Self-Destructive Behavior: A Red-Flag for Many Clinicians

If you have ever encountered a client or patient who consistently behaved counter to their best interests and did not realize it, you could be noticing a red-flag that the case may be beyond your scope of practice, license, or professional ethics. For example, consider a person who comes to you to cease a bad habit which is negatively affecting their emotions, relationships or health.

Later it becomes clear that they cannot sufficiently recognize that their behaviors are incongruent with obvious outcomes. Be careful! Their statements and demonstrated actions may indicate a more serious neurological disorder.A "normal" person will experience dread or anxiety related to an adverse possible outcome. This is not the same as a phobia. Rather, a healthy realization that placing one's hand into a hot flame may not be a good idea is an acceptable conclusion. However, when a person is involved in a clearly destructive behavior without such misgiving, qualified neuro-psychologists would say that the patient lacks the somatic markers, which should establish a motivation pattern that moves them away from the action. While there could be other explanations, such a pattern could very well signify damage to the patient's frontal lobes. (Note that another set of warning signals may occur if the client experiences a headache, dizziness, or other discomfort during hypnotic trance. Changes in the functioning of the frontal lobes are drastic during any significant depth of trance. However, this should not cause such problems in routine sessions.)

Frontal lobes occupy about one-third of the total area of the cerebral cortex. There are two types of damage that may occur. First, if the damage involves the upper and lateral surfaces of the prefrontal cortex, a reduction of activity may occur. This may be represented by lethargy, apathy, or a loss of creativity. (I've also seen this caused by certain medications prescribed by psychiatrists.) The second is damage to the underside of the lobes just above the eyes. The symptoms are just the opposite. Over activity, impulsivity and self-destructive activity may occur.

It is important that all clinicians be sufficiently knowledgeable about neurological and psychological disorders so that they may know when their limits have been reached. None of us want to do any harm (or break the law). Therefore, our professionalism requires us to sufficiently familiarize ourselves with various physiological and mental topics so we are more prepared to recognize when we need to use caution. Yes, I know that many clinicians are not allowed to diagnose. Nevertheless, we must be able recognize a "grey area" when we see it. At that time it is incumbent for us to stop the session immediately and to inform the client or patient that it would be better for them to see someone more qualified to help them.

If you are clinical hypnotherapist, this should rarely be a problem. Someone seeing us for a behavior modification issue would probably not have a neurological or psychological pathology requiring a referral. Conversely, I have seen some people that are "therapist shoppers", who seem to be proud of their dysfunctionality, or those who demonstrate instabilities during the intake interview. When my gut tells me that I'm not the right therapist, I quickly get my ego out of the way and follow my better instincts.

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.