In keeping with modern approaches to patient care and autonomy patients are encouraged to become more involved in their own management, both by selecting their own fantasies and maintaining a two-way communication with a hypnotic practitioner. There is a trend towards natural methods, and the authoritative hypnotist is giving way to a more permissive guide, who takes the hypnotic subject through the new territory of their altered state of awareness until they are prepared to take their own initiative. The modern approach to hypnotic pain control is more individualized, the clinician attending to the special needs of the patient and preparing them for what is to come and enhancing the patient's own capacity to cope. The recent introduction of so-called indirect approaches to hypnosis has introduced more naturalistic elements to hypnotic practice and has led to claims that resistance in hypnosis can be overcome.
Studies have shown that subjects highly susceptible to hypnosis are likely to have a vivid imagination. On the other hand, having a good imagination reveals little about susceptibility to hypnosis. Bowers (1976) reached the conclusion that: 'To the extent that imagery, and fantasy, are different cognitive functions, hypnosis may be more related to imagery than fantasy.'
The display of imagery and fantasy implies the requirement of special skills and abilities of the hypnotized person. Active imagination is permitted by the hypnotist who attempts to create the most favourable situation possible for the display of the subject's abilities and talents. Reality and fantasy then coexist potentially to influence the subject in how they choose to behave. Success depends on motivation.
Organically caused pain is often amenable to hypnotically based techniques. This is so even when the subject has deeply entrenched economic and social reinforcers for wanting to perpetuate the pain situation. These may be to maximize a payout in a law suit or the person may have entered an alternative way of life as a professional pain patient, one who has adopted the permanent role of being chronically 'sick'. Psychologically based pain, usually brought on by one or other type of stress, is often the only way a particular individual is able to express his or her stress. It is much less likely therefore that hypnosis can be successfully used to treat it.
When motivated by pain, even patients not considered good hypnotic subjects may develop effective pain control . Thus, hypnotic suggestions may be most effective both with good hypnotic subjects and in those well motivated to succeed.
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