A Continuum of Hypnotherapeutic Interactions: From Formal Hypnosis to Hypnotic Conversation

American Journal of Clinical Hypnosis,  Oct 2004  by Teleska, John,  Roffman, Andrew

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Hypnotherapeutic interactions can be mapped on a continuum from formal hypnosis to hypnotic conversation. Unlike the structured forms of formal hypnosis, hypnotic conversation relies upon utilizing the client's responses, both verbal and non-verbal, to facilitate therapeutic process. In this paper, we illustrate this continuum with a series of anecdotal clinical examples starting with formal hypnosis and moving incrementally towards hypnotic conversation. Finally, we offer an example similar in appearance to formal hypnosis, but now described in the context of hypnotic conversation. We are neither putting forth a theory nor offering a new perspective for those who research hypnosis as a phenomenon. Rather, these ideas and metaphors serve to broaden the framework of what constitutes hypnotic interaction so as to evoke new opportunities for increasing therapeutic efficiency and efficacy.

Hypnosis is art and science masquerading as conversation.

James Warnke (personal communication, September 22, 2000)

Introduction

In this paper, we wish to broaden (and ultimately deepen) the clinician's awareness of interactions in which the dynamics of hypnotherapy, induction, and trance are in play. To do this we will propose and describe a continuum in hypnotherapy from modes of interacting considered as formal hypnosis to one that we are calling hypnotic conversation. This continuum is a scaffold on which we will drape a set of ideas and metaphors regarding hypnotherapy, induction, and trance.

Zeig (1985) tells us that, although Erickson used formal hypnosis in only a fifth of his cases, he consistently used hypnotic technique even when he was not "doing hypnosis." In our work we often do not use the terms "hypnosis," "trance," or "unconscious." We may choose not to use formal induction or hypnosis. Nonetheless, our interactions with our clients are informed and organized by premises and components operative in formal hypnosis including: building rapport, assessing client responsivity, focusing attention, framing client responses in a way that promotes therapeutic outcome, indirect suggestion, and utilizing more of a client's attitudes, understandings, and abilities on behalf of his or her desires and well-being (Erickson & Rossi, 1979; Zeig, 1984; Lankton & Lankton, 1983; Hammond, 1990).

We acknowledge the growing body of research generating data, facts, and measurements of trance and hypnosis as a phenomenon. This includes several generations of hypnotizability scales (Council, 2002). We are neither putting forth a theory nor trying to provide a new perspective for those who research hypnosis as a phenomenon. Rather, we offer these ideas and metaphors in order to increase therapeutic efficiency and efficacy through 1) the utilization of client responses during induction, 2) (he use of the client's natural response-tendencies as a tool for therapeutic interaction, 3) the utilization of the immediate therapist-client interaction for the initiation of trance instead of waiting for the opportunity for formal hypnosis to arise, and 4) the incorporation of hypnotherapeutic interaction into the conversation that arises between clinician and client.1

Working Definitions

Trance

When asked to define trance, Erickson is reported to have replied, "whatever I say it is...will distract me from recognizing and utilizing the many possibilities that are" (Gilligan, 1987; p. 39). Despite the long history of dedicated scientific research, trance has, in our view, no stable referent. While there are enough significant differences among researchers and theorists to support this assertion (Weitzenhoffer, 2000), our point keeps with Erickson's: any definition that proposes explanatory closure limits possibilities.2

Induction

In most varieties of clinical hypnosis and hypnotherapy, induction is seen as a means towards the establishment of a trance. In explicating our continuum of hypnotherapeutic practice, we will add to this definition. An induction is an interaction in which attention becomes focused or directed such that the person becomes absorbed in the details of his experiencing. A focus can be a very wide focus (to keep with the visual-spatial metaphor), a blurry or defocused focus, a multiply placed focus, and so forth. A direction (also a spatial metaphor) may be in any direction, even in the direction of not-knowing or not-having a direction.

Hypnotherapy (Including Formal)

Broadly defined, hypnotherapy is a form of interaction in which attention becomes focused in a way that brings forth an experiential context that is therapeutic. Most traditional descriptions of hypnotherapy favor a container schema (Lakoff & Johnson, 1980/1999) to describe the actual practice of the work. For example: a person, by means of an induction, goes into a trance (Trance as Container). Once inside, therapeutic suggestions are received that go into the person's unconscious (another Container). This flowchart neatness belies the complexity of the process and conceals rather more than it reveals.3 Hypnotherapy, and therapy in general, takes place in an alive, richly thick, experiential context, a system, that is not reducible to the sum of its individual components. We will illustrate what we mean by hypnotherapy in the examples that follow.