In trance, it is much easier to exert the minimal effort of finger signals than to do head shaking, but either will work.
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97. Direct Suggestion in Hypnosis
(DSIH) and hypnoanalysis
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Direct Suggestion in Hypnosis (DSIH) and hypnoanalysis are as different as night and day. We teach DSIH in our basic workshops and have large books of scripts to use for different situations. Hypnotizability is a major issue in success with this technique, and in my experience it gets little better than a placebo response, maybe 50 percent (only 20 to 40 percent for smoking cessation). DSIH is better than a placebo because it seals an idea, and doesn’t wear off like a placebo.
Hypnoanalysis, using ideomotor signals, gets closer to 80 percent results and hypnotizability is not an issue. It can be done in the waking state with a pendulum. It is insight therapy and identifies the dystonic idea, allowing replacement (reframing) with a syntonic idea. When a hurtful idea has been changed to a healthy one, a long term cure is accomplished.
I would rather treat a low hypnotizable patient by hypnoanalysis than a high by DSIH. Graham and Evans’ research (1977) shows that highs treated with DSIH relapse more frequently than lows.
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98. Closed eye roll induction
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The Hypnotic Induction Profile (HIP) is a rapid test of hypnotizability, and it includes an open eye roll. Many clinicians use it as an initial induction to assess what kind of response they are likely to get using direct suggestions.
I have found that when a patient has a low score on the eye roll it lowers my expectation of success, it dampens my enthusiasm, and it hurts our rapport. So I decided that I don’t want to know a patient’s hypnotizability before starting treatment – it can always be tested later since it is a stable trait.
I have my patient close his/her eyelids first, then roll the eyeballs up and take a deep breath (my usual induction), avoiding a readable eye roll sign. Since hypnotizability is not an issue when using my preferred technique of hypnoanalysis (Things 96 and 97), I believe that my clinical outcomes have been enhanced rather than diminished by not testing initially.
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99. I want to talk
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When doing hypnoanalysis with ideomotor signals, an important signal to set up is “If something crosses your mind that you want to tell me, or you want to ask a question, just raise your hand (extend patient’s wrist) and we’ll talk.”
A patient will not ordinarily initiate speech while in trance (Thing 57), but has no problem with a motor signal. Much significant free association goes on during trance, and the time to access it is while it is occurring, not at debriefing. In fact, much of it is lost once the patient is alerted and back into left brain processing.
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100. Spirituality
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Spirituality is very different from religiosity. One does not need to belong to any organized denomination or sect to wonder about the meaning of one’s own life. It is psychologically depressing to lead a meaningless life, and many of my depressed patients have lost track of the idea that all of our Creator’s children are precious, even though none are perfect (Thing 14). We are responsible for making our own lives meaningful, useful, and joyful, and when a patient feels his life is meaningless, I consider it a spiritual problem.
Nobody goes to the doctor to get his religion changed, and I don’t preach to my patients, but just saying that my perception is that the patient has a spiritual problem seems to open doors and cause a different kind of introspection that is often productive. Rather than the Bible, a quote from the Declaration of Independence is a good starting point: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are the right to life, liberty, and the pursuit of happiness.”
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101. Post-Concussion Syndrome
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Post-Concussion Syndrome is worth mentioning because in my experience it is most often the result of poor communication and error in diagnosis, and therefore of iatrogenic (physician generated) origin. Anatomically, the cerebrum is the brain, and a true cerebral concussion is a temporary physiological (not neurological and no MRI abnormality) dysfunction of the brain, followed by full recovery (as occurs when the leg “falls asleep” during a movie). It includes being unconscious and losing short term memory of the accident. This differs from a cerebral contusion which causes clear injury to the brain, with neurological and MRI changes, and may have long term consequences.
Pliny the Elder said “He who saw the lightning and heard the thunder is not the one who was struck.” So when a patient who had a blow to the scalp (remember the brain is protected by a bony skull) tells me all the details of the accident, I know he wasn’t brain injured even if he believes he was momentarily unconscious. The correct diagnosis is a scalp contusion, and that’s like a contusion to the arm, leg, or any other part of the body that happens in any football game. The scalp is sore for a while, and gets well.
The word “concussion” has meaning to lay persons very different from what I have written above. When a doctor tells a patient he had a concussion, without pointing out that his neurological exam is perfectly normal and his prognosis is excellent (whether he thinks he was unconscious or not), a bag of worms is opened up. He goes home and tells his wife that the doctor said he had a concussion, she tells her friends, there are questions about any headaches or behavior changes (nocebos, Thing 54), and so on, and when the doctor sees the patient next week he’s full of subjective symptoms that are not explainable on a physical basis, and disability may have set in already. There are exceptions to this, but in head injuries we must be particularly careful what we say.
Mittenberg et al. (1992) showed that “Imaginary concussion reliably showed expectations in controls of a coherent cluster of symptoms virtually identical to the post-concussion syndrome reported by patients with head trauma.”
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Praise for
101 things I wish I’d known
when I started using hypnosis
I have often described the remarkable Dr. Dabney Ewin as “a treasure”. Now in 101 Things I Wish I’d Known When I Started Using Hypnosis, he has given the hypnosis world a treasure chest full of the gems and pearls he has polished in his 40 years of practicing medical hypnosis. Dr. Ewin describes hypnosis as “an empathetic involvement with another and as we interact with our patients/clients we evolve in our tone of voice, choice of words, what we emphasize, and our timing”. This cogent, concise resource is a gift of shared wisdom from an evolved master to assist the next generations of clinicians in mastering the art of hypnosis. “101 Things” helps the novice as well as the accomplished clinician learn what to say, when to say it and how to say it. Dr. Ewin often remarks that “we are all created precious” and this little gem certainly is precious.
Linda Thomson, PhD, APRN, ABMH
In general conversation, Dabney M. Ewin, M.D., is a congenial, meticulously courteous Southern gentleman, a pleasant and unfailingly interesting companion. However, when conversation turns to the clinical use of hypnosis, without Dabney’s manifesting any apparent change in his appearance, behavior or demeanor, one’s experience of Dabney undergoes a metamorphosis. One rapidly appreciates that he or she is in the presence of an unusual and gifted clinician, for whom the term “therapeutic genius” is a pallid understatement. In fact, the more knowledgeable one is about hypnosis, the more easy it is to appreciate that Dabney Ewin is so skilled that he stands as an almost mythical figure in the world of hypnosis, conjuring up associations to Merlin, Gandalf, Yoda, and, more recently, Albus Dumbledore. As my experience grows in depth and in breadth, I continue to find in Dabney an inexhaustible fund of skill and wisdom. A few years ago my son was burned in an accident. I was given an upsetting estimate of his injuries. As I drove to the hospital I utilized some of Dabney’s techniques over the telephone. When I arrived, the physician attending to my son apologized for having overestimating the severity of the burn wounds! My son healed without either scars or disfigurement, thanks to a skill I had learned from Dabney Ewin. In 101 Things I Wish I’d Known When I Started Using Hypnosis, the reader encounters Dabney Ewin reflecting on many topics and offering insights into what he has learned along the way in his distinguished career. 101 Things… is a pathway into the experience of learning from Dabney Ewin. This is a book to read slowly and reflect upon, observation after observation. It will not serve as a textbook or a “good read.” For those readers who have had the pleasure of knowing and/or learning from Dabney, it offers a chance to review and reflect, with many a smile, on the many (and still-evolving) facets of his approach to helping the hurt, the ill, and the suffering. For those readers who have not yet had the good fortune to know and learn from Dabney, I am confident that this introduction to him and his approaches will incline many of them to make their way to his workshops.
Richard P. Kluft, MD, PhD, President, Society for Clinical and Experimental Hypnosis,
Past President, American Society of Clinical Hypnosis
The first thing that struck me about this book was the title–101 things I wish I’d known when I started using hypnosis. As a seasoned practitioner and teacher of hypnotherapy I asked myself ‘how needed is a snapshot of an experienced and respected practitioner’s innermost thoughts and feelings into his work with clients?’. The answer was ‘desperately’!
On further reading, his initial explanation of the idiosyncrasies of our definitions of what
our clients need to be ‘doing’ both excited me and called into mind the term ‘Thank you!’. What a relief to see an author make what may be a commonsense differential statement between words such as ‘stop’ and ‘quit’, which at first sight may not mean much when working with clients, until you realise that they may understand the power of language, but on many occasions do not resonate with its importance for them.
This insightful exploration into the complexities of language continues into much sought after areas of knowledge that both practitioners and clients desire, including working with pain and many other common complaints.
This is a short book, but do not let that mislead you as to its importance. I am reminded of Yalom’s Gift of Therapy, when I say that some ‘short’ books are career definers. This is up there with the best of them in terms of succinct, wise, inspired insight, and I recommend it for any therapist who either needs to know more, or who needs some fire in their belly to reignite their love of therapy.
Tom Barber MA, Course Director,
Contemporary College of Therapeutic Studies
For a small book it carries a big punch!
This is definitely a ‘must have’ for anyone who uses hypnosis in their work or in their practice. For therapists, doctors, social workers, teachers and nurses - it has something for everyone, no matter how experienced you may be.
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