Counseling and Hypnotherapy

by Maurice Kouguell, Ph.D., BCETS

As hypnotherapists, we should be required to use hypnosis to treat problems which we would be qualified to treat with a non-hypnotic technique.

Hypnosis training by itself does not qualify us to work in subspecialties which are beyond our expertise. Learning a few hypnotic inductions or a variety of inductions and applying them may at some time prove to be ineffectual for the client and harmful to the profession.

There are basically two forms of hypnosis: Self Hypnosis and Hetero-Hypnosis (depending on whether or not a hypnotist is present). There are also two basic approaches to hypnosis: the traditional one and the Ericksonian approach.

My first formal training in hypnosis was in workshops given by the late Dr. Wolberg. His was an authoritarian method. Later, I studied with trainers in the Ericksonian approach and in NLP (which is based on Ericksonian thinking). In both cases, it was clear to me that hypnosis was only a tool and results could not be achieved without a basic knowledge and understanding of psychotherapy.

Hypnotherapeutic work, whether with one person or with groups, demands very special care. The wording used with one individual or with groups experiencing hypnosis is very important.

It is also important for us to know why we use hypnosis.

Remember that hypnosis is a technique. We must continuously ask ourselves: of what benefit is this technique to the client? Could we do as well with waking hypnosis? With simple dialogue? Or with other verbal techniques?

In John Hartland’s classic book, Medical and Dental Hypnosis and Its Clinical Application, he states that,“it cannot be too strongly emphasized that whenever psychological or neurotic illnesses are involved, the general practitioner should use the greatest care in selecting the cases he proposes to treat unless he possesses a sound working knowledge of psychopathology.” He continues to say, “...apart from the medical and dental professions, no one should attempt to practice hypnosis unless he/she has received adequate training in both normal and abnormal psychology...the general practitioner should use it only in the course of their daily work.” (pp. XV & XVI) This view is shared by several other writers and practitioners.

Where does one begin? After one has received training in how to produce a hypnotic state, the hypnotist is now on his way to becoming a hypnotherapist.

Basic knowledge of counseling and therapeutic procedures need to be part of the newly trained hypnotist. A very skilled hypnotist who knows all kinds of hypnosis techniques is ready to hypnotize. However, how competent is the hypnotist in recognizing the pathology of a client even though the client is coming to his office for what may at first appear to be a simple procedure such as smoke ending, weight control, nail biting or any procedure dealing with a habit disorder? In my opinion, there is no such thing as a person with a well-defined, simple symptom. Not every smoke-ender is like every other smoke-ender. Not everyone who comes to lose weight is like anyone else who comes to lose weight. Although standard, readily available scripts for inductions may be useful, one may need to go beyond that and begin to learn basic simple counseling techniques.

In my own training with a well known professional in the field, having volunteered to be the “subject” for an induction, the instructor turned to the group to indicate that I was “resisting.” I had made a request that the background music be changed because it interfered with my ability to relax. The reason for this was that, as a musician, I was spending too much time trying to figure out an obsession about the particular performance which was being played. This was interpreted as resistance. The very important lesson which I learned at that point and in subsequent years, was that there is no such thing as resistance. There is just the inability of the hypnotist to establish rapport not only on his terms, but on the terms of his client. If rapport cannot be established there can be no communication. In hundreds, if not thousands, of cases after that experience, it became clear to me that every time rapport needs to be established, we need to communicate congruently and that this brings about a state of consciousness which then would be advantageous for trance.

I would like to emphasize the importance of recognizing and understanding defense mechanisms. During my National Guild of Hypnotists Convention Workshop on Clinical Counseling Skills for the Hypnotherapist, my students commented that perhaps the most important and clearest point they had in their profession now was the importance and meaning of defense mechanism.

All the members had heard of the various terms and found it very useful to have a refresher course. Defense mechanisms are part of the overall development of the ego system. They basically protect the infant against a frightening situation such as fear or anxiety. Keeping in mind that the reason that you are seeing the client is that the client is not capable of giving up his symptom and is coming to you to help him give it up. Yet, the symptom is something very precious and something he wants to hold on to. Consciously he knows he should give it up and the conflict comes from his unconscious where he is incapable of giving up that symptom.

Dr. Louis Wolberg in Techniques of Psychotherapy mentions the following rules for the building of a relationship with the client or patient. This text has become a classic in the training of all clinicians and in supervisory work in psychotherapy, the following have become guidelines:

•Avoid exclamations of surprise
•Avoid expressions of over-concern
•Avoid moralistic judgements
•Avoid being punitive under all circumstances
•Avoid criticizing the patient
•Avoid making false promises
•Avoid personal references boasting
•Avoid threatening the patient
•Avoid political or religious discussions
•Avoid arguing with the patient
•Avoid ridiculing the patient
•Avoid belittling the patient
•Avoid blaming the patient for his failures
•Avoid rejecting the patient •Avoid displays of intolerance
•Avoid dogmatic utterances
•Avoid premature 'deep interpretations'
•Avoid a dogmatic analysis of dreams
•Avoid the probing of dramatic material when there is too great resistance
•Avoid flattering and praising the patient
•Avoid unnecessary reassurance
•Extend reassurance when really necessary
•Express open-mindedness, even toward irrational attitudes
•Respect the right of the patient to express different values and preferences from your own.
•Clarify the purpose of the interview as often as necessary
•Make sympathetic remarks when indicated
•Avoid burdening the patient with your own difficulties
•Avoid displays of impatience

Techniques of Psychotherapy by Dr. Louis R. Wolberg, pp. 331-337.