Four months later, an advanced workshop in Clinical Methods in Hypnosis and Psychotherapy: Integration and Applications is offered. The art of psychotherapy depends on the individual therapist as well as his or her individual patients. The advanced workshop as given is different from the workshops usually given in annual meetings of the National Constituent Societies of the International Society of Hypnosis. Usually an intermediate workshop is given to further one's experience with deepening techniques and using hypnosis in more complicated clinical cases, before advanced workshops in treating specific syndromes such as chronic pain, cancer, post-traumatic stress disorders, sexual problems, anxiety disorders, and dissociative identity disorders (formerly Multiple Personality Disorders) are presented. My own advanced workshop, presented here, shifts the emphasis from the problems of the patient/client to the professional development of the therapist. Let us examine what an 'ideal' advanced workshop might look like in this regard.
Creating a strong therapeutic alliance is the essential basis of successful psychotherapy. The context in which this relationship develops must be understood. The 'demand characteristics' described by Orne (1962) in the laboratory also contribute to the outcome of therapy in the clinical setting. With this in mind, I begin the first workshop session with a detailed examination of the setting of my own office: the location of the windows and doors, the arrangement of the chairs and bookshelves, and the creation of various visual lines to create a sense of comfort. It is not surprising, and in fact it was the specific requirement I had for creating my office, that each new patient would respond, when asked for the first word to come to their minds when sitting down, with 'comfortable'.
Once the context of the office is described, the personal styles of various therapists, both contemporary and historical, are discussed. While there should be no ideal style, emerging styles that are unique to each therapist should be recognized and encouraged as valuable. Finding one's voice as a therapist is a lifetime task (Bloom, 1995a,b). Selecting the 'right' patient and learning to treat the 'wrong' patient are challenges that can lead to therapist and patient growth. How to identify and strengthen the unique styles of each participant is the main task of the group's leader in collaboration with the other members of the workshop.
The next session examines the 'mind of the therapist', a concept originated by Bernauer W. Newton, PhD (personal communication, 1988). By presenting our mutual cases, we elaborate what we were thinking as the therapy unfolded and clinical choices in therapy were made. When is hypnosis utilized, what is the nature of the interventions, what are the goals of treatment, and how are the results of therapy understood and enhanced the next time? We all know that hearing audiotapes or seeing videotapes of our therapy with our patients evoke the same thoughts and words in our minds that occurred during the actual therapy—even if the therapy occurred years before. Unexpressed of course during the process of therapy, these inner deliberations can be shared in a small group setting devoted to examining the mind of the therapist. It is these inner deliberations, not solely the actual patient-therapist dialogues, that shed the most light on our work.
The third session focusses on treating the 'untreatable' patient. Difficult patients force the therapist to return to basic concepts of history, mental status, diagnosis, and treatment planning. Issues of transference and countertransference must be examined freshly and often by consultation with colleagues. I believe Carl Whitaker (1950) once said 'Every impasse is an impasse in the therapist.' Yet some patients are simply unable to summon sufficient motivation to change. Others, of course, experience symptoms derived from unknown biological disorders that resist psychological interventions. All patients benefit from a supportive therapeutic alliance which enhances ego building and coping mechanisms. Teaching self-hypnosis enables these simple goals to be accomplished in almost every case.
The next two sessions focus on using hypnosis in short-term and long-term therapy with special emphasis on problems with memory retrieval. In this advanced workshop, the participant's own case material is shared by the group and the direction of the workshop is shaped and refined by these particular interests. It is necessary to create a context of trust to facilitate this sharing, and yet it still remains difficult to encourage these presentations and thereby exposure of the participant's case material. This problem rests both in the persisting hesitancy to use hypnosis in clinical practice, and in discomfort in reviewing publicly one's basic psychotherapy skills. The leader must set the example by presenting his or her own difficult patients and the process of dealing with them (Bloom, in press). He or she must also be aware that the group will readily allow the allotted time to pass in this way without presenting their own cases. Occasionally an eager participant will monopolize all the time, again allowing other members the opportunity to remain silent. Experience in group dynamics and a clear understanding of the educational goals of the workshop helps the leader to navigate these seemingly conflicting agendas. These are the challenges and rewards of good adult education.
The sixth and seventh sessions go to the heart of the advanced workshop. In all creative therapy, true art occurs when science is fused with intuition (Bloom, 1990). Learning to rely on one's intuition or hunches takes time and willingness to trust oneself. Weaving these insights into the fabric of an individual's psychotherapy often advances the process of therapy in useful ways. When participants become more comfortable in finding responsible freedom to be creative in their work, they begin to find their style or 'voice' in their work. This path of learning leads to the knowledge that they are healers: it is the art and process of becoming a therapist. In learning hypnosis and psychotherapy, each workshop member is rewarded for examining his or her success and failures. However, while expanding our flexibility to treat a wider array of individuals, it is also important to learn who not to treat. Some patients unduly demand time, energy, and effort that far exceeds our capacity to give. If our creative energies are depleted, we must refer these patients to colleagues more able to treat them.
No advanced workshop is complete without a review of current research findings and the relationship to clinical practice. Areas of mutual interest to the researcher and clinician include pain management in chronic illness, sickle cell anemia (Dinges, Whitehouse, Orne, Bloom, P.B. et al., 1997), and cancer. Also teaching self-hypnosis in patients who are dying can be a life-extending intervention (Spiegel, Bloom, J.R., Kraemer & Gottheil, 1989). Self-hypnosis techniques enhance self-control, increase coping, and increase freedom from discomfort in these patients. In establishing the therapeutic alliance with dying patients, a rich experience for both the patient and the clinician is created for the benefit of both.
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HYPNOTISM is by no means a new art. True, it has been developed into a science in comparatively recent years. But the principles of thought control have been used for thousands of years in India, ancient Egypt, among the Persians, Chinese and in many other ancient lands. Miracles of healing by the spoken word and laying on of hands are recorded in many early writings.