International Handbook of Clinical Hypnosis - E-Lib FK UWKS

266 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
often the only way a particular individual is able to express his or her stress. It is
much less likely therefore that hypnosis can be successfully used to treat it.
When motivated by pain, even patients not considered good hypnotic subjects
may develop effective pain control . Thus, hypnotic suggestions may be most
effective both with good hypnotic subjects and in those well motivated to succeed.
ASSESSING THE POTENTIAL FOR HYPNOTIC RESPONSE
IN THE PATIENT WITH PAIN
Factors considered helpful to the therapist in predicting the outcome of hypnotic
pain control include:
· The nature and origin of the pain and whether it is organically or mainly
psychologically caused
· Whether the patient/client believes in hypnosis or notÐand whether they expect
it will bring pain relief
· The presence of `secondary gain'Ðsocial or ®nancial rewards for the maintenance
of the pain problem
· The patient's motivation to improve
· The development of a positive and trusting relationship between therapist and
patient/clientÐrapport
· The patient's willingness to practise self-hypnosis
The ability to produce a deep state of hypnotic trance is not always important and
good results occasionally occur in the presence of light hypnotic or light sleep-like
states. Training in self-hypnosis gives patients a sense of mastery and control over
their pain and they become independent of the therapist. As an alternative, audiotapes
are often provided as an extension of the therapy.
TECHNIQUES FOR PAIN CONTROL BY HYPNOSIS
Techniques for hypnotic pain reduction present a number of interesting similarities
to familiar psychological defence mechanisms normally used as coping mechanisms.
These are amnesia repression), substitution, denial, displacement and retreat
into fantasy. Thus, symptoms may be substituted: pain can become a tingling
sensation or `painless pain'. One problem seen at times in the pain clinic is that of
severe intractable pain following motorcycle crashes. Typically the brachial plexus
is torn away from the spinal cord as the victim's shoulder strikes the ground and is
violently forced downward. Intractable uncontrolled pain is often associated with a
`¯ail arm' resulting from the paralysis resulting from nerve pathway interruption.
The pain caused by this type of injury is similar to that experienced in patients with
phantom limb pain, and is due to an absence of the normal endogenous controls on