International Handbook of Clinical Hypnosis - E-Lib FK UWKS

36 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
applying hypnosis, which are tailored to the client's often complex presentation of
symptomatology. A full discussion of patient selection must therefore include
issues about hypnotic responsiveness, individual differences, and positive expectancies.
Establishing the hypnotic relationship with a client may be seen as a four-step
process. First is the evaluation phase during which the building of rapport guides
the clinician's every thought and action. Second is the educational phase during
which the client is introduced to the concept of hypnosis and informed consent is
garnered. Third is the assessment of hypnotizability, done either with formal or
informal techniques. And fourth is the teaching of self-hypnosis phase, during
which time positive expectancies about hypnosis and motivation of the client are
further enhanced. These phases do not always occur in a linear fashion but are
subject to the ebb and ¯ow of the therapeutic relationship. However, it is a useful
way for the clinician to organize his or her own experience of the unfolding of the
hypnotic relationship. In addition, the four phases serve as a guide to the areas that
should be covered in preparing the client for hypnotic treatment.
PHASE 1 EVALUATION
WHO ARE OUR HYPNOTIC CLIENTS? INDICATIONS
This new exposition of hypnosis changes the way we think about patient selection.
No longer is it simply a matter of the doctor selecting what is best for the patient.
This change in how we think about hypnosis, in combination with our increasing
understanding of the interactive nature of the treatment process and the relational
aspects Miller, 1986; Surrey, 1984) of the `doctor±patient' partnership alters the
lens through which we view the suitability of hypnosis for clients.
In fact, patients are far more apt to present in our of®ces requesting an hypnotic
intervention. We might then think of clients as falling into several categories. There
is that group of clients who present with symptoms that are particularly amenable
to an hypnotic intervention. Areas of increased use of hypnosis include stress
reduction, pain management/wellness, and uncovering work in a psychodynamic
relationship. Many of these clients are sophisticated in their knowledge of
alternative health bene®ts and ask for information on hypnosis, while others are
aware of the bene®ts of stress reduction techniques such as relaxation exercises,
meditation and guided imagery, but are uninformed about their similarity to
hypnosis. Still others are uninformed about hypnosis and ignorant of its application
to their problem. Those who are actively resistant to the idea of hypnosis pose a
particular challenge to clinicians. Resistance may come from several sources.
Religious and cultural beliefs may in¯uence a client's willingness to consider
hypnosis Marcum, 1994). Fear of the proposed procedure of the unknown) may