Ted Benton, MED, ACH, CI, Staff Hypnotherapist,
Winchester Hospital, Winchester, MA 01890
It has long been established that the use of hypnosis/hypnotherapy is effective in the treatment of pain. Hilgard & Hilgard, (1975) have demonstrated the analgesic effects of hypnotic suggestion are indeed very powerful in the treatment of pain. Common sense tells us never to begin pain-work with a patient without written permission from his/her doctor. Hypnotherapy in this situation is always a multi-model approach (psychotherapy, the use of medications, etc. ) As a hypnotherapist you will find that working with chronic pain patients will be one of your greatest challenges, but one that will be very rewarding too.
Great empathy is needed with these patients. Rapport building is critical to your success. If you are judgmental you will almost always loose the patient early on! Remember the chronic pain patient experiences the pain emotionally and physically. The pain is not in “their head”, so to speak. It is very real to them. You need to have the ability to enter their world, to share their pain. Why is rapport building so difficult? Place yourself in their shoes! Many of these patients have been experiencing chronic pain for years; this makes them demanding and irritable, and depressed and anxious too. They have tried everything and little has been very successful. Many have even become addicted to their medications; you will have to work with this at a later point. So the key words here are profound empathy and patience on your part. It is obvious that many patients with chronic pain experience secondary gain from their conditions; do NOT begin by demonstrating this to them! They will immediately resent you and will establish, if they remain with you, very powerful negative therapeutic transference.
After the full medical and psychological intake is completed, a good place to begin is teaching self-hypnosis for deep relaxation. Very often people will ask, “what does hypnosis feel like?” And we all know that the basic feeling is deep to profound relaxation depending on the patient’s ability to do self-hypnosis. Conventional hypnotic wisdom is that the victims of trauma, physical or emotional, often go right into hypnosis as a means of self-protection. My experience here in the hospital is that most patients with chronic pain are very easily hypnotized because many have experienced so much previous trauma. I was recently working with a patient who was a medical referral from McLean Hospital in Belmont, MA whose presenting pain level was at an 8 on a scale of 1 to 10. Her response to hypnosis which included direct and indirect suggestions for relaxation, binds, visuals and metaphors was excellent. I gave the post hypnotic suggestion on a taped session for her that I would teach her a rapid method for immediate self-hypnosis. Again, her response was awesome. She left the hospital basically pain free. Deep relaxation and chronic pain cannot coexist. So, by successfully teaching and doing self-hypnosis in the first office visit the patient whit chronic pain will experience a positive possibility for treatment with hypnosis.
The following is a typical pain script in which a variety of methods and approaches are used to manage chronic pain. After the induction:
(Direct) _____________I would like you to focus mentally on the pain that has been associated with the present condition; this condition will be balanced in your favor.
(Indirect ) I am wondering, __________, how you will feel as you see these changes in pain management ?
(Indirect) I am wondering who the first person in your life will notice these new and powerful changes?
(Direct) Your unconscious mind will assist you in learning how to manage your pain. You know, __________, the conscious mind is very limited in problem solving, while your unconscious mind is limitless in this area. You are soon going to break the mental cycle involved in pain: PAIN PRODUCES NEGATIVE EMOTIONS, NEGATIVE EMOTIONS PRODUCE TENSION, AND TENSION PRODUCES MORE PAIN.
(Direct) So, ___________, in the future whenever you are aware of a negative feeling that produces tension you will simply throw up a mental stop sigh that says, “sorry, you are no longer welcome here!” This will also be true with any thoughts that can create depression or anxiety. So, ____________, the first step is to work on thought control that eliminates negative thinking. One of the Old Testament prophets is quoted as saying, “as a man thinks, so shall he be!”
(Direct) You know, __________, the imagination is one of the most powerful constructs in the human mind. Albert Einstein said, “Imagination is more important than knowledge.” and Napoleon said that “imagination rules the world!” Now, ___________, in your mind’s eye shift your attention to the hand that you write with. Focus on that hand. Visualize it in front of you. See or imagine it there. Also, ___________, see a bucket filled with ice and a small amount of water. Imagine now that you hand is in that bucket all the way up to your wrist. Your hand is beginning to become cold and numb, cold and numb from your wrist down. See, feel and imagine this! The new feeling of coldness and total numbness is intense now. With every breath that you take and every heart beat that you experience this profound numbness increases. Tune into your breathing and heartbeats! Your hand is totally numb now; you have numbed your hand out totally by using the mind and the imagination. Now, __________, in your mind’s eye remove the hand and you will imagine a small table next to you that has a towel and a thick leather glove; dry your hand and slide the glove over it to increase the numbness to where it is 100 percent effective. Pinch the hand as hard as you can; you will feel touch but no pain, no pain! You can now transfer this numbness to any area of your body where there is pain. This will last for several hours. You can reactivate this experience by listening to this tape or using self-hypnosis. Remember, ___________, what is conceived in the unconscious is made manifest in the body!
(Direct) __________, the more sensations that your unconscious mind has to produce, the more likely there other sensations are to occur. The power of the unconscious is awesome! Your unconscious mind is totally committed to your healing. It controls all of the pathways that pain must travel for you to experience it — many gates can now be opened and closed by your unconscious mind to reduce the flow of pain in your nervous system. This gate control will be an on going process. Your unconscious mind is the builder of your body and it will heal you.
(Indirect) I am again wondering how you will feel as you see these changes? They will happen, will they not ?
(Direct) __________, just relax now. All pain reacts favorably to hypnosis because your mind is more able to focus and concentrate. Every time you hear the word relax, you will go deeper into relaxation; relax, relax deeply now. Now as you relax visualize your whole body in a warm bath, totally relaxed as the warm water draws the pain from your body. See yourself in the warm tub. Relax deeply!
I will count from one to five. At the number 5 you will be wide awake and deeply relaxed:
- You are coming back fully now.
- Your mind and body are deeply relaxed.
- More and more relaxed now.
- Feeling wonderful!
- Eyes open and totally relaxed!