Before beginning an induction procedure, the operator should describe as simply as possible what he is going to do, what the subject is supposed to feel, and what is expected of him—this raises the expectancy level. The operator must stress that the more attention the subject directs to his suggestions, the more successful the induction will be. Needless to say, all misconceptions regarding surrender of the will, loss of consciousness, inability to “wake up,” and revelation of secrets must be removed. Rapport can be increased by mentioning that only suggestions compatible with the subject's wishes will be followed. It is axiomatic that induction is more successful in the presence of good rapport and motivation,2,6,7 particularly if relief is really desired for the presenting complaint.5
Confidence is essential, since most subjects, on the basis of subliminal cues, pick up the operator's insecurities and hesitancies. Therefore, the operator must approach every induction with the expectation of success. The experienced operator is readily recognized, and there cannot be even a modicum of success in the absence of the conviction of success on his part.1
Modern technics seldom require challenges. Unsophisticated operators generally use them and, when subjects defy the challenges, the operator “loses face.” This can be avoided by not giving the patient the impression that the suggestion will be acted upon. Rather, he should be given a wide latitude of choices to follow.
All suggestions should be made on the basis of logic and common sense rather than by deception. Subjects should be controlled, not fooled.
Failures during induction often are due to inability to understand the full meaning of the operator's suggestions. Hence, clarity and simplicity in the verbalizations are mandatory.
The operator must never appeal to the will, but must stress that willingness to cooperate and to use the imagination induces hypnosis. Maximal effects are achieved if the patient's own ideational activities are utilized to the utmost. This depends on the subject's involvement in as many ideomotor and ideosensory activities as possible. An individual must be kept so busy thinking about the heaviness of his lids, his toes, his legs, and his thighs, while counting backward with each breath he takes in order to relax, that he figures he might as well escape all this intense mental work and enter instead into hypnosis.
When an individual is deliberately switched from one type of ideomotor and ideosensory activity to another, the resultant misdirection is conducive to induction of hypnosis. This approach works on analytic or overly introspective subjects. It also is of distinct value for the overcurious and over cooperative patient; these are resistances against being hypnotized. Changing the suggestions or switching to a different technic minimizes the resistance. That is one reason why all skillful hypnotherapists must be conversant with a variety of technics. These must be adapted to the needs and the personality of the subject and the operator.
The following ten practical hints have proved useful in achieving successful hypnotic induction:
1. Make sure that the subject is absolutely comfortable. When an individual is sitting in an uncomfortable position, he may interrupt the induction by saying, “My neck hurts. Can't you stop talking until it relaxes?” This distraction is “noise,” and such interference prevents the subject from focusing his attention on your suggestions. If your “message” does not come through, failure in the induction is inevitable. The room should be free from distracting influences, and, if this is impossible, one can use the distractions as reinforcement (see p. 58).
2. It is helpful to remark, “If you follow the simple ABC suggestions, such as looking at a spot above your eyes, counting to yourself, imagining, thinking, and feeling that your legs are getting heavier and heavier, you will follow other and more complex suggestions.”
3. Another effective instruction is as follows: “The ability to achieve hypnosis is within you. I do not hypnotize you. You do! I cannot force you into hypnosis. However, if you really wish to be hypnotized at your own pace and by your own effort, all you have to do is to follow the ABC suggestions. If you follow these in sequence, you should readily develop a nice, pleasant state of relaxation, provided that you really wish to reach the ultimate goal of very, very deep relaxation.”
4. Monotonous, repetitive stressing of key words, such as “heavy” and “relaxed,” increases relaxation.
5. Sequentially building up ideosensory and ideomotor responses first by simple suggestions, then by more complicated ones, helps to limit voluntary movements and is conducive to hypnotic relaxation. For instance: “With every breath (ideomotor) you take and every number you count backward (ideosensory), you will go deeper and deeper relaxed.” (The author never uses the word “sleep” in his induction technics for reasons discussed on p. 36.)
6. Reinforcing a psychological suggestion (ideosensory) by a physiologic effect, such as lightly stroking a limb (ideomotor), facilitates acceptance of suggestions.
7. Suggestions must be given slowly, with sufficient time allowed for their assimilation and response.
8. Never tell the subject that he is difficult to induce. Using positive conditioning such as, “You did very well considering that it was the first time; you will do better the next time,” facilitates future inductions.
9. Fearful subjects never should be traumatized by too early testing for anesthesia; be certain that this phenomenon has been obtained.
10. Never blame the patient for his inability to enter hypnosis, as this only mobilizes resistances. Fear over failure to enter hypnosis, and subsequent anxiety, can be allayed by a confident, sympathetic, and reassuring approach, rather than by a condemnatory one.
The skillful operator closely observes his subject's responses to use every voluntary or involuntary manifestation to reinforce the subject's expectancy and belief that hypnosis will be induced. Here, too, the dictum bears repeating: One must use what he sees and see what to use. If the subject's eyelids tremble involuntarily during the induction, it is helpful to remark: “Trembling of your lids is a good sign that you are becoming deeper relaxed.” If the patient voluntarily swallows, say, “You just swallowed. That's good; it shows you are relaxing!” Every inconsequential movement, even the uncrossing of the patient's legs, is a good sign. Constant reassurances, if made convincingly, especially during the initial phases of induction, are helpful to unsophisticated subjects. These promote relaxation in subjects who doubt the effectiveness of the suggestions.
If a suggestion is not followed, the experienced operator should use another one so that the subject thinks that he is progressing nicely. If the subject refuses to close his lids, one can suggest: “The harder you try to keep your eyes open, the deeper relaxed you become.” Always emphasize that better results are obtained if the sequence of the suggestions is not broken.
This author finds that it is helpful (whenever possible) to have a new patient observe an induction procedure on a well-conditioned subject—a few minutes of observation are worth hours of discussion. Through identification with patients who successfully enter hypnosis, the subject now knows what to expect; this helps to overcome resistances due to misconceptions. Most patients have little or no reluctance when asked, “Would you mind allowing me to demonstrate the technic of hypnotic induction? After my new patient has seen you induced, he will leave the room.” Since this was the way he was introduced to hypnosis, the old patient does not mind showing the uninformed one how easy it is to attain hypnosis. He also feels a sense of achievement by collaborating. And it must be remembered that many individuals are retreating from the world because they feel inadequate, insecure, frustrated, and lonely. This gives the unhappy and disturbed individual the feeling that he is finally being noticed and is capable of helping a fellow sufferer. Furthermore, this saves valuable time that would be lost in talking to uniformed and skeptical patients.
It should be emphasized that successful induction depends upon the subject's needs and his expectations of the way in which the hypnotic relationship will fulfill them. Thus it is up to the operator to instill in the subject a positive attitude that he will be hypnotized.
Some hypnotherapists are not concerned about the hypnotic induction procedure. This author feels that the initial induction procedure is a means of initiating the foundation for successful psychotherapy. If the patient feels that the suggestions of the operator are effective, there is greater likelihood that the desired changes will occur. A deeper degree of hypnotizability is attained if the goals that the patient is seeking are interspersed and paired with the induction procedures. If, for example, the individual is desirous of breaking the smoking habit, he can be told, “If you really wish to stop smoking, you will feel your lids getting heavier and heavier.” As one's experience increases, these goal-oriented suggestions can be integrated into a sophisticated induction technic. Moreover, the all important motivational factors are increased when the subject realizes that specific changes did indeed occur! It has been noted that if suggestions are given in a more positive manner, the depth of the hypnosis increases.3 This, too, is the author's experiences.
A novel concept has been advanced to convince the subject that he will be hypnotized.4 The patient, while in hypnosis, is instructed to produce muscle fasciculations (i.e., tiny, tic-like movements or twitches of small muscles with larger muscles). When these occur without additional control, they provide credible evidence for subject and hypnotist that a bona fide hypnotic state has been achieved. This establishes an expectancy and favorable mind-set that facilitates acceptance of additional suggestions.
REFERENCES
1. Blumenthal, L.S.: Confidence—the keystone of the physician-patient relationship: how hypnosis is based on this confidence. Am. J. Clin. Hypn., 1:169, 1959.
2. Estabrooks, G.H., and May, J.R.: Hypnosis in integrative motivation. Am. J. Clin. Hypn., 7:346, 1965.
3. Hartland, J.: The general principles of suggestion. Am. J. Clin. Hypn., 9:211, 1967.
4. Overglade, D.C.: The production of fasciculations by suggestions. Am. J. Clin. Hypn., 19:50, 1976.
5. Podolnick, E.E., and Field, P.B.: Emotional involvement, oral anxiety, and hypnosis. Int. J. Clin. Exp. Hypn., 18:194, 1970.
6. Von Dedenroth, T.E.A.: Trance depths: An independent variable in therapeutic results. Am. J. Clin. Hypn., 4:174, 1962.
7. Wagner, F.: A dynamic approach to the problem of hypnotic induction. J. Clin. Exp. Hypn., 4:93, 1956.