Question The name is derived from ‘ideo’

Question 1 
Describe Ideomotor Responses (IMR) and its installation. Discuss briefly when you would use IMR and the benefit and limitation of this technique. 

Ideomotor Responses (IMR) 

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An Ideomotor Response (IMR) is a technique that can be used during a hypnotherapy session to communicate with the patient whilst they are in trance – asking the sub-conscious mind questions and receiving answers using finger motions to signal ‘yes’ or ‘no’. The name is derived from ‘ideo’ meaning idea and ‘motor’ meaning movement and refers to the immediate involuntary movement of muscles responding to thoughts, feelings and ideas.

Allen (2016) explains that there is a belief amongst many therapists that asking patients to speak during hypnosis can interfere with their depth of trance. IMR provides therapists with an easy non-verbal way to receive answers from their clients, whilst maintaining their trance.

Installation 

IMR is installed in a directive manner by telling the patient’s unconscious mind how to communicate. Whilst the patient is in quite a deep trance the therapist asks the patient’s unconscious mind to take over and raise the right index finger to indicate ‘yes’ to any questions posed. This can be confirmed by asking the patient to slowly raise that finger and acknowledge the instruction. After observing the movement, the therapist would thank the unconscious mind and repeat with the left index finger which will be used to indicate ‘no’. After witnessing the ‘no’ finger moving the therapist would thank the unconscious mind again and return to the session. 

Benefits and Limitations 

If a therapist wishes to use IMR with a patient, they should seek their permission to do so before beginning the hypnotherapy. 

Using IMR to communicate with the unconscious mind can result in more accurate answers being given than may be achieved by communicating with the more analytical, conscious mind.  This makes it a useful way to check the efficacy of therapy as it is more difficult to be dishonest when using IMR (Erickson1998; McColl 1998).  

IMR can also be helpful when dealing with introverted patients, patients who find it hard to verbalise their problems or those whose conscious memories are blocked, perhaps due to trauma. 

Clear communication is vital when asking questions – the therapist must be careful to ask only one simple question at a time to which the client can clearly answer ‘yes’ or ‘no’.

References 

Allen R  (2016) Scripts & Strategies in Hypnotherapy, The Complete Works Crown House Publishing Limited   
page 263

Erickson M (1984) Life reframing in Hypnosis Irvington Pub; Har/Cas edition 
pp74-75, 87, 210 

McColl D (1997) Precision Therapy: A Professional Manual of Fast and Effective Hypnoanalysis Techniques Ashgrove Pr Ltd  
pp 43, 48 

Question 2 
Hypnotic   phenomena   can   be   spontaneous   or   suggested   by   the hypnotherapist. Discuss the ethical considerations making reference to specific hypnotic phenomena.

Some of the most commonly occurring hypnotic phenomena are catalepsy, ideosensory activities, ideomotor activities, amnesia, dissociation, hypermnesia, regression, revivification, pseudo-orientation in time, analgesia, anaesthesia, hallucinations, automatic writing and time distortion.  These phenomena can all be experienced during an individual’s normal ‘awakened’ state, or during a hypnotic trance – either spontaneously or in response to the hypnotherapist’s suggestion.

Yapko (2012) explains that the phenomena themselves are neither ‘innately positive, nor are they innately negative in character’ rather the way they are applied by the therapist can result in problem resolution or exacerbation. Therefore, before suggesting the patient experience hypnotic phenomena, the therapist must carefully consider all potential contraindications. Prior to utilising catalepsy or ideomotor responses the therapist should enquire regarding physical limitations. Before using regression or revivification to address past trauma, the therapist must consider the client’s state of readiness for the treatment and be confident that they have been adequately prepared using ego-strengthening or similar. It is also helpful to have a safe place of relaxation ‘prepared’ should the patient experience any abreaction.   

Any hypnotic phenomena employed should work towards the client’s goals and address the problems they are seeking to resolve. If a patient has accepted a post hypnotic suggestion and seeks to complete it, but is unable to do so for any reason – internal conflict or external factors – this can result in significant levels of anxiety.  Kroger (xx) therefore emphasises the importance of ensuring that post hypnotic suggestions are not ‘of a bizarre nature, but in keeping with the subject’s needs and goals’. 

If a therapist plans to deliberately employ a specific phenomena he must first make reasonable checks that it will be in line with the patient’s beliefs and therefore in their best interests. To omit these checks could inadvertently create additional issues. For example, a therapist considering past-life regression should seek prior consent to ensure it is not contrary to the patient’s beliefs and therefore undesirable for them – any experience of past-life regression for someone who is religiously opposed to this could cause them additional distress rather than assist them.    

Phenomena should never be used for the therapists ‘advantage’, such as asking the patient to employ amnesia to a specific moment of therapy that the therapist feels he did not handle well. 

 

References
Yapko M (2012) Trancework – An Introduction to the Practice of Clinical Hypnosis, Fourth Edition Routledge   
page 343 

Kroger W (2007?) Clinical & Experimental Hypnosis revised second edition Lippincott / LWW? 
P14

Question 3 
Critically differentiate between the use of permissive and authoritarian approaches in Clinical Hypnosis.

Historically therapists took a direct – authoritarian – approach to hypnotherapy with their clients. This covered the whole process from the chosen method of induction and deepener to the suggestions they gave them for change. Therapists believed that giving the patient explicit instructions on how to enter trance and exact post hypnotic suggestions to change and reprogramme their behaviour was the most effective way to elicit change. However, when Milton Erickson started practising hypnotherapy, he used indirect or permissive approaches, suggesting ways in which the unconscious mind may wish to explore the various possibilities for change before deciding upon a response. Both methods are widely used today and can be combined together to great effect with each having its own advantages. 

Generally, authoritarian approaches are best suited to patients who are used to receiving or giving orders in their daily lives such as servicemen, policemen or teachers, or those who have very logical minds such as mathematicians or scientists. These individuals appreciate receiving very clear instructions, giving them confidence in the process and its outcomes. They are also ideal for reprogramming ‘negative’ behaviours that clients wish to change, such as stopping smoking or overeating where the issuance of an instruction gives no room for error.

Permissive approaches are more beneficial for patients who do not respond well to authority, who find a direct approach too threatening, or who are anxious. Children also tend to respond well to more indirect approaches. An permissive suggestion creates the expectation of change whilst leaving it open to the client’s unconscious mind to work out the best way of making that change – leading to something that suits them personally.       

Ultimately, the therapist has to judge what they think is the best approach for each client’s personality to most effectively help them achieve their goals. Therapists may choose to blend the two approaches by altering both the style of their language and the intonation and speed of their voice to create a strong expectation of change. For example, the therapist could use direct instructions to tell the patient to cease eating unhealthy food and favour healthy foods, combined with indirect suggestions asking the client when they will start to notice the benefits of their new lifestyle such as increased energy, clothes starting to fit better or feel loose etc… 

Bibliography 

Bryant M, Mabbutt P (2006) Hypnotherapy for Dummies John Wiley & Sons, Ltd  

Question 4
Critically   evaluate   the   differences   between   the   conscious   and   the unconscious mind and discuss these in the context of a hypnotic session.

The ‘conscious’ and ‘unconscious’ are names used to articulate the theory that there are different aspects to the mind. Although these aspects are impossible to prove it is a widely accepted principle that they exist. There have been many theories over the years attempting to explain both the phenomenon of hypnosis and the capabilities and differences between the conscious and unconscious minds. This discussion will focus on some of the more recent and most widely accepted principles.  

The conscious mind is alert to everything that we are experiencing now and uses logic, numbers and words to assess what reaction to have in any given moment. Its assessment utilises memories, beliefs and feelings, all of which are stored in the unconscious, in order to make its decisions. Everything that is in the conscious mind must therefore also be in the unconscious mind, which means that the unconscious mind is significantly larger than the conscious – the image of an iceberg where 20% (the conscious) is above the water and the remaining 80% (the subconscious) is below it is often used to explain this. 

The unconscious mind does not know the difference between something that was ‘imagined’ (such as a visualisation) or real. It processes information simultaneously, rather than sequentially and without the need for logic (like the conscious mind). It can link multiple internal resources together in order to make a decision based upon intuition. These qualities mean that a good way to alter an individual’s ‘learned response’ is through visualising an experience in the future turning out in line with the individual’s goal (e.g. rather than repeating previously experienced fear based behaviour), allowing patients to overcome fears such as public speaking or even rehearsing to remain calm during the birth of a baby. 

During a hypnotic session, the therapist takes the patient into trance, diminishing the analytical,  conscious mind and communicating directly with the unconscious which is very receptive to suggestion – making changes to the ‘programming’ in a patient’s mind more likely. After hypnosis, when the conscious mind references the unconscious for memories, beliefs and feelings to make its ‘every day’ decisions the programmes that have been changed via hypnosis are accessed – enabling the conscious to make new choices.  Thus the most effective and long-lasting way to make different decisions and change behaviours is to change the references stored in the unconscious. 

Bibliography 

Bryant M, Mabbutt P (2006) Hypnotherapy for Dummies John Wiley & Sons, Ltd  

Barg J & Morsella E (2008) The unconscious mind Perspectives on Psychological Science, 3(1): 73–79
https://www.ncbi.nlm.nih.gov/pubmed/18584056 

Vrabel J & Zeigler-Hill V (2017). Conscious vs. Unconscious Determinants of Behavior. . 10.1007/978-3-319-28099-8_1124-1. 
https://www.researchgate.net/profile/Jennifer_Vrabel/publication/312154445_Conscious_vs_Unconscious_Determinants_of_Behavior/links/59cff5ab4585150177ee23ba/Conscious-vs-Unconscious-Determinants-of-Behavior.pdf

Question 5 
List and discuss the contraindications to the use of hypnosis giving specific examples.

Therapists treating patients using hypnotherapy should be aware of a number of possible contraindications. 

The dangers of the method – The therapist should take a thorough background of the patient and any medical conditions or limitations to inform the choice of treatment plan – including the induction and deepener scripts and the post-hypnotic suggestions.  For example avoiding certain scripts for patients with physical limitations (1) someone who suffers with arm or upper shoulder / back pain should not be asked to take part in a handXXXX induction (2) someone with acute hay fever should not be asked to imagine walking through a meadow of long grasses or strolling through a flower garden (3) an individual who is scared of heights should not be encouraged to imagine standing at the top of a tall flight of steps and walking down. 

Symptom removal –  If a patient is seeking the removal of a symptom, the therapist must not just remove the symptom, but they must also replace it with something more positive. If the symptom is simply removed then the space it leaves could be filled with something worse. Because some symptoms may provide a secondary benefit for the patient (which may appear dysfunctional) the replacement suggestion should take the benefit into account and provide that same benefit in a more functional manner.  If someone is seeking treatment for chronic pain then, assuming a doctor has agreed there is no underlying medical issue, a posthypnotic suggestion of reduced pain is appropriate. However, the therapist must leave the body’s pain response for indicating any other problems as they arise. 

The dangers to the therapist – Because therapists provide care on a one-to-one basis there are potential dangers inherent in this situation, such as patients becoming dependant upon them, clients accusing them of unethical conduct and of being subject to physical attack. With no one to give them independent, constructive feedback therapists must also be mindful of avoiding their own delusions of grandeur.      

The dangers of drink, drugs and organic brain conditions – Clients could be abusing alcohol,  recreational or prescription drugs, or self-medicating. All of these could interfere with their mindset. It is therefore important to enquire into these during the introduction (subtly!). Should the patient indicate they have any history of organic brain condition then treatment must not be started without the express consent of their GP. 
 
Question 6 
Explain what are the six stages of hypnosis with particular reference to the objective and significance of each stage

There are six stages to a hypnotherapy session and all six stages should be practiced during every session.  

Stage 1 – Introduction
Most patients are a little nervous about their first hypnotherapy experience and many have false expectations of the process from parodies they have encountered. The introduction’s purpose is two-fold – to put the client at ease, building rapport with them and for the therapist to understand the presenting problem and decide upon the best treatment protocol. Because hypnotherapy is a collaboration between the therapist and patient, a good relationship is vital and must be established so the therapist inspires complete confidence in the patient.  

Stage 2 – Induction 
The therapist seeks to induce a hypnotic state with the patient by encouraging them to focus their  attention on one specific thing and then direct their attention inwards, creating focused attention. By focusing the patient’s attention onto one specific stimulus – the therapist’s voice – the conscious mind is ‘busied’, providing an open channel to the unconscious, which tends not to analyse each suggestion. 

Stage 3 – Deepener 
Deepeners are used to manage the patient’s level of hypnotic trance by furthering their relaxation often via suggestions of drowsiness and continued focused attention. It is helpful if scripts are created to favour the patient’s ‘primary’ sensory modalities to describe the scenario – making it easier for them to hand over to the subconscious. 

Stage 4 – Therapy of Post-Hypnotic Suggestions 
Specific suggestions are delivered to work on the presenting issue using the most suitable treatment protocol. These can be delivered in a variety of ways – directly, permissively, via story telling or metaphors. The suggestions provide the patient with alternative ‘beliefs’ and ways of acting or reacting after the hypnosis has ended. 

Stage 5 – Awakening 
Patients must always be awoken at the end of the session, removing any suggestions that have been given to alter their receptiveness to certain stimulus such as noise or pain or to change their perceptions such as the heaviness of their own limbs. After considering awakening a patient will often experience a level of increased suggestibility. Positive suggestions, known as ego strengthening, to suggest good health and reinforce the effectiveness of the post-hypnotic suggestions can be given at this time. 

Stage 6 – Homework 
It is important to give patients homework to ensure their motivation for change continues. This could be self-hypnosis or journaling.   

Bibliography 
Hammond D Handbook of Hypnotic Suggestions and Metaphors W.W. Norton & Company 
Page 11  
Karle H & Boys J (1987) Hypnotherapy – A practical handbook Free Association Books 
Page 22 
Rosen S (1991) My Voice Will Go With You The Teaching Tales of Milton H. Erickson W.W. Norton & Company
Page 27