Hypnotically Enhanced Treatment for Addictions E-Book

Joseph Tramontana

• Herausgeber: Crown House Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2009

Seitenzahl: 270

Beschreibung

This book offers new strategies, techniques, and scripts as well as reviewing traditional methods of treating addictions. The five key addictions addressed are: alcohol abuse and dependency; drug abuse and addiction; gambling compulsions/obsessions and addiction; tobacco addiction (including cigars, pipes and chew); food addiction/compulsions. Many of the techniques and strategies incorporate a variety of therapeutic modalities, including: cognitive behavioral techniques, reframing and other NLP techniques, systematic desensitization, covert sensitization, 12-step-programs, guided imagery and meditation, and more. The techniques described can be employed both in and out of trance.

Leseprobe

HypnoticallyEnhancedTreatment forAddictions

Alcohol Abuse, Drug Abuse,Gambling, Weight Control,and Smoking Cessation

Joseph Tramontana, Ph.D.

Crown Housing Publishing Limitedwww.crownhouse.co.ukwww.crownhousepublishing.com

First published by

Crown House Publishing Ltd

Crown Buildings, Bancyfelin, Carmarthen, Wales, SA33 5ND, UK

www.crownhouse.co.uk

and

Crown House Publishing Company LLC

6 Trowbridge Drive, Suite 5, Bethel, CT 06801-2858, USA

www.crownhousepublishing.com

© Joseph Tramontana 2009

The right of Joseph Tramontana to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system, published, performed in public, adapted, broadcast, transmitted, recorded or reproduced in any form or by any means, without the prior permission of the copyright owners. Enquiries should be addressed to Crown House Publishing LLC.

British Library Cataloguing-in-Publication Data

A catalogue entry for this book is available from the British Library.

13 Digit ISBN 978-098235736-1

eBook ISBN 978-184590422-7

LCCN 2009927264

Printed and bound in the USA

Dedicated to My Loving Wife, Lynn,and my Children, Jim and Jody,of whom I am so proud.

Acknowledgments

To my clinical assistant, Traci Olivier, without whose meticulous editing and assistance with the technical aspects of constructing the manuscript, I would have been figuratively “up the creek without a paddle.”

I also wish to take this opportunity to thank the American Society for Clinical Hypnosis (ASCH) for the excellent training opportunities which allowed me, first of all, to gain the confidence to incorporate hypnosis into my clinical practice. Thanks to all of the ASCH presenters and faculty over the years who have expanded and fine-tuned my clinical hypnosis horizons. Finally, thanks to ASCH for allowing me to become a faculty member and present the materials in this manuscript at the 2009 ASCH Conference and Workshops.

Contents

Introduction

Chapter One

The Lens

Chapter Two

Focus on Problem Drinking, Alcohol Abuse and Addiction

Chapter Three

Focus on Drug Abuse and Addiction

Chapter Four

Focus on Gambling Addiction

Chapter Five

Focus on Smoking Cessation

Chapter Six

Focus on Weight Loss/Obesity

Chapter Seven

The Panorama

Appendix A: Example of Smoking Cessation Inventory

Appendix B: Example of Eating Questionnaire

Resource List and Recommendations for Further Reading

References

Index

Introduction

In a recent article entitled “The Science of Addiction,” Lemonick and Park (2007) noted that 18.7 million Americans, or 7.7% of the population, are dependent on or abuse alcohol. They reported an estimate of 2 million members in Alcoholics Anonymous. They estimated that 3.6 million people are dependent on drugs, and approximately 700,000 are undergoing treatment for addiction. They estimated 71.5 million users of tobacco products, including about 23.4% of men and 18.5% of women who smoke cigarettes. The article stated that 2 million American adults (0.67% of the population) are reportedly thought to be pathological gamblers, and that 4 million adults are addicted to food, with about 15% of mildly obese people being compulsive eaters.

I have been treating smokers and weight loss clients with hypnotherapeutic interventions since shortly after my first ASCH workshop in 1978, and at some point thereafter began using hypnosis as an adjunctive technique with alcohol, drug abuse, and compulsive gambling. Over the years, I have been acutely aware of the lack of literature regarding hypnotherapy with the latter three addictions. My focus is on patients who call or show up at an outpatient office requesting treatment for previously untreated or ineffectually treated alcohol, drug, or gambling addiction, in addition to smokers or those interested in weight loss.

What is the reason behind the dearth of literature and training opportunities on treatment of alcohol, drug and gambling addictions via hypnotherapy? There are likely several. Perhaps it is because hypnotherapists are reluctant to “step on the feet” of programs/philosophies such as Alcoholics Anonymous, Narcotics Anonymous, or Gamblers Anonymous. Perhaps it was because Milton Erickson (Erickson, 1976), who is so highly revered in the hypnosis field, stated that hypnosis was not a good approach for alcoholics because hypnosis encouraged: (1) an unhealthy negative transference, and (2) dependence on the therapist. One might find this quote strange in light of the fact that Haley (1985) reported conversations with Erickson in 1957 regarding several cases in which he successfully treated alcoholics. Of course, he was using what he referred to as a “strategic therapy” approach rather than formal hypnotherapy. In Rossi’s (1980) four volumes on The Collected Papers of Milton H. Erickson on Hypnosis, there are absolutely no references in any of the four subject indexes on alcohol abuse, drug abuse, or gambling.

All of this is to say that the purpose of this book is, therefore, to offer new strategies, techniques, and scripts for use with problem drinkers, alcoholism, drug addiction, and gambling addiction in an outpatient population, as well as to review old and to present new techniques or combinations of techniques, strategies, and scripts for other addictions. The five addictions to be addressed are: alcohol abuse and dependency, drug abuse/addiction, gambling compulsions/obsessions and addictions, tobacco addiction (including cigars, pipes and chew), food addiction/compulsions. In the latter two, the “strategies and techniques” section will also address marketing and/or providing a package of sessions, with various preplanned scripts used in each session.

The title includes the term “hypnotically enhanced” versus “hypnotherapy” because, as the reader will note, many of the techniques and strategies incorporate a variety of therapeutic modalities, including: cognitive-behavioral techniques (Meichenbaum, 1977; Zarren & Eimer, 2002), solution-focused brief therapy (de Shazer, 1988), reframing and other NLP techniques (Grinder & Bandler, 1976), systematic desensitization, covert sensitization, techniques from the literature on “healing the wounded child within” (see Whitfield, 1987), 12-Step programs, guided imagery and meditation, among others. Furthermore, the techniques are employed both in and out of trance.

In the chapters on alcohol, drugs, and gambling, the reader will note that in not all of the sessions will hypnotic states even be induced or elicited. In the chapters on smoking cessation and weight loss, the time- or session-limited structure of the program will incorporate hypnosis into each session.

Additional points of note have to do with “hypnotic states” versus “trance” and “elicitation” versus “induction.” Although the author may at times utilize the terms “trance” or “induction” loosely, “hypnotic state” and “elicitation” are preferred, for similar reasons. From an anthropological perspective, DePiano (2004) stated that “trance” could imply both “possession trance” in which someone loses conscious awareness and an invading spirit “takes over” with it’s own behavior, speech patterns; and body movements or “trance,” a so-called altered state of consciousness including the loss of conscious awareness but without the presence of a spirit or other outside entity. He adds that since a hypnotic practitioner is not an intrusive spirit or a sorcerer (I like to add, “At least, most of us aren’t”), it makes more sense to talk about “the hypnotic condition,” “hypnotic situation,” “hypnotic process,” or “the hypnotic experience” than about “the hypnotic trance.” I prefer “the hypnotic state.” So while I may occasionally call it a “trance,” the goal is for patients to feel comfortable with the idea that hypnosis does not involve my controlling them, but rather that I will be teaching them to control themselves. So after considerable discussion of what hypnosis is and what it’s not, the term “hypnotic state” seems preferable.

Likewise, “induction” implies something from outside going in, while “elicitation” implies bringing out what was inside, as was so aptly described by Zeig (2005) in a recent presentation. Again, the terms might be used interchangeably (i.e., “induction” for “elicitation,” “trance” for “state”), and this is explained to the patient/client (also used interchangeably).

While there are some excellent books of hypnotic scripts in the literature (Allen, 2004; Hammond, 1990; Havens & Walters, 1989) which can be adapted to use with alcohol abuse or problem drinking, drug abuse, and pathological gambling, none have specific scripts for this client population. In summary, all of the strategies, techniques, and scripts herein have to do with helping clients take more effective control of their lives. As will be discussed in the chapter on alcohol treatment, the first Step in 12-Step approaches fosters the idea that the addicted client is powerless over alcohol (for example). This concept is somewhat antithetical to the approach most psychotherapists attempt to engender in their clients; i.e., take effective control of your life. In fact, Glasser, who a number of years ago began the Reality Therapy treatment approach, wrote a book titled Take Effective Control of Your Life (Glasser, 1984). Ways in which a slight modification of these words to be more consistent with psychotherapy will be presented.

A special word of note is offered here. As members of ASCH will attest, there is such “in-breeding” of teachers, trainers, and their students who become trainers, that many use similar techniques/methods. Many of the techniques described in the subsequent chapters reflect a 31-year evolvement of techniques or blending of approaches; therefore, there may be places where the exact lineage of a concept or tool is no longer discernible. For example, after attending Mutter and Crasilneck’s (2007) presentations at the ASCH/SCEH joint meeting in Dallas, I realized that I utilize many of their techniques, albeit heard or read about many years earlier. Likewise, in hearing Torem’s (2007) presentation on weight loss, I realized that many of my techniques were similar to those he espoused, suggesting that I have heard him present these techniques in past years or have read about his work, without being consciously aware of the experience. However, my goal is to, whenever possible, give credit to those teachers, trainers, or contributors who deserve it, thereby honoring their contributions and providing readers with additional resources in their quest for knowledge.

After the appendices, there is an annotated resource list for further study or utilization.

Chapter One

The Lens

Let me begin by describing the way in which I understand psychotherapy in general and more specifically the role of hypnotherapy within it. My view has evolved over the course of 39 years doing psychotherapy, the last 31 of which have included hypnotherapy. This evolution was in collaboration with hundreds of patients I have seen over those years.

As indicated in the Introduction, like many of my colleagues, I started using hypnosis with smokers and weight loss clients at first. As I became more proficient in the utilization of hypnosis as a technique to effect positive changes, I began using it for many other applications. These included (not in any chronological order): chronic pain patients to reduce subjective pain; stress/anxiety reduction; overcoming phobias; performance enhancement, including sports, study habits, exam taking; public speaking; recovering lost memories; uncovering subconscious reasons for self-sabotage; dealing with self-esteem issues by uncovering unconscious origins for feelings of low self-worth; uncovering early origins of sexual fetishes; decreasing habits such as scratching infected skin or hair pulling (trichotillomania); working with bed-wetters; patients with Dissociative Identity Disorders (it was called Multiple Personality Disorder when I started); and last, but not least, with the topic of this book, patients with addictions.

Over the years, I have had great success with all of the above, or I wouldn’t be writing about it (although I do note some failures). A few years ago, I gave an American Psychological Association approved continuing education presentation (Tramontana, 2005) at the Gulfport, MS VA Hospital entitled “Hypnosis as an adjunctive technique in psychotherapy.” In that training seminar, a number of case studies were briefly presented covering most if not all of the above applications.

Harry Feamster, who has been retired quite some time, taught me a technique using aversive stimuli with problem drinkers (Feamster & Brown, 1963). Harry told me once: “Joe, hypnotherapy is the most economically efficient psychotherapy tool we have. It is quick and effective.” Over the years I have found Harry right on target; that is, I can often find out as much in one hour of hypnotherapeutic uncovering as I could in many, many hours of traditional talk-type therapy.

A word about uncovering may help the reader understand how I use this technique. As explained in some of the later chapters, I use what I describe to the client as an “affect-bridge.” I tell them that if we can uncover some early origin of the presenting problems, then it “bridges the gap”, so to speak. I then indoctrinate them to the technique of hypnoprojection whereby they are imagining watching a movie of themselves in the past, so that they do not have to re-live the experience, just in case the experience was traumatic. In fact, they can describe it almost as if they were narrating a documentary.

As described in Chapter 3, my understanding of using hypnosis to treat drug abuse or addiction happened somewhat by accident. A young woman came in because her treating physician said that he had done all that he could to alleviate her back pain, but that if she could find someone who could teach her self-hypnosis, this technique would help. I thought: What an enlightened soul! After our first hypnotic session, I asked my typical post-trance question: “How do you feel?” She responded: “Damn, that was better than drugs!” It turned out that she was not talking about pain medications; rather, she and her husband used to do a lot of illicit drugs, mostly downers, such as Quaaludes and marijuana. I thought, “Hmm!” Especially for the population of clients whose drug of choice is one to quiet, mellow, or calm them down, hypnosis/self-hypnosis would be a valuable tool. And it is natural!

As the word got around that I was rather proficient at hypnotherapy, a number of clients with various addictions sought my services. As I describe in Chapter 2 on Alcohol Abuse and Problem Drinking, at first I was reluctant to treat alcoholics or drug addicts unless they agreed to attend a verbally contracted number of 12-Step meetings per week. Over time, I realized that I was excluding some people I might have otherwise helped who had trouble with AA/NA specifically or the group process in general. As a result, I became more flexible about this requirement. I was also impressed by Flemons (2002), who described how AA teaches clients that they can never trust themselves, and how this seems rather antithetical to psychotherapists’ attempts to teach people that they can take effective control of their lives. So as time passed and experience grew, I became more flexible in developing treatment plans that would best suit the individual.

A short time before completing this manuscript, I had the good fortune of attending a CEU presentation by Dabney Ewin. While Dabney was presenting his ideomotor signaling technique, with a focus on working with patients with psychosomatic illnesses (Ewin, 2008), I came to realize how it might also be adapted to my work with addictions. My interest level was piqued, and I bought his book on this subject (Ewin & Eimer, 2006). This workshop also stimulated me to take another look at David Cheek’s work (Cheek & LeCron, 1968; Rossi & Cheek, 1988). One case in which this approach was used with good results with a pathological gambler is presented in Chapter 4. A case in which Ewin’s approach was successfully incorporated into a weight loss program is presented in Chapter 6.

Enter the Client

When clients first come into my office, whatever the reason, they fill out a problem checklist and we briefly discuss the symptoms they have checked. Following that, I give them an overview of how I see therapy, using a coaching metaphor that came out of a session with a client.

A number of years ago, I had a young man come in for his first psychotherapy session. I noticed from his information sheet that he had not been in therapy before. He was kind of fidgety and shuffling his feet. I asked him if he felt a little uncomfortable being there. He said: “Yeah man, I don’t know if I’m wasting your time and mine.” To which I responded: “I know, guys are supposed to solve their own problems, right?” He agreed, and I continued, “And big boys don’t cry, right?” Again he nodded in agreement. Well, luckily for me, it happened to be that time of year when the Summer Olympics were going on. Coincidentally, the Summer Olympics are on the same four-year rotation as the presidential campaigns for the November elections, so the races were heating up. I asked: “Did you read the newspaper today?” After he acknowledged he had, I asked: “Did you read about all of the Olympic athletes?” He responded: “Oh yes. I love the Summer Olympics!” I continued: “Did you read about all of the presidential candidates? I’ll bet everyone you read about who was any good at anything had someone working with them behind the scenes to make them better. The athletes all have coaches. The candidates have advisors, campaign managers, and speech writers. Actors have directors. Anybody who is good at anything has someone helping him or her to get better. Mike Tyson was heavyweight champion of the world, before he got so crazy and started biting people’s ears off. But even Mike had this little old guy in his corner reminding him to keep up his left, how to move, etc. Mike knows he is supposed to keep up his left, but sometimes it helps to have someone objective looking in and giving guidance … And that is how I see therapy. It is like having a coach, but one who coaches or consults with you regarding life’s issues or problems you want to change.”

This metaphor worked so well with this man that I began using it with others. The idea of a “coach” is accepted especially well by adolescents, and it is not gender-specific.

Another topic stressed in the opening session is the importance of being open. I explain to the client:

The therapist has only as much power to help as you give to him or her. And the way you give this power is by being honest and open. Now I know it is sometimes hard to open up to a total stranger, but for me to help, I have to know what I am really dealing with … A number of years ago, when I was director of a mental health center, I had an employee who was going through a divorce and needed therapy. She was also a friend. So I referred her to one of the psychiatrists who worked for us in one of our satellite clinics. I never breached privacy by asking her how the treatment was going, but one day I asked, “Are you still seeing F?” She responded: “You know, it is interesting you should ask. We just had our final session last week.” I asked: “Well, did it help?” She answered: “Oh, I don’t know; not really.” I expressed my surprise: “Really, I always heard he was such a good therapist!” Her reply told the story: “Well, you know, Joe, he never did really know me.” I responded: “You mean you went to see that man once a week for six months and you didn’t let him get to know you?”

The first session is also often when I talk with clients who come in seeking treatment for addictions about the “acting-out cycle.” The idea is that when one engages in a behavior that causes feelings of guilt, embarrassment, or shame, the logical, rational response would be to say: “Well, I’m not going to do that again. I don’t like the way I felt after doing that!” Often, however, the very behavior that caused the negative feelings arouses the person to a level of excitement (or calm) that gets them over the negative feelings. The high that comes with drinking, or drugs, or gambling, for example, helps one forget the previous negative feelings, and so the behavior continues to be repeated in a cyclical fashion. I explain this phenomenon so early in treatment because of what is often referred to in psychiatric hospitals as a “flight to health.” Whether in a psychiatric unit or a substance abuse rehabilitation unit, patients often report after just a few days that they have learned the error of their ways, have “seen the light,” and are “reformed.” If they subsequently are successful in extricating themselves from the treatment facility, relapse is often quite rapid. The client is warned that the same issues arise in outpatient psychological treatment; therefore, I want at least a verbal commitment regarding continuing to work with me until we mutually agree on termination. As will be seen in the chapters on smoking cessation and weight loss, for those issues I have the client commit and pay for a package of sessions in advance. While I do not do that type of contracting with alcohol, drugs, and gambling, the intent is to let clients know that hypnosis is not a quick or magical cure, and that they will need to “stay the course” (a phrase from 12-Step programs) if we are to be successful.

Many patients come to my office specifically seeking hypnosis for addictive behaviors because they have seen my ad in the Yellow Pages or have heard about my treatment from others. In other cases, I am the one who mentions hypnotherapy as a possibility. It is interesting that even those who ask for hypnotherapy are sometimes quite skeptical about the procedure and whether or not they will be responsive to hypnosis.

When a patient reports that they do not know if they can be hypnotized, my standard answer is, “Oh, anybody bright and creative can be hypnotized.” Not surprisingly, the client typically says, “Oh, okay.” I tell the patient, “Only once has a client called my bluff, stating, ‘Oh well, I guess that leaves me out!’ As it turned out, she was a very bright (and witty) woman, and she was an excellent hypnotic subject.” This response typically brings a chuckle from the client, thus enhancing rapport.

Regardless of why the patient wants to be hypnotized – whether to quit smoking, lose weight, deal with addictions, for pain control, as an adjunctive technique to other psychotherapy, or something else – I always start off by providing an overview. Even if the patient has been hypnotized by another provider in the past, this overview presents my particular philosophy about hypnosis and how it works. Typically, the patient is told that when talking about what hypnosis is, I often find myself spending a lot of time talking about what it is not. Many people only have the image of stage hypnotists who try to convince their audience that they can use hypnosis to control the minds of individual members of the audience, even to do silly things like crawl around like a chicken and cluck. A little education is called for:

In medical and psychological hypnosis, the idea is that I can’t control your mind, nor would I want to. But I can teach you to use your own mind power to achieve your goals. The key is that it is your mind power, not mine, so I serve only as a teacher or guide. You can’t be hypnotized against your will, so we say that all hypnosis is self-hypnosis in a way. You have to be a willing participant. You have to want to do it.

The explanation continues:

Hypnosis is an altered state of consciousness. It is not an unconscious state. The name is a misnomer. It comes from the Greek word hypnos, which in Greek means sleep. But you will not be asleep … you will be very much awake. Your eyes will be closed only to block out distractions, just like the music lover might put on headphones and close his or her eyes to focus more intently on the sound and block out visual distractions. You will hear everything I say. You’ll be able to talk back if I ask you questions. You will remember everything we talk about, unless there is some reason to block it out. When your mind and body are totally relaxed, you can concentrate better on everything I say … on whatever it is we are dealing with … in this case, suggestions about drinking (for example).

Depending on the situation, the patient may or may not be given a test of hypnotic suggestibility; instead, they may be given a muscle testing demonstration during which I say: “This is not hypnosis. This is a demonstration of the power of your mind.” My first experience of this technique (Poulos & Smith, 1998) was later demonstrated by a number of other mental and physical health providers. I adapted this approach for my work with clients. In fact, I now use this muscle testing with almost all clients, even though hypnosis may never be part of their treatment plan. The client is told:

I want you to hold out one arm (the one closer to me), and as I describe something to you, I want you to make it very rigid and resist to the best of your ability when I try to push your arm down … Now, I want you to think about the greatest accomplishment of your whole life … something you are totally proud of that you would like everyone to know about. You would be happy to see it published on the front page of the local newspaper. Nod when you have something in mind. Clients nod and invariably show great power to resist their arm being pushed down. Then the client is told to relax the arm for a while, after which they are told: Now I’m going to ask you to make your arm rigid again … and now I’m going to tell you something else to think about. I want you to think about the lowest, most lowdown thing you have ever done in your life; something you are totally embarrassed about that you would not want anyone to know about … nod when you have it in mind … now resist. Invariably the client’s arm is easily pushed down. I then tell a story about when I used this technique as a demonstration to the athletic coaches at the University of New Orleans. I had worked with a varsity volleyball player who after just three sessions had her best game ever. She was written up in the local newspaper as having her career high in “digs.” I did not even know what a dig is but soon found out that it is a defensive “save.” When the coaches learned that I had taught her self-hypnosis, they asked if I would give a presentation to the athletic department. I used this technique, asking for a volunteer from the audience. The women’s basketball coach volunteered. He was not only tall, but very muscular. I whispered the first instruction (something you are very proud of) in his ear. I was practically hanging from his arm and couldn’t budge it. Then I whispered the negative suggestion, and it immediately and easily went down.

On other occasions, such as when a patient comes in for a free consultation for a weight loss program [putting together and marketing weight-loss programs are discussed in Chapter 6], they might be given a little test of hypnotic suggestibility.

The goal is to show the potential client that they are likely to be a good hypnotic subject. Whether this test is done is often determined by the client’s report of whether or not they have been previously hypnotized. Their degree of skepticism is also a determining factor. If the client acknowledges experience with hypnosis, they are asked their response to hypnosis. Time constraints may also be a determining factor as to whether or not a test of hypnotizability is employed. The test I most often use is one that I learned at one of my first ASCH workshops. The person is told to sit back comfortably in the chair, relax as much as possible, and when I say to put out their arms, to put both arms out, directly in front, at about shoulder height. I demonstrate the position and then continue:

I want you to imagine a scene … a beach scene. I want you to imagine sitting on a beach, on a beautiful spring or summer day. Perhaps you are sitting on a beach towel or blanket, or maybe a recliner of some sort … enjoying the beautiful weather … you feel the warm sunshine on your skin … and a nice breeze coming off the ocean … enjoying the beautiful scenery … and imagine there are some children playing near the water’s edge … they could be children you know or could be strangers … playing with their little sand buckets and shovels … now when I was a child these buckets were usually made out of some kind of metal material, tin or aluminum … nowadays they are typically rubberized or plastic … but the one thing they still have in common is they all have the little curved handle so that the child can carry the bucket … imagine that one of the children comes over to you asks you to put out your arms, so go ahead and do so now, just as I showed you … then imagine that the child places the handle of the bucket over one of your wrists, whichever you decide, and then starts filling the bucket with sand … and as the child does so, the bucket gets heavier and heavier … the natural pull of gravity will cause that arm to gradually descend toward the ground, the sand below …. And you’d like to hold it up, but it gets heavier and heavier. It’s now about one third full and getting really heavy … and then the child starts filling it with wet sand, and wet sand is even heavier than dry sand because it is denser.

By then the arm is usually descended, or at least the client will report it feeling strained from holding up the bucket.

All of the above are part of the client’s orientation to hypnosis. At this point (the first meeting) formal hypnosis has not commenced. I would like to note here that by design, different induction techniques are used as well as different deepening techniques. The first hypnotic session is often not until the actual second meeting. Because of my feeling regarding the importance of orienting the client to what we are doing and why, the first hypnotic session (typically the second actual meeting with the client) is very much structured and includes very specific techniques. An exception to this format is smoking cessation and weight loss clients, for whom I often start hypnosis in the first formal session because of the time-limited (packaging) techniques that are discussed in Chapters 5 and 6.

As will be seen in Chapter 2 on alcohol abuse and problem drinking, I often start the first hypnotic session with a reverse arm levitation technique, deep breathing techniques, followed by a deepening technique involving visual imagery of an elevator ride (unless the client has an elevator phobia) to a safe comfortable room. By design, different induction techniques are used in subsequent sessions. Such techniques include eye fixation, an eye roll approach, and progressive relaxation (imagined, not via progressive relaxation exercises). Sometimes, after patients are very experienced in working with me with a variety of techniques, I might say: Just close your eyes and go into a deeper trance than you are already in. I have come to realize that for some clients just sitting in my recliner has become a conditioned stimulus for trance induction. Further, with clients experienced in my approach, after the first three or four sessions, I will use what I refer to as “flex induction.” In such cases, the client is told:

You have been practicing a variety of induction techniques here and at home. Some clients prefer some methods and others prefer others! Now, just put yourself into a hypnotic state using whatever technique you like best.

Different deepening techniques are also employed. If I use the imagery of an elevator ride the first time, I might use a staircase, escalator, or gently sloping hill in subsequent sessions, always counting the client down. Later, I might even use counting forward as they imagine an escalator ride up into the clouds, each number taking them to a higher level of relaxation … where you can be above the humdrum of daily living and see things from a better perspective. Again, after the client becomes experienced in my deepening techniques, I will do the same as with the induction:

You have also been practicing a number of different deepening techniques both here and at home, so you pick whichever one you like best and allow yourself to go deeper now. Nod your head when you have completed the deepening technique in your mind.

The sessions typically go from more structured, detailed approaches to shorter, less detailed and more flexible ones. I prefer the reverse arm levitation technique in the first hypnotic session because this approach is slower and more dramatic than some of the others. While I am telling the client what is likely being felt in the arm and in the eyes, they actually feel the physiologic response of the arm getting heavier and the eyes getting heavier.

After hypnosis is elicited with the reverse arm levitation technique, some time is spent with diaphragmatic breathing. Then the client is told: