Sussex Counselling & Psychotherapy
Sally McLaren is a psychotherapist in private practice in Horsham. She has a particular interest in the work and ideas of Swiss psychiatrist and psychotherapist Carl Gustav Jung. She writes: ‘In 2012 I completed a two year Infant Observation Course with the Jungian Section of the British Psychotherapy Foundation. I observed a baby in his home each week from birth to two years in order to build up a picture of his developing inner world and relationships, and deepen my understanding of the human psyche. My experiences with baby Max have left me with a conviction that images and imagination play a central part in connecting us to the deeper levels of the psyche, that this connection is there from the beginning, long before words are available, and that this has implications for the consulting room and indeed for our own personal journeys.
Sally presented her report on observations of baby Max, focusing on events in his second year. Max was too young to speak, but growled and communicated through sounds and gestures, his house and books were full of images of the animals that he loved. The seminar was advertised with the Carlo Crivelli painting from 1480 of the Madonna with the Goldfinch, in which the infant Christ is pictured clasping a goldfinch as he sits on his mother's lap. The painting also shows a stylised landscape with strange three-part trees, turbaned people, and large images of a fly, an apple and a cucumber. Sally explained the significance of these objects, that they were part of a visual language understood at the time, but obscure to 21st century observers. The apples and fly are symbols of sin and evil and are opposed to the cucumber and the goldfinch, symbols of redemption.
Birds and a fly featured in anecdotes about Max, describing how he wished to touch a fallen bird, but obeyed his mother's instructions to hold back. Birds also featured in Sally's real experience and in dreams, leading her to speculate on their significance in her own life and in her training.
After two years as a regular silent presence in Max's life, Sally had to end her observations. Her account of her last visit impressed me that Max's behaviour that day included him disappearing behind bushes then reappearing, which he did four times. It seemed to me that Max sensed that he was facing a loss.
The talk was illustrated with drawings and paintings, by Sally and by Carl Jung - especially the series of paintings that Jung produced daily over a period of three years in an effort to connect with his own unconconscious, that are bound into the famous Red Book.
We spent the second part of the morning, like Jung, using drawing to reconnect with our own preverbal unconscious selves. It isn't easy to switch off my logical conscious self and let the unconscious take over, but we were each able to make a drawing and reflect on it without trying to interpret it. Some made drawings of experiences from childhood, others about what was happening with them today. I think we all appreciated the opportunity to connect with those other parts of ourselves as we gazed at our drawings.
Parts of Sally's observations included looking at stories that deal with the "wild things" within us, the Gruffalo, and Maurice Sendak's "Where the Wild Things Are" evoked visual versions of strong feelings, so Sendak's book was an apt leaving present that she gave to Max and his family.
“The wonderful thing about a hip operation is that you know when it is going to happen. And, therefore, you can plan/prepare around it...,”
In 2007 when, following an unfortunate accident, Catherine Baudino found herself facing a left hip replacement surgery. Eight years later Catherine’s right hip needed to be replaced as well. At this point Catherine took matters into her own hands. Having worked hard before her first operation, using Pilates as a pre-operation preparation, Catherine understood the importance of exercise for a healthy and speedy recovery.
Understanding that for many a hip operation indicated the sign of ageing, Catherine was determined to prove that, no matter what your age, recovery was an option for those who were prepared to work for it. “Whatever your age, or circumstance, there is no need for trepidation, nor do you need to be a fitness fanatic to have a speedy recovery”, says Catherine.
Fitness is not the only contribution required in preparation for a speedy and successful recovery. Catherine says "determination and self-discipline appears to be equally as important when dealing with obstacles of physical and mental pain". She admits, “I was ruthless with myself and absolutely determined to be as prepared as possible for my recover, regardless of pain and discomfort”.
However, her real obstacle was not her body but rather her mind-set. Catherine, who is studying to become a Reality Therapist and is beginning to apply the ideas of Choice Theory in her life, soon realised she had choices when it came to her mental behaviour, and opted for a positive attitude, coupled with as much exercise as her body would allow.
Play and Laughter
Tony Buckley (Chair of the Sensorimotor Association, and former Clinical Director for London Transport’s staff counselling service) was in Brighton in September to offer his workshop on The Art and Science of Play: Using Play, Humour and Laughter in Therapy. If you missed the event, here are a few helpful nuggets from the day!
1. Play is universal to all mammals
We have always played, even when we were cave dwellers. Play prepares us for life by helping us develop the relational and survival skills necessary for a successful life. An example of this is when kittens chase and pounce on string that their humans dangle in front of them. Really they are learning to catch mice. When people have been traumatised or are depressed, their play system shuts down. They forget how to play.
2. Play is hard-wired into our brains
Play is ‘hard-wired’ into our brains according to neuroscientist Jaak Panksepp. In his book The Archaeology of Mind (Norton, 2012) Panksepp seeks to discover the origins of emotion and outlines 7 main hard-wired emotional systems in the brain. These are: Seeking, Rage, Fear, Lust, Care, Panic, and Play. Panksepp has given a TED talk on The Science of Emotions which explains the 7 emotional systems. You can watch Panksepp’s TED talk on You Tube.
3. What is Real Play?
“Real Play” is defined as an activity that is spontaneous, intrinsically pleasurable, free of anxiety or other overpowering emotion. Typically play involves ‘alternating dominance’ where one mammal is dominant over the other and then the roles are reversed. We can observe this behaviour in baby animals who play with one another by rolling around, first one on top then the other.
In humans we can observe that if one person remains always dominant in play this ceases to be pleasurable and free of anxiety for the submissive person. Play turns into bullying. Real play involves laughter and rough-and-tumble type activities as characterised by natural child-play. It doesn’t include organised activities like playing a football game as these are too structured and competitive, causing stress and anxiety.
4. Depression and play
Why is play and laughter important? Jaak Panksepp sums this up by saying that “depression and play are opposite sides of the same coin”. Laughter (the result of playfulness) can help to regulate feelings, enable both feelings of hyper arousal (anxiety, for example) or hypo arousal (depression, for example) to be safely and positively moderated. In short, play helps us develop the capacity to be happy. Panksepp can be seen discussing the play system and his discovery that rats laugh when tickled in a brief video called The Primal Power of Play (which you can find on You Tube).
5. Play and laughter as emotional regulators
The lesson for therapists is that playfulness and laughter are emotionally regulating and if encouraged and nurtured can enable clients to become more resilient. It doesn’t mean that therapists need to do a short-course in stand-up comedy, but if you understand the importance of play, laughter and humour you can use and share laughter to positive effect within the therapeutic relationship.
Psychotherapy and Hypnosis
Paul gave a fascinating talk on the subject of Medical Hypnosis: when it might sensibly be chosen as a referral option by a therapist not specifically trained in its use, and contrasted the benefits and limitations of hypnosis with other potential options. We learned that hypnosis is not a standalone model; it is best used as an adjunct to a practitioner's core approach.
Why would a therapist want to know about hypnosis, if they didn't use it? In Paul's opinion hypnotic phenomena are often encountered by therapists (eg dissociation) and it is helpful to understand that hypnosis could in turn potentially enhance the efficacy of other approaches and modalities.
There is still a view in the NHS that the efficacy of hypnosis is unproven but this is not so (Wampold 2008). Lang & Rosen 2002 found that the use of hypnosis to enhance eg relaxation, greatly reduces the costs of surgical procedures and aftercare. Research also shows that antidepressant drugs produce only a very small percentage improvement (2 points) compared with Placebo when assessed using the Hamilton Depression scale - pharmaceutical and psychotherapeutic interventions are “equally effective at turning misery into money”! Kirsch et al (2008) found “the effects for SSRIs are greatly inflated” and the NHS bill for them is similarly large!
I found a real bonus of Paul's approach was his meticulous referencing from academic clinical research – he included no less than 7 pages of references in the set of slides he kindly circulated to participants in advance. ( This review will only include a few but for further information, please contact Paul direct.) Despite his academic credentials and in depth knowledge of the subject however, his style of presenting was relaxed and conversational, liberally interspersed with laconic humour. He was able to de-mystify the jargon and often impenetrable terminology of research with clarity and good humour.
It was very encouraging to learn of so much evidence already “out there” for the efficacy of the talking therapies; also that despite each modality being passionate about the superiority and distinctiveness of its own approach, in fact this has not been proven to be so! Research concludes that psychotherapy outcomes are generally beneficial but that it is difficult to differentiate between different therapeutic systems in terms of outcomes. “Differences attributable to specific treatments are small”(Wampold 2008). Therapy works! But no particular approach works better than another. It seems that the passion with which a therapist espouses the presenting issues of the client, and how much account they take of the story, IS very significant. What makes a difference to outcome is the individual therapist; the working alliance being a significant predictor of retention and hence improvement, independent of outcome (Springhovn et al 2007).
What does hypnosis offer? As a specialist “tool” it seems to intensify, or turbo-charge, any approach. It can amplify or de-amplify specific elements of memory, strengthen ego and accelerate rapport between therapist and client. It could be viewed as on a spiritual spectrum of experience, but does not require a specific faith, or any faith at all, to be effective as a therapeutic intervention. As Kirsch comments (op cit) “hypnosis is Placebo without deception”! (Paul explained that “Placebo” became synonymous with “there's nothing there” because of Random Control Trial research, an unfortunate link, since hypnotic phenomena are definitely “there” and experienced by us all in everyday life eg “having a train of thought” is a type of hypnotic trance where the thoughtstream runs along a specific “track”,, often to the exclusion of other thoughts, while the Placebo response is a distinctively different phenomenon.) Illnesses like IBS are very susceptible to Placebo apparently, yet PTSD patients are more hypnotisable than susceptible to Placebo.
One of the benefits of hypnosis is its transparency regarding the procedures, itself an alliance building element for clients. Hypnosis isn't related to either sleep or gullibility (NB gullibility is not the same as suggestibility), its about client skills, and those skills can be learned, putting the client firmly in the driving seat at all times. It is an “altered state” over which an individual has complete control. There is also a strict adherence to procedure with hypnosis, which can build confidence for clients because again, they know what's coming and are active and essential participants. Without active participation, hypnosis cannot occur. Lastly, if the client knows the therapist has confidence in the approach, this too helps build their confidence in it. A quote from Mende 2009 (p 180) regarding the Altered State Debate – Paul recommended downloading this if possible - “hypnotic trance has special qualities as a distinctive state of awareness with the patterns of brain activities characteristic only for the hypnotic trance, setting it aside from the waking state, relaxation, sleep and even meditation.”
So what exactly is hypnosis? Paul posed another question: what is the baseline of “consciousness”? “ “Hypnotic phenomena are behavioural, cognitive, and experiential alterations that emerge with or are enhanced by an induction. This might include a series of compulsive/enhanced suggestibility, diminution of reflective awareness/absorption, unusual experiences eg alternations in body image, sense of time, dissociative experiences.” (BPS 2001). “Induction” is therefore via a series of therapist's suggestions – following a strict protocol - to achieve a trance-like state which includes inter alia enhanced suggestibility. This enables the client to accept new information, or different perspectives, much more readily. Paul pointed out that hynosis doesn't enhance recall of memories, but does enhance remembering. It is a myth that hypnosis removes control from a client: control doesn't occur other than by the client, in the same way that a pilot is in control and the “driving seat” but has a co-pilot (herapist) as back up At no point can the co-pilot (= therapist) take over without the full consent and willing participation of the pilot. Agency always remains with the client, and if there is resistance to it, it can't happen.
The idea of “brain washing” has been compared to hypnosis, but this is another myth. Paul pointed out brainwashing occurs as a result of a combination of environment (usually fear filled and coercive), repetition and duration, and is thus quite distinct from hypnotic trance induced in a therapeutic setting.
Induction is via concentrated focus on X – by definition, this will mean a lessened focus on YWZ, where YWZ are the anxieties or preoccupations currently and normally occupying much brain space for the client and causing distress. Raz et al 2006 state “it appears that trance learned suggestions bypass the control of the executive attentional system and allow the subject to interpret information independently of deeply entrenched learning”. In other words, hypnotic trance enables the client to bypass any previous negative assumptions/beliefs/fears and focus on something else which is positive. It is in this sense only that hypnosis enhances suggestibility.3
A comparison of Medical Hypnosis with EMDR (another altered state of consciousness) was summed up by Paul in his own words as “EMDR is a therapy-facilitating memory reconsolidation which dissolves and reconstitutes emotional learning, enabling change of current unwanted responses [to that memory]. This involves activation of memory networks including sensory, affective, cognitive and somatic aspects, via application of bilateral stimulation of the brain”
A comparison of meditative practice with Hypnosis: “mindfulness can be defined in part as the self regulation of attention ...” (Bishop et al 2003).
Paul believes that all these approaches encourage a healthy scepticism towards habitual experience, and aim to disrupt automaticity of responses, but they do so by quite different means, and practitioners may have different underlying accounts of the acquisition and maintenance of psychological disturbance.
What about outcomes for hypnosis? Kirsch et al (op cit ) state that “hypnosis in general enhances the effectiveness of therapy” and found that meta-analysis of outcomes indicate that “patients receiving hypnosis as an adjunct to treatment show significantly greater improvement than 70% of patients receiving the same treatment without hypnosis.” Mendoza &Capafons 2009 also found that clinical/medical hypnosis can be an effective adjunct to treatment of a wide range of medical and psychological problems; but that “hypnosis should be excluded in medical conditions when the use of hypnosis is understood to be the only intervention.”
Finally, what conditions might therapists choose to treat using hypnosis as an adjunct to their core model? (Mendoza & Capafons op cit ) list typical problems such as
- anxiety including phobias
- psychosomatic disorders
- medical settings
In Paul's opinion, in addition to the above are conditions such as IBS, excema and other skin disorders.
During a lively Q&A session at the end, Paul recommended anyone interested in finding out more to visit the official website of the British Association of Academic & Clinical Hypnosis (www.bsach.com) which has recommended training options.
Paul Atkinson is a BACP Senior Registered Practitioner, qualified Hypnotherapist and EMDR Consultant based in Brighton. He can be contacted via his website www.hypnotherapy-emdr.com