Hypnotherapy is no longer just a party trick
Hospices can use it to relieve pain and grief
When sane people — those who believe with certainty that Elvis isn’t working as a short-order cook in a Memphis diner — hear the word "hypnosis," it is likely to conjure up a spooky-looking man sporting a goatee and dangling his pocket watch at the end of someone’s nose, proclaiming the subject’s intense need for sleep.
A gimmick. A party trick. People clucking like chickens on stage at the utterance of a single word.
"Hypnotherapy has always been a fringe thing," says Richard Neves, PhD, president of the Santa Ana, CA-based American Board of Hypnotherapy. "In most states, it is not a licensed therapy."
While states do not regulate hypnotherapists, the discipline is recognized as a legitimate therapy by the American Medical Association and the American Psychiatric Association. It is commonly used to help boost athletic performance or to help smokers kick their habit. While not prevalent in hospices today, some are using the complementary therapy to address psychosocial issues, pain, and grief. The National Hospice and Palliative Care Association (NHPCO) of Alexandria, VA, also recognizes hypnosis therapy as a viable complement to required services. This provides hospices with another complementary therapy in addition to a stable of others, such as art, music, massage, and occupational therapies.
"Hypnosis is an effective tool that empowers a patient to take control of her/his response to the physical pain and the psychosocial/spiritual pain of the dying process," says the NHPCO in its reference manual Complementary Therapies in End-of-Life Care.
Neves acknowledges that the reputation of hypnotherapy suffers from the stereotypes prevalent in pop culture, but he offers hospices this dare: "If you haven’t tried it, find one [hypnotherapist] to see how successful it can be. You will see the results: a peaceful shift in patients’ behavior."
The body will respond peacefully’
Hypnosis is a therapy with roots dating back to ancient times. The most common form of hypnosis is the permissive technique, which is based upon a mutual relationship between the client and hypnotherapist. As the name implies, the client gives her permission to be hypnotized. The client then allows the hypnotherapist to guide her into a focused state of attention, increasing the power of suggestion on the subconscious.
"We’re working with the imagination, which doesn’t know the difference between imagination and reality," says Neves. "The body will respond peacefully."
Helping a patient who has unresolved issues with a loved one who is not present is one example of how hypnosis can be used. In Neves’ own experience, he has helped dying patients imagine they are speaking directly to a loved one so that they can express feelings that have previously been repressed. In those cases, Neves says, patients were able to let go and experience a peaceful death.
Hypnotherapy is the use of hypnosis to enable you to take control of feelings, behaviors, habits, and self-image, says Paul Gustafson, RN, BSN, CH, a former hospice nurse turned certified hypnotherapist and president of his own hypnotherapy practice, Healthy Hypnosis in Burlington, MA. "It is a very effective mental tool that enables people to take control of things that may have seemed beyond their control in the past. Hypnosis is a completely natural, yet different, state of consciousness from the normal waking state."
Contrary to popular belief, a patient does not surrender control to the hypnotherapist. Rather, the patient remains awake and alert and is aware of what is happening at all times. In short, patients do not have to worry about being placed in a deep trance that is followed by an awakening where the subject has no recollection of what occurred during treatment. While under hypnosis, the patient’s awareness is actually heightened and carefully focused. Patients become receptive to positive suggestions and are able to learn from the experiences perceived in the hypnotic state.
"A well-trained and experienced therapist can use the experiences perceived under hypnosis to desensitize a client’s fears, improve his self-image, or gain other behavioral or emotional goals," Gustafson says. "Goal achievement is an area of human behavior where this tool of hypnosis is very helpful. Other areas include overcoming fears, improving sports performance, stress control and relaxation, elimination of habits, gaining self-confidence, sexual dysfunction, and success motivation. Basically, if a feeling or behavior in your life is undesirable to you, in most cases hypnotherapy can be of value."
How should it be used?
As with most complementary therapies, hypnotherapy is not for everyone. Generally, patients who experience psychotic or paranoid ideation or dementia or who suffer from organic brain syndrome are not candidates for hypnotherapy. In addition, patients unwilling to be hypnotized or who have cultural or religious beliefs that frown upon the practice of hypnosis should also be excluded.
The NHPCO offers the following guidelines for using hypnotherapy:
- An interdisciplinary team should determine if the patient is an appropriate candidate for hypnosis intervention to reduce symptoms of physical and/or psychosocial/spiritual discomfort.
- The patient should have a willingness and the cognitive ability to participate in hypnosis.
- A certified hypnotherapist should be available to facilitate the hypnosis.
- It should occur in an environment that is conducive to the therapeutic process.
During the course of a session, the hypnotherapist will rely on the natural process of opening one’s subconscious mind for a period of time. During relaxed moments, the hypnotherapist will try to help the patient perform two different but related tasks: removing old, unhealthy, or unwanted values and patterns, and replacing them with new, healthy, desirable ones.
Neves recalls working with a dying patient who had some unresolved issues with a family member who was not present during her illness or as death approached. Prior to dying, the woman was having a difficult time letting go because she had feelings she desperately wanted to share with the family member. Neves placed the woman in a hypnotic trance where she envisioned the family member, which gave her the opportunity to unload her emotional burden.
"She was able to let go and died soon after," says Neves. "I have a number of stories like that."
Gustafson describes the subconscious mind as a place where one stores beliefs and values and which controls our bodily functions. On the other hand, the conscious mind judges, critiques, and approves or disapproves of what gets stored in the subconscious. The conscious can send back unhelpful or unproductive values and beliefs for the subconscious to store. Hypnosis is used to reinforce productive values and to weed out unhealthy ones.
"We all go in and out of trance many times a day," says Gustafson. "We call it daydreaming, staring, or zoning out. Have you ever driven to the store and realized you remembered no details of the drive? You were in a hypnotic trance."
Ensuring quality
One of the drawbacks to hypnotherapy is the lack of regulation, which would help ensure quality by forcing practitioners to earn a license to practice the discipline. But that should not exclude the therapy from all hospice programs. Instead, the NHPCO offers the following recommendations to help ensure the quality of hypnotherapy provided in hospices:
- Appropriate policies and procedures should be in place, including a job description for hypnotherapists, certification requirements, and documentation requirements.
- Comprehensive assessments must identify patient needs and desires.
- Hypnotherapists should collaborate with the interdisciplinary team.
- Hospices should be sure to use only certified hypnotherapists.
The last point deserves emphasis. Because there are no governmental safeguards to ensure a therapist has demonstrated an expertise in the discipline, health care providers must rely upon the industry to weed out the charlatans from the experts. Hospices can obtain a list of certified hypnotherapists from the American Board of Hypnotherapy and the National Guild of Hypnotists in Merrimack, NH.
Nurses’ role
While a hospice may be willing to allow hypnotherapists into their stable of complementary therapy clinicians, costs may prevent them from bringing one on board. According to the NHPCO, there are grants available, provided the hospice is willing to track data collected from hypnotherapy visits. Hospices can also rely on donations and their operating budget to pay for the programs.
Still, hospices that cannot afford hypnotherapists can rely on basic techniques rooted in hypnotherapy to help their patients overcome their problems. "Once you earn the family’s trust and can get them more relaxed and focused, you can nearly always dramatically enhance their ability to cope and to manage the daily changes and inevitable hospice surprises by what you say and how you say it," Gustafson says. "Most hospice families are ready and eager to hang on every word the hospice nurse has to say. They want straight answers, guidance, and empowerment. Seize the moment. This is what all nurses are looking for, to teach important things to people in need and get positive results."
Early in Gustafson’s hospice nursing career, he realized that the hospice population was starving for a compassionate ear following a grim diagnosis and torturous treatment. Because patients are eager to share their feelings, hospices nurses are usually ready to listen. Allowing for these cathartic experiences places nurses in a position to provide helpful words.
"Your job is easy; just ask open-ended questions, get comfortable, and let them run with it. When you think it’s time for you to speak, don’t. Listen a little more. Give them all the time they want," Gustafson says. "This simple process of actively listening does three things: It supplies you with information, it creates a trusting therapeutic relationship, and more importantly, it helps them to relax and focus. You can almost see the relaxation unfolding as they speak."
Once you have your hospice family relaxed and focused, Gustafson says, how you speak and what you say can offer profound impact and direction. Nurses should speak slowly and confidently, with direct eye contact and positive, affirming tones. One statement should build on the next. For example: "You’ve shown that you can manage his pain, and there is enough medication in the house." Any victory along the way is praised and added to your laundry list of positive review topics, such as: "You did a great job repositioning him in bed. You’ve also made excellent decisions using the breakthrough medication, and you know you can call us any time."
Packaging distracting emotional debris can open the mind for direction, validation, and clarity in a way that supports continued growth and success, adds Gustafson. The more order and control are created, the more relaxed and focused the patient becomes. When a nurse’s words and suggestions reach the patient’s subconscious, a patient’s ability to cope and make difficult decisions is enhanced. In short, the nurse’s words become the patient’s or family member’s words, as well as their actions.
"By understanding the principles of suggestion and how the conscious and subconscious minds work, hospice nurses can empower effective change with every move they make," says Gustafson. "The repetition of supportive constructive suggestions and affirmations to those in a more relaxed and focused state of mind can have an enormous therapeutic effect. Good nurses know the obvious advantages of reducing stress and putting their clients at ease. By also practicing these simple communication techniques, your hospice families will be much more autonomous, confident, and in control during this difficult transition."
[Editor’s note: For more information, contact the American Board of Hypnotherapy at (800) 872-9996 or the National Guild of Hypnotists at (603) 425-9438.]
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