Resistance Shelly Johnson Gottsegen, LICSW Hypnovations April, 2010
Definition: • “A force that works against the aims of treatment.”
Resistance • According to Michael Yapko, PhD a preeminent psychologist, hypnotherapist, author and teacher: • “Resistance is a real force to reckon with in treatment, and can be tied to one or both of the two main areas of treatment,: resistance to hypnosis, and/or resistance to therapeutic progress” (Yapco, p.527)
Resistance • And: • “…the responsibility of the clinician is to structure suggestions responsibly and competently to maximize the likelihood that they will be accepted and translated into a therapeutic change”.
Resistance • “When a client reacts in unexpected ways, the person is choosing (at some level) to do so and your role is to be as supportive and helpful as possible.” • The importance of allowing the client to feel accepted, understood, respected and likely to be helped cannot be over stated.
Resistance to Hypnosis or Treatment? • Determine if: • Fear of hypnosis • Fear of treatment progress • Fear of change • All of the Above • Collaborate with patient to address the resistance
Resistance • Utilize resistance as an opportunity to deepen understanding and to provide direction for treatment. • Example:And when you feel quite comfortable sitting, you might discover a growing curiosity about how it would feel to walk across the ice and when you are ready to do so….
Reasons for Patient Resistance • Fear of change • Misconceptions about hypnosis • Symptom has secondary gain • Dynamics in the therapeutic relationship • Self -Protective • Expectation of negative results • Religious and Cultural beliefs
Resistance • When resistance occurs, the clinician takes responsibility and uses the opportunity to adapt the treatment method. • Adopt a permissive style that emphasizes flexibility in following the lead of the client.
Resistance • Resistance is much less a debilitating factor when it is viewed as an acceptable response. • Suggest possibilities in a way that encourages individual choice and control.
Examples of Suggestions • You can allow your eyes to close, if you would like. (eye closure) • You may choose to uncross your legs. (Postural shift) • You might be willing to let yourself relax even more deeply. (Deepening) • It’s possible to experience your body differently. (Perceptual shift) • Perhaps you can remember a time when you felt comfortable, (Age regression)
Use a Metaphor to address the Resistance • Tell a story that reflects clients resistance and option for resolution • Example: Like dropping a pebble in a lake and watching the ripples it takes time and patience to feel calm.
Unconscious issues causing resistance: (ASCH) • Hidden client issues • Dissociated issues • Repressed issues • Symptom has secondary gain • Client came for different reason than stated reason • Hypnosis Resistance – Hypnosis complications: Hypnosis brings up previously uncovered material which interfere with hypnosis process • Trust in the unconscious
Make Hypnosis Safe (ASCH) • Accept: “it is understandable…” • Normalize: “Many people wonder…” • Educate/demystify: “ hypnosis/trance is…”, “You are in control of your hypnotic experience…” • Collaborate/Rebalance power: “We will find out together…” • Negotiate: Would it be alright if…”
Utilizing Resistance (ASCH) • Be permissive – all patient’s responses are ok • Build a “Yes set”: “would it be alright to and would it also be ok if you…?” • Use of negatives to obtain a positive: “you want/need to…do you not? • Provide the illusion of choice for greater patient choice • A patient’s hand won’t levitate say “And I don’t know whether it’s the left hand or the right hand that has gotten too heavy…”
Utilizing Resistance for induction: (ASCH) • Offer easy to comply with Suggestions • Foster a successful experience • Pace suggestions for a positive and controlled response • Monitor for signs of distress • Communicate with the client, in and out of trance, about the hypnotic experience • “Stay with the client” and adapt for a successful outcome
Utilizing Resistance during deepening: (ASCH) • Offer neutral suggestions for increased comfort and relaxation • Monitor depth • Monitor body language for signs of distress and address the distress • Validate, reassure and comfort • Communicate with client during hypnotic experience
Utilizing Resistance during Re-alerting/terminating trance: (ASCH) • Specify expectation for successful re- alerting • Give permission to re-alert at own speed • Be firm • Ascertain full alert • Process hypnotic experience together • Plan for next hypnotic experience
Caveats- Patients that may not be suited for hypnosis, especially in the beginning of treatment:(ASCH) • Severely depressed (Catatonic, psychotic) • Suicidal • Psychotic • Organic brain injuries or syndromes • Borderline Personality with thought disorders and/or psychosis (severe)