Clinical and Health Affairs
Healing from Loss
Using Clinical Hypnosis to Help Navigate the Way
By Kelly Grosklags, M.S.W., LICSW, BCD
Abstract
Clinical hypnosis is a technique for helping patients achieve an altered state of consciousness and is similar to guided imagery and other relaxation and focusing techniques. Clinicians can use it to help patients face powerful emotions such as those evoked during grief. This article describes the way clinical hypnosis can be used to help bereaved patients understand and gain control over their feelings.
Helen (the name of the patient has been changed) is a 52-year-old woman who was referred to me for counseling related to her grief. Her husband of 25 years had been diagnosed with metastatic lung cancer only 3 months prior to his death. Helen was experiencing panic attacks and an increase in chronic pain. As her husband’s death became imminent, she reported that she “completely lost it.”
Helen’s husband had died only 4 weeks prior to my first appointment with her. In her acute state of grief, she was experiencing extreme loneliness, guilt, insomnia, frequent panic attacks, and a marked decrease in appetite. She had been taking 0.5 mg of Xanax 3 times a day, which was prescribed by her family physician. But she reported that it wasn’t alleviating her panic symptoms. Helen found little joy in most activities and felt no hope for the future. She was desperate for relief from her intense guilt, as she strongly believed she could have prevented her husband’s death by taking him to the emergency room (ER) sooner. Her large network of friends and extended family expressed concern for her safety. Their concerns prompted her husband’s oncologist to refer her to me for help.
After seeing Helen for 3 sessions, I suggested that she try clinical hypnosis. Several years ago, Helen had used hypnosis for chronic headaches. It allowed her to achieve a state of relaxation that decreased her pain. I explained that this time, the goals were to help her relax and feel more calm and to teach her exercises to help her get through the day. Although she was skeptical that hypnosis would help alleviate her mental suffering, she agreed to try it.
Clinical Hypnosis Defined
Clinical hypnosis is best understood as a technique that leads patients to an altered state of consciousness.1 Some say it is similar to or even the same as guided imagery, intentional prayer, yoga, guided visualization, and other relaxation and focusing techniques. Others describe it as a means for putting a bothersome issue under a microscope where the patient can see it magnified.1 Although patients may become so relaxed that they slip into a brief moment of sleep, a hypnotic state is not a sleep state. It is more like the state one is in while meditating or like a quieting of the mind.2
Many researchers and practitioners agree that a hypnotic trance is actually a state of increased awareness and enhanced mental clarity. The late Ernest Hilgard, a Stanford professor of psychology who was a pioneer in the scientific study of hypnosis, believed that during hypnosis the subconscious is capable of functioning more independently than it is in a waking state.3 During a hypnotic trance, electroencephalogram shows a decrease in beta brain waves and an increase in alpha and theta brain waves—the slower waves associated with a relaxed state.1
Clinicians can use hypnosis to facilitate a gentle and productive means of moving through and understanding a set of emotions such as those that emerge during grief. It can be helpful because it allows the patient to experience peace and comfort during a time when he or she is overwhelmed by ambivalence and despair. And it can enable people to at least begin to address what they are too fearful to discuss in an alert state. By accessing the subconscious and making repeated optimistic suggestions, the therapist can also help the patient understand that healing and understanding are possible.
How Hypnosis Works
When Helen came to my office for our first hypnosis session, I had her sit in a chair I call the “hypnosis chair.” (Repeat patients often feel relaxed just sitting in the chair, as they have come to associate it with a positive feeling.) To make her comfortable, I gave her a blanket to wrap herself in and then turned on soothing music.
After initial induction, I helped her into a deeper, more relaxed trance by asking her to imagine a warm light covering her from head to toe. She began to relax one muscle at a time. This phase, called the deepening phase, can last from 5 seconds to 10 minutes. To determine whether a patient is in a trance, I look for body stillness, slower breathing, and a slight forward nod of the head.
Like many patients who are working through grief, Helen was overwhelmed with worry, fear, and guilt. At times, this made it difficult for her to concentrate on my voice. I asked her to picture her mind as a bucket overflowing with her concerns. I suggested she imagine emptying her bucket into a large container and allowing her mind to be open to thoughts of healing and comfort—an exercise Helen could use outside of our sessions as well.
Because one of Helen’s chief complaints was loneliness, I suggested she imagine all of the people who could provide her with support gathered in a circle around her, holding hands. It reminded her that she does have people in her life. I told her that when her head touches the pillow at night, she would be reminded of all the people in the circle and the love and support they have to offer her. Helen became quite successful at picturing this image on her own, which she found gave her a feeling of control and helped ease the loneliness.
During a subsequent visit, we addressed a second complaint: the guilt she was feeling. Grief is often accompanied by irrational guilt, and hypnosis can help with reframing this kind of guilt and reprogramming a person’s thinking. In Helen’s case, she felt that she could have saved her husband from dying had she taken him to the ER sooner. When she was in a trance, I asked her to imagine her husband sitting in a chair next to her and to express her regrets to him. I then asked her to listen carefully for any response from him. Later in this session, she told me that she heard this response: “I would have ignored your encouragement anyway; you know how stubborn I was about my health. After 25 years of marriage, I would hope you would have learned that I am an independent, strong-willed person who only did what I wanted.”
I “re-alerted” Helen (brought her out of the trance) by asking her to focus on and move her feet, then do the same with each body part, ending with her head. At the same time, I started speaking in a louder tone in order to help her refocus on the here and now. Tears were streaming down Helen’s face as she explained what she had heard. “How could I have possibly forgotten that he never listened to me anyway?” she asked. Helen also remembered that her husband hid his symptoms of back pain and chest pain from her until 2 days prior to his diagnosis.
After Helen was in an alert state and we processed what had happened, I asked her to imagine a warm, healing light around her heart and suggested that she let this light start to mend the wounds she suffered from this intense guilt. After the 25-minute session, Helen found marked relief and was encouraged that hypnosis would be useful in her grief work. More important, she realized that she was in control and on her way toward healing.
Toward Clearer Understanding
As we know, loss is inevitable, and feelings of grief are the universal response to loss. These feelings are most profound when a loved one dies. Grief is a mind-body-spiritual experience that can manifest physically as insomnia, anorexia, headaches, and gastrointestinal problems; and emotionally as anger, guilt, confusion, regret, and anxiety. And often, physical manifestations can affect the individual’s mental or spiritual health.
Hypnosis is one way to help the bereaved understand that their thoughts are connected to their physical health.4 A therapist can use hypnosis to help patients understand that the many and complicated emotions and physical symptoms they are experiencing are a normal part of processing grief. It is an especially effective tool for helping patients get to the heart of an issue quickly because they are less inhibited while in a trance and, therefore, more willing to face the intensity of their pain.
In my practice as a clinical social worker who specializes in grief, loss, and transition issues, I rely on clinical hypnosis for helping patients move through grief in a safe and effective way. I do not use hypnosis until I have seen a patient at least once or twice and know what triggers his or her overwhelming sense of fear, guilt, anger, or other emotions.
When working with bereaved patients, I begin by taking a comprehensive history. I ask about the specifics of the loss as well as previous losses in their lives and how they coped with them, which helps me understand how they have handled past losses. For example, if they found comfort in reading the Bible, I may suggest that they do that again. In addition, I ask them to describe what they believe to be their most overwhelming thought or feeling related to their loss.
For Helen, guilt was the issue, and my intent was to use hypnosis to discover what the guilt was trying to tell her. One way of doing that was to ask her before and during the trance what she believed was the message of the persistent guilt. I wanted to know what she believed to be true when she was in an alert state as compared with what she believed when she was in a trance.
More often than not, the unresolved issue that the feeling represents becomes clearer when the patient is in an altered state and feeling calm. I have the patient ask the guilt or fear what it is they need to learn from it in order to heal. In Helen’s case, when talking to her deceased husband about going to the ER sooner, she learned that it wasn’t necessary to feel guilty because her husband wouldn’t have done what she wanted anyway and that anger toward her husband was lurking beneath the guilt.
Requisites for Success
Each patient, depending on his or her needs, defines “success” from hypnosis differently. And the therapist and patient may define success differently as well. In my practice, there have been times when I have felt pleased with an outcome and the patient has felt defeated because the issue was not completely resolved. Therefore, it is essential to discuss goals for treatment prior to hypnosis.
Sometimes I will ask patients to write down what they hope to gain from hypnosis and what benefits they hope this will have before they come to my office. This is one way I can assess their expectations, and I often use their own words when making suggestions during hypnosis. Additionally, having patients articulate their expectations helps make them accountable for their healing, which is another way of honoring their control. If patients have realistic expectations before going into hypnosis, they are more likely to feel that they have succeeded in the end and that taking the risk of trying hypnosis was worth it.
In addition to clarifying expectations, 2 other things need to be present for favorable outcomes to occur: The patient needs to be motivated to change, and the patient needs to perceive the suggestions and possibilities given while in a trance as realistic. In other words, the patient needs to buy in to hypnosis.
Fear of losing control is the most common concern my patients express. In order to best instill a feeling of control, which is critical to a successful outcome, a patient needs to trust the clinician. No one can be hypnotized against his or her will. The person has to want to be hypnotized in order to experience its altered state of consciousness.5 People can be quite ambivalent toward working on their intense grief; therefore, I often start by suggesting that patients think of a comforting image in order to provide them with something positive to focus on during the session. This becomes a safe place in their mind that they can return to when necessary.
I see much more authentic healing and understanding come from my patients who believe they will heal and are willing to do the work involved, despite the discomfort. More often than not, those patients are pleasantly surprised when they realize that hypnosis can actually provide a welcome break from the hard realities of daily life.
Conclusion
It is essential to understand that grief is not an event; rather, it is the body’s and the mind’s reaction to loss. If we view grief as an event, we expect it to have a defined beginning, middle, and end. But grief is anything but clear and defined. Patients want it to end, but the truth is, it doesn’t. It just becomes less intense and more manageable.
Grieving people experience great fear and feel a loss of control. Clinical hypnosis enables them to address what they are too fearful to discuss in an alert state. And it offers them a tool that they can use on their own to alleviate physical and mental suffering.
Instilling hope is important for recovery from grief, and hypnosis helps patients learn and believe that it is possible to experience relief from the pain they are feeling. As such, it can help many people confront their fears and regain the sense of control that they have lost. MM
To find a clinician who is trained in hypnosis, contact the Minnesota Society for Clinical Hypnosis, 651/642-9883.
Kelly Grosklags is a clinical social worker who specializes in grief, loss, and life transitions. She practices in Minneapolis.
References
1. Potter G. The Use of Clinical Hypnosis in Counseling. Available at: http://www.gpotter.com/Hypnosis/clinical.htm. Accessed September 15, 2006.
2. Stewart JH. Hypnosis in contemporary medicine. Mayo Clin Proc. 2005;80(4):511-24.
3. Hilgard ER. Consciousness in Contemporary Psychology. Ann Rev Psychol. 1980;31:1-26.
4. Rossi EL. The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis. Rev ed. New York, New York: W.W. Norton; 1993.
5. Eimer B. What is hypnotherapy? Available at: www.hypnosisgroup.com/hypnosis/index.html. Accessed September 19, 2006.