This new exposition of hypnosis changes the way we think about patient selection. No longer is it simply a matter of the doctor selecting what is best for the patient. This change in how we think about hypnosis, in combination with our increasing understanding of the interactive nature of the treatment process and the relational aspects (Miller, 1986; Surrey, 1984) of the 'doctor-patient' partnership alters the lens through which we view the suitability of hypnosis for clients.
In fact, patients are far more apt to present in our offices requesting an hypnotic intervention. We might then think of clients as falling into several categories. There is that group of clients who present with symptoms that are particularly amenable to an hypnotic intervention. Areas of increased use of hypnosis include stress reduction, pain management/wellness, and uncovering work in a psychodynamic relationship. Many of these clients are sophisticated in their knowledge of alternative health benefits and ask for information on hypnosis, while others are aware of the benefits of stress reduction techniques such as relaxation exercises, meditation and guided imagery, but are uninformed about their similarity to hypnosis. Still others are uninformed about hypnosis and ignorant of its application to their problem. Those who are actively resistant to the idea of hypnosis pose a particular challenge to clinicians. Resistance may come from several sources. Religious and cultural beliefs may influence a client's willingness to consider hypnosis (Marcum, 1994). Fear of the proposed procedure (of the unknown) may render a client resistant, as well as fear of the clinician relationship (of a lack of safety).
Another group of clients seem to use the request for hypnosis as a way to get their proverbial foot into the therapist's door. They often request help with a discrete problem, such as the cessation of a smoking habit or the need to lose weight. Evaluation of the full clinical picture often reveals no conscious wish for help with the presenting problem, but rather help with an entirely different concern. The importance of the diagnostic skills of the practitioner is highlighted in these instances, rather than the hypnotic skills. The practitioner may be able to do a very credible job assisting the client with the 'presenting problem' but miss the underlying problems which the client may be unable to voice or explain.
Therefore when we conceptualize the process of introducing hypnosis to a patient population, we are reminded that patients are partners in their treatment and either partner may initiate the discussion about the suitability of hypnosis for the presenting problem. It follows from this relational perspective that both the client and the therapist variables are operative in the success of hypnotic application (Rhue, Lynn & Kirsch, 1993). However, 'patient acceptance of the hypnotic relationship is the primary determinant of the appropriateness of the patient for hypnosis' (Murray-Jobsis, 1993, p. 430).
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