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Client won't give up control

Client won’t give up control

Client won't give up control

I had what I think must be my most difficult client the other day.

She was a young woman who came in because she has a fear of injections. However, that was only one of her multiple problems. She also has a fear that she will stop breathing when she is going to sleep. She has fear of losing control, she wants to have things remain the same, and hates change. For example rearranging the furniture at home sends her into a frenzy and she must move it back again. She is never on time and never seems to be able to get things finished on time.

All of these symptoms suggest someone with a touch of OCD. It seemed to me that these are all aspects of a collusive disorder. However, I am not a psychiatrist so I just deal with what is presented to me.

Why go to a hypnotist, if you don't want hypnosis?

She seemed very nervous, so I tried to create rapport and establish a common ground. Eventually she relaxed enough  to let down her guard and chatted in a friendly way until I brought up the idea of hypnosis. She was absolutely dead against it. She said she could never give up control and did not want to be hypnotized. I explained that hypnosis was natural and normal and that she went into hypnosis several times a day, and gave her examples of daydreaming etc. She agreed that she did all these things but still would not try formal hypnosis.

I explained what metaphor therapy was and she agreed that she could do that. So I moved her to the big comfy chair and said 'This is not hypnosis, I am just going to ask you to breathe.' This brought out an instant opposition. She was not going to focus on breathing because it would remind her of sleeping and the fear of stopping breathing. Ok, I said "just close your eyes". Again total opposition, not going to close her eyes, because it would be like losing control.

Progressing when the Client won't give up control

I then tried a simple relaxation routine. I asked her to raise her hands then then slowly let them down and feel the body relaxing as they are lowered.

Lowering her hands six inches took about five minutes. She was totally reluctant to do any thing that would make her relax because of the loss of control. So I abandoned that idea. I then asked her to imagine that her arms and legs were so tired that she couldn't move them. She said 'Oh yes, I know what that is like. I don't like it.' So that was out.

I then tried a progressive relaxation. I had her lift up her shoulders and let them slump. Then tense her arms and let go the tension. This generated lots of giggles, but eventually I persuaded her to tense and release her chest, tummy, hips etc all the way down to her feet. She was a bit less tense by the end, so I did it again. And after a third time she agreed that she did feel less tense, and would like to do the metaphor engineering to get rid of the needle phobia.

"Close your eyes." She still couldn't close her eyes. I therefore tried the oldest hypnotic trick in the book, a eye fixation induction. I told to keep relaxed in her body, but to fix her gaze on a spot somewhere. Then I did a long, gradual series of suggestions that her eyes were getting heavy and her eyelids wanted to close. This took so long that by the end,  my eyelids wanted to close! This was hard work.

How to give up control

Eventually she started flickering her eyelids. I then developed the safe place induction: imagine lying in some comfortable place etc. Her eyes finally closed and I could get on with the therapy.

I started with the therapy, and asked her to get the feeling she gets when she thinks about the needle. As might be predicted, even fully relaxed and with her eyes closed, she said could not get the feeling. More suggestions about relaxing and eventually she said that she could feel it. I was able to make some progress on the phobia and she agreed that it had been cleared.

I then gave her some general suggestions to help with the intrusive thoughts of the OCD pattern and brought her out. And the first thing she said was 'I just felt tired, that's why I had my eyes closed, it wasn't anything you did.'

I cannot recall ever having a client who was so unable to give up control.

 

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Screened for depression

Should everyone be screened for depression?

Smoking, weight loss and anxiety are the most common problems seen by hypnotherapists. But many of the problems that clients seek help with are actually symptoms of depression. Depression is the leading cause of disability worldwide (WHO, 2017), If it is so common, should everyone be screened for depression?

Why not screen everyone?

On the face of it, this would seem like a very sensible option. At the very least we could screen pregnant women and teenagers. Early intervention would seem to be very desirable. And it has been proposed many times by many organisations. So why is it not being done?

The main reason is the fear that it would lead to overtreatment. This concern is so prevalent that medical associations in Canada and the UK have a policy of opposing routine mental health screening for everyone.

It is argued that routine screening has not proved to be effective. In fact, it can prove to be counter-productive. Someone going through a temporary session of "the blues" might acquire a lifelong label. They may actually get depressed through worry, and may spend time and money seeking treatment they don't actually need. Giving people SSRIs that they don't need opens up to unnecessary side-effects of the drug. Too many false positives might make the problem worse.

This is not to suggest that doctors should not screen patients they suspect have depression. However they should not routinely apply it to everyone who presents to them.

Publication bias

The research that has been done on the benefits of screening have not shown good results. Screening has proved effective at identifying problem cases, but the outcomes have been very modest. Medical associations worry that the results show "publication bias". This is the tendency to only report positive or significant research. Editors of medical journals prefer to fill their journals with reports of success. For every successful trial, there may be three or four unsuccessful trials. The trials where the results were just not very clear don't get published. So when looking through published results it appears that the situation is much better and much clearer than it actually is.

Another reason for not doing routine screening is that it would be captured by the pharmaceutical companies. They would see this as a bonanza for their products. In fact, at least one of the most used questionnaires for depression was developed with funding from a pharmaceutical company.

I am not a supporter of the conspiracy theories against "Big Pharma". Pharmaceutical companies produce wonderful products that keep the population healthy and well. They are entitled to make a profit and to market their products. However, routine screening of 100% of the population would lead to a blowout of virtually every health authority's budget.

Without a guarantee of a clear and measurable benefit it is just not worth it.

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ask the expert

Ask the expert what to do

When I am working with a client, I am often not sure what to do next. Clients come to me with all sorts of problems, and expect me to know how to fix them. Quite often I don't know. Over the years I have come to realise that there are two sources you can go to for help. They both involve asking the expert. So who is this expert? Actually there are two. One is your own unconscious mind, and the other is the client.

Asking the expert - the client

Always bear in mind that the client comes to for a reason, and knows exactly what they want, even if you don't.  And the client is the expert. Nobody knows more about their problem than they do. So I ask the expert what to do.

The way I do this is to use the equivalent of the My Friend John induction as hypnotherapy.

I ask the client to tell me what they would do if they were in my seat.

I ask them 'How would you go about dealing with this problem?'. 'What would you able to try to make you feel better?'. 'How could the situation be seen differently if you took different perspectives?'

You can also ask the client the Miracle Question 'If everything you wanted happened to you overnight, what would be different when you woke up? What would see, what would you feel, how would you know that it had happened?'.

You will be surprised at how inventive your client can be. Even if they don't come up with a complete solution, they will often suggest a way forward that you haven't thought of.

Ask the expert - Your own subconscious

The other expert is you. At least the part of you that holds all your expertise and intuition. Part of hypnotherapy professional practice is being comfortable with ambiguity, and uncertainty. Therapists don't have all the answers. You sometimes have to wing it. And that is exactly what I do.

I listen to the client describe what they want, what they feel, what they have tried. Even if I'm not aware of it, my unconscious mind is thinking about this and assessing various possibilities. As the client talks, various words and phrases will strike you as being of particular interest and importance. When I consider how to go about the therapy part, I read over my notes. And I take a moment to think about those words and phrases. This primes my unconscious mind, and sets up images and associations at the unconscious level.

Then I start on the induction. I guide the client into trance, deepen, and tester make sure the client is somnambulistic. I find that by the time I put the client into trance, there is always something that occurs to me as a way forward. Something will suggest itself to me from the workings of my unconscious mind. It may be an image, and I was start describing the image. Usually this turns into a metaphor that I develop for the client. Sometimes I would just repeat the word or phrase, and again something will resonate with me and my unconscious mind will guide me in what to do.

It's always good to ask the expert in the room.

 

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client refunds

Should you give client refunds?

I got this email about client refunds:

I just want your opinion re this situation that came up today
Group session of 6 for smoking cessation.
45 mins later got a message that it hadn’t worked and it was my fault because I didn’t do stage hypnosis induction etc. she could have done the session herself.
So I replied answering her points. Now she has come back wanting her money back.  Paid 1/2 price as it was a group session and I travelled about an hour to get to the venue.
She was told it was a group session but she complained that there were others there.
Given her strong belief in what she thought I should be doing and saying and clearly not following my suggestions and her complete denial that it worked within 45 mins would you offer a refund? 
Your thoughts please.

 

My attitude to client refunds:

You get customers like this. Everyone does. You cannot avoid them.

You do your best and they throw it back in your face. Unfortunately, that is just the business we are in. We deal with people with mental health problems, and they do not act rationally.

If it was me, I would give her the money back immediately.

Life is too short to let these people upset you. There is nothing you can do. In our business the clients hold all the aces. When it comes to a dispute the client will always win. Even if you succeed in not refunding her payment, she will gleefully spend the next 10 years telling everyone who will listen what a crap hypnotist you are, and how she was right all along and you just could not help her.

You don’t need that kind of publicity. Refund her money and write it off to experience. Send her a nice little note saying you are sorry that it didn’t work out for her and you hope that she will find someone who can help her.

She has probably been to every health professional in the area and dismissed them all as useless. You were just the next in line. It doesn’t mean anything. And she is not worth spending time on.

All you can do is think back to see if you can identify any indicators that you can use to identify this kind of person in the future. And refuse to deal with them.

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Prevent heart attacks

Prevent heart attacks with hypnosis

Recent research  suggests that hypnosis has a role to play as a front line treatment to prevent heart attacks. Doctors have known for a long time that stress is associated with increased risk of heart attack. However there was only a correlation, and no direct proof that stress caused heart attacks. It was just as likely that the factors that lead to heart attacks also lead to stress.

Two new studies show that stress actually has a direct effect on the brain. The brain responds as if to a threat. It orders the body to produce new white cells. The increased blood cells then cause inflammation in the walls of the blood vessels. And this leads to narrowing of the arteries and  a higher chance of being blocked by blood clots. Blockages lead to heart attacks, angina and strokes. According to the study, this is the first time that a direct link between stress and cardiovascular disease has been proved.

Using hypnosis to prevent heart attacks

What the study shows is that stress is just as important as diet and smoking. Hypnotherapists have an excellent record on stopping people smoking, and also help people to lose weight. These two outcomes both reduce the risk of heart problems. It seems that we can now play another role in keeping people healthy.

Hypnosis and relaxation therapy are very good ways of reducing stress. It now appears that teaching our clients how to relax, or how to go into self hypnosis, can have direct effects on their cardiovascular health.

This is something that hypnotherapists should develop. Perhaps we should emphasis stress reduction in advertising and when talking to clients. Perhaps one day we will have clients coming to hypnosis as the treatment of choice  to deal with their general feelings of stress.

 

Source:

Tawakol, A., et al.  (2017) Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. The Lancet

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Initial consultation

Is the initial consultation a scam?

Do you need to spend an hour with your client before you can start doing hypnosis? Or is insisting on an initial consultation a scam?
Many hypnotherapists make an initial consultation part of their business model. Their treatment plan consists of the initial meeting, and then one or more sessions of hypnosis. Clients sometimes refuse to go along with this, and often feel that the initial consultation, is a con, a waste of their time and money.

Those therapists who use an initial paid consultation put forward the arguments:
a) hypnosis is more successful when it is aimed at a precise and specific target. They say that without an extensive consultation you cannot identify exactly what the problem is. Until you know exactly what is wanted and what is causing it, you cannot fix it.
b) the initial meeting build rapport. The better the connection between the client and the therapist, the better the outcome is likely to be.
c) sometimes the client needs to talk to someone, to get their feelings out in the open, to know that somebody cares. Hearing themselves describe their problems sometimes helps them to put their problems into perspective.

I can see that there are merits in these arguments.

Analysing the arguments for an initial consultation

But do you actually need a whole hour to find out what the client's problem is?
If the client wants to stop nail biting, what else is there to know?

It seems to me that a competent therapist should be able to nail down exactly what the issue is within 15 minutes so. That leaves plenty of time to do some actual therapy. And if not, at least learn enough to be able to suggest some different type of therapy based on what was learned.
I suspect that the desire to know about the specific target is actually an outcome of NLP training. NLP practitioners try to know exactly how you do the behaviour, exactly what you feel when you do the behaviour, exactly how you will feel when you have stopped doing the behaviour. Without knowing this you cannot really apply NLP principles and expect to have much success. If your practice is based on NLP, and I think you need to be upfront with the client and explain that this is part of the process. It is a little deceiving to call it a consultation when you are really exploring whether they can identify feelings and not.

The second reason given is about building rapport. This is another principle of NLP. Having rapport is good, but not essential, in my view. If rapport was essential, then recorded CDs would never work. If you never meet the client, the person listening to the CD, then you cannot possibly have rapport. And yet CDs do work.

The third reason, that the client needs to talk to someone is perfectly valid. But if you're actually offering counselling, then you should tell the client that it is a counselling session, and do proper counselling.

My experience with initial consultation

When I first started doing hypnosis professionally, I had just come out of a training school. As part of the training I was taught basically NLP with a bit of hypnosis. The basic instruction was to get a client and then invite them to come to your office to discuss what it is you might do in some future session. I actually started off offering hypnosis sessions for free. And I quickly discovered, even if it was free, clients hated spending the first session without either getting hypnotised, or getting some explicit therapy. I therefore quickly adopted the strategy of finding out what the client wanted, agreeing what we would be able to do, and getting on with it. Over time I was able to work out ways of finding exactly what I needed to do in just a few minutes, or extending the session, at my cost, until I did know exactly what the problem was and felt confident I could fix it.

As far as I'm concerned, I am not prepared to waste the client's time, or more importantly, their money, just to indulge my own need to have a plan. Hypnotherapy involves a great deal of uncertainty. The therapist needs to be prepared to let things develop organically. I often start a client into hypnosis when I really don't have a clear idea of where it's going, and just allow my unconscious mind to interact with their unconscious mind until something new and powerful emerges. This process has never let me down.

If you think that for your own comfort you need an hour from every client, then I suppose if the client is willing to waste an hour and get nothing done, then that's okay. But I really don't think you should be charging for it.

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ethical

Is it ethical to give the customer what they want?

Is it ethical to do what the client needs, rather than what they came for? The customer is not always right, especially in the hypnotherapy business. In fact, in hypnotherapy, the customer is usually wrong. When a client comes in and asks for say, Gastric Band Hypnotherapy, or Past Life Regression, that is what they want, but it is not usually what they need.

The fact is, if the client knew what they actually needed, they would do it themselves, and they wouldn't need a therapist at all. The client therefore seeks  a solution based on faulty reasoning. They decide what it is that will cure them, and demand that you do it. They know what outcome they want, but usually how they want to go about getting it is wrong. 

As a therapist, is it ethical to do what the client asks for?

You can always outright refuse to do the procedure. But what is the Ethical position if you recognize that the client is showing symptoms of depression, or childhood trauma? Do you give them what they want, or what they actually need?

Suppose a clients says they want to explore a Past Life. Some friend told them they are being punished for some bad thing they did in a previous life. Do you just do the Past Life Regression as they ask, or should you first explore what is going on in this life? And if it becomes clear that their problems are all caused by something in this life, should you persuade the client to accept a different procedure?

Or should you agree and then do what they need? It is quite easy to do anything you want, within limits, when the client is in trance. You can disguise your therapy in a metaphor, or you can 'accidentally' go back to an early trauma and clear it with Regression to Cause. The client probably would never realise that what they got was not what they asked for. 

But if it works, is that ethical? Equally, is it ethical do what they ask for, when you know it won't work?

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hypnosis personal fail

Clients who want to fail

Some clients want to fail. Some clients are afraid of failure, others are afraid of success. Being a therapist you have to deal with whatever the client brings. You put yourself under constant pressure to get the right result. We worry about whether we have enough knowledge, enough training and whether we are good enough at all. And we are very disappointed when we fail.

We always assume the client  wants to succeed too. But there are also clients who want to fail. I was reminded of this by a client I saw recently. She has a long history of drug abuse, emotional outbursts, destructive behavior and failed relationships. She is clearly unhappy, her life is out of control and she is afraid that she will attempt suicide again. 

And yet I got the distinct impression that she does not want the therapy to succeed. She is willing to go through the motions, to say the right things, to pretend to go along with what other people want for her. But deep down inside she is afraid of not being able to cope if she does change.

She feels that if she gets cleaned up from drugs then she will be on her own again. She does not believe that she has the strength to survive without drugs. Stopped taking them before has always left her feeling awful. That feeling just  got worse and worse over time until she no choice but to go back on the drugs and ended up more dependent than ever. She knows that stopping is not the answer for her. So she is not going to stop. 

This attitude is entirely understandable. She is simply protecting herself from future pain. 

What can you do when the client wants to fail?

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Hypnosis epilepsy

Hypnosis and Epilepsy

Hypnosis and epilepsy worries some people, and believe that epileptics should not be hypnotized . This is not true. There is no reason why an epileptic should not benefit from hypnotherapy. There is nothing in hypnosis that would cause the onset of an attack, so there is no reason to avoid it.

There is no special procedure to use, just the normal approach. It is sensible to talk to the person about their epilepsy. Most epileptics already have their condition under control and know what to expect and what to do. All that is necessary is for the hypnotist to learn what to do in case an attack comes on during the office visit. The simplest way is to simply ask the client how to tell if they are having an attack, and what they would like you to do if one happens to strike while you are there.

Epileptics know exactly what they need and have been through it many times, so there is no great mystery: it is just something that happens occasionally in their life. The hypnotist just needs to accept that there is a remote possibility of an onset, and be ready if one happens. 

It is just an illness, it has to be treated with understanding, and can be worked around. Hypnosis and epilepsy is really not a problem. 

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dream interpretation

Dream Interpretation with hypnosis

Have you ever considered Dream Interpretation as part of your hypnotherapy?

I love hearing about dreams, because I believe they are the subconscious mind is revealing what is going on inside the brain. It is often difficult to know if your hypnotherapy has actually been helping your client. This is especially the case when you are using Metaphor Therapy or Gestalt Therapy techniques. These indirect methods are designed to make subtle long term changes, sometimes so subtle that even the client doesn't realize they are happening.

I always ask the client what changes they have experienced since our last session. Usually the client can say what has or has not worked, and how they know that. But quite often the client will say that they haven't feel any change, even though I know that I have done some powerful work  with them, and they should have noticed some changes.

In that case I always ask if they have been having any dreams. Dream interpretation often gives deep insights into changes in the unconscious.

One of my recent clients said that she felt that something was happening but she couldn't really say what, exactly. So I asked about dreams, and she told me the following vivid dream.

In my  dream I was laboring up a steep hill and there were other people going up as well. At the top was an airplane and we were going towards it. As I got closer the plane began to slip, and then it started sliding down towards me. I got frightened of being squashed and looked around for help, but I could only see two people, men, and when the men turned towards me I could see that they were unreal, with faces like cardboard cutouts from old cartoon comic strips. I realized that they were no help. The plane was sliding down towards me, so I put out my hands and was surprised that  the plane was pushed out of the way and passed by me harmlessly. That was the end of the dream.

I gave her my interpretation of the dream. Understanding dreams is simple. Everything in the dream is you. Other people are parts of you. Objects are metaphors for what you want to happen.

Using these rules, the going up the hill is a metaphor for struggling to change. The plane at the top of the hill is a metaphor for a means of escape. The other people on the hill are various parts of who she is. Metaphorically she want to get on the plane and fly out of there,  but is afraid of it, afraid of what might happen after the change. So that fear is translated into the plane turning into a threat. She seeks help from other parts, but sees that they in fact are cardboard cutouts, not real and not of any use any longer. So she gets the courage to deal with the threat, and deflects the plane and realizes that it actually can not harm her.

This was a perfect summary of her situation. She wants to change, but part of her is afraid to, so her mind shows her resolving this problem in dream. After the dream turns out OK, her mind can accept that she can change, and she starts the process of change on her own.

Later sessions actually confirmed this. She told me she no longer cared what she wore, or how she looked, because in fact 'Nobody cares what I look like. I have been obsessing for years over something that is not real'.

So her mind has now released the constant worry of having to look perfect, to be perfect. At some point she got on that plane.

Another case of dream interpretation helping with hypnosis.

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