Sunday, January 1, 2012

Eclectic Therapy -2) Hypnotherapy

I am indeed an "Eclectic Therapist' simply because of all the training and experience in a variety of psychotherapies I've formally and informally learned and applied.  Maybe if I was ever really a great therapist I'd not have to continue learning as I've had  all these years. The fact is I'm fascinated by the human mind and behaviour and the more I actually learn the more I realize how little I actually know.
Having already learned "Counselling" and "Supportive Psychotherapy"  I next learned Hypnotherapy.  I was working as a country general practitioner in southern Manitoba at the time.  I was doing deliveries every couple of weeks and doing minor surgery. I had already learned how to anesthetize every part of the body with a long needle.  The one time I was forced by an emergency to do a high forceps delivery I was very thankful for this knowledge. Otherwise I'd have had to do a caesarian section with spinal block. I hadn't done a spinal block myself though witnessed enough. I'd done countless spinal taps and the block isn't that much more technically difficult, just potentially more lethal.  Anesthetists aren't well appreciated by the public but they are the unsung heros of surgery and obstetrics.  I have thanked my lucky stars many times when I've had the benefit of an anesthetist present.
Despite my basic surgical training and training in intensive care medicine I was  frankly often alone and scared in the backwoods. If I had a competent nurse things were much better. I have the greatest respect and love for some of the old battle axes that helped me in those early years.  In contrast I've had nurses green or incompetent nurses screaming at the sight of blood or fainting in the emergency room. I even had to ask one nurse to leave in a delivery because her fear of childbirth was getting the patient all worked up. When she and her 'textbook knowledge' left this lovely country woman delivered easily a rather big boy.
It was in this context that I learned about hyposis as a therapy for doing medical and dental procedures. I thought that as I was often doing home visits and working in places without an anaesthetist including the country hospital where I was principally located, this 'skill' could be very beneficial.  The Amercan Society of Hypnosis had a 2 level training program taking a matters of weeks to obtain. I read extensively and took the time off work to attend the hands on training workshop and attend the examinations. When I finally got my certification I was amused that I could use the acronym CASH after my name as I truly had obtained a Certificate of the American Society of Hypnosis.  Unfortunately hypnosis never made me any money but it certainly was an eye opener.
ndeed I think all my colleagues should be required to observe surgery done under hypnosis.  It's one thing to know that 90% of pain is processed mentally and another thing to witness something so revolutionary as to see a person being cut open without even local anesthesia.  The fact is I went on to do it when I got back to my practice, electively.  I cut out moles and warts using hypnosis and had a marvellous old time for a while until I found that just using xylocaine 1% took a tenth of the time and was more certain.  It had cost me roughly $10,000 in training and loss of income and then this further experience to have a skill which really was never compensated by the health care system despite it's proven benefit. Nonetheless it sure was fun. Talk about feeling like a wizard.  Gandolf Doctor Hay!
I'd become a certified yogi too with years of formal training, papers from a highly recognised International and American Institution, and even later a trip to India where I studied advanced meditation.  I've even a childhood friend Kirk who I thought at one time had overdosed on yoga and definitely must be a saint. Despite the scientific double blind evidence of the benefits of meditation therapy (see Herbert Benson MD and Relaxation Therapy) and today (Mindfulness Therapy) that too was never compensated or paid for. Another $20,000 to $30,000 training and experience which was never 'supported' by the institutions despite the overwhelming 'evidence' scientifically and otherwise of healing benefit.
I mention this because I can't get over patients expecting doctors to 'learn' alternative therapies and keep up with latest developments in medicine when to do so we have to put out the time and money ourselves and very little except the narrowest areas of study are supported financially.  The cost of all the alternative practitioners even the phd's is minute compared to the expenses we accept to be healers in the modern sense. The richest, most powerful and hence most influential physicians do their basic training and then the minimal level of training to keep up with their 'niche'.  Relatively, I made the most money I ever made as a country gp and lost all my income to do advanced specialist training and never have been compensated for the training or the skills. Indeed I've not even been able to use a third to a half of my most advanced training because there is no support network for the training 25 years later despite the evidence supporting those therapies.  I trained as a psychiatrist with the promise of having hospital beds for the elective admission of patients for therapeutic treatments.  Even when I was a member of a hospital all I was ever able to admit were emergency suicidal or psychotic patietns because of lack of resources.  I'm not alone. Many of my surgical colleagues are trained in advanced surgical approaches but can't get operating room time becasue of the politics of hospitals and most importantly so much of what is proven scientifically and advanced is simply not funded.
Many of my finest colleagues have left the so called 'mainstream' and moved into private areas, some have even left medicine altogether ,to go completely private.  Most of those I knew who went to the US didn't go for money alone but rather they went so they could do procedures which required MRI's.  Canadians simplyt don't know that while Canada was at the height of world medicine 20 years ago Canadians limitted to the public care system are often getting only third world medicine.  Europeans and sometimes even Cubans are appalled by how limited our health care system is. The amount of administration and regulation that has arisen in the last 20 years is eating away all of what was once 'medical' care and now has become 'health' care.  Millions of dollars in 'advertising' are called 'health care' funding and people don't realize that. .
But I was talking about Hypnotherapy.Ooops!
Milton Erickson, MD is the psychiatrist who is the father of hypnotherapy.  He was a midwest American. He said Freud was wrong about the ID.  Jung had said Freud was afraid of the  Id and the 'irrational' as well.  It might have had something to do with Freud's  relationship his wife's sister and the experience of genital mutilation as a child.  Maybe it was just the residual effects of his cocaine abuse.  That said, Freud is still to my mind, perhaps the world's greatest psychotherapist and certainly to psychiatry what Einstein was to Physics.  He was a true adventurer.  I accept that I stand on the shoulders of those who went before and with the knowledge they gave us we can advance but we'd not be where we are were it not for them.  I sail and I see this in navigation and maps without having to listen to the petty political criticism of Columbus mistaking North America for India. If Columbus were a psychologist, boy would he be pilloried today for that. Freud unfortunately went astray when politically he got into the business of empire building.  That said, I save 'reverence' for God and tend to irreverence with myself and my  fellows, a fault that no end of therapy has been unable to eradicate. I can't help but think that Jung and Erickson would have enjoyed Monty Python and Seinfeld more than Freud despite Freud's intellectual support of laughter.  Now Anna Freud on the other hand would have loved even George Castansa and the Canadian Air Farce.
Milton Erickson said that it was the 'unconscious processes' that caused us to 'automatically' protect ourselves when we fell.  We didn't think about putting up our arms to 'block a blow'.  Milton Erickson believed in the 'child' within and felt that we had to 'free' the natural healing process of the human.  Jay Haley wrote the classic "Uncommon Therapy' describing best the work with Milton Erickson.  Though I was fortunate to know and train with Jay Haley and his wife Bianca Jenks I missed meeting Milton Erickson by a year or two when I began training in hypnosis and later in Structural and Strategic Family Therapy and Strategic Therapies in general. I even studied with the original Palo Alto group whose research gave rise to the mind body therapies that produced EMDR for instance.  "Mind Body Therapy" and other "Psychosomatic' therapies were foundational to hypnotherapy.
"Frogs into Princes' by Grinder and Bandler is a marvellous text teaching the basics of inducing a trance. These students of Milton Erickson went on to develop Neurolinguistic Programming which makes alot of Erickson's work more accessible to the lay public.   Milton Erickson was famous for saying everyone could be hypnotised. What he didn't say is that some took seconds to minutes while others could take hours to days.
I feel terribly guilty for not remembering the name of my original hypnosis teacher. He was the most extraordinary doctor whose job it was to hypnotize people for major elective surgery who were allergic to anethesia.  He told amazing stories about hypnotizing people for heart surgery and lung surgery.  Despite having learned and done extensive work using local anesthesia I was still impressed when I met a Russian doctor who'd removed a lung in the Urals because he had no anesthesetist.  This doctor who taught me hypnosis and wrote a classic book about his work   trumped us all.  I witnessed him hypnotise people stick them with needles and their showing no physical or psychological changes.   Having learned hypnosis from him I too went home and cut people under hypnosis was amazed.
Thanks to hypnosis and yoga I even learned the party trick of slowing my heart to where medical students couldn't feel it beating.  Those were halcyon days for learning about the mind and body in the early years of training before learning that the 'powers that be' were simply not interested in anything that was not 'orthodox'. Indeed the medical legal crisis was such that doctors who tried anything new were at the greatest risk for being punished royally. Adding lawyers and administrators to the healing equation guarateed mediocrity would reign.  That said, there have been major gains for all in the development of ethical research policies and advances again can be made but usually only by committee and with large financial funding.  It didn't surprise me to hear of a recent potential cure of cancer going unnoticed in Alberta because there was no likely profit from the development.  Business medicine reigns and with it comes pros and cons.
There are many ways to induce a trance. Later I'd even use amytal to do amytal interviews, injecting what has been called 'truth serum' into the veins of patients and then doing interviews and hypnotherapy with them. Most people who belittle pharmacology do so because they haven't learned it themselves, can't do it and don't have a license to do it.  It's called "cutting the heads off others to make yourself taller."  The "holistic' doctors often would be left with nothing to say if all their criticism of traditional medicine was removed from their repetoire.  And here I'm doing the same.
So hypnosis doesn't require pharmacology.  Hypnosis is done by joining with a person at their unconscious level using ritual and repetition.  It's really easy with children.  I ask a person to stare at something and this wil cause their eyes to tire and their eye lids to droop.  It's classic.  So I begin by using that 'tarot talk' , 'hypnotherapy' ' "mesmer voice' low and slow saying "I am observing you breathing, you are breathing in and out, your eye lids are fluttering and growing tired, you are breathing more slowly now, your eyes are drooping and as I count backwards from 10 to 1 your breathing will grow slower your eyes more tired and you will enter deeper and deeper into a relaxing calming pleasant thoroughly satisfied trance like state where you will be able to hear my voice and respond to my requests or commands but you may not remember anything that we say and do thereafter, I'm beginning now as I observe you breathing in and out, in and out, your eyes more and more tired, 10, 9, you are going deeper and deeper into that semiconscious realm, 8, deeper down deeper into the trance, where you will hear me and we will be able to communicate but your body will be so relaxed that you won't be able to move without my voice helping you 7, deeper now, your breathing in and......out, and out....6, you are getting sleepy but not like sleep going into that twilight state, where you can hear me and respond to me but only as I ask you to where you won't remember what we have said because we will be so tired, 6 5 4 3 2 are hypnotised now and your eyes are closed but your are able to hear me, can you hear me ....etc.

This 'induction of trance' is done in a whole variety of ways. It's used in marketting and advertising and commonly most adults aren't even aware when they are being manipulated and hypnotised.  Everyone should read 1984 and the Animal Farm.  These are dangerous times.  Especially with corporations like Abercrombie and Fitch marketting padded bikinis bras to baby girls.
That said any party animal should be able to hypnotise his friends to be clowns at a party.  What separates the professionals from the amateurs is if the patient lets you cut them open with a knife or tells you in horrifying detail about some memory that is frankly unbecoming and surprising.
The trouble with hypnotherapy is that alot of what one can learn using techniques such as reqression of a patient back through the ages is that for the benefit to be gained this 'unconscious' material must be 'learned' in the conscious.
Freud was probably one of the world's greatest hypnotists and hypnotherapists. His development of the technique of 'free association' and use of a couch was indeed a means of establishing a' partial trance' that faciltated the development of 'insight'.
Many is the time that I learned things about paitent's pasts in hypnotherapy but it did no good for the patient until they were subsequently 'ready' to 'learn' and 'accept' the material.
As every psychoanalyst and every psychoanalytic psychotherapist knows it's all albout the 'timing'.  Of course I know I want to go back in the womb and I want to be on another planet but telling me this is of little value and importance than if you tell me at exactly the right time I need to hear it.
Zen teachers call that the 'aha' moment and frankly amateurs are 'impatient'. I was lucky to have surgical training prior to psychotherapy training because I'd already learned to wait for an abscess to be ripe before cutting it or squeezing it.
Hypnotherapy is also all about association.  Being a poet before  learned hypnotherapy I found it easy to use allegory and metaphors in my work with patients. This allowed me to bring patients to get around 'blocks' without having to address them directly.  A famous Erickson metaphor was when he talked to a woman about growing tomatoes and her fear of sex left her. He never mentioned sex but he did talk about stroking ripe red tomatoes and the tall green stalk.
I don't think I could do hypnotherapy in another culture or as a second language.  Maybe if I was Joseph Conrad I could do hypnotherapy with English speaking people but despite my little knowledge of spanish and french I simply can't imagine doing hypnotherapy outside of my primary language of English and my culture.. I certainly couldn't see myself doing it with a translator. I've not tried but it seems foreign.
I did hypnotherapy extensively for anxiety disorders and mood disorders. Ironically people would want me to do it for quitting smoking and I'd not see it as that effective in that regard. But then in addiction psychaitry I wasn't doing forrmal hypnosis and hypnotherapy.
What I found was that I had to have a therapeutic setting for doing psychoanayltic psychotherapy and especially hypnotherapy.  It's been over a decade since I've had a practice in which I can guarantee that my sessions won't be interrupted by an emergency or in which I can guarantee silence in the room. Indeed most male psychiatrists and female psychiatrists as part of the organized destruction of the therapeutic process hardly feel safe with their door closed. Most doctors would like a lawyer in their office for all patients. And most doctors simply won't discuss sex or ask about sexual matters because of the risk of false accusation, or as is more often the case down right 'extortion'.
More pateints also have a 'secondary gain' issue when they see the doctor in a public setting. Their insurance company needs a report and often my role is 'illness recorder'.  In the mental health teams the psychiatrist is often told they're only there to prescribe and indeed if a psychiatrist does anything more than prescribe he or she will make less money.  I am paid most for recording illness and I can face severe penalties if I 'confront' a patient.  Indeed whereas 'confronting' illness was what we were trained to do in medicine, telling a person they have cancer, I found increasingly I was told that patients shouldn't be told anything they don't want to hear or they can 'sue' you.  We used to mock 'feelgood' medicine likening the valium prescriber and hand holding counsellor to the pusher and masseuse.  Now here we are terribly afraid of saying anything that might upset a patient for fear they might complain. Family physicians actually sometimes refer patients to me rather than tell them an unsavoury diagnosis for fear of retaliation.
I heard one doctor afraid of telling his patient he had cancer because he was afraid this very 'litiginous' patient would blame them.  The stress that doctors work under just going to work and making diagnosis is such that many colleagues have taken to calling everything 'bipolar II" because it's a diagnosis which actually has no clear specificity and if anyone doubts it the doctor can say its because the patient 'rapidly cycled'.  Epidemiologically there's been epidemics of 'bipolar II " diagnosis breaking out everywhere without the World Health Organization even investigating it. It's terribly infectious to say the least.  The most cowardly of doctors and lowest of doctors flee the frontlines of patient contact and hide in administrative office or worse police doctors acting out their own unresolved 'identification with the aggressors'.
The only treatment I've read for Bipolar II is pharmacalogical.
A pharmacalogical psychiatrist can see 6 to 10 patients in an hour billing for visits every 5 to 10 minutes whereas a hypnotherapist takes usually an hour and a half.  The provincial plans pay at most for 50 minutes of therapy wiht any one patient but will pay ad infinitum for 5 minute visits weekly ad infinitum. The richest most relaxed and satisfied of pscyhiatrists are the pharmacological psychiatrists.  Their frequent trips to Hawaii  providing by drug companies revive them.
Psychotherapists don't make anyone any money and the payment for psychotherapy is the least that a doctor can receive despite the fact that psychoanylitic pscyhotherapy and hypnotherapies and couple and family therapies are the most intensive of work.
So I don't do much hypnotherapy.  As I've got older I've learned that I'm stupider than alot of my colleagues. Rather than criticize them for doing those things that are remunerated I've come to realize that the 'market system' repays those things that people want.  I get great satisfaction personally from alot of the successes that I've had as a result of my training and the exdellent teachers I've had. I use the lessons of  hypnotherapy in my day to day language and in the way I talk to patients and do therapy itself.
One of my favourite hypnotherapy techniques is to 'seed' conversations and by 'story telling'.  I talk about 'irrelevant' matters and 'seed' this material with whatever it is I'm 'selling " the patient.  So I may talk about my dog and comment on how the young are constantly exercising. It's no surprise that all my obese patients have heard these stories but none of my athletic patients would hear about my dogs constant exercise.  I tell a story about a patient who recoverd from cancer giving up smoking and indirectly I'm telling my patient who I've already told to stop smoking because of her cancer, to stop smoking in another way.  I never do 'nocebos'. I never undermine a person's work on their wellness or suggest they can't.
I've dozens of students in my practice whose grades have gone any where from failing to passing or from c's to A's and I take that as evidence of the effectiveness of therapy.  Naturally I have all manner of psychiatric disorders improve or get better but take even more pleasure in seein my patients with somatic illnesses and addictions get better because these have more obvious 'markers' for the success of the interventions I'm using.  Some of my patients are just living a lot longer than their doctors predicted and I like that too. I actually take great pleasure in my patients getting better and leaving practice where I had a locally famous pharmacological psychiatrist say his patients never got better and always had to see him. He didn't see any irony in this because frankly he's a fairly stupid rich thug and gives pharmacalogical psychiatry a bad name by his barbarianism.
These days I enjoy working with addicts and take every success to heart because the life expectance of a downtown eastside addict is maybe 30 years of age or so.  I love seeing alcoholics and addicts achieve sobriety or needle users get off needles.
Alot of my work with somatic illness is to get patients otherwise dying to adhere to their medical regimen. I work with some of the finest endocrinologists, cardiologists, neurologists, gastorenterologists and internists who every once in a while phone me and tell me that they realize that their patient is alive and following medical regimen since seeing me and that before that they didn't think they were going to live out the year. I am blessed to work with some of the finest of family physicians as well and so often together with a motley team of community resources manage the most difficult of patients watching them go from the dregs of life to whatever passes for normal living.
I had alot of fun working with a pediatric endocrinologist getting teen agers to accept their diabetes and take their insulin. She was great to work with and together we had tremendous succes with this really tough crowd.  Overdoses and diabetic catastrophes literally stopped the year we worked together.
Trauma interests me now. When I worked with the military and police what  I learned in hypnotherapy helped me walk people through the trauma that had given rise to often chronic ptsd.  It's one thing to remember but remembering can re traumatize. So how one does this is really tricky and I enjoyed honing my skills with these amazing heros of our society.  I loved having them tell me their nightmares were gone but mostly I had a great deal of fun working with a military captain and his secretary who truly loved the vets who had been in the front lines. Often these were the ones who were most stoic and least likely to talk about their experinces. This beautiful captain doctor would send these amazing men to me and over time they'd tell me stories that I was truly priviledged to hear, often stories that had never been told.  Not only would Veteran Affairs be able to help these individuals then but also we could get psychologists trained specifically in the treatment of ptds to help these folk regain their lost lives.
Oh well, that's about all I'm going to say about hypnotherapy.  I did regress a guy in hypnotherapy once by saying "I want you to go back to when you were happy' and he told me he was surrounded by blue and felt warm and there was this loud comforting drum beating.  He was back in the womb.  He had chronic depression and never had a happy day in his life as far as I could see so my task went from restoring a sick man to health to teaching a blind man to see. All the failed therapies he'd had hadn't taken into acount that he simply had nothing to build on.  Hypnotherapy certainly helped him.  His telling me he actually felt what he understood to be happy one day, really did make my day.

No comments: