It is advisable in nearly every instance to have a preinduction discussion, especially with the skeptical or apprehensive patient. The set of remarks to follow should prove a helpful guide in achieving a favorable mind-set.
“Physicians, dentists, and clinical psychologists are becoming seriously interested in medical hypnosis, which is not a state of ‘trance,’ ‘sleep,’ or ‘unconsciousness.’ Rather, it is an exaggerated state of being awake! More simply, it is selective attention to my words, with selective inattention to distracting noise and everything else around you. Now, if you wish to relax, imagine and feel all of my suggestions. Do not try too hard. Just try to concentrate on my suggestions to the best of your ability. Don't press, just relax! Remember that if you do this you will relax, and then, the better you relax, the better you will concentrate on what I am saying. As a result, you will respond more effectively to those suggestions which are for your benefit.
“Medical hypnosis is different from entertainment hypnosis. The entertainer-hypnotist makes you think that he hypnotizes you because he is a powerful person. Physician-hypnotists know that hypnosis is effective because of the patient's desire and expectant attitude. The physician uses this tool with respect, realizing that every patient is an individual personality who should be treated with dignity both in and out of hypnosis.
“I really do not hypnotize you, and I have never hypnotized a single human being in my life! However, many individuals have entered into deep hypnosis because they really wanted to do so. I cannot make you close your eyes by suggesting eye closure unless you wish to close your eyes. I cannot make you count to yourself if you do not wish to count. And I have no way of knowing whether or not you are counting to yourself. I cannot make you lift your arm, if you do not care to lift it. Our relationship, therefore, is a cooperative one and not a mental ‘tug of war.’ For instance, you will raise your arm, not because you have to, but because you want to. Also, if I suggest that you drop your arm limp, relaxed, that is the way it will drop—limp.” (The operator can lift the arm and let it slip from his fingers. If the arm is relaxed, he can remark, “That's just the way you will relax.”)
“Hypnosis is a learning process and, of course, as in any other learning procedure, one begins with very simple suggestions. Isn't that logical? And if you follow the simple suggestions, then naturally you will follow complicated ones. May I repeat, you will not really be in a trance, even though we refer to it as such for want of a better term.
“Actually, we are being hypnotized continually as a part of everyday life. When I sit in a rowboat, fishing, the monotonous ripples relax me and time passes by rapidly. The first thing I am apt to say is,
‘Have I been here for 6 hours?’ It seemed like 3 hours, because a part of that time I was in reverie. Or how many times have you been in a theater, engrossed in a movie? As you looked at that screen, you became fixated on the movie and registered all types of emotions just as if it was real. You forgot who was sitting on your left and who was sitting on your right. Because you identified with the picture on the screen, you may even have forgotten what city you were in at the time. Next time you are at the theater, turn around and notice the ‘glassy’ stare in everyone's eyes. Of course, after it was over, you realized that what made you cry and laugh was not reality. Yet, for an hour and a half, you reacted to what you saw and heard as if it was real—yet it was an illusion. In other words, you were ‘entranced,’ but you did not think of this as hypnosis. However, is this any different from what happens when a stage hypnotist tells you that you will itch because ‘ants’ are crawling all over your body?
“Attainment of deep relaxation is easy, if you follow my suggestions. The capacity to be deeply relaxed is already present within you. I merely bring it to the surface, and only act as a guide. Is that clear?”
In addition, it should be emphasized, “You will do nothing to violate your moral code; you will not reveal information of a personal nature unless you wish to do so; you will be completely aware of what is said; and you will not act contrary to your wishes. Finally, every suggestion will be for your benefit.”
With this preliminary talk, the operator can remove the apprehension, fear, anxiety, and tension that are naturally present in all individuals undergoing a hypnotic induction for the first time.
Crasilneck and Hall describe their “screening” interview as a prelude to hypnotic induction.1 This excludes those for whom hypnosis is contraindicated and helps to assess the possible symbolic meanings of the presenting complaint. They also use the initial interview for ascertaining why the patient has presented himself for therapy: Did he decide to come in on his own? Is he sufficiently motivated to yield the symptom, or is the symptom utilized to manipulate others? The introductory talk also is utilized to assay the patient's frustration tolerance, to obtain a good psychiatric history, and to ascertain his prior experience with hypnosis. This establishes a positive mind-set, diminishes fears, and corrects misconceptions. The screening is also used to emphasize that medical hypnosis and the showmanship of the stage hypnotist are different entities.
Despite the advances of serious hypnotherapy, many patients continue to harbor preconceived notions fostered by the stage hypnotist. To dispel the idea of sleep, unconsciousness, or trance, I state: “A hypnotized person is super-alert.” I ask: “Do you think you are awake?” Invariably, the patient says “Yes.” I then say: “I am going to ask you two questions to see if you are really as awake as a hypnotized person would be. The first is: Would you mind telling me your father's first name?” Nine out of ten times the patient will give the first name. Then I ask: “What is your father's first name?” The patient nearly always repeats the first name. I go on to ask: “What was the first question?” Most patients reply, “You asked what is your father's first name,” to which I reply: “See, you forgot the first question entirely and did not even hear it.” This has a potent influence on the patient, as he now understands in no uncertain terms that a person in hypnosis hears better and as a result responds with a literalness or pinpoint specificity to words. He will not say after being hypnotized, “I heard everything you said.”
REFERENCE
1. Crasilneck, H.B., and Hall, J.A.: Clinical Hypnosis. Principles and Applications. New York, Grune & Stratton, 1975.