Provides information on all things social work, including direct practice (both clinical and community organizing), research, policy, education... and everything in between.
[Episode 139] In today's episode, I speak with Tia Dole, PhD, Chief 988 Suicide and Crisis Lifeline Officer, about updates to 988. We talk about how 988 provides services to Deaf and hard of hearing people, crisis support in Spanish, and the September 17, 2024 launch of geo-routing for T-Mobile and Verizon customers. We talk about how geo-routing is different than geo-location, and what people should know about contacting 988 in a suicidal crisis.
At the 988 Suicide & Crisis Lifeline, we understand that life's challenges can sometimes be difficult. Whether you're facing mental health struggles, emotional distress, alcohol or drug use concerns, or just need someone to talk to, our caring counselors are here for you. You are not alone.
[Episode 131] In today's episode, I speak with Scott Miller, Ph.D. about how we can use feedback to improve client outcomes. Scott is one of the developers of Feedback Informed Treatment, or FIT - an "empirically supported, pantheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services. It involves routinely and formally soliciting feedback from clients regarding the therapeutic alliance," client outcomes, and using that information to improve services (https://centerforclinicalexcellence.com/wp-content/uploads/2021/02/FIT-what-is-it-2020.pdf).
[Episode 126] In today's episode of the Social Work Podcast I speak with Carol Tosone, Ph.D., Professor of Social Work and Director, DSW Program in Clinical Social Work at NYU's Silver School of Social Work.
Carol and I spoke on April 1, 2020 about her insights into the COVID-19 pandemic, psychotherapy, technology and shared trauma. Because of everything that was happening in the world, it took me nearly 5 weeks to publish the episode. Although five weeks is a quick turnaround for me, it was an eternity in an environment where life was changing daily.
In today's episode we talked about how the concept of shared trauma can help us to understand what's going on in a global pandemic, how we can think about the role of technology-mediated services, and what social workers can do to care for themselves while caring for others.
[Episode 111] Today's episode of the Social Work Podcast is about engaging people who are suicidal into professional mental health services. I spoke with Dr. Dana Alonzo from Fordham University. We talked about some of the reasons why people might not want to seek professional mental health services when they are suicidal, and some of the things that mental health professionals do to make it hard for folks to want to stay in treatment. Dana sees this as a problem of engagement. She described the process of how she developed her intervention and what it entails. She ends with some tips on how to improve engagement in treatment for anyone, regardless of suicide risk.
If you’re feeling suicidal, please talk to somebody. You can reach the National Suicide Prevention Lifeline at 1-800-273-8255; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488- 7386. Text “START” to Crisis Text Line at 741-741. If you don’t like the phone, consider using the Lifeline Crisis Chat at www.crisischat.org.
[Episode 109] Today’s episode of the Social Work Podcast is about Death and Grief in the Digital Age. I spoke with Dr. Carla Sofka, professor of Social Work at Siena College. Dr. Sofka has been studying and writing about the intersection of technology and death and grief since the earliest days of the world wide web. Her edited 2012 text,Dying, Death and Grief in an Online Universe, looks at how changes in communication technology have revolutionized the field of thanatology.
In today’s episode we talk about the role of social media in how, why, where and when, who we grieve. She shares stories of people whose loved ones have died, only to find out that because of social media they are the last to know. Carla provides some digital literacy around death and grief in the digital age. She talks about social media posts as death notifications, about establishing digital advance directives and thinking about our digital dust.
She talks about STUG reactions which are Sudden Temporary Upsurges of Grief. I had never heard of a STUG reaction, but I actually had one during our conversation. You’ll hear me talk about college friend of mine who died several years ago and during the interview start to tear up as I recalled getting a Facebook notification that it was her birthday. We then talked about internet ghosts, memorial pages, memorial trolls, how and when people should respond to death notices online and what that means for the loved ones. She suggests that just as we provide sex education to kids, we should be providing death education. She also recommends including technology assessment in the standard biopsychosocialspiritual assessment. We ended our conversation talking about resources for mental health professionals who want to learn more.
[Episode 107] Today's episode of the Social Work Podcast is about self-psychology. Tom is a retired professor of social work from Widener University and the author of several publications on social work and self psychology. In today's episode Tom talks about the role of empathy in self psychology, the function of mirroring, idealizing, and twinship experiences in the development of the self, how self psychology can be applied in individual, couple, and family contexts. Tom talks us through a case involving an adolescent male and shares resources for those interested in learning more.
In today's interview Danna and I talk about what makes a social worker a clinical social worker, what distinguishes a good from a bad clinical social worker, the one essential thing that all social workers bring to supervision, and the role of narcissism, observing ego, transference, counter-transference and the real relationship in clinical social work. We end with a discussion of money and how social workers need to earn enough so they can be present with their clients.
@socworkpodcast Holy #99 podcast. LOVED Danna Bodenheimer's interview. Buying the book ASAP. Thank you.
[Episode 96] In today's Social Work Podcast I speak with two of the three developers of Attachment-based Family Therapy (ABFT), Guy S. Diamond, Ph.D. and Suzanne Levy, Ph.D. The third developer Gary M. Diamond (no relation to Guy Diamond) lives in Israel and was unavailable for the interview.
ABFT is the only family-based psychotherapy with empirical support for reducing suicidal ideation in youth. In today's interview, Dr. Diamond and Dr. Levy discuss the theory and practice of Attachment-Based Family Therapy. Dr. Diamond mostly covers theory and concepts, and Dr. Levy addresses the question of "what does the therapist actually do in the therapy room."
"Attachment-Based Family Therapy (ABFT) is a treatment for adolescents ages 12-18 that is designed to treat clinically diagnosed major depressive disorder, eliminate suicidal ideation, and reduce dispositional anxiety. The model is based on an interpersonal theory of depression, which proposes that the quality of family relationships may precipitate, exacerbate, or prevent depression and suicidal ideation. In this model, ruptures in family relationships, such as those due to abandonment, neglect, or abuse or a harsh and negative parenting environment, influence the development of adolescent depression. Families with these attachment ruptures lack the normative secure base and safe haven context needed for an adolescent's healthy development, including the development of emotion regulation and problem-solving skills. These adolescents may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. ABFT aims to strengthen or repair parent-adolescent attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help the adolescent cope with stress, experience competency, and explore autonomy.
ABFT is typically delivered in 60- to 90-minute sessions conducted weekly for 12-16 weeks. Treatment follows a semistructured protocol consisting of five sequential therapy tasks, each of which has clearly outlined processes and goals:
Task 1: The Relational Reframe Task, with the adolescent and parents (or parent) together, sets the foundation of the therapy. After an assessment of the history and nature of the depression, the therapist focuses on relational ruptures. This shift pivots on the therapeutic question, "When you feel so depressed or suicidal, why don't you go to your parents for help?" The progression of this conversation leads parents and the adolescent to agree that improving the quality of their relationship would be a good starting point for treatment.
Task 2: The Adolescent Alliance Task, with the adolescent alone, identifies relational ruptures in the family and links them to the depression. The adolescent is encouraged and prepared to discuss these often avoided feelings and memories with his or her parents.
Task 3: The Parent Alliance Task, with the parents alone, explores their current stressors and their own history of attachment disappointments. These conversations activate parental caregiving instincts to behaviorally and emotionally protect their child, which helps motivate parents to learn and use new attachment-promoting parenting skills.
Task 4: The Attachment Task, with the adolescent and parents together, creates an opportunity for the adolescent to directly express his or her thoughts and feelings about past and current relational injustices. Rather than defending themselves, parents help the adolescent fully express and explore these emotionally charged topics. This conversation helps the adolescent work through trauma, address negative patterns in the relationship, and practice new conflict resolution and emotion regulation skills.
Task 5: The Autonomy Task, with the adolescent and parents together, helps consolidate the new secure base. In solving day-to-day problems, parents provide support and expectations and the adolescent seeks to develop autonomy while remaining appropriately attached to his or her parents." (http://legacy.nreppadmin.net/ViewIntervention.aspx?id=314)
[Episode 94] Today’s episode of the Social Work Podcast is on Objective Structured Clinical Examination (OSCE) for social work. My guests, Marion Bogo and Mary Rawlings, and their co-authors Ellen Katz and Carmen Logie, are pioneers in the development, implementation, and evaluation of OSCE adapted for social work.
The audience for today's episode is social work faculty, specifically practice instructors who are interested in learning more about how to objectively evaluate their student's skills. Today's episode reviews the origins of OSCE adapted for social work, how it is implemented in different types of social work programs, some findings from the research that has been conducted on OSCE, and some recommendations for faculty who are interested in learning more about this approach.
[Episode 74] Today’s Social Work Podcast is an interview with Shawn Christopher Shea, M.D., developer of an approach to uncovering suicidal ideation and intent called the Chronological Assessment of Suicide Events (CASE) approach. In today’s episode, Shawn takes us through the CASE approach. He explains the value of assessing for suicidal content at different time points and emphasizes that eliciting suicidal ideation and intent is a difficult and sensitive topic. He talks about how moving through the CASE approach to help establish a therapeutic alliance and rapport with suicidal clients. He emphasizes the art of the interview, using validity techniques, and how we use words as central to uncovering suicidal ideation and intent. He talks about how the CASE approach is useful for any mental health provider. Shawn makes the argument that the CASE approach is an ideal approach to for assessing for suicidal risk that doesn’t sound like a pat suicide assessment. He emphasizes that the CASE approach is one-third of a thorough suicide assessment, the other two parts being identifying risk and protective factors, and the final part being developing a clinical formulation.
This figure represents the three components of a thorough suicide assessment. The CASE approach provides a framework for assessing the information in the red square (ideation, plan, behaviors, desire, and intent).
Shawn has written that a thorough suicide assessment has three parts: 1) Gathering information related to risk factors, protective factors, and warning signs of suicide; 2) Collecting information related to the patient’s suicidal ideation, planning, behaviors, desire, and intent; and 3) Making a clinical formulation of risk based on these 2 databases. He writes that in the “clinical and research literature, much attention has been given to the first and third tasks (gathering risk/protective factors/warning signs and clinical formulation). Significantly less attention has been given to the second task—the detailed set of interviewing skills needed to effectively elicit suicidal ideation, behaviors, and intent. But in many respects, it is the validity of the information from the second component that may yield the greatest hint of imminent suicide.” (Shea, 2009, p. 1).
My interview with Shawn is a single episode in two continuous parts. In Part I Shawn and I talk about the CASE approach, including some of the validity techniques he has developed or uses to elicit suicidal ideation and intent. In the second part Shawn and I do a role play where he uses the CASE approach.
[Episode 29] Today's podcast is the second 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. Today I spoke with Dr. Elizabeth Winter about how and when to use clinical hypnosis. In the first episode, Dr. Winter and I spoke about the history of clinical hypnosis, key assumptions, goals, the client's role and types of problems that might be addressed with clinical hypnosis.
Jonathan Singer: So as a clinician, how do you decide when to use hypnosis?
Elizabeth Winter: Probably the first caution is to use only to do something that you’re already trained to do. And that may sound a little bit obvious but for example, it would be appropriate for me as a social worker to use it with somebody who comes to see me for work on addictions. It would not be appropriate as a social worker for me to help someone to induce analgesia or anesthesia with an intention of my performing surgery on them. I’m not trained to do that, I shouldn’t do it. And conversely somebody who is perhaps and anesthesiologist shouldn’t be doing psychotherapy using hypnosis. So it may seem obvious, but it’s really important that you don’t work outside your field or do anything that you’re not already trained to do. Having said that, not everyone is going to want hypnosis and it’s not going to be something that I would do with everyone. If somebody specifically comes and asks for hypnotic intervention, typically I would do that as part of a broader therapeutic relationship. And it may or may not be appropriate. For example, people will sometime specifically ask if they can use hypnosis to recover memories, typically memories they think they may have buried somewhere about past abuse. Now, I won’t do that kind of work and I won’t do it for a number of reasons, the primary one being memory is not history. And the fact that you recall something in a trance state doesn’t make it true, and in fact there is a fair amount of research that suggests that people who appear to remember things in trance have a higher degree of confidence in those memories but less accuracy. So that would be a time not to use it. If someone is motivated to use it for something like habit control, or anxiety, then certainly it’s worth exploring, and you would start out by teaching the skill before you would use it for the specific purpose. And I’ll give you a quick example of that. I once heard a story of a woman who had grown up in Europe and was towards probably her middle years looking to stop smoking, and she had smoked for many many years, and she wanted to use hypnosis to stop smoking. And what she found was she really got stuck going into trance, and kind of couldn’t go into trance, and when she was asked what her first memory of smoking was, when did you start smoking, it was when she had been smuggled out of Germany in the late 1930’s early 1940’s during the second World War. She had been smuggled out, she was a Jewish woman, and when she crossed the border into Switzerland, someone gave her a cigarette, and she took the first puff of that cigarette, they said this is what freedom tastes like. And so until she knew that she had you know her belief in freedom paired with her smoking habit, then no amount of teaching her to go into trance was going to make any difference, and sometimes you find those things out as you work. So it really depends, it depends on do you have the training and the skill set to do a particular piece of work, and if you wouldn’t without hypnosis, you shouldn’t do it with.
Jonathan Singer: So you use clinical hypnosis when someone asks for it, when it seems clinically appropriate, but also with the caveat that hypnosis is used within a treatment context that is within your scope of expertise and in your scope of practice.
Elizabeth Winter: Exactly.
Jonathan Singer: Let’s say they that all this criteria had been met with a client and you decided to use it. How do you actually use clinical hypnosis?
Elizabeth Winter: The first thing I do is to help someone learn how they best go into trance. There are a number of different inductions, so probably the one people are going to be most familiar with is fixing their eyes on a particular object, and it need not be a watch, and it need not be swinging in front of ones face, I will say that quite categorically now. But there is something called an eye fixation technique and this is one of what is known as the formal inductions. And when I talk about using hypnosis and what is ethical and what is appropriate, really talking about this sort of formal induction of hypnosis. Now the eye fixation may be helpful for someone who is more visually oriented and there are other forms of formal induction, one for example is an arm levitation induction. So that would be perhaps, and this is someone who is more comfortable with more physical and more body oriented rather than visual. There’s another, which focuses more on the ability to visualize things so that may be more appropriate for someone who thinks in that way. So there are different formal inductions. To use those help somebody to learn how to go into trance. Once somebody is in trance then a clinician would add what we would think of as a utilization, which would be what is it we are trying to accomplish, it may be suggestion in a fairly direct way, so you know one might say to somebody “You will be surprised at how much more comfortable you will be when …”. “As you monitor your breathing and slow down your next breath out, you will find that you’ve become calmer, more relaxed, and so on”. A simple example of just relaxation based, but that’s the utilization part of the trance. They then within that, or following that, perhaps be a suggestion for how that comfort or whatever it is will follow that person once the trance has ended. So just because the trance ends they don’t have to stop feeling comfortable you know, that comfort can go with you, that’s the post-hypnotic suggestion part of that. And then there is a termination of that, of the trance experience, which may sound something like “You return your attention to the room in your usual way in the next few breaths and so on”. So there is usually a structure to the formal induction of trance, but the induction, you know the induction of the early trance state is really just the beginning of that. And that will be completely really individualized for the person. There are some standard forms of script, actually some really really nice publications that have standardized scripts, and you know people often make their own but there are some really nice pieces of work for different applications. Now, formal induction is not the only way to use an understanding of hypnosis in the clinical setting. Now here’s the deal, since we go into trance spontaneously, I can intentionally work with someone to induce trance sitting in my office, but I can’t stop them spontaneously going into trance in my office. What I can do is recognize it and work with it because some spontaneous trances are useful and some are really quite harmful. So if there is a trance state which is what we would think of as a negative trance, so a highly focused attention perhaps in a relational situation, that is really really negative then my recognizing when someone has gone into hat sort of highly focused state that is not working well for them, is something that can be very useful clinically.
Jonathan Singer: So would this be something that you might recognize in a couples therapy session?
Elizabeth Winter: Oh sure, an induction into a trance state doesn’t have to be intentional obviously, so couples have a well worn path into an argument, into an old disagreement, into the you always do this, you never do that, so that can certainly operate as an induction if you like, with a focused attention or perhaps even more often focused disattenion, let’s say the induction "You never…"and then the other party disappears, they are not listening after that, they defocus, they have gone elsewhere. Could you view that as a couple’s trance? Certainly. I think it’s also helpful to consider negative trances that children go into and what operates as an induction for a child in a negative way might be the “You’re stupid, you never listen, you never get this right, you’re always so clumsy…” and at that point children often defocus and go elsewhere and they’re in their trance where they can’t get anything right, so of course the don’t. I think that can be a very helpful frame for parents to understand, for teachers to understand. Now on the positive trance side for children, I think it’s helpful again for parents, teachers, families to understand when a child is not being inattentive or disobedient, but simply highly focused in their internal world. So just useful ways to use that conceptualization of trance in a way that is helpful but does not involve necessarily a formal induction of a trance state, but really the recognition of naturally occurring states.
Jonathan Singer: So it does, it sounds like there’s a distinction between these naturally occurring and these formally induced trance states, and you’ve talked about positive and negative trance states. Are there limitations or strengths to clinical hypnosis in terms of the formal work that a clinician would do, not the naturally occurring trance states, but are there strengths and limitations or contraindications in terms of the clinical usage of hypnosis?
Elizabeth Winter: I think there are times when you absolutely wouldn’t use it, and we’ve certainly mentioned you know where you’re really not trained to. You may understand trance work but you may not be appropriate for you to use it in a particular area. Contraindications for me as a social worker seeing people for psychotherapy. I typically, probably would not use hypnosis for someone who has psychotic symptoms because they’re experiencing altered states in any case and adding in another form of altered state really is probably not going to be helpful, it just isn’t.
Jonathan Singer: That makes sense.
Elizabeth Winter: So I probably wouldn’t, I wouldn’t do it. I think I’ve already mentioned that I wouldn’t do, I don’t do memory retrieval work, and again that is something to be really cautious of. Might somebody remember something during the course of psychotherapy, absolutely, memory is not a continuous thing. Might somebody remember something while they’re in trance, certainly, but I wouldn’t go fishing for it. I wouldn’t use trance if somebody said I only want to do this and nothing else, that’s like telling a surgeon all they can use is a scalpel, nothing else, no retractors, no forceps, you know you wouldn’t limit yourself in that way. One aspect of using clinical hypnosis that I think is important for people to bear in mind is that where there is a legal case going on the admissibility of your clients evidence can really be put in jeopardy by that person having done hypnosis. Not because hypnosis makes them a less credible, well literally makes them a less credibly witness, but the law certainly views it that way. You know when, if you’re a forensic, if you’re doing forensic work as a therapist or a psychiatrist, you probably would not want to be using hypnosis. And it’s appropriate if someone wants you to work with hypnosis or if you’re considering it, to bear in mind that if they have a case pending or they might have a case against an abuser for example, that their testimony could be set aside in court. If you’re thinking of using clinical hypnosis with someone to really discuss with them in a psychotherapeutic setting whether this is something they’re comfortable with, not everyone is going to be comfortable with it. And there are some real cultural differences on the use of hypnosis with some people being very comfortable and some people being extremely uncomfortable and not feeling ok with that at all.
Jonathan Singer: And you are talking about informed consent, essentially, yes.
Elizabeth Winter: Absolutely, yes, and obviously that applies to anything but particularly to this. Particularly because of the misconceptions around it. You know just because I think it’s a great idea, if my client doesn’t then we’re not doing it, it’s really simple. The obvious limitation I think for clinicians is that you don’t do hypnosis as entertainment and you don’t do it if you’re not trained, same as anything else. You really, really want to receive the appropriate training. Interestingly, training for hypnosis puts people often in a multidisciplinary kind of setting because if you go and get formal training in clinical hypnosis, you’re probably going to be… As a social worker, you’re going to be with other social workers, but you’re also going to be with physicians, with dentists, you know nosis and so on because typically those trainings are multidisciplinary. Which is actually a very very interesting you know in addition to getting the training, it’s a very interesting setting to get some learning.
Jonathan Singer: If somebody is listening to the podcast and they say ok this sounds like it would be really a useful skill for me to have as an adjunct to what I normally do in my treatment, are there other references, are there books, are there authors, are there specific places where people could go to get training that you would recommend or that you would say off the top of your head?
Elizabeth Winter: I think I would probably start with the American Society for Clinical Hypnosis, which has an excellent website and I know and also look at the Milton Erickson Foundation website. But the American Society for Clinical Hypnosis, which is fondly known as ASCH (pronounced Ash) runs a number of trainings across the country, and these are very experiential trainings. To be an ASCH approved training it has to not just have lecture content but it has to have practical, you know practical learning. So learning how to induce trance, being a recipient of that, and really is quite extensive training. There are many places that you can an online or a weekend course, or a and get a, I think you can even get a Doctorate in hypnosis, that really is not the kind of training I would recommend, I have to say. I would say start with the American Society for Clinical Hypnosis; it is one of the very few national and longstanding professional organizations for therapeutic and clinical hypnosis.
Jonathan Singer: Well Dr. Winter this has been fascinating for me and I hope for our listeners. Thank you so much for being here and talking with us today about clinical hypnosis.
[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.
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.
In this podcast, the last of four on pathological gambling, I speak with Jody Bechtold, LCSW, NCGC-II, PC about the process for becoming a nationally certified gambling addictions counselor. Jody compares the national certification process with the process to be designated as "competent" to treat pathological gambling in the state of Pennsylvania. If you are interested in becoming nationally certified, you might want to listen to the podcast a couple of times, as there are a number of steps in the process.
June, 2012: Journal of Social Work Education publishes Jody's article on graduate education and gambling:
Engel, R.J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012) Beating the odds: Preparing graduates to address gambling-related problems. Journal of Social Work Education, 48, 321-335. doi: 10.5175/JSWE.2012.201000128.
National Testing Corporation for the NCGC exams: http://www.ptcny.com/clients/NGCCB/
The following is an example of costs associated with becoming a certified gambling counselor:
Singer, J. B. (Host). (2007, June 11). How to become a nationally certified gambling addictions counselor [Episode 20]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/06/how-to-become-nationally-certified.html
In today's podcast, the third of four on pathological gambling, Jody Bechtold, LCSW, NCGC, PC talks about two concepts that are central to understanding the thinking of the pathological gambler: Illusions of Control and Chance vs. Skill.
June, 2012: Journal of Social Work Education publishes Jody's article on graduate education and gambling:
Engel, R.J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012) Beating the odds: Preparing graduates to address gambling-related problems. Journal of Social Work Education, 48, 321-335. doi: 10.5175/JSWE.2012.201000128.
References
Benhsain, K, Taillefer, A. & Ladouceur, R. (2004). Awareness of independence of events and erroneous perceptions while gambling. Addictive Behaviors, 29, 399-404.
Ladouceur, R. (2004). Perceptions among pathological and nonpathological gamblers. Addictive Behaviors, 29, 555-565.
APA (6th edition) reference for this podcast: Singer, J. B. (Host). (2007, June 5). Thinking like a pathological gambler: Illusions of control and chance vs. skill. [Episode 19]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/06/thinking-like-pathological-gambler.html
Today's podcast is the second in our four-part series on pathological gambling. I talk with Jody Bechtold, LCSW, NCGC-II, PC about treatment basics for clinicians who work with pathological gamblers. We'll start with a quick overview of crisis intervention and then move into some of the assumptions and techniques of the treatments with the most empirical support in the treatment of pathological gamblers - behavior and cognitive therapy. We end with a brief overview of some challenges that can arise during the treatment of pathological gambling.
This interview targets practicing clinicians or students in clinical courses. If you are not familiar with the approaches discussed in this podcast, you can find more general overviews of crisis intervention, behavior therapy and cognitive-behavioral therapy on the Social Work Podcast website. Disclaimer - this podcast is intended to be a general overview of treatment approaches, rather than a clinical training. If you are currently working with, or intend to work with people with gambling addiction, proper education and training is essential. In the fourth part of this series, Jody and I talk about some of the requirements for obtaining the NCGC-1 - the national certified gambling counselor certification.
Download MP3 [27:00] This series on pathological gambling includes the following podcasts:
June, 2012: Journal of Social Work Education publishes Jody's article on graduate education and gambling:
Engel, R.J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012) Beating the odds: Preparing graduates to address gambling-related problems. Journal of Social Work Education, 48, 321-335. doi: 10.5175/JSWE.2012.201000128.
Singer, J. B. (Host). (2007, May 28). Treatment of pathological gambling [Episode 18]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/05/treatment-of-pathological-gambling.html
