The Anatomy of a Great Session

by Tim Brunson, PhD
The purpose of any therapeutic session is to relieve the discomfort and suffering of another person and return them to a state of happiness and contentment. This typically involves a presenting problem – although the clinician may uncover other issues that must be addressed initially. The structure of the session is critical to its success. In this article I will share with you a process which I currently employ with many of my hypnotherapy clients.
For the purpose of this article it may be helpful to regard the person seeking help as a patient. Regardless of the traditional and preferred terminology of a particular helping profession, the word patient denotes a person who is experiencing an "enduring situation that is causing discomfort." Realizing this and having a compassionate attitude is helpful.
I must warn you that there are three major mistakes that clinicians often make during a session. The first is to allow an uncontrolled and unstructured session to exacerbate – rather than alleviate – the presenting problem. Secondly, the clinician may tend to use the session to address their own unresolved issues. A session with a paying client is not the appropriate time to conduct self-therapy. And third – and related – a session may be seen as an opportunity to address the clinician's ego issues through inappropriately impressing the patient as to their importance and value. The session must be all about the patient and be considered successful only if it reaches the therapeutic intent.
When a person initiates contact and makes an appointment with a clinician, they are in a stressful situation. Therefore, the session must be initially structured to give them the assurance that you are going help them relieve this stress. I find that starting off by listening in a non-threatening way is the best approach. Typically, I'll start by saying something like: "I understand that you are here today to address your concerns regarding your hair pulling habit. Can you share with me some your background regarding this?" At this point I am much more concerned about process rather than content. My goal here is to allow them to relieve stress through talking. I'm also calibrating to their communication style and developing verbal and non-verbal rapport. This helps establish me in their eyes as a person who is going to help alleviate their stress. The content of their statements is secondary – even though I'm vigilant of any facts that may indicate that I should not proceed and noting any significant information regarding the nature of their concerns. It is also the time to start noticing patterns regarding how they represent and express the presenting problem to themselves. My questions at this stage are generally limited to discerning the origin and nature of the problem as well as what they have previously done to resolve it.
This initial stage is one of listening to the patient. The clinician should show empathy and understanding while striving to interfere as little as possible with their discourse. Empathetically signaling with your expressions and timely taking notes on their chart shows them that you are listening. Your verbal expressions should be short, such as "I understand" or "can you tell me more?" Of course, be careful to avoid any distracting behavior such as doodling, checking your cell phone, looking at your watch, and taking notes other than at times that appear to reinforce the feeling of empathy. These bad habits lead to the subject feeling that you have other priorities. After all, they are paying for your time and should expect that your eyes and ears will be on them.
What you want to be careful of is making sure that you don't allow the patient at this stage to get into a negativity spiral. If this happens, you will lose control of the session. They will do nothing but reinforce the presenting problem. Their stress level will increase and they will not regard you as a solution to their problem. You will most likely never see them again.
Another thing to avoid is allowing turning this initial listening stage into an opportunity for you to express your opinions and making this session all about you. This particularly happens when you begin paraphrasing their statements and informing them of the importance of what they just said. This will backfire for three primary reasons. First, it will interfere with the rhythm of their communication – thereby raising their stress. You will be seen as a stress-creator instead of a stress-alleviator. Second, despite your altruistic intent, this will make you appear to be slow, dimwitted, and not very intelligent. You will appear to be having a problem comprehending what they are saying. And lastly, you may come across as insulting their intelligence as it will seem like you are implying that their brain is incapable of establishing meaning and understanding without your help. While this communication pattern may be helpful when working with pre-school children, most adults – to include the surgeons, professors, and business owners with whom I frequently work – will feel rather affronted. There will be time that paraphrasing a client's statements may serve to insert needed processing time into the flow of communication. However, it should be used very rarely.
The next step is where the clinician begins to talk more and take over flow of the session. I like transitioning by saying something like: "I understand how you got to this point and what you have done to resolve it. As you know I predominantly use hypnosis as a tool to help my clients (or patients). So, if I may, I would like to share with you how I work." After they give me their verbal or non-verbal consent, I proceed. My goal now is to further alleviate their stress and to position myself as the resource that is going to move them toward a positive resolution. Although I consider myself highly trained and technically well versed in several academic fields, it is important that I tailor my explanations to the level that they will best respond. I do not want to overwhelm them. Rather, I want to build their confidence.
Once this education and disclosure segment is complete, it is now time to get the patient talking again. However, this time my intention is different than in the first stage. While their negativity dominated their previous verbalizations, now I require them to start thinking positively. I'll ask them something like: "Suppose at this point, you have not had the compulsion to pull your hair for two or three months. Can you tell me how your life has changed?"
I have a couple of intentions at this point. First, I want them to start replacing their previous negativity with positive thought patterns. Obviously their former method for resolving their issue did not work. This is why they are paying me for my services. I have no intentions of participating in their unproductive patterns. Secondly, I am looking for positive imagery that I can weave into the hypnotherapy session, which is to soon follow.
One thing that I am extremely vigilant of at this point is the patient's tendency toward negativity. Hopefully, I resolved that tendency in the first stage. If not, I must make sure that negative thoughts stay out of their mind. Unfortunately, when this happens I hear them expressing something like "what I would like to do is X" and following up their statement almost compulsively with a "but when" statement. For instance, "I would like to eat better, but when..." By quickly stopping this recidivist impulse, I see a rapid physiological change. With a little work, they normally respond quite well. This technique is one of the most important aspects of my therapy sessions.
The next stage is the hypnotherapy. As my goal is to become a stress-reliever, I find that by fully explaining the hypnotic process I further eliminate the patient's fears and apprehension. By following the hypnosis-protocol that I describe in my courses and interjecting positive patient-created content described previously, I find that they are well on their way to replacing negative, limbically-oriented patterns, with more positive, cognitive-oriented patterns. After the hypnosis portion of the session is completed, I give them some time to re-orient, ask them how they feel, and then proceed to teach them a short self-hypnosis routine – which is also included in their take-home packet.
This session structure is contrary to what I was taught almost twenty years ago and what is typically taught by most hypnotherapy certification programs. As Advanced Neuro-Noetic HypnosisTM, a field which I pioneered, focuses on designing hypnosis sessions to better fit how the brain operates, the methods presented in this article have proven to be much more effective than traditional protocols. My goal is to become extremely efficient in transforming people. I want to take them from their enduring suffering and quickly move them toward happiness and contentment. Therefore, I continually redesign – and evolve – my sessions as scientific research provides additional information as to how the brain and body operate.
The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD's and MP3's.
https://www.hypnosisresearchinstitute.org/trackback.cfm?9B1727A3-C09F-2A3B-F61257975C23F38A
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