“Each person is a unique individual. Hence, psychotherapy should be formulated to meet the uniqueness of the individual’s needs, rather than tailoring the person to fit the Procrustean bed of a hypothetical theory of human behavior.” – Dr. Milton H. Erickson (The Milton H. Erickson Foundation, 2016)
Helping clients overcome addictions is one of the most difficult cases clinical mental health counselors can undertake. Calling it challenging and complex in some scenarios would be an understatement. There are numerous reasons clients find themselves trapped in the quicksand of addictions that have slowly swallowed their lives with each movement. Upon agreeing to help these people, the role of clinical mental health counselors is to utilize tools that can be used for these clients to safely pull themselves onto dry land. This is no easy task due to the number of reasons people somehow become trapped inside the sinking sands of misery.
There are endless therapeutic tools clinicians use to assist clients suffering from addictions. Many of those tools are touted as a cure-all for any mental health disorder imaginable. Personally, I do not believe in cookie-cutter therapeutic modalities. Unlike the medical model, where patients are treated in similar ways due to the similarity of our bodies, the human mind is individualized, specialized, and often uncharted territory. Our minds have been created in amazing biological, psychological, sociological, and environmental ways formulated for survival, thus allowing us to be very unique from one another. If clinicians are to succeed in helping clients overcome addictions, then we should carefully explore the challenging terrain of the addictive mind using therapeutic approaches that are as individualized and creative as the clients’ learning systems and personalities.
Imagine for a moment opening the box of a puzzle consisting of one thousand pieces. All the separated pieces are poured onto a table. As you listen to your clients’ challenges, dreams, and aspirations, you begin to draw a picture in your mind of how the puzzle should look once it’s fully assembled. It will take much time, patience, understanding, luck, and hard work to put all the pieces back in place. But, if clients are highly motivated, it is possible.
It’s always easier to put a puzzle together in sections; therefore, I usually begin to explore the different corners of this game. In one corner I examine the causes for the addiction: genetic, learned behavior, and trauma-based. In another corner I explore actions maintaining the behavior: triggers, environmental, physiological, and motivational. In another corner I explore various techniques that might prove beneficial: individual, family, group, behavioral, somatic, conscious, and subconscious. In the last corner I’m constantly monitoring maintenance—tools clients can utilize to maintain sobriety during treatment and once the goal has been achieved.
I believe clinicians working in the addiction field often encounter problems due to the highly cognitive nature of the evidence-based treatment approaches that many of us use. If sobriety is to be achieved, then the method of treatment has to focus much deeper than the cognitive therapies are designed to do. Due to the highly avoidant nature of addicted clients and the changes that have occurred in the brain, it is best to use an eclectic therapeutic approach that includes cognitive, somatic, and subconscious features for successful outcomes. As a result I am much more interested in treatment protocols that have a high level of practice-based evidence. This means that you can determine the effectiveness of my treatment protocol by asking any of my clients, past or present, if what I do actually works. This article will focus on my preferred subconscious technique: clinical hypnosis.
Eight years ago I became trained in clinical hypnosis. I use this treatment as part of my therapeutic protocol quite often, at least on a weekly basis. I can confidently say that clinical hypnosis is one of the most highly effective, underrated treatment modalities that I’m aware of for mental and physical issues. The main problem with hypnosis is its misconception. Due to the use of hypnosis in the entertainment business there are a number of fallacies associated with it. As a result of this it is highly criticized in the medical community. It is also devalued, misunderstood, feared, thought of as a carnival act, and generally not given the respect it deserves as a legitimate, effective therapeutic tool that works very quickly and gently for many clients.
Division 30 of the American Psychological Association (APA) is called the Society of Psychological Hypnosis. It is devoted to exchanging scientific information, advancing appropriate teaching and research, and developing high standards for the practice of hypnosis. Areas of interest of the membership are diverse, including topics such as mind/body connections; dissociation; and hypnosis with women, children, and adolescents. Current initiatives of the division include advancing applications of hypnosis in behavioral medicine, professional and public education, and establishing clinical hypnosis as a certifiable proficiency. Division 30 defines hypnosis as
. . . a therapeutic technique in which clinicians make suggestions to individuals who have undergone a procedure designed to relax them and focus their minds Although hypnosis has been controversial, most clinicians now agree it can be a powerful, effective therapeutic technique for a wide range of conditions, including pain, anxiety and mood disorders (APA, 2016).
The American Society for Clinical Hypnosis (ASCH), a premier training organization on the advancement of clinical hypnosis, defines clinical hypnosis as
An altered state of awareness, perception or consciousness that is used, by licensed and trained doctors or masters prepared individuals, for treating a psychological or physical problem. It is a highly relaxed state. Hypnosis is a state of inner absorption, concentration and focused attention. Recent research supports the view that hypnotic communication and suggestions effectively changes aspects of the person’s physiological and neurological functions (ASCH, 2016).
When an individual goes into a state of hypnosis it is known as a “trance.” Human beings appear to be designed to go in and out of trance easily and naturally—often without much focus or thought. One of my favorite ways of taking people into a trance state is by the use of a candle. The flicker of the light has a very calming effect over most people who have not been hurt in a fire. Considering that fire has been apart of the human experience since the dawn of time, I would wager that human beings have been going into trance since then as well.
In an examination of recorded history, hypnosis can be traced as far back as the famed sleep temples of the Egyptians, Hindus, Persians, and others. Hypnosis probably began a formal taking off with famed German physician Franz Anton Mesmer (1734-1815; “Franz Anton,” 2012). He is credited with the terms “animal magnetism” and “mesmerism.” Dr. Mesmer’s use of hypnosis was very effective in helping people with various ailments, but his approach was also very theatric (“Franz Anton,” 2012). This is probably how hypnosis split from its primary focus on medicine into a dual platform of entertainment. In the middle of the nineteenth century another physician named Dr. James Braid who also used hypnosis within his medical practice coined the term hypnosis after the Greek god of sleep, Hypnos (“James Braid,” 2012).
Legendary psychiatrist Dr. Sigmund Freud studied hypnosis in France in 1885 (Bachner-Melman & Lichtenber, (2001). It is widely believed that he wasn’t particularly skilled at the art of hypnosis, causing him to eventually modify the technique to suit his own personality. While Dr. Freud may have abandoned clinical hypnosis, he certainly maintained a healthy level of appreciation and respect for the model, which can be seen throughout his widely used theory known as psychoanalysis.
Many clinicians, such as myself, thank Dr. Milton Erickson for creating one of today’s most widely used from of hypnosis called Ericksonian Hypnosis (The Milton H. Erickson Foundation, 2016). Dr. Erickson was a brilliant psychiatrist and clinical hypnotherapist who was a master at observing, then speaking with his patients using metaphors, imagery, confusion, and humor to assist the suffering individuals in healing from a variety of serious clinical issues.
How it Works
How does hypnosis work? This is a simple, yet difficult answer. Here, I’ll offer a few of the most important components that should give you a basic understanding and possibly encourage you to learn more. First and foremost when speaking of a hypnotic trance, I am speaking of the phenomenon of something begins in the mind that causes a physical change in the body. The conscious mind is the part of the mind that is active right now as you read this article. It is the part of the mind that we are consciously aware of. The subconscious mind is just below the surface—behind the scenes. It has an awareness of information that is easily and quickly retrieved, such as the name of one of your elementary school teachers who you haven’t thought about in years. Along with the unconscious mind, it is also responsible for many of your body’s functions such as heartbeat and breathing. Consider for a moment the fact that we don’t normally think about breathing. We just breathe unless something serious is going on and we have to focus on the act.
The unconscious mind is said to be the deepest part of the mind that we do not have access to. It is the source of our dreams, urges, desires, and motivations. The last important part of the mind is the critical filter. I often refer to this as the “door to the subconscious” and another lower door leads further down to the unconscious part of the mind. This critical filter is where judgment, doubt, praise, and willpower resides.
For the most part hypnosis only works by way of active permission from clients. There is some research that says otherwise, but for now this is the rule that most hypnotherapist live by. Once clients understand what hypnosis is and agree to go into the trance, therapists talk them into a very relaxed state using the rule of focused attention. This creates a controlled dissociated experience. Then clients slowly and comfortably move into an altered consciousness, the doors to the critical filter open, and the subconscious mind is entered. Once here, subconscious reframes are introduced which often have the power to change years of information in one or two sessions. There are other ways to introduce a trance, but this is the main way that most hypnotherapists complete this task. The words used are called a “script.” Needless to say, trust and rapport are paramount. If clients do not trust their therapists, then the key to the critical filter will not be offered and neither the subconscious or unconscious mind can be entered. The hypnotic part of the session will effectively be over. Clients often report the session as being a very relaxing, dream-like experience.
How it’s Used
I’ve briefly reviewed the challenge of addiction therapy along with the brief history of hypnosis. Now, let’s explore how it’s used in my specialty, which is posttraumatic stress disorder (PTSD), and how this relates to addictions. PTSD is a mental health disorder characterized by the continuously experiencing of a traumatic event in the form of flashbacks and triggers. Numerous clients who struggle with addiction also have an in-depth history of trauma. This is not by coincidence. The numerous challenges individuals with PTSD struggle with are extremely difficult to cope with day in and day out. On a daily basis victims of trauma struggle with hypervigilence, anxiety, paranoia, nightmares, flashbacks, and as a result they constantly seek anything that can help them avoid the disturbing reminders of the event as well as to feel better. If people with a history of trauma are to ever become sober, the root of the addiction has to be successfully addressed. In the case of PTSD, it will be a traumatic event.
Once the assessment is complete—hypnotic pretalk, history, goals—then I begin to address and resolve the trauma by attacking the triggers. The triggers clients are struggling with will almost always lead me back to the trauma and what’s maintaining the fear. It is very difficult to remove trauma triggers using a cognitive approach such as cognitive processing therapy due to the fact that once clients begin talking or even thinking about the event it will become reactivated and they will attempt to avoid. This is the nature of the trauma and the human brain’s way of coping. Clinical hypnosis allows clients to effectively resolve the trauma while they are in a dissociated state, meaning they are not fully aware of our discussion. With the use of metaphors and other creative means of discussion the trauma can be approached and resolved indirectly and thereby removed. Once the trauma is successfully addressed, the trigger automatically becomes diminished and the avoidance feature is lessened or completely removed. If the trigger is absent, then so is the behavior associated with the trigger. This makes it much easier to address the habitual nature of the addictive behavior as well as the other reasons maintaining the addiction: anxiety, fear, anger. If those symptoms are less bothersome, then the therapy becomes much easier. There are a number of ways to use hypnosis to address clients struggling with an addiction. Let’s review one of my cases.
CC was a middle-aged Hispanic, married woman of ten years who had been with her current spouse for fifteen years in total. She was the middle child of six whose parents were married for over fifty years. CC had been previously married as well. She reported a history of being in five auto accidents, which is what originally brought her to my practice. She also reported a “lifetime of being controlled.” CC admitted to gambling regularly to the sum of donating over $10,000 to a local casino last year. She stated that her husband was very kind and supportive, but also a very controlling man (the same as her father) at times. CC enjoyed going to the casino to get away and have time to herself, but after a thorough look at her bank account she realized how much of a problem gambling had become.
Regarding the gambling part of her problem, I determined that CC was unconsciously exerting a sense of independence by going to the casino. It was her way of regaining the control she felt was taken away from her. Her husband didn’t like her going to the casino, but she often went regardless of his permission or not. Unfortunately, the casino is in the same direction as her home, which made this case a little more challenging.
After escorting her into trance, I began with a subconscious exploration of CC’s reported feeling of “always being controlled.” As suspected, its root cause led me back to her childhood and was a major factor in her growing up. In my eyes this was one of the main contributors feeding her unconscious desire to go to the casino. Using a subconscious reframe I was able to assist CC in understanding her childhood experiences with being controlled was the family’s way of keeping her safe. Removing or reframing the core trigger (or trauma) is a critical part of helping people overcome their addictions. If not complete, clients will continue to be haunted by memories, which will activate the addiction—I believe this to be one of the main drivers for addictive urges.
Once the core trigger was successfully reframed I hypnotically searched for other potential subconscious triggers connected to CC’s need to gamble. Satisfied with this part, I then placed an unconscious positive anchor, which is used to create an automatic relaxation response whenever CC would become stressed, without thinking about having to relax. This is an important part of my therapy due to a belief that many addicts retreat to their vice when they feel the most stressed or vulnerable. CC was then awoken and we discussed the session.
In the next session CC reported less of an urge to gamble. She still went to the casino, but reported the need to go “somehow” felt different. In this next session I began to work with CC’s need to use passive aggression with her husband (or others). She also reported going to the casino when she was bored. Again, I helped her into a trance and used hypnosis to reframe her feelings that were emerging in the form of an addiction, its association with her husband and also it’s connection with being “bored.” I planted suggestions (based on our discussion) of other activities she could consider if she became bored. Once complete I awoken her, then discussed her experience. The next week CC again reported feeling less of a “pull” to go to the casino. During this week she reported going to the casino once as opposed to several times. She also reported staying there less time. CC even admitted that she hadn’t realized she was near the casino until she had passed it and was pulling into her driveway.
In the next session, after discussing other techniques and agreeing on the goals of this session I placed CC in trance, then created a negative trigger for her addiction. A negative trigger is exactly what it seems like. When activated, clients will experience a negative emotion, forcing them to leave the scene to feel better. Note that this part of protocol cannot be utilized without clients fully understanding and agreeing to the treatment. With this particular trigger, if CC were to enter a casino for any reason she would feel very nauseated and have to leave. In the next session CC was very excited and told me she had not gone to the casino at all and hadn’t thought about it much. That session (and the next couple) was a talk session to bring everything together and check the work. We also worked on some of her negative and positive cognitions associated with gambling and the casino.
Then, CC reported she went to the casino. I was surprised that she had gone, but also intrigued about what happened. She said she didn’t go there to gamble. Instead, she went there to have dinner, but became very ill with a strong migraine and had to leave the area where the gambling was taking place. Once upstairs in the restaurant the pain subsided until she left and had to once again go through the casino. Then she felt it again. Needless to say, that was the negative trigger I installed. I had not anticipated this and had to take her back into trance to alter the suggestion so that she could comfortably go into the casino for dinner or a show. As addiction counselors I’m sure you recognize this as being a gamble (pardon the pun), but I worked with her goals and interests and not mine. After discussing the risk of going back into the casino for any reason, I reset the negative trigger. As a result, if CC entered a casino and her intention was to gamble, then the negative trigger would take place. If she entered for any other reason, such as watching a show, then she would be fine.
These sessions took place several months ago and appear to be helping her tremendously. I have discharged CC since then. We have spoken a few times over the phone and she has reported doing very well. She admitted having one relapse, but was able to handle it. I have reminded her to return if this becomes a problem again, to which she has agreed.
As mentioned previously, I believe hypnotherapy to be one of the most powerful tools available to us as therapists and addiction counselors. It offers a quick resolution while at the same time being the most gentle of all the therapeutic tools combined. For more information about clinical hypnosis training, contact either ASCH or the Milton H. Erickson Foundation.
American Psychological Association (APA). (2016). Hypnosis. Retrieved from http://www.apa.org/topics/hypnosis/
American Society for Clinical Hypnosis (ASCH). (2016). Frequently asked questions about hypnosis. Retrieved from http://www.asch.net/Public/GeneralInfoonHypnosis/FAQsAboutHypnosis.aspx
Bachner-Melman, R., & Lichtenber, P. (2001). Freud’s relevance to hypnosis: A reevaluation. American Journal of Clinical Hypnosis, 44(1), 37–50.
“Franz Anton Mesmer.” (2012). Retrieved from http://www.historyofhypnosis.org/franz-anton-mesmer/
“James Braid.” (2012). Retrieved from http://www.historyofhypnosis.org/james-braid/
The Milton H. Erickson Foundation. (2016). Biography of Milton H. Erickson. Retrieved from https://www.erickson-foundation.org/biography/