International Handbook of Clinical Hypnosis - E-Lib FK UWKS

256 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
etc.), may be relevant to later hypnotic strategies. By asking the patient to give his/her
pain a name `Mr Sonofabitch'seems to be a popular choice), a letter can be written to
`Dear Mr Sonofabitch'. By encouraging a stream of consciousness approach ignore
punctuation, spelling, etc.) the patient is easily introduced to experiencing dissociation,
and the letter may give clues about relevant psychodynamics.
While it is assumed that the chronic pain patient is depressed until proven
otherwise, the masked depression cannot be dealt with initially. 3 For example, the
patient involved in compensation or litigation cannot give up the pain easily until
the legal proceedings are resolved. Initially, hypnosis may not be very successful.
However, when gradually introduced with supportive psychotherapy, hypnosis may
be the adjunctive treatment of choice. Similarly, the chronic pain patient who is
masking depression will not easily relinquish his/her pain with hypnotic or any
other) intervention. Where there is the possibility of unmasking depression due to
too rapid removal of the pain symptom, complications, including suicide risk, must
be carefully considered. Fortunately, those patients usually have their symptoms
too well integrated to allow such a possibility. The symptom is usually too
important to relinquish with direct hypnotic interventions.
Several techniques Evans, 1989, 2001) are useful to help the patient `discover'
that he/she is capable of controlling bodily sensations, especially pain. Suggested
glove analgesia can be induced in all except a few resistant patients. Done with care,
the patient gradually begins to believe that he/she can control a physiological
experience in a part of his/her body. With repeated experience glove analgesia can be
transferred to the pain-af¯icted area, but this should be done cautiously. Imagery,
relaxation and self-hypnotic methods are usually introduced. Use of the Chevreul
pendulum will help circumvent resistance almost all patients respond unless
deliberately resisting). The use of ideomotor suggestion Evans, 1967, 2001) is an
elegant way to introduce the mind±body connection, which usually plays such an
important role in later hypnotic interventions. Several techniques borrowed from
sports medicine applications Unesthal, 1979) are helpful. For example, visual mental
rehearsal of getting out of bed for 30±60 seconds before arising will stimulate action
potentials that will help the patient quickly overcome the stiffness often experienced
when inactive for a period of time see Evans, 2001, for sample transcripts).
In the subsequent hypnosis sessions a delicate balance is required between the
initial, authoritarian, direct approach by the hypnotist to teach the patient mind±
body control, and the later non-directive cognitive discovery of success and mastery
of physical and bodily control in unrelated areas which will gradually be insightfully
discovered by the patient as relevant to subsequent pain control. At the same
time, this progress must be suf®ciently slow so that the patient can be drawn into
the therapeutic alliance to handle the psychological issues that are more relevant
than the pain experience e.g., `What if I don't win the compensation case'? `How
do I handle my spouse's sexual advances and the children's behavior'?).
It is the melody rather than the lyrics that are important in hypnotic techniques.
The hypnotic procedures used need to be a comfortable mix of the patient's abilities