Therapeutic Hypnosis with Children and Adolescents

Second edition

Laurence L Sugarman, William Wester II, Laurence L Sugarman, William Wester II, Laurence Sugarman, William Wester III, William C. Wester

• Publisher: Crown House Publishing
• Year: 2014
• Print ISBN: 9781845908737
• eBook ISBN: 9781845908867
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

In this completely revised, updated and expanded volume, the editors have brought together some of the field's most outstanding contributors to examine the wide-ranging applications and promise of the use of hypnosis with children. The book develops core principles of clinical hypnosis with children and adolescents and each contributor delineates how they apply these precepts in a range of psychological and medical settings. The result is a constellation of perspectives and clinical applications that move the reader beyond literature review to practical advice.

Part I

Introduction to Hypnosis

Chapter One

Hypnosis with Children and Adolescents: A Contextual Framework

Laurence I. Sugarman, MD
William C. Wester, II, EdD

Hypnosis started when the first mother kissed it and made it better.

—F. Bauman, personal communication, September 21, 1996

He was seven years old and the youngest of five children. He hated having to be the first to bed each night when so much happened in the family outside his bedroom door. So, he would sneak out, sit at the top of the stairs, and listen to his brother and sisters argue and laugh, his parents’ stern voices, and hushed phone conversations. He wanted to hear everything and figure out what was going on.

Somehow, his mother would always know he had escaped his room. She would send him scurrying back, while yelling up the stairs, “You stay in that bed!” This repeated sentencing to his room further fueled his resentment and his determination to dodge his bedtime restrictions.

One evening, as he lay seething in his bed, he suddenly realized that his mother only forbade him to leave his bed, not his room. He was inspired! Lying under the covers, he gripped the mattress edges, focused his concentration, squeezed his eyes shut, and willed his mattress to float carefully out his second floor bedroom window. He was aloft! He hovered defiantly outside his parents’ bedroom window, flying away just before they could see him. He zoomed over his house in the cool night air, grateful for his blankets. He sailed up over the rooftops, over his school, and down into the backyard of his best friend Stuart’s house. Then he soared up high: over the trees and the park and his neighborhood. He flew for what seemed hours and hours. But he got tired and began to descend. It was as if his concentration was what kept him up. Breathing deeply, he landed, softly, back in his room just as he fell, peacefully, into sound sleep.

He woke in the morning refreshed, winning praise and extra cinnamon toast from his mother for staying in his bed after bedtime. After that, he got away with his escape every night.

After a time, he grew up, left home and became a man, husband, and father. He worked, traveled, and worried. He did all those hard things that grown-ups do. And, even when he was much older, when his worries troubled him and he could not sleep, he would know to lie in his bed, a seven-year-old, tightly close his eyes, calm himself by floating through his neighborhood, seeing his world from a different perspective. He’d make it back to his room just in time to fall, peacefully, into sound sleep.

His parents never found out.

What is hypnosis? What is different about hypnosis with children and adolescents? The fascinating, elusive answers to these questions are the subject of this text in general and this chapter in particular.

Ever since James Braid coined the term “neurypnosis” (Braid, 1843), ongoing debate has delayed consensus on a definition of this discipline. The 2003 American Psychological Association, Division of Psychological Hypnosis (Division 30) definition of hypnosis spawned a cacophony of criticism (Green, Barabasz, Barrett, & Montgomery, 2005–6; Barabasz, 2005–6; Woody & Sadler, 2005–6; Yapko, 2005–6; Spiegel & Greenleaf, 2005–6; Heap, 2005–6; Araoz, 2005–6; Rossi, 2005–6; Hammond, 2005–6; McConkey, 2005–6; Daniel, 2005–6). Is hypnosis a natural state along a continuum of normal waking processes? Is it a socio-cognitive phenomenon manifested by role-enactment that is labeled hypnotic? Is hypnosis simply the “cultivation of imagination” (D. P. Kohen, personal communication, September 16, 1993), or is imagination less relevant to hypnotic processes than a sense of involuntary experience and subconscious activation? What are the important differences between reverie, self-hypnosis, and therapeutic hypnosis in a clinical setting? What is the validity of hypnotizability scales in clinical work? Is hypnotizability an innate trait or a self-limiting construct? Of the characteristics assigned to hypnotic experience or trance, which are most crucial: dissociation, suggestion, relaxation, absorption, or rapport? What is trance? What distinguishes hypnosis from the myriad of other mental states and human interactions that are not hypnotic (Lynn & Rhue, 1991)?

The essence of the debate is that, lacking some discrete, objective, exclusive device that measures when hypnosis has occurred, clinicians define hypnosis from within their individual frames of reference. What is hypnosis? As Michael Heap put it, “I suspect the answer will remain: ‘It depends what you mean by hypnosis’” (Heap, 2005–6). It depends on context.

Neurodevelopment, Trance and Hypnosis

When we are born, our brains contain about 100 billion neurons (as many as there are stars in our galaxy). We maintain that number for most of our adult life, though our brains nearly quadruple in weight during its first two decades. This growth is due to the proliferation of synaptic connections from approximately 2,500 per neuron at birth to over 15,000 by age three. This is followed, throughout childhood and adolescence, by a reduction and intensification (i.e., synaptic pruning) of about a third of these connections in the adult brain. This fury of neurological activity is but an index of the psychophysiologcal development integrating motor reflexes, the conditioning of immune and endocrine systems, cognitive learning, emotional and social attunement, and more, all subsumed in “the mind.”

This process is triggered by a number of hard-wired responses. The orienting response is a phylogenetically primitive reaction to novelty that pauses attention, searches memory, and shifts autonomic state to neutral (Porges, 2011). Humans are also hard-wired for emotional resonance and attunement, such that both increased sympathetic tone (“fight or flight,” vigilance for external threat) and its opposite (comfort and social receptivity) are contagious (Siegel, 2012).

Finally, our entire psychophysiological system is driven towards seeking familiarity, consistency, and pattern recognition. The brain-body networks that we call “experience” are constantly being revised based upon incoming perception, as if we are incessantly asking, “have we seen or done this before?” As Daniel Siegel explains, memory is simply the likelihood that a given neurophysiological network will “fire” again (Siegel, 2012).

An abundance of evidence from developmental neuroscience indicates that this process of growing our minds—shifting attention to novelty, checking social interaction, and integrating this new experience through memorization through repetition—is what is commonly called trance. Clinicians can use this word “trance” to refer to this complex process of neurophysiological change in response to novelty, intentional desire to learn, or absorption in imagination and reverie.

It is often noted that children are in trance all of the time. In childhood, the impetus for curiosity, novelty seeking, autonomy, and mastery are manifestations of this growing meshwork of psychophysiological reflexes. Imagination and dreams are the conscious representation of this subconscious psychophysiological development. Children use their imaginative capacities to rehearse skills, cope with fears and challenges, and set goals for themselves. They explore their psychophysiological terrain through mother’s first touch, the comfort of satisfied hunger, the repeated surprise of peek-a-boo, balancing on two legs, balancing on two wheels, playing catch, and so on. Their drives for curiosity, novelty, autonomy, and mastery also foster creative social engagement, social learning, the sense of self/other, and the understanding of empathy (Hilgard, 1970; Olness, 1985). Current neuroscience research continues to confirm that the blossoming, malleable neurohumoral pathways that join sensory input, memory, and physiological response at these deepest levels of a child’s mind evolve into the frameworks of adaptation for the rest of their lives (Fitzgerald & Howard, 2003; Jessell & Sanes, 2012). If clinicians can conceive of developmental tasks as psychophysiological imperatives that govern the formation of mind-body reflexes and behavioral response, then it is easy to imagine kids as always being in trance and open to suggestion. It is not so much that children are “good at hypnosis,” but rather that they live in the trance of intense psychophysiological development. Children are in the business of learning how their brains and bodies are connected. They are engaged, full-time, in the process of changing their minds.

The behavioral manifestations of both trance and intensified neurological change are the same. They include focused gaze, a paucity of extraneous motor activity, decreased peripheral awareness, prolonged periods of attention, repetition, and intensified attachment, to name a few. It is therefore useful and phenomenologically accurate to equate the behavioral aspects of trance to this process of intensified neurophysiological change.

The previously noted lack of consensual definition of hypnosis is hampered by the confusion of the terms hypnosis and trance. Since trance is a neurodevelopmental imperative that occurs without hypnosis, the authors think a useful and operational definition of hypnosis is: the purposeful utilization of these nonconscious processes called trance for an expressed purpose with or without conscious awareness. The purpose of that hypnotic engagement is determined by its context. Stage hypnotists use hypnosis for the purpose of entertainment. Sales programs use hypnotic elements to sell a product. Acute trauma enacts deep subconscious processes with the same, though alienating, hypnotic rudiments. The spontaneous dissociation experienced by a sexually abused child typifies this naturally occurring trance (Kowatsch, 1991). In the case of clinical hypnosis, the purpose is to help a client or patient alter a maladaptive, conditioned, psychophysiological reflex. As James Maddocks (personal communication, July 28, 1995) declared, “While all hypnosis is not therapy, all therapy is hypnosis.”

This means that hypnosis refers to the application of a skill set involving interpersonal, multi-level communication—noticing, suggesting and responding—that is tuned to an individual. Self-hypnosis, as in imaginative play, purposefully uses one’s own trance states to help one’s self. Hetero-hypnosis is the skill set that uses interpersonal influence, often expressing more faith in the other than he or she has in him or herself. In this frame, it is not useful to refer to hypnosis as a process or procedure. These terms imply a ritual done to a person or to one’s self and place too much emphasis on the social influence aspect, as if hypnosis takes over trance. As Karen Olness has stated, the process belongs to the person who “owns the trance” (Sugarman, 2005). Similarly, hypnotic phenomena are more accurately labeled trance phenomena. This implies that one cannot be “under” or “in” hypnosis, but one can be involved in trance during which hypnotic skills are applied. Clinical hypnosis and hypnotherapy with children, then, involves a collection of competencies—communication skills, strategies, knowledge of response contingencies—that both utilize and guide trance in therapeutic directions for the purpose of healthy adaptation and expanding that young person’s capacity for psychophysiological change. Hypnosis is how we utilize tra...

Table of contents

• Cover
• Praise
• Title Page
• Dedication
• Contents
• Contributors
• Foreword to the Second Edition
• Foreword to the First Edition
• Preface to the Second Edition
• Preface to the First Edition
• Acknowledgements
• Part I: Introduction to Hypnosis
• Part II: Psychological Applications
• Part III: Medical Applications
• Name Index
• Subject Index
• Copyright