Hypnotherapy is an effective and flexible tool for selective cases of enuresis, nail-biting, stammering, asthma, epilepsy, tics, and behavior problems associated with chronic tensions, stress, and environmental difficulties. Hypnotherapy is also useful for attacking the psychogenic components of minimal brain damage, mental retardation, neuromuscular involvements, and chronic debilitating ailments requiring prolonged bed rest.16 Hypnosis can help those with learning problems.30,36 and, according to Laquarte, can aid in correcting vocal difficulties.34 Hypnoanesthesia also can be used for children as well as for adults to minimize fear reactions prior to surgery.
Children over 5 years of age have the necessary verbal understanding to be hypnotized. Their blind trust and vivid imaginations make them very susceptible to suggestions. Children have a short attention span, and the best induction procedures are those which continually involve them in fantasy experiences, such as those described under Picture Visualization Technics (p. 75).
Dentists who hypnotize children draw “Mickey Mouse” on their thumbnails and maintain interest by relating a series of humorous incidents built around him. Games appeal to children, and they are easily shifted from reality to unreality by such measures, often being dissociated without their knowledge. Thus fear reactions are minimal because criticalness is reduced.
Because of children's autistic tendencies, a light to medium stage is usually sufficient for hypnotherapy. Picture or scene visualization is employed to enable the child to “see” himself as a character on an imaginary television screen—this reinforces the artificial dissociation.
Further imagery manipulation is oriented around the child's rapidly developing emotional responses by utilizing his greater flexibility, overtness and curiosity, his intense desire to learn, and his eagerness to participate. However, since he has only a limited ability to understand the meaning of a suggestion, communication must be at his level. One should never use “baby talk,” “speak over his head” or “talk down to him,” as this angers the child. Also, there should be no sudden and unexpected change in tone or content, as this may disrupt the rapport. Wright has detailed the technics particularly applicable to children.64 Gardner recommends an approach involving a great many specific images and emphasizes ego-strengthening technics and self-hypnosis for reinforcement.16 Parental attitudes are also included in the total therapeutic setting.
If the child is told what actions to expect rather than be taken by surprise, rapport is enhanced. Startle reactions usually terminate the hypnosis and produce resistances. Asking the child to imagine himself relaxing in his bed or on a comfortable couch deepens hypnosis. The escalator technic is helpful for further deepening. The child, at all times, must be flattered and given the impression that the suggested ideas originated from his own feelings, thinking, and experience.
A reward for his efforts, such as a medal, a prize, or a treat, strengthens the interpersonal relationship, shows the therapist's appreciation, and increases motivation. If new ideas are presented in such a manner as to apprise him fully that therapy is a collaborative venture, cooperation is increased. An authoritative approach rarely succeeds with children. They require patience and understanding; it is easier to agree that a symptom is annoying than to argue a child out of it. This helps to establish further rapport. Children seldom respond to logical ideas but readily comprehend those dealing with their own experiences, especially those affording them the most satisfaction and achievement.
Thus, with an enuretic child, it is useless to suggest that “Only babies wet the bed.” It is better to ask, “How do your playmates feel about this? How many of them do this?” If the answers indicate a desire for help, therapy can be instituted. If not, further interrogation should be made. Assuming a desire for treatment, the next statement is, “With your help, I think we can lick this problem together. Wouldn't you like to do this? If you really want to, I'll show you how it can be a ‘do-it-yourself’ treatment.” Such statements invite the child's participation in helping to remove an undesirable habit pattern which he recognizes as his problem. They also build up selfesteem. All psychotherapy must be directed toward helping the child to cope with the emotional significance of his difficulties. Recently, the coping mechanisms of children have received considerable attention.16,17
The use of hypnosis in child therapy has been discussed, varying from supportive treatment directed toward release of tension, reassurance, and reeducation to acting out and other complex hypnotherapeutic procedures.3,5,9,10,14,35,39,50,64 Call emphasizes that symptomatic improvement should be reinforced by the total need-systems of child and family.6 This view has been reiterated by Williams and Singh, who advocate using a total approach consisting of family and behavior therapy with hypnosis.62 Unfortunately, space limitations preclude their detailed description. The reader is referred to an excellent bibliography on these aspects prepared by Weitzenhoffer.60 Several of the commonest conditions that are amenable to hypnosis will now be discussed.
NOCTURNAL ENURESIS
Etiology
Bed-wetting is a difficult symptom to treat. The causes can be divided into two broad classifications: physical and psychogenic. Physical causes comprise spina bifida, congenital and mechanical factors, a small bladder capacity,24,57 neurogenic factors, cystitis, hypospadias, and other involvements. Psychogenic factors such as sibling rivalry, loss of a mother or a nurse, faulty attitudes toward masturbation, improper development of urinary control due to frequent micturition, inadequate toilet-training, poor hygiene, deep sleep, and emotional immaturity due to over-protection must be considered.
Often the symptom is a manifestation of a passive rebellious interplay between child and parents. Once the child realizes, following his initial bed-wetting, that he now possesses a weapon against the parents, he may maintain a conditioned pattern long after the original cause for his hostility is forgotten. When this reflex becomes firmly entrenched, the harder he tries not to wet the bed on a volitional level, the more likely he will be to lose control during sleep.
Even though it is used as an aggressive act, the child is ashamed of the bed-wetting. However, he is loath to give up the secondary gain value that the symptom of enuresis affords. The mother, unable to cope with the problem, resorts to nagging, which, in turn, makes the child more frustrated. She also becomes insecure, intolerant, and harsh, and displaces her own hostilities and tensions upon him, not realizing that he desperately needs sympathy and support. This further increases the child's tensions and insecurities so that he is unable to adjust to more mature levels of development. The chronic bed-wetter has never developed beyond the diaper stage! In dealing with the situation thus created, the parents must be treated concurrently with the child by family therapy.
Treatment
Before instituting therapy, the presence of physical problems such as kidney infections, bladder involvements, and diseases of the nervous system must be eliminated. Treatment is not simple, and various combinations of therapy, such as reeducation and psychotherapy, must be used together. Parents must not humiliate, punish, or use the child for the displacement of their own tensions. There are a number of well-controlled studies showing that imipramine is effective in nocturnal enuresis. Several other studies indicate that anticholinergic drugs are of little value. Hypnotherapy, as a potentiating agent, has been used successfully by numerous investigators.1,8,18,33,35,52,59 The following scenario illustrates the author's approach:
The child usually is brought in for the initial visit against his will. Therefore, a friendly relation-ship must be established immediately. The following ruse is often effective: In mock anger, the mother is asked, “Why did you bring Johnny in on such a beautiful day?” Without waiting for her reply, I remark, “Isn't that right, Johnny?” Wide-eyed, he now sees in me a new-found friend. (The mother has been apprised of these tactics prior to the first appointment.) Then he is told, “Johnny, you have a perfect right to wet the bed as often as you please, and it is also your privilege to stop wetting the bed whenever you feel like it.” After listening carefully to his views, one can ask him, “How would you like to play a little game where you can relax and imagine seeing your favorite television program?” Invariably, Johnny will agree, because of the good rapport that has been established. Visual-imagery technics are used to induce hypnosis.
After hypnosis is achieved, the child is asked, “Do you enjoy wetting the bed?” If a negative response is elicited, the following questions are asked: “How many of your classmates wet their bed?” (By indirection, this makes him feel unusual and helps to establish the motivation for a change.) “If you slept overnight at the house of a friend, who did not wet his bed, and had an accident, how would you feel?” If he agrees that this would be embarrassing, he is asked, “Would you like to be helped to avoid this situation in the future?”
These questions focus his attention on the fact that he has a problem, and yet he has not been made to feel guilty. They also reveal his personality structure and, hence, the most appropriate therapeutic route. With an aggressive child, a permissive approach is used in order not to identify the therapist with the parents. The therapist can also point out, providing the child is mature enough, that he is harming himself more than his parents. If the child is passive and dependent, he can be encouraged to assert himself the way others of his age group do, by allowing him to vent his resentments on the therapist, and later, channel his aggression into more constructive outlets.
The usual posthypnotic suggestions for symptom removal are presented briefly as follows: “Would you try holding your water (urine) as long as possible during the day?” (This increases the bladder capacity.) “Also, perhaps you might be interested to see how well you can start and stop the passing of your water.” (This invites his participation.) “Maybe you will gain better control than your friends. If you concentrate on what it feels like to pass your water during the day, you will have little or no trouble feeling this identical sensation even when you are sound asleep. And after you have gone to the toilet, you will return to your bed and immediately fall deep asleep.” The child should be given positive suggestions that, when he gets out of bed to urinate during the night, the time intervals between trips to the toilet will be increased until he can sleep through the night without urinating.
Under hypnosis, he is taught how to contract the diaphragm and simultaneously relax the pubococcygeus muscles; the downward push on the vesical neck stimulates contraction of the detrusors and opens the internal sphincter, which leads to urination. Rehearsal of the act of urination should be repeated several times during each session. Under autohypnosis he can “rehearse” or have a “dry run” of all the accompanying sensations of micturition, and thus speed up bladder control.
The next step is to reverse the child's fears about the bed-wetting. The youngster is asked, while under hypnosis, “Would you be interested in how much of your bed can remain dry?” This shifts his attention from himself to the bed. It can be suggested that since he controls his own bladder functioning, he can have a dry bed if he wants it badly enough. The word “wet” is never used! The mother also is instructed always to speak in terms of a “dry bed.” She can remark, “My goodness, your bed was three quarters dry!” or “Last night it was all dry!” If this positive approach is used over a period of time, the idea of a “dry bed” will be indelibly imprinted on the child's mind. Convincing the child that a dry bed is a sign of maturity is in itself often therapeutic.
Therapy is facilitated, in some instances, by establishing a time limit for when the bed will be dry. Most effective are posthypnotic suggestions such as, “Johnny, you can set a time when you will be able to have full bladder control.” If he names a date, this goal can be strengthened by saying, “You can be very proud if you reach your goal beforehand.” This, of course, implies that bladder control will be developed (extraverbal suggestion). A child can be hypnotically conditioned to derive pride in the achievement of establishing bladder control. These suggestions may be repeated as necessary to effect a conditioned response. Any reason for failure should be analyzed.
The urine also can be measured every morning, a larger amount indicating increased bladder capacity. It is very helpful, too, to give a reward for achieving a goal within a certain period. A calendar used to mark off the nights on which the bed was dry helps to add to the sense of achievement. Drugs to reduce the depth of sleep, tranquilizers, atropine, and such procedures as fluid restriction have only a placebo effect. However, if parents and child are convinced of their utility, they may be employed. Interrupting sleep is of little help and only increases tension. Devices which sound alarms when the bed is wet are seldom helpful.
The parents are instructed not to scold or chastise the child over a wet bed. Humiliation and ridicule only serve to compound the problem. The entire family should look upon the child's progress in overcoming his difficulty as an important event, and he should be praised for each small victory. He should likewise be encouraged to overcome a sense of defeat if the bed is wet on occasions. Often the problem is intensified if the child cannot communicate effectively with his parents. The insecurity, the inadequacy, and the tensions present in the mother, therefore, must be corrected. She can be advised to read a bedtime story in a soft and soothing manner and to emphasize her love for the child. Other members of the family who need help for their own tensions often must be treated as part of the total therapy. The following case illustrates the author's approach:
Simon B., a 12-year-old boy, was a chronic bed-wetter. In addition to poor grades in school, he had poor relationships with playmates, superiors, and relatives. The bed-wetting began soon after the adoption of a sister for him when he was 4.
He was hypnotized readily in the first session. During the second session, he was taught autohypnosis. It was also suggested that he practice inducing self-hypnosis frequently and that the more he practiced, the more proficient he would become. On the third visit, a week later, he readily induced self-hypnosis, and related how his mother continually “rode” him, that he was unwilling to accept any of his mother's suggestions because she favored his adopted sister. During subsequent sessions, he stated that he was looking for ways to get even with his parents and that perhaps the bed-wetting pattern was being maintained for this purpose.
At this time, Simon's mother was interviewed. She said that Simon had always wanted a baby sister; he knew that she was adopted. She thought that perhaps because of her own perfectionistic attitudes and demands she had pushed Simon too rapidly. In addition, she was not getting along too well with her husband and wondered if she might not be displacing her tensions to Simon. Simon and his sister were constantly fighting, and this, too, made her nervous. For some reason, she always protected the little girl. One day, in a fit of anger, Simon remarked, “Pretty smart girl we've got here.” After this, she noted that Simon was becoming increasingly argumentative and sulky. During the next few sessions, other ambivalent attitudes toward his mother were brought out. He angrily remarked, “The tone of my mother's voice annoys me. She never even lets me finish what I have to say.”
Other areas of insecurity were explored. During the next three sessions, at weekly intervals, he was given posthypnotic suggestions to maintain a full bladder until the last possible moment; to remember the sensations accompanying a full bladder, and to reexperience these sensations even during the deepest sleep. It was emphasized that all sensations accompanying a full bladder would be “telephoned” to his brain and would wake him up; that if he wished, he would then awaken and go to the toilet, empty his bladder, and promptly return to his bed and fall asleep.
Simon reported at the next session that during sleep his bladder “felt like a big balloon,” and that he awakened, was able to pass his water and again immediately fall asleep. It was now suggested that under no circumstances would the symptom be given up until he was willing to yield it, and that this would occur through autohypnosis and in full accordance with his wishes. When autohypnosis is employed, there is little possibility that other symptom equivalents will be produced.
The mother was also instructed never to mention the word “wet” but always to speak in terms of a “dry bed.” She was advised particularly to watch the tone of her voice when speaking to Simon. In several sessions, at nonhypnotic levels, it was made evident to her that she should love the boy for himself rather than for his intellectual accomplishments. She was advised not to vent her ire on him; this would curb his rebellious attitudes. Through the combined use of hypnosis, directed toward symptom removal, and psychotherapy for the mother, Simon overcame his bed-wetting pattern within 3 months from the time he began therapy.
NAIL-BITING
Nail-biting is generally indicative of insecurity and anxiety. Therefore, therapy must be directed to the causes of the child's tensions, which usually involve the parents. The latter must be cautioned against evincing displeasure over the habit, as this only mobilizes more guilt and frustration and serves to perpetuate the vicious circle.
Treatment
Hypnotherapy can be employed for direct symptom removal; at least, the conditioned pattern can be interrupted until the emotional needs are elicited, as the following case illustrates:
A child of 9, who had an older and a younger sister, began to bite her nails following the birth of the younger one. Utilizing the permissive technics described above, posthypnotic suggestions were employed as follows: “Would you like to stop biting your nails by your own efforts? Then, perhaps, you might be willing to bite one nail on each hand as often as you wish. Which one would you like to choose?” If the forefinger on each hand is chosen, one can remark, “Let's make the nail-biting more interesting. Maybe you would like to start biting the nail on the left side of your mouth first, using one bite from each tooth in succession across the mouth, and then doubling back to the side where you started. You will find it fun to repeat this at least three times. If you still think you are not satisfied, turn the nail upside down and repeat the same procedure.” This makes the nail-biting so complicated that it becomes a chore.
As soon as the other nails began to grow, the child was praised for following instructions: “Aren't you really proud that the other four nails on each hand are as good looking as your girl friends? Haven't any of your schoolmates noticed the other nice-looking nails?” Under hypnosis, it was suggested, “You can increase or decrease biting the nail you selected to the degree that you think necessary.” Such a suggestion is designed to make the nail-biting a routine and boring task against which the patient will rebel just as she did against parental admonitions not to bite the nails. This reaction follows the law of reversed effect.
Four more sessions were required to “wean” the child from biting the one nail. During this period, the procedure was continually made more complex until the child's natural resistance to regimentation made the nail-biting nonrewarding in terms of her oral satisfactions. At this point, she described her jealousy of her parents' attention to her baby sister.
Therapy was now directed toward the emotional needs for the nail-biting. She was asked whether it was her desire to stop the habit or whether it was the wish of her parents that she do so. In order to determine how much of the habit the patient needs to maintain equilibrium, it is necessary to evaluate the strength of the desire to stop as opposed to the degree of oral satisfaction obtained. At a subsequent session, the child was asked to see herself as a little baby, and it was pointed out that it was perfectly natural for her at this earlier age to put a rattle or a thumb in her mouth. She readily agreed to this and stated. “I guess I was trying to be a little baby all the time, wasn't I?”
The parents were instructed to pay equal attention to all the children, to ignore the nail-biting and not to punish the girl if the habit returned. Further psychotherapy directed toward the parents, and permissive technics employed for reinforcement, enabled the patient to break the habit in several months.
Often, excessively dominating parents, or those who delegate the care of their youngsters to servants, need psychotherapy more than the child who is made insecure by such factors. Children who are unresponsive to permissive technics can be counterconditioned by a more direct approach: “Whenever you bite your nails, you will get a very bitter taste in your mouth; you will feel sick to your stomach.” Weekly reinforcements under hypnosis are necessary to break the habit. In general, however, a permissive approach is more successful. Manicuring the nails weekly is also a valuable adjunct to hypnotherapy.
TICS OR HABIT SPASMS
Tics or habit spasms may involve all sorts of facial or bodily movements. They occur usually in hyperkinetic, sensitive, and nervous children. Other extenuating factors, such as familial traits and mannerisms, quarreling parents, an insecure mother who continually screams at the child, or physical defects, contribute to the child's unhappiness and tensions. Anxiety over poor grades, lack of interests, fright, and identification with children who display similar involvements are other causes. It is also believed that some tics are suggested.
A 13-year-old boy who was failing in school had had a blinking tic of the eyelids for 3 years. The constant blinking was accompanied by a severe conjunctivitis. He had been treated unsuccessfully by psychotherapy. His father was a physician and wanted the boy to follow in his footsteps. However, the boy was more interested in mechanical hobbies such as radio and electronic devices. It was apparent that the frustrated father was attempting to live out his life in the son.
Under hypnosis it was suggested, “Would you mind twitching the forefinger of your right hand several times a minute? This will take the tension off your lids.” Four sessions were required for reinforcement of this suggestion under autohypnosis before the blinking tic of the lids was transferred to a finger-twitch. During the next six sessions, the finger-twitch was reduced in frequency until it, too, subsided. The father's faulty attitudes were discussed, and he decided not to push the boy.
Symptom transformation is usually successful because it is much easier to remove a recently acquired conditioned reflex than a long-standing one. When the new reflex is manifested, one can be fairly certain of a successful outcome. If psychological guidance is combined with conditioning under autohypnosis and proper posthypnotic suggestions, better results can be obtained. For refractory cases, the specialized technics discussed in Chapter 50 are indicated.
Lindner and Stevens discuss the hypnotherapeutic approach for a young male with Gilles de la Tourette syndrome.37 These investigators felt that the underlying dynamics probably consisted in the compulsive tic's replacing a strong physical aggression to strike his mother. The author has had poor results in this syndrome when hypnosis per se was employed. My results are more in accord with Clement, who used hypnotherapy, haloperidol, and psychotherapy—each played an essential part in the apparent “cure.”7 (See page 258-259).
STUTTERING
Stuttering in young children, adolescents, or adults is often a very difficult problem. There are some interesting cases of the use of hypnosis in speech therapy and clinical audiology.2,15,41,53,63
Treatment
Stuttering is an enormously resistant symptom which cannot be removed by simple posthypnotic suggestions. Some cases, especially those of mild stutterers, do respond to this approach. However, a moderate or a severe stutterer ordinarily requires an intensive evaluation of what is taking place between himself and his hearers. Ordinarily, there is a great deal of repressed hostility, the expression of which is masked. The stutterer feels insecure around other persons, and is unable to express his feelings since he is always on guard. Stuttering is a compromise between the simultaneous desire to express an idea and to inhibit it.
In children, the anticipation of stuttering brings it about by setting up a conditioned pattern. The attempt to defeat this anticipation and to control it, and the resulting heightened tension, lead to further hesitation and disruption of speech. Thus the stutterer believes that he is going to stutter, and that he must not stutter. He is controlled by these two conflict-ridden thoughts, which have become entrenched through repeated enforcement in speech situations, often since he first started to talk. He now finds it impossible to eliminate them by will alone.
Most stutterers are, of course, very reluctant to deal with the symptom itself. The stutterer is so ashamed and overwrought about the symptom that he is unable to cope with it directly. Because stuttering is not a uniform phenomenon, its severity is more or less dependent upon the environmental situation.
Therefore, one must elicit situations that the individual fears or emotional expressions in relation to other people that he finds it impossible to make freely. Under hypnosis, the symptom is much more amenable to a direct attack, as he can rehearse speech situations particularly dreaded by him, especially in relation to those who upset him.
Hypnosis is an excellent method for investigating the particular situations and stimulus patterns that produced the stuttering. It enables the patient to understand the need for the avoidance reaction, to rehearse it and to work it through so as to help to release the specific tensions which arise in his oral musculature during the act of speaking. Exploration through hypnotic age regression in good subjects often helps to pinpoint specific episodes which brought about these inhibitory patterns. Orton contends that the critical periods are when speech and writing were first learned.48
The stutterer often develops auxiliary symptoms which are a misguided effort to overcome his speech defect. He blinks his eyes, stamps his foot, or pounds his fists in order to overcome the blocking. He develops these reactions to avoid becoming aware of certain words and sounds. He then substitutes other words or sounds in a vain attempt to hide his stuttering. These attempts invariably lead to more symptoms. The individual who starts out by stuttering and finds that, initially at least, he stutters less when he lifts his head, will begin to lift his head more and more until he develops a real spasm. And this spasm can often become more disabling than the initial stuttering symptom which he is trying to overcome by this mechanism.
Successful hypnotherapy must be directed to all the accompanying symptoms. The subject is shown that in the hypnotic state he can speak in a manner that is more satisfactory both to himself and to his listeners. Stutterers are surprised that they can speak without the involuntary head motions, the foot stamping, the finger snapping or whatever other muscular manifestation they employ.
The tape recorder can be used to good advantage with hypnotherapy. Stutterers are almost always free of symptoms when their ears are plugged, when they are reading from a prepared text, when they are speaking in unison with someone else, or when alone. It is helpful to have the individual speak into the tape recorder while he is by himself. Then he listens to himself while under hypnorelaxation, and reads the same passage in unison with his tape-recorded verbalization. The resulting good, fluent speech encourages him to identify with a person who obviously is able to speak normally.
This procedure is accomplished best by a permissive approach, judiciously utilizing posthypnotic suggestions. Suggesting that the subject is never going to stutter again is seldom effective, as this works for only a short time. As a result, the patient becomes disheartened and loses confidence not only in the therapist but also in hypnotherapy.
Posthypnotic suggestions and autohypnosis can be limited to specific situations; for example, comfort and ease can be induced in the child who dreads speaking in class by remarking, “Under self-hypnosis you will imagine that you feel relaxed and more comfortable in class, and if you can see yourself talking without difficulty in your imagination, you will find it easier to talk.” If each situation is approached through sensory-imagery conditioning, there is a good chance that, to a degree, the vicious fear-reaction cycle in which the child has become enmeshed can ultimately be reversed. The following selected case is illustrative of the author's technic:
A 12-year-old child was taught hypnosis and autohypnosis in one 50-minute session. He was a hissing stutterer who took about half a minute to say one word. Yet, under hypnosis, he said, “Around the rugged rock the ragged rascal ran” and other tongue twisters, all in one breath, without any hesitation whatsoever. This indicated that a psychological approach would be helpful.
Since his speech difficulty began at age 2, it was patently impossible to elicit traumatic episodes that might have occurred prior to this age. He also had received intensive psychotherapy. It was decided that the best course was to break up the reflex at one level or another.
During the next session, he spoke under hypnosis into a tape recorder without difficulty. It was suggested: “If, under autohypnosis, you listen enough to yourself, you will become accustomed to the sound of your own voice speaking normally. After all, when we hear a tune played over and over again, do we not hum the tune exactly the way we heard it?” Such measures establish a healthy pattern, so that the stutterer has a firm foundation upon which to build a more natural and normal type of speech. At first, if he wishes, he can hum a tune, then sing words, and later speak short sentences. The first tapes can be compared with later ones; the resultant improvement instills confidence.
During the third hypnotic session, it was suggested that perhaps the blocking of the muscles involved in speaking might be transferred to another portion of the body. It was pointed out that the subject had no control over the gestures and the spasms that usually accompanied his stuttering; that Nature's first line of defense could be employed in a constructive manner by giving him something that he could control. A twitching of one of the fingers of either the right or the left hand was suggested. Under hypnosis, he was asked, “Which finger would you like to twitch; would it be the little finger on the left hand, or perhaps the little finger on the right hand, or even the thumb on the left hand?” The fact that he was given a choice led him to believe that he was acting under his own volition. A posthypnotic suggestion was given that “Each time you feel that you are going to stutter, you can control it by twitching your finger. And you can, if you feel embarrassed, do this with your hand closed. In this way no one will see it.”
The transfer of the blocking from the muscles of the speech to the muscles of the finger is a “trading down” or an attempt to siphon off the energy with which the original symptom is invested. Furthermore, the finger twitch takes the place of stuttering in fulfilling the need for a symptom. Symptom transformation of this type does not remove the symptom all at once but, rather, substitutes a weak conditioned response for a noxious or well-entrenched one. In this case, the child made progressively more use of the finger twitch for several weeks. At this point, the twitch could be either increased or decreased. If it can be increased, obviously it can be decreased. The child was eventually weaned from the finger twitch by posthypnotic suggestions directed toward increasing and diminishing it. During this period, considerable improvement in his speech difficulty was manifested.
Under hypnosis, he was next taught “loose contact.” Most stutterers have difficulty only with the first letter or two of any word on which they block. Therefore, it is advisable to reverse the emphasis by suggesting, “You are going to worry about the last syllables. For example, if you have trouble saying the word ‘democratic’ and you find yourself saying ‘de-, de-, de-,’ become more interested in the ‘mo-cra-tic’ portion, and you will notice that if you direct your attention to the bulk of the word, you will easily slide over the first two or three letters.”
In the case just described, the child had considerable resentment toward the father, who was too busy to spend an appreciable amount of time with him. In another case, that of the son of a physician, a similar mechanism was elicited. In both instances the parents were interviewed and these problems were discussed. Both boys were completely cured of their stuttering after attending the author's group hypnosis speech-training program. In many instances, such patients must be prepared for a relapse. Rather than regarding this as a failure, they should be asked to describe the factors that produced the relapse. Patients are urged to return at monthly or bi-monthly intervals for reinforcement suggestions.
Other posthypnotic suggestions are commonly employed, such as, “If possible, try looking at the face of the person to whom you are speaking.” Most stutterers look down or away in shame. It is emphasized that they should maintain a steady gaze at all times; that, just as they need not be ashamed of speaking rapidly, they likewise should not feel embarrassed if they speak slowly. Reading backward and forward again and again helps to slow rapid speech, and also favorably conditions the auditory centers to adopt normal speech patterns. Other posthypnotic suggestions are directed toward improvement in vocalization and articulation.
Another feasible approach, as described above, is via the use of sensory-imagery conditioning under autohypnosis. In this technic, the individual imagines that he is speaking normally. Just as we have a “mind's eye,” we have a “mind's ear.” In the hypnotic state, the subject is asked to “listen” to his own voice, and to “hear” himself talking on a wide variety of subjects, without hesitation, blocking, or difficulty of any type. After he begins to think that he can “speak” normally, he finds it much easier to speak at nonhypnotic levels.
It is easier to recognize the basic speech patterns than to direct treatment primarily to the cause of the speech disorder. As fluency improves, the stuttering will diminish, particularly if training is directed to sensory functions rather than to motor ones. The thinking processes involved in speech are more important than the talking process. Thus, as the eartraining establishes a good mental pattern of speech, talking becomes “thinking out loud.” As a result, the autonomic portion of the brain transmits impulses to the mouth; the words “say themselves.” Sensory-imagery conditioning was most efficacious in the case of a 16-year-old boy with hysterical aphonia who had not spoken for 2 years because of profound guilt over masturbation.
Another valuable approach is to suggest that the stutterer speak out loud as often as necessary when he is alone. A 15-minute session daily is suggested. Through posthypnotic suggestions, the duration can be decreased by 1 minute daily, and then 1 minute every other day, every third day, etc., until he is weaned off the symptom. It is surprising that, when a stutterer deliberately tries to stutter, he is unable to do so. By reversing his fears, one can break up the reflex; through hearing his own voice speaking normally, especially when speaking into a mirror, the stutterer gains confidence in his ability.
Group hypnotherapy is ideal for the stutterer. The “emotional contagion” of the group operates with beneficial effects when stammering is being treated by hypnosis. Most stutterers feel that they are “all in the same boat” and do not hesitate to speak before other members of the group. It is surprising how quickly they pick up another individual's mistakes and make constructive suggestions for improved speech. This, of course, increases the stutterer's self-esteem and confidence and motivates him toward further therapy.
Faulty parental attitudes can arouse tensions in a child and lead to stuttering. Many parents are worriers and perfectionists. They react to their child's nonfluent speech with concern or impatience. By correcting him, they make the child conscious that his speech is unacceptable. He responds by talking less and less, with the growing fear of failure—until he is speaking with the fear and stress of a stutterer. Hence, parents should allow the child to develop at his own pace, and his speech should not be judged by adult standards.
Since stuttering often begins early, there is no use exhuming a great deal of memorial data; nor is it helpful to search for early traumata by questioning about events before the age of 4 or 5. Attempting this generally yields diminishing returns. Johnson states: “Considerable research to data provides no appreciable support for the hypothesis that stuttering is characteristically associated with or symptomatic of severe emotional disturbance or neuroses in a clinically significant sense.”26 In this regard, he states that speech training often does more harm than good, as it emphasizes the use of the will rather than the imagination. The stutterer becomes more conscious of his speech difficulty, and it thus becomes intensified.
According to Johnson, the symptom developed because the stutterer had too critical a listener during a crucial period of speech learning. It begins the day that a listener, usually the mother, begins to worry that perhaps her preschool-age youngster is unduly repeating himself or hesitating in his speech. Once this notion enters her head, the stage is set for the child to become a stutterer.
If the mother would pay no attention to his hesitancy and repetitiveness—which is a natural part of speech development in a 3- to 4-year-old—there would be no stutterers in the world. Unfortunately, however, too many mothers judge a child's speech by adult standards. They make the child conscious of their own unfounded fears. They attempt to correct the child's speech, and the child, if he is desirous of pleasing the parents, will develop doubt and fear of his ability to express himself and stuttering begins.
If a child gets past the age of 3 or 4 years without being classified as a stutterer, the chances are that he will never stutter unless he runs into the same problem with listeners when he enters school. There are approximately two and a half times as many male stutterers as female. One possible explanation of this is that mothers are less likely to be critical of the speech of girls than of boys.
Marchesi cured 75 to 80 per cent of 98 cases of stammering by hypnotherapy directed toward symptom removal, even though antecedent emotional tensions and traumas apparently were causative factors.47 Stammering developed as an imitative reflex; removal from the person who caused it is all that is necessary. The condition also may be due to an accident, with personal involvement or as a witness.
The specific treatment begins with a study of the vital capacity of the lungs, as breathing exercises are employed with hypnotherapy. The breathing is chosen as the starting-point because the arrhythmic respiration, upon which the stammering is based, is restored to a more normal rhythm. More important, as a result of the rhythmic breathing, the emotional aspect of the stammering is now separated from the association with the abnormal breathing. Hypnotherapy is continuously maintained—on the average, two sessions weekly for about one month. The breathing exercises are prescribed in the office for use during hypnorelaxation there as well as at home. Concentration is directed to the character of the breathing as well as to subjective thoughts. However, the patient is informed that he should not try to concentrate too hard, as failure is inevitable. At the beginning, he is apprised that progress will not be upward and that relapses can be expected.
Marchesi stresses a nondirective hypnotic approach which leads to very deep hypnotization because criticalness is not developed. This provides considerable self-satisfaction because the patient gets the impression that the operator needs his help. Objectivity and the self-realization that hypnosis produces psychophysiologic alterations enhances the expectancy level of the patient. By the second week, the patient is able to develop numbness and lightness of the extremities, and is able to breathe so that the rhythm is undisturbed by any type of noise. After this the breathing becomes smooth in type.
The stammering is attacked by asking the patient to spell out words which caused difficulty in the past. Success in doing this leads to a more positive attitude. The patient who does not respond is asked to speak under those emotional conditions which formerly caused the stammering. Attention is directed to spasmodic contractions of the diaphragm, the glottis, and the character of the breathing. Errors are pointed out, and under hypnosis he is asked to breathe as taught, to spell words without any hesitation, and to note the differences in speech when these functions are correctly performed. This, too, adds to his confidence.
In the failure group, 15 per cent did not respond, due to insufficient attention by the therapist. About 5 per cent did not have the necessary intelligence to participate in the program. Another method that often stops stuttering requires that patients interrupt their speech to take an exaggerated deep breath when they begin to stutter, and thus they have time to think of what they are going to say. Hypnotherapy has been used by other investigators with moderate success.10,21,22,26,49
DYSLEXIA
Crasilneck and Hall report that over 75 per cent of children unable to recognize and read words normally can be helped by direct hypnotherapy.10 During the initial sessions, the child pronounces new words very carefully, with attention to each syllable. Following hypnotherapy which includes positive suggestions for improving performance, pronunciation, and recognition seem to become much more rapid and automatic. These results are as good as those reported by the behavior modifiers.
MENTAL RETARDATION
McCord finds that mentally retarded children are readily hypnotized; good intelligence is not an important requisite for hypnotizability.44,55 Rather, these children are “uneducated” and really have never been taught how to learn; I.Q. tests are not indicative of their learning capacity; and many generalizations about “intelligence” do not apply to the mentally retarded child.
Hypnosis, by increasing motivation, convinces the child that he can learn more than was anticipated; thus the child's self-concept is altered and healthier attitudes are developed. The author noted similar findings when he was working with spastic children, as described in Chapter 39; their learning capacity was improved after teaching them how to “tap their forgotten assets.”
McCord reported on a series of “mongoloidtype” subjects with I.Q.'s under 40.43 In addition to bringing about an increased motivation to learn, vocational motivation, and a lengthening of the attention span, hypnosis was believed to be of possible help in controlling perseverative excitement, including relaxation and relief of insomnia. McCord and Sherrell noted that altering the self-concept was an important motivational variable for improving learning when hypnosis was used.45 Kroger and Fezler add time distortion to facilitate learning.32
Uhr's excellent review of the effects of hypnosis on learning indicates that the results are inconclusive.58 However, the clinical observations overwhelmingly show definite and possibly striking improvements in learning. Other experiments indicated an improvement in learning of from 2 to 40 per cent when time distortion, specifically time condensation, was employed.
The consensus from Uhr's studies is that “suggestion” or “motivation” or “attention” may well prove to be the crucial variable, and that hypnosis merely potentiates these factors. This view is in keeping with what is known about hypnosis.
EXAMINATION ANXIETY AND READING
Several investigators have demonstrated that hypnosis improved performance in cases of examination anxiety.10,23,38 Motor capacity, attention and perception, association, learning and memory, speed of reading, and comprehension were improved. Taped suggestions were more effective if given during hypnosis than during sleep.33 Another investigator in this area found hypnosis more effective than a tranquilizer, and the latter better than ordinary waking suggestions.20 These results through hypnosis could not be replicated by others.13 With reference to reading skills, there are several studies which indicate that hypnotic subjects do better than nonhypnotic ones.12,15,31 This has been the author's experience for a wide variety of children with reading disorders. It is self-evident that counterconditioning the associated anxiety must be of benefit.
THUMB-SUCKING
Most infants suck their thumbs, but the maneuver becomes more marked when a baby is weaned too soon. This results in an inner need for more sucking activities, and unless he gets more food, he may suck his thumb or even his whole hand. Not all children are alike, and the process of weaning cannot be governed by a timetable. Thumb-sucking at this early stage of development is not harmful even though it is done vigorously. The baby teeth may be distorted, but the effects are temporary, provided that the youngster discontinues the habit before the permanent set erupts.
Interference only intensifies the symptom and makes the child rebellious. Thumb-sucking usually is gradually stopped by the age of 4. Some children return to it as a consolation when bored, tired, sleepy, or hungry. Others revert when lonely, tense, or upset because a younger brother or sister is getting more attention. If the youngster is made to feel important, loved, and secure, the habit disappears completely.
But something must be done if the child persists in sucking his thumb after his fourth birthday. Elbow-splints, mitts, rings, and horrible-tasting concoctions are valueless. Little is accomplished through nagging, shaming, bribing, teasing, or punishing an already unhappy child. Parents should make it a point to fuss over the child, and it will help if other children in the family, relatives, and friends will do the same, or at least make no mention of the habit. Adequate rest and play outlets should be encouraged.
Eventually most children give up the habit, as by age 5 they are capable of self-discipline and can be taught to help themselves. But if the problem has been mishandled, the youngster may switch to nailbiting. Hypnotherapy can be very helpful in thumbsucking and is employed in a fashion similar to that used for nail-biting.35
BEHAVIOR DISORDERS
The behavior pattern of the child is laid down from the first few weeks of life. Recently it was shown that, if newborn monkeys were taken away from their mothers and nursed on a wire surrogate “monkey,” these monkeys, deprived of warmth, became asocial, detached, quarrelsome, nervous, and, in short, psychoneurotic adults. When a control group was nursed on a soft, cuddly, teddy bear “monkey,” they grew up to be warm, gregarious, mature adults, normal in every respect. It was also found that leaving the monkeys on the wire “mother” for only a week and then transferring them to the teddy bear monkey did not reverse the harmful patterns that were laid down. This ingenious experiment indicates that personality is molded early in life.
The developing personality, in order to mature into a healthy one, as pointed out by Freud, must pass through the early emotional mileposts of infantile sexuality. If an individual is unable to adapt himself to a mature orientation, he will do one of two things: He will either retreat to a previous stage of development or remain at the latest one. This is analogous to the soldier who finds that the pillbox which he is attempting to attack is too heavily fortified, and so he retreats back to his slit trench where he once knew safety. Immature, frustrated individuals who are insecure hate to leave the “slit trench of childhood” and remain fixated at early levels of development.
To encourage growth of the personality, parents, particularly the mother, of necessity, have to “walk a tightrope”; they must give the child an equal amount of love and of discipline. However, children must not be reared as if they were mass-produced; each child needs to have his own particular needs, wishes, and feelings satisfied in his own particular manner. Therefore, mothers especially must make their children feel that they are loved for themselves and not for their accomplishments. If he is given a considerable amount of love, the child will be willing to abandon his hostility and reciprocate with compliance and the giving up of earlier patterns of behavior. “Smother love” is not “mother love,” and mothers must be careful not to be over-solicitous toward the child. This will only make him more dependent and less likely to mature in a healthy fashion.
Parents should also remember that unruly behavior, rebellion, and delinquency of any type are often used as attention-getting devices—the child uses these mechanisms to invite interest on the part of the parents. This type of behavior is often seen in the chronically ill child, who uses complaints as a means of gaining sympathy and attention.
It is important to ascertain whether or not parents are taking out their own frustrations on a child as a means of acting out their own neurotic needs. Other parents live out their own thwarted ambitions through the child—the stage mother is a typical example. And still others make unreasonable demands that the child is unable to fulfill, and, as a result, he retreats to earlier levels of behavior and develops many of the sequelae described in this book.
A big problem in evaluating the emotional behavior of a child is that the same symptom may signify different levels of disturbance in different children. There are criteria for evaluating the seriousness of a child's behavioral difficulty that can be helpful in determining whether or not a child needs hypnotic treatment. Whether the conflicts are internalized or external is an important criterion. Problems created by the environment are much easier to deal with than internal conflicts.
Another criterion is whether the disturbance is limited or affects most aspects of the child's development. Does the child have difficulty getting along with his mother only, or does he have difficulty in other interpersonal relationships? Most normal adolescents are in a state of turmoil. In fact, the adolescent who is not struggling to conquer his impulses and to achieve independence is the one who may eventually need psychological care. However, the particular type of emotional disturbance which develops depends on the parental behavior, the degree of the child's exposure, and the response of the parents and others to his psychological disorder. The length of time that the disturbance has been present also is important. One present for a month will clear up more readily than a symptom present for years.
School phobia can be treated in the incipient stage by posthypnotic suggestions directed to increasing the child's interest in his studies. If this approach is not successful, arrangements can be made for the mother to sit in class with the child for gradually diminishing periods of time. If the classroom, schoolmates or teachers are disturbing factors, these should be discussed at either hypnotic or nonhypnotic levels.
Eating problems, appearing early in life, usually represent hostility toward parents. When eating becomes a means of expressing pleasure or displeasure, hunger ceases to dictate the amount of the food intake; a vicious cycle is established, the origin of which is eventually forgotten. In this situation, the mother needs greater confidence in her ability as a parent. She must recognize that the child's own physiology will ensure an adequate dietary intake as long as she does not fuss about his eating habits.
Dawdling is probably normal in preschool children and it, too, denotes resentment of the “nagging” parent. Fear of punishment or loss of love causes the child to choose this pattern rather than one of overt rebellion. Therapy should be directed against parental overreaction but, the longer dawdling has existed, the more time and support will be required to help parents guide their child through this phase of adjustment.
Rebellious behavior suggests that the child is angry and has such a poor relationship with his parents that he fears neither punishment nor loss of love. At other times, rebellion occurs when the child feels omnipotent as a result of lacking parental control. Thus the parents require guidance regarding the need for parental unity in providing realistic, consistent demands on the child, combined with continuing love and acceptance.
Sadistic and destructive behavior gives pleasure to most 2- or 3-year-old youngsters, as they seek and even enjoy punishment for their misdeeds. Parents should recognize this as an attention-getting device, and increase approval, and decrease rejection and punishment. If the syndrome is noted too late, psychotherapy will be required when the child is older.
Ambrose employed hypnotherapy in a child guidance clinic and reported cures or improvement in school phobias, nightmares, chronic anxiety states, and other psychosomatic disorders.2,3 Symptomatic cure was established in over 60 per cent of the cases. In investigations he demonstrated how hypnosis could speed up psychotherapy, as compared with more time-consuming methods.3 Hypnotherapy was utilized primarily to relieve tension, and positive suggestions were stressed along with reeducation and supportive therapy for both parents and children. Symptom removal by direct authoritative suggestion is seldom effective.52
DRUG ABUSE
Addiction to drugs of all types, including narcotics, is increasing. Many drug abusers can be treated in the office rather than in a hospital setting. However, unless the entire family is treated and the environmental factors are altered, the results are poor. Children must be motivated to change. Hypnosis can countercondition the anxiety resulting from drug withdrawal, and it can also enhance motivation to “kick the habit.” All children who use drugs invariably need supportive psychotherapy, either by insight therapy or behavior modification. Those who fear damage to their health do better than those who conceptualize their drug intake as harmless.5 The author's results with hypnosis per se have been poor. However, when combined with behavior therapy and imagery conditioning, the results have improved.32
JUVENILE DELINQUENCY
Hypnotherapy has been employed effectively in juvenile delinquency.18 Relaxation alone, under hypnosis, relieved the significant tensions.18 Behavioral problems such as stealing, truancy, sex offenses, and lying were helped in patients who were followed for 1 to 6 years.
Ambrose and Newbold have an excellent chapter devoted exclusively to the use of hypnotherapy in delinquency.4 They note that many anxious children have a need to provoke their parents into punishing them for their wrongdoings. The causes may be an overly strict upbringing, excessively high standards, parental hostility, or rejection. Hypnosis was used to allow children to vent their fears and, together with reeducation, helped a high percentage of delinquents. Parents were also treated to correct aggravating factors. When they saw the improvement in their children through hypnosis, the parents became even more cooperative. In some cases, abreaction, regression, and revivification were used to relieve actual traumatic episodes. The protective value of hypnosis, as well as its corrective features, is emphasized.
N. H. Mellor cured 13 of 14 hardened juvenile delinquents, who had resisted all types of therapy, in an average of 6 sessions. He made use of communication with the “unconscious” by technics involving finger or hand levitation to produce answers establishing the authenticity of traumatic or emotional causative factors. This technic (finger signalling) rapidly eliminated emotional blocks and avoided anger and defiance.
In several cases the benefits occurred during the first session. It is likely that the finger signalling here acts as a “magical gesture,” fitting in with the subject's inordinate need for security, attention and love. This, together with a permissive and noncritical approach, could be of distinct value in the juvenile delinquent.
Weitzenhoffer recently questioned the validity of eliciting the “wisdom” of the “unconscious” by ideomotor finger signalling.60 He believes that there is little justification for assuming that some sort of psychic entity, “the unconscious,” has been communicated with, or is responsible for, the observed phenomena. Nevertheless, Mellor's brief pilot study indicates that the method established good motivation for self-improvement. Regression, revivification, and cathartic recall aided recognition and understanding of the underlying reasons for the tensions. Mellor thinks that, during hypnosis, subjects overcome their difficulties by developing insight and learning better ways of responding to their tensions.
ASTHMA
Numerous investigators have found hypnosis valuable for relieving asthma in children (see Chap. 33).46,51,56 Some of these reports stress individual therapy, and others employ group hypnosis. Diamond reported the complete cure of 40 cases of asthma by eliciting the “causative” factors, emotional or environmental.11 He stresses that hypnosis is never to be used for symptom suppression. Other researchers agree with this tenet.4 La Scola has developed an ingenious hypnotic technic involving imagery, double-bind technics, and fantasy evocation.35 He states: “The asthmatic child responds most dramatically to the hypnotic approach, and the cure is so gratifying that it seems incredible for any other method of treatment ever to be considered.”
HYSTERICAL SYMPTOMS
Ambrose and Newbold have classified under hysterical reactions a group of bodily symptoms which had “purposive” aspects and symbolic significance.4 Here hypnotherapy with reeducation was helpful.
MISCELLANEOUS CONDITIONS
Many of the other psychosomatic disorders described in the chapter on hypnotherapy in internal medicine have been treated effectively by hypnotherapeutically oriented pediatricians. Pain of physical origin often can be helped by hypnotherapy.10,35 Other conditions reputedly treated by hypnosuggestive procedures are the hyperkinesis of infectious chorea, hyperkinetic syndromes associated with encephalitis, and other neurologic conditions. The hypnosis was employed as a symptomatic auxiliary method to other forms of medical and psychological therapy, especially for encopresis,35 anorexia nervosa, obesity, and nutritional problems.
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