With mere words, healthy subjects can be made ill, and ill subjects can be made healthy.—Abbé Faria
Hypnosis is a process that nobody really understands, but about which everyone has an opinion. Despite the fact that it has a 200-year history as a valuable tool in the practice of Western medicine, many health professionals still regard it with suspicion and fear.
The real problem, of course, is the word. As another nominalization, ‘hypnosis’ suggests some-‘thing’ that is implanted inside the patient to operate independently of his ‘will’.
This has prompted the most recent researchers to turn to neural scanning in order to find out where it lives and what it looks like when it’s at home.
Predictably, changes in brain function have been found, most notably in the brainstem, thalamus and anterior cingulate, suggesting, in part at least, that it can be observed as affecting the level of executive functioning of the brain. However, none of these studies210 explains how such a wide range of effects can take place under hypnosis, although they do agree that certain changes are characteristic of the state.
For example, diminished peripheral awareness and increased focal attention are common, as is suspension of the experience of linear space and time. One theory is that a ‘dislocation’ between the somatosensory cortex and the higher brain centers, somehow, gives the nervous system permission to create or ignore certain subjective experiences.
Of course, neural activity does not occur in isolation. It is contextual, and our experience is that the phenomenon we call hypnosis, in fact:
Because we feel that at least part of the reservations of the medical profession result from the word itself and the image projected by the popular media, we will more frequently use the terms ‘trance’, ‘trance state’, ‘unconscious response’, ‘other-than-conscious processing’, and ‘altered state’ as synonyms, depending on the context.
The trance state exhibits three important characteristics: focus, abstraction, and association/dissociation.
Focus, as we have said, involves a reduction of peripheral data. Rather than scanning the internal or external environment, the subject deletes any information not consciously or unconsciously perceived as relevant to the issue at hand, whatever that happens to be.
Abstraction refers to the process of withdrawing from the external environment, moving progressively inward at the expense of competing data from the ‘outside’.
Dissociation occurs when the subject disidentifies with his physical and psychological boundaries, uncritically becoming merged (associated) with the experience contained within the boundary conditions of the current trance state.
A state in which the subject has little or no overt contact with the external world is known in NLP as ‘down-time’ trance.
Trance states are accompanied by various degrees of suggestibility, from the gentle exhortations of the hypnotist to ‘relax and let go’, to the phenomenon of post-hypnotic suggestion, the apparently automatic behavior carried out after the subject emerges from the trance in which the suggestion has been implanted. We are not claiming that ‘suggestibility’ exists as some ‘thing’ inside the subject. Rather, as we will discuss further below, it is a function of certain classes of relationship.
It is comparatively easy to observe specific changes related to developing trance in the subject’s physiology, especially when the practitioner’s vision is wide and relaxed. The most common markers include:
These minimal cues may emerge spontaneously as the subject becomes increasingly absorbed in his internal world, or in response to the practitioners suggestions. ‘Suggestions’, in turn, may be direct or indirect (see Inducing and amplifying trance later in this chapter—page 242).
Trance can develop spontaneously. We are all deeply familiar with the process of becoming completely absorbed in a book or film, or of arriving at a destination without any conscious awareness of having driven there through busy traffic.
When that happens, we might not immediately realize that someone has spoken to us, or have been aware of the passage of time. Where film, drama, and well-crafted literature are involved, we enter a curious state of dual awareness: part of us is immersed in the challenges and emotions of the protagonists as if they were happening to us, while at the same time we are well aware that we are reading a novel or clutching the DVD remote control.
These state changes are accompanied by natural trance phenomena, such as analgesia (forgetting a headache while engaged in an interesting conversation); amnesia (forgetting to carry out a task agreed while involved in another absorbing experience), and negative hallucination (experiencing something as ‘absent’, even when it is in plain sight of others).
The spectrum of consciousness extends from conditions in which conscious cognitive processing is significantly reduced, to heightened states of awareness, usually associated with ‘peak’ or ‘religious experiences’.
From the ‘blackness’ of the former to the heightened sensory virtual reality of the latter, an almost infinite range of possibilities exists. We drift in and out of a rich variety of altered states without noticing. Familiarity is what prevents us from noticing the shifts that come with changes in our sensory input; social demands; biological rhythms, and emotional fluctuations.
Our ‘default consciousness’ is considered ordinary to us simply because no ‘unordinary’ quality comes into our awareness. We do not regard it as a trance state, even though our attention encompasses only what presents itself as ‘important’ at that particular moment. Our foci of attention are reduced, but still serve our immediate needs. When we simply ‘are’, we are in our most habitual altered state.
Thus, ‘everyday’ trances are unlikely to cause problems; indeed, if we define trance as involving focus, abstraction, and association, we may well have created a number of varying trance states appropriate to the different roles we are required to play during each day. However, when trance hijacks our freedom to involve ourselves in experiences other than those contained within itself, problems arise. Our default consciousness fades, along with our ability fully to function within it, as we become increasingly absorbed in the characteristics of the problem-trance.
Trance experience has been a favored pursuit of our species since the beginning of time. From the altered awareness induced by driving tribal drums and the ingestion of sacred organic substances, to the ‘buzz’ of contemporary club music and recreational drugs, humans have been inexorably drawn towards heightening or changing their experience of ‘reality’. But what predisposes us to state-alteration in the first place?
One theory is that trance evolved as a protective mechanism for where physical fight or flight failed. The cascade of endorphins that accompanies both the ‘freeze’ and the trance state, so the theory goes, reduces (somewhat) the experience of being torn limb from limb.
Many of the markers of trance occur in human beings in times of extreme crisis, including a loss of physical sensation and extreme distortion of the subjective sense of time. Some researchers believe that Multiple Personality Disorder (MPD), characterized by several different and discrete ‘personalities’, is the product of trauma-induced trance-formation.
Certainly, ‘deep’ trance, with its rigidity of limbs, slow, shallow breathing, and absence of reaction to external stimuli, has, on the surface, much in common with the ‘playing possum’ response observed throughout the natural world. These behavior patterns also seem to have much in common with unwanted feelings, responses, and behaviors that patients often claim ‘just happen’, no matter how illogical they seem or how much they want to suppress them.
Another shared characteristic is that of trance logic, the tendency to ‘explain’ the symptom in terms that may seem utterly absurd to the observer. This parallels Michael Gazzaniga’s ‘spin doctor’ or ‘interpreter’, suggesting that the experience of trance occurs wordlessly in the right cortex, while the left struggles to make sense of the behavior.
A further argument to support the ‘protective mechanism’ theory emerges from studies of childhood trauma, some cases of which are believed to create states dissociated from the hostile environment and associated into a ‘safe’ fantasy world or alternative ‘identity’.
According to some neurobiologists—who call these trances ‘imprints’—such experiences are ‘fixed’ in our neurophysiological structure by chemical washes, presumably creating a kind of template of situations to be avoided in the future. Several factors appear to be instrumental in creating and amplifying trance, including: heightened emotion; repetition; a sense of reduced control; and sustained allostatic load.
Our contention, in advancing this model, is that many ‘functional’ disorders share key characteristics with trance, and that part of the Medical NLP practitioner’s role is to disassemble the problem trance, while creating more resourceful responses based on widened, rather than constricted, perception and cognitive processing.
Trance itself is a product of relationship—whether it is the relationship between hypnotist and subject, subject and object of absorption (a movie or book), or the patient and his problem.
Bonded disconnection is a particularly insidious trance-deepener. The more focus, absorption, and association are applied to attempting to ‘not-have’ the problem, the more deeply entrenched it is likely to become. As Korzybski pointed out, the quality of the inferences made about the experience can feed back to higher levels to deepen allostatic load.211 This inevitably occurs when the problem is framed as ‘other’ than ‘ourselves’.
Attempts to make changes at this level of separation are unlikely to be successful.
We know from experience that adopting the ‘one-up’ role of advisor or coach has minimal impact on the structure and process of complex ‘functional’ problems—and recommend that you avoid this, unless absolutely necessary (such as instructing the patient how to take his medication). Avoid too, the trap of entering into a symmetrical argument with the patient in the hope that your superior logic will prevail. Symmetrical arguments, you may remember, are usually characterized by a series of ‘yes-but’ answers to all your well-meaning suggestions.
This latter approach runs counter to the Ko Mei principles of Medical NLP and risks placing the practitioner as ‘other’ to the patient, thereby reducing his ability to influence.
Effective influence is, by nature, en-trancing. The etymological origin of the word ‘trance’ is the present participle of the Latin verb transire, to ‘go’ or ‘cross over’. The sheer number of English words deriving from this compound verb (transit, transition, transitory, transfer, etc) reflects the multi-ordinality of the word ‘trance’ itself.
We may think of ‘going into trance’ variously as crossing over the boundaries of conscious and unconscious, external and internal, left hemisphere and right hemisphere, body and mind.
We might also consider the ‘effectiveness’ of trance as a mutually agreed breaching of the boundaries between ‘you’ and ‘me’. In trance, the boundary conditions between patient and practitioner become increasingly permeable, so that ‘your’ thoughts may merge seamlessly with ‘mine’, your ‘suggestions’ become my ‘decisions’.
Needless to say, it is especially important to be ethical and respectful as these distinctions are breached.
Patients and their problems do not exist separately from the system in which they live, and the most immediate system we should consider is the family. It is fairly self-evident that one member’s chronic illness may disrupt the lives of siblings, parents, or children. This, in turn, can worsen the patient’s condition, particularly if there exists an atmosphere—real or imagined—of resentment or blame.
Two other issues need to be examined to facilitate healing and health:
In chunking for positive intentions (‘What does this condition do for you or your family that wouldn’t happen if you were well?’), it may emerge that the symptom acts to prompt other family members to provide the nurturing the patient desires.
Such a strategy, albeit an unconscious one, may be effective, but at a price—for example, a depletion of the family’s energy, patience, and financial reserves. Equally, the caregivers may be meeting their own needs for significance and meaning within the relationship; they are ‘needed’, and therefore important.
Another possibility—most frequently encountered in children who present with behavioral disorders or problems such as bed-wetting and soiling—is that the condition acts to distract the parents, or other members of the family, from problems perceived as potentially more threatening to the patient’s safety than the condition itself. Some patients, adults included, appear somehow to have the capacity to create or maintain an otherwise distressing condition for some perceived ‘greater good’.
Case history: The patient, a 34-year-old married man with two children, presented with ‘work-related stress’. Although he had one of the worst cases of weeping eczema the practitioner had ever seen, he initially made no mention of his skin condition.
When the practitioner referred to it, the patient shrugged and said that even though his condition had not responded to treatment, it was ‘under control’. He explained that his widowed mother came to his home every day to clean and dress the eruptions. He admitted that his relationship with her was conflicted and that he resented her ‘fussing’, but felt he could not ask his mother to stop caring for him because ‘I’m the only person she’s got left in her life and she needs to feel needed.’
Some months later, the patient called, in considerable distress, saying his mother had died unexpectedly of a cerebral hemorrhage. When the patient arrived for his appointment, the practitioner was stunned. The patient’s skin appeared new and pink and without blemish. When the practitioner had the opportunity to ask about any treatment he had received, the patient seemed slightly embarrassed. He said, ‘It’s the strangest thing. I was unbelievably shocked and guilty when I heard about my mother’s death. I felt somehow I hadn’t done enough for her. But, within a few hours, the itching stopped, and a few days later I noticed that the eczema was drying up. It disappeared in less than a week. Do you think the two things had any connection?’
The possibility that the patient’s problem was caused, or at least, maintained, by a need to provide his mother with a ‘purpose’ in life cannot easily be dismissed. However, rather than implying that some gain or benefit may be causing or maintaining any problem, which we regard as presumptuous and disrespectful, it is preferable to open the subject of family dynamics in the following manner:
‘Now, because this problem has been going on for some time, the roles of all the people around you will change when you start to get better. Even though they may have been upset that you have been ill, there could be the chance that in some way they will feel they are not needed or appreciated any more. How would you suggest you could make them still feel important even as you’re getting better?’
The intention here is to encourage the patient to begin to alter his role as a passive recipient of care to an active agent of his own recovery, while ensuring that the system within which he lives regains balance. When we asked one little girl the question suggested above, she smiled in delight and responded immediately, ‘I’ll ask my Daddy to help me with my homework—even if sometimes I know the answers.’
Conflicting responses and behaviors are commonly encountered in many ‘functional’ disorders. These are usually signaled by linguistic markers, such as, ‘On the one hand I…and on the other…’ or ‘Part of me wants [X], but another part wants…’
If conflicting trances are seen to have been set up at different stages in the subject’s development, each with the positive intention of meeting a specific need, deconstruction and integration are both practical and effective. We will discuss approaches to resolving conflicting trances in the chapter, Patterning and Future-Pacing, but, for the moment, we advise practitioners to begin to approach each state as discrete and functioning in some way (at some time in the patient’s life) as a protective mechanism, even though they are presently experienced as functioning in opposition to each other.
Chunking to core values and positive intentions often allows us to resolve conflict.
Case history: The patient, a new father who had been diagnosed with Obsessive Compulsive Disorder, reported that ‘one part’ of him wanted to be a good, responsible, and normal parent, whereas ‘the other part’ was convinced that if he did not carry out certain rituals, his family would die. His obsessive behavior, though, was causing problems with his wife and, he believed, was also affecting his baby son.
After the practitioner helped the patient to reduce the level and automaticity of his sympathetic arousal, they arrived at the understanding that both ‘parts’ wanted safety and security for him and his family, but were pursuing it in mutually destructive ways. Together, the patient and practitioner worked to resolve the conflict (see Re-patterning and Future-Pacing, pages 293 to 314), and the patient returned home to ‘see what happens’.
On his second consultation, some weeks later, the patient reported that his obsessive behavior had ‘just gone away’—except for one ritual he needed to discuss. He said he felt compelled each night to kiss his fingers four times and place them gently on his sleeping son’s cheek.
The practitioner asked whether he felt that this ritual helped him and his wife to sleep better at night. The patient said, ‘I’m pretty sure it does’. The practitioner then suggested that the ritual might even help his baby sleep well and grow up secure in his father’s love and protection, and the problem was permanently laid to rest. (Incidentally, this approach is also a neat example of a reframe of the meaning of the ‘problem’.)
Two other forms of interpersonal trance may be encountered. These are what we call the ‘couple trance’ and the ‘cultural trance’.
Where problems in relating are concerned, the couple trance may often be found to exist as a self-reinforcing loop, in which certain actions of one person trigger a response in the other, which, in turn, sets off another round—and, so it continues.212 In designing interventions, the practitioner should take this two-point loop into consideration.
Cultural trance refers to the unquestioned acceptance of the rules and injunctions of one’s cultural or religious group, and the conflicts that this might cause. Problems often occur simply because the ‘rules’ imparted by the group are ‘self-sealing’—that is, they discourage new information or interpretations that might challenge the belief. The practitioner should be particularly careful not directly to challenge the belief-system, nor attempt to impose his own world-view.
Case history: The patient, a young man who was about to be married, presented with erectile dysfunction. Although he was due to get married, he was shocked while changing after a work-out at his local gym to ‘catch himself’ looking at the bodies of other men. Coming from a deeply conservative and religious family, he ‘just knew’ this was ‘wrong’ and that he deserved to be punished.
He spontaneously shifted into a significantly altered state when asked to pay attention to the memory of the experience of looking at other men—‘to simply watch yourself and notice what happens’. This is controlled dissociation, a valuable approach to disassembling trance states.
Anxious not to pre-judge whether or not the patient had homosexual inclinations, the practitioner then invited him to ‘go inside and ask’ what ‘other meanings’ this behavior might have (the presupposition here was that there might be meanings other than the one that was limiting him). The man remained silent for some minutes, and then emerged from his state of absorption, visibly relaxed and smiling. He confided that he had never seen another man’s naked body and wanted to see how he ‘shaped up’ by comparison. Apparently, he had decided that he had shaped up well enough, and called back several months later to report that he was happily married and sexually fully functional again.
It may seem paradoxical that we can induce trance to ‘undo’ trance, until we recognize and accept that neuronal networks have the potential to reorganize themselves when their boundary conditions are breached and new information is introduced and accepted.
Psychiatrist Dr. Susan Vaughan believes that effective change-by-communication directly alters neuronal networks,213 while Nobel prizewinner Eric Kandel, one of the world’s leading experts in neuroplasticity, suggests that information (words) may even alter the way our genes express themselves via a rearrangement of the connections between the nerve cells of our brains.214
As the subject dissociates from external triggers and reduces the flow of data competing for his attention, he relaxes and moves further away from higher-order levels of verbal abstraction and deeper into the non-verbal levels of Object and Event experience. Put more simply, he ‘does’ less, and ‘is’ more.
By becoming a relaxed, permissive observer of his own internal functions, he effectively removes the two strongest bulwarks of trance: physiological tension and semantic evaluation. Without either words to tell his story or a pattern of muscle tension to help maintain the state, the boundary conditions of a specific trance can begin to disassemble.
We contend that moving closer to the silent, purely experiential level is a necessary precursor to restructuring experience; we are still surprised how often patients spontaneously self-regulate when they master this ability simply to ‘let go and let it be’.
As we explain in the exercise section at the end of this chapter, this is a valuable skill specific to Medical NLP and with many useful applications. Patients who understand and master this process have a powerful tool to support them in dealing with bouts of chronic pain, depression, anxiety, compulsive behavior, etc. Arthur J. Deikman notes that the ability to shift attentional awareness into what he calls the observing self ‘reduces the intensity of affect, of obsessive thinking, and of automatic response patterns, thus providing the opportunity for modification and control, for increased mastery’.215
One of the misconceptions that still dominate is that people cannot be hypnotized ‘against their will’. While it may be true that, when the subject is fully aware that the hypnotist is ‘trying to put me under’, he will be able to counteract suggestions to relax and focus, it is nevertheless entirely possible to facilitate the development of trance without ever using words such as ‘hypnosis’, ‘trance’, and ‘relax’. As we have stated elsewhere (see page 251), states are contagious; we seem to be equipped with a tendency to entrain one to another. ‘Suggesting’ that the patient enter an altered state therefore can be accomplished by entraining.
This is a skill elevated to high art by Richard Bandler. ‘If you want someone to relax, or go into any other state,’ he says, ‘go there first.’ However, we should add that, while the ability to enter a trance state in which you can still function in full conscious awareness—called ‘up-time’ trance—is an extremely useful and energy-preserving state, it does require practice.
We have observed more than one student trying to hypnotize a colleague only to succumb himself.
You may lead the patient into an altered state by:
As trance develops, it may be wise to reassure the patient that it’s ‘okay to close your eyes for a few moments to relax if that feels more comfortable. I’ll let you know when it’s time to come back into the room.’
The representation of trance as a hole into which we fall, sink, drop, or float—the ‘deeper’ the better, if we wish to ‘fix’ a particularly recalcitrant condition—may be a useful metaphor to use with patients. However, ‘levels’ of trance are artificial measures created in research laboratories and bear little relation to real-world transformational work.
The assumption that a ‘deep’ trance is a prerequisite of major shifts in perception and capability is misplaced. Deep, somnambulistic trance often leaves the subject slow and unresponsive, while a state barely perceptively different from the subject’s default consciousness is often enough to permit effective work to be carried out. A certain level of skill and sensory acuity is required by practitioners to recognize the developing trance state and to exploit it effectively.
In many ways, our role as practitioners is to help ‘de-hypnotize’ the patient who is in the grip of bonded disconnection, by changing his relationship to his problem.
Even in the face of strong ‘resistance’, this may be accomplished in any number of ways. We have already given several examples of this, including the tried-and-tested, ‘When you have (accomplished the desired state), what would be different and better?’ Another example might be to ask the patient simply, ‘Why should you change?’, or, even, ‘Why shouldn’t you change?’ The purpose of overcoming ‘resistance’ is always to satisfy patient needs and never to dominate or control.
However, we do, on occasion, use these questions gently to provoke the patient to argue for change, rather than—as is often the case—to present every argument for why he has to stay the same (the ‘yes-but’ symmetrical argument referred to above). Do not be surprised if he seems disoriented when you change tack this way. Paul Watzlawick suggests that this kind of shift in logical typing undermines the patient’s ‘game’, which is entirely based on the (often unconscious) presupposition that the practitioner’s role is to make him change.216
A number of possibilities to create bespoke approaches quite naturally occur when we understand that, while structure and process can be changed and outcomes designed, these have the greatest potential for success when we have helped the patient to change his relationship with his problem—and, possibly with others in his familial or cultural environment.
Very little distinction can be made between trance and NLP processes and techniques. By definition, when the subject turns inwardly to focus on certain processes and procedures, he may be said to be ‘in trance’.
Equally, concordance and adherence—two qualities necessary to effective treatment outcomes—may be thought of as a form of trance. Andre Weitzenhoffer, a researcher and prolific writer on the subject of hypnosis, often remarked that spontaneous responses to suggestions in the waking state were indistinguishable from those elicited by hypnosis. Few practitioners will have considered trance as a significant factor in good clinical practice. We suggest they do.
Non-evaluative self-observation
You will undoubtedly recognize this pattern from earlier discussions in this book:
from external, verifiable ‘reality’ into a more internal state of absorption.
1. Make three factual statements followed by one statement inferring comfort, relaxation, etc. (For example: ‘You are sitting back in the chair, your feet on the ground, your hands in your lap, and you can allow yourself to relax, just a little more…’)
2. Follow this by two factual statements and two inferential statements. Follow this, in turn, by one factual statement and three inferential statements. From this point on, all statements can be overtly ‘hypnotic’. Pace the statements to the subject’s breathing, ensuring that phrases match the out-going breath.
Note: This pattern can be used to practice self-hypnosis. Factual statements may be sights, sounds, or sensations in and around you. When you wish to end the trance, simply tell the subject (or, yourself) slowly and comfortably to come back into the room, wide awake.
1. Scan your body internally for any pain or tension. If you have a specific ‘negative’ emotion or worry that dominates your attention, notice how and where it manifests itself as a kinesthetic.
2. Give the kinesthetic permission to be there as it is and, in your imagination, step back, out of your body, and simply observe what is happening purely as a physical experience.
3. Describe out loud (if possible) the characteristics (sub-modalities) of the experience, being careful to avoid semantic evaluations, such as ‘painful’, ‘worrying’, ‘awful’, etc.
4. Stay aware of changes as they occur, and describe them (again in purely physical terms), as the experience resolves itself. Patients must be guided through this process, possibly several times, so they fully understand it and can have the confidence to apply it on their own.
Note: We often use this to depotentiate the response to a specific problem, and then follow it with the appropriate intervention (see following chapters).
By definition, ‘induction’ means ‘inwardly turning’. In creating trance-inducing statements, we reverse the inference-to-fact process discussed earlier. This progressively leads the subject (or oneself) into more focussed levels of awareness in which suggestibility and change may be the natural consequence.
210. Rainville P, Price D (2003) Hypnosis phenomenology and neurobiology of consciousness. International Journal of Clinical and Experimental Hypnosis 51(2): 105–29; Ray WJ, De Pascalis V (2003) Temporal aspects of hypnotic processes. International Journal of Clinical and Experimental Hypnosis 51(2): 147–65; Szechtman H, Woody E, Bowers K, Nahmias C (1998) Where the imaginal appears real: a positron emission tomography study of auditory hallucinations. Proceedings of the National Academy of Sciences of the United States of America 95: 1956–60.
211. Korzybski A (1933) Science and Sanity: An Introduction to Non-Aristotelian Systems and General Semantics. Englewood, NJ: Institute of General Semantics.
212. Kershaw CJ (1992) The Couple’s Hypnotic Dance. New York: Brunner/Mazel.
213. Vaughan AC (1997) The Talking Cure: The Science behind Psychotherapy. New York: Grosset/Putnam.
214. Kandel ER (1998) A new intellectual framework for psychiatry. American Journal of Psychiatry 155(4): 457-69.
215. Deikman J (1982) The Observing Self: Mysticism and Psychotherapy. Boston, MA: Beacon Press.
216. Watzlawick P (1974) Change: Principles of Problem Formation and Problem Resolution. New York: WW Norton.