One of the most important hindrances to hypnotic induction is the therapist who has neurotic problems. He may talk too much about his abilities or his successful cases. The various problem areas in which the hypnotherapist may have unrecognized countertransference reactions to the patient have been identified.2 Orne cautions against the indiscriminate use of hypnosis by therapists, and especially by those who enjoy the self-aggrandizement afforded by being able to hypnotize and who are not concerned with its therapeutic effectiveness. He points out other problem areas as well, such as looking upon hypnosis as a test of wills or utilizing hypnosis in the seduction of attractive patients.
The emotional status of the subject may also be a hindrance to hypnotic induction. It was mentioned previously that a skeptical or an analytic attitude toward hypnosis is not conducive to the establishment of hypnosis. In others, over-cooperation often may be a defense against being hypnotized. Some subjects are merely curious or are unable to concentrate because of the fear of being hypnotized. All these factors decrease rapport and the ability to be hypnotized. Trivia, such as the pipe or cigar which the doctor is smoking, may be objectionable. These and other factors can produce resentment and interfere with successful induction.
Apprehensive individuals also show other elements of conflict, such as excessive giggling or laughing, sweating and trembling, weeping or crying; these are indicative of profound tension and anxiety. Unless the operator is experienced, induction should not be continued in such emotionally disturbed individuals, because chagrin, a sense of failure, and other depressive reactions can be brought to the surface. Although induction of hypnosis depends, to a degree, on the strength of the interpersonal relationship, it must be emphasized again that it is a subjective and intensely intrapersonal problem for the subject.
Hypnotic response usually is facilitated by making the subject comfortable and eliminating all distracting influences; freedom from interruption helps to promote relaxation. However, many therapists do not have soundproof offices; some have consultation rooms that overlook busy intersections. Often certain types of distractions can be utilized to facilitate a hypnotic induction. The monotonous traffic hum or other sounds can be incorporated in the induction technic as follows: “With every car that goes by, you will go deeper and deeper relaxed.” If a secretary's typing is audible, one says: “With each click, click, click of the machine, you will go deeper and deeper relaxed.”
An office near the author's was being remodeled, and the hammering was continual. Several patients were hypnotized by using this distraction, as follows: “With each beat, beat, beat of that hammer, you will go deeper and deeper relaxed. With each pounding of that hammer, you will feel that you are being pounded into a deeper and deeper relaxed state.” Thus the operator must use what he sees and see what to use! He must utilize anything and everything that the patient manifests to build up his confidence and reduce his resistance to hypnosis.
The room must not be too hot or too cold. Even a draft will be uncomfortable enough to interfere with the induction procedure. The posture of the subject is important. If he prefers a chair, his feet should be flat on the floor and his hands on his lap. The back of the head should be well supported, as neck strain becomes unbearable and interferes with induction. If the subject lies down, he should assume his usual position for sleeping. Some subjects much prefer to lie on their sides.
Noises such as those made by a chiming clock should be eliminated from the room. Naturally, all outside noises, such as loud talking, should be discouraged. Subjects with a severe cough or a head cold should not be induced for the first time, as they often are disturbed by sneezing, coughing, or the need to clear their throats. Others may have a postnasal drip, and this can be a distinct hindrance to induction. All disturbing situations should be under control before any type of induction procedure is attempted with any individual.
REFERENCES
1. Orne, M.T.: Can a hypnotized subject be compelled to carry out otherwise unacceptable behavior? Int. J. Clin. Exp. Hypn., 20:107, 1972.
2. Stein, C.: Some old-fashioned uncovering techniques in psychotherapy. Am. J. Clin. Hypn., 9:140, 1966.