Should a therapist be crying?

Is it unprofessional to be crying during a session? It is quite normal for clients to cry. In fact I regard it as a help to diagnosis. It is a sign that the client's emotions must be near the surface. It makes it easier to find the right feeling to use when doing regression therapy. However therapists cry as well. A recent academic article has looked into the issue of therapists getting emotional during therapy. The article reported more than half the therapists in the study admitted becoming emotional with a client at some time in the previous four weeks.

Is detachment good?

When I started out in this business I was as damaged as any of my clients. I frequently heard stuff that echoed my own upbringing. I could listen to it with detachment, but I think the similarity to my own experience helped me understand and empathize more.

Listening was no problem. Using a script of mostly direct suggestion was no problem either. But when it came to delivering a metaphor for an individual client, the closer it was to my own issues the more it resonated with me. The result was that I found myself getting emotional along with the client.

Empathizing with your client

I was quite startled by this at first, but I later realized that it was doing me good. And it if was doing me good then it was probably doing good for the client as well. Then I deliberately started writing metaphors that would cause me to cry, because that way I knew they were good powerful metaphors. By listening to my own emotions I got better at dealing with other people's emotions.

As I got more experienced I realized that in order to get into the client's mind, I first had to imagine what they were feeling. To get real empathy, I had to generate that same feeling in myself. Once I had the feeling I would allow my mind to open up to whatever visualizations I felt might work for me. As the session progressed, I turned those visualizations into a continuous metaphor. I described the images I was experiencing internally and just allowed whatever actions and events that wanted to happen, to happen. The metaphor wrote itself. Since I had to imagine the images and actions in my mind first, of course my mind was being affected by them at the same time as the client's mind was being affected. This set up a feedback loop. The more I got into the client's feeling, the more focused the metaphor became. The better the metaphor, the more emotion it generated and that changed the metaphor to fit better.

Crying develops empathy

As I progressed, by fixing other people's problems in this way, I fixed more and more of own problems. Nowadays I no longer feel that same raw emotion to the same extent. But I think that I do in fact come close to tears with more clients, rather than fewer. Healing myself has allowed me open up to other people, to get more empathy with them. I now feel the sadness of an abusive childhood probably more keenly than I ever did years ago.

In the study, only one percent of therapists thought that they had disadvantaged their clients by showing emotion. In my case I only get emotional after the client is in trance, and so the client does not see me, since they have their eyes closed by that point.

But I often remark to them afterwards that they were not the only ones crying during that session. I think that the client appreciates sincere emotional contact.

Healthy Body Healthy Mind

The health benefits of exercise are being demonstrated in more and more new research studies: Healthy body healthy mind. However it often difficult to get clients to be motivated to exercise, so some researchers are offering advice on that as well:

1. Get the client to compare their current level of exercise with what they used to do, to emphasize how it has changed.

2. Talk about the evidence that exercise can help with their problem, and show that exercise should be regarded as one part of their overall treatment.

3. Talk about how exercise shaped the health of their ancestors, that human beings were designed to work hard and be in constant motion, and that our current lifestyle is one of the things affecting their health.

4. Make it very clear that you expect them to start exercising more, and get them to commit to doing some specific exercise.

5. Encourage the client to identify what type of exercise will fit into their life style./Don't recommend a specific method. Point out that they can do simple things like walking and gardening to help get fitter.

6. Show them how to use motivational tools such as exercise diaries, goal setting.

7. Explain what resources are available from their local community, how to join groups such as cycle clubs and weight watchers.

8. Give clear instructions as to how much exercise they need. The usual recommendation is between half and hour and an hour a day, at least three times a week. However, not to take on too much too soon.

9. Discuss the benefits of aerobic and strength training.

10. Help the client to realise that exercise is not an all or nothing thing. Getting fit is a process, not an end, and they should expect some setbacks, and teach them how to deal with them.

I think that all therapists need to start treating the whole person.

A healthy body helps to ensure a healthy mind.

It’s what they don’t want that is important

I had a question from a hypnotherapist:

What do you recommend would be the best script to use for Career Goal Attraction and also, the same client opening themselves to Attracting a new boyfriend, or girlfriend.

Whenever a client comes with a problem, the therapist really needs to think about what the client is asking for, and why? What they ask for is not always what they need. The therapist always should consider the other side of the coin. It is often a case not of what they want, but what they don't want.

People want to lose weight, but never stop to ask why they have to eat. People smoke, but don't ask themselves what they get from it. Every behavior has a reason. No behavior in a normal person is random. And very often, the behavior is a reaction to that reason, without ever having the courage to tackle the reason head-on.

You have to get the client to ask themselves 'what is it that is stopping you having what you want?', and work on that.

In this case, the client wants to be open to attracting a romantic partner. The right question is therefore: "what do you think is stopping you?" You cannot influence the actions of others, you can only change your own actions. And what your actions will be depend on how you feel about yourself. How you feel about yourself depends on your own beliefs about who you are.

Therefore the therapist should focus on investigating what the client is afraid of, what they think is wrong with them. In almost every case it will be quite clear: lack of self esteem, lack of confidence, or long term anxiety.

The correct approach would therefore be based on the script that most closely matches their particular circumstances.

Hypervigilance

Hypervigilant client

I had an interesting client today with Hypervigilance. Even though I have done thousands of hypnotherapy sessions I find there is always something new to learn.

This client was a man in his late twenties. He said "I lack the confidence to assert myself. My wife says I always gives in too easily. It is costing me salary and promotion. I just cannot stand up for myself". In the interview I learned that he will do anything to avoid aggression. He feels he has to keep people happy and never put forward his own views in case he causes aggression. He has to tell people what he thinks they want to hear.

It was obvious that he was afraid of confrontation but I couldn't find anything in his life that caused him to want to avoid aggression. Like many people he feared rejection and wants to be liked. But I noticed that every time I asked him about how he feels, he tells me what he thinks. This is the typical behaviour of the over-analytical person.

Symptoms of hypervigilance

One probing further I found that he has many symptoms of hypervigilance. Hypervigilance starts when a child feels that their environment is unpredictable and they become afraid of what is happening to them. The child then withdraws and puts up barriers to intimacy. The child's reasoning is that if they don't feel anything they can't be hurt. This client confirmed that he has no real feelings about anyone.

The client said he felt that he had a shell around him. That is the cue to start using a metaphor therapy technique. When I started with this client it did not work. He would not open up to his emotion. Instead he kept talking about what he thought of it.

Hypervigilant clients are hard to hypnotize because they analyse everything you say to them. Instead of reacting to your suggestions, they analyse the structure of the sentences or wonder about why you used that particular word. They are so busy analysing that you can't get through their defences.

Hypnotizing Hypervigilance

I thought that he would be hard to hypnotize and he agreed.
So I started the session with a rapid induction, he started smiling, and the impression I got was that he was feeling the induction but refusing to follow what his body was telling him. I then did a breathing induction and to my surprise his head started to nod, an indication of trance. I then did a deepener with a staircase induction, and he was in trance. Surprised me greatly. Tested with eye catalepsy. Worked.

So I learned that this hypervigilant client, at least, could be hypnotised. I think the key to it was using a kinesthetic induction to get him to focus on a feeling he had never before noticed, the feeling of the air inside his head as he breathed in.

The therapy was a long metaphor session.

Did the standard RIVERWALK with embelishments.
When he was looking at the town he saw someone like him at a table with friends doing all the things he wanted to do.
Had people following along the other bank.
Had him and his wife walking towards the town. Started with everything around stale and tired.
Then the little bridge where he says aloud what his problem is.
Then DROPPING THE STONES
CLOAK OF POWER
BRIDGE TO FREEDOM
DIRECT SUGGESTION
CONGRATULATE the mind.
FINGER LIFT CONFIRMATION

good session. What I learned from this is that even a therapy I have used many times can still surprise me. My own unconscious mind came up with a new twist to suit this particular client.

So what I ended up with is a new way of treating lack of confidence.

The power of the unconscious mind never ceases to amaze.

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 therapy 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.

What would you do in this case?

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.

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 test to 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.

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.

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

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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