Monday, November 19, 2007

Clinical Hypnosis (Part I): An Interview with Dr. Elizabeth Winter

[Episode 28] Today's podcast is the first in a two-part series on Clinical Hypnosis. According to the American Society for Clinical Hypnosis, hypnosis is a state of inner absorption, concentration and focused attention. In today's podcast, I talked with Dr. Elizabeth Winter about the history of clinical hypnosis, key assumptions, goals, the client's role and types of problems that might be addressed with clinical hypnosis. In Part II, Dr. Winter and I talk about how and when to use clinical hypnosis.

Download MP3 [22:36]



Jonathan Singer: Dr. Winter thank you for joining us today, I am really looking forward to talking about clinical hypnosis.  I was wondering if first you could give us a brief overview of the history of clinical hypnosis, including perhaps some of the key figures in its’ development?

Elizabeth Winter: Certainly.  Clinical hypnosis started early in the 19th century when the term was coined by a physician called James Braid, who had observed exhibitions of what was then known as mesmerism or animal magnetism, and Braid thought that rather than a magnetic force of any kind, he thought that this was suggestibility and a form of sleep, which so he then called it hypnosis after the Greek word hypnos for sleep.  Hypnosis was used for anesthesia and analgesia by a surgeon by the name of Esdale in India where he had used this on Indian patients in need of surgery and it was very successful in reducing what were then very very high mortality rates.  With the advent of ether hypnosis became something that was a skill that had to be learned rather than a chemical that could be applied, and became less popular.  It was used later in the 19th century by some of the big names in psychotherapy at that time such as Jacque, and Jeanea, Joseph Boyer and Freud of course.  Freud had an early interest in hypnosis which gave way really as he developed psychoanalysis, and so hypnosis kind of waned in popularity again.  Probably the main name from the 20th century was Milton Erickson and we still have the Erickson Foundation and what is often called the Ericksonian methods of hypnosis in hypnotherapy.

Jonathan Singer: What are some of the key assumptions of clinical hypnosis?

Elizabeth Winter: There are a number of things to consider here, one is that trance, or the hypnotic state is usually conceptualized as highly focused attention so that a person in trance is very highly focused on a certain thing, and conversely defocused on other things.  So it’s a very tightly focused attention on the inward rather than in the outward, not exclusively but certainly, probably most commonly.  What it is not is perhaps also extremely important.  It isn’t sleep as we said earlier, it isn’t a form of mind control, which is perhaps how it’s popularly portrayed in terms of stage hypnosis, so it really does need to be distinguished from hypnosis, as a form of entertainment.  A person who is going to be working with hypnosis clinically really needs to be I think well trained in the use of that.  So perhaps one of the assumptions if you like is that the person doing this has had appropriate training.  Other assumptions are that a trance state enables a person to perhaps address both their mind and their body at the same time.  People may have come across this stage before, is that every psychological event is a physical event and every physical event is a psychological event.  So it’s never one thing or the other, we perhaps have a slightly dualistic concept of the mind and the body.  But working in trance really tends to draw on the idea of a holistic single thing.  Again, one of the ways I think of that is you can look into a building through one window and see a particular view, you can look into a building from another window and see another view, but it’s the same building, it’s the same contents.  Other assumptions would be that obviously, the obvious things like informed consent and so on and so forth, so the same kinds of assumptions that you would have for any forms of treatment. 

Jonathan Singer: So it sounds like one of the main assumptions of clinical hypnosis is that it’s an internal focusing, possibly to the exclusion of the external world, and that there is an understanding of the mind and the body as a Gestalt.

Elizabeth Winter: I think that’s right, and I think that I’d also add that there’s an assumption that trance is a naturally occurring phenomenon.  In other words, when you use it clinically you’re intentionally using something that we all know how to do anyway, and to give you an example of that, if you have ever watched a young child glued to a television set or to a computer screen, to the exclusion of all else, they’re not perhaps focused internally, but they are very very tightly focused on that thing, and you can talk to them sometimes for quite some time and they have absolutely no idea that you are there, not because their ears don’t work but because they have defocused on that particular form of input.  So that if you like is a naturally occurring trance state.  Likewise, if you’ve ever driven home and completely spaced the drive, and you know that you knew where you were going, but you have no recollection of how you got there, chances are that was a naturally occurring, and what is often called the driving trance.  It is a naturally occurring thing, the difference is when you are using it clinically is that you have an agenda.  So you have a therapeutic intention and an agenda for that trance, and if you can enter trance spontaneously, then you can enter it intentionally, and that’s also I think an assumption of practice.  For research purposes, people often use hypnotizeability scales, which will show that some people are more hypnotizeable than others, and that can be tremendously useful for research work.  From a clinical practice perspective, most people who work with this particular skill, will make the assumption that if someone can go into trance naturalistically or naturally if you like, then they can do it intentionally.

Jonathan Singer: Is clinical hypnosis a stand-alone treatment or is it something that can be used in conjunction with other forms of treatment, such as behavior therapy or solution focused treatment?

Elizabeth Winter: Hypnotherapy is not a treatment per say, it really is a skill or a tool; it’s a sort of scalpel if you like, it’s analogist to that, so does it stand-alone?  Well, not really, it depends on what you want to do with it.  So you can use trance work or hypnosis as part of cognitive behavioral therapy, as part of psychodynamic therapy, as part of couples therapy, individual, group, self-management, you can really use it a variety of different ways.  So no it’s not a stand alone, in my estimation best used as part of an ongoing planned psychotherapeutic intervention.  People will often say well can you just teach me how to go into trance so I can quit smoking, well yes you can absolutely teach it as a skill, and it certainly might preference to teach it as a skill that someone takes away with them rather than as something that the clinician does to them, but it’s not going to be something that will stand alone without looking at what, you know someone wants it for habit cessation, why do the smoke, what’s the context of that, obviously it’s not you know a magic solution but sued within an appropriate course of treatment, then yes it’s a very useful tool.

Jonathan Singer: What is the role of the client when the clinician is using hypnosis?

Elizabeth Winter: That’s really an interesting question and I think it depends as much on the clinician in question as much as it does on anything else.  Clinical hypnosis is used really by a broad variety of folks, so that may be social workers, it may be psychologists, it may also be dentists, physicians, chiropractors, nurses, so how the clients role is conceptualized is really as much a function of whether and to whom they’re presenting for service as it is of hypnosis itself.  So I’m speaking personally as a social worker, I will usually be working with someone on the basis of using hypnosis as a personal skill, for example, typically in the first session with someone who wants to learn hypnosis, we will do some trance work in that first session with the goal that this person can then induce trance for themselves, whether or not I happen to be there.  So really for me it is something that someone takes away, not something that they have to come to me to get. 

Jonathan Singer: So it sounds like the clients role differs based on the setting, so if I was a patient in a dentist’s office, it would be different than if I was in a psychotherapy office.

Elizabeth Winter: I think that’s right and I think that, as we talk more about how it’s used, I think perhaps that will become clearer too.  I am thinking of people that I’ve worked with over the years, some of whom practice it and practice a great deal because it’s a skill, practice is important, and so they have sort of taken it as their own and do what they need to do with it, and I’m thinking that there are other people who use it more rarely but will come in and say I’m having trouble with this, can we do some trance work around this particular thing.  One example that comes to mind is somebody who is getting some quite distressing physical discomfort and couldn’t work out whether this was stress related or not, well of course as a social worker the first thing you do is send someone to get a complete medical workup, but in terms of preparation for that workup one of the things that we did was to have this person go into trance, and they were very good at that, they had done it many times, and to do what you might call a full-body scan, what was paining them, how was it paining them, what was the quality of that, so that when they went for their medical workup, they could really give some high quality information to the physician, and also be a little calmer in themselves about knowing what was going on for themselves. 

Jonathan Singer: What are some other types of problems that can be addressed using clinical hypnosis?

Elizabeth Winter: Well, if we look at that in a very general way, those are going to fall into the more medical kinds of things, and then what we would think of as the more psychosocial kinds of areas.  Hypnosis certainly can be used both with adults and with children, and actually since children, their natural ability to go into trance is really really high until we train them not to, and so they are very very susceptible and very comfortable going into trance.  And there’s a lot of medical work done with kids around pain control, and to prepare children for procedures, particularly painful procedures.  Karen Ulness actually has written a very very nice book and done a great deal of work on working with children in medical settings using hypnosis.  Obviously pain control or shifting perceptions of pain is certainly a way to use hypnosis and there is a fair amount of evidence actually looking at using hypnosis to reduce the need for using analgesic medication post-operatively to reduce subjective perception of pain and to decrease wound healing time also, so some quite nice evidence out there for that.

Jonathan Singer: I also know that hypnosis is used in birthing, there’s a whole area called hypno-birthing, and in hypno-birthing they reconceptualize pain as pressure and suggest that if you’re in a state of deep relaxation you won’t be fighting your body’s natural process.  So the idea is that the fight is what causes the pain, and hypno-birthing points to cultures where the birth experience is not discussed in terms of pain, like it is in the United States.  Interestingly this approach seems to be very different than other birthing classes, like Bradley or Lamaze, even though those classes include basic hypnotic techniques, like breathing for relaxation. 

Elizabeth Winter: Interestingly Lamaze was trained in hypnosis, so you know there are probably some very strong links around what Lamaze did in childbirth and his training in hypnosis, as I understand it.  But yes, certainly, that’s a very nice cognitive intervention to reconceptualize pain as something that is not pathological, but quite appropriate for the process, and there’s again a lot of folks working with childbirth preparation with hypnosis so to help somebody to understand what to expect and again going back to that assumption that you’re not just talking to the mind but you’re talking to the body.  So one of your suggestions may be as you feel a certain kind of pressure, than that will be your cue to allow that muscle to relax and lengthen or the ligament to soften and lengthen and do what it needs to do in the childbirth process.  So that would be a very nice example. In the sort of psychotherapeutic world hypnosis is used in a number of different ways.  Anxiety, and of course that could well be related, well it could be related to anything at all, but I am thinking of your example of childbirth, so you would deal not only perhaps with the physical sensations of that but also fear of pain, fear of the process, whatever the process is.  So anxiety certainly, depression, ADHD actually.  There’s some of use of that in terms of filtering input, if you consider hypnosis again as a state of highly focused attention, and if you think of Attention Deficit Disorders as the inability to not focus, something that would help somebody filter input would be very very helpful.  Addictions, as a skill in terms of perhaps understanding and identifying some of the triggers for addictions, and also in dealing with cravings when they arrive.  Some very good applications there, and then some really general things, like general ego strengthening, general relaxation, stress reduction, and actually I tend to use hypnosis for folks who have post-traumatic symptoms, helping people to find a way to ground and to deal with some of the physiological anxiety symptoms that really hit people hard in Post-traumatic Stress Disorder.

Jonathan Singer: It sounds like a wide variety of issues that can be addressed with clinical hypnosis and it sounds like with the examples that you gave there are similarities but they are really targeted to whatever the most distressing symptom is, so with the ADHD with be attention, with the childbirth it might be what does this pain mean, you know what is this triggering, what is this telling you to do at this point as opposed to “Oh my God make it stop”.

Elizabeth Winter: Right, and what you’re dealing with is our ability to focus.  So whatever one focuses on or chooses not to focus on, I mean that’s why it’s a wide variety, because focus itself can be applied to absolutely anything.  I think it’s also important to add that contrary to the misconception that hypnosis reduces somebody’s control, or has control over the person that you’re working with, the goal if you like of the many uses of trance is to increase control.  So that somebody has more control over emotional responses, over physiological processes, and can again given the childbirth example, feel more control of what is happening in that particular process.  So control over levels of perceived pain, control over how long something appears to take.  There’s a concept in hypnosis called time distortion, and if you think about being a kid on the last afternoon on the last day of school before summer vacation, how long does that afternoon stretch out?  Subjectively for a kid, it’s forever, now if you want to make something last longer, that’s great, you then might cue somebody to remember that long long long time, if you’re dealing with something like discomfort or pain, then you might want to do the opposite, and talk about how quickly time can pass, so that our ability to experience time in this very subjective way is something that we can use in a trance state to have some control over procedures, and some of the procedures that you know things that involve like bone marrow procedures, and so on where there’s a high degree of discomfort, and use trance to sort of go away and you know change the length of time that that seems to take can be very very helpful to people.  But the whole idea of this is to have more control over what’s happening.  So for anxiety for example, the control that one might like to have is control over some of the physiological aspects of anxiety.  Things like reducing your heart rate, calming your breathing down, and when you do that then your subjective experience of anxiety changes because you’ve dealt with some of the physiological things that you know are part of it and that then feed that whole process of becoming anxious and maintaining an anxious state.  So it really is about putting control, you know giving control to the person who is learning to do this, and again importantly, taking that away out of the office so they can do it as and when they need to or want to.

APA (6th ed) citation for this podcast:

Singer, J. B. (Host). (2007, November 19). #28 - Clinical hypnosis (part I): An interview with Dr. Elizabeth Winter [Audio podcast]. Social Work Podcast. Podcast retrieved from

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