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Incorporating Hypnosis into a Cognitive Behavioral Treatment Program
by Richard Blumenthal, MS, NCC, LMHC
*The author acknowledges with gratitude the critical comments made by Dr. Daniel L. Araoz and Dr. Albert Ellis in the preparation of this article.
The effective use of suggestion is important to all who practice clinical hypnosis. In this article, the therapeutic goals and philosophical foundations of RET are combined with the principles of cognitive suggestion, producing a hybrid therapeutic approach, Rational Suggestion Therapy. Three phases comprising a total treatment are explained, while exploring some of the historic and current theories of suggestion and rational thought. Pertinent concepts are drawn most notably from the works of Ellis, founder of Rational-Emotive Therapy; Baudouin, practitioner and author at the original New Nancy School: and Araoz, modern proponent of the New Hypnosis. Other references and extrapolations attempt to join these independently effective approaches into a coherent mode and encourage the use of the subconscious in psychotherapy.
In recent years the rational ideas of Albert Ellis and others of the Institute for Rational-Emotive Therapy have served as a definition of mental health for a large segment of American counseling and psychotherapy (Heesacker, Heppner and Rogers, 1982; Smith, 1982). Since its inception, two ongoing concerns of RET have been the speed and effectiveness of treatment, and many varied techniques are employed in the pursuit of therapeutic efficiency. Perhaps this willingness to expand its horizons combined with the adaptability of RET's theoretical foundations are responsible for its continued success and wide use.
Much of the effectiveness of RET depends on the completion of homework assignments designed to act as relearning devices (Walen, DiGuiseppe and Wessler, 1980). To be learned are ideas deemed appropriate substitutes for irrational ideas. It is the aim of RET to enable the client to have at his/her disposal ideas which comprise an appropriate philosophy of life - an elegant solution to psychological difficulties (Ellis and Harper, 1975). If the client eventually is able to experience spontaneously an appropriate emotion or behavior without conscious deliberation, it seems proof of a breakthrough in treatment. The rational philosophy serves as preparation for situations as yet unencountered and may be considered as a consciously arrived-at body of autosuggestion. It has been theorized that autosuggestion, rational or not, forms a subconscious predisposition to specific emotional and behavioral reactions (Araoz, 1981). We seem to be in a continual process of suggestion-reaction-suggestion. Autogenic Therapy (Luthe and Schultz, 1969), coping statements (Meichenbaum, 1977), rational disputation (Walen, DiGuiseppe and Wessler, 1980) and other self-talk techniques are effective methods of conscious deliberate attempts to intervene in unhealthy suggestion cycles. These may be supplemented with subconscious therapy, the rational suggestion.
CONDITIONAL SPONTANEOUS AUTOSUGGESTION
Of the work at the New Nancy School in the early part of the twentieth century, one of the greatest contributions was the recognition of conditional spontaneous autosuggestion (Baudouin, 1922). Emile Coue reported numerous cases in which he brought remarkable relief after one or two sessions to individuals who suffered physical or emotional symptoms, experienced in association with activating conditions. Each time the conditions were experienced the same symptoms surfaced. Coue theorized that perhaps the first time the event took place the reaction may have been due to a genuine physical disorder. Thereafter, the expectation of the symptom alone was strong enough to repeat the first reaction spontaneously. This expectation Charles Baudouin (1922) called conditional spontaneous autosuggestion. An idea learned from prior experience had been employed without conscious deliberation when triggered by key conditions similar to the original experience. With each subsequent experience, the autosuggestion became more and more a part, of the event, and soon an entrenched habit was formed. By using a counter-suggestion to replace the original autosuggestion, thus forming a new and purposeful conditional autosuggestion, Coue showed the power of autosuggestion as it reaches out from the subconscious (Baudouin, 1922). It would appear that the principle of conditional spontaneous autosuggestion is at work to a more or less degree in every problematic situation which could be the focus of an RET treatment. Even under previously unexperienced conditions, autosuggestion will arise from actual or imagined similarities to prior conditions. Reintegration learning theory (Hulse, Deese and Egeth, 1975) shows that a part of either the stimulus (conditions) or the response (learned autosuggestion) is enough to elicit the entire learned stimulus/response pattern. For this reason, ideas translated into autosuggestions may have extremely wide applications. This is especially true of ideas concerning the self.
It is desirable to attempt to alter un- profitable autosuggestion with rationally developed autosuggestion in advance of anticipated conditions. This technique may be used for the immense benefit of the individual whose current ideas are working against his/her own best interest.
The aim of Rational Suggestion Therapy (RST) is to master autosuggestion by using the therapy arena to enable the individual to control the source of autosuggestion. The conscious self becomes the source. A rational decision is made by the client to seek a change in ideas. We may call this decision-making process, the first of three phases in RST, the theoretical phase of treatment. In the light of RET, the client with the aid of the therapist imagines and agrees to more appropriate ideas. The practical phase is next, offering the new ideas to the subconscious. This is followed by the spontaneous phase which occurs outside the treatment arena, during in vivo experience, The spontaneous phase is the measure of success of the treatment because it is in this phase that the client either experiences the desired spontaneous autosuggestion or not.
THE THEORETICAL PHASE
RST is a cognitive technique making a basic assumption: that suggestions be aimed at ideas rather than behavior or emotion. The idea is the genesis of emotional or behavioral expression (Ellis, 1973). RST does not block expression. It attempts to improve the ruler of expression, ideas. If the symptom alone is blocked without a fundamental improvement in the causal idea, that idea will exert influence on another area (Ellis, 1973), seeking to establish a new association of conditions and behaviors, as real and imagined alternatives become available to the individual.
Because the suggestion is a rational idea (Ellis, 1973), its use may have positive results in more than one set of conditions, wherever the idea may he applied. The subconscious finds a means for the in vivo realization of the suggestion, even if the specific means has not been suggested. This is known as the law of subconscious teleology (Baudouin, 1922), and explains the movement of ideas implied by one experience and applied to a different one. For example, an idea assimilated in childhood may be the cause for adult behavior because of the symbolic yet logical nature of sub- conscious thought. No matter the dissimilarities of the material conditions, if autosuggestion is at work, the subconscious will find a way to make the idea suit the event symbolically and achieve the suggested outcome.
It is therefore imperative that suggestions deal in ideas which may be usefully applied to many possible situations. If an idea is truly to work for the person, it will work in the most extreme applications, and in conjunction with other rational ideas. Rational suggestions agree with and support one another, creating a rational philosophy. In RST, the therapist's function is not to trace the original conditions of the autosuggestion, simply identify the autosuggestion and, if need be, enable the client to replace it. It is also important to note that RST involves an exchange of ideas, not only the elimination of an inappropriate one. Without a new idea to take the place of the un- wanted one, there is no telling where the new autosuggestion will come from and the results will probably be lacking.
THE PRACTICAL PHASE
Once the new ideas are agreed upon by the client and the therapist, the practical phase of RST begins. Conscious opposition to spontaneous autosuggestion is difficult. There appears to be a direct conflict between the conscious and the subconscious. Baudouin (1922) called this the law of reversed effort, observed time and again at the New Nancy School. Attempting to force the acceptance of a new idea against the wishes of the sub- conscious, has the reversed effect of obsessively concentrating the mind on the undesired idea, frustrating the individual's willful efforts.
If we are to resolve this conflict between conscious and subconscious, the subconscious must be appealed to in order for it to conform to the will of the rational conscious. It is postulated that induction into a suggestible state of consciousness is actually focusing the mind's attention on the creative, imaginative part of the brain, the right hemisphere (Araoz and Bleck, 1982). When right hemisphere focus is attained and the individual is dissociated from the surrounding reality and engrossed in an inner reality (Araoz, 1982), the subconscious mind is accessible. This outcropping of the subconscious (Baudouin, 1922) becomes an alternate, though no less cognitive, state of consciousness (Fromm, 1977). During the outcropping, suggestibility is heightened and the subconscious may be addressed directly and purposefully.
While the conscious mind has difficulty willing away unwanted thoughts, it is with relative case that most people can be shown the difference between rational and irrational ideas (Ellis and Harper, 1975). It is the willingness to accept a new idea as desirable, not necessarily the self-discipline to consciously practice it (though this of course is also welcome) that is necessary in RST. If the client accepts the idea to the point of wishing to possess it, earnest per- mission by the client to be placed in a suggestible state for the expressed purpose of learning and employing the new idea, will enable the therapy to be effective (Araoz, 1982). The degree to which permission has been granted seems to be in direct proportion to the satisfaction of the conditions contained in Daniel Araoz's (1982) TEAM acronym (trust, expectations, attitudes and motivation), required for hetero-hypnosis. In this sense, there is no suggestion, only autosuggestion as Coue believed (Baudouin, 1922). Permission may be used as the start of any ritual model for hypnotic induction, and is implicit in the subtle New Hypnosis induction techniques (Araoz, 1982). TEAM-work is sought throughout the three phases of RST.
THE LANGUAGE OF THE SUBCONSCIOUS
Using the language of the client's subconscious will help in the creation of effective induction and suggestion. Observation of the client's idiosyncratic communication patterns, is a means for determining what language will reach the subconscious mind. Clues are found in the nature of the images exhibited. Araoz (1983) points out the necessity for the therapist to set aside personal preferences for imagery and concentrate on the client's inclinations. Words, figures of speech, analogies and other communication forms which reveal subconscious representations belonging to the sensory apparatus of sight, taste, smell, hearing and kinetic sensations, including skin contact, may be observed and used by the therapist in "connecting" with the client (Araoz, 1983). This client-centeredness is the essence of the New Hypnosis (Araoz, 1982), which does not recognize any individual as unhypnotizable. The New Hypnosis paradigm need not be limited to hypnotic induction, and may serve well for wording the actual suggestion, using terms and phrases which will connect with the individual.
THE SPONTANEOUS PHASE
Following the observation of in vivo experience, the client reports on the results of therapy. If no change has occurred, it could mean that the application of the suggestion is too limited and the applicable conditions did not arise. Since nearly every day presents us with some form of adversity or dissonance, it would seem that the troubled individual would find reason to employ newly acquired rational ideas in a short time. This does not mean that the suggestion had not been absorbed, it is merely a case of suggestion a longue echeance, in which the suggestion is subconsciously stored until the moment the suggested activating conditions are met (Bernheim, 1884). Poor results could also mean that the selected idea was not the true cause of the symptom, or was couched in obtuse language. In any case, the client's observations become the new presenting problem for a return to the Theoretical Phase. If the required suggestion remains the same, reinforcement is needed. Tapes and autosuggestion training are helpful.
Otto Rank (1936) in his challenge to the practice of psychoanalytic therapy, addressed the psychoanalysts' fear of suggestion, an "undesirable" they accused Rank of fostering by his utilization of the present in Will Therapy (Rank, 1936). Rank exclaimed: "One does not escape, however, because one refrains from consciousness of it or denies it completely. However passive the analyst may keep himself otherwise, in the last analysis his interpretations are suggestions, for he suggests to the patient a definite ideology or attitude...If I could heal by means of suggestion, I should do so without being ashamed of it" (Rank, 1936, pp. 110-111). Richard A. Blumenthal, M.S.
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All material contined herein (c) Richard A. Blumenthal
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