you have all the protection of your own
    needed to hug that child, to hold that child, and to unconscious which protects you in your dreams,
    tell that child how very, very sorry she was that permitting you to dream what you wish, when you
    those things had happened to it. She felt so badly wish, and keeping it as long as your unconscious
    for the pain, so badly for the fear, so badly for the thinks necessary or desirable.
    anger. But she knew she had to say goodbye. Your unconscious mind is powerful and has a
    Finally, she had to leave it behind and go on with sacred trust to protect you. In your dreams, you can
    her life. She knew there was nothing she could do reframe any thought that you need to, to let you
    to save that child, to change the past, to undo what know that you survived all your past experiences,
    was. What was, was, and there was nothing she and all the powers that are behind you that have
    could do. gotten you through this, continue to serve you as
    they do now in your waking state and even when
    So she hugged that child and said goodbye, and
    you dream. Just as you are now able to allow your
    walked away and cried and cried. The hardest thing
    conscious mind to drift off into some pleasant
    she had ever done was to say goodbye, leave it
    place, your unconscious can listen to me and deal
    behind, abandon it to the past. She felt awful, but
    with other things at the same time and do what it
    she knew that was what she had to do. There was
    needs to get this experience behind you, placing
    nothing she could do to change the past, nothing
    these old thoughts in the inactive file, and
    she could do to undo what that child went through.
    permitting you to go on with the rest of your life.
    But afterwards she was free, felt free, to do what
    she wanted. The child was gone and she was free, As you continue self-hypnotic skills, your
    free of the past, free to be. unconscious mind will use this time to find out,
    And so as you relax and drift upward toward the explore things about you and your abilities, and
    surface of wakeful awareness, your unconscious solve any problems that you have. And this
    knows what you can do, your conscious knows it experience is yours; it belongs to you, and can be
    too, and you can feel the freedom of that relaxed used in any way that you decide.
    letting go in your own way, even as you drift
    upwards now to the surface of wakeful awareness.

    Suggestions and Metaphors for


    Post-Traumatic Stress Disorder
    Reframing Dreams in PTSD and Pain Control (in Spanish)
    Charles B. Mutter, M.D. Marlene D. de Rios, Ph.D., and
    Miami, Florida Joyce K. Friedman, Ph.D.
    Fullerton, California, and Los Angeles, California
    In your sleep at night you dream. In those
    dreams you hear, you see, you move, you have
    many experiences, and a part of that experience is METAPHOR PRIOR TO HYPNOTIC
    forgetting that dream after you awaken. Forgetting INDUCTION (ENGLISH TRANSLATION)
    is an experience that is not unusual for anyone.
    One of the nicest things about hypnosis is that in I want to explain to you just what happens to
    the trance state you can dare to look at, and you now that you have experienced an accident or
    burn trauma [substitute exact type of trauma or
    accident experienced by patient]. You see,
    336 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    the body responds in a very special way after you Feel the fresh energy, passing through your
    experience a trauma like the one you have just had. body, move that energy, little by little, through your
    This trauma is felt in the body, especially in the body, from the top of your head, passing your
    muscle system. forehead, your cheeks, feel your jaw relaxing, your
    You know, your blood flows through your veins mouth opening a little bit, as that energy passes to
    and arteries very much like the irrigation canals you your shoulders. Take 10 seconds and feel that cool
    remember from your home country. That is, when energy passing through your body, from the top of
    we use very high-powered microscopes, we see that your head until your shoulders: begin now, 1, 2, 3,
    the arteries and veins have walls, very small so that 4, more and more relaxed, calm and tranquil, 5, 6,
    the eye can't see them, but these walls are made up 7, more and more relaxed, calm and tranquil, 8, 9,
    of muscles. The whole thing is like an irrigation and 10.
    canal you know so well in Mexico, you know, when
    Now, feel that cool energy passing through your
    the mud falls into the canal, the water cannot flow body, move it little by little, inside your body, from
    to irrigate the plants and crops. In this way, when
    the shoulders, passing through your chest, passing
    you have an accident (trauma), the muscles of the
    your back, until your waist, take 10 seconds to feel
    walls of your arteries and veins get narrower and
    that fresh energy, passing through your body, move
    narrower until your blood doesn't flow as much and
    it little by little, into your body, from the shoulders
    as quickly as it should. Just like the mud in the until the waist. Begin now, 1, 2, 3, more and more
    irrigation canal falling into the water, your arteries relaxed, more and more relaxed, calm and tranquil,
    and veins get smaller and smaller and your hands
    4, 5, 6, very calm, 7, 8, 9 and 10, the most relaxed
    get cold, and you get tense; it is like a little tiger
    feeling that you have ever felt.
    ready to attack, that is the startle effect you feel
    very often. Now, feel the fresh energy passing through your
    body, move it little by little into your body, from
    Well, there are special exercises that I am going the shoulders, passing your arm, passing your
    to teach you which will help you to communicate elbow, passing your wrist, until the tips of your
    with your muscles. It appears to be a lie, but indeed fingers. Take 10 seconds to feel the fresh energy
    it is true, that we can indeed control our own passing through your body, move it little by little,
    muscles and we can make these irrigation canals in into your body, from the shoulders, until the tips of
    our body open and we can allow our blood to flow your fingers. Begin now. 1, 2, 3, more and more
    normally the way it should. So, I will sit here in this relaxed, calm and tranquil, 4, 5, and 6, more and
    chair, and you will sit over there and close your more relaxed, calm and tranquil, 7, 8, 9 and 10, the
    eyes and simply follow the words that I say. When I most relaxed feeling that you have ever felt, as if
    am finished, I will say to you, "Open your eyes." you were floating on top of a pretty white cloud in a
    Do you understand? OK, let's begin. blue sky, so calm, so tranquil.
    Now, feel the fresh energy pass into your body,
    move it little by little, into your body, from the
    INDUCTION AND SUGGESTIONS waist, past your thighs, past your knees until your
    (ENGLISH TRANSLATION) feet. Take 10 seconds to feel the fresh energy pass
    through your body, move it little by little, into your
    Pay attention to your breathing . . . breathe in, body, from the waist until the feet, begin now. 1, 2,
    slowly, breathe out slowly, listen to the sound of 3, calm and tranquil, 4, 5, 6, more and more
    my voice and try not to sleep, and with each breath relaxed, calm and tranquil, 7, 8, 9, and 10, the most
    that you take, feel yourself becoming more and relaxed feeling you have ever felt.
    more relaxed, more and more relaxed, calm and Now, imagine that you are standing by the
    tranquil. seashore, you feel very relaxed, calm,
    very
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 337
    happy, at ease, feel the breeze caress your face, METAPHORIC SUGGESTIONS FOR
    smell the fresh air, feel the cool sand in your feet, SELF-HYPNOSIS
    more and more relaxed, more and more relaxed,
    calm and tranquil. You are like the eagle, king of the birds, king of
    Now imagine that you are in a beautiful pine all his dominion. Whenever you want, wherever
    forest, it is a spring day, smell the fresh air, listen to you are, with the tape or without the tape, you
    the sound of the birds, see the flowers in all the know how to calm yourself. Simply close your
    colors, you feel very good, tranquil, calm, very eyes, pay attention to your breathing, won't you,
    calm, very tranquil. and little by little, feel that fresh energy pass into
    your body, little by little. You are like the king
    eagle, king of all your dominion, because you
    know how to calm yourself, you know how to
    SUGGESTIONS WHEN THERE ARE
    relax.
    SLEEP PROBLEMS

    Now, imagine that you are in your house, it is


    RE-ALERTING
    nighttime, you are sleeping in your bed. Imagine
    you are sleeping well, all night long, have happy Now, I am going to count from 1-10. Imagine
    dreams, pretty dreams, tranquil dreams, without that you are walking up a pretty staircase, and with
    waking up, breathing peacefully all night long, you each number that I say, feel that you are walking up
    feel very well, calm, tranquil, very relaxed. the staircase, and you feel more and more alert with
    each step, very awake. 1, 2, 3, more and more alert,
    very happy, 4, 5, 6, very, very alert, more and more
    SUGGESTIONS WHEN THERE ARE awake, 7, 8, 9, and 10, open your eyes.*
    PROBLEMS OF PAIN

    Now, imagine that you have a green pitcher of TRADUCCION EN ESPANOL:


    iced water, very cold, put your right hand inside the INDUCCION ANTES DEL HIPNOSIS
    pitcher, and feel the cold passing to that right hand,
    Quiero explicarle exactamente lo que le pasa
    until it is very numb, so that you don't feel it at all. ahora que Vd. ha experimentado un acidente o
    Now, place that right hand on whatever part of your quemadura (substituya el tipo exacto de trauma o
    body is bothering you, and little by little, feel that acidente experimentado por el paciente). Mire, el
    coldness pass to your body, you feel very good, cuerpo responde al accidente de una manera
    calm and tranquil, very relaxed. especial como aquello que recientamente ha tenido
    Vd. Este trauma se siente en el cuerpo,
    especialmente en el sistema muscular.
    SUGGESTIONS WITH PROBLEMS OF Sabe, la sangre corre por sus venas y arterias tal
    BODY IMAGE AFTER AN ACCIDENT como en los canales de irrigacion que Ud. recuerda
    OR INJURY de su tierra. Es decir, cuando utili-zamos un
    microscopio de alto poder, vemos que las paredes
    Imagine that you are in your house, in front of de las arterias y las venas son muy pequenas que el
    your mirror, how handsome (pretty) you are. You ojo no puede verias, pero
    feel very tranquil; your hand is fine. Imagine that
    you are in your house, in front of your mirror, how *A tape of the suggestions given above for pain control and
    progressive relaxation is available from Dr. de Rios in
    handsome you are, how tranquil you feel. Vietnamese, German, Spanish at the following address:
    Department of Anthropology. California State University,
    Fullerton, CA 92634, USA.
    338 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    estas paredes estan hechas de musculos. Todo esto que es fresca, va a pasar por su cuerpo, tiene que
    es como un canal de irrigacion que Vd. conoce tan moverla poco a poco, de ntro su cuerpo . . . desde
    bien en Mexico, Vd. sabe, cuando el barro cae los hombros, hasta la cintura. Empe-zamos ahora,
    dentro del canal, el agua no puede correr para 1, 2, 3, mas y mas relajado, mas y mas relajado
    irrigar a las plantas y las cosechas. De igual calmo y tranquilo, bien calmo, 7, 8, 9, 10 el mas
    manera, cuando Vd. se acidenta, los musculos de relajado que nunca sentia.
    las arterias y las venas se obstruyen de tal manera Ahora, siente la energia que es fresca, va a pasar
    que su sangre no corre libre-mente. Justo, como el por su cuerpo, tiene que moverla poco a poco,
    barro en el canal de irrigacion que cae al agua, dentro su cuerpo, desde los hombros, pasando el
    igualmente sus arterias y sus venas se estrechan y brazo, pasando el codo, pasando la muneca, hasta
    sus manos se enfrian y Vd. se pone tenso. Es como las yemas de los dedos. Tome 10 segundos para
    un tigrillo listo para saltar en ataque. Esto es el sentir la energia que es fresca, va a pasar por el
    susto que Vd. siente muy frecuentamente. cuerpo, tiene que moverla poco a poco, dentro su
    Ahora bien, hay ejercicios especiales que voy a cuerpo desde los hombros, hasta las yemas de los
    enseflarie que le ayudaran a communicarse con sus dedos. Empezamos ahora, 1, 2, 3, mas y mas
    musculos. Parece mentira, pero es la verdad, relajado, calmo y tranquilo, 4, 5, 6, mas y mas
    podemos controlar a nuestros propios musculos y relajado, calmo y tranquilo 7, 8, 9 y 10, el mas
    podemos hacer que estos canales de irrigacion en relajado que nunca sentia si fuera flotando encima
    neustro cuerpo se abran y podemos permitir que de una nube bonita , bianco en un cielo azul, tan
    nuestra sangre corra normalmente. Pues, voy a calmo, tan tranquilo.
    sentarme aqui en la silla, y Vd. se sienta alii, y
    Ahora, siente la energia que es fresca, va a pasar
    cierre los ojos y simplemente escuche a las palabras
    por su cuerpo, tiene que moverla poco a poco,
    que yo digo. Cuando termino, voy a decide, "abra
    dentro su cuerpo, desde la cintura, pasando los
    los ojos." Comprende Vd.? Bien, empezamos. . . .
    muslos, pasando la rodilla, hasta los pies, tome 10
    Preste atencion a la respiracion . . . aspire Vd. segundos para sentir la energia que es fresca, va a
    lentamente . . . expire Vd. lentamente, escucha el pasar por su cuerpo, tiene que moverla poco a poco,
    sonido de mi voz y procure no dormir . . . y con dentro su cuerpo, desde la cintura hasta los pies,
    cada respiracion, se va sentir mas y mas relajado, empezamos ahora, 1,2,3, calmo y tranquilo, 4,5,6,
    mas y mas relajado, calmo y tranquilo. mas y mas relajado, calmo y tranquilo, 7,8,9 y 10,
    Siente la energia que es fresca, va a pasar por su el mas relajado que nunca sentia.
    cuerpo . . . tiene que moverla poco a poco, dentro su
    Ahora, imagine Vd. que esta parado por la orilla
    cuerpo . . . desde la corona de la cabeza, pasando la
    del mar, Vd. siente relajado, calmo, bien a gusto,
    frente, pasando las mejil-las, . . . la mandibula
    alegre, siente la brisa cariciar en su cara, huela el
    relajada, la boco abre un poco . . . pasando el cuello
    aire fresco, siente la arena fresca en sus pies
    hasta los hombros. Tome 10 segundos para sentir la
    descalzos, mas y mas relajado, mas y mas relajado,
    energia va a pasar por su cuerpo, desde la corona de
    calmo y tranquilo.
    la cabeza hasta los hombros . . . empezamos ahora.
    1, 2, 3, 4, mas y mas relajado, calmo y tranquilo, 5, Ahora, imagine Vd. que esta en un bosque
    6, 7, mas y mas relajado, calmo y tranquilo, 8, 9 y bonito, de pinos, es un dia de la primavera, huela el
    10. aire fresca, escucha el sonido de los pajaros, vea las
    flores de todos colores, Vd. siente muy bien,
    Ahora, siente la energia que es fresca, va a pasar tranquilo, calmo, bien calmo, bien tranquilo.
    por su cuerpo, tiene que moverla poco a poco,
    dentro su cuerpo, desde los hombros, pasando el (Si hay problemas con el dormir)
    pecho, pasando la espaldo hasta la cintura tome 10 Ahora, imagine Vd. que esta en su casa, es
    segundos para sentir la energia noche, esta dormiendo en su cama, imaginese
    dormiendo bien, toda la noche,
    teniendo
    suenos alegres, bonitos, tranquilos, sin
    des
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 339
    pertarse, respirando con tranquilidad toda la noche, fering multiple personality disorder (MPD). It
    Vd. siente muy bien, calmo, tranquilo, bien begins long before any personalities begin to lose
    relajado. (Si hay problemas de dolor en el cuerpo) the signs and/or sense of separateness and
    Ahora, imagine Vd. que tiene un jarro verde de continues as an intrapsychic process of reorga-
    agua helada, bien helada, ponga Vd. la mano nization even after the personalities achieve unity.
    derecha dentro el jarro, y siente que el frio va Fusion is the coming together of the several
    pasando a la mano derecho, hasta que esta personalities into a unity and is said to occur after
    entumecida bien, que no lo siente. Ahora, tome la several indices of dividedness have not been
    mano derecho a donde en su cuerpo esta observed for three months. Interventions which
    molestando, y poco a poco siente la frialdad pasa al suggest and help bring about the occurrence of
    cuerpo, Vd. siente muy bien, calmo y tranquilo, fusion at a particular point in time are often called
    bien relajado. fusion rituals; they often are facilitated by formal
    (Si hay problemas de desgusto del cuerpo heterohypnosis.
    despues del acidente, injurio, etc.) Fusion rituals are ceremonies at a discrete point
    Imaginese que esta en su casa, frente su espejo, in time which are perceived by some MPD patients
    que Undo (guapo) esta, tranquilo, su mano esta as crucial rites of passage from the subjective sense
    bien, esta linda, imaginese que esta en su casa, of dividedness to the subjective sense of unity.
    frente su espe jo, que linda esta, que bonita, Some MPD patients, however, experience fusion
    tranquila. . . . as a spontaneous, abrupt or gradual process, and
    Vd. es como el rey aguila, rey de todo su complete their treatments successfully without
    dominio, cuando quiere donde sea, con la cinta o undergoing fusion rituals. Because such
    sin la cinta, Vd. ya sabe calmarse, Vd. simplemente ceremonies are obvious and memorable landmarks
    tiene que cerrar los ojos, hacer caso a la in the treatment, they often are accorded an
    respiracion, y poco a poco, siente la energia que es unfortunate overemphasis and unnecessarily
    fresca va a pasar por su cuerpo, poco a poco, Vd. es invested with drama by both patient and clinician
    como el rey aguilar, rey do todo su dominio, alike. In fact, a fusion ritual will not substitute for
    porque Vd. sabe calmarse, saba relajarse. the hard work of other aspects of the therapy and is
    not a potent technique in and of itself. It is no more
    (Para despertarle al cliente)
    than an agreed-upon congenial formalization of
    Ahora, voy a contrar de 1 a 10, imaginese
    work already accomplished. Some MPD patients'
    subiendo una escalera bonita, y con cada numero
    personalities fuse one at a time, some fuse in
    que digo, siente que esta subiendo la escalera, y se
    clusters, and some fuse all at once. Some
    siente mas y mas alerto con cada peldano, muy
    personalities experience the process of fusion as a
    despierto, 1, 2, 3, mas y mas alerto, bien a gusto va,
    joining to or coalescence with specific other alters
    4, 5, 6, mas y mas alerto, mas despierto, 7, 8, 9 y
    among the system of personalities; some simply
    10, abre los ojos.
    cease to be separate.

    The timing of a fusion should emerge from the


    A Fusion Ritual in Treating intrinsic process and momentum of the therapeutic
    Multiple Personality endeavor. It should never be undertaken because
    the therapist or patient is eager to see fusion
    Richard P. Kluft, M.D. achieved or hopes to find some form of short-cut.
    Philadelphia, Pennsylvania In essence, it is a permissive and positive
    intervention that is understood as tentative and
    THE ROLE AND TIMING OF framed in a manner that clearly states that, if the
    INTEGRATION fusion does not hold, it is not a failure, but more an
    Integration is the process of undoing the indication that there is more work to be done
    dissociative dividedness of an individual suf- before a fusion would be appropriate. For this
    reason, it is not helpful to
    340 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    bypass resistances to fusion. They should be dealt more readily than those which imply elimination,
    with straightforwardly. A bypassed resistance or a subtraction, death, or going away. I have described
    procedure perceived as coercive virtually images of dance, embrace, shared activities, and the
    guarantees a rapid relapse into div-idedness. In the like, but most of my patients have preferred images
    long run, going slower and more gently speeds of light or streams of water flowing together, or
    therapy and reduces both crises and failure scenes in which the snow on mountain peaks melts
    experiences for both clinician and patient. and flows together into a lake on the surface of
    Useful considerations in the timing of an attempt which all the mountains are reflected (Kluft, 1982).
    at fusion are based on clinical experience. Fusion I have found science fiction scenarios quite useful
    in young boys (Kluft, 1985). Braun (1984) has
    should occur when work on all reasons for the
    described fantasies in which alters go to a library
    dividedness of the alters about to fuse has been
    and read about and absorb one another, scenes of
    completed, i.e., when the particular separateness in
    streams flowing together or of the mixing of red
    question no longer serves a meaningful function in
    and white paint to form pink and the imagery of an
    the patient's ability to adapt to environmental and
    antibiotic capsule dissolving and thereby
    intra-psychic pressures. This is usually the case
    circulating throughout the body and mind and
    when the alters under consideration for fusion
    becoming thoroughly absorbed. As a concrete
    identify with one another, empathize with one example of this process, I will share the wording of
    another, and each accepts not only the other(s), but a recent and successful fusion ritual. This particular
    the other's (or others') memories and affects. At this patient enjoyed the additional reassurance of a
    point they often feel no need to remain separate. recheck and reinforcing ritual. What follows is a
    Although some alters experience fusion as a death, nearly verbatim ritual used with an MPD woman
    most which fuse successfully reach a sense of who had already fused many personalities during
    assurance that they will survive within the blended similar procedures. Joan and Anne are two alters in
    self of a united individual. Often when issues of a patient named Claire (all pseudonyms). Joan and
    survival have been negotiated with the first alters to Anne have already been elicited by hypnosis. Each
    fuse, the other alters perceive that the influences of affirmed she had no more separate memories or
    fused personalities persist as contributions to an issues which required further work, and each
    increasingly unified psyche, then such concerns affirmed a readiness to join with and accept the
    cease to be pressing. other. The objections of an alter opposed to all
    fusion were dealt with by reminding it that its
    The wording of fusion rituals should be freedom of decision was being accepted and that
    individualized rather than cookbookish. In general, alters who wanted to decide to join deserved similar
    one should be permissive and make it clear that the consideration.
    patient may interrupt the procedure at any time if
    discomfort is felt. It is useful to inquire about
    unsuspected remaining areas of conflict and
    concern before beginning. It is not uncommon for
    alters not involved in the proposed fusion, but
    WHITE LIGHT SUGGESTIONS FOR
    opposed to it for some reason, to intercede. Usually
    they will withdraw after being allowed to verbalize FUSION
    their objections, but sometimes one must defer the
    procedure. Clinical experience indicates that Please allow your eyes to roll up and your
    images which suggest merger, union, and rebirth in eyelids to flutter down and close. Let yourself go
    which all aspects of all personalities are preserved deep at the count of three— one, two, three. If at
    as they come together are accepted much any time you want to stop or talk with me about
    something, raise your right index finger.
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 341
    And now, deeper still at the count of four . . . forever at the count of two . . . that feels so natural,
    (deepening by count until eight, and then) . . . as so right. . . .
    deep as you've ever been at the count of nine, and And now the light recedes. All of you look
    now deeper still at ten. That's right. Nod if you're around. Everyone feeling better, stronger, safer.
    ready. [Patient nods.] Where there were Joan and Anne, there is a single
    OK. You all are in a beautiful clearing in the individual, stronger, more peaceful, more resilient,
    woods, a place of complete privacy and safety. All and unified now and forever at the count of one.
    stand in a circle, take one another's hands, and now How do you feel? [The patient opens her eyes and
    move toward the center of the circle. You'll find says it went well.] OK. Close your eyes and rapidly
    you have to let your arms slide gently around one go as deep as you were. You had said that the
    another as the circle grows smaller. And as you get unified person would be called Joan. Joan, nod if
    closer, already you can feel a pleasant warmth from you are there and OK. [Nods.] Anne, nod if you
    the closeness, a sense of warmth and closeness that remain separate. [No nod.] Everyone else, raise the
    feels good to you all, even those who have no plans right index finger if anyone senses or knows Anne
    to join with one another today. remains separate or notices anything amiss. [No
    signal.] OK, let this fusion be sealed and solid, now
    Above the center of the circle, a point of light is
    and forever, at the count of three . . . one, two,
    seen, which rapidly becomes brighter and more
    three. [The patient opened her eyes, and
    radiant, a warming, comforting, and healing form
    volunteered that she felt good.]
    of light that rapidly becomes so beautiful, bright,
    and radiant that, although it does not hurt your eyes [This verbalization is only an example of what
    at all, is so luminous that each of you, no matter was congenial to one patient at one point in her
    where you look, all you see is a beautiful field of treatment. It is offered as food for thought, but not
    light that engulfs you all. No matter where you as a tool for use with any other patient.]
    look, there is no evidence of detail or separateness.
    And now the light seems to enter you as a warming
    current, and flows back and forth, forth and back,
    sharing with you all the experience of peace and
    well-being. Another Fusion Ritual
    And now the current flows to Joan and Anne Richard P. Kluft, M.D.
    alone, back and forth between you. Back and forth,
    Philadelphia, Pennsylvania
    forth and back, and soon it takes with it all the
    memories, feelings, and qualities of Joan into
    Anne, and of Anne into Joan [this is elaborated]. INTRODUCTION
    Nothing is withheld, nothing is omitted [elaborate
    back and forth motif]. And now that all from each Many patients with multiple personality dis-
    has flowed into the other, and all from the other has order have had sufficient traumata that almost any
    flowed into each, it seems so pointless to be
    set of images may be affectively loaded. The
    separate. At three, the barriers between Joan and
    following is often sufficiently neutral, complex,
    Anne gently crumble, and peacefully are washed
    and distracting that it is accepted and engrosses
    away. All that was Anne flows into Joan, and all
    that was Joan into Anne. . . . And it's so easy and attention throughout the procedure across all alters,
    gentle because you already have become the same. even those that are not participants in the fusion.
    Everything blending, joining, and mixing Since it requires considerable concentration, it
    [elaborate]. And now everything settles gently and makes enough demands upon the patient to divert
    peacefully, joined now and him or her from low to moderate levels of anxiety
    that may be attendant upon the fusion process. In
    this hy-
    342 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    pothetical example, three alters are joining into the Containing Dysphoria in MPD
    total human being or the host personality, and the
    others are simply bystanders. Richard P. Kluft, M.D.
    Philadelphia, Pennsylvania
    MODELED SUGGESTIONS
    INTRODUCTION AND INDICATIONS
    [After trance has been induced:] And now
    imagining yourselves on the side of a gentle sloping Often the issue in treating MPD is not how to
    hillside that overlooks the sea, high up, near the top. open things up but how to settle things down.
    Each of you will see it in the way that seems most
    Frequently an alter feels in too much pain to cope or
    peaceful, safe, and beautiful to him or to her. It is
    fears that it cannot control its impulses. At such
    near the end of a very full and complete day. Much
    times, a variant of the following may be very useful
    has been accomplished, and all of you can feel a
    great sense of satisfaction. You look down the hill, and forestall a hospital admission, a suicide
    toward the sea, and there are three [the number of attempt, self-injury, or other counterproductive
    alters to fuse] rivers winding their way to the sea. acting-out. It presupposes the patient's experience
    You watch them flow, peacefully and calmly. The with some variant of the "safe room" technique and
    day is near its end. The sun is low over the horizon. requires that at least one competent and trustworthy
    As it becomes level on the horizon behind you, all alter agrees to remain in charge in the interim. The
    of you are bathed with a beautiful light, that is so patient is placed in a trance, and addressed as
    bright that unless you look ahead of you, down follows.
    toward the sea, all you can see is a beautiful field of
    light. You can no longer see one another, only the
    rivers as they wind their way to the sea, and the ILLUSTRATIVE SUGGESTIONS
    rivers are golden, reflecting the sunlight behind
    you. And now, it is time for peace, time for safety.
    Each of you, in your own way, in your own safe
    As the sun sinks lower, the gold on the surface of place, a place that is completely secure from all
    the rivers seems to move into the sea; in fact, by the danger of intrusion, from all hurt. And now, for
    time I count from one to ten, all of the gold in the those of you who are in pain, and for those of you
    rivers has flowed into the sea [count, and indicate who feel it is so very difficult to hold on, it is time
    the march of the gold into the sea]. The gold from for rest, for peace, and for relief. When I count to
    all the rivers have joined the gold of the three, for those of you who would like to accept this
    sun-covered sea—at three, all the gold of the rivers, time of restoration and healing, it is time to fall into
    all of their waters, is completely within the sea. At a healing sleep, safe and secure. So, all of you in
    two, the flow of the water and the ebb and flow of your own special places of safety, and now, for
    the tide has blended them completely. At one, who those of you who would like to, at one, go to the
    could say this water came from one river or the special place within that special place in which you
    other. All has become one, now and forever. And can rest with peace. At two, lying down or reclin-
    now, the sun is below the horizon, and what was ing, closing your eyes and allowing pain to wash
    gold has become purple, red, all of the colors of a away, uncomfortable urges and pressures to
    beautiful sunset. All of you look around, and can be dissolve, and permitting yourselves to drift toward
    pleased to find that there are fewer of you who sleep, a sleep that will last calmly and without
    remain separate, and that those who do can feel the disturbance until you actually enter my office for
    tremendous satisfaction of a job well done, and an your next appointment. At that time, you will
    even stronger sense of how all of you, at the right awaken, and be able to work on the problems that
    time and place, can find a way to be one. beset you. And now, it's time to sleep at the count of
    one. [As an added safety
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 343
    measure, it can be suggested that disruptive new understanding, and new energy in the
    memories be put in a time-lock vault in between determination to recover, heal, and get
    sessions.] well. 10. Every day and every way, I am getting
    better and better.

    Modified Ego-Strengthening
    for MPD
    Corporate Headquarters of
    Moshe S. Torem, M.D. the Mind
    Akron, Ohio
    Donald A. Price, Ph.D. Salt Lake
    The patient is guided into self-hypnosis and is City, Utah
    then asked to repeat the following statements after
    the hypnotherapist: INTRODUCTION AND INDICATIONS

    1. I deserve to live my life with The following is a visual imagery structure that
    respect and dignity. 1 use very frequently with adults molested as
    2. I deserve to live my life to the children (AMACs) and multiple personality
    fullest. disorder (MPD) patients. Since most AMAC and
    MPD patients are quite visual and excellent
    3. I
    hypnotic subjects, these internal structures and
    _____am an adult, mature individ
    pictures are usually easy for them to visualize, and
    ual, intelligent, educated, clever, inge
    the effects are often quite remarkable. Some of the
    nious, tolerant, creative, and wish to get
    ideas are not original, and where I can remember
    well.
    their source, I have cited it.
    4. Any emotional disagreements will be resolved
    on a psychological level through internal At some point in a formal induction procedure,
    dialogue, writing in the journal, therapeutic after teaching several hypnotic phenomena, such
    sessions, writing poetry, and developing a new as ideomotor finger signals, and glove anesthesia,
    understanding of the difference between the arm rigidity, etc., for deepening purposes, I give
    past and the present. the following suggestion.
    5. Any internal conflicts will be resolved on a
    psychological level. THE ELEVATOR OF YOUR MIND
    6. I _________ give my word of honor and
    vow that I will do no harm to myself Picture yourself getting on an elevator at the top
    externally, internally, passively or actively, of a tall building and pushing the down button. As
    intentionally or unintentionally, and I will the elevator descends floor by floor, you go deeper
    resolve all my conflicts and emotional dis- and deeper into trance and relaxation. I do not
    agreements on a psychological level. know with my conscious mind nor my unconscious
    7. I ________ as a whole person, including mind, and you do not know with your conscious
    all of my parts and ego-states as well, as alters mind, but your unconscious mind knows just how
    and fragments, deserve to heal, recover, and deep you need to be in trance for us to work
    to get well. effectively today. Just continue to go down deeper
    8. 1 ________ as a whole person give with each floor, with each exhalation, with each
    my passing second. When your unconscious mind
    word of honor and vow to do whatever is knows you have reached the right depth of trance,
    necessary in this therapy to heal, recover, and the elevator will stop descending, and then move
    to get well. the "yes" finger.
    9. Every day in every way, I continue on the
    road to full recovery. I gain new insight,
    344 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    Some elevators are old and you can feel them usually does, and we may then proceed from there.]
    going down, deeper and deeper; more modern ones Put the cassette into the VCR and when a picture
    are so smooth you cannot feel them descend, but starts to appear on the screen move the "yes" finger.
    have to watch the numbers to know that you are [As the picture starts:] You can review the episode
    going down; some of the very old ones and the very silently and then tell me what you have seen, or you
    new ones you can see out and see that you are going can tell me as you are seeing it. [As the person gets
    down, deeper and deeper into trance. [Sometimes into the memory I usually start talking in the
    the elevator gets stuck, at which point one deals present tense to help him/her be there now.
    with resistance, usually some kind of fear, until the Sometimes the picture will stop and it is obvious
    elevator starts descending again. With some that there is more, but it will not proceed. This is a
    patients, and after practice in using this image, you good time to ask questions through the chalk, such
    can suggest that they are on the "express elevator." as, "Why did the picture stop?" or "Does another
    These deepening suggestions may also be used as part of your mind have this information?"]
    an introduction to any of the following metaphors.]
    THE CORRIDORS OF YOUR MIND

    THE LOUNGE ROOM [With patients who have or are suspected of


    having ego states or alter (multiple) personalities,
    [When the "yes" finger moves indicating that the after getting off of the elevator, I suggest:] As we
    person has reached the right depth, I suggest:] The walk down the corridor, look at the doors and see if
    elevator door opens, and we get off and go across there are any names on them. [If there are, I begin
    the hall into a nice comfortable lounge room. Inside to ask if we can talk to the people behind the door.
    there is a large comfortable easy chair. Can you see Sometimes a window or speakeasy hole needs to be
    that? Good; have a seat and make yourself very placed into the door. The corridor image is often a
    comfortable. In front of you is a large screen TV way to begin to get a "map" of the alters. Find out
    and a VCR. Can you see those? [If patient says they how many doors there are, and how resistant the
    are unclear or fuzzy, I suggest: "Take some deep occupants are to talking. For non-MPD patients
    breaths to take you deeper into trance, and the these corridors and doors may represent people and
    picture will become clearer." It usually does.] memories — locked in the rooms — of abusive
    events, or issues to be resolved.]
    On one wall or the other, to your right or left, is a
    chalkboard. At the bottom of the board is a tray
    with a piece of chalk in it [source of chalkboard THE CONFERENCE ROOM
    image is Bernauer Newton, Ph.D.]. This chalk is
    very special. It can help us by writing answers to [Particularly with MPD patients, the conference
    questions we may have and provide us with room is a place to gather alters together for
    directions. [At this time if we are in the uncovering meetings and negotiations, to share feelings and
    process with an AMAC patient I will ask him/her:] information, as well as to decide who is ready to
    Pick up a video cassette from the stack at the side of fuse, etc. The therapist need simply suggest:] I
    the chair. Our mind is very much like a giant video would like all (or certain alters) to gather in the
    library. Take the tape that we need to review today. conference room so we can dis-
    [If the patient does not know which tape to choose, cuss.

    I ask her to "ask the chalk to write on the board


    which tape to pick." Any time there is difficulty
    with retrieving the memories in this way, we ask THE COMMUNICATION ROOM
    the chalk to tell us why; it The communication room is particularly useful
    with MPD patients. When a new alter
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 345
    has been identified who does not know the other to being removed. All of this is material that the
    alters or host, but is willing to begin therapist with experience learns to respond to with
    communication, the patient can be taken to the creative suggestions, dealing with the resistance,
    communication room and shown a row of "video whatever its nature. A cartoon showing a workman
    phones" or even one "video phone" with the inside the brain amid a myriad of wall plugs, hanging
    instruction: "All you need to do is punch the name plugs, and criss-crossed extension cords is often
    shared with the patient to introduce humor into the
    of (host or alter) into the telephone and listen and
    therapy.]
    watch on the screen to see what she looks like. Can
    you see her? Let her know you are there and are
    interested in talking with her now. Any time you
    need to tell her something, all you need to do is THE COMPUTER ROOM
    punch in her name and you will be in
    I have found the visualization of a computer
    communication with her." Gradually, as the
    amnestic barriers are broken down, and alters room to be particularly useful with cult victims
    communicate and see each other directly, internal who have actually been programmed with hyp-
    communication is facilitated in a fairly nosis, drugs, and torture. When attempting to
    nonthreatening way. change programs with such victims, the therapist
    must be prepared to deal with pain reactions that
    have been conditioned to any attempts at
    deprogramming. Other highly sophisticated
    CENTRAL CONTROL OR brainwashing techniques, such as "backup"
    CIRCUIT ROOM programs and programs that are protected by
    "screens" are also found. With experience,
    After having identified and worked through
    practice, luck and creativity, however, the therapist
    important issues, imagery of the circuit room can
    can learn to circumvent even the most devious
    help to formalize change. Attitudes and behaviors
    brainwashing "programs." Recently a TV episode
    that have been linked by trauma or learning can be
    of Matlock depicted the creation of an "umbrella
    "unplugged" or "disconnected." Intensity (or
    program" to surround a sophisticated security
    feelings, pain, etc.) can be "turned down." Certain
    program, mimic it, and circumvent it by relaying
    dysfunctional "plugs" may be removed and
    information to a different person. A cult abuse
    replaced with new functional "plugs." On-off
    patient had fortunately viewed this TV episode and
    switches (e.g., black/white, either/or attitudes and
    I was able to create just such a program for her.
    behaviors) can be replaced with light-dimmer type
    Therapists who are caring and have a good
    intensity switches. Suggestions like the following
    therapeutic relationship with a cult victim have a
    are often used:
    power in their visualizations that the cult
    programmers and perpetrators of pain and abuse
    Take the elevator down deep into your uncon- simply do not have. Eventually the caring,
    scious mind to that depth, that floor where we find consistent, and genuine relationship, coupled with
    the control room. [Pause] Let me know when we creative hypnotherapy, wins out. Many patients
    reach that depth by moving the "yes" finger. Now, have experience with computers, which facilitates
    look around and find a door that says Control
    the use of imagery about computers.
    Room, or Circuit Room, and let me know when you
    see it. . . . That's right. Now, let's go in, and look for
    that circuit board [plug, etc.] labeled [name of the Some patients, 1 have found, can use this
    issue being dealt with]. [If two issues are connected imagery self-hypnosis to communicate with ego
    with each other that should not be connected, I states (typing messages on the CRT of their mind).
    suggest:] Notice that the plug labeled (e.g., sex) is Very concrete suggestions are given such as: "Go
    connected by a wire to (e.g., pain). Let's cut the down the elevator floor by floor, deeper and deeper
    wires. Take some wire cutters or an ax, whatever you into trance . . . etc. When you reach that depth of
    need to disconnected the wires. [Sometimes the wires trance where the com-
    automatically go back together, or a plug is resistant
    346 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS
    puter room of your mind is located, the elevator procedures, the patient is told: "OK, now let's go
    will stop. Get off of the elevator and look for a door back and get on the elevator and push the 'UP'
    that says 'Computer Room' . . . yes, that's it. We go button. As the elevator takes you back up, your
    in and sit down at the console. Now look around for breathing begins to return to normal, and as you
    the disk that has the program on it that is causing reach the top floor, your breathing returns to
    trouble (e.g., with overeating). Take out the disk, normal. And as the door opens, your eyes open, and
    and let's look around for any other backup copies. you find yourself oriented back in the present time,
    Let's put them in a pile and burn them." New place and person." I have found that when this is
    programs that the patient helps to create can then be not done, talented hypnotic subjects may still
    typed into the console. Backup copies are always remain in a trance, or if they realert too fast, they
    made. may experience a headache, especially in MPD
    For removing programs that have been installed patients where there has been a lot of switching
    through more complicated means, such as through between alters. When this happens, simply suggest
    electroshock during brainwashing or cult that they go back down, and come up the elevator
    programming, a reversal of the programming with more slowly.
    hypnotically compressed time can be effective. In
    this latter case I give the following suggestions
    while the person is in trance, even in the computer
    room: Metaphors with Multiple
    Personality and Trauma
    Now we are going to completely remove this
    program, and the way we will do it is to go through Patients
    the rite/programming episode backwards, using hyp-
    notically compressed time. You will feel some pain, D. Corydon Hammond, Ph.D. Salt
    just as you did when the original program was Lake City, Utah
    installed, but it will go fast and will be minimal.
    [Since wires were sometimes attached to the victim's
    head, I will put my hands on each side of the SETTING A BROKEN BONE AND
    patient's head, partly to restrain the seizure-like LANCING A WOUND
    jerking as he abreacts, partly to simply use healing
    touch.] Now I will count backwards from 5 to 1, and [This has proven to be a useful metaphor in
    by the time I finish counting, all of the program and preparing a victim of trauma for the painful
    pain will be removed. Now I will begin: 5 . . . 4 . . . 3 abreactive work of reliving a past event.] The work
    ... 2 ... 1. [If the patient is still in pain or trembling I that we have to do is very much like what must
    will ask if there are backup copies of the program. If
    happen after a child breaks her leg, or an adult has a
    there is a nod for yes, I repeat the counting with the
    suggestion that this will remove all backup copies of painful, infected wound that must be lanced. The
    the program. Usually the pain or abreaction stops and physician doesn't want to cause the patient pain.
    the patient becomes calm.] But he/she knows that if he/she doesn't set the bone
    or lance the wound, the patient will continue to hurt
    for even longer, and will remain disabled and never
    recover properly and normally. It's hard and painful
    GOING BACK UP THE ELEVATOR for the physician to do that procedure and create
    pain through setting that bone or lancing that
    Sometimes during the recall of a memory,
    wound. But it's an act of caring, that allows healing
    during an abreaction, or other work with the above to take place.
    methods, a patient will appear to come out of the
    trance state and to seem as if they have finished and And this process of facing painful memories and
    are alert in the present. Frequently this is not the feelings from the past will be painful for a short
    case. Thus, routinely in concluding work with time, just like setting a broken bone. But
    any of the above
    HYPNOSISWITHEMOTIONALANDPSYCHIATRICDISORDERS 347
    then you won't have to continue hurting from what begun asking hypnotized MPD patients about their
    happened, and healing will finally take place. fears. Ideomotor signals may be obtained so that
    any alter personality may indicate if he/she is
    afraid of an item, or individual personalities may
    PRESSURE COOKER METAPHOR be asked these questions. The italicized items
    below are believed to be more likely to elicit a fear
    [This metaphor is helpful with patients in crisis
    reaction in ritualistic abuse victims. They have
    who have tremendous internal pressure, often from
    been embedded within a list of numerous other
    alter personalities who are overwhelmed with
    more common fears. Clinicians might also have
    feelings. It may motivate patients to allow the
    patients rate the strength of the fear (e.g., on a 1-7
    controlled release of emotions, for example,
    scale).
    through the technique of dissociating affect and
    content (Hammond, 1988f; Hammond & Miller, in
    press; Erickson & Rossi, 1979).]
    Have you ever seen an old-fashioned pressure IDEOMOTOR FEAR INVENTORY FOR MPD
    cooker? My grandmother used to have one. You PATIENTS
    would latch it shut, and turn up the heat, and the
    bubbling water and steam inside created "Is anyone inside afraid of . . .?" [Patients not
    tremendous pressure. After a while, some of that diagnosed as MPD may be asked, "Is any part of
    pressure had to be released or something would you afraid of . . . ?"]
    burst.
    Right now you're experiencing tremendous 1. Heights
    pressure, from all the feelings inside. And it's 2. Doctors
    important for us to use a safety valve to release that 3. Dentists
    pressure, gradually, safely, in a protected and 4. Stars
    controlled way so that no one is harmed in an 5. Speaking in Public
    explosion of emotions. 6. Fire
    7. Being teased
    8. Knives
    9. Crowds
    A Projective Ideomotor Screening 10. Blood
    11. Sudden noises
    Procedure to Assist in Early 12. Being criticized
    Identification of Ritualistic Abuse 13. Being photographed
    Victims 14. Dying
    15. Large open spaces
    D. Corydon Hammond, Ph.D. 16. Candles
    Salt Lake City, Utah 17. Sick people
    18. Feces
    It is certainly well-known that many MPD 19. Dogs
    patients have a variety of fears and phobias, many 20. Cats
    of them stimulated by the nature of their traumatic 21. Animals being hurt
    experiences. It is the experience of many clinicians, 22. Robes
    however, that MPD patients who are victims of 23. Being in an elevator
    ritualistic abuse often have very idiosyncratic fears 24. A certain color (specify)
    and phobias. As a tentative clinical tool for which 25. Sight of deep water
    there is currently no data on reliability or validity, I 26. Rope
    have 27. Colored rope
    28. Certain animals
    29. Fences
    348 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    30. Masks 47. People in authority


    31. Eating certain things (specify) 48. Certain numbers (specify)
    32. Birds 49. Goats
    33. Enclosed places 50. Horses
    34. Coffins 51. Cows
    35. Airplanes 52. Digging in the dirt
    36. Red meat 53. Snow
    37. Lightning 54. People with a missing finger
    38. Being shocked 55. People with a deformity
    39. Being ignored 56. Nude men or women
    40. Cemeteries 57. Taking a test
    41. Crying 58. Halloween
    42. Crossing streets 59. Clouds
    43. People in a circle 60. Winter or summer solstice
    44. Snakes 61. An eclipse of the sun
    45. Spiders 62. The equinox
    46. Journeys by car
    HYPNOSIS WITH SEXUAL
    DYSFUNCTION AND
    RELATIONSHIP PROBLEMS

    INTRODUCTION

    HE FIRST SECTION OF this chapter will present suggestions and metaphors


    for use in the treatment of sexual dysfunction. I have included many suggestions
    that I use in sex therapy since, unfortunately, very few suggestions were received
    from other clinicians. Although there are two volumes (Araoz, 1982; Beigel &
    Johnson, 1980) on this topic that describe useful procedures, there are very few
    actual suggestions modeled in the literature. The latter portion of the chapter
    provides suggestions that may be used in couples or family therapy and in general
    to enhance interpersonal relationships.

    Hypnotherapy with Sexual Dysfunction

    Far too many therapists with a superficial knowledge of sex therapy techniques
    (e.g., sensate focus exercises, the "squeeze" technique) have been willing to treat
    dysfunctional patients. An elementary knowledge of traditional sex therapy or
    hypnosis techniques that has been gleaned from a book or brief workshop is
    inadequate preparation for ethical practice. The hypnotherapist wishing to treat
    sexual dysfunctions must first master an extensive and complex body of literature
    on the evaluation of sexual disorders (Kaplan, 1983; Kolodny, Masters &
    Johnson, 1979; Krane, Siroky & Goldstein, 1983; Schover & Jensen, 1988;
    Wagner & Green, 1981). Afterwards, NIMH sponsored ethical standards
    mandate 50-100 hours of

    349
    350 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    advanced supervision in sex therapy (Masters, Johnson, & Kolodny, 1977;


    Masters, Johnson, Kolodny, & Weems, 1980) to hold oneself out to the public as
    qualified to work with such referrals.
    It should be noted that even well trained sex therapists are now finding the
    successful treatment of sexual disorders to be much more challenging than was
    originally believed. Initial reports (e.g., Masters & Johnson, 1970) in the field of
    sex therapy suggested an extremely high success rate. But recent effectiveness
    studies of behaviorally oriented sex therapy (DeAmicis, Goldberg, LoPiccolo,
    Friedman, & Davies, 1984) and surveys of certified sex therapists (Kilmann,
    Boland, Norton, Davidson, & Caid, 1986) have documented lower success rates
    than were originally suggested (Heiman & LoPiccolo, 1983). Methodological
    flaws have also been pointed out (Zilberg-eld & Evans, 1980) in the work of
    Masters and Johnson (1970; Schwartz & Masters, 1988) that cast further doubt on
    the validity of the high success rates reported for their traditional approach. Sex
    therapists are struggling with difficult cases and finding that their traditional
    approaches are, in many cases, unsuccessful or only partially successful.
    This seems due, at least in part, to the increased incidence of cases of inhibited
    sexual desire (ISD). This is a term originated by Lief (1977) to describe a
    syndrome that he and others (Frank, Anderson, & Rubinstein, 1978; Kilmann, et
    al., 1986; Lief, 1985; LoPiccolo, 1980; Schover & LoPiccolo, 1982) find is the
    most widespread sexual dysfunction. Recent estimates suggested that 50% or
    more of sex therapy clinic patients have the diagnosis of ISD (Shover &
    LoPiccolo, 1982). And yet this is perhaps the most complex and least successfully
    treated sexual complaint (Kaplan, 1979; Leiblum & Rosen, 1988; Zilbergeld &
    Ellison, 1980), typically requiring a greater number of treatment sessions than
    other dysfunctions (Kilmann et al., 1986; Leiblum & Rosen, 1988). It seems often
    to involve problems with communication and intimacy, traumatic sexual
    experiences, and negative parental models (Stuart, Hammond & Pett, 1986,
    1987).
    Since ISD is exceptionally widespread and traditional sex therapy highly
    limited in treating this problem, we perceived an increasing need for more
    effective treatment protocols. Hypnosis has been used in the treatment of sexual
    problems for a long time. Almost 50 years ago, Erickson and Kubie (1941)
    provided us with the earliest known case of the successful treatment of ISD with
    hypnosis. Hypnotic interventions with sexual dysfunctions (Araoz, 1980, 1982;
    Crasilneck, 1979, 1982; Hammond, 1984b, 1985c; Zilbergeld & Hammond,
    1988) seem to hold considerable promise in sex therapy, although the literature
    consists exclusively of case studies and outcome reports on series of patients.
    However, a recent survey (Kilmann et al., 1986) indicates that the potential of
    hypnosis remains largely untapped by certified sex therapists, only 7% of whom
    use hypnosis in their clinical work.

    ADVANTAGES OF HYPNOSIS IN SEX THERAPY. The use of hypnosis in sex therapy has
    several unique strengths to recommend it. Hypnosis may be used in the treatment
    of the individual patient without a partner. Relatively few treatment options have
    typically been available for the single patient or those without cooperative
    partners, particularly if the therapist does not use sexual
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 351

    surrogates. Interestingly, the largest and most extensive follow-up reports on the
    use of hypnosis with sexual dysfunction have been on individual patients
    suffering with erectile dysfunction (Crasilneck, 1979, 1982). Crasilneck reported
    follow-ups on a larger number of impotent patients than any other sex therapy
    researchers, including Masters and Johnson, and with comparable outcome rates
    to those of Masters and Johnson (1970).
    Hypnosis also offers techniques that allow rapid exploration and identification
    of underlying conflicts, unresolved feelings about past events, and factors beyond
    conscious awareness. For example, many patients have reported in an initial sex
    history that they had never experienced incest or sexual molestation. Later,
    however, early childhood sexual abuse was uncovered through the use of
    hypnosis. There are additionally times when adaptive functions are being served
    by sexual dysfunctions, of which the patient has only limited or no conscious
    awareness. A dysfunction, for instance, may serve as a way of protecting the
    patient against a fear (e.g., of infidelity), of punishing the self for past
    misbehavior, or of expressing anger toward a partner.
    Learning self-hypnosis may provide patients with a sense of self-control and a
    technique for stress management. Physical and mental tension and fatigue often
    inhibit sexual interest and performance capacities. Some patients need a method
    for mentally "changing gears" and making a transition from a hectic day to being
    able to focus on sensual involvement. Self-hypnosis provides them with such a
    skill for anxiety reduction and decompression, as well as for the arousal of sexual
    passion through sexual imagery prior to sexual involvement.
    Discouragement is a factor too often overlooked in sex therapy. Many patients
    simply no longer believe that they will ever be able to experience passion and
    interest or to perform adequately. However, perhaps due to the popularized
    images of hypnosis as mystical, some patients come to therapy with a belief that
    hypnosis can do for them what they cannot do for themselves: promote change.
    Hypnosis may be used to provide hope, increased feelings of self-efficacy
    (Bandura, 1977), and confidence that change can occur. "Trance ratification"
    procedures can convince patients of the power of their own mind and of hypnosis
    to help them. When patients feel an arm levitate and float up involuntarily, they
    are often convinced that this thing called hypnosis may, in fact, be capable of
    doing something for them. Similarly, when a glove anesthesia is created in a hand
    so that a needle may be painlessly put through a fold of skin on the back of the
    hand, patients are convinced that they have more potentials than they realized and
    that perhaps their mind is powerful enough to stir sexual desire, facilitate orgasm,
    or create erections.
    We are well aware that some patients are endowed, either through heredity
    and/or early life experiences, with exceptional hypnotic capacity. For individuals
    with these native capacities, hypnosis can be an extremely powerful tool. When
    patients possess the capacity to focus and use their minds so powerfully, it seems
    a shame not to utilize their unique talents.
    Hypnosis also offers us a variety of techniques for altering problematic
    emotions and increasing desired emotional states. Symbolic imagery techniques
    often allow patients to release pent-up feelings like anger and
    352 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    resentment, without further harming the relationship with the partner. For
    example, such a patient may experience himself gradually smashing a huge
    boulder in the mountains while simultaneously venting his angry feelings. Other
    patients may imagine breaking through a barrier, discarding old parental
    messages that evoke negative emotions, or placing feelings of guilt in the gondola
    of a hot air balloon and watching it float away. The chronically fatigued patient
    may imagine an energy transfusion or withdraw to a serene place in self-hypnosis.
    The master control room technique, found at the beginning in this chapter, has
    proven surprisingly effective in stimulating feelings of sexual desire, particularly
    after roadblocks to desire (e.g., relationship problems) have been removed.
    In the treatment of secondary dysfunctions (e.g., inhibited sexual desire,
    erectile dysfunction), hypnotic age regression may revivify memories that help
    rekindle and recapture positive sexual and affectional feelings. Hypnosis and
    self-hypnosis can enhance the patient's ability to focus attention and increase
    sensory awareness, thereby facilitating increased arousal and pleasure. Hypnotic
    techniques can also aid in elucidating internal (cognitive, imagery) processes that
    are impossible to observe and difficult to explicate through discussion alone.
    Occasionally, for instance, spouses report a very unpleasant experience with
    assigned tasks like sensate focus, but they are unable to explain why or provide
    details about thoughts or images that may have interfered. Through hypnosis
    patients may be regressed to the sexual date several days earlier; as they mentally
    relive the experience, the suggestion may be offered, "Everything that you are
    thinking, mentally picturing, and experiencing, just say out loud." Patients are
    often able to provide details of what were elusive and unavailable internal
    processes.

    LIMITATIONS OF HYPNOSIS. Despite the many advantages of hypnosis, hypnosis is


    not a panacea and is frequently most effective when combined with other
    therapeutic methods. Although I use hypnosis with considerable frequency, I do
    not rely on or advocate the unitary use of hypnosis. As with any single treatment
    modality, there are also some limitations and cautions in the use of hypnotic
    techniques in this area.
    First, hypnotherapists may experience the temptation to overemphasize an
    individual focus for treatment, neglecting important relationship factors that may
    be involved. Individual psychotherapy has been known for many years to have the
    potential to evoke pathological reactions in the untreated spouse (Kohl, 1962),
    and deterioration in the marital relationship appears to be a greater risk in
    individual marital therapy (Gurman & Kniskern, 1978a, 1978b). We find in sex
    therapy that, unless individually focused hypnosis is used in a context that
    involves the partner in assessment and in at least part of the treatment, there is a
    risk that some patients may feel singled out as the "identified patient," and
    relationship factors may be neglected. It is recommended, therefore, that the
    partner be included from the beginning in assessment. When I do individual
    hypnotic work, the mate is typically involved in behavioral assignments
    afterwards. If the individual work requires more than three or four sessions, it is
    further recommended that a conjoint session occur for one-half hour or an hour
    each month to maintain
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 353

    the spouse's feeling of involvement and input. The temporarily uninvolved


    partner is also encouraged to call between conjoint sessions if an individual or
    conjoint session is desired and/or to send feedback through the spouse. It should
    also be noted that spouses may sometimes be present during hypnotic work. Some
    patients will feel self-conscious, as though they have an audience, and prefer not
    to have the spouse in attendance. However, occasionally a patient will feel more
    secure having his/her mate present. Inquire about this matter and respect the
    feelings of the patient. When a partner witnesses an age regression to a negative
    past experience(s), he/she will generally be more empathic and supportive of the
    mate. Some hypnotic techniques also focus on both partners simultaneously, such
    as mutual hypnosis. Both mates may also be age regressed to a wonderful
    experience, or the technique of pseudo-orientation in time into the future may be
    used to have them share a fantasy of having beautiful sexual experiences together.
    On the other hand, if the patient is being taught to enter a self-hypnotic state and
    create sexual fantasies to facilitate sexual desire, and the fantasies are about
    partners other than the spouse, an individual session will be desirable.
    Variations in the native hypnotic talent level of patients provide an inevitable
    limitation to hypnotic work. Thus the 5%-10% of patients who either cannot or
    will not be hypnotized and realistically the other 10%-15% of patients who enter
    only very light trance states will be limited in their hypnotic capacity and unlikely
    to benefit from such treatment. Furthermore, even after being educated about the
    nature of hypnosis, a very small number of patients will not want to be hypnotized
    because of the widespread misconceptions about hypnosis. Thus hypnosis is like
    any other therapeutic technique: it will not be effective with everyone. Finally, we
    should note, once again, the need for controlled research in this area to accurately
    investigate the potentials of hypnotic treatment of sexual dysfunction.

    Hypnosis with Interpersonal Problems


    In the final section of the chapter you will find a variety of suggestions focused
    on relationships with spouses, families, and others. Although we cannot directly
    control the reactions of another person, hypnosis may be an aid in fostering
    healthier interactions with others and healthier perceptions of relationships.
    Hypnosis may also serve a number of functions in couples therapy. For example,
    it may be used to work through resistance and overcome stalemates in therapy.
    Hypnosis may assist in resolving problematic emotions, such as anger and
    resentment. Hypnotic exploration can uncover the hidden goals and unconscious
    expectations behind interaction patterns, as well as promote insight into parataxic
    distortions rooted in experiences with the family of origin. Certainly, hypnosis
    may also be used in the service of individual treatment needs with one partner
    from a marriage, for example, in resolving past trauma or learning self-hypnosis
    to cope with premenstrual syndrome.
    354 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    HYPNOTHERAPY WITH SEXUAL DYSFUNCTIONS

    The Master Control what it's like to really want and desire something.
    Nod your head when you see the panels and the
    Room Technique dial.
    Now look closely at the panel regulating sexual
    D. Corydon Hammond, Ph.D. Salt
    desire and interest [arousal, erection], and tell me,
    Lake City, Utah what number does it look as though it's set on? Um
    hmm. Now reach over and take hold of the dial or
    INDICATIONS AND lever, and move it slightly, gradually. And as you
    do so, you're experiencing a different feeling. Be
    CONTRAINDICATIONS
    aware of that change in sexual desire [arousal].
    This technique was designed to be used in the [Brief pause] You may find it interesting to notice,
    treatment of inhibited sexual desire, ejaculatory how and where you begin to experience an
    increased desire [arousal]. [Pause] And now, as
    inhibition, orgasmic dysfunction, erectile dys-
    you get ready to turn the dial again, what number is
    function, and sexual addictions. It seems most
    the dial on? [Wait for response] And where would
    effective when hypnotic exploration has been done
    you like to turn it to? [Following response:] Okay,
    first to rule out or work through unconscious and as you turn the dial from (3) to (4), let me know
    conflicts or resistance to change. This method may when your body senses the difference.
    be easily adapted for application to eating
    disorders. [If resistance is encountered and the patient does
    not report an ideosensory experience, refer to the
    alternative phrasing for resistance section found
    SUGGESTIONS later in the script, and then return to the text
    below.]
    Now you are going to enter a very special room, Um hmm. And move the knob from______
    a nerve center, a control room in the hypothalamus to ____ , as you begin to experience the delight,
    part of your brain. This is the control room for all or perhaps the exhilaration, of the desire [arousal]
    your feelings and desires. As you find yourself in that's increasing. And those hormones are being set
    this room, notice all the panels of lights, lights of free, released, into your bloodstream, pulsing, and
    different colors. You may be aware of the sounds of flowing all through your body, and especially
    the computers, the temperature of the room, and concentrating in certain places. And you really
    perhaps even a distinctive smell. don't need to know how to do this, because you
    As you observe the banks of colored lights, you know that you know how at an unconscious level.
    can notice the different panels. There may be one And you may be aware of how those hormones are
    panel that regulates your appetite for food. And you stimulating sensations, very natural urges, and
    can notice another panel that regulates your level of feelings, in such a fascinating way.
    sexual desire and interest [or, arousal, erection]. Let me know when it's all right to increase the
    And on those panels you'll see a dial, or I wonder if dial one more level. [Pause for response] All
    it's going to be a lever, or perhaps some other kind right, turn the dial from_______ to _____ , as you
    of control that can be set from 0-10. Zero is the effortlessly begin to appreciate, and savor the
    level of no interest. Everyone has had the feelings of desire [arousal], circulating through
    experience of not being hungry. Sometimes you're you. And when would you like to increase the dial
    not interested in food, and not interested in sex. Ten one more level?
    is the level of strong desire or appetite. We all
    know
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 355
    NEGOTIATION, IDEOMOTOR changes are. They're almost imperceptible when
    COMMITMENT, AND POSTHYPNOTIC they first begin. And we really don't need to know
    SUGGESTION what's going on. It's kind of like sometimes when
    we're watching a television program, or when a
    movie is really exciting, you become very
    And would you like to increase the dial again, or
    absorbed and involved in it. And while you're
    leave it at this level? [Negotiate and allow the
    sitting there, wrapped up in the show, you're not
    patient to determine the level where the dial is set.
    noticing your body's response. And yet as the
    Ideomotor signaling may also be used to determine
    tension builds in the movie, your body also gets
    if it is acceptable with the unconscious mind to
    very tense and tight, and adrenaline is being
    leave the dial at its current level for the following
    released. And then, after while, when the
    two weeks to determine how that feels. When an
    excitement of the show is over, and everything has
    ideomotor commitment is obtained, reinforce the
    turned out well, you suddenly become aware of the
    commitment with posthypnotic suggestions. When
    sense of relief and release, and all those feelings
    a commitment is not obtained, the following kinds
    that you weren't even aware of. And these changes
    of suggestions may be given.]
    also begin subtly at first, as the hormones begin
    And you can feel relieved, and pleased, and their work, and the nerves become more alert. And
    perhaps even a pride in knowing that you'll now be it's really not important for you to fully sense these
    able to regulate the level of your own sexual desire changes, in this environment. [Now return to
    [arousal]. And you may choose to permit this turning up the dial, saying:] And you may or may
    change, so that you can leave it at either a not notice the physical and subjective feelings
    moderate, or even a high level. Or, you may choose associated with the hormones that are being set
    to allow your unconscious mind to modify it, free. [Return to the primary text above.]
    depending on the appropriateness of the
    circumstances. From now on, you can be so [Later, the resistant or less talented subject may
    satisfied, knowing that you can easily and be given the following types of suggestions:] And
    automatically adjust that dial to regulate your level I'm not sure just when, or where, you'll begin to
    of desire and interest [arousal]. You may find it detect the difference. Your unconscious mind can
    particularly surprising to discover, how rapidly bring about that awareness, of change, in a way that
    you can increase your level of sexual desire meets your needs. It may be that you suddenly and
    [arousal], when you snuggle against your partner. spontaneously become aware, that you feel urges,
    So that when he/she cuddles you, in a pleasant way, feelings, an impulse. Or, perhaps there will be a
    you can become aware of interesting sensations gradual growing sense of progressive changes, of a
    that develop, and flow. And as you snuggle, subtle, unhurried, natural evolution. And I don't
    pleasant sensations may spread more than you'd know if you'll recognize those changes tomorrow,
    anticipate, as you recognize, perhaps with some or Thursday, or next week. But in an interesting
    surprise, how rapidly you can increase your level way, you'll realize that you are changing, in your
    of sexual desire [arousal], when you're close to own personal way.
    your partner.
    [Still another optional suggestion that may be
    useful with a subject who resists turning up the dial
    significantly is to add:] And you can wonder, how
    soon it will be, until your unconscious mind has
    ALTERNATE PHRASING WITH prepared, so that you'll be able to move that dial to
    RESISTANCE a higher number, whenever you really want to.

    [When the patient does not notice feelings and


    sensations, you may suggest:] Isn't that
    interesting? That just proves how subtle those
    356 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Illustrative Suggestions in Sex and get just what you want, and enjoy the feeling of
    taking control, being the director of what happens
    Therapy to you.
    "Just as you have been focusing on sensation in
    Bernie Zilbergeld, Ph.D.
    the last few moments, engrossed in the feelings in
    Oakland, California your chest, so you'll be able to become focused and
    immersed in sensation when your wife caresses
    "The only important thing is the sensations you your arms and legs.
    experience. So focus where you're being touched. "Just as you functioned well and had satisfying
    Experience the texture, temperature, pressure and sex before your baby was born, so you'll be able to
    movement. Immersed in feeling and sensation. function well and have satisfying sex in the future.
    Nothing to do but to feel and experience the As it was before, so it shall be."
    pleasure.
    "It can be exactly as it was [name a time when
    things went well, e.g., before you moved to
    California; in Hawaii]. You can feel the same Hypnotherapy with
    feelings, experience the same sensations and
    pleasure, and function just as you did then. Psychogenic Impotence
    Everything can be just as it was in Hawaii. Just as Harold B. Crasilneck, Ph.D.
    much pleasure, just as much fun. Everything Dallas, Texas
    exactly the same." [This suggestion may be used in
    conjunction with mental rehearsal or age
    progression.] INTRODUCTION AND
    "I wonder if you know how really excited you CONTRAINDICATIONS
    can be, how truly, totally turned on, feeling arousal
    Crasilneck's (1979, 1982) reports on the treat-
    from your toes to your nose, in every nook and
    ment of patients seen for erectile dysfunction
    cranny of your being.
    represent the largest and most extensive follow-up
    "I wonder if you can find a way of enjoying this.
    reports on the use of hypnosis with sexual
    Some way of making it your own and enjoying it
    dysfunction. Crasilneck's (1982) outcome rate at
    for your own interests, growth and pleasure. Some 12-month follow-up for his last 100 consecutive
    people get into it because they like giving pleasure patients treated was 87% with an average of 10
    to their partners. Some people because they feel it's sessions. The return of good erectile function
    an important skill for themselves. Some because occurred on average following the fifth hypnotic
    they're curious about what they can learn. There are session.
    lots of ways of getting into this and enjoying it. I
    wonder what way you'll find. Hypnosis, particularly when combined with
    education of the patient and work with the spouse,
    "A man who can only give pleasure to his partner may be extremely effective with this condition.
    is halfway there. It's also necessary to be able to Hypnosis also has the distinct advantage of
    take pleasure for himself. To ask for it, direct it, dramatically expanding the range of intervention
    focus on it, luxuriate in it, and be totally immersed techniques available for treating the patient without
    in it. Learning to take and experience pleasure is so a cooperative or available partner. Despite Masters
    important to being a good lover. and Johnson's (1970) original claims that 95% of
    "You can't give up control until you have it, so erectile failure was psychogenic, recent research
    what you need to do is take more control. Ask for suggests that perhaps 40% of erection problems
    stimulation when you want it, and get it exactly, have an organic contributor (e.g., Krauss, 1983;
    precisely as you want it. Be in charge Spark, White & Connoly, 1980). Therefore, before
    proceeding with hypnotherapy it is vital for
    clinicians to
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 357
    conduct careful diagnostic workups on erectile he could do so with his penis. When the patient is
    dysfunction patients. Most physicians, including in a deep level of trance, the writer takes one hand
    urologists, do not conduct thorough and adequate of the patient and with the tip of a blunt nail file
    evaluations for this condition. Nocturnal penile gently touches the fingers, and includes all areas
    tumescence monitoring is perhaps the best single front and back of the hand, up to the wrist, saying,
    test for discriminating organic from psychogenic "The fingers, the palm, the back of your hand up to
    impotence. An adequate endocrine screen should the wrist will begin to lose feeling. Your hand will
    include evaluating serum testosterone, LH, FSH, feel like a thick electrician's glove. When you have
    and prolactin levels. Doppler studies may be achieved this loss of feeling, this anesthetized
    conducted to evaluate vascular involvement. feeling in your hand, nod your head." Then, during
    Finally, a fasting glucose tolerance test should be this trance state the writer requests that the subject
    conducted to determine if undiagnosed diabetes open his eyes. The writer says, "See what I am
    may be a contributor. In addition, Crasilneck doing. I am stimulating the middle finger of the
    (1982) has advised: "It is expedient and judicious anesthetized hand with this blunt nail file. The
    for the referring physician to realize that there are thick electrician's glove which envelops the hand
    certain individuals who should not be hypnotized prevents you from feeling any pain. Pressure, no
    and that there are contraindications to the use of pain. Pressure, no pain. Good. Now close your
    hypnosis with such people. The highly masochistic eyes. Normal sensation returns to the hand. All
    person, the extremely depressed male, the indi- normal sensations return . . . good. Now as you feel
    vidual with a psychotic history and/or the person me stimulate the middle finger, pull your hand
    with a background of severe conversion reaction. away. . . ."
    In such cases, the decision must be made between
    the referring physician and the hypnotherapist. The The writer then continues: "A deeper and a
    assessment and evaluation of the patient prior to the sounder, and a more relaxed state. The muscles in
    use of hypnosis is foremost in every case" (p. 56). your body are relaxed and at ease. Free from
    (Ed.) tension and tightness and stress and strain. You
    have just observed that you are capable of
    obtaining catalepsy and rigidity in your arm. You
    have just observed that you are capable of
    HYPNOTIC TECHNIQUE controlling the perception of pain in your hand, and
    WITH IMPOTENCY if one can control the cataleptic strength in a
    specific part of his body and control the perception
    As early as 1954, the author used hypnotic
    of pain in a specific part of his body, so may he
    induction and the suggestion of catalepsy [arm
    control the erection of his penis. You have
    rigidity] to one of the patient's arms, in order to
    complete control over every part of your body and
    demonstrate the control and strength his un- you can and will control the erection in your
    conscious mind has over this part of his body. The penis."
    patient is requested to open his eyes, feel the
    cataleptic arm with his normal hand (in order to The writer describes to the patient the
    prove that he had achieved this physiological psychology and physiology involved in an
    cataleptic rigidity), and is told that this power erection. "First there is the attraction and the
    which he displays over another part of his body foreplay." The writer holds up his index finger,
    could be easily transferred to his penis and squeezes it tightly and says, "Erection is a
    premature ejaculations. Then, the patient is asked combination of psychology and physiology. It is a
    perception of the love object, a response, a
    to close his eyes, told to enter a deeper level of
    stimulation, a gorging of blood and the trapping of
    trance, and that normal sensations would return to
    blood. Then following ejaculation the trapped
    the rigid arm. blood is released causing the penis to relax."
    Repeated suggestions are made that if the patient
    could achieve such rigidity in his arm,
    358 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    In such cases where premature ejaculation is a Suggestions for Spectatoring and
    problem, the patient is told, "As you were able to
    control the perception of pain in your finger, so can Sensate Focus
    you control the hypersensitivity in your penis
    which has caused you to ejaculate prematurely. D. Corydon Hammond, Ph.D.
    Your fears and anxieties will be less and you will Salt Lake City, Utah
    gain both intellectual and emotional insight into
    your problem."
    INDICATIONS
    Therapeutic sessions are weekly, thirty minutes
    per visit and on an individual basis. . . . The writer These suggestions were prepared for use in
    did not take as much of an authoritarian approach conjunction with assigning sensate focus exercises,
    in the first study as he did in his second and third and to reduce pressure and "spectatoring" in
    studies (1979 and 1981). It is now the writer's patients with orgasmic dysfunction, erectile
    opinion that such an approach is necessary in the
    dysfunction, ejaculatory inhibition, and inhibited
    treatment of psycho-genic impotency because the
    sexual desire.
    hypnotherapist transfers this dominant attitude to
    the patient who in turn exhibits authoritarian
    control over his own bodily functions. . . .
    SUGGESTIONS
    The impotent patient is encouraged by the writer
    to make every attempt to divulge his innermost, As you're touched, you may notice there are
    secret and cloistered sexual fantasies, not only to times, that you begin watching yourself, almost as
    the therapist but also to his partner. That is, "What though you were a spectator across the room,
    sexual fantasies turn you on more than anything curious to observe what's happening. Much like
    you can think of?" when we sort of observe ourselves when doing
    The patient is allowed the freedom to discuss all some new activity [individualize: like being
    his libidinous feelings concerning his heretofore consciously aware of a golf or tennis swing, or in
    internalized, suppressed sexual caprices and driving a car with a different type of gear shift than
    encouraged to share these thoughts and feelings we're used to]. Whenever we begin a process of
    with his sexual partner. Many times he requests change, many people feel a little nervous or
    that his partner join him for a session or two, so that embarrassed, and as a result it's really quite natural
    he may discuss these visionary fancies with his to briefly take the role of a spectator. But this will
    partner, while experiencing the supportive pass easily, and you can look forward to refocusing
    presence of the writer during the session. In most your attention back onto this body, and its pleasant
    instances the patient has had complete trust and sensations, and just effortlessly become absorbed in
    faith in his sexual partner to a point of mutual the feelings.
    regard and respect for each other's feelings and
    welfare, because to this date only a few partners Whatever pleasant sensations you're aware of,
    have been unwilling to participate in the subject's you can just explore them and allow them to
    fantasies. In some cases the sexual partner, too, has continue, giving yourself plenty of time. And when
    revealed her own lascivious longings. . . . you feel pleasure or arousal for a few moments, and
    then lose those sensations, this is all right too. That
    The verbal expression of sexual fantasies by the is very normal and natural, especially when you're
    patient is an important phase of treatment and the learning, to notice and appreciate such sexual
    expressions of such fantasies are encouraged. feelings. And I wonder how you can focus on the
    Whenever feasible the therapist encourages the feelings at the place where you are being touched.
    patient to bring these desires into reality with his Allow your attention to remain on those feelings. If
    sexual partner. your thoughts momentarily wander, gently
    bring
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 359
    them back to your physical sensations, and scious mind can automatically take care of
    follow your partner's touch with your mind. everything for you, freeing you to just relax and
    And as you do so, just enjoy this opportunity, for enjoy yourself. So you don't need to push the river,
    you to discover and rediscover, the sensations, the it will flow all by itself. So just let the goals be fun
    fun, the pure pleasure of touching. And you really and pleasure. You can allow yourself to just get
    don't need to wonder about his/her reactions, involved and participate in that pleasure, and your
    because he/she will tell you if anything is unconscious mind will take care of all the rest. And
    unpleasant. So that leaves you free to just playfully if occasionally your mind wanders, that's just
    touch him/her in ways that are fun, and interesting natural, and you can just wait and see where it
    for you, and you can just use his/her body for your wanders to, and how it gently comes back to the
    enjoyment. pleasure. Just gently, and patiently, go back to
    There are so very many ways, that you've already enjoying and paying attention to your body's
    learned how to trust your unconscious mind. If you sensations, comfortably engrossed, satisfyingly
    allow it to do its job, it takes very good care of you. absorbed in the pleasure from your body, savoring
    Each day, you speak and just say things each touch.
    spontaneously and automatically, without
    consciously having to think about how to
    pronounce each word or each syllable. In a similar
    way, without consciously having to think, your SUGGESTIONS FOR SEXUAL AVERSION
    unconscious mind is continually regulating the PATIENTS GIVEN SENSATE FOCUS OR
    flow of blood through thousands of miles of MASTURBATION ASSIGNMENTS
    arteries and capillaries, to tissues and muscles that
    need the blood and its nutrients, causing chemical
    and nerve changes to close the right, appropriate Perhaps you will, be aware, of several different
    capillaries, and open others. Simultaneously, it feelings. You don't have to experience arousal. It
    may be opening and closing the retina of your eye, isn't even necessary, to be aware of pleasurable
    adjusting to the light, while at the same time it is feelings right now. It's all right to just experience,
    monitoring your blood levels of numerous whatever you experience. And I think you'll be
    hormones, and releasing more, when it's necessary. pleased to discover, and you can learn, that there's
    nothing to bother you or disturb you. And some
    Without any conscious thought, your uncon- things may feel familiar, and some things may feel
    scious mind coordinates 650 muscles, and more new and unfamiliar, and that's all right. That's the
    than 100 joints in intricate ways, so that you can way we grow and develop. For now, you can just
    walk, and maintain balance, without requiring any concentrate on places that feel different from other
    conscious thought about how far apart to place places, and notice the distinctive sense of different
    your feet, or which muscles to move. Your types of touch. And I really don't know what you'll
    unconscious mind takes care of all that, notice, and it doesn't really matter to me. You may
    independently. Consciously, you don't know how be aware of textures, and differing pressures. You
    to will your body to perspire. But throughout each may also be aware of warmth or comfortable
    day, your unconscious regulates the temperature of coolness. You might even notice dryness or some
    your body, through creating perspiration just when moistness. And I wonder what you'll learn about
    it is needed. the meaning of those things as you feel them, and I
    wonder how you're going to feel about what those
    I wonder whether you really need to put so much things mean. Some things may feel soothing, and
    pressure on yourself? Maybe not? You've already others more restful. Some relaxing, and some
    learned that trying to help with your conscious unusually interesting.
    mind, and worrying about how you're doing, will
    only interfere with your pleasure. Please
    recognize, that your uncon-
    360 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    OTHER POSTHYPNOTIC SUGGESTIONS
    SUGGESTIONS
    If at times you find that your mind is wandering
    And as more and more skin is exposed, your skin elsewhere during sex, that may be a good time, to
    can feel more and more tantalizingly alive. direct those thoughts so that your mind can drift off
    to a memory, or perhaps a fantasy, of something
    And as you sense his/her increasing arousal, you
    very arousing. So when you notice stray thoughts
    can feel more and more aware of the stimulus,
    which is stimulating in itself. As if somehow, the distracting you, you can use that as the time, for a
    sounds and movements of his/her arousal are very sensual, a very vivid, a very enticing
    contagious, and are causing a warm flush to pulse daydream to just kind of flow into your mind.
    and flow to your genitals. And it's like every rush of And I don't know if that image will be from a
    circulation, every movement of pleasure, increases movie you particularly liked, or from something
    your excitement. you've read. Perhaps you'll find yourself picturing
    an especially erotic scene, noticing the sensual way
    And when he cuddles you, in a pleasant way you
    a couple kiss, [pause] the way they lovingly caress
    can become aware of the interesting sensations that
    each other, [pause] how they begin to gradually,
    develop and flow. And as you snuggle, pleasant
    seductively remove clothes. You feel as you
    sensations can spread —it's really fascinating — so remember what you're observing them doing.
    much more than you'd anticipate. Perhaps playfully, seductively teasing each other,
    Learn to trust your body. It doesn't need your or tenderly beginning to explore the other's body,
    help; it knows what to do, so stop trying to help, and with lips, with fingers. Maybe noticing them
    just relax and enjoy. It isn't necessary to help, it can beginning to move and responding to the pleasure,
    do it all by itself. So just remember that there is no the sounds of pleasure you hear, the tender, loving
    way that you can fail, because the goal of sex is things said to each other.
    pleasure and sharing closeness.
    On the other hand, it's fine and fun to know that
    when stray thoughts distract you during sex, you
    don't need a movie of others. You may have some
    vivid memories of your own, that can come freely
    to mind; sensuous, erotic experiences you shared
    Suggestions for Facilitating with someone in the past, or that you wish you had
    Sexual Fantasy shared with someone. [Pause] And you can
    become deeply involved and absorbed in those
    memories, in enjoying the excitement of the
    D. Corydon Hammond, Ph.D. Salt interaction, feeling what you know how to feel and
    Lake City, Utah felt then, experiencing the excitement and
    pleasure. Memories can be so real. Many people
    can sense the texture and gentle softness of skin,
    INDICATIONS silky and smooth; the feel of warm, pleasant
    curves, and the sensations of soft hair; hearing
    breathing, whispered words, sighs of pleasure. And
    In traditional sex therapy, patients with per- it may be that you are even aware of the pleasant
    formance dysfunctions are encouraged to absorb fragrance of cologne or someone's hair, along with
    themselves in sexual fantasy when they are unable the mounting pleasure and excitement.
    to attend to sensual sensations in the present
    moment and they begin to engage in spectatoring. At other times when your mind begins to
    These suggestions may facilitate this process and wander, it could be fun to allow your unconscious
    make it more automatic. mind to get involved in a fantasy,
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 361
    knowing something you might particularly enjoy. vicariously enjoy some perhaps forbidden plea-
    And I wonder if it might involve someone else, or sures, in an exciting but safe way. And it's your
    perhaps be about the fun of making love in a partner who really reaps the benefits.
    different place. I don't know. 1 wonder whether
    your unconscious will decide that it will be a
    quicky, a brief image, or an involved, creative
    story; if it will be more sensual, or if it will be an Changes in Preference
    elegant kind of romantic adventure. But it really
    doesn't matter. Doesn't matter at all. All that Metaphor
    matters, is that you enjoy this gift, from your
    D. Corydon Hammond, Ph.D. Salt
    unconscious.
    Lake City, Utah
    So during sex, whenever you notice your mind
    wandering elsewhere, and you think you might
    become distracted, that's the reason that it's time, INDICATIONS
    for you to find very erotic, very sensual images
    coming into your mind. And you can be satisfied, This metaphor may be used with cases of sexual
    with the good effects these fantasies will have on aversion or inhibited sexual desire. It may also be
    your sexual relationship. useful whenever you need to create a belief that
    change is possible, and that it can occur
    autonomously. Rather than simply being a
    OTHER SUGGESTIONS concocted story, this illustrates a metaphor built
    around almost universal truisms that the vast
    FACILITATING FANTASY
    majority of people have experienced and cannot
    And his/her touch will probably remind you of deny. Commas have been used to encourage
    other experiences. And that's all right, to just appropriate brief pauses, and italics are used to
    remember, really remember. Images of someone suggest words to be very slightly emphasized
    from long ago, images of something very exciting, which generally contain implications and
    embedded suggestions.
    can just come washing over you, when (name)
    begins to intimately touch you. As if, his/her touch
    is the signal, for your unconscious mind to
    spontaneously, automatically, remind you of your THE METAPHOR
    passionate, erotic experiences.
    Most of us have some foods we like better than
    And when she touches your penis [or, when he
    others. I can recall when I was a child, I loved
    kisses you], you can be surprised and pleased to certain foods. I remember how much I just loved
    find very sensual, erotic memories beginning to pancakes, and the smell of hot, fresh pancakes
    come, into your mind—exciting, sexual pictures cooking in the morning. And umm, after that
    that can absorb much of your attention. [Use warm, sticky feel of the syrup, a glass of cold milk
    repetition of these suggestions.] tasted so good. And I recall the warm, comfortably
    full kind of feeling after eating them.
    SUGGESTIONS NORMALIZING I don't know, when you were a child, what foods
    FANTASY FOR THE INHIBITED you liked. But you certainly remember, maybe not
    all of them, but some of them. I don't know, for
    PATIENT
    instance, if when you were a child, you liked eating
    Using fantasy is one way you can take re- pancakes, or pizza, or even strawberries. Maybe
    sponsibility for your own pleasure, instead of there was a particular food that you liked very
    expecting your partner to do everything. And of much. [Pause] I wonder how you are able to
    course, people never actually do most of the things remember as a child, smelling the aroma, or seeing
    they fantasize about, but they can still that food
    362 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    before you. Do you remember the taste of that food, time, we aren't even quite sure exactly how or when
    the texture of it in your mouth as you relished it? those changes came about. But one thing that we
    Perhaps you remember the tingly juiciness of can be sure of, is that we will continue to change
    strawberries, and that feeling on your tongue. Or and to grow. Change is just a very natural part of
    maybe you'd rather recall the crunchiness of fresh life.
    carrots out of the garden. For a moment, maybe you
    can just really enjoy the real memory of your
    favorite childhood foods again. [Pause]
    Most of us as children, also had some foods that Metaphors for Going Out to Dinner
    we disliked. I can recall as a child, how I hated and Back Scratching
    several kinds of foods. I didn't like peas, and at that
    time I hated clam chowder and enchiladas. I was D. Corydon Hammond, Ph.D.
    turned off by all salads, and mushrooms, and yuk, Salt Lake City, Utah
    the thought of eating a lobster or clam was
    repulsive. I'm sure you can remember some of the
    different foods that you disliked. [Pause] INDICATIONS
    There were so many things then, that I didn't This metaphor conveys the message that it is
    like, to eat. But you know, it's interesting, even
    vitally important to take responsibility for your
    surprising, how dramatically our tastes and
    own sexual pleasure through communicating with
    preferences can change. Some of the foods that you
    your partner. It may be useful when patients have
    avoided and disliked as a child, can be enjoyed as
    an adult. And what I notice now, is that the taste of problems with orgasmic dysfunction, erectile
    an enchilada, and the slipperi-ness of a clam, seems dysfunction, or ejaculatory inhibition. It may be
    different. I'm not sure how; I just know that, it's equally valuable for sexual enhancement with
    different. And we learn that what was unappealing, normal couples or individuals, and in modified
    can become really pleasant and delicious. form to encourage general assertiveness instead of
    mind reading in relationships.
    And I guess that's because it's a part of nature, as
    we are continually growing and changing.
    Remember as children, we couldn't imagine how SUGGESTIONS
    our parents could enjoy watching or listening to the
    news. It had no appeal to us then, but later, that You may enjoy just allowing your mind to drift
    changed. As a child, you can probably remember back to an evening when you and your partner
    some television shows that you had no interest in. (spouse) went out for dinner, to an especially nice
    [Pause] Many of us just couldn't understand how restaurant. Perhaps you recall arriving at the
    anyone could enjoy a movie that was romantic. A restaurant together, and how it looked, possibly
    love story had no appeal to us then. We had no aware of the smell of the food outside or as you
    desire, to see it. At the time, it seemed boring. But entered. And can you kind of remember the details
    certain types of programs which once seemed of the restaurant, perhaps aware of the sound of
    uninteresting, as we changed, can become silverware and glasses, the sound of people talking
    enjoyable. in the background, of being taken to your table, and
    And it was the same with certain kinds of noticing the things around you, near where you're
    movies, and with certain kinds of music. [Pause] sitting. And perhaps you can recall looking over
    We couldn't have imagined it at the time, but we the menu, seeing the different selections, and their
    have changed, in many ways that we could have prices. Some of the entrees probably don't sound
    never predicted. And most of the very inviting, but there are likely several things that
    appear very appealing. And at times
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 363
    like this we often talk, and look around, until up and down. Sometimes in just one place; other
    finally the waiter or waitress comes to take the times with very long strokes. And when you have
    order. an itch, and you guide them in just the right way, to
    Have you ever noticed how when the waiter or just the right spot, it feels so good. But of course
    waitress comes, you just tell them what you'd like? he/she can't know, unless you tell him/her. Even
    You don't even have to think about it, you just say though he/she wants to please you, he/she needs
    what it is you've decided you'd like. Now I'm sure you to tell him/her, somehow. If not by telling
    that your husband/wife knows what you often like. him/her verbally, then by the way you move.
    But your tastes can be different from night to night. Sometimes you can guide someone with your
    You don't really feel like liking the same thing hand, and sometimes you guide them just by being
    every night. And you probably, don't think much,
    able to move your body.
    about giving your order for what you want to eat. I
    And it would be really, really nice, for you to
    suspect you really wouldn't want your
    remember, that you are really the world's authority
    husband/wife to be the only one to see that menu,
    and to then place an order for you, making the on only one thing. You are the world's authority on
    assumption that he/she knows what you want, yourself, and on what's natural for you. You are the
    without consulting you. Because you both know best teacher about what you want, and what gives
    that he/she can't read your mind. you pleasure, and what will make you happy at any
    particular time.
    And so you just naturally take the responsibility, And so sexually [or, in your marriage] . . . [And
    for getting the kind of food that will satisfy your now make the bridging association to the patient's
    tastes and desires. It's just second nature. We've all specific problem.]
    learned to speak up, and you express your desires
    and indicate what will satisfy your preferences that
    particular evening. Because, after all, your
    husband/wife can't magically know what you want Organ Transplant Metaphor
    and desire from night to night. You're going to get
    tired of the same thing. Anyone would get tired of a D. Corydon Hammond, Ph.D. Salt Lake
    diet of steak every night, and so sometimes lobster City, Utah
    or Chinese food is just what you're ready for, and
    sounds much more appealing. So of course it's INDICATIONS
    perfectly all right, completely natural, to help your
    husband/wife, so that he/she knows what it is you'd This is a metaphor that may be used in
    enjoy on different evenings. overcoming sexual myths and misinformation. It
    may also be used in correcting self-defeating
    There are lots of other situations when you really
    have to do the same kind of thing. You know that introjects associated with nonsexual problems.
    when you have an itch on your back, and you can't
    quite reach it, you don't expect your partner to SUGGESTIONS
    know, unless you tell him/her. And of course, even
    when he/she knows you have an itch, he/she may Some years ago, they began doing organ
    not be able to find the right spot. So he/she needs transplants, putting hearts and kidneys into people
    you to guide him/her. And sometimes you want who needed them. What they began to discover
    him/her to rub hard, and at other times you just was that when a foreign object, from someone else,
    want him/her to scratch lightly. There are times was put into another person, that person's body
    when it may feel better to be scratched back and would accept it, for a time. But then, after a while,
    forth, and sometimes you want him/her to rub his body would recognize it as not being his own,
    and the immune system would reject it.
    364 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    In a very similar way, as children, with limited found in their urine, they might have their
    discrimination abilities and limited experience, we parole revoked.
    often took in ideas that were given to us by our These men had urinated tens of thousands of
    parents and other people. They were someone else's times before, without ever thinking about it,
    concepts, but for a time, most of us accept them. without every questioning their ability to urinate.
    But later on, as adults, our mature unconscious But when one of us had to go into the restroom with
    mind finally recognizes these ideas as not being our them, to observe them urinate in a specimen bottle,
    own, as foreign, and something that doesn't really they often couldn't get their urine flow started.
    fit for us. And our unconscious mind can reject When they felt pressure to perform, they couldn't.
    those ideas, that were someone else's and may have The harder they tried to will it to happen, the more
    fit for them, but that later are recognized as foreign, they couldn't urinate.
    and that don't belong in us. And your unconscious
    We simply can't will our body to respond. It's
    mind can inwardly review, the ideas and concepts
    kind of like when we've stayed up too late one
    that you picked up from other people, and even
    night, and the harder we try to help ourselves go to
    without your full conscious awareness, can begin to
    sleep, the more wide awake we are. You can't will
    determine which of those are compatible, and
    yourself to perspire. And in a similar way, we can't
    which are alien to you.
    will an erection, or orgasm, or ejaculation. We
    simply have to allow it to occur ... to simply trust
    our unconscious mind, to know what to do, and
    how to do it. The more we try to help out, the more
    The Pee Shyness Metaphor for we interfere.

    Sexual Dysfunction
    D. Corydon Hammond, Ph.D. Metaphoric Suggestions and
    Salt Lake City, Utah
    Word Plays for Facilitating
    Lubrication
    INDICATIONS
    D. Corydon Hammond, Ph.D.
    This is a brief metaphor illustrating the concept Salt Lake City, Utah
    that we cannot consciously will sexual response,
    but must allow it to happen and trust the INDICATIONS
    unconscious. It may be used with performance
    problems such as erectile dysfunction, orgasmic These suggestions may be helpful for those
    dysfunction, and ejaculatory inhibition. female patients who have problems with sexual
    arousal and, in particular, in becoming lubricated.
    Such patients experience dyspareunia secondary to
    SUGGESTIONS the lack of lubrication. Commas have been placed
    to suggest brief pauses. [The author is indebted to
    Many years ago, I used to work occasionally Dr. Kay Thompson for her model and instruction
    with drug abusers who were on parole. A condition many years ago in the use of word plays.]
    of their parole was that they be in therapy, and that
    they be on urine surveillance. Twice a week they
    came to the clinic to leave a urine specimen. The SUGGESTIONS
    urine specimen would be mailed to a lab, and if I know and you know that you have been
    traces of drugs were experiencing some difficulty lubricating. But I
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 365
    wonder if you have ever thought about the many don't know we know. And I know that your body
    different kinds of lubrication? What you may not has the know-how, without your needing to know.
    know that you know, is that it's a very common And you have no notion of how to will your body to
    experience to find ourselves around some really do what it already knowingly knows how to do
    delicious food, and to notice that our mouth is with no effort. And you don't need to consciously
    involved in lubrication, because it's watering know. You've been saying no to a lot of things that
    involuntarily. It isn't something we think about. you don't need to no, and maybe it's time for you to
    When we're in the right circumstance, whether it's stop saying no, just so you can let yourself know
    food or whatever, it just happens. And everyone that you know things that you didn't know you
    knows that on a hot day, we will spontaneously knew.
    perspire, whether we expect to or not. It isn't And I wonder if it will surprise you, as you
    something that we can voluntarily control. It's just simply enjoy playfully touching and being
    an intrinsic, innate part of us. Certain things like touched, to discover that warm wetness. Because
    lubrication are just part of our natural make-up, the you will find that as your husband/partner
    way they flow. sensually touches you, and as you enjoy his body,
    And there are many things that we know and do, and just concentrate on the pleasure, that your body
    without knowing that we know or do them. For will respond all by itself. Just like on a warm day
    instance, one of the things that most of us don't when you spontaneously perspire, you will feel the
    realize, is that during a baby girl's first day of life, warmth between your legs, and the wetness. And
    without any conscious thought, even without any you will know what this lubrication means, what it
    sexual arousal, her vagina lubricated and became stands for in terms of your caring, and the
    wet, several times in fact. It's just sort of a natural playfulness, and the readiness, knowing that you
    body rhythm, that occurs in all women, each night don't need to say no to that knowledge.
    of their lives. And you haven't realized that each
    night since you were born, that you've lubricated.
    It's just a fundamental quality. Although you aren't
    consciously aware of it, your unconscious knows
    that last night as you slept, your body responded on
    its own, and about every 100 minutes your
    Suggestion for Ejaculatory
    lubricated, and became wet. Do you realize that that Inhibition or Orgasmic
    is about every hour and a half? You haven't realized Dysfunction
    that because you haven't had to pay any attention to
    it, because it just happens, and you've known how to
    lubricate all your life. D. Corydon Hammond, Ph.D. Salt
    Lake City, Utah
    And your mouth knows how to water in an
    appropriate fashion in response to food, and your
    body knows how to perspire. And there are many INDICATIONS
    reasons why you perspire. Sometimes you perspire
    when you are warm and overheated, and sometimes
    This suggestion is intended to reduce perfor-
    you will perspire with embarrassment. And you can
    mance anxiety and pressure in patients suffering
    lubricate in many situations, even when you don't
    with orgasmic dysfunction or retarded ejaculation.
    have the opportunity to do anything about it. Your
    The suggestion seeks to change the focus to when
    body has been doing it automatically ever since you
    orgasm will occur, instead of if it will occur. This
    were born. We really do know a lot of things we
    suggestion may be given in hypnosis while the
    patient is also being assigned traditional sex
    therapy tasks like sensate focus.
    366 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    SUGGESTION SUGGESTIONS

    And you're not really sure when you'll ejaculate I wonder what kind of an erection (how much
    (come) with her/him. Do you think you'll ejaculate wetness) you are going to have at first? Maybe
    (come) with her/him by (three days hence)? I don't there will be hardly any erection (lubrication) at all.
    and I don't think you or (part-ner's name) do either. More likely, you may (notice some wetness) have
    I don't expect that you'll come with her/him after an erection that comes and goes, or maybe you'll
    you come to the next session, and you probably even be surprised to notice a full hard erection
    don't either. After all, you've had this habit for a (how very wet you've become). But even if there's
    while. I think we agree on that. I don't know if hardly an erection, that's all right, because that's a
    you'll ejaculate (reach orgasm) by accident soon very important message from your body, that it's
    after two more sessions, or if you'll come soon after time to remember to enjoy the pleasure, and to have
    three more sessions. I really don't know, and neither more fun, trusting all the rest to your unconscious
    do you. Will it be earlier in an evening, or maybe in mind.
    the morning when you're not so tired, or will it be
    later in an evening when you're so tired that you're
    not thinking about it and it just surprises you? I'm
    not sure; you're not sure; your unconscious mind
    isn't sure. But we are in agreement that it's surely
    unlikely to happen for a while, just as it's sure to Suggestions for Impotence and
    happen after a while. So isn't it great that you can Anorgasmia
    just have some fun with each other, and just enjoy
    some pleasure together. Leo Alexander, M.D.

    ERECTILE DYSFUNCTION

    [Some patients are so overly worried about their


    Suggestion for Erection or partner's pleasure that their worry impairs
    Lubrication performance. Such individuals must receive
    permission to be temporarily selfish and to become
    absorbed in their own pleasure. The following
    D. Corydon Hammond, Ph.D. 5 a / t suggestion seems particularly designed for such a
    Lake City, Utah patient. (Ed.)] "Sex will be enjoyment, not a
    performance — pure enjoyment! No thought of
    performance at all! Please her out of the bedroom,
    INDICATIONS but in bed enjoy yourself!"
    "Performance applies to study and work, but to
    This is an indirect suggestion that covers all nothing else. ... In sex, enjoyment is primary. . . .
    possibilities, intended primarily for use with This will become easier for you, every day, every
    patients with erectile dysfunction. The suggestion week, every month, every year; you will achieve
    also reframes any erectile difficulty as a message enjoyable, automatic mastery. . . . You will
    and cue to focus on fun and pleasure, rather than countermand all negative ideas about performance.
    performance. It may also be useful in women with . . . Just enjoy her-don't perform. Touch, kiss, and if
    lubrication problems, and alternative phrasing for anything happens, let it happen."
    this (instead of erections) is included.
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 367
    ORGASMIC DYSFUNCTION surprising in their content. It may be that the dream
    will be like a romantic love scene, from a novel.
    [Once again, the following suggestion must be For instance, you might have a dream where you
    very selectively used with the woman who has are with your partner, and he's/she's saying very
    focused primarily on giving pleasure, rather than tender things to you, and very romantically
    learning to receive pleasure. She must learn to play seducing you. Perhaps the dream will involve
    at sex rather than working at it. (Ed.)] "First of all, people you know, or maybe some interesting
    you must please yourself. Please your man in any people you've been close to in the past. [Pause] I'm
    other way. Make him the most sumptuous not really sure whether you'll feel as if it's
    breakfasts, the most fabulous dinners, shine his happening to you, and be completely involved, or
    shoes, take his socks off, do whatever you want. if it will seem more as if you are intimately
    But in bed, please only yourself . . . Sex should be observing the very erotic scenes.
    pure enjoyment, without any thought!"
    But what I do know is that it's not unusual, for
    people I work with to have very exciting, very
    erotic dreams. It's a very common experience,
    because every night we just inevitably dream,
    Suggestions for Induced sometimes unknowingly, several dreams. And this
    is just a very natural process, that our unconscious
    Erotic Dreams mind uses, to work things through. It's been going
    D. Corydon Hammond, Ph.D. Salt on all our lives, will continue all our lives. It's just
    innate in you and in me.
    Lake City, Utah
    And because your goal is to increase your sexual
    desire, in all probability, you will have an
    INDICATIONS interesting experience tonight, while you're
    sleeping. I'm not absolutely sure about the
    These suggestions were formulated for patients
    particular night. I suspect it will be tonight, when
    with inhibited sexual desire or sexual aversion.
    you have the first erotic dream which you'll
    When such patients report that they experience remember, but perhaps your unconscious mind will
    nocturnal dreams, and especially when their value be inclined to wait until tomorrow night, or even
    systems discourage or prohibit the reading or the next night. I'd be somewhat surprised if your
    viewing of erotic material, these suggestions may unconscious waited until (e.g., Friday) night to let
    be of value. you remember an erotic dream, but I'm not really
    sure. I expect that it will very likely be tonight or
    tomorrow night, that you have a very sexually
    SUGGESTIONS stimulating dream, which is remembered. And
    perhaps you may have some doubts about it, until
    You already know how to experience stimu- you awaken one morning. And at first, I don't know
    lating dreams. And it's perfectly natural, following if you'll fully remember the relevant dream, or if
    the kind of work we're doing, to have some you will just sense and know that something is
    pleasurable dreams. And the dreams of the night different, even though you don't know quite what it
    are a perfect occasion, to sort through is that you know.
    understandings, and rehearse, preparing us for new
    experiences. And your unconscious mind has the And of course we're not responsible, for what
    ability to continue, independently, to work on occurs in dreams. The wonderful thing is, that your
    increasing your sexual desire toward (partner), unconscious mind not only helps you, but it also
    through the dreams of the night. protects you. Many times in the past,
    I don't know what you'll dream about, and you
    don't either. Dreams are often so creatively
    368 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    your unconscious has allowed you to forget parts of Suggestions with Sexual
    dreams after awakening. So even though you are
    not consciously responsible for the content of your Dysfunctions
    dreams, if part of a dream would make you too
    uncomfortable or embarrassed, you may just find it Don E. Gibbons, Ph.D.
    difficult to remember everything after awakening.
    You've had that experience many times. And that INTRODUCTION
    will be all right, because those dreams will have
    already served their purpose, of stirring sexual Gibbons (1979) uses the crystal gazing tech-
    feelings and desires and releasing hormones. And nique, one that was often used by Erickson, to
    those desires will be carried with you into your day, enable a patient to visualize the successful
    where they will appropriately influence your resolution to a problem in the future. It will
    thoughts and behavior. And even though you won't undoubtedly have the most impact on patients
    remember all your erotic and sexy dreams, in the capable of amnesia. As an alternative to a crystal
    mornings, you can still sense and know that ball, the patient may be asked to visualize a stage in
    something is different, even if you can't quite put a theater, a movie screen, or a television screen.
    your finger on precisely what it is. This technique is most likely to have applicability
    And you don't even have to believe that you're with dysfunctions where performance anxiety is
    going to have erotic dreams. One of the most involved, such as erectile dysfunction, ejaculatory
    interesting things about this is, that you don't even inhibition, orgasmic dysfunction, or perhaps
    have to believe it's going to happen. In fact, it may premature ejaculation. Ideomotor signals may be
    even be fun for you to doubt that you're going to obtained from the patient to track their progress and
    have such a dream, because if you didn't have a experience of scenes. {Ed.)
    doubt, you wouldn't be able to be amused or
    surprised. And so you may even doubt it as you're
    driving home, and doubt it as you're going to sleep, THE CRYSTAL GAZING TECHNIQUE
    right up until the moment you awaken one
    Now I would like you to imagine yourself seated
    morning, with a realization. And most likely, you'll
    comfortably in front of a large crystal ball, gazing
    have your first erotic dream which you remember,
    into its depths. Continue to visualize the crystal ball
    tonight. I can't really be sure though. It
    and to focus on it, and soon you will begin to see
    may be
    the images appear within. You will be able to
    ________night or _________ night, although I describe everything you see, just as it occurs; and I
    think it's going to be tonight that you have a very will be able to guide and direct the images as they
    erotic, exciting, stimulating dream which you appear, or to suggest new images from time to time.
    remember. Now you can picture the crystal ball very clearly in
    But your unconscious mind can determine your mind, and as soon as you are ready, you can
    whether you recall the dream or not, or only part of begin to describe the images as they appear.
    it. But whether you consciously remember or not, [Pause]
    is irrelevant, because your unconscious mind will Now, as you continue to watch the crystal ball,
    enjoy it, and the next morning you will carry those you are gradually going to be able to see an image
    warm desires and sexual interests into your day, appear within it of yourself at some time in the near
    and will realize, that something is different. And I future, making love extremely well. I will not ask
    don't think you'll want to have those romantic, you to describe the scene; but as you continue to
    stimulating dreams every night, but your
    gaze into the crystal ball, you can see that both you
    unconscious mind will thoroughly enjoy
    and your partner are going to be fully and
    scheduling some irresistibly tantalizing dreams,
    completely satisfied. And now, as this is occurring,
    fairly often.
    the scene is beginning
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 369
    to fade, and the crystal ball is fading away too. And and just as rigid as your index finger was a moment
    even though you will not be able to recall the ago. And it will also be just as numb, as stiff and as
    memory of the crystal ball when the trance is over, numb as a bar of iron.
    you will still be aware that you are irresistibly You will be able to maintain your erection and
    headed for certain success; and that your future prolong intercourse for as long as necessary to
    sexual experiences will be just as pleasurable, and fully satisfy your partner. And when you are ready
    just as enjoyable, as you have already seen that they for normal feeling to return, you will only need to
    will be in the crystal ball. [Amnesia for the specific clench your jaw firmly three quick times in a row
    details of the experience is suggested so that factual for this to happen. But even after your sensitivity
    discrepancies between the details of the visualized does come back, you will still be able to maintain
    scene and the actual experience, when it does take your erection as long as necessary so as to achieve
    place, will not negate the validity of the positive your own orgasm.
    expectations engendered by this procedure.] [Additional sessions may be necessary until the
    subject has achieved the necessary control. When
    this has been accomplished, subsequent
    SUGGESTIONS WITH ERECTILE suggestions should emphasize retaining pro-
    DYSFUNCTION AND PREMATURE gressively more feeling in the penis until the
    EJACULATION subject has clenched his jaw three times, allowing
    more and more restraint to be developed, until
    Please extend the index finger of your right [or finally such suggestions are no longer necessary.]
    left] hand straight out in the air in front of you.
    That's fine. Now, as I continue to speak, you will SUGGESTIONS WITH DISCREPANT OR
    soon notice that your index finger is becoming very INHIBITED SEXUAL DESIRE
    stiff and very rigid. And as it does, you will also
    find that you are completely losing all feeling in it. Sometime during the next few nights, when you
    Soon your index finger will be just as stiff and just are asleep in bed with your partner, you are going
    as numb as a bar of iron. It's becoming just as rigid to have a pleasant dream which you will find
    and just as numb as an iron bar now. Your index sexually very stimulating. The dream will be
    finger is just as rigid as a bar of iron, and just as formed out of images and sensations which you
    insensitive. find especially pleasant and arousing at the time,
    and you will be so excited by them that you will
    Now please clench your jaw firmly, three times
    awaken even before the dream is completely over,
    in a row. And as you do, you notice that feeling is
    fully aroused and ready to make love.
    returning to your finger, even though it continues to
    be stiff and rigid. The feeling is returning The arousing effects of the dream will persist for
    completely now; and even though your finger some time after you wake up. They will add new
    remains as rigid as before, the feeling in it is dimensions of richness and pleasure to your
    entirely normal once again. lovemaking, and they will enable you and your
    And now, in order to make the stiffness go away, partner to discover new avenues of pleasure, and
    all you have to do is to decide that you are ready for new channels of communication, which will
    it to do so. And notice as you do that your finger deepen your relationship considerably.
    has become completely flexible once again. Just You will be particularly pleased to find that
    bend it a couple of times to assure yourself of this your orgasm will be unusually profound and
    fact, and then go ahead and put it down. satisfying, and it will seem to last much longer than
    From now on, each time you are ready to have it usually does.
    intercourse, you will find that at the proper time And you will continue to have dreams of this
    your penis has become just as stiff sort at appropriate intervals in the
    future,
    370 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    which will continue to enrich and deepen your repetitiously, was to insure that he had both a
    relationship in just the same manner. conscious and an unconscious understanding of the
    fact that a deep hypnotic trance would settle once
    and for all time whether or not he could ever
    succeed in sex relations. Two hours of repetition of
    Suggestions for Premature these general ideas resulted in a deep trance, but no
    effort was made to give him an awareness of this
    Ejaculation fact. An amnesia, spontaneous or one indirectly
    suggested, was desired for therapeutic purposes.
    Milton H. Erickson, M.D.
    Then, as a posthypnotic suggestion, he was told
    that he must, absolutely must, get a wrist-watch. If
    INTRODUCTION, INDICATIONS AND at all possible, this wristwatch should have an
    CONTRAINDICATIONS illuminated dial and illuminated hands. Absolutely
    imperative was the fact that the watch should have
    Premature ejaculation is the most easily treated a second hand. The second hand, it was stressed
    male sexual dysfunction, with success rates over and over, would be absolutely necessary.
    generally in the range of 90% -95% (Stuart &
    Hammond, 1980) using traditional, behavioral sex The second posthypnotic suggestion was given
    therapy techniques. Due to the high effectiveness that he must and could, and would, thenceforth
    of the squeeze and stop-start techniques, hypnosis sleep with a night light at his bedside so that he
    is certainly not the first treatment of choice for could tell time to the very second at any time
    premature ejaculation problems. When more during the night, since he must, absolutely must,
    validated methods have failed, however, or when and would wear his wristwatch whenever he should
    the patient does not have a cooperative partner to happen to be in bed.
    do behavioral assignments, then hypnosis is Solemn promises in relation to these demands
    extremely helpful. In addition to suggestive were secured from the patient with no effort on his
    hypnosis, uncovering methods such as ideomotor part to question the author's reasons for his various
    signaling may be used to explore underlying insistences.
    functions or resistances. Physical metaphors, such It was then explained to him that he would
    as creating a glove anesthesia and then suggesting a continue his "useless inviting of girls to spend the
    similar control of sensations in the penis, may night" with him. To this he also agreed, whereupon
    likewise be effective. The rather elaborate and it was emphasized that only in this way could be
    complex procedure below was successfully used in find out what he "really, really, really would want
    a suggestive hypnosis format by Erickson with a to learn."
    compulsive, single patient with premature
    ejaculation. This method seems primarily indicated The next posthypnotic suggestion was presented
    when more parsimonious procedures have failed to most carefully, in a gentle yet emphatic tone of
    produce satisfactory results in patients capable of voice, commanding, without seeming to command,
    deeper trances and experiencing amnesia. (Ed.) the patient's full attention and his full willingness to
    be obedient to it. This suggestion was a purportedly
    soundly based medical explanation of the
    expectable development, on an organic
    THERAPEUTIC PROCEDURE physiological basis, of his "total problem." This
    was the fact that his premature ejaculation, by
    Therapy was begun by inducing a light trance in virtue of body changes from aging processes,
    the patient and impressing upon him, most would be diametrically changed. The explanation
    tediously, that the "light trance" was a most was the following posthypnotic suggestion:
    important measure. Its purpose, he was told
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 371

    Do you know, can you possibly realize, can you And now, this is what I want you to do. Find one
    genuinely understand, that medically all things, ev- of the girls you are used to. Walk her to your
    erything, even the worst of symptoms and condi- apartment. When you come to the corner at 8th,
    tions, must absolutely come to an end. But not, but even as you turn right [all of this was said with the
    not, I must emphasize, not in the way a layman utmost of intensity] try so very hard to keep your
    would understand? Do you realize, do you under- mind on the conversations, but notice that you can't
    stand, are you in any way aware, that your premature help counting one by one the cracks in the sidewalk
    ejaculation will end in a failure, that no matter how until you turn into the courtway and step upon the
    long your erection lasts, no matter how long and boardwalk. With complete intensity you are to try
    actively you engage in coitus, you will fail to have an hard, very hard to keep your mind on the conversa-
    ejaculation for 10, for 10 long, for 15 long minutes, tion, but keep counting desperately the cracks, the
    for 20, for 25 minutes? Even more? Do you realize cracks between the boards, the cracks under you [to
    how desperately you will strive and strive, how the unsophisticated, slang often gives opportunities
    desperately you will watch the minute hand and the for double meanings], all those cracks all along the
    second hand of your wristwatch, wondering, just way to your apartment until it seems that you will
    wondering if you will fail, fail, fail to have an never, never, never get there, and what a profound
    ejaculation at 25 minutes, at 251/2 at 26, at 261/2 relief it will be to enter, to feel comfortable, to be at
    minutes? Or will it be at 271/2, at 271/2 minutes - at ease, to give your attention to the girl, and then, and
    271/2, at 271/2 minutes? [This last said in tones expres- then, to bed, but not the usual —but the answer, the
    sive of deep relief] real, real, real answer, and from the moment you
    enter [pause] the apartment [pause] your mind will
    And the next morning you still will not believe, be on your wristwatch, the watch that, as time goes
    just can't believe, that you won't fail to have an by, can, at long last, bring you the answer.
    ejaculation, and so you will have to discover again,
    to discover again, if you really can have an Quickly now, keep all that I have said in your
    ejaculation, but it won't be, it can't be, at 271/2 unconscious mind — locked up, not a syllable, not a
    minutes, nor even at 28, nor even at 29 minutes. Just word, not a meaning forgotten — to be kept there,
    the desperate hope will be in your mind that maybe, used, obeyed fully, completely. You can even forget
    just maybe, maybe at 33 minutes, or 34, or 35 me— just obey fully — then you can remember just
    minutes the ejaculation will come. And at the time, me and come back and tell me that the wristwatch
    all the time, you will watch desperately the was right when it read 27/2 minutes and when it read
    wrist-watch and strive so hard lest you fail, fail again, 33, 34, and 35.
    to ejaculate at 27 minutes, and then 33, 34, 35 minutes Arouse now, completely rested and refreshed,
    will seem never, just never, to be coming with an understanding in your unconscious mind the com-
    ejaculation. pleteness of the task to be done."

    HYPNOTIC SUGGESTIONS FOR INTERPERSONAL RELATIONSHIPS

    Hypnotic Ego-Assertive there are times when it is vitally important to


    correct a deficit in interpersonal skills through
    Retraining modeling and either rehearsal or covert, mental
    rehearsal (Bandura, 1969). Waxman's (1989)
    David Waxman, L.R.C.P., M.R.C.S. ego-assertiveness training provides modeling and
    London, England mental rehearsal to promote feelings of
    self-efficacy and assertiveness in specific contexts.
    INTRODUCTION AND INDICATIONS This method seems particularly indicated for
    patients who lack confidence and who are passive,
    Ego-strengthening techniques are designed to unassertive, and threatened in specific
    enhance self-esteem and self-image. However, interpersonal situations. (Ed.)
    372 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    A TYPICAL EGO-ASSERTIVE ROUTINE Therapist: "Stop apologizing — it's not your


    fault. Speak up."
    The patient is put in hypnosis and the trance state is Patient: "Personnel say that all replacements are
    deepened. Proceed as follows: on attachment elsewhere."
    Therapist as manager (even more aggressively):
    You are completely calm and in a deeply relaxed "Then what are you going to do about it?"
    state. I want you to see yourself at work and
    Therapist: "Speak up and speak out (remain
    attending your weekly departmental meeting. You
    quite calm and relaxed) — It's your department.
    are sitting in the manager's office. The others are
    seated rather informally about the room. See that You are in charge of the department, of the
    situation and confirm that you are there with the situation and of yourself, now speak!"
    usual signal. Patient: "I'll get on to them and tell them that we
    must have immediate replacements."
    The patient raises his right index finger. Now ask Continue in this way simulating the manager
    the patient where he is sitting. speaking very aggressively and showing the patient
    Patient: "On the chair by the door." that he can reply assertively but politely and
    Therapist: "Are there any empty seats?" remaining calm and in control throughout the
    Patient: "Yes, the armchair by the desk." interview.
    Therapist: "You are feeling totally calm and A wide range of situations may be dealt with in
    relaxed. Go and sit in the armchair . . . tell me when this manner working through various aspects of the
    you are sitting in the armchair and feeling totally patient's life events.
    calm and relaxed." It must be understood that assertive retraining
    After a few moments the patient will give the involves dealing not only with the emotions of
    ideomotor signal. anxiety invoked by the pressure of some person or
    Therapist: "You will remain totally calm and persons whom the patient may consider threatening
    relaxed . . . and now the manager is opening the in the authoritarian sense. It may also include the
    meeting ..." difficulties which many people experience with
    Therapist as manager (very assertively): "Good their peers or in achieving friendship, affection and
    morning gentleman. We will have department love. The person may feel such a social misfit that
    reports first of all." even life itself may become unacceptable. He or
    Therapist: "He's looking at you." she may act out and even indulge in antisocial
    Therapist as manager: "What have you got to tell behavior.
    us?"
    Therapist: "You feel completely calm and
    relaxed and full of confidence. Completely at ease
    and comfortable in yourself. Speak up now. "Fruits & Vegetables": A Simple
    Answer him ..."
    Patient: "Well sir, I think . . ." Metaphor for Understanding
    Therapist: "Forget about sir — speak up — you People Better
    don't think — you know — speak out!"
    Patient: "We have two problems, I'm sorry to Gerald J. Mozdzierz, Ph.D.
    say." Hines, Illinois
    Therapist: "Forget about being sorry, you have
    no reason to apologize! It's your department—you This is a simple metaphor for people who may be
    are in charge of it and you are in charge of discouraged because they have been disappointed
    yourself!" by a significant other person. The disappointment
    Patient: "We have some problems regarding may have been experienced as a result of having
    staff. Two of our typists are off sick and one is on exaggerated expectations or as a result of simply
    holiday." not knowing the
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 373

    obvious, namely, that people have their idio- Suggestions to Increase


    syncrasies and limitations. The clinician can
    simply call this the "fruit and vegetable theory of Interpersonal Effectiveness
    people."
    Once a client has expressed disappointment in
    Don E. Gibbons, Ph.D.
    someone and difficulty in understanding the
    behavior, feelings, or attitudes of the other person, INDICATIONS
    the therapist may point out that the person in
    question is very much like a strawberry (or some Dr. Gibbons designed these suggestions for
    other fruit, vegetable, or other living plant). As improving social skills, enhancing assertive-ness,
    such, no matter what we may want that person to and improving interpersonal relationships. They
    look like, taste like, be like, or act like, that person seem particularly indicated for egocentric patients
    is a strawberry and will always be a strawberry. who talk excessively about themselves. (Ed.)
    Yes, we may want that person to be more like a
    combination of peach, plum, raspberry and several
    other good things, but, in essence, some people are SUGGESTIONS
    strawberries and we have to learn to accept them as
    such. When we do accept them as such, we become This experience will provide you with a great
    less disappointed that a strawberry looks like, tastes deal more confidence in yourself, which will be
    like, and acts like a strawberry. But then something reflected in the greater ease and skill with which
    else happens! you will be able to deal with others. You will be a
    great deal less aware of yourself, and a great deal
    At this point in time, we become a little more more attentive to those around you. You will be
    able to enjoy the other person's essence of much more interested in what other people have to
    "strawberriness" and all the things that strawberries say, and much more able to lose yourself in the
    can be! Strawberry pie, strawberry shortcake, topic of conversation.
    strawberry ice cream, strawberry soda, etc. In As you come to derive more and more enjoy-
    describing the fruit or vegetable, the clinician can ment out of talking to others, you will find yourself
    be as simple or as elaborate and elegant as is called constantly alert for qualities, attributes, and
    for by the client and the situation. achievements which are justly deserving of praise,
    This simple metaphor is meant to suggest that and you will be able and willing to unstintingly
    other people can act like desirable and more provide it. At the same time, you will be able to
    undesirable fruits and vegetables as well. At times, exercise a great deal of restraint over any anger or
    the client will volunteer that the person with whom impatience you may have over the shortcomings of
    he has been having trouble is exactly like a other people. And if you should happen to feel that
    horseradish root. Not much you can say about that, another person is unfairly taking advantage of you
    is there? Nevertheless, that troublesome person in some way, you will be able to phrase your
    must be accepted for what he or she is, a objections kindly and tactfully, in a manner which
    horseradish root. will enable you to speak up for your own rights
    The metaphor is designed to help clients put without becoming unduly emotional, and without
    other people into perspective. The focus of the the other party unnecessarily taking offense. As
    metaphor may also be gently shifted so that the your confidence and skills improve, you will
    client begins to wonder what type of fruit or become vastly more sensitive to the emotional
    vegetable he or she is, whether he has been needs of those around you, and you will be able to
    accepting himself for what he is, etc. Finally, the find new sources of wisdom and understanding
    metaphor obviously includes a dimension of humor which will help you to meet those needs. There will
    that helps others to see things with a twinkle. be many people who will be able to look upon you
    as a friend to
    374 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    whom they can turn for comfort, for reassurance, tion, without excessive energy, without nervous
    and for advice, and there will be many whom you talking or laughter. And this is because you're
    will be able to look upon as a friend in return. Your aware that others need the opportunity to share with
    own life will consequently take on a great deal you about themselves, and your ability to listen,
    more meaning, and you will be able to enrich the and your ability to give them that opportunity,
    lives of those around you considerably. creates a warm feeling for yourself . . . possibly a
    feeling of curiosity about them, that allows you to
    listen while they're talking, without interrupting,
    because what they're saying is interesting or
    Suggestions for Difficulties in important for them.
    Interpersonal Situations
    Kermit E. Parker, Jr., Ph.D.
    Albuquerque, New Mexico The Symbolic Imagery Letter
    [Following hypnotic induction and deepening:] Writing Technique
    You know from past experience that as you achieve
    this level of comfort and relaxation, you can Mark S. Caric h, Ph.D.
    become physically more comfortable, and you're Centralia, Illinois
    able to become mentally more comfortable as well.
    And in this process, your unconscious mind allows INDICATIONS AND
    you the opportunity to grow, and to develop new
    CONTRAINDICATIONS
    attitudes and new feelings, and new ways of feeling
    about yourself and your circumstances.
    This is a cognitive behaviorally oriented hyp-
    In this state you can become more receptive, notic technique wherein the client writes an
    more creative, more aware of the abilities that you imaginary letter. The client is instructed, while in a
    have within yourself. This hypnotic state allows hypnotic state, to imagine writing a letter pertaining
    you to gain confidence in yourself, to be in touch to a specific topic. Expressing emotions through
    with that part of you that's confident and writing letters is a powerful technique that has been
    comfortable, and knows how you want to feel and demonstrated not only to provide cathartic relief,
    behave. Within yourself, that quiet part of you that but also to result in enhanced functioning of the
    we sometimes call the unconscious, or that still, immune system on both short- and long-term
    small voice, or that intuition within yourself, that follow-ups of individuals writing about their
    knows you are an outgoing and warm and friendly feelings about traumas in their lives (Pennebaker &
    person. These characteristics are abilities which Beall, 1986; Pennebaker, Kiecolt-Glaser, & Glaser,
    you have, and your intuition can tell you that you 1988; Pennebaker & O'Heeron, 1984). Carich finds
    can freely allow yourself to express those this technique valuable in working through
    characteristics when it is appropriate, when it is resentments and anger, facilitating forgiveness of
    called for. oneself or others, reducing guilt, letting go of and
    bringing a sense of closure over past relationships,
    fostering acceptance of a situation, and altering
    CULTIVATING THE ABILITY TO LISTEN beliefs or perceptions about a problem. If it is to be
    done through self-hypnosis in an uncontrolled
    And in being quietly confident, you find yourself setting, this method seems contraindicated or
    being calm inside with the necessary amount of should be used cautiously with suicidal, severely
    activation of your physiology and your mind, to be disturbed or unstable patients. (Ed.)
    outgoing and warm, and friendly and talkative,
    without excessive activa
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 375

    THE TECHNIQUE atory methods to uncover the purpose of the


    block.] Good! Now imagine writing the goodbye
    Although this method may be used in letter, and as you begin to write, just say everything
    nonhypnotic therapy [as Pennebaker has], it may that you're writing out loud. And as you write,
    also be used following hypnotic induction and you'll begin to notice that heavy burden being
    deepening. The hypnotized client is instructed to lifted. [Suggestions for encouraging cathartic
    imagine writing a letter to a specific person or release of feelings and therapeutic, reframing
    about a specific topic. Naturally, the content and suggestions may then be given.]
    topic of the letter depend on the nature of the
    problem. For example, a grieving patient who has
    been angry and blaming God for years for the death
    of a loved one may be asked to write a letter about The Jazz Band Metaphor for
    her feelings. The goal may be to vent and defuse
    the anger and come to an acceptance of the
    Family Interaction
    situation. The client may imagine writing the letter, Philip Barker, M.B.
    verbalizing what is being mentally written as it's
    Calgary, Alberta, Canada
    written. A deeper trance subject may actually write
    the letter in trance through the technique of
    Let us now consider the functioning of a jazz
    automatic writing. Before the client is assigned the
    band. . . . Jazz, an improvised music, depends for
    task of "writing" the letter, the therapist may "seed"
    its quality and success on the constructive and
    ideas about emotionally letting go of the loved one,
    creative interplay of different musicians, playing a
    accepting the loss, obtaining a relief of her burden,
    variety of instruments. A jazz band has its different
    letting go of anger and the past, and forgiving God
    parts; there is usually at least a "rhythm section"
    and the deceased person.
    and a "front line." These have distinct functions.
    While the client verbalizes the "letter," the The rhythm section lays down the beat of the
    therapist may offer suggestions to encourage music. The front line instruments are responsible
    cathartic relief and the letting go of outdated for the melodic lines and their interplay. The front
    emotions and to reframe the situation. For example, line may be further divided into different
    some of the following types of suggestions may be instruments or groups of instruments, for example
    given as the client "writes" the letter: "And as you brass instruments and reed instruments; the players
    express those feelings, allow yourself to accept of each must know what they are supposed to be
    his/her death." "As you write, notice the past is the doing, and how what they are doing is distinct from
    past and does not have to bother you. You can let but at the same time fits in with what the other
    go of that pain." Rational-emotive suggestions may musicians are doing. The collective effort of the
    also be given to correct cognitive distortions. band as a whole also needs direction.
    As you watch a jazz band playing you will see
    that the leader is continually giving instructions to
    ILLUSTRATIVE SCRIPT FOR the members of the band, setting the tempo for
    SAYING GOODBYE each tune; indicating when the musicians should
    take solos, and how long each should be; defining
    [Addressing the hypnotized subject:] What I "riffs," which are repetitive musical patterns that
    would like you to do is to write a goodbye letter in the other musicians may play behind a soloist or at
    your mind. Allow yourself to visualize and see a some other point during the performance of a
    pad of paper. Do you see the paper? [Wait for piece; and of course letting the members of the
    confirmation.] Now visualize a pen. [Obtain band know when each tune should come to an end.
    confirmation. If there is resistance, use explor- Such instructions are often given quite
    unobtrusively, perhaps by a nod of the head, some
    other non-
    376 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    verbal cue or the use of a musical phrase or jazz musicians adjust their playing according to
    emphasis with which the musicians are familiar. what the other members of the group are doing. The
    Sometimes the musicians have played together for families we see are all faced with the task of making
    so long that instructions are no longer needed. They progress through developmental stages. .. . In the
    know how their leader likes a certain tune played, same way, jazz bands develop over the years; an
    who should take solos when, and so forth. excellent example is that of the Duke Ellington
    Nevertheless, the leader's decisions and authority Orchestra. This was a small group, playing
    are still in operation, even though the band is relatively simple pieces when it was formed in the
    functioning so well and is so experienced and mid-1920s. It developed impressively between that
    well-rehearsed that few or no instructions need be time and 1974, when Ellington died. The changes in
    given while they are playing. Some bands have Ellington's orchestra and music were sometimes
    dual leadership; this can work well, but it carries gradual, sometimes quite rapid. The organization
    with it the risk of friction between the leaders. had its ups and downs, sometimes losing key musi-
    cians, but gaining new recruits too, people who
    enriched the orchestra with their talents. It also had
    to cope with the loss to the armed forces of several
    COMMENTARY
    of its members during the war. This process of
    development, and the vicissitudes encountered
    Few, if any, therapeutic metaphors perfectly along the way, bear many similarities to a family's
    represent the clinical situations for which they are long-term development. A well-functioning family
    constructed, but there is a considerable may be likened to a well-practiced band, whose
    resemblance between some aspects of the musicians have played together for a long time,
    subsystems of a family and those of a jazz band. communicate well with each other, respect each
    The metaphor of the functioning of a symphony others' roles and professional skills, understand the
    orchestra could of course be used, as could many different functions of the members of the group,
    other forms of organization. A symphony orchestra and have common objectives. Few, if any,
    has the same need for the smooth interaction of its instructions need be given to the musicians while
    different sections, and also the same need for such a band is playing. On the other hand, in a
    leadership. But it probably provides a less exact poorly functioning band there may be struggles for
    metaphor for a family than a jazz band does; for power, disagreements about the tempos at which
    one thing it plays predetermined, composed pieces, tunes should be played, uncertainty about who has
    rather than creating its own musical structure as it the final decision about what should be done when
    goes along. Few families are as ordered and members disagree, competing desires to share the
    predictable as a symphony orchestra. limelight, and a general lack of order and
    Playing in a jazz band is predictable only up to a organization. When such problems exist the
    point; things are changing all the time, as the collective effort of the band suffers.
    individual musicians, operating within the overall
    framework of the group, define their own melody
    lines and create their own mini-compositions while
    they play. Also, when the members of a band stay
    together over a period of years, they develop new
    Golden Retriever Metaphor
    skills, learn new musical tricks and techniques, and D. Corydon Hammond, Ph.D.
    extend their repertoire. In the same way the Salt Lake City, Utah
    behaviors, as well as the emotional and physical
    states, of the members of a family are, typically, INDICATIONS
    changing all the time. Thus constant adjustments
    must be made by each individual in the family, This is a brief metaphor with a paradoxical
    rather as message for selective use with a spouse (or
    HYPNOSIS WITH SEXUAL DYSFUNCTION AND RELATIONSHIP PROBLEMS 377

    premarital individual) who tends to pursue an SUGGESTIONS


    uncommitted partner excessively, almost begging
    him/her for love. According to mythology, there was once a very
    accomplished sculptor who lived on the island of
    Cyprus. His name was Pygmalion. Pygmalion was a
    THE METAPHOR man with such specific and definite expectations
    that he couldn't be satisfied. He simply could not
    I don't know if you have ever trained or watched find a woman to equal his concept of beauty. So he
    the training of a golden retriever. If you throw found some very beautiful, pure white marble, and
    something out for the dog to retrieve, sometimes it in his studio he sculpted the image in his mind. He
    will run out to fetch it, but then refuse to bring it created in stone his conception of a beautiful,
    back to you. You can coax and call it, but it refuses perfect woman. He continued to search and look
    to come to you. If, out of frustration, you finally everywhere for this perfect woman to match his
    start to go after it, it will run away. But if you sculpture. But he was so critical that he found
    accept its behavior, and start to walk away, it will something wrong with every woman he saw. No one
    often decide to come to you. And sometimes could match the statue's beauty. He was so in love
    relationships with people operate that way too. with this perfect image from his mind that he finally
    prayed to the goddess Aphrodite, pleading with her
    to help him find a woman who would equal and be
    as lovely as his sculpture. But, being a wise
    goddess, Aphrodite knew that Pygmalion's
    The Pygmalion Metaphor expectations were too high and uncompromising.
    She knew that no woman could ever live up to all
    D. Corydon Hammond, Ph.D.
    his expectations. So it is said that Aphrodite
    Salt Lake City, Utah
    breathed life into the statue, and Pygmalion named
    her Galatea, and married his own creation.
    INDICATIONS
    And I wonder if many of our problems in
    This metaphor may be useful in working with an relationships are not caused by being like
    individual who is perfectionistic, has exceptionally Pygmalion — wanting our partners to be perfect
    high expectations of his marital partner or fiance, clones of ourselves and our expectations, rather
    and tends to be intolerant of differences rather than than accepting and respecting differences.
    respecting them.
    HYPNOSIS WITH OBESITY AND
    EATING DISORDERS
    INTRODUCTION

    Weight Control

    Osuccessfully as drugresult
    BESITY APPEARS TO from an addiction that is as difficult to treat
    dependency and smoking—and probably much more
    so. Stunkard and McLaren-Hume (1959), for instance, discovered that only 5% of
    obese patients lose weight without relapsing, and Brownell (1982) pointed out
    that the cure rate for many forms of cancer is greater than the success rate with
    obesity.
    There are numerous case studies and reports of outcomes with a clinical series
    of patients (e.g., Crasilneck & Hall, 1985; Stanton, 1975; Aja, 1977) who were
    treated through hypnosis for problems with obesity. There are very few studies
    (Wadden & Flaxman, 1981) that have compared hypnotic with nonhypnotic
    treatments, but these have generally found no difference between hypnotic and
    nonhypnotic treatment (Wadden & Anderton, 1982). Unfortunately, the hypnotic
    approaches used in these studies were unsophisticated and relied simply on
    suggestive hypnosis. We must await further research to determine if hypnosis
    truly has something to offer beyond behavioral, low-calorie diet, and
    multidimensional treatment approaches and, if so, to what types of patients.
    It is my clinical belief and experience that, although this is one of our greatest
    treatment challenges, hypnosis is of clear value with some obesity patients. Since
    this is an addictive disorder, you will undoubtedly find it helpful to consult some
    of the suggestions that are used with smoking in Chapter 13. The suggestions that
    are presented in this chapter offer the finest ideas available for suggestive
    hypnotic work with weight control. You should keep in mind, however, that
    success in many cases may require that you use hypnotic strategies for
    unconscious exploration and for internal

    379
    380 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    conflict resolution in connection with (or prior to) suggestive hypnotherapy. A


    simplistic approach to a complex addictive problem, whether in hypnosis or
    psychotherapy, will seldom be effective.

    Anorexia and Bulimia


    Studies of hypnotizability (Pettinati, Horne, & Staats, 1985) have now
    documented that patients with bulimia possess higher hypnotic capacity than
    other patients. The greater dissociative capacity may enable these patients, in fact,
    to more easily induce vomiting. On the other hand, there is tentative evidence
    (Pettinati et al., 1985) that patients with anorexia nervosa may be less hypnotically
    responsive than other patients. Naturally these studies reflect averages; we should
    not conclude that all patients with bulimia will be responsive to hypnosis or that
    anorexics cannot be helped with hypnosis. There are, in fact, case reports of
    successful outcomes from treating anorexic patients through hypnosis (Thakur,
    1984).
    The last section of this chapter will provide some illustrative suggestions for
    altering body image and perception, as well as for treating eating disorders
    through suggestive hypnosis.

    HYPNOSIS WITH OBESITY

    Examples of Suggestions for pertaining to obesity in the literature of behavior


    modification, and (c) the suggestions used in the
    Weight Reduction treatment of overweight developed by many
    clinicians, especially by William S. Kroger (see
    Sheryl C. Wilson, Ph.D., and Theodore X. Kroger & Fezler, 1976), Herbert Mann (1973), and
    Barber, Ph.D. Harold B. Crasilneck and James A. Hall (1985).
    Framingham, Massachusetts, and The suggestions below are typically given after
    Ashland, Massachusetts relaxation suggestions and positive suggestions for
    well-being. The positive suggestions typically
    INTRODUCTION conclude as follows.

    The following suggestions are illustrative of POSITIVE SUGGESTIONS FOR


    suggestions that we have used as one part of a WELL-BEING
    broad based program for the treatment of
    overweight. The suggestions are presented to the Day by day, you will have increased feelings of
    client in the office and are simultaneously tape confidence, self-assurance as you realize that you
    recorded. The client is then given the cassette tape can and will reach your desired weight. You can
    and is asked to listen to the tape daily. These and will become a new, slender, more attractive,
    illustrative suggestions, which are presented below more energetic, more vivacious you . . . the real
    in a generalized form, are tailored specifically for you.
    each client. These illustrative suggestions are
    derived from (a) an application of our theoretical CHANGING SELF-DEFINITION
    framework (see Barber, Spanos, & Chaves, 1974)
    In the past you have come to think of yourself as
    to the treatment of eating disorders, (b) the many
    heavy, overweight, and unattractive. It is
    writings
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 381

    important that you now change the way that you taste buds on your tongue and obtain greater
    think of yourself— this is as important as changing pleasure from your food, enjoying each mouthful
    your eating habits. Picture yourself maximumly.
    weighing _________ pounds [patient's Each time that you swallow, focus your attention
    ideal on all of the feelings and sensations in your
    weight], standing in front of a full-length mirror, stomach. As you continue eating, let yourself
    having just come out of the shower. Imagine that become aware of an ever increasing feeling of
    you are standing in front of a full-length mirror. See fullness in your stomach, so that when you have
    your reflection in the mirror, slender, streamlined, finished your meal, you will feel comfortably full,
    and completely satisfied until your next meal.
    and attractive. When you see yourself slender and
    shapely standing in front of the mirror, raise your As you are focusing on all the subtle tastes in
    right index finger. [Pause and wait for the patient to each bite that you take, and on the feeling of
    raise the index finger.] Now, let yourself feel how fullness in your stomach each time that you
    very light you feel without all that unnecessary swallow, tell yourself that time is slowing down
    and there's lots of time. Each second is stretching
    weight. Tell yourself that you can and will look and
    out . . . far, far out. Notice how as you eat, there's so
    feel like this because this is the real you, which has
    much time between each bite you take. And as you
    been hidden and imprisoned by excess weight and
    chew your food, slowly, notice how you feel as if
    which you are now determined to set free. every second is a minute and there's so much time .
    . . as if everything is in slow motion. When at last
    EATING AS AN ART you've finished your meal . . . you will feel
    comfortably full and satisfied . . . as if you have
    Eating can be an art. You can learn and use some been eating for hours.
    special techniques for eating as a gourmet. When
    you use these techniques, you will enjoy food more S o , instead of giving up food, or trying not to
    and obtain pleasures in eating that are greater than think about food, you can become a gourmet by
    you ever imagined possible. learning to enjoy food to the utmost. You can do
    this first by becoming aware of the colors, textures,
    This is how you can enjoy food infinitely more
    and aromas of your food, and then by taking only
    than you ever have enjoyed it in the past. Eat only
    small bits of your food into your mouth and totally
    at mealtimes, and when you eat, focus all your
    focusing on your food and all the subtle flavors as
    attention on your food. Do not watch TV or read,
    you chew your food slowly and move it slowly
    and unless absolutely necessary, do not engage in
    about your mouth with your tongue, as if in slow
    conversation. Before you begin eating, spend a few
    motion.
    moments observing your food. Notice the colors
    and textures. Inhale deeply and enjoy the aromas.
    When you are ready to begin eating, take only
    small bits of food, place only small portions on IMPORTANCE OF HUNGER
    your fork or spoon, or take very small bites of those
    foods that you hold in your hand, such as In addition to totally focusing on your food and
    sandwiches. Focus your complete attention on the eating as a gourmet, there is yet another aspect
    food you are eating. Don't let your thoughts which is an integral part of the enjoyment of food,
    wander. Become aware of all the taste buds on your and this important aspect is hunger. You simply
    tongue and how they are stimulated by each tiny bit cannot totally enjoy food if you are not really
    of food. Chew your food many times, and move hungry when you begin to eat. If you are not really
    your food around in your mouth slowly with your hungry, when you begin to eat, your hunger will be
    tongue before finally swallowing it. By doing this satisfied with the first few bites of food. After that,
    you will satisfy all the you will not be able to truly enjoy eating your
    meal.
    382 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Hunger is nature's signal to tell us that we should Now relax your arm and let it float back down.
    begin searching for food. Years ago, this signal was Now concentrate on your body and listen to me.
    very effective. People would feel hungry and by the Imagine that your whole body is becoming lighter
    time they found food and prepared it, they were and lighter, your head, your shoulders, your trunk
    really hungry and consequently they could really are becoming lighter and lighter. It feels as if they
    enjoy their food without gaining weight. But today, don't have any weight at all. And as if you're
    with our modern convenience foods, we can eat as floating suspended in the air. Let yourself feel light
    soon as we feel hungry, and so we become over- as a feather. Feeling lighter and lighter, rising and
    weight. We have learned from our culture that floating, feeling lighter and lighter. It feels as if you
    hunger is a bad thing, that one should not be hungry,
    don't have any weight at all, and you're just floating
    and if we become hungry between meals, we often
    pleasantly in space. You feel lighter, and lighter,
    snack on something to satisfy our hunger.
    floating and drifting lighter and lighter. And as you
    Consequently, we seldom know what real hunger
    is. Hunger is a bad thing only when someone is let yourself feel lighter and lighter, and as if you're
    starving to death and is unable to obtain food. floating and drifting along, think of how pleasant it
    Otherwise, in normal everyday life, hunger helps us will feel when you feel feathery light after you lose
    to enjoy our food when we eat. Whenever you feel all the unnecessary weight you wish to lose.
    hungry and it's not time for you to eat, tell yourself
    two things. Tell yourself, "My body is now using up AGE REGRESSION
    some of the excess fat, the excess weight, that I
    want to lose." And tell yourself, "When it is time for [If the overweight patient was not overweight as
    me to eat my meal, this feeling of hunger will help a child, you can use age regression to reinstate in
    me to enjoy it to the utmost." "Starting today, the patient the feeling of not being overweight; that
    whenever you feel hungry, along with the feeling of is, of being the ideal weight. Tell the patient the
    hunger, you can have a feeling of real joy, an inner following:]
    feeling of deep satisfaction, because whenever you By directing your thinking, you can bring back
    feel hungry, you will know that you are the feelings you experienced when you were in
    accomplishing your goal . . . you are losing weight. elementary school. Think of time going back, going
    back to elementary school, and feel yourself
    becoming smaller and smaller. Let yourself feel
    your hands, small and tiny, and your legs and body,
    FEELINGS OF LIGHTNESS small and tiny. As you go back in time, feel
    yourself sitting at a big desk. Notice the floor
    Hold your right arm straight out in front of you, beneath you. Feel how good and healthy you feel,
    parallel to the floor. Concentrate on your arm and without any unnecessary weight to carry around.
    listen to me. Notice how your clothes fit you comfortably,
    without binding or pinching. Feel how comfortable
    Imagine that the arm is becoming lighter and
    it is to sit at a desk without any protruding stomach
    lighter, that it's moving up and up. It feels as if it
    to get in your way. Feel the top of the desk now, and
    doesn't have any weight at all, and it's moving up
    you may feel some marks on the desk top, or maybe
    and up, more and more. It's as light as a feather, it's a smooth, cool surface. [Continue with age
    weightless and rising in the air. It's lighter and regression suggestions from the Creative
    lighter, rising and lifting more and more. It's lighter Imagination Scale.] Now just feel how healthy and
    and lighter, and moving up and up. It doesn't have energetic you feel without any excess weight.
    any weight at all and it's moving up and up, more [15-30 second pause] Now tell yourself its all in
    and more. It's lighter and lighter, moving up, more your own mind and bring yourself back to the
    and more, higher and higher. present.
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 383

    LOOK TOWARD THE FUTURE EGO-STRENGTHENING SUGGESTIONS


    [AGE PROGRESSION]
    Your mind can be at peace. Just at peace,
    Picture yourself slender and attractive, standing relaxed, calm and so comfortable. Lots of time. So
    on a scale. Notice that the dial on the much time, just more and more time, so good.
    scale is pointing to _______pounds [the patient's You're breathing now easily and gently. You can
    desired weight]. Feel how joyous, ecstatic, and feel yourself relaxing more and more. Your mind
    overwhelmingly happy you feel as you realize that becomes calm, like a lake without a ripple. So calm
    you can and will achieve your goal. Notice how and more and more at ease. It feels as if all the
    healthy, vibrant, and alive you feel as you realize cares are just rolling away. And it can feel so good,
    the full potential of your mind. as if nothing matters, nothing at all. Just a feeling
    Whenever you think of eating something you're of "I don't care." It's so nice to be alive, to have
    not supposed to eat, or eating at a time other then peace of mind, to be calm and relaxed, feeling so
    mealtime, picture yourself healthy and trim, and tell good. You can feel more and more peaceful.
    yourself that you do not want to eat this food, or Floating so peacefully, so at ease, so calm. Lots of
    that you do not want to eat at this time, because you time, more and more time, so much time. Lots of
    want to get rid of the unnecessary weight you have time. So at ease. Mind becoming more and more
    so that the real you (slender, shapely, attractive and clear and open, like a clear, beautiful lake that
    healthy) may be set free. Then let yourself feel the reflects the sky without a ripple. Just so at ease,
    true deep inner satisfaction, security, and confi- feeling so good. A little drowsy, but so relaxed and
    dence you have, knowing that you can and will at peace. You can become more and more at ease,
    control the amount of food that you eat and that in calm and relaxed. Lots of time; so much time. You
    this way you will take control of your life. can feel this way whenever you wish by telling
    yourself and hearing these words: "I can be calm
    Don't worry or be anxious about losing weight. and I can be relaxed. I can feel so good to be alive."
    Worry and anxiety will not help you lose weight. You can hear these words whenever you wish. You
    Relax and tell yourself that you are now on a road can feel calm, relaxed and so good to be alive.
    that will lead to a new you . . . to a more attractive,
    Starting now, in any situation, whenever you feel
    healthier, more energetic, and more alive you. Feel
    tenseness, any bother, and especially when you sit
    an overwhelming sense of confidence and security
    down to eat, you'll be able to hear these words.
    rising up within you as you realize that you have
    You'll be able to say them to yourself, and hear
    taken control, taken charge of your life, and you
    them in the back of your mind. You'll be able to say
    will no longer allow yourself to be the victim of
    them to yourself and hear them in the back of your
    each tempting, fattening food that comes along.
    mind. You can be calm, relaxed, so calm and
    relaxed. It feels so good to be alive. You can feel
    calm and relaxed in every aspect of your life, in
    every day, all the time with your eyes open,
    Hypnotic Suggestions for walking, moving, working, all the time. You can
    Weight Control feel in the back of your mind, the same feeling, this
    good feeling as you hear these words and say them
    T. X. Barber, Ph.D. to yourself. "I can be calm and I can be relaxed. It
    Ashland, Massachusetts feels so good to be alive."

    [These suggestions are offered following an Starting now, you can start a new life. Ready to
    induction, for example, emphasizing relaxation live in a new way, to enjoy every aspect of
    and imagery of a beautiful place.] everything around you. To be aware of all the
    beauty of the earth. The beauty and goodness
    384 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    of being alive, to feel so aware, that you are to have these high calorie, rich, fattening foods.
    conscious and aware, and able to think, and feel, You're free now. You're no longer an addict. You
    and smell, and taste, and love, and experience. To no longer have to have them." You'll hear me say,
    be fully alive more and more, every day, as you feel "STOP," loud and strong in the back of your mind.
    this calm, relaxed mind, enjoying more and more, You'll hear me say, "STOP" over and over. And
    starting now. after awhile, you'll internalize it, and it will be your
    Starting now you'll be able to flow with own thoughts saying, "STOP," and saying, "You're
    everything around you so much better, more and free now. You're no longer an addict. You don't
    more all the time. Just flowing, experiencing, not need them. You're free."
    hung up, not bothered, just enjoying the calm,
    relaxed mind, able to face life with its problems in a
    relaxed way. Flowing with the problems. Doing SUGGESTIONS FOR EXERCISE AND
    your best to be able to move with them and not be ACTIVITY
    bothered. In the same way, starting now, if you feel
    any feelings of hunger, be able to flow with it, feel You can start a new life, enjoying everything
    good about it. Say, "That's perfectly okay. 1 flow around you. Enjoying being alive, feeling good to
    with the hunger so my body uses up the stored up be alive, with a calm, peaceful mind. Relaxed, at
    food. I don't need it now. I already have it. I have ease, living with reverence of being alive, and
    plenty of fats and sugars, and ice creams and cakes, enjoying every aspect of it. Determining today that
    and chocolates stored up, and now I'll use them up. you can make your life as good as you possibly can,
    I flow with hunger as my body uses up the stored in every way. Being aware of how good it is to
    up food." move, and exercise and be active. How good it is to
    be strong and healthy, and have a wonderful,
    healthy body, and a healthy, wonderful, calm mind.
    Starting today, it can feel so good when you
    SUGGESTIONS FOR SELF-TALK exercise, when you move, when you walk, when
    you work. You're going to feel good to be able to
    And you'll find another interesting thing starting control your body, and to feel how good it is to be
    now. Whenever you eat, be able to eat slowly, with strong and healthy. And you'll increase the amount
    reverence, in a relaxed way. You'll feel there is lots of exercise, of effort, of walking, of moving. You'll
    of time. You'll hear these words. You'll say them to notice that it is going to feel real good as you
    yourself in the back of your mind. "I can be calm, become more and more alive. You'll begin to enjoy
    relaxed, feeling so good to be alive. And there's lots everything more, starting now, as if you've just
    of time. So much time." Now eat with reverence, come to the earth, and everything is new and fresh
    knowing how wonderful it is to be alive, to be able and sparkling clean. You'll be able to look around
    to enjoy and to feel, experience, and be conscious you and see the colors and the beauty of the earth.
    and aware. "I eat with reverence, starting now." You'll be able to hear the music of the earth and
    If you ever have any feeling that you want these everything that's around you, and everything that's
    high calorie, rich, fat foods for the next few days alive.
    and few weeks, this too will drop away. In the
    meantime, whenever you think of candies, cakes,
    chocolates, ice cream, and other high calorie, rich, REPETITION OF EARLIER
    unnecessary foods, you'll hear me say, "STOP."
    You'll hear it quite loud, you'll hear it over and
    SUGGESTIONS
    over. You'll hear me say, "STOP! You're free. You'll enjoy people more and every aspect of
    You're no longer an addict. You no longer need your life more as you flow with all the problems
    these. You don't have
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 385

    of living. You'll take them as they come with SUGGESTIONS ABOUT CRAVINGS
    calmness, peace, relaxation, calm, feeling good to
    be alive. Starting today you can start a new life. INTRODUCTION. The following suggestions, for
    More calm, relaxed, feeling good to be alive. purposes of illustration, focus on a problem with
    Eating with reverence and living with reverence. overeating. The suggestions seek to reframe
    Enjoying every aspect of the food as you eat cravings and to facilitate positive self-talk.
    slowly, moderately, with preplanning and Cognitive behavior modification approaches offer
    foresight, as a conscious, aware, very much alive, us valuable strategies for impulse control.
    human being. Whenever you feel any need, even Unfortunately, cognitive therapy usually
    any thought of high calorie, addictive foods, like concentrates on only consciously teaching patients
    candies and cakes, you'll hear me say, "STOP. coping statements to say to themselves.
    You're free. You don't need them any more." And Posthypnotic suggestions, however, may assist in
    you'll be able to flow with the feeling of hunger as making positive self-talk a more automatic
    your body uses up the stored up food, knowing that process.
    you have plenty of sugars and fats and
    carbohydrates, all stored up. You'll be able to flow
    SUGGESTIONS. You may be one of those people,
    with it and feel good about it, as you flow with all
    the problems of living. You'll be able to feel good who have mistakenly believed that cravings and
    about being alive, moving, walking, working, and eating urges occur because of physical withdrawal,
    exercising. You'll feel so good, starting now. and because you need to eat. But that isn't true.
    Most of our urges or hunger pangs are triggered by
    Let these thoughts now go deep in your mind. unrelated things, like the time of day, certain
    They'll be there to help you as the days go by. As people whom we're around, a type of feeling, or the
    they go deep into your mind now, you begin to alert kids coming home. Some people also mistakenly
    yourself. You become quite alert, very alert, more think that if they experience a hunger pang, that
    and more alert, as you open your eyes. hypnosis has worn off or failed. That's not true
    either. Cravings or urges are simply conditioned
    responses, that seldom last very long. And when
    you don't indulge them, they get weaker and
    weaker, and easier to ignore.
    Hypnotic Strategies for So when you feel a craving or hunger pang, you
    Managing Cravings can talk to yourself in your mind, reminding
    yourself that, in a minute or two it'll go away.
    Hunger pangs are always fairly brief and
    D. Corydon Hammond, Ph.D. Salt Lake
    time-limited. Many people don't realize that, and
    City, Utah fear that they won't stop unless you eat. But urges
    to eat pass fairly quickly. So, whenever you feel a
    hunger pang or craving, you can hear a voice in
    INDICATIONS your mind, reminding you, "It will go away in a
    minute or two." When you feel a craving, it can be
    These suggestions and strategies are designed to as if a voice comes into your mind, or from deep
    inside you, reminding you, "I don't have to eat right
    be used with urges and cravings commonly
    encountered in addictions and habit disorders. now. This urge will stop shortly. Just wait a short
    They have proved useful in working with smoking, time, and it'll go away." And your unconscious
    obesity, alcoholism, drug dependency, and sexual mind can and will so govern your conscious mind,
    addiction. These procedures may also prove that you'll remember that, urges or cravings will
    valuable with other compulsive urges. pass, and you don't have to in-
    386 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    dulge them. So you can become absorbed in doing may also be reinforced hypnotically, and recorded
    something, and almost before you realize it, the on self-hypnosis tapes for patients. Spiegel and
    cravings are gone. And that's going to be a delight, Spiegel (1978) have also provided some valuable
    discovering that eating urges and hunger pangs suggestions about choosing to ignore urges or
    quickly pass, and you can put off responding to cravings, focusing instead on respecting the body.
    them. And in a few minutes, much to your surprise, These suggestions encourage detachment and
    you suddenly realize you're comfortable again. externalization of the urge. The following
    suggestions for increasing impulse control
    SYMBOLIC IMAGERY TECHNIQUES illustrate the adaptation of RET concepts along
    with some of Spiegels' ideas.
    The patient may be taught to use symbolic
    imagery in self-hypnosis for decreasing cravings. ILLUSTRATIVE SUGGESTIONS. Most people don't
    The red balloon technique [found in the Chapter like to be told, "You can't," or "You shouldn't."
    13] is an illustration of this method. In this And we don't like it much better when we say those
    technique, patients imagine gradually putting their things to ourselves. Have you ever noticed that
    cravings into the gondola of a hot air or helium when we tell ourselves, "I can't eat that," that we
    balloon and then releasing it. Other symbolic often secretly want to rebel? But you'll be pleased
    methods may include slaying the urge like an to find, that you can talk to yourself in other ways,
    enemy or picturing the sensations inside that are much more helpful. Instead of fighting or
    themselves, and then modifying the imagery until trying to deny an urge to eat or drink, you can admit
    the urge decreases. The interests of patients may be it. But then realize that cravings are very brief, and
    utilized in individualizing the imagery that is will pass within a couple of minutes. Instead of
    selected. thinking, "I'm dying for (e.g., a doughnut)," you
    can detach yourself from the urge to eat, and say
    something like, "I'm feeling an urge to eat. I
    SUGGESTIONS FOR IMMEDIATELY wonder what the situation or feeling is that's
    IMAGINING NEGATIVE triggering this desire?" You will realize, "It will
    CONSEQUENCES pass in a moment. This craving is just a signal to let
    me know that I need to cope with this situation."
    Posthypnotic suggestions may be given to the
    effect that when the patient thinks about eating It's interesting to realize how sometimes we
    fattening foods, he/she will immediately have deceive ourselves. Maybe you can recall saying to
    images come to mind of horrible and negative yourself, when you're trying not to eat between
    consequences that could occur in the future. This meals, "This is too hard!" Of course it's hard, but
    may likewise be used with smokers, sexual addicts, what makes it too hard? Naturally it's difficult to
    and substance abusers. For instance, they may learn new habits. But you've done many difficult
    imagine losing their spouse and family, losing their things before. [Pause] Urges to eat will pass fairly
    job in disgrace, etc. This method is essentially a quickly. So the only thing that makes it "too hard,"
    hypnotically reinforced version of the cognitive is our irrationally telling ourselves that it is. But as
    therapy technique called covert sensitization. you reaffirm your commitment, to respect and pro-
    tect your body, so that (cite their individual
    motivations), you will find your eating behavior
    COGNITIVE REFRAMING changing.
    SUGGESTIONS FOR INCREASING
    You know, maybe you can remember once
    IMPULSE CONTROL when something was difficult, and you said or
    Rational-emotive therapy (RET) concepts that thought to yourself, "I can't stand it!" And
    are usually discussed at a conscious level
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 387

    then you went and ate something tempting. We've awakens and opens his/her eyes. After a minute or
    all thought that before. But this is an irrational two, trance may be reinduced and the anesthesia
    self-deception, and you don't want to stand under removed. Then comments may also be made (in
    any misunderstandings. Of course we can "stand addition to the suggestions above) about the
    it." And you can keep in mind that if you don't eat a "power of the unconscious mind to control your
    certain food, or at a certain moment, you're not body and feelings at any time, even when you are
    going to explode. When we choose not to eat not in hypnosis."
    something, we're not going to evaporate. For a few
    moments from time to time, it may not be entirely
    pleasant or easy, but we can stand it. There is no
    logical reason why life should always be perfectly
    comfortable, pleasant and easy, for every moment.
    Weight Control
    You can handle a little brief discomfort. We all can. David Spiegel, M.D., and
    And when we master things that are not easy, we Herbert Spiegel, M.D.
    feel very good about ourselves. Remember, you
    Stanford, California, and
    don't "have to" have a certain food, at some
    particular moment. You don't need it. Sometimes New York, New York
    you want it, but you also want to be slender, and
    you want to respect your body so that you can live. The instruction for weight control is similar to
    So you can admit that sometimes you want a that used for smoking control. Subjects are given
    fattening food, and that it's not always entirely easy, the following three points:
    but you can choose not to eat it, and not to eat right (1) For my body, too much food is damaging (or
    now, or you can eat something that's much better disfiguring); (2) I need my body to live; (3) I owe
    for you. my body respect and protection.
    Subjects are instructed to recognize that most of
    the food they eat nourishes their body, but an
    excess damages it, and that they can use
    self-hypnosis to learn to eat with respect for their
    TRANCE RATIFICATION body — eating with respect involves giving the
    body only the food it needs for nourishment and
    Methods of trance ratification (e.g., glove not forcing it to take in food which is damaging or
    anesthesia, limb rigidity, ideomotor phenomenon) disfiguring to it. They are further taught to
    may be used to increase patient confidence and concentrate on the concept of eating like a gourmet
    feelings of self-efficacy. "And just as your inner — savoring every aspect of the food they take in,
    mind is so powerful that it can even control the color, the texture, temperature, the aroma, the
    something as fundamental and basic as pain, so you flavor, the seasoning—so that they learn that they
    now know that it can control any of your feelings can actually eat less but enjoy eating more when
    and desires, and anything about your body. And they concentrate fully on the food they eat. This
    because of the incredible power of your includes eating slowly and eating without
    unconscious mind, your urges and cravings will distraction such as the television or a newspaper.
    increasingly come under your control, and will Other elements include, of course, a balanced diet
    grow less and less. Just as it controlled pain in your and exercise. The plan is, again, to help patients
    hand, so your cravings and desires for (food, restructure their approach to food, putting the
    cigarettes, drugs, sex) will come under your emphasis on eating with respect rather than a
    control." In the case of glove anesthesia, temporary state of deprivation. This approach is
    suggestions may be given for the anesthesia to applied primarily to patients who are within 20%
    remain after the patient of their ideal body weight.
    388 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Suggestions for Patients with is deprivation. They think they have to be deprived
    of things that they want and like. But, in actual fact,
    Obesity Problems all we really need to do to become the slender
    Joan Murray-Jobsis, Ph.D. person we wish to become is to help ourselves shift
    Chapel Hill, North Carolina our perceptions of our satisfactions about food.
    And instead of perceiving the old, destructive foods
    as satisfying, we shift our perceptions into new
    INDUCTION healthy, constructive patterns of eating that are
    In working with problems of overeating and satisfying. And so we begin by helping ourselves
    obesity, I typically will use an induction that forget to remember the old destructive eating
    employs progressive relaxation and an arm patterns, the old destructive satisfactions.
    levitation. During the arm levitation, I suggest to
    SYMBOLIC IMAGERY OF A CLOUD. We might imagine
    the patients that they are experiencing an altered
    putting all the old destructive foods —the fatty,
    sense of perception — that at one point in time they
    greasy foods, the fast foods, the snack foods, the
    have perceived their arm or their hand as if it were
    junk food, the excessively sweet foods, the
    under their control, but that during the levitation excessive amounts of food —putting all that
    they can perceive the arm or hand in an altered destructive food on a cloud. Finding it somewhat
    sense, as if it were dissociated and separate, heavy and distasteful, all that excessive, heavy,
    floating and apart. greasy, sweet mixed-up food. And then we give the
    cloud a push and watch it float off into the distance,
    until eventually it floats so far away that it becomes
    SUGGESTIONS
    a mere speck on the horizon, and we can scarcely
    SHIFTING PERCEPTIONS AND REFRAMING. [I later refer
    remember the taste or the aroma or even the look of
    back to this experience of altered perception and some of those old destructive foods, forgetting to
    suggest to the patient:] Since we can alter perception remember those old destructive foods. And be-
    about something as real and concrete as a physical ginning to discover in their place all the healthy,
    part of our body, our hand and our arm, then it must positive foods that we can eat and enjoy, even as we
    be an even simpler matter still to imagine altering become slender — finding satisfaction in lean meat
    perceptions about things such as ideas and thoughts and poultry, and fish and fruits and vegetables—
    and feelings. And then we can begin to imagine how the satisfaction of being free of the greasy, fatty
    we might alter our perception about ourselves and foods and the difficulty with digestion that follows,
    our perceptions about food, our thoughts and and the satisfaction in being free of the excessively
    feelings and behaviors about food. Perhaps sweet, sticky food, and the highs and lows of
    beginning to see ourselves as a slender thinking, high/low blood sugar rebounds. Feeling free from
    feeling, eating person. the addiction of eating sweets, the kind of addictive
    eating where one taste never seemed to satisfy, and
    And you can see yourself off in a distant future there was always a need for another, and then
    time with some sense of perspective and distance, another and another. And when we begin to
    and begin to notice that you do indeed have unhook, when we refrain from taking that first taste
    choices. You can choose to give care and respect to of sugary food, we suddenly, within a very few
    this physical being within which you reside. And days, begin to discover a sense of freedom from
    with that sense of care and respect, you can indeed that addictive, compulsive, mindless, empty eating,
    choose healthy, caring eating patterns. where food was passed into the mouth and body
    [Remind the clients about their ability to alter almost untasted. We find ourselves free to
    perception and then suggest:] When most people choose, sometimes to eat,
    think about dieting, one of the first things they
    think about immediately afterward
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 389

    sometimes not to eat, sometimes to eat moderately, INCREASING ACTIVITY LEVEL And then we can
    discovering the satisfaction and being comfortably begin to visualize ourselves in the coming days of
    full, but never again having to be overstuffed and the coming week following healthy, moderate
    bloated. You'll begin to discover that we have the eating patterns and activity patterns. Remembering
    capacity to find more lasting, more constructive the capacity to shift perception, we visualize
    satisfactions in life. ourselves following healthy moderate patterns of
    eating and activity throughout the day. Perhaps
    CHOOSING LONG-TERM, NOT SHORT-TERM increasing activity, enjoying physical activity even
    REWARDS.
    more. Remembering that the body has the capacity
    The fleeting moment of the taste of a piece of food to alter metabolism, automatically helping us find
    in the mouth was never meant to be much of a a more moderate, healthier weight level as the
    satisfaction. It's far too fleeting. We discover that
    body was designed to do —balancing body weight
    we can indeed find healthier, more lasting, more
    by balancing food intake and calorie consumption,
    constructive satisfactions: in hobbies and
    and setting that balance point at a more moderate,
    entertainment, or satisfactions in work and
    accomplishment, satisfactions in friends and loved healthier weight level as it was intended. Re-
    ones, or even in comfortable, relaxing and easy minding our body to activate the metabolic
    solitude. We can create for ourselves far more process, even as it depresses and suppresses
    lasting, constructive satisfaction, discovering appetite, finding that balancing point at a level that
    healthy ways of soothing ourselves, distracting allows a healthy, moderate body weight.
    ourselves.
    VISUALIZING THE GOAL. And then beginning to
    visualize ourselves at a still more future time at
    HANDLING EMOTIONS AND EMOTIONAL NEEDS DIRECTLY. some more slender weight, and beginning to
    And then we discover that we have the capacity of experience all of the feelings of that more slender
    mind to begin to deal with our feelings directly, no body, feeling a smaller, but stronger body,
    longer needing to submerge feelings in food. We healthier, more self-confident, attractive, a sense of
    discover that the mouth never ever solved the pride and accomplishment, feeling all of the good
    problems of the mind, but that we have the capacity feelings. And knowing that we are indeed already
    with our mind to deal with our feelings directly, to becoming that future slender self, and that all it
    allow ourselves to experience feelings: feelings of takes is time and perseverance, simply following
    anger, or frustration, or sadness, or boredom, or the moderate, healthy, satisfying patterns that we
    even joy. Discovering that we have the capacity to are already developing. And we are already
    experience our feelings, to feel them, to resolve becoming that future slender self.
    them, and that we no longer need to try to distance
    feelings or submerge them in food. And learning
    that we can deal far more effectively with our
    feelings with our mind rather than our mouths. We Computer Metaphor for
    discover that we no longer need the excuse of food
    in order to take a break, that we can simply choose Obesity
    to allow ourselves break time, down time, rest time.
    Richard B. Garver, Ed.D.
    We no longer need the crutch of food for concen-
    San Antonio, Texas
    tration or for socializing.

    We begin to discriminate between the body's real It is explained to patients that in order for them
    hunger for food for energy and the emotional to really lose weight and keep it off, it is necessary
    hungers where food was eaten even when we were for them to change their eating behavior, and not
    full. We learn that we can deal with our emotional just go on a diet. Therefore, I use a computer
    hungers with our mind rather than our mouth. metaphor and suggest to patients that before I see
    them again, they are to
    390 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    make a behavioral list for me. It is to consist of they assess their emotional stability. Patients are
    behaviors that they feel are negative or inap- asked to keep a daily diary of food intake, and
    propriate eating behaviors. This "program out" list unless there are medical contraindications, they are
    may include the kinds of foods they eat, emotional asked to not consume over 900 calories daily.
    eating, binge eating, any sort of inappropriate or Patients are further asked to walk one mile daily
    negative eating behavior. (other daily exercise may be substituted). (Ed.)
    Then, they are to make a list of "program in"
    behaviors —all those behaviors associated with
    positive, desired and appropriate eating behaviors. SUGGESTIONS
    When the patient returns, these lists are discussed.
    The patient or I may add some behaviors, and You simply will not be hungry. . . . The limited
    together we decide what is to be programmed out food intake can and will satisfy your hunger needs. .
    and programmed in. Then, in the hypnotic session, . . You will eat slowly and enjoy the food you are
    the unconscious mind is asked to specifically eating . . . you will eat slowly, masticate your food
    program out and program in behaviors that were slowly . . . you will enjoy every mouthful. . . . You
    selected. It is suggested that, "These will continue will have a full feeling in your stomach much
    to be reinforced, and since the programmed in sooner than usual . . . and as you are aware of this
    behaviors will be used more, they will get stronger; full feeling in your stomach much sooner than usual
    the programmed out behaviors will be used less and . . . you will then discontinue eating. . . . You will be
    less, and they will grow weaker, until the new relaxed and at ease, free from tension, tightness,
    eating behavior program is dominant." stress, and strain, free from excessive hunger. . . .
    Because of the power of your unconscious mind
    This can be reinforced with audiotapes, you will want to lose this weight. . . . You can and
    self-hypnosis and, of course, individual therapy you will tolerate this diet with minimal desire for
    sessions. This computer metaphor works nicely food. . . . You will be proud of every pound you lose
    with most behavior modification, but particularly and you will perceive yourself as becoming thinner,
    with habit disorders. I also find it useful to use less obese, and more like you've wanted to be. . . .
    unconscious ideomotor signaling, both to uncover You will not continue a habit pattern of overeating
    problem areas and also to validate patients' positive in which you have been taking certain risks
    self-reports. Then, they can see that not only concerning your physical and psychological health
    consciously but also unconsciously they are . . . you will want to lose weight and you can lose
    accepting the suggestions and processing them in a weight. . . . Regardless of circumstances you will
    positive way. maintain your diet without fanfare or resentment . .
    . you simply will be relaxed and at ease, free from
    hunger and tension, and tightness. . . . The weight
    loss will be consistent and permanent.
    Suggestions for Decreasing
    Food Intake
    Harold B. Crasilneck, Ph.D., and ILLUSTRATIVE SUGGESTIONS
    James A. Hall, M.D. Dallas, Texas FOR USE IN SELF-HYPNOSIS
    I am lying here with my eyes closed, ruling out
    INTRODUCTION all other thoughts and feelings. I am now
    Crasilneck and Hall (1985) have each of their concentrating on my right hand, which
    obesity patients medically screened and then is
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 391

    resting comfortably on my abdomen. ... I am Historic Landmark Technique for


    concentrating on the breathing of my abdomen, on
    the sensitivity of the fingers in my right hand ... to Treating Obesity
    the texture of the material in my clothing . . . my
    hand rises and falls with every breath I take . . . and William C. Wester, II, Ed.D.
    1 am beginning to enter a much deeper state ... I am Cincinnati, Ohio
    relaxed, free from tension, free from psychological
    stress and strain . . . every muscle, every fiber in my INTRODUCTION
    body is relaxing . . . from my head, shoulders, arms,
    torso, legs, feet, toes. . . . My breathing is This is a circular hypnotic technique whereby
    comfortable and with every breath I take I am the patient begins a journey at a certain point and
    entering a much deeper, a much more relaxed state. then ends the journey at the same point. This
    . . . Now my right leg feels heavy ... as I feel it, technique can be used following a basic
    normal sensation returns to my right leg . . . a progressive relaxation technique, and a variety of
    deeper and sounder state ... my right arm becomes direct and indirect suggestions can be given during
    tense and rigid like steel . . . one, two, three . . . steel the patient's imagined journey. The technique can
    . . . this passes. . . . As I slowly count from 1 to 10, be altered to fit the specific nature of the patient's
    which I now start doing, I will progressively enter problem. I will use the problem of obesity as an
    into the deepest state possible so that I can accept example of this treatment procedure. The brief
    into my unconscious mind and put into effect with example below can be embellished in any way. The
    my unconscious mind these suggestions — food procedure can be modified to be consistent with
    intake is no longer of great importance to me. ... I any hypnotic or therapeutic style. A recording of
    will no longer overeat as I once did, in a hurried, this procedure can be completed during the session
    forceful fashion. ... I will eat extremely slowly, and given to the patient to be played a minimum of
    frequently pausing while I eat, respecting my body once every other day until the next visit.
    rather than gorging it with food ... the loss of weight
    will have much more meaning to me than being
    grossly obese . . . and I am never going to be fat SUGGESTIONS
    again! ... I am going to respect my body, and I will
    not be excessively hungry. ... I will enjoy eating, And now, I would like you to see yourself
    but I will not exceed the caloric count prescribed standing at the edge of a beautiful field. It's a
    for me. . . . I am so very relaxed, and 1 am going to gorgeous day, just the way you would like it to be.
    know a peace of mind in achieving this weight loss. And even the field itself can be any kind of field
    . . . This weight loss will be permanent. ... I will you might wish it to be. A field of beautiful
    maintain my diet in my home and social situations flowers, or perhaps a wheat field, with the wheat
    under any conditions because I want to. . . . Now as gently flowing with the breeze. Cutting across the
    I slowly count from ten to one I am slowly going to field there is a path; it's very safe and secure and
    be awakened. . . . I am going to be refreshed, my I'm going to ask you to walk along the path as I'm
    thoughts will not be obsessed with food or food talking to you and simply enjoy this beautiful day.
    intake . . . but instead, I will be pleased with every As you walk along the path, you can find yourself
    pound that I lose. ... I am now counting slowly, I am relaxing more deeply, thoroughly, and
    awakening, and I am fully awake at the count of completely— feeling so good and so comfortable
    one. and so relaxed.
    On the other side of the field you will notice that
    the path just continues across a meadow. Stay on
    the path, enjoying a gorgeous day, and
    392 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    just ahead you're going to come to a footbridge. continue to control your eating habits and
    Now there's just a couple of steps onto the foot- behaviors, and to develop new eating habits and
    bridge; there's a bench built into the bridge where behaviors appropriate to your goal. Each day,
    perhaps you would like to stop a moment and rest allowing you to feel and be more and more in
    and relax even more completely. Beneath the control — in control, comfortable, confident,
    bridge there's a brook. The water is crystal clear, it's knowing what you're doing is a good and healthy
    quite shallow; you may even be able to hear the and appropriate thing for you. Because you're going
    water trickling over the rocks. It's just so relaxing to be so much in control, you're going to feel
    and so comfortable. Just enjoy that comfort and relaxed, calm, less stressed, less tense, less anxious,
    relaxation for a moment and then continue off the less nervous, no need to overeat or to eat
    other side of the footbridge, staying on the path. inappropriate foods. You're in charge and you're in
    You'll notice up ahead that there is a marvelous control. And even when sitting down at a regular
    old building, like an old castle. Along the side of meal, you're going to find that your subconscious
    the path there's a marker which indicates that this is mind gives you a nice feeling of fullness much
    a historical landmark, and visitors are welcome at sooner than before, allowing you to eat
    all times. Stay on the path now, and as you appropriately and consistent with your goal. [Any
    approach the old building, there's a caretaker and other specific motivations provided by the patient
    the caretaker's spouse out working in the grounds, during the prehypnotic interview can also be
    and you are really impressed. The grounds are just included at this time.]
    magnificent! Everything is hedged and weeded and
    pruned and mulched—just right. All of the various Now take all of that strength, motivation, and
    flowers and plantings are just beautiful. It's obvious control with you. Your subconscious mind is a very
    to you that here are two people who take great pride powerful part of you. Take all of that with you now
    in what they do, and have worked very hard to and come back outside of the old castle, say
    accomplish a goal important to them. You might goodbye to the caretaker and the caretaker's spouse;
    even want to speak to them and acknowledge what and begin walking back down along the path, back
    a great job they have done. They indicate to you down to the footbridge, and as you come to the
    that the front door to this old building— this old footbridge, I'd like you to pause for a moment, look
    castle— is left propped open, so that visitors can down into the water, and see a reflection of yourself
    step inside and really enjoy the splendor of this at your desired weight; see yourself right there, the
    magnificent, strong and sturdy structure. As you way you would like to look and feel. Notice
    step inside the entrance way, you find yourself perhaps even what you're wearing and how good
    standing in a light source; it's not direct sunlight, you feel about yourself. Just allow that image to be
    but simply a light source and a very special feeling very clear and helpful to you, because each time
    comes over your body. that you even think about overeating, or eating
    inappropriate foods, that image is just going to pop
    There's a point in time when we really feel good, into your mind, and continue to give you that added
    comfortable and totally relaxed. Some people strength, control and motivation needed to keep
    describe it as a glow — that point in our life when those eating habits and behaviors consistent with
    things seem to be going quite well and we really your goal.
    feel good. Just allow that special feeling to come
    over your body, a feeling of deep comfort and deep Take that image now and all of those feelings
    relaxation. As you experience this feeling, that you have with you from the old castle, and
    recognize the degree to which your subconscious come off the other side of the footbridge and begin
    mind is going to allow you to maintain extremely to walk back across the meadow, feeling so good
    high motivation, to and so comfortable, and so much in control and
    really looking forward to each pound that you lose,
    getting closer and closer to
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 393

    your goal. And now as you reach the edge of the RATIFICATION THROUGH LEVITATION. At this time I would
    field, I'm just going to count from one to five, and like you to focus attention on feelings in your left
    when I reach the number five, your eyes will open hand. Imagine that colored balloons are tied to the
    and you will be completely, completely alert; fingers of your left hand and that several balloons
    feeling good, feeling refreshed, completely, are tied to your left wrist. Feel the lightness in your
    completely alert. One . . . two ... a little more alert fingers and wrist as the balloons in their upward
    now, 3 . . . really feeling that control, and knowing flight support the weight of your fingers and hand.
    that you're in charge of your eating habits and As your hand feels lighter and lighter and you go
    behaviors; four ... a little more alert, almost more deeply relaxed, your subconscious mind will
    readily accept ideas for making your whole body
    completely alert now, and five . . . opening your
    lighter.
    eyes completely, completely alert.

    EATING IS AN ART. Reduction of body weight can


    be accomplished by learning to thoroughly enjoy
    Hypnosis in Weight Control those foods that do not contribute to the formation
    of body fat while eliminating sweets and starches.
    Herbert Mann, M.D. Your enjoyment of those foods that are good for
    San lose, California you can be markedly enhanced. To help you
    appreciate the pleasure in eating properly, I would
    like you to picture in your mind's eye a wine taster.
    WEIGHT CONTROL SUGGESTIONS You relax more deeply as your hand continues to
    As you relax comfortably, I am going to offer rise toward your face and the image of a wine taster
    ideas and suggestions that will be most helpful in appears. He/she spends a little time holding a glass
    attaining deeper levels of relaxation and in of wine toward the light and fully appreciates the
    controlling your desire for fattening food. It isn't beautiful color and clarity of the beverage. He/she
    really necessary for you to pay close attention to permits himself the luxury of enjoying the delicate
    what I have to say. You may involve yourself in aroma and bouquet. Only then does he allow a few
    your own thoughts, your own body feelings, your drops of the liquid to touch his lips and tongue, and
    own sensations. In its unique way, your to bring into play the sensitive taste buds. Taking
    subconscious mind listens and responds to new full advantage of the organs of sight, smell, taste,
    learnings and experiences. Your eyes are growing he derives the most exquisite gustatory pleasure.
    heavier, and a delightful feeling of deep relaxation Eating is an art. You are learning to apply
    is spreading through the muscles of your face, your techniques that give you more satisfaction and
    neck, shoulders, and downward through your chest, enjoyment in eating than you have ever experi-
    back, abdomen, thighs, and legs. enced in the past. You automatically find yourself
    Your attempts in the past to starve yourself into eating slowly, appreciating the color and fragrance
    reducing body weight developed tension, anxiety, of those foods that are good for you. You take
    and frustration. That is all over. Now you have the small bites of food and devote time to appreciate
    wonderful opportunity to associate relaxation of patterns of eating, and textures. As you establish
    body and mind with a relaxed attitude toward new and delightful patterns of eating, you enjoy a
    eating. You find yourself comfortably choosing feeling of release from anxiety and frustration, a
    only those foods that are good for you, and passing feeling of increased confidence in your ability to
    up the foods that are fattening. Each passing day achieve your goal.
    you gain more and more confidence in your ability As you continue to relax more deeply and
    to control your food intake. comfortably, I will touch your left hand and
    394 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    lower it to your lap. The lightness disappears and changes in eating habits that will result in weight
    you go deeper into trance and feel more confident loss. To help you do this, I would like you to picture
    in your ability to carry out instructions and in your mind a professional coffee taster raising a
    recommendations. As time goes on you will find cup of coffee and spending a little time analyzing
    yourself eating only those foods that are good for the reflections of light on the surface of the coffee,
    you and that will permit your body to lose excess the color and clarity of the coffee. When you see
    weight. [Specific foods that are acceptable and this clearly, let me know by nodding the head.
    prohibited may be indicated.] [Note: Raising a finger may be used in lieu of
    The change in your eating habits results in loss nodding the head.] Then the taster slowly raises the
    of excess weight, a more attractive figure, and cup and spends a few moments enjoying the
    increased pep and energy. You develop confidence delicate aroma of the coffee. As you develop this
    in your ability to be a dynamic and effective image, you go into a deeper, delightful trance state,
    person. Your subconscious mind has a tremendous and as you go deeper and deeper relaxed you notice
    capacity for learning, and as you continue to relax the coffee taster taking a sip of the beverage,
    more deeply your new learnings automatically bringing into play the sensitive organs of taste. By
    become an integral part of your total personality. taking advantage of the organs of sight, smell, and
    You respond to ideas and suggestions that are most taste, the coffee taster derives the utmost
    helpful in establishing a new point of view, a new gratification from a small quantity of coffee. As
    orientation, a new way of life. you continue to go into a deeper, enjoyable trance
    state, it might be interesting for you to compare the
    [As the patient's ability to operate within the coffee taster's unhurried appreciation of a small
    hypnotic situation increases, self-hypnosis is used amount of coffee with another person who quickly
    to reinforce therapeutic suggestions in daily home gulps a whole cup of coffee without taking time to
    sessions. In a self-induced trance, the patient appreciate all the subtleties of good eating, his taste
    reviews ideas and suggestions that have been buds so overwhelmed by a large quantity of coffee
    imprinted on the subconscious. By actively rapidly consumed that he cannot appreciate the
    participating in the weight reduction program, delicate flavor.
    patients learn to depend less on the therapist and
    more on their innate ego-strengthening capability.]
    You can develop the habits of a professional
    Your success in learning to relax and to ex-
    taster taking time to concentrate on color, aroma,
    perience various hypnotic phenomena may now be
    flavor, enjoying eating slowly, limiting yourself to
    utilized in another learning process. Just as your
    small bites of food and developing a feeling of
    subconscious mind learned to experience various
    comfortable fullness after eating relatively small
    sensations and activities, it can learn to control the
    portions of food. You will pass up fattening foods
    pleasurable activity of eating. While you continue
    because they become associated in your mind with
    to relax more and more deeply and comfortably, I
    being overweight. Eating properly is associated
    am going to offer you ideas that your subconscious with pleasurable feelings, feelings of lightness,
    mind can readily accept. In that way you will attractiveness and good health. As you continue to
    automatically change your eating habits so that you develop good eating habits, you will take pleasure
    can comfortably lose excess weight, then continue in increasing physical activity and exercise. Eating
    through life eating pleasurably and sensibly while properly helps develop a feeling of physical
    maintaining normal weight. You can accomplish well-being and attractiveness. It diminishes mental
    this by eating food that is good for your body. and muscle fatigue so that you find yourself more
    SAVORING FOOD LIKE A COFFEE alert and inclined to participate in that form of
    TASTER. YOU Can
    exercise and recreation that best fits your particular
    learn to enjoy eating while making appropriate needs.
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 395

    Weight Control Suggestions your health will become better and better.
    Remember, too, that your own suggestions will
    Harry E. Stanton, Ph.D. now be just as effective as the suggestions I give
    Hobart, Tasmania, Australia you, either personally or by tape.

    [Following induction, deepening, and


    ego-strengthening suggestions:] And now I want
    you to have a clear mental image in your mind, of Miscellaneous Suggestions for
    yourself standing on the scales and the scales Weight Control
    registering the weight you wish to be. See this very,
    very clearly for this is the weight you will be. See William S. Kroger, M.D., and
    yourself looking the way you would like to look William D. Fezler, Ph.D.
    with the weight off those parts of the body you want Palm Springs, California, and
    the weight to be off. See this very, very vividly and Beverly Hills, California
    summon this image into your mind many times
    during the day; particularly just after waking in the EAT LIKE A GOURMET. If you really wish to lose
    morning and before going to sleep at night, also weight, you will roll the food from the front of the
    have it vividly in your mind before eating meals. tongue to the back of the tongue and from side to
    And this is the way you will look, and this is the side in order to obtain the last ounce of satisfaction
    weight you will be. As you believe this, so it will and the "most mileage" out of each morsel and
    be. When you have attained this weight, you will be each drop that you eat. By doing this you will more
    able to maintain it, you will find yourself eating just readily satisfy the thousands of taste cells that are
    enough to maintain your weight at the weight you located all over your tongue (there is an appetite
    would like to be. Until you do attain this weight you center located in the hypothalamus) and, as a
    will find you have less, and less desire to eat result, less food will be required and your caloric
    between meals. In fact, very, very soon, you will intake will be immeasurably curtailed.
    have no desire at all, to eat between meals. You
    simply will not want to. Also you will find you will
    be content with smaller meals. There will be no THINK THIN. Second, you will "think thin"; that is,
    sense of unhap-piness or dissatisfaction, smaller you will keep an image uppermost in your mind of
    meals will be quite satisfactory to you, and you will how you once looked when you were thin. Perhaps
    have no desire to eat large meals. Also you will you have a picture of yourself when you weighed
    have less, and less desire for high calorie, rich, less. If so, place this in a prominent position so that
    unhealthy foods. Day by day, your desire for such you will be continually reminded of the way you
    foods will become less and less, until very, very once looked. There is considerable basis for this
    soon, you will have no desire at all for rich, high suggestion. You undoubtedly are aware that, if a
    calorie, unhealthy foods. Instead, day by day, you woman imagines or thinks that she is pregnant, her
    will desire low calorie, healthy foods, and these will body will develop the contour of a pregnant
    replace the high calorie foods, the rich foods, you woman; her breasts will enlarge and she may, in
    have eaten in the past. As you lose weight and many instances, stop menstruating. Also, you may
    approach closer and closer to the weight you wish have at one time experienced a great deal of inner
    to be, you will find yourself growing stronger and turmoil and lost weight in spite of the fact that you
    stronger, healthier and healthier. Your resistance to ate excessively. Cannot a frustrated lover also
    illness and disease will increase, day by day. With "pine away" for the beloved?
    less weight you will feel better and better, and
    AVERSIVE CONDITIONING. Third, you might like to
    think of the most horrible, nauseating, and
    396 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    repugnant smell that you have ever experienced. will notice a numb, tingling sensation in the fingertips.
    Perhaps it might be the vile odor of rotten eggs. In As you imagine your hand in that cold, chilling ice
    the future, whenever you desire to eat something water, the colder and more numb your fingers will
    that is not on your diet, you will immediately become. So, if you wish to develop this numbness in
    your hand, just lift it toward the side of your face. If
    associate this disagreeable smell with it. Also, you
    you wish to increase the numbness, suggest to
    might like to think of the most awful and disgusting yourself that with each motion of your hand toward
    taste that you may have had in the past. This, too, your face it will get more numb and more
    can be linked with fattening foods even when you wooden-like. [At this point the hand continues to
    merely think of them. move upward.] After each movement, pause to give
    your hand a chance to feel the suggestions of numb-
    MOTIVATING YOURSELF. Finally, for this session, ness. [The hand continues to move a short distance
    remember that you cannot will yourself of lose of an inch or two at a time, and to move steadily
    weight. The harder you try, the less chance you will toward the side of the face.] If you wish more
    numbness of the hand, notice that the closer it
    have to accomplish your aims. So relax — don't
    approaches your cheek the more numb it will get.
    press. The next suggestion is to motivate you. And when it finally reaches your cheek, just let the
    Would you mind purchasing the most beautiful palm of your hand rest lightly against your cheek.
    dress that you can afford? Hang it up in your Then allow the numbness to be transferred from
    bedroom where you can see it every morning and your palm to the side of your cheek. After you are
    imagine yourself getting into it within a relatively certain that your cheek has become very numb, only
    short time. You can speculate how soon this will then will your hand drop to your side, and it will feel
    be. Now this is important! The dress you buy normal. However, the side of your face will feel just as
    should be at least one or two sizes too small for if a dentist had injected novocaine into your gums.
    you. Remember how leathery and stiff one side of your
    face feels following an injection?

    Such suggestions make full use of subtle tech-


    Further Suggestions for niques leaving the patient no alternative but to
    Management of Obesity make the side of his face feel completely "anes-
    thetized." After feeling the glove anesthesia he is
    William S. Kroger, M.D. convinced that the numbness of the cheek is
    Palm Springs, California genuine. This suggestion is given as follows:

    SUGGESTIONS FOR GLOVE Whenever you feel the onset of hunger, you can
    ANESTHESIA stop it by placing the anesthetized hand over the pit
    of your stomach to control the hunger pangs.
    "Glove anesthesia" is another valuable dyna-
    mism for appetite control. It is extremely useful for
    minimizing hunger contractions. The patient places USING IMAGINATION
    the hand "made numb" over the epigastrium. This
    technique has been employed in dentistry, for . . ."Think thin," that is, keep an image uppermost
    amelioration of pain in cancer, with surgical and in your mind of how you once looked when your
    obstetrical patients. . . . The technique for glove weight was normal. Pick your own good points
    anesthesia is as follows: (smile, eyes, hands, hair, complexion, etc.) and
    concentrate on how these will be enhanced by
    Imagine that your right or left hand is in a pitcher, weight loss. Also, place a picture of yourself when
    jug or bowl of ice water. You can practically feel the you weighed less in a prominent position so it
    imaginary ice cubes bumping your hand. At first you continually reminds you of the way you once
    looked.
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 397

    Erickson's Suggestions with Negative Accentuation:


    Obesity Vivifying the Negative
    During Trance
    Milton H. Erickson, M.D.
    M. Erik Wright, M.D., Ph.D.

    [With a severely obese young woman who


    already described herself as a "fat slob":] I really INDICATIONS AND
    don't think you know how unpleasant your fatness CONTRAINDICATIONS
    is to you ... so tonight when you go to bed, first get
    in the nude and stand in front of a full-length mirror Indications and guidelines concerning the use of
    aversive, negative hypnotic techniques are
    and really see how much you dislike all that fat you
    discussed to some degree by Dr. Wright below, but
    have. And if you think hard enough and look
    a few remarks seem appropriate. It is not currently
    through that layer of blubber that you've got fashionable to use aversive or negative hypnotic
    wrapped around you, you will see a very pretty methods. But when more positive techniques do
    feminine figure, but it is buried rather deeply. And not produce success, and when the patient is very
    what do you think you ought to do to get that figure hypnotically talented and capable of experiencing
    excavated? ideosensory phenomena, aversion suggestions may
    potentially contribute to favorable outcomes.
    Aversive methods also seem to me to be indicated
    THOROUGHLY ENJOY A when they are congruent with the patient's
    SMALL PORTION expectations for therapy. Some patients want,
    expect and even request this type of suggestion. It
    And I'd like you to enjoy it thoroughly and well. seems reasonable in such instances to meet the pa-
    You know, it's just as easy to enjoy a small portion tient's expectations and preferences by providing
    as it is a large portion. In fact, those . . . who eat a such suggestions, albeit preferably within the
    context of many other positively framed
    small portion will enjoy a small portion much more
    suggestions. Dr. Wright's approach to accentuating
    than you would a large portion. And you really
    the negative provides a particularly balanced and
    will, because you won't even have to feel guilty thoughtful model for us. Dr. Stock's metaphor that
    about that small portion. You'll be perfectly follows also illustrates a subtle method for giving
    delighted with it. aversive suggestions. (Ed.)

    FAIL-SAFE QUESTIONS UTILIZING


    INTRODUCTION
    THE UNCONSCIOUS
    The client is asked to prepare a list of personally
    And what will be the effective means of losing negative consequences of overeating and to rank
    weight? Will it be because you simply forget to eat them in order of increasing negative value. . . .
    and have little patience with heavy meals because Even though the client is the person who prepares
    they prevent you from doing more interesting the list of negative effects and chooses the one(s) to
    things? Will certain foods that put on weight no be initially elaborated, it remains prudent for the
    longer appeal to you for whatever reasons? Will therapist to use either the Chevruel pendulum or
    you discover the enjoyment of new foods and new the finger signaling technique to check whether
    ways of preparing them and eating so that you'll be accentuating the negative in fantasy would be
    surprised that you did lose weight because you accept-
    really didn't miss anything?
    398 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    able to the client. An affirmative response confirms lap . . . letting go . . . your whole being relaxed . . .
    the client's readiness to accept the heightened stress drifting . . . drifting . . . drifting to an eating
    that may be associated with negative accentuation situation where you have an inexhaustible supply
    during hypnotic trance. It also implies that the of food in front of you. . . . Signal with your right
    client recognizes the purpose of negative index finger when that image or that idea is clear to
    accentuation in facilitating better self-management you. . . .
    of eating. Okay . . . [Dissociation is suggested:] I'm going
    The particular client in the following demon- to ask you to describe the scene, and as you talk you
    stration was a 45-year- old male who had drawn up become more and more involved in the scene until
    a list of negative consequences of overeating that part of you feels like it is right there in the scene
    began with a double chin and ended with a very and the main part remains right here with me
    deep concern about high blood pressure and watching what is happening. . . .
    diabetes, both of which were quite frequent on his Client: I see myself in the restaurant. . . . There is
    father's side of the family. He had always had a a huge smorgasbord table spread out in front of me
    vigorous appetite, but his weight problem had piled high with wonderful food. ... It all looks and
    become aggravated since he had become sales smells so appetizing. . . .
    manager of an insurance firm, a position that T: Imagine yourself with an unlimited appetite . .
    required frequent luncheon and dinner meetings . begin feeding yourself from the heaping plates . . .
    with clients. He had gained 25 pounds in the past and imagine that it is like time-lapse photography.
    nine months, reaching his present weight of 230 ... As the food goes into you ... it is processed
    pounds. There was a classical history of crash diets almost immediately . . . and you can see the effects
    and rapid regaining of weight, usually to a point of the food ... as if weeks and weeks of eating were
    greater than the preceding figure. This time he had being condensed into minutes. . . .
    made a commitment to his family to stay with the
    program under the supervision of his internist and C: I can taste the food on the back of my tongue
    psychotherapist. His only constraint was that no and just feel the swallowing. . . . The skin under my
    appetite-suppressing medication be used. chin is filling out. ... It seems to be getting larger
    and fuller until my chin seems to blend into this
    under-skin. ... I can hardly see the neck line. ... It
    looks almost like a frog's neck, and my head is
    forced upward a way, by the mass under my chin . .
    SUGGESTIONS
    . that's really weird-looking. . . .
    Therapist: You indicated with the Chevruel T: Keep on with your eating. . . . See where your
    pendulum that you were ready to give full image leads you as you continue eating. . . .
    emphasis to these feelings while in trance so that C: Now I see myself beginning to get larger
    the inner part of your mind could get the message around my chest and middle. ... A funny thing is
    to use them to become a balanced eater. happening . . . now I can see myself only from the
    Please raise your right hand in front of you with back, and I am no longer sitting on a chair but on a
    the palm facing away, and focus upon your fingers bench, and my back end is beginning to drape over
    as you have done several times before. Let the it. . . . I see the midseam in the back of my jacket
    feelings of heaviness come into your hand as your pulling apart ... as though it might give way any
    eyes maintain their fixed focus. . . . As you feel moment. . . . Now it shifts again and I am looking at
    your hand moving down, let the heaviness in your the front of me . . . I can hardly
    eyes increase until they want to close . . . good . . .
    let them close and let your arm come to rest in your
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 399

    recognize myself. . . . My eyes are deep in my head problems, each one the equivalent of a detective
    with big rolls of cheek. . . . story.
    T: How are you feeling? One day my teacher and I were presented with an
    C: Terrible . . . yet I still see myself eating . . . and unusual problem. He was a young man in white
    getting more and more bloated .. . hardly a large coveralls and a chef's hat. Now one of the first
    enough opening in my face for the food to be put in. things that was required of us medical students, as
    ... I don't know if I could stand up on my legs if I part of our learning, was to guess the patient's age
    tried. . . . and occupation, the problem, and then the solution.
    T: Intensify the image . . . [Client comanagement Looking at the young patient, the most obvious
    is suggested:] Bring it to the point where it will be things about him were the numerous green and
    most helpful to you in managing your daily eating yellow stains on his coverall. Naturally I first
    program. . . . considered which occupations would produce
    C: I'm beginning to get a sickish feeling inside. . stains of that sort. However, it turned out that he
    . . That's hardly human. ... I can't seem to recognize worked at Laura Secord, with chocolate, and none
    myself. ... It stopped feeding itself. . . . of the fillings used were that color. As is the
    T: Good . . . make use of this image when your custom, we asked him why he had presented
    inner mind needs it to help you become a balanced himself at the O.P. department, and he said, "Look."
    eater. . . . Now condense future time. . . . See that He removed his chefs hat and the coveralls and
    image begin to restore itself as the eating becomes a stood there in his underwear. He was covered with
    balanced eating. . . . When the figure of yourself is large boils, each boil like a volcano erupting, pus,
    back to where it pleases you . . . signal with your yellow in some areas, green in other areas. It had
    right index finger. . . . Count yourself back to the seeped through the material of the uniform and
    here and produced the green and yellow stains. By the time
    we had established the connection between the pus
    stains on his garment and the erupting boils, the
    aroma of putrefaction had reached us, the typical
    revolting smell of pus from BACILLUS
    PYOCYANEUS.
    Aversive Metaphor for
    My teacher explained this was quite common
    Chocolate Eaters among chocolate workers. A light dusting of sugar
    provides just the right condition for bacteria and
    Marvin Stock, M.D. mold to grow. With my vivid imagination I could
    Toronto, Ontario, Canada see hordes of chocolate workers covered with all
    kinds of vile skin lesions. My stomach heaved the
    When you mentioned your problem with premonitory acid to the back of the mouth that
    chocolate, I told you how I understand that, and precedes vomiting. I quickly made up my mind to
    that I will tell you of my personal experience. Years renounce chocolate and felt better. Needless to
    ago, when I was a young adult in medical school, I say, my acne cleared rapidly after that. That was a
    suffered from acne. The dermatologist repeatedly worthwhile experience.
    informed me that my adolescent acne was Later in medical school, in the course on
    maintained, actually made worse, by the chocolate nutrition, we were given the most advanced and
    I regularly consumed. Despite the disfiguring acne, detailed analysis of foods, and in the breakdown of
    I found it impossible to stop. The years went by. At chocolate, it turns out there is always 5%-10% of
    last I was at the stage where I could work with unrecognizable organic material. Now what could
    actual patients in the outpatient department. I found that mean?
    the O.P.D. filled with fascinating and
    challenging
    400 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Our professor informed us that this represents the when turning down the dial. The actual details of
    remains of insects, and rodent droppings that could the dial or control box may be left to the client's
    not be washed off the cocoa bean during imagination and liking.
    manufacturing. Furthermore, during the
    manufacturing process, similar unwanted animal SUGGESTIVE WORDING. And now visualize a box
    life falls into the vats all the time. I was so glad that with a dial on it. Do you see the dial box? [Obtain
    I had rejected chocolate before. verbal or nonverbal confirmation.] That's it, and
    Now I suggest when you look at chocolate, you now visualize the dial, and notice the different
    do what I have done, you imagine for a moment degrees of intensity, perhaps ranging from 1 to 10.
    that you have microscopic vision and see those bits [Obtain verbal or nonverbal confirmation.] Become
    and pieces, up to 10%, dispersed through the aware of the level of [e.g., pain, desire, problematic
    chocolate. When you do so effectively, just be behavior]. What level do you feel it on a scale of 1
    prepared for a pleasant surprise. to 10? [Alternatively: "What level is this currently
    on the dial box?"] Now allow yourself to turn it
    down. [Pause] That's it, visualize yourself turning
    the sensation down to a comfortable level. [Obtain
    input about the process.] What are you feeling? Is it
    Symbolic Imagery: The Dial comfortable? [If a "no" answer is obtained, have the
    Box Shrinking Technique client explore the symptom and decide its various
    attributes, characteristics, sensation, etc.] And
    Mark S. Carich, Ph.D. notice how easy it is to turn the dial. Notice how
    Collinsville, Illinois easy it is to control things. [Have the client practice
    modifying the intensity of the symptom. This
    procedure may also be tape recorded for use in
    INTRODUCTION AND INDICATIONS self-hypnosis. With each practice session the client
    may be able to decrease the intensity toward a
    This technique has the hypnotized client imagine manageable level or reinforce symptomatic
    a dial with different degrees or levels that indicate control.]
    reduction of the specified behavior. For example,
    the client may imagine a dial ranging in intensity
    from 0 to 10. This method may be beneficial in
    "shrinking" a symptom, whether it is a "need" or
    desire, pain, a cognitive belief or perception, or a
    behavior. [Another illustration of this type of The Attic of the Past
    method is Hammond's master control room
    technique in Chapter 11.] Eleanor S. Field, Ph.D.
    Tarzana, California

    THE TECHNIQUE
    INDICATIONS
    The client is instructed to imagine or visualize a
    dial that controls the intensity of the symptom. It is
    This technique may be used with habit disorders
    important to tailor the metaphor to the sensory
    such as obesity or smoking. Instead of "trading
    modalities that the client uses. For example, if the
    down" to another kind of oral habit or addiction,
    client is capable of imagining sounds, it is
    important to emphasize the clicks the patient is encouraged to "trade up" instead by
    ascending the stairs to the attic of the past.
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 401

    SUGGESTIONS put them in that big knapsack that lies near the door
    of the attic. Perhaps you might like to put them in a
    And with each step you climb toward the attic, at jar, the one over there with the pretty lid. Perhaps
    the same time you go deeper and deeper relaxed. you might just like to keep them within your
    One, going up toward the attic of the past. Two. psyche or your innermost mind.
    [Etc.]. At five you reach the landing and turn as the Close the doors to the attic and descend the
    stairs take you in another direction. Six, smelling stairs. Ten, coming down. Nine, beginning to leave
    the pleasant, familiar smell of the cedar. Seven, the smell of the cedar behind you. Eight, carrying
    experiencing the warmth of the air. Eight. Nine. those valuable experiences back with you. Seven,
    Ten. As you open the doors to the attic, the rafters almost to the landing now. Six. [Pause] Five,
    appear to reach in every direction, and the rickety turning again toward your initial direction. Four.
    old floor cracks beneath your feet. Three. Two. One, leaving the attic of the past,
    Before your eyes are several large old chests and knowing you can return there on your own,
    several large cartons. You might wonder what they whenever you please, and having with you those
    contain. You might like to take a moment now and valuable experiences from out of your past.
    rummage through one of the old chests and come And I now make the suggestion to you that each
    upon a past experience of your life that was and every time you have the desire to eat at a time
    particularly pleasant, and joyful, perhaps even a you know is not in your best interest, or eat
    peak experience for you. When you come upon that something which is not in the realm of becoming
    experience, lift a finger on either hand that indicates the "slim, trim, thin you" [or whatever you have the
    "yes" for you. Now, really reexperience that desire to reach for a cigarette, etc.], instead, I
    situation in every way, see it in every detail, what suggest that you think of the title of one of your
    you look like, the colors you are wearing, the past peak experiences, and allow yourself to take a
    surrounding environment. Feel the joyous and few moments to relax and reexperience it again in
    pleasant feelings associated with that experience, every detail, with all the sounds, smells, colors, and
    and any other feelings that are a part of that time of especially the good feelings, the feelings of
    your life. Hear the sounds involved with that accomplishment, of attainment of goals, and
    episode. Smell the smells associated with that time. whatever sensations are related to that experience.
    Take a few moments and do just that. [Pause]
    And won't it be exciting for you to realize that
    Would it be all right to share that experience with you can do just that, and you don't even need to sit
    me? [If "yes," allow the patient to do so. If "no," or or lie down to do it. You can be anywhere you
    following the patient's sharing, continue as happen to be at that time. And won't it be especially
    follows.] Before we move on, please title your exciting when five weeks or five months from now,
    experience, like the name of a book or movie. Now I really don't know when, you look back at today
    move forward or backward over the river of time here in this office, and you have achieved this
    and come upon another such experience, perhaps present goal of becoming the "slim, trim, thin you"
    an anniversary, wedding, graduation, or the birth of [or the person who no longer desires a cigarette,
    a child. [Repeat the process, accessing three or four etc.]. And you'll realize that you were able to
    positive episodes, going backward or forward over become the person you wanted to be, entirely on
    the river of time or the highway of life.] your own, utilizing all of your courage, your own
    control, and especially your very own life expe-
    Now I'd like you to descend the stairs from the
    riences to make the present and future happen for
    attic of the past, and as you do so, it might be
    you, as you wanted it to happen, having achieved
    especially nice if you could bring those
    your goal and knowing you can maintain it for the
    experiences back with you. Perhaps you could
    rest of your life.
    402 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    TREATMENT OF EATING DISORDERS

    Suggestions to Modify attractive. These thoughts will simply spring into


    your mind over and over again. [Repeat
    Body Attitude suggestions again.]
    Eric J. Van Denburg and
    Richard M. Kurtz, Ph.D. SUGGESTION FOR AMNESIA
    Chicago, Illinois, and St. Louis, Missouri
    ... I want you to forget that I gave you this
    suggestion — you will carry out the suggestion —
    INTRODUCTION AND INDICATIONS but you will not remember that 1 gave it to you. No
    matter how hard you try you will not be able to
    The authors documented that these suggestions remember that I gave you this suggestion. The
    may produce attitudinal and phenomeno-logical harder you try to remember the more difficult it will
    changes in hypnotically responsive subjects. In become. You'll completely forget about my
    support of traditional clinical wisdom, they also suggestion about your body as if it never happened.
    found that the suggestions were primarily effective This is the one thing that you cannot remember.
    when the subject was amnestic for the suggestions. You are going to wake up in a few minutes. You
    Thus their amnesia suggestions have also been will feel refreshed, wide awake, and in a good
    included with their other suggestions. (Ed.) mood. I will count from 1 to 5 and with each count
    you will be more fully awake.

    SUGGESTIONS

    Now listen very carefully. I want you to Altering Body Image


    concentrate on your bodily appearance, form a
    picture of how you look in your mind and listen to Hans A. Abraham, M.D.
    what I say. During the next two weeks you are Palm Beach, Florida
    going to think over and over again —"How
    attractive I am, how good looking I am, how You are comfortably seated by the side of a
    beautiful I am." These ideas will spring into your beautiful mountain lake, the blue of the sky
    mind over and over again. You will think about reflected in the mirror-like surface of the lake.
    your bodily appearance and you will be very There are sailboats with billowing white sails
    satisfied with how you look. When you see yourself sailing into the distance, the ripples in their wake
    in a mirror, you will be very pleased with all representing the past, as they spread further and
    aspects of your body. You will like everything
    further until they disappear in the surface of the
    about your body. Everything you do—putting on a
    water. There is a small island not far from the shore
    coat, adjusting your clothes, combing your hair
    with beautiful trees, dark green oaks, reddish
    —will remind you of your body, and you will think
    how good-looking you really are. You will think brown beech trees, yellow-green birches and the
    over and over— "How attractive I am, how good lacy branches of the weeping willows reaching to
    looking I am." These ideas will come to you the surface of the water. There's a rustic bridge,
    naturally, over and over again. You will find slightly curved upward with a wooden rail leading
    yourself thinking this over and over — it will seem to this island. You can see yourself standing on that
    very natural — it will not seem silly and you will bridge at 125 pounds [give the weight that the
    not feel the least bit embarrassed by the idea that patient desires to achieve], beautiful, strong, happy.
    your body is very Under the bridge, reflected in the
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 403

    water — we know this is a distorted image — is advice of your doctor, supplementary feedings are
    your likeness at 180 pounds. necessary for your health and recovery. . . . you
    Pick up a pebble, right there, and toss it into the will also tolerate these well. . . . You will be
    lake. [Have the patient indicate with an ideomotor hungry, you will ingest and digest your food easily
    signal when he/she observes the splash of the stone . . . food will taste good . . . you will enjoy eating,
    in the water.] Circular waves quickly spread from for you will do all in your power to sustain life . . .
    that splash obliterating the obese image. These you will feel hungry and you will eat to satisfy your
    ripples are the past, just like the wake of the hunger. . . . You will be able to tolerate more and
    sailboats. You know that sailboats go forward only, more food as prescribed by your physicians . . .
    no matter which way the wind blows. Sailboats go food will be a source of comfort in the fact that in
    forward only, just as you go forward only toward eating the food you are getting well . . . you will
    the newfound image. This image will be in your tolerate the increase in food easily, consistently,
    subconscious mind wherever, whatever, whenever
    until you have reached the desired goal advised by
    you eat. This image will guide your eating habits
    your physicians.
    from now on, and you are looking forward to the
    time when you will reach the beautiful image on
    that bridge.
    Suggestions for Presenting
    Symptoms in Anorexia Nervosa
    Suggestions for Increasing Food Meir Gross, M.D.
    Intake Cleveland, Ohio

    Harold B. Crasilneck, Ph.D., and James A. INTRODUCTION


    Hall, M.D. Dallas, Texas
    Gross (1984) identified target symptoms for
    hypnotic intervention with anorexia patients. The
    INTRODUCTION
    modeled suggestions were from a case study
    The authors (Crasilneck & Hall, 1985) em- included with his original report. (Ed.)
    phasize that increased food intake in medical
    patients may result in complications, such as "food SUGGESTIONS FOR RELAXATION
    shock" if there is acute overfeeding or the
    possibility of irritating eroded esophageal mucosa One of the earliest beneficial effects of
    in severely burned patients. Thus hypnotherapy hypnotherapy on the anorexic is relaxation, which
    should proceed under close supervision from the reduces the level of hyperactivity. Whether
    primary care physician. Eleven of twelve patients through self-hypnosis or regular sessions with a
    were reported to have responded positively to these hypnotherapist, the patient is able to calm her
    suggestions. (Ed.) overactive neuromuscular system.

    SUGGESTIONS SUGGESTIONS FOR CORRECTING


    BODY IMAGE
    Because of the power of the unconscious mind,
    you can and will accomplish any goal necessary. ... The anorexic patient has a notoriously distorted
    I give you the strongest of strong suggestions that body image. To help her realize this, the
    you will be hungry . . . you will be hungry for hypnotized patient is shown photographs of her
    meals and if, on the emaciated body, and a healthier body image is then
    suggested. Asking the patient to draw
    404 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    pictures of herself is also instructive. Often, she be controlled automatically with much confidence
    will draw a normal torso but attach it to hugely on your part.
    distorted hips. Once the therapist realizes that only
    part of the body image is distorted, he can
    concentrate primarily on this portion. During SENSE OF EFFECTIVENESS AND NEED
    trance, the patient is asked to touch each part of her FOR CONTROL
    body, including the stomach and heart, and
    especially the parts of most distorted image. After a Most anorexics lack self-esteem. Perfec-tionistic
    to extremes, anything they do seems unsuccessful
    time, the patient comes to understand that her
    and not good enough, which may be the main
    conception of that part of her anatomy is not real.
    reason most of them also suffer depression.

    SUGGESTIONS. Touch your body and concentrate on


    SUGGESTIONS. See yourself as you would like to be
    the feelings you get. Feel the softness of your skin, five or ten years from now. Realize how
    the warmth of your body and the size of any part, independent and self-sufficient you can be with
    especially your limbs. Touch your thighs and complete control over your life.
    calves and feel their real size, how round and nice
    they are shaped. Does it make you think about the
    wonders of creation, of man's creation, of your own HYPNOSIS AS A TOOL FOR
    creation, of the wonder and beauty of it? That's THERAPEUTIC ABREACTION
    right. These wonders are yours to enjoy and
    admire. Sometimes a traumatic event is the source of
    anorexia. Early trauma, not discussed during
    regular sessions, might be revealed during hypnotic
    age regression. Recognition of this childhood event
    DEFECTS IN INTEROCEPTIVE
    and working through the abreacted feelings can
    AWARENESS lead to successful resolution of anorexia.
    The anorexic has no perception of sensations
    SUGGESTIONS. Now you are watching the movie of
    from her own internal organs, especially hunger.
    Because of this, she cannot even perceive the your life going backwards from the present time to
    sensation of satiety, and, when hunger can no your childhood. If you see anything upsetting, raise
    longer be blocked, she will eat huge amounts of your right finger. I will stop the movie, and you can
    food without being able to stop. Vomiting becomes tell me about it. [If the event is too traumatic, the
    an artificial means of control, and the use of therapist can remind the patient that it is only a
    laxatives an everyday measure of reducing. "movie."]
    Hypnosis can help unblock these sensations.
    HYPNOSIS TO OVERCOME
    SUGGESTIONS. Concentrate on your stomach and RESISTANCE
    the sensation you feel coming from it. You can
    recognize the feeling of hunger and respond to As already mentioned, one of the major
    them by eating small amounts. At the same time difficulties in psychotherapy of anorexic patients is
    you can tune yourself to the feeling of satiety, being overt or covert resistance. At the very beginning of
    able to respond by stopping eating at that point. therapy, the patient will object to any pressure to
    Being able to be perceptive to hunger and satiety increase food intake and direct suggestions may
    will give the security of eating according to the actually antagonize her. When hypnotherapy is
    needs of your body, letting your body regulate it present as a tool for weight control, it is often
    like a clock. You can trust your body and its accepted. Properly presented, self-hypnosis will
    sensation, letting it pose no threat to the
    HYPNOSIS WITH OBESITY AND EATING DISORDERS 405

    patient's personal sovereignty, since it becomes a phenomenon engages the conscious mind, for the
    means of gaining further control over herself. A individual with an eating disorder who engages in
    therapist can seize on something important to the the bulimic behavior of bingeing and purging, a
    patient to introduce self-hypnosis, and, at the same pattern not at all unrelated to the eating disorder of
    time, indirectly suggest better eating habits in order anorexia (in fact, some refer to these patterns that
    to improve her performance, e.g., in tennis, etc. The frequently occur in tandem as "bulimorexia"), the
    therapist can emphasize that in self-hypnosis, the unconscious mind can begin to work on developing
    patient will gain complete control and that even in the recognition of seemingly strange behavior as
    purposeful, a strategy of reframing. In the author's
    heterohypnosis the operator does not control the
    own clinical practice, this same metaphor has been
    subject.
    used successfully on numerous occasions, with the
    following additions to the metaphor:

    Metaphors for Bulimia and . . . and in the world of nature, things are so finely
    balanced . . . and each stage of the life cycle leads to
    Anorexia the next . . . and when the baby birds are old enough
    to obtain food for themselves in order to live their
    Michael D. Yapko, Ph.D. lives naturally . . . and constructively . . . the mother
    San Diego, California bird no longer needs to self-induce vomiting .. . and
    that pattern stops naturally one day . . . simply
    because it is no longer necessary . . . and there are
    INTRODUCTION AND no recorded instances of deviant woodpeckers who
    CONTRAINDICATIONS keep up a pattern that has outlived its usefulness. . . .

    Yapko (1986) has stressed the potential im-


    portance of addressing family enmeshment, Metaphors may also be utilized to facilitate a
    perfectionism, poor self-esteem, and distorted body recognition of differences between "thin, at-
    image, and of using behavioral prescriptions as tractive" exteriors and the overall quality of the
    well as hypnosis in treating anorexia. He individual. Metaphors about glamorous individuals
    emphasizes the importance of individualizing who were dishonest or otherwise flawed may serve
    treatment to unique dynamics and personality. this purpose, shifting the personal worth from an
    Metaphors are one important component of his emphasis on appearance to an emphasis on
    treatment. He stresses, however, that such personal integrity.
    techniques may be contraindicated in cases when Hypnosis may also be used to facilitate greater
    the physical condition of the patient is too poor for awareness of and responsiveness to internal cues
    meaningful engagement, when the patient is too about one's physical needs. Metaphors about the
    fragile, unmotivated, or suicidally depressed, or various signal systems of the body such as pain,
    when the patient does not have rapport with the thirst, fatigue, and illness are framed as keys to
    clinician. (Ed.) survival while fostering the recognition that not all
    signals are easily detected and that many can easily
    be overlooked if one is motivated to do so.
    IDEAS FOR METAPHORS Regression to the initial learning experiences of
    body signals indicating the need to go to the
    Erickson (Rosen, 1982) described the habits of a bathroom, eat and drink may be a useful hypnotic
    particular species of woodpecker which lives in the pattern as well. Metaphors, such as the temperature
    Black Forest in Germany. This particular species of drops that signal winter's arrival to seasonal plants
    bird feeds her offspring a predigested meal by and migratory birds, the signals of sexual
    catching beetles, swallowing them, digesting them,
    and then regurgitating them into the mouths of the
    baby birds. While this interesting story about
    a natural
    406 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    attraction that stimulate reproduction, and the cues as a goal of treatment of the anorectic is
    signals through which animals mark their indi- necessary not only to successfully treat the
    vidual territory, may enhance awareness for the anorexia, but also to reduce the chance of an
    vital role natural signals play when properly overcompensatory weight gain from occurring
    noticed and responded to. Building a strong once the client begins to eat more normally again.
    awareness for and responsiveness to internal
    SMOKING, ADDICTIONS, AND
    HABIT DISORDERS
    INTRODUCTION

    SMOKING AND OTHER addictions are some of the most difficult problems
    that health and mental health professionals treat. A review of the smoking
    cessation literature reveals an average success rate of about 25% on six- to
    twelve-month follow-ups with smokers. Clearly there is still much to be learned
    about curing addictive behavior of all kinds, whether smoking, alcohol and drug
    abuse, obesity, or sexual addiction.
    Although far too many of the published papers on hypnosis for smoking
    cessation are anecdotal, there is enough research available to at least begin
    evaluating the helpfulness of hypnosis with smoking. We find that a single
    session approach with hypnosis (e.g., like the Spiegels') results in about 17%-25%
    success in most studies (Berkowitz, Ross-Townsend, & Kohberger, 1979;
    Shewchuk, Dubren, Burton, Forman, Clark, & Jaffin, 1977; Spiegel, 1970),
    although Stanton (1978) had a 45% success rate and Grosz (1978a) reported 31%
    abstinence at six months. It is my suspicion that hypnosis fares no better than
    other approaches when it is used for a single session.
    However, when we examine hypnotic treatment programs with a four or five
    session format, success rates are found to dramatically increase (Holroyd, 1980;
    Orr, 1970). Crasilneck and Hall (1985) report a 64% success rate on over one-year
    follow-ups (11% who could not be located on follow-up are included in the failure
    rate). Using a five session approach, Watkins (1976) successfully treated 67% at
    six-month follow-up. Comparable abstinence rates of 60% were found by Nuland
    and Field (1970) after four weekly sessions. In planning a multi-session treatment
    program, it is recommended that one of the hypnosis sessions be conducted
    approximately two to three weeks following the first appointment. This counsel is
    offered because the average number of days between initial abstinence and
    relapse for smokers has been found to be 17 days (Marlatt, 1985).

    407
    408 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Group hypnosis has also been utilized with quite positive effects in most (Kline,
    1970; Sanders, 1977), but not all, cases (Pederson, Scrimgeour, & Lefcoe, 1975).
    When compared with individual hypnotherapy, group hypnosis seems to be
    somewhat less effective (Barkley, Hastings, & Jackson, 1977; Grosz, 1978a,b;
    MacHovec & Man, 1978; Watkins, 1976). But effectiveness may be enhanced in
    group hypnosis by using individualized suggestions and extending the length of
    group sessions (Holroyd, 1980).
    Individualizing hypnotic suggestions to the unique motivations and concerns of
    patients also appears prominently related to more effective outcome (Nuland &
    Field, 1970; Sanders, 1977; Watkins, 1976). In fact, a review of hypnosis and
    smoking literature (Holroyd, 1980) found that four of the five most successful
    studies emphasized the use of individualized suggestions, while all ten of the
    reports that achieved less than 40% success utilized the same standardized
    suggestions with everyone. Consequently, I want to reemphasize the importance
    of tailoring hypnotic work to the motivations and needs of the patient. The value
    in providing you with the multitude of suggestions in this chapter (and, indeed, in
    this book) is in presenting you with many different alternatives for intervening
    with the unique patients who will seek your services.
    It is particularly recommended that you query patients concerning the benefits
    and payoffs derived from smoking (e.g., to cope with nervousness or anxiety, as a
    social facilitator, for rebellion and to establish independence, to give oneself an
    excuse to take a break). Most especially, determine if smoking has been used to
    cope with feelings of frustration and anger. This has been found to be the most
    common single relapse event among smokers, alcoholics, and drug abusers
    (Marlatt, 1985). Addictive patients need help in expressing anger constructively
    and in engaging in appropriate assertive behavior, rather than creating an altered
    state of consciousness or distracting themselves with a chemical.
    Feelings of low self-efficacy and powerlessness, which may be treated with
    suggestions for ego-strengthening, also seem to be vitally important in relapse
    prevention efforts with smoking and other addictions (Candiotte & Lichtenstein,
    1981; DiClemente, 1981; McIntyre, Lichtenstein, & Mermelstein, 1983; Rist &
    Watzl, 1983). Some ego-strengthening suggestions specific to smoking and
    addictions may be found in the work of several of the contributors to this chapter.

    Hypnosis with Habit Disorders


    Hypnosis has been successfully used with a variety of habit disorders including
    thumbsucking, nailbiting, trichotillomania, skin (and acne) picking, tongue
    thrusting, and bruxism. Suggestions for several of these conditions are contained
    in sections of the book pertaining to children, dentistry and dermatology. At the
    conclusion of this chapter, however, you will find suggestions that may be used
    with nailbiting and trichotillomania (hair pulling).
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 409

    HYPNOSIS WITH SMOKING AND ADDICTIONS

    Smoking Suggestions oughly interested, and willing, with full intention,


    to carry out this plan, to stop smoking — because
    Joseph Barber, Ph.D. you are a man/woman who used to smoke. You no
    Los Angeles, California longer smoke. And, as you have indicated, there is
    no reason on earth, that is sufficient, to justify your
    And as you continue, I want to talk to you, in a ever, picking up a cigarette again. You are a
    way that feels most receptive, for you. And I want man/woman who used to smoke. And you no
    to talk to that aspect of your mind, that is most longer smoke. You no longer need to do that.
    interested in hearing, what I have to say; that is And it may feel almost as if you can, hear in
    most interested in helping you to get, what you your mind, the echoing words, "I am a man/woman
    want. And you know what you want. who used to smoke." And those words can serve as
    a kind of, comfort, a kind of, acknowledgment to
    you, of the power, behind what you have done, of
    EXPLORATION OF RESISTANCE the efficacy, of your own ability, to do what you
    And I would like you to let yourself become have chosen to do.
    aware, even as you continue attending to your
    breathing, I would like you to let yourself become
    UNDERMINING RATIONALIZATIONS
    aware, of any possibility, for ambivalence, that you
    may feel. For instance, if you have any ambivalence And yet, sometimes, we can confuse ourselves,
    now, with respect to stopping smoking, let yourself with rationalizations, no matter how good our
    become aware of that, ambivalence. A particular intentions, no matter how clear our plan. And that's
    idea, or word that you may become aware of, may all right too. Because, if you have a child, or if
    seem silly to you, or it may seem unreasonable, or it someone else you love, say, had for some reason, a
    may seem perfectly reasonable. It doesn't really really strong craving, to eat poison, you wouldn't
    matter. If you have any ambivalence at all, you can let them eat that poison, would you? Not even if it
    just allow yourself, to describe that now, without tasted very good. No, of course not. Not even if
    disturbing the rest of your experience at all. If you that person gave you excellent reasons why it
    have any ambivalence at all, if you have any good would be okay for them to eat that poison. No, of
    reason at all, or any silly reason at all, why you course not. You might be amused, or even
    shouldn't stop smoking, just talk with me about that surprised, by the inventiveness of the reasons they
    now, without disturbing the rest of your experience might give you. But you would never take the
    at all. Can you think of any possible objections at reasons seriously, would you? No, of course not.
    all? [Listen to response. Use ambivalence to assess You can be delighted, by the creativity you might
    and deal with potential obstacles to stopping show, in developing really interesting, really
    smoking. Don't accept "no ambivalence."] That's inventive, rationalizations. But you won't take
    fine. them seriously, will you? No, of course not.
    YOU USED TO SMOKE
    Just let yourself know, almost as if you are FREE FROM THE PRISON
    sending a kind of signal throughout your mind, a
    signal of clarity, in which you acknowledge that And as you continue resting deeper and deeper,
    you are, clear about the fact, that you now have no and allowing yourself to hear the things I'm saying
    ambivalence. That you really are thor- to you, effortlessly, I want you to
    410 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    know that, you may occasionally have, very brief, do something because, someone else once con-
    very interesting, but possibly very peculiar, vinced you that you must. You are now free to
    experiences over the next several hours or days, or choose to care for yourself, and to do so, freely.
    even weeks, possibly even months. Every now and
    then, you might have a sense, of a kind of image
    perhaps, or a feeling, possibly just the vaguest FLUIDS AND EXERCISE
    feeling, of looking, back over your shoulder. Every
    now and then, you might just have a sudden sense And you know that it's very important, beginning
    of, looking back over your shoulder at the high, now and over the next several days, to care for
    white, walls, of a kind of prison. A prison which, yourself in other ways, as well. To become more
    you know, held you for some reason, perhaps long clearly aware of your needs, and to let yourself
    forgotten. But now, you know, you have liberated begin to discover how to satisfy those needs. It's
    yourself. You are no longer a prisoner there. important that you begin to drink more water. It's
    important that you begin to be more physically
    Every now and then, you may have a sudden, active. And you can really enjoy, feeling good about
    odd, fleeting sensation of looking back over your your body. As you become more physically active,
    shoulder at the high, white walls of a prison. A it can really feel, pleasurable, to notice, how well
    prison, that once held you, for some reason. But your body works. To notice how freely your limbs
    now, you have liberated yourself from that prison. can move, to notice how, well your lungs can begin
    You are no longer a prisoner there. And you can to work. To notice how good it feels to be more
    just feel, the delight, of that recognition! You may physically active, and to somehow enjoy the, kind of
    be able to hear, or even somehow feel the, special tiredness you get, from becoming physically
    discomfort, of the prisoners who are still there. And active.
    you may probably feel compassion for them. But
    you can also, fully enjoy, the clear air, of your
    freedom.

    SELF-HYPNOSIS TRAINING
    ENHANCING SELF-ESTEEM I also want to remind you, that this experience,
    right now, of comfort and well-being, this is your
    And you can feel really proud, of your decision experience, not mine. And the ability, to create, this
    to become free, and to remain free. In fact, you may experience, is your ability, not mine. And you can
    be surprised over the next while, at sudden, fleeting really enjoy discovering how to use, your ability to
    feelings — perhaps familiar, perhaps now — create this experience whenever you need to.
    feelings of real pride, and well-being. Pride, that Anytime that you would like to feel, more
    you have chosen, to take care of yourself. Pride that comfortable than you do, anytime that you would
    you have chosen, to free yourself. Pride that you like to feel relief from a sense of stress or tension or
    have chosen to stand by, what you know to be right. discomfort, all you have to do is sit back, in a chair,
    And you can even feel pride that you have chosen or a sofa, or a bed— just to rest back, and to take a
    to let this experience be one, that is calmer, more very deep, very satisfying breath, and hold it, hold
    comfortable, easier, than you may once have ex- it, for just a moment. And [exhaling] then as you let
    pected. You are free now. it all the way out, these feelings of comfort, and
    well-being, just automatically wash over you, like
    You can enjoy the process now, of learning to water in a hot tub.
    live freely, and of continuing to enjoy the
    unencumbered experience, of living the way you Any time that you feel anxious, or feel a craving,
    choose; of making even small, freely chosen or feel tense, all you have to do is take a very deep,
    movements, with your hands, simply because you very satisfying breath, and hold it, hold it for a
    choose to. You no longer have to moment. And then [exhaling] as
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 411

    you let it all the way out, these feelings, of comfort mind. Getting the feeling of how good it is to be
    and well-being, just come washing over you, like alive with a calm, peaceful mind. At peace with
    water in a hot tub. yourself, at peace with everything around you,
    And you can take comfort in knowing, that if any feeling so good to be alive.
    feelings were bothering you, they no longer need
    to. You can take a special kind of pleasure, in
    knowing, that you were able to relieve yourself of FEELING ALIVE AND STARTING A
    that discomfort, very quickly, very easily, and in a NEW LIFE
    way that, can simply make you feel more confident,
    and more proud of yourself. You don't have to Beginning to get a feeling of how good it is to be
    depend upon anything else, for this kind of alive, to be conscious, to be able to think and feel
    comfort. and know and understand. To have a mind, to be
    able to remember and dream and sense and taste
    and smell and hear and see. To be able to feel, to be
    FAIT ACCOMPLI fully alive, to have feelings and strength and
    You are beginning a process, that will take consciousness. It's so good to be alive, so good to
    several days, and some of that time will be much be aware. Starting now, you begin more and more
    more comfortable than others. And I don't know to get a feeling as if you're starting a new life.
    when it will be — perhaps in a week, maybe in a Starting now, you are going to determine to make
    month, maybe even in six months — I don't know your life as good as you possibly can, every day.
    exactly when it will be, when you'll just kind of To utilize all that wonderful energy and health and
    automatically one day look back at this time, and be strength and being that's been given to you. To
    so pleased, at what you have done. To feel so utilize the consciousness and the intelligence and
    pleased with yourself, for what you did, back then. the awareness and the love and the ability to think
    and to feel. And to see with your eyes and hear with
    And now, I'd like you to let yourself rest even a your ears, and to be fully alive starting now, every
    little more deeply. And take this experience of day.
    comfort, deeply inside you, and really appreciate,
    for the moment, how well you're feeling. Be aware Every day determined to live in a new way. The
    of the excitement that you probably feel, and the old life will change as you determine that starting
    anticipation. And when I see you again, I'm going now you can live fully, completely, every day. To
    to be very interested, in hearing you tell me, how be more and more determined to live with full
    much more easily the days have gone, than you enjoyment, with full health, to the utmost of your
    thought they would. ability, every day. Every precious day in your life
    as you determine that you will no longer wish to
    chance illness or an early death. That was part of
    our old life where things didn't matter very much.
    Hypnotic Suggestions for We weren't aware of how good it is to be conscious
    and aware and fully alive, and to have health and
    Smoking Cessation strength and energy, and to live every day fully and
    T. X. Barber, Ph.D. completely, and to enjoy everything around us.
    Ashland, Massachusetts Starting today, you begin to get more and more
    the feeling that you have just come to earth. You're
    [Following an initial induction focused on starting to live in a new way. Starting a new life.
    relaxation, calmness of body and mind, and You begin to see everything again as if it's fresh
    drowsiness, with a sense of so much time:] and new. You begin to see your body and mind
    Calmness is spreading throughout your mind again in a new way, as if
    and body. So calm. Ready to feel and experience
    new things in a new way, with a calm open
    412 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    you've forgotten how wonderful it can be to be more. In fact, as time goes on, smoking will seem
    alive, and to feel good and strong and healthy, and so trite. It will seem kind of silly. You will feel so
    to know that you are doing your utmost everyday to sorry for people who smoke as time goes on. You
    live fully. You begin to enjoy every day, the stars, will begin to become as aware that people who are
    and the sun, and the sky, and the birds, and the smoking are chancing illness and early death, that
    trees. And every person you meet, you see them in in a way they are almost willing to commit slow
    a new way. You begin to feel so good to be alive. suicide. That they don't really care about
    themselves and about life and about being fully
    alive, and really living. And they just don't know.
    SUGGESTIONS FOR SELF-HYPNOSIS
    AND RELIEF OF TENSION
    SUGGESTIONS FOR SELF-TALK AND
    Whenever you feel any signs of tension, you'll be INTERNAL DIALOGUE
    able to relax by taking a deep breath, and breathing
    out slowly as you hear these words deep in your You'll hear yourself saying things like: "I'm so
    mind: "I can be calm. I can be relaxed. I can feel so glad I don't smoke. I'm so glad that I've stopped
    good to be alive." Whenever you have any thoughts smoking. It's so good to feel strong and healthy, and
    that bother you, or any tensions or any feelings of to know that I've had the strength to conquer this
    tension that lead to smoking, you'll be able to miserable habit." When you see other people
    overcome them by taking a deep breath, breathing smoking, you'll feel very sorry for them. You'll feel
    out slowly, and feeling yourself relaxing. As you so sad that they are willing to chance an early death
    hear these words and say them to yourself: "I can be or sickness because of such a habit. You'll feel so
    calm. I can be relaxed. I can feel so good to be sad when you see people who smoke.
    alive." Starting now, your determination rises to live
    fully every day, to enjoy every day as much as
    possible, to live your life as fully every day as you
    INCREASING MOTIVATION possibly can. Smoking will become less and less
    important, and whenever you think of a cigarette or
    Starting now and every day, you'll feel so good, anybody offers you a cigarette or you smell
    as your determination increases that you're going to cigarette smoke or have any associations to
    live in a new way with full health, with full cigarettes, you'll hear in the back of your mind:
    capacity, with full enjoyment, knowing that every "STOP!" And you'll hear it very, very strong. It
    day you're doing your best to live fully, to fulfill may be my voice, but it will combine with your
    whatever reasons you were placed on this earth, to own background voice, the voice in your own mind
    fulfill them for yourself and everybody you love. saying, "STOP, I don't need it anymore. I'm no
    Starting now, you will no longer wish to chance longer a puppet, I don't need to smoke the way I
    illness or an early death. In fact, as time goes on, learned to. I had to learn to smoke years ago, but
    you'll begin to enjoy living more and more each I've outgrown that now. I'm no longer a child. I'm
    day. And smoking will become less and less no longer a puppet. I now control my life. I start
    important, very quickly. Smoking will seem more living today fully, completely, enjoyably, with all
    and more silly, more and more something you my powers, knowing that every day I will do my
    learned to do many, many years ago when you were best to live as fully as I possibly can for myself, for
    young. You learned to smoke to feel big and part of everyone I love, and for the meaning and
    a group, to be like others. But you don't need that preciousness of life."
    anymore. You are now mature. You are now free.
    You don't need that any- So whenever any thought of smoking comes to
    your mind, you'll hear these words in the
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 413

    back of your mind: "STOP! I don't need it anymore. based on the motivations of each client. Spe-
    I am free." These words will become stronger. This cialized suggestions and specifically tailored
    STOP will become stronger and stronger as time fantasies are then initiated to undermine ratio-
    goes on. And you'll hear it and you'll take a deep nalizations and to reinforce the person's com-
    breath. And as you breathe out slowly, you'll relax mitment to stop smoking. Six-month follow-up
    and you'll feel calm and relaxed, and good to be rates with this approach are 67% still not smoking.
    alive. (Ed.)
    Starting now, more and more every day, to
    become more and more aware. You have decided SESSION I. A smoking history is obtained to
    and determined to make your life, that one precious determine the client's reasons for smoking, why he
    life that you have, complete and full, and to fulfill wants to stop, under what circumstances he
    all the potentials, all the beauty, and strength, and smokes, how much, what feelings he derives from
    health, and love that you have. As this smoking, how long he has been smoking, and what
    determination gets very, very strong, you will think happened when he tried to stop previously. In
    of smoking as more and more trite, and more and addition, information is obtained about any
    more silly. And you'll feel more and more sorry for pertinent medical history, any emotional
    people who smoke. And a strong thought will be in disturbances of significance, and relevant
    the back of your mind: "I don't smoke. I'm not a medication.
    smoker anymore. I've stopped. I shall live all my Between the first and second appointment, the
    life with full health and enjoyment." As time goes
    history is studied and about three suggestions and
    on, you'll be able to utilize this as you hear the word
    two visual images are chosen and typed on cards.
    "STOP." You'll hear it strong in the back of your
    These are read to the client in the subsequent
    mind. You'll take a deep breath and breathe out
    slowly and feel yourself relaxing as you hear these sessions. The cards feed back to the client his own
    words: "I can be calm. I can be relaxed. I don't wish reasons for quitting, attack rationalizations for
    to smoke anymore." As life goes on you will find it smoking, provide substitutions and undermine his
    can be so good as you feel the strength, and health, motivations for continuing the habit. Examples of
    and full vitality of your being coming to the fore suggestions that were designed for one particular
    more and more every day. client will be presented below.

    Let these thoughts now go deep into your mind SESSION II. Self-hypnosis is taught with his hand
    as you become more and more alert. Quite alert stretched out above eye level, focusing on the
    now, you are becoming very alert as you open your finger of choice. It is suggested that the more he
    eyes. concentrates on his finger, the heavier the hand
    becomes, and as the hand becomes heavier it will
    move down to a state of relaxation, but he will not
    enter a deep state of relaxation until the hand is all
    Hypnosis and Smoking: A Five the way down. When the hand is down, he is
    Session Approach relaxed more through the suggestion of muscle
    relaxation, abdominal breathing and imagery. In
    Helen H. Watkins, M.A. this relaxed state, the cards are read to him. After
    Missoula, Montana that he is given about one minute to meditate about
    all the ways he can fight the smoking habit. Then
    INTRODUCTION self-arousal is suggested by silently counting up to
    five.
    This an individualized method of treatment At the end of the second session, the client is
    aimed at the reduction of smoking which is asked to phone in each day to report his
    414 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    progress. These daily phone calls are important to get the same effect, by taking a deep breath in,
    allay fears of failure, give support, and provide letting it out slowly and telling yourself to relax.
    suggestions to root out trouble spots. It is also Do that now. Take a deep breath in, let it out slowly
    important for the therapist to make a commitment: and tell yourself to relax. [The numbered inserts
    "If you don't phone me by 10:00 p.m., I will call apply only to this client.]
    you." Such commitment provides an alliance
    against the enemy— the smoking habit.
    VICTORY SUGGESTIONS
    SESSION III. This session involves repetition of the
    previous session, exploration of any smoking
    behavior, along with support, plus the use of You tell me you want to feel a sense of victory
    over your smoking habit — a sense of willpower
    appropriate therapeutic measures to correct
    and self-control — a feeling of winning over this
    problem areas that continue the habit. For example,
    vice. You can have this feeling by doing the
    if dealing with anger is a problem area, then the
    following: Every time you pick up a pack of
    client is helped to release anger in a constructive
    cigarettes and then put that pack down again, this
    way.
    feeling of victory will come over you. You will feel
    good and strong. It's like winning one battle after
    SESSION IV. Self-induction is done by the client the other. Each time you repeat this behavior of
    along with learning the suggestions and visual- saying no to a cigarette, either in fantasy or reality,
    izations on the cards. Between the fourth and fifth you will be winning one battle after the other until
    session, the client is asked to practice the the final victory — the victory over your smoking
    self-induction daily. habit. [I have the client experience this scene in fan-
    tasy. The good feeling he derives from putting
    SESSION v. The client is asked to repeat the down the pack is the immediate reinforcement
    self-induction technique, rephrase the suggestions which tends to increase future probabilities of his
    in his own words, picture the imageries, meditate, actually putting down the pack without smoking.
    and arouse himself to complete alertness. This This is in line with current behavior modification
    theory.]
    technique is now a tool the client can use in the
    future should he have the desire to return to
    smoking. At the end of this session, the client is
    told that the therapist will send him a questionnaire
    periodically for one year to determine his smoking ANGER SUGGESTIONS
    status.
    You tell me that you smoke to put a damper on
    your anger and frustrated feelings. You can see that
    RELAXATION SUGGESTIONS smoking is one way you handle anger, but you and I
    both know that smoking is no solution to this
    You tell me that smoking calms your nerves, that problem. Smoking ends up hurting you physically
    and it cannot discharge or control your feelings. If
    (1) it is relaxing and settles you down, but what's so
    you are angry at someone, express those feelings in
    good about a cigarette that (2) shortens your breath,
    a constructive way. If this is not appropriate, then
    and gives you a dry, cotton feeling in your mouth?
    release your anger via exercise, or beating a pillow,
    A cigarette may seem relaxing because you pause or imagine you have a small rubber ball in your
    to reach for a cigarette, remove it from the pack, hand and knead it as you would dough. Try that
    light it, and take a deep inhalation. It gives you a now. Just imagine there is a soft rubber ball in your
    tension-free relaxing moment. But there are other hand and squeeze it. Keep working the ball until
    ways to get the same effect, the same relaxing mo- your hand is tired.
    ment. I'm going to teach you a substitute way to
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 415

    COST IMAGERY EXCUSEFORABREAK


    Cigarettes cost $ _______a pack. You tell me Suggestions may be given justifying a break
    that you smoke up to two packs a day. That without smoking.
    means you pay at least $ _ a day for ciga
    rettes. Multiply $ ______ by 7 and the result is
    $ _____ a week. If you multiply $ _______ by the SOCIALIZATION
    number of days in a year, then the total amount you
    are paying for cigarettes in a year is $ , and for Suggestions may be offered showing that a
    what? For a habit that makes you miserable. cigarette interferes with socialization in that it
    Wouldn't you like to use that money for something separates the smoker from the other person,
    else— for something that would make you happy making listening and sharing more difficult. Client
    instead of miserable? If you stop smoking you fantasizes intently listening to someone without a
    deserve to spend the money you save by buying cigarette.
    something that won't go up in smoke. Think now
    what you would like to
    buy with the $ ______ you would save in a year's PACIFIER
    time, something perhaps that you have always
    wanted but felt it was too much of a luxury. In your Clients who use cigarettes as a pacifier may
    imagination right now buy this item, and have suggestions customized to them denying
    experience using it. Feel the pleasure you derive emotional control and safety via cigarettes.
    from it. Experience this pleasure while I am silent
    for a minute. [In this imagery, I motivate the client
    by picturing a desirable long-term goal to which he KEEPING HANDS AND MOUTH BUSY
    can commit himself. If so inclined, I suggest to him
    after arousal from the relaxation that he save the For clients who use cigarettes to occupy their
    money he doesn't spend for cigarettes in a glass jar hands, substitute activities may be suggested.
    and watch the money accumulate daily.]
    IMAGES
    The following images may be used with one
    DAY-OF-NOT SMOKING IMAGERY minute of concentration at the end of the
    description.
    Imagine that the day has come that you no longer
    smoke. You are walking across campus to this
    building. The air is fresh; the sun is shining; and it's 1. Hospital scene. Describing hospital setting
    a beautiful day. You woke up this morning feeling sometime in the future with patient lying in bed
    good about yourself and your world. You like the listening to the doctor saying, "I'm sorry , but I
    way you're handling your life. For one thing, the can't do much for you now. I told you years ago
    feeling of being a slave to a cigarette no longer you should stop smoking. Too bad you didn't.
    haunts you. You are in control, not the cigarette. All I can do now is give you medication for
    You have more energy; your throat is clear; and temporary relief."
    you know your lungs are clearing. You feel great, 2. Exercise. Aversive experience of hiking, be-
    and the more you think about how good you feel, coming short of breath, sitting down, panting,
    the more energetic your step becomes. Continue and putting out a pack of cigarettes, then
    walking across campus now while I am silent for a making the connection between the panting
    minute. and the cigarettes.
    3. Tobacco smell. Aversive experience of tobacco
    smell on clothes, furniture and dirty ashtrays.
    416 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Smoking Control affirmation experience, i.e., protecting their body


    from poison, rather than fighting smoking.
    David Spiegel, M.D., and
    Herbert Spiegel, M.D.
    Stanford, California, New York, New York Suggestions for
    Smoking Cessation
    The essence of our hypnotic instruction for
    smoking control is the following: (1) For my body, Harold B. Crasilneck, Ph.D., and
    smoking is a poison; (2) I need my body to live; (3) James A. Hall, M.D.
    I owe my body respect and protection. Dallas, Texas
    This dialectical restructuring strategy is ex-
    panded upon during the hypnosis: You will not crave excessively for a habit
    1. For my body smoking is a poison. This negatively affecting your health. . . . Your mind can
    point is especially important because it empha block the perception of discomfort, as when your
    sizes that fact that smoking is not so much a finger felt insensitive to the pressure of the sharp
    poison for you as it is quite specifically a poison nail file. . . . Your mind will function in such a
    for your body. Your body is like a trusting, manner that you will no longer crave for a habit that
    innocent child that has to take into it anything has negatively affected your life with every drag of
    that you put into it even if it is damaged by it. cigarette smoke you have taken into your lungs. . . .
    Like an infant, your body cannot tell you in You will block the craving for tobacco ... a habit
    words that it is being poisoned. It tells you that is causing your heart and your lungs to work
    through the symptoms you experience, the much harder than necessary, forcing your lungs to
    cough, the shortness of breath, the chest pain. labor beyond all necessity, stressing and straining
    These are your body's ways of telling you it is these vital organs . . . like a car constantly driven in
    being poisoned by cigarette smoke, so "For my low gear . . . constantly laboring uphill . . . stressing
    body, smoking is a poison." and straining the motor. . . . But because of the great
    control of your unconscious mind, the craving for
    2. I need my body to live. Your body is the this vicious and lethal habit will grow steadily and
    precious physical plant through which you ex- markedly less until it rapidly reaches a permanent
    perience life. You are not the same as your body zero level. . . . You simply will not crave for
    but you cannot live without it, so "I need my body cigarettes again. . . . You will be relaxed and at
    to live." ease, pleased that you are giving up a habit which
    3. I own my body respect and protection. This has such a negative effect upon your life and
    point emphasizes the fact that for you to do what well-being. . . . You are improving your life by
    you wish to do with your life, you need to treat your giving up cigarettes and you will continue to do so.
    body in such a way that it can enable you to do it. . . . You will not smoke cigarettes again. . . . You
    You cannot put sugar in the gas tank of your car will not be hungry or eat excessively . . . your
    and expect it to drive you into the mountains. craving will reach a permanent zero level . . .
    Likewise, putting poison in your body hampers its through the virtually omnipotent and godlike power
    ability to enable you to do what you wish to do, so of your unconscious mind, you can and you will be
    "I owe my body respect and protection." able to resist a craving that is harmful to your body .
    . . you will treat your body with kindness and
    Subjects are instructed to practice this exercise consideration . . . your body that
    every one or two hours at any time they have an
    urge to take a cigarette. In this way they are
    instructed to restructure their approach to the
    smoking problem by concentrating on an
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 417

    serves you so unselfishly . . . you will no longer packs/day. Then it is determined when the patient
    consciously or unconsciously choose to impose this smokes (for instance, when first awakening in the
    undeserved burden of smoking on your heart, your morning, with a cup of coffee, while driving to
    lungs, your circulation, and the vital organs of your work, arriving at work, on the phone, during
    body . . . you will treat your body with kindness, as stressful times, after meals, etc.). These times and
    if it were your closest friend . . . you will find that situations in which the patient smokes are
    through the immense power of your unconscious explained to the patient as environmental cues
    mind you will be able to overcome this old, out- which trigger the smoking response. Then, during
    grown, outworn addiction, which we now know, the hypnosis session of the first day, it is suggested
    statistically, robs you of four minutes of life with to the patient: "When these environmental cues
    every cigarette you smoke. . . . You will be able to occur, there will be another unconscious program
    give up this dirty and unhealthy habit. ... As you that will respond, instead of the smoking program.
    permit your body to rid itself of this undeserved An unconscious non-smoking program will re-
    burden of smoking, your lungs will again become spond, to be relaxed, calm and comfortable,
    efficient, your red blood cells will carry more without a cigarette." In each of these situations, this
    oxygen to all your vital organs, you will feel more new response ("relaxed, calm and comfortable,
    alert and alive . . . and you will have a justifiable without a cigarette") is paired with each one of
    sense of pride for having worked toward and these environmental cues. The patient is also told
    accomplished this important, healthy, worthwhile that, "There will be no other unconscious
    goal. . . . You are no longer a smoker, you are using substitute, other than the one that we have agreed
    your own free will, you are treating yourself in a upon. No other substitutes, such as increased
    healthy, proper manner. . . . You will not be eating, or drinking, or nailbiting, or any other
    excessively nervous or tense . . . you will not gain unproductive behavior. You may have no urge
    excessive weight . . . you will exercise, you will whatsoever to smoke when this new program of
    walk a mile a day, if your physician approves . . . being 'relaxed, calm and comfortable without a
    you will sleep well . . . your craving for tobacco will cigarette' works perfectly. However, there may be
    be minimal and will rapidly decline to a zero level times that the old smoking program will respond as
    at a rapid pace. well and you may have an urge to smoke. If you do,
    you are to say, 'No,' and if necessary, take a few
    deep breaths which will reduce the urge noticeably,
    if not eliminating it, but certainly reducing it to a
    tolerable level."
    Smoking Cessation
    When the patient returns on the second day, all
    Richard B. Garver, Ed.D. of these situations are again discussed. Usually, in
    San Antonio, Texas over half of the response situations, the patient has
    been relaxed, calm, and comfortable without any
    RESPONDING TO CONDITIONED urge to smoke. At the times when there is an urge
    to smoke, usually it is tolerable, and when met with
    ENVIRONMENTAL CUES
    the decision, "No," and with a few deep breaths,
    We structure hypnosis for smoking in three the urge disappears. Any urges that persist are
    sessions. The first two sessions occur on con- identified as difficult times, and during the second
    secutive days, the third session is held two weeks hypnosis session, these times which were teased
    later. In the first session, a history is taken, out as being the more difficult ones are now given
    followed by determining how much the patient has special attention and the unconscious mind is
    smoked, how long, and how many asked to give the patient additional help and
    418 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    reinforcement at these times. It is suggested to the that they learned for entering hypnosis (for
    patient: "Day by day this new program gets instance, to focus on a spot, take a deep breath and
    stronger as it's being used, and the old smoking hold it, release the breath, and let their eyes close).
    program gets weaker since it is not being used. The Once in hypnosis, the third step is to count slowly
    new one is stronger, the old one weaker, until the backwards from 100 to 95. When they are counting,
    new one replaces the old." This sometimes is they cannot be thinking or worrying about the
    completed within a few days, and other times it suggestion. As soon as the number 95 is reached,
    may take two or three weeks. the suggestion is given (Step 4) as it was planned,
    in a positive and simple statement. As soon as the
    suggestion has been given, the fifth step is to count
    SELF-HYPNOSIS TRAINING 95, 94, 93, 92 91, 90. When they are counting, they
    cannot think about or criticize the suggestion. As
    At the end of two weeks, the patient returns for a
    soon as the counting reaches 90, the exit cue is
    session in which he/she is taught self-hypnosis,
    given. This may be any exit (awakening) cue that
    which should help him/her during any specific
    the patient has learned to come out of a hypnotic
    times that have remained difficult. It is explained
    state.
    that he will be able to use the self-hypnosis
    technique in many other situations. Reference is These six steps are explained intellectually to the
    made here to the article that I published (Garver, patient, and then modeled while the patient
    1984). The eight steps proposed there have been observes. Next, the patient is taken step by step
    modified to six simple steps that I go over with each through these self-hypnotic procedures before he
    patient. The steps are designed for the patient to do leaves the office.
    the self-hypnosis exercise in one minute or less,
    and to limit the conscious screening that often oc-
    curs (e.g., thinking too much about the suggestion
    before it is given and critically thinking about it
    after it is given). Suggestions Regarding Smoking
    The six steps are as follows: The first step is to Steven Gurgevich, Ph.D.
    plan the suggestion before going into hypnosis. Tucson, Arizona
    This reduces the tendency, once in hypnosis, to do
    too much thinking. It is also suggested that patients
    plan the suggestion, thinking about the event or GENERAL INSTRUCTIONS
    time that they are planning, which should ideally be
    within the next hour or two. They are instructed to A patient's program for smoking cessation
    think of themselves in the situation, responding to begins in the waiting room, where there is a
    the situation exactly as they would like to respond. conspicuous sign that says, "If you still enjoy
    For instance, suppose they are concerned about an smoking, ashtrays are located in the patio." The
    important meeting and being too anxious or smoking cessation program involves seeing the
    nervous. Instead of saying that they will not be patient on three consecutive days with a follow-up
    anxious or nervous, they will picture how they in one week. He or she is also asked to make
    would like to respond, and the positive suggestion telephone calls to the office/answering service on a
    may be given: "I will go to that meeting and I will daily basis upon arising each morning to announce,
    feel comfortable. I'll feel relaxed, calm, and in "This is , I am not smoking today."
    control, and will remember everything that I have
    planned for."
    SUGGESTIONS
    After the planning of the positive suggestion, the
    second step is the entry cue. This is a cue After the patient is able to demonstrate trance
    phenomenon (e.g., arm levitation,
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 419

    hypnoanesthesia), the following suggestion is SUGGESTIONS


    offered:
    You are confident, completely confident, that
    Today, I don't know how long you will wait to you are going to overcome the cigarette smoking
    discover the pleasure of non-smoking. Today, I habit. . . . You will be able to let go of the habit so
    wonder how long you will wait to discover the easily. . . . You will wonder why you ever bothered
    pleasure in non-smoking. to smoke. . . . You won't miss smoking at all. . . .
    When you began smoking, you taught your body From this moment on, whenever you think of
    to suppress its natural reaction to burnt tobacco having a cigarette, if you automatically reach for
    particles. Now you may begin to forget those uncon- one, if someone offers you one, you will say "No"
    scious instructions and allow your body to remember
    ... a voice will echo through your mind, "No! No!
    what it does best. I don't know if your body will go
    back to coughing out uninvited guests. ... I don't No! . . . Smoking is a foolish, stupid habit ... it hurts
    know how badly burnt tobacco will smell within your me physically. ... it damages my health. ... I am not
    nose. ... I don't even know what your unconscious going to smoke again." You will completely
    mind will begin associating to tobacco particles as overcome the cigarette smoking habit. .. . You will
    you begin enjoying fresh, clean air. find you are able to do this. . . . Know in your mind,
    now, that you will be able to do this. ... It is easy
    and you can do it. . . . Your mind can and should
    These suggestions oftentimes are embellished with control your body. . . . When you stop smoking,
    visualizations of linings of the lungs, bronchial and you can do so from this moment, you will feel
    tubes, etc., and with greater detail of the physically better, healthier, your breathing easier,
    suppression process that was achieved in order for your senses sharper . . . and you will also feel
    the patient to become a successful smoker. This mentally better, pleased that you have been able to
    allows for associating achievement and success to
    control your body . . . happy that you are in control
    non-smoking with greater ease, as it can now be
    . . . happy that you are strong enough to stop
    viewed as a natural state that preceded his
    smoking so easily. . . . You do it, not me. ... It is
    conditioning as a smoker.
    your triumph . . . your victory. When you see others
    smoking around you, you will feel delighted that
    you don't smoke. . . . You'll say to yourself, "I'll
    never smoke again ... the sight and smell of
    Suggestions to Modify cigarettes is unpleasant ... I haven't any desire to
    smoke at all. ... I have no need to smoke ... it doesn't
    Smoking Behavior help me in any way and I feel so much better when
    I don't smoke."
    Harry E. Stanton, Ph.D.
    Hobart, Tasmania, Australia
    Make your decision now. . . . You will com-
    pletely overcome the cigarette smoking habit and
    INTRODUCTION stop smoking now . . . and you will never smoke
    again. ... It is easy and you can do it. . . . You will
    Stanton (1978) outlined his one-session ap- feel no sense of loss or unhap-piness . . . instead
    proach to smoking cessation. He begins with you'll feel good, happy, proud of yourself. . . . Once
    ego-enhancing suggestions "that the patient will you make this decision to stop smoking, no force
    feel physically healthier, more relaxed, more calm will be able to change this decision. . . . You will be
    and unworried, more self-confident, self-reliant, completely confident that you will stop and stop
    independent, and be able to think more permanently.
    optimistically and positively." He then feeds back
    to the patient his own reasons for wanting to stop
    smoking. More direct suggestions concerning
    smoking are then given. (Ed.)
    420 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    You don't need to smoke cigarettes. . . . From ral, motivation, discussion of hypnosis, questions
    now on, if you think about smoking, and this will pertaining to it, etc.) have been observed.
    happen very infrequently, you will immediately Suggestions are given following the induction of
    take a deep breath, let go and relax, and you will hypnosis. [Appropriate pauses should, naturally, be
    realize in your mind that you don't need to smoke. . included to allow imagery and perceptions to
    . . You are in complete control and your decision to develop. Head nods or ideomotor finger signals
    stop smoking cannot be reversed. may also be used to alert the therapist to the pace of
    the patient's progress. (Ed.)]
    FURTHER TECHNIQUES
    [Stanton's (1978) approach next utilizes Walch's CHECKING MOTIVATION AND
    (1976) red balloon technique, imagining throwing
    OBTAINING COMMITMENT
    cigarettes one at a time into the basket of a hot air
    balloon, symbolizing throwing away all needs, Imagine a cigarette on the desk (or table) in front
    desires and wishes to smoke. The balloon then of you . . . one single cigarette. And as you look at it
    floats away, carrying away desires to smoke. more and more intently, you notice a curious thing
    Finally, Stanton had patients imagine coping happening. The cigarette seems to be moving, ever
    imagery in situations where they used to smoke. so slightly, in the direction away from you. It's
    (Ed.)] moving just a little, but noticeably. You become
    Another visualization is to have the patient more and more fascinated as you relax even more
    imagine himself in a room, writing on a black- deeply, watching the cigarette moving away from
    board. The blackboard is divided into two halves you, as if pulled by an invisible force. It's moving,
    and on the left hand side he writes a reason for moving. [Keep repeating these suggestions as
    smoking. Once he has done so, he imagines himself indicated.]
    erasing what he has written. On the right hand side
    You begin to realize that soon it is going to reach
    of the board he then writes, much larger, a reason
    the edge of that desk (table). You have the thought
    why he should stop smoking, and this he leaves
    that only you can allow it to fall off, or to stop it
    intact. He then goes back to the left hand side of the
    from falling off. The thought keeps occurring to
    board and writes up another reason for smoking
    you that only if you are really and genuinely ready
    and again wipes this out immediately after he is
    to quit smoking can this cigarette fall off the desk
    finished putting it up. This process is repeated, and
    (table). You know, without any great surprise, that
    the end result is a blackboard with a blank left hand
    once it has fallen, that's the end of your smoking.
    side and a right hand side containing a number of
    This cigarette stands for all the cigarettes in the
    reasons written largely why the patient should
    world that could be yours to smoke. But when you
    cease smoking.
    let it fall off, you know that cigarettes will no
    longer exist for you.

    Suggestions Applicable for


    Smoking, Obesity, and Other SPECIAL ROOM WHERE SMOKING
    Addictive Behaviors DOES NOT EXIST
    Doris Gruenewald, Ph.D. [After using a stairway or escalator technique
    Laguna Hills, California for deepening, the patient enters a special room.]
    Make yourself comfortable in this very special,
    INTRODUCTION beautifully furnished and appointed room. As you
    It is to be understood that all suitable prelim- do, you notice that there are no
    inaries (e.g., pertinent history, reason for refer
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 421

    ashtrays, and it dawns on you that you have entered [This technique is in the interest of reinforcing
    a place where smoking does not exist. Not just that the patient's sense of control. In suitable cases, I
    you have to refrain from smoking while in this may add provision for less than complete success
    room. On the contrary, this room is a space where —"if occasionally your answer is 'yes,' it does not
    smoking just does not exist. That thought gives you mean that you failed — it just means that this one
    a great feeling of peace and serenity. You realize, time it didn't work, and you started over again."]
    dimly at first, and then more and more distinctly,
    that you have acquired (created) a space inside you
    that will be forever yours . . . and into which you
    can go (retreat, withdraw) any time you need to do APPLYING THESE SUGGESTIONS TO
    so . . . whether it is to turn away from the . . . OVEREATING
    inevitable temptation to smoke . . . or for some
    other reason, like unwinding, becoming relaxed and
    The suggestions above lend themselves to
    at peace with yourself, or whatever.
    adaptation for control of overeating. However,
    The idea of this room, and you know and accept during treatment it must be brought out that food is
    that it is an idea, will remain with you from now on, necessary for life (in contrast to smoking, etc.) and
    for you to make use of at your own choosing. You should be enjoyed. The focus should be on control
    will not have to go into hypnosis to do it. All you of what is eaten and when, with emphasis on
    need is to let yourself think, "my room," and all that dietary knowledge, thorough chewing, a more
    you are now experiencing will arise, like an echo of leisurely pace, etc.
    this situation: the ambience, the relaxed feeling, the
    realization of an environment where smoking does
    not exist to you . . . even if you are in a room or
    other place with people who smoke . . . that need EGO-SUGGESTIONS FOR FEELINGS OF
    not concern you at all. [Expand on these ACHIEVEMENT
    suggestions, if appropriate.]
    [In the case of other addictions, the complete
    absence of the substance in question must be
    STOP SIGN IMAGERY reinforced. The pleasure issue is addressed as
    follows (or with some variant thereof)-]
    [The two modules of suggestions above may be You can take great pleasure in your growing
    used singly or in combination. In either case, ability to do what you have decided to do. There
    preface these suggestions, or add to them the image will be a sense of real achievement, so much
    of a stop sign which arises as soon as an urge to greater than any feeling of deprivation that you are
    smoke is experienced. That would include reaching very likely to experience at times. Your joy in
    for a pack, going out to buy some, getting ready to gradually or even suddenly achieving your goal
    light up, etc. (Of course, cigars and/or pipe outweighs everything else, even in the face of an
    smoking are included.) The stop sign is intended to occasional setback which is almost inevitable. If
    introduce a delay factor.] that happens, it is, and can be experienced as, an
    isolated incident. It does not spell the collapse of
    As you heed that stop sign, you have a little time
    what you are building up, only a small interruption.
    to think whether you really want that cigarette . . .
    and mostly your answer will be "no" . . . and the [Conclude with repeating the main points,
    urge passes . . . until the next time . . . when you placing emphasis on what appears prominent in the
    will repeat the "stop sign" procedure. individual patient. Where indicated, be sure to
    instruct the patient to continue or seek out medical
    consultation.]
    422 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Suggestions for Rational Occasionally when something is difficult, some


    people say to themselves, "I can't stand it," and then
    Self-Talk for Smoking and give in to a tempting urge. They are deceiving
    Other Addictions themselves. Of course they can "stand it." When we
    choose not to smoke a cigarette, we're not going to
    D. Corydon Hammond, Ph.D. Salt Lake explode. We won't evaporate. For the first few
    City, Utah hours, choosing to respect our bodies, may not be
    entirely pleasant or completely, easy, but we can
    stand it. There is no logical reason why life should
    INDICATIONS always, be perfectly comfortable, and completely
    pleasant. But when we choose to do things that are
    A prominent cognitive therapy method for not entirely easy, we grow as people, and you feel
    facilitating impulse control is "self-talk." good about yourself. Remember, you don't have to
    Rational-emotive therapy and other cognitive have a cigarette when you feel a momentary urge to
    approaches stress the importance of undermining smoke. You don't need it. You briefly want it for a
    irrational self-talk by patients and replacing it with moment, but you also want to respect and protect
    positive internal dialogue. Any of the kinds of your body, and [cite patient motivations]. So you
    suggestions given at a conscious level in these can admit an occasional, brief urge to smoke, but
    therapeutic approaches may also be given or
    then choose to ignore it and respect yourself.
    reinforced in hypnosis. The following suggestions,
    modeled after concepts of Albert Ellis, seem
    particularly indicated with patients who engage in
    negative, self-defeating internal dialogue.
    Furthermore, some patients are more
    intellectualizing and seem to prefer approaches that
    Suggestions for Smoking
    emphasize rationales rather than the stirring of Cessation
    emotions. These kind of suggestions may be
    particularly helpful with such patients. The reader W illiam C. Wester, II, Ed.D. Cincinnati,
    should also refer to "Hypnotic Strategies for Ohio
    Managing Cravings," found in Chapter 12.
    INTRODUCTION

    Wester advocates an approach that is individ-


    SUGGESTIONS
    ualized to the patient. Suggestions illustrative of his
    It's interesting to realize, how we sometimes method are reprinted below. A very positive aspect
    deceive ourselves. Some people tell themselves, of his approach is that he has patients send progress
    "This is too hard," when they feel the urge to postcards for 10 days, and six-month and one-year
    smoke. Occasionally, briefly, momentarily, it can follow-up cards. Examples of postcards that have
    be hard, but what makes it too hard? Naturally it been received from patients who had positive
    can sometimes be difficult to learn new habits, but responses are reviewed at the end of the session.
    you've done many difficult things before. [Pause] (Ed.)
    The only thing that makes not smoking "too hard,"
    is our irrationally telling ourselves that it is. So
    remember, there may be a few times when it is INCREASING MOTIVATION AND
    briefly hard to remain a non-smoker, but it's not too DECREASING WITHDRAWAL
    hard. In fact, I wonder if you'll be surprised to
    notice, how much easier it is to stop smoking, than As you are enjoying that experience with your
    you'd imagined it would be. conscious mind, your subconscious is now very
    aware. You are going to experience some
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 423

    interesting things in the next few days and for TIPS FOR NEW EX-SMOKERS
    weeks to come. You don't have to try to figure out
    why— just enjoy what your subconscious mind is Over the years, I have found that a personal
    doing for you. Your motivation to quit smoking is approach enhances the hypnotic procedures. At the
    going to be higher than it has ever been. Each day end of the hypnosis session, I give all of my
    you will find yourself feeling more relaxed, patients the following "Tips for New Ex-Smokers."
    comfortable, confident and very much in control. I go over the list step by step making special
    There will be less tension, less anxiety, less suggestions based on the history.
    tightness and little or no withdrawal. As a result of
    being more relaxed, confident, comfortable and in
    1. Clean and store away all ashtrays.
    control, there will be no need for a cigarette.
    2. Exercise if there is any withdrawal tension.
    Check with your physician regarding proper
    exercise if you have any health problems.
    RESPECT YOUR BODY 3. If there is an urge to smoke— sit down and
    relax, take a deep breath, hold it for 5-10
    seconds and release it slowly.
    Your subconscious is also going to remember
    4. Increase fluid intake— juice, water, diet
    something very important. Your body is very
    drinks, etc. (no caffeine).
    important to you and you need your body to live.
    5. Decrease caffeinated coffee and alcohol.
    You want to respect and care for your body.
    6. If needed, get a supply of sugarless gum or
    Smoking is a poison to your body. Since you do not
    use carrot/celery sticks if you feel you need
    want to poison yourself in any way you will stop
    something in your mouth. 7. Talk with
    smoking immediately and continue to be an
    another non-smoker or someone who has
    ex-smoker. Remember, your body is important to recently quit for any positive strokes.
    you and you need your body to live.
    7. Send your daily postcards for 7-10 days.
    8. Keep thinking —"I am now an ex-smoker."
    9. Call if you have any problem. Do not smoke
    AVERSIVE SUGGESTION that first cigarette and you will be fine.

    [This suggestion is not necessary in all cases.


    Use it when the patient tells you that something
    strong is needed to get him/her to quit.] We know
    that if you took a regular drinking glass (8-10 oz.),
    Aversive Metaphor for Smoking
    filled it completely with tar and nicotine from
    Marvin Stock, M.D.
    cigarettes, and drank it, you could be dead before 12
    Toronto, Ontario, Canada
    minutes. You do not want to poison yourself—
    even slowly— and therefore will stop smoking
    immediately and remain a non-smoker. [Positive INDICATIONS
    motivations elicited from the patient may be
    introduced at this point.] There is an emphasis in modern hypnosis on
    In addition to respecting your body, you can feel using positively focused suggestions. Nonetheless,
    so proud that you are now in control and no longer particularly when more positive methods are not
    subject to this bad and dirty habit. Everywhere you entirely successful, and when the patient has high
    go people will appreciate the fact that you are not hypnotic talent and is capable of experiencing
    smoking — no longer making people feel ideosensory phenomena, aversive suggestions may
    uncomfortable. potentially contribute to fa-
    424 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    vorable outcomes. Aversive methods also seem could follow the course of the breeze across the field
    indicated when they are congruent with the ... a constantly changing wave pattern tilting the
    patient's expectations for therapy. Dr. Stock has wheat before it . . . and as it did so, carrying the
    offered us an indirect, subtle option for conveying sound of gently rustling heads of wheat . . . carrying
    aversive suggestions. Note the interspersed the sweet scent of the hay. Whether it was the beauty
    suggestions that appear in italic. They may be set of the time ... or the peace and quiet ... it was a
    off by a very slight emphasis, different tonal golden opportunity to think . . . about the day . . . the
    quality or pause. (Ed.) future. When the lane reached the road ... I would
    usually turn right . . . prolonging the walk beside the
    bright gold wheat.
    METAPHOR The character of the countryside abruptly turned
    somber when I reached the first of the many tobacco
    Years ago, while I was a medical student at the U farms in the area. Now if one of the dogs would dash
    of Toronto, after being virtually locked in ... by a after a ground hog into the tobacco field and not
    dark and dirty winter ... I was determined to get return ... I would have to crawl through the fence to
    away ... to make a complete change . . . from all fetch it. Walking the furrows between the tobacco
    that dirt and slush. plants ... I observed many unexpected things. For
    By March, I had assessed the options . . . and I example, the grayish stain on the leaves . . . the
    chose the outdoor freedom of farm life. I arranged a residue of the chemical sprayed to kill fungus. There
    contract from May 15 to August 15 ... on a mixed were regular spraying days. When we were
    farm . . . which happened to be in the middle of downwind, the spray made us gag . . . and
    tobacco growing country. After being stuck ... in the five-year-old Henrietta would always vomit. Now
    dirt and dark . . . what a welcome relief it was . . . the the tobacco leaf is broad . . . so birds flying over the
    broad expanse of sky . . .wide open spaces . . . fresh field inevitably spatter the leaves with the pale green
    air. of their droppings. In the slanting evening light,
    there were long shadows cast by the half-eaten
    There was so much I enjoyed about the life. The
    bodies of grasshoppers . . . bees . . . flies . . . caught
    arrangement between the farmer and the land ... he
    and lying suspended in the cobwebs fastened to the
    cared for the fields . . . and they grew crops for him
    leaves. I made certain they wouldn't stick to my
    ... the arrangement with the barnyard animals ... in
    pants by walking around them.
    return for feeding .. . looking after their stalls . . .
    they would provide all kinds of amusement . . . and
    And you know those little drying houses called
    work hard if called on. The beauty and strength of
    kilns [pronounce "killins"]? Sometimes the door
    those work horses . . . and how well they responded
    was left ajar and if the dog chase ended there ... I
    to control . . . such a contrast to the noisy and
    found it unpleasant to enter because the frightening
    smelly tractor.
    bats were flying wildly about ... 1 thought they
    And I still think about the evenings; the work of might stick in my hair. Now the tobacco leaves hang
    the day completed. And you know what it is like at to dry from the lines ... as they age, they wrinkle and
    8:00-8:30 p.m. in June or July. The light is golden turn yellowish-brown. You can see where those bats
    ... it slants across the fields casting long shadows. had been sleeping . . . for the leaves below are
    The birds are quieting down. I'd usually take a walk streaked yellow by their feces.
    . . . from the house . . . down the lane to the road . . . No matter how much I enjoyed farm life . . . time
    five or six dogs as companions ... it was all so passes . . . the day arrives where no matter how
    peaceful and quiet. On my right there was a ten acre reluctant . . . how difficult . . .
    field of wheat . . . made more golden by the light. I
    SMOKING, ADDICTIONS, A N D HABIT D I S O R D E R S 425

    you do have to say goodbye and get on with life.


    In September, I returned to medical school . . . INTRODUCTION
    strengthened by the experience. On the first courses Erik Wright (1987), a former President of the
    that semester was public hygiene. We were divided
    American Society of Clinical Hypnosis, outlined
    into groups of ten and required to visit
    six major approaches for use with habit or
    manufacturing facilities to check their hygienic
    addictive disorders.
    procedures. By good luck our group was assigned to
    a cigarette manufacturing factory for rating. We 1. STRATEGY OF POSITIVE FUTURE
    learned that by law, one out of every 200 cigarettes CONSEQUENCES.
    was removed from the line . . . and placed under a This strategy concentrates on highlighting the
    30-power microscope. On first looking through the long-term rewards from overcoming the habit,
    eyepiece . . . everything is murky brown. Then if you while simultaneously stressing the decrease in the
    focus . . . you see the cut tobacco leaf, and suddenly negative side effects. Wright emphasized such
    with more precise focusing . . . you see other things . long-term benefits as health, self-esteem,
    . . quite unexpected. Tiny bits . . . pale green . . . pale appearance, and financial reward. Either age
    yellow. 1 recognized these from my experience in regression or age progression might be utilized by
    the summer . . . the tobacco leaves spattered by birds Wright in emphasizing such positive
    . . . and the bat droppings on the drying tobacco consequences.
    leaves . . . and other fragments . . . cross-sections of
    insects . . . torsos, limbs . . . the insects that had been 2. STRATEGY OF NEGATIVE ACCENTUATION.
    lying half eaten in the cobwebs . . . we became quite W right
    expert at determining which was the eye of the believed there were times to confront patients with
    grasshopper ... or fly ... or bee. And then the reason the long-term negative consequences from a
    for the law . . . other pieces . . . dark grayish brown . destructive habit, while at the same time devaluing
    . . these turned out to be rat droppings. We were the short-term pleasure.
    informed the law permitted up to six pieces per
    cigarette . . . more than six, and the batch was 3. STRATEGY OF SUBSTITUTING ALTERNATIVE MEANS
    OF
    destroyed. Now we were curious as to how this
    GRATIFICATION. Other methods may be found for
    could be. It turned out the leaf was transported from
    the kilns ["killins"] straight to the cutting room of reducing tension that are less destructive.
    the factory . . . no washing process . • . the cut leaf is
    then placed in bins to await wrapping in paper . . . 4. STRATEGY OF CONSCIOUS DECISION -MAKING. Instead of
    and the bins are a favorite nesting place for rodents . responding in a habitual, automatic fashion,
    . . who leave their urine and feces willy-nilly. patients are required to take responsibility for
    making a conscious choice if they indulge a
    destructive habit.
    Now 1 ask you ... to wonder . . . just how long it
    takes that group of medical students to refuse to put 5. STRATEGY OF ENVIRONMENTAL CHANCE.
    cigarette to lips . . . let alone light up . . . and permit Another
    penetration of that smoke . . . and all it contains. To of Wright's strategies was to change the social and
    this very day ... I find it uncomfortable to even touch environmental context in which a habit could
    a cigarette . . . for 1 know what is inside. occur.

    General Strategies for Overcoming 6. STRATEGY OF SELF-REWARD. The last tactic was
    to encourage self-reinforcement for changes
    Pleasure-Producing Habits and successes.
    M. Erik Wright, M.D., Ph.D.
    426 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    NEGATIVE ACCENTUATION: present. These two bad reactions can help you reach
    CONFRONTATION WITH FUTURE your goal of becoming a nonsmoker instead of just
    CONSEQUENCES being things that have frightened you as threats to
    your health. I would like to ask the inner part of
    The following illustrative suggestions and your mind if it would be okay for you to intensify
    interaction with a patient demonstrate Wright's the frightening feelings that each of these
    technique of negative accentuation. His style of experiences arouses in you, so that these feelings
    using this technique is different from many who are not just pushed out of mind as soon as the event
    use aversive imagery in that he personalizes the is over, but that they remain up front in your
    process, concentrating on natural consequences memory. If you should reach for a cigarette, not
    that are specific to the patient. only will you have a vivid recall of how you felt
    when these events happen, but you might even have
    Although this method is less popular in
    the events begin right there and then.
    hypnotherapy today than it was in the past, with
    certain difficult patients it may prove beneficial to C: I don't see how that would be any worse than
    have the patient to imagine highly specific negative what actually happens. I have had some terrible
    consequences — for instance, hacking coughs, feelings about both of these experiences. [The
    choking on the thick phlegm in the morning, client closes his eyes and relaxes and the right
    burning holes in clothes, the smell, and health index finger, the "yes" finger, rises up.]
    consequences. It is important, in my opinion, that T: Good. Your inner mind seems strongly
    this technique not be relied upon as a central committed to nonsmoking. . . . Give yourself the
    strategy, but rather be used in combination with signal to go into trance . . . and drift ahead in time to
    other techniques and suggestions. However, when tomorrow morning. . . . You are in the bathroom,
    patients have difficulty completely stopping and you are ready to try raising the heavy phlegm
    smoking in response to other suggestions, and have from your throat. . . . Signal with your right index
    during assessment identified many negative finger when you are ready for this. . . . [The client's
    consequences, this technique may be considered finger rises.]
    along with exploration of the underlying functions
    T: Fill your thoughts with wondering how hard it
    of continuing the addictive disorder. In such cases,
    will be to bring it up this time . . . Will it be slimy
    however, it seems very wise to follow Wright's
    yellow or green? . . . Will there be some flecks of
    model of checking the acceptability of this
    blood in it? . . . Feel yourself gagging as you
    approach with the patient through ideomotor
    struggle to bring it up. . . . When you finally
    signals before proceeding to actually offer sug-
    manage to bring it up . . . look at it . . . feel disgust
    gestions. Note, in the modeling provided below,
    and anger at the cigarettes that have done this to
    how respectful Dr. Wright is in his use of aversive
    you ... at yourself for letting it happen. ... It will
    methods. (Ed.)
    disappear when you are a nonsmoker. . . . More
    smoking will make it heavier, slimier, harder to
    ILLUSTRATIVE SUGGESTIONS. T: You listed two dis- bring up. . . . Tomorrow morning . . . when you
    clear your throat . . . flood your mind with these
    tressing experiences that were important to you in
    thoughts. . . . More smoking . . . worse crud ... No
    making your decision to become a non-smoker:
    smoking . . . clear throat. . . . Let the inner part of
    first, the heavy yellow crud that you have so much your mind consider this. . . . Does it want to use
    trouble with in bringing up from your lungs in the these suggestions each morning for as long as you
    morning; second, the 10 to 15 minutes of deep need support to become a nonsmoker? . . . [The
    coughing and wheezing each night when you first client's right index finger indicates "yes."]
    hit the sack.
    C: Right, both of them really worry me. They Now move yourself ahead in time until night. . . .
    were part of the reason I saw my doctor. You are just stretching out on the bed
    T: There is no question about your getting
    pleasure out of smoking in the past and in the
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 427

    when the first coughing attack starts. . . . Feel how nonintrusive activity to relieve a smoker's social
    deeply the cough reaches down into your lungs. . . . strain:]
    Feel the bed shake with each coughing spasm. ... It [After recalling a memory associated with these
    feels as if your belly button wants to pop out with feelings:] Let this sense of comfort, of well-being,
    all the straining to get the smoke poison out of your of confidence flow through your body like a
    lungs. . . . Feel yourself beginning to wonder how pleasurable force ... so real that you can feel it in
    much more the lungs can take before the smoke your body. . . . Some people feel it like a color ... or
    poison is cleared out. . . . No smoking ... no poison. a muscle sense ... or an inner glow. . . . Each person
    . . . Tonight ... if the coughing begins . . . focus on knows what it is, even though different words are
    the coughing . . . how it feels . . . how hard your used. ... It is more than an absence of strain or
    lungs are working to clear out the past residue of tension. . . . It is a positive strength that is your own
    smoke poisoning. . . . . . . that can grow as you learn to recognize it . . .
    Each time you make a move for a cigarette ... let that can help you to reduce big problems to man-
    each of these images flood into your mind . . . feel ageable size. . . . Signal with your right index finger
    the strain in your lungs . . . then decide whether you as you feel that special strength in you. . . . [The
    want to smoke the cigarette. ... It remains your client signals.] Very good. . . .
    decision. . . . The more unpleasant and vivid these [The therapist suggests the substitute activity:]
    images are . . . the easier it will be to become a As you enjoy that feeling of strength moving in
    non-smoker. ... It is worth the effort. . . . After you you . . . gently let your thumb and index finger
    have signaled yourself to return to the here and begin to turn the ring on your fourth finger. . . .
    now . . . the inner part of your mind will continue to [The therapist identifies the substitute activity with
    rehearse these images and make them available to wellness:] As you move it around, it seems to bind
    you immediately whenever you need them to that feeling of well-being ever more strongly into
    sustain your decision to be a nonsmoker. . . . your consciousness as well as into your
    subconscious self . . . making it a part of you . . .
    belonging to you . . . yours to call on when you
    COMMENT need it. . . .
    [The therapist offers a posthypnotic suggestion
    Some hypnotherapeutic procedures involving concerning autohypnosis:] Should you feel stress
    negative accentuation do not limit themselves to building up . . . that thumb and index finger can
    actual life experiences of the client. The client may begin to move the ring . . . and you will be able to
    be encouraged to create highly aversive fantasies put yourself in trance to draw on this sense of
    about cigarettes and smoking during the trance well-being, of confidence in yourself. . . .
    state, and then, with strong posthypnotic Whatever is confronting you can be brought back
    suggestions, to evoke these aversive fantasies and into manageable size ... to be dealt with . . .
    their concomitant psychosomatic stresses sometimes in part, if you are not ready to deal with
    whenever there is a temptation to smoke. all of it. . . . And then you can either continue the
    trance or terminate it as you deal with the situation.
    ...
    RELAPSE PREVENTION SUGGESTIONS [The therapist reassures and protects the client:]
    TO SUBSTITUTE AN ACTIVITY F O R As you practice with this feeling . . . you will
    SMOKING become increasingly secure in your capacity to
    cope realistically. . . . You will be able to talk and
    [The suggestions that follow illustrate part of act while in the trance situation. . . . Even if you do
    Wright's (1987) technique of substituting not give yourself the signal to terminate your own
    a trance ... it will terminate when the need is
    fulfilled. . . .
    428 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    [Confirmation is sought from the client:] Tell the usual rushed feeling. Therefore, you begin to
    me how you will use this new skill. . . . [The client discover that you can accomplish many things well
    presents some situation, step by step.] Very good . . and efficiently with much less effort than before
    . now let yourself go very relaxed . . . and give while your brain is completely eliminating any
    yourself the signal to be in the here and now. . . . wish or need to smoke.
    [I then added specific posthypnotic suggestions
    that upon reopening his eyes he would find himself
    in "a pleasant and interesting posthypnotic state";
    Illustrative Suggestions with that during this state his right hand would take a
    Smokers pencil and begin to write on a sheet of paper the
    word "sleep" several times until his eyes became
    Paul Sacerdote, M.D., Ph.D.
    heavy and closed; that when the pencil would
    Riverdale, New York
    become too heavy and fall out of his hands he
    [After obtaining sufficient depth through would find himself in a deep and relaxed sleep. His
    fractionation I verbalized as follows:] need to be in control permitted him to write the
    word "sleep" 10 times before any response to the
    Through the experience of having learned during
    posthypnotic suggestion of falling asleep became
    the last 10 minutes to produce a state of hypnosis,
    evident.
    you have established in your brain new circuits,
    new pathways, and new patterns of activity through While the patient was "asleep," I repeated to him
    which your brain learns to assume better and fuller all the previous suggestions and added that, if he
    control of your body. Your brain is the needed to, he could dream, using the dreams for his
    communications center; every second it receives own needs and pleasure, but feeling free to forget
    millions of bits of information from every part of or recall them without having to tell me about
    your body and from the outside; it coordinates this them. Noticing the rather prompt development of
    information, reaches decisions, and sends out REM's (rapid eye movement), I assumed that he
    orders and instructions. . . . Therefore, your brain is was indeed responding to the suggestion,
    in full control and will continue to control your congratulated him for his understanding response
    hands and will keep your hands from picking up to my suggestions, and then added the following
    cigarettes, from holding cigarettes, from lifting verbalizations:]
    cigarettes, from lighting cigarettes. . . . Your brain Every hour and every day that you go without
    also controls your lips and your entire mouth and smoking permits your body to eliminate the
    will keep them from holding any cigarette, from nicotine and the carbon monoxide that are now in
    puffing on any cigarette. . . . Your brain controls the your system, while tar and other impurities will
    muscles of your chest, of your shoulders, and of gradually be removed from your lungs until they
    your diaphragm and will keep them from pumping may become again as healthy as the lungs of a
    any more tobacco smoke into your lungs. . . . person who had never smoked. . . . Gradually you
    are beginning to develop a dislike for cigarettes,
    New patterns and new circuits have already
    and it will be enough for you to see cigarettes, to
    become activated in your brain; among other
    see or hear advertisements about cigarettes, or to
    changes, you will experience prolongation and
    smell cigarettes or cigarette smoke for you to
    continuity in your periods of enjoyment and
    immediately think of a cigarette that has just been
    satisfaction, while episodes of irritation and
    stubbed out, to see it, and to smell it as it is
    frustration will seem to be quite short. . . . During
    smoldering and gradually releasing that stale
    the next few days additional patterns become
    disgusting smell. . . . You will always be aware of
    established in your brain and you begin to
    and avoid traps that anybody, even you, may set for
    experience calmness and comfort instead of
    you by tempting you with a cigarette puff "just to
    see how well hypnosis works."
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 429

    A Posthypnotic Suggestion and better care of myself. A very healthy thought to


    remember at these times is that I can avoid
    Cue with Smokers smoking. I may smell that many people are
    smoking around me. I may hear other people
    Brian M. Alman, Ph.D. coughing and see their eyes watering. But as I sip
    San Diego, California my drink and hear the ice clinking against the clear
    glass, I may be reminded that my lungs can be
    Occasionally, when I'm having a social cocktail, clearer than theirs. The clarity and freshness in my
    I know it is an enjoyable and relaxing diversion. lungs can be maintained by avoiding cigarettes.
    This is a time when I may also take

    HYPNOSIS WITH HABIT DISORDERS

    Hypnosis with Nailbiting worthwhile and desirable goal.

    Harold B. Crasilneck, Ph.D., and


    James A. Hall, M.D. Erickson's Suggestions for
    Dallas, Texas Nailbiting
    Milton H. Erickson, M.D.
    INTRODUCTION
    . . . I don't think you really like those stubby
    fingernails of your either. And you have been
    Crasilneck and Hall (1985) typically explore the
    biting them since you were four years old . . . and
    possible psychodynamic meaning of nailbiting and
    I feel rather sorry for you, because
    assess family interaction to determine if there is a
    for______ years you have been biting
    functional purpose to the symptom. The following
    your
    types of hypnotic suggestions are then given.
    fingernails and you have never gotten anything
    Afterwards, if the patient is a child, he or she is
    more out of it than a teensy, teensy little piece of
    asked to learn appropriate methods for caring for
    fingernail; and you have never had a decent-sized
    his/her fingernails. (Ed.) piece of fingernail to chomp
    on. _____ years of frustration! Now what I am
    going to suggest to you is this: You have ten
    SUGGESTIONS
    fingers. Certainly you can spare one on which to
    grow a decent-sized fingernail, and after you have
    When you begin to put your hands toward your grown a decent-sized fingernail on it, bite it off,
    mouth, there will simply be an automatic and and have something worth chewing on.
    opposite withdrawal movement. You will no
    longer wish, nor desire, to continue this outgrown,
    unwanted habit that injures your hands and
    embarrasses you before your family and friends. ... Suggestions for Nailbiting
    As you begin to discontinue the habit of biting your David Waxman, L.R.C.P., M.R.C.S.
    nails, you will feel a sense of well-being and London, England
    self-approval. You will begin to respect your
    fingernails and hands and be proud of them. Each One of the most important factors in successful
    time that you successfully avoid nailbiting, you treatment is to be found in strength-
    will feel proud of yourself for accomplishing a
    430 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ening the patient's desire and motivation to stop the This will become stronger and nastier . . . and will
    habit. This is equally necessary in child, adolescent make you feel sick.
    or adult, first in the waking state, and subsequently
    repeated during hypnosis. Once again, the deeper Conditioning a feeling of nausea to the habit in this
    the trance, the more rapid and effective treatment is way may help greatly in establishing control. When
    likely to be. The procedure seems to be particularly this particular method is used, however, fairly
    successful when the patient is female: frequent sessions will be necessary, and even when
    the nails begin to grow the suggestions may need to
    As you grow up . . . you will become more and be reinforced about once a fortnight, for a time.
    more attractive. You will not want your appearance Increasing motivation is a much superior method
    to be spoilt by ugly hands. Nice hands and shapely and the results are likely to be more effective.
    nails will make you even more attractive . . . and
    An alternative method is to permit the biting of
    you will want to make every effort to stop biting
    your nails, and spoiling them. With my help . . . you one or two nails, whilst allowing the others to
    will be able to stop biting them altogether . . . and grow. Once this succeeds, it is surprising how often
    then they will soon begin to grow. and rapidly the habit is abandoned altogether.
    Whilst the patient has actually stopped biting her
    nails after one or two sessions, she may substitute a
    Commence treatment with the routine habit of picking them instead. This occurs more in
    ego-strengthening and then proceed in the adults and adolescents than in the case of children.
    following manner: It is not difficult to deal with, since the inclusion of
    specific suggestions prohibiting this as well will
    As your nerves become stronger and steadier . . . usually cause it to stop.
    as you become calmer and more relaxed, each day
    ... so, there will be no reason for you to go on biting
    your nails.
    You will no longer want to bite them . . . you will
    stop biting them. If at any time you do start to bite Suggestions for Nailbiting
    them, without realizing what you are doing . . . the
    moment your fingers touch your mouth . . . you will
    know immediately what you are doing . . . and you Don E. Gibbons, Ph.D.
    will be able to stop yourself right away . . . before
    you have done any damage at all. Every time you bit your nails from now on, you
    From now on . . . you will stop biting your nails . will have to bite them with your hand turned
    . . they will begin to grow . . . and you will feel completely upside down from the way you usually
    proud of your hands. hold it. You are going to be absolutely unable to
    bite your nails in the way you have been doing it,
    Strong, authoritative, direct suggestions under because every time you start to bite your nails in the
    hypnosis will often succeed in stopping the habit usual way, you are going to have to turn your hand
    altogether. Where a very deep trance or completely over before you do.
    somnambulism can be obtained, the prohibition Every time you feel like biting your nails, your
    may be rendered much more effective by telling the desire to stop biting them is going to be felt too.
    patient that he will experience a strong feeling of And this is what is going to make you do it in such
    distaste whenever he puts his fingers in his mouth: an awkward and uncomfortable way. You won't be
    able to express one desire without expressing the
    Whenever you start biting your nails ... the other one at the same
    moment you put your fingers in your mouth . . . you
    will get a horrible bitter, nasty taste in your mouth.
    SMOKING, ADDICTIONS, AND HABIT DISORDERS 431

    time, so if you do let yourself bite your nails, you SUGGESTIONS


    won't let yourself enjoy it.
    And when you do turn your hand upside down to You will be acutely aware whenever you put
    bite your nails, you will soon find that this position your hand to your head, then it is entirely up to you,
    is so uncomfortable, that your desire to bite your you have the power, the control, no one else, no
    nails is going to get weaker and weaker, until your habit controls you. You can pull your hair if you
    desire to bite your nails is so weak, and it is just so want to or you can choose to control the habit.
    much trouble, that you will just give it up
    completely.

    Suggestions for Scalp Sensitivity with


    Suggestions with Trichotillomania
    Trichotillomania
    T.J. Galski
    Marianne Barabasz, Ph.D.
    Pullman, Washington
    INCREASING AWARENESS OF
    BEHAVIORS PRECEDING HAIR
    INTRODUCTION PULLING

    Trichotillomania, compulsive hair pulling, is Become immediately aware of reaching up to


    estimated to be a chronic habit disorder of 8 million pull your hair. Feel your fingers wrap around a lock
    people (Azrin & Nunn, 1978). There are many case of hair . . . feel the texture, the softness and
    reports in the behavior modification literature, with silkiness of the hair wrapped around your fingers. .
    varying success rates, using methods like aversive . . When you become aware of your arm reaching
    self-stimulation (e.g., snapping a rubber band on up and your hair wrapped around your fingers,
    the wrist), covert sensitization, self-monitoring and another interesting feeling can occur— just
    stimulus control procedures (Bornstein & touching your hair in these circumstances can
    Rychtarik, 1978; Levine, 1976; Mastellone, 1974; serve as an emotional trigger for your scalp to
    Saper, 1971). There are also case reports of the become very sensitive, sensitive as when you get a
    successful use of hypnosis with this condition bad sunburn and touching the sunburned area can
    (Galski, 1981; Rowen, 1981; Spiegel & Spiegel, make you cringe! . . . [Patients may only be
    1978). Barabasz (1987) successfully used the minimally aware of the discomfort.] The
    following permissive suggestions to treat awareness of hair-pulling behaviors will
    trichotillomania in three of four cases. She used the immediately be followed by letting go of your hair,
    restricted environmental stimulation technique that relaxing, . . . inhaling . . . letting all normal
    she and her husband developed to enhance hyp- sensations be restored. There'll be no need to soon
    notic responsiveness. reach up again with any urge to pull out your hair.
    CONCENTRATION, ACADEMIC
    PERFORMANCE, AND ATHLETIC
    PERFORMANCE
    INTRODUCTION
    FIRST SECTION OF this chapter will present suggestions that have
    commonly been used to enhance motivation for learning, concentration,
    THE
    study skills, reading ability and to overcome text anxiety. The next section of
    the chapter will contain several suggestions that have been gleaned from the
    literature for enhancing creativity. The final section of this chapter will provide a
    brief overview of the applications of hypnosis to athletic performance along with
    suggestions for sports hypnosis.

    Research
    Through the years hypnosis has been used in a number of ways in academic
    performance. In particular, it has been used to reduce generalized anxiety and test
    anxiety. Excessive anxiety lowers intellectual efficiency and may impair
    performance, but hypnosis, especially learning self-hypnosis skills, gives the
    student a self-management tool. Although one study did not find hypnosis helpful
    (Egan & Egan, 1968), Eisle and Higgins (1962) and Mellenbruch (1964) reported
    positive results, as did Lodato (1969) in a single case report. With 130
    undergraduate students, Goldburgh (1968) documented that hypnosis was more
    effective than a tranquilizer or "expressive-directive" treatment.
    Attempts to enhance learning and recall through hypnosis have been another
    focus of research. Haggendorn (1970) gave graduate students hypnotic
    suggestions to stimulate interest in and retention for lecture material, and found
    improved recall. But a variety of other studies have found hypnosis to be
    ineffective for this purpose (Fowler, 1961; St. Jean,

    433
    434 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    1980; White, Fox, & Harris, 1940) and found that it does not increase recognition
    for previously learned material (Council on Scientific Affairs, American Medical
    Association, 1985).
    There have also been many studies concerning the ability of hypnotic
    suggestion to enhance reading ability and concentration. Knudson (1968)
    documented increased reading speed and comprehension with four sessions (24
    subjects) at 11-week follow-up. Compared to a control group, subjects in a study
    by Mutke (1967) similarly showed improved reading speed and comprehension
    with hypnosis. Holcomb (1970), experimenting with seventh grade students,
    found significant increases in speed of reading, but only slight increases in
    comprehension. Improved reading and spelling skills were also obtained by
    Krippner (1963, 1966), and Wagenfeld and Carlson (1979) reported a successful
    adult case utilizing ego-strengthening to alter a negative self-concept. Koe and
    Oldridge (1988) additionally reported mildly positive effects on reading from
    hypnotic suggestions. Finally, alert trance (Banyai & Hilgard, 1976), rather than
    relaxation or drowsiness suggestions, has also been used with reading and study
    skills. In a tangentially related study, Liebert, Rubin, and Hilgard (1965) found
    fewer learning errors (in learning word-number pairs) in a group given
    suggestions in alert trance versus a traditional hypnotic procedure. Oetting (1964),
    whose suggestions are included in this chapter, described his alert trance approach
    but without any outcome data. But Donk, Vingoe, Hall, and Doty (1970)
    documented that alert trance increased reading speed more than traditional
    hypnotic induction or conversation. Recently, Wark (1989), using his alert trance
    procedure that is included in this chapter, documented positive increases in
    reading comprehension in nine university students. No control group was used.

    There are negative results as well, however, concerning the effects of hypnosis
    on reading. Swiercinsky and Coe (1971) used Oetting's alert trance approach with
    58 university undergraduates with no effects. Using alert trance, Willis (1972)
    also failed to find an increase in reading speed between a waking suggestion and
    hypnosis group, but only one session was used. Cole (1977, 1979) similarly failed
    to find improvements in reading and test-taking skills with either traditional
    hypnosis or waking suggestions over what a class for improving study skills
    produced (which presented similar information).
    Thus we cannot be sure at this time how much the use of hypnosis is truly
    capable of enhancing reading speed, comprehension, or concentration during
    studying. Hypnosis has been successful in some studies, and unsuccessful in
    others. Further research is needed.
    It should also be noted that there has been some experimental work done on
    hypnosis and creativity. Raikov (1976) had subjects in deep hypnosis roleplay
    someone famous and talented in art, music, etc., and reported positive results, as
    did Dave and Reyher (1978) with real life problems. Bowers and Bowers (1979)
    also documented a relationship between level of hypnotic capacity and creativity,
    leading them to conclude: "The personality characteristics that allow one person
    to be more susceptible to hypnosis than another coincide to some extent with
    those characteristics that make him more creative. Perhaps the ease with which
    one can deconventionalize
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 435

    experience and accept the unrealistic and fantastic contributes both to


    susceptibility and creativity" (p. 378). But, on the other hand, results are
    inconclusive since some experimental work has failed to find hypnosis capable to
    enhancing creativity (K. Bowers, 1968; K. Bowers & van der Meulen, 1970).
    Gibbon's suggestions in this chapter model Raikov's approach to enhancing
    creativity.

    Hypnotic Enhancement of Athletic Performance


    References to the use of hypnosis to enhance sports performance have been
    made in the literature for a long time (e.g., Lindemann, 1958; Mitchell, 1972;
    Narcuse, 1964a, 1964b; Schultz, 1932). In 1964, Narcuse found that of 125
    Japanese Olympic athletes, only 20% had invested time in developing a means of
    coping with performance anxiety, and few of them had done this systematically
    or reliably. In contrast, today cognitive training and hypnosis training are widely
    utilized with Olympic athletes and a wide variety of professional athletes.
    It is my recommendation that you individually design hypnotic training for
    athletes based on their particular needs. A training plan may be formulated by
    determining which of ten overall strategies are needed with the individual athlete:

    1. Enhance sensory awareness and muscle control.


    2. Increase concentration, control internal dialogue, and decrease awareness of
    unimportant external stimuli.
    3. Control anxiety, anger and emotionality.
    4. Enhance motivation and enthusiasm.
    5. Increase energy, feelings of invigoration, and endurance.
    6. Enhance performance skill.
    7. Increase self-esteem, confidence, and self-efficacy.
    8. Control perception of time and focus on the present experience (time contraction
    or expansion).
    9. Resolution of unconscious blocks or conflicts.
    10. Management of discomfort.
    Under these ten strategies we may identify the specific hypnotic techniques that
    will allow us to accomplish the goals, such as age regression (e.g., to outstanding
    performances), imagining an ideal model, mental rehearsal, use of end-result
    imagery, age progression, direct suggestions, progressive relaxation, symbolic
    imagery techniques, ideomotor signaling for unconscious exploration, amnesia
    (e.g., for past defeats), ego-strengthening methods, positive internal dialogue,
    alert trance, suggestions for time distortion or (temporary) time reorientation, the
    protective shield technique, analgesia and so forth.
    In the last section of this chapter you will have an opportunity to study a
    sampling of suggestions that are used in sports hypnosis. You will also find it
    beneficial to consult Jencks' suggestions for increasing energy and for
    invigoration found in Chapter 8.
    436 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ENHANCING ACADEMIC PERFORMANCE

    Suggestions for Enhancing pletely any tension which might be reawakened by


    your starting to take the test, so that by the time the
    Academic Performance test begins, you will be in just the proper mood to
    function most effectively.
    Don E. Gibbons, Ph.D. You will be able to recall a great deal of
    information which might otherwise be blocked
    IMPROVING STUDY SKILLS because of tension. Your mental processes will be
    much more flexible, and you will be able to draw
    As a result of what I am about to tell you now, on vast reserves of potential which will enable you
    you will find many helpful improvements taking to concentrate much more easily on the questions
    place in your study habits, and in the effectiveness asked and your answers to them.
    with which you utilize your abilities in studying. You will be able to remain perfectly relaxed and
    Whenever you have any studying to do, you will calm throughout the entire test as the ideas, facts,
    find that you will be in just the right mood for it. and concepts continue to flow smoothly into your
    You will really feel like studying, and as a result, awareness and to organize themselves naturally
    you will be able to dig into the material with a lot and almost spontaneously, as if they were flowing
    more energy and a lot more enthusiasm than you onto the paper by themselves. You are going to be
    usually have. You will be able to use your study thrilled and delighted at how much easier the entire
    time much more effectively; for you will be able to process of taking examinations is going to be, and
    concentrate much more easily and to remember at how much better you will be able to perform.
    with much less effort what you have learned.
    Each time you complete a period of study, you
    will find that you experience very strong feelings of
    FACILITATING CLASS PARTICIPATION
    pride, achievement, and accomplishment because From now on, you will find that the subject
    you have been able to perform so effectively and so matter of all your classes has taken on a great deal
    well. These feelings will reward you for the time more meaning. You will want to ask many more
    you have spent in study, and you will come to look questions in class, and you will be very interested
    forward to your study periods in the same way that in the answers which are provided, both to your
    a trained athlete looks forward to a good workout. own questions and to the questions of others.
    It will be a source of deep personal satisfaction to
    you that you are able to use your abilities so fully As you continue to participate more and more in
    and so well, and you are going to be thrilled and the give-and-take of class discussion, you will
    delighted at the results. become ever more interested in everything that is
    being presented. You will become more and more
    absorbed in the content of what is being taught, as
    each new fact and concept to emerge becomes
    TAKING EXAMINATIONS more vivid and more interesting than those which
    have gone before.
    From now on, you will be able to approach your
    examinations calmly and to feel calm and relaxed As time continues to pass, your personal
    involvement will continue to grow, for you will
    as you take them. When you enter the room in
    constantly be discovering new ways to relate the
    which the test is being given, the act of walking
    material to your own life and experiences. And
    through the doorway will serve as a stimulus that
    these applications will give rise to still more
    will release within you a great wave of additional questions, resulting in an even greater desire to
    peace and tranquility, confidence and calm. And know.
    it will drive out com-
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 437

    As these new questions are satisfied in turn, the Now, as the mood continues to grow ever clearer
    process will continue at an ever-increasing rate, for and stronger by the second, you are going to be able
    the more your aroused curiosity is fed, the stronger to carry it back with you and to call it up again
    it is certain to become. whenever you wish. The mood will persist for a
    while after the trance is terminated, and whenever
    ACHIEVEMENT MOTIVATION you need to, you are going to be able to act and feel
    in just this manner once again. You are going to be
    Please extend both arms straight out in front of able to act and feel as if you were going toward a
    you, palms facing inward, about four inches apart. predetermined and certain success. You are going to
    Now I would like you to imagine that there is a be able to act as if it were impossible to fail. For this
    large rubber band stretched around your wrists is the key which will enable you to continue to tap
    holding them close together, as they are now. This into your true potential and to employ your abilities
    rubber band represents all the negative thoughts to the fullest in pursuit of the goal you have chosen.
    and feelings which have been holding you back and
    preventing you from attaining your true potential;
    and as I continue speaking, you will begin to notice
    a force pulling your hands apart, until the rubber The Memory Bank
    band will suddenly snap and you will be free of all
    these negative thoughts and feelings once and for Douglas M. Gregg, M.D.
    all. Feel the force beginning to pull at your
    outstretched hands now —tugging and tugging as it
    slowly draws your hands apart. Feel your wrists INDICATIONS
    drawing farther and farther apart, and feel the These are suggestions for enhancing memory.
    rubber band stretching tighter and tighter between
    The metaphors concerning checking and banking
    them. Soon the band will snap, and you will finally
    will be most appropriate with older adolescents or
    be free of these negative influences. It's ready to
    break; ready to break. Now! You are free! adults. (Ed.)

    Now you can rest your hands comfortably in


    your lap, as you continue listening to my voice. Let
    SUGGESTIONS
    yourself relax completely now and think back to a As you drift along deeper and deeper relaxed,
    time in the past when you were in a totally positive concentrating your mind more and more, you are
    frame of mind, looking forward to a complete and receptive to and you accept suggestions about
    certain success. This need not be a great success in memory and recall. The art of memory is the art of
    the usual sense of the term— it's the positive attention and retention. You must pay attention to
    feeling that counts. Everyone has experienced this anything in order to remember it. People who do
    type of feeling at one time or another, even if only not pay attention, do not remember. To remember
    in childhood. So take your time, and when you something you must pay attention. For instance,
    have thought of the kind of situation I am you think of the name, you look at the man, you
    describing, let your imagination focus on it clearly associate them. You want to know the man's name.
    and capture the mood once more. And when you You really want to remember. This is the process
    have caught this mood once again, you can signal that you use to remember anything: you
    me by raising the index finger of your right [or left] concentrate your mind, you think, you look, listen,
    hand. associate, and remember.
    [After the subject has responded:] All right. In being able to recall something you have to
    Now just hold this mood for a moment, and feel it have stored the information properly; you have to
    growing even stronger. put the facts in your memory bank before
    438 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    you can recall them. You have an excellent One way to promote recall is to go down the
    memory; you are going to use it; you are going to alphabet. What is the name of that hotel? A, B, C,
    pay attention. You must very literally pay attention, or D? Oh, D, that is it! It is the Delaware Hotel.
    close attention. That way you store the facts You use a hook, a hook which you stretch down
    properly in your memory bank and they are ready into your memory, into your subconscious mind,
    for you when you want or need them. and you use it to withdraw your answer.
    From this moment on, every day, you utilize Another technique: If you want to remember
    your good memory, you use your good memory where you left something, go through the motions
    every day. You always pay attention. You pay of what you were going through or what you were
    attention to exactly what is going on around you, to doing at the time you left it. You retrace your steps
    exactly what is being said, to exactly what you mentally.
    hear, and exactly what you see, so that when you By retracing the steps, you write a check, and it
    need to go into your memory bank to make a is cashed in the memory bank. To write a mental
    withdrawal, you have already deposited something check, do something that is associated with the
    to withdraw. The facts are properly stored and they information you want. You want something from
    are ready for you. They are ready for you whenever your memory bank. You do not know what it is.
    you want or need them. However, you do know some other bit of
    Your memory bank is just like any other bank. information that is associated with what you want
    When you go into a bank to withdraw some of your or that is related to it. You use that bit of
    money, you do not hold them up with a pistol. You information as the check you write in order to get a
    fill out a withdrawal slip or write a check and have withdrawal from the memory bank of your
    it cashed. You do the same thing with your memory subconscious mind. Knowing and practicing this
    bank. It is not necessary to force your memory bank technique tremendously increases your ability to
    to give you the information. You simply concen- recall. You are surprised and amazed at how
    trate your mind, request the information, relax, and precisely accurate and effective your memory is.
    let it drift up to your conscious awareness. Your memory has always been good. By properly
    training and utilizing the memory system that you
    You have a good memory, you have an excellent
    have in your subconscious mind, you are able to
    memory. This is true for every single living human
    obtain maximum recall. You provide yourself with
    being. It is part of the way we are made. You need
    maximum deposits. You develop maximum recall.
    only to use your memory properly. Force only leads
    You have an excellent memory . . . always alert and
    to frustration. In order to recall anything, you
    active.
    simply let your subconscious mind know what you
    want. Anything you want to know then comes into Now, all of these suggestions are very important,
    your conscious awareness naturally and easily. If it for they represent the proper way to utilize your
    does not come immediately, forget about it, forget good memory, the excellent memory that you have.
    about it, forget about the process of remembering First, you make the proper deposit in the memory
    it. Do not try to force it. The information that you bank by paying attention; you concentrate your
    want washes up on the sands of your conscious mind, you think, look, listen, associate, and
    awareness in a few moments . . . sometimes when remember. Second, when you want to make a
    you least expect it. Any information that you want withdrawal from the memory bank, your memory,
    comes into your conscious awareness . . . naturally your recall is always successful because you make
    and easily. the withdrawal in the proper manner. You do not
    force it; you utilize some natural association that
    you already know in order to bring out the
    information that you want. All of these
    suggestions improve your
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 439

    memory, your recall; they take complete and word or a sentence very well, you will be pleased
    thorough effect upon your mind, emotions, body and happy. You will want to read more and more.
    and spirit as they seat themselves in the deepest As you relax, you begin to stop worrying. You
    parts of your subconscious mind, reinforcing stop worrying about reading. You begin to think
    themselves over and over again as you drift down how much you would like to read better. You begin
    deeper now . . . way down . . . to think how much you would like to improve your
    As you drift down deeper now . . . way down ... reading ability. You know that you can read better
    so calm, so comfortable ... relaxed, you realize that if all the muscles of your body are relaxed. If all of
    all of these suggestions are completely and totally your muscles are relaxed, you will be able to pay
    effective and available to you throughout your life closer attention to what you read. You want very
    whenever you need them. Growing more and more much to relax your muscles while you read and to
    comfortable . . . more and more confident . . . be completely at ease. You want very much to
    feeling calm and serene and secure in the relax all the little muscles in your eyes while you
    knowledge that these suggestions which are now read. This will help you to read with your eyes
    seated permanently in your subconscious mind are wide open so that you will not miss any of the
    available for your use whenever you need them. As letters. If your eyes are wide open, you will not
    you sink down deeper relaxed, all of these miss any of the words. If your eyes are wide open
    suggestions are implanted firmly and permanently you will read much better.
    in the deepest parts of your subconscious mind;
    completely and thoroughly effective . . . always
    automatically available as you drift down deeper
    and deeper relaxed, deeper relaxed. HIGH SCHOOL
    Before you start to study this evening, form an
    outline of the work you wish to accomplish so that
    you, by following your outline, study very
    Academic Study Suggestions efficiently. You will accomplish a great deal as you
    follow this outline.
    Stanley Krippner, Ph.D. When you are studying this evening, you will
    find that your concentration is so intense that you
    will be interested in nothing but your [e.g.,
    ELEMENTARY SCHOOL
    mathematics] assignment.
    Every time you read a word or a sentence
    correctly, you will feel very good inside. You will
    feel proud of yourself because you read so well. COLLEGE
    You will enjoy the feeling that reading well gives
    you. You will want to read some more words and As you begin to study [e.g., chemistry], your
    sentences. You will become interested in reading mind will quickly grasp the information at hand.
    books and magazines and newspapers. Every time Each important fact will make a profound
    that you read something correctly, and understand impression upon you. You will be able to recall the
    what you read, your interest will increase. You will information easily when future events demand it.
    want to read another book, or another magazine, or At (e.g., 8:00 p.m.) you will be absorbed in
    another newspaper. Sometimes you will make completing your history term paper. For the
    mistakes while reading. These mistakes will not following three hours, you will want to do nothing
    bother you because we all make mistakes. None of else. Barring emergencies, nothing will interrupt
    us is perfect. However, when you read a you. If your friends enter the room
    440 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    you will, with as much tact as necessary, send them reading, my mind will be focused on the words and
    away. thoughts in this book. Just as a funnel can direct
    When you start working on your paper, you will and concentrate water flowing into it — my eyes
    organize your references and other material can channel and focus my concentration onto the
    according to an outline of the general formation of words and concepts in this book.
    your paper. As you plan your paper, you will
    become very eager to make your plan a reality and
    put the ideas into writing.
    Suggestions and Success Imagery
    for Study Problems
    Concentration Suggestions Jeannie Porter, Ph.D.
    Murray Bridge, South Australia
    William T. Reardon, M.D.
    Wilmington, Delaware
    INTRODUCTION
    If you would like to improve your power of
    comprehension, concentration, memory, and recall, Within a broad clinical context embracing the
    practice your relaxation [self-hypnosis] for varying aspects of the learning process, this paper
    one-and-one-half to two minutes just before you presents a set of specific suggestions in conjunction
    start to study, take an examination, have an with use of success imagery. Guidelines are given
    interview, or do anything that is usually for posthypnotic suggestion and contingency
    disconcerting to you. management. Success imagery adopts the approach
    When you open your eyes, you will be able to of idealized-self-imagery (ISI) proposed by
    concentrate on the work that is to be done. Susskind (1970) as a confidence training technique.
    Concentrate to such a degree that you will absorb Principles of self-fulfilling prophecy and operant
    the material like a sponge taking up water, making reinforcement shape change in self-perception
    an indelible mark in your mind so you will be able towards successful outcome responses. While
    to recall it any time in the future. You will get twice relaxed under hypnosis, the patient is taught to
    as much work done in half the period of time. imagine his "ideal self"—the person he knows he is
    capable of being —if present inhibiting influences
    The things that used to be distractions will no were to be removed. The technique is directly
    longer bother you, whether they were persons, comparable to Maltz's (1973) use of "target
    places, or things. You will be able to take your imagery" in programming the subconscious to
    examinations with a relaxed body, a clear sharp realize self-fulfillment, as goals are successively set
    mind, with no butterflies in your stomach. You on a conscious level and achieved through the
    won't be able to explain how and why things come ongoing activity of the subconscious working to
    so easily to you. Don't try to analyze it; no one bring about the "desired end."
    knows how it works. Just let it happen and it will
    happen. Since most study problems are seen to intimately
    involve the self-concept (Porter, 1975), however, it
    would seem essential to convince the student
    seeking help that he can change (Gindes, 1951, p.
    Suggestion for Concentration Brian 84) before he can set his targets and formulate what
    "success" means to him within his own unique
    M. Alman, Ph.D. perception of the world (Combs, Avila, & Purkey,
    San Diego, California 1971). Only then will a change in self-concept,
    from labeling himself a "doomed failure" to a
    [This suggestion is phrased as a patient may "potentially
    deliver it to herself in self-hypnosis.] While I sit
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 441

    successful and aspiring person," enable him to 1. First thing in the morning on wakening, before
    begin to expect success and break out of the stirring, as the student eases from natural sleep
    "failure syndrome" (Porter, 1975). The role of the into wakefulness— the hypnagogic state of
    therapist is to feed this expectancy with his own "natural trance."
    belief in the person's potential (Porter, 1974). With 2. Last thing at night as the student drifts
    the first taste of success, confidence begins to grow comfortably into natural sleep from normal
    and social reinforcement from others strengthens wakefulness — the hypnopompic state of
    the possibility of future success where once failure "natural trance."
    had been expected. Success begins to bring success
    3. Before each meal— pausing before taking
    as a self-fulfilling prophecy (Rosenthal &
    the first mouthful to "flash" the success
    Jacobson, 1968).
    image into his mind for a few seconds. This
    This paper ascribes to the concept of mastery as invokes the added operation of the Premack
    emphasized by Gardner (1976). Mastery becomes (1959) principle, whereby the strong positive
    an active therapy goal aided in achievement by use primary reinforcer of food follows the con
    of self-hypnosis and self-management exercises. scious evocation of the "success image" at
    One would hope to engender an "attitude of the mental level. By association, food being
    activity" (Raikov, 1976), while maintaining belief linked since birth with positive consequenc
    in the self and inducing self-programming. It is es, this strengthens the adoption of the
    pointed out that in creating this image for himself, positive image of the self into the person's
    the student already knows within himself what he cognitive structure and allows it to become a
    is truly capable of doing. Given the removal of determinant of the individual's inner and
    present barriers, limitations, and inhibiting outer life (Combs et al., 1971).
    influences, this success image will become more
    4. As many times as possible during the day —
    and more a reality until soon it is no longer an
    especially in moments of boredom, inactivity,
    image but the student's actual self that has been
    or negative feeling states, to switch the mood to
    allowed free and full expression. The therapist
    a positive, self-enhancing one and away from a
    conveys his belief that this will be the case very
    negative, self-defeating one.
    soon, thus adding his own belief to the student's to
    increase the expectancy of change and to catalyze 5. Whenever self-hypnosis is used, as discussed
    (Bednar, 1970) the change process. later. Students who find it difficult to "imagine
    themselves" are given alternative methods. A
    student can "let his mind go blank" as though it
    becomes a blank television or movie screen
    INSTRUCTIONS FOR DAILY USE and then imagine the film rolling and the
    Further instructions are given to the student for screen showing a film of himself acting out the
    daily use, first under hypnosis and then reinforced "success image." With poor visualizers, a
    in the discussion on awakening. It is explained that change of wording to "feeling as if rather than
    each time he flashes this success image as a total "imagine" or "think" seems sufficient.
    percept into his mind, the student will speed the
    realization of his goal through known principles of
    learning and receptivity of mind at stages of SPECIFIC STUDY SUGGESTIONS
    "natural trance." He is asked to bring the success
    image to mind, just long enough for it to seem real, The following suggestions present content
    without any particular effort, giving full reliance to rather than exact wording. Actual paraphrasing
    belief and imagination to effect the change should be uniquely adapted to the patient's level of
    (Gindes, 1951). The times specified for daily use understanding and emotional state at the time. It
    are: also seems more natural and acceptable to repeat
    the same types of suggestions on different
    occasions with slightly altered word-
    442 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ing rather than to use direct repetition. Ordering of overall conviction that you can be a success. . . .
    suggestions can be made flexible, with deletions Have an increasing sense of achievement and
    made of more threatening ones on earlier accomplishment.
    inductions and of irrelevant ones for the particular
    individual. Format is best discussed prior to the
    actual induction, thus establishing agreement as to USE OF POSTHYPNOTIC SUGGESTION
    what to expect in the therapeutic segment of the
    trance and enhancing acceptance (Porter, 1974). Since study problems are usually associated with
    The suggestions include: high tension and anxiety levels, a simple technique
    Work efficiently without being fatigued by the for self-management of anxiety is introduced under
    sheer effort of study, it will come naturally and hypnosis and further elaborated on awakening. A
    easily. . . . handout sheet gives a basic rationale as to why it
    should work. This is given at the session's close.
    • Enjoy the learning process, find it easy and
    natural to study and to learn. . . . RELAXLET co FIVE BREATHS. Initially, the student is
    • Ability to learn and recall information, to asked to take five slow, deep breaths, thinking at
    integrate new information with what you the same time to relax as he breathes in and to let
    already know, and answer appropriately any go as he breathes out. This encourages awareness
    oral or written questions. . . . of the natural body response of relaxation that
    • Spend adequate time to ensure success. Take comes with exhalation and its use in control of
    sufficient rest pauses to remain alert and inner emotional states. Under hypnosis, the student
    efficient. . . . is then told that during the day he can evoke this
    • Have increasing belief in your own abilities and same control with ever increasing facility —merely
    certainty that you will succeed. by pausing whenever he experiences some inner
    • Gain ability to switch on the internal success disturbing negative thought or feeling state, or feels
    mechanism within the mind, instead of the under pressure from external influences, and
    failure mechanism . . . until very soon you repeating the process as just experienced under
    forget even how to switch on the failure hypnosis. By taking the five deep breaths, he calls
    mechanism. on the body's natural resources to relax and, with
    the conscious mental commands of "relax" and "let
    • Treat failures as merely pointers to a new path
    go," chooses to exert control in the situation and
    to success.
    acquires inner strength and calmness to deal with
    • Have general confidence in your ability to do present demands.
    not only what you have to do but also what you
    want to do. Thus the student has been given a posthyp-notic
    • Maintain a pleasant balance between work and suggestion. When he actually uses the suggested
    pleasure while remaining always on an overall self-management exercise, he further strengthens it
    path to success. . . . by invoking a self-induced post-hypnotic
    • As belief in your own abilities increases, you suggestion. With repetition, the control becomes
    will see potential as unlimited. . . . more immediate, and the student's confidence in
    • Given the opportunity to learn and the ability, his own ability to cope generally increases. The
    you can do anything if you have the desire. student knows a technique that he can use without
    • Do the necessary practice and have the others becoming aware. At any time during the
    determination to bring success, but you will be day, in any situation, he can attain inner control
    able to do this without having to strive unduly. . without the necessity of even relaxing first.
    . . The entire process will be enjoyable and
    pleasant and you will have the
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 443

    RELAXATION, ENERGY, AND CONFIDENCE VERSUS TENSION, energy to continue working, to remove all barriers
    TIREDNESS, AND FEAR (REC/TTF). or limiting influences whether past or present, and
    Following the to allow him to think clearly and work efficiently
    same principles as the above self-management without strain.
    technique, the student is told that he can pair his
    breathing rhythm with further mental conditioning.
    Most students wish to feel they can dispel CONTINGENCY MANAGEMENT
    debilitating tension interfering with concentration,
    In order to reinforce the person's increasing
    tiredness impeding progress, and fear producing
    control over when and where he studies (Thoresen
    confused thinking. Ridding the mind of negatives
    is not sufficient, however, as other debilitating & Mahoney, 1974) for his time to be spent more
    emotions or thoughts will quickly fill their place. In effectively, the student is asked to decide on
    this instance, the three positive opposites of the specific places where he will study. Within the
    negative states "tension, tiredness, and fear" are home environment, it may be at a desk in a
    deliberately internalized by thought concentration, particular room. At the learning institution, it could
    viz. "relaxation, energy, and confidence." be in the library. Once decided, he goes to the
    specific place to study. The chosen localities
    Again the exercise is initially carried out under become the places of work. Other places are free
    hypnosis. With attention directed to relaxing with space where he has no obligation to himself to even
    breathing, active concentration is then given to think of work. This discrimination makes it much
    breathing IN: relaxation, energy, and confidence; easier to work. If the student is jaded, he leaves his
    and breathing OUT: tension, tiredness, and fear. place of work. Away from his place of work he is
    With each subsequent inhalation/exhalation, it free to let go and relax, with no associated guilt. In
    becomes easier for the person to feel he really is giving himself permission to take times to relax
    drawing in with the pure life-giving air these and recuperate, he returns to the selected study
    qualities he wishes to absorb and become environment with a readiness and ability to
    permanent within him, while letting go with the concentrate and work effectively.
    stale, impure air the distressing inner states he
    wishes to reject as no longer affecting him.
    Use of the exercise during the day again employs DISCUSSION OF PROCEDURE
    a "self-induced posthypnotic suggestion," which
    gains in strength on repetition. Anything from five In the author's experience, the following general
    to ten breaths are taken as concentration is given to format has proven useful in progressing through
    the mental taking in/letting go, the number of therapy sessions. Usually, three sessions seem
    breaths depending on what seems natural and sufficient for most student needs, with the first two
    sufficient at the time. one week apart and the third session two weeks
    later. With some students, a fourth "booster
    CONCENTRATE AND RECALL. The command session" after another four weeks removes any
    to lingering blocks or resistances. The student then
    "concentrate and recall" is given as a direct continues with the use of self-hypnosis and the
    posthypnotic suggestion under a deeper stage of self-management exercises to fully master his
    hypnosis toward the end of the session. The student problem (Lazarus, 1971). An outline of the
    is instructed when he enters the study situation and complete procedure by session follows.
    prepares to commence the task at hand, to briefly
    pause and say three times firmly and slowly to I. Session 1 A. Contingency management is
    himself, "concentrate and recall." This command is
    introduced and explained.
    presented as directing the subconscious to release
    to him the necessary
    444 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    B. With the initial induction, the student is it will lose its hold over you as it loses
    introduced to the experience of hypnosis its meaning for you.
    and conditioned to a "cue signal" to allow e. You will be able to go through the day
    quick induction on subsequent occasions. without even thinking about the former
    This cue signal is later used for self- problem, symptom, difficulty.
    hypnosis induction. f You will find that you feel good as you
    C. Hypnosis is reinduced using the "cue sig realize the problem (is leaving) has left
    nal," then deepening follows. you, it no longer needs to be there, and
    1. Suggestions. A paraphrased version of has lost its power and influence over
    Stanton's (1977) form of rational-emotive you. You are free of its former effects,
    therapy suggestions [see Chapter 5 on and no longer need to consider it as
    ego-strengthening] is used. These belonging to you or as being part of you
    suggestions seem more directly relevant to or your personality.
    this specific type of problem as general g. When you indeed get to the point when
    strengthening suggestions than the more you want to give up the symptom,
    commonly used ego-strengthening problem, difficulty, and are ready and
    suggestions of Hartland (1971). willing to give it up completely, it will
    2. Specific study suggestions are used. (See simply vanish and no longer be there. It
    detailed explanation above.) will no longer be necessary to you, and
    3. Relax/let go with five breaths is used as the with its disappearance it will no longer
    posthypnotic suggestion to induce be part of you or your personality.
    self-management. (See detailed explana- h. With this change, you will grow in
    tion above.) strength day by day, becoming happier
    II. Session 2 and more content within yourself,
    A. Contingency management is discussed stronger and healthier in every respect,
    and reinforced. as you become free to be yourself.
    B.Hypnosis is induced using the cue signal. 2. The relax/let go exercise is reinforced.
    1. Wolberg's (1965) suggestions are para 3. REC/TTF with breathing is introduced as
    phrased as noted below (designed here to another posthypnotic suggestion inducing
    remove any blocks or resistances without self-management. (See detailed
    having to bring them to the conscious explanation above.)
    level). C. Hypnosis is reinduced.
    a. You will have a desire to yield, give 1. Rational-emotive therapy suggestions are
    up, relinquish the symptom, diffi used.
    culty, problem. 2. Specific study suggestions are used.
    b. The desire will grow so strong that it 3. Self-hypnosis is taught to the cue signal.
    will make you want to do whatever is III. Session 3
    necessary to relinquish, give up, the A. The use of contingency management and
    problem. self-hypnosis is reviewed.
    c. As this happens, you will enjoy the B. Hypnosis is induced.
    experience of becoming increasingly 1. Wolberg's (1965) suggestions are used.
    free of the past problem, difficulty, 2. The relax/let go exercise is reinforced.
    symptom. 3. REC/TTF is reinforced.
    d. You will be so much more relaxed, C. Hypnosis is reinduced.
    feel so much better in yourself and at 1. Rational-emotive therapy suggestions are
    ease, that it will no longer be neces used.
    sary to have that particular problem,
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 445

    2. Specific study suggestions are used. and goal-setting. As for young children, the
    3. "Concentrate and recall" is given as a direct procedure should be tailored to current needs, with
    posthypnotic suggestion. modification to age comprehension level and
    4. Self-hypnosis is reinforced. minimization of complexities. Selective choice of
    pertinent steps are matched to the child's needs and
    It should be appreciated that the procedures implemented through clear presentation, feedback
    outlined are intended only as guidelines. Each understanding, and the gain of acceptance without
    individual case presents unique difficulties that arousing the typical resistance areas met with
    may require modification in procedure. Clinical adults. However, for children under 10 years of
    experience, however, has shown four sessions to be age, the guided fantasy technique (Porter, 1976) is
    generally sufficient to establish a carryover to probably more amenable, since it has a wider
    self-management. applicability to childhood complaints and
    capitalizes on the child's inherent delight in
    This method has been shown to be clinically
    fantasy. Originally proposed for the treatment of
    useful for patients with problems of attention span,
    childhood insomnia, this method is also a
    concentration, recall, creative thought and
    nonthreatening procedure for study phobia, tension
    problem-solving, phobic withdrawal, recurrent
    cramps in the writing arm and hand, disruptive
    failure, lack of direction and motivation for
    acting-out behavior, and fear reactions.
    achievement, test anxiety, and performance fear.
    Although these behavioral aspects are inherent to
    the study problem, they are also common to other
    confidence and relationship difficulties. With
    ingenuity, this general procedure can become
    Suggestions for Studying,
    applicable to more extensive behavioral Concentration, and Test
    management. Anxiety
    Caution should be exercised in application of
    this general procedure to depressive cases. Con- Richard B. Garver, Ed.D.
    current psychotherapeutic management is man- San Antonio, Texas
    datory to prevent lack of control precipitated by
    fantasy escape into self-hypnosis. The same applies SUGGESTIONS
    to cases of social withdrawal. Self-hypnosis is As you study this material, whether it is reading
    introduced only when its possible adoption as an it or listening to a lecture, your unconscious mind
    alternative escape mechanism is outweighed by the will help you concentrate. You will have very
    benefits already realized by growing selective attention. It is as though a light that is
    self-management as a general coping skill to allay focused everywhere begins to constrict, and the
    anxiety states. peripheral areas grow dim as the center of that light
    Personal clinical experience supports particular increases in intensity. And you can see and hear
    application of the procedure to adults returning to very clearly what it is within that narrow band of
    study or seeking academic advancement outside of concentration. And since you are perceiving this
    study hours. This is especially true of housewives information with great intensity, your unconscious
    returning to the school situation or work force out mind will be able to store and keep it until you need
    of interest or financial necessity and of business it. It is important that your unconscious mind
    executives trying to keep abreast of the rapidly knows where to store it, not just anywhere, but to
    expanding advances in technology. In such cases, put it in a convenient place, so that you will have
    performance pressure often exacerbates anxiety access to it by (a date or an approximate time may
    and feeds uncertainty and confusional thought. be specified). And so that you know right where it
    Adolescents also become prime candidates when is, you know how to retrieve it when you need to,
    faced with society's demands for self-identity for whatever
    446 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    purpose there is, whether it is oral recitation or Alert Trance Suggestions for
    written examination.
    Concentration and Reading
    METAPHOR E. R. Oetting, Ph.D.
    Imagine a board, perhaps two feet wide, that
    stretches across the floor in my office from one end
    to the other. You have plenty of room. Do you think INTRODUCTION
    you could walk across that board to the other side?
    [If a positive response is given:] Would you be Basically, the approach consists of training the
    willing to bet me five or ten dollars that you could? student in the autohypnotic induction of an "alert
    [Typically the answer is yes, they know that they trance." The process differs sufficiently from the
    can do it.] Then, I want you to imagine that I am usual trance induction so that it is not identified as
    pushing a button on my desk, and now the board hypnosis. In fact, it is important that the student
    stays there, but the floor parts, and what you see is a does not visualize the training as related to
    pit 20 feet below filled with rattlesnakes. Do you hypnosis or he will bring into the situation his
    think this will affect your performance? [Most will previous conceptions of what hypnosis involves,
    say, yes, absolutely.] So you can see that it is thus creating many of the problems that we are
    important to make an intelligent decision about the trying to avoid.
    risk versus the outcome. If the outcome is
    important, then you will feel strong enough to take As usual, the preliminary orientation plays an
    the risk, and you will then focus on the board rather important part in trance induction. In this situation,
    than on the snakes, and on the outcome on the other any reference to hypnosis is avoided, but a
    side. But, in order to get there, the focus must be on considerable amount of discussion of approaches to
    the board, rather than on the snakes. study and general principles of learning is used to
    establish a set so that subsequent development of
    an "alert trance" and training in the technique
    seems reasonable and appropriate to the subject.
    The first interview includes a discussion of the
    Erickson's Suggestions for problems that the individual student has in
    Facilitating Speed of Learning studying. The technique is then presented as a
    solution to some aspect of the individual's problem,
    Milton H. Erickson, M.D. not as a general solution to all study problems.
    Most frequently the application is centered around
    I don't know how quickly you can learn, but then
    a discussion of concentration. Suggestion in this
    we all have different learning speeds. . . . Some of preliminary stage is used to communicate the
    us learn to type rapidly but to take shorthand very following points: (1) that the problem is a common
    slowly; to drive a car very quickly but to play golf one and that these techniques, if learned
    very slowly. We all have different learning speeds, successfully, can solve it; (2) that the solution is
    and we differ in our learning speeds for different simply a matter of learning some new techniques;
    kinds of learnings. [What are you doing with these (3) that these techniques can be learned easily but
    statements? You are raising the question of a rate of will require time and effort on the part of the
    learning, but you used the word speed. You haven't patient; (4) that the process of learning involves
    said we have different degrees of slowness in presenting a set of specific cues; and (5) that
    learning; you've said we have different degrees of learning anything is a function of the number of
    speed in learning, and so you have suggested a trials and, to be established firmly, the trials must
    rapidity.] be presented over a period of time.
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 447

    It is important that the subject should be dealing shoes on your feet. Keep your eyes on the book and
    with real materials right from the beginning. In our nod when you can feel your shoes pressing against
    case we use standardized reading materials, but the your feet. . . . You can feel the chair pressing
    student's ordinary study materials could be used against you and the weight of your body on the
    effectively. A typical trance induction, after rapport chair . . .and then against the back of the chair. . . .
    has been established and the subject's attention has If you simply pay attention to it, you can feel the
    already been narrowed to the person of the weight of your shirt on your shoulders . . . and on
    hypnotist and to the topics, would occur as follows. your neck . . . and you can feel your collar touching
    your neck. . . . All you have to do is concentrate on
    these feelings and you can sense them anytime that
    you want to. That is right, keep looking at the book
    SUGGESTIONS in front of you. Now if you know how these
    muscles feel, and where they are, you can sit
    I am going to teach you how to concentrate. comfortably, smoothly, and easily. Just let your
    Really concentrating is quite easy once you learn weight down on the chair and let your body and
    the knack. You have not been able to concentrate muscles take care of themselves comfortably and
    because nobody has ever shown you exactly how to
    easily. . . . Very good! Your feet are firm and
    do it. I am going to show you how to do this, and,
    comfortable on the floor, you are balanced and
    then we will practice the technique several times
    comfortable in your chair. Let me show you. Here.
    until you can do it by yourself. Here, this is going to
    See how your arm is free to move. Now it will
    be your desk. You will notice that the desk is
    reach forward. [The arm is moved by a light, firm
    entirely clear of everything but the one piece of
    touch.] Pull your book towards you a little bit and
    material that you are going to work on. Now stand
    the rest of your body stays comfortable and easy
    quietly in front of the desk by the chair. Look at the
    desk and at the material on the desk. You are and well balanced in the chair. Your other arm is
    already beginning to pay attention to the material free to pull a piece of paper toward you. [The other
    that you want to study and learn. When you reach arm is moved, gently but firmly.] Place it in
    this point, you have decided to really get down to position to write. You head is free to turn from the
    work. Keep your eyes right on the material. Now book to the paper and you are still comfortable,
    keep looking at it while you reach down, pull the balanced firmly in the chair, and at ease. That's
    chair out, and seat yourself comfortably. That is very good.
    good. We are going very slowly now so that you
    can see all of the steps. Later you can go through [By this time the trance induction is already well
    these steps very rapidly. Now we are concentrating under way. The subject has been following
    on them very carefully, one at a time, so that you repeated suggestions to focus his attention on the
    can see how they feel, and concentrate on each one. materials in front of him. The concentration has
    Fine! Keep your eyes on the desk and the material been intensified by the gentle, but firm, movement
    in front of you while 1 show you something about of his arms and hands, and by strong suggestions of
    concentration. ease and well-being, as well as the implied
    suggestion of immobility of the rest of his body.
    At any time your body is sending a lot of signals The next step involves holding a pencil or finger on
    to your brain that you have learned to ignore. I the same level as the subject's head but to the side
    want to show you some of these. Just for a moment so that he can just see it out of the corner of his
    pay attention to your legs and your feet and how eye.]
    they feel. All you have to do is pay attention to
    them and you can feel your Now, keep your eyes fixed on the book. I am
    going to show you something about concentration.
    Can you see the pencil that I am holding up out of
    the corner of your eye? That's right.
    448 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Keep looking at the book. Now, look at my finger a normal one of sliding forward in your chair into
    on the book. Watch the fingernail carefully. I am the exact position that you were in before, picking
    going to press my finger against the book. I will up your pencil, and concentrating. Now, open the
    press harder and harder until finally my fingernail book to where I have it marked. Hold it open with
    changes color. Watch carefully, and when it your left hand like this. There is a very short
    changes color, nod your head. Watch it very paragraph on this page. Read the title of the
    carefully so you can see the first slight change in paragraph. All right, get ready . . . slide forward . . .
    color. Good. Now notice when you are reach over and pick the pencil up. . . . Get ready to
    concentrating intently on the tip of my finger, you make notes if you want to. Now, read the
    can no longer see the pencil out of the corner of paragraph, find out what it says about the subject.
    your eye, and yet now when I have called your When you finish, put the pencil down and slide
    attention back to it, you can see the pencil clearly back.
    even though your eyes are still focused right on the
    tip of my finger. Now look again at my finger on
    the book in front of you and concentrate intently
    just like you did before. Notice that as you
    COMMENTARY
    concentrate ... as you really concentrate . . . you do
    not notice the things around you. All you see is my
    finger, and the book, and the paper next to it. It is The student repeats this process several times in
    almost as though there were a spotlight shining on the office. We then discuss how to break down the
    the book and the paper on which you will take material that he is ordinarily studying into short
    notes. As you really concentrate you will only see segments so that he can repeat the process on his
    the materials right in front of you that you are going own. Generally two or three sessions repeating,
    to work on. Nothing else is important, and you reinforcing, and deepening are sufficient for a
    simply don't pay any attention to anything else, you student to learn a technique that he can use on
    simply concentrate right here in front of you on the himself in almost any situation, regardless of
    work you are going to do. That is very good! Now outside distractions.
    lean back and relax. The technique of developing an "alert trance
    state" has distinct advantages over the classical
    [The repetition is for adding and deepening techniques for trance induction. Since it is
    suggestions eliminating distracting noises and "concentration training," the fear and criticism that
    peripheral vision. The field of awareness is would be associated with the use of "hypnosis"
    narrowed to relevant ideas and materials, but is not with students is avoided. More importantly, the
    restricted to a single point.] student himself does not bring his preconceived
    Now I have shown you how to concentrate. You ideas about hypnosis to the situation. Most students
    can do this at any time but to make it really work who want to be hypnotized to help with study also
    for you will require practice, repeating it over and want to avoid the responsibility for motivating
    over again. Now we also need some kind of cue or themselves and training themselves in study
    signal so that you can turn on the concentration techniques. They tend to lean on the trance state as
    yourself, and another signal when you stop. Then though it were a crutch, waiting for it to solve their
    you can turn yourself on, using the signal, problems. With this technique they are required to
    concentrate intently and accurately on the material, train themselves and to practice active studying and
    and turn yourself off afterward. Repeating this concentrating. From the beginning the student has
    again and again when you study will make you the feeling of doing everything himself.
    better and better at it. The signal we will use is
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 449

    Alert Self-Hypnosis Technique to feet. Keep your eyes on the target, and slowly relax
    your whole body. Take a third deep breath. Tense
    Improve Reading your whole body, and observe your target while
    Comprehension your body relaxes. Now, give yourself your
    suggestion.
    David M. Wark, Ph.D.
    Minneapolis, Minnesota
    BASIC SELF-HYPNOSIS SUGGESTIONS
    THE LEVER INDUCTION IN AN ALERT TRANCE

    PURPOSE AND INDICATIONS. This is a practical Enter an alert trance state by using the LEVER
    technique to quickly bring your mind to a state of or some other exercise. Then give yourself the
    focused tension and your body to a state of efficient basic suggestions. After the suggestion, begin to
    relaxed calmness. Since studying is an alert study in an alert trance state.
    activity, the typical deep induction involving
    drowsiness is inappropriate. The technique is
    1. Notice the paper. What color is it? Notice how
    called the LEVER because you lift your mind to a
    clean and crisp it seems. Fingers slide over the
    state of sharp focus and relax your body while surface, and feel how smooth. Eyes can flow
    holding your mind's tension. Then you lever up across the page, going easily from side to side,
    your mental focus a bit higher, and again relax your seeing everything.
    body. And then, a third time, you raise your mental
    2. Notice the letters on the page. They seem dark
    focus and relax your body.
    and distinct. The round parts of the O's and C's
    1 have found it useful to use two levels of are very smooth; the up and down parts of the
    suggestion. The first is a basic suggestion, which T's and L's are tall and strong. The printing is
    focuses on the perceptible qualities of the text especially vivid. The words seem to stand out
    (color, shape, texture, etc.) and then suggests some very clearly.
    cognitive changes (ideas will flow up from the 3. And it seems that every sentence suggests
    page, attention will be focused, study will be images and ideas, that flow up from page to
    enjoyable). When students have learned to use mind, directly and easily, recalling what has
    those suggestions, I have them move on to the already been learned. The new ideas from the
    advanced suggestions, designed to increase page and old ideas from the past seem to fit
    comfort, meaning, or various types of imagery. together now. New ideas come forward, and
    the meaning gets clearer and clearer.
    4. After the reading, the learning will continue,
    PHYSICAL PRACTICE and the meaning will get ever more clear.
    Sit comfortably in your chair. Pick a spot to 5. Attention will become completely focused on
    focus on, and attend to it alertly. Take in a deep the page. The only sound will come from the
    breath, sit straight up in your chair and extend your reading and study. The reading and study will
    spine right up to the sky. Keep your eyes on the become more and more enjoyable, more and
    target, and begin to exhale. As you do, keep your more involving.
    spine straight, but allow your shoulders to relax, 6. At the end of the lesson, close the book and
    like a cape falling over your back. review the learning. When the trance ends,
    Take another deep breath while focusing on attention will return to other things, but the
    your target. Tense all the muscles below your waist learning will continue. It will become easier
    — your hips and thighs, and calves and and easier to enter an alert trance and enjoy
    studying.
    450 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Advanced Comprehension A small seed lives nested in the warm, dark earth
    of a garden. It is just the time, just the beginning,
    Suggestions for an Alert Trance just the very start of something to be. Slowly the
    warm light of the sun reaches down through the
    David M. Wark, Ph.D. dark soil and warms the shell of the seed. The shell
    Minneapolis, Minnesota expands and slowly water and nutrients seep inside,
    around the old, hard, protective shell and into the
    AUTHOR rich inner core. A small sprout starts to push out
    and up, slowly at first, and then more and more
    [This suggestion increases comfort and moti- confidently, up through the layers of dark soil. The
    vation.] sprout grows, gets stronger. It grows tall and strong
    Behind the book is an author who wrote the in the sunlight, buds and flowers, adding color and
    book. When I sit alertly focused on my page, it may fragrance to the garden. Then, one by one other
    sound as if the author is talking directly to me. The seeds repeat, until the pattern of the planting is
    author is another teacher, one who really wants to obvious for all to see. I can do that with my reading.
    get a message to me. I remember another important
    person, who helped me so much. I may get an
    image of us together, and feel how I am enjoying ANTS
    the learning. I may feel a real closeness to the [The metaphor of ants can be used to facilitate
    author, and the author back to me. As I read alertly, kinesthetic imagery.]
    the ideas from the author will seem to flow easily Some people devour and digest what they read.
    into my mind. It will seem that I can make a The soldier ants march across the field in lines and
    connection with the mind of the author. lines. They are organized and orderly. No one lags,
    no one gets ahead. They present a pleasing pattern
    to the eye. They are moving directly forward. Then
    PUZZLE an obstacle appears in the path. Somehow the ants
    know just what to do. Some move off to one side or
    [The Puzzle suggestion is useful in increasing
    the other, looking for a toe hold, a crevice, the
    meaning and comprehension.]
    smallest little chink to use as a foot hold. Others
    Reading can be like putting together a jigsaw move directly up and over, covering the obstacle. If
    puzzle. I remember a time when I really enjoyed it is nourishing, the ants chew and digest. I can do
    doing a puzzle. I saw the parts all spread out in that as I read and study.
    front of me on the table. Some looked familiar, like
    things that I had seen before. Some had no pattern,
    just out-parts and in-parts, but they looked like they
    might fit together. I looked again and saw two bits
    with the same shade, and when I tried them Improving Reading Speed by
    together they fit with a click. What pleasure! More Hypnosis
    and more I pushed and fit and clicked. Soon the
    whole puzzle seemed to make sense. I can do that Raymond W. Klauber, Ph.D.
    with my books. Edwardsville, Illinois

    [If, upon examination, it is found that the slow


    FLOWERS reader is moving his throat, lips, or tongue, he
    should be told that the fastest readers move
    [This metaphor increases the use of visual only their eyes. With proper
    imagery.]
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 451

    rapport and diagnosis of the reading difficulty, the The same forgetting of your lips will take place
    therapist could move into hypnotic techniques. when you read. Your lips will be relaxed and
    After a relaxing hypnotic induction, slowly say:] comfortable. They will be still rather than making
    Your mind reads by ideas —in an instant, your the words you read.
    mind grasps complete ideas through your eyes, Without moving your throat or lips as you read,
    faster than anyone could say each word. Your eyes the printed words group together into ideas that
    are faster than your throat, lips, or tongue. Saying quickly leap through your eyes into your mind.
    each word prevents a slow reader from achieving a Lower your hand to your lap when you have
    pace quicker than he can speak. Without moving imagined this in order to receive the next sug-
    your throat, lips, or tongue, the meaning of the gestion. . . . Good!
    words quickly leaps through your eyes into your Now slowly raise your left hand to your mouth
    mind. If you like, I will teach you a way you can and place one finger lightly on your tongue. Now
    prevent these movements while reading. Would imagine there is no movement, try to further
    you like to learn such a method? If your answer is imagine that not only does the area you are
    yes, raise this finger [after you touch his right index touching not move but that you no longer feel it
    finger, wait for him to raise it]. . . . Good! ... it disappears.
    Now slowly raise the fingers of your left hand to Signal me with your right-hand finger when you
    your throat, that is, place your finger lightly about have imagined away your tongue [wait for the
    your Adam's apple [guide hands and fingers if signal and give further suggestions if necessary]. . .
    necessary]. . Good!
    Now imagine that there is no movement; try to The same forgetting of your tongue will take
    further imagine that not only does the area you are place as you read. Your tongue will be relaxed and
    touching not move but that you no longer feel it ... comfortable. It will be still rather than making the
    it disappears. Signal me with your right finger words as you read.
    when you have imagined away your throat [wait Without moving your throat, lips, or tongue as
    for the signal and give further suggestions if you read, the printed words group together into
    necessary]. . . . Good! ideas that quickly leap through your eyes into your
    The same forgetting of your throat will take mind.
    place when you read. Your throat will be relaxed Lower your hand to your lap when you have
    and comfortable. It will be still, rather than making imagined this in order to receive the next sug-
    the words you read. Lower your hand to your lap gestion. . . . Good!
    when you have imagined this in order to receive You have now learned to read without using
    the next suggestions. . . . Good! your throat, lips, or tongue. However, as you read
    Now slowly raise the fingers of your left hand to you will lightly touch your throat, lips, and tongue
    your lips, that is, place your fingers lightly on your so that you know they don't move. You will be
    lips [guide hand and fingers if necessary]. further assured that they aren't moving as you
    Now imagine there is no movement, try to touch them.
    further imagine that not only does the area you are You will make these movements from time to
    touching not move but that you no longer feel it ... time until you are sure that you never move your
    it disappears. . . . Signal me with your finger when throat, lips, or tongue while reading. You will
    you have imagined away your lips [wait for the make these movements without thinking about
    signal and give further suggestions if necessary]. . . them so that you will continue to concentrate upon
    . Good! your reading.
    Think about everything I told you. . . . When you
    believe that you can read as you learned today,
    open your eyes and be fully awake.
    452 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Gorman's Ego-Strengthening firm, strong muscles, bones and joints; smooth,


    healthy, elastic skin and the absence of any excess
    Technique Adapted for Reading fat or flesh; greater, increased resistance to all
    forms of infection or disease and an increasingly
    G. Gerald Koe, Ed.D. Mission, British
    great measure of control of both the au-tonomic
    Columbia, Canada
    nervous system and the hormone glands which,
    between them, control all the functions and
    INTRODUCTION AND INDICATIONS conditions of the body.
    Good health means not only physical health but
    The suggestions contributed by Koe, previously
    also a healthy attitude of mind in which the nerves
    unpublished, were used in an experiment (Koe &
    are stronger and steadier, the mind calm and clear,
    Oldridge, 1987) with university students. They
    more composed, more tranquil, more relaxed, more
    found that, with four sessions utilizing these
    confident.
    suggestions, self-concept improved, particularly
    with regard to self-satisfaction and personal It can mean a greater feeling of esteem in the
    self-concept. Of the three sets of suggestions used eyes of others, a greater feeling of personal
    in the study, the suggestions printed here were the well-being, safety, security and happiness than has
    most effective. These suggestions are ever been felt before.
    recommended for use with university or high It can mean others will perceive you as having
    school students who need to improve reading, complete control of your thoughts and emotions,
    academic performance and self-esteem. (Ed.) with the ability to concentrate better and utilize all
    the vast resources of the memory and the full
    intellectual powers of the subconscious mind.
    SESSION I SUGGESTIONS It can mean that others will perceive you as
    having the ability to sleep deeply and refreshingly
    You are now so deeply relaxed that your mind at night and to awake in the morning feeling calm,
    has become very receptive. In this state of deep relaxed, confident and cheerful — ready to meet all
    relaxation the critical part of your conscious mind the challenges of the new day with boundless
    is also very deeply relaxed so that you can accept energy and enthusiasm. The words good health can
    any idea you wish to accept for your own good. mean to others any or all of these things and more.
    Because I wish you to remain in this uncritical These words have tremendous power. I want you to
    state, I am not going to give you any direct let them sink deeply into your subconscious mind,
    suggestions with regard to any of your particular which always can reproduce in you your dominant
    problems. I am only going to ask you to think about thoughts.
    certain words and their meanings and associations The next word I would like you to think about is
    for others. I want you to think lazily of these words, success. It may mean a sense of recognition, a
    to turn them over in your mind, to examine them, to fulfillment of your desires.
    let them sink deeply into your subconscious mind. It may mean the ability to set and achieve goals
    The first word I want you to think about is the in life which people who are important to you
    word "health," and I want you now and always to consider to be realistic, worthwhile and
    couple it with the word "good." What can the words progressive, and the motivation and determination
    good health mean? They can mean a sense of to achieve those goals. It may mean the confidence
    superb physical well-being, with strong heart and to recognize that friends perceive you as being able
    lungs; perfect functioning of all the organs, nerves, to throw off your inhibitions, being spontaneous,
    glands and systems of the entire body; expressing your feelings without fear or hesitation.
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 453

    Success may mean wealth in terms of money and now and you are completely out of the hypnotic
    the things that money can buy, or security for trance.
    yourself and your family. It can also show itself in
    the attitude of mind which gives inner happiness
    regardless of material possessions or SESSION II SUGGESTIONS
    circumstances. It could mean the ability to You are now so deeply relaxed that your mind
    overcome some particular problem — perhaps has become very receptive. In this state of deep
    even some problem about which you do not know. relaxation, the critical part of your conscious mind
    Whatever the word success means to others, I want is also very deeply relaxed so that you can accept
    you to use this word as an emotional stimulus to any idea you wish to accept for your own good.
    produce in you all the feelings which go with
    Because I wish you to remain in this uncritical
    success.
    state, I am not going to give you any direct
    Finally, I want you to think of the word suggestions with regard to any of your particular
    motivation. What can it mean to others? It can problems. I am only going to ask you to think
    mean a gradual but progressive strengthening of about certain words and their meanings for others.
    one's desire to be in charge of one's life; to destroy I want you to think lazily of these words, to turn
    the old recordings of habit patterns; to play new them over in your mind, to examine them, to let
    music instead of old; to cease being a puppet to them sink deeply into your subconscious mind,
    one's early conditioning and to become a creator of until they become woven into the very fabric of
    a new, healthy, happy, successful script in the play your beliefs as to how others perceive you.
    of life.
    The first word I want you to think about is the
    It can mean the gradual but progressive building word health, and I want you now and always to
    of a stronger and stronger feeling of how positively couple it with the word good. What can the words
    others perceive you until your self-confidence is good health mean to others? They mean a sense of
    much stronger than your fear of failure and superb physical well-being, with a well
    achieving high grades at university [in high school] conditioned, well functioning body. They can
    presents no difficulty, hardship or discomfort for mean that the body feels full of power and strength,
    you. with greater balance and stamina, increased
    We have all been conditioned since birth to resistance to fatigue and disease, more slender with
    associate words with feelings. Words are, there- firm muscle tone and vibrant complexion. Good
    fore, the tools which we are going to use to produce health can result in greater awareness of the body,
    the feelings and results which we want. And these greater control of all parts of the body, and a sense
    words are health, success, and motivation. of harmony in the functioning of the body.
    In a few seconds, I will slowly count to three. Good health means not only physical health but
    When I do, you will come out of the hypnotic also a healthy attitude of mind, in which others see
    trance you are in now. You will remember the you as feeling calmer, safer, more secure; more
    suggestions given you regarding health, success, confident and sure of yourself, happier and more
    and motivation while you were hypnotized. You self-satisfied than you ever felt before at
    will incorporate these suggestions into your university.
    self-image. It can mean that others perceive you as being
    When you wake you will feel deeply relaxed. able to control your thoughts and emotions. It can
    You will remember being hypnotized as an mean that others perceive you as being better able
    enjoyable and pleasant experience. Ready now. I to concentrate on your studies at university [in
    am going to count to three. One — you are starting school]. It can mean that others
    to wake up. Two — your eyes are starting to open.
    Three — your eyes are open
    454 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    perceive you as being able to sleep better at night. It self-confidence is much stronger than your fear of
    can mean that others will perceive you as feeling failure, and achieving high grades at university [in
    calm, confident, and cheerful in the morning when school] presents no difficulty, hardship, or
    you rise, ready to meet the challenges of a new day. discomfort for you.
    The words good health can mean any or all of We have all been conditioned since birth to
    these things and more. These words have associate words with feelings. Words are, there-
    tremendous power. I want you to let them sink fore, the tools which we are going to use to produce
    deeply into your subconscious mind, which always the feelings and results which we want. And these
    can reproduce in you your dominant thoughts. words are health, success, and motivation.
    The next word I would like you to think about is In a few seconds, I will slowly count to three.
    success. It may mean that others see you as feeling When I do, you will come out of the hypnotic
    a sense of worthiness or fulfillment, the attainment trance you are in now. You will remember the
    of your desires in terms of your achievement at suggestions given you regarding health, success,
    university [in school]. It may mean that others see and motivation while you were hypnotized. You
    you as having the ability to set and achieve goals at will incorporate these suggestions into your
    university [school] which are realistic, worthwhile, self-image.
    and progressive, and the motivation and When you wake up you will feel deeply relaxed.
    determination to achieve these goals. It may mean You will remember being hypnotized as an
    that friends see you as having the confidence to ask enjoyable and pleasant experience. Ready now. I
    questions in class, to enable you to be spontaneous, am going to count to three. One— you are starting
    to express feelings without fear or hesitation. to wake up. Two— your eyes are starting to open.
    Success can mean higher marks at university [in Three— your eyes are open now and you are
    school], which may mean security for you and your completely out of the hypnotic trance.
    family. It can also manifest itself in the inner
    happiness that comes when you know that you
    have done the best you can. SESSION III SUGGESTIONS
    It could mean the ability to overcome some
    particular problem that is interfering with your You are now so deeply relaxed that your mind
    university achievement. has become very receptive. In this state of deep
    Whatever the word success means to others, I relaxation the critical part of your conscious mind
    want you to use this word as an emotional stimulus is also very deeply relaxed so that you can accept
    to produce in you all the feelings that go with any idea you wish to accept for your own good.
    success. Because I wish you to remain in this uncritical
    Finally, I want you to think of the word state, I am not going to give you any direct
    motivation. What can it mean? It can mean the suggestions with regard to any of your particular
    desire, determination, and driving force to achieve problems. I am only going to ask you to think of
    at university [school]. It can mean a gradual but your particular problems. I am only going to ask
    progressive strengthening of one's desire to be in you to think about certain words and their
    charge of one's life, to change habit patterns so that meanings and associations for others. I want you to
    they facilitate the goal of high achievement at think lazily of these words, to turn them over in
    university. your subconscious mind, until they become woven
    It can mean the gradual but progressive building into the very fabric of your substance and of your
    of a stronger and stronger feeling of how positively self-image and into the very fabric of your beliefs
    others perceive you until your as to how others perceive you.
    CONCENTRATION, ACADEMIC PERFORMANCE. AND ATHLETIC PERFORMANCE 455

    The first word I want you to think about is sion; a sense of satisfaction with this accom-
    health, and I want you now and always to couple it plishment.
    with the word good. What can the words good It may mean that others feel you have the ability
    health mean? They can mean that people will to set realistic goals in study habits. It may mean
    perceive you as feeling good physically; alert when others see you as having the motivation and
    studying; strong and healthy; and happy with how determination to achieve these goals. It may mean
    your body looks and responds. Good health may that others feel you are confident when reading or
    mean less fatigue and illness, better body weight, studying, easily making connections between
    less muscle strain and other irritations which keep material read and information stored in memory. It
    you from performing to your fullest capacity in may mean that others think you easily remember
    your studies and work. It may mean friends important facts and information and are able to
    perceive you as looking good as well as feeling easily identify crucial issues, lead discussions, and
    good. in general be a superior student.
    Good health means not only physical health, but Success may mean wealth in terms of money
    also a healthy attitude of mind in which your and the things that money can buy, or security for
    friends perceive you as feeling better about yourself and your family. It can also show itself in
    yourself than ever before; more confident in and the attitude of mind which gives inner happiness
    sure of your ability to analyze the material you regardless of material possessions or
    read; calmer and more relaxed when expressing circumstances. It could mean the ability to
    yourself; happier and more satisfied in your classes overcome some particular problem — perhaps
    this year than ever before. even some problem about which you do not know.
    It can mean that others will feel that you are Whatever the word success means to others, I want
    better able to control your thoughts and attention, you to use this word as an emotional stimulus to
    better able to concentrate and remember produce in you all the feelings that go with success.
    information in the material you read. It can seem Finally, I want you to think of the word
    that friends will feel that you are able to use your motivation. What can it mean to others? It can
    subconscious mind to the full extent of your ability, mean that friends perceive you as having the desire
    allowing your subconscious mind to focus on to improve your reading. It can mean they feel you
    pertinent data when needed. have the drive and determination to improve your
    It can mean that others will feel that you are able achievement. It can mean they feel you have the
    to sleep better at night; free from anxiety and progressive desire to change habits, to take control
    self-doubt; awaking calm and confident in the of your life rather than to passively respond to old
    morning. It can mean that friends will perceive you feelings.
    as feeling wide awake in the morning, eager and It can mean the gradual but progressive building
    ready to absorb all you can from the coming day. of a stronger and stronger feeling of how positively
    The words good health can mean any and all of others perceive you until your self-confidence is
    these things and more. These words have much stronger than your fear of failure and
    tremendous power. I want you to let them sink achieving high grades at university [in school]
    deeply into your subconscious mind, which always presents no difficulty, hardship, or discomfort for
    can reproduce in you your dominant thoughts. you.
    The next word I would like you to think about is We have all been conditioned since birth to
    success. It may mean that friends see you as feeling associate words with feelings. Words are therefore
    a sense of accomplishment as you improve in your the tools which we are going to use to produce the
    reading speed and comprehen- feelings and results which we want. And these
    words are health, success, and motivation.
    456 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    In a few seconds, I will slowly count to three. time away from work as a result of fatigue or
    When I do, you will come out of the hypnotic tiredness.
    trance you are in now. You will remember the Good health means not only physical health
    suggestions given you regarding health, success, but also a healthy attitude of mind. Because you
    and motivation while you were hypnotized. You know and accept your body limits you feel calm
    will incorporate these suggestions into your and confident in your ability to succeed in your
    self-concept. endeavors. Knowing you approach your limits
    When you wake up you will feel deeply gives you a feeling of pride and confidence in a
    relaxed. You will remember being hypnotized as job well done.
    an enjoyable and pleasant experience. Ready It can mean appearing to others to be in
    now. I am going to count to three. One— you are charge of your thought processes, thinking
    starting to wake up. Two— your eyes are starting calmly, logically, and making good decisions on
    to open. Three — your eyes are open now and the information available. Others feel you weigh
    you are completely out of the hypnotic trance. and use all the information before drawing
    conclusions or making inferences. They feel
    you are able to concentrate better, remember
    more, and progressively gain more information
    SESSION IV SUGGESTIONS
    each day.
    You are now so deeply relaxed that your mind It can mean friends feel you sleep more
    has become very receptive. In this state of deep deeply at night and awake more alert in the
    relaxation the critical part of your conscious morning ready to assimilate new material. Be-
    mind is also very deeply relaxed so that you can cause you are rested, yesterday's problems are
    accept any idea you wish to accept for your own seen with a new perspective and you are able to
    good. make decisions which enhance success.
    Because I wish you to remain in this uncritical The words good health can mean to you any
    state, I am not going to give you any direct or all of these things and more. These words
    suggestions with regard to any of your particular have tremendous power. I want you to let them
    problems. I am only going to ask you to think sink deeply into your subconscious mind, which
    about certain words and their meanings and always can reproduce in you your dominant
    associations for others. I want you to think lazily thoughts.
    of these words, to turn them over in your mind, to The next word I would like you to think about is
    examine them, to let them sink deeply into your success. It can mean high achievement in class,
    subconscious mind until they become woven into outstanding performance on exams; recognition
    the very fabric of your beliefs as to how others and rewards. It may mean you appear calm and
    perceive you. confident during exams, easily recalling
    The first word I want you to think about is the pertinent facts and knowing that you will be
    word health, and I want you now and always to successful despite transitory difficulties. You
    couple it with the word good. What can the words will appear to be motivated to re-read questions
    good health mean to others? They can mean that on exams to be sure you fully understand their
    others perceive your body is in top physical implications so that you can answer completely
    shape. It feels good to exercise and exert your and in a logical manner. Others will perceive
    body. It feels good to strive and achieve physical you as feeling motivated to re-check answers on
    limits. You find exercise exhilarating rather than examinations to ensure success. If you don't
    fatiguing. By keeping physically fit, studying know an answer, you will appear confident to
    comes easily because the mind feels alert in a allow yourself to make spontaneous guesses,
    healthy body. This feeling may reflect in your knowing that your subconscious mind will help
    work because you spend less recall the correct answer.
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 457
    Success may mean higher marks at university [in
    school] because of improved examination now and you are completely out of the hypnotic
    performance. It may also mean more security for trance.
    you and your family. It can mean friends will
    perceive you as feeling the happiness and
    self-worth that comes from making the best effort
    you can, not only in study habits, but in exam Suggestions for Foreign
    performance. It could mean the ability to overcome
    some particular problem that is interfering with
    Language Study
    your exam performance. Whatever the word Don E. Gibbons, Ph.D.
    success means to others, I want you to use this
    word as an emotional stimulus to produce in you Now I would like you to think of a particular
    all the feelings that go with success. nursery rhyme, bedtime story, or fairy tale which
    Finally, I want you to think of the word was your favorite when you were a child; or if you
    motivation. What can it mean? It can mean the prefer, you can think of a motion picture or a
    willingness to apply yourself for gradually in- television program which you particularly enjoyed
    creasing periods of time while studying. It can when you were very young. I would like you to
    mean the determination to use the full allotment of picture yourself as a young child again, listening to
    time on exams. It can mean the willingness to ask the story, or watching the program or the movie,
    the instructor to clarify obscure or ambiguous and feeling completely enthralled by the
    questions. It can mean the desire to take performance, just as you did then. Just let your
    responsibility for your own performance onto imagination go, and soon you will be able to
    yourself, to take charge of your life and your recapture the mood completely, feeling now just as
    successes rather than letting life's forces mold and you felt then. And when you have fully caught the
    shape your performance. You appear this way to mood, you can signal me by raising the index
    others and seem to have the perseverance and finger of your right [or left] hand.
    ability to achieve the goals you desire. [After the subject has raised his hand:] That's
    We have all been conditioned since birth to fine. Now just hold the mood for a moment and
    associate words with feelings. Words are therefore continue to listen to my voice, and as you do, you
    the tools which we are going to use to produce the will notice the feeling growing even stronger.
    feelings and results which we want. And these Notice how enthralled you feel, and how easy it is
    words are health, success, and motivation. to concentrate and to absorb new information,
    In a few seconds, I will slowly count to three. almost without any deliberate effort.
    When I do, you will come out of the hypnotic From now on, whenever you wish, you will be
    trance you are in now. You will remember the able to call up this mood yourself, just by thinking
    suggestions given you regarding health, success, of a situation like the one you have chosen and
    and motivation while you were hypnotized. You letting your imagination drift backward in time
    will incorporate these suggestions into your until you have recaptured the feeling completely.
    self-concept. And the more often you practice doing this, the
    When you wake up you will feel deeply relaxed. easier it will become, and the more strongly you
    You will remember being hypnotized as an will be able to feel such a mood once you have
    enjoyable and pleasant experience. Ready now. I captured it again.
    am going to count to three. One —you are starting Now the mood is completely gone, but as a
    to wake up. Two — your eyes are starting to open. result of this experience, you are going to be able
    Three — your eyes are open to transfer to your present language study more
    and more of the wonder and excitement which
    learning and using your language used to
    458 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    hold for you as a child. When you are ready to


    begin your language homework, you will be able to matics or related fields such as statistics. The
    call forth this same mood once again, just as I have following suggestions have been utilized to create
    shown you; and if the mood should start to "wear an analogous condition between language talent
    off before you finish studying, you can take a break and the ability to understand and use mathematics
    for a few moments and call it back again. For the and statistics. To personalize the suggestions, use
    more often you practice recalling and the name and words of a specific language or
    reexperiencing these feelings, the stronger your languages. If the subject does not know a foreign
    ability to reex-perience them will become, and the language, the suggestions may be modified so that
    more easily you will be able to do so. English (or any native language) can be used for
    And as a result of this change in mood and in the analogy.
    attitude, you will find a great improvement taking
    place in your ability to acquire and to use foreign
    words and phrases; for they will not seem "foreign" SUGGESTIONS
    to you at all, but rather, a continuation of the
    language learning you have always enjoyed. These Think for a moment how easily language(s)
    new words and phrases will come to possess the comes to you. Your talents, your abilities, allow
    same interest, the same fascination and appeal, and you to learn vocabulary, grammar and syntax
    the same power to arouse your curiosity and to almost without effort. Consider how easily the
    capture and hold your attention as did you own words [predetermined words the subject knows]
    native language when you were first acquiring it. come to you, how easily you use them. The ease
    You will spend a great deal of time turning the new with which you learned and use these words is
    information over in your mind and making up indicative of how easily you learn languages.
    games with it in order to amuse yourself, just as There are many languages in the world. Your
    children often do. And consequently, you will be ability would allow you to learn any one easily that
    able to learn, to retain, and to use the new language you would want to learn, almost without effort,
    with the same ease, the same naturalness of effortlessly. You would have to study some, but
    expression, and the same inherent grammatical you would learn. And you would be pleased at
    sense which characterized the learning of your your ability, just as you have been pleased and
    mother tongue as a child. proud of yourself as you have learned [specify the
    The entire process of language learning will language].
    become a natural, an enjoyable, and a spontaneous One language you have learned and mastered is
    process once again, and you are going to be English, another is . Another language that you can
    absolutely delighted at your progress. learn and master is the language of mathematics [or
    statistics, etc.]. In fact, mathematics is one of the
    easiest languages to learn. It is logical, with no
    surprises like irregular verbs or strange spellings.
    Suggestions for Mathematics or In mathematics, everything means what it says.
    Statistics Performance Letters and numbers are the words, equations are
    sentences, problem solutions are paragraphs. The
    Robert M. Anderson, Ph.D. beauty of language is present in the beauty of
    Takoma Park, Maryland mathematics, and you will see this beauty more and
    more as you learn mathematics.
    INTRODUCTION AND INDICATIONS You will see that sentences like, "Michael is a
    good boy," or "My car is a compact car," are
    Some people who have facility in language merely verbal equations, showing that one side
    studies do not have similar talents in mathe- (Michael) equals the other side (good boy). "Marty
    and Bob are a couple," is the same as 1
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 459

    + 1 = 2 or a + b = 2 or x + y = z. And with your exceptionally confident will probably feel un-


    facility for language guiding you, you will see comfortable using some of them. Erickson re-
    more and more clearly the language of ported only a few failures with the technique. "All
    mathematics. The language of mathematics will of these first-time failures occurred with subjects
    become more and more friendly to you. As you who developed only light trances and who could
    understand it as a language, its beauty, symmetry not seem to learn deep trances. The deeper the
    and meaning will become clearer and clearer to trance, the better pleased was the examinee with
    you. As you study mathematics, it the examination results" (p. 358). It is, therefore,
    will become like English or____________ , easy, recommended that the patient be placed in the
    understandable. And you'll find that you may even deepest trance possible prior to offering these
    be surprised at first at how easily, effortlessly, you suggestions. (Ed.)
    learn and recall the language of mathematics.
    [To reinforce the suggestions, at the end of the
    session, go through a few simple problems that the SUGGESTIONS
    patient already understands, allowing the patient to
    look for the analogies between language and You wish to have help in passing your exam-
    mathematics in them.] ination. You have sought hypnosis and you have
    developed the trance state that I know to be
    sufficient to meet your needs. You will continue in
    that trance state until I tell you otherwise.
    Examination Panic Now, here is the help you wish. Listen carefully
    and understandingly. You may not want to agree
    Milton H. Erickson, M.D. with me but you must remember that your own
    ideas have led only to failures. Hence, though what
    INDICATIONS I say may not seem exactly right, abide by it fully.
    In so doing, you will achieve your goal of passing
    The late Dr. Erickson formulated the following the examination. That is your goal and you are to
    suggestions that he tended to give to highly achieve it and I shall give you the instructions by
    motivated subjects who had test anxiety and who which to do it. I cannot give you the information
    were going to take an essay exam. These patients that you have acquired in past study and I want you
    included physicians, lawyers, Ph.D. candidates, to have it available for the examination in the way I
    college and high school students. The central specify.
    theme of the suggestions is the avoidance of First of all you are to pass this examination, not
    perfectionism and motivating the student for "the trying in the unsuccessful ways you have in the past
    comfortable achievement of lesser goals" (1965, p. but in the way I shall now define. You want to pass
    358). Erickson, despite myths to the contrary, did this examination. I want you to pass it. But listen
    not individualize all of his suggestions. He closely: You are to pass it with the lowest passing
    specifically indicated that "the procedure grade — not an A or a B. I know you would like a
    employed with these various applicants for help high grade but you need a passing grade, that's all
    was essentially constant in character" (p. 356). He and that is what you are to get. To this you must
    reported "uniformly good" results. The essence of agree absolutely, and you do, do you not? [An
    Erickson's overall approach was tremendous affirmation was always given.]
    flexibility and he was willing to be both highly Next, after leaving this office I want you to feel
    direct and highly indirect, depending on the carefree, at ease, even forgetful of the fact that you
    patient. You will note that the suggestions he are to write an examination. But no matter how
    typically used with this problem are sometimes so forgetful of that fact you become,
    highly directive and authoritarian that therapists
    who are not
    460 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    you will remember to appear on time at the place of learned your colors, how to draw between lines,
    the examination. At first you may not even perhaps a few of your ABC's, to count at least to
    remember why you are there but it will dawn on ten. You learned how to get up and down stairs,
    your mind in time, and comfortably so. how to get around your yard and immediate
    Upon taking your place, you are to read through neighborhood. You learned how to write a few
    all the questions. Not one of them will make sense, characters, how to draw, how to bathe, how to
    but read them all. [The purpose of this was to give brush your teeth, comb your hair, and dress. One of
    the subject an unwitting appraisal of the number of the big achievements in learning was how to
    questions and the amount of time each would distinguish your right from your left when you put
    require.] on your shoes, how to lace them, and especially
    Then get ready to write and read the first how to tie a bow. To accomplish all this learning
    question again. It will seem to make a little sense and memory, you had to study, to concentrate. You
    and a little information will trickle into your did not allow yourself to be distracted; you kept on
    conscious mind. By the time you have written it trying until you were successful.
    down, there will be another trickle keeping you All of the learning, concentration, studying, and
    writing until suddenly the trickle dries up. Then memory I have just mentioned was data which you
    you move on to the next question and the same programmed into your computer brain. Now that
    thing will happen. When the time is up, you will you are older, you daily perform these tasks, but
    have answered all of the questions comfortably, they were not so simple when you were learning
    easily, just recording the trickle of information that them. The same principle applies in learning,
    develops for each question. concentration, studying and memory at any age.
    When finished, turn in your examination paper Now you are not studying how to tie your
    and leave feeling comfortable, at ease, at peace shoelaces, you are studying math [or chemistry,
    with yourself. anatomy, design, architecture, music, adeptness at
    sports, etc.]. But the same principle applies in
    learning your [e.g., math]. You learned by
    concentration and thinking logically even before
    you knew the meaning of the word "logical." Now
    Suggestions for Concentration, that you know the meaning of the word and you
    Studying, and Overcoming Test have the interest and the need to learn, it ought to
    Anxiety be easier for you if you have the attitude to broaden
    your learning.
    Alcid M. Pelletier, Ed.D. Try an experiment in concentration. Take a
    Grand Rapids, Michigan ballpoint pen, discover its parts and functions, and
    fully describe it, its color, size, circumference,
    Your brain is like a computer. It is superior to a length, spring mechanisms, slip, bands, ink, etc.
    computer. As a matter of fact, your brain is the You can spend five or more minutes describing
    prototype for all computers. All of them have been that ballpoint pen if you really concentrate. Then
    fashioned after some of the processes of your mind. that pen will be different from other pens. Think of
    During the first five years of your life, you the possibilities of your social and personal life if
    learned more than you did in any other five-year you become aware of people like that. Think of
    period since. You learned a language, how to walk how you can excel in math when you concentrate
    and run; you learned how to distinguish one person on its logistics, theorems, calculations, and
    from another and one object from another with accurate conclusions, make your studying exciting
    all their proper names. You and you will become excited in learning.
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 461

    Since your brain is like a computer, you are No matter how difficult the questions may seem
    storing data into it every time you study and at first sight ... or how little you seem to know . . .
    concentrate. Whatever you feed into a computer you will not panic . . . because you will find that
    can, in turn, be retrieved from it. Now you are things are not as bad as they seem.
    about to take a test, an examination — written, You will read all the questions carefully and
    oral, true-false, essay, multiple choice —it really deliberately . . . you will decide upon the one that
    doesn't matter. What matters is that it is a test to you can tackle best . . . and answer that one as fully
    test what you have stored in your computer brain as you can . . . without worrying about the others
    and how effective is your trained retrievable until you have completed it.
    system. Since you have placed the data in your As you do this . . . you will find that you will
    computer, you can retrieve it. actually remember far more than you originally
    thought you would.
    When you have put down all you know about
    this first question . . . choose the next easiest to
    answer . . . and tackle that in exactly the same way.
    Suggestions for Continue in this way with the rest of the
    Examination Phobia questions until you have written all that you can
    remember ... or until the time is up.
    David Waxman, L.R.C.P., M.R.C.S. When you have finished . . . you will find that
    London, England you have remembered far more that you thought
    possible when you first read the questions.
    [The combination of the two techniques of
    The moment you enter the examination room desensitization and ego-strengthening will usually
    and pick up your paper to read the questions . . . be found to be successful. However, in all cases
    you will become completely calm and relaxed . . . one must be certain that there is no other
    and all your nervousness and apprehension will underlying neurosis or personality problem.]
    disappear completely.

    SUGGESTIONS FOR AESTHETIC REFINEMENT

    Suggestions for Artistic longer be here in the present setting; but instead,
    you will be seated in the middle of a lovely forest
    Expression glade with your easel, paint, and brushes still
    Don E. Gibbons, Ph.D. before you. By the time I get to the count of one,
    you will be able to open your eyes and look
    INDICATIONS
    around, and you will be able to paint what you see
    These suggestions are designed for somnam- in rapid, steady strokes.
    bulistic, deep trance subjects who wish to enhance You will always be able to hear and to respond
    their creativity as artists. Gibbons suggests that the to my voice, and I will return you to the present
    subject be seated ready to paint when the hypnosis setting in a while; but until I do so, every aspect of
    takes place. (Ed.) the situation to which I guide you will be
    completely real, and you will experience it all just
    SUGGESTIONS
    as if you were actually there. And even though the
    I'm going to count backward from five to one, experience may actually last for only a few
    and by the time I get to one you will no moments, it will seem to be
    462 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    going on for a much longer time, so that your Now you are back in the original setting, still very
    ability to respond to it artistically will be cor- much in trance, but feeling thrilled and delighted at
    respondingly enhanced. Just continue to listen to all that you have seen and done and retaining the
    my voice now, as I begin to count backward from mood and the memory perfectly. And when the
    five to one. trance is over, you will be able to paint from
    Five. Your awareness of the present scene is memory just as clearly and just as well as if you
    beginning to grow dim, as you feel yourself and were still there in the forest.
    your equipment being transported to that lovely
    forest glade. Four. Your awareness of the present is
    dimming more and more, and you can begin to be Suggestions for Aesthetic
    aware of yourself seated in that lovely forest glade,
    with your easel and brushes before you, ready to Appreciation and Enjoyment
    commence painting in a few moments. And as soon Don E. Gibbons, Ph.D.
    as 1 get to the count of one, you will be able to open
    your eyes and look around, catching the mood The next time you read a good novel, or see a
    perfectly as you do, and you will be able to paint as quality motion picture, stage play, or television
    you have never painted before. Three. You can feel performance, what I am about to tell you will set in
    yourself becoming more and more aware of the motion a number of changes in your artistic
    forest glade around you, but keep you eyes closed sensitivity and responsiveness; and these changes
    until I get to the count of one and the transition has will greatly enhance your appreciation and
    been completed. Two. Your anticipation and understanding of what you experience, multiplying
    excitement are increasing with each passing your enjoyment many times over.
    second; for soon you will be able to open your eyes You will find that all your senses will suddenly
    and gaze upon one of the most beautiful landscapes begin to feel much keener as the event begins, and
    you have ever seen. One. Now you can open your that your emotional responsiveness is also
    eyes and take in all the breathtaking beauty before considerably enhanced. These changes will enable
    you, and in just a few seconds you will have caught you to become more and more deeply involved in
    the mood and you can begin to paint. the experience as it unfolds; for you will be able to
    follow it not merely with your senses alone, but
    [After a few moments have elapsed, it may be with your entire being.
    suggested to the subject that he will be able to As time continues, the degree of your in-
    retain the same mood, and the same ability to volvement in such cultural experiences will con-
    express what he has seen, after the trance is tinue to increase, as this process repeats itself. And
    terminated. He may then be requested to close his this enhancement of your artistic responsiveness
    eyes once more while the suggestor counts forward will help you to discover new depths of
    from one to five:] appreciation in life itself, as you come to possess
    One. Your awareness of the forest glade is an ever-increasing ability to experience life in a
    beginning to grow dim, as I return you to the scene richer and more rewarding manner.
    from which you left. Two. Coming back more and
    more now, as your awareness of the forest glade
    begins to leave completely and you start to become Suggestions to Enhance
    aware of yourself back in the original setting.
    Three. Almost back now. And by the time I get to Musical Performance
    the count of five, the transition to the original Don E. Gibbons, Ph.D.
    setting will be complete. Four. Almost back. But
    you will remain in trance for a while, until I bring
    AINTRODUCTION
    you out. Five.
    The following post-induction suggestions are
    intended to facilitate musical performance by
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 463

    encouraging a close identification with musicians and enjoy it fully for a moment, and then it will be
    whose performance the student has previously time to return.
    come to admire. A similar approach has been [After a moment's pause:] Now I am going to
    reported by Raikov (1976). return you to your original identity. But you will be
    able to carry back with you the feelings which you
    have experienced, and your own playing and your
    SUGGESTIONS own confidence will be greatly enhanced as a
    result. By the time I get to the count of five, you
    Now I would like you to think of some musician will be back to your normal identity; but you will
    who plays the same instrument you do, whose remain in trance for a while, until I bring you out.
    playing you are especially fond of— or, if you One. Beginning to lose your awareness of
    wish, you can think of one of the great virtuosos on yourself as the other person, and beginning to
    this instrument from the past. I'm going to count become aware of your original identity once more,
    backwards from five to one; and by the time I get here in trance, with me once again. Two. Coming
    to one, you will be able to feel just as if you were back now, coming all the way back, but remaining
    this person, feeling as he [she] feels and playing as in trance for just a while longer. Three. Beginning
    he [she] plays. to be fully aware of your true identity now. Four.
    You will always be able to hear and to respond Almost back. Five. Now you have fully resumed
    to my voice, and I will return you to your own your own identity, but you will still remain in
    identity in a while; but until I do so, every aspect of trance for a while, until I bring you out.
    the situation to which I guide you will seem As a result of the experience you have just
    completely real, and you will be able to experience undergone, you will notice a great many im-
    it all just as if you were really there. So just provements taking place in your own musical
    continue listening to my voice now, as I begin to performance. Whenever you begin to play for
    count backward from five to one. others, you will become completely absorbed in the
    Five. Your awareness of the present is beginning music with the very first note. You will become so
    to grow dim as you feel yourself being mentally absorbed in the piece you are playing that all sense
    transported into a new situation and into a new of self is lost, and all traces of fear and doubt are
    identity. And by the time I get to the count of one, lost as well. Your timing and your concentration
    the transition will be complete. Four. You are will be perfect, and as you and the music merge
    beginning to lose awareness of the present together, you will be able to tap into the feelings
    completely now, as my words transport you on to you have experienced just now and feel the same
    the identity of the person you have chosen. Three. wonderful sense of power and ability flowing out
    You are becoming aware of yourself as this other from the innermost depths of your being and
    person now, as the musician you have selected. flowing on to touch the hearts of everyone who
    Feel yourself entering this other body, and feel hears you play.
    your identities beginning to merge. Two. You can When the performance is ended, you will realize
    feel great wellsprings of talent and ability flowing just how deeply you have been able to tap into the
    through every muscle and every fiber and every boundless wellsprings of talent and ability which
    nerve of this new body as your identities merge lie within you, and you will experience a great
    completely now; and you can see yourself playing surge of exaltation and a deep sense of personal
    as you have never played before. One. Your fulfillment and satisfaction at the realization that
    identities have merged completely now, and you you have been able to perform so well. It will
    can see and feel yourself playing as you have never always be a source of deep personal satisfaction to
    played before. Live the experience, you that you are
    464 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    able to use your own vast talents so fully and so strengthening and for achievement motivation, to
    well, and you will come to look forward to each assist the subject to replace recurring fantasies of
    performance supremely confident that you are failure with positive expectations of success.
    honing your talent to its finest possible edge,
    looking forward to the inevitable moment of
    triumph which this awareness will bring to you
    when the performance is completed. SUGGESTIONS
    [A specific situation may also be suggested
    which represents a special moment of triumph in Whenever you are engaged in creative writing,
    the career of the artist chosen, or in the future you will find that during your spare moments your
    career of the artist himself. Moreover, if the subject thoughts will tend to turn to whatever you are
    is able to open his eyes without disturbing his writing about. These frequent moments of extra
    ongoing experience of trance, he may actually attention will keep new ideas constantly forming in
    perform for a few moments while imagining your mind, even when you are consciously
    himself in the identity of another. With the subject preoccupied with other matters.
    seated before his instrument and ready to play, an Because of this extra attention, new ideas and
    induction may be administered in the usual manner associations will frequently emerge into your
    and the preceding suggestions may be awareness as though unbidden; and when you
    administered as far as the count of two, at which begin to write, these new ideas and associations
    time the following verbalizations may be will flow even more freely, providing you with a
    substituted:] steady stream of inspiration.
    You can feel great wellsprings of power and As you write, you will be able to maintain
    ability flowing through every muscle and every continuous contact with these vast resources of
    fiber and every nerve of your body as your creativity which lie within you. You will be able to
    identities begin to merge completely. One. Your carry out any revisions which may be necessary as
    identities have completely merged together now, the work progresses, without any undue reluctance
    and you can open your eyes and begin to play. Live on your part to change what you have already
    the experience fully and play as you have never written, and without striving for perfection for its
    played before. own sake in those instances wherein it is more
    important to finish what you have begun.
    [After a moment or two has elapsed, the subject
    You will be able to break your writing down into
    may be requested to close his eyes and the
    small segments which can be comfortably fitted
    suggestions for canceling the identification may be
    into the time you have at your disposal, enabling
    administered as previously indicated.]
    you to maintain a pace which is both productive
    and enjoyable, without feeling unduly rushed or
    under pressure. And when each writing period is
    over, or each segment of the work is completed,
    Suggestions to Enhance you will experience strong feelings of pride,
    Writing Ability achievement, and accomplishment, which stem
    from an ever-growing realization that you are
    Don E. Gibbons, Ph.D. employing your abilities fully and well. Writing
    will thus be experienced as a spontaneous, natural,
    and joyful process, which will enable you to make
    INTRODUCTION the fullest use of your creative potential.
    The following suggestions for the enhancement
    of writing ability may also be presented, in
    conjunction with suggestions for ego-
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 465

    ENHANCING SPORTS AND ATHLETIC PERFORMANCE

    Suggestions Used to Enhance they will be able to translate these visualiza-


    tions into action during a game or practice at
    Sport Performance the same level of expertise that they had
    visualized. Most crucial here is that, during the
    Keith P. Henschen, Ph.D.
    visualization sessions, the athletes are
    Salt Lake City, Utah
    instructed that, while visualizing the various
    motor skills, there will be a concomitant
    The value of hypnosis in enhancing sport physical experience in their bodies. This leads
    performance has been the subject of considerable to strengthening of neural patterns through
    debate over the years. Athletes, or performers of hypnotic mental imagery, which reinforces
    any type for that matter, are constantly seeking neuromuscular coordination.
    techniques that will help their performances. It is B. When competing against one particular op
    now understood that hypnosis can be of great value ponent, a young golfer feels stressful and
    if it is correctly utilized in sports; but it can also be consequently performs poorly. This happens
    a disaster if it is incorrectly applied to the over and over again against the same person,
    performance realm (Unesthal, 1983). Hypnosis is but not against other opponents. His belief
    recognized as one possible tool for aiding the of not being able to perform is reinforced
    athlete to achieve his/her full potential. every time this particular opponent is
    present. This is obviously an emotional
    problem and not a matter of poor technique.
    INDICATIONS
    In this situation hypnosis is used to influence
    Currently, hypnosis in sports is mainly used to the emotions and attitudes of the golfer and
    control the athlete's emotional experience, that is, to focus attention on particular relevant cues
    to control anxiety levels, to regulate to improve his golf game. A suggestion such
    concentrational demands, to stimulate aggressive as "block out the entire environment on each
    behavior when appropriate, to enhance motivation, shot and concentrate on the rhythm of your
    to instill self-confidence and pride, and to inhibit swing" is very constructive in this situation.
    any psychological factors that often serve to limit C. Many athletes have great difficulty getting
    physical performances. Most sport psychologists to sleep, especially the night before an im
    are very cautious in their use of hypnosis and agree portant contest. Suggestions such as "re
    that: (1) hypnosis is not a performance panacea, laxed and calm" or "deeply relaxed and
    but a very useful tool; (2) hypnosis is only as good comfortable" are frequently used to facili
    as the skill of the person using it; and (3) the tate relaxation and/or sleep.
    athlete using hypnosis must be thoroughly trained D. A gymnast is experiencing fear when at
    (Ziegenfuss, 1962). tempting a particularly difficult routine. She
    A few specific examples of how hypnosis is is told to visualize a "happiness room" in her
    currently being used in athletic settings follow: mind. This is to be a completely pleasant
    room, decorated to her taste, with money
    A. A performance team (volleyball, basketball, being no handicap. Anything that makes her
    etc.) is hypnotized in a group setting and then happy is to be placed in the room. She is
    asked to mentally visualize themselves told to have a television in the room and to
    executing precise motor skills. They are then watch herself perform the difficult routine
    presented a posthypnotic suggestion to perfection on the TV. Then she is given a
    that posthypnotic suggestion "relaxed and easy"
    as she initiates the difficult routine. In prac-
    466 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    tice and meet situations, she is to visit her over other hypnotic methods. Hypnotic procedures
    happiness room just prior to performing this commonly used in sports include: yoga breathing,
    routine. age regression, autogenic training, progressive
    relaxation, awareness through movement, mental
    As was mentioned previously, it is in the area of practice with imagery, and posthypnotic
    mental attitude for athletics where hypnosis is most suggestions.
    effective. It can be applied to specific situations in It is thought that by eliminating the psycho-
    sports to reduce the feelings of pressure, tension, logical factors which inhibit an athlete, physical
    stress and anxiety. Suggestions which have been performance will be improved. Hypnosis is a
    most useful for athletes include the following: technique that allows the athlete to gain control of
    him/herself and mitigate the effects of distracting
    1. Muscles are strong, relaxed and non-tight. psychological factors.
    2. You are in complete control of your envi-
    ronment.
    3. You are like a coiled spring— powerful and
    strong. Sports Performance
    4. Feel the sensations within your muscles. Enhancement
    5. Focus on this skill and block out all other
    distractions. Richard B. Garver, Ed.D.
    6. Gain complete control of yourself. San Antonio, Texas

    Essentially there are two areas that are very


    CONTRAINDICATIONS important and helpful: (1) control of arousal level
    and (2) neuromotor facilitation. Arousal level, no
    At present, the most difficult problems in using matter what the motivations are behind it, affects
    hypnosis in the sports setting can be categorized performance. It is not always necessary to
    into two general areas: (1) opposition to its use by
    psychotherapeutically work through all of the
    the uneducated and ill-informed, and (2) the lack of
    many complex issues that produce these arousal
    competent therapists who are trained to use
    levels; they may not even be important any longer.
    hypnosis appropriately in athletic situations. Most
    But it is important to begin to control the arousal
    of the dangers to using hypnosis in sports are
    level even if you are working through the reasons
    identical to the dangers of using it in any situation.
    behind it. You may still bargain with the
    Many of these dangers are intrinsic to the close
    unconscious mind to begin to help controlling the
    interpersonal relationship that develops in any
    arousal level. [See Garver's method for working
    form of counseling and/or psychotherapy. with study, concentration, and test anxiety
    Hypnosis should not be used by coaches because of problems (p. 000) for an example of his method for
    their vested interest in the outcome of controlling arousal level.] The control of arousal
    competitions. level is important because, no matter how skillful
    you are or how well you use any technique, it can
    SUMMARY all be lost if the arousal level is too low or too high.
    Secondly, the facilitation of neuromotor
    Hypnosis is used in sports to supply motivating pathways is very important. Physical educators call
    instructions, to boost confidence, to remove fears, it mental practice; psychologists call it covert
    to influence arousal levels, to control anxiety or rehearsal; imagers call it using visual imagery.
    pain, and to increase self-concept. Most sport Whatever the process, it is a mental review that the
    psychologists advocate various techniques of performer goes through, previewing his actual
    self-hypnosis in sports performance. This is an image of an ideal
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 467

    performance of a role model (like a videotape as you want it to and the outcome is right, reach
    presentation of a sports performance), which is then with your left hand and touch your right shoulder.
    applied in some way or adopted to the athlete's own That is a cue to your unconscious mind that has
    technique and physical capacities. It is, however, been established to program in that behavior. If the
    very important to make sure that the image that performance is not good, then touch your left
    performers have is the correct one, whether it's one shoulder with your right hand." Any cue may be
    developed by their coaches or one they have used. What is important is that this process
    conceived from a book, videotape or other credible reinforces everything that is right and does not
    source. It is important to be able to see yourself reinforce what has been practiced wrong. This
    from without (dissociated), as though looking at maximizes optimal reinforcement of positive
    yourself on a videotape replay, and it is important to performance and minimizes any reinforcement of
    look out from yourself as you would when actually negative behavior.
    performing this particular motor skill. It is also When we recognize what we did right and what
    extremely helpful to have a kinesthetic sense of we did wrong, it can also be used in rehearsing a
    what you are doing, to feel every move as well as specific skill. For instance, after a golfer has made
    see it. You should sense in any way {including two or three perfect practice swings or mental
    hearing) what you are doing, and then memorize
    images, the right shoulder may be touched to
    the way that you do it best. Then you need to
    program it in, and then he can go ahead and hit the
    continue reinforcing what you do right versus what
    shot. The principle is to program very specifically
    you do wrong. This is essential because it does not
    how the person wants to perform, to be very
    matter how often you practice if you are practicing
    specific about the arousal level, and to use
    wrong patterns. Your unconscious mind memorizes
    posthypnotic cues while both practicing and
    behavioral performance both good and bad, without
    performing. "Trust the unconscious program; trust
    making a judgment about it. Thus, it is very
    important to memorize what is good. the cue that will trigger the right program, the
    specific program that you know is there and that
    The following is a technique that I have found you are reinforcing. This is much better than trying
    very effective in reinforcing correct behavior to get rid of or not do negative behavior. If you are
    patterns and releasing or ignoring incorrect or bad hitting from the top in a golf swing, the worst thing
    performance. I use the sequence of having subjects you can do is to try not to hit from the top. Instead,
    visualize what it is, how it is, how it feels, how they concentrate on doing something else that will
    want to do this, and then to simply focus on doing prevent you from hitting from the top [the principle
    it. I tell them, "It is important to be in the left brain of using positive rather than negative suggestions].
    when planning, but you had better be in the right For example, think of shifting your weight or
    brain when you are performing or you will be moving your lower body through, rather than not
    consciously interfering and get what I call hitting from the top. Always focus on how you
    paralysis by analysis. Thus it is important to trust want to perform."
    whatever program is in the unconscious mind, even
    if it is not the best program, because it is the best
    that you currently have, and it will be ineffective if Metaphor for Athletics/Sports
    you try to consciously change it in some way when
    you are actually performing." Competition
    The cue to be used while the subject is Richard R. Wooton, Ph.D.
    performing and/or practicing for a performance is Provo, Utah
    the following: "When you do it right, when you
    feel that the program has run exactly INDICATIONS
    The following metaphor was used with a
    nationally ranked university volleyball team. It
    468 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    was designed for use with a team who had a little by little — even though he continued to win
    tendency to lose because its members were "slow most of his races, he would occasionally lose.
    starters." The last paragraph was also designed for Since he knew that he was running faster and
    one of the players who had a problem with anger harder than he had ever run before, the whole
    and when he made an error was practically of no reason for losing was a mystery to him.
    use for a period of time until he could pull himself He was fortunate to have a coach who cared a
    together. It may be used with a group induction of great deal about him personally and about his
    the entire team and tape recorded for use in performances. The coach had a keen eye and a
    self-hypnosis. (Ed.) particularly good ability to analyze running styles.
    After watching the sprinter in several races, the
    coach came to him and said, "I think I've
    METAPHOR discovered your problem. You have always been a
    very strong and a very fast runner, but you have
    I'd like to tell you about a friend of mine who never learned to use the starting blocks and, in fact,
    used to be an outstanding runner. He was a sprinter you really do not know how to start very fast at all.
    who could run the 100 meters faster than any junior The result is that you are always running faster and
    high or high school kid in his city or for several faster in an attempt to catch up with the
    competition, rather than leading from the
    surrounding cities. He was so much faster than
    beginning. This has resulted in your sometimes
    anyone his age that he consistently ran away from
    winning but sometimes losing to those who know
    his competition. The interesting thing about him is
    how to come out of the starting blocks faster."
    that he seemed to run faster and faster as he
    approached the tape and coaches often were heard In the end, because of effective coaching and a
    to comment on how strong and fast he was at the willingness of this athlete to listen, he learned to
    end of the race. He dominated all of the junior high charge out of the blocks quickly, and, while it was
    school track meets in which he was a participant still possible for him to lose on occasions, he rarely
    and was almost as strong throughout his high lost once he had learned to put the whole race
    school years. He did notice while in high school together— beginning with a fast start and ending
    that, while he consistently won, the competition with a strong and quick finish.
    seemed to be getting better. He knew that he was [Continuing after about a 10-second pause:]
    running as well — if not better — than he had ever Many of you have heard of a rather famous artist
    run in his life, but, for some reason unknown to who lived some years ago by the name of Vincent
    him, others seemed to also be getting faster. He Van Gogh. His paintings now command a very
    began to realize that he often just barely beat his high price even though he was not as well-known
    competitors as they got to the finish line. in his own lifetime — perhaps because he acted in
    some very peculiar ways and had such a violent
    This young man was such a fine competitor that
    temper that he would get totally out of control for
    he was offered an athletic scholarship at a
    periods of time. In fact, in one such period of rage
    university known for its strong track teams. He
    he became so angry at a situation that he could not
    continued to compete well, but for the first time in control that he cut off his own ear. The really sad
    his life he began to be aware that there were others thing about what he did, besides losing his ear, was
    who not only were very fast, but probably had a that most other people simply thought that he was
    good chance of beating him. As hard as he would acting like a crazy man and they really didn't have a
    run, the competition seemed to edge ever closer, lot of sympathy for him. I suppose that they would
    making each race one that he would barely win. have respected and befriended him more if he had
    The time came when, in one important event, he acted in a more appropriate manner rather than
    lost a close race and then— simply looking stupid by allowing his anger
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 469

    to go so uncontrolled. His effort to gain attention proper height and configuration in order to make
    and to show others how bad he felt, only resulted in the star. Each has an individual job to do, but
    others' not wanting to have as much to do with him without each participant doing his or her job in
    and, in the final analysis, he only ended up looking exactly the right in relationship to the other
    kind of silly walking around with one ear! jumpers, then the star cannot be made.
    The star is by far the skydivers' favorite design to
    make because of its difficulty and also because of
    its beauty — so much so that if any one of the
    Metaphor for Facilitating jumpers does not make the needed response in
    Cooperation and Teamwork in relationship to all of the other jumpers, then the star
    cannot be made at all and each of the skydivers
    Athletics must float to the ground individually. But, again,
    Richard R. Wooton, Ph.D. because they enjoy making the star so much and
    Provo, Utah because it is such a beautiful thing to see from the
    ground as well as to experience as a jumper, they
    immediately go back into the airplane, return to the
    INDICATIONS skies, and jump again so that they can continue
    trying to "connect up" as well as they can with each
    This metaphor was used successfully with a
    other, and until the star turns out to be as satisfying
    nationally ranked male volleyball team. It may be
    in its structure and beauty as they would like. The
    used to facilitate working cooperatively together
    dependency that the jumpers feel for one another in
    as a team, rather than playing as a "group of
    their group and the precision with which they
    individuals." This metaphor may be given
    contribute to the star is, indeed, one of the most
    following a group hypnotic induction, and may be
    satisfying experiences that they can share together.
    tape recorded for use in self-hypnosis. (Ed.)

    METAPHOR Suggestions for Concentration


    Six friends of mine love to sky dive. One of Brian M. Alman, Ph.D.
    their biggest thrills is getting together whenever San Diego, California
    they can so that they can fly together in a plane up
    into the skies, where they can prepare to make their SELF-SUGGESTIONS FOR
    jumps. Without question, their biggest thrill is CONCENTRATION BEFORE A GAME
    when they jump from the plane and make a
    [These suggestions may be given by the subject
    six-sided star in the sky. Now to make a star takes a in self-hypnosis, and reinforced in
    lot of talent along with some courage to jump as heterohypnosis.] Whenever I lace up my shoes
    well as a good deal of trust in your fellow jumpers. before a game or workout, I may notice that my
    You see, not all six of the skydivers can leave the mind cinches up in its focus, also. As I tighten the
    place at the same time. One must leave first, and laces on my shoes, perhaps I am also tightening my
    then delay pulling the rip cord of the parachute concentration on my game to come.
    until all of the five others have jumped one at a
    time. It takes great discipline and cooperation for
    SELF-SUGGESTIONS FOR
    each diver to pull his own rip cord at a different
    time, and yet at precisely the right time so that they CONCENTRATION IN TENNIS
    can line up in a way that will give them the As I walk onto the court I will see the net
    dividing the area. The net can prevent the ball
    470 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    from passing from one side to the other. I will find skills, to facilitate control of physiologic processes
    that the concentration of my attention is able to and to enhance athletic performance.
    screen out distractions just as the net stops poorly The Self-Directed Behavior Change Instrument
    hit balls. (Tosi, 1973) was used with the athletes "as an
    When I first step out on the court, I can notice exercise to facilitate high cognitive control over
    that there are lines marked off for the boundaries. I other processes and as an initial means of
    may be able to form boundaries in my modifying self-concept. Subjects used this in-
    concentration that mark those actions and events strument to identify negative self-referring
    that are in bounds, and pay attention only to them. statements. The subjects were then directed to
    I can also ignore those actions, sounds and provide themselves with more 'rational' alterna-
    events that are out of my mental bounds for this tives" (p. 252). It was emphasized that the
    game. I can allow them to pass through me without individual, not the environment, was responsible
    interrupting my concentration. If I am distracted, for his thoughts and emotions (Ellis, 1962).
    I'll be able to see the distraction as momentary. As Specific efforts were also made to identify negative
    if I'm on automatic pilot, I can return to my game ideation associated with subjects' athletic
    and focus. performance (e.g., concentrating on the amount of
    I will grasp my racket firmly and confidently. weight to be lifted, rather than the process of
    The racket is designed for a specific purpose— to lifting; worrying about what others would think if
    play the game most effectively. As I grip the they "failed"). A variety of negative cognitive
    racket, I may bring that same kind of concentration sequences were presented to the athletes as a
    and purpose to my game. stimulus in helping them to pinpoint their own
    I will associate the feeling of concentration and self-defeating ideations. The athletes were also
    readiness with stepping onto the court. My encouraged to employ cognitive strategies in real
    stretching exercises before a match can be a life settings in their everyday lives. (Ed.)
    complete stretch. My physical flexibility and my
    mental readiness can begin with those exercises.
    COGNITIVE-HYPNOTIC TRAINING

    After a general discussion of hypnosis, the


    A Cognitive-Hypnotic Approach to subjects were hypnotized . . . and directed to
    Athletic Performance with Weight experience the negative emotional states associated
    with the above identified situations as well as
    Lifters identifying the negative irrational cognitions. The
    therapist negatively reinforced this entire
    W. Lee Howard, Ph.D., and
    self-defeating sequence. The therapist next di-
    James P. Reardon, Ph.D. rected the subject to refocus on relaxing thoughts
    Columbus, Ohio and then visualize the same sequence, visualizing
    himself engaging in more rational self-talk and
    INTRODUCTION experiencing more positive affective,
    physiological and behavioral responses. This
    This hypnotic training approach, adapted from self-enhancing sequence was positively reinforced
    the authors' original article (1986), was found to by the therapist.
    produce successful results in a controlled The above process was designed to facilitate the
    experimental study. The authors used hypnotic restructuring of negative cognitive-emotional
    relaxation and imagery techniques to facilitate and responses to specific internally/externally
    reinforce cognitive restructuring disturbing situations. This process was also
    designed to restructure the self-concept (nega-
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 471

    tive self-referring statements). The hypnotic state sometime in the future with increases in muscular
    was next utilized to enhance physiological size in the chest and arms. The subjects were
    processes associated with increased performance directed to visualize themselves proud and happy
    via rich hypnotic imagery. about the increases they had achieved, and to see
    More specifically, the subjects were directed to others recognizing their muscular gains. All
    visualize themselves performing the behavioral subjects were encouraged to practice the imagery
    criterion measure (supine barbell press) while techniques described above (without hypnosis)
    hypnotized. They were directed to practice several during the week.
    dimensions via hypnotic imagery: (1)
    psychological — elimination of negative ideation,
    increased focusing, elimination of distractions, (2)
    physiological — attaining proper levels of arousal,
    Suggestions for Sports
    (3) behavioral — successful performance of the
    supine barbell press (facilitation of correct neural Performance
    pathways).
    The behavioral dimension and neural pattern Don E. Gibbons, Ph.D.
    facilitation were accomplished by a detailed
    description of the behavioral task, encouraging INTRODUCTION AND INDICATIONS
    only positive visualization and performance. The
    psychological dimension was practiced via the Since even the best players can occasionally
    standard cognitive restructuring process. The encounter a losing streak, care should be taken to
    physiological variable (appropriate arousal level) avoid suggesting specific targets which might lead
    was developed through the use of an arousal scale to a loss of faith in the efficacy of the procedure if
    in which specific events and physiological specific levels of athletic performance are not
    variables (heart beat, perspiration, etc.) were attained. By the same token, athletes should not be
    associated with numbers on the scale. That is, on a encouraged by means of suggestion to train or to
    scale of one to five (with one being the lowest compete so strenuously that they run the risk of
    arousal level and five being the highest), the possible injury or of diminishing their resources
    subjects first associated sleep with one, walking instead of continuing to improve. However,
    with two . . . their best performance with five, etc., suggestion may be employed to maximize the
    until they were able to monitor and control their enjoyment of playing well, while simultaneously
    arousal level. They were given instructions to decreasing the fear of possible failure, thus
    perform the monitoring of arousal during their real providing the subject with positive attitudes which
    life performances, as well as in controlling of the are highly conducive to continued growth. The
    other dimensions mentioned. following suggestions may be administered at the
    conclusion of an appropriate induction.
    Subjects were encouraged via hypnotic imagery
    to experience sensory hallucinations to facilitate
    physiological control associated with muscular
    growth. They were asked to visualize themselves SUGGESTIONS
    in a comfortable location in which "hot, moist
    towels" were placed on their chest and arms. They As a result of what I am about to tell you now,
    were directed to "feel a warm, swelling, pulsating you will find that any negative aspects of sports
    sensation" in these areas. They were also asked to performance which might have troubled you in the
    visualize their body as a "giant transport system in past will have greatly diminished in importance,
    which all available blood is being sent to the chest and as times goes on, their importance will
    and arms." Next, the subjects were told to see continue to decrease. With each passing day, you
    themselves will find yourself adopting a
    472 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    much brighter outlook, in which the positive closer and closer to the goal of becoming the player
    aspects of playing and the lure of success have that you want to be.
    taken on a great deal more appeal. And in this more
    positive frame of mind, you will come to
    experience wonderful new feelings of strength and
    energy as you find yourself looking forward Endurance Suggestions with
    eagerly to each new challenge, wanting more than Distance Runners
    ever to play and to win.
    Any psychological barriers or obstacles which J. Arthur Jackson, Gregory C. Gass, and
    might have been keeping you from performing E. M. Camp
    well are being eliminated. You are able to look
    forward to each new game, secure in the You are now so deeply relaxed that all the
    knowledge of your own abilities and of the vast suggestions that I am going to give you will be
    potential within you for further growth. Nothing is firmly fixed in the unconscious part of your mind;
    holding you back any longer. Every barrier, every so firmly fixed, so deeply embedded, that nothing
    obstacle, has been removed. You are completely will remove them. Everything that I tell you that is
    free to develop all the vast potential within you to going to happen to you, will happen exactly as I tell
    its fullest extent. you. Every feeling and sensation that I tell you that
    And as you proceed, the success of winning will you are going to experience, you will experience
    be experienced as infinitely richer and more just as I tell you and these things will happen
    rewarding than it has ever been before; whereas the particularly when you run. This entire project is
    sting of any occasional setback you may still really an experiment on human potentialities.
    encounter will be so considerably diminished that Exercise experts have discovered that most people
    you will scarcely notice it. You will be able to tend to underestimate their own capacities and
    accept any occasional reversal calmly and abilities. . . .
    philosophically, as the small price which must be There are really two major factors that allow you
    paid to experience the rich joys of playing and of to do your very best when running. The first, of
    winning. And even an occasional losing streak will course, is really wanting to do well with the
    no longer be of any undue concern to you. Since exercise tasks which you are to perform. This is
    playing itself has become so enjoyable, you will be something with which you are already familiar. But
    able to derive satisfaction from any game, the second one, which is even more important, is
    regardless of the outcome. something which you may not know about. This is
    All these changes will naturally result in marked the fact, that if you realize in advance what things
    improvements in your training, your preparation, ordinarily make you think you have reached your
    and in everything which contributes to your actual limit, you will be able to keep on going beyond the
    performance. You will make sure that you get all point where you are beginning to experience them.
    the rest that you require, and you will be able to Most people use discomfort and fatigue as signs
    sleep soundly and well. You will be able to do that they should stop what they are doing. They fail
    whatever else is necessary as part of your training to realize that discomfort and fatigue are the first
    and preparation. signs that they are approaching their maximum
    You will not waste time and energy worrying performance and that they can, in fact, keep on
    about your past or future performance; for each going far beyond that point. Most people generally
    time you play, you will feel yourself improving. assume that when they start feeling uncomfortable,
    Each time you play, regardless of whether you win this feeling will get worse but, as a matter of fact, if
    or lose, you will take continuing pride in your you allow yourself to keep on going after you start
    strategy and skill, and in your timing and to feel that discomfort, that feeling will actually di-
    coordination. And each time you play, you will
    find that you are advancing
    CONCENTRATION, ACADEMIC PERFORMANCE, AND ATHLETIC PERFORMANCE 473

    minish. I am taking it for granted that you are here the arms; you may experience breathlessness, a
    because you really want to be and that you are feeling of tightness in your legs, or a sensation of
    really eager to explore your potentiality and to do discomfort in the chest, throat, or mouth. You will
    your utmost on these tasks. In that case, the thing probably develop a sense of fatigue after you have
    that you really must keep in mind is the importance been running for some time. As you start to
    of noticing each sign of discomfort or fatigue and experience any of these sensations, this will be a
    using it as a stimulus to keep on going. Then put it stimulus for you to run even harder. As a result of
    aside in your mind and concentrate on the running this, you will find that you are able to go on and
    itself. It is terribly important to us in this actually run through this experience so that you
    experiment, to find out exactly how much you can become less aware of whatever discomfort you
    do with these tasks. The outcome of this were experiencing. You will feel as though you
    experiment cannot be successful unless you could go on running for a longer and longer period
    cooperate by giving us your absolute maximum of time. You will feel a greater desire to give a total
    performance. This is not going to be easy for it is effort; to use every bit of willpower that is within
    going to take every ounce of concentration, effort you. You will actually run through your most
    and willpower that you can muster. I want you to difficult period and, no matter how tired you start
    give it everything that you have got; to feel the to become, this will act as a stimulus so that you
    strain all through your body and to use that strain can continue running without becoming unduly
    and effort to good advantage using every resource distressed. As you concentrate on my voice, so all
    within you. Make this a total effort. these things that I am telling you will act on you
    As you run for a longer and longer period of when the time comes for you to perform the
    time, you may experience certain symptoms. You exercise task.
    may experience a feeling of heaviness in
    HYPNOTIC SUGGESTIONS
    WITH CHILDREN
    INTRODUCTION

    Hypnotic Responsivity in Children

    THE RESEARCH AND clinical literature on hypnosis with children suggests


    that they are usually good hypnotic subjects and typically more easily
    hypnotizable than adult subjects (London & Cooper, 1969). Children generally
    have very active fantasy lives, a characteristic of more hypnotically talented
    adults (Hilgard, 1979), and seem to be entranced in a world of their own much of
    the time. Most research suggests that as children reach adolescence, perhaps in
    response to socialization demands to become more rational and realistic, their
    hypnotic capacities tend to decline (Morgan & E. Hilgard, 1973; Morgan & J.
    Hilgard, 1979). Although much research has suggested that hypnotic talent
    reaches a peak of responsiveness between the ages of eight and twelve, there is
    controversy concerning the methodology of these studies (Olness & Gardner,
    1988), and hypnosis has also been found to be quite valuable with preschool
    children (Gardner, 1977). Thus, hypnotic techniques may be of particular benefit
    in the practice of enlightened pediatricians, emergency room personnel, dentists,
    child psychiatrists, psychologists, and social workers.

    Tailoring Hypnosis to Children


    As you will see in the presentation in this chapter by Kohen, success in
    working with children requires that you adapt induction procedures and
    suggestions to the age of the child. Significant research has documented, for
    instance, that children have difficulty closing their eyes in hypnosis and will
    often respond better when this is not demanded (London & Cooper, 1969;

    475
    476 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Moore & Cooper, 1966; Moore & Lauer, 1963). Developmental issues with children should be taken into
    account (e.g., adapting language to the age of the child and considering cognitive and perceptual skills at
    various ages).
    Taking developmental issues into account, Olness and Gardner (1988) recommend induction techniques
    with children ages two to four that include blowing bubbles, pop-up books, storytelling, using a stereoscopic
    viewer, imagining a favorite activity, speaking to the child through a stuffed animal or doll, use of a
    Raggedy Ann or Andy doll, and watching an induction on videotape.
    Between the ages of four and six, useful inductions may include imagining a favorite place, imagining
    interactions with favorite animals, imagining being in a flower garden, storytelling, imagining a chalkboard
    with letters of the alphabet appearing on it, imagining a television program, use of a stereoscopic viewer,
    pretending to be bouncing a ball, and imagining activities on a playground (Olness & Gardner, 1988).
    In middle childhood (ages seven to eleven), meaningful inductions often include imagining a favorite
    place, activity, or music, imagining riding a bike or being carried on a magic flying blanket, imagining
    watching clouds change shapes and colors, or eye fixation on a point on their hand. Adolescents frequently
    enjoy induction procedures such as arm catalepsy, imagining driving a car, being in a favorite place or
    engaged in a sports activity, imagining playing or hearing music, arm levitation, absorption in breathing, and
    adult methods of induction (Olness & Gardner, 1988).
    Sometimes parents will be resistant to the idea of using hypnosis with their children because of
    widespread misconceptions about hypnosis (Gardner, 1974b). Educating parents concerning myths and the
    nature of hypnosis, as well as the specific advantages of using hypnosis with their child, will be invaluable.
    You may also allay parental fears by allowing them to observe hypnotherapy with their children, although it
    has been suggested that this be postponed until after the initial induction (Gardner, 1974b). Some parents
    may additionally wish to experience hypnosis themselves to set their minds at ease. Gardner's contribution at
    the beginning of this chapter provides other ideas for helping parents see the advantages of child
    hypnotherapy.

    Indications and Contraindications


    Olness and Gardner (1988) suggest the following broad indications for child hypnotherapy: (1) when a
    child shows responsiveness to hypnotic inductions; (2) when a problem has been shown to be treatable
    through hypnosis; (3) when there is a positive relationship between the therapist and child; (4) when the
    child possesses at least some motivation to remedy the complaint; (5) when parents or guardians approve the
    treatment plan; and (6) when the use of hypnosis is not anticipated to cause iatrogenic harm.
    In contrast, we must be cautious about acceding to parental demands to use hypnotic magic to bludgeon
    their children into submission. The child
    HYPNOTIC SUGGESTIONS WITH CHILDREN 477

    must possess at least some motivation for change. We should point out, once again, that mere knowledge of
    hypnosis does not qualify one as a child therapist. This is a subspecialty area requiring training in more than
    hypnosis alone. If you are not trained to treat a pediatric problem with techniques other than hypnosis, you
    should not be treating the patient with hypnosis. There are certainly times (e.g., enuresis) when thorough
    medical evaluation is indicated prior to using hypnosis. Other absolute contraindications (Olness &
    Gardner, 1988) for child hypnotherapy include: (1) when it would lead to physical endangerment of the
    patient (e.g., in athletics); (2) when the use of hypnosis might aggravate existing psychological problems or
    create additional ones (e.g., creating amnesia for a girlfriend who has rejected an adolescent.); (3) when it is
    "for fun" (stage or entertainment hypnosis); (4) when a problem may be more effectively treated by a
    nonhypnotic method (e.g., family therapy); and (5) when a referral source or parent asks for hypnosis based
    on a misdiagnosis, and the actual problem should be treated in some other way.

    Areas of Application
    Hypnosis has been used with a tremendous diversity of childhood problems: text anxiety, problems with
    studying and concentration, reading difficulties [suggestions on these topics may be found in Chapter 14],
    phobias (e.g., of school, animals), sleep disorders, social skill training and anxiety, conversion reactions,
    psychogenic amnesia, seizures, pain, bulimia and anorexia, enuresis (bedwetting), encopresis (soiling),
    stuttering, trichotillomania (hair pulling), nailbiting, thumbsucking, obesity, sleepwalking, tics, learning
    disabilities, chronic and acute pain, preparation for surgery, burns, gastrointestinal complaints, asthma,
    hives, allergies, warts, hyperhidrosis (excessive sweating), to increase compliance in diabetics, hemophilia,
    juvenile rheumatoid arthritis, dentistry, headaches, urinary retention, cerebral palsy, Tourette syndrome,
    cancer and terminal illness, and sports. You will find suggestions concerning some of these areas of
    application in the pages to follow.
    Those who wish to consult excellent texts concentrated on hypnosis with children are encouraged to
    study Olness and Gardner (1988), Wester and O'Grady (in press) and Ambrose (1961).

    Helping Parents See Specific and misunderstandings, we show them that there
    are specific reasons for selecting hypnosis as the
    Advantages in Child Hypnotherapy treatment of choice at a particular time. That is,
    G. Gail Gardner, Ph.D. parental enthusiasm and cooperation will be
    maximal if hypnosis is perceived not as "just
    Parents can be of the greatest help in child another treatment" but as having its own special
    hypnotherapy if, beyond alleviating their fears advantages. Of course, some of these benefits will
    be more relevant for one child than
    478 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    for another, and the hypnotherapist PARENTAL PARTICIPATION


    should vary the emphasis accordingly.
    Many parents, especially those whose children
    have serious medical or emotional problems,
    LIKELIHOOD OF SUCCESS experience marked feelings of helplessness. They
    feel that they must stand by— at best useless and
    The parents can be told that most children are more often in the way— while the "experts" work
    quite easily hypnotized because of several reasons, to relieve the child's distress. This is not just true of
    including their interest in the technique and the parents who feel guilty or in some way responsible
    absence of pain or unpleasantness in hypnotic for their child's problem; most parents derive a
    induction. Of course, the parents are cautioned that special sense of pleasure and fulfillment from
    hypnosis is not effective in every case and, even for helping their children and feel frustrated when this
    a particular child, may be helpful for some is not possible. Parents who are encouraged to
    problems but not others. It may help to discuss the assist in hypnotherapeutic sessions, or at least to
    literature on the use of hypnosis for the problem at encourage the child between sessions, enjoy
    hand. This might alleviate parental fear that the participating with the "experts" in the helping
    child is being experimented upon, especially in the process.
    unfortunate but all-too-frequent event that In fact, it is usually not long before a parent
    hypnosis is being tried as a last resort. notes that the simple, repetitive, soothing features
    of hypnotic inductions are similar to the normal
    behavior of parents toward children in distress.
    LACK OF SIDE EFFECTS Thus, participation in hypnotherapy can be seen by
    them as an extension of natural parenting behavior
    For many medical and emotional problems,
    and not as part of the vast array of exotic and
    previous treatment has included drugs which
    unpronounceable drugs, machines, paraphernalia,
    produce drowsiness, nausea, or other unpleasant
    and concepts which comprise most treatment
    side effects. Parents are relieved to realize that this
    procedures. Parents come to regard hypnosis with
    is not the case with hypnotherapy. Occasionally,
    an attitude of casual confidence, knowing that
    they ask if a child can become "addicted" to
    neither they nor we fully understand how it works,
    hypnosis, wanting to be in hypnosis all the time,
    but still not looking on it as magic.
    but they are reassured, especially when reminded
    that the purpose of posthypnotic suggestions is to When hypnosis is presented as a state which can
    carry the benefits of the hypnotic state over into the be used for many purposes, parents often find
    waking state. themselves being quite creative in using
    hypnotherapy for purposes other than those
    originally intended. Of course this assumes that the
    ACHIEVING AND MAINTAINING THE parent has had sufficient training to know when
    CHILD'S MOTIVATION hypnosis might not be appropriate and can
    maintain contact with the hypnotherapist for
    Both parents and children often become en- consultation as needed. Thus, for example, one
    thusiastic when hypnotherapy is suggested, es- parent, whose terminally ill child had successfully
    pecially if other treatment techniques have failed. used hypnosis for relief of pain and nausea, thought
    It relieves growing despair by offering a new of trying it to help curb the child's excessive
    approach. Increased hope then increases appetite when he was put on large doses of
    cooperation. If the hypnotherapy is successful, the steroids; the boy cooperated well and the result was
    results are usually obvious and appear quickly, a return to normal appetite level after one
    thus allowing even young children to see its value. hypnotic session. The same
    HYPNOTIC SUGGESTIONS WITH CHILDREN 479

    parent, however, raised thoughtful questions with the situation. Such a positive parental attitude also
    the hypnotherapist and agreed to abandon her idea gets communicated to the child, who can use it
    of possibly using hypnosis to gain more constructively to help develop still stronger
    understanding of the child's concept of death when feelings of hope and mastery. Thus a growth cycle
    it became clear that the outcome might produce of positive feeling results between parent and
    unnecessary distress for the child. child.
    One mother listened to her sick child's hypnotic
    dreams of being an eagle who could fly easily from
    FLEXIBILITY one safe and happy place to another, and she
    reported her own feelings of relief and tenderness,
    In addition to the kinds of creativity already as she heard him express previously untapped faith
    described, parents are comforted and relieved to in his potential for self-protection and recovery.
    learn of other dimensions of flexibility in Another mother, whose family lived at a great
    hypnotherapy, and this, too, maximizes hope and distance from the medical center where the child
    participation. For example, they like the idea that was being treated, reported instances when both
    flexibility of wording or induction technique can she and her daughter had encouraged each other by
    bring them closer to a desired goal. Parents report discussing the value of hypnosis for easing pain
    successfully varying original wording in an and inducing sleep. . . .
    unexpected situation. Likewise they find appealing Although these kinds of successful experiences
    the idea that hypnotherapy can be done with are not possible for the parents of all children, it
    children by telephone or with the aid of a tape certainly seems worth the effort of trying to
    recorder. educate them concerning the value of hypnosis.
    Once parents are comfortable with the idea that Though parents' initial attitudes may indeed be
    their child can master self-hypnosis, they gain a obstacles to progress, a positive and low-keyed
    special feeling of security in knowing that this approach from the hypnotherapist can usually
    treatment modality is available to the child at any result in the parent's becoming an ally and an asset
    time or place. One parent of a leukemic child in the effort to help the child. Unfortunately, some
    remarked on how nice it is that hypnosis is "so professionals focus only on the obstacle
    portable" and reported that this had allowed the phenomenon and never work toward a better goal
    family to feel more comfortable visiting relatives with the parents. They feel that the solution is
    during the later stages of the child's illness. This either to abandon the idea of hypnosis altogether or
    writer deliberately avoids using any sort of to use it surreptitiously, calling it by some other
    "gadgetry" such as egg-timers or locking in the name. While the latter approach may bring some
    induction to any particular set of circumstances or success, the potential results might be far greater
    environment, since these may not be always with the parents' active support.
    available when needed. Finally, a word about the ethics of using
    hypnosis with a child without the knowledge of the
    HOPE AND MASTERY parents. As indicated in a previous paper (Gardner,
    1974a), this writer is willing to call hypnosis by
    It is commonly known that, when a child is in some other name (suggestive therapy, relaxation
    distress, the parents' anxiety and despair can get therapy) if it is clear that the parents are too
    communicated to the child, thus aggravating the uncomfortable with their concept of "hypnosis"
    child's distress and setting up a vicious cycle. and cannot benefit from professional explanation.
    Likewise, when parents see their children The point here is that the parents agree with the
    experience feelings of hope and mastery after essentials of the technique (e.g., using relaxation to
    successful use of hypnosis, the parents, too, report reduce fear)
    feeling more hopeful and peaceful about
    480 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    and that the name given to it is really not that awareness, and in their ability and desire to learn
    important. However, if after discussion with the something new, I appeal in a matter-of-fact,
    hypnotherapist, the parents expressly state they do expectant fashion to those experiences I know they
    not want hypnosis to be used, then this writer must have had with daydreaming or imagination. I
    would not do so. This experience, however, is quite then build on these in order to introduce, explain,
    rare, unless one or more professionals have already and demystify the forthcoming hypnotherapeutic
    discussed hypnotherapy with the patients in very experience. Thus, I may say, "You know how
    negative terms, usually saying either that it is when you daydream you can pretend to be
    dangerous or that it is ineffective for this problem. wherever you are daydreaming and still be where
    you are?" And they understand. And I might add,
    "And you can notice everything about whatever
    you are daydreaming about— what you see and
    Hypnosis with Children hear there. Isn't that pretty neat?" And then I might
    matter-of-factly present a "quick opportunity" for a
    Daniel P. Kohen, M.D. safe, brief hypnotic experience, designed
    Minneapolis, Minnesota
    purposely to facilitate comfort, trust, and enhance a
    sense of personal control:
    In working with hypnotherapeutic techniques "Well, before we do anything on purpose to
    with children it is fundamentally important to work on the [problem], let's just practice some
    remember that hypnosis with children is easy but daydreaming and imagining and relaxing together
    not simple, it is fun but requires concentration, and [reassurance to the child that he/she is not alone] to
    it should be conducted with respect for the child remember how easy it is; . . . and then later
    and his/her intrinsic abilities. Children learn [creating expectations] I'll show you how you can
    hypnosis even more easily than adults because they use the same thing [anchor] to help yourself
    are, as part of their normal growth and [ego-strengthening]. So . . . just get comfortable
    development, spontaneously in and out of and close your eyes and start daydreaming or
    alternative states of awareness (imagination) all pretending about something." [Note: Children
    day long. They are also usually highly motivated to under six or seven may not want to close their eyes.
    make a change (in the problem for which they have Clinicians must be aware of, prepared for, and
    come). A key to teaching children how to build comfortable with this. One might say instead, "And
    you can close your eyes or keep them open until
    these self-regulatory skills is trust and rapport with
    they close or just look at something carefully to
    the clinician. The clinician's approach to and
    help you concentrate the way you want to on your
    language with the child are also more important
    daydream."]
    than the precise "hypnosis" induction or technique
    utilized. As is critical with most if not all hypno-
    therapeutic suggestions for children, these state-
    ments are framed with certain principles in mind:
    INTRODUCING HYPNOSIS TO i.e., choices that imply directly both that change
    will take place and that the child has options within
    CHILDREN
    that choice; that you believe what you are saying
    Children understand hypnosis as the same as or and that the child is competent to make a change
    analogous to pretending, daydreaming or occur; that the child is in control and you are the
    imagining. Accordingly, it can and should be coach or teacher; and that you respect and believe
    presented to them as "something you already know in the child.
    how to do but maybe didn't know you knew, or As the child closes eyes and/or develops fixed
    maybe didn't know you could use to help yourself gaze to indicate trance has begun, simple sug-
    with [whatever problem they are having]." gestions to build the imagery are all that are
    Believing in children's ability, in their
    HYPNOTIC SUGGESTIONS WITH CHILDREN 481

    required to enhance the belief in (and "depth"of) the enhance a sense of personal control, as well as to
    hypnotic experience. These should be multisensory, create awareness of physical changes that occur in
    permissive, open-ended, and general: "While you relation to changes in the mind. Thus, in expectant
    are daydreaming or pretending or imagining— I fashion, while the child is in a hypnotic state, I will
    don't know which you like the best — make sure it say, "You probably already noticed [and if she
    is really fun because [children, like adults, need a didn't, she will now!] that your face muscles are
    reason to carry out the suggestion] you are the boss relaxed" [or "your neck muscles" or . . .] and that
    of your imagination [ego-strengthening]. Notice [an your breathing is slower than it was before, and
    invitation to concentrate, pay attention] what you that's because you are doing this exactly the right
    see there in your imagining, who is with you or way . . ." [to reinforce personal control, acceptance,
    maybe you're alone or with friends or family or new and take the whole thing out of the realm of
    friends. Notice where you are, whether you're inside "spooky or scary"]. I then build on this by adding,
    or outside, whether the weather is hot or cold or in "And since you and your brain are the boss of your
    between, or rainy or snowy . . . and hear the sounds body, you can even make your relaxation even
    there in your favorite place . . . maybe you'll hear more than it already is . . . because our bodies
    voices of people talking, or sounds of music, or already know how to relax .. . and we even relax a
    machines, or of the weather ... or maybe it's quiet little bit each time we breathe out . . . just notice
    and you'll listen to the quiet . . . and notice the smells how your shoulders go down every time you
    where you are imagining, and the tastes there. . . ." breathe out . . . [pause, add "that's right" on next
    exhalation] so, to help relax even more, just take a
    Often I will point out to the child the importance
    slow . . . deep . . . breath . . . in . . . and . . . out . . .
    of understanding the "natural way that the body
    and when you breathe out . . . say 'relax' to yourself
    relaxes when you focus your imagination this
    in your inside thinking . . . and just notice what
    way." This, like other suggestions, is offered in
    happens as your shoulders go down and relax."
    order to demystify the experience, to

    HYPNOSIS WITH PAIN

    Hypnotic Procedure for Pain (e.g., in dental or surgical procedures) or a patient


    may be at risk for injury. The management of this
    Relief matter is discussed by Dr. Wall in the latter part of
    Valerie J. Wall, Ph.D. this procedure. (Ed.)
    Seattle, Washington
    PRE-INDUCTION
    INDICATIONS
    Today we are going to talk about ways to teach
    This hypnotic method is designed for treating you and your body to be comfortable during what
    pain problems in children who are between six and might normally be a painful procedure or injury.
    ten years of age. The induction and deepening We know that your mind can help you be more
    verbalizations are included along with the comfortable, even when we wouldn't normally
    therapeutic strategy because of the comparatively expect that to be true. Your mind is able to make its
    limited amount of modeling that is available own sort of numbing medicine which it can send
    concerning hypnotic work with children. All pain out through your body to help you be comfortable
    should not be removed hypnotically except under whenever you need to be. There are many ways in
    very selective conditions which your
    482 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    body is able to make numbing for you and today would like to experiment with your car. You can
    we need to find the way that is just right for you. begin by flying it low along the ground, or perhaps
    you would like to soar high into the sky and take a
    look at the view from up there. Whatever you do,
    THE CLOUD CAR INDUCTION have a good time doing it. Make your experience as
    real as you can, enjoy yourself, see yourself
    To begin with, I'm going to ask you to use your
    laughing and feeling the comfort of being in your
    imagination to think about something that you like
    own special car. [Pause]
    to do very much. You may want to think about
    doing this with your eyes open or you may want to And now that you've had a chance to fly your car
    think about doing it with your eyes closed. a bit, I'd like you to begin to head toward that
    Whichever one works best for you is the one that special place that you and I have already talked
    you need to do. I want you to start by imagining about. You may want to take a scenic route there,
    that your body is becoming very, very relaxed and looking at the mountains or the ocean. Perhaps
    very comfortable, and that your mind is busy you'd like to fly over and check out the Pyramids or
    thinking about the things I am saying to you. Big Ben in London, or a castle or two. Wherever
    you go, remember that you have a bird's eye view
    Let your body feel relaxed and comfortable and
    and that the air you are flying in is fresh and clean
    let the chair you are sitting in begin to feel soft and
    and relaxing, and that it feels very, very soft against
    fluffy. You can notice that this soft and fluffy
    your skin. After you've toured some and are ready
    feeling happens somewhat gradually, but that it is
    to head toward your special place, you can let me
    beginning to be there by now. And as you're
    know by moving your finger [head nodding or
    thinking about this feeling, you can also notice that
    it's possible to turn that soft and fluffy feeling into a verbal communication are also used, depending on
    very special car just for you. We'll call this your the youngster.]
    cloud car, and it is your own cloud way toward fun That's fine. And now I'd like you to move toward
    and imagination, and more control of your mind your special place and very gradually begin to
    and body. You may picture your cloud car in your lower your cloud car to the ground. You may land
    mind's eye any way that you would like to. Get a very, very slowly. As you do so, look around and
    good look at the controls, look at the size and enjoy the sights and the sounds and the smells of
    shape. Is it fast, does it maneuver well, can it go your special place. And once you have landed your
    high in the sky? All of these things can be true and car, coming down slowly, drifting, gradually
    what's most exciting of all is knowing that this car landing, softly on the ground, you can park your
    is completely under your control, and that you're car and get ready to play in your special place.
    able to drive it in a way that is fun and exciting, and
    relaxing and beneficial to you.
    ENHANCEMENT

    DEEPENING And now you can enjoy the feeling of being in


    your special place. Perhaps as you walk you can
    I'd like you to begin to fly your cloud car now. feel the ground beneath your feet. The warmth and
    Get very comfortable and used to the controls. You the comfort of walking across such a familiar and
    will notice that if you lean forward your car goes happy place, the soft freshness of the air against
    down, if you tip back it goes up, if you tip to the your skin and body, and the pleasantness of the
    right it goes to the right, and if you tip to the left it warmth from the sun on your skin.
    goes to the left. These are just a few of the ways in You can also see your surroundings. You can
    which you can control the flight of your car. see the animals and the planets, the sky above and
    Perhaps you all the things that you love to have there
    HYPNOTIC SUGGESTIONS WITH CHILDREN 483

    with you. And you can make the pictures more mind and body together. You can bring a friend
    vivid in your mind and make your experience with you if you'd like, or perhaps your pet or your
    more real by seeing and feeling being there. favorite toy. And you can enjoy playing in the mist
    Use your sense of smell. Find out what you can and feeling good about yourself. If you want to,
    smell. Can you smell the freshness of the air, the use the mist to help you with numbing your body.
    fragrance of being out in nature, the freshness? Use You can do this simply by touching the place
    your sense of smell to enhance your experience. where you need numbing medicine while you are
    You can also use your sense of taste. Can you in the mist. When you do this, your body will know
    that it is time for it to put numbing medicine there.
    taste the smells? Can you taste the air? All of your
    And you will experience a small amount of
    senses help to make your imagination experience
    tingling or a funny feeling in that one spot. And it's
    very, very real and vivid for you. They help to
    a good feeling, a feeling of confidence and
    make your experience more comfortable and more well-being.
    fun for you. Use your imagination and your mind's
    eye to make your experience become very, very [After the youngster has been given adequate
    real. time to play in the mist, I generally encourage
    him/her to talk with me about his/her body
    sensations and other experiences while there. This
    is all done during trance, in order to facilitate
    THERAPEUTIC STRATEGY
    feelings of control regarding physical
    symptomatology and to improve general
    And now I'd like you to begin to see, at a short
    self-confidence. Once these objectives have been
    distance away, a small area in which there is an
    obtained, the youngster is brought back out of the
    amount of mist or fog. The interesting thing about
    mist and the induction, deepening and
    this mist is that it's very inviting, very welcoming,
    enhancement phases are worked through in reverse
    and very safe for you. It's quite a special place in
    order to the conclusion of trance.]
    that you can walk over to the mist and it will assist
    you in making your body more comfortable. Go Now that you have had an opportunity to play in
    ahead, walk toward the mist, taking all the time the mist, you can get ready to leave and gradually
    you need to become familiar with how it looks. return to your cloud car. It is important for you to
    [Pause] When you get closer, perhaps you'd like to remember that the mist is always available to you
    reach out and touch it with your finger. You will and that you can return to it at anytime you so
    find that it has a pleasant feeling, that it makes your choose. The mist is always available and able to
    skin feel good. It may even make you tingle just a help you whenever you need it. The mist will help
    little in your fingertip as you touch it, just as if you to gain greater control over mind and body.
    there were just a little numbing medicine there. Go The more you practice, the easier this will become,
    ahead, have fun with the mist. You can play in it and the easier it becomes for you, the greater
    and you can enjoy it. [Pause] And as you play in it, control and confidence you will experience over
    your body is more and more able to produce its mind and body. As you return to your cloud
    own numbing medicine inside, and send that vehicle, you can enjoy the sense of confidence and
    medicine wherever you would like it to be. You well-being which you have in knowing that you
    can feel a sensation of happiness when you are in can return, and in knowing that you have gained
    the mist. Your body is pleasantly warm and new skills that you can use to help yourself. And as
    comfortable while you are there and you are you return to your vehicle, you can step in and take
    relaxed and happy in the mist, and see yourself charge of the controls and gradually fly your
    laughing and enjoy knowing that, that is what vehicle into the air and begin your journey back,
    you're doing. flying back toward the office and back toward the
    chair, knowing that at any time you choose in the
    And you can know that whenever you come to
    future you can turn your chair into a cloud vehicle
    the mist, you wilt develop greater control of
    and into
    484 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    an imagination experience which will lead you to several in combination. Every technique involves
    the mist and to the comfort and confidence of being suggested dissociation, either directly or indirectly.
    there. You can do this at any time that you need to. For instance, notice how the phrase "that arm"
    And now you can gradually begin to land your rather than "your arm" facilitates dissociation. Our
    vehicle in the chair and let the chair begin to feel list is by no means complete. Other
    once again more like a chair, more like the chair in hypnotherapists will prefer variations of our
    the office, and more like the room in which we are methods or will develop other methods.
    sitting. And now I am going to wait here for you,
    and you can enjoy your journey, coming back to the
    chair and back to the room in which we are sitting
    whenever you are ready. And I'll wait for you and DIRECT SUGGESTIONS FOR
    I'll know that you're ready to talk to me about your HYPNOANESTHESIA
    experience once again, when you open your eyes
    and are comfortable, and relaxed, and alert and REQUEST FOR NUMBNESS. "You know what a numb
    refreshed. feeling is. How does numbness feel to you? [Child
    [In the debriefing period following induction, I responds.] Good, just let that part of your body get
    generally discuss the children's experiences with numb now. Numb like a block of ice [or whatever
    them, adding or guiding any therapeutic image the child has used]."
    corrections that might be necessary. I also suggest
    to children that they have learned a skill which they TOPICAL ANESTHESIA. "Just imagine painting
    can use in order to reduce or eliminate pain when numbing medicine onto that part of your body. Tell
    necessary. However, I emphasize that pain is a me when you're finished doing that."
    necessary body signal which warns us that we are
    in some danger. Therefore, I ask that all children LOCAL ANESTHESIA "Imagine injecting an anes-
    agree to report the presence of pain to a responsible thetic into that part of your body. Feel it flow into
    adult and to make sure that they are being cared for your body and notice the change in feeling as the
    by someone else before "shutting off the feelings of area becomes numb."
    pain. This insures that they will receive either the
    necessary parental or medical attention before di- CLOVE ANESTHESIA "First, pay attention to your
    minishing their distress. Children are generally hand. Notice how you can feel tingling feelings in
    very responsible about this condition, as they that hand. Then let it become numb. When it is
    recognize the need for adult assistance when very numb, touch that hand to your jaw [or other
    physical injury or insult is present.] body part] and let the numb feeling transfer from
    the hand to the jaw."

    SWITCHBOX The therapist explains the idea that


    Techniques of Hypnoanalgesia pain is transmitted by nerves from various parts of
    the body to the brain, which then sends a "pain
    Karen Olness, M.D. message" back to the body. The therapist can
    Cleveland, Ohio, describe nerves and their pathways or can ask the
    and child to provide a color for nerves. The importance
    G. Gail Gardner, Ph.D. of accuracy varies with the age and needs of the
    child. Then the child is asked to choose some sort
    The following techniques represent methods we of switch that can turn off incoming nerve signals.
    have used with our patients. We often use The therapist can describe various kinds of
    switches, such as flip, dimmer, pull, or even a
    television computer push-button panel or control
    panel of
    HYPNOTIC S U G G E S T I O N S WITH CHILDREN 485

    lights. Having chosen a switch, the child is asked SUGGESTIONS FOR FEELINGS
    to begin practicing turning off the switches or the ANTITHETICAL TO PAIN
    lights that connect the brain and certain areas of
    the body. It is useful to ask the child to turn off the COMFORT. "Recall a time when you felt very
    incoming nerve signals for defined periods of time comfortable, very good. Then bring those good
    (e.g., 10 minutes, 15 minutes, or 90 minutes). The comfortable feelings into the present. Let your
    success of the exercise is judged by touching the body feel comfortable here and now. You can let
    child with a small gauge needle or some other comfortable feelings fill your whole body and
    sharp object and asking for a comparison with mind completely, until there is just no room for
    feelings on the other side where the nerve signals discomfort. You can be completely comfortable,
    are unchanged. and you can keep these good feelings for as long as
    you like."

    DISTANCING SUGGESTIONS LAUGHTER "Laughing helps pain go away. Think


    of the funniest movie you ever saw or the funniest
    MOVING PAIN AWAY FROM THE SELF. "Imagine for thing you ever did or your friend did. Each time
    a you imagine laughing, your pain becomes less and
    while that that arm [or other body part] doesn't less. You may find yourself really laughing and
    belong to you, isn't part of you. Think of it as part feeling very good."
    of a sculpture or a toy, or picture it just floating out
    there by itself." Some patients comfortably RELAXATION. "Concentrate on breathing out,
    imagine having only one arm; others imagine three for that is a relaxing motion. If you relax
    arms, one of which is dissociated. completely when you breathe out, you can reduce
    the pain. Follow your breathing rhythm. Relax
    TRANSERRING PAN TO ANO THER B ODY PART. "Im- more each time you breathe out. You may find that
    agine putting all the discomfort of the spinal tap you can cut the pain in half. And then in half again.
    into the little finger of your right hand. Tell me Use your energy where it will help you feel better
    how much discomfort is in that little finger. Give it and get better."
    a numerical rating and let me know if it changes.
    Good. Now let it float away."
    DISTRACTION TECHNIQUES
    MOVING SELF AWAY FROM THE PAIN. "YOU Said
    you
    FOCUS ON UNRELATED MATERIAL Young children
    like to go to the mountains. Imagine yourself there
    often obtain some pain relief if the therapist tells a
    now. Let yourself really be there. Just leave all the
    story, either in its original form or with ridiculous
    discomfort and be in the mountains. See the trees
    variations such as changing the characters ("Once
    and flowers. Watch the chipmunks playing. You
    upon a time there were three little wolves and a big
    can give them some of your food if you like. Smell
    bad pig") or their roles ("Once there was a wolf
    the fresh air and the pine trees. Listen to the gentle
    who cried 'Boy, boy'"). Older children may be
    wind. Listen to the running stream." In one study
    distracted by discussion of areas of interest such as
    of adults (Greene & Reyher, 1972), it was
    sports or music.
    suggested that body-oriented imagery (e.g., feeling
    the warmth of the sun) was less effective for hyp-
    FOCUS ON PROCEDURE OR INJURY. This method is
    notic pain control than imagery that was not body
    especially useful for children for whom cognitive
    oriented (e.g., looking at scenery or skiing). We do
    mastery is a major coping mechanism. The
    not know if these same results are applicable to
    therapist asks the child to describe the injury in
    children.
    detail, how it occurred, how others reacted, and so
    on. In the case of a painful procedure, the
    486 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    therapist describes various instruments and asks therapist can ask the child to focus on a piece of
    the child to assist by holding instruments or music, or a smell (e.g., by bringing an open bottle
    bandages, counting sutures, or checking the time at of perfume near the child's nose), and on the
    various points. discomfort at the same time. The child will
    gradually learn that the perception of two stimuli
    FOCUS ON LESSER OF TWO EVILS. If a child feels fades as the attention is shifted to one.
    both pain and cold, the therapist can focus on the
    cold. If a child is having a spinal tap and also has an REINFORCEMENT
    IV running, the therapist can focus on the IV.
    We encourage — but do not demand — that our
    patients practice their skills in hypnotic pain
    control, using variations or new methods as they
    DIRECTING ATTENTION TO PAIN
    see fit. The more confident children are of their
    ITSELF
    ability to use these skills, the more likely it is that
    they will use them whenever it is appropriate to do
    For various reasons, some children refuse or are so. Other methods of reinforcement include
    unable to focus attention on anything but the selected use of audiotapes, videotapes, parents
    experience of pain. The therapist can utilize this acting as therapeutic allies, group meetings, and
    behavior to the child's own advantage. By joining communication with other patients who have
    with the child and asking for a detailed description successfully used hypnotherapy for pain control.
    of the pain, the therapist can offer subtle
    After several practice sessions, the therapist can
    suggestions for change and relief. Confusion
    ask the child which type of relaxation or imagery
    techniques also help.
    exercise is most helpful. This can be taped and
    placed over the child's favorite music, if he or she
    LIGHTED GLOBE. "Imagine you are inside a lighted
    wishes, and made available on a Walkman-type
    globe and you can see yourself walking around on
    recorder during procedures. The child can also be
    the inside of a map of your discomfort. Notice that
    encouraged to tape himself guiding himself
    discomfort very carefully. See it right now in a
    through a relaxation exercise; this can also be
    color you don't like. I'll ask you to check it again
    placed over favorite music. Therapists should also
    later. Notice what size it is. It might be the size of a
    encourage children who are skilled in pain control
    grapefruit or a grape or a lemon. Even a pinhead
    to help the therapist coach other children. This
    has a size. We'll check the size again later. And
    gives confidence to the child who is teaching, and
    notice the shape. What shape is it right now? And
    the learner will trust that other child.
    what is it saying to you now? How loud is it right
    now? Later we'll see if you can still hear it. Look
    again. What color is it now? That's interesting. It
    seems to be changing. I wonder how you did that. Pediatric Wound
    How small is it now? Can you change the size too? Injection-Using a Visual
    Yes. You are really in charge there in that lighted Distraction Technique
    globe. You are a good map maker. You can go
    wherever you want. Feel whatever you want. What Steven F. Bierman, M.D.
    shape is the discomfort now? Can you still hear it?" Encinitas, California
    Older children can benefit from a technique of
    focusing on breathing, then shifting focus to the INTRODUCTION
    area of discomfort, with emphasis on the fact It is a sad paradox that the injection of local
    that it is changing. Subsequently, the anesthesia into a wound — in order to render
    HYPNOTIC SUGGESTIONS WITH CHILDREN 487

    debridement and wound closure painless— is itself TECHNIQUE


    painful. In pediatrics, especially, such an unpleasant
    prelude often aggravates the situation for both What follows is a transcript of the technique, from
    patient and physician. the first moment of the encounter to the conclusion of
    The following technique serves to eliminate the the injection. Often, the author proceeds from this
    pain of wound injection. It makes simple use of the technique to trance induction and maintenance,
    fundamental fact that consciousness (i.e., present thereby offering suggestions for wound healing,
    awareness) is limited. Thus, when consciousness is continuing comfort, etc., as circumstances require.
    preempted by pain, other stimuli are disregarded. [Doctor enters the room, looks directly and
    Distraction, then, is merely the redirection of inquiringly at the patient, momentarily disregarding
    consciousness from painful to nonpainful stimuli. parents.]
    Of course, when distraction redirects consciousness "And where is [JOHNNY]?" [The child is helpless
    from kinesthetic (i.e., feeling) to visual perceptions, and unimportant. With this question, he/she
    the likelihood of anesthesia is enhanced. immediately becomes the central figure. Moreover,
    the child now knows something the doctor does not
    know, and so, is no longer quite so helpless.]
    PRINCIPLES [Child indicates himself as Johnny] "Hi Johnny."
    Doctor extends his hand [something the child can
    The success of this technique hinges on the refuse], "I'm Dr. Steve. You really were scared,
    following basic principles. weren't you?" [By affirming the fact that the child
    was scared, the physician is both "pacing" the child's
    internal experience and consigning that experience to
    1. All children like to think of themselves as the past.]
    bigger, older, more capable. [Doctor touches or points to some unaffected part.]
    2. Confusion is an element of all hypnotic "Hmmmm, how is this part?" [Unlim-bering
    inductions. attention.]
    3. The degree of absorption of the subject is Child: "Okay."
    proportional to the degree of absorption and Doctor: "Okay . . . [moving elsewhere], "and this
    sincerity of the operator. part here?"
    Child: "Okay."
    Doctor: "Okay . . ." [moving again], "and this part
    PREPARATION here?"
    Child: "Okay." [giggles, curiously]
    In most cases, the presenting configuration is one of Doctor: "So, there really is quite a lot that's okay,
    (a) consciousness, fixed and fully absorbed in (b) a isn't there?" [Not waiting for an answer — building
    stimuli-generating wound. Both members (a and b) of response potential. Doctor now points to blood near
    the system warrant preparatory attention. the wound.]
    Accordingly, consciousness is unlimbered/unstuck Doctor: "And I see you had some good red blood,
    by attending to the wound last while devoting serious, didn't you?"
    brow-furrowing attention to other parts. The wound is Child: [bewildered nod]
    prepared by applying proparacaine 5% ophthalmic Doctor: "Good. Because if there is one thing I don't
    drops, after first placing a drop on the subject's hand like it's blue blood, or that crummy old pink blood. . .
    or forearm: "Now, that may feel just cold, or nothing . Good red blood."
    at all." Then, moving to the wound, "And I wonder Thus, the experience of bleeding is "re-framed" into
    how you will even know when it is all the way an opportunity for the child to witness one of his
    asleep?" superior qualities. The doctor
    488 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    now introduces himself to the parent and re peats two dogs, a mother dog and a father dog. And one
    the importance of noting whether it is, in fact, good is blue and the other is yellow. Okay? And the two
    red blood. dogs have four puppies. . . .Half of the puppies are
    [Doctor now turns to the wound.] the mixed color; and the other half are the color of
    "And now I can look." [Doctor regards wound.] the mother. What are the colors of the puppies? . .
    "Hmmm, and did you want just three stitches, or . And really think."
    four really good ones?" [That the child wants The question creates a focused state of internal
    stitches is presupposed.] absorption, requiring:
    Child: "Umm, . . . just three."
    Doctor: "Okay, just three stitches." 1. A mathematical operation (halving four);
    [The doctor now prepares to suture, placing 2. A visual operation (determining the outcome of
    sterile drapes, etc., and applies proparacaine to the mixing colors); and,
    wound.] 3. The resolution of the confusion resulting from
    Doctor: [continues] "And you're five years old, the deletion of necessary information (the color
    aren't you?" [Guessing the age at one year more of the mother). Similar questions—using other
    than the child's actual age.] animals, numbers, and colors —can also be
    Child: "No. Four." [Again, the child knows posed. It does not matter that some of the
    something the doctor doesn't know, but the mistake operations may be beyond the child's range of
    is in the child's favor.] competence, so long as they capture his/her
    Doctor: "Oh, I see, but smart enough to be a attention. However, it is best to allow for some
    five-year-old . . . and do you know how to mix measure of success. Two or three such
    colors?" questions are often used during a single
    [Child grimaces ambiguously.] procedure. Of course, the operator must always
    be seriously attentive and willing to repeat the
    Doctor: "Well, do you know what happens when
    question or to go on to another.
    you mix red paint and white paint?"
    Child: "Mmm. ..." [Many children will supply
    the answer correctly.]
    CONCLUSION
    Doctor: "It's pink, isn't it?
    Child: "Yeah." A method for painless pediatric wound injection
    Doctor: "And when you mix blue paint and is presented. Almost daily use of this method has
    yellow paint?" proved gratifying to the author and delightfully
    Child: "Green." surprising to both patient and parent.
    Doctor: "That's right! So you can mix colors.
    And do you know how to do algebra, too . . .?"
    [Parents usually discharge some nervous laughter
    here.] "Okay, so I'm going to show you how to do Examples of Suggestions for Use in
    algebra, just like a five-year-old, and mix colors.
    And this is just for you, Johnny; so your parents can
    Pediatric Emergencies
    just listen and wonder." Daniel P. Kohen, M.D.
    [Doctor now delivers a set of instructions, Minneapolis, Minnesota
    watching carefully for signs of maximal absorp-
    tion: eyes roll upward, distracted gaze, altered "As I wash it, all of the hurt can be washed away;
    facial tonus, etc. It is during this period of maximal as I wash and you breathe out, your muscles can get
    absorption that injection proceeds. Occasionally, if loose, soft, and comfortable."
    the child perceives the injection, the operator A pediatric patient with abdominal discomfort,
    desists momentarily and reemphasizes the nausea and vomiting enjoyed dancing, so she was
    visual/intellectual task at hand.] told she would be "pleased to find out how little
    Doctor: [continues] "Ready? Okay. There are things have to bother you, and you
    HYPNOTIC SUGGESTIONS WITH CHILDREN 489

    can be happy to see how relaxed you can become are sick.' Without altering his gaze or his breathing,
    even as you breathe slowly." he nodded, apparently in response to my
    "During trance several other suggestions were comments. The following exchange then occurred:
    given. These included the 'ease of learning how to Doctor: Isn't it good to know that you're going to
    help yourself feel good'; the 'ease of pain control'; be okay?
    and finally 'now that you know you are safe, and T.S.: [He nodded and turned his head toward
    going to be okay, you can allow yourself to become me.]
    more and more comfortable, knowing you don't Doctor: I guess it was hard when they put that
    have to vomit anymore, and that you don't even tube in your nose before?
    have to let the hurt bother you.' After pelvic T.S.: [Shakes head no.]
    examination, and before termination of Doctor: It's to clear all the blood out of your
    relaxation/mental imagery, the posthypnotic stomach so you won't have to throw up any more
    suggestion was given that, 'In a moment or two you blood . . . and then you can begin to get better . . . so
    can stay relaxed, even when you slowly reorient to it's real important that the tube goes into the
    this room . . . and then you may use this place in stomach. . . . Isn't it good to know that?
    your mind and these good feelings to feel T.S.: Yes. [Nod.]
    comfortable during further examinations, during Doctor: Now that you know that, I know that
    surgery, and after surgery.'" you want to find out how to do that really easily. . .
    . You know those switches in your brain that turn
    The following interaction took place in an
    off hurts? [This metaphoric suggestion for control
    emergency room setting with a boy, almost 13
    was offered directly and matter-of-factly—as a
    years old with first-time upper gastrointestinal
    foregone conclusion.]
    bleeding. He was uncooperative and staff had been
    previously unsuccessful in inserting the nasogastric T.S.: [A knowing nod.]
    tube. "It was apparent that T.S. was in a Doctor: Find the one for your nose and mouth . .
    spontaneous, albeit unhappy trance. He was staring . and when it's off, you know that will make it very
    quietly at the blood dripping into the tubing in his easy to swallow the tube down into your stomach.
    arm. His gaze was fixed, He was staring quietly at The helping tube will go down easy when the
    the blood dripping into the tubing in his arm. His switch is off . . . and, of course, your breathing tube
    gaze was fixed, his breathing very slow, and his will be very comfortable an won't be bothered . . .
    attention obviously focused. I then suggested to this goes only in the food tube . . . I'll help you. Did
    him, 'It is nice to know that the blood running is to you notice how when you breathe in you breathe in
    replace what you threw up.' In a similar, direct, and good feelings . . . and that you breathe out bad
    matter-of-fact way, I also whispered that he was feelings?
    'smart to come to the hospital when you T.S.: Yes."

    HYPNOSIS WITH ENURESIS

    A Hypnotherapeutic predicated at least in part upon those things that


    occur "before" any "official" hypnotherapy occurs.
    Approach to Enuresis Initially there must be the development of a
    Daniel P. Kohen, M.D. sensitive and positive rapport with the child, the
    establishment in the mind of the parents that the
    Minneapolis, Minnesota
    clinician is both competent and confident, and the
    As with any clinical problem in children, the appropriate and thorough clinical assessment of the
    success of a hypnotic approach to enuresis is problem itself.
    490 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    It is critical that a careful and comprehensive wet the bed" is usually the answer. My response is
    history be obtained so that the clinician can be usually to begin the reframing by talking instead
    assured that appropriate medical assessment of about dryness. I might say, therefore: "I'm sorry to
    enuresis has taken place prior to proceeding to do know that. Well, how many times a week do you
    hypnotherapy and teaching self-hypnosis. wake up in the morning in a DRY bed? In addition
    The history should assure that (1) the child is to reframing the focus on dry not wet, this
    over six years of age (at under age six, enuresis represents the introduction of language that will be
    should be considered a normal developmental used later in hypnosis, and thus is the "planting of
    variant unless the child has been completely dry seeds" for later use in the cultivation of
    and suddenly started to wet again); (2) the absence imagination. The history is then obtained (with the
    of associated daytime wetting (which most often parent present, but usually directed largely to the
    indicates either an important physical cause or a child) of the frequency of dry beds. We also learn
    more profound psychological problem), (3) the what happens, for instance, whether the child
    absence of known physical causes of enuresis such awakens during the night or learns in the morning
    as urinary tract infections, chronic constipation that the bed is wet, who changes the sheets, whether
    with or without soiling, urinary tract or not there is or has been punishment and the
    malformations, juvenile onset diabetes mellitus, child's feelings about that, and what the child
    diabetes insipidus, hyper-thyroidism, or spinal perceives will be different when he wakes up in a
    dysraphism. Such histories can be obtained with dry bed every day. This positive suggestion is
    questionnaires as well as being corroborated during offered as an expectation but also as an assessment
    an initial visit. to identify both the degree of motivation of the
    child for change, as well as his awareness of how
    In the context of history taking and rapport the problem is affecting his life. (Often this results
    development in the first visit, it is mandatory that in a response that being dry will enable him to go
    the child learn that the clinician (1) believes s/he on more sleepovers or to camp, which previously
    can help the child help him/herself, (2) knows that had been discouraged or disallowed.)
    the child feels bad about this problem, (3) knows
    that often many things have been "tried" before that It is important briefly to ascertain the thinking of
    "didn't work," and (4) believes that the child's both the child and the parents about the reason for
    ideas, thoughts, beliefs and worries are important the accidents. While the response may often take
    to the clinician. These can only be accomplished in the form of "he sleeps too soundly," or "it's
    the context of taking the history from the child, inherited, her uncle wet until age 14," the
    "joining" with the child, and teaching about the identification and discussion of their beliefs are
    body without trying to go "too fast." nonetheless important. I follow this with a brief
    I often learn the details of the problem by explanation that the specific cause is not easily
    focusing on dryness. Thus when a child comes in, I discovered, but that the method that I am about to
    often ask directly, "What are you doing here?" teach the child can be helpful as long as the child
    Some are shy, embarrassed, and/or sad and prefer won't mind having dry beds. Another indirect
    not to acknowledge the problem right away in this assessment of motivation, this usually results in the
    fashion. In turn, I ask instead if they would prefer child's agreement that he would indeed like to be
    to "talk about some other stuff for a few minutes dry every day.
    before we talk about why you're here or what
    problems you have?" This provides respect,
    comfort, and relief, while also creating a positive EXPLAINING HOW THE BODY WORKS
    expectation for what will follow. Ultimately I ask
    something like, "Lots of kids come here for A simple explanation of how the body works, an
    different kinds of problems, some big ones, some important part of the approach, is another
    little ones. ... I wonder what your problem is? "I
    HYPNOTIC SUGGESTIONS WITH CHILDREN 491

    medium through which expectations and phrases know how to talk to each other just fine all day long
    that will be used during hypnosis may be easily and [positive suggestions, ego-strengthening about com-
    comfortably introduced. A drawing of the heart, petence]. [If the child is also having some dry beds
    kidneys, bladder, a "gate" or "door" on the bladder, each week, I add something like:] And even two or
    a urethra, a brain, and a toilet are made while three nights each week they talk to each other fine.
    teaching about the function of each. The heart is
    I then ask the child and parent what they think the
    described as a pump muscle that sends blood all
    brain is doing at night. Often the response is that
    over the body. The kidneys are described as a filter,
    strainer, or "one kid told me once that the kidney the brain is asleep. Irrespective of the response,
    was the washing machine for the blood and he was however, I continue the notion that:
    right." The bladder is described as the place where The brain is the boss of the body. The brain takes
    the urine ("pee" or whatever words the family uses) care of us, and even when we are asleep it may be
    is stored up. resting, but it is paying attention, taking care of us,
    dreaming, keeping our heart beating, our lungs
    I then stop and ask the child, if he had to pee right breathing, telling us how to kick the covers off if
    then, how would he know. Children often say they we're too hot, to turn the pillow over, etc. Sometimes
    feel it, and some say they know they feel it because the brain and bladder get in the bad habit of not
    of their brain. At this point the concept of the brain talking to each other at night, and they need some
    as the master computer of the body is introduced. reminders and some training, just like you trained
    Using the picture that was drawn and arrows going yourself when you were even younger. And now that
    back and forth between the brain and bladder, a bladder and that brain [dissociative suggestions]
    story is told about the brain and the bladder know what to do without thinking about it out loud.
    communicating with one another. I present So, when you learn this relaxing and imagining in a
    something like this: few moments [or, at the next visit], you'll learn how
    to give them instructions to talk to each other just
    fine during the night so you can wake up in the
    Let's just pretend that we could listen in on the morning in a nice, warm, comfortable, dry bed.
    communication between your brain and your blad-
    der even though they don't talk loud. So your I often offer the suggestion, then, that they keep
    bladder fills up and it sends a message to the brain
    track of dry beds during the next two weeks, and
    like, "Hello, brain, this is the bladder speaking. I'm
    full." And the brain sends a message back, some- that before going to sleep at night, they look at the
    thing like, "Well, we're busy talking now, or we're drawing of the body and "just think about what we
    busy in class now, or we're outside playing now, so talked about. I don't know what instructions you
    keep the gate closed and keep the pee inside because will give your brain and bladder about how to talk
    it wouldn't be very nice to pee on Dr. 's chair!" And to each other. Maybe you will tell them to talk to
    the bladder sends a message back to the brain like, each other during the night and either have the
    "Well, that's fine for you to say, but I really have to brain wake you up so you can walk to the
    go; I'm really full." Then the brain says, "Well, okay, bathroom, open the gate pee in the toilet and walk
    so keep the gate closed and I'll send a message to the
    mouth and tongue to ask where the bathroom is and back to your nice, warm, comfortable dry bed, OR
    if I can be excused, and then I'll send a message to maybe you'll have the brain simply tell the bladder
    the ears to hear the answer and then to the legs to to keep the gate closed through the night. I don't
    stand up and walk to the bathroom, and to the hands know which" [This so-called double bind
    to close the door. Then I'll send a message to you to suggestion is a no-lose suggestion that offers
    open the gate, bladder, and let the pee out in the choice within the context of the desired outcome of
    toilet where it belongs, and then close the gate dryness.] Whether the "official" hypnosis session
    again." And that's the way it really happens, isn't it? is conducted that day or at the next visit, it is done
    Even though they don't talk out loud, and they have
    in the context of a carefully developed positive
    known how to do that for a long time in the daytime,
    haven't they? Since you were about [age, parent fills relationship of trust, of a positive expectation for
    in the age of daytime learning] . . . So they already success, and of a mutual understanding of how the
    body works.
    492 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    RELAXATION AND IMAGERY relaxation even more than it already is, because our
    FOR ENURESIS bodies already know how to relax, and we even
    relax a little bit each time we breathe out. Just
    notice how your shoulders go down every time you
    INTRODUCTION. Now that you know about how the breathe out [pause, and add "that's right" on the
    body works and have been thinking about it, I'm next exhalation]. So, to help relax even more, just
    happy to show you how to use your inside thinking take a slow, deep, breath, in, and, out, and when
    and daydreaming [or pretending or imagining] to you breathe out, say relax to yourself in your inside
    help teach your brain and bladder how to talk to thinking, and just notice what happens as your
    each other even better than they already are doing. shoulders go down and relax" [e.g., "just like
    Raggedy Ann"]. Pacing and leading according to
    IMAGERY (INDUCTION). Just go ahead and close cues from the child, proceed with progressive
    your eyes and pretend or daydream something fun. relaxation down the body, utilizing language
    Notice everything about whatever you are comfortable for the child ("letting your muscles get
    daydreaming about — what you see and hear there, loose and floppy, maybe like jello or spaghetti!").
    who's there with you. Notice the smells, tastes.
    [Enhance the imagery with emphasis on
    UTILIZATION-THERAPEUTIC S U G G E S T I O N S . Now that
    enjoyment, on "because you're the boss of your
    you have given your body good relaxation, keep
    imagination like you're the boss of your body."]
    enjoying your imagination, or maybe you're having
    While you are daydreaming or pretending or
    a new daydream, I don't know. But, in another
    imagining — I don't know which you like the best
    corner of your mind, just imagine that you are in
    — make sure it is really fun because [children, like
    your bedroom getting ready to go to bed. Let me
    adults, need a reason to carry out the suggestion]
    know when you notice that in one corner of your
    you are the boss of your imagination
    thinking. [Head nod, finger signal, etc.] While you
    [ego-strengthening]. Notice [an invitation to
    are noticing that, just watch yourself getting ready
    concentrate, pay attention] what you see there in
    for bed, and notice how before you go to bed you
    your imagining, who is with you or maybe you're
    walk to the bathroom, send a message from your
    alone or with friends or family or new friends,
    brain to your bladder to open the gate, let the pee
    where you are, whether you're inside or outside,
    out in the toilet where it belongs, close the gate, and
    whether the weather is hot or cold or in between, or
    then walk back to your bedroom and get ready to
    rainy or snowy, and hear the sounds there in your
    get into your nice, warm, dry, comfortable bed.
    favorite place. Maybe you'll hear voices of people
    talking, or sounds of music, or machines, or of the While you do this special inside thinking
    weather, or maybe it's quiet and you'll listen to the practice, it's best to do it sitting up before you fall
    quiet, and notice the smells where you are asleep. Then remind [they already know, they just
    imagining, and the tastes there. need reminders] your brain and bladder that tonight
    while you're asleep you will have a good night's
    sleep, and a great dream, and during the night while
    RELAXATION (DEEPENING). To enhance the imagery you sleep if your bladder fills up with pee it will of
    and ego-strengthening and to deepen the expe- course send a message to your wide awake brain to
    rience, suggestions about relaxation are often let it know. And then your brain will have two
    added. For example: "You probably already no- choices: either wake you up, wide awake, get out of
    ticed that your face muscles are relaxed and that bed, walk to the bathroom, send a message from
    your breathing is slower than it was before. That's your brain to your bladder to open the gate, let the
    because you are doing this exactly the right way, pee out in the toilet where
    and since you and your brain are the boss of your
    body, you can even make your
    HYPNOTIC SUGGESTIONS WITH CHILDREN 493

    it belongs, close the gate, and then walk back to about how you want them to talk to each other
    your bedroom and get ready to get into your nice, during the night. And when you're finished, then
    warm, dry, comfortable bed, OR send a message you'll be done. When you're practicing at night you
    back to the bladder to keep the gate closed until you can then just fall asleep, and if you're practicing in
    wake up in the morning proud and happy in your the day, then you can just gradually come back to
    nice, warm, dry, comfortable bed. where you were at the start, but be sure to bring
    I don't know which one your brain and bladder your proud and relaxed feelings with you!
    will choose . . . maybe sometimes one and [At the end of the session, I tell the patient I
    sometimes the other, or maybe one and not the thought he did a wonderful job. I also ask, "What
    other. But before you go to sleep you can remind did you notice that you liked the most?" as a
    them to be sure and talk to each other tonight, just reinforcement, and ask him for a time commitment
    the same way they talk to each other so well all day as to when he will practice the self-hypnosis at
    long, because your brain is the boss of your body home. Following reinforcement about keeping
    and the main computer. And when you practice track of dry beds, we then agree on a time for a
    this way, the way you are doing so well, you are
    return visit.]
    really programming the computer, just the same
    way you teach your brain to teach you to do so
    many of those other things you do so well. [Include
    here other things that the history indicates that the
    patient does well without thinking about them, such
    Imagery with Bed wetting
    as playing soccer, singing, musical instrument, H. E. Stanton, Ph.D.
    grades, video games, etc.] So, the more you Hobart, Tasmania, Australia
    practice, the better you get.
    Now, before you finish, take a few moments of INDICATIONS AND
    inside thinking time to repeat those messages to CONTRAINDICATIONS
    yourself . . . and to let me know when you have
    completed that [signal]. Great! Now, keep enjoying Enuresis is an extremely common pediatric
    your daydreaming for these last few moments. I problem, but one that requires careful evaluation,
    don't know who will be most proud of you when as just indicated by Kohen. Before the age of five,
    you have given yourself a dry bed every morning . . the majority of bedwetting does not seem linked to
    . but probably you will be most proud and the . . . I organic or underlying psychological or family
    don't know . . . Mom or Dad or me or who . . . but system causes (Olness & Gardner, 1988).
    when you practice each day for 10 or 15 minutes, Situational enuresis and secondary enuresis (where
    two or three or maybe only one time, be sure and do there previously was good control) are somewhat
    it just as easily and well as you learned today. So, more suggestive of the absence of an organic
    start your self-relaxing by closing your eyes and problem. However, it is recommended that a
    thinking of something fun like you're doing now ... careful medical evaluation always be conducted in
    it might be the same thing as now or something children over the age of five. A pediatrician needs
    different but you'll find out because you're the boss to rule out such potential organic causes as
    of your imagining . . . and then when you're ready, diabetes, urinary tract infections, congenital
    you can relax your body, either from head to toe or anomalies, seizures, occult spinal dysraphism,
    toes upward. One kid I know starts at his belly neurological etiologies, hyperthyroidism, and
    button and goes both ways! And then when you're potential contributors such as diuretic medications
    ready, be sure to give instructions to your and caffeine drinks (Olness & Gardner, 1988).
    bladder and brain Functions of the symptom within the family system
    and historic, unconscious factors may be ex-
    494 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    plored through interview assessment and greater sense of self-confidence and control when
    ideomotor signaling. When hypnosis is used, you're sleeping at home or at a friend's house. We
    cassette tapes may assist in reinforcing sugges- know that learning to have dry beds is something
    tions. An addition to the suggestions provided by that people do as they grow older and develop more
    Stanton is to suggest repetitively that the control regular patterns of sleeping during the night. Some
    panel "will send a message to wake you up when people do this when they are very young, perhaps
    the dam is full and you need to pee. Then you can two or three years of age, and other people do this
    get up, walk to the bathroom, urinate in the toilet, when they are somewhat older. Still other people
    and enjoy going back to sleep in your dry bed." develop more adult sleeping patterns and dry beds
    (Ed.) at night when they are in middle school. I'm not
    exactly sure at what age you will develop these
    patterns; however, I am sure that you can teach
    SUGGESTIONS your mind to have greater control over urinating so
    Imagine a dam equipped with gates to hold back that when your body is ready, you will be able to be
    the flow of water. When they are open, water flows confident and comfortable every night.
    through the dam; when they are closed, no water is In order to assist you in feeling dry and more
    able to pass. Their operation is controlled by a confident, I am going to talk to you about a walk
    computer-controlled instrument panel. As soon as which you and I can take in our mind's eye, and I'm
    you get into bed, set the controls in such a way that also going to talk to you about the things we can
    the gates are closed. They are to remain that way observe on this walk. We will be taking a walk, in
    until you awaken in the morning. At that time, our mind, to the beach, where there are many
    change the controls on the instrument panel so that interesting things to see. While I'm talking with
    the gates will open. you, you can simply relax and picture the things
    that I am talking about. As you picture them in your
    mind, they may look just the way I've described
    them to be, or they may look somewhat different to
    Induction and Ocean you. Either way is fine, for you will be able to
    Metaphor for Bedwetting understand and remember the most important parts.
    You may choose to close your eyes while I'm
    Valerie J. Wall, Ph.D. talking to you, or you may choose to keep your eyes
    Seattle, Washington open. Either way is fine with me. I'd like you to
    choose the way which allows you to concentrate
    INDICATIONS AND most successfully on what I'm saying and which
    allows you to create a very real imagination
    CONTRAINDICATIONS experience in your mind.
    This procedure is designed for working with
    children between seven and twelve years of age
    who enjoy and have been to the beach. As cited at
    the beginning of Stanton's paper, it is vitally INDUCTION
    important to obtain careful pediatric evaluation for
    bedwetting problems prior to pursuing psy- To begin, I'd like you to sit comfortably in the
    chologically oriented therapy. (Ed.) chair, allowing all the muscles in your body to
    relax, and enjoy the feeling of being fully
    supported and at ease. Remember, that if you
    PRE-INDUCTION choose to close your eyes, this may be helpful to
    you in making your imagination experi-
    Today I want to talk with you about learning to
    keep your bed dry at night and feeling a
    HYPNOTIC SUGGESTIONS WITH CHILDREN 495

    ence more real. ... [At this point, with the older and flowers. There continue to be animals of
    child, 1 encourage children to close their eyes by interest to us along this part of the path. However,
    suggestions for eyelid heaviness or seeing the the animals are somewhat less active than before;
    pictures better when their eyes are closed. 1 do not they seem more drowsy, as if they know that
    suggest drowsiness or sleepiness, as this is evening will be coming in a while. And now,
    somewhat disconcerting to many children.] perhaps, you can see ahead of you another slight
    slope downward, and this slope leads to the beach.
    Once again, as we approach this slope, you
    DEEPENING, ENHANCEMENT, AND know that it is possible to walk down it at an even
    BEGINNING OF THERAPEUTIC pace, a pace which demonstrates to you your
    STRATEGY control of your muscles. You are able to walk
    down the slope without having to run or to go very
    As you and I prepare to go on our walk, you may slowly, and as you go down the slope you can see
    notice that we are in a very pleasant surrounding in in front of you the wide sands of the beach. It's a
    which there are numerous plants, and some small beautiful beach with waves coming up on the
    and rather friendly animals. You may also see shore. The sunlight here is very tranquil and the
    larger animals which are friendly and curious about ocean is very beautiful. As you walk along the
    our presence here. One other thing to notice is that beach, you will notice the shells, and the seaweed,
    we are on a definite path, and that pathway seems and the seashore animals that live here.
    to be leading gradually toward a small hill, which Of particular interest is an area of rocks where
    slopes down in the direction of the ocean. While we there are some tide pools that have formed. The
    are still quite a ways from the ocean, you can notice water inside these tide pools is contained perfectly
    that it is some ways off in the background. As we within them by the rocks, and it provides the
    walk along this path, you can watch the animals perfect home for the seashore plants and animals.
    playing, the birds flying, and notice the We know that the tide of the ocean, which rises and
    peacefulness and yet the amount of busy-ness falls, and the waves, which move rhythmically, are
    occurring around you in the lives of the small controlled by the force of gravity which comes
    animals. from the moon. The moon acts sort of like a master
    It is a very pleasant time of day, perhaps the late control above the ocean and the tide pools. It
    afternoon, with the sun about halfway down to the contains them well within the ocean beaches, and
    horizon. As we walk along this pathway it becomes allows the tide pools to stay in their basins. The
    more tranquil and peaceful, with many interesting moon maintains control over the tides and the tide
    events going on around us. However, you can feel pools, and provides a comfortable home for the
    calm and at ease. We are gradually approaching a animals of the beach. The moon does this for the
    small slope which leads down to another flat area oceans and the beaches and the beach animals in
    between the ocean and us. As we go down this the same way that your mind can do this for you.
    slope, we can travel at an even and smooth pace In the same way that the moon controls an even
    without unnecessary hesitation or unnecessary and steady rhythm for the ocean, so your mind can
    hurrying. As we reach the next level, the sunlight is maintain an even and steady rhythm for you while
    somewhat less bright. However, there is still ample you sleep. This rhythm will allow you to sleep
    light and it is not yet dusk. This level of the comfortably and allow you to maintain control
    pathway is even calmer, and we can feel the over your bladder. By doing this, you will be able
    tranquility, peacefulness and comfort of this area to experience the comfort and confidence of dry
    of the path, as we walk along through the grasses beds. As you prepare to
    and brush, through the little bushes
    496 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    come back from your walk along the beach, you return from your imagination experience whenever
    can enjoy knowing that this is a place to which you you are ready, knowing that you can revisit the
    can return at any time, a place where you can learn pathway, the slopes, the flat areas, the sand, the
    greater control of mind and body together. Greater ocean, and the tide pools at any time. You will
    control of mind and body allows you to feel more know the sun and the moon will always be above to
    confidence in yourself and in your physical growth. guide your progress. And whenever you are ready,
    The more often you return and the more often you you can open your eyes and return to this room
    practice, the easier it will become for you to have alert, relaxed, and refreshed, feeling an increased
    control of mind and body together. The easier it sense of confidence and well-being. And I'm going
    becomes, the easier it will be for you to practice and to be quiet now, and you can open your eyes
    the more confidence you will experience. You will whenever you feel that you are ready.
    find that this is very pleasant and easy for you to do, [After the induction and therapy phase, I discuss
    and that your learning and development will with children their responses to the therapeutic
    improve on a regular basis as you come back to the metaphor. I have included the concept of a
    ocean in your mind's eye and practice what you walkway which either changes directions or moves
    have learned. into different areas across slopes in order to assist
    And now I would like you to begin walking back youngsters with maintaining an even pace across
    across the ocean sand toward the path that brought phases of sleep. This is incorporated along with the
    you here. And as you walk back across the beach, metaphor of the moon's control over the tide pools,
    you will come to the gentle slope that leads you as there was some research done in the Stanford
    down to the beach. You will find that it is very easy Sleep Research Lab in the late 1970s which
    to walk back up this slope, and that you can do so at suggested that bed wetting might be tied to
    a regular and controlled pace, which is just the inappropriate neurological triggering when moving
    same as the walking rate you maintained on the from one phase of sleep to another.]
    beach. And you can walk back across the second
    flat area where the animals were a little more
    sleepy, and notice how comfortable and contented
    they are. These animals live up from the beach in a
    dry area and enjoy the warmth and comfort of the
    Suggestions with Enuresis
    dry sand and grasses around them. And you can Franz Baumann, M.D. San
    continue across this area up towards the next slope.
    Francisco, California
    Once again, you can walk up this hill at a
    comfortable and even pace, on to the first flat area
    where our path began. Here the animals are more You can wake up all the way when you need to
    active and playful, just as they were before. And empty your bladder. You can learn how good it
    they, too, are comfortable and happy in the warm, feels to empty your bladder completely. You can
    dry grasses and sand of their homes. learn to control the flow of urine from your bladder
    through your penis. You can learn to enjoy fully the
    feeling of urine coming from your penis. Because
    this enjoyment is such a good feeling, you will
    RE-ALERTING want to be fully awake for it at all times. You can
    practice stopping and going every single time you
    And when you have walked across the path and urinate. Every time you do this you can learn that
    up the slopes and across the flat areas, you can you are the boss of your bladder and urine. You can
    begin to sense that you are returning closer to being have a wonderful feeling of pride every time you
    in the chair in this room. And you can put your urine where you really want it, namely,
    HYPNOTIC SUGGESTIONS WITH CHILDREN 497

    into the toilet. You can do all these things because bed or two dry beds, but I don't think it would be
    they make you happy. [They are taught to repeat reasonable to expect more than three dry beds in
    these suggestions in self-hypnosis before going to any one of those four weeks. . . .
    sleep.] [After still more progress it was suggested:]
    Now, I still don't know when your permanently dry
    bed will come about, but you are Irish and St.
    Patrick's Day is a very nice day; but when I think
    Erickson's Suggestions with about how your father and mother have treated
    Enuresis you, I think April Fools' also would be a very nice
    day. There is one thing I would like you to get
    Milton H. Erickson, M.D. straight, Joe, and that is that when you have your
    dry bed, whether it is on St. Patrick's Day or April
    This is the second day of January . . . and you Fools' Day or any day in between, that day is your
    have wet the bed, your parents say, every night for business. It is none of my business. It is nobody
    twelve years. You know that and I know that, so else's business either.
    now let us forget about it. Let us talk about
    something that is really important. Now, this is the
    second of January, and I don't think it would be
    reasonable, not the least bit reasonable in any way, Enchanted Cottage
    for me to expect you to have a permanently dry bed
    two weeks from now. And you know, by that time
    Suggestions for Enuresis
    January will be practically over, and then February
    Don E. Gibbons, Ph.D.
    is a short month. Does anybody want to dispute
    that? It is a short month, and I certainly don't think
    As you look around the room we have entered,
    you ought to start a permanently dry bed before
    here in the enchanted cottage, you see a fireplace at
    March. It doesn't seem reasonable that you do it
    the far end of the room, with a warm log fire
    before then, but I will tell you what you might be
    burning brightly, and beside the fireplace is an
    interested in doing. In a couple of weeks from now
    easy chair, which looks so comfortable that you
    [I point to the calendar on the wall], 1 would like to
    decide to go over and curl up in it for a while.
    have you puzzle mentally over this question: In two
    weeks from today, will it be on Wednesday, or will Our journey here has made you sleepy, and as
    it be on Thursday, that I will have a dry bed for the soon as your curl up in the chair and begin to watch
    first time? Two weeks from now, will it be on the fire, you find yourself starting to drift off to
    Wednesday, or will it be on Thursday, that I will sleep, soundly and comfortably, there in that soft
    have my first dry bed? And you will have to wait easy chair.
    until Friday morning to know for certain, and so Now you are sleeping very soundly. But in just a
    that Friday you will come in to tell me whether it minute or two, you are going to have to go to the
    was Wednesday or whether it was bathroom. And as soon as you begin to feel that
    Thurs- you have to go to the bathroom, you are going to
    start to move around, and you will open your eyes
    and wake up before you have wet. Your eyes will
    [Later, after some progress the suggestions were open, and you will be completely awake before you
    given:] February is such a short month . . . that you actually start to do anything. And when you do
    really ought not to have a dry bed, reasonably open your eyes, you will be back here with me, and
    speaking, more than three times in any one of those not in the cottage anymore. We can go back to the
    four weeks of February— three times in succession cottage after you have gone to the bathroom. But
    in any one of those weeks. Now that doesn't mean first, you will open your eyes and wake up, ready to
    you can't have one dry
    498 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    go to the bathroom before you have wet. And from Any time now, you are going to feel that you
    now on, whenever you are asleep at night, you will have to go to the bathroom, and you will begin to
    wake up before you have wet, just as you are going move around, and your eyes will open before you
    to do now. have wet.

    SUGGESTIONS FOR THUMBSUCKING

    Erickson's Suggestions for your mouth, and with your teeth. They are yours,
    and let us get that straight. I want you to do
    Thumbsucking anything you want to do. . . . One of the first things
    you have learned when you went to nursery school
    Milton H. Erickson, M.D. was to take turns. You took turns with this little girl
    and with that little boy in doing things in nursery
    school. You learned to take turns in the first grade.
    Your father and mother want you to stop sucking In fact, you learned to take turns at home. When
    your thumb, and they told you that they were going Mother serves the food she serves it first to one
    to bring you to me and make you stop. I'd like you brother, and then it may be your turn, then it may be
    to understand one thing: your thumb is your thumb; sister's turn, then it is Mother's turn. We always do
    your mouth is your mouth. If you want to suck your things by turns. But I don't think you are being right
    thumb, you go right ahead. Your Daddy can't boss or fair or good in always sucking your left thumb
    me; your Mommy can't boss me; and I'm not going and never giving your right thumb a turn. . . . Your
    to boss you. But if you want to, you can boss your left thumb has received all of the sucking. . . . The
    thumb, and you can boss your mouth, and you can right thumb hasn't had a turn; the first finger hasn't
    go ahead and suck your thumb as much as you had a turn; not a single other finger has had a turn.
    like. Now I think you are a good little boy, and I don't
    think you are doing this on purpose. I think you
    [ . . . I pointed out to him that I thought it awfully
    really would like to give each of your fingers a
    unfair that he sucked only his left thumb; that his
    proper turn. [Can you imagine giving a turn to ten
    right thumb was just as nice a thumb and it was
    separate digits? Can you imagine a more laborious
    entitled to just as much sucking, and that I was
    task in the world? And Jimmy strove manfully to
    astonished (that he wasn't sucking his right thumb
    give his fingers an equal turn at sucking. Next I
    as well). Little Jimmy thought that he was at fault.
    pointed out:] You know, Jimmy, you are over six
    Being a nice, bright boy, Jimmy should be willing
    years old now, and soon [in two months] you will
    to suck both thumbs. But, you see, what happens is
    be a big boy of seven; and you know I have never
    that as surely as Jimmy sucks both thumbs he has
    seen a big boy or a big man that ever sucked his
    cut down sucking his left thumb by about fifty per
    thumb, so you had better do all of your sucking
    cent. He has reduced his habit. And what about that
    before you are a big boy of seven. [No longer a
    forefinger, and the other three fingers? When you
    mere six. He would be joining the big kids when he
    start dividing, you start conquering.]
    turned seven years old.] And you know, Jimmy, I
    Now, let us get one thing straight. That left don't know a single big kid that sucks his thumb, so
    thumb of yours is your thumb; that mouth of yours you'd better do plenty of thumb sucking before you
    is your mouth; those front teeth of yours are your join the big kids. You'd really better get plenty of it.
    front teeth. I think you are entitled to do anything
    you want to with your thumb, with
    HYPNOTIC SUGGESTIONS WITH CHILDREN 499

    Suggestions with a Four-Year-Old bigger and bigger and smarter and smarter every
    day. And pretty soon you will be big like big sister
    Thumbsucker and will go to school just like big sister, for you
    really are getting bigger and bigger, and smarter
    Lawrence M. Staples, D.M.D.
    and smarter every day. And pretty soon you will be
    big like big sister and will go to school just like big
    INTRODUCTION sister, because you are getting bigger and bigger
    every day . . . and pretty soon you will be so very
    Gretchen was four years old and sucked her big that you will not suck your thumb anymore. Of
    thumb "continuously," in spite of anything that her course lots of little girls and boys suck their
    parents could do to stop her. The young lady thumbs, perhaps I sucked my thumb when I was a
    happened to come to my office with her mother and very little boy, but if I did, as I grew bigger and
    an older sister. Out of curiosity she came into the bigger, like lots of little boys and girls, I stopped
    operatory while her older sister was having dental sucking my thumb because 1 had grown big, and
    service rendered, and she saw her older sister I'll bet pretty soon you are going to get so very big
    calmly reposing in a deep state of hypnosis. After that you will not suck your thumb anymore.
    older sister's dental period was over, Gretchen Perhaps it will be next month, perhaps you will be
    came running into my operatory and said she so big by tomorrow, or perhaps it will be by the
    wanted to "hip-patized . . . hippatized like big next day, and when that thumb goes up to your
    sister." My first thought was to merely give mouth you will say, "Naughty thumb, I am not
    Gretchen a ride in the dental chair, but she insisted going to suck you anymore, because I am a big girl
    that she be "hippatized." now. You just stay out of my mouth. Big girls don't
    suck thumbs. That's just what little people do. I am
    getting to be a big girl. You, Mr. Thumb, stay out
    INDUCTION AND SUGGESTIONS of my mouth." Yes, Gretchen, you are getting to be
    a big, big girl, you have been hippatized just like
    [Following an induction utilizing her teddy big sister, and you will pretty soon be big and you
    bear:] You are now doing just what big sister was will not suck your thumb anymore, not any,
    doing a few moments ago, which means that you anymore.
    are being big, and some day you will be big like big
    sister, for you really are getting

    MISCELLANEOUS PEDIATRIC PROBLEMS

    Metaphor for a Boy with problems. The father was busy, the mother
    handicapped, and there was an irresponsible older
    Behavioral Problems brother and an older sister who wished to leave
    home. Parts of the metaphor that were designed for
    Norma P. Barretta, Ph.D., and Philip
    each family member are specified in brackets.
    F. Barretta, M.A. San Pedro, California

    INDICATIONS METAPHOR

    This is a metaphor that was designed for use with Once upon a time, there was a herd of wild
    the family of a boy with severe behavioral horses roaming the hills of southern California,
    500 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    eating the scrub grass, and running through the valleys. horse. These brown horses knew what to do,
    [Boy] This herd of horses had many beautiful, wild but they didn't like to do what was good, so
    horses in it. None of these horses had ever been around they just played around all day and didn't learn
    human beings, and none had ever been broken to do their lessons and didn't help the rancher.
    work. None of the horses in the herd could be controlled As you can see, the brown horses would not
    by human beings. All of their lives they had roamed make good work horses and would not make
    free. good show horses. It is very difficult to know
    In the valley below the mountains where the horses ran, what to do with such horses. The rancher at the
    there was a town where many farmers lived and worked. Bee Haven Ranch is getting ready to catch the
    As you know, farmers often have horses on their farms wild horses in the hills and train them to be
    to help with the work and to give rides to the farmers and good work horses.
    their families. When any of these farmers needed a good When the rancher catches the wild horses,
    horse to help them with the farm work, they went to the he saves them from starvation (from
    Bee Haven [behaving] Ranch. overpopulation) and provides warm, safe
    The Bee Haven Ranch was a famous ranch in that part of homes for them. Wild horses, when there are
    southern California, for the rancher who owned the land too many of them, can get into trouble. So, the
    was an excellent trainer of horses. In addition to training rancher will catch some and make them into
    horses, the ranch raised bees and made an excellent good, dependable work horses. It is important,
    honey which was sold in the town. too, that when the rancher starts to train the
    At the Bee Haven Ranch there were all kinds of horses wild horses only the best horses on the ranch
    and they all had jobs for which they were trained. There share in the training duties. It would not be a
    was a strong and dependable work horse. This work good idea for the wild horses to learn the
    horse [Father] was smart and knew just how to best help brown show horses' bad habits. The training of
    the rancher with the duties and responsibilities at the the wild horses must follow the examples of
    ranch. Sometimes the strong work horse worked longer the steady, dependable work horse, the snow
    hours than even the rancher, making sure all the jobs on white show horses, the lovely horse Lady, and
    the ranch got finished. This horse was a steady worker. the rancher himself.
    The rancher knew he could depend on this well trained
    work horse.
    There was also a group of well trained show horses at
    the Bee Haven Ranch. These were being trained for the
    circus. [Sister] This team of show horses consisted of
    four snow white horses who knew exactly what the
    world would expect of show horses. They had been
    trained for this job, and they were ready to join the
    circus. They were in the final stages of training, and the
    rancher was just about ready to send the snow white
    show horses to the circus. As they waited for the final
    days of their training, the show horses worked together
    and worked with other, not-so-well-trained horses to
    help he rancher in the horse training activities at the
    ranch.
    [Mother] The ranch also had a lovely horse named
    Lady who was the rancher's wife's horse. Lady had
    recently fallen and had hurt her knee. Lady was being
    treated by the vet. Lady could not help the rancher with
    the training of other horses while she was sick, but she
    was still strong and would soon be able to help the
    rancher again. Lady would never be able to carry heavy
    loads again, the vet told the rancher, but she could help
    with some of the easier training jobs.
    [Brother] A team of brown horses that were supposed
    to go to the Budweiser stables was also at the ranch.
    These horses had been well trained, at least as well as the
    snow white show horses, but did not like to remember
    their training. The brown horses did not like to work
    together and did not like to remember all the things they
    had been taught by the rancher and the steady work
    HYPNOTIC SUGGESTIONS WITH CHILDREN 501

    Hypnosis in the Treatment of On each word that I say, you may let all other
    thoughts — all other feelings— all other sounds
    Tourette Syndrome fade, fade away into the distance so that everything
    David N. Zahm, Ph.D. that I tell you you may take to help you with your
    Lawrenceburg, Indiana tics. As I talk to you, you may let yourself relax
    more and more completely, and without even
    INTRODUCTION thinking about it, your mind automatically makes
    each suggestion a part of your everyday life,
    Gilles de la Tourette syndrome is typically helping to solve your problems. As you drift along,
    diagnosed in childhood, and boys display this you feel yourself relax, deeper and deeper relaxed
    problem three times more frequently than girls. — way down — so that more and more you know
    Zahm (1987) has stressed that the clinician must that you are the boss of your body. You can control
    have a good understanding of pediatric hypnosis your tics — all your tics [list specific tics]. Now,
    (Olness & Gardner, 1988) in order to be effective. right now, you can begin to control your body and
    He finds that parents have often been frustrated relax and be rid of your tics. You have control, you
    with previous failures in controlling the tics and have the say. You are relaxed and very, very
    will usually be rather skeptical of hypnosis. comfortable now and are able to control your tics.
    Parents may be willing to experiment with Now, very good, you can and will be able to
    hypnosis, however, after medication has failed or control your tics and relax other times, whenever
    produced negative side effects. you wish. You are the boss, you can make your
    Zahm explains the organic etiology of TS, but body do what you want it to. You can relax your
    stresses the mediating effect of anxiety and muscles and make your body stop your tics — stop
    stressful life circumstances. Thus, it is explained, [list specific tics].
    the relaxation and focused concentration of
    Now, as you drift along deeper, deeper relaxed,
    hypnosis may serve to reduce tic frequency.
    deeper, deeper relaxed — way down, you feel
    Parental myths and misconceptions about hypnosis
    very, very sure that you are able to relax and
    must be dispelled, since the parents' involvement is
    control your own muscles. These suggestions may
    crucial. The author further recommends that
    sink down, down into your memory and you will
    parents be invited to observe at least one hypnotic
    be able to completely remember. You know that
    session. Children are encouraged to practice
    you are the boss of your own body, and that you
    self-hypnosis but the responsibility for practice is
    can relax and stop your tics — all your tics [list
    left with the child, thus avoiding power struggles.
    specific tics].
    Zahm obtains a baseline measure of the frequency
    of the tics and then sees the patient twice a week You can use this very nice, calm, relaxed feeling
    for outpatient hypnotherapy. Frequent sessions fa- to help you throughout the week. Whenever you
    cilitate rapid mastery of skills, greater encour- are tense or uptight, you can relax, just like now,
    agement to practice self-hypnosis, additional and feel the tension leave your body. Each time you
    reinforcement of suggestions, and increased practice at home, you will be better able, better and
    awareness of treatment gains. A self-hypnosis better all the time, to relax and control your tics.
    practice record may facilitate compliance. He finds You are getting better and better — relaxing and
    that children often respond well with a directive able to control your tics. You know what to do
    approach that might be offensive to adults. (Ed.) whenever you are upset or tense, just relax and
    calm yourself—you're the boss of your own body,
    you have the ability to control your muscles and
    SUGGESTIONS stop your tics. Each time you practice, you get
    [These suggestions are given following hyp- better and better, more and more relaxed and able
    notic induction and deepening.] to control your body.
    502 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Now that you fully understand and are able to tial to embarrass the child when he or she becomes
    enjoy and use this pleasant relaxation, I want you increasingly aware of the tic behaviors. (Ed.)
    to begin to become more alert, beginning to wake
    up, feeling very, very good — refreshed and very
    comfortable. You remember that each time you PROCEDURE
    practice, either at home or here, you will be able to
    better relax and enjoy this calm sense of relaxation. At the time of the initial interview a detailed
    Soon it will be time to be fully alert, fully awake. description of each tic behavior was obtained. The
    Feeling fresh, feeling fine. And as you awake, now salient characteristics of each tic behavior
    awake, you remember and feel fine, feel very good. included: when it occurs, which muscle groups are
    involved, and its frequency, intensity, and
    duration. This was requested independently from
    both the parents and the child. Baseline data were
    collected by parents, at home, after the initial visit.
    A New Hypnobehavioral Method for
    The treatment design has three major phases:
    the Treatment of Children with (1) discrimination training and skill acquisition;
    Tourette's Disorder (2) skill application and problem resolution;
    and (3) generalization, symptom mastery, and
    Martin H. Young, Ph.D. maintenance.
    Worcester, Massachusetts
    DISCRIMINATION TRAINING AND SKILL ACQUISITION.
    and A
    Robert J. Montano commonly described characteristic of individuals
    who have tics is that they tend to be unaware of the
    type, frequency, and intensity of their tic
    INTRODUCTION AND INDICATIONS behaviors. The first step in phase one is to increase
    the patients' awareness of tics and to help them to
    The authors describe an innovative treatment discriminate the tic from other motor behaviors.
    method for children with Tourette's Disorder that This was accomplished in the following manner.
    utilizes self-hypnosis with habit reversal and Two methods were used to enhance awareness
    response prevention techniques. They documented of tic behaviors. The first method consisted of
    its effectiveness in three case studies and made asking the children to identify the tic behaviors
    suggestions for further controlled research in their they would like to decrease first, and then, both
    original publication, from which the description of parents and children were asked to separately
    their technique is adapted (Young & Montano, record the frequency of this tic. This was
    1988). The original article may be consulted for performed at a time when the tic behaviors were
    further details, literature review and references. known to occur and could be conveniently
    Their method offers an encouraging treatment recorded for one hour. The second method was
    option since psychotherapy has proven of limited designed to help the children discriminate the tic
    effectiveness for patients with tics. The authors behavior from other motor behaviors by directly
    recommended that the clinician should limit the observing themselves alone in a mirror or
    children's target choices (for change) to tic face-to-face with a parent for 15 minutes a day.
    behaviors that are the most easily managed and the Simultaneously, self-hypnosis training was
    most distressing, so that too many tic behaviors are initiated. A naturalistic approach (Gardner &
    not targeted. They also suggested that this Olness, 1981) utilizing a muscle relaxation in-
    technique may have the poten- duction technique with visual imagery for deep-
    HYPNOTIC S U G G E S T I O N S WITH CHILDREN 503

    ening of the trance state was used. Children were ment session, the children were instructed to practice
    interviewed for activities they found enjoyable and self-hypnosis with their chosen technique to decrease
    relaxing. These were incorporated into the their tiquing behavior. Generalization, outside the
    suggestions for deepening of the trance by visual treatment session, occurred by instructing the children to
    imagery. Instructions for progressive muscle use their chosen technique during periods of
    relaxation training (Jacobson, 1973) included high-frequency tics. Recording of tic behaviors by the
    suggestions for the children to let their arms "go children and their parents continued. Symptom mastery
    floppy like a rag doll." Instructions to deepen the was defined as the time when the tic behavior was no
    trance state were facilitated by using imagery and longer occurring or when the children reported that they
    asking the children to think of activities they have felt adequate self-control. Parents continued to monitor
    found enjoyable (i.e., fun, pleasant), different their children's progress and were instructed to utilize
    sensations associated with these activities, and verbal praise and special privileges and/or activities to
    suggestions of being in control of themselves. positively reward their children for achieving symptom
    For example, "Now that your arms feel floppy, mastery. Recurrence of tics is common among children
    think about something that you've done or would with TD following initial treatment. Therefore, a
    like to do that you really liked and found fun. relapse-prevention technique (Marlatt & Gordon, 1980,
    Imagine yourself being there again . . . the feelings 1985) was employed as a precautionary measure to
    you had . . . the smells, sounds, and the things you insure treatment gains. Relapse prevention consisted of
    saw. Notice how good you feel right now . . . how discussions with both children and their parents about
    in control you are of your body, feelings, and the probability of tic behaviors recurring. The children
    thoughts." Children were initially given an were asked to think about how they would respond if
    audiotape of their first training session with the relapse occurred and then to imagine during
    therapist and were instructed to listen to the tape self-hypnosis how to respond successfully. They were
    for approximately 15 minutes twice a day. then instructed to utilize this approach if and when
    relapse occurred. Parents were instructed to expect
    relapse to occur and to support their children's efforts at
    SKILL APPLICATION AND PROBLEM RESOLUTION.
    The self-management.
    children were requested to identify the subjective urge
    that precedes their tic behaviors in imagination, as part
    of the instructions in the use of the symptom-prevention SUMMARY
    technique. Self-hypnosis aided the children by
    increasing their ability to concentrate and focus on this This hypnobehavioral method appears to be an
    urge. The therapist determined the muscle response that extremely effective psychotherapeutic procedure for the
    competed with the tic behavior as part of the instructions treatment of TD. It utilizes self-hypnosis to allow the
    in the use of the habit-reversal technique. During child to self-select one of two promising treatment
    self-hypnosis, the children were asked to imagine their techniques: habit reversal and response prevention.
    tic behavior occurring. They were asked to select and Furthermore, the present method represents a brief
    apply which of the above two procedures would be most treatment model which can be easily applied by the clini-
    successful in decreasing their tics. cian and learned by the child.
    Self-hypnosis plays multiple roles in this approach
    and can be incorporated into a cognitive interpersonal
    GENERALIZATON, SYMPTO M MASTERY, AND MAINTE- model that is multi-interactional. First, self-hypnosis
    NANCE The children were instructed to continue provides the means by
    self-hypnosis practice in imagination, while applying
    their chosen technique for approximately 15 minutes a
    day. During the treat-
    504 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    which the child can successfully achieve greater relaxed and as you feel yourself relaxing still more,
    self-awareness, motivation, and concentration. This squeeze my hand, yes. . . . Good . . . just relax as
    helps the child maintain focused interest in much as you can. Now I want you to imagine that
    treatment. Second, self-hypnosis permits children you are looking at your television set at home . . .
    to self-select habit-reversal or response-prevention can you see it? Good, now you are going to see the
    techniques to control their tic behaviors in set come on and a movie of cowboys riding on
    imagination. Third, self-hypnosis facilitates horses. As you see this, nod your head. . . . Good. . .
    reduction of symptoms in imagination. Fourth, . You will notice that the horses are running very
    self-hypnosis helps children to modify cognitions fast and they are breathing hard and fast . . . like
    and perceptions. This allows children to your breathing . . . can you see this? Can you feel
    conceptualize their tic behaviors as being within this? . . . Good . . . but now the horses are beginning
    their control and, therefore, subject to change. to run more slowly. . . . Breathing is becoming
    Fifth, self-hypnosis facilitates the child's sense of slower and easier and your breathing is slowing
    self-efficacy. Sixth, self-hypnosis permits the child down. [The therapist should talk in tempo to the
    to reduce symptoms and develop mastery in real patient's breathing rhythm.] . . . That's it. . . . The
    life. Therefore, self-hypnosis is felt to decrease horses are slowing down . . . slower now . . .
    both overall feelings of stress as well as the targeted walking . . . breathing almost normal. . . . The
    tic behaviors. wheezing is much less ... so relaxed. . . . The
    television scenes fade out. . . . Just let yourself be as
    comfortable as possible ... all over . . . secure,
    relaxed and at ease. I take your hand again. Now I
    Technique with Asthmatic give you the suggestion that you will smell a nice
    odor. . . . You can smell this nice odor. . . . You can
    Children smell this nice odor and when you do . . . squeeze
    Harold B. Crasilneck, Ph.D., and my hand. . . . Good. . . . Now a very deep and sound
    state of relaxation . . . and breathe deeply and
    James A. Hall, M.D. slowly, deeply and slowly . . . enjoying the nice
    Dallas, Texas odor and you see that your rapid and hard breathing
    is slowing down . . . your wheezing is less . . .
    Look at a spot on the ceiling. As you continue relaxed, so relaxed and at ease . . . free from
    looking at this spot, you will begin to relax as much tension. . . . Your lungs and chest muscles are so
    as possible. You will notice that your eyelids begin relaxed. Smelling the nice odor and now you see
    to feel heavy . . . yes . . . starting to flutter . . . and so your breathing is deep and relaxed, taking deep
    just let them close and relax just as much as you relaxed breaths ... so relaxed and at ease. Now the
    can. Let your arms and hands hang limp at your odor is gone. I release your hand. Anytime you
    side . . . your body is so relaxed . . . your legs and need to relax yourself you can do so ... by closing
    feet at ease. your eyes and giving yourself these same
    [If the patient is younger than 13 years of age, suggestions just as I have or anytime you are ready
    we usually hold the child's hand to establish the to work with me. ... If I take out my fountain pen
    best rapport and sense of security possible. and tap it on my desk five times, you can enter this
    Children are then told the following:] same depth of trance. Do you understand? . . .
    How cooperative you can be indicates that you Good. . . . Remember that you can enter this deep
    are in a state of hypnosis. If you can cooperate with state and your asthma will become controlled. As I
    your mind, you can also relax every muscle in your slowly count from ten to one, backward, you will
    body, but especially the muscles that control the be
    breathing in your chest . . . and you can become
    much more
    HYPNOTIC SUGGESTIONS WITH CHILDREN 505

    fully awake and your breathing will be normal and Your speech will be very soft-spoken, relaxed
    the asthma will be gone. and at ease. . . . Your previous fears and tensions
    and staccato and jerking type of talking will be
    replaced by a smooth and flowing manner of
    speaking. . . . Your fears of talking to strangers, to
    Suggestions with Dyslexia
    groups of people, on the telephone, reciting in class
    Harold B. Crasilneck, Ph.D., and James will be greatly reduced because of the great power
    A. Hall, M.D. Dallas, Texas of your unconscious mind. . . . Your speech will be
    soft, secure, and you will be much more relaxed
    INTRODUCTION and at ease, pleased that you can speak without
    stammering or stuttering. . . . Now speak in a
    Although there has been relatively little use of whisper without stammering or stuttering and hear
    hypnosis in treating dyslexia, Crasilneck and Hall how your voice sounds.
    (1985) anecdotally report that three-fourths of the
    dyslexic children treated through hypnosis
    demonstrated moderate to marked improvement.
    (Ed.) Personalized Fairy Tales for
    Treating Childhood Insomnia
    SUGGESTIONS
    Your vision is simply going to improve. . . . You Elaine S. Levine, Ph.D.
    can recognize words with much more ease. . . .
    Once you have learned the word, it will make an INTRODUCTION
    impression upon your unconscious brain and mind,
    and recall of this word in the future will be much Levine (1980) used indirect hypnotic sugges-
    easier. . . . Your memory for words that you learn tions presented through the medium of audiotaped
    will become implanted in your mental processes childhood fairy tales tailored to each child. In two
    and will be recalled in a smooth, coordinated cases, after the audiotape was played at bedtime
    fashion. There will be an excellent coordination for six consecutive nights, the maladaptive
    between your eyes, your brain, and your memory . . behaviors were successfully eliminated. The
    . and your reading capabilities will continuously outline of her procedure is presented here.
    improve until they return to normal. . . . You will Excerpts from the fairy tales used in two case
    be much less anxious and much less afraid in your examples may be seen in her original article.
    reading and learning habits. . . . Your reading is (Ed.)
    going to improve consistently.

    PROCEDURES FOR THE TREATMENT

    Hypnotic Suggestions with The procedures for creating the indirect hyp-
    Stuttering notic tape can be summarized into five steps:

    Harold B. Crasilneck, Ph.D., and James 1. Hypotheses about the child's primary stresses
    A. Hall, M.D. Dallas, Texas and conflicts are drawn from discussions with
    the parents and, if the child is old enough, with
    [After hypnotizing the patient to the deepest the child himself/herself.
    level, the following suggestions are given:] 2. A list of the child's likes and dislikes are
    generated from a discussion with the child. The
    list should include the child's favorite
    506 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    fantasy figures, colors, foods, and animals, as well deemed appropriate, ego-strengthening sugges-
    as preferred activities. 3. A fairy tale is created tions like the following may be a useful part of the
    in which: hypnotherapy. (Ed.)
    • The child's favored objects and activities are
    woven into the plot (use of the child's
    SUGGESTIONS
    preferences and avoidance of the child's
    dislikes assures a positive cathexis to the Every day ... (at such and such a time) . . . you
    fairy tale). will get into the habit of working for at least two
    • The fantasy figures interact with the child in hours or so . . . without fail.
    the story. You will be able to think more clearly . . . you
    • The fantasy figures demonstrate appropriate will be able to concentrate much more easily.
    ways of dealing with the stresses that were You will become . . . so deeply interested and
    targeted as central concerns of the child. absorbed in what you are studying that you will be
    • It is suggested at the ending of the fairy tale able to give your whole attention to what you are
    that a fantasy figure falls asleep in the child's doing ... to the complete exclusion of everything
    lap, and the child also sleeps in order not to else.
    disturb the new fantasy friend. Because of this . . . you will be able to grasp
    1. An audio recording of the fairy tale is made. things and understand them more quickly . . . more
    Suggestions of relaxation, comfort, happiness easily . . . and they will impress themselves so
    and self-confidence are included. deeply upon your memory that you will not forget
    2. The child is informed, "This recording will them.
    make going to sleep much easier and much With every treatment that you have . . . your
    nicer. Simply play this tape each night before memory will improve enormously . . . and your
    you get into bed, and it will help you feel more work will become easier and easier.
    and more relaxed each night." You will not only be able to remember what you
    have learned . . . but you will be able to recall it
    without difficulty . . . whenever you need to do so.

    Suggestions with School Phobia


    David Waxman, L.R.C.P., M.R.C.S. A Science Fiction-Based
    London, England Imagery Technique
    Gary R. Elkins, Ph.D.
    INDICATIONS AND Temple, Texas
    CONTRAINDICATIONS and
    Bryan D. Carter, Ph.D.
    Waxman (1989) appropriately recommends that
    parents must always be involved in therapy for INTRODUCTION AND INDICATIONS
    school phobia. Parents may be an important part of
    the problem, for example, through pushing the The authors recommend that this technique
    child too hard for achievement or being overly should be used flexibly and indicates that it has
    critical. School phobia may likewise be been found to be useful with children between six
    symptomatic of family problems requiring a and thirteen. It has proven effective in trance
    broader focus than simply hypnosis with the child. induction and in the treatment of a variety of
    Where individual hypnosis is problems including school phobia,
    HYPNOTIC S U G G E S T I O N S W I T H CHILDREN 507

    adverse chemotherapy reactions, fear of swal- Here the therapist may call forth any number of
    lowing and choking, secondary enuresis, and as an imaginary characters, devices, and scenes as
    adjunct in treating hyperactivity syndrome. (Ed.) helpful therapeutic approaches to coping and
    problem resolution. In the treatment of children
    with pain the following has been utilized:
    THE TECHNIQUE
    In the initial session, rapport is built and Now, look around at the trees and buildings on
    pre-induction talk centers around a discussion of this planet. I want you to meet someone you have
    science fiction, space travel and movies with wanted to meet. You can see "Dr. Zargon" coming
    which the child is familiar. We have found it useful toward you. He is a very famous space traveler and
    at this stage to have short movie strips, audio or the doctor for this galaxy. As he shakes your hand
    videotapes, or books available for viewing. you can see him smile and you feel good. That's
    The child is then invited to go on a science right. Now, Dr. Zargon knows that you have a
    fiction adventure and take a ride in a space ship "in problem with pain and you know he can help you.
    his imagination." The child is then asked to relax Dr. Zargon has a "super ray machine" that he can
    and the following approach is used: focus on the pain and cause it to go away. And as it
    goes away you may feel a tingling feeling or a warm
    sensation where the pain was. Now as Dr. Zargon
    I want you to relax and get ready to go on an
    adventure in a space ship. Just sit back in the focuses this machine on the pain, the tingling feeling
    "cockpit" of your space ship. Now put on your or warmth begins. Very good. As the different
    "space helmet" and your "oxygen mask." Now take a feeling begins, you can let Dr. Zargon know by
    deep breath of oxygen through your mask. With raising your right hand. That's right.
    each breath you take you can relax even more and get
    ready to "take off into space on an adventure.
    Similar suggestions are given until the goal for that
    When you are ready to begin your adventure you can
    session has been reached. In terminating the
    close your eyes. Very good. Now you can see the
    instrument panel in front of you and hear the roar of session the child is told: "Now you feel very good
    the engines. When you are ready you can reach out and relaxed and it is time to return to your space
    and "fire the rockets" and climb into space. Feel the ship and to return to Earth."
    pressure of the seat as you lift off. Very good. You The child is encouraged to return to conscious
    can look out the window of the space ship and see the alertness whenever he is ready. Afterwards it is
    stars as they go by. See all the pretty stars and the useful to have the child discuss the experience and
    beautiful and interesting planets. any objects or characters he perceived which were
    Now, in space there is no gravity and you can have or were not specifically suggested. This reinforces
    a lot of fun with this. Your body is becoming very prior suggestions and provides valuable
    light and your hands and arms can begin to drift information which can be used in future sessions.
    upward because they feel weightless. Very good. If possible the child's parents may be involved
    Now you can land on a friendly planet to have a in the hypnotherapy sessions and/or audiotape
    good adventure and "learn something new." You can
    recordings of the session may be made and given
    relax even more as you land your spaceship on the
    planet and your arms return to the sides of the chair. to the child for use at home. The parents may be
    Good. Now you can step out the door of the space helpful in encouraging and leading the child
    ship to look at the planet. through specific images and suggestions at home
    during practice sessions.
    TIME REORIENTATION: AGE
    REGRESSION, AGE PROGRESSION,
    AND TIME DISTORTION
    INTRODUCTION Age Regression

    Age regression as a therapeutic technique has been described since at least the late 1800s. Although
    Erickson's (Erickson & Rossi, 1979, 1989) "February Man" technique of inserting new memories or
    creating new endings for historical events appears innovative, as early as 1889 Janet described the use
    of very similar techniques in his work with Marie (Ellenberger, 1970; Janet, 1889). The technique of
    hypnotic age regression and particularly particularly became more popular among those working with
    victims of trauma ("shell shock" and "war neurosis") following World War I (Wingfield, 1920) and
    World War II (Watkins, 1949).
    Age regression is commonly described as being either a partial or a complete regression. Partial
    regression refers to a state wherein the patient has a divided sense of consciousness: part of her feels the
    regressed age, and part of her is aware of her adult perspective. In a complete regression or
    revivification, the patient may seem to lose such dual awareness; for example, he feels four years old,
    seemingly without a knowledge of future events that transpired. A great deal of research through the
    years has focused on the nature of revivification and age regression.

    SCIENTIFIC R E S E AR C H ON AGE REGRESSION


    There is a very small amount of evidence suggesting that there may be some quite limited
    physiological or neurophysiological regression in
    510 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    revivification. For example, it has been possible to regress excellent subjects to infancy and elicit a
    Babinski reflex and similar phenomena that simulating subjects (actors) could not produce
    (Gidro-Frank & Bowersbuch, 1948; Raikov, 1980, 1982; True & Stephenson, 1951). It has been
    pointed out, however, that this may be the result of depressed muscle tone which allows this response to
    be elicited in adults (Barber, 1962), a challenge that should be examined in controlled research. Further
    supporting the evidence for a lack of a genuine physiological regression during age regressions,
    Aravindakshan, Jenner, and Souster (1988) failed to find a change in auditory evoked response
    morphology in the direction of those seen in children. On the other hand, Kupper (1945) provided
    evidence of changes in EEG patterns when a subject was regressed to various ages prior to age 18, the
    age at which a seizure disorder developed. Clearly, further well-controlled research would still be
    beneficial on the extent of physiological regression that may take place.
    In contrast, there is a tremendous amount of evidence concerning the degree of genuine regression
    that occurs in cognitive and perceptual processes during revivification experiences (Asher, Barber, &
    Spanos, 1972; Barber, 1962; Bynum, 1977; Crasilneck & Michael, 1957; Fellows & Creamer, 1978;
    Gard & Kurtz, 1979; Gordon & Freston, 1964; Hoskovec & Horvai, 1963; Leibowitz, Graham, &
    Parrish, 1972; Nash, Johnson, & Tipton, 1979; O'Brien, Kramer, Chiglinsky, Stevens, Nunan,
    & Fritzo,
    1977; O'Connell, Shor, & Orne, 1970; Orne, 1951; Perry & Chisholm, 1973; Porter, Woodward,
    Bisbee, & Fenker, 1972; Reiff & Scheerer, 1959; Roberts, 1984; Sarbin, 1950; Sarbin & Farberow,
    1952; Schofield & Reyher,
    1974; Silverman & Retzlaff, 1986; Spiegel, Shor, & Fishman, 1945; Staples & Wilensky, 1968; Taylor,
    1950; True, 1949; Young, 1940). Such research has examined tests of memory, cognitive and
    intelligence tests, projective test performance, Bender-Gestalt test performance, Piagetian-based tests
    of cognitive developmental level and illusion tests to which children respond in predictable ways.
    Although Reiff and Scheerer (1959), Erickson and Kubie (1941) and others suggested that there is a
    reinstatement of childhood cognitive patterns with an ablation of adult memories, most of the research
    demonstrates that this is not truly the case. For instance, subjects who are regressed to a certain age are
    found to have higher IQ scores than when they were that age (Sarbin, 1950). The cognitive performance
    of age-regressed subjects is generally found to exceed norms for the regressed age and thus is not a
    reinstitution of childhood mental processes.
    Thus, overall there is an overwhelming body of evidence suggesting that age regression is not truly a
    return to the childhood experience any more than hypnotically suggested amnesia, blindness or
    deafness is the functional equivalent of its physiological counterpart (Nash, 1988). Age regression does
    not allow subjects to return to previous modes of mental functioning.
    Truly, however, age-regressed subjects may in some cases retrieve memories and information that
    was not originally available to them consciously, perhaps especially under circumstances where
    emotional trauma has created a block to memory (Nash, Johnson & Tipton, 1979; Sheehan &
    McConkey, 1982; Smith, 1983). On the other hand, subjects have been shown to be clearly capable of
    filling in gaps of memory with
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 511

    confabulated information, of distorting information, and of being influenced in what is


    "remembered" by leading questions or suggestions (Council on Scientific Affairs, American
    Medical Association, 1985; Pettinati, 1988). Nevertheless, despite the fact that hypnotized
    subjects may distort or produce false information, there is abundant evidence of startling and
    accurate information that may also be retrieved through the use of hypnosis. A particularly
    dramatic case (Fromm, 1970) demonstrated how a Japanese-American man, unable to speak or
    understand Japanese, was able to speak Japanese fluently, accurately and in a age-appropriate
    manner when regressed to early childhood (when he had lived in a relocation center during World
    War II).
    The fact that hypnosis may at times impressively facilitate the recall of information and yet also
    produce recall of inaccurate information presents a forensic dilemma that is beyond the scope
    of this clinically oriented volume. Nonetheless, it is incumbent upon clinicians to be aware of
    these facts and issues and to realize that careful forensic hypnosis guidelines must be followed
    when litigation or court testimony is involved. For this reason I have included Garver's summary
    overview of such guidelines at the end of this chapter. Forensic hypnosis may be of clear value in
    providing investigating leads, but these leads must always be corroborated through independent
    sources because of the possibility of inaccuracy. Those interested in forensic work should
    thoroughly study Pettinati (1988), Laurence and Perry (1988), Scheflin and Shapiro (1989), and
    Sies and Wester (1987).
    Although research has severely questioned the degree to which regression reinstitutes cognitive,
    perceptual, or physiological states from the past, clinicians may find it interesting that
    experimental evidence thus far suggests that during an age-regression experience there may be
    a reinstitution of the affective aspects of the regressive situation (Nash et al., 1979). And, in fact, the
    most effective age regressions in experimental work appear to be those associated with affect-laden
    events (Nash et al., 1979; Sheehan & McConkey, 1982). This research suggests that under
    conditions of emotional arousal, such as those encountered in our clinical work, memory may
    be more effectively revived.

    PAST AND FUTURE LIVES

    When the technique of age regression is discussed, questions about the possibility of
    regression to past life experiences are often raised. This controversy stemmed in large part from
    the famous Bridey Murphy case (Bernstein, 1956), in which a lay hypnotist hypnotized a woman
    who subsequently imagined herself to be the reincarnation of an Irish woman. Credible hypnosis
    experts immediately debunked this idea (Kline, 1956), and in fact investigative reporters
    discovered background experiences of the woman that accounted for her seemingly inexplicable
    knowledge about Ireland (Gardner, 1957).
    The phenomenon of source amnesia (Evans & Thorn, 1966) thus seems adequate to account for
    this and the many similar cases (Barker, 1979; Edwards, 1987a, 1987b; Harris, 1986; Hilgard,
    1986; Wilson, 1982), where
    512 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    investigations have both revealed flaws in the accounts of the subjects and have also identified
    that they had been exposed to historical information in the past that was related to their presumed
    past lives. In cases that have been investigated where the regressed subject supposedly spoke in
    another language, a linguist found the claims to be patently false (Thomason, 1984, 1986-87).
    Carefully controlled research (Baker, 1982) has also confirmed that having the experience of
    regressing to a "past life" is based on a combination of the expectations of the subject and of
    suggestions and the demand characteristics from the hypnotherapist. But, despite scientific
    evidence to the contrary, there has never been a dearth of gullible individuals willing to
    believe in anything from abductions by UFOs to people living inside the earth under the north
    pole (Hines, 1988). Thus, there continue to be individuals who will promulgate a belief in
    regression to previous lives, most of them lay hypnotists.
    However, there are also skilled and respected professionals like Barnett (1981) and Cheek (Rossi
    & Cheek, 1988) who believe that it is possible to regress patients to birth experiences and even
    prebirth uterine experiences. Despite fascinating recent evidence about the ability of the fetus to
    hear, which may give one pause to wonder, regressions to uterine or birth experiences seem to
    me more likely to consist of projective processes. However, if a patient should spontaneously
    "regress" to such an experience, it may still be useful in promoting therapeutic change. From my
    point of view, such "believed-in imagining" may, because it is believed by such a patient, be a
    catalyst for altering perceptions and at the same time provide a face-saving excuse that some
    patients need.

    CAUTIONS AND GUIDELINES IN USING AGE REGRESSION

    In introducing the topic of age regression, we should begin with some cautions. Many years
    ago, Wolberg (1964) warned us that, "We may conjure up a situation permitting us to track
    down the origin of each of the patient's symptoms. Having done this, we should probably find, in
    most cases, that the symptoms themselves would not vanish. The expectation that recovery of
    traumatic experiences will invariably produce an amelioration or cure of the patient's neurosis is
    founded on a faulty theoretic premise" (p. 321). Although I have found age regression to be a
    powerful and highly effective technique, bear in mind that not all patients need or benefit from
    age regression. Nor is insight always a necessary precondition for change. Motivated patients will
    often benefit from suggestive hypnosis. Furthermore, adaptive functions that are being served
    in the present may be ignored if one looks almost exclusively to the past.
    It is strongly recommended that you do not age regress a patient without first obtaining
    permission from their unconscious through an ideomotor signal. When a "no" signal is given,
    one should respect and work through the patient's defenses (Hammond, 1988f; Hammond &
    Miller, in press).
    Another helpful guideline is: the less experience you have in using hypnotherapy, the more
    structure you should maintain (reducing ambiguity rather than being vague or permissive) in
    doing a regression. You will find
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 513

    it helpful to pinpoint an incident with ideomotor exploration (Hammond & Cheek, 1988; Rossi &
    Cheek, 1988) and then do the regression to that specific incident. Regressing patients to specific,
    identified events seems to improve the quality of age regressions. The ego strength and capacity of the
    patient to uncover trauma and to handle the intensity of the abreaction should also be taken into
    account. When treating borderline and psychotic patients, for example, the emphasis should be on
    ego-strengthening and using self-hypnosis for self-control. Age regression and abreactive work can be
    done, but must be approached more cautiously and preferably in controlled, inpatient settings.
    Alternatively, in working with fragile or severely disturbed patients, one may use dissociative age
    regression techniques and methods like Kluft's fractionated abreaction and slow leak techniques, which
    may be found later in this chapter.
    A final consideration in conducting age regression and abreactive work is your own capacity to
    handle the expression of intense affect without panicking and prematurely terminating the experience.
    If patients sense that even their therapist cannot handle the emotions and intensity within, it becomes
    truly frightening for them. Not all therapists feel comfortable facilitating such intense experiences;
    some may choose instead to refer patients to another therapist for this portion of their therapy.

    METHODS OF FACILITATING ACE REGRESSION

    Less experienced therapists often try to facilitate age regressions in relatively light hypnotic states.
    Some degree of hypermnesia or improved memory may be obtained, but unless the patient is very
    hypnotically talented the results will often be limited and disappointing. Erickson (1952) often worked
    at deep levels of trance when doing age regression, using extended length interviews. He reported that
    he commonly only gave important suggestions after patients had been in trance for over 20 minutes.
    Wolberg (1964) also reserved extended time interviews for age regression work. I likewise prefer to
    have the patient in deeper levels of trance and I usually do a minimum of 15-20 minutes of induction and
    deepening work prior to beginning an age regression.
    There are a variety of methods for facilitating an age regression. In the first part of this chapter you
    will find several modeled examples of verbalizations illustrating various methods. Stanton's
    contribution demonstrates imagery techniques for producing regression. My own contribution
    illustrates a straightforward method for producing regression after identifying a specific event through
    ideomotor signaling. Brown and Fromm's contribution will provide you with tips for enhancing the
    quality of the regressions.

    INDIRECT AGE REGRESSION. It should also be noted that when age regression is being used for metaphoric
    work, it may often be facilitated informally through simply using phrases like, "Remember when . . .,"
    "A long time ago, when you were very, very young . . .," or "As children . . ." For example: "You can
    probably remember as a little boy how painful it was
    514 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    when your best friend moved away" [assuming you know this event occurred]. A metaphor about loses
    and getting over losses may then be used. This type of informal regression often does not produce the
    high quality regression experience that is desired in working with trauma, but is usually sufficient for
    metaphoric work involving earlier life experiences. Examples of this type of informal (metaphoric)
    regression may be seen in my two metaphors later in the chapter.

    REVIVIFICATION. If you are interested in the type of wording that is used in facilitating a full age
    regression (revivification), you will find this modeled in the sections by Brown and Fromm and by
    Greenleaf. One of Erickson's contributions also illustrates one of his methods for facilitating a full
    regression. His technique of age regression by disorientation is one wherein a state of confusion is
    induced in the patient. The patient is disoriented as to what day of the week it is, and then the week and
    date, and finally concerning what month and year it is. After completely disorienting the patient for time
    and place, the patient is reoriented to the earlier age. We should mention, however, that a partial age
    regression is generally sufficient for therapeutic work and is much easier to obtain than a full
    revivification. The advantage of a partial regression is that the patient will feel emotionally involved in
    the experience, and yet will have the advantage of an adult perspective that can be applied in reframing
    and working through negative past events.

    ABREACTION AND REFRAMING

    Skills in conducting hypnotic induction, deepening and age regression to a past event are relatively
    easy to teach. It is, however, much more difficult to readily impart skills for how to facilitate intense
    abreactions and to then cognitively reframe and work through trauma in such a manner that it provides a
    corrective emotional experience. It is beyond the scope of this book to systematically describe all the
    steps and details in this process. You should consult hypnotherapy textbooks (e.g., Hammond & Miller,
    in press; Watkins, in press) for more detailed information concerning abreaction, working-through,
    strategies in age-regression work, and working with resistance to age regression. Some limited
    information and modeling concerning abreactive technique will be found, however, in Kluft's contri-
    butions to this chapter. Erickson's suggestions for dissociating affect and content and his screen
    technique illustrate dissociative regression techniques for reducing the intensity of an experience.
    Kluft's fractionated abreaction and slow leak techniques demonstrate other ways of doing gradual
    abreactive work. Some models of working-through techniques are also provided in the contributions by
    Wright and Barnett. Please bear in mind that the working-through of intense material from the past is an
    advanced hypnotherapy skill deserving of your thorough and careful study, as well as supervision.
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 515

    Age Progression
    "Age progression," "time projection," "pseudo-orientation in time into the future," "mental
    rehearsal," "process imagery," "goal imagery," "success imagery," "end-result imagery" are all terms
    that have often been used in a rather fuzzy and sometimes interchangeable manner in hypnosis. All of
    these terms refer to future-oriented therapeutic work, but they are not all synonyms for the same thing.
    I conceptualize mental rehearsal in hypnosis as essentially being the parallel to this technique as it is
    discussed by cognitive behavior therapists; that is, the patient is asked to mentally, covertly roleplay an
    anticipated future situation. In an elaboration on this method, the patient may be asked to imagine an
    ideal role model handling a situation effectively, and then to imagine himself reacting similarly. Mental
    rehearsal has also been called process imagery (Zilbergeld & Lazarus, 1987) - imagining the process or
    means by which you will eventually accomplish the end result.
    End-result, goal, or success imagery are terms, as I conceptualize them, that refer to imagining
    oneself in the future, after changes have already taken place, experiencing what life and oneself are now
    like as a result of the changes. However, we do not need to be in a trance state to do this. Each of us,
    right now, can close our eyes and construct such an image. One step beyond this is what Erickson
    referred to as time projection or pseudo-orientation in time, and what is often called age progression.
    This consists of having patients in deep trance imagine themselves in the future, but because of the
    depth of trance and degree of hypnotic talent, the experience has an intensity and quality of reality to it
    that a more consciously willed experience does not possess.
    The difference between end-result imagery and age progression is like the difference between
    consciously remembering an event from your childhood versus undergoing a complete age regression
    and having a revivification of a childhood experience while in a deep trance. Erickson likened this to the
    difference between conscious fantasies (mental rehearsal, success imagery) and "unconscious
    fantasies" (age progression). The deeper trance experience is truly "believed-in imagining" wherein the
    experience is very intense and seems quite real to the subject. When we consider the research that
    documents how utterly real and convincing a confabulated (or therapist-suggested but inaccurate) age
    regression may feel to a subject, why shouldn't age progressions have the potential to feel just as actual
    and real?
    I refer to this group of methods as goal-directed hypnotherapy techniques, and each one of them may
    be helpful and beneficial. They all seem compatible with Alfred Adler's teleological or future-oriented
    approach to treatment, wherein people are perceived as being basically goal-oriented. From this
    perspective, we may see ourselves as moving forward toward goals in the future at least as much as we
    are impelled from behind by causes in the past. The problem is that many of our patients are moving
    toward irrational goals and/or using their imaginations in self-defeating rather than constructive ways.
    Erickson certainly appreciated the value of such an orientation when he said that we should have an
    "appreciation that practice
    516 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    leads to perfection, that action once initiated tends to continue, and that deeds are the offspring of
    hope and expectancy" (1980, Vol. 4, p. 397).
    Because of limitations in the hypnotic talent level of patients and in the confidence and experience
    level of therapists, mental rehearsal (process imagery) and end-result imagery are the future-oriented
    hypnotic techniques used most commonly in everyday clinical work. However, age progression
    should also be appreciated as a powerful method. In considering this technique, Erickson (1980, Vol.
    4) realized that "the patient could respond effectively psychologically to desired therapeutic goals as
    actualities already achieved" (p. 397).
    This section begins with an outline and illustration of Erickson's technique of time projection.
    Afterwards, you will have an opportunity to study verbalizations of several other clinicians as they
    illustrate their use of process and goal imagery techniques. Finally, Erickson's future-oriented
    self-suggestion technique concludes this section.

    Time Distortion

    The hypnotic phenomenon of time distortion may consist of a subjective sense of either time
    contraction or of time expansion. How does one go about producing time distortion? Sometimes this
    phenomenon occurs spontaneously, simply by hypnotizing someone. It may also be suggested to
    patients.

    AREAS OF APPLICATION. Time distortion may be of particular value in working with acute and
    intractable pain, in childbirth training, in helping patients endure unavoidable but miserable
    experiences or suffering (e.g., hospital -ization, cancer), in athletics, in treating obesity (making the
    time between meals seem to go by very rapidly), in treating cravings and withdrawal symptoms, with
    hypnoanesthesia, and in treating anorgasmia and retarded ejaculation. It may also be of value in
    conducting a time distorted review of experiences from the past. Time distortion may even be used to
    have patients conduct internal reviews of learnings in therapy and to review potentially disturbing
    dreams (Rossi & Cheek, 1988). In working with severe trauma, time distortion may be suggested (in
    an age regression) so that the traumatic event will be subjectively experienced in a much shorter
    period of time.

    RESEARCH IN TIME DISTORTION. Although time distortion is frequently mentioned, modern texts on
    hypnosis are amazing barren of information about this phenomenon. There is an extensive literature
    on this topic, however. Cooper (1948, 1952) began initial research in this country on time distortion,
    and later allied himself with Milton Erickson to investigate this topic (Cooper & Erickson, 1954).
    Through the years there have been a variety of other investigations (Cooper & Rodgin, 1952;
    Erickson & Erickson, 1958; Graef, 1969; Loomis, 1951).
    Barber (Barber & Calverly, 1964) challenged time distortion as a hypnotic phenomenon in much
    the same way that he has challenged almost every-
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 517

    thing else in hypnosis. Orme (1962, 1964, 1969) demonstrated that, as with other hypnotic
    phenomena, there are individual differences in the hypnotic capacity to experience this phenomenon.
    And Weitzenhoffer (1964) directly challenged Barber's (Barber & Calverly, 1964) claims and
    documented that deeply hypnotized subjects experienced time distortion significantly more than
    waking control subjects.
    Unique pioneering research with what we may conceptualize as major time reorientation was
    pioneered by Fogel and Hoffer (1962), and extended by Aaronson (1968a, 1968b), Zimbardo,
    Marshall, and Maslach (1971), and Sacerdote (1977). This research examined the implications of
    altering perceptions of past, present and future time — for example, contracting a sense of past time
    while expanding a sense of present and future time. If you are interested in examining suggestions for
    time reorientation, you may refer to Sacerdote's contributions on eliciting mystical states in Chapter 3
    and refer to my textbook (Hammond & Miller, in press).

    TIME DISTORTION THROUGH SUGGESTIONS When you want time distortion, you may simply give
    suggestions for the patient to experience it. In most clinical contexts and with most problems, this is
    the most practical approach and patients often respond positively to these suggestions. For example,
    one may simply suggest, "A lot of time will pass. But pass very rapidly" (Erickson & Rossi, 1979, p.
    374). Or, as I have heard a couple of different colleagues suggest: "You will have all the time you
    need, in the time you have."
    Thus, Erickson (Rossi & Ryan, 1985, p. 194) explained:

    You do not have to use an awfully extensive verbalization for time distortion. Yesterday I gave just this
    amount of verbalization to subjects who had never before demonstrated time distortion: "You are waiting for
    a bus on a cold, wet, rainy day. You're in an awfully hurry to get downtown, and that bus is two minutes late.
    Your appointment downtown is important, and you've just got to be there on time. And waiting those two
    extra minutes for that bus seems like waiting all day. Then once it arrives, the bus seems to poke along all
    the way to town. Now it's a nice sunny day, and you're going downtown, and you're not in a hurry. A friend
    comes along and talks to you, and the bus is two minutes late the way it was the other time. But this time
    you're ready to swear that the bus is ten minutes ahead of schedule!"

    Kroger and Fezler (1976) emphasized the use of imagery conditioning and of standardized,
    multisensory images to produce hypnotic phenomena. The interested reader may consult their book
    for two examples of structured images designed to produce and train subjects in experiencing time
    contraction and time expansion.

    TIME DISTORTION TRAINING. There are situations, however, when therapists or physicians desire to
    make extensive use of time distortion and to have a patient reliably experience it in self-hypnosis.
    These situations may include working with severe chronic pain, in psychotherapy where extensive
    exploration of past events is anticipated, in therapy with multiple personality disorder or other patients
    with a background of extensive trauma, and when
    5I8 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    anticipating using hypnosis as the sole anesthetic for surgery. Experimentalists who want to use time
    distortion may likewise desire an added confidence that their subjects have been carefully prepared to
    experience this phenomenon.
    In situations such as these and where you have the luxury of preparation time, it may be desirable
    to specifically train the patient to more fully experience this hypnotic phenomenon. The last section
    on time distortion by Cooper and Erickson (1959) has, therefore, been reprinted. It is filled with
    beneficial clinical nuances and provides modeling in phrasing suggestions that will be beneficial in
    brief interventions aimed at producing time alteration, in more thorough time distortion training, and
    in experimental work. Specific time distortion training may enhance the patient's ability to experience
    time contraction or expansion.
    It is well-known that Erickson often preferred to conduct four to eight hours of "trance training"
    with patients, both to augment their hypnotic performance and to become thoroughly familiar with
    their capacities to experience the various phenomena. You are encouraged to consult Cooper and
    Erickson (1959) for further details concerning training, and particularly for a review of some of
    Erickson's fascinating cases in which time distortion was used. For the benefit of clinicians,
    suggestions that may have particular value have been printed in italics so that they may pick them out
    more easily.

    AGE REGRESSION AND ABREACTION

    Ideomotor Identification Followed by following suggestions to facilitate a regression to


    the specific event identified as relevant to the
    Partial Regression problem.

    D. Corydon Hammond, Ph.D. SUGGESTIONS


    Salt Lake City, Utah
    Then allow your unconscious mind to begin
    reorienting you back in time, orienting you
    back to that event at the age of ________ Drifting
    INTRODUCTION back through time, perhaps as if you're drifting
    back through a long tunnel, drifting back through
    Through ideomotor signaling you may ask time, to that event at the age of
    patients, "Is there some past event or experience ______ And it will feel almost as if you're
    responsible for the beginning of this problem?" reliving that experience again, thinking and feeling
    When an affirmative response is given, the next as you thought and felt then. Allow you
    step is to obtain the patient's permission to explore unconscious mind to take you back to that event,
    this event: "Then would it be all right with your and when you're there, your "yes" finger will float
    unconscious mind for us to go back and explore, up to signal me. [Pause. Allow time for the
    and understand, and resolve whatever it was that reorientation; however, if a signal has not been
    happened when you were X years old?" If a signal given after about 30 seconds, repeat the
    of "no" is given, we must work through the suggestions. After receiving a "yes" signal:] Tell
    resistance before proceeding. When a signal of me where you are and what's happening. [Note the
    "yes," is given, I then use the use of the present tense.]
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 519

    Imagery Methods of Facilitating you had at that time. Whenever you so desire, you
    Age Regression can return to your present age by going forward
    through the pages of the book of time.
    H. E. Stanton, Ph.D.
    Hobart, Tasmania, Australia BOOKSHELVES
    Visualize yourself going into a pleasant room,
    INDICATIONS AND its walls lined with bookcases. Filling these
    bookcases are diaries, one for every year of your
    CONTRAINDICATIONS
    life. Should there be some problem worrying you
    at the present moment, you may wish to use these
    Dr. Stanton models two methods for facilitating
    diaries to find relevant information from your past.
    age regression through the use of imagery.
    Or you may simply wish to find out more about
    Naturally, use of such methods presupposes that
    your past life. To help you do this, stored in
    the patient is talented at visualizing. These methods
    drawers beneath the bookshelves are old
    may be used for promoting a dissociated regression
    photographs, report cards, letters, and other
    in which the patient feels one step distanced from
    memorabilia.
    intense material. Alternatively, the patient may be
    asked to enter the scene pictured and experience it
    firsthand, Dr. Stanton's methods are permissive and
    allow the patient considerable latitude in Improving the Quality of the Age
    determining what time or event to select for
    regression. This may be desirable with seasoned Regression
    clinicians and relatively stable, Daniel P. Brown, Ph.D., and Erika
    psychologically-minded patients. But for the less
    Fromm, Ph.D.
    experienced hypnotherapist and with less stable
    patients, this lack of structure introduces an extra Cambridge, Massachusetts, and Chicago, Illinois
    element of unpredictability. There is less certainty
    concerning what event will be selected from the Suggestions can be designed in various ways to
    past. Less experienced therapists may want to improve the quality of the regression and to
    impose more structure in conducting a regression. achieve genuine age regression. . . . To increase the
    (Ed.) likelihood of reinstating previous modes of
    functioning over current adult functioning, the
    therapist can directly suggest:

    THE BOOK OF TIME You will find yourself thinking, acting, feeling,
    and behaving like a child of [specify suggested age].
    Imagine that you have before you the book of No matter what you find yourself doing, you will
    time, in the pages of which you will find experience yourself exactly as you did when you were
    photographs spanning your entire life. As you open [x] years old. You will temporarily forget your
    the book, it reveals a picture of yourself at your current ways of thinking, acting, feeling, and be-
    having until the next time you hear me say these
    current age. Turn back the pages one year, and see words, "Soon you will find yourself growing up
    the photograph of yourself as you then were, and again."
    you can be there again, feeling the things you felt
    then, having the knowledge you then had. He may also suggest a change in the body image,
    Continue turning the pages if you wish, going back especially for regression to childhood:
    further and further into your past, knowing you are
    able to stop at any point in order to explore more You are younger and younger, and your body is
    fully the experiences getting smaller and smaller . . . your arms and legs
    seem smaller and smaller . . . your whole body
    520 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    seems smaller and smaller ... the room which you "What is happening?" Talking to the patient in the
    are in seems so large as you look around . . . present tense, as if the childhood experience were
    happening right now, favors the occurrence of a
    The reinstatement of previous modes of func- genuine age regression. . . . The therapist must also
    tioning is for the most part quite unstable. The treat the patient as if the patient were a child. To
    regressive experience characteristically fluctuates develop a context appropriate for the age
    between revivification and . . . age regression. In regression, the therapist may need to engage the
    order to bias the fluctuation in favor genuine age "child" in fantasy, sit down on the floor and play at
    regression, the therapist must help the regressed mental age of the regressed patient.
    patient temporarily suspend his orientation to the Some highly hypnotizable patients with a talent
    therapeutic context and adopt the context of the for age regression may manifest two additional
    regressed situation. The hypnotist does this in a features of age regression. If they are capable of an
    number of ways. Once the therapist has suggested open-eyed trance, they may open their eyes and
    the regression, he should give the patient enough hallucinate a childhood setting to which they are
    time to orient himself to the new level of regressed. That is, they perceive the office in which
    functioning. The hypnotist should pause before they currently are as if it were, say, their school
    giving any further suggestion. A graded suggestion room. Yet, they also see the therapist's office when
    is also useful: ". . . and the longer you find yourself they open their eyes. Because of trance logic (Orne,
    to be [x] years old, the more you will actually 1959), perceiving two realities with open eyes
    experience yourself once again as an [x]-year-old." simultaneously is not necessarily a problem for the
    A finger signal may be added: ". . . and whenever age-regressed patient (Sheehan & McConkey,
    you feel exactly the way you did when you were [x] 1982). Other patients are capable of experiencing
    years old, the index finger will lift up." As most themselves simultaneously as the regressed child
    patients did not know the hypnotist when they were and the observing adult (Fromm, 1965a; Laurence
    children, he must explicitly suggest an alteration in & Perry, 1981). Still others, by dividing the ego
    the way he is perceived. An open-ended suggestion into an experiencing part and an observing part
    will allow the patient the freedom to imagine the (Fromm, 1965b), alternate between the experience
    hypnotist in a way that best fits the internal of the regressed child . . . and the observing adult. .
    experience of the age regression: "I will be a person . . Such patients can be given "hidden observer"
    you know and like. Who am I?" The age-regressed (Hilgard, 1977) suggestions to help then achieve a
    patient may say that the hypnotist is a teacher, a fuller age regression:
    relative, a sibling, a parent, a friend. The hypnotist
    then uses the information from the patient's history
    Now, often it is possible for people who are
    to play the part chosen for him as well as possible.
    hypnotized to comment in some way on their expe-
    Thus, the hypnotist structures the situation to riences, what they are feeling at the time, the various
    favor a context congruent with the regressed sensations and experiences they feel while they are
    hypnotized. You're back in the classroom and five
    situation, giving task-appropriate suggestions that
    now, and you are deeply hypnotized. In a little while I
    will elicit childlike responses. Giving suggestions am going to tap you on the shoulder, when I do that,
    that demand adult-appropriate response will I want that other part of you that can comment on
    interfere with genuine age regression. For instance, these experiences to tell me what you are feeling at the
    if the patient is regressed to the age of five years, time, just simply tell me what's happening. When I
    the therapist must relate and talk to the patient as if tap you on the shoulder again, the other part of you
    he were talking to a five-year-old. And he must will go, and you will be right back to where you are
    word the inquiry with the regressed patient in the now, five years of age. So when I tap you the first
    present, not in the past tense - not "What time, the other part of you can tell me what you are
    happened?" but feeling and thinking and when I tap you again you
    will be back, to five years of age. I'll tap you the first
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 521

    time now. Describe to me the feelings and thoughts SUGGESTIONS


    you have at this moment. (Sheehan & McConkey,
    1982, p. 126)
    [Following induction and deepening:] Now that
    When regressing a patient to a very young age, it is things are becoming deeper and easier with every
    a good idea to have the patient imagine being in a minute, I'm going to tell you about the pleasant,
    warm and safe setting, perhaps being surrounded interesting experience you're about to have. You
    by warm blankets or feeling the comforting may wish to listen very carefully to the interesting
    presence of the mother or teddy bear. Because a things I'm about to tell you, but they'll register in
    very young child does not understand language, the your unconscious mind whether you pay close
    hypnotherapist must also prearrange a nonverbal attention, or just sit back and watch the hands of the
    signal to bring the patient back to the verbal level, clock going round and round in reverse. You've
    where he understands language: "The next time probably begun to feel that pleasant, quiet air of
    you feel the touch on your arm like this [therapist expectation, something like kids feel when they
    touches patient], you will no longer be six months know they're about to get a present with no strings
    old but will be [therapist names an older age]." attached; before they know it, the birthday is there,
    even if it seems far in the future or long ago.

    Suggestions to Facilitate BEGIN DISSOCIATION INDUCTION


    Revivification
    Now I'd like you to imagine that you're watching
    Eric Greenleaf, Ph.D. a small child who looks very much like you. He's
    wearing handsome party clothes, and he looks
    INDICATIONS very, very pleased and happy because he's about to
    play with the presents at his fourth birthday party.
    Greenleaf s (1969) suggestions were prepared to Can you see him clearly? What is he wearing? Do
    facilitate full age regression. As a regression his shoes buckle or lace? Can he tie his own shoes?
    approaches full revivification, the patient loses Very good. [Subject is encouraged to develop and
    adult perspectives and increasingly has the per- respond to the image of himself as a child.]
    ception of more fully being the regressed age. While you watch him, and see all the nice things
    Although full revivification is not usually nec- he does, I'm going to continue to talk to your
    essary in clinical practice and often requires much unconscious mind. So, while your conscious mind
    more deepening to obtain, the following watches, and feels pleased at watching this
    verbalizations serve as a useful model for facil- four-year-old child who looks so much like you
    itating more complete regressions. {Ed.) and who is so pleased with things, your
    unconscious mind will register everything that I
    say, without any effort on your part, as you sit,
    INTRODUCTION pleased and expectant, and watch this little child
    who looks so much like you.
    The regression suggestions were devised to [These suggestions encourage expectation of
    include both standardized and individuated and participation in the child experience, yet they
    methods. A number of possible "ways" into the allow the subject distance and time to adjust to the
    experience of regression are introduced to the new experience. There are also a number of
    subject, who may then resist one or the other while disguised binds which allow for resistance to
    still complying with the general directive to suggestion or individual accom-
    "regress."
    522 H A N D B O O K OF HYPNOTIC SUGGESTIONS AND METAPHORS

    modation to suggestion without retarding the things are of no importance — only those things
    direction of the regression.] belonging to the present — thoughts, feelings,
    [Following this introduction, the subject is events, spontaneous present— only these are vivid
    confronted with Erickson's (1964e) confusion and meaningful.
    induction. This is designed to disorient the subject Things at age four will be remembered so
    as to time and place, and to prepare him for vividly that you will find yourself in the middle of
    amnesia during regression. At the same time, such a pleasant life experience, not yet completed.
    a technique should make the subject more
    amenable to the direct instructions to follow.]
    REGRESSION: "THE
    BIOLOGICAL CLOCK"
    REGRESSION BY CONFUSION
    Everybody knows that clocks can go forward, to
    (ERICKSON) register the passing of time, or backward, to
    indicate time going into the past. Sometimes, in the
    Everyone knows how easy it is sometimes to movies, pages are taken from a calendar, or clocks
    become confused as to the day of the week, to
    run backwards, to indicate the passing of time into
    misremember an appointment as of tomorrow
    the past. That's how it is with "outside" time— time
    instead of yesterday, and to give the date as the old
    year instead of the new. Although today is you can see. Many people don't know that there's
    Tuesday, one might think of it as Thursday, but also a kind of "inside" time — time you can't see.
    since today is Wednesday and since it isn't Everyone has a kind of biological clock that can
    important for the present situation whether it is really go forward or backward, that can really take
    Wednesday or Monday, one can call to mind you into the past. You can feel that inside clock,
    vividly an experience of one week ago Monday, even without being quite aware of it, and we can
    that constituted a repetition of an experience of the turn it backwards just by counting; later, we can
    previous Wednesday. This, in turn, may remind turn it back to the present, just as easily.
    you of an event which occurred on your birthday in
    1958. At this time you could only speculate upon
    but not know about what would happen on the REIFF AND SCHEERER INDUCTION
    1959 birthday, and, even less so about the events of (MODIFIED)
    the 1960 birthday, since they had not yet occurred.
    Further, since they had not yet occurred, there In a little while I am going to start counting from
    could be no memory of them in your thinking in [subject's age] back to four. As I count, the
    1958. biological clock will start to run backwards and
    you'll become smaller and smaller and younger and
    Now people may remember some things and
    younger, so when I reach four you'll be four years
    forget others; often one forgets things he is certain
    old. With each count you'll lose all memory of that
    he will remember but which he does not. In fact,
    year-number, so when we reach four you'll have
    certain childhood memories stand out more vividly
    forgotten everything that happened to you after
    than memories of 1960, 1959, 1958. Actually,
    four. That's the way the biological clock works.
    every day you are forgetting something of this year
    When we reach four you'll really be four,
    as well as last year or of 1958 or 1957, and even
    celebrating your fourth birthday. You'll move and
    more so of 1956, '55 and '54. As for 1950, only
    talk and act and think four years old; it will be easy
    certain things are remembered identifiably as of
    because you'll really be four and won't be able to
    that year and yet, as time goes on, still more will be
    think of being anything else: being four will be
    forgotten.
    very happy, and being anything else will seem silly
    Forget many things, as naturally as one does, until we count again on the biological clock. So,
    many things, events of the past, speculations about
    you'll be four years old. When we reach
    the future; but, of course, forgotten
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 523

    four, you'll slowly open your eyes and look around and we are way back again." In this manner you
    the cozy room. I will be somebody you know and keep going backward in your suggestions, shifting
    like and like to talk to. this direction and that direction a little bit at a time
    until your patients . . . get awfully confused. They
    do wait for you to make a sensible, intelligent
    remark to which they can attach a meaningful
    Erickson's Confusional Method for significance. And so you say, "You know, this is
    Revivification really a nice day in June, 1940, and it really is."

    Milton H. Erickson, M.D.

    INTRODUCTION AND INDICATIONS Watkins' Affect or


    Somatic Bridge
    One of Erickson's techniques for facilitating a
    revivification was to begin by producing a John C. Watkins, Ph.D.
    disorientation of the patient. This may be done in Missoula, Montana
    several ways. For instance, the patient may be
    disoriented spatially by having him or her tumble
    over and around in a cloud. Erickson seems to have INDICATION AND
    particularly tended to use the following method of CONTRAINDICATIONS
    disorienting the patient temporally. {Ed.)
    This method, summarized by the editor from
    Watkins (1971), should be considered for use when
    ILLUSTRATIVE VERBALIZATIONS a patient is experiencing an emotion (e.g.,
    depression, anxiety), compulsion, or physical
    "You all, I believe, had breakfast this morning; sensation (e.g., pain) of unknown origin. It is
    or at least it is customary for you to have breakfast vitally important, however, that the patient be
    in the morning. You had breakfast yesterday considered sufficiently stable and the therapist
    morning, and you expect to have breakfast sufficiently experienced to constructively handle
    tomorrow morning. In fact, you expect to have an age regression where intense emotion and
    breakfast next week. But last week you had perhaps a revivification may be experienced. The
    breakfast in the morning, and before you had technique is Dr. Watkins, but the summary steps
    breakfast last week in the morning you had dinner and verbalizations below are mine, adapted from
    on the evening before that, but before that dinner his important article. (Ed.)
    you had a lunch, and, let us see — last week ... let
    us see, last week was May 6th . . . but before May
    6th came May 5th, and of course, May 1st always THE TECHNIQUE
    precedes May 5th, but, of course April comes
    before May and you know that April also follows STEP ONE. Obtain permission with an ideo-motor
    March just as March follows February, and signal for "us to explore and understand what
    February comes after January, and New Year's Day originally happened to cause this feeling."
    was such a delightful day, but of course it was only
    seven days after Christmas. And you are following STEP TWO. Age regress to a recent experience where
    along, and this happens to be May and we are back the feeling, compulsion or sensation was felt. The
    to Christmas of 1964 already, but then, you know, therapist then facilitates the experiencing of this
    Labor Day preceded Christmas, and before that state again, having the patient signal when he/she
    was July 4th, is feeling it.
    524 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    STEP THREE. Intensify the feeling. "The feeling is Facilitating a Full Abreaction
    becoming more and more intense. It is becoming
    so strong that it seems as if you can think of D. Corydon Hammond, Ph.D.
    nothing else." Salt Lake City, Utah

    STEP FOUR. Disorient the patient and further intensify


    the feeling. "You are beginning to feel confused. INDICATIONS AND
    The room is beginning to fade away and everything CONTRAINDICATIONS
    is becoming very, very blurry. [Use fog if the
    patient likes it.] The only thing that you can It is my belief that most patients who do not
    experience is the feeling of display serious psychopathology and for whom the
    __________. The whole world is just trauma is not unusually severe (e.g., brutal rape or
    filled gang rape, torture, or cult abuse) are capable of
    with __________ ." experiencing an age regression back to a negative
    event or traumatic episode, and enduring a full
    STEP FIVE. Age regress the patient to the origin of abreaction of feelings about the event. When this is
    symptom. "And now this feeling is a bridge that possible, therapy progresses more rapidly.
    we'll use to travel back into your past, like However, facilitating a complete abreaction also
    a railroad track consisting of____________ . And requires that the therapist is someone who is
    you are becoming younger, going back further and experienced and skilled in this type of work.
    further in time, into the past, traveling As indicated earlier, I always ask the patient's
    back on this bridge of ____________. Everything unconscious mind if "it would be all right for us to
    is changing except _________ . The is go back and explore, and understand, and resolve"
    the whatever happened at a specified age that has
    same. And you are becoming younger and younger, already been identified as relevant to the patient's
    traveling back through time over the bridge of this problem. Given the contraindications already
    feeling, back to the very first time you ever stated above, it is my experience that if a patient
    experienced this feeling, going back in your life to has inner apprehensions or serious reservations
    when you first felt this." The patient may be about reexperiencing a traumatic event, he or she
    instructed to give an ideomotor signal when there. will not give permission for the regression. This is
    If necessary, verbalization can continue: "As I an indication for consideration of other less intense
    count from one to ten, you can finish traveling abreactive alternatives and methods of dissociative
    backward to an earlier time, to another place. You regression which require more time but are gentler.
    can experience yourself getting smaller and It is generally believed that feelings associated
    younger, and younger and smaller, until, by the with more specific events will probably respond
    count of ten, you'll be reexperiencing the situation more favorably to abreaction than generalized
    that first produced this feeling. Don't try to feelings toward someone that have evolved
    consciously remember. Simply allow it to happen through the process of many unpleasant (but not
    and let yourself experience it, as your unconscious particularly traumatic) events, although this is not
    mind takes you back. 1... 2... 3... 4... 5... 6 ... 7 ... 8 always the case. It is also commonly believed in
    ... 9 .. . 10. Where are you? What is happening? the field that the more intense a traumatic episode,
    How old are you?" the more extreme the abreaction that will
    If another feeling is encountered that appears eventually be required to work through the
    fundamental, another affect bridge may be used incident. In cases of particularly severe trauma, an
    from this regressed age back to an even younger abreaction may have to be repeated two or
    age. A reverse affect bridge may also follow a
    feeling forward from the original experience to
    later ones involving the same feeling.
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 525

    three times, until almost no emotion is evoked by After the patient has narrated the entire event, I
    the regression. This may be done in one of two will often have her confront the perpetrator of
    ways: (a) In an extended time interview where the abuse in imagination. For instance, if a woman was
    patient is given five- or even ten-minute "sleep" incestuously molested by her father, I may ask her
    periods between abreactions. At the beginning of to imagine that he is in front of her, in the same
    the "sleep" period the patient may be given room with us, but now unable to harm or do
    suggestions for having "peaceful" dreams and for anything to her. She is then asked to speak directly
    time distortion so that "in a few minutes of this to her father. This procedure generally facilitates
    special trance time, it can seem as if hours of much more intense expression of affect, and a great
    peaceful, restful, refreshing sleep have occurred." deal of reframing and working-through is accom-
    (b) Abreactions may also be repeated in sessions plished simultaneously with the expression of
    one day, several days, or a week apart. feelings.
    The suggestions below are frequently used in
    this process. Typically one such comment will be
    ILLUSTRATIVE VERBALIZATIONS
    made, and then, after the patient has vented
    After the patient has been regressed back to the feelings and begins to "run out of steam," another
    beginning of an incident, instruct him/her to, "Tell comment will facilitate continued and more
    me where you are, and what's happening." Further thorough expression of emotion. In this process I
    detail may be obtained through giving the focus on encouraging the patient's expression of
    following suggestion: "You will find yourself the four primary feelings of anger, hurt, fear, and
    thinking and feeling as you did then, and guilt.
    everything you're thinking and feeling, just say out "And tell [e.g., your father, mother] now all the
    loud." The latter suggestion may be repeated from things you couldn't tell him then." "Speak directly
    time to time. This suggestion not only assists in to [e.g., your grandpa], as if he's here right now,
    identifying the emotions involved, but also and tell him about all the anger and hatred inside."
    frequently allows you to identify the internal
    "Say that to him again, even louder." "That's right.
    dialogue— what is going on in the patient's mind
    Just let all the fear out. Tell him how scared it made
    and how he was interpreting what is occurring.
    you." "Tell him what it was like." "And tell him
    Both as the patient reports what is happening and
    after the details of the incident have been reported, how bad that hurt. Tell him what that did to you
    you should seek to intensify the expression of inside." "Tell him the words that go with the tears."
    emotion. "Tell him what your tears are saying." "That's right,
    just let out all that pain." "Tell him what you'd like
    As the patient reexperiences the past trauma, to do to him." In some cases the patient may even
    you may facilitate the release of the emotions be allowed to imagine acting out against the
    associated with it through some of the following perpetrator of the trauma.
    types of suggestions: "That's right. Just let all the Following a certain amount of abreaction, it is
    feelings out. Just like a dam breaking, all those
    sometimes useful to use ideomotor signals to
    feelings can come out now." "Let all those feelings
    determine which primary emotions are unresolved:
    out. You don't have to keep them inside anymore."
    "Now I'd like to ask that little four-year-old girl
    "And as you let those feelings out, it's as though
    down inside, and you can communicate with me
    they evaporate. As you let those feelings out,
    through the fingers. Are you feeling frightened?
    they'll no longer influence how you think, or feel,
    Are you feeling hurt and a lot of pain inside? Are
    or see things. Let go of all those feelings, so that
    you feeling angry? Are you feeling guilty?" Later,
    this incident will no longer influence your
    thoughts, or your feelings, or your actions." following reframing and interpretive work, a
    check can be con-
    526 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ducted to determine that each of these feelings has Trance is induced by whatever method is
    been resolved and that they do not require further mutually agreeable to by both therapist and patient.
    abreaction or interpretive work. Clinical circumstances dictate whether the patient
    will envision doing this technique or experience it.
    For the more timorous patient, a double-distancing
    CONCLUSION technique may be used in which the patient may
    Depending upon the individual patient, you may see himself on a screen or television as he or
    select one of the many methods that follow to someone just like him goes through this technique.
    reduce the intensity of the cathartic experience
    during age regression. However, most patients who
    have been through a significant trauma, will sooner VERBALIZATIONS
    or later need to experience a full confrontation with
    and abreaction of the material. I have treated many And now it's time to learn a little more, to move
    patients who talked extensively about traumatic closer to the health and well-being you deserve.
    events with previous therapists, but on a more Let's walk together through a pleasant garden, into
    intellectual level, with limited release of emotion. a beautiful and stately building that feels safe and
    Many of these patients consciously believed that secure. Its furnishings are very luxurious, but rich,
    the past experience was resolved and that the root tasteful, and understated. We pass through an
    of their continuing problems was elsewhere. impressive living room and turn down an
    Through ideomotor exploration, however, we have impressive hall, lined with oil paintings and
    commonly discovered that the events were still sculptures on pedestals. Midway down the hall
    unresolved emotionally, at a deeper level. there is an especially ornate door, wooden, heavy,
    Following age regression and more adequate and intricately carved. Looking through a small
    abreaction, these patients became asymptomatic. window, we can see that it is a door to a library. We
    Incomplete abreaction of underlying feelings has enter, the door opening easily. Wherever the eye
    also been cited by many others as a cause of may look, there are impressive volumes, each with
    therapeutic failure (Kline, 1976; Kluft, 1982; Maoz its own story to tell. We walk along the shelves,
    & Pincus, 1979; Putnam, 1989; Rosen & Myers, and leaf through a number of the books. Their
    1947; Shorvon & Sargant, 1947; Watkins, 1949). illustrations are so vivid that what they depict, we
    can see, hear, feel, taste, and smell. It is engrossing,
    compelling, to be drawn so completely into the
    worlds of these absorbing books.
    An Abreactive Technique Now we stop at a shelf that seems to draw us to
    it. There, like the volumes of an encyclopedia from
    Richard P. Kluft, M.D., Ph.D.
    another century, or the leather-bound first editions
    Philadelphia, Pennsylvania
    of the works of a great author from another time
    and place, is an impressive set of [the patient's age
    INTRODUCTION in years] books, numbered from one through
    [current age], entitled, "The Complete Life and
    The following technique is often used as a first Thoughts of [patient's name]." We open the
    step toward a complete abreaction. It encourages a volume [current age], and can see ourselves right
    distanced abreaction that diminishes the emotional here as we read the very book that shows us as we
    charge of the event somewhat; if the patient is are. We can smile at that, and close the volume,
    ready, it is followed in subsequent sessions by putting it back on the shelf. And now we begin to
    procedures in which there is no effort to blunt the look down the row of volumes
    impact of the reliving of the traumatic event.
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 527

    [count down from the current age to the age you whose equilibrium is precarious, unless the patient
    hope to explore] . . . and now we are standing right is in a structured setting or one can be provided if
    in front of volume [age that one wishes to explore]. necessary. Its use with such a patient is only for the
    We open the volume, and leaf through it slowly experienced and expert, and SHOULD NOT BE
    [here insert suggestions that are specifically keyed ATTEMPTED BY A NOVICE OR SOMEONE
    to the material that is to be retrieved or more WITHOUT GREAT FAMILIARITY WITH
    precisely suggest what is to be explored]. And now ABREACTIVE TECHNIQUES.
    we find what we are looking for, a series of
    pictures that takes us rapidly and surely into the VERBALIZATIONS
    flow of how things were, of how things felt. With
    each picture, we become more absorbed, more [After trance is induced and deepened (if
    completely involved. And now, as you become necessary or desirable), the patient is instructed as
    more in touch with how things were, as you see follows:]
    yourself as you were, you will find yourself And now, let's go back over time, back over
    reading more rapidly than I, and involved space, directly to [the incident]. Let the pain of [the
    completely. Therefore, you begin to tell me what incident] come back, and make it more and more
    you see, what you feel, how things were. intense, just to the point that it feels like it is
    happening again. Deeper and deeper into the pain.
    And now, let the pain stay with you. Let all the pain
    COMMENTARY and all the memory return, and put into words
    whatever may occur. Allow all the pain to come
    Again, this allows for several measures of through, at full force as I count from 1 to 10.
    remove, distancing, and security. For patients with [Count] For the next X minutes [sometimes time
    multiple personality disorder, this can be modified distortion is a desirable adjunct], allow everything
    so that the volumes bear the names of the alters, to come through, full force. [Offer encouragement
    and this procedure can be used to induce throughout.] And now, allow all the pain that needs
    co-consciousness and to facilitate fusion. to come out to do so within the next X minutes.
    [Count it down and reassure the patient that time is
    passing.] And now everything is coming out by the
    count of ten. [Count]
    A Vigorous Abreaction The positive aspects of this technique are the
    Technique sense of mastery and closure that the patient gains.
    In the course of the abreaction, the patient learns to
    Richard P. Kluft, M.D., Ph.D. Philadelphia, both induce and ablate the pain that is most feared.
    Pennsylvania

    INTRODUCTION
    The Fractionated Abreaction
    Technique
    This technique is used when an effort is being
    made to exhaust the remaining dysphoria, recover Richard P. Kluft, M.D., Ph.D. Philadelphia,
    the remainder of a trauma, and to enhance mastery. Pennsylvania
    It is designed for use with extremely cooperative
    INDICATIONS AND
    patients who have good ego strength, with whom
    the therapist has developed a good therapeutic CONTRAINDICATIONS
    alliance, and who have given informed consent to An abreaction can be an emotionally wrenching
    what is to be done. It should not be used with a and physically demanding experi-
    patient
    528 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    ence. Many patients whose current problems are used.] And now let us return to where we have
    rooted in unsettling past traumas need to confront been before, back to that book in the library of the
    and process these traumas in the course of their mind [or any other congenial metaphor] in which
    treatments; however, for a variety of reasons these we found [the incident that we have been
    patients may not be suitable candidates for discussing]. We can open the book once again, at
    traditional abreactive approaches. Some patients' the place where we left a bookmark. As we read,
    anxiety tolerance is inadequate to the task. For the pages come alive to us with sights and sounds
    them a full-fledged abreaction may become a and feelings. Let us read together for a paragraph
    retraumatization rather than a healing process; in or so, and put into words what we see. [Note:
    extreme instances a decompensation or major Verbalization is essential in this technique, lest the
    regression may occur. Still other patients suffer patient abruptly encounter material that is too
    physical conditions that render an exposure to pro- much to handle all at once while the therapist is
    longed and intense affect undesirable or dangerous. unaware.]
    Although it might seem that the obvious solution All right. Now at the count of three, your body
    would be to avoid abreactive work with such and mind will enter a state of profound relaxation;
    patients altogether, often this proves to be you may, however, want to open your eyes, and we
    impractical and/or impossible. Sometimes such can begin to discuss what you have learned. The
    patients stumble into traumatic material and the emotions can be left aside for now. Some will enter
    spontaneous breakthrough of the material begins our discussion in a mild and gentle manner. The
    and cannot be completely curtailed. In others, the remainder will gradually percolate to the surface of
    patient's difficulties do not become appreciated the mind in the course of the week, only when your
    until the work with painful material has begun. body and mind are profoundly relaxed in a state of
    For such individuals the fractionated abreaction self-hypnosis, when you are ready to allow them to
    technique was developed. It allows for the recovery be processed. One, two, three.
    of experiences in discrete bits with a minimal [The materials are discussed in great detail, over
    experience of the associated affect, which is and over. Before terminating the trance, one says:]
    allowed to emerge later on, in small amounts, after And as you study and work over what you have
    the patient has placed him/herself in a state of found, always in a state of profound relaxation and
    autohypnotic relaxation. In addition, subjective peace, you will find that small bits of feeling can
    time distortion is used so that each encounter with rise to the surface of the mind, always in amounts
    the affect, however brief, is experienced as having that you can handle with no difficulty. Although
    been quite extensive in duration. The overall goal is they will actually only be with you for a few
    to bring unsettling material into awareness in moments, these moments will feel very impressive
    manageable bits and process them in a very and complete; in fact, by the time we next meet,
    attenuated fashion. It is first used with minimally those feelings will have been completely metab-
    upsetting material to assess the patient's response olized, completely processed, and trouble you no
    to it. It is not designed to be used for the first time longer. If at any time in your autohypnotic work
    with highly charged material. you do begin to feel some distress that is more than
    we have agreed is useful, you will immediately
    allow that feeling to slide away, and remain away,
    SUGGESTED VERBALIZATION
    and you will call me so that we can consult together
    [The patient is placed in trance in whatever on its management.
    manner is mutually congenial, and deepening is
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 529

    The Slow Leak Technique ploys an implicit pseudo-orientation in time that


    reassures the subject that whatever was thought to
    Richard P. Kluft, M.D., Ph.D. be so difficult or impossible has, in fact, already
    Philadelphia, Pennsylvania been mastered successfully.

    INTRODUCTION AND INDICATIONS ILLUSTRATIVE VERBALIZATIONS

    The slow leak technique was developed for BACKGROUND. [This is a highly abbreviated
    work with patients who had some or all of the version of a story that helped an elderly and
    following features: they were anxiety phobic, had timorous woman who lived near the scene of a
    poor anxiety tolerance, and/or were physically nuclear reactor mishap. Prior to the induction of
    compromised. Such patients are not optimal hypnosis, we had spoken at length about the proper
    candidates for the more strenuous experience of a way to dispose of toxic wastes. Hypnosis had been
    traditional abreaction, which makes considerable induced with a version of the eye-roll technique.
    demands upon both their physical and emotional Deepening was achieved by the use of a peaceful
    resources. At first glance it might seem that all bucolic image in which she imagined herself
    abreactive work should be avoided with such walking through a lovely meadow on the edge of
    individuals. However, often a clinician will find the woods, and then entering deeper and deeper
    himself confronted with a patient who, despite his into the forest.]
    or her limitations, has begun to abreact a traumatic And now you have reached a beautiful place in
    experience spontaneously or has unexpectedly the woods, where there is a clean flat rock, a rock
    begun to do so in the course of psychotherapy. On where it is easy to find a comfortable place to sit.
    occasion, unique circumstances may make it As you enjoy the unspoiled beauty of the scene,
    necessary to initiate an abreactive process with you find your thoughts going back to a time when
    such a patient. it seemed to be in terrible danger, and you
    An effort was made to devise an approach that wondered whether all of this beauty and all of this
    would allow the transformation of the abreactive serene loveliness could be preserved. Now that
    process in such patients from an overwhelming these woods are no longer threatened, it is possible
    experience that had the potential to become an to heave a sigh of relief and reflect back upon how
    additional {and potentially dangerous) this all came to pass. There was a time when you
    traumatization to a situation involving elements of and your community did not know that you lived
    control and mastery. among dangerous and threatening toxic wastes,
    dreadful things left over from what had been done
    The slow leak technique is used only after the
    in the past and been long forgotten. Then,
    patient has been introduced to hypnosis in a
    suddenly, you became aware of them, and it
    positive and nonthreatening manner. It was named
    seemed that your way of life might be changed for
    for the verbalizations that were utilized on the first
    the worse, that it might be destroyed or, at the least,
    occasion of its employment (and spoke directly of
    changed forever.
    a slow leak). It is a wordy technique that relies
    upon the development of a metaphorical story that That's how it seemed. The toxic wastes were
    constitutes a constructive alternative to the dire beginning to escape containment. But you recall
    outcome the patient anticipates will follow in the how some of the older and wiser members of the
    aftermath of facing painful material. In essence, it community realized that since the toxic wastes
    creates an expectancy that the material can and will could not be contained forever, they needed to find
    be managed without untoward disruption. It em- a way to both deal with them and preserve
    everything they valued and they
    530 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    loved. Finally, after they thought and thought, and self-control and a way of draining off intense
    got plenty of consultation and advice, they decided feelings during the luteal phase of the menstrual
    to release them very, very slowly by creating a cycle. It should be noted, however, that in some
    deliberate slow leak that would provide no risk at cases (especially with severe abuse and multiple
    all for anyone in the environment. personality disorder) a more overt, intense
    It might be good to remember something that abreaction is generally required. The following
    you probably have forgotten — about the time that description and verbalizations are mine, modeled
    you visited the place where the slow leak had been after Watkins' description of the technique, but this
    arranged, about how scared you were to make that contribution has been credited to her because it is
    visit, and about how, when you finally arrived at her technique. (Ed.)
    the scene that you had been afraid to behold, you
    discovered that the leak that had been arranged was
    so very small and the drops that came out were so THE TECHNIQUE
    minuscule and infrequent, so far apart, that you left
    wondering why you had allowed yourself to Have the hypnotized patient imagine walking
    become so concerned and apprehensive. It's along a path in the woods with the therapist,
    amazing at times how our apprehensions can be so deepening the trance as you enjoy details of the
    much more terrible than what we really have to scenery. As you walk, you approach a waist-high
    face. So let's spend a while longer in this beautiful boulder, covered with moss and dirt. Nearby is a
    place. You know, its survival is a tribute to the large hammer with an axe-like handle that is lying
    capacity of human beings like yourself to find, on the ground. Have the patient nod when he/she
    within their conscious and their unconscious can see the hammer and then have him/her pick it
    ingenuity, a way to heal and to become well and up. Suggest that the boulder represents feelings
    whole. toward a specific person, a traumatic event, etc.,
    and symbolizes all the frustration and resentments
    he/she has, encompassed in this mass of stone.
    Some patients may wish to visualize the boulder
    Watkins' Silent Abreaction resembling a sculpture of a person.
    Technique
    ILLUSTRATIVE VERBALIZATIONS. "In a moment I
    Helen H. Watkins, M.A. want you to start beating on that boulder, hitting it
    Missoula, Montana harder and harder, until you're completely
    exhausted. And when you're worn out and too tired
    INDICATIONS to go on, signal me by lifting your "yes" finger.
    Even though you won't be heard here in this office,
    This is a symbolic imagery type of abreactive you can yell and scream, and do or say whatever
    technique. It was designed for patients with strong you wish in this place of ours beside the boulder.
    feelings of resentment and anger. It is ideally suited I'll make sure that no one will intrude on our scene
    for the office setting because the venting of the in the woods. So you can feel free to hit that
    feelings is internal, and thus a loud catharsis in a boulder, and yell or scream, or say whatever you
    less than soundproof environment is avoided. It has want, here in the mountains, and no one will hear
    proven valuable in dealing with anger toward you. You can yell or scream the things you've only
    parents, spouses, ex-spouses, employers, and said inside before, or that you've always wished
    perpetrators of abuse, and in self-hypnosis tapes you could say, while you hit that boulder. And each
    with women with premenstrual syndrome. In the time you hit it, pieces of it will break off or
    later case, it can provide the patient with a means crumble."
    of Urge the patient to "keep hitting that boulder
    until it's completely demolished. And by that
    TIME REORIENTATION: A G E REGRESSION, A G E PROGRESSION, A N D TIME DISTORTION 531

    time you'll be worn out and exhausted, and you'll me with your "yes" finger [or, alternatively, "Nod
    have gotten all those feelings out." You may your head"]. [After the signal:] Good. And notice,
    typically urge the patient to continue for four, five, with a sense of curiosity, how that sensation begins
    or more minutes. to spread throughout your foot, and when it has
    Periodically encourage the patient with ver- flowed all the way up to your ankle, signal me
    balizations such as, "Come on, hit it again, again." Proceed in this manner up to the knees, the
    harder!" "Keep on going. Get it all out. You don't top of the thighs, through the trunk, to the
    have to keep it inside anymore." "More, and more, shoulders, then down the arms, and throughout the
    and more. Keep going. Don't give up. Just keep head.
    hitting that boulder, and yelling or saying whatever After the pleasant, warm, tingly sensation has
    you want, until you're just too worn out to spread through the entire body, following Watkins'
    continue! And then that "yes" finger can lift. But model, the therapist may state: "These pleasant
    don't stop until you get it all out and are really sensations come from your own positive feelings
    exhausted." It is important to convey some of the about yourself, from your inner resources and faith
    anger and intensity in your voice during these that you can resolve your problems." [Be careful to
    verbalizations. say only what you know is true about the patient.]
    Occasionally, an especially inhibited patient or "And now this warm, glowing, tingly feeling
    someone fearing loss of control may balk at hitting can become even stronger, and when you feel it
    the rock. Explore his/her hesitancy. In some cases, getting stronger, you can signal me again. [Pause]
    you may have the patient imagine laboriously That's right. And this added sensation symbolizes
    pushing the rock over the edge of the deep ravine, another resource that you have. It represents
    just behind the boulder. Another option is to energy coming from me and my belief in you, my
    dissociate the patient, having him view someone faith that you have the strengths and resources you
    who looks like him, yelling and screaming and need to grow and solve your problems. [Be sure at
    hitting the boulder. this point to say what you honestly feel] And this
    added energy represents my part in our
    POST ABREAC T ION EGOST RENGTHENNG Next, Sug- relationship, as a partner in working with you to
    gest that the patient can now drop the large get to where you want to be. It symbolizes my
    hammer. And together, walk up a small rise to a caring, and respect, and belief in you and the inner
    beautiful meadow with wild flowers, where the resources of your unconscious mind. And you can
    sun is shining and there is a gentle breeze. allow yourself to feel it as a positive, strong
    Describe a lovely group of trees nearby, with soft energy, circulating all through your body."
    green grass underneath. Suggest that the patient In awakening the patient, suggest that the tingly
    can lie down on the grass and watch the clouds feeling will probably be gone, but that the glow
    peacefully drifting in the sky, while you sit nearby. can remain.
    The patient may now be told: "Before we go on
    today, I need to hear something positive that you're
    willing to share with me about yourself." [This
    requires patients to shift frames and perceive some Erickson's Age Regression
    positive things about themselves]. If there is some Techniques
    hesitancy, persist. Next, particularly when the
    patient is responsive to kinesthetic, ideosensory Milton H. Erickson, M.D.
    imagery, the patient may be told: "I want you to
    pay very close attention to your toes. Something
    INTRODUCTION
    interesting is going to happen. In a moment you'll
    become aware of a warm, glowy, tingly sensation The following verbalizations illustrate several
    in your toes. When you notice that feeling, signal of Erickson's procedures for working through
    532 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    trauma or negative life experiences. They are begins to see the little girl. Of course, my subject is
    typically dissociative regression experiences that a woman, and who is the little girl she is likely to
    allow the patient to begin by more gently see? It is the little girl that is herself. Once in a
    experiencing an event and the feelings about it in a while a subject (or patient) will see another little
    gradual, piecemeal fashion. (Ed.) girl, so then I ask; "Tell me about that little girl.
    What is she doing now? I don't see her clearly. I
    couldn't see that movement she just made. . . . What
    SUGGESTIONS FOR A was it? . . . What is she picking up now?" And my
    DEPERSONALIZED REGRESSION subject tells me. Next I want to know: "You know, I
    And now you can look back on last night as if it think the little girl is talking to somebody, but I
    were last week or even last month — who really can't hear. Will you listen carefully and tell me
    cares now? Just feel comfortable and just as if you what she is saying? Now tell me, what is she
    were another person. Tell me what happened to saying?" So my subject tells me. I may then add:
    that young woman [the patient] in her kitchen that "No! She said that! And now she is going to do
    scared her." some thinking, and will you tell me what she is
    thinking?" And so my subject begins to tell me
    what that little girl is thinking. Now I ask: "And
    REGRESSION WITH THE VISUAL how do you suppose she feels? Can you notice how
    HALLUCINATION SCREEN she is feeling? Does she feel the way her feet are
    TECHNIQUE placed on the ground? Does she feel the swing
    moving?" . . . Next I say: "You know, as you swing
    INTRODUCTION. One method for reducing affective up there a voice here beside me can talk to me. And
    intensity is to physically dissociate the patient from a voice beside me can talk to me." And so she keeps
    the experience. Thus the patient may view the on swinging, and playing with the doll, and making
    traumatic event on a visualized or hallucinated mud pies, and what not; and a voice down here
    movie or television screen. During an interview, talks to me and tells me what the little girl up there
    the patient may even be asked to view the event is thinking and doing, because I really can't know
    several times, from different camera angles and those particulars.
    gradually with a zoom lens to bring the patient
    closer to the experience. (Ed.)
    I later discovered that it is much easier to elicit SYSTEMATIC SURVEY OF EARLY
    regression with the following technique: You have CHILDHOOD MEMORIES
    the person hallucinate a movie screen, and on that
    movie screen is a living, moving picture. . . . My INTRODUCTION. It seems that sometimes Erick-son
    behavior suggests that I am actually looking at a had a patient systematically survey the learnings
    movie screen. It is a nonverbal communication, a and memories throughout early childhood. We
    nonverbal suggestion; but my behavior— my eye only have the following brief glimpse of some of
    behavior, my head behavior, the position of my his verbalizations available in his writings. (Ed.)
    upper torso — suggests that I am really looking This was governed and directed by the therapist
    right at that movie screen and that I am indeed by intruding such statements as: "And in that first
    viewing something on it. "And now a little girl year what a wealth of fundamental learning, from
    appears from that direction over there, and she is diapers to pretty things and sounds and colors and
    walking happily along. Now she is standing still, noises;" or, "And then you come to the second
    but what is she going to do next?" And my subject year, creeping and walking and falling and using
    is aware of my behavior; the subject looks in the the toilet like a
    direction I am looking and also
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 533

    good little baby and saying little sentences"; and, long do you think it would take you to cover it up
    "Of course, there comes the third year and again?'"
    language is growing, words, so many, the parts of The patient in trance may be told that it is
    the body, the little hole in your tummy, and you perfectly possible to remember the intellectual
    even know the color of your hair." facts of something, but not to remember the
    emotions associated with it, and vice versa. You
    may then give a truism and metaphoric illustration:
    DISSOCIATING AFFECT AND "Every once in a while, almost everyone has the
    CONTENT experience of feeling discouraged and down, and
    yet we don't really know why. We sense that there
    INTRODUCTION. Erickson believed that we try too must be some reason, but we just can't put our
    often to recover entire experiences all at once. As finger on why we feel that way."
    an alternative in working with a subject capable of "You can experience all your feelings about
    amnesia, Erickson would have the patient something that occurred at age X without being
    reexperience the emotions associated with the able to remember just what caused those feelings.
    event, but without knowledge of what caused the When you next open your eyes you will have an
    emotions. He would then uncover the content (or unusually clear memory of all that, but without the
    sometimes just a part of the content), and then feelings you had then." Apparently, Erickson
    create an amnesia for it. Finally, the patient would sometimes gave posthypnotic suggestions to
    retrieve and integrate the complete memory, awaken and recall an aspect of the trauma, rather
    including affect and content. This method is most than restricting all the work to a formal hypnotic
    successful with highly talented hypnotic subjects state. This technique is further illustrated in
    who are capable of experiencing amnesia. (Ed.) Erickson's dialogue from a specific case:
    "Now after you awaken I will ask you casually,
    'Are you awake?' In a moment you will say 'yes,'
    ILLUSTRATIVE VERBALIZATIONS and as you say 'yes,' there will come over you all
    the horrible feeling that you experienced sometime
    Erickson provided us with detail on how he before the age of ten . . . , but you'll have just the
    initially introduced this technique to the hypno- feelings. You won't know what the thing is that
    tized patient so as to minimize resistance: "You caused those feelings. You will just feel feelings,
    point out to a patient that there are various ways of and you won't know what is making you feel so
    remembering things. Undoubtedly, when we cover miserable. And you will tell us how miserable you
    up a memory, we usually cover up a lot more than feel. [Pause] Get a firm grip on those horrible
    the memory itself [e.g., an address, a place, other feelings. You won't know about them until after I
    things that happened that year]. . . . Does the year ask if you are awake and you say, 'yes,' and at that
    need to be covered up? All the other things that moment those feelings will hit you hard. Do you
    happened that year? You thus emphasize that the understand now?"
    patient undoubtedly covered up many things that After therapeutic work: "Now the next time I
    didn't need to be covered up. So why not uncover awaken you, 1 have a different kind of task for you.
    every one of those things that are safe to uncover When next I ask you casually if you are awake, you
    and be sure to keep covered up the things that are will say 'yes,' and then there will come to your
    not safe to uncover? You then define the situation mind something that could have scared you years
    as one from which the patient can withdraw at any ago. But you won't feel any emotions at all, is that
    time. You point out, 'Suppose you did accidentally all right? It won't scare you, is that all right? . . .
    uncover something you didn't want uncovered. You'll just remember,
    How
    534 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    'Yes, when I was a little kid I was scared.' That's the would be together. The picture of the jigsaw puzzle
    way you'll remember it. You will be able to laugh is the intellectual content. . . . The back of it is the
    about it and take an adult person's view." Erickson emotional foundation, and that will be without any
    would emphasize, "It will be just a memory, as if it picture. It is going to be just the foundation. Now
    happened to somebody else." "But then there were you can put that jigsaw puzzle together by putting
    other pictures, some of them taken when we were two pieces on one corner together, two pieces in the
    very young, that we couldn't remember at all. They middle together, two pieces in another corner
    were interesting, but we had no memory of them, together, two pieces in a third corner, two pieces in
    no feelings associated with them. The picture a fourth corner, and then, here and there, you can
    showed us the details, or if it was an old home put two or three pieces together. You can put some
    movie, we would have seen all the facts of what of the pieces together face up, some pieces together
    occurred, but we didn't have any feelings face down. You can put them all together face
    associated with it. And in a similar way, you'll find down, put them all together face up, but you do
    that you can remember details, facts that happened, what you want to do . . . Suppose you haul out from
    but it will be as if they happened to somebody else. your unconscious just a few little pieces of that
    Your unconscious mind will bring up some facts unpleasant memory." After processing the feelings
    and information about what happened, but none of he got back, Erickson had him experience an
    the feelings, just the content and details, but amnesia for what he recalled. "Suppose you reach
    without any feelings about it. Do you understand?" down into your repressions and bring up a few
    After working singly with affect and content, pieces of the picture." After talking about the
    Erickson then facilitated a full recall of the content that he remembered, Erickson said: "That is
    experience: "And when I ask you if you are awake fine, now you shove that down. Now bring up some
    and you will say 'yes,' then immediately this entire more pieces of emotion." Afterwards Erickson had
    episode will flash into your mind very vividly. Is the patient re-repress the material and bring up
    that all right? . . . Completely, intellectually and more content. As already stated, this process may
    emotionally complete. So that you will know what continue back and forth, creating an amnesia for
    your feelings were then and everything about how each aspect after it's experienced, and providing
    you felt then, even knowing yourself then." rest periods as needed after intense abreaction and
    Another of Erickson's suggestions to facilitate the before the final recall of the complete memory.
    final integration of the repression was to tell the
    patient, "As you review that, you can now
    experience an appropriate balance of thinking and
    feeling about the whole thing." Gradual Dissociated Release of
    Since this is a unique method, you may Affect Technique
    appreciate the opportunity to review still other
    suggestions that Erickson used with a different D. Corydon Hammond, Ph.D.
    patient: "All right, you are in a deep trance. I would Salt Lake City, Utah
    like to explain a few things to you. You know what
    a jigsaw puzzle is? You can put a jigsaw puzzle I have often used another variant of Erickson's
    together in two ways: You put it together right side technique of dissociating affect and content in
    up, and then you will know what the picture is; you successfully working with severe trauma in cases
    can put it together reverse side up, and there you of multiple personality. A personality who holds
    have just the back of the jigsaw puzzle. No picture both the content and feelings of a memory is asked
    on it — just blankness and no meaning, but the by the therapist to give back feelings only to the
    puzzle appropriate
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 535

    personality (most commonly the host). The THE METAPHORS


    therapist then negotiates with the host personality
    to establish a willingness to receive these feelings Remember a time when you got the flu, and how
    back for a limited period of time (e.g., 30 seconds). completely miserable you can feel. Remember
    When agreement has been reached, the personality how your stomach feels, when you're sick like that,
    holding the feelings is told that when a cue word and how your head feels. [Pause] And there's the
    ("NOW") is given, he/she should give back only nausea, and sometimes the congestion. And when
    feelings (no content) for the prescribed period of you're so sick like that, it drags on, seeming
    time, which the therapist will monitor. This endless. And you wonder if it will ever be over.
    personality is then instructed that in a moment he [Pause]
    will see the number 100 as he looks up and to the And you feel so exhausted, worn out, and
    right. This number, he is told, signifies the amount depressed. And you may recall how miserable the
    (percentage) of feeling that he currently has inside high fever is, how hot you feel. And with high
    about the traumatic incident. After the carefully fevers, sometimes our perceptions become so
    timed abreaction is concluded, the host personality altered, distorted. You lay around, and don't do
    is given soothing, calming suggestions and allowed much, and time passes so slowly. And sometimes
    to rest or sleep while imagining being in a peaceful, our sleep is so fitful, and we have nightmares, or
    secure setting. The other personality is then asked confused, mixed-up dreams. And we can't seem to
    think very clearly.
    to look up and to the right and to verbalize the
    number he sees. This number has often been And sometimes you get the cold sweats, perhaps
    reduced to one in the range of 60-85. Later in the in part because it gets frightening. You start having
    hypnotic session, or in another session, this process vague fears, that you won't get over it, or that
    may be repeated until the number is sufficiently maybe it's more serious than you imagined. And at
    these times, you feel so alone, so cut off from the
    reduced that the patient is willing to recall the
    world. Although sometimes we cut ourselves off
    content of the memory along with the remainder of
    when we're sick, because we feel so rotten, and
    the feelings.
    because we're afraid we'll make others sick or
    miserable. We can't imagine anyone wanting to be
    with us. And so the world can seem uncaring, and
    not understand how really sick you feel. And yet
    Sickness and Immunity this is the time when you really want and need
    Metaphors attention, and tender loving care.
    But as really miserable and bad as that was, you
    D. Corydon Hammond, Ph.D. got over it. It ended. And it really wasn't very long
    Salt Lake City, Utah
    before, you began forgetting how bad it was. You
    were so completely miserable. It seemed endless,
    INDICATIONS and like torture, but you lived through it, and before
    long, forget how bad it was. And later, you just
    There are many methods of interpreting and vaguely remember that it happened, a long time
    helping the patient to reframe negative life events. ago. But it doesn't continue to influence you. And
    Metaphors are one of those methods. This is an after a while, you can hardly even remember it at
    example of what I refer to as trauma metaphors. all, and rarely ever think about it. There's no need.
    This type of metaphor may be useful with victims It was just something long ago, and so many happy
    of incest, grief, divorce, and other types of past and wonderful things happened later, that they can
    trauma. This particular metaphor is even more just sort of obscure, and outweigh that brief period,
    useful with a patient who is also kinesthetic. long ago. And with this pain,
    536 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    that you've been through, even though it was much winds. Those painful experiences have formed
    worse than the misery of the flu, it also, will seem [will form] a foundation of strength. And therefore,
    this way. And later, it will be hard to remember, deep inside, you can have an inner sense, that
    how bad it was. having survived the pain of this, you have the
    strength to cope with anything, that comes along.
    ADDITIONAL OPTION. And as I think about this, I
    wonder if you ever had chicken pox? I did. And the
    misery that you've been through, is maybe kind of
    like that experience, of having chicken pox. I found Metaphor of an Injury,
    that it can leave some marks on you. It usually
    leaves a scar or two behind. But they're usually in Scab, and Healing
    places where other people can't see them, and
    where they won't show, or interfere. And it just D. Corydon Hammond, Ph.D.
    Salt Lake City, Utah
    becomes a part of you, that you seldom even think
    about.
    INDICATIONS
    IMMUNITY METAPHOR FOR This is a trauma metaphor that is valuable in
    REFRAMING working with incest, rape or trauma victims, as
    well as with patients struggling to work through
    And when we're miserable and hurting, we divorce. It consists of truisms about a virtually
    usually don't realize a hidden benefit, in the universal experience, tending to facilitate ac-
    suffering. Through the process of suffering, ceptance by the patient. It is my belief, however,
    without any conscious awareness, we inwardly that metaphors are primarily part of the reframing
    change. After something has happened, like the and working-through process and, as such, are best
    chicken pox or the measles, we develop some reserved until after an abreaction has been
    immunity. We've been influenced in such a way, facilitated. The abreaction will release outdated
    that in a sense, we've grown stronger, much emotions, lower patient defenses, and create an
    stronger, internally. It's as though, because of the openness to accepting subsequent therapeutic
    adversity and suffering—even though we seldom suggestions. Stated another way, experiencing
    recall the experience later — we've been made precedes conceptualization.
    stronger, more immune to some things, for having
    lived through it. And we also change, in that we
    also have a greater sense of compassion and THE METAPHOR
    empathy for others, who suffer. And we can
    appreciate, that without unpleasant experiences in We've all had the experience of scraping a knee,
    life, you wouldn't be able to so fully enjoy and or an arm, or an elbow. And after we're injured like
    appreciate how wonderful the beautiful, happy that, when it's first beginning to scab over, it's still
    times are. soft, and kind of bloody, and many people don't
    And as you reflect for a moment about the like to look at it, and kind of wince when they see
    suffering you've been through, you can feel a sense it. And that may even make us feel self-conscious.
    of inward strength, realizing that you survived this. And when it's still raw and painful, we don't want
    [If the suffering is current: "As you reflect on the people to touch it, because the wound is still too
    suffering you're going through, you can know that painful and fresh. But it can be nice when there are
    as miserable as it is, it will end, and you will be people who show care, and who are nurturing and
    stronger for it."] As they say, a smooth sea, never show us the tender loving care we need, without
    made a skillful sailor. And this pain and struggle touching the hurt directly.
    have made you stronger, like a tree strengthened
    by the
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 537

    But then, after a little while, as a natural part of THE COLLAGEN METAPHOR
    the healing process, it scabs over to protect us, and
    that part of us can get very hard, as a defense to And sometimes when there has been a par-
    protect us for a while, while processes within ticularly deep scar, with modern techniques and
    ourselves, natural healing processes are gradually advancements, our healers of today have learned
    taking place. And that healing takes a little time. how to overcome that. For instance, we can take
    And because of that scab, we're very aware of some collagen, and inject it, which is, of course, a
    that hurt for quite some time. But inside, healing is little painful. But that little pain that is caused by
    taking place. After most of the healing process has the doctor is well worth it, because we have
    already been automatically occurring inside, the discovered now how to inject new things into that
    outer protective hardness and scab begin to space, so that new tissue grows to replace the old,
    disappear, breaking off from the outer edges gaping hole. And it fills in with new life, so that the
    toward the middle, so that the less sensitive parts, scar no longer remains, and something new and
    that weren't as seriously wounded, are able to wonderful has replaced it.
    disappear first. And often the very core of it takes a And in a similar way, with the spaces where
    little longer to recover and regenerate. there has been pain, and suffering, and anger, new
    Sometimes, when we're young and don't know things can fill those spaces. You'll find that you can
    better, we're tempted to keep picking at it and let go of those old, outdated, painful feelings, that
    bothering it, which only reopens and exposes the belong to the past. And there are new feelings, and
    wound too soon, so that it takes even longer to new meanings that you can allow to fill those
    mend, and leaves a scar. So you don't want to take spaces, where the old feelings were stored. And
    off that protective scab right away. You want to when your unconscious mind can sense you letting
    allow a certain amount of time that's necessary, for go of old, outdated feelings, your "yes" finger can
    natural healing to occur. And if someone is wise float up. [Following an affirmative reply:] Good.
    and caring enough to help us, and gently lubricate And when your unconscious mind feels the empty
    the scab and keep it oiled to soften it up, then it spaces that are left, being filled in with positive,
    may heal without even leaving a scar. new, good feelings, your "yes" finger can float up
    But most of us in the process of growing up got again.
    some scars, that later, may be little reminders that [After an affirmative reply, suggestions may be
    something happened a long time ago, but which reinforced. For obvious reasons, it is infinitely
    doesn't have to mean much later on. And after a easier for patients to let go of old feelings after they
    while, we hardly even have to notice it. In fact, I have already, earlier in the interview,
    have several scars that remind me that I was hurt reexperienced the past events and had a cathartic
    once, a long time ago, but I really can't even release and working-through of the experience.]
    remember just what that was. And later, in the
    couple of cases when we can remember what
    caused a scar, we don't feel anything any longer.
    We just remember that something happened a long Example of an Analytical
    time ago, but it doesn't hurt anymore, in Procedure for Reframing
    remembering.
    And with this pain that you've been through, I E. A. Barnett, M.D.
    think you'll find that your healing process is really Kingston, Ontario, Canada
    very similar to what happens with your body. [This
    is the bridging association; suggestions very
    INDICATIONS AND INTRODUCTION
    specific to the patient's needs may now be made.]
    The following excerpts illustrate a method
    referred to as ego-state reframing (Hammond,
    1988f; Hammond & Miller, in press) for the
    538 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    working-through and reframing of feelings. This plex, and this can be done at an entirely uncon-
    method may be used following the identification of scious level with the ideomotor signals as the only
    a problematic past experience. It is recommended evidence that this has been accomplished.
    that an abreaction be facilitated prior to using this
    reframing technique. When abreaction is done RECOGNITION OF THE CURRENT
    without cognitive restructuring the therapist runs IRRELEVANCE OF THE PREVIOUSLY
    the risk of simply creating a transitory emotional
    REPRESSED EMOTION
    release. On the other hand, when emotional
    experiencing of the event does not precede the "Four-year-old John, with the wisdom and
    conceptualization process, the experience becomes understanding that you now have, do you still need
    overintellec-tualized and may well be ineffective. to keep those old tensions?" At this point the
    Barnett's method illustrates the manner in which specific emotions identified as being repressed can
    a therapist may use the metaphor of an adult ego be enumerated individually. . . .
    state helping a child ego state to work through "Are you keeping those old out-of-date un-
    negative emotions. It is essentially a method, comfortable feelings for protection?" A yes answer
    following catharsis, for facilitating self-healing. It to this question means that the therapist must renew
    will be apparent that Barnett uses a transactional his efforts to persuade the Adult of 40-year-old
    analysis model for conceptualizing this process. John to convince four-year-old John that he
    For further details about the rationale of this (40-year-old John) is now able to protect himself
    method and additional examples, consult Barnett and he needs no further protection from
    (1981). four-year-old John's outdated feelings.
    Note in the case example how Barnett initially Four-year-old John needs to be reassured that
    determines the primary emotions involved in the 40-year-old John has ready access to his own
    incident. He subsequently encounters initial protective emotions should the need arise. If
    resistance and, therefore, begins by facilitating a necessary, four-year-old John can be asked to hand
    more dissociative regression and gently moves the over all his outdated, uncomfortable feelings and
    patient into a partial regression. There is then responsibilities to 40-year-old John, who is now
    greater affective involvement on the part of the quite capable of protecting every part of the
    patient. After obtaining the details of the personality complex. If 40-year-old John has been
    experience and at least some emotional release, the sufficiently convincing, the question as to whether
    reframing process is illustrated. (Ed.) these old tensions are necessary should now
    receive a no response. This procedure may have to
    be repeated before this reply is attained. Sometimes
    UNDERSTANDING THE REPRESSED four-year-old John remains convinced that he must
    EMOTION(S) AND THE ASSOCIATED retain his old protective emotions for one reason or
    another. He should then be asked, "Do you need to
    FEELINGS OF GUILT
    keep these uncomfortable feelings all of the time?"
    "I would like you to give all of your 40 (present A no to this question should be followed by a
    age) years of wisdom and understanding to direction to four-year-old John to be certain of the
    four-year-old John, and when this has been done, kind of circumstances when he feels that he needs
    the yes finger will lift. . . ." "Is there more all of his uncomfortable tensions and confirm this
    information that needs to be divulged before full fact with ideomotor signals. He is then asked to be
    understanding can be attained?" If so, this equally certain of those circumstances where the
    information should be imparted to the 40 year old uncomfortable feelings are not necessary and be
    John (Adult) by the four-year-old John persuaded to discover means of relinquishing these
    (Child/Parent) ego com- feelings at such times. This maneuver does not
    abolish
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 539

    symptoms but it does establish considerable personality with the resources and the commu-
    control over them. nications within the personality to accomplish this
    "Are you keeping these tensions to punish task. With ideomotor questioning, it is easy to
    yourself with?" A more difficult situation arises switch from addressing the unconscious Adult to
    when old tensions are deemed to be necessary not communicating with the Child/Parent ego state
    for protective reasons but for self-punitive reasons. complex simply by labeling states by their
    When the Parent remains convinced that it is still respective ages.
    its duty to punish the Child {in spite of the "Four-year-old John has agreed that these old
    intervention of the Adult), a renewal of this tensions are no longer necessary. Forty-year-old
    intervention is called for. The objective is to John, using all of your wisdom and understanding,
    convince the Parent that the Child did not do I would like you to find a way for four-year-old
    anything that could be regarded as bad, even John to let go of all of these unnecessary, outdated,
    though it may have originally merited parental useless old tensions. When this has been
    disapproval, and the punishment so far meted out accomplished, the yes finger can lift to let me
    by the Parent should now be regarded as having know." Fortunately, this state is usually
    been more than adequate. To aid the Parent, the accomplished readily, even though it may take
    therapist can make such statements as the some time for the unconscious mind to find an
    following: "I know that you have done a great job appropriate solution. It is wise to assure the patient
    in disciplining four-year-old John and have done that the solution need not be known at a conscious
    so to the best of your ability, but the time has come level. In some cases, no solution is found.
    for you to forgive him. I believe that you can do Invariably this is because a strong Parent has
    this if 40-year-old John will make sure that all will decided to retain a punitive position.
    go well and if four-year-old John can assure you
    that he really did not mean to create so much
    distress by his behavior." In this way the Parent is RECOGNITION OF THE RESOLUTION
    given a means of relinquishing the arduous OF THE CHILD/PARENT CONFLICT
    responsibility of maintaining a punitive stance
    toward the Child and can then be encouraged to At this stage, a solution of the conflict between
    take care of four-year-old John in other, more the Child and the Parent has been found but not yet
    appropriate, protective, nurturing and loving, applied. It is now necessary to apply this solution
    parental ways. to see if it is acceptable to all parts of the
    personality.
    "Four-year-old John, 40-year-old John has now
    RELINQUISHING THE REPRESSED found a means by which you can let go of all of the
    AND REPRESSING EMOTIONS old, out-of-date, unnecessary tensions that you
    have been keeping. Please use that way right now
    While the Parent ego state has agreed to stop and let go of all of those tensions. When you have
    punishing the Child (and the Child has recognized done so, let me know by raising the yes finger." In
    that the old outdated feelings need no longer be most cases the yes finger is promptly raised and the
    retained), it must nevertheless be empowered to therapist knows that the conflict is probably at an
    discover means of relinquishing its repressing end. Nevertheless, he should then confirm that the
    activity. It may need to obtain permission from tensions have been relinquished by saying, "If you
    other parts of the personality to accomplish this; it have really let go of all of the old tensions, John,
    also needs to find improved ways of relating you should now be feeling very comfortable
    internally with the Child. All of these new inside, more comfortable than you have felt for 36
    behaviors must be discovered if the Child/Parent years. If you are really very comfortable, the yes
    conflict is to come to an end. The Adult ego state is finger will lift again."
    that part of the individual's
    540 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    An even better confirmation of this relief from about it now? [Shakes.] Can you tell her all about
    tension comes if there is a spontaneous smile. A it? [Nods.] Will you tell her? [Nods.] Okay.
    simple confirmation of this inner comfort is the [Pause] Does she know all about it now? [Nods.]
    smile test, in which the previously distressed ego Can she now feel all of that scared feeling and all
    state complex is asked to indicate its relief by of that sad feeling and all of that angry feeling?
    smiling, as follows: "Four-year-old John, if you are [Nods.] She can? Oh, good. Do you think that you
    really feeling comfortable, you can give me a nice are going to be able to tell me anything about it at
    smile to let me know." The presence of a really all? [Nods.] Okay, five-year-old Vera. It is really
    happy smile is excellent proof of total relief from scary, is it? [Nods.] And sad? [Nods.] Okay, bring
    the original tension. Conversely, any difficulty in it all forward. What's happening now? Where are
    giving that smile will alert the therapist to the you?
    probability that some old tension remains. Pt.: I'm waiting at home. [Tearfully.]
    Dr.: You are? What for?
    Pt.: For my Mum.
    CASE EXAMPLE Dr.: Oh?
    Pt.: She's late.
    [This dialogue follows suggestions for age Dr.: Oh, dear.
    regression to "the first experience that has anything Pt.: I'm afraid of being left alone.
    whatever to do with" a problem of anxiety attacks.] Dr.: I see. What are you afraid of?
    Dr.: When you are at that very first experience Pt.: I don't know where to go if she doesn't come
    that has anything whatever to do with it — you do home.
    not need to become consciously aware of it— but Dr.: Yes . . . what happens?
    when your deep inner mind is there, your head will Pt.: Well, I cry.
    nod for yes. [Head nods.] Now I want you to go Dr.: Is there anyone about?
    through that experience just in your deep inner Pt.: No.
    mind — your conscious mind doesn't need to know Dr.: Are you in the house?
    about this — and when you have done that, again Pt.: Yes. [Looking frightened.]
    your head will nod for yes. [Head nods.] That Dr.: Very scared? Do you cry for a long time
    experience you have just gone through ... is it a before she comes?
    scary experience? [Head nods.] Makes you feel Pt.: No.
    sad? [Nods.] Makes you feel angry? [Nods.] Dr.: Does she come soon?
    Guilty? [Nods.] Is it sexual? [Head shakes.] Are Pt.: About five or ten minutes.
    you five years of age or younger? Dr.: And how do you feel when she comes?
    Pt.: About five. Pt.: Relieved. [With a sigh.]
    Dr.: You're five years of age. Okay. Dr.: Did she say anything that bothers you?
    Five-year-old Vera, what's happening? What's Pt.: No.
    happening at five years of age? [The patient is Dr.: Does she ask you how you are? [Nods.]
    beginning to look extremely sad and is obviously Does she give you a cuddle? [Nods.] Do you feel
    on the verge of tears.] You're feeling very sad, safe? [Nods.] Okay, 28-year-old Vera, did you
    scared and angry. What's happening there? hear all of that?
    Five-year-old Vera, if it is okay to talk to me about Pt.: Yes.
    it, just nod your head. If it is not, shake your head. Dr.: There is five-year-old Vera still feeling
    [Head shakes.] Okay, you needn't talk about it. scared and still feeling hurt. Would you please give
    Does 28-year-old Vera know all her all of your comforting, your wisdom and your
    understanding? When you have done that, nod
    your head for yes. [Nods.] Five-year-
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 541

    old Vera, now you've heard that, do you still need her to let go of those uncomfortable feelings for
    to keep that scared feeling, that hurt feeling, that good. When you have found a way, nod your head
    angry feeling any longer? If you do, nod your head for yes. [Pause.] [Nods.] Five-year-old Vera, you
    for yes, but if you don't, then shake your head for can now let go of those uncomfortable feelings. Let
    no. [Shakes head for no.] Okay, 28-year-old Vera, go of those uncomfortable feelings right now, and
    five-year-old Vera has told me that she doesn't when you have done that, just nod your head to let
    need to keep that old scared feeling any longer. me know that you have done it. [Pause.] [Nods.]
    Would you please find a way for her to let go of it? Now if you really have let them all go,
    When you have found a way, nod your head for five-year-old Vera, you should be feeling very
    yes. good inside. Good, comfortable feelings, so good
    Pt.: [Nodding.] I've found a way. to let go of all that pain and unnecessary
    Dr.: Five-year-old Vera, there is a way now. uncomfortable feeling. When you are feeling really
    There's a way you can let go of that scared feeling good inside, perhaps you can give me a smile
    right now. You can feel safe to change that sad which says, yes, I am feeling good.
    feeling into a happy one. Let that old angry feeling
    go and be loving. When you have done that, let me
    know by nodding your head. [Pause.]
    Five-year-old Vera, can you do it? [Shakes head Desensitization: An Example of
    slowly.] Okay. [Pause.] Now, 28-year-old Vera,
    five-year-old Vera can't do it yet. She is still Rapid and Repetitive Memory
    keeping some uncomfortable feelings. I want you Evocation
    to really understand what it is she is keeping.
    Maybe, five-year-old Vera, you can tell me what it M. Erik Wright, M.D., Ph.D.
    is that is making you feel so bad. [Pause.] You
    haven't told me about something that is bothering
    INTRODUCTION
    you. What is it? [Pause.] Are you still angry with
    her— with Mum for not coming? [Pause.] Do you Distressing memories, whether stirred by one of
    feel guilty about being angry with her? the projective techniques or by some other
    Pt.: [Sighs.] precipitating event, may lose their emotional
    Dr.: Do you feel guilty about being angry with intensity and impact through a process of de-
    her? [Nods.] Is there anything else that you want to sensitization. Desensitization can be achieved by
    tell us, five-year-old Vera? If there is, nod your having the client repeatedly relive the painful
    head for yes; if there isn't, shake your head for no. memory while the therapist offers suggestions to
    [Pause.] [Shakes.] Okay, 28-year-old Vera, talk to dissipate the emotional hurt, as in the following
    five-year-old Vera again and see if you can get her example.
    really to feel good. When you have done that, nod
    your head for yes. [Pause.] [Nods.] Five-year-old
    Vera, now you've heard that, do you still need to FACILITATIVE SUGGESTIONS
    keep those old, out-of-date, uncomfortable
    Therapist: This time you will go through this
    feelings any longer? [Pause.] [Head shakes.]
    entire stressful experience again, but it will occur
    Good. Twenty-eight-year-old Vera, five-year-old
    at a much more rapid pace. You will experience
    Vera now says she doesn't have to keep those
    every detail of the situation again as I count from
    uncomfortable feelings anymore. They're out of
    TWENTY to ZERO. . . . [The therapist suggests
    date, they're finished with. It's all past. It's over,
    reduction of hurt:] But as I reach the ZERO count
    and I am going to ask you to please find a way for
    you will also note a significant discharge of some
    of the emotional
    542 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    intensity tied up with the remembrance of this 2. The interrogative part of the conference should
    episode in your life. . . . Let yourself begin the be accomplished by a law enforcement officer
    experience . . . TWENTY . . . NINETEEN . . . etc. . with special training in conducting interviews
    . . ELEVEN. . . . You are well into the experience in the hypnotic environment.
    and it is beginning to come to an end. . . . NINE, 3. The mental health professional and the law
    etc. . . . TWO. . . . The episode is ending . . . ONE . enforcement investigator should work as a
    . . ZERO. . . . The episode is over. . . . Take a deep team. It is wise and discretionary that they not
    breath. . . . [The therapist suggests emotional be informed about the facts of the case in any
    calmness to dissipate hurt:] Go more deeply into detail, lest the inquiry become biased and
    trance and have a quiet calmness flow through you contaminate the information desired. The law
    as the pain, hurt, and stress of this episode dissipate enforcement interviewer should not be
    and decrease. . . . [The process is repeated:] Let us involved in the investigation of the case, and
    ask the inner part of your mind if it would be the mental health professional should be
    helpful to once more go through this experience at independent of responsibility to the pros-
    an even more rapid pace, with an even greater ecution or investigating agency.
    decrease in the stored tensions that remain in some 4. All conferences of the interview team with the
    form right up to the present. . . . The "yes" finger individual to be hypnotized should be
    signaled that it was okay. . . . So, once more . . . etc. videotaped. Before the hypnotic interview, a
    brief mental evaluation of the interviewee
    should be conducted by the mental health
    COMMENTARY professional.
    5. Before the hypnotic interview, the person to be
    Desensitization, abreaction, or whatever one questioned should be given an opportunity to
    chooses to call the release process is beneficial for provide a conscious, detailed recital of the
    many clients in the assimilation and detoxification experience. It is important to have a record of
    of past painful experiences that, in terms of the what the witness describes in conscious recall
    current status of the individual, no longer need to before the hypnotic interview.
    arouse undue distress. With repetition and reliving
    6. While conducting the interview, the consul-
    under hypnotic trance, the "alien" quality
    tation team should be careful not to prompt the
    dissipates, the episode begins to assume
    witness with any new components to the
    manageable proportions, and a better
    description of his/her experience and should be
    psychological perspective about the memory
    especially careful not to alter the perceptual
    evolves.
    reality of the incident in any way.
    7. The number of people present in the room
    during the interview should be kept to a
    minimum, but may include the prosecuting
    Forensic Hypnosis Guidelines: The and/or defense attorneys, the case agent, a
    "Federal Model" chaperone when appropriate, or a close friend
    or family member at the request of the
    Richard B. Garver, Ed.D. interviewee.
    San Antonio, Texas 8. Finally, all information gleaned from the
    hypnotic interview must be independently
    1. The investigative hypnotic examination should corroborated by other evidence before it is used
    be the responsibility of a psychologist or as an investigative lead or is presented in court.
    psychiatrist with specific training in its use.
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 543

    AGE PROGRESSION

    Erickson's Time times in his life. He will be able, therefore, to


    observe his behavior, reactions and patterns at
    Projection Technique different times, to compare, to contrast, and to
    D. Corydon Hammond, Ph.D. discern the threads of continuity between different
    Salt Lake City, Utah ages. This review may also include reviewing
    achievements and learnings that have occurred in
    therapy.
    INDICATIONS AND
    CONTRAINDICATIONS STEP 4: DISORIENTATION AND CONFUSION
    REGARDING
    Erika Fromm has expressed her belief that age TIME. "The deeply hypnotized subject is re-
    progression procedures are contraindicated with minded of the current date; told that the seconds,
    seriously depressed and suicidal patients. Erickson minutes, and hours are passing; that tomorrow is
    still used this method, however, with quite approaching, is here, and now is yesterday; and
    depressed patients. Nonetheless, I urge great that as the days pass, this week will soon be over
    caution in utilizing it with seriously depressed and then all too soon next month will be this month
    patients who may project themselves negatively . . . and do it easily and gradually without rushing
    into the future, stimulating further feelings of the subject." (Erickson, 1980, Vol. 4, p. 400). In
    hopelessness. This technique may be used with this manner the patient is disoriented first for the
    couples as well as individual patients, but it is not day, then the week, then the month, "culminating
    recommended for use it with couples who are in an amnesia for time, place, and situation, but
    highly discouraged or teetering on the brink of with an awareness of the general identity of the self
    divorce. (p. 425). Erickson recommended that we not be too
    specific in defining the future period of time,
    STEPS IN THE TECHNIQUE allowing the future dates to be selected by the
    patient.
    All of Erickson's subjects
    STEP 1: TRANCE T R A I N I N G . The following confusional suggestions, tran-
    were described as somnambulistic and he scribed verbatim from one of Erickson's (Erickson
    specifically indicated that this technique was & Rossi, 1989) cases in 1945, further illustrate his
    generally used with a deep trance (Rossi & Ryan, method of reorienting the patient in time. In this
    1985, p. 196). Subjects should also, ideally, be particular case age regression was employed, but
    capable of experiencing amnesia. the direction of movement in time is simply
    reversed in age projection:
    STEP 2: IDENTIFY HOPES AND WISHES FOR THE FUTURE.
    After deeply hypnotizing the patient, while in the Time can change, can it not? And I want you to
    forget something. I'm not going to tell you just what it
    trance, have him meditate about and identify his
    is. But you are going to forget something gradually,
    hopes and wishes for the future. slowly, easily, and comfortably. It almost seems as if
    it might be Monday [the day is Sunday], or perhaps
    STEP 3: (OPTIONAL) REVIEW PAST HISTORY AND PATTERNS. it might be Saturday, or as if it might even be Friday.
    Have the patient visualize or hallucinate a series of [Going backwards because this is to be a regression.]
    TV sets (Erickson had the patient hallucinate And I want it to seem that way, and I would like to
    "crystal balls"), like in an appliance store with a have you feel a bit amused as you begin to get
    whole wall of TV sets. Instruct the patient that he confused about the date, and enjoy it . . . And since
    will be able to see himself in a variety of situations you don't know what day it is, it will be hard to tell
    (in moving pictures) and at different what week it is. It has to be this week, but what
    544 H A N D B O O K OF HYPNOTIC SUGGESTIONS A N D METAPHORS

    week is this week? Is it the last week in May or the is August, 1945. Just keep sleeping as time goes by,
    first week in June? [It was actually June.] Or maybe as things happen to you — many things happen. And
    it isn't either one. I want you to enjoy that. June, in August, 1945, you are going to come to see me.
    May, May, June, and the first thing you know the You are, are you not? When it is August, 1945, I
    thought of April will come into your mind [because want you to sleep with your eyes open, and talk to
    this is an age regression]; and it can't be June, it can't me, and tell me those things that happened the last
    be May, it can't be April. And now as you experience week in June, and in the weeks of July and the first
    that feeling, I want you to realize you have forgotten week of August [an implied directive type of sugges-
    something else. You forget it is May, and if you tion, allowing the patient to take whatever internal
    think it is April or March, or even if you think it is time was necessary, and then providing a behavioral
    February — March, April, May, and June are forgot- response when it was completed]. And you've got to
    ten, and now I want you to discover you are not tell me about . . ., what you did, and how you did it.
    certain whether it is 1944 or 1945 [actually it's 1945].
    [At another time the following suggestions were STEP 5: PSEUDO-ORIENTATION IN TIME INTO THE FUTURE.
    used:] Now listen carefully to me. It's 1942, is it not? The patient is now projected into the future.
    And time is changing, changing, and soon it won't be After being oriented in time, interact with the
    1942. Soon it won't be 1941. Many things are slipping subject as if both patient and therapist are now in
    from your mind, and you are forgetting and forgetting
    the future. This step is illustrated in the following
    and forgetting and forgetting, and you are just a little
    suggestions that were used by Erickson (1980,
    girl - just a little girl and feeling happy. Now you can
    talk to me. Vol. 4, pp. 401-402):
    What day of the week is it? You really don't know,
    do you? You have more important things to think "As I remember, I saw you last about two months
    about. ago. You came in to report your progress. I put you
    in a trance and had you visualize yourself in crystal
    After the patient had received further trance balls so that you could give me full accounts. Now,
    training, the following suggestions for time suppose you remember tonight all the things you said
    and saw that night about two months ago. Never
    projection into the future were then used (Erickson
    mind anything I saw or did; remember only the
    & Rossi, 1989): things you said and saw and did while you were
    giving me the report. [This was to prevent him from
    And now I want you to understand, listen carefully recalling anything about preliminary or subsequent
    and understand, that time is going to change again. hypnotic inductions, particularly in relation to time
    And it is now June, 1945. And I'm going to change projection.] Now review all those things, some of
    time again. I want you to forget June, 1945. Forget, them go way back to our first meeting and even way
    June, 1945, and yet be able to listen to me and back to the beginning of the problem you brought to
    understand me. And time is going to change and you me. Think them over carefully, clearly, extensively,
    won't know what day it is, or what month it is, and and then discuss things for me."
    you won't even care. You will be comfortable,
    sleeping deeply and soundly. You won't even care
    what day it is. All you want is to sleep. And now time is You now have the patient evolve "fantasies in
    changing, and I want you to realize that time has keeping with their understandings of actually
    changed very quickly. Still you don't know the day attainable goals" (1980, Vol. 4, p. 422). Erickson
    and you don't care. Soon it is going to be August, found "there was no running away of the
    1945. August, 1945. And it is really going to be imagination, but a serious appraisal in fantasy form
    August, 1945; and before it will be August, 1945, of reality possibilities in keeping with their
    many things must happen to you. Many different understandings of themselves" (p. 422).
    things. And slowly I want those things to happen to Erickson indicated that he would provide
    you. I want them to go through your mind [or the
    "elaborate instruction" to the patient "to ensure a
    patient could see them on TV sets or crystal balls] —
    every day in July and every day in the first week of calm, comfortable feeling and to induce an
    August. I want these days to be clear in your mind overwhelming interest in whatever the writer
    until slowly you begin to recall even the last week in might have to say" (Vol. 4, p. 405). He further
    June, 1945. And now sleep and let time go by until it
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 545
    explained: "Then I ask the patient who has altered I want you to keep that knowledge in your uncon-
    his time orientation to think comprehensively scious. Do you understand? I want you to keep this
    about stressful matters— about those things that knowledge in your unconscious and not to discover it
    worry him and make him fearful in his current life until later this summer. Do you understand? Just as
    situation. And since he can look upon those things you repressed and forgot painful things in the past, I
    want you to repress this knowledge until the right
    from his reoriented vantage point as having
    time comes for it to burst out into your understanding,
    occurred in the past, he now can employ hindsight so that you can actually have the experience of
    in their resolution!" (Rossi & Ryan, 1985, p. 196). finding yourself. ... Do you understand? And I want
    In facilitating the patient's analysis, you may ask it to be a tremendously pleasing surprise to you (p.
    questions like, "How was it that you finally ..." and 225).
    "What was it that happened?"
    Prior to suggestions for amnesia, you may STEP 7: (OPTIONAL) REPETITION OF THE ENTIRE PROCEDURE
    present confident suggestions concerning what the IN THE NEXT INTERVIEW. It appears that on occasion
    patient has accomplished in the future. For Erickson had the patient repeat the entire age
    instance, "You now know that you can, you are progression experience in the following session. It
    confident. In fact, you have succeeded, and there is may have been that he felt this would further
    nothing that you can do to keep from succeeding formulate the goals and images at an unconscious
    again and again" (Erickson, 1980, Vol. 1, p. 172). level in the patient's mind and provide further
    repetition of suggestion.
    STEP 6: EXTENSIVE SUGGESTIONS FOR
    AMNESIA. STEP 8: POSTHYPNOTIC SUGGESTION. After the com-
    Erickson (1980) indicated that "every effort was pletion of the age projection experience, you may
    made to keep them unconscious by prohibitive and once again give positive, confident suggestions to
    inhibitive suggestions. By so doing, each patient's the patient: "You now know, deep inside, that this
    unconscious was provided with a wealth of is how it will be. You have actually experienced
    formulated ideas unknown to the conscious mind. it." "You now know that you can, you are
    Then, in response to the innate needs and desires of
    confident. In fact, you have succeeded, and there is
    the total personality, the unconscious could utilize
    nothing that you can do to keep from succeeding
    those ideas by translating them into realities of
    again and again" (Erickson, 1980, Vol. 1, p. 172).
    daily life as spontaneous responsive behavior in
    opportune situations" (Vol. 4, p. 421). If at all
    possible, he did not want this process to be one
    wherein the patient simply consciously imagined
    the future and remembered it following hypnosis. Age Progression to Work
    "For the patients, special understandings for the Through Resistance
    future were developed in their unconscious minds,
    and their actual life situations presented the reality Richard B. Carver, Ed.D.
    opportunities to utilize those ideas in responsive San Antonio, Texas
    behavior in accord with their inner needs and
    desires" (p. 422). "Furthermore, [because of the [After the induction, the following suggestions
    amnesia] their behavior was experienced by them are given:] "It's now (e.g., 1995, or some year in the
    as arising within them and in relation to their needs future) and you can see yourself in a situation that
    in their immediate life situation" (p. 422). is safe and as comfortable as it can be. And I would
    like for you to tell me when you are there, and how
    The following suggestions from one of
    Erickson's (Erickson & Rossi, 1989) cases illus- you feel, and how you look."
    trate this step: [If responses are very negative or depressed,
    then appropriate supportive psychotherapy is
    helpful, but if they tend, as they often do, to be
    546 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    positive, then it is important to say:] "Well, I'm trances. However, when time does not permit
    glad things are going better for you. I wonder if you sufficient trance deepening, with less talented
    could tell me, because frankly I just forget, what it subjects, and in self-hypnosis, end-result imagery
    was that helped you the most when you and I were may also produce very beneficial results. The
    working on this in therapy five years ago? I following two contributions by Korn and Pratt
    remember we worked on a lot of things, but what (1988) model such interventions. Such goal
    was it that seemed to really make a difference that imagery may be beneficial whenever you are
    helped you change your behavior?" working with individuals who have specific goals
    Often the patient will say, "Oh, it was dealing toward which they are working. These techniques
    with that issue about my father, or it was helping present a very positive approach to promoting
    control my emotions differently from the way I did behavior change, recognizing that people are
    when I was a teenager," etc. Thus, when we come motivated from in front, toward goals, as well as
    back to the present, we can often use that insight being pushed from behind by the influences of the
    from age progression which the patient was unable past. These techniques have applicability with
    to see prior to projecting himself into the future. business success, sales, athletic performance, and
    Perhaps this technique provides patients with such problems as obesity, smoking, academic
    enough distance to look more objectively at their achievement, parenting, low self-esteem, and
    problems and to provide their own answers. relationship or interpersonal problems. These types
    of suggestions may also be recorded on tape, along
    with induction and deepening, for subjects to use
    for reinforcement at home. (Ed.)
    Suggestions Following Age
    Progression with Public
    Speaking SUGGESTIONS

    Don E. Gibbons, Ph.D. [Following induction.] Imagine now that you


    are in a very large room. A private, very
    As a result of your experience, you know that comfortable room. It may be a room in your own
    without anxiety you can perform efficiently and house. It is a room of safety and of comfort. You
    well before a group. And as you think back upon feel good when you are in this place.
    your experience now, you are feeling a great deal Now imagine yourself seated in a large, com-
    of pride, achievement, and accomplishment in the fortable chair. Feel your body sink into the chair. In
    knowledge of how well you performed. front of you is a television set with a very large
    screen. On your chair are buttons and dials that will
    allow you to control every aspect of this television
    set.
    Imagery of the End Result Now in your mind, formulate a goal that you
    would like to work on. It can be any goal —
    Errol R. Korn, M.D., and short-term or long-term. It can be a goal related to
    George J. Pratt, Ph.D. your personal life, or to your job. Now turn the
    Lajolla, California television set on and allow a picture to appear. You
    see yourself. You are experiencing the goal,
    INTRODUCTION AND INDICATIONS already achieved. You have done it. Imagine a
    scene that could only take place if you had
    As we have already indicated, age progression accomplished your goal. [Pause]
    may be used with subjects capable of deep Experience the scene fully. Use the fine controls
    of the television set to slow the scene
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 547
    down, to study the details. Make it move more it move around you. [Pause] Practice using the
    quickly. Add people, or change the set or the bubble, not only while you're listening . . ., but at
    music. It's your program, it's your goal. anytime when you are relaxed and safe. The bubble
    Now feel yourself being drawn into the picture, is your own place, a place where you are
    so that you become the person on the screen. completely safe and in control.
    Instead of looking into the television set, you are As you begin to feel your own breathing, and the
    merging with the person who accomplished the energy that it brings back to your body, focus on
    goal. Again, this could only take place if your goal this idea: This protective shield will help you to
    was achieved. Spend the next few moments become more powerful. You will be able to
    completely experiencing the imagery of your fully express your personal power, more and more, with
    realized goal. [Awaken the subject upon every day that passes. Your strength will come
    completion.] from inside of you. Virtually anything will be
    possible. And your power can affect others. Not
    only will you believe in yourself; others will
    believe in you as well. You will be able to feel this
    Mental Rehearsal: The energy come up from within you, whenever you
    Protective Shield wish.
    Now, as you have done before, breathe the
    Errol R. Korn, M.D., and energy back into your body. Feel the energy move
    George J. Pratt, Ph.D. to all parts of your body. When you are completely
    Lalolla, California back in the present time, simply open your eyes,
    feeling alert and awake.
    [Following induction:] To experience your
    personal power, you must be certain that you are a
    special person, a person who truly contributes to
    the community. You can be that person. You are
    Mental Rehearsal of Presentation
    already becoming that person. Now, you need to
    find the safety and protection that you need. And and Sales Skills
    then, you can begin to step forward, to take the
    risks that will allow you to make the changes that Errol R. Korn, M.D., and
    you need to make in the world and in your life. George J. Pratt, Ph.D.
    Imagine, all around you, a protective shield, or a La]olla, California
    bubble. The shield, or the bubble, is completely
    transparent. It can be as far away from you as you Bring to mind a presentation that you have to
    please, or as close to you as your second skin. You make in the near future. It may be a sales
    are in control — you choose the size and shape of presentation to a client, it may be a speech to a
    your protection. The bubble is visible only to you. gathering of your peers or your superiors, it may be
    Nobody else can see it. It is like a one-way mirror; a simple meeting. Imagine yourself getting a good
    you move outward, but only the things that you night's sleep — focus on feeling as though you're
    allow in, will get in. You can choose who, or what falling asleep . . . and that you're waking refreshed.
    you want inside the bubble — people, ideas, inci- Imagine dressing as you would dress on the day of
    dents, physical surroundings. You can keep your the presentation, feeling very good about yourself.
    fears outside the bubble. You are smiling.
    Spend the next few moments experimenting At the place where the presentation is to take
    with the bubble. Experience it. Make it larger. place, imagine yourself walking into the room.
    Make it smaller. Feel its texture, or consider its Your audience, or your client, is eagerly awaiting
    absence of texture. Move around within it. Feel your arrival. You are several minutes early,
    comfortably early. There is little pres-
    548 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    sure. The people are interested in what you have to issue or event you did not understand, to settle
    say. some unfinished business. We all live in the
    Before giving your presentation, take a deep present, which tomorrow will be the past, and the
    breath. Use your physical cue, touching your future becomes the present. Time is always
    thumb and your finger together on your moving. You can see the future in fantasy to make
    nondominant hand. For a brief moment, visit your the present move progressively happy and
    place of safety. Imagine your protective shield successful.
    around you. And now, return to the meeting. Fantasies are good to have. Unrealistic fantasies
    Imagine the faces and the potential questions. can be fun and entertaining, then discarded as one
    The real questions. Imagine the points that you will would shut off a TV set. Realistically achievable
    cover. Understand each question beyond just the fantasies can provide the material for you to
    words; you understand WHY each question is establish and work at accomplishing your goals.
    asked, what the underlying emotional concerns Then, when the tomorrows become the present,
    would be. You are intuitive, you are sensitive to fantasies will become realities.
    their thoughts and ideas. Just as you went down the road, or a corridor, or
    Now imagine the result. A positive result. A stairs to go back into the past, you can go up that
    handshake, a job well done, the sale closed, the same road, corridor, or stairs to envision your
    promise of a contract. The nods of approval, the future. You can see the pleasant future happening
    smiles, the anticipation of working together again. to you, or, if you prefer and it is more helpful, you
    A standing ovation from your public speaking can be an observer watching it happen to someone
    audience. else. And then afterwards, you can imitate the
    Next, picture yourself under the worst possible model. You may select either method; simply
    conditions. The room is noisy, the people are not at select the method which will give you the greatest
    all cooperative. They're rude. They're interrupting revelation and that will be the most beneficial to
    you. You're forgetting your key points. You're you.
    losing your cool. After imagining the worst By looking into the future, you are establishing
    possible conditions, you feel better. You know that goals — let's say five-year goals. For the present,
    the presentation will seldom become as rough or as you will need to determine how to really make it
    difficult. happen so it won't always remain a fantasy. To do
    You are back in control. You are again in the so, you will break that five-year goal into five
    positive environment. People want to buy what you shorter one-year goals. Each of these years will be
    have to sell. They are very pleased to see you. You broken down into 12 months. Each of those months
    rehearse the presentation once again. Take your will be broken down into weeks. Thus, each week
    time; think through every point. . . . you are achieving some of your goals, until you
    Now, as you have done before, breathe the realize that the future is now. You can write all
    energy back into your body and feel the energy those goals down after you come out of hypnosis,
    move to all parts of your body. When you are and then, on a weekly basis, review your plea-
    completely back in the present time, simply open surable and successful progress. Looking into the
    your eyes, feeling alert and awake. future, you are concerned about relationships. See
    them as you desire them to transpire. [Pause] You
    are concerned about a career, work, an occupation.
    Suggestions for Goal-Imagery See that self efficiently functioning in the choice of
    work. [Pause] You are concerned about health
    Alcid M. Pelletier, Ed.D.
    possibly. You are concerned about finances. See
    Grand Rapids, Michigan
    the process unfold without careless debt. [Pause]
    You remember that we use hypnosis in age You can
    regression, to help you go back to deal with an
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 549
    also see interest in hobbies, recreation, travel, bask in the warm rewarding glow of a job well
    personality improvement or whatever you real- done.
    istically desire, and see the process you must go And as you allow yourself to let go completely
    through to realize these achievements. [Pause] and experience this event fully, savoring your
    You are making things happen, even some things triumph and all its fruits, the feelings of
    that you haven't done before, but that you can satisfaction and achievement are becoming clearer
    realistically accomplish. and sharper and more intense with every passing
    Now you won't be saying, "When I get around to moment.
    it . . .," "One of these days, I'll . . .," "When I get the In a little while, I'm going to return you to the
    chance, I will ...," or "Soon, I'll. . . ." Instead, you present time. But until I do, let yourself continue to
    will make things happen. You are making some enjoy the fulfillment of the goal which you have
    things happen now. There is power in this, and you worked so hard to attain, as the feelings of
    can come to realize that the future is now. achievement and satisfaction continue to grow, and
    each passing second finds them stronger than they
    were before.
    [After a two-minute interval of free fantasy:] It's
    End-Result Goal Imagery for Sales time to return to the present now, to the time from
    Productivity which you left. You are beginning to return to the
    present time, and the scene you have been
    Don E. Gibbons, Ph.D. experiencing in your mind is beginning to fade, but
    you will still remain in trance for a while, until I
    Now I would like you to think of some major bring you out. You will feel renewed and
    incentive which you are working toward, and recharged as a result of your experience, and you
    which you would like to achieve in the future. It will possess a heightened resolve to succeed in the
    might be taking an ocean cruise, or seeing a child attainment of your goal.
    graduate from college, or building your dream And now the scene is fading more and more,
    house — in fact, it could be almost anything. But almost gone. Now the scene is completely gone,
    whatever it is, this goal should be an important and you are back with me in the present. You are
    one, and one which is within your power to achieve feeling renewed and recharged, and more
    as a result of your own efforts. determined than ever to succeed in the attainment
    And when you have the goal firmly in mind, I of the goal you have envisioned, for its benefits
    would like you to picture yourself transported into and attractions are now so much more clearly
    the future, savoring the fruits of your achievement apparent than they were before.
    and enjoying the knowledge that the goal for
    which you have worked so long and so hard is
    finally yours. Continue to hold the image in your
    mind, and to focus on it, and soon it will be just as Erickson's Self-Suggestion
    if you were really there. Technique
    Let yourself begin to live the experience now.
    You have achieved what you have set out to attain, D. Corydon Hammond, Ph.D. Salt
    and the fruits of your efforts are yours to enjoy. Lake City, Utah
    Live the fulfillment of your goal and allow
    yourself to experience all the joy and the INDICATIONS
    satisfaction which come from knowing that your
    ambitions have at last been realized. Let yourself This technique is included in this section on
    savor the thrill of achievement and goal-directed hypnotherapy techniques because it
    is a procedure that assists the patient in focusing
    on the future and on establishing
    550 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    highly specific goals. This is also a technique with thoughtfully indicate what you need, and what you
    particular value for "resistant" patients who will want. And as you slowly speak, with each word,
    not accept direction from authority, and with "scalp your unconscious mind can take you deeper and
    collectors" who have been to many therapists deeper into trance. The mere sound of your voice,
    without success. Such patients often come to will take you into a deeper and deeper state, in
    hypnotherapy seeking a "hypnotic miracle" after which you can continue to talk to me, listen to me,
    everything else has failed. This procedure places answer questions, and do anything asked of you.
    the burden of responsibility for results on the And you will find yourself in such a deep state, that
    patient himself, rather than on the therapist trying you will be under a most powerful compulsion, to
    to promote change. It will probably be most do precisely what is indicated. Now, meditatively,
    thoughtfully, slowly, review precisely what you
    effective with intelligent patients who basically
    need and what you want. [Pause. If necessary,
    already possess insight concerning what they need
    occasionally help the patient to be more specific,
    to do, but who are not translating insight into
    for example, by asking, "When?" "How often?"]
    action.
    After this method has been used successfully and All right. Now continue to drift into a deeper,
    a patient has found it effective, it may also be and sounder trance, deeper with every breath you
    recorded on tape for use in self-hypnosis, having take. And as you continue to go deeper, in a
    the patient speak inwardly to him or herself. moment I'm going to have you outline the therapy,
    Erickson originally used the procedure itself as a and the actions that will be necessary, to
    hypnotic induction, having patients speak with accomplish what you want. Once again, as you
    their eyes closed. However, when there is no speak, you will continue to go into a deeper, and
    resistance to induction itself, I prefer to induce more profound trance, with every sound of your
    voice, and with every word you speak. Simply the
    trance before using the procedure.
    sound of your voice, will take you into such a deep
    hypnotic state, that you will find yourself
    compelled and constrained, to do exactly that
    THE TECHNIQUE which is indicated. So, in a moment, when I stop
    speaking, I want you to slowly, thoughtfully,
    [Induce a trance and then suggest:] You can meditatively, describe specifically what you will
    speak in a hypnotic state, without awakening, just need to do. Now, slowly, thoughtfully, describe
    as you can talk in the dreams of the night. And in a exactly what you need to do. [Pause. As necessary,
    moment, still remaining in a hypnotic state, I want very briefly question the patient for greater
    you to begin to review your problem and your specificity and detail.]
    goals. I want you to review your problem and goals
    slowly, thoughtfully, and carefully. And as you do Very good. And continue drifting deeper, and
    so, simply the sound of your voice, will take you deeper into comfort. In a moment, I'm going to ask
    deeper and deeper into a hypnotic state, in which you to speak again. And I want you to specify in
    you can continue talking to me, without any great detail, precisely what's necessary, and
    interruption of your story and review. So, in a exactly what you will do, so that you'll reach your
    moment, as I tell you to begin, you can slowly, goals. As you speak, you can do so with an
    thoughtfully describe your problem from beginning increasing effortlessness, allowing your
    to end. Describe your problem in detail, and the unconscious mind to take over, and take you into a
    very specific goals you have for yourself, going deeper, and more profound trance, with each sound
    deeper and deeper into trance as you speak. Now, of your voice. And you find yourself in such a deep
    begin to slowly describe your problem." [Pause for trance, that the things you indicate are necessary,
    the patient's description.] the sugges-
    Good. Now in a moment I want you to speak
    again. 1 want you to slowly, carefully, and
    TIME REORIENTATION: AGE REGRESSION. AGE PROGRESSION, AND TIME DISTORTION 551
    tions you give to yourself, will profoundly and comprehensive detail, to affirm again, pre-
    influence your thoughts, and feelings, and actions. cisely what you will do. [Pause]
    You are in such a deep trance, that you will feel [Repeat this last step once or twice more to
    impelled from deep within you, to do precisely provide repetition of suggestion.]
    what is indicated. Now, thoughtfully, slowly, and Now before awakening you, I want to point out,
    in detail, indicate exactly what you will do, so that that I have offered you no advice or suggestions.
    you'll have what you want. [Pause] Every suggestion has come from you, yourself.
    Very good. Now just rest, into an even deeper, And these suggestions will sink deep into your
    and sounder state, as each breath takes you into a unconscious mind, and profoundly influence your
    deeper hypnotic sleep. [Pause] Now in a moment, I thoughts, and feelings, and your behaviors. And
    want you to speak again. And once again, as you you will find yourself under a powerful
    speak, each sound of your voice will take you compulsion, arising from deep inside you, to do
    deeper; so deep, that you'll find yourself under a everything that you have indicated. You will feel
    most powerful compulsion, to do exactly what is unconsciously impelled, deeply compelled, to do
    indicated. Now I want you to slowly, emphatically, the things that you yourself have indicated.
    and in full [Awaken the patient.]

    TIME DISTORTION TRAINING

    Training Patients to Experience training in time distortion requires from three to 20


    hours (best spent in daily sessions), not including
    Time Distortion
    the time required for the training in hypnosis per
    Linn F. Cooper, M.D., and se. Furthermore, once learned, the ability decreases
    Milton H. Erickson, M.D. with lack of use and retraining may then be
    necessary to restore the former level of proficiency.
    In this section, those techniques will be con- With sufficient effort, and the proper technique, the
    sidered whereby a subject, already trained in the phenomenon can probably be produced, to varying
    production of the more common phenomena degrees, in the majority of subjects. A casual
    characteristic of the trance state, is taught to approach to the work is almost certain to lead to
    experience time distortion and to perform the disappointment.
    various sorts of tasks discussed in this treatise. In general, it may be said that time distortion,
    Although a small percentage of "good" subjects and related phenomena, depends upon a high
    will produce many of the phenomena under degree of withdrawal, by the subject, into his
    discussion on the first attempt to elicit them, it is hallucinated world, with an accompanying lack of
    most important for investigators to realize that the awareness of his surroundings as such. This state
    training of subjects for time distortion in hypnosis of detachment, in which the subject becomes
    usually requires considerable time, effort, and skill. completely engrossed in his hallucinatory
    Methods that succeed with one subject may fail experience, constitutes the first goal in training.
    with another, and a keen appreciation of, and When achieved, subjects will report that, during
    sensitivity to, the delicate interpersonal their task performance, they were quite unaware of
    relationship involved in hypnosis is of paramount their surroundings. Indeed, some subjects have
    importance, along with resourcefulness, and the reported that, at the termination signal, they
    willingness to try original and varying approaches. experienced a slight "jolt" or "shock." One
    By and large, subject gave evidence of her
    552 HANDBOOKOFHYPNOTICSUGGESTIONSANDMETAPHORS

    engrossment in a different world by referring to the hallucinatory experience. One of our subjects
    termination of the task by saying, "When you exemplified this in describing how he went about
    called me out, I was combing my hair." When she putting himself into a self-induced trance state. He
    said this, she was still in the trance state, reporting said, "I first imagine myself in a certain situation
    on the performance of a just-completed task. as, for instance, lying on a rubber raft off a beach. I
    Sudden noises likewise will "jolt" a subject who is look about me and visualize the raft, the water, and
    hallucinating during time distortion, and so forth, and imagine that I feel the warm sun on
    sometimes they will destroy the production. my back and hear the waves. After a while,
    A most helpful suggestion to encourage with- everything comes into focus, and I'm 'actually
    drawal from the physical world is, "During these there.'"
    experiences you will be completely unaware of We have always used the word "Now" as a
    your surroundings in the waking world." starting and termination signal, and have avoided
    Prior to the starting signal, while the experi- concurrent reporting almost entirely. Concurrent
    menter is assigning the task, subjects generally reporting is the reporting on an experience, by the
    think about what they will do. Then, with the subject, as he is actually living it, and is, of course,
    starting signal, well-trained subjects find them- common practice in experimental hypnosis. We
    selves in the hallucinated world, living the assigned avoid it because we believe that it tends to prevent
    experience. This may or may not proceed along the the subject from becoming detached from his
    lines they had planned, but it generally satisfies the surroundings in the physical world, and hence from
    conditions stipulated in the instructions, and is learning time distortion. Obviously, experience
    subject to volitional direction by the subject. Thus, proceeding in distorted time cannot be reported
    not only does he do what was suggested to him but, concurrently, for it proceeds too rapidly relative to
    within this limitation, he will carry out decisions as world time.
    he is faced with them, just as he does when awake. It would seem that reality tone is in some way
    One subject, for instance, whose wrist became dependent upon a free flow of material from the
    uncomfortable while hallucinating the writing of a
    unconscious. Since most persons dream, it may be
    large amount of material, interrupted the writing well to cite dreams, pointing out to the subject that
    long enough to go into the bathroom and put some they are a form of hallucinatory experience, that
    alcohol on the lame wrist (this was, of course, they show reality tone and time distortion, and that
    hallucinatory activity only, and involved no actual the dreamer is quite unaware of his surroundings.
    movement). This will give him an idea of the sort of thing that
    The well trained subject does not consciously we are after. And in order to encourage a free and
    construct the details of his hallucinated world, but spontaneous flow of material from the unconscious,
    rather finds himself among them. In other words, it is probably advisable to instruct the subject to
    whatever be the mechanism of fantasy production, permit free association to guide his imagery during
    it is spontaneous and effortless. This is in sharp his early training. Some such suggestions as the
    contrast to the case of the waking subject who is following may be used:
    asked, say, to imagine that he is looking at his "When I give you the starting signal by saying,
    house. Here he is likely deliberately to construct the 'Now,' you will let some sort of visual image, or
    image from his knowledge of it, and this is scene, come to you. It makes no difference what it
    accompanied by more or less effort, depending is. As you watch, other images will come, of their
    upon how good a visualizer he is. And even then his own accord, one after another. These images will
    productions generally lack what Dunne refers to as become more and more clear and more and more
    "reality tone," which is so characteristic real, so that eventually you will find yourself
    of 'actually there' in another world. You will be
    a part of that
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 553

    world, which will be just as real as the waking ". . .polish your shoes."
    world, and you will truly live such experiences as ". . .change a tire on a car."
    you have there. After a while I shall say to you, ". . .hear a record."
    'Now, make your mind a blank,' whereupon a Here again, a report of each task, with its
    hallucinatory activity will cease. I shall then ask seeming duration, should be obtained.
    you to tell me what you saw or did, but you need tell Early in training, the seeming duration may be
    me only what you wish of your experience." way out of proportion to the amount of activity
    The subject is thus introduced to the use of a reported. As the work progresses, this
    starting signal and a termination signal. disproportion tends to disappear, and the amount
    The subject should be allowed several minutes of activity becomes more appropriate to the
    (allotted time) for such an exercise. experiential time.
    The next step is to assign definite tasks. These Next, continuous activities with a suggested
    tasks should be familiar ones, and the instructions personal time and an allotted time are introduced.
    should be as general as possible. This permits the The "finishing" of such activities consists, of
    subject a wide range of action, with a minimum of course, in the activity having continued for the
    limitations. We may simply instruct him to do suggested personal time. Here again, it may be well
    anything he wishes. At first we may tell him that he to run the activity first as a task without an allotted
    is to imagine himself in such a place, or doing such time, allowing the subject to signal when he has
    and such a thing. Soon we discontinue the use of finished. It can then be repeated, using the world
    the phrase "to imagine" and tell him that he will be time interval as the allotted time. With this, the
    in such a place, or will do so and so, adding that "it subject should be assured that "when the time
    will be very real, so that you will actually live the (suggested personal time) is up, the termination
    experience." signal will be given." These activities are
    introduced by telling the subject that he will be at a
    As training progresses, a series of tasks is run certain place, or doing a certain thing. The reliving
    with completed activities. In these, it is important to of pleasant past experiences is a type of task that is
    assure the subject, after the activity suggestion, that useful at this stage of training. However, any
    he will "have plenty of time between signals to familiar type of activity is quite satisfactory, such
    complete the task." In order to be certain that the as the following:
    allotted time is long enough for him to complete the
    task, it may be assigned first with no allotted time, "When I give you the starting signal by saying
    allowing the subject to signal when he has finished. 'Now,' you will . . . ". . .be at a beach." ". . .be in the
    Having noted the world time, the task is then country."
    repeated, using the world time as the allotted time. .be in school."
    By employing this technique with a number of .be at work."
    tasks, the subject is introduced to the use of ". .be on a vacation."
    completed activities that he can finish within an ". .be taking a walk."
    allotted time. ". .be at a movie."
    ". .be taking a drive in a car."
    Examples of such tasks follow: "When I give you
    etc. The subject should be asked for a report
    the starting signal by saying 'Now,' you will . . . ". .
    .take a walk." ". . .buy a pair of shoes." ". . .watch a after each task, and the seeming duration of
    the experience should be asked for. Time
    movie 'short'." ". . .order a meal in a restaurant." ". .
    distortion will soon become evident to the
    .draw a picture."
    experimenter and, at some point in the training, it
    is advisable to point out to the subject the
    difference between the seeming duration and the
    clock
    554 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    reading during his experiences. This will help him "You will have plenty of time."
    to realize that time distortion is a fact, and that he "You will not have to hurry."
    himself can experience it quite naturally. In this "You will have all the time you need."
    way, the subject will become accustomed to "Relax and take your time."
    finishing "completed" activities and "continuous" "You can loiter over it if you wish."
    ones (with a suggested personal time) within an "Remember, you have an unlimited supply of
    allotted time. special trance time at your disposal, so take as
    The next step is to run a series of tasks, either much of it as you need."
    completed or continuous (with suggested personal "You are to do this slowly, without hurrying."
    time), using at first an allotted time long enough to We have found the following technique useful,
    permit the subject to finish the task and then, in at times, in teaching the subject to work with short
    repeating it, gradually to decrease the allotted time allotted times. It consists merely in suggesting a
    in steps of from 10 seconds to 30 seconds. The series of 10 tasks, each with an allotted time of 10
    subject, "caught short" at first, will soon learn to seconds, with reporting deferred until the series has
    adjust to the shorter allotted time, and will fit his been completed.
    hallucinatory experience into the interval allowed 0 sec: "When I give you the starting signal by
    him, without hurrying or compromising in any saying 'Now,' you will get a haircut . . .
    way. Thus he learns to work with short allotted
    10 sec: "Now."
    times. How far the process can be carried is not
    20 sec: "Now, blank. At the next signal you will
    known at present.
    wash your car ... "
    A few words are in order concerning suggested 30 sec: "Now."
    personal time. This is used, as a rule, only with 40 sec: "Now, blank. At the next signal you will
    continuous activities, and may be introduced by buy a pair of shoes . . ."
    such an expression as, "You will spend 10 minutes 50 sec: "Now."
    (of your special time) doing so and so." Or, the etc.
    experimenter may say, after the activity Another helpful technique is to repeat a given
    instructions, " You will do this for 10 minutes." task over and over, keeping the allotted time
    Some subjects readily accept this early in their constant. Although the subject may not be able to
    training; others have difficulty doing so. The finish it at first, he often will learn to do so, without
    difficulty seems to arise from at least two factors — hurrying in the slightest, after repeated attempts.
    a residual awareness of surroundings and This will facilitate high degrees of time distortion
    consequently of world time, and a deep conviction in subsequent tasks.
    that it "just is impossible." Practice, and use of a To encourage progress, the activity instruction
    deeper trance, will help overcome the first should be followed by such suggestions as the
    difficulty. With the second, it may help to point out following, given repeatedly, and with conviction:
    to the subject that he has on many occasions during "You will finish this, without hurrying."
    his training himself experienced the variability of
    "Remember, you're going to finish this task, and
    subjective time in relation to world time. The
    you won't hurry."
    results of some of his earlier tests will convince
    "You will take as much time as you need to
    him of this when shown to him.
    finish the task without hurrying."
    Repeated assurance, to the subject, that he will "You will finish the task."
    have plenty of time for his task is of great A most interesting technique, learned from
    importance during training, and should be used Erickson and applicable to a very wide range of
    frequently. Such suggestions should be given with suggestions is, after an affirmatory suggestion, to
    conviction, and it is often wise to repeat them many ask the subject the question, "Won't you?" thus:
    times. Examples are:
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 555

    "You will finish, won't you?" things about it is that it is very variable. Thus, if
    The subject, in answering "Yes," increases the several persons are asked to judge the length of a
    likelihood of his carrying out the suggestion. five minute interval as measured by a clock, they
    This technique may be used with commands in may have very different ideas as to the duration of
    the following way: "Take as much time as you need the interval, depending upon the circumstances in
    in order to finish the task. You'll do this, won't which each person finds himself. To those who were
    you?" enjoying themselves, or who were absorbed in
    Even further affirmatory reinforcement may be some interesting activity, the interval might well
    obtained by adding, "Are you sure?" after the seem shorter. On the other hand, to those in pain or
    subject has answered "Yes" to the above question. discomfort, or anxiety, the five minutes would seem
    As is pointed out elsewhere, the hallucinatory much longer. We call this time distortion, and the
    productions with which we deal in these exper- most familiar example of it is found in the dream.
    iments are, in certain important respects, different You yourself have probably often noticed that you
    from most dreams. On the other hand, the nocturnal can experience many hours of dream life in a very
    dream is the commonest form of experience that short time by the clock.
    resembles them, and in which time distortion is "Now, it has been repeatedly demonstrated that
    present. Therefore, in some subjects, production of subjective time appreciation can be hallucinated
    a few hypnotically-induced dreams may serve as a just as you can hallucinate visual or auditory
    useful introduction to hallucinatory experience of sensations, in response to suggestion during
    the sort we seek to develop. If the dreams are hypnosis. The subject thus actually experiences the
    produced, we explain to the subject that we shall amount of subjective time that is suggested to him.
    ask for no more of them, but shall strive for So, in a sense, you have a 'special time' of your
    productions that are identical with waking own, which you can call on as you wish. Moreover,
    experience, that are continuous, "real" experiences, you have an unlimited supply of it. It is the time of
    which he will actually live. Thus they will "make the dream world and of the hallucinated world, and
    sense," and will be rich in detail, and will contain since it is readily available, you will never have to
    no omissions or gaps. We must frequently suggest hurry in these tests. Furthermore, it bears no
    that the experiences will be "very, very real, so that relation whatever to the time of any watch, which,
    you will actually live them." This is extremely consequently, you will ignore.
    important.
    "Knowing these things, you can now relax and
    At some point during training, it is desirable to take your time."
    discuss time with the subject. How this is done will Certain suggestions other than those pertaining
    vary with different experimenters. We generally to specific tasks have proved useful. Among these
    employ some such approach as the following: are the following:
    "There are two kinds of time: one, the time the "As we practice these tasks, they will become
    clock tells us, the other, our own sense of the easier and easier for you."
    passage of time. The first of these is known as " With practice, the experiences will become
    physical, or solar, or world time. It is the time used more and more clear, and more and more real, so
    by the physicists and the astronomers in their that you will actually live them."
    measurements, and by all of us in our work-a-day "With each experience, you will go deeper and
    life. The second is called personal, or subjective deeper asleep."
    time. Einstein refers to this as 'I-time.' "The experiences will come of their own accord,
    "It is this subjective time that we are most promptly and effortlessly, when I give you the
    interested in here. One of the most starting signal."
    important "The experiences will stop immediately, as I
    give you the termination signal."
    556 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Throughout the training, advantage is taken of 2. Experiencing a continuous activity with sug-
    the following: gestions for personal time. Example: "You're
    going to listen to a record for 15 minutes."
    1. The inherent tendency toward spontaneous 3. Experiencing a completed activity without
    time distortion in hallucinated activities. suggestions for personal time. Example:
    2. The effort and the need on the part of the "You're going to cook a meal."
    hypnotized subject to carry out suggestions, 4. Experiencing a completed activity with sug-
    especially to finish a completed activity. gestions for personal time. Example: "You will
    3. The fact that, at the beginning at least, familiar spent 15 minutes cooking a meal."
    activities are more readily hallucinated than
    5. Experiencing a continuous activity, in an
    unfamiliar ones.
    allotted period of time, without suggestions
    4. The fact that the interest and curiosity of the for personal time. Example: "You're listening to
    subject, and his feeling of being productive, a record." [Subject is allotted two minutes,
    tend to improve cooperation and performance. without telling him or her the amount of time.]
    Advantage can be taken of this by giving him
    6. Experiencing a continuous activity, in an
    sufficient understanding of what he is doing so
    allotted period of time, with suggestions for
    that he accepts and does not reject it.
    personal time. Example: "In the next two
    5. The tendency to improve with practice. minutes you're going to listen to an entire
    record, and you'll find that you have all the time
    In all training, it is of utmost importance for the
    you need." [Subject is allotted a certain number
    experimenter to give the subject his undivided
    of minutes, and on subsequent trials, the
    attention when addressing him. Subjects are quick
    amount of time is reduced.]
    to detect the slightest deviation from this approach,
    and may resent highly any evidence that they 7. Experiencing a completed activity, in an
    themselves are not the sole object of the allotted period of time, without suggestions
    experimenter's interest and attention. Thus, they for personal time. Example: "You're going to
    can often tell, by changes in his voice, when the watch a television program, without hurrying,
    experimenter is thinking of something else, or and will have all the time you need." [Subject is
    turning his face away, as in looking at his notes, allotted three minutes, without telling him or
    etc., even though their eyes are closed. her how much time is allotted.]
    It must be remembered that subjects vary widely 8. Experiencing a completed activity, in an
    in their capabilities as regards time distortion in allotted period of time, with suggestions for
    hypnosis. After a few hours of training, the personal time. Example: "In the next three
    experimenter will have obtained a fair idea as to a minutes of time by the clock, you're going
    given subject's ability to acquire this skill. For to watch one of your favorite TV programs,
    routine experimental work, it has been our policy to without any sense of rushing. And you'll
    continue training with only those who are find you have plenty of time to thoroughly
    promising. enjoy it."

    Summary of Suggested Steps in After each experience, patients may be questioned


    about their experience. For example: "Tell me what
    Time Distortion Training you experienced." "What was that like?" "How
    D. Corydon Hammond, Ph.D. long did it seem to you?" "Were you able to
    Salt Lake City, Utah
    finish?" "Was it real to you?" "Did you experience
    it from beginning to end?"
    1. Experiencing a continuous activity without
    suggestions for personal time. Example: "You
    are listening to a record."
    TIME REORIENTATION: AGE REGRESSION, AGE PROGRESSION, AND TIME DISTORTION 557

    USE OF A METRONOME IN until it was over. After inducing a somnambulistic


    FACILITATING TIME DISTORTION trance "the suggestion was offered that, first of all,
    it might be well to have her experience, as a means
    A metronome may be used to facilitate time of keeping her hypnotized [as she desired] and as a
    distortion in an office or experimental setting. The measure of giving her satisfaction, the various
    hypnotized patient may be told: "In a moment I am common phenomena of the hypnotic trance" (p.
    going to turn on a metronome, and it will tick at one 177). Trance training in the hypnotic phenomena
    tick per second. I would like you to listen to the was conducted for another 50 minutes.
    metronome carefully, as it makes a sound once
    each second. And you will continue hearing the She was then told, while still in trance, that there
    sound of the metronome in the background of your remained a couple more phenomena which she could
    awareness, as it continues to make one sound each enjoy. One of these was related to time and would
    second. And with each sound of the metronome, really center around a stopwatch, which was exhib-
    you'll go deeper and deeper into trance. And the ited to her. With every effort to be instructive, she
    metronome will beat once each second, and each was reminded of the rapidity with which time passed
    sound will take you deeper." when she was pleased, how slowly when bored, the
    endlessness of a few seconds' wait for an intensely
    The therapist subsequently has two options. regarded outcome of a matter of doubt, the rapidity
    First, after a period of time, the metronome may be with which a mere word could cause to flash through
    gradually slowed down (e.g., to one beat every 2-4 the mind the contents of a well liked book or the
    seconds), or speeded up (e.g., to 2-4 beats/second). events of a long, happy trip and the tremendous
    Patients will typically become lethargic, depressed rapidity and momentum of thought and feelings.
    and slowed in motor behavior when the metronome Against this background, a detailed elaboration
    slows down. They will become hyperactive, was presented of the concept of distorted, personal,
    happier, and finally manic as a metronome is special or experiential time as contrasted to clock
    speeded up. Second, the metronome may be left at time. Extensive discussion was also offered of the
    the same speed, but it may be suggested that it is "normal tempo" of distorted or experiential time.
    slowing down or speeding up. For example, "As When she seemed to understand, the explanation
    you listen to the metronome, it will begin going was offered that this hypnotic phenomenon could be
    faster and faster." This method often produces initiated for her by giving simple instructions which
    impressive demonstrations, but is more limited in she could easily accept fully. These instructions
    clinical applications. would be followed by the starting signal of "Now," at
    which time the stopwatch would be started. Then,
    when the phenomenon had been completed, she
    would be told to stop. This explanation was repeated
    until she understood fully.
    TIME DISTORTION IN Then with compelling, progressive, rapid, em-
    EXPLORATORY HYPNOSIS phatic, insistent intensity, she was told, "Begin at the
    beginning, go all the way through in normal experi-
    Psychotherapists will particularly find it in- ential tempo with a tremendous rush of force, skip-
    structive to review case reports in Erickson's ping nothing, including everything, and reach a full
    complete understanding of everything about
    (Cooper & Erickson, 1959) chapter on clinical and Blood—Now."
    therapeutic applications of time distortion. Brief
    She reacted to the word "blood" by a violent start,
    elaboration of one of these cases may prove trembled briefly, became physically rigid, and
    instructive. clenched her fists and jaw. She appeared to be in
    A dental hygienist consulted Erickson for a acute physical distress but too rigidly involved phys-
    phobic response of anxiety, nausea and fainting at ically and mentally to break into disruptive actions.
    the sight of blood. She wanted hypnosis to remedy Twenty seconds later, at the commend "Stop," she
    the problem, but to not let her know relaxed, slumped in the chair and breathed hard.
    Immediately she was told emphatically, "You now
    558 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    know, you understand, you no longer need to fear. I will not tell you yet what your experiment or task
    You don't even need to remember when you are is. As soon as you nod your head to show that you
    awake, but your unconscious now knows, and will are ready, I will start the stopwatch and give you the
    continue to know and to understand correctly, and signal now and very rapidly I will name the task [as
    thus give to you that ease you want." She was asked had been done in previous "experiments"] and you
    if she wished to awaken or to think things through. will start at the beginning of it, the very beginning,
    (Cooper & Erickson, 1959, pp. 177-178) [This was and go right through to the end, no matter how far
    successful in resolving her problem.] away it is in time. Ready? All right, listen carefully
    for the click of the watch, my signal, and the name of
    This case illustrates how Erickson seems to have the task. Now— from Childhood to Now— Remem-
    often used time distortion in the process of ber! (The Now was repeated as literally a double
    unconscious exploration. He would train patients to signal.) (Cooper & Erickson, 1959, p. 171) [Twenty
    experience time distortion, sometimes taking them seconds later this patient was told to stop, asked if
    through the kinds of hypnotic training exercises she was through, and asked if she would be willing to
    share what had been reviewed after awakening.]
    discussed in the previous section. Then, in the guise
    of another training "experiment," he might give the
    following type of suggestion: In a similar case, following training to "system-
    atically" teach the patient "a working knowledge of
    You have many times taken a trip in a car and time distortion," Erickson gave the following
    enjoyed it immensely. The car was moving very suggestions:
    rapidly. You saw this sight, you saw that scene, you
    said this, you said that, all in an ordinary way. The With this stopwatch I will give you an allotted
    car moved fast but you were sitting quietly, just world time of twenty seconds. In your own special
    going along. You could not stop the car, nor did you experiential time, those twenty seconds will cover
    want to. The telephone poles were so many feet apart hours, days, weeks, months, even years of your
    and they came along one by one and you saw them experiential life. When I say "Now," you will begin
    pass. You saw the fields and they passed by, large the experiment. When I say "Stop," you will be
    fields, small fields, and you could only wait quietly finished. During that twenty seconds of world time,
    to see what would be in the next field, and to see you will sit quietly, neither speaking nor moving, but
    whether the next house would be brick or frame. mentally, in your unconscious, you will do the
    And all the time the car went along and you sat experiment, taking all the experiential time you need.
    quietly, just saw, you thought, all in your own way, This you will do thoroughly, carefully. As soon as I
    at your own speed, just as it happened, and the car give you the starting signal, I will name the experi-
    just kept going. You did not need to pay attention to ment and you will do it completely. Are you ready?
    the car, just to what next would happen, a field, a
    house, a horse or whatever was next. Now —Go through all the causes of your problem.
    Now.
    However, this experiment will not be a car ride. I Stop. (Cooper & Erickson, 1959, p. 185)
    have just used it to explain more fully to you. 1 could
    have described going through the cooking of a
    dinner — peeling potatoes, washing carrots, putting It is interesting to note how Erickson talked about
    on pork chops — anything that you could have done. providing "intensive" and "systematic" training to
    Now I'm going to give you much more time than patients who were excellent hypnotic subjects.
    you need to do this experiment. I will give you twenty Most of these patients could have undoubtedly
    seconds of world time. But in your special time, that responded at least to some extent to brief,
    twenty seconds will be just as long as you need to straightforward suggestions for time distortion.
    complete your work. It can be a minute, a day, a Nonetheless, Erickson invested the time to "train"
    week, a month or even years. And you will take all these patients to respond more fully when he
    the time you need. anticipated using time distortion as an important
    aspect of his intervention.
    REFERENCES
    Aaronson, B. S. (1966). Behavior and the place names of time. Alman, B. M. (1983). Self-Hypnosis: A Complete Manual for
    American Journal of Clinical Hypnosis, 9, 1-17. Health and Self-Change. San Diego: International Health
    Aaronson, B. S. (1968a). Hypnotic alterations of space and time. Publications.
    International Journal of Parapsychology, 10, 5-36. Ambrose, G. (1961). Hypnotherapy with Children (Second
    Aaronson, B. S. (1968b). Hypnosis, time rate perception, and Edition). London: Staples.
    personality. Journal of Schizophrenia, 2, 11-14. Anderson, J. A. D., Basker, M. A., & Dalton, R. (1975).
    Aaronson, B. S. (1971). Time, time stance, and existence. Migraine and hypnotherapy. International Journal of
    Studium Generate (Springer Verlag), 24, 369-387. Clinical & Experimental Hypnosis, 23(1), 48-58.
    Abarbanel, A. R. (1978). Diagnosis and treatment of coital Antich, J. L. S. (1967). The use of hypnosis in pediatric
    discomfort. Chapter in J. LoPiccolo and L. LoPiccolo anesthesia. Journal of the American Society of Psy-
    (Eds.), Handbook of Sex Therapy. New York: Plenum. chosomatic Dentistry & Medicine, 14, 70-75.
    Abramson, M., Greenfield, I., & Heron, W. T. (1966). Response Araoz, D. L. (1980). Clinical hypnosis in treating sexual abulia.
    to or perception of auditory stimuli under deep surgical American Journal of Family Therapy, 5(1), 48-57.
    anesthesia. American Journal of Obstetrics & Araoz, D. L. (1982). Hypnosis & Sex Therapy. New York:
    Gynecology, 96, 584-585. Brunner/Mazel.
    Abramson, M., & Heron, W. T. (1950). An objective evaluation Aravindakshan, K. K., Jenner, F. A., & Souster, L. P. (1988). A
    of hypnosis in obstetrics: Preliminary report. American study of the effects of hypnotic regression on the auditory
    Journal of Obstetrics & Gynecology, 59, 1069-1074. evoked response. International Journal of Clinical &
    Adam, L. (1976). Sleep-assisted instruction. Psychological Experimental Hypnosis, 36(2), 89-95.
    Bulletin, 83, 1-40. Asher, L. M., Barber, T. X., & Spanos, N. P. (1972). Two
    Ader, R. (Ed.). (1981). Psychoneuroimmunology. New York: attempts to replicate the Parrish-Lundy-Leibowitz ex-
    Academic Press. periment on hypnotic age regression. American Journal of
    Aja, J. H. (1977). Brief group treatment of obesity through Clinical Hypnosis, 14, 178-185.
    ancillary self-hypnosis. American Journal of Clinical Auerbach, A. H., & Johnson, M. (1977). Research on the
    Hypnosis, 19, 231-234. therapist's level of experience. In A. S. Gurman & A. M.
    Alexander, F. M. (1910). The Use of the Self. London: Razin (Eds.), Effective Psychotherapy: A Handbook of
    Re-Educational Publications. Research. New York: Pergamon.
    Alexander, L. (1974). Treatment of impotency and anorgasmia August, R. V. (1960a). Obstetrical hypnoanesthesia. American
    by psychotherapy aided by hypnosis. American Journal of Journal of Obstetrics & Gynecology, 79, 1131-1138.
    Clinical Hypnosis, 17{\), 31-43. August, R. V. (1960b). Hypnosis: An additional tool in the
    Alman, B. (1983). Bypassing hypnotic susceptibility scales. study of infertility. Fertility & Sterility, 11, 118-123.
    Paper presented at the Annual Scientific Meeting of the August, R. V. (1960c). Hallucinatory experiences utilized for
    American Society of Clinical Hypnosis, Dallas, Texas. obstetric hypnoanesthesia. American Journal of Clinical
    Alman, B., & Carney, R. E. (1980). Consequences of direct and Hypnosis, 3, 90-92.
    indirect suggestions on success of posthypnotic behavior. August, R. V. (1961). Hypnosis in Obstetrics. New York:
    American Journal of Clinical Hypnosis, 23, 112-118. McGraw-Hill.
    Azrin, N. H., & Nunn, R. G. (1978). Habit Control in a Day.
    New York: Simon & Schuster.
    Bakal, P. A. (1981). Hypnotherapy for flight
    phobia.

    559
    560 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    American Journal of Clinical Hypnosis, 25(4), 248-251. Barber, J., Donaldson, D., Ramras, S., & Allen, G. D. (1979).
    Baker, E. L. (1981). An hypnotherapeutic approach to enhance The relationship between nitrous oxide conscious sedation
    object relatedness in psychotic patients. International and the hypnotic state. Journal of the American Dental
    Journal of Clinical & Experimental Hypnosis, 29, Association, 99, 624-626.
    136-147. Barber, T. X. (1962). Hypnotic age regression: A critical
    Baker, E. L. (1983a). The use of hypnotic dreaming in the review. Psychosomatic Medicine, 24, 286-299.
    treatment of the borderline patient: Some thoughts on Barber, T. X., & Calverly, D. S. (1964). Toward a theory of
    resistance and transitional phenomena. International "hypnotic" behavior. Archives of General Psychiatry, 10,
    Journal of Clinical & Experimental Hypnosis, 31, 19-27. 209.
    Baker, E. L. (1983b). Resistance in hypnotherapy of primitive Barber, T. X., Spanos, N. P., & Chaves, J. F. (1974). Hypnosis,
    states: Its meaning and management. International Journal Imagination and Human Potentialities. New York:
    of Clinical & Experimental Hypnosis, 31, 82-89. Pergamon.
    Baker, E. L. (1983c). The use of hypnotic techniques with Barber, T. X. (1984). Hypnosis, deep relaxation, and active
    psychotics. American Journal of Clinical Hypnosis, 25, relaxation: Data, theory, and clinical applications. Chapter
    283-288. in R. L. Woolfolk & P. M. Lehrer, Principles and Practice
    Baker, R. A. (1982). The effect of suggestion on past-lives of Stress Management. New York: Guilford Press, pp.
    regression. American Journal of Clinical Hypnosis, 25(1), 164-166.
    71-76. Barker, D. (1979). Correspondence. Journal of Parapsy-
    Bandler, R., & Grinder, J. (1975). Patterns of the Hypnotic chology, 43, 268-269.
    Techniques of Milton H. Erickson, M.D. (Volume 1). Barker, P. (1985). Using Metaphors in Psychotherapy. New
    Cupertino, CA: Meta Publications. York: Brunner/Mazel.
    Bandler, R., & Grinder, J. (1978). Frogs into Princes: Barker, W., Rodenheaver, G. T., Edgerton, M. T., et al. (1982).
    NeuroLinguistic Programming. Moab, Utah: Real People Damage to tissue defenses by a topical anesthetic agent.
    Press. Annals of Emergency Medicine, 11, 307-310.
    Bandura, A. (1969). Principles of Behavior Modification. New Barkley, R. A., Hastings, J. E., & Jackson, T. L. (1977). The
    York: Holt, Rinehart & Winston. effects of rapid smoking and hypnosis in the treatment of
    Bandura, A. (1977). Self-efficacy: Toward a unifying theory of smoking behavior. International Journal of Clinical &
    behavior change. Psychological Review, 84, 191-215. Experimental Hypnosis, 25, 7-17.
    Bandura, A. (1981). Self-referent thought: A developmental Barlow, D. H., & Cerny, J. A. (1988). Psychological Treatment
    analysis of self-efficacy. In J. H. Flavell & L. D. Ross of Panic. New York: Guilford.
    (Eds.), Cognitive Social Development. New York: Barnett, E. A. (1981). Analytical Hypnotherapy. Kingston,
    Cambridge University Press. Ontario: Junica.
    Banyai, E., & Hilgard, E. (1976). A comparison of active-alert Bartlett, E. E. (1966). Polypharmacy versus hypnosis in surgical
    hypnotic induction with traditional relaxation induction. patients. Pacific Medicine & Surgery, 74, 109-.
    Journal of Abnormal Psychology, 85(2), 218-224. Baumann, F. (1981). Hypnosis in the treatment of urinary and
    Barabasz, A F., & Barabasz, M. (1989). Effects of restricted fecal incontinence: A twenty-year experience. Chapter in
    environmental stimulation: Enhancement of H. J. Wain (Ed.), Theoretical & Clinical Aspects of
    hypnotizability for experimental and chronic pain control. Hypnosis. Miami: Symposia Specialists Inc.
    International Journal of Clinical & Experimental Bednar, R. L. (1970). Persuasibility and the power of belief.
    Hypnosis, 57(3), 217-231. Personnel & Guidance Journal 48, 647-652.
    Barabasz, A. F., & McGeorge, C. M. (1978). Biofeedback, Bennett, H. L. (1988). Perception and memory for events during
    mediated biofeedback and hypnosis in peripheral adequate general anesthesia for surgical operations.
    vasodilation training. American Journal of Clinical Chapter in H. M. Pettinati (Ed.), Hypnosis & Memory.
    Hypnosis, 21, 28-37. New York: Guilford, pp. 193-231.
    Barabasz, M. (1987). Trichotillomania: A new treatment. Bennett, H. L., Davis, H. S., & Giannini, J. A. (1984).
    International Journal of Clinical & Experimental Hyp- Nonverbal response to intraoperative conversation.
    nosis, 35, 146-154. Anesthesia & Analgesia, 63, 185. (Abstract)
    Barber, J. (1977). Rapid induction analgesia: A clinical report. Bennett, H. L., Davis, H. S., & Giannini, J. A. (1985).
    American Journal of Clinical Hypnosis, 19, 138-147. Nonverbal response to intraoperative conversation. British
    Barber, J., & Adrian, C. (1982). Psychological Approaches to Journal of Anaesthesia, 57, 174-179.
    the Management of Pain. New York: Brunner/ Mazel. Bensen, V. B. (1971). One hundred cases of post-anesthetic
    suggestion in the recovery room. American Journal of
    Clinical Hypnosis, 14, 9-15.
    Benson, H., Rosner, B. A., Marzetta, B. R., & Klemchuk, H. M.
    (1974). Decreased blood pressure in borderline
    hypertensive subjects who practice meditation. Journal
    REFERENCES 561

    of Chronic Disease, 27, 163-169. Bowers, K. S. (1968). Hypnosis and creativity: A preliminary
    Benson, H., & Wallace, P. K. (1972). Decreased blood pressure investigation. International Journal of Clinical &
    in borderline hypertensive subjects who practice Experimental Hypnosis, 16, 38-52.
    meditation. Circulation, 46, (Supplement II), 130. Bowers, K. S., & van der Meulen, S. J. (1970). Effect of
    Berkowitz, B., Ross-Townsend, A., & Kohberger, R. (1979). hypnotic susceptibility on creativity test performance.
    Hypnotic treatment of smoking: The single-treatment Journal of Personality & Social Psychology, 14, 247-256.
    method revisited. American Journal of Psychiatry, 136, Bowers, P. G., & Bowers, K. S. (1979). Hypnosis and
    83-85. creativity: A theoretical and empirical rapprochement.
    Bernstein, M. (1956). The Search for Bridey Murphy. New Chapter in E. Fromm & R. E. Shor (Eds.), Hypnosis:
    York: Doubleday. Developments in Research & New Perspectives. New
    Best, J. A., & Hakstian, A. R. (1978). A situation-specific model York: Aldine, pp. 351-379.
    for smoking behavior. Addictive Behaviors, 3, 79-92. Brauer, R. O., & Spira, M. (1966). Full thickness burns as
    Betcher, A. M. (1960). Hypnosis as an adjunct in source for donor graft in the pig. Plastic & Reconstructive
    anesthe-siology. New York State Journal of Medicine, 60, Surgery, 37, 21-30.
    816-822. Braun, B. G. (1984a). Uses of hypnosis with multiple
    Beutler, L. E. (1983). Eclectic Psychotherapy: A Systematic personalities. Psychiatric Annals, 14, 34-40.
    Approach. New York: Pergamon. Braun, B. G. (1984b). Hypnosis creates multiple personality:
    Bierman, S. F. (1988). Painless wound injection through use of a Myth or reality? International Journal of Clinical &
    two-finger confusion technique. American Journal of Experimental Hypnosis, 32, 191-197.
    Emergency Medicine, 6(3), 266-267. Brice, D. D., Hetherington, R. R., & Utting, J. E. (1970). A
    Bishay, E. G., & Lee, C. (1984). Studies of the effects of simple study of awareness and dreaming during
    hypnoanesthesia on regional blood flow by transcutaneous anesthesia. British Journal of Anaesthesia, 42, 535-542.
    oxygen monitoring. American Journal of Clinical Brown, P. (1985). Hypnosis as an adjunct to the psychotherapy
    Hypnosis, 27(1), 64-69. of the severely disturbed patient: An affective
    Bishay, E. G., Stevens, G., & Lee, C. (1984). Hypnotic control development approach. International Journal of Clinical
    of upper gastrointestinal hemorrhage: A case report. & Experimental Hypnosis, 33, 281-301.
    American Journal of Clinical Hypnosis. 27(1), 22-25. Brown, D. P., & Fromm, E. (1986). Hypnotherapy &
    Bliss, E. L. (1980). Multiple personalities. Archives of General Hypnoanalysis. Hillsdale, N.J.: Lawrence Erlbaum.
    Psychiatry, 37, 1388-1397. Browne, R. A., & Catton, D. V. (1973). A study of awareness
    Bonke, B., & Verhage, F. (1984). A clinical study of so-called during anesthesia. Anesthesia & Analgesia, 52,
    unconscious perception during general anesthesia. 128-152.
    Unpublished manuscript cited in H. L. Bennett, Perception Brownell, K. D. (1982). Obesity: Understanding and treating a
    and memory for events during adequate general anesthesia serious, prevalent, and refractory disorder. Journal of
    for surgical operations. Chapter in H. M. Pettinati (Ed.), Consulting & Clinical Psychology, 50, 820-840.
    Hypnosis and Memory. New York: Guilford. Brunn, J. T. (1963). The capacity to hear, to understand, to
    Bonello, F. J., Doberneck, R. C, Papermaster, A. A., et al. remember experiences during chemoanesthesia: A per-
    (1960). Hypnosis in surgery. I. The postgastrectomy sonal experience. American Journal of Clinical Hypnosis,
    dumping syndrome. American Journal of Clinical 6, 27-30.
    Hypnosis, 2, 215-219. Bynum, E. (1977). Hypnotic age regression: An experimental
    Bonilla, K. B., Quigley, W. F., & Bowen, W. F. (1961). investigation. Doctoral dissertation, Pennsylvania State
    Experiences with hypnosis and surgical service. Military University. Dissertation Abstracts International,
    Medicine, 126, 364-370. 38(5-B), 2394-2395.
    Bootkin, R. R. (1977). Effects of self-control procedures for Byrne, S. (1973). Hypnosis and the irritable bowel: Case
    insomnia. Chapter in R. B. Stuart (Ed.), Behavioral histories, methods and speculation. American Journal of
    Self-Management: Strategies, Techniques & Outcomes. Clinical Hypnosis, 15, 263-265.
    New York: Brunner/Mazel, pp. 176-195. Callan, T. D. (1961). Can hypnosis be used routinely in
    Bornstein, P. H., & Rychtarik, R. G. (1978). Multi-component obstetrics. Rocky Mountain Medical Journal, 58, 28-30.
    behavioral treatment of trichotillomania: A case study. Candiotte, M. M., & Lichtenstein, E. (1981). Self-efficacy and
    Behavioral Research & Therapy, 16, 217-220. relapse in smoking cessation programs. Journal of
    Borysenko, J. (1987). Minding the Body, Mending the Mind. Consulting & Clinical Psychology, 49, 648-658.
    Reading, Mass.: Addison Wesley. Caritis, S. N., Edelstone, D. I., & Mueller-Heubach, E. (1979).
    Bowen, D. (1973). Transurethral resection under self-hypnosis. Pharmacologic inhibition of pre-term labor. American
    American Journal of Clinical Hypnosis, 16, 132-136. Journal of Obstetrics & Gynecology, 145, 557-578.
    562 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Carnegie, D. (1966). How to Win Friends and Influence People. Coons, P. M. (1980). Multiple personality: Diagnostic
    New York: Pocket Books. considerations. Journal of Clinical Psychiatry, 41,
    Chapman, L. F., Goodell, H., & Wolff, H. G. (1959a). 330-336.
    Augmentation of the inflammatory reaction by activity of Cooper, L. F. (1948). Time distortion in hypnosis. The Bulletin,
    the central nervous system. American Medical Association Georgetown University Medical Center, 1, 214-221.
    Archives of Neurology, I, 557-572. Cooper, L. F. (1952). Time distortion in hypnosis. Journal of
    Chapman, L. F., Goodell, H., & Wolff, H. G. (1959b). Changes Psychology, 34, 247-284.
    in tissue vulnerability induced during hypnotic suggestion. Cooper, L. F., & Erickson, M. H. (1954). Time Distortion in
    Journal of Psychosomatic Research, 4, 99-105. Hypnosis. Baltimore: Williams & Wilkins.
    Cheek, D. B. (1959). Unconscious perception of meaningful Cooper, L. F., & Erickson, M. H. (1959). Time Distortion in
    sounds during surgical anesthesia as revealed under Hypnosis. Baltimore: Williams and Wilkins.
    hypnosis. American Journal of Clinical Hypnosis, 1, Cooper, L. F., & Rodgin, D. W. (1952). Time distortion in
    101-113. hypnosis and non-motor learning. Science, 115, 500-502.
    Cheek, D. B. (1966). The meaning of continued hearing sense Cooper, L. M., & London, P. (1976). Children's hypnotic
    under general chemo-anesthesia: A progress report and susceptibility, personality, and EEG patterns. International
    report of a case. American Journal of Clinical Hypnosis, Journal of Clinical & Experimental Hypnosis, 24,
    8(4), 275-280. 140-148.
    Cheek, D. B. (1981). Awareness of meaningful sounds under Copeland, D. R. (1986). The application of object-relations
    general anesthesia: Considerations and a review of the theory to the hypnotherapy of developmental arrests: The
    literature 1959-1979. Chapter in H. J. Wain (Ed.), borderline patient. International Journal of Clinical &
    Theoretical & Clinical Aspects of Hypnosis. Miami: Experimental Hypnosis, 34, 157-168.
    Symposia Specialists, pp. 87-106. Corley, J. B. (1965). Hypnosis and the anesthetist. American
    Cheek, D. B. (1986). Using hypnosis with habitual aborters. Journal of Clinical Hypnosis, 8, 34-36.
    Chapter in B. Zilbergeld, M. G. Edelsticn, and D. L. Araoz Council on Scientific Affairs, American Medical Association.
    (Eds.), Hypnosis: Questions and Answers. New York: (1985). Scientific Status of refreshing recollection by the
    Norton, 1986, pp. 330-336. use of hypnosis. Journal of the American Medical
    Cheek, D. B., & LeCron, L. (1968). Clinical Hypnotherapy. Association, 253, 1918-1923.
    New York: Grune & Stratton. Courtois, C. A. (1988). Healing the Incest Wound. New York:
    Chiasson, S. W. (1964). Hypnosis in postoperative urinary W. W. Norton.
    retention. American Journal of Clinical Hypnosis,6, Crasilneck, H. B. (1979). The use of hypnosis in the treatment
    366-368. of psychogenic impotency. Australian Journal of Clinical
    Cialdini, R. B. (1988). Influence: Science & Practice (Second & Experimental Hypnosis, 2, 147-153.
    Edition). Glenview, IL: Scott, Foresman & Co. Crasilneck, H. B. (1980). Clinical assessment and preparation of
    Clarke, J. C, & Jackson, J. A. (1983). Hypnosis & Behavior the patient. Chapter in G. Burrows and L. Dennerstein
    Therapy: The Treatment of Anxiety & Phobias. New York: (Eds.). Handbook of Hypnosis & Psychosomatic Medicine.
    Springer. Amsterdam: Elsevier/North Holland.
    Clarke, J. H., & Persichetti, S. J. (1988). Hypnosis and Crasilneck, H. B. (1982). A follow-up study in the use of
    concurrent denture construction for a patient with a hypnotherapy in the treatment of psychogenic impotency.
    hypersensitive gag reflex. American Journal of Clinical American Journal of Clinical Hypnosis, 25(1), 52-61.
    Hypnosis, 30(4), 285-288. Crasilneck, H. B., & Hall, J. A. (1985). Clinical Hypnosis:
    Cole, R. (1977). Increasing reading and test-taking skills with Principles & Applications. Orlando: Grune & Stratton.
    hypnosis and suggestion. Unpublished doctoral Crasilneck, H. B., McCranie, E. J., & Jenkins, M. T. (1956).
    dissertation, Texas A & M University. Dissertation Special indications for hypnosis as a method of anesthesia.
    Abstracts International, _?7(8-A), 4859. Journal of the American Medical Association, 162,
    Cole, R. (1979). The use of hypnosis in a course to increase 1606-1608.
    academic and test-taking skills. International Journal of Crasilneck, H. B., & Michael, C. M. (1957). Performance on the
    Clinical & Experimental Hypnosis, 27(1), 21-28. Bender under hypnotic age regression. Journal of
    Colgan, S. M., Faragher, E. B., Whorwell, P. J. (1988). Abnormal & Social Psychology, 54, 319-322.
    Controlled trial of hypnotherapy in relapse prevention of Crowley, R. (1980). Effect of indirect hypnosis (rapid induction
    duodenal ulceration. Lancet, 11(1), 1299-1300. analgesia) for relief of acute pain associated with minor
    Combs, A. W., Avila, D. L., & Purkey, W. W. (1971). Helping podiatric surgery. Dissertation Abstracts International,
    Relationships: Basic Concepts for the Helping Professions. 40, 4549.
    Boston: Allyn & Bacon, 1971. Cullen, S. C. (1958). Current comment and case reports:
    Conn, J. H. (1972). Is hypnosis really dangerous? International Hypno-induction techniques in pediatric anesthesia.
    Journal of Clinical & Experimental Hypnosis, 20, 61-70.
    REFERENCES 563

    Anesthesiology, 19, 279-281. Edwards, P. (1987b). The case against reincarnation: Part 3.
    Daniels, E. (1962). The hypnotic approach in anesthesia for Free Inquiry, 7(2), 38-49.
    children. American Journal of Clinical Hypnosis, 4, Eich, E. (1984). Memory for unattended events: Remembering
    244-248. with and without awareness. Memory & Cognition, 12,
    Dave, R., & Reyher, J. (1978). The effects of hypnotically 105-111.
    induced dreams on creative problem solving. Journal of Eich, E., Reeves, J. L., & Katz, R. L. (1985). Anesthesia,
    Abnormal Psychology. amnesia, and the memory/awareness distinction. An-
    Davidson, J. A. (1962). An assessment of the value of hypnosis esthesia & Analgesia, 64, 1143-1148.
    in pregnancy and labour. British Medical Journal, 5310, Eisle, G., & Higgins, J. (1962). Hypnosis in education and
    951-953. moral problems. American Journal of Clinical Hypnosis,
    DeAmicis, L. A., Goldberg, D. C, LoPiccolo, J., Friedman, J. 4(4), 259-261.
    M., & Davies, L. (1984) Three-year follow-up of couples Eliseo, T. S. (1974). Three examples of hypnosis in the
    evaluated for sexual dysfunction. Journal of Sex & Marital treatment of organic brain syndrome with psychosis.
    Therapy, 10(A), 215-218. International Journal of Clinical & Experimental Hyp-
    Deabler, H. L., Fidel, E., Dillenkoffer, R. L., & Elder, S. T. nosis, 22, 9-19.
    (1973). The use of relaxation and hypnosis in lowering high Elkins, G. R. (1984). Hypnosis in the treatment of myofibrositis
    blood pressure. American Journal of Clinical Hypnosis, and anxiety: A case report. American Journal of Clinical
    16, 75-83. Hypnosis, 27(1), 26-30.
    Deiker, T., & Counts, D. K. (1980). Hypnotic Elkins, G. R., & Carter, B. D. (1981). Use of a science
    paradigm-substitution therapy in a case of hypochondriasis. fiction-based imagery technique in child hypnosis.
    American Journal of Clinical Hypnosis, 23(2), 122-127. American Journal of Clinical Hypnosis, 23(4), 274-276.
    Deiker, T. E., & Pollock, D. H. (1975). Integration of hypnotic Ellenberger, H. F. (1970). The Discovery of the Unconscious.
    and systematic desensitization techniques as in the New York: Basic Books.
    treatment of phobias: A case report. American Journal of Elliotson, J. (1843). Numerous Cases of Surgical Operations
    Clinical Hypnosis, 17, 170-174. Without Pain in The Mesmeric State. Philadelphia: Lea
    Deyoub, P. L., & Epstein, S. (1977). Short-term hypnotherapy and Blanchard.
    for the treatment of flight phobia: A case report. American Ellis, A. (1962). Reason and Emotion in Psychotherapy. New
    Journal of Clinical Hypnosis, 19, 251-254. York: Lyle Stuart.
    DiClemente, C. C. (1981). Self-efficacy and smoking cessation Ellis, A. (1986). Anxiety about anxiety: The use of hypnosis
    maintenance. Cognitive Therapy and Research, 5, with Rational-Emotive Therapy. Chapter in E. T. Dowd
    175-187. and J. M. Healy (Eds.), Case Studies in Hypnotherapy.
    Doberneck, R. C, McFee, A. S., Bonello, F. J., Papermaster, A. New York: Guilford, pp. 3-11.
    A., & Wangensteen, O. H. (1961). The prevention of Erickson, M. H. (1952). Deep hypnosis and its induction.
    postoperative urinary retention by hypnosis. American Chapter in L. M. LeCron (Ed.), Experimental Hypnosis.
    Journal of Clinical Hypnosis, 3, 235-237. New York: Macmillan, pp. 70-114.
    Donk, L. J., Vingoe, F., Hall, R., & Doty, R. (1970). The Erickson, M. H. (1959). Further clinical techniques of hypnosis:
    comparison of three suggestion techniques for increasing Utilization techniques. American Journal of Clinical
    reading efficiency utilizing a counterbalanced research Hypnosis, 2, 3-21. [Also reprinted in E. L. Rossi (Ed.), The
    paradigm. International Journal of Clinical & Collected Papers of Milton H. Erickson on Hypnosis,
    Experimental Hypnosis, 27(2), 126-133. Volume 1, pp. 177-205.)
    Golden, W. L., Dowd, E. T., & Friedberg, F. (1987). Erickson, M. H. (1960). Psychogenic alteration of menstrual
    Hypnotherapy: A Modern Approach. New York: Pergamon functioning: Three instances. American Journal of
    Press. Clinical Hypnosis, 2, 227-331.
    Dubovsky, S. L., & Trustman, R. (1976). Absence of recall after Erickson, M. H. (1963). Chemo-anaesthesia in relation to
    general anesthesia: Implications for theory and practice. hearing and memory. American Journal of Clinical
    Anesthesia & Analgesia, 55(5), 696-701. Hypnosis, 6, 31-36.
    Egan, R.M., & Egan, W. P. (1968). The effect of hypnosis on Erickson, M. H. (1964). The confusion technique in hypnosis.
    academic performance. American Journal of Clinical American Journal of Clinical Hypnosis, 6, 183-207.
    Hypnosis, 11, 30-34. Erickson, M. H. (1964b). The burden of responsibility in
    Ebert, B. W. (1988). Hypnosis and rape victims. American effective psychotherapy. American Journal of Clinical
    Journal of Clinical Hypnosis, 31(1), 50-56. Hypnosis, 6, 269-271.
    Edelsticn, M. G. (1981). Trauma, Trance, & Transformation. Erickson, M. H. (1965). Hypnosis and examination panics.
    New York: Brunner/Mazel. American Journal of Clinical Hypnosis, 7, 356-357.
    Edwards, P. (1987a). The case against reincarnation: Part 2. Erickson, M. H. (1966). The interspersal hypnotic technique
    Free Inquiry, 7(1), 38-47. for symptom correction and pain control. American
    Journal of Clinical Hypnosis, 8, 198-209.
    564 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Erickson, M. H. (1973). Psychotherapy achieved by a reversal response: Relationship to susceptibility to hypnosis and
    of the neurotic processes in a case of ejaculation praecox. laboratory sleep patterns. Journal of Nervous and Mental
    American Journal of Clinical Hypnosis, 15(4), 219-221. Disease, 148, 467-476.
    Erickson, M. H. (1980). The Collected Papers of Milton H. Evans, F. J., & Thorn, W. A. F. (1966). Two types of
    Erickson on Hypnosis, Volumes 1-4. Edited by E. L. Rossi. post-hypnotic amnesia: Recall amnesia and source
    New York: Irvington. amnesia. International Journal of Clinical & Experimental
    Erickson, M. H. (1983). Healing in Hypnosis: The Seminars, Hypnosis, 14, 162-179.
    Workshops & Lectures of Milton H. Erickson, Volume 1. Ewin, D. M. (1974). Condyloma acuminatum: Successful
    Edited by E. L. Rossi, M. O. Ryan, & F. A. Sharp. New treatment of four cases by hypnosis. American Journal of
    York: Irvington. Clinical Hypnosis, 17(2), 73-78.
    Erickson, M. H. (1985). Life Reframing in Hypnosis: The Ewin, D. M. (1978). Clinical use of hypnosis for attenuation of
    Seminars, Workshops, & Lectures of Milton H. Erickson, burn depth. In F. H. Frankel & H. S. Zamansky (Eds.),
    Volume 2. Edited by E. L. Rossi and M. O. Ryan. New Hypnosis at its Bicentennial. New York: Plenum.
    York: Irvington. Ewin, D. M. (1979). Hypnosis in burn therapy. In G. D.
    Erickson, M. H. (1986). Mind-Body Communication in Burrows, D. R. Collison, & L. Dennerstein (Eds.),
    Hypnosis: The Seminars, Workshops, & Lectures of Milton Hypnosis, 1979. Amsterdam-New York:
    H. Erickson, Volume 3. Edited by E. L. Rossi & M. O. Elsevier/North Holland Press.
    Ryan. New York: Irvington. Ewin, D. M. (1983). Emergency room hypnosis for the burned
    Erickson, M. H., & Erickson, E. M. (1958). Further patient. American Journal of Clinical Hypnosis, 26, 5-8.
    considerations of time distortion: subjective time con- Fagan, J., & Shepherd, I. L. (1970). Gestalt Therapy Now. New
    densation as distinct from time expansion. American York: Harper & Row.
    Journal of Clinical Hypnosis, 1, 83-88. Fava, G. A., & Pavan, L. (1976-77). Large bowel disorders. I.
    Erickson, M. H., & Kubie, , L. S. (1941). The successful Illness configuration and life events. Psychotherapy &
    treatment of a case of acute hysterical depression by a Psychosomatics, 27, 93-99.
    return under hypnosis to a critical phase of childhood. Feinstein, A. D., & Morgan, R. M. (1986). Hypnosis in
    Psychoanalytic Quarterly, 10, 583-609. regulating bipolar affective disorders. American Journal of
    Erickson, M. H., & Rossi, E. L. (1974/1980). Varieties of Clinical Hypnosis, 29(1), 29-38.
    hypnotic amnesia. American Journal of Clinical Hypnosis, Fellows, B. J., & Creamer, M. (1978). An investigation of the
    16(4). Reprinted in E. L. Rossi (Ed.), The Collected Papers role of 'hypnosis,' hypnotic susceptibility and hypnotic
    of Milton H. Erickson on Hypnosis, Volume HI. New York: induction in the production of age regression. British
    Irvington, pp. 71-90. Journal of Social & Clinical Psychology, 17, 165-171.
    Erickson, M. H., & Rossi, E. L. (1975). Varieties of double Fermouw, W. J., & Gross, R. (1983). Issues in
    bind. American Journal of Clinical Hypnosis, 17, 143-157. cognitive-behavioral treatment of performance anxiety.
    Erickson, M. H., & Rossi, E. L. (1976). Hypnotic Realities. Chapter in P. C. Kendall (Ed.), Advances in
    New York: Irvington. Cognitive-Behavioral Research: Volume 2. New York:
    Erickson, M. H., & Rossi, E. L. (1979). Hypnotherapy: An Academic Press.
    Exploratory Casebook. New York: Irvington. Fey, W. F. (1958). Doctrine and experience: Their influence
    Erickson, M. H., & Rossi, E. L. (1989). The February Man: upon the psychotherapist. Journal of Consulting Psy-
    Evolving Consciousness & Identity in Hypnotherapy. New chology, 22, 103-112.
    York: Brunner/Mazel. Figley, C. R. (1978). Stress Disorders Among Vietnam
    Esdaile, J. (1846/1976). Mesmerism in India. New York: Arno Veterans. New York: Brunner/Mazel.
    Press. Finer, B. L., & Nylen, B. O. (1961). Cardiac arrest in the
    Evans, C, & Richardson, P. H. (1988). Improved recovery and treatment of burns, and report on hypnosis as a substitute
    reduced postoperative stay after therapeutic suggestions for anesthesia. Plastic <$ Reconstructive
    during general anesthesia. Lancet, 2(8609), 491-493. Surgery, 27, 49-.
    Evans, F. (1979). Hypnosis and sleep: Techniques for exploring Finkelstein, S. (1984). Hypnosis and dentistry. Chapter in W. C.
    cognitive activity during sleep. Chapter in E. Fromm & R. Wester 11., & A. H. Smith, Jr. (Eds.), Clinical Hypnosis: A
    Shor (Eds.), Hypnosis: Developments in Research and New Multidisciplinary Approach. Philadelphia: J. B. Lippincott,
    Perspectives. New York: Aldine, pp. 139-183. pp. 337-349.
    Evans, F., Gustafson, L. A., O'Connell, D. N., Orne, M. T., & Fischer, R. (1971). A cartography of the ecstatic and meditatives
    Shor, R. E. (1966). Response during sleep with intervening states: The experimental and experiential feature of a
    waking amnesia. Science, 152, 666-667. perception-hallucination continuum are considered.
    Evans, F., Gustafson, L. A., O'Connell, D. N., Orne, M. T., & Science, 174, 897-904.
    Shor, R. E. (1969). Sleep-induced behavioral Fogel, B. S. (1984). The "sympathetic ear": Case reports of a
    self-hypnotic approach to chronic pain. American
    REFERENCES 565

    Journal of Clinical Hypnosis, 27(2), 103-106. The use of hypnosis, as an adjunct to anesthesia, to reduce
    Fogel, S., & Hoffer, A. (1962). Perceptual changes induced by pre- and post-operative anxiety in children. Paper
    hypnotic suggestion for the posthypnotic state. I. General presented at the Annual Scientific Meeting, American
    account of the effect on personality. Journal of Clinical & Society of Clinical Hypnosis, Minneapolis.
    Experimental Psychopathology & Quarterly Review of Galski, T. J. (1981). The adjunctive use of hypnosis in the
    Psychiatry & Neurology, 23, 24-35. treatment of trichotillomania: A case report. American
    Fowler, W. (1961). Hypnosis and learning. Journal of Clinical & Journal of Clinical Hypnosis, 23(3), 198-201.
    Experimental Hypnosis, 9, 223-232. Gard, B., & Kurtz, R. M. (1979). Hypnotic age regression and
    Frank, E., Anderson, C, & Rubinstein, D. (1978) Frequency of cognitive perceptual tasks. American Journal of Clinical
    sexual dysfunction in "normal" couples. New England Hypnosis, 21, 270-277.
    Journal of Medicine, 299(3), 111-115. Gardner, G. G. (1974). Parents: Obstacles or allies in child
    Fredericks, L. E. (1980). The value of teaching hypnosis in the hypnotherapy? American Journal of Clinical Hypnosis,
    practice of anesthesiology. International Journal of 17(1), 44-49.
    Clinical & Experimental Hypnosis, 28, 6-12. Gardner, G. G. (1974b). Hypnosis with children. International
    Freytag, F. K. (1961). The Body Image in Gender Orientation Journal of Clinical & Experimental Hypnosis, 22, 20-38.
    Disturbances. New York: Julian Press. Gardner, G. G. (1976). Hypnosis and mastery: Clinical
    Fricton, J. R., & Roth, P. (1985). The effects of direct and contributions and directions for research. International
    indirect suggestion for analgesia in high and low Journal of Clinical & Experimental Hypnosis, 24,
    susceptible subjects. American Journal of Clinical 202-214.
    Hypnosis, 27, 226-231. Gardner, G. G. (1977). Hypnosis with infants and preschool
    Friedman, H., & Taub, H. A. (1977). The use of hypnosis and children. American Journal of Clinical Hypnosis, 19,
    biofeedback procedures for essential hypertension. 158-162.
    International Journal of Clinical & Experimental Gardner, M. (1957). Fads and Fallacies in the Name of Science.
    Hypnosis, 25, 335-347. New York: Dover.
    Friedman, H., & Taub, H. A. (1978). A six-month follow-up of Garver, R. B. (1984). Eight steps to self-hypnosis. American
    the use of hypnosis and biofeedback procedures in essential Journal of Clinical Hypnosis, 26(4), 232-235.
    hypertension. American Journal of Clinical Hypnosis, Garver, R. B. (1987). Investigative hypnosis. A chapter in
    20, 184-188. William Wester (Ed.), Clinical Hypnosis: A Case
    Fromm, E. (1965a). Hypnoanalysis: Theory and two case Management Approach. Cincinnati: Behavioral Science
    excerpts. Psychotherapy: Theory, Research and Practice, Center, 1987.
    2, 127-133. Gaskin, I. M. (1978). Spiritual Midwifery. Summertown, TN:
    Fromm, E. (1965b). Awareness versus consciousness. Psy- The Book Publishing Company.
    chological Reports, 16, 711-712. Gerbert, B. (1980). Psychological aspects of Crohn's disease.
    Fromm, E. (1970). Age regression with unexpected reap- Journal of Behavioral Medicine, 3, 41-58.
    pearance of a repressed childhood language. International Gibbons, D. E. (1971). Directed experience hypnosis: A
    Journal of Clinical & Experimental Hypnosis, 18, 79-88. one-year follow-up investigation. American Journal of
    Frumkin, L. R., Ripley, H. S., & Cox, G. B. (1978). Changes in Clinical Hypnosis, 13, 101-103.
    cerebral hemispheric lateralization with hypnosis. Gibbons, D. E. (1979). Applied Hypnosis & Hyperempiria.
    Biological Psychiatry, 13, 741-750. New York: Plenum.
    Fuchs, K, Brandes, J, & Peretz, A. (1967). Treatment of Gibbons, D., Kilbourne, L., Saunders, A., & Castles, C. (1970).
    hyperemesis gravidarum by hypnosis. Hanfuah, 72, The cognitive control of behavior: A comparison of
    375-378. systematic desensitization and hypnotically induced
    Fuchs, K., Marcovici, R., Peretz, B. A., & Paldi, E. (Panelists). "directed experience" techniques. International Journal of
    The use of hypnosis in obstetrics. International Congress of clinical & Experimental Hypnosis, 12, 141-145.
    the Israeli Society of Hypnosis in Psychotherapy & Gidro-Frank, L., & Bowersbuch, M. K. (1948). A study of the
    Psychosomatic Medicine. Haifa, Israel (1983). Cited in H. plantar response in hypnotic age regression. Journal of
    B. Crasilneck & J. A. Hall (1985). Clinical Hypnosis: Nervous & Mental Disease, 107, 443-458.
    Principles & Applications. Orlando: Grune & Stratton. Gillett, P. L., & Coe, W. C. (1984). The effects of rapid
    Fuchs, K., Paldi, E., Abramovici, H., Peretz, B. A. (1980). induction analgesia (R1A), hypnotic susceptibility, and
    Treatment of hyperemesis gravidarum by hypnosis. severity of discomfort on reducing dental pain. American
    International Journal of Clinical & Experimental Hyp- Journal of Clinical Hypnosis, 27, 81-90.
    nosis, 28, 313-323. Gilligan, S. G. (1987). Therapeutic Trances. New York:
    Fuller, A. K. (1986). A method for developing suggestions from Brunner/Mazel.
    the literature. American Journal of Clinical Hypnosis, Gindes, B. C. (1951). New Concepts of Hypnosis. New York:
    29(1), 47-52. Julian Press.
    Gaal, J. M., Goldsmith, L., & Needs, R. E. (Nov. 1980). Gindhart, L. R. (1981). The use of a metaphoric story in
    566 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    therapy: A case report. American Journal of Clinical affective instability. American Journal of
    Hypnosis, 25(3), 202-206. Clinical Hypnosis, 25, 263-266.
    Glick, B. S. (1970). Conditioning therapy with phobic patients: Gurman, A., & Kniskern, D. (1978a) Deterioration in marital
    Success and failure. American Journal of Psychotherapy, and family therapy: Empirical, clinical and conceptual
    24, 92-101. issues. Family Process, 17, 3-20.
    Golan, H. P. (1975). Hypnosis: Further case reports from the Gurman, A., & Kniskern, D. (1978b) Research on marital and
    Boston City Hospital. American Journal of Clinical family therapy: Progress, perspective and prospect.
    Hypnosis, 12, 55-59. Chapter in S. Garfield & A. Bergin (Eds.), Handbook of
    Golan, H. P. (1989). Temporomandibular joint disease treated Psychotherapy & Behavior Change. New York: Wiley.
    with hypnosis. American Journal of Clinical Hypnosis, Gustavson, J. L., & Weight, D. G. (1981). Hypnotherapy for a
    3/(4), 269-274. phobia of slugs: A case report. American Journal of
    Goldburgh, S. J. (1968). Hypnotherapy, chemotherapy, and Clinical Hypnosis, 23, 258-262.
    expressive-directive therapy in the treatment of Haggendorn, J. (1970). The use of posthypnotic suggestions on
    examination anxiety. American Journal of Clinical recall and amnesia to facilitate retention and to produce
    Hypnosis, 11, 42-44. forgetting for previously learned materials in classroom
    Goldmann, L. (1986). Awareness under general anesthesia. situation. Unpublished doctoral dissertation. University of
    Unpublished doctoral dissertation, Cambridge University. Tulsa, Dissertation Abstracts International, 30(10-A),
    Goldmann, L, Shay, M. V., & Hebden, M. W. (1987). Memory 4275.
    of cardiac anesthesia. Psychological sequelae in cardiac Haley, J. (1973). Uncommon Therapy: The Psychiatric
    patients of intra-operative suggestion and operating room Techniques of Milton H. Erickson, M.D. New York: W. W.
    conversation. Anaesthesia, 42(6), 596-603.
    Norton.
    Gordon, D. (1978). Therapeutic Metaphors. Halfen, D. (March 12, 1986). What do "anesthetized" patients
    Cupertino, hear? Anesthesiology News, p. 12.
    CA: Meta Publications. Gordon, J. E., & Freston, M. Hall, C. W. (1980). Psychiatric Presentations of Medical
    (1964). Role-playing and age Illness: Somatopsychic Disorders. New York: SP Medical
    regression in hypnotized and nonhypnotized subjects. & Scientific Books.
    Journal of Personality, 32, 411-419. Gorman, B. J. Hall, H. R. (1982-1983). Hypnosis and the immune system: A
    (1974). An abstract technique for ego-strengthening. review with implications for cancer and the psychology of
    American Journal of Clinical Hypnosis, healing. American Journal of Clinical Hypnosis, 25(2-3),
    16(1), 209-212. Graef, J. R. (1969). The influence 92-103.
    of cognitive states on
    Hammond, D. C. (1984a). Myths about Erickson and
    time estimation and subjective time rate. Unpublished
    Ericksonian hypnosis. American Journal of Clinical
    doctoral dissertation, University of Michigan,
    Hypnosis, 26, 236-245.
    Ann
    Hammond, D. C. (1984b). Hypnosis in marital and sex therapy.
    Arbor. Greene, R. J., & Reyher, J. (1972). Chapter in R. F. Stahmann & W. J. Hiebert (Eds.),
    Pain tolerance in Counseling in Marital & Sexual Problems (Third Edition).
    hypnotic analgesia and imagination states. Journal of Lexington, Mass.: Lexington Books, pp. 115-130.
    Abnormal Psychology, 79, 29-38. Greenleaf, E. Hammond, D. C. (1985b). An instrument for utilizing client
    (1969). Developmental-stage regression interests & individualizing hypnosis. Ericksonian
    through hypnosis. American Journal of Clinical Hypnosis, Monographs, 1, 111-126.
    12(1), 20- 36. Grinker, R. R., & Spiegel, J. P. (1945). Men Under Hammond, D. C. (1985c). Treatment of inhibited sexual desire.
    Stress. Chapter in J. Zeig (Ed.), Ericksonian Psychotherapy.
    Philadelphia: Blakiston. Grinker, R. R., & Spiegel, J. P. Volume II: Clinical Applications. New York:
    (1943). War Neuroses in Brunner/Mazel, 415-428.
    North Africa. New York: Josiah Macy, Jr. Founda- Hammond, D. C. (1988a). Utilization & individualization in
    tion. Gross, M. (1984). Hypnosis in the therapy of hypnosis. Chapter in D. Corydon Hammond (Ed.),
    anorexia Hypnotic Induction & Suggestion: An Introductory
    nervosa. American Journal of Clinical Manual. Des Plaines, IL: American Society of Clinical
    Hypnosis, Hypnosis.
    26(3), 175-181. Grosz, H. J. (1978a). Nicotine Hammond, D. C. (1988b). Will the real Milton Erickson please
    addiction: Treatment with stand up? International Journal of Clinical &
    medical hypnosis, part 1. Journal of the Indiana State Experimental Hypnosis, 36(3), 173-181.
    Medical Association, 71, 1074-1075. Grosz, H. J. Hammond, D. C. (Ed.). (1988c). Hypnotic Induction &
    (1978b). Nicotine addiction: Treatment with Suggestion. Des Plaines, IL: American Society of Clinical
    medical hypnosis, part 2. Journal of the Indiana State Hypnosis.
    Medical Association, 71, 1136-1137. Gruber, L. Hammond, D. C. (1988d). A clinical approach of a psy-
    N. (1983). Hypnotherapeutic techniques with
    REFERENCES 567

    chologisl to PMS. Chapter in W. R. Keye (Ed.), The Hines, T. (1988). Pseudoscience and the Paranormal: A
    Premenstrual Syndrome. New York: Saunders, pp. Critical Examination of the Evidence. Buffalo:
    189-198. Prometheus Books.
    Hammond, D. C. (1988e). The psychosocial consequences of Hinshaw, J. R. (1963). Progressive changes in the depth of
    Premenstrual Syndrome. Chapter in W. R. Keye (Ed.), The burns. Archives of Surgery, 87, 993-997.
    Premenstrual Syndrome. New York: Saunders, pp. Hodge, J. R. (1959). Management of dissociative reactions with
    128-141. hypnosis. International Journal of Clinical &
    Hammond, D. C. (Ed.) (19880- Learning Clinical Hypnosis: An Experimental Hypnosis, 7, 217-221.
    Educational Resources Compendium. Des Plaines, IL: Hodge, J. R. (1972). Hypnosis as a deterrent to suicide.
    American Society of Clinical Hypnosis. American Journal of Clinical Hypnosis, 15(\),
    Hammond, D. C, & Cheek, D. B. (1988). Ideomotor signaling: 20-21.
    A method for rapid unconscious exploration. In D. C. Hodge, J. R. (1976). Contractual aspects of hypnosis.
    Hammond (Ed.), Hypnotic Induction & Suggestion: An International Journal of Clinical & Experimental Hyp-
    Introductory Manual. Des Plaines, IL: American Society of nosis, 14, 391-399.
    Clinical Hypnosis, pp. 90-97. Hodge, J. R. (1980). Hypnotherapy combined with psycho-
    Hammond, D. C, Hepworth, D., & Smith, V. G. (1977). therapy. In T. B. Karasu and L. Bellak (Eds.), Specialized
    Improving Therapeutic Communication. San Techniques in Individual Psychotherapy. New York:
    Francisco: Jossey-Bass. Brunner/Mazel, pp. 400-425.
    Hammond, D. C, & Miller, S. (in press). Integrative Hodge, J. R.(1988). Can hypnosis help psychosis? American
    Hypnotherapy: A Comprehensive Approach. New York: Journal of Clinical Hypnosis, 30(4), 248-256.
    W. W. Norton. Hodge, J. R., & Babai, M. (1982). Strategies and tactics in
    Hammond, D. C, & Stanfield, K. (1977). Multidimensional hypnotherapy. Presentation to the annual scientific
    Psychotherapy. Champaign, IL: Institute for Personality & meeting, The American Society of Clinical Hypnosis,
    Ability Testing. Denver, Colorado (October).
    Harris, M. (1986). Are "past-life" regressions evidence of Hodge, J. R., & Wagner, E. E. (1964). The validity of
    reincarnation? Free Inquiry, 6(4), 18-23. hypnotically induced emotional states. American Journal
    Hartland, J. (1971a). Medical & Dental Hypnosis (Second of Clinical Hypnosis, 7, 37-41.
    Edition). London: Balliere Tindall. Holcomb, L. (1970). The effects of hypnosis on the reading
    Hartland, J. (1971b). Further observations on the use of remediation of seventh grade boys. Unpublished doctoral
    "ego-strengthening" techniques. American Journal of dissertation. University of Oregon. Dissertation Abstracts
    Clinical Hypnosis, 14, 1-8. International, 31(5-A).
    Heiman, J., & LoPiccolo, J. (1983). Clinical outcome of sex Holroyd, J. (1980). Hypnosis treatment for smoking: An
    therapy: Effects of daily versus weekly treatment. Archives evaluative review. International Journal of Clinical &
    of General Psychiatry, 40, 443-449. Experimental Hypnosis, 28, 341-357.
    Henker, F. O. (1976). Psychotherapy as adjunct in treatment of Holroyd, J., & Maguen, E. (1989). And so to sleep:
    vomiting during pregnancy. Southern Medical Journal, Hypnotherapy for Lagophthalmos. American Journal of
    69, 1585-1587. Clinical Hypnosis, 31(4), 264-266.
    Hilgard, E. R. (1977/1986). Divided Consciousness: Multiple Horowitz, S. L. (1970). Strategies within hypnosis for reducing
    Controls in Human Thought & Action. New York: Wiley. phobic behavior. Journal of Abnormal Psychology, 75,
    Hilgard, J. R. (1970). Personality and Hypnosis: A Study of 104- 112.
    Imaginative Involvement. Chicago: University of Chicago Hoskovec, J., & Horvai, J. (1963). Speech manifestations in
    Press. hypnotic age regression. Activitas Nervosa Superior, 5,
    Hilgard, J. R. (1979). Imaginative and sensory-affective 13-21.
    involvements in everyday life and hypnosis. Chapter in E. Howard, W. L., & Reardon, J. P. (1986). Changes in the self
    Fromm & R. E. Shor (Eds.), Hypnosis: Developments in concept and athletic performance of weight lifters through
    Research & New Perspectives. New York: Aldine, 1979, a cognitive-hypnotic approach: An empirical study.
    pp. 483-517. American Journal of Clinical Hypnosis, 28(4), 248-257.
    Hilgard, J. R., Hilgard, E. R., & Newman, D. M. (1961). Hunter, M. E. (1988). Daydreams for Discovery: A Manual for
    Sequelae to hypnotic induction with special reference to Hypnotherapists. Vancouver: Sea Walk Press.
    earlier chemical anesthesia. Journal of Nervous & Mental Hutchings, D. D. (1961). The value of suggestion given under
    Disease, 133, 461-478. anesthesia: A report and evaluation of 200 consecutive
    Hilgenberg, J. C. (1981). Intraoperative awareness during cases. American Journal of Clinical Hypnosis, 4, 26-29.
    high-dose fentanyl-oxygen anesthesia. Anesthesiology, 54, Jackson, J. A., Gass, G. C, & Camp, E. M. (1979). The
    341-343. relationship between posthypnotic suggestion and en-
    Hill, N. (1963). Think & Grow Rich. Greenwich, Conn.: durance in physically trained subjects. International
    Fawcett. Journal of Clinical & Experimental Hypnosis,
    27(3),
    568 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    278-293. the treatment of multiple personality. American Journal of


    Jacobson, E. (1973). Teaching and Learning. New Methods for Clinical Hypnosis, 24, 230-240. Kluft, R. P. (1983).
    Old Arts. Chicago: National Federal for Progressive Hypnotherapeutic crisis intervention in multiple personality.
    Relaxation. American Journal of Clinical Hypnosis, 26, 73-83.
    Janet, P. (1889). L'Automatisme Psychologique. Paris: Felix Kluft, R. P. (1985a). Using hypnotic inquiry protocols to
    Alcan. monitor treatment progress and stability in multiple personality
    Jencks, B. (1977). Your Body: Biofeedback al its Best. Chicago: disorder. American Journal of Clinical Hypnosis, 28, 63-75.
    Nelson-Hall. Kluft, R. P. (1985b). Hypnotherapy of childhood multiple
    Jencks, B. (1979). Exercise Manual for J. H. Schultz's Standard personality disorder. American Journal of Clinical Hypnosis,
    Autogenic Training and Special Formulas (With 27, 201-210.
    Appendixes on Procedures with Children and Advanced Kluft, R. P. (1986). Preliminary observations on age regression
    Autogenic Training). Des Plaines, IL: American Society of in multiple personality disorder patients before and after
    Clinical Hypnosis. integration. American Journal of Clinical Hypnosis, 28,
    Jones, C. W. (1977). Hypnosis and spinal fusion by Harrington
    147-156.
    instrumentation. American Journal of Clinical Hypnosis,
    Knudson, R. A. (1968). A program for improving reading
    19, 155-157.
    efficiency through the use of suggestion. Unpublished
    Kaplan, H. S. (1983). The Evaluation of Sexual
    Disorders. doctoral dissertation. Dissertation Abstracts International,
    29(l-B), 359.
    New York: Brunner/Mazel. Koe, G. G., & Oldridge, O. A. (1988). The effect of hypnotically
    Kaplan, H. S. (1979) Disorders of Sexual Desire. New York: induced suggestions on reading performance. International
    Brunner/Mazel. Journal of Clinical & Experimental Hypnosis, 36(4),
    Kaplan, H. S. (1983). Evaluation of Sexual Disorders. New 275-283.
    York: Brunner/Mazel. Kohen, D. P. (1986). Applications of relaxation/mental imagery
    Kardiner, A., & Spiegel, H. (1947). War Stress & Neurotic (self-hypnosis) in pediatric emergencies. International
    Illness. New York: Hoeber. Journal of Clinical & Experimental Hypnosis, 34,
    Karoly, P., & Jensen, M. P. (1987). Multimethod Assessment of 283-294.
    Chronic Pain. New York: Pergamon Press. Kohl, R. (1962) Pathological reactions of marital partners to
    Kelly, M. A., McKinty, H. R., & Carr, R. (1988). Utilization of improvement of patients. American Journal of Psychiatry,
    hypnosis to promote compliance with routine dental 118, 1036-1041.
    flossing. American Journal of Clinical Hypnosis, 31(1), Kolodny, R. C, Masters, W. H., & Johnson, V. E. (1979).
    57-60. Textbook of Sexual Medicine. Boston: Little, Brown &
    Kelsey, D., & Barron, J. N. (1958). Maintenance of posture by Company.
    hypnotic suggestion in patients undergoing plastic surgery. Kolough, F. T. (1962). Role of suggestion in surgical
    British Medical Journal, I, 756. convalescence. Archives of Surgery, 85, 304-315.
    Kilmann, P. R., Boland, J. P., Norton, S. P., Davidson, E., & Kolough, F. T. (1964). Hypnosis and surgical convalescence: A
    Caid, C. (1986). Perspectives of sex therapy outcome: A study of subjective factors in postoperative recovery.
    survey of AASECT providers. Journal of Sex & Marital American Journal of Clinical Hypnosis, 7, 120-129.
    Therapy, 12(2), 116-138. Korn, E. R., & Pratt, G. J. (1988). Release Your Business
    Klauber, R. W. (1984). Hypnosis in education and school Potential. (Cassette recording). New York: John Wiley &
    psychology. Chapter in W. C. Wester & A. H. Smith (Eds.), Sons.
    Clinical Hypnosis: A Multidisciplinary Approach. Krane, R. J., Siroky, M. B., & Goldstein, I. (1983). Male Sexual
    Philadelphia: J. B. Lippincott. Dysfunction. Boston: Little, Brown & Company.
    Klein, K. B., & Spiegel, D. (1989). Modulation of gastric acid Kratochvil, S. (1970). Prolonged hypnosis and sleep. American
    secretion by hypnosis. Gastroenterology, 96(6), Journal of Clinical Hypnosis, 12(4), 254-260.
    1383-1387. Krauss, D. (1983). The physiologic basis of male sexual
    Kleinhauz, M. & Beran, B. (1984). Misuse of hypnosis: A factor dysfunction. Hospital Practice, 2, 193-222.
    in psychopathology. American Journal of Clinical Krippner, S. (1963). Hypnosis and reading improvement among
    Hypnosis, 26, 283-290. university students. American Journal of Clinical
    Kline, M. V. (1956). A Scientific Report on the Search for Hypnosis, 15, 187-193.
    Bridey Murphy. New York: Julian Press. Krippner, S. (1966). The use of hypnosis with elementary and
    Kline, M. V. (1970). The use of extended group hypnotherapy secondary school children in a summer reading clinic.
    sessions in controlling cigarette habitu-ation. International American Journal of Clinical Hypnosis, 8(4), 261-264.
    Journal of Clinical & Experimental Hypnosis, 18, Kroger, W. S. (1970). Comprehensive management
    270-282. of
    Kline, M. V. (1976). Emotional flooding: A technique in
    sensory hypnoanalysis. Chapter in P. Olsen (Ed.).
    Emotional Flooding. New York: Human Sciences Press.
    Kluft, R. P. (1982). Varieties of hypnotic interventions in
    REFERENCES 569

    obesity. American Journal of Clinical Hypnosis, 12(3), Clinical & Experimental Hypnosis, 13(\), 11-25.
    165-175. Leiblum, S. R., & Rosen, R. C. (1988). Sexual Desire
    Kroger, W. S. (1977). Clinical & Experimental Hypnosis Disorders. New York: Guilford.
    (Second Edition). Philadelphia: J. B. Lippincott. Levine, B. A. (1976). Treatment of trichotillomania by covert
    Kroger, W. S., & Fezler, W. D. (1976). Hypnosis and Behavior sensitization. Journal of Behavior Therapy &
    Modification: Imagery Conditioning. Philadelphia: J. B. Experimental Psychiatry, 7, 75-76.
    Lippincott. Levine, E. S. (1980). Indirect suggestions through personalized
    Kumar, S. M., Pandit, S. K., & Jackson, P. F. (1978). Recall fairy tales for treatment of childhood insomnia. American
    following ketamine anesthesia for open-heart surgery: Journal of Clinical Hypnosis, 23(1), 57-63.
    Report of a case. Anesthesia & Analgesia, 57(2), Levinson, B. W. (1965). States of awareness during general
    267-269. anaesthesia. British Journal of Anaesthesia, 37, 544-546.
    Kupper, H. I. (1945). Psychic concomitants in wartime injuries. Levinson, B. W. (1969). An examination of states of awareness
    Psychosomatic Medicine, 7, 15-21. during general anesthesia. Unpublished doctoral
    Kuriyama, K. (1968). Clinical applications of prolonged dissertation. University of Witwatersrand, South Africa.
    hypnosis in psychosomatic medicine. American Journal of Levitan, A. A. (1985). Hypnotic death rehearsal. American
    Clinical Hypnosis, 11(2), 101-111. Journal of Clinical Hypnosis, 27(A), 211-215.
    LaBaw, W. L. (1970). Regular use of suggestibility by pediatric Levitan, A. A. (1987). Hypnosis and oncology. Chapter in W.
    bleeders. Haematologica, 4, 419-425. C. Wester, Clinical Hypnosis: A Case Management
    LaBaw, W. L. (1975). Autohypnosis in hemophilia. Approach. Cincinnati: Behavioral Science Center, pp.
    Haematologica, 9, 103-110. 332-356.
    LeBaron, S., & Zeltzer, L. (1985). Hypnosis for hemophiliacs: Lewenstein, L. N., Iwamoto, K., & Schwartz, H. (1981).
    Methodological problems and risks. American Journal of Hypnosis in high risk surgery. Ophthalmologic Surgery,
    Pediatric Hematology & Oncology, 7(3), 316-319. 12, 39-.
    Lait, V. S. (1961). Effect of hypnosis on edema: A case report. Lewis, S. A., Jenkinson, J., & Wilson, J. (1973). An EEG
    American Journal of Clinical Hypnosis, 3, 200. investigation of awareness during anaesthesia. British
    Lankton, C. H. (1985). Elements in an Ericksonian approach. Journal of Psychology, 640), 413-415.
    Ericksonian Monographs, 1, 61-75/ Lieberman, M. A., Yalom, E. D., & Miles, M. B. (1973).
    Lankton, C. H... & Lankton, S. R. (1989). Tales of Enchantment. Encounter Groups: First Facts. New York: Basic Books.
    New York: Brunner/Mazel. Liebert, R. M., Rubin, N., & Hilgard, E. R. (1965). The effects
    Lankton, S. R., & Lankton, C. H. (1983). The Answer Within. of suggestion of alertness in hypnosis on paired-associate
    New York: Brunner/Mazel. learning. Journal of Personality, 33,605-612.
    Laughlin, H. P. (1967). The Neuroses. Baltimore: Reese Press. Leibowitz, H. W., Graham, C, & Parrish, M. (1972). The effect
    Laurence, J. R., & Perry, C. (1981). The "hidden observer" of hypnotic age regression on size constancy. American
    phenomenon in hypnosis: Some additional findings. Journal of Psychology, 85, 271-276.
    Journal of Abnormal Psychology, 90, 334-344. Lief, H. (1977) What's new in sex research? Inhibited Sexual
    Laurence, J. R., & Perry, C. (1988). Hypnosis, Will and Desire. Medical Aspects of Human Sexuality, 11(1),
    Memory. New York: Guilford. 94-95.
    Lazarus, A. A. (1971). Behavior Therapy & Beyond. New York: Lief, H. (1985). Evaluation of inhibited sexual desire:
    McGraw-Hill. Relationship aspects. Chapter in H. S. Kaplan (Ed.),
    Lazarus, A. A. (1981). The Practice of Multimodal Therapy. Comprehensive evaluation of disorders of sexual desire.
    New York: McGraw-Hill. Washington, D.C.: American Psychiatric Press.
    Lazarus, A. A. (1989). The Practice of Multimodal Therapy Lindemann, H. (1958). Alone at Sea. New York: Random
    (Second Edition). Baltimore: John Hopkins University House.
    Press. Lodato, F. (1969). Hypnosis as an adjunct to test performance.
    Leavitt, F., Garron, D. C, Whisler, W. W., & Sheinkop, M. B. American Journal of Clinical Hypnosis, 6, 276-279.
    (1978). Affective and sensory dimensions of back pain. Loftus, E. F., Schooler, J. W., Loftus, G. R., & Glauber, D. T.
    Pain, 4, 273-281. (1985). Memory for events occurring under anesthesia.
    LeBaron, S., & Zeltzer, L. (1985). Hypnosis for hemophiliacs: Acta Psychologica, 59, 123-128.
    Methodological problems and risks. American Journal of Logsdon, F. M. (1960). Age regression in diagnosis and
    Pediatric Hematology & Oncology, 7(3), 316-319. treatment of acrophobia. American Journal of Clinical
    Leckie, F. H. (1964). Hypnotherapy in gynecological disorders. Hypnosis, 3, 108-109.
    International Journal of Clinical & Experimental London, P., & Cooper, L. M. (1969). Norms of hypnotic
    Hypnosis, 13, 11-25. susceptibility in children. Developmental Psychology, I
    Leckie, F. H. (1965). Further gynecological conditions treated 113-124.
    by hypnotherapy. International Journal of
    570 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Loomis, E. A. (1951). Space and time perception and distortion Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse
    in hypnotic states. Personality, I, 283. Prevention. New York: Guilford.
    LoPiccolo, L. (1980) Low sexual desire. Chapter in S. R. Marmer, M. J. (1959). Hypnosis in Anesthesiology. Springfield:
    Leiblum & L. A. Pervin (Eds.), Principles & Practice of Charles C. Thomas.
    Sex Therapy. New York: Guilford, 29-64. Maslach, C, Marshall, G., & Zimbardo, P. G. (1972). Hypnotic
    Lugan, W. G. (1963). Delay of premature labor by the use of control of peripheral skin temperature: A case report.
    hypnosis. American Journal of Clinical Hypnosis, 5, Psychophysiology, 9, 600-605.
    209-211. Mastellone, M. (1974). Aversion therapy: A new use for the old
    Lynn, S. J., Neufeld, V., & Matyi, C. L. (1987). Inductions rubber band. Journal of Behavior Therapy & Experimental
    versus suggestions: Effects of direct and indirect wording Psychiatry, 5, 311-312.
    on hypnotic responding and experience. Journal of Master, W., & Johnson, V. (1970) Human Sexual Inadequacy.
    Abnormal Psychology, 96, 76-79. Boston: Little Brown & Co.
    Lynn, S. J., Weekes, J. R., Matyi, C. L., & Neufeld, V. (1988). Masters, W. H., Johnson, V. E., & Kolodny, R. C. (1977).
    Direct versus indirect suggestions, archaic involvement, Ethical Issues in Sex Therapy & Research. Boston: Little,
    and hypnotic experience. Journal of Abnormal Psychology, Brown & Company.
    97(3), 296-301. Masters, W. H., Johnson, V. E., Kolodny, R. C, & Weems, S.
    MacHovec, F. J., & Man, S. C. (1978). Acupuncture and M. (1980). Ethical Issues in Sex Therapy & Research,
    hypnosis compared: Fifty-eight cases. American Journal of Volume 2. Boston: Little, Brown & Company.
    Clinical Hypnosis, 21, 45-47. Matthews, W. J., Bennett, H., Bean, W., & Gallagher, M.
    Mainord, W. A., Rath, B., & Barnett, F. (1983). Anesthesia and (1985). Indirect versus direct hypnotic suggestions-An
    suggestion. Paper presented at the 91st Annual Convention initial investigation: A brief communication. International
    of the American Psychological Association, Los Angeles. Journal of Clinical & Experimental Hypnosis, 33,
    Cited in H. L. Bennett, Perception and memory for events
    219-223.
    during adequate general anesthesia for surgical operations.
    Matthews, W. J., Kirsch, I., & Mosher, D. (1985). Double
    Chapter in H. M. Pettinati (Ed.), Hypnosis and Memory.
    hypnotic induction: An initial empirical test. Journal of
    New York: Guilford.
    Abnormal Psychology, 94, 92-95.
    Maltz, M. (1960). Psycho-Cybernetics. New York: Matthews, W. J., & Mosher, D. L. (1988). Direct and indirect
    Prentice-Hall. hypnotic suggestion in a laboratory setting. British Journal
    Mann, H. (1973). Suggestions based on unlimited calorie, low of Experimental & Clinical Hypnosis, 5(2), 63-71.
    carbohydrate diet. A Syllabus on Hypnosis and a Handbook May, R. (1958). Contributions of existential psychotherapy.
    of Therapeutic Suggestions. Des Plaines, IL: American Chapter in R. May, E. Angel, & H. F. Ellenberger (Eds.),
    Society of Clinical Hypnosis, pp. 81-83. Existence: A New Dimension in Psychiatry & Psychology.
    Mann, H. (1981). Hypnosis in weight control. Chapter in H. J. New York: Simon & Schuster, 37-91.
    Wain (Ed.), Theoretical and Clinical Aspects of Hypnosis. McConkey, K. (1984). The impact of an indirect suggestion.
    Miami: Symposia Specialists, Inc. International Journal of Clinical & Experimental
    Maoz, B., & Pincus, C. (1979). The therapeutic dialogue in Hypnosis, 32, 307-314.
    narco-analytic treatments. Psychotherapy: Theory, McIntyre, K. O., Lichtenstein, E., & Mermelstein, R. J. (1983).
    Research & Practice, 16, 91-97. Self-efficacy and relapse in smoking cessation: A
    Margolis, C. G., Domangue, B. B., Ehleben, C, & Shrier, L. replication and extension. Journal of Consulting &
    (1983). Hypnosis in the early treatment of burns: A pilot Clinical Psychology, 51, 632-633.
    study. American Journal of Clinical Hypnosis, 26(1), 9-15. Meares, A. (1983). A form of intensive meditation associated
    Marks, I. M., Gelder, M. G., & Edwards, G. (1968). Hypnosis with the regression of cancer. American Journal of
    and desensitization for phobias: A controlled prospective Clinical Hypnosis, 25(2-3),114-121.
    trial. British Journal of Psychiatry, 114, 1263-1274. Meares, A. (1979). Regression of cancer of the rectum following
    Marlatt, G. A. (1985). Situational determinants of relapse and intensive meditation. Medical Journal of Australia,
    skill-training interventions. Chapter in G. A. Marlatt & J. 539-40.
    R. Gordon, Relapse Prevention: Maintenance Strategies in Meichenbaum, D. (1971). Cognitive factors in behavior
    the Treatment of Addictive Behaviors. New York: modification: Modifying what people say to themselves.
    Guilford, pp. 71-127. Paper presented at the Fifth Annual Meeting of the
    Marlatt, G. A., & Gordon, J. R. (1980). Determinants of relapse: Association for the Advancement of Behavior Therapy,
    Implications for the maintenance of behavior change. Washington, D.C.
    Chapter in P. O. Davidson & S. M. Davidson (Eds.), Mellegren, A. (1966). Practical experiences with a modified
    Behavioral Medicine: Changing Health Life Styles. New hypnosis-delivery. Psychotherapy & Psychosomatics, 14,
    York: Brunner/Mazel, pp. 410-452. 425-428.
    Mellenbruch, P. (1964). Hypnosis in student counseling.
    REFERENCES 571

    American Journal of Clinical Hypnosis, 7(1), Ericksonian Monographs, 4, 12-27.


    60-63. Melzack, R. (1975). The McGill Pain Questionnaire. In Murray-Jobsis, J. (1984). Hypnosis with severely disturbed
    R. Melzack (Ed.), Pain Measurement & Assessment. New patients. Chapter in W. C. Wester II & A. H. Smith, Jr.,
    York: Raven. Millar, K., & Watkinson, N. (1983). (Eds.), Clinical Hypnosis: A Multidisciplinary Approach.
    Recognition of words Philadelphia: J. B. Lippincott, pp. 368-404.
    presented during general anesthesia. Ergonomics, Murray-Jobsis, J. (1985). Exploring the schizophrenic ex-
    26, 585-594. Miller, S. (1977). Dialogue with the higher perience with the use of hypnosis. American Journal of
    self. Synthesis 2. Clinical Hypnosis, 28, 34-42.
    San Francisco: Institute for the Study of Humanistic Mutke, P. (1967). Increased reading comprehension through
    Medicine, 285-300. Mills, J. C, & Crowley, R. J. hypnosis. American Journal of Clinical Hypnosis, 9(4),
    (1986). Therapeutic Metaphors for Children and the Child 262-264.
    Within. New York: Narcuse, G. (1964a). "Agari" no tsisaku ni tsuite (On a
    Brunner/Mazel. Minalyka, E. E., & Whanger, A. D. treatment of stage fright). Olympia, 6, 29-.
    (1959). Tonsillectomies Narcuse, G. (1964b). Hypnotic treatment of stage fright in
    under hypnosis: Report of Cases. American Journal of champion athletes. Psychologia, 7(324), 199-.
    Clinical Hypnosis, 2, 87-89. Mitchell, W. M. Narcuse, G. (1965). The hypnotic treatment of stage fright in
    (1972). The Use of Hypnosis in Athletics. champion athletes. International Journal of Clinical &
    Stockton: Mitchell. Mody, N. V. (1960). Report Experimental Hypnosis, 13, 63-70.
    on twenty cases delivered Nash, M. R. (1988). Hypnosis as a window on regression.
    under hypnotism. Journal of Obstetrics & Gynecology Bulletin of the Menninger Clinic, 52(5), 383-403.
    in India, 10, 3-8. Monteiro, A. R. de C, Nash, , M. R., Johnson, L. S., & Tipton, R. D. (1979). Hypnotic
    de Oliveira, D. A. (1958). age regression and the occurrence of transitional object
    Amigdalectomia sob hipnose [Tonsillectomy relationships. Journal of Abnormal Psychology, 88,
    under hypnosis). Medicine Cirsugia Formaria, 267, 547-555.
    315-320. Moore, R. K., & Cooper, L. M. (1966). Item Nash, M. R., Lynn, S. J., & Givens, D. L. (1984). Adult
    difficulty in childhood hypnotic susceptibility scales as a hypnotic susceptibility, childhood punishment, and child
    function of item wording, repetition, and age. abuse: A brief communication. International Journal of
    International Clinical & Experimental Hypnosis, 32, 6-11.
    Journal of Clinical & Experimental Hypnosis, Newton, B. W. (1982-83). The use of hypnosis in the treatment
    14, 316-323. of cancer patients. American Journal of Clinical Hypnosis,
    Moore, R. K., & Lauer, L. W. (1963). Hypnotic susceptibility 25(2-3), 104-113.
    in middle childhood. International Journal of Clinical & Norcross, J. C. (1986). Handbook of Eclectic Psychotherapy.
    Experimental Hypnosis, II, 167-174. New York: Brunner/Mazel.
    Morgan, A. H., & Hilgard, E. R. (1973). Age differences in Norcross, J. C, & Prochaska, J. O. (1982). A national survey of
    susceptibility to hypnosis. International Journal of clinical psychologists: Affiliations and orientations. The
    Clinical & Experimental Hypnosis, 21, 78-85. Clinical Psychologist, 35(3), 1, 4-6.
    Morgan, A. H., & Hilgard, J. R. (1979). The Stanford Nowlis, D. P. (1969). The child-rearing antecedents of hypnotic
    Hypnotic Clinical Scale for Children. American Journal susceptibility and of naturally occurring hypnotic-like
    of Clinical Hypnosis, 21, 148-155. experience. International Journal of Clinical &
    Mosconi, G., & Starcich, B. (1961). Preparacion del parto con Experimental Hypnosis, 17, 109-120.
    hipnosis (Preparation for childbirth with hypnosis). Nuland, W., & Field, P. B. (1970). Smoking and hypnosis: A
    Review of Latin American Hypnosis Clinics, 2, 29-34. systematic clinical approach. International Journal of
    Moss, C. S. (1965). Hypnosis in Perspective. New York: Clinical & Experimental Hypnosis, 18, 290-306.
    Macmillan. O'Brien, R. M., Kramer, C. E., Chiglinsky, M. A., Stevens, G.,
    Mozdzierz, G. J. (1985). The use of hypnosis and paradox in Nunan, L., & Fritzo, J. (1977). Moral development
    the treatment of a case of chronic urinary examined through hypnotic and task motivated age
    retention/"bashful bladder." American Journal of Clinical regression. American Journal of Clinical Hypnosis, 19,
    Hypnosis, 28(1), 43-47. 209-213.
    Muehleman, T. (1978). Age regression as a possible en- O'Connell, D. N., Shor, R. E., & Orne, M. T. (1970). Hypnotic
    hancement to conception: A case report. American age regression: An empirical and methodological analysis.
    Journal of Clinical Hypnosis, 20(4), 282-283. Journal of Abnormal Psychology, 76 (Monograph Issue
    Murphy, J. K., & Fuller, A. K. (1984). Hypnosis and No. 3, Pt. 2).
    biofeedback as adjunctive therapy in blepharospasm: A Oetting, E. R. (1964). Hypnosis and concentration in study.
    case report. American Journal of Clinical Hypnosis, American Journal of Clinical Hypnosis, 7(2),
    27(1), 31-37. 148-151.
    Murphy, M. B. (1988). A linguistic-structural model for the Olness, K., & Gardner, G. G. (1988).
    investigation of indirect suggestion. Hypnosis and
    572 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Hypnotherapy with Children (Second Edition). Phila- Perry, C. W., Evans, F., O'Connell, D. N., Orne, E. C, & Orne,
    delphia: Grune & Stratton. M. T. (1978). Behavioral response to verbal stimuli
    Omer, H. (1987). A hypnotic relaxation technique for the administered and tested during REM sleep: A further
    treatment of premature labor. American Journal of Clinical investigation. Waking & Sleeping, 2, 35-42.
    Hypnosis, 29(3), 206-213. Peterson, G. F. (1981). Birthing Normally: A Personal Growth
    Omer, H., Darnel, A., Silberman, N., Shuval, D., & Palti, T. Approach to Childbirth. Berkeley: Mindbody Press.
    (1988). The use of hypnotic-relaxation cassettes in a Pettinati, H. M. (1982). Measuring hypnotizability in psychotic
    gynecologic-obstetric ward. Ericksonian Monographs, 4, patients. International Journal of Clinical & Experimental
    28-36. Hypnosis, 30, 404-416.
    Omer, H., Friedlander, D., & Palti, Z. (1986). Hypnotic Pettinati, H. M. (Ed.). (1988). Hypnosis & Memory. New York:
    relaxation in the treatment of premature labor. Psy- Guilford.
    chosomatic Medicine, 48, 351-361. Pettinati, H. M., Horne, R. L., & Staats, J. M. (1985).
    Orme, J. E. (1962). Time estimation and personality. Journal of Hypnotizability in patients with anorexia nervosa and
    Mental Science, 108, 213. bulimia. Archives of General Psychiatry, 42, 1014-1016.
    Orme, J. E. (1964). Personality, time estimation, and time Poncelet, N. M. (1982). The training of a couple in hypnosis for
    experience. Acta Psychologica, 22, 430. childbirth: A clinical session [Videotape]. Western
    Orme, J. E. (1969). Time, Experience, & Behavior. New York: Psychiatric Institute and Clinic Library, 3811 O'Hara
    American Elsevier. Street, Pittsburgh, PA 15213.
    Orne, M. T. (1951). The mechanisms of hypnotic age Poncelet, N. M. (1983). A family systems view of emotional
    regression: An experimental study. Journal of Abnormal & disturbance during pregnancy. Clinical Social Work
    Social Psychology, 46, 213-225. Journal, 11, 1.
    Orne, M. T. (1959). The nature of hypnosis: Artifact and Poncelet, N. M. (1985). An Ericksonian approach to
    essence. Journal of Abnormal and Social Psychology, 58, childbirth. Chapter in J. K. Zeig (Ed.). Ericksonian
    277-299. Psychotherapy: Volume II New York:
    Orr, R. G. (1970). Hypnosis helps reluctant smokers. Brunner/Mazel, pp. 267-285.
    Practitioner, 205, 204-208. Porter, J. (1974). Personalistic considerations for the
    Parloff, M. B., Washow, I. E., & Wolfe, B. E. (1978). Research hypnotherapist drawing from both humanistic and learning
    on therapist variables in relation to process and outcome. In orientations. Australian Journal of Clinical Hypnosis, 2,
    S. L. Garfield & A. E. Bergin (Eds.), Handbook of 101-105.
    Psychotherapy & Behavior Change (2nd Edition) New Porter, J. (1975). Self-hypnosis for study success. SA. Teachers
    York. Wiley. Journal, 1, 14.
    Pearson, R. (1961). Response to suggestions given under Porter, J. (1976). Self-hypnosis as self-management for student
    general anesthesia. American Journal of Clinical Hypnosis, problems involving the self-concept. Paper presented to
    4, 106-114. Murray Park College of Advanced Education, Adelaide.
    Pederson, L. L., Scrimgeour, W. G., & Lefcoe, N. M. (1975). Porter, J. (1978). Suggestions and success imagery for study
    Comparison of hypnosis plus counseling, counseling alone, problems. International Journal of Clinical &
    and hypnosis alone in a community service smoking Experimental Hypnosis, 26(2), 63-75.
    withdrawal program. Journal of Consulting & Clinical Porter, J. W., Woodward, J. A., Bisbee, C. T., & Fenker, R. M.
    Psychology, 43, 920. (1972). Effect of hypnotic age regression on the magnitude
    Pelletier, A. M. (1979). Three uses of guided imagery in of the Ponzo illusion: A replication. Journal of Abnormal
    hypnosis. American Journal of Clinical Hypnosis, 22(1), Psychology, 79, 189-194.
    32-36. Premack, D. (1959). Toward empirical behavior laws: I.
    Pennebaker, J. W., & Beall, S. K. (1986). Confronting a Positive reinforcement. Psychological Review, 66,
    traumatic event: Toward an understanding of inhibition 219-133.
    and disease. Journal of Abnormal Psychology, 95(3), Price, D. D., & Barber, J. (1987). An analysis of factors that
    274-281. contribute to the efficacy of hypnotic analgesia. Journal of
    Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Abnormal Psychology, 96(1), 46-51.
    disclosure of traumas and immune function: Health Prochaska, J. O., & DiClemente, C. C. (1984). The
    implications for psychotherapy. Journal of Consulting & Transtheoretical Approach: Crossing the Traditional
    Clinical Psychology, 56(2), 239-245. Boundaries of Therapy. Homewood, IL: Dow Jones-Irvin.
    Pennebaker, J. W., & O'Heeron, R. C. (1984). Confiding in Pryor, G. J., Kilpatrick, W. R., Opp, D. R., et al. (1980). Local
    others and illness rates among spouses of suicide and anesthesia in minor lacerations: Topical TAC vs lidocaine
    accidental-death victims. Journal of Abnormal Psy- infiltration. Annals of Emergency Medicine, 9(November),
    chology, 93, 473-476. 568-571.
    Perry, C, & Chisholm, W. (1973). Hypnotic age regression and
    the Ponzo and Poggendorff illusions. International Journal
    of Clinical & Experimental Hypnosis, 21, 192-204.
    REFERENCES 573

    Putnam, F. W. (1989). Diagnosis & Treatment of Multiple 57, 161-172.


    Personality Disorder. New York: Guilford. Rosen, S. (1982). My Voice Will Go With You: The Teaching
    Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Tales of Milton H. Erickson. New York: W. W. Norton.
    Post, R. M. (1986). The clinical phenomenology of Rosen, S. (1985). Hypnosis as an adjunct to chemotherapy
    multiple personality disorder: A review of 100 recent cases. in cancer. Chapter in J. K. Zeig (Ed.), Ericksonian
    Journal of Clinical Psychiatry, 47, 285-293. Psychotherapy: Volume II New York:
    Raikov, V. L. (1976). The possibility of creativity in the active Brunner/Mazel, pp. 387-397.
    stage of hypnosis. International Journal of Clinical & Rosenberg, S. W. (1983). Hypnosis in cancer care: Imagery to
    Experimental Hypnosis, 24, 258-268. enhance the control of the physiological and psychological
    Raikov, V. L. (1980). Age regression to infancy by adult "side-effects" of cancer therapy. American Journal of
    subjects in deep hypnosis. American Journal of Clinical Clinical Hypnosis, 25(2-3), 122-127.
    Hypnosis, 22(3), 156-163. Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the
    Raikov, V. L. (1982). Hypnotic age regression to the neonatal Classroom: Teacher Expectation and Pupils" Intellectual
    period: Comparisons with role playing. International Development. New York: Holt, Rinehart & Winston.
    Journal of Clinical & Experimental Hypnosis, 30, Rossi, E. L. (1986). The Psychobiology of Mind-Body Healing:
    108-116. New Concepts of Therapeutic Hypnosis. New York: W. W.
    Rath, B. (1982). The use of suggestions during general Norton.
    anesthesia. Unpublished doctoral dissertation. University Rossi, E. L., & Cheek, D. B. (1988). Mind-Body Therapy. New
    of Louisville. York: W. W. Norton.
    Rausch, V. (1980). Cholecystectomy with self-hypnosis. Rossi, E. L., & Ryan, M. O. (1985). Life Reframing in Hypnosis:
    American Journal of Clinical Hypnosis, II, 124-130. The Seminars, Workshops, and Lectures of Milton H.
    Rausch, V. (1987). Dental hypnosis. Chapter in W. C. Wester, Erickson, Volume 2. New York: Irvington.
    Clinical Hypnosis: A Case Management Approach. Rossman, M. L. (1987). Healing Yourself: A Step-by-Step
    Cincinnati: Behavioral Science Center Publications, pp. Program for Better Health Through Imagery. New York:
    85-95. Walker & Co.
    Read, A. D. (1944). Childbirth Without Fear. New York: Rowen, R. (1981). Hypnotic age regression in the treatment of
    Harper Brothers. trichotillomania. American Journal of Clinical Hypnosis,
    Redd, W. H., Rosenberger, P. H., & Hendler, C. S. (1983). 23, 195-197.
    Controlling chemotherapy side effects. American Journal Russell, D. E. H. (1986). The Secret Trauma: Incest in the Lives
    of Clinical Hypnosis, 25, 161-172. of Girls and Women. New York: Basic Books.
    Reiff, R., & Scheerer, M. (1959). Memory and Hypnotic Age St. Jean, R. (1980). Hypnotic time distortion and learning:
    Regression: Developmental Aspects of Cognitive Function Another look. Journal of Abnormal Psychology, 89(1),
    Explored Through Hypnosis. New York: International 20.
    Universities Press. Sacerdote, P. (1970). Theory and practice of pain control in
    Reyher, J., & Wilson, J. (1973). The induction of hypnosis: malignancy and other protracted or recurring painful
    Indirect vs. direct methods and the role of anxiety. illnesses. International Journal of Clinical & Experi-
    American Journal of Clinical Hypnosis, 15, 229-233. mental Hypnosis, 18, 160-180.
    Rist, F., & Watzl, H. (1983). Self-assessment of relapse risk and Sacerdote, P. (1974). Convergence of expectations: An
    assertiveness in relation to treatment outcome of female essential component for successful hypnotherapy. In-
    alcoholics. Addictive Behaviors, 8, 121-127. ternational Journal of Clinical & Experimental Hypnosis,
    Roberts, D. (1984). Hypnotically induced age regression versus 22(2), 95-115.
    age regression in response to task motivation instructions Sacerdote, P. (1977). Applications of hypnotically elicited
    on five developmental tasks. Doctoral dissertation, Hofstra mystical states to the treatment of physical and emotional
    University. Dissertation Abstracts International, 45(5), pain. International Journal of Clinical & Experimental
    1594B. Hypnosis, 25, 309-324.
    Rock, N. L., Shipley, T. E., & Campbell, C. (1969). Hypnosis Sacerdote, P. (1978). Induced Dreams. Brooklyn: Theo Gaus.
    with untrained nonvolunteer patients in labor. International Samuels, M., & Bennett, H. (1973). Create your imaginary
    Journal of Clinical and Experimental Hypnosis, I7(\), doctor. Chapter in M. Samuels & H. Bennett, The Well
    25-36. Body Book. New York: Random House.
    Rodger, B. P. (1982). Ericksonian approaches in Sanders, S. (1977). Mutual group hypnosis and smoking.
    anesthe-siology. Chapter in J. K. Zeig (Ed.), Ericksonian American Journal of Clinical Hypnosis, 20, 131-135.
    Approaches to Hypnosis & Psychotherapy. New York: Saper, B. (1971). A report on behavior therapy with outpatient
    Brunner/Mazel. clinic patients. Psychiatric Quarterly, 45, 209-215.
    Rosen, H. (1953). Hypnotherapy in Clinical Psychiatry. New Sarbin, T. R. (1950). Mental age changes in experimental
    York: Julian Press.
    Rosen, H., & Myers, H. J. (1947). Abreaction in the military
    setting. Archives of Neurology & Psychiatry,
    574 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    regression. Journal of Personality, 19, 221-228. 323-336.


    Sarbin, T. R., & Farberow, N. L. (1952). Contributions to Shorvon, H. J., & Sargant, W. (1947). Excitatory abreaction:
    role-taking theory: A clinical study of self and role. Journal With special reference to its mechanism and the use of
    of Abnormal Psychology, 47, 117-125. ether. Journal of Mental Science, 43, 709-732.
    Sargant, W., & Slater, E. (1941). Amnesic syndromes in war. Sies, D. E., & Wester, W. C. (1987). Admissibility of
    Proceedings of the Royal Society of Medicine, 34, 751-764. hypnotically refreshed testimony. Chapter in W. C. Wester
    Saucier, N., Walts, L. F., & Moreland, J. R. (1983). Patient (Ed.), Clinical Hypnosis: A Case Management Approach.
    awareness during nitrous oxide, oxygen, and halothane Cincinnati: Behavioral Science Center Publications, pp.
    anesthesia. Anesthesia & Analgesia, 62, 239-240. 226-273.
    Scagnelli, J. (1976). Hypnotherapy with schizophrenic and Silverman, P. S., & Retzlaff, P. O. (1986). Cognitive stage
    borderline patients: Summary of therapy with eight regression through hypnosis: Are earlier cognitive states
    patients. American Journal of Clinical Hypnosis, 19(1), retrievable? International Journal of Clinical &
    33-38. Experimental Hypnosis, 34, 192-204.
    Scagnelli-Jobsis, J. (1982). Hypnosis with psychotic patients: A Simonton, D. C, Matthews-Simonton, S., & Creighton, J. L.
    review of the literature and presentation of a theoretical (1978). Getting Well Again. Los Angeles: Tarcher-St.
    framework. American Journal of Clinical Hypnosis, 25, Martins.
    33-45. Sinclair-Gieban, A. H. C, & Chalmers, D. (1959). Evaluation of
    Scheflin, A. W., & Shapiro, J. L. (1989). Trance on Trial. New treatment of warts by hypnosis. Lancet, 2, 480-482.
    York: Guilford. Smith, D. S. (1982). Trends in counseling and psychotherapy.
    Schmideberg, M. (1959). The borderline patient. In S. Arieti American Psychologist, 37, 802-809.
    (Ed.)., American Handbook of Psychiatry, Vol. 1. New Smith, M. C. (1983). Hypnotic memory enhancement of
    York: Basic Books. witnesses: Does it work? Psychological Bulletin, 94,
    Schneck, J. M. (1966). Hypnoanalytic elucidation of a 387-407.
    childhood germ phobia. International Journal of Clinical Smith, M. S., & Kamitsuka, M. (1984). Self-hypnosis
    & Experimental Hypnosis, 14, 305-307. misinterpreted as CNS deterioration in an adolescent with
    Schofield, L. J., & Reyher, J. (1974). Thematic productions leukemia and vincristine toxicity. American Journal of
    under hypnotically aroused conflict in age regressed and Clinical Hypnosis, 26, 280-282.
    waking states using the real-simulator design. Journal of Snow, L. (1979). The relationship between "Rapid Induction"
    Abnormal Psychology, 83, 130-139. and placebo analgesia, hypnotic susceptibility an chronic
    Schover, L. R., & Jensen, S. B. (1988). Sexuality & Chronic pain intensity. Dissertation Abstracts International, 40,
    Illness. New York: Guilford. 937.
    Schover, L., & LoPiccolo, J. (1982) Treatment effectiveness for Spark, R. F., White, R. A., & Connoly, P. B. (1980). Impotence
    dysfunctions of sexual desire. Journal of Sex & Marital is not always psychogenic. Newer insights into
    Therapy, 8(3), 179-197. hypothalamic-pituitary-gonadal dysfunction. Journal of
    Schultz, J. H. (1932). Das Autogene Training. Leipzig: Verlag. the American Medical Association, 243, 750-755.
    Schwartz, M. (1963). The cessation of labor using hypnotic Spiegel, D., Detrick, D., & Frischholz, E. (1982).
    techniques. American Journal of Clinical Hypnosis, 5, Hypno-tizability and psychopathology. American Journal
    211-213. of Psychiatry, 139, 431-437.
    Schwartz, M. F., & Masters, W. H. (1988). Inhibited sexual Spiegel, H. (1970). A single-treatment method to stop smoking
    desire: The Masters & Johnson Institute model. Chapter in using ancillary self-hypnosis. International Journal of
    S. Leiblum & L. Pervin (Eds.), Sexual Desire Disorders. Clinical & Experimental Hypnosis, 18, 235-250.
    New York: Guilford, pp. 229-242. Spiegel, H., Shor, J., & Fishman, S. (1945). An hypnotic
    Scott, D. L. (1969). Hypnosis as an aid to anesthesia in children. ablation technique for the study of personality devel-
    Anesthesia, 24, 643-644. opment. Psychosomatic Medicine, 7, 273-278.
    Scott, M.J. (1960). Hypnosis in Skin & Allergic Diseases. Spiegel, H., & Spiegel, D. (1978). Trance & Treatment. New
    Springfield, IL: Charles C. Thomas. York: Basic Books.
    Secter, I. 1. (1964). Denial surgery in a psychiatric patient. Spinhoven, P., Baak, D., Van Dyck, R., & Vermeulen, P.
    American Journal of Clinical Hypnosis, 6, 363-371. (1988). The effectiveness of an authoritative versus
    Sheehan, P. W., & McConkey, K. M. (1982). Hypnosis & permissive style of hypnotic communication. International
    Experience: The Exploration of Phenomena & Process. Journal of Clinical & Experimental Hypnosis, 36(3),
    Hillsdale, N.J.: Lawrence Erlbaum. 182-191.
    Shewchuk, L. A., Durren, R., Burton, D., Forman, M., Clark,, R. Stalb, A. R., & Logan, D. R. (1977). Hypnotic stimulation of
    R., & Jaffin, A. R. (1977). Preliminary observations on an breast growth. American Journal of Clinical Hypnosis,
    intervention program for heavy smokers. 19, 201-208.
    International Journal of Addictions, 12,
    REFERENCES 575

    Stanton, H. (1975). Weight loss through hypnosis. American warts. Archives of General Psychiatry, 28, 439-441.
    Journal of Clinical Hypnosis, 18, 34-38. Susskind, D. J. (1970). The idealized self-image (ISI): A new
    Stanton, H. E. (1977). The utilization of suggestions derived technique in confidence training. Behavior Therapy, 1,
    from rational-emotive therapy. International Journal of 538-541.
    Clinical & Experimental Hypnosis, 25(1), 18-26. Swiercinsky, D., & Coe, W. (1971). The effect of "alert"
    Stanton, H. E. (1978). A one-session hypnotic approach to hypnosis and hypnotic responsiveness on reading com-
    modifying smoking behavior. International Journal of prehension. International Journal of Clinical & Exper-
    Clinical & Experimental Hypnosis, 26, 22-29. imental Hypnosis, 19(3), 146-153.
    Stanton, H. E. (1989). Ego-enhancement: A five-step approach. Sylvester, S. M. (1985). Fear in the management of pain:
    American Journal of Clinical Hypnosis, 31(3), 192-198. Preliminary report of a research project. Chapter in J. K.
    Staples, E. A., & Wilensky, H. (1968). A controlled Rorschach Zeig (Ed.), Ericksonian Psychotherapy: Volume II New
    investigation of hypnotic age regression. Journal of York: Brunner/Mazel, pp. 464-472.
    Projective Techniques, 32, 246-252. Tasini, M. F., & Hackett, T. P. (1977). Hypnosis in the
    Stein, C. (1963). The clenched fist technique as a hypnotic treatment of warts in immunodeficient children. American
    procedure in clinical psychotherapy. American Journal of Journal of Clinical Hypnosis, 19, 152-154.
    Clinical Hypnosis, 6, 113-119. Taylor, A. (1950). The differentiation between simulated and
    Stein, C. (1972). Hypnotic projection in brief psychotherapy. true hypnotic regression by figure drawings. Unpublished
    American Journal of Clinical Hypnosis, 14, 143-155. masters thesis, The City University of New York.
    Stein, V. T. (1980). Hypnotherapy of involuntary movements in Taylor, C. B., Farquhar, J. W., Nelson, E., & Agras, S. (1977).
    an 82-year-old male. American Journal of Clinical Relaxation therapy and high blood pressure. Archives of
    Hypnosis, 23(2), 128-131. General Psychiatry, 34, 339-342.
    Steinberg, S. (1965). Hypnoanesthesia —A case report in a 90 Terman, S. A. (1980). Hypnosis in depression. Chapter in H.
    year old patient. American Journal of Clinical Hypnosis, Wain (Ed.), Clinical Hypnosis in Medicine. Chicago:
    7, 355. Symposia Specialists.
    Sternbach, R. A. (1982). Medical evaluation of patients with Thakur, K. (1984). Hypnotherapy for anorexia nervosa and
    chronic pain. Chapter in J. Barber & C. Adrian (Eds.), accompanying somatic disorders. Chapter in W. C. Wester
    Psychological Approaches to the Management of Pain. & A. H. Smith (Eds.), Clinical Hypnosis: A
    New York: Brunner/Mazel, pp. 21-39. Multidisciplinary Approach. Philadelphia: J. B. Lippincott,
    Stolzy, S., Couture, L. J., & Edmonds, H. L. (1986). Evidence of pp. 476-493.
    partial recall during general anesthesia. Anesthesia & Thomason, S. (1984). Do you remember your previous life's
    Analgesia, 65, S154. (Abstract) language in your present incarnation? American Speech,
    Stone, J. A., & Lundy, R. M. (1985). Behavioral compliance 59, 340-350.
    with direct and indirect body movement suggestions. Thomason, S. (1986-87). Past tongues remembered? Skeptical
    Journal of Abnormal Psychology, 94, 256-263. Inquirer, II, 367-375.
    Strupp, H. H. (1955). An objective comparison of Rogerian and Thoresen, C. E., & Mahoney, M. J. (1974). Behavioral
    psychoanalytic techniques. Journal of Consulting Self-Control. New York: Holt, Rinehart & Winston.
    Psychology, 19, 1-7. Thorne, F. C. (1967). Integrative Psychology. Brandon, VT.:
    Stuart, F., & Hammond, D. C. (1980). Sex therapy. Chapter in Clinical Psychology Publishing Co.
    R. B. Stuart, Helping Couples Change. New York: Tinterow, M. M. (1960). The use of hypnotic anesthesia for a
    Guilford, pp. 301-366). major surgical procedure. American Surgery, 26, 732-737.
    Stuart, F., Hammond, D. C, & Pett, M. (1986). Psychological Toomey, T. C, & Sanders, S. (1983). Group hypnotherapy as an
    characteristics of women with inhibited sexual desire. active control strategy in chronic pain. American Journal
    Journal of Sex & Marital Therapy, 12(2), 108-115. of Clinical Hypnosis, 26(1), 20-25.
    Stuart, F., Hammond, D.C., & Pett, M. (1987). Inhibited sexual Tosi, D. J. (1973). Self directed behavior change in the
    desire in women. Archives of Sexual Behavior, 16(2), cognitive, affective, and behavioral motoric domains: A
    91-106. rational-emotive approach. Focus on Guidance,
    Stunkard, A. H., & McLaren-Hume, M. (1959). The results of December.
    treatment for obesity. Archives of Internal Medicine, 103, Truax, C. B., & Carkhuff, R. R. (1967). Toward Effective
    79-85. Counseling and Psychotherapy: Training & Practice.
    Surman, O. S., Gottlieb, S. K., & Hackett, T. P. (1972). Chicago: Aldine- Atherton.
    Hypnotic treatment of a child with warts. American Journal True, R. M. (1949). Experimental control in hypnotic age
    of Clinical Hypnosis, 15, 12-14. regression states. Science, 110, 583-584.
    Surman, O. S., Gottlieb, S. K., Hackett, T. P., & Silverberg, E. True, R. M., & Stephenson, C. W. (1951). Controlled
    L. (1973). Hypnosis in the treatment of experiments correlating electroencephalogram, pulse, and
    plantar reflexes with hypnotic age regression and induced
    emotional states. Personality, I, 252-263.
    576 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Tucker, K. R., & Virnelli, F. R. (1985). The use of hypnosis as a Clinical Hypnosis, 5(2), 79-82.
    tool in plastic surgery. Plastic & Reconstructive Surgery, Wark, D. M. (1989). Alert self-hypnosis techniques to improve
    76, 140-146. reading comprehension. Unpublished paper.
    Turk, D. C. (1980). A cognitive-behavior approach to pain Watkins, H. H. (1976). Hypnosis with smoking: A five-session
    management. Paper presented at the American Pain approach. International Journal of Clinical &
    Society, New York, 1980. Experimental Hypnosis, 24, 381-390.
    Unestahl, L. E. (1983). The Mental Aspects of Gymnastics. Watkins, H. H. (1980). The silent abreaction. International
    Orebro, Sweden: Veje Publishers. Journal of Clinical & Experimental Hypnosis, 28(2),
    Van Denburg, E., & Kurtz, R. (1989). Changes in body attitude 101-113.
    as a function of posthypnotic suggestions. International Watkins, J. G. (1949). Hypnotherapy of War Neuroses. New
    Journal of Clinical & Experimental Hypnosis, 37, 15-30. York: Ronald Press.
    Van der Hart, O. (1981). Treatment of a phobia for dead birds: A Watkins, J. G. (1971). The affect bridge: A hypnoanalytic
    case report. American Journal of Clinical Hypnosis, 23, technique. International Journal of Clinical & Exper-
    263-265. imental Hypnosis, 19, 21-27.
    Van der Hart, O. (1985). Metaphoric hypnotic imagery in the Watkins, J. G. (1986). Hypnotherapeutic Techniques, The
    treatment of functional amenorrhea. American Journal of Practice of Clinical Hypnosis, Volume I. New York:
    Clinical Hypnosis, 27(3), 159-165. Irvington.
    Van der Kolk, B. A. (1984). Post-Traumatic Stress Disorder: Watkins, J. G. (in press). Hypnotherapeutic Techniques:
    Psychological & Biological Sequelae. Washington, D.C.: Volume II, Hypnoanalytic Techniques. New York:
    American Psychiatric Association. Irvington.
    Van Dyke, P. B. (1970). Some uses of hypnosis in the Waxman, D. (1978). Misuse of hypnosis. British Medical
    management of the surgical patient. American Journal of Journal, 2, 571.
    Clinical Hypnosis, 12, 227-232. Waxman, D. (1989). Hartland's Medical & Dental Hypnosis
    Van Gorp, W. G., Meyer, R. G., & Dunbar, K. D. (1985). The (Third Edition). London: Bailliere Tindall.
    efficacy of direct versus indirect hypnotic induction Weitzenhoffer, A. M. (1964). Explorations in hypnotic time
    techniques on reduction of experimental pain. distortions. I. Acquisitions of temporal reference frames
    International Journal of Clinical & Experimental Hyp- under conditions of time distortion. Journal of Nervous &
    nosises, 319-328. Mental Disease, 138, 354.
    Vingoe, F. J. (1968). The development of a group alert-trance Weitzenhoffer, A. M. (1989). The Practice of Hypnotism,
    scale. International Journal of Clinical & Experimental Volume 1 &2. New York: Wiley.
    Hypnosis, 16(2), 120-132. Werbel, E. W. (1960). Experiences with frequent use of
    Wadden, T. A., & Anderton, C. H. (1982). The clinical use of hypnosis in a general surgical practice. Western Journal of
    hypnosis. Psychological Bulletin, 91, 215-243. Surgical Obstetrics & Gynecology, 68, 190-191.
    Wadden, T. A., & Flaxman, J. (1981). Hypnosis and weight Werbel, E. W. (1963). Use of posthypnotic suggestions to
    loss: A preliminary study. International Journal of Clinical reduce pain following hemorrhoidectomies. American
    & Experimental Hypnosis, 29, 162-173. Journal of Clinical Hypnosis, 6(2), 132-136.
    Wagenfeld, J., & Carlson, W. (1979). Use of hypnosis in the Werner, W. E. F., Schauble, P. G., & Knudson, M. S. (1982). An
    alleviation of reading problems. American Journal of argument for the revival of hypnosis in obstetrics.
    Clinical Hypnosis, 22(1), 51-56. American Journal of Clinical Hypnosis, 24, 149-171.
    Wagner, G., & Green, R. (1981). Impotence: Physiological, Wester, W. C. (1987). Hypnosis for smoking cessation. Chapter
    Psychological, Surgical Diagnosis <S Treatment. New in W. C. Wester, Clinical Hypnosis: A Case Management
    York: Plenum. Approach. Cincinnati: Behavioral Science Center Inc.
    Wakeman, R. J., & Kaplan, J. Z. (1978). An experimental study Publications, pp. 173-182.
    of hypnosis in painful burns. American Journal of Clinical Wester, W. C, & O'Grady, D. O. (Eds.), (in press). Clinical
    Hypnosis, 2/(1), 3-12. Hypnosis with Children. New York: Brunner/Mazel.
    Walch, S. L. (1976). The red balloon technique of White, R., Fox, G., & Harris, W. (1940). Hypnotic hypermnesia
    hypnotherapy: A clinical note. International Journal of for recently learned material. Journal of Abnormal &
    Clinical & Experimental Hypnosis, 24(1), 10-12. Social Psychology, 35, 88-.
    Walker, B. B. (1983). Treating stomach disorders: Can we Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). Controlled
    reinstate regulatory processes? In R. Hozl & W. E. trial of hypnotherapy in the treatment of service refractory
    Whitehead (Eds.), Psychophysiology of the irritable-bowel syndrome. Lancet, 2, 1232-1233.
    Gastrointestinal Tract: Experimental & Clinical Appli- Whorwell, P. J., Prior, A., Colgan, S. M. (April 1987).
    cations. New York: Plenum, pp. 209-233. Hypnotherapy in severe irritable bowel
    Walker, L. G., Dawson, A. A., Pollet, S. M., Ratcliffe, M. A., & syndrome:
    Hamilton, L. (1988). Hypnotherapy for chemotherapy
    side effects. British Journal of Experimental &
    REFERENCES 577

    Further experience. Gut, 28(4), 423-425. Young, M. H., & Montano, R. J. (1988). A new
    Wiggins, S. L., & Brown, C. W. (1968). Hypnosis with two hypnobehavioral method for the treatment of children with
    pedicle graft cases. International Journal of Clinical & Tourette's disorder. American Journal of Clinical
    Experimental Hypnosis, 16, 215. Hypnosis, 31(2), 97-106.
    Willard, R. D. (1977). Breast enlargement through visual Young, P. C. (1940). Hypnotic regression —Fact or artifact?
    imagery and hypnosis. American Journal of Clinical Journal of Abnormal & Social Psychology, 35, 273-278.
    Hypnosis, 19, 195-200. Zahm, D. N. (1987). Hypnosis in the treatment of tourette
    Williams, J. E. (1973). Stimulation of breast growth by syndrome. Chapter in W. C. Wester, Clinical Hypnosis: A
    hypnosis. Journal of Sex Research, 10, 316-326. Case Management Approach. Cincinnati: Behavioral
    Willis, D. C. (1972). The effects of self-hypnosis on reading rate Science Center, pp. 319-331.
    and comprehension. American Journal of Clinical Zeig, J. (1980). Erickson's use of anecdotes. Chapter in: J. Zeig
    Hypnosis, 14(4), 249-255. (Ed.), A Teaching Seminar with Milton H. Erickson, MD.
    Wilson, 1. (1982). All in the Mind. Garden City, N.Y.: New York: Brunner/Mazel, pp. 3-28.
    Doubleday. Zelling, D. A. (1986). Snoring: A disease of the listener.
    Wingfield, H. E. (1920). An Introduction to the Study of Journal of the American Academy of Medical
    Hypnotism. London: Balliere Tindall. Hypnoanalysis, 1(2), 99-101.
    Witztum, E., Van der Hart, O., & Friedman, B. (1988). Journal Ziegenfuss, W. B. (1962). Hypnosis: A tool for education.
    of Contemporary Psychotherapy, 18(4), 270-290. Education, 82, 505-507.
    Wogan, N., & Norcross, J. C. (1985). Dimensions of therapeutic Zilbergeld, B., & Ellison, C. R. (1980) Desire discrepancies and
    skills and techniques: Empirical identification, therapist arousal problems in sex therapy. Chapter in S. R. Leiblum
    correlates, and predictive utility. Psychotherapy, 22, & L. A. Pervin (Eds.), Principles & Practice of Sex
    63-64. Therapy. New York: Guilford, 65-101.
    Wolberg, L. R. (1948). Medical Hypnosis. Vol. 1&2. New York: Zilbergeld, B., & Evans, M. (1980, August). The inadequacy of
    Grune & Stratton. Masters & Johnson. Psychology Today, 14(3), 28-43.
    Wolberg, L. (1954, 1967, 1987). The Technique of Psycho- Zilbergeld, B., & Hammond, D. C. (1988). The use of hypnosis
    therapy. Orlando: Grune & Stratton. in treating desire problems. Chapter in S. R. Leiblum & R.
    C. Rosen (Eds.), Sexual Desire Disorders. New York:
    Wolberg, L. R. (1964). Hypnoanalysis. New York: Grune &
    Guilford Press, 192-225.
    Stratton.
    Zilbergeld, B., & Lazarus, A. A. (1987). Mind Power. Getting
    Wolberg, L. R. (Ed.). (1965). Short-Term Psychotherapy. New
    What you Want Through Mental Training. Boston: Little,
    York: Grune & Stratton.
    Brown & Co.
    Wolfe, L. S., & Millet, J. B. (1960). Control of postoperative Zimbardo, P. G., Marshall, G., & Maslach, C. (1971).
    pain by suggestion under general anesthesia. American Liberating behavior from time-bound control: Expanding
    Journal of Clinical Hypnosis, 3, 109-112. the present through hypnosis. Journal of Applied Social
    Wollman, L. (1960). The role of hypnosis in the treatment of Psychology, 1, 305-323.
    infertility. British Journal of Medical Hypnotism, 2, 3. Zimmer, E. Z., Peretz, B. A., Eyal, E., & Fuchs, K. (1988). The
    Wright, M. E. (1987). Clinical Practice of Hypnotherapy. New influence of maternal hypnosis on fetal movements in
    York: Guilford. anxious pregnant women. European Journal of Obstetrics
    Yapko, M. D. (1986). Hypnotic and strategic interventions in & Gynecology & Reproductive Biology, 27(2), 133-137.
    the treatment of anorexia nervosa. American Journal of Zisook, S., & DePaul, R. A. (1977). Emotional factors in
    Clinical Hypnosis, 28(4), 224-232. inflammatory bowel disease. Southern Medical Journal,
    Yapko, M. D. (1988). When Living Hurts: Directives for 70, 716-719.
    Treating Depression. New York: Brunner/Mazel.
    CREDITS
    Chapter 3 Toomey, T. C, and Sanders, S. (1983). Group hypnotherapy as an
    active control strategy in chronic pain. American Journal of
    Clinical Hypnosis, 26\l), 20-25.
    Techniques of Hypnotic Pain Management was reprinted with permission Quotes in Erickson's Interspersal Technique for Pain were adapted with
    from: Barber, J., and Adrian, C. (1982). Psychological permission from: Erickson, M. H. (1966). The interspersal
    Approaches to the Management of Pain. New York: hypnotic technique for symptom correction and pain control.
    Brunner/Mazel. American Journal of Clinical Hypnosis, 8, 198-209.
    Pain Reduction was reprinted with permission from: Jencks, B. (1977).
    Altering the Quality of Discomfort: Example of Leg Pain was reprinted
    Your Body: Biofeedback at its Best. Chicago: Nelson-Hall.
    with permission from: Wright, M. E. (1987). Clinical Practice of
    Hypnotherapy. New York: Guilford Press. "Body Lights" Approach to Ameliorating Pain and Inflammation
    Transformation of Pain was reprinted with permission from: Golden, W. (Arthritis) was reprinted with permission from: Rossi, E. L., and
    L., Dowd, E. T., and Friedberg, F. (1987). Hypnotherapy: A Cheek, D. B. (1988). Mind-Body Therapy. New York: W. W.
    Norton.
    Modern Approach. New York: Pergamon Press.
    Suggestions with Postherpetic Neuralgia ("Shingles") is copyrighted
    Erickson's Suggestions for Pain Control were reprinted with permission
    from: (a) Erickson, M. H. (1983). Healing in Hypnosis: The (1989) by Diane Roberts Stoler, Ed.D. and all rights are reserved.
    No portion of this material may be reproduced, republished or
    Seminars, Workshops, and Lectures of Milton H. Erickson, Volume
    used for any commercial purpose without permission of Diane
    I. Edited by E. L. Rossi, M. O. Ryan, and F. A. Sharp. New York:
    Irvington, (b) Erickson, M. H. (1985). Life Reframing in Hypnosis: Roberts Stoler.
    The Seminars. Workshops and Lectures of Milton H. Erickson, Suggestions to Reduce Pain Following Hemorrhoidectomies was
    Volume 2. Edited by E. L. Rossi and M. O. Ryan. New York: reprinted with permission from: Werbel, E. W. (1963). Use of
    Irvington, (c) Erickson, M. H. (1986). Mind-Body Communication posthypnotic suggestions to reduce pain following
    in Hypnosis: The Seminars, Workshops, and Lectures of Milton H. hemorrhoidectomies. American Journal of Clinical Hypnosis,
    Erickson, Volume 3. Edited by E. L. Rossi and M. O. Ryan. New 6(2), 132-136.
    York: Irvington. Suggestions for Pain Control was reprinted with permission from:
    Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria.
    General Principles for Alleviating Persistent Pain was reprinted with
    New York: Plenum Press.
    permission from: Rossi, E. L., and Cheek, D. B. (1988).
    Suggestions with Migraine was reprinted with permission from:
    Mind-Body Therapy. New York: W. W. Norton.
    Anderson, J. A. D., Basker, M. A., and Dalton, R. (1975).
    Religious Imagery of Universal Healing for Ego-Strengthening and Pain
    Migraine and hypnotherapy. International Journal of Clinical
    was reprinted with permission from: Wright, M. Erik. (1987).
    and Experimental Hypnosis, 230). 48-58.
    Clinical Practice of Hypnotherapy. New York: Guilford Press, pp.
    167-168. Diminution Rather than Elimination of Headache was reprinted with
    permission from: Secter, I. 1. (1964). Dental surgery in a
    The "Sympathetic Ear" Technique with Chronic Pain was adapted with psychiatric patient. American Journal of Clinical Hypnosis, 6.
    permission from: Fogel, B. S. (1984). The "sympathetic ear": Case 363-371.
    reports of a self-hypnotic approach to chronic pain, American
    Suggestion for Symptom Substitution was reprinted with permission
    Journal of Clinical Hypnosis, 27(2), 103-106.
    from: Elkins, G. R. (1984). Hypnosis in the treatment of
    Reactivation of Pain-Free Memories: An Example of Intensifying and myofibrositis and anxiety: A case report. American Journal of
    Relieving Pain was reprinted with permission from: Wright, M. E. Clinical Hypnosis. 27(1), 26-30.
    (1987). Clinical Practice of Hypnotherapy. New York: Guilford.
    Hypnotically Elicited Mystical States in Treating Physical and Emotional
    Pain was reprinted with permission from: Sacerdote, P. (1977).
    Applications of hypnotically elicited mystical states to the
    Chapter 4
    treatment of physical and emotional pain. International Journal of
    Clinical and Experimental Hypnosis, 25(4), 309-324. Hypnosis and the Anesthetist was reprinted with permission from
    Active Control Strategy for Group Hypnotherapy with Chronic Pain American Journal of Clinical Hypnosis, 1965, 8, 34-36.
    was adapted with permission of publisher from: Summary Steps for Preoperative Hypnosis to Facilitate Healing was
    reprinted with permission from: Rossi, E. L., and Cheek, D.
    B. (1988). Mind-Body Therapy. New York: W. W. Norton.
    Ericksonian Approaches in Anesthesiology was reprinted
    with
    permission from: Rodger, B. P. (1982). Ericksonian
    ap-

    579
    580 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    proaches in anesthesiology. Chapter in J. K. Zeig (Ed.), Suggestions for Self-Reinforcement was reprinted with permission from:
    Ericksonian Approaches to Hypnosis and Psychotherapy. New Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria. New
    York: Brunner/Mazel. (Quotes taken from pp. 317-321, 323-328.) York: Plenum Press.
    Examples of Preoperative Suggestions was reprinted with permission
    from: Barber, J., and Adrian, C. (1982). Psychological Approaches
    to the Management of Pain. New York: Brunner/Mazel.
    Preparation for Surgery was reprinted with permission from: Sylvester, Chapter 6
    S. M. (1985). Fear in the management of pain: Preliminary report
    of a research project. Chapter in J. K. Zeig (Ed.), Ericksonian
    Psychotherapy: Volume II. New York: Brunner/Mazel, pp. Methods of Relaxed Breathing was reprinted with permission from:
    464-472. Jencks, B. (1977). Your Body: Biofeedback al its Best. Chicago:
    Rapid Induction Analgesia was reprinted with permission from: Barber, Nelson-Hall, pp. 139-143.
    J. (1977). Rapid induction analgesia: A clinical report. American The Autogenic Rag Doll was reprinted with permission from: Jencks, B.
    Journal of Clinical Hypnosis, 19, 138-147. (1973). Exercise Manual for J. H. Schultz's Standard Autogenic
    Surgical and Obstetrical Analgesia was reprinted with permission from: Training and Special Formulas with Appendixes on Procedures
    Rossi, E. L., and Cheek, D. B. (1988). Mind-Body Therapy. with Children and Advanced Autogenic Training. Des Plaines,
    New York: W. W. Norton. Illinois: American Society of Clinical Hypnosis, pp. 42-44.
    Techniques for Surgery was reprinted with permission from: Kroger, W. Rational-Emotive Suggestions About Anxiety was reprinted with
    S. (1977). Clinical and Experimental Hypnosis (Second Edition). permission from: Ellis, A. (1986). Anxiety about anxiety: The use
    Philadelphia: J. B. Lippincott. of hypnosis with Rational-Emotive Therapy. Chapter in E. T.
    Dowd and J. M. Healy (Eds.), Case Studies in Hypnotherapy.
    New York: Guilford, pp. 3-11.
    The Closed Drawer Metaphor was reprinted with permission from:
    Chapter 5 Alman, B. M. (1983). Self-Hypnosis: A Complete Manual for
    Health and Self-Change. San Diego: International Health
    Publications, pp. 118-119.
    Suggestions for Raising Self-Esteem was reprinted with permission from: He Who Hesitates Is Lost: A Metaphor for Decision-Making was
    Barber, T. X. (1984). Hypnosis, deep relaxation, and active reprinted with permission from: Yapko, M. D. (1988). When
    relaxation: Data, theory, and clinical applications. Chapter in R. L. Living Hurts: Directives for Treating Depression. New York:
    Woolfolk and P. M. Lehrer, Principles and Practice of Stress Brunner/Mazel.
    Management. New York: Guilford Press, pp. 164-166. De-Fusing Panic was reprinted with permission from: Hunter, M. E.
    Barnett's Yes-Set Method of Ego-Strengthening was adapted with (1988). Daydreams for Discovery: A Manual for Hypnotherapists.
    permission from: E. A. Barnett, Analytical Hypnotherapy. Vancouver: Sea Walk Press.
    Kingston, Ontario, Canada: Junica, 1981. A Reframing Approach for Flight Phobia was reprinted with permission
    Ego-Enhancement: A Five-Step Approach was adapted with permission from: Bakal, P. A. (1981). Hypnotherapy for flight phobia.
    from: Stanton, H. E. (1989). Ego-enhancement: A five-step American Journal of Clinical Hypnosis, 23(4), 248-251.
    approach. American Journal of Clinical Hypnosis, 5/(3), Hypnosis with Phobic Reactions was reprinted with permission from:
    192-198. Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria
    Suggestions Derived from Rational-Emotive Therapy was reprinted with New York: Plenum Press.
    permission from: Stanton, H. E. (1977). The utilization of Example of Treating Phobic Anxiety with Individually Prepared Tapes
    suggestions derived from rational-emotive therapy. International was reprinted with permission from: Wright, M. E. (1987).
    Journal of Clinical and Experimental Hypnosis, 25(\), 18-26. Clinical Practice of Hypnotherapy. New York: Guilford Press.
    Suggestions to Facilitate Problem Solving was reprinted with permission Treatment of Lack of Confidence and Stage Fright was reprinted with
    from: Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria permission from: Waxman, D. (1989). Hartland's Medical and
    New York: Plenum Press. Dental Hypnosis (Third Edition). London: Bailliere Tindall, pp.
    An Abstract Technique for Ego-Strengthening was reprinted with 295-297.
    permission from: Gorman, B. J. (1974). An abstract technique for Overcoming Anxiety over Public Speaking was reprinted with
    ego-strengthening. American Journal of Clinical Hypnosis, permission from: Gibbons, D. E. (1979). Applied Hypnosis and
    16(3), 209-212. Hyperempiria New York: Plenum Press.
    The Prominent Tree Metaphor was reprinted with permission from: Suggestions with TMJ and Bruxism was reprinted with permission from:
    Pelletier, A. M. (1979). Three uses of guided imagery in hypnosis. Golan, H. P. (1989). Temporomandibular joint disease treated
    American Journal of Clinical Hypnosis, 22(1), 32-36. with hypnosis. American Journal of Clinical Hypnosis, 31(4),
    269-274.
    The Seasons of the Year: A Metaphor of Growth was reprinted with
    permission from: Gindhart, L. R. (1981). The use of a metaphoric Erickson's Suggestions with Bruxism was reprinted with permission
    story in therapy: A case report. American Journal of Clinical from: Erickson, M. H. (1985). Life Reframing in Hypnosis. Edited
    Hypnosis, 23(3), 202-206. by E. L. Rossi and M. O, Ryan. New York: Irvington, pp. 39-40.
    Suggestions for Emotional Enrichment was reprinted with permission Suggestions to Promote Dental Flossing was reprinted with permission
    from: Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria from: Kelly, M. A., McKinty, H. R., and Carr, R. (1988).
    New York: Plenum Press. Utilization of hypnosis to promote compliance with routine dental
    Stein's Clenched Fist Technique was adapted from: Stein, C. (1963). The flossing. American Journal of Clinical Hypnosis, 31(1),
    clenched fist technique as a hypnotic procedure in clinical 57-60.
    psychotherapy. American Journal of Clinical Hypnosis, 6. Imagery with Hypersensitive Gag Reflex was reprinted with permission
    113-119. from: Clarke, J. H., and Persichetti, S. J. (1988). Hypnosis and
    Suggestions for Ego-Strengthening was adapted with permission from: concurrent denture construction for a patient with a hypersensitive
    Hartland, John. (1971). Further observations on the use of gag reflex. American Journal of Clinical Hypnosis, 30(4),
    "ego-strengthening" techniques. American Journal of Clinical 285-288.
    Hypnosis, 14, 1-8. The copyright for Denture Problems and Gagging is reserved by the
    author.
    CREDITS 581

    Illustrative Suggestions with Tooth Extraction was reprinted with Suggestions for Vaginal Warts is copyrighted 1989, by Diane Roberts
    permission from: Finkelstein, S. (1984). Hypnosis and dentistry. Stoler, Ed.D. All rights reserved. No portion of this material may
    Chapter in W. C. Wester II, and A. H. Smith, Jr. (Eds.), Clinical be reproduced, republished or used for any commercial purpose
    Hypnosis: A Multidisciplinary Approach Philadelphia: J. B. without permission of Diane Roberts Stoler.
    Lippincott, pp. 337-349. Suggestions with Condyloma Acuminatum (Genital Warts) was
    Dental Hypnosis was adapted and reprinted with permission from Rausch, reprinted with permission from: Ewin, D. M. (1974). Condyloma
    V. (1987). Dental hypnosis. Chapter in W. C. Wester, Clinical acuminatum: Successful treatment of four cases by hypnosis.
    Hypnosis: A Case Management Approach Cincinnati: Behavioral American Journal of Clinical Hypnosis, 17(2), 73-78.
    Science Center Publications, pp. 85-95. Suggestions for Immunodeficient Children with Warts was reprinted
    Suggestions for Operative Hypnodontics was reprinted with permission with permission from: Tasini, M. F., and Hackett, T. P. (1977).
    from: Kroger, W. S. (1977). Clinical and Experimental Hypnosis Hypnosis in the treatment of warts in immunodeficient children.
    (Second Edition). Philadelphia: J. B. Lippincott. American Journal of Clinical Hypnosis, 190), 152-154.
    Erickson's Approach with Bruxism in Children was reprinted with Evoking Helpful Past Experiences and Medical Treatments: Example
    permission from: Erickson, M. H. (1983). Healing in Hypnosis. with Skin Rash was reprinted with permission from: Wright, M.
    Edited by E. L. Rossi, M. O. Ryan, and F. A. Sharp. New York: E. (1987). Clinical Practice of Hypnotherapy. New York:
    Irvington, pp. 123-124. Guilford Press, pp. 66-67.
    Suggestions with Pruritus was reprinted with permission from: Kroger,
    W. S., and Fezler, W. D. (1976). Hypnosis and Behavior
    Chapter 7 Modification: Imagery Conditioning. Philadelphia: J. B.
    Lippincott.
    Suggestions with Burn Patients was reprinted with permission from:
    Clinical Issues in Controlling Chemotherapy Side Effects was adapted
    with permission from: Redd, W. H., Rosenberger, P. H., and Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    Principles and Applications (Second Edition). Orlando: Grune
    Hendler, C. S. (1983). Controlling chemotherapy side effects.
    and Stratton.
    American Journal of Clinical Hypnosis, 25, 161-172.
    Emergency Hypnosis for the Burned Patient was reprinted with
    Suggestions for Chemotherapy Patients was reprinted with permission
    from: Levitan, A. A. (1987). Hypnosis and oncology. Chapter in permission from: Ewin, D. M. (1983). Emergency room hypnosis
    W. C. Wester, Clinical Hypnosis: A Case Management Approach for the burned patient. American Journal of Clinical Hypnosis,
    Cincinnati: Behavioral Science Center, pp. 332-356. 26, 5-8.
    Hypnosis in Painful Burns was adapted with permission from: Wakeman,
    Hypnotic Suggestions with Cancer Patients was reprinted with
    permission from: Crasilneck, H. B., and Hall, J. A. (1985). R. J., and Kaplan, J. Z. (1978). An experimental study of hypnosis
    Clinical Hypnosis: Principles and Applications (Second Edition). in painful burns. American Journal of Clinical Hypnosis, 21(1),
    Orlando: Grune and Stratton. 3-12.
    Ideomotor Healing of Burn Injuries was reprinted with permission from:
    Imagery to Enhance the Control of the Physiological and Psychological
    "Side Effects" of Cancer Therapy was adapted with permission Rossi, E. L., and Cheek, D. B. (1988). Mind-Body Therapy. New
    from: Rosenberg, S. W. (1983). Hypnosis in cancer care: Imagery York: W. W. Norton.
    to enhance the control of the physiological and psychological Direct Suggestions in Emergencies with the Critically III was reprinted
    "side-effects" of cancer therapy. American Journal of Clinical with permission from: Rossi, E. L., and Cheek,
    Hypnosis, 25(2-3), 122-127. D. B. (1988). Mind-Body Therapy. New York:
    W. W.
    Breast Cancer: Radiation Treatment and Recovery, copyright 1989 by
    Diane Roberts Stoler. All rights reserved. No portion of this Norton.
    material may be reproduced, republished or used for any Suggestions for Use of Spontaneous Trances in Emergency Situations
    commercial purpose without permission of author. was reprinted with permission from: Wright, M. E. (1987).
    Hypnosis as an Adjunct to Chemotherapy in Cancer was reprinted with Clinical Practice of Hypnotherapy. New York: Guilford.
    permission from: Rosen, S. (1985). Hypnosis as an adjunct to Painless Wound Injection Through Use of a Two-finger Confusion
    chemotherapy in cancer. Chapter in J. K. Zeig (Ed.), Ericksonian Technique was reprinted with permission from: Bierman, S. F.
    Psychotherapy: Volume II. New York: Brunner/Mazel, pp. (1988). Painless wound injection through use of a two-finger
    387-397. confusion technique. American Journal of Emergency Medicine,
    Hypnotic Death Rehearsal was adapted with permission from: Levitan, 6(3), 266-267.
    A. A. (1985). Hypnotic death rehearsal, American Journal of Symphony Metaphor was reprinted with permission from: Hunter, M. E.
    Clinical Hypnosis, 27(4), 211-215. (1988). Daydreams for Discovery: A Manual for
    Hypnotherapists. Vancouver: Sea Walk Press.
    Healing Imagery was reprinted with permission from: Hunter, M.
    Chapter 8 E. (1988).
    for
    Daydreams for Discovery: A Manual

    Hypnotherapists. Vancouver: SeaWalk Press.


    Erickson's Reframing Suggestion with Pruritus was reprinted with Prolonged Hypnosis in Psychosomatic Medicine was reprinted with
    permission from: Erickson, M. H., and Rossi, E. L. (1979). permission from: Kuriyama, K. (1968). Clinical applications of
    Hypnotherapy: An Exploratory Casebook. New York: Irvington, prolonged hypnosis in psychosomatic medicine. American
    p. 227. Journal of Clinical Hypnosis, 11(2), 101-111.
    Suggestions for Itching was reprinted with permission from: Jencks, B. Further Suggestions for Facilitating Prolonged Hypnosis was reprinted
    (1977). Your Body: Biofeedback at its Best. Chicago: with permission from: Kratochvil, S. (1970). Prolonged hypnosis
    Nelson-Hall. and sleep. American Journal of Clinical Hypnosis, 72(4).
    Hypnotic Technique for Treating Warts was reprinted with permission 254-260.
    from Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis: Vascular Control Through Hypnosis was reprinted with permission from:
    Principles and Applications (Second Edition). Orlando: Grune and Bishay, E. G.. and Lee, C. (1984). Studies of the effects of
    Stratton, pp. 374-375. hypnoanesthesia on regional blood flow by transcutaneous
    Suggestions for Warts (Modeled after Hartland) was reprinted with oxygen monitoring. American Journal of Clinical Hypnosis,
    permission from: Gibbons, D. E. (1979). Applied Hypnosis and 27(1), 64-69.
    Hyperempiria. New York: Plenum. Suggestion for Control of Bleeding was reprinted with permission from:
    Erickson, M. H. (1985). Life Reframing in Hypnosis.
    582 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Edited by E. L. Rossi and M. O. Ryan. New York: Irvington, p. 121. Management of Antenatal Hypnotic Training was reprinted with
    Suggestions for Control of Upper Gastrointestinal Hemorrhage was permission from: Waxman, D. (1989). Hartland's Medical and
    reprinted with permission from: Bishay, E. G., Stevens, G., and Lee, Dental Hypnosis (Third Edition). London: Bailliere Tindall.
    C. (1984). Hypnotic control of upper gastrointestinal hemorrhage: A Erickson's Childbirth Suggestions was reprinted with permission from:
    case report. American Journal of Clinical Hypnosis, 27(1), Rossi, E. L., and Ryan, M. O. (1986). Mind-Body
    22-25. Communication in Hypnosis: The Seminars, Workshops, and
    Teaching the Other Side of the Brain was reprinted with permission Lectures of Milton H. Erickson. Volume III. New York: Irvington,
    from: Hunter, M. E. (1988). Daydream for Discovery: A Manual for pp. 120-121.
    Hypnotherapists. Vancouver: SeaWalk Press, Ltd. An Ericksonian Approach to Childbirth was reprinted with permission
    Once Learned, Can Be Relearned was reprinted with permission from: from: Poncelet, N. M. (1985). An Ericksonian approach to
    Hunter, M. E. (1988). Daydream for Discovery: A Manual for childbirth. Chapter in J. K. Zeig (Ed.). Ericksonian
    Hypnotherapists. Vancouver: SeaWalk Press, Ltd. Psychotherapy: Volume II. New York: Brunner/Mazel, pp.
    Hypnosis with Blepharospasm was reprinted with permission from: 267-285.
    Murphy, J. K., and Fuller, A. K. (1984). Hypnosis and biofeedback Childbirth Script, copyright 1989 by Diane Roberts Stoler. All rights
    as adjunctive therapy in blepharospasm: A case report. American reserved. No portion of this material may be reproduced,
    Journal of Clinical Hypnosis, 27(1), 31-37. republished or used for any commercial purpose without
    Hypnotherapy for Lagophthalmos was reprinted with permission from: permission of Diane Roberts Stoler.
    Holroyd, J., and Maguen, E. (1989). And so to sleep: Hypnotherapy Preparation for Obstetrical Labor was reprinted with permission from:
    for Lagophthalmos. American Journal of Clinical Hypnosis, 31(4), Kroger, W. S. (1977). Clinical and Experimental Hypnosis
    264-266. (Second Edition). Philadelphia: J. B. Lippincott.
    Suggestions for Involuntary Muscle Jerking was reprinted with Suggestions with Untrained Patients in Labor was reprinted with
    permission from: Stein, V. T. (1980). Hypnotherapy of involuntary permission from: Rock, N. L., Shipley. T. E., and Campbell, C.
    movements in an 82-year-old male. American Journal of Clinical (1969). Hypnosis with untrained nonvolunteer patients in labor.
    Hypnosis, 23(2), 128-131. International Journal of Clinical and Experimental Hypnosis,
    Suggestions for Insomnia was reprinted with permission from: I7(\), 25-36.
    Erickson, M. H. (1986). Mind-Body Communication in Hypnosis. Hypnotic Relaxation Technique for Premature Labor was reprinted
    Edited by E. L. Rossi and M. O. Ryan. New York: Irvington, pp. with permission from: Omer, H. (1987). A hypnotic relaxation
    145-146. technique for the treatment of premature labor. American
    Snoring: A Disease of the Listener was reprinted with permission from: Journal of Clinical Hypnosis, 290), 206-213.
    Zelling, D. A. (1986). Snoring: A disease of the listener. Journal of Use of Immediate Interventions to Uncover Emotional Factors in
    the American Academy of Medical Hypnoanalysis. 1(2). Pre-Abortion Conditions was reprinted with permission from:
    99-101. Cheek, D. B. (1986). Using hypnosis with habitual aborters.
    Hypnotic Techniques and Suggestions for Medical-Physical Com- Chapter in B, Zilbergeld, M. G. Edelstien, and D. L. Araoz
    plaints was reprinted with permission from: Jencks, B. (1977). Your (Eds.), Hypnosis: Questions and Answers. New York: Norton,
    Body: Biofeedback at its Best. Chicago: Nelson-Hall. 1986, pp. 330-336.
    Paradoxical Self-Hypnotic Assignment for Chronic Urinary Retention Suggestions for Hyperemesis was reprinted with permission from:
    or "Bashful Bladder" was reprinted with permission from: Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    Mozdzierz, G. J. (1985). The use of hypnosis and paradox in the Principles and Applications (Second Edition). Orlando: Grune
    treatment of a case of chronic urinary retention/"bashful bladder." and Stratton.
    American Journal of Clinical Hypnosis, 28(1), 43-47. Suggestions for Hyperemesis Gravidarum was reprinted with per-
    Hypnosis in Postoperative Urinary Retention was adapted with mission from: Waxman, D. (1989). Hartland's Medical and
    permission from: Chiasson, S. W. (1964). Hypnosis in postoperative Dental Hypnosis (Third Edition). London: Bailliere Tindall.
    urinary retention. American Journal of Clinical Hypnosis,6, Suggestions with Psychogenic Amenorrhea was reprinted with
    366-368. permission from: Kroger, W. S. (1977). Clinical and Exper-
    Hypnotic Paradigm-Substitution with Hypochondriasis was reprinted imental Hypnosis (Second Edition). Philadelphia: J. B.
    with permission from: Deiker, T., and Counts, D. K. (1980). Lippincott.
    Hypnotic paradigm-substitution therapy in a case of Suggestions with Leukorrhea was reprinted with permission from:
    hypochondriasis. American Journal of Clinical Hypnosis, 23(2), Leckie, F. H. (1965). Further gynecological conditions treated
    122-127. by hypnotherapy. International Journal of Clinical and
    Suggestions with Asthma was reprinted with permission from: Experimental Hypnosis, I3(1), 11-25.
    Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria. New
    York: Plenum.
    Erickson's Metaphor with Tinnitus was reprinted with permission from:
    Erickson, M. H., and Rossi. E. L. (1979). Hypnotherapy: An Chapter 10
    Exploratory Casebook. New York: Irvington, pp. 117-118.
    Responsibility to a Fault: A Metaphor for Overresponsibility was
    reprinted with permission from: Yapko, M. D. (1988). When
    Chapter 9 Living Hurts: Directives for Treating Depression. New York:
    Brunner/Mazel.
    Suggestions for a Comfortable Delivery was reprinted with permission Different Parts: A Metaphor was reprinted with permission from:
    from: Barber, J., and Adrian, C, (1982). Psychological Approaches Yapko. M. D. (1988). When Living Hurts: Directives for
    to the Management of Pain. New York: Brunner/Mazel, pp. Treating Depression. New York: Brunner/Mazel.
    174-176. Enhancing Affective Experience and Its Expression was reprinted with
    The Hypnoreflexogenous Technique in Obstetrics was reprinted with permission from: Brown, D. P., and Fromm, E. (1986).
    permission from: Fuller, A. K. (1986). A method for developing Hypnotherapy and Hypnoanalysis. Hillsdale, NJ: Lawrence
    suggestions from the literature. American Journal of Clinical Erlbaum, pp. 172-174.
    Hypnosis, 29(1), 47-52. Can Hypnosis Help Psychosis was reprinted with permission from:
    Hodge, J. R.(1988). Can hypnosis help psychosis? American
    Journal of Clinical Hypnosis, 30(4), 248-256.
    Suggestions for Creative Self-Mothering was reprinted with permis-
    sion from: Murray-Jobsis, J. (1984). Hypnosis with severely
    disturbed patients. Chapter in W. C. Wester II and A. H.
    CREDITS 583
    Smith, Jr., (Eds.), Clinical Hypnosis: A Multidisciplinary Further Suggestions for Management of Obesity was adapted with
    Approach. Philadelphia: J. B. Lippincott, pp. 368-404. permission from: Kroger, W. S. (1970). Comprehensive
    Hypnotherapeutic Techniques with Affective Instability was reprinted management of obesity. American Journal of Clinical Hypnosis,
    with permission from: Gruber, L. N. (1983). Hypnotherapeutic 12(2), 165-175.
    techniques with affective instability. American Journal of Clinical Erickson's Suggestions with Obesity were reprinted with permission
    Hypnosis, 25, 263-266. respectively from: (a) Erickson, M. H. (1983). Healing in
    Hypnotic Suggestions to Deter Suicide was reprinted with permission Hypnosis. Edited by E. L. Rossi, M. O. Ryan, and F. A. Sharp.
    from: Hodge, J. R. (1972). Hypnosis as a deterrent to suicide. New York: Irvington, p. 268. (b) Erickson, M. H. (1985). Life
    American Journal of Clinical Hypnosis, 15(1), 20-21. Reframing in Hypnosis. Edited by E. L. Rossi and M. O. Ryan.
    Hypnosis with Bipolar Affective Disorders was reprinted with New York: Irvington, p. 184. (c) Erickson, M. H., and Rossi, E. L.
    permission from: Feinstein, A. D., and Morgan, R. M. (1986). (1979). Hypnotherapy: An Exploratory Casebook. New York:
    Hypnosis in regulating bipolar affective disorders. American Irvington, p. 31.
    Journal of Clinical Hypnosis, 29(1), 29-38. Negative Accentuation: Vivifying the Negative During Trance was
    reprinted with permission from: Wright, M. E. (1987). Clinical
    Practice of Hypnotherapy. New York: Guilford.
    Suggestions to Modify Body Attitude was reprinted with permission
    Chapter 11 from: Van Denburg, E., and Kurtz, R. (1989). Changes in body
    attitude as a function of posthypnotic suggestions. International
    Hypnotherapy with Psychogenic Impotence was reprinted with Journal of Clinical and Experimental Hypnosis, 37, 15-30.
    permission from: Crasilneck, H. B. (1982). A follow-up study in Suggestions for Increasing Food Intake was reprinted with permission
    the use of hypnotherapy in the treatment of psychogenic from: Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    impotency. American Journal of Clinical Hypnosis, 25(1), 52-61. Principles and Applications (Second Edition). Orlando: Grune
    Changes in Preference Metaphor was reprinted with permission from: and Stratton.
    Hammond, D. C. Treatment of inhibited sexual desire. Chapter in Suggestions for Presenting Symptoms in Anorexia Nervosa was adapted
    J. K. Zeig (Ed.), Ericksonian Psychotherapy, Volume II, New with permission from: Gross, M. (1984). Hypnosis in the therapy
    York: Brunner/Mazel, 1985, pp. 415-428. of anorexia nervosa. American Journal of Clinical Hypnosis,
    Suggestions for Impotence and Anorgasmia was reprinted with 26(3), 175-181.
    permission from: Alexander, L. (1974). Treatment of impotency Metaphors for Bulimia and Anorexia was reprinted with permission
    and anorgasmia by psychotherapy aided by hypnosis. American from: Yapko, M. D. (1986). Hypnotic and strategic interventions
    Journal of Clinical Hypnosis, 17(\), pp. 34, 37, 29, 42. in the treatment of anorexia nervosa. American Journal of
    Suggestions with Sexual Dysfunctions was reprinted with permission Clinical Hypnosis. 28(4), 224-232.
    from: Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria
    New York: Plenum Press.
    Suggestions for Premature Ejaculation was reprinted with permission
    from: Erickson, M. H. (1973). Psychotherapy achieved by a
    Chapter 13
    reversal of the neurotic processes in a case of ejaculation praecox.
    American Journal of Clinical Hypnosis, 15(4), 219-221. Hypnosis and Smoking: A Five-Session Approach was reprinted with
    Hypnotic Ego-Assertive Retraining was reprinted with permission from: permission from: Watkins, H. H. (1976). Hypnosis and smoking:
    Waxman, D. (1989). Hartland's Medical and Dental Hypnosis A five-session approach. International Journal of Clinical and
    (Third Edition). London: Bailliere Tindall. Experimental Hypnosis, 24(4), 381-390.
    Suggestions to Increase Interpersonal Effectiveness was reprinted with Smoking Control was adapted from: Spiegel, H., and Spiegel, D. (1978).
    permission from: Gibbons, D. E. (1979). Applied Hypnosis and Trance and Treatment: Clinical Uses of Hypnosis. New York:
    Hyperempiria. New York: Plenum Press. Basic Books. (Reissued by American Psychiatric Press, Inc.,
    The Jazz Band Metaphor for Family Interaction was reprinted with 1987).
    permission from: Barker, P. (1985). Using Metaphors in Suggestions for Smoking Cessation was reprinted with permission from:
    Psychotherapy. New York: Brunner/Mazel, pp. 132-135. Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    Principles and Applications (Second Edition). Orlando: Grune
    and Stratton.
    Suggestions to Modify Smoking Behavior was reprinted with permission
    Chapter 12 from: Stanton, H. E. (1978). A one-session hypnotic approach to
    modifying smoking behavior. International Journal of Clinical
    Weight Control was adapted by the authors from: Spiegel, H., and and Experimental Hypnosis, 26(1), 22-29.
    Spiegel. D. (1978). Trance and Treatment: Clinical Uses of Suggestions for Smoking Cessation was adapted and reprinted with
    Hypnosis. New York: Basic Books. [Reissued by American permission from: Wester, W. C. (1987), Hypnosis for smoking
    Psychiatric Press, Inc., 1987]. cessation. Chapter in W. C. Wester, Clinical Hypnosis: A Case
    Suggestions for Decreasing Food Intake was reprinted with permission Management Approach. Cincinnati: Behavioral Science Center
    from: Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis: Inc. Publications, pp. 173-182.
    Principles and Applications (Second Edition). Orlando: Grune and General Strategies for Overcoming Pleasure-Producing Habits was
    Stratton, pp. 200, 430-431. reprinted with permission from: Wright, M. E. (1987). Clinical
    The First group of suggestions in Hypnosis in Weight Control was Practice of Hypnotherapy. New York: Guilford Press.
    reprinted with permission from Mann (1973), and the last Illustrative Suggestions with Smokers was reprinted with permission
    suggestions were adapted with permission from Mann (1981). from: Sacerdote, P. (1974). Convergence of expectations: An
    Weight Control Suggestions was reprinted with permission from: essential component for successful hypnotherapy. International
    Stanton, H. E. (1975). Weight loss through hypnosis. American Journal of Clinical and Experimental Hypnosis, 22(2), 95-115.
    Journal of Clinical Hypnosis, 18(2), 94-97. A Posthypnotic Suggestion and Cue With Smokers was reprinted with
    Miscellaneous Suggestions for Weight Control was reprinted with permission from: Alman, B. M. (1983). Self-Hypnosis: A
    permission from: Kroger, W. S., and Fezler, W. D. (1976). Complete Manual for Health and Self-Change. San Diego:
    Hypnosis and Behavior Modification: Imagery Conditioning. International Health Publications.
    Philadelphia: J. B. Lippincott. Hypnosis with Nailbiting was reprinted with permission from:
    Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    584 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS
    Principles and Applications (Second Edition). Orlando: Grune for Health and Self-Change. San Diego: International Health
    and Stratton. Publications.
    Erickson's Suggestions for Nailbiting was reprinted with permission A Cognitive-Hypnotic Approach to Athletic Performance with Weight
    from: Erickson. M. H. (1983). Healing in Hypnosis. Edited by E. Lifters was adapted with permission from: Howard, W. L., and
    L. Rossi, M. O. Ryan, and F. A. Sharp. New York: Irvington, pp. Reardon, J. P. (1986). Changes in the self concept and athletic
    259-260. performance of weight lifters through a cognitive-hypnotic
    Suggestions for Nailbiting was reprinted with permission from: approach: An empirical study. American Journal of Clinical
    Waxman, D. (1989). Hartland's Medical and Denial Hypnosis Hypnosis, 28(A), 248-257.
    (Third Edition). London: Bailliere Tindall. Suggestions for Sports Performance was reprinted with permission from:
    Suggestions for Nailbiting was reprinted with permission from: Gibbons, Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria. New
    D. E. (1979). Applied Hypnosis and Hyperempiria New York: York: Plenum Press.
    Plenum Press. Endurance Suggestions with Distance Runners was reprinted with
    Suggestions with Trichotillomania was reprinted with permission from: permission from: Jackson, J. A., Gass, G. C and Camp, E. M.
    Barabasz, M. (1987), Trichotillomania: A new treatment. (1979). The relationship between posthypnotic suggestion and
    International Journal of Clinical and Experimental Hypnosis,3S. endurance in physically trained subjects. International Journal of
    146- 154. Clinical and Experimental Hypnosis, 27(3), 278-293.
    Suggestions for Scalp Sensitivity with Trichotillomania was reprinted
    with permission from: Galski, T. J. (1981). The adjunctive use of
    hypnosis in the treatment of trichotillomania: A case report.
    American Journal of Clinical Hypnosis, 230), 198-201. Chapter 15

    Chapter 14 Helping Parents See Specific Advantages in Child Hypnotherapy was


    adapted and reprinted with permission from: Gardner, G. G.
    Suggestions for Enhancing Academic Performance was reprinted with (1974). Parents: Obstacles or allies in child hypnotherapy?
    permission from: Gibbons, D. E. (1979). Applied Hypnosis and American Journal of Clinical Hypnosis, 17(1), 44-49.
    Hyperempiria New York: Plenum Press. Techniques of Hypnoanalgesia was reprinted with permission from:
    Suggestion for Concentration was reprinted with permission from: Olness, K., and Gardner, 0. G. (1988). Hypnosis and
    Alman, B. M. (1983). Self-Hypnosis: A Complete Manual for Hypnotherapy with Children (Second Edition). Orlando: Grune
    Health and Self-Change. San Diego: International Health and Stratton.
    Publications. Examples of Suggestions for Use in Pediatric Emergencies was reprinted
    Suggestions and Success Imagery for Study Problems was reprinted with with permission from: Kohen, D. P. (1986). Applications of
    permission from: Porter, J. (1978). Suggestions and success relaxation/mental imagery (self-hypnosis) in pediatric
    imagery for study problems. International Journal of Clinical and emergencies. International Journal of Clinical and Experimental
    Experimental Hypnosis, 26(2), 63-75. Hypnosis, 34, 283-294.
    Erickson's Suggestions for Facilitating Speed of Learning was reprinted Suggestions with Enuresis was reprinted with permission from: Baumann,
    with permission from: Erickson, M. H. (1985). Life Reframing in F. (1981). Hypnosis in the treatment of urinary and fecal
    Hypnosis. Edited by E. L. Rossi and M. O. Ryan. New York: incontinence: A twenty-year experience. Chapter in H. J. Wain
    Irvington. (Ed.), Theoretical and Clinical Aspects of Hypnosis. Miami:
    Alert Trance Suggestions for Concentration and Reading was reprinted Symposia Specialists Inc.
    with permission from: Oetting, E. R. (1964). Hypnosis and Erickson's Suggestions with Enuresis were reprinted with permission
    concentration in study. American Journal of Clinical Hypnosis, from: Erickson, M. H. (1983). Healing in Hypnosis. Edited by E.
    7(2). 148-151. L. Rossi, M. O. Ryan, and F. A. Sharp. New York: Irvington, pp.
    Improving Reading Speed by Hypnosis was reprinted with permission 175-177.
    from: Klauber, R. W. (1984). Hypnosis in education and school Enchanted Cottage Suggestions for Enuresis was reprinted with
    psychology. Chapter in W. C. Wester and A. H. Smith (Eds.), permission from: Gibbons, D. E. (1979). Applied Hypnosis and
    Clinical Hypnosis: A Multidisciplinary Approach. Philadelphia: J. Hyperempiria New York: Plenum Press.
    B. Lippincott. Erickson's Suggestions for Thumbsucking was reprinted with permission
    Suggestions for Foreign Language Study was reprinted with permission from: Erickson, M. H. (1983). Healing in Hypnosis. Edited by E.
    from: Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria L. Rossi, M. O. Ryan, and F. A. Sharp. New York: Irvington, pp.
    New York: Plenum Press. 117-118, 263-264.
    Examination Panic was reprinted with permission from: Erickson, M. H. Hypnosis in the Treatment of Tourette Syndrome was reprinted with
    (1965). Hypnosis and examination panics. American Journal of permission from: Zahm, D. N. (1987). Hypnosis in the treatment
    Clinical Hypnosis, 7, 356-357. of tourette syndrome. Chapter in W. C. Wester, Clinical
    Suggestions for Examination Phobia was reprinted with permission from: Hypnosis: A Case Management Approach Cincinnati: Behavioral
    Waxman, D. (1989). Hartland's Medical and Dental Hypnosis Science Center, pp. 319-331.
    (Third Edition). London: Bailliere Tindall. A New Hypnobehavioral Method for the Treatment of Children with
    Suggestions for Artistic Expression was reprinted with permission from: Tourette's Disorder was adapted with permission of publisher
    Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria from: Young, M. H., and Montano, R. J. (1988). A new
    New York: Plenum Press. hypnobehavioral method for the treatment of children with
    Suggestions for Aesthetic Appreciation and Enjoyment was reprinted Tourette's disorder. American Journal of Clinical Hypnosis,
    31(2), 97-106.
    with permission from: Gibbons, D. E. (1979). Applied Hypnosis
    and Hyperempiria New York: Plenum Press. Technique with Asthmatic Children reprinted with permission from:
    Suggestions to Enhance Musical Performance was reprinted with Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    permission from: Gibbons, D. E. (1979). Applied Hypnosis and Principles and Applications (Second Edition). Orlando: Grune
    Hyperempiria. New York: Plenum Press. and Stratton.
    Suggestions to Enhance Writing Ability was reprinted with permission Suggestions with Dyslexia was reprinted with permission from:
    from: Gibbons, D. E. (1979). Applied Hypnosis and Hyperempiria Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis:
    Principles and Applications (Second Edition). Orlando: Grune
    New York: Plenum Press.
    and Stratton.
    Suggestions for Concentration was adapted with permission from:
    Alman, B. M. (1983). Self-Hypnosis: A Complete
    Manual
    CREDITS 585
    Hypnotic Suggestions with Stuttering was reprinted with permission atory Casebook. New York: Irvington, pp. 34, 318-319,
    from: Crasilneck, H. B., and Hall, J. A. (1985). Clinical Hypnosis: 321-322, 326, 348, 349, 350.
    Principles and Applications (Second Edition). Orlando: Grune Example of an Analytical Procedure for Reframing was adapted with
    and Stratton. permission from: Barnett, E. A. (1981). Analytical Hypnotherapy.
    Personalized Fairy Tales for Treating Childhood Insomnia was reprinted Kingston, Ontario, Canada: Junica. Pp. 143-148 and 151-156.
    with permission from: Levine, E. S. (1980). Indirect suggestions Desensitization: An Example of Rapid and Repetitive Memory
    through personalized fairy tales for treatment of childhood Evocation was reprinted with permission from: Wright, M. E.
    insomnia. American Journal of Clinical Hypnosis, 23(1). 57-63. (1987). Clinical Practice of Hypnotherapy. New York: Guilford
    Suggestions with School Phobia was reprinted with permission from: Press, pp. 83-84.
    Waxman, D. (1989). Hartland's Medical and Denial Hypnosis Forensic Hypnosis Guidelines: The "Federal Model" was adapted from
    (Third Edition). London: Bailliere Tindall. Richard B. Garver, "Investigative Hypnosis," a chapter in
    A Science Fiction-Based Imagery Technique was reprinted with William Wester (Ed.), Clinical Hypnosis: A Case Management
    permission from: Elkins, G. R., and Carter, B. D. (1981). Use of a Approach. Cincinnati: Behavioral Science Center, 1987.
    science fiction-based imagery technique in child hypnosis.
    American Journal of Clinical Hypnosis, 23(4), 274-276. Imagery of the End Result was reprinted with permission from: Korn, E.
    R., and Pratt, G. J. (1988). Release Your Business Potential.
    (Cassette recording). New York: John Wiley and Sons.
    Mental Rehearsal: The Protective Shield was reprinted with permission
    Chapter 16 from: Korn, E. R., and Pratt, G. J. (1988). Release Your Business
    Potential. (Cassette recording). New York: John Wiley and Sons.
    Improving the Quality of the Age Regression was reprinted with Mental Rehearsal of Presentation and Sales Skills was reprinted with
    permission from: Brown, D. P.. and Fromm, E. (1986). permission from: Korn, E. R., and Pratt, G. J. (1988). Release
    Hypnotherapy and Hypnoanalysis. Hillsdale, N.J.: Lawrence Your Business Potential. (Cassette recording). New York: John
    Erlbaum. Wiley and Sons.
    End-Result Goal Imagery for Sales Productivity was reprinted with
    Suggestions to Facilitate Revivification was reprinted with permission
    permission from: Gibbons, D. E. (1979). Applied Hypnosis and
    from: Greenleaf, E. (1969). Developmental-stage regression
    Hyperempiria. New York: Plenum Press.
    through hypnosis. American Journal of Clinical Hypnosis,
    I2(\), 20-36. Erickson's Self-Suggestion Technique was adapted from: Erickson, M.
    H. (1964). The burden of responsibility in effective
    Erickson's Confusional Method for Revivification was reprinted with
    psychotherapy. American Journal of Clinical Hypnosis, 6,
    permission from: Rossi, E. L., Ryan, M. O., and Sharp, F. A.
    269-271.
    (Eds.). (1983). Healing in Hypnosis: The Seminars, Workshops,
    and Lectures of Milton H. Erickson, Volume I. New York: Training Patients to Experience Time Distortion was reprinted with
    Irvington, p. 254. permission from: Cooper, L. F., and Erickson, M. H. (1959).
    Time Distortion in Hypnosis. Baltimore: Williams and Wilkins.
    Watkins' Silent Abreaction Technique was adapted from: Watkins, H. H.
    Quotations in Summary of Suggested Steps in Time Distortion Training
    (1980). The silent abreaction. International Journal of Clinical
    were reprinted with permission from: (a) Cooper, L. F., and
    and Experimental Hypnosis, 28, 101-113.
    Erickson, M. H. (1959). Time Distortion in Hypnosis. Baltimore:
    Erickson's Age Regression Techniques were reprinted with permission
    Williams and Wilkins, (b) Erickson, M. H. (1985). Life
    from: (a) Erickson, M. H., and Rossi, E. L. (1979). Hypnotherapy:
    Reframing in Hypnosis. Edited by E. L. Rossi and M. O. Ryan.
    An Exploratory Casebook. New York: Irvington, p. 357. (b) Rossi,
    New York: Irvington, (c) Erickson, M. H., and Rossi, E. L.
    E. L., Ryan, M. O., and Sharp, F. A. (Eds.). (1983). Healing in
    (1979). Hypnotherapy: An Exploratory Casebook. New York:
    Hypnosis: The Seminars. Workshops, and Lectures of Milton H.
    Irvington, (d) Rossi, E. L., and Cheek, D. B. (1988). Mind-Body
    Erickson, Volume I. New York: Irvington, pp. 255-256. (c)
    Therapy. New York: W. W. Norton.
    Erickson, M. H., and Rossi, E. L. (1979). Hypnotherapy: An
    Exploratory Casebook. New York: Irvington, pp. 453-454. (d)
    Erickson, M. H., and Rossi. E. L. (1979). Hypnotherapy: An
    Explor-
    NAME INDEX
    Aaronson, B. S., 64, 154, 517 Barker, D., 511 Braun, B. G., 312. 340
    Abarbanel, A. R., 46 Barker, P., 37, 38, 375 Bresler, D. E.. 318
    Abraham, H. A., 265, 402 Barker, W., 236 Brice, D. D., 86
    Abramovici, H., 269 Barkley, R. A., 408 Brown. C. W.. 88
    Abramson, M., 87, 269 Barlow, D. H, 154 Brown, D. P.. 4, 12, 42, 311, 316. 322.
    Adam, L., 86 Barnett, E. A., 120, 512, 537, 538 324. 330, 519
    Ader, R., 199 Barnett. F., 87 Brown, P., 325
    Agras, S., 218 Barretta. N. P., 499 Browne, R. A., 86
    Aja, J. H., 379 Barretta, P. F., 499 Brownell. K. D., 379
    Alexander, L., 366 Bartlett, E. E., 89, 101 Brunn. J. T.. 85 Burton,
    Allen, G. D., 87, 155 Basker, M. A.. 80. 371 D., 407 Bynum, E., 510
    Alman, B. M., 23, 24, 172, 429, 440, 469 Baumann, F., 496 Byrne, S.. 218
    Ambrose, G., 477 Beall, S. K., 374
    American Medical Association, 434, 511 Bean, W.. 23
    Anderson, C, 350 Bednar, R. L., 441 Caid, C., 350
    Anderson, J. A. D., 80, 371 Beebe. D. R., 188 Callan, T. D., 269
    Anderson, R. M., 458 Bennett, H., 23, 318 Calverly, D. S., 516, 517
    Anderton, C. H., 379 Bennett, H. L., 85. 86, 87 Camp, E. M., 472
    Antich, J. L. S., 88 Bensen, V. B., 88 Campbell, C, 296
    Araoz, D. L.. 349, 350 Benson, H., 218 Candiotte, M. M., 408
    Aravindakshan, K. K., 510 Beran, B.. 324, 325 Carich. M. S., 374, 400
    Asher, L. M., 510 Berkowitz, B.. 407 Caritis, S. N., 269
    Auerbach, A. H., 2 Bernstein, M., 511 Carkhuff, R. R., 37
    Auerbach, J., 204, 241 Betcher, A. M., 88 Carlson, W., 434
    August, R. V., 88, 269, 270. 302 Beutler, L. E., 3 Carnegie, D., 15, 16
    Avila, D. L., 440, 441 Biermann, S. F., 236, 486 Carney, R. E., 23
    Azrin. N. H., 431 Bisbee, C. T., 510 Carr, R., 88. 185
    Bishay, E. G.. 221, 244, 245 Carter, B. 0.. 506
    Baak, D., 23, 24 Bliss, E. L., 311 Castles, C., 154, 177
    Babai, M., 324, 325 Boland, J. P., 350 Catton, D. V., 86
    Bakal, P. A.. 154, 175 Bonello, F. J., 85. 86 Cerny, J. A., 154
    Baker, E. L., 311, 324, 325 Bonilla, K. B., 85, 86 Chalmers, D., 220
    Baker, R. A., 512 Bonke, B., 87 Chapman, L. F., 229, 231
    Bandler. R., 24, 330 Bootkin, R. R., 220 Chaves, J. F., 380
    Bandura, A., 19, 109, 351 Bornstein, P. H., 431 Cheek. D. 8.. 4, 48, 56, 75, 85-86, 87, 94.
    Banyai, E., 434 Borysenko, J., 200 106, 154, 185, 233, 270, 299, 316.
    Barabasz. A. F., 218, 242 Bowen, D., 88 512, 513.516 Chiasson, S.
    Barabasz, M., 242, 431 Bowen, W. F., 85, 86 W., 252, 263. 271 Chiglinsky, M. A..
    Barban, L., 312 Bowers. K. S.. 434. 435 510 Chisholm, W., 510 Cialdini, R.
    Barber, J., 23, 49, 50, 87, 98, 102, 155, Bowers, P. G.. 434 B., 17 Clark, R. R., 407
    275,409 Barber, T. X., 110, 112, 113, Bowersbuch, M. K., 510
    118, 380, Brandes. J., 269
    383, 411, 510, 516, 517 Brauer, R. O., 229

    587
    588 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    Clarke, J. C, 153, 154 Edwards. G.. 153 Friedman, H., 218


    Clarke, J. H., 187 Edwards, P., 511 Friedman. J. K., 335
    Coe, W., 434 Egan. R. M., 433 Friedman, J. M., 350
    Cole, R., 434 Egan. W. P., 433 Frischholz, E., 324
    Colgan, S. M., 218 Ehleben, C, 229 Fritzo. J., 510
    Combs, A. W„ 440, 441 Eich, E., 86 Fromm. E., 4, 12, 42, 311, 316, 322, 330,
    Conn, J. H., 324 Eisle, G„ 433 511, 519, 520 Frumkin.
    Connoly, P. B.. 356 Elder, S. T., 218 L. R.. 332 Fuchs, K., 269, 270.
    Coons, P. M., 311 Eliseo, T. S., 324. 325 433 Fuller, A. K., 88. 250, 277
    Cooper, L, F., 516, 518, 551, 557, 558 Elkins, G. R., 81, 506
    Cooper, L. M., 311, 475, 476 Ellenberger, H. F„ 509
    Copeland, D. R., 311 Elliotson, J., 88 Gallagher, M., 23
    Corley, J. B., 92 Ellis, A„ 168, 422, 470 Galski, T. J., 431
    Council on Scientific Affairs, AMA, 434, Ellison, C. R., 350 Gard. B., 510
    511 Counts, D. K„ 264 Courtois, C. Epstein, S., 154 Gardner, G. G., 441, 475. 476, 477, 479,
    A., 311 Couture, L. J., 86, 87 Cox, G. B., 332 Erickson, M. H., 2, 4. 13. 15, 17, 21, 22, 24. 484, 493, 501 Gardner, M., 511
    Crasilneck, H. B., 1, 20, 49, 88, 89, 154, 25, 26, 27, 28, 33, 35, 37. 39, 54, 55, Garron, D. C, 47 Garver, R. B., 61, 132, 253,
    205, 218, 219, 221, 223, 228, 270, 56. 66, 68-69, 70, 71, 135, 184, 195, 389, 417,
    305, 350. 351, 356, 357, 379. 380. 223, 237, 245, 255, 266, 270, 281, 418, 445, 466, 542, 545 Gaskin, I. M.,
    390, 403, 407, 416, 429, 504, 505, 347, 350, 370, 397, 429, 446, 459, 285 Gass, G. C, 472 Gelder, M. G., 153
    510 Creamer, 497, 498, 509, 510. 513. 516. 517, Gerbert, B., 218 Giannini. J. A., 87 Gibbons,
    M., 510 Creighton. J. 518,522.523. 531.543, 544,545, D. E., 78. 130, 143, 149, 154,
    L„ 199 Crowley, R., 24 551,557,558 177, 182, 224, 265, 368, 373, 430,
    Crowley, R. J., 38 Erickson, R. M., 516 436, 457. 461. 462, 464. 471, 497,
    Cullen, S. C, 88 Esdaile, J.. 88 546, 549 Gidro-Frank,
    Evans. C, 85, 86 L., 510 Gindes, B. C, 440, 441
    Evans, F. J., 88, 511 Gindhart, L. R., 140, 154
    Dalton, R., 80, 371 Daniels, E., Givens, D. L., 311 Glaser, R.,
    88 Darnel, A., 24 Dave, R., 434 Ewin, D. M,, 226, 229
    58, 200, 374 Glauber, D. T„ 86
    Davidson. E., 350 Davidson, J. Eyal. E., 270. 433
    Glazer, D., 184 Glick, B. S., 154
    A., 269 Davies. L., 350 Davis,
    H. S.. 87 Dawson, A. A., 199 Golan, H. P., 89, 183, 185, 186, 209
    Deabler. H. L., 218 DeAmicis, Fagan, J., 318 Goldberg, D. C, 350
    L. A., 350 Deiker, T. E., 154, Faragher. E. B., 218 Goldburgh. S. J., 433
    264 de Oliveira, D. A,, 88 Farberow, N. L., 311. 510 Golden, W. L.. 53
    DePaul, R. A., 218-19 de Rios, Farquhar. J. W., 218 Goldmann. L., 86, 87, 278, 303
    M. D„ 335 Detrick, D., 324 Fava, G. A.. 218 Goldstein, I., 349
    Deyoub, P. L., 154 DiClemente, Feinstein, A. D.. 332 Goodell, H.. 229, 231
    C. C, 3, 408 Dillenkoffer. R. L., Fellows, B. J., 510 Gordon, J. E., 510
    218 Doberneck, R. C, 85. 86 Fenker, R. M., 510 Gordon. J. R., 109. 110. 503
    Domangue, B. B.. 229 Fermouw, W. J., 155 Gorman. B. J.. 133. 452
    Donaldson, D.. 87. 155 Donk, Gottlieb. S. K., 220
    Fey. W. F.. 3
    L. J., 434 Doty, R., 434 Dowd, Graef, J. R., 516
    Fezler, W. D., 218, 227, 380, 395, 517
    E. T., 53 Dubin, L.. 9. 189 Graham. C, 510
    Fidel, E., 218
    Dubovsky, S. L., 86 Dunbar, K. Gregg, D. M., 150, 437
    Field. E. S., 170, 400
    D.. 24 Durren, R.. 407 Green, R., 349
    Field, P. B., 22, 407, 408
    Greene, R. J., 485
    Figley, C. R.. 311
    Greenfield, L., 87
    Finer. B. L., 88
    Greenleaf, E.. 521
    Ebert. B. W., 334 Finkelstein, S.. 158, 1 9 1 Grinder, J.. 24, 330
    Edelstone, D. I., 269 Fischer, R., 63 Grinker, R. R., 311
    Edgerton, M. T., 236 Fishman, S., 510 Gross, M., 403
    Edmonds, H, L., 86, 87 Flaxman, J., 379 Gross. R., 155
    Fogel, B. S.. 58, 59 Grosz, H. J., 407, 408
    Fogel, S., 64, 517 Gruber, L. N., 328
    Forgione, A., 208 Gruenewald, D., 253, 420
    Forman, M., 407 Gurgevich, S., 167. 418
    Fowler, W., 433 Gurman, A., 352
    Fox, G., 434
    Frank, E„ 350
    Fredericks, L. E., 72, 80, 89, 90
    Freston, M., 510
    Freytag, F. K., 316
    Friction. J. R., 23
    Friedberg, F., 53
    Friedlander, D., 270
    Friedman. B., 38
    NAME INDEX 589

    Guroff, J. J., 312 Jaffin, A. R., 407


    Leckie, F. H., 270, 306
    Gustafson, L. A., 88 Janet, P., 509 LeCron, L., 87, 185, 270
    Gustavson, J. L., 154 Jencks, B., 72. 162, 165, 223, 238, 256 Lee, C , 221, 244, 245
    Jenkins, M. T., 88, 89 Lefcoe, N. M., 408
    Jenkinson, J., 86 Leiblum, S. R., 350
    Haberman, M. A., 177
    Jenner, F. A., 510 Leibowitz, H. W,, 510
    Hackett, T. P., 220, 226
    Jensen, M. P., 48 Levine, B. A., 431
    Haggendorn, J., 433
    Jensen, S. B., 349 Levine, E. S., 505
    Haley, J., 27
    Johnson, L. S., 510, 511 Levinson, B. W., 85, 87
    Halfen, D., 85
    Johnson, M., 2 Levitan, A. A., 71, 201, 202, 215
    Hall, C. W., 45
    Johnson, V. E., 349, 350, 351, 356 Lewenstein, L. N., 89
    Hall, H. R., 199
    Jones. C. W., 88 Lewis, S. A., 86
    Hall. J. A., 1, 20, 49. 89. 154. 205. 218, 221,
    223, 228, 270, 305. 379, 380, 390, Lichtenstein, E., 408
    403, 407. 416. 429, 504, 505 Lieberman, M. A., 3, 22
    Kamitsuka, M., 324
    Liebert, R. M.. 434
    Hall, R., 434 Kaplan, H. S.. 46, 349. 350
    Lief, H., 350
    Hamilton, L., 199 Kaplan, J. Z., 231
    Lindemann, H., 435
    Hammond, D. C.. 2. 3, 11, 22. 27, 37, 39, 45, Kardiner, A., 311
    Lodato, F., 433
    70, 71, 81, 101, 124, 130. 135, 145, Karoly, P., 48
    Loftus, E. F., 86
    154, 156, 219, 228, 305, 313, 315. 316, Katz, R. L., 86
    Loftus, G. R., 86
    318. 346. 347, 350, 354. 358, 360, 361, Kelly, M. A., 88
    Logan, D. R„ 270
    362, 363, 364, 365. 366, 367, 370, 376, Kiecolt-Glaser, J. K., 58, 200, 374
    Logsdon. F. M.. 154
    377, 385, 422, 512, 513, 514, 517, 518, Kilbourne, L., 154, 177
    London. P., 311,475
    524, 534, 535, 536, 537, 543, 549, 556 Kilmann, P. R.. 350
    Loomis. E. A., 516
    Harris, M., 511 Kilpatrick, W. R., 236
    LoPiccolo. J.. 350
    Harris, W., 434 Kirsch, I., 24
    LoPiccolo, L., 350
    Hartland, J., 110, 133, 147, 185, 444 Klauber, R. W., 450
    Lugan, W. G., 270
    Hastings, J. E., 408 Klein, K. B., 218
    Lundy, R. M., 23, 24
    Havens, R. A., 334 Kleinhauz, M., 324, 325
    Lynn, S. J., 23, 24, 311
    Hebden, M. W., 87 Klemchuk, H. M.. 218
    Heiman. J., 350 Kline, M. V., 408, 526
    Hendler, C. S., 200 Kluft, R. P., 312. 339, 340, 341, 342, 526,
    Henker, F. O., 269 527, 529 Kniskern, D., 352 Knudson,
    McConkey, K. M., 24, 510, 511, 520, 521
    M. S., 277 Koe, G. G., 434, 452 Kohberger, R.,
    Henschen, K. P., 465 McCranie, E. J., 88, 89
    407 Kohen, D., 9, 480, 488, 489 Kohl, R., 352
    Hepworth, D., 37 McDowell, M. H. 149
    Kolodny, R. C, 349, 350 Kolough, F. T., 85.
    Herbert, C. P., 238, 333 McFee, A. S., 86
    86. 88 Korn, E. R., 546, 547 Kramer. C. E., 510
    Heron, W. T., 87, 188, 269, 304 McGeorge, C. M., 218
    Krane, R. J., 349 Kratochvil, S., 242. 244
    Hetherington, R. R., 86 MacHovec, F. J., 408
    Krauss. D., 356 Krippner, S., 434, 439 Kroger,
    Higgins, J., 433 McIntyre, K. O., 408
    W. S., 107, 193, 218, 227, 270,
    Hilgard, E. R., 85, 185, 434, 475, 511. McKinty, H. R.. 88, 185
    520 Hilgard, J. R., 85, 185,311,475 293, 306, 380, 395, 396, 517 McLaren-Hume, M., 379
    Hilgenberg, J. C., 85 Hill, N., 318 Hines, T., Kubie, L. S., 350, 510 Kumar, S. M., 85 Maguen, E., 251
    512 Hinshaw, J. R.. 229 Hodge, J. R.. 322, 324. Kupper, H. I., 510 Kuriyama, K., 242 Mahoney, M. J., 443
    325. 330, 331 Hoffer, A., 64, S17 Holcomb, L., Kurtz, R. M., 402, 510 Mainord, W. A., 87
    434 Holroyd, J., 22, 251, 407, 408 Horne, R. L., Maltz, M., 149, 440
    380 Horowitz, S. L., 153 Horvai, J., 510 Man, S. C , 408
    LaBaw, W. L., 221 Lait, V. S., 88
    Hoskovec, J., 510 Howard. W. L., 470 Hunter. Mann, H.. 380, 393
    Lankton, C. H., 23, 38 Lankton, S. R.,
    M. E., 173, 238, 239, 247, 248 Hutchings, D. Maoz, B., 526
    23, 38 Lauer, L. W., 476 Laughlin, H.
    D., 86. 88 Marcovici, R., 269
    P., 154 Laurence, J. R., 511,520
    Lazarus, A. A., 3, 154, 443, 515 Margolis, C. G., 229
    Iwamoto, K.. 89 Leavitt, F-, 47 LeBaron, S., 221 Marks, I. M., 153
    Marlatt, G. A., 109, 110, 407, 408, 503
    Jackson, J. A.. 153, 154 Marmer, M. J., 88
    Jackson, P. F., 85 Jackson, T. Marshall, G., 218, 517
    L., 408 Jacobson, L., 441 Marzetta, B. R., 218
    Mashman, R. C, 132, 133
    Maslach, C, 218, 517
    Mastellone, M., 431
    Masters, W. H., 349, 350, 351, 356
    Matthews, W. J., 23, 24
    Matthews-Simonton, S., 199
    Matyi, C. L., 23. 24
    May, R., 39
    Meares, A., 160, 242
    Meichenbaum, D., 67
    Mellegren, A., 269
    509 HAND BOOK OF H Y P N O T I C S U G G E S T I O N S AND M E T A P H O R S

    Mellenbruch, P., 433 Paldi, E., 269 Rosen, S., 212, 405
    Melzack, R.. 86 Palti, T., 24 Rosenberg, S. W., 206
    Mermelstein, R. J., 408 Palti, Z., 270 Rosenberger, P. H., 200
    Meyer, R. G., 24 Pandit, S. K., 85 Rosenthal. R., 441
    Michael, C. M., 510 Papermaster, A. A., 85, 86 Rosinski, D. J., 196
    Miles, M. B., 3, 22 Parker, K. E., 374 Rosner. B. A.. 218
    Millar, K., 87 Parloff, M. B., 3 Rossi, E. L., 2, 4, 13, 15, 21, 24, 27, 28, 33,
    Miller, S., 3, 11, 318, 347, 512, 514, 517, Parrish, M.. 510 35. 48, 56, 75, 85-86, 87, 94, 106.
    537 Millet, J. B., 86 Mills, J. C, 38 Pavan, L., 218 199, 233, 237. 316, 347, 509, 512,
    Minalyka, E. E., 88 Mitchell, W. M., 435 Pearson, R., 87 513, 516, 517, 543, 544, 545
    Mody, N. V.. 269 Montano, R. J., 502 Pederson, L. L., 408 Rossman, M. L., 318
    Monteiro, A. R. de C, 88 Moore, L. E., 246 Pelletier, A. M., 139, 460, 548 Ross-Townsend. A., 407
    Moore, R. K., 476 Moreland, J. R„ 310 Pennebaker, J. W., 58. 200, 374 Roth, P., 23
    Morgan, A. H.. 475 Morgan, R. M., 332 Peretz, A.. 269 Rowen, R., 431
    Mosconi, G., 269 Mosher. D. L.. 24 Peretz, B. A., 269, 270, 433 Rubin, N.. 434
    Mozdzierz, G. J., 262, 267, 372 Muehleman, Perry, C., 510, 511, 520 Rubinstein, D., 350
    T., 270 Mueller-Heubach, E., 269 Murphy, J. Perry. C. W., 88 Rummel, R. L., 139
    K., 250 Murphy, M. B., 23 Murray-Jobsis, J.,
    Persichetti, S. J., 187 Russell. D. E, H., 311
    136, 203, 311, 324,
    Peterson, G. F.. 285 Ryan, M. O., 2, 517. 543, 545
    326, 328, 388 Pett, M.. 350 Rychtarik, R. G., 431
    Mutke, P., 434 Mutter. C. Pettinati, H. M., 324, 380,511
    B., 68, 335 Myers, H. J., Pincus, C,, 526
    526 Pollet, S. M., 199 Sacerdote, P.. 63, 65, 80, 316, 428
    Pollock, D. H., 154 St. Amand, A., 208
    Poncelet, N. M., 282 St. Jean, R., 433-34
    Porter, J., 440, 441, 442, 445 Samuels, M . 318
    Narcuse, G., 153, 435 Nash, M.
    Porter, J. W., 510 Sanders, S., 66, 408
    R., 311,510, 511 Neiburger, E.
    Post, R. M., 312 Saper, B., 431
    J., 183 Nelson, E.. 218 Neufeld,
    V., 23, 24 Newman, D. M., 85 Pratt, G. J., 546, 547 Sarbin, T. T., 311, 510
    Norcross, J. C, 3 Norton, S. P., Premack. D., 441 Sargant, W., 311,526
    350 Nowlis, D. P., 311 Nuland, Price, D. A., 343 Saucier, N., 310
    W., 22, 407, 408 Nunan, L., 510 Price, D. D., 49 Saunders, A., 154, 177
    Nunn, R. G., 431 Nylen. B. O., Prior, A., 218 Scagnelli, J., 324, 5
    88 Prochaska, J. O., 3 Scagnelli-Jobsis, J., 325, 326
    Pryor, G. J., 236 Schauble, P. G., 277
    Purkey, W. W.. 440, 441 Scheerer, M., 510
    Putnam, F. W., 312, 526 Scheflin, A. W., 511
    O'Brien, R. M., 510 Schmideberg, M., 328
    O'Connell, D. N., 88. 510
    Schneck, J. M., 154
    Oetting, E. R., 434, 446 Quigley, W. F., 85. 86 Schofield, L. J., 510
    O'Grady, D. O., 477
    Schooler, J. W., 86
    O'Heeron, R. C., 374
    Raikov, V. L., 434, 441, 510 Schover, L. R., 349, 350
    Oldridge, O. A., 434, 452
    Ramras, S., 87, 155 Ratcliffe, M. A., Schultz. J. H., 165, 435
    Olness, K., 475, 476, 477, 484, 493, 501 Schwartz, H., 89
    199 Rath, B., 87 Rausch, V„ 88, 192
    Omer, H., 24, 270, 296
    Read, A. D., 165 Reardon, J. P., 470 Schwartz, M., 270
    Opp, D. R., 236 Reardon, W. T-, 151, 440 Redd, W. Schwartz, M. F., 350
    Orme. J. E., 517 H- 200 Reeves, J. L., 86 Retzlaff, P. Scott, D. L., 88
    Orne, E. C, 88 O., 510 Reyher. J., 23. 434. 485, 510 Scott, M. J., 220, 222
    Orne, M. T., 88, 510, 520 Richardson, P. H., 85, 86 Reiff, R., Scrimegeour, W. G., 408
    Orr, R. G.,407 510, 522 Ripley, H. S., 332 Rist. F., Secter, I. I., 81, 188, 189, 195, 266
    Oystragh, P., 151 408 Roberts, D., 510 Rock, N. L., Shapiro, J. L., 511
    296 Rodenheaver, G. T., 236 Shay, M. V., 87
    Rodger, B. P., 91,94. 101,273 Sheehan, P. W., 510, 511, 520, 521
    Rodgin, D. W.. 516 Rosen, H., 322, Sheinkop, M. B., 47
    323, 526 Rosen, R. C., 350 Shepherd, I. L., 318
    Shewchuk, L. A., 407
    Shipley, T. E., 296
    Shor, J., 510
    Shor, R. E., 88, 510
    Shorvon, H. J., 311, 526
    Shrier, L., 229
    Shuval, D., 24
    Sies, D. E., 511
    Silberman, E. K., 312
    NAME INDEX 591

    Silberman, N., 24 Taylor, A., 510 Taylor, C. Watkins, J. G., I, 4, 81, 311. 316, 325,
    Silverberg, E. L., 220 B.. 218 Terman, S. A., 330 509, 514, 523, 526 Watkinson, N.,
    Silverman, P. S., 510 Thakur, K., 380 87 Watzl. H., 408 Waxman, D.. 180. 279,
    Simonton, D. C, 199 Thomason, S., 512 305, 330, 371,
    Sinclair-Gieban, A. H. C, 220 Thompson, K., 364 429,461, 506 Weekes, J. R., 24
    Siroky, M. B., 349 Thoresen. C. E., 443 Weems, S. M., 350 Weight, D. G., 154
    Slater, E., 311 Thorn, W. A. F-, 511 Weitzenhoffer, A. M„ 1, 14, 517 Werbel,
    Smith, D. S., 3 Thorne, F. C, 3 Tinterow, E. W., 77, 85, 86 Werner, W. E. F., 277
    Smith, M. C, 510 M. M.. 88 Tipton, R. D., Wester. W. C, 1, 391, 422. 477, 511
    Smith, M. S., 324 510, 511 Toomey, T. C, 66 Whanger, A. D., 88 Whisler, W. W., 47
    Smith, V. G., 37 Torem, M. S., 110, 343 White, R., 434 White, R. A., 356
    Snow, L., 24 Tosi, D. J., 470 Truax, C. Whorwell, P. J., 218 Wiggins, S. L., 88
    Souster, L. P., 510 B., 37 True. R. M., 510 Wilensky, H., 510 Willard, R. D., 270
    Spanos, N. P., 380, 510 Trustman, R., 86 Tucker, Williams, J. E., 270 Willis, D. C, 434
    Spark, R. F., 356 K. R., 88 Turk, D. C, 67 Wilson, I., 511 Wilson, J., 23, 86 Wilson,
    Spiegel, D., 67, 157, 175, 218, 255, 324, S. C., 112, 380 Wingfield, H. E., 509
    386, 387, 416, 431 Spiegel, H., 67. Witztum, E.. 38 Wogan, N., 3
    157, 175, 255, 311, 386, Unestahl, L. E„ 465
    387,407,416,431, 510 Spiegel, J. P., Utting, J. E., 86 Wolberg, L. R.. 3, 154, 316, 444, 512, 513
    311 Spinhoven, P., 23, 24 Spira, M., 229 Wolfe, B. E., 3 Wolfe, L. S.. 86 Wolff, H. G.,
    Staats, J. M., 380 Stalb, A. R., 270 Stanfield, 52, 229. 231 Wollman, L.. 270 Woodward, J.
    Van Denburg, E. J., 402
    K., 11,45 Stanton, H. E., 122, 126, 141, 143. A., 510 Wooton, R. R., 467, 469 Wright, M.
    159. Van der Hart, O.. 38, 154, 270
    E.. 52, 58, 59, 180, 226, 234, 316, 397, 425,
    Van der Kolk, B. A.. 311
    254, 313, 316. 379, 395, 407, 419, 541
    van der Meulen, S. J., 435
    420, 444, 493, 519 Staples, Van Dyck, R., 23, 24
    E. A.. 510 Staples, L. M., 194, 499 Yalom. E. S.. 3, 22
    Van Dyke. P. B., 89
    Starcich, B., 269 Stein, C, 145, 316 Yapko, M. D., 9. 173, 320, 321, 405
    Van Gorp, W. G., 24
    Stein, V. T., 251 Steinberg, S., 88 Young. M. H., 502
    Verhage, F., 87
    Stephenson, C. W., 510 Stevens, G., Young, P. CM 510
    Vermeulen. P., 23. 24
    245, 510 Stickney, E. L., 159 Stock,
    Vingoe, F., 434
    M., 399, 423 Stoler, D. R., 76, 209, Zahm, D. N., 501 Zeig, J.. 36, 38, 299
    Virnelli, F. R., 88
    225, 286 Stolzy, S., 86, 87 Stone, J. Zelling, D. A., 255 Zeltzer, L., 221
    A., 23, 24 Strauss, B. S., 203 Ziegenfuss. W. B., 465 Zilbergeld, B.,
    Strupp, H. H., 3 Stuart, F., 350, 370 Wadden, T. A., 379 Wagenfeld, 318, 350, 356, 515 Zimbardo, P. G.,
    Stunkard, A. H., 379 Surman, O. S., J., 434 Wagner, E. E., 322 218, 517 Zimmer, E. Z., 270, 433
    220 Susskind, D. J.. 440 Wagner, G., 349 Wakeman, R.
    Swiercinsky, D., 434 Sylvester, S. J., 231 Walch, S. L., 310, 313,
    M., 98 420 Walker, B. B„ 218, 219
    Walker, L. G., 199 Wall, V., 9,
    481,494 Wallace, P. K., 218
    Tasini, M. F., 220, 226 Walts, L. F., 310 Wangensteen,
    Taub, H. A., 218 O. H., 86 Wark, D. M.. 434,
    449, 450 Washow, I. E., 3
    Watkins. H. H., 127, 301, 310, 312, 407, 408,
    413, 530
    SUBJECT INDEX
    abandonment, 321 age regression: contraindications for hypnosis, 477
    abdominal area, relieving discomfort in, and abreaction, 518-42 for enhancement of athletic
    74-75 abortion, the trauma of for anxiety, case example, 540-41 performance, 435
    prospective, 301-2 abreaction, 208, 526-27 and ego-strengthening, 110 for pain, 55-56
    and age regression, 514, 518-42 for enhancement of athletic suggestions for, 402
    and anorexia nervosa therapy, 404 performance, 435 for unpleasant memories, 534
    cautions about, 323 to experiences of mastery, 135-36 using in age regression, 533
    facilitating, 524-26 and hopelessness, 212 analgesia. 50, 155, 206
    prior to reframing, 536, 538 indirect, 513-14 in childbirth training, 284
    abreactive work: for obesity control, 382 for enhancement of athletic
    nonverbal signaling in. 18 and phobias, 153, 154 performance, 435
    with psychotic patients, 513 abused child, for psychogenic amenorrhea, 306 for gynecologic procedures, 270
    saying goodbye to, 334-35 academic and renurturing, 326 rapid induction ofl02-6
    performance: in sexual dysfunction therapy, 352 rehearsing prior to labor, 276
    dyslexia, 505 in recalling wellness, 60 alertness, self-testing of, 233
    enhancing, 436-61 acceptability of invigoration exercises for, surgical and obstetrical, 106
    suggestions. 16-19 acceptance, for burn 259-61 anchoring, 480
    patients, 232 acceptance set, 15-16 alert trance: for childbirth, 282-83
    achievement, ego-suggestions for feelings advanced comprehension suggestions, 450 of evoked feeling states, 330
    of, 421 achievement for concentration and reading, 446-48 anesthesia, 50, 73. 85-108
    motivation, 437-43 for enhancement of athletic performance, 435 dental, 186, 192, 193
    allergies, suggestions with, 265-66 altered state for hyperemesis gravidarum, 305
    for writing skill enhancement, 464
    of consciousness, ending, 167 alternatives: hypnotic, 56
    action myoclonus. 251-52 activity:
    in gratification, 425 progressive, 81-83
    suggestions for, 384
    images and fantasies that emphasize, 66-67 suggestions for, 91-92
    visualizing, 389
    ambulance attendants, suggestions for, 235 for tooth extraction, 191-92
    addiction, 407-31
    amenorrhea, 270 truisms for developing, 54 anesthesiology,
    obesity as, 379-80
    psychogenic, 306 American Journal of Ericksonian approaches in,
    suggestions for, 420-21 aesthetic
    Clinical Hypnosis, 6, 94-98 anesthetist, hypnosis and
    refinement, 461-64 affect bridge technique,
    the, 92-93 anger, 58
    179 affect intensification, 323 affective 154, 160 American Society of Clinical
    Hypnosis, 1, 4-5, 235 suggestions and smoking, 414
    experience, enhancing, 322-24 affective
    angina pectoris, 244 anorexia nervosa,
    instability, 328-30 affirmatory reinforcement, component sections, 7
    380, 403-6 antenatal hypnotic
    555 age progression, 515-16, 543-51 membership qualifications, 8-9
    training, 279 anticipation, 54
    for enhancement of athletic newsletter, 7-8
    creating, 42, 43
    performance, 435 for amnesia:
    of pain relief, 74 anticipatory
    obesity control, 383 and in age progression. 545
    anxiety, 179 anxiety, 138-39, 153-55,
    phobias. 153 with suicidal about childbirth's unpleasant events, 288
    156-75
    patients. 330 in childbirth training. 284
    control of, 208
    in labor and childbirth, 290
    reducing, 433

    592
    SUBJECT INDEX 593

    apposition of opposites, 33 bellows technique, breathing, 163 Bell's Palsy, use in therapy, 119
    arousal level and sports performance, 252-53 bind of comparable alternatives, 34 catalepsy, 224
    466-67 arthritic biological clock for age regression, 522-23 for trance ratification, 187
    pains, 75-76 bipolar affective disorders, 332-33 bleeding cautions:
    managing, 73 ASCH, see American Society control: about abreactive techniques, 527
    of Clinical in childbirth, 291 about age progression, 543
    Hypnosis ASCH Manual for gastrointestinal hemorrhage, 245-46 about age regression, 512-13
    Self-Hypnosis. The, after labor, 286 about age regression and abreaction,
    6-7 assaulted patients, suggestions for, see also vascular control 524-25
    333-34 assertive behavior for smoking blending rivers image, 333 in reducing pain, 481-82
    management, 408 blepharospasm, 250 about the symbolic imagery, 530
    assertive retraining, 372 blistering, evocation and prevention, 229 in working with children, 476-77
    assessment of pain, 45-46 blood perfusion protocol, 246 body attitude, chaining suggestions, 32 change:
    asthma: suggestions to modify, and comfort, 133
    in children, 504-5 402-3 body the inevitability of, 132-33
    suggestions with, 265-66 image, 403-4 ugly duckling metaphor, 139 changes in
    athletic performance: for burn patients, 232 preference metaphor, 361-62 chemical
    cautions for using hypnosis, 471, 477 anesthesia, awareness under,
    and smoking, 423
    enhancing, 435, 465-73 athletic 86-87
    suggestions for, 337 "body
    warm-up, 261 attention, focusing the chemotherapy:
    lights" approach, 75-76 book
    patient's, 42 attic of the past, 400-401 metaphor, 526-27 book of time, control of side effects, 205
    attitude of activity, 441 authoritarian 519 clinical issues in, 200-201
    approach in treating hypnosis as an adjunct to, 212-15
    borderline personality disorder, 328, 334
    impotence, 358 authoritarian suggestions for patients, 202 chest,
    boundaries, discovering, 326 brain:
    instructive induction, 192 authoritative relieving discomfort in, 74-75 child abuse
    as a computer, 491
    suggestions: patients, 334-35
    teaching the other side of the, 247-50
    and nailbiting, 430 brainwashing techniques, 345 breast cancer, visual imagery technique, 343
    and patient's need for a symptom, 222 209-12 childbirth:
    autogenic rag doll, 165-67 autohypnosis: an Ericksonian approach to, 282-86
    suggestions for, 213-15
    in labor, 294 script for. 286-93
    breast growth, 270
    for pain control, 57 breathing, 174 suggestions for. 278-79, 281
    see also self-hypnosis autoimmune training for, 271-96
    relaxed, 162-65 breezes, in imagery, 241
    disease, 241-42 automaticity, 99-100 Bridey Murphy case, 511 bronchia] asthma, see also delivery; labor
    autonomous responding, 29-30 prolonged hypnosis for, children:
    aversive conditioning: burns in, 231-32
    243 bruxism,
    for chocolate eaters, 399-400 Erickson's approach to bruxism, 195
    155-56, 190
    for weight control, 395-96 hypnotic suggestions with, 475-507
    Erickson's approach with children, 195
    aversive method: immunodeficient, 226
    suggestions with, 184
    future consequences, 426-27 bulimia, 380 see also pediatric problems choices,
    and nailbiting, 430 images and fantasies that
    metaphor for, 405-6 burning
    for smoking, 423-25 emphasize, 66-67 chronic anxiety,
    pain, managing, 73 burn patients,
    and smoking cessation, 423 244 chronic pain syndrome, 61-63 circuit
    221
    for weight control, 397-99 room image, 345 class participation,
    suggestions with, 228-29
    facilitating, 436-37 clenched fist technique,
    awareness, enhancing, 42, 117 burns:
    145-47 closed drawer metaphor, 172
    painful, 231-33
    clotting, 192, see also bleeding control;
    produced by a thought, 231
    Babinski reflex, 510 vascular control cloud car
    baby, focus in childbirth, 292 induction, 482-83 cloud image in obesity
    back scratching metaphor, 363 cancer patients, 199-216 control, 388-89 cloud metaphor, 159
    barrier metaphors in ego-enhancement, meditation for, 161 for confidence building, 141 coffee taster
    123 "beached whale" comment, 86 suggestions with, 62-63 cancer therapy, side image, 394 cognitive behavior
    behaviorally oriented sex therapy, 350 effects of, 206 cardiac emergency patients, modification, 385-86 cognitive-hypnotic
    behavioral management, 145, 179 of chronic suggestions approach to athletic
    pain reduction, 72 and contingency for, 235 Carnegie, Dale. 15 carrot performance, 470 cognitive
    management. 445 behavioral problems, principle, 14 case example, age regression for patterns, reinstatement of
    499-500 behavioral response and implied anxiety childhood's, 510
    directives, 33 cognitive therapy:
    attacks, 540-41
    cassette tapes, 128-30 reinforcing, 1 6 8
    for phobia anxiety, 180-81 self-talk, 422 collagen
    self-hypnosis, 165 metaphor, 537
    594 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    college, studying effectiveness, 439-40 corridors of your mind image, 344 dial box shrinking technique, 400
    color in imagery, 240-41 cost imagery and smoking, 415 dialectical restructuring strategy, for
    comfort, devices to aid during labor, 275 cramps, managing, 73 smoking control, 416
    commitment: cravings, managing, 385-86 diaphragm, 164 diminution of
    obtaining, 17 creativity: pain, 56 direct suggestions:
    of smoking patients, 420 enhancing, 461-62 conditions for effective use, 25
    communication: research on, 434-35 and ego-strengthening, 110
    logical, 161 in treating children, 479 in emergencies, 234
    play on words, 97-98 crediting oneself, 124 for enhancement of athletic
    see also language communication criteria for hypnosis in anesthesiology. 89 performance, 435
    room image, 344-45 competition, crystal gazing technique for sexual see also indirect suggestions; suggestions
    destructive, 138-39 complications, dysfunction, 368-69 discharge resistance, 33-34 discomfort,
    postsurgical: cues: altering the quality of, 52-53 disorientation:
    and positive suggestions under in age regression, 535 technique with pain, 56
    anesthesia, 87-88 compliment, 109 for athletic performance, 467 see also confusional method
    and compliance, 15 in contingency management, 444 displacement:
    computer: for the learning process, 446 of the locus of pain, 50
    brain as, 491 to the onset of severe pain, 67-68 of pain, 55 disposing of rubbish, in
    metaphor for obesity, 389-90 computer with smokers, 429 ego-enhancement,
    room image, 345-46 concentrated attention, cult victims, treating, 345 123 dissociated release of affect
    law of, 12-13 concentration, 445-46, 460-61 cycle of positive feelings between parent and technique,
    in athletics, 469-70 concentration child, 479 534-35 dissociation, 29-30, 65, 95, 153, 208.
    suggestions, and cyclothymic disorder, 328 232, 286, 339-41, 398, 467
    achievement motivation, 440 in age regression, 519, 533-34
    conditioned environmental cues, and in childbirth, 272, 283
    smoking, 417-18 conditioned dangers of hypnosis, 324-25, see also for dental pain, 190
    response, and phobias, 178 conditioning, in cautions; iatrogenic harm daydreaming, and early childhood trauma, 312
    childbirth training, 280 Condyloma parallel with hypnosis, 480 day-of-not smoking encouraging, 43
    Acuminatum, 226 conference room imagery, 415 day tape suggestions, 128-30 in labor, 285
    image, 344 confidence: death rehearsal, 215-16 debridement, 236 from pain, 50-51, 62
    building of. 141-43 suggestion prior to, 232-33 decision making, regression experiences, 532
    hypnotic enhancement of, 109-51 a metaphor for, 173 deepening, 99-100, 127, suggested, 484
    instilling, 19 156-57, 249, 286 suggestions, with chronic pain, 52
    see also ego-strengthening; in time, 48 distancing suggestions,
    cloud car induction, 482
    self-confidence confusional hypnoanesthesia
    hypnosis training for childbirth, 283-84
    method, 24 with children, 485
    imagery as, 316
    with a child in pain, 486 distraction, 487
    as labor progresses, 288
    and induction, 522 for hypnoanesthesia with children, 485-86
    delivery, 290-91
    with pain, 56 disturbed patients, 374
    reducing pain during, 269
    for revivification, 523 hypnosis with, 324-33 diving
    suggestions for a comfortable, 275-77
    suggestions, 35-36, 543 reflex, 78 Door of Forgiveness,
    see also childbirth dental
    for wound injection, 236-37 congruence, 312-13 double binds:
    hypnosis, 155, 183-97
    and language utilization, 26 conscious
    dentures and gagging problems, 188 conscious-unconscious, 34-35
    decision-making, 425 consistency, need for,
    suggestion to promote flossing, 185 in suggestions, 491
    17 contingency management for academic
    depotentiating consciously trying, 100 therapeutic, 28 double dissociation, double
    achievement, 443-61 end, 35-36 double distancing, 526 double
    depression, 330
    contingent suggestions, 31-32 induction. 24 dreams:
    contractions, comfort with, 289 and age progression, 543
    cautions about hypnosis in cases of, 445 reframing in PTSD. 335
    contraindications, see cautions
    in PMS. 219 depth of trance, 21 utilizing in sex therapy, 367-68 drug,
    control:
    dermatologic disorders, 219-20, 222-24 imagined, 164 dull aches, managing, 73
    in anorexia nervosa therapy, 404 dysfunction, adaptive functions of, 351
    during labor, 289 control room reducing irritation, 228
    desensitization, 177, 179 dyslexia, 505 dysmenorrhea, 270 dyspareunia,
    image, 333 convalescence, painful, 46, 270
    79-80 coolness, imagined: advantages of hypnotic, 154
    with age regression, 541-42 secondary to the lack of lubrication, 364-65
    and pain control, 73
    and relaxation, 167 behavioral, 208
    coping strategies: and fractionation, 179
    for burn patients, 232 and phobias, 153
    for chronic pain, 67 and stage fright, 182 determination,
    corpus callosum, 248 143 developmental issues in work
    with
    children, 476 developmental
    stages, adult, 132-33
    SUBJECT INDEX 595

    dysphoria, 312 emergencies, 234-36 questions on, 30 failure syndrome,


    and multiple personality disorders, with the critically ill, 233 overcoming, 441 fairy tales, for treating
    342-43 hypnosis for the burned patient, 229 childhood
    emergency room suggestions, 333-34 insomnia, 505 faith enhancement, 206
    early childhood memories, systematic emotional disorders, 309-48 emotional family of origin, competitive games in,
    survey of, 532-33 Early Learning Set enrichment, 143-45 emotional factors, in 138 fantasy of the perfect world,
    (Erickson), 212-13 Eastern meditative pre-abortion 327 fantasy with tongue thrusting, 195-96
    traditions, influence on conditions, 299-301 emotional "fatty" comments, 85 fear, 178
    Meares, 160 eating as an art, 381. needs and food, 389 emotion, repressed, and athletic performance, 465
    393-94 eating disorders, master control 538 empathy, living with, 116 empty chair dental, 189-90
    room technique, 318 enchanted cottage in labor and childbirth, 290 fear inventory
    technique, 354 eat like a metaphor, 497-98 end-result imagery for for MPD patients. 347-48 February Man
    gourmet suggestion, 395 eclectic enhancement of technique. 509 feedback:
    approach, 3 ecstasy, 63 athletic performance, 435 endurance, nonverbal, 16-17
    edema in burn patients, 229 EEG patterns, physical, 262 energy, conserving and patient, 44
    during age regression, 510 effective living, increasing, 261-62 enhancement, cloud car from spontaneous remission of symptoms,
    suggestions for, 113-18 ego-assertiveness induction, 238 feelings, incomplete abreaction of. 526
    training, 371 ego building, 136-39 ego 482-83 entertainment, filling and emptying the bottle exercise
    defenses and phobias, 178 ego-enhancement: contraindications for (breathing), 165 finger questioning in
    barrier metaphors for, 123 a five-step hypnosis, 477 enuresis, 490-98 premature labor, 298 flexibility, 25 floating
    approach, 122 ego-image, visualization of an environmental change, 425 environmental relaxation, 157 fluid balance:
    idealized, manipulation in prolonged in burn patients, 229
    149-50 ego receptivity, need for, 325 ego-slate hypnosis, 243 erectile dysfunction, in childbirth training, 273
    reframing, 537-41 ego-strengthening, 109, suggestions with, 366. flying blanket, 208 flying
    110-12, 174, 206, 207, 208, 281, 312, 444, 369 Ericksonian phobia:
    480-81, 482, 492, 531 abstract technique for, approach: paradigm for, 175
    133-35 for burn patients, 232 in cancer to anesthesiology, 94-98 reframing approach for, 175-77
    patients, 203 in dental hypnosis, 193 for to the encouragement of amnesia, 123 rehearsal suggestions, 1 7 7 focusing
    enhancement of athletic to flying phobias, 176 attention, 99 fog of anesthesia image, 208
    naturalistic, 170 erotic dreams, suggestions follicle stimulating hormone, 357
    performance, 435 with multiple
    for induced, follow-up and smoking cessation, 422
    personality disorders,
    367-68 food:
    343 and nailbiting, 430 and pain
    control, 49 with psychotic patients, 513 for esteem: suggestions for decreasing intake, 390
    reading, 452-57 religious imagery of hypnotic enhancement of. 109-51 suggestions for increasing intake. 403 food
    universal healing in PMS, 219 ethics in treating shock, 403 foreign language study,
    children, 479 evaluation, 17 suggestions for,
    for, 58 research on enhancing, 434
    and school phobia, 506 serenity place, of direct versus indirect suggestions, 457-58 forensic hypnosis
    130-31 for smoking management, 408 23-26 guidelines, 542 format for the implied
    and stage fright, 181-82 suggestions for, of intraoperative suggestion, 86-87 directive, 33 fractionation technique, 179
    132, 147-49, 151, of pain, 45-46 with abreaction, 527-28 fragmenting
    (racking progress with implied sensations in pain control, 55 free from the
    383-84 techniques for, 371 for
    directives, 33 prison image, 409-10 fruits and vegetables
    writing skill enhancement, 464 yes-set
    of treatment for medical disorders, 218-19 metaphor, 372-73 fusion, definition, and
    method of, 120-22 ejaculatory inhibition,
    examination panic, 459-60 examination criteria for, 339 fusion of extremes technique,
    suggestion for,
    phobia, see test anxiety examinations, 315-16 fusion rituals, 312, 341-42
    365-66 electrochemical regulation,
    skills for taking, 436 exercise, suggestions with multiple personality disorder, 339-42
    suggestions
    for, 384 expectancy, creating, 43 future consequences:
    for, 332-33 elementary school,
    expectations: and habit, 426-27
    studying effectiveness,
    creating through suggestion, 42 positive, 425 future-oriented
    439 elevator image, 346 elevator of your mind
    structuring, 96 approach, 515-16
    image, 343-44 embedded suggestions and pain
    exploratory hypnosis: suggestion, 151
    control, 69
    nonverbal signaling in, 18
    time distortion, 557 extrovertive mystical gagging, 185-89
    experiences. 64, 65 eye fixation: Gandor's garden (guided imagery), 317-18
    example of questions used in, 30-31
    hypnosis training for childbirth, 283

    fail-safe approach: covering all response


    options, 29-30
    596 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    garden metaphor, 159 healing, 234 in work with children, 476-77


    gastric acid secretion, control under of burn injuries, 233 idealized-self-imagery (ISI), 440
    hypnosis, 218 gastrointestinal imagery for, 239 ideomotor identification followed by
    hemorrhage, suggestions preoperative hypnosis to facilitate, 94 partial regression, 518
    for control, 245-46 genital warts, 226 gestalt suggestions for, 100-101 ideomotor signaling, 87
    therapy, 315 gingival health, improving, 185 after tooth extraction, 192 healing for enhancement of athletic
    glass metaphor, 137-38 glove anesthesia, 61, dream, 128 healing water image. 241 performance, 435 imagery, 12, 227
    81, 202, 224, 293-94, 305, 396, 484 heartbeat, 166 helplessness, countering for age regression, 513, 519
    in childbirth training, 273 with cancer for childbirth, 287-88
    in labor, 294 patients, 199 hemispheric asymmetry of the end result (age progression), 546
    and pain control, 49 in hypnosis, 332 hemorrhoidectomies, pain with enuresis, 492-93
    for trance ratification, 183 following, healing, 239-41
    goal imagery, 548-49 77-78 hiccups, 267 hidden observer and immune system functioning, 204-5
    of sales productivity, 549 suggestions and trance for perfusion, 246
    goal-oriented therapy, 515-16 logic, 520 high school, studying science fiction-based, 506-7
    goals: effectiveness, 439 historic landmark with sleep disturbances, 254
    of cooperation and contributing, 124-25 technique for treating with smokers, 415
    process, introducing, 43 obesity, 391-93 hole in the for study problems, 440-45
    for promoting behavior change, 546 small of back. 163 hope, 19 symbolic and metaphoric, 38-39
    visualizing, in obesity control, 389 for burn patients, 232 as a therapeutic modality, 207-9
    going out to dinner metaphor, 362-63 in sexual dysfunction therapy, 351 imagery modification, 38 imagination,
    golden retriever metaphor, 376-77 good hopelessness, and age regression, 212 12, 396
    enough world, 327 good health, 134 group hunger, 381-82 husband: parallel with hypnosis, 480
    hypnosis: participation in childbirth, 284 imagining pleasant scenes. 48
    for athletic performance, 469 preparing for childbirth, 282 immune system, 204, 241-42, 374
    for childbirth training, 271 hyperemesis: and negative feelings, 58
    with chronic pain, 66-67 in childbirth training, 273 responses to calm and tranquility, 199
    for smoking management, 408 group pre-induction discussion, 303 immunodeficiency, 226 implied suggestion,
    training with obstetrical patients, suggestions for, 304-6 hyperemesis 27-29, 33 impotent patients, 351 indirect
    302 gravidarum, 269, 302-6 hypersensitive gag suggestions, 12
    growth: reflex, imagery with, and ego-strengthening, 110
    metaphor of, 140 187-88 myth of the superiority of, 23-25
    ugly duckling metaphor, 139 guided hypertension, 218 for premature labor, 299
    fantasy technique for children hypnagogic state of natural trance, 441 for sexual dysfunction, 366
    under ten, 445 guided hypnoanalgesia, treating children. 484-87 individualization, principle of, 22-27
    imagery, 310, 316-18 guidelines: hypnoanesthesia, 88-89 individualized treatment:
    for forensic hypnosis, 542 direct suggestions for, 484-85 for smoking, 413-14
    suggested steps for time distortion, 556 maintenance of, 107
    suggestions for smoking management, 408
    guilt, 58. 321 preparation for, 95-96
    individuation and separation, 327 induction:
    reduction of, 312-13 vascular control in, 244-45
    rapid, 227
    repressed, 538 hypnobehavioral method: stress reduction trance, 170-72
    for treating Tourette syndrome, 502-4 infertility, 270 information-gathering
    hypnopompic state of natural trance, interview for
    habit disorders, 407-31 441 hypnoreflexogenous childbirth hypnosis, 282
    strategies for overcoming technique in inhibited sexual desire (ISD), 350
    pleasure-producing, 425-28 obstetrics, 277-78 metaphor for treating, 361
    hallucinated world, time distortion hypnotic experiences: suggestions with, 369-70 inner adviser
    training, 552 for providing trance ratification, 19-20 technique, 309, 318-20 insight-oriented
    hallucinations: Hypnotic Induction and Suggestion techniques, 309, 318 insomnia, 179
    negative sensory, 227 (Hammond), 1, 6 hypnotic hypnosis techniques with, 255
    sensory, 471 phrasing, examples of suggestions for (Erickson), 255
    with tongue thrusting, 195-% introductory, 40-42 hypnotic talent in treating childhood, 505-6
    happiness, creating, 115 happiness children, 475-81 hypnotizability level, and visualization for treating, 254-55
    room technique, 465-66 harmony, pain strategies, integration of polarities, 315 integration, role
    living with, 116 headaches, 62 67-68 hypochondriasis, and timing of, 339-41 integrative
    in childbirth training. 273 paradigm-substitution with, 264-65 hypnotherapy, 2-4 Integrative Hypnotherapy
    diminution of, 81 (Hammond &
    managing, 74 Miller), 3 intellectual activity,
    suggestions for, 78-79 atrogenic harm: avoiding, 161
    depression, 212
    SUBJECT INDEX 597

    interactive trance, 16-19, 173 of dominant effect, 13-14, 107 elevator, 74-75
    for meeting an inner adviser, 318 of parsimony, 27 Erickson's use of, 13
    internal dialogue: of reversed effect, 12, 29, 38 for facilitating teamwork in athletics, 469
    for enhancement of athletic see also principle Learning Clinical flowers, for reading, 450
    performance, 435 Hypnosis (Hammond), 7 learning, fruits and vegetables, 372-73
    and smoking, 412-13 suggestions for, 248-50 leg pain, 52-53 "let's garden, 159
    utilizing, 100 interoceptive awareness, pretend" game in dental hypnosis, gate control theory, 61
    anorexia nervosa 194-95 leukorrhea, 270. glass, 137-38
    therapy, 404 interpersonal 306-7 LEVER technique, 449 going out to dinner, 362-63
    relationships, 353 levitation induction, 223-24 golden retriever, 376-77
    effectiveness in, 373-74 example of questions used in, 30-31 life growth, 140
    suggestions for, 371-77 interspersal energy, 128 guide rope, 74
    technique for pain control, 68 interspersed lightness image in obesity control, 382 of an injury and healing, 536-37
    suggestions, 70 local anesthesia, 484 locus of control and interspersed with suggestions, 36-38
    principle of, 22 introvertive mystical response to inverted funnel, 74
    experiences, 64-65 involuntary response, 24 suggestions, 24 island of serenity, 159-60
    encouraging, 43 irritable bowel syndrome, long breath, 163 jazz band, for family interaction, 375-76
    control under losses, dealing with in age regression, 514 knot, 75
    hypnosis, 218-19 island of serenity lounge room image, 344 Low Back Pain lake, 142-43
    metaphor, 159-60 Questionnaire, 47 lubrication problems, lake, for managing nausea, 201
    suggestion for, 366 luteinizing hormone, 357 lancing a wound, 346-47
    jazz band metaphor for family interaction, laundry, 313
    375-76 jigsaw pieces (guided magic mirror, 202
    imagery), 317 joining: McGill Pain Questionnaire, 47 magic melting butter, 72
    with a child, 490 mirror metaphor for managing Mexican food, 71
    with a child in pain, 486 joints, nausea, 202 making up stories, 37 mountain, 138
    loosening, 164-65 joy, 144 manic-depressive patient, 329-30 master ocean, for bedwetting, 494-97
    expanding, 137 control room technique, 310 opening flower, 74
    with sexual dysfunction, 354-55 organ transplant, 363-64
    kinesthetic imagery, 249, 450 mastery, 441 for overresponsibility, 320-21
    kinesthetic sense, 467 through abreaction, 527 pain, 56
    expanding, 136-37 masturbation pool, 159
    labor: assignments, 359 mathematics or statistics pressure cooker, 347
    conduct of, 274 performance, prominent tree, 139-40
    preparation for obstetrical, 293-96 suggestions for, 458-59 meaning protection, 313
    suggestions for the patient in, 96 and naming, 54 medical disorders, 217-67 puzzle, for reading, 450
    lactation, 281 medical-physical complaints, 256-67 pygmalion, 377
    promoting or suppressing, 270 medical procedures, comfort for, in pyramid, 142
    suggestions for, 291 childbirth, 292 meditative ranch, for behavioral problems, 499-500
    lagophthalmos, 251 lake trance, 160, 199 for reinterpreting pain, 68
    metaphor: and phobias, 153 memories, reactivation of restaurant, 202
    for confidence building, 142-43 pain-free, 59-60 memory bank, suggestions, room and fire, 313
    for managing nausea, 201 lancing a 437-39 mental calmness and ego-enhancement, back scratching, 363
    wound metaphor, 346-47 language, 122-23 mental rehearsal, 515, setting a broken bone, 346-47
    160-61 547-48 metaphoric work, age regression setting sun, 71, 75
    hypnotic phrasing, 40-42 for, sickness and immunity, 535-36
    meaning of events, 54 513-14 snake pit, 446
    phrasing, apposition of opposites, 33 metaphors, 70 snowball, 143
    phrasing for a double dissociative of ants, for study enhancement, 450 switchbox, 484-85
    double bind, 36 for athletics/sports competition, 467-69 symphony, 238-39
    phrasing, implied directive, 33 aversive, 424-25 turn off the light, 201
    phrasing of suggestions, 38-39 for bulimia and anorexia, 405-6 ugly duckling, 139 metronome, in
    rhythm and pauses, 39 callous formation, 71-72 facilitating lime distortion,
    types of phrasing, contingent changes in preference, 361-62 557 migraine headaches, 46, 80-81
    suggestions, 32 closed drawer, 172 misdirection of attention in labor, 295 morning
    types of phrasing, not knowing and not cloud, 141, 159 sickness, see hyperemesis motivating yourself
    doing, 29 computer programming, 62 suggestions, 396 motivation, 135, 207
    types of phrasing, truisms, 29 of different parts, 321-22 a child's, 478
    utilizing patient patterns, 25-26 and ego-strengthening, 110 for recovery, 208
    laundry metaphor, 313 law: and smoking, 412
    of concentrated attention, 12-13 in smoking control, 422-23
    of smoking patients, 420
    598 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    mountain metaphor, 138 60 postoperative verbalizations, 92


    multiple personality disorders, 311-12 management of, 45-84 post-traumatic stress disorder. 311-12
    containing dysphoria, 342-43 numeric levels of, 210 suggestions and metaphors for, 335-39
    ego-strengthening for, 343 fusion ritual and relaxation, 95 powerlessness, countering with cancer
    in treating, 339-41 metaphors with, religious imagery of universal healing for, patients, 199 praise and
    346-47 and time distortion training, 58 compliance, 15 Premack
    517-18 visual imagery techniques for, soliloquy, 96-97 principle, 441 premature
    343 suggestions for, 337 ejaculation. 358
    muscle jerking, suggestion for involuntary, and time distortion training, 517-18 suggestions for, 369, 370-71
    251-52 treating in children, 481-89 premature labor, 269-70
    muscle relaxation training, with Tourette painless wound injection, 236-37 relaxation technique for, 296-99
    syndrome, 503 panic, de-fusing, 173-74 paradoxical premenstrual syndrome (PMS), 160, 219
    musical performance, enhancing, 462-64 assignment: preoperative hypnosis:
    music, imagery of, 241 for chronic urinary retention, 262 to facilitate healing, 94
    "My-friend-John" approach, 176 paradoxical message, 376-77 para-logical suggestions, 98 preoperative visit, 90
    mystical states, hypnotically elicited, 63-66 use of words, 160-61 parataxic preparation, therapist's, 39 prescriptive
    distortions, 353 parents, help in child techniques, 3 presentation skills, 547-48
    nailbiting, 429-31 hypnotherapy, pressure cooker metaphor, 347
    National Institute of Mental Health, 350 477-79 paresthesia, 189-90, 252 past presurgical hypnotic suggestions, 85
    native hypnotic talent level, 353 life experiences, and source amnesia, principle:
    natural childbirth, 165 511-12 patients, language patterns of individualization, 22-27
    nausea, 201-2 of, 25-26 pediatric problems, 499-507 of interspersing and embedding
    counteracting, 262 needs and wants, 169-70 emergencies, 488-89 suggestions, 22
    negative accentuation. 425 negative see also children pee shyness of positive reinforcement, 15
    consequences, imagining, 386 negative sensory metaphor for sexual of positive suggestion, 14
    hallucination, 227 negatives, to discharge dysfunction, 364 pendulum metaphor of successive approximations, 13
    resistance, 33-34 negative suggestion, 195 and breathing, 164 perception-hallucination of trance ratification, 19-21
    nerve damage, 190-91 neurological conditions, continuum, 63 perceptual distortion, 192 of utilization. 22-27
    247-56 neurology, uses of hypnosis in, 219 perfectionism, suggestion for modifying, see also law
    night tape suggestions, 128-29 nitrous oxide, principles:
    124-26
    combined use with
    permissiveness: for alleviating persistent pain, 56-58
    hypnosis, 155 nonhypnotic treatment concerning time, 13 of hypnotic suggestions, 11-27
    options for pain in fusion, 340 permissive technique, 12 of visual distraction, 487
    management, 49 nonverbal feedback, personal experiences, 37 personal meaning of private refuge, 158 problem
    16-17 nonverbal responses, 17 nose and throat images, 240 philosophy, therapeutic, 2-4 solving:
    disorders, 257 not knowing and not doing phobia anxiety, cassette tapes for, 180-81 imagined screen for, 158
    suggestions, phobias, 175-82 suggestions to facilitate, 130 process
    29 dental, 189 physical relaxation, and imagery, 515 prochlorperazine, 80
    numbness, 484 ego-enhancement, professional orientation, 4 progress, cycle of,
    122 150-51 progressive relaxation for
    obesity, 400 physiological effects: enhancement of
    suggestions for, 112-13, 388-89 obstetrics involved in an erection, 357 athletic performance, 435
    and gynecology. 269-307 ocean metaphor, making suggestions to produce, 12 pool prolactin levels, 357 prolonged
    494-97 one-true-light-assumption, 3 operant metaphor, 159 positive expectancy: hypnosis, 199
    reinforcement. 440 operative hypnodontics, creating, 11-12 in psychosomatic medicine, 242-44
    193-94 ophthalmologic problems, 247-56, and trance ratification, 19 positive suggestions for, 244 prominent
    257-58 organ transplant metaphor, 363-64 feedback, 109 positive reinforcement, tree metaphor, 139-40 prompting, 15
    orgasmic dysfunction, suggestion for, 174, 175 positive suggestions: proparacaine, 236 protection
    365-66, 367 overcompetitiveness, 124 during chemical anesthesia, 86-88 metaphor, 313 protective shield, 547
    Overresponsibility, a metaphor for, 320-21 for chronic pain reduction, 72 post-delivery for enhancement of athletic
    caretaking, 292-93 postherpetic neuralgia performance, 435 pruritus, 222-23
    pace of response, 43-44 pain: (shingles), 76-77 posthypnotic response, and reframing suggestion with (Erickson), 223
    altering awareness of, 190 directness, 24 posthypnotic suggestions, in suggestions with, 227
    altering perceptions of, % childbirth pseudocyesis, 270
    in childbirth. 290 training, 284 post-menopausal pseudo-orientation:
    control of, 206 symptoms, 270 postoperative pain, in childbirth training, 284
    intensification as a control technique, 85 postoperative suggestions, 90 into the future, 544-45
    into the future, treating pain, 57
    SUBJECT INDEX 599

    psychiatric disorders, 309-48 for flying phobia, 175-77 to fusion, 340


    Psycho-Cybernetics (Maltz), 149 hospital language, 285 and indirect communication, 97
    psychogenic impotence, 356-58 hypnotic suggestion/metaphor to begin, 167 and questions, 30
    psychological casualties: immunity metaphor for, 536 and smoking, 409
    due to failure to individualize, 22 for increasing impulse control, 386 suggestions for, 355
    psychological rewards for pain behavior, and letter-writing technique, 375 in treating chronic pain, 52
    58-59 psychological stressor and of mistakes, 125-26 unconscious, 35 resistant patients, age
    phobic panic of a negative self-image, 238 progression with,
    responses, 178 the nursing experience, 285-86 550 respect, living
    psychoneuroimmunology, 199-200 the pain of childbirth, 284 with, 116 respiration, 166
    psychosis, critique of hypnosis for, 324-25 with pruritus, 223 response:
    psychosomatic disorders, 239 public speaking, in reexperiencing trauma, 525 covering all possibilities of, 29-30
    overcoming anxiety over, the straining in childbirth, 285 managing failure of, 44 responsibility
    182-83 pulmonary disorders, with trauma metaphors, 535 for study techniques, 448 restaurant
    258-59 pygmalion metaphor, 377 of traumatic dreams, 312 metaphor, for managing
    pyramid metaphor for confidence regression, 249 nausea, 202 restricted
    building, 1 4 2 of cancer, 162 environmental stimulation
    by confusion, 522, 523 therapy (REST), 242,431
    rehearsal: retraumatization in abreaction, 528
    questions, use for induction, 30-31
    for death, 215-16 reversed effect, law of, 12
    and phobias, 153 revivification, 514
    rape victims, suggestions with, 334 rapid reinforcement, 15, 43 confusional method for, 523
    induction analgesia, 102-6 rapport: of earlier suggestions, 117-18 experiences in, 510
    through focus on the patient, 26 for hypnoanesthesia with children, 486 fluctuation with age regression, 520
    between therapist and patient, 201 suggestions to facilitate, 521-23
    and pain control, 49 reinterpreting
    rapture, 63 rate of response, 13 see also age regression rewards,
    pain, 54-55, 61, 68 relapse
    ratification, 234, 393 choosing long-term, 389 rhythm in
    prevention:
    of healing, 233 speaking, 39 rigidity, 224
    suggestions for smoking, 427-28
    rating scale: ritualistic abuse victims. 347-48 room and
    with Tourette syndrome, 503
    for pain, 50, 61 fire metaphor, 313 room where smoking
    relationship factors:
    utilizing in pain reduction, 51-52 does not exist,
    in sexual dysfunction therapy, 352-53
    rational-emotive therapy (RET), 386, 444 420-21 runners, endurance suggestions
    relationship with the patient, 11 relaxation,
    and phobias, 154 with, 472-73
    184-85, 208
    suggestions about anxiety, 168-70
    in childbirth training, 273
    suggestions derived from, 126-27
    for enuresis, 492-93
    rationalizations and smoking, 409 reaction "safe room" techniques, 342
    and hypertension, 218
    formation, 315 reading: sales productivity, 549
    hypnosis training for childbirth, 283
    ego-strengthening to improve, 452-57 sales skills, 547-48
    imagery scenes facilitating, 159
    improving speed, 450-51 salivation, control of, 189
    of the lower abdomen, 75
    reading comprehension: schizophrenic patients, 334
    psychological, 157-58
    research on enhancing, 434 hypnosis with, 310-11 special
    and smoking, 414 relaxation induction,
    self-hypnosis to improve, 449 reading speed, problems with. 325
    156-57 relaxation therapy, as a euphemism for
    research on enhancing, 434 realerting, school phobia, 506
    hypnosis, 479-80 relaxed breathing,
    101 reality tone, 552 reassurance, 175 recall: secondary gain
    162-65 relief of heartburn, 75 relinquishing
    accuracy of during hypnosis, 511 reduction of, 206, 208
    repressed emotions, 539 removal of a barrier in
    of events in surgery, 87-88 role in sustaining pain behavior, 59
    ego-enhancement,
    improved, 433-34 red balloon technique, secret of Socrates, 15-16
    310, 313-15. 386, 123 renurturing, self-blame, 321
    420 reflected 326-28 repetition, 43 self-concept, 452
    image, 150 reframing, through metaphor, 37 restructuring, 470-71
    18 replacement of pain, 54-55 and study problems, 440-41
    in age regression, 514 research: self-confidence, restoration of, 181
    an analytical procedure for, 537-41 on age regression, 509-11 self-control:
    anxiety, 138-39, 285 on enhancing learning, 433-35 with the imagery technique, 208-9 with
    cognitive, 154 on indirect suggestions, 23-25 psychotic patients, 513
    in dieting, 388 resentment, 58 resistance: self-definition, suggestions for, 380-81
    of dreams in PTSD, 335 age progression to work through, Self-Directed Behavior Change
    with enuresis, 490 545-46 Instrument, 470
    in anorexia nervosa therapy, 404 self-efficacy:
    determining existence of, 17 enhancing in pain management, 48
    and directiveness, 24 hypnotic enhancement of, 109-51 in
    sexual dysfunction therapy, 351
    600 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    suggestions for, 291 sexual aversion: studying, 445-46, 460-61


    and trance ratification, 19 metaphor for treating, 361 college, 439-40
    self-esteem, 134 suggestions for, 359 elementary school, 439
    and smoking, 410 sexual dysfunction, 349-53 high school, 439
    suggestions for raising, 118-19, 127-30 pee shyness metaphor for, 364 sexual suggestions for, 441-42
    self-forgiveness, 313 self-fulfilling prophecy, fantasy, suggestions for facilitating, stuttering, 505 subjective
    440 360-61 sexual myths, overcoming, time, 555 substitution:
    success as, 441 self-healing, 363-64 sharp pain, managing, 73 shell shock, of pain, 54-55
    suggestions for, 203-4 self-hypnosis, 80, 509 shock and surprise, 35 sickness and for a painful sensation, 50 success, 134-35
    199, 238 immunity metaphors, 535-36 signal pain, success imagery, 440, 515 successive
    for blepharospasm, 250 retaining, 78 silent abreaction technique, 310, approximations, principle of, 13 suggestions:
    in bruxism and TMJ, 156 530-31 skin, breathing through, 164 skin rash, for addictive behaviors, 420-21
    for cancer patients, 207 226-27 sleep: for allergies, 265-66
    in childbirth training, 280 and athletic performance, 465 for amnesia, 402
    deep muscle relaxation, 220 suggestions for, 116 sleep for anesthesia and surgery, 91-92
    in dental procedures, 193 disturbance, 220-21 about anxiety, 168-70
    and dependence upon the therapist, 201 suggestions with, 253-56, 337 slow for asthma, 265-66
    for enhancing learning, 433-34 leak technique, 529-30 smile test, 540 for bruxism, 184-85
    with flying phobias, 179 smoking, 400 for burn patients, 228-29
    to improve reading comprehension, 449 control of, 416-24 for cancer patients, 62-63. 204-5
    in the Lamaze method, 271 five session approach, 413-15 for change and comfort, 133
    learning, 302 one-session approach, 419 for chemotherapy patients, 202
    metaphoric suggestions for, 337 success of hypnosis in managing, 407 for childbirth. 278-79, 287
    for obesity control, 390-91 suggestions for cessation, 112-13, 409-13, for confidence building, 143
    and pain control, 49 416-19, 428 snake pit metaphor, 446 for decreasing food intake, 390
    for PMS, 219 snoring, 255-56 snowball metaphor, 143 for ego-strengthening, 111-12, 132
    in sexual dysfunction, 351 social phobias, 155 for emotional enrichment, 144
    in sexual dysfunction therapy, 352 suggestions for, 178-80 somatic bridge for enuresis, 496-97
    and smoking, 410-11, 412 technique, 523 somnambulistic behavior during for erectile dysfunction, 366, 369
    and stress, 172 labor, 289 source amnesia, 511-12 space, for facilitating sexual fantasy, 360-61
    suggestions for, 76, 292-93 dimensions of, 64 Spanish version of an for fear of public speaking, 182-83
    suggestions for cancer patients, 205 induction, 337-39 special place visualization, formulating, 11-44
    tape, 209-12 and future-oriented, 151
    tapes, 220 ego-enhancement, 123 spectatoring, for healing and reframing pain, 100-101
    in a weight reduction program, 394 suggestions for, 358-59 splinting technique for for increasing food intake, 403
    see also autohypnosis self-hypnosis pain control, 68 spontaneous miscarriages, 302 for induced erotic dreams, 367-68
    tape, 165 self-hypnosis training, for spontaneous trances, suggestions for use for inhibited sexual desire, 369-70
    smoking of, 234-36 spouses, and sexual for inserting of needles or short
    control, 418 self-images, 150 dysfunction therapy, procedures, 101
    self-mothering, suggestions for creative, 352-53 stabilization, suggestions after, for interpersonal effectiveness, 373-74
    328 self-punishment, reasons for old 235-36 stage fright, 181-82 staircase imagery interspersed for metaphors, 36-38
    tensions, with sleep disturbances. for labor, 96
    539 self-reinforcement, suggestions 254 Stanford Sleep Research Lab, for lactation, 291
    for, 149 self-reward, 425 496 stillness of mind, 161 stimulus control for lubrication problems, 366
    self-suggestion technique, 549-51 and insomnia, 220-21 Stoler Program for to modify body attitude, 402-3
    self-talk, for smoking and other Pain-Controlled for modifying perfectionism, 124-26
    addictions, 422 self-understanding, Childbirth, 286 for nailbiting, 430-31
    scenes for facilitating, stone into well, 163 stop outline for obstetrics, 273-75
    316 sign imagery, 421 stress: for pain control, 76-77
    sensate focus: in bruxism and TMJ, 156 for pain control (Erickson's), 54-56
    assignments for, 359 physical symptoms caused by, 238 stress for patients with chronic pain, 72
    suggestions for, 358-59 sensory reduction trance, 170-72 stroke patient phrasing of, 38-39
    description of pain, 46-47 sensory rehabilitation, 247-50 for premature ejaculation, 369
    modalities, identifying an for problem solving, 130
    individual's, 22-23 separateness, for prolonged hypnosis, 244
    enjoying, 327-28 separation and individuation, for pruritus, 227
    327 serenity, 159 serenity place, 130-31 question format for, 31
    setting a broken bone metaphor, 346-47 sex from rational-emotive therapy, 126-27
    therapy: reducing pain, 77-78
    standards for, 349-50 reframing, 176
    suggestions in, 356 for self-healing, 203-4
    for self-reinforcement, 149
    SUBJECT INDEX 601

    suggestions (Continued) for managing pain, 47-51 sympathetic ear, trance ratification, 78, 213-14, 224
    and the serenity place, 131 58-59 temperature change for trance catalepsy for, 187
    for sexual aversion patients, 359 ratification, in craving management, 387
    for sleep disorders, 253-56 183 temperature suggestion, 101 experiences for providing, 19-20
    for smokers, 428 temporal dissociation, and phobias, 153 glove anesthesia for, 183
    for smoking relapse prevention, 427-28 temporomandibular joint syndrome, principle of, 19-21
    for social phobias, 178-80 155-56 in sexual dysfunction therapy, 351
    structure of, 42-44 tension, 184 temperature change for, 184
    for suicidal patients, 331-32 tension headaches, and TMJ, 184-85 lest transactional analysis model, 538-41
    for symptom substitution, 81 anxiety, 445-46, 460-61 transformation, 55
    for thumbsucking, 498-99 reducing, 433 testosterone, 357 of pain, 53-54
    time distortion, 80 tetracaine-adrenaline-cocaine (TAC) trauma, 536
    for TMJ, 183-184 solution, 236 theatre (guided and hypnotic age regression, 509
    for trance ratification, 20-21 imagery), 317-18 therapeutic alliance, metaphors with, 346-47
    for trichotillomania, 431 need for, 325 therapeutic tool, and pain, 48
    types of, 27-38 commitment of the and phobias, 154
    for untrained patients in labor, 296 patient, 17 reexperiencing, 525
    use of questions, 30-31 therapist: and time distortion training, 517-18
    for vaginal warts, 225-26 attributes of, 324 trichotillomania, suggestions with, 431
    for warts, 224-25, 226 comfort with his own mortality, 216 think tropical island fantasy, 254-55 truism
    for weight control, 395-96 thin suggestion, 395, 396 thumbsucking, metaphors, utilizing the therapists',
    for well-being, 112-13 498-99 tides metaphor and breathing, 164 37 truisms, 29,
    while light, 340-41 suggestive therapy, as a time-binding introduction, and implied 94-95
    euphemism for directives, 33 time, dimensions of, and and acceptance sets, 16
    hypnosis, 479-80 patient's mood, anesthesia developed with, 54 turn off the
    suicide, 374 64 time dissociation, 48 time light metaphor, for managing nausea, 201
    hypnotic suggestions to deter, 330-32 distortion, 80, 206-7, 516-18
    superiority, 124 surgery: in childbirth, 288 ugly duckling metaphor, 139 unconscious
    preparation for, 90, 98 for enhancement of athletic mind, consulting the, 17 unconscious
    techniques for, 107-8 surgical and performance, 435 negotiation, 321 unconscious purposes:
    obstetrical analgesia, 106 swallowing, 196 and pain control, 62 for pain, 48
    difficulty with pills, 266-67 suggestions for, 213 for retaining pain, 53, 58-59
    swing, 163-64 suggestions for childbirth, 285 uncovering techniques with suicidal
    switchbox metaphor, 484-85 switching training in, 551-58 lime progression in patients, 330 unverbalized
    off the senses, 101-2 symbolic imagery premature labor, 298 time reorientation, 509-58 phonation, 160-61 urinary retention,
    techniques, 309-12 for enhancement of athletic performance, 435 postoperative, 263 utilization, principle
    abreactive, 530-31 timing of suggestions, 21 tinnitus, metaphor of, 22-27 utilizing the unconscious, 54
    for enhancement of athletic with (Erickson), 266 TMJ:
    performance, 435 suggestions for, 183-184 tolerance vaginal warts, suggestions for, 225-26
    letter writing, 374-75 for dental pain, 190-91 tongue vaginitis, 270
    for obesity control, 386 thrusting, 195-97 tooth extraction, vascular control, 192, 193, 221, 244-45
    in sexual dysfunction therapy, 351-52 191-92 topical anesthesia, 484 suggestion for (Erickson), 245
    for weight control, 400 touching, 160-61 vascular involvement, and sexual
    sympathetic ear technique, 58-59 cautions with, 334 dysfunction, 357
    symphony metaphor, 238-39 Tourette syndrome, 501-2 verbal interaction, 18-19
    symptoms, 110 hypnobehavioral method for, 502-4 verbalizations, 229
    maintained by anxiety, 160 training: for the conduct of labor, 294
    need for, 222 symptom substitution, annua] workshops, 5-6 for obstetrical patients, 272
    suggestions for, 81 synesthesias, 65 regional workshops, 5 for postoperative dehypnotization, 107-8
    synonyms, utilizing, 22 trance: for postoperative urinary retention, 263
    alert, learning during, 434 for reducing problematic emotions, 314
    target imagery, 440 depth of, and success of suggestions, 459 suggestive, 64-65
    tasks, in lime distortion training, 553-54 interactive, 173 for treating severe pain, 193 victory
    team performance, athletic, 465 as a mystical state, 63 suggestions, and smoking, 414 visual
    metaphor for facilitating, 469 trance behavior, 282 trance distraction technique, 486-89 visual
    technical eclecticism, 3 techniques: logic, 520 hallucination screen technique, 532 visual
    confusion, 56 imagery, 343-46, 450
    disorientation, 56 evocation of two mental states, 329
    for ego-strengthening, 134-35 visualization:
    of hypnotic pain management, 50-52 control switch, for pain, 61
    imagery modification, 38 of the death experience, 216
    of the idealized ego-image, 149-50
    602 HANDBOOK OF HYPNOTIC SUGGESTIONS AND METAPHORS

    warmth: waves metaphor, and breathing, 164 wonderment, 12 work, suggestions


    imagined, and pain control, 73 weight control, 379-80, 387, 421 about. 117 wound injection, pediatric,
    internal and external, 166-67 suggestions for. 393, 395-96 486-89 writing ability, enhancing,
    war neurosis, 311 well-being, suggestions for, 112-13. 464
    warts, 223-26 116-17.380 white light suggestions
    hypnotic treatment for, 220 for fusion, 340-41 wind, in imagery, 241
    suggestions for, 224-25 treatment withdrawal in smoking control, 422-23
    of, 20-21 yes-set, 15-16, 17, 94-95

    You might also like