Cette page contient des paragraphes accueillant quelques textes qui portent à réflexion sur la nature de la transe, la manière de gérer douleur et anxiété, ...
Ces textes sont soit en français, soit en anglais, langue native de la communication présentée.
Invitation à la clef : de l'art d'entrer en transe
Ways to treat pain and anxiety
Invitation à la clé : de l'art d'entrer en transeCe texte a été présenté lors des rencontres professionnelles du 20 mars 1999, à la Société Française d'Hypnose, au Palais des Congrès de Paris.
Lorsque le patient paraît, à moins que ce ne soit l’assistance comme celle-ci, quelles clés et quelles serrures se font face, se rencontrent, se découvrent ?
Hypnothérapeute, hypnotiste, hypnopraticien... saurais-je me faire dépanneur, plombier, pompier, braqueur, serrurier ?
Dépanneur de l’oubli, de l’urgence, de l’absence ? Plombier colmateur, retardateur, plombier retardé ? Pompier du premier secours, du dernier recours ? Pompier volant, pompier casseur, pompier incendiaire, pompier sauveteur ? Ou encore, braqueur, ouvreur de coffres-forts, cherchant la bonne combinaison à l’oreille, au doigté, au mouvement ? Ou simplement, serrurier, celui qui fabrique les clés et les serrures ? Celui qui travaille la clé ou la serrure avec des limes, des râpes, des grattoirs, des tenailles, des burins, des poinçons, des vis, des vrilles, des forets, et quelques instruments de mesure dont le compas droit ou celui d’épaisseur appelé maître à danser ?
Saurais-je me faire maître à danser ? Ou simplement danseur dans cette invitation que fait le patient en narrant sa réalité à lui, sa souffrance avec ses ouvertures et ses fermetures.
Peut-être commencerais-je par citer un de nos grands éricksonien, peut-être un peu méconnu, Michel Tournier.
La serrure évoque une idée de fermeture, la clef un geste d’ouverture. Chacune constitue un appel, une vocation, mais dans des sens tout opposés. (...) Une serrure sans clef, c’est un secret à percer, une obscurité à élucider, une inscription à déchiffrer. (...) Mais une clef sans serrure, c’est une invitation au voyage. (*1)
Vous pouvez peut-être vous demander de quelles clés il s’agit et à qui elles appartiennent. Sont-ce celles du thérapeute ? Sont-ce celles du patient ? Ou bien naissent-elles de la rencontre de l’un et de l’autre ? De la présence de l’un et de l’autre ?
Vous pouvez vous demander et peut-être, êtes-vous surpris, curieux, étonné, amusé par ces détours auxquels vous êtes familiers lorsque vous entrez dans la relation avec l’autre, le sujet, le patient, qui est d’ailleurs est souvent impatient, lorsque vous participez à cette entrée dans la danse, dans la transe, dans ce démêlé, ce déroulé où vous laissez votre imagination s’inviter au voyage, où vous laissez votre imagination tisser des toiles et des méandres, glisser peut-être une clé dans une serrure, l’essayer ici, l’essayer là, où vous laissez votre imagination gambader en respirant au même rythme que celui du patient, en ratifiant ses soupirs et ses aises, en observant ses légèretés et ses à peine perceptible mouvements involontaires car parfois il n’est nul besoin de marteau de porte, de guichet ou de judas pour se laisser aller à découvrir en même temps que le patient que les portes sont ouvertes et que parfois même, il n’est pas de serrure et pas de porte, qu’il est simplement une respiration à redécouvrir, qu’il s’agit simplement de se laisser absorber par soi-même à partir de la serrure ou de la clé apportée, déposée en pâture.
Car qui, sinon le patient, amène ses clés et ses serrures ?
La corporation des serruriers fut longtemps considéré comme la gardienne de la vie et des biens des sujets grâce à l’ingéniosité de ses serrures, la solidité de ses grilles et de ses défenses. La devise qui figurait dans ses armes était SECURITAS PUBLICA. A ces qualités techniques, s’ajoutait le souci de l’embellissement des demeures et de l’agrément de la vie quotidienne que procuraient les objets fabriqués par les serruriers. (*2)
Car qui, sinon le patient, amène ses clés et ses serrures ? Qui, sinon le patient, amène de superbes constructions, de superbes volutes, de superbes arabesques en nous livrant sa réalité, sa souffrance.
Car c’est bien de cela dont il s’agit : partir de ce qui est et non de ce qui n’est pas. Si le patient souffre, vous ne pouvez pas lui dire de se détendre quand bien même, votre objectif est louable, votre objectif d’amener le patient à se détendre. Erickson nous disait que c’est tout simplement dire des absurdités parce que vous ne prêtez pas attention à ce que l’hypnose devrait signifier pour le patient. L’approche correcte d’un patient souffrant de douleurs extrêmes n’est pas de suggérer qu’il pourrait être confortable ou détendu. Je dis au patient qu’il souffre vraiment de douleur ; que ça fait réellement mal ; qu’il peut minutieusement prêter attention à cette douleur. (*3)
Inviter à la danse, à la transe, même lorsque le patient a le bras ou la jambe cassée ne peut commencer par un, et je cite Erickson, un << Maintenant asseyez-vous ; peut-être vous trompez-vous, vous n’avez pas un bras cassé ; vous n’avez pas vraiment un bras cassé ! >> Le patient sortira de votre bureau pour chercher un médecin qui verra et admettra l’angle qui déforme cet avant-bras !
Pourtant, des médecins disent aux patients : << vous n’avez pas besoin de vous en faire ; vous n’avez pas besoin d’avoir peur, vous n’avez pas besoin d’être anxieux. >> (*4)
Et vous, avez-vous besoin d’être anxieux ?
Nombre de mes patients viennent pour des peurs, des phobies, de l’anxiété, des stress..., des isolements, des évitements, des blocages, des douleurs qu’ils ne savent pas nommer et qui constituent leur réalité, clé ou serrure.
Vous ne pouvez mettre à part cette réalité que lorsque vous avez orienté votre patient sur sa réalité et que vous avez pu, dès lors, le laisser s’absorber dans une transe plus ou moins profonde, à la fois centrée sur sa douleur et en même temps ailleurs. Vous commencez par ratifier l’expérience pénible du patient et vous identifiez e qui, dans le discours du patient les clés, les solutions qu’il vous livre, à son insu au détour d’une phrase ou en vous parlant de ce qu’il sait faire ou de ce qu’il aime faire, de ce qu’il aime ou de ce qu’il contemple, ou encore quand il vous parle d’une expérience ou d’un évènement récent.
En ce moment, ce doit être la saison, j’ai deux bras cassés. Avant-hier, du bras confortable au bras moins confortable, de l’habitude du confort d’hier et de demain, de la tension et de la contention, Noémie a fini par s’étirer comme un gros chat gris sans savoir où était la limite ou l’infini du bien-être, en sachant comment sa nicher dans un confort contraint et en même temps léger. J’aurais pu, comme Erickson, l’inviter à se construire des habitudes de douleur qui deviennent des apprentissages du goût comme après avoir fait l’expérience d’une bouche en feu lors de la première absorption de nourriture épicée, pimentée.
Mais c’est Etienne, 65 ans, qui m’a confié spontanément ses clés sans cérémonie alors qu’il crevait de trouille depuis des années, et qu’il s’arrangeait bien pour le cacher et éviter toute situation de panique, dans le métro, sur les quais de gare, les ponts et les hauteurs : vous pouvez simplement imaginer comment la légère euphorie créée en compagnie d’amis est devenue, pour lui, avec le bon repas qui l’accompagne, le fil conducteur, l’invitation à la transe et à la dégustation de l’ici et maintenant que ce soit dans un voyage en métro ou une traversée de Seine tout en étant ailleurs dans cette lente activation des papilles gustatives à s’exciter au vin ou au plat délicatement parfumés. Et ces clés, il les a déposé sur le bureau de son safe place, ce lieu de haute sécurité intérieure où il a pu s’exercer à déguster sur place et en vidéo les euphories de ses dîners amicaux et ses simplissimes traversées de Paris en sous-sols oui en hauteurs. Pourtant c’était un homme-serrure, un homme qui ne voulait partir avant d’avoir compris et il a fini par s’envoler...
Il vaut mieux orienter les patients sur ce qu’ils savent faire plutôt que sur ce qu’ils ne savent pas faire, parce qu’ils savent faire les aide plus que ce qu’ils ne savent pas faire. Il vaut mieux orienter les patients sur ce qu’ils aiment le plutôt que sur ce qu’ils n’aiment pas, parce qu’ils aiment les aide plus que ce qu’ils n’aiment pas.
Un autre de mes patients au bras cassé a su transformer celui-ci en une clé, une ouverture à l’échange et à la rencontre : son bras cassé, il l’a appelé un mieux qu’un chien car ça n’a pas besoin d’être nourri quand bien même cela a besoin d’être sorti... pour favoriser la rencontre.
Vous, hypnothérapeute, hypnotiste, hypnopraticien, ne travaillez vous pas avec l’inconscient en ligne directe et ne vous laissez pas découvrir combien votre écoute, votre vigilance à écouter vous permet d’identifier les ressources du patient sur lesquelles vous allez pouvoir vous appuyer, que vous allez activer, que vous allez utiliser tout en respectant le rythme du patient dans une évidence humble et modeste. Vous ne savez pas quelle piste choisira l’inconscient du patient et vous vous laisserez découvrir et applaudir le mises en œuvre, les traductions, les mises en musique, les mises en boîtes de ce que pour quoi le patient est venu vous voir.
Votre vigilance à écouter, votre attention, votre présence mobilise votre capacité à créer la relation, à pousser ou à ouvrir des portes chez le patient, à laisser son inconscient coopérer et dénicher des ressources latentes. Vous usez de ses (ces) clés, peut-être plus que des serrures, pour laisser l’inconscient faire son travail, l’inconscient de votre patient comme le vôtre. Car qui est entré dans la danse le premier ? Dans cette danse inédite, cette danse, cette transe qui n’en finit pas de nous surprendre.
Pour conclure, je cite à nouveau Michel Tournier et vous invite au voyage et peut-être même à de superbes délectations.
qui possède une clef sans serrure ne doit pas rester les deux pieds dans le même sabot. Il doit courir les continents et les mers, sa clef à la main l’essayant sur tout ce qui a figure de serrure. (*5)
Alors, hypnothérapeute, hypnotiste, hypnopraticien, vous pouvez vous laisser savoir ignorer comme ignorer savoir comment vous y prendre pour ce voyage et cette danse, cet espace de communication et cette aire de jeu.
Alors, dépanneur, plombier, pompier, braqueur, serruriers ? Peut-être simplement danseur. Qui conduit ? Il suffit simplement de vous laisser surprendre par cette créativité qui s’emprise, dans cette interaction puissante où vous et moi, et, moi et vous cultivons l’échange.
Merci de cette valse à transe-temps.
(*1) ; (*5) Tournier Michel, Des clefs et des serrures, Chêne-Hachette, 1979
(*2) Encyclopédie Universalis
(*3), (*4) Erickson Milton H., Hypnose thérapeutique, Quatre conférences, ESF, traduction française, 1993, p52, p62
Ways to treat pain and anxietyCe texte a été présenté au 8ème Congrès International des Approches Ericksoniennes en Hypnose et Psychothérapie, à Phoenix le 6 décembre 2001.
This paper has been presented at the 8th International Congress on Ericksonian Approaches to Hypnosis and Psychotherapy, Phoenix, Arizona, on December, 06th, 2001.
Some patients are referred to me by physicians or health care professionals. They mention a chronic pain. As Joseph Barber says "one can assume than an organic basis for pain exists or did exist, in nearly every case of chronic pain, even when current organic sources cannot be found." Anyhow the patient suffers now.
Some other patients come to me with what they describe as a recurring pain, a pain that in some ways could be considered as anxiety but what those patients present as a recurring pain occurs in certain situations which they can't define.
In this paper today, we will consider anxiety as a type of pain. Anxiety has physical aspects as does pain: muscle tensions, shaking, palpitations,irregular breathing suffocation or pressure, hot flashes, blushing, sweating, butterflies in one’s stomach, lumps in one’s throat, ... These states of persisting tension can induce physical effects interpreted as pain which can have physical aspects without any organic cause and without any physical lesion.
Coming from the four corners of the Earth, if we can say that Earth has four corners, you may wonder about the theme of this afternoon on the treatment of pain and anxiety. Pain may have different names in different langages and what comes to my mind in English is ache, sorrow, grief, wound, suffering... I don’t know if we can approach this word from different meanings or play with the different words that refer it. Let me introduce the word in French: « douleur »... and introduce a first dissociation or a window onto a different meaning, shall we say a way to reframe the pain, « doux leurre ». La douleur est « un doux leurre ». Pain is « a soft, a mild, a sweet lure/ a soft, a mild, a sweet illusion ». But what is the illusion about? What does pain create mirages for ? About what in the pain can be a lure, a move, a shift? What is hidden behind this « lure », this illusion ? Those are questions to be considered while listening to the description given by the patient.
Let’s sit back, relax and listen to this example of a description that has been written by a woman, Betty, 35 years old, who works as a free-lance writer who analyses and synthesizes interviews she conducts with people for marketing researches. Here are some extracts from a letter she addressed to her pain.
You have flattened me since Tuesday morning, early morning. Then you became very sharp, lancinating, piercing, crushing, searing. I thought you were an urge to go to the bathroom. I go to the bathroom and you’re still with me, still on me, still in me. At the same time, I feel like vomiting. I rock myself, I lull myself to sleep like a baby. I suck a digestive drop to help me to digest, I throw in two Ibuprofen. I blame my last night’s dinner, I look for a hero to be your cause, could it be food poisining? Are you just telling me that the food wasn’t sufficiently fresh? The beef had a strange taste in my mouth, even some kind of a no-taste taste. I need a guilty party, an external factor, not an internal one. It can’t be possible then, it’s beyond imagination to be caused by an internal factor. I’m doubled-over in pain, from you. (je me tords de douleur). You’re so awfull, so strong that I want to tear my guts out, to be as violent as you are, to master you by emptying my stomach, by getting rid of my body. I want to kill you, to kill me but I feel no strength to fight, you’re too strong. You keep me in bed and as my friend comes with a slice of bread and butter, I keep rocking myself to sleep before pulling myself up and going to the meetings and appointments of that day (...)
Today, it’s been three days that you’re with me. You’re dull and gnawing (gourde, engourdie) as if you had decided to invade me, to stay with me, to go with me in throughout my daily activities, every second of the day. As if you had decided that the room was suitable and to your liking.
Who are you? When I think of you, the words that come to my mind are: gnawing, dull, deaf, belted, tied up, encircled... I am surrounded, tied up by you and nevertheless you’re inside me. Belt. I write the expression (« faire ceinture ») « to go without » meanwhile I go with you. Or, so far as I spend most of my time alone, without seeing anyone, writing my articles. Alone and without getting in touch with others. A few phone calls keep me in contact with the animated and swarming world (grouillant). I work home, sometimes in my bed, always putting cushions and pillows around my bag, around you. I warm you up, I warm me up. Lots of lamps are lighted around. I am excited about the article I have to write right now and at the same time I need to talk to you. You’re with me and I feel my tommy as a balloon, as a rubber ring, may be a life buoy. You’re my companion. (...)
I dream of an ancient time where I see ribbons, ribbons like sweet thick batter, candy, taffy (nougatine) without nuts. The thick batter (and I should play here with the word « sick ») is red and pink, its becomes smooth (se lisse) on a warm plate, it becomes smooth with a gesture that is so delicate, light, lively. But this ribbon is not in me, it is somewhere by the coastal road, by the seaport of Royan. The one that is in me is made in gold satin, I wish it were in bright gold satin like on a present? To what, to whom could I be offered as a present?
Yes, you’re a present, not a past, not a future - I hope not -. I’m in you, you’re in me. Who belongs to whom? Sometimes you wake me up by a few sensations like one of pin cushions, or small darts in my back or in my tommy. You go with me; you are with me every moment like a companion sleeping even as I sleep. Yes, I can talk to you, I know who to talk to, I know who to rock and by whom I am rocked. You take care of me; you go with me at this time of retreat. (...)
But belted, encircled, surrounded, ... A belt that encircles and surrounds me, I’m « tightening my belt ». And you know I’m tired of tightening my belt, to be short on money; I need more contracts and better pay. But how can I get that? I’m too specialized in what I do; I have tried to get in contract with companies but to no avail, I feel stuck. (...)
Belt, life buoy: is this what you mean?
I wonder if you’re not only telling me, shouting to me that I am alive, that life is not some place else, somewhere far away, but that it is here, in me, inside me. May be you’re telling me that my life is inside me stronger than a life outside that would be scattered all over. (...)
Siege. On/in my « siege », during a « siege » (I keep the word in French for its double meaning: its means siege and seat), coming under siege, laying siege to me until I give up and resign, until I give up and open the doors to the attacking forces.
Staying stuck in my own « siege »; is it a way to avoid battle to you, to avoid battle of the market field? Is it a way to submit, to dismiss, to resign one’self?
It is as if this terrible work of writing had nothing to do with the nobility of the fight, as if it was being pushed in a entrenched camp, as if the fight were being enacted in the trenches, as if it took the stance (posture) of a target.
And isn’t the stance, standing still, an illusion, a lure? We move all the time... even though we think we don’t. Aren’t we to help, to go with others, to give our knowledge to others, all the more silently in the long run.
Ouside-inside. Outward-inward. To be outside, one needs to be inside, to be grown. In fact, my pain, you’re probably here to reinforce my strenght to be able to go outside. (...)
Here we get a lot of information about the meaning Betty gives to her pain but she gives no information, or very little of where the pain is located,
She gives some idea of what it look likes and how it interferes with her work - in fact she can spend hours writing to her pain distracting herself from her job. At the same time, it’s a way she’s found to accept her pain, live with it and get to work. Once she wrote a long document about her moods and suffering when she had to write a report on Computer Aided Learning. - We’ll go back to this example later on.
A careful and respectful interview is required in order to explore the nature and the location of the pain, its interpretation and meaning for the patient, in what ways it invalidates the patient in his (her) every day life and what seems to be its function, and what is the attitude of the patient toward hypnosis.
As a psychologist, you need to know what is the medical diagnosis before doing any further exploration. Examens are needed to check any possible disease. The patient comes with the idea that something can be done to help him with his/her pain, to control his/her pain. The patient tries his/her best.
Some patients imagine that there is « a cause » , a « universal and unique cause » to their pain so that it can be eradicated. Some doubt that it can be controlled because it has a physical cause or because. Some think there cannot be any other element than the responsible cause of it.
A pain that persists can remain for reasons that can be different from the ones at its origins. The pain can be maintened, even encouraged by elements in the system the patient interacts with, what we can call the secondary gains or the benefits for the paient or his surroundings. That’s why it’s important to « approach » the pain in all its components: physical, psychological/cognitive and behavioral.
Location and exploration of the pain
exploration of the its submodalities:
Visual: brightness, size, magnification, color/black & white, saturation (vividness), hue or color balance, shape, location, distance, contrast, clarity, focus, duration, movement (slide/movie), speed, direction of movement, 3-dimensional/flat, perspective or point of view, associated or dissociated, foreground/background (self/context), frequency or number (simultaneous and/or sequential) (split screen or multiple images), frame/panorama (lens angle), aspect ratio (height to width), orientation (angle, tilt, spin, etc.), density (« graininess » or « pixels »), transparent/opaque, strobe, direction of lighting, symmetry, horizontal or vertical hold, digital (words), sparkle, bulge, ...
Auditory: pitch, tempo (speed), volume, rhythm, continuous or interrupted, timbre or tonality, digital, associated/dissociated, duration, location, distance, contrast (harmony/dissonance), figure/ground, clarity, number, symmetry, resonance with context, external/internal source, monaural/stereo, ...
Kinesthetic: pressure, location, extent, texture, tempertaure, movement, duration, intensity, shape, frequency (tempo), number,...
- tactile: skin senses
- proprioceptive: the muscle senses and other internal sensations of posture, breathing movement, muscle tension, etc.
- evaluative meta-feelings ABOUT perceptions or representations, also called emotions, feelings, or visceral kinesthesics because they are usually represented in the abdomen and chest or along the mid-line of the torso. These feelings are not direct sensations/perceptions, but are evaluative representations derived from other sensations/perceptions.
Sometimes it’s hard to get a good description of the pain so drawing can be a useful tool to help understand and assess the location of the pain and its characteritics.
At the same time you gather this information, it is also very useful to identify the images and the metaphors the patient give of and about his/her pain.
History of the pain
Acute (injury or medical procedure or disease process) (ex: lumbar puncture, bone fracture, appendicitis)
recurring (injury or disease, can be constant) (ex: cancer pain, migraine, arthritis, irritable bowel syndrome, phantom limb pain)
chronic (low back pain, other pains that persist even after healing has occured)
Jack-in the box or continuous?
A pain that is an alarm signal is probably associated with a lesion or a trauma. A pain, resistant and persistant, is probably a disorder of the system of perception of the pain.
A pain whose medical cause has been identified and healed and that persists has no use as an alarm signal. A recurring or chronic pain can be considered as a false alarm signal - medically speaking -, it’s nevertheless a real pain and a self-maintened pain.
What are the antecedents associated with exacerbation and improvement of the pain ? and level of depression?
Interpretation and meaning of the pain ?
What does the pain talk about ? what does it try to tell the patient? how can he/she look at it ? how does it look at him/her ? how does it see him/her ? What does it want the patient to feel, to experience ? What do the pain want to make the patient feel, to make him/her experience ?
Is it a punishment, fate, bad luck, destiny, genetics, a signal, an alarm signal, a sign for a break, stress, the law straw (la petite goutte d’eau qui fait déborder le vase), a focalisation, a diversion, a distraction, an act of sabotage, an adventure, a teaching of life, an experience, an opportunity to grow, an awakening of some buried resources, ..., a sign of life... because when every thing’s ok, we don’t feel ourselves (« on ne se sent pas »!)
How is the pain « talked » ? How does the patient talk about the pain ?
The patient has someone on his/her back; he has something that’s difficult to digest, ...he has a hole in his head, a pain in his/her neck, a lump in his/her throat, cold hands, warm heart, heavy heart, butterflies in his/her stomach..., or a knot in his/her stomach... He feels very down (n’a pas le moral).
There are probably many more idiomatic expressions in English or in American English and you can extend the list...
What is the contextual environment of the pain ?
- thru generations: antecedents of pains and illnesses, the attention is directed towards some specific organs
- in the family: for example, to avoid particular conflicts, and more especially, kids can show some form of pains that are induced by their parents
- in the couple: the pain of the patient can put him/her down (position basse), it may be a position of one down, or a request of mothering, ...
- towards the society: it’s a useful way to go to the doctor, to the physical therapist, the chiroprator...
- towards the job: pain can protect from difficult situations, allow the patient to avoid « painful » clashes, bring comfortable benefits.
- culture or situation: in certain cultures, people can easily express their emotions and their sensations and needn’t hesitate to complain, to ask for attention and support, to look for reassurance all the time (Italians and Jewish) and when it’s over, it’s over. (research of Mark ZBOROWSKI, on 4 groups of people: some from Southern Italy, some Jewish, some from Ireland, some of « old American », People in pain, Jossey-Bass, 1969). The Jewish patients sometimes refuse painkillers or help: for them, pain means just a fight against the illness; they’re worried about healing. The « old Americans » show disdain about their pain and try to be as quiet as possible. The Irish group is very much alike the « old American » group; they don’t ask to be relieved and can’t bear an illness that keeps them from their job and their every day activities.
Today these cultural differences are fading.
War situations can show also differences: if the soldier suffers from a serious wound, his pain is more easily bearable than if he was a civilian. The interpretation of pain is quite different: the soldier has fought for his country and he can be proud of it. The civilian is broken in his life and is worried about how he can face his responsabilities towards his family. This may bring to mind the worker who’s had a serious on the job accident...
What seems to be its function ?
Are current symptoms or is current pain being used to get needs met by others ?
In what ways does it invalidate the patient in his/her every day life ? what is its impact on relationships, on the job, on leisure activities, on sexual activity, ...
How much can the patient tolerate his/her pain ?
What can be the benefits or the potential benefits of the pain ?
If the pain could magically be taken away, in what ways would the patient’s life be changed ? What would he/she be able to do that he/she can’t do today ?
What is the attitude of the patient toward hypnosis ?
How does the patient come to us?
With the idea of hypnosis as being something he/she has to obey ? as an abnormal experience that can be harmful and nevertheless attractive and fascinating ? a threat, a test to his own integrity ? as a way to be manipulated against his/her will ? as being something magic where he/she has nothing to do but be charmed? as a unique shot that will solve the problem ? as a way to get to the historical source of his/her pain ? as a way to transform the pain and make it disappear, or at least, reduce it ? as an alternative to medication ? as a way to be able to talk to someone else about his/her pain ? as being an ultimate solution to treat his/her pain ? as a way to sleep and be free from pain ?
There was a time when there was no pain, no suffering ; there will be a time when there is no pain, no suffering.
Several hypnotic techniques, most of them based on dissociation, can be used to change the sensation of pain, decrease it and sometimes, make it disappear.
Let us look to a few definitions. What is dissociation? How can it be considered?
BRAID has defined hypnotism as a process of dissociation or a reverse amnesia, which goes to a state of split consciousness. Later on, Pierre JANET studied the amnesia phenomenon and founded his theory of dissociation between the mind and the body.
Hypnotic states appear spontaneously during a trance, a formal trance that can be induced by a therapist, or a natural trance that can occur in certain situations, as when doing a repetitive task or watching a movie, reading a book, working on an exciting project. Hypnotic phenomena can be astonishing... For example, war anesthesia can occur when a person is focused on saving people or fighting against the enemy even though he is badly injured. Probably we’ve all experienced that kind of anesthesia while absorbed in an action and then when we’ve discovered a wound, even a small cut, we just realize it and its starts to hurt.
For Milton H.Erickson, dissociation is a process that separates the conscious mind from the unconscious mind. It occurs when we focus our attention on what we experience now and ignore the elements that are all around.
It’s a separation from left brain and right brain. Left brain and right brain have their own characteristics, their own abilities. The left brain is devoted to rationality, analysis, abstraction and is oriented. The right brain is devoted to dream, intuition, synthesis and is spontaneous without linearity.
In this sense, hypnosis is the experience of dissociation between the left brain, the conscious mind and the right brain, the unconscious mind. In hypnosis, we aim at overloading (saturation) the conscious mind to better communicate with the unconscious mind. We have to keep the outside busy with the outside and to open the inside to possibilities of an incouscious exploration and dialogue, in other words, to help the conscious mind give room to the unconscious mind so that the unconscious mind can be mobilized. (cf Erickson, p59 Malarewicz-Godin, Erickson MH, Rossi EL & Rossi SI, Hypnotic Realities, Irvington, New York, 1976, p18)
While giving room to the unconscious mind through different techniques of trance,induction we help the patient to « relax » the usual level of scrutiny, critical thought, and/or « mind chatter » that may interfere with his wish to become absorbed in the experiences that are suggested. >> (Joseph Barber, p6)
Dissociation can be considered as a focus of attention of the unconscious mind towards some part of the experience and not on all parts of the experience while the conscious mind is (dépotentialisé) left on hold.
Dissociation can be seeing a part of ourself, hearing one part of ourself, feeling one part of ourself. It can be experiencing an event or memory from any perspective other than seeing from our own eyes, our own hears, our own tactile and proprioceptive senses and our evaluative meta-feelings.
What techniques to be used to transform or alter the sensation of pain, to alter it, decrease it or even make it disappear?
We first have to recognize and take into account the pain itself, whether it is considered real or imaginary. For us, every pain is a real.
We have 4 possible orientations in the treatment of pain:
- we start from the pain and « play » with it inside the body,
- we go some place else, away from the pain and not mentionning it ; we create distraction from it
- we look at the pain from the distance, from another angle, another time
- we create analgesia or anesthesia, we promote forgetting
So here are a few techniques (this list is not beeing exhaustive):
- distraction from the pain: the patient goes some place else (in a pleasant memory of the past or of the future)
- observation or view from the distance or V/K dissociation: the patient observes the pain as if he or she was watching it on a movie or TV screen), he/she can thus describe it without suffering and with no concern.
- shift/displacement of the pain: the patient replaces or substitutes sensations for those of his pain. For example, a migraine, described/felt as a cold net or a tight burning helmet, can be transformed into some soft fudge, candy or marshmallow... This in turn should bring changes about the sensation of pain.
The shift can be made from one area of the body to another one while transforming the sensation as it is being moved.
- substitution by a pleasant pain, a more tolerable pain: the patient can have pleasant and bad pains, he can have a repertoir of pains to play with, such as coldness, itching, tingling.
- concentration on the pain: the patient describes his pain from a dissociative point of view. He talks to his knee that hurts: « I’d like to get rid of you. You’re spoiling my life... » As we’ve already seen in the example first given. The patient is already in an hypnotic state. (He/She can write a letter to his/her pain to pursue the dissociation)
- prescription of the symptom: we ask the patient to increase his pain to bring about the realisation that if he can increase the level of the pain, he can lower it. Or that he can decide to play with his pain at a precise time in the day.
- visualization of an electrical switch or an electronic keyboard: the patient can play with it to get to a more confortable level of pain. S/he can reduce the level of sensations: intensity, volume, brightness, warmth can be turned down
- age regression and age progression: the patient can go to a time where he had no pain and/or a time where he will have no pain.
- time distortion: the patient can alter his perception of time, reduce it or increase it. The pleasant memories seem to be short ones, the bad ones to be long moments. So far as you are in a pleasant time, it’s so short. S/he can lenteur the pleasant membres and shorten the painful ones.
- spread (étendre) the relief and extend the therapeutic effect: that comes with time distorsion, it’s in cross-fading with the post-hypnotic suggestion.
- saturation: we tell long and confusing stories so that the patient gets bored. - One story has been told hundreds of time and when you listen to it once more, you get bored. After some time, they saturate, they get bored.
- reinterpretation or reframing of the pain: using the patient’s description, the prick/stings of pins can be reinterpreted as mosquito bites.
- relaxation (« relaxer » in French means « to give freedom »)
- hypnotic analgesia or anesthesia: you probably know the glove technique where you create a local anesthesia through the hand that brings numbness to the part where the pain is. A numb hand can spread numbness.
- amnesia of something in the past or something that hasn't arrived yet: the patient can forget a difficult and painful birth or event just to be in the present or in the future.
Added tasks or questions to help the therapeutic process:
- what would you like to retain (from the pain or the situation) in your everyday life?
- what would be the slighest sign that would show you things are getting better? or that you will have more confort in the future?
- writing a letter from the future, rating the pain: the patient imagines he is relieved or healed (his rating is 1 or 2 on a rate from 0 to 10) and writes a letter to an other patient that is suffering (8) (or to himself) to give him advice, thoughts and sensations that will be usefull for him to change and live a new life.
- writing a letter to the pain (for kids, ) and burn it
- drawing the future: 1) pain 2) healing 3) ways to go from 1) to 2).
Learning to control one’s pain is a step by step process which needs time and exercice. There is no miracle.
distraction and sensory substitution
and, of course, suggestion to use self-hypnosis when needed
Robert, 78 years old, comes to me and says « I’m an hypocondriac » and describes all the illnesses his parents and his 3 boys had and have. He says he is conscious that he can suddenly realize that « Oh! I had no stomach ache today. » and ten minutes later, he has stomach ache. He complains he’s always out of breath.
He was referred to me for hypnosis by a pharmacist who has told him not to think about all those symptoms and all those pains he has.
After his divorce, his three boys took care of him. He started to travel with organized tours. He met his second wife, Mary, 56, in Indonesia. She suffers from epileptic attacks and depression. He takes care of her and she’s much better now than when he met her. Now his three boys consider he is set up for life (il est casé, rangé, garé des voitures. In French, that means he’s put in a box, settled down and well-behaved) and have removed themselves somewhat from him. Moreover he has fallen out (fâché) with his mother-in-law. So their family life is reduced to each other.
Their life is « badly organized, with very few activities ». It is organized around meals, sleep and TV. His life and her life are away from stimulations or « spice ».
He goes out for shopping but stops every 200 yards because of the tendinitis pain. A diagnosis of tendinitis has been made on the right arm and he has pain in the left arm.
« What would be different for him if everything in his life was ok? »
In fact, there might not be so many changes. However one of the big differences would be that he would go out and walk in a park near where he lives; he would go out and walk on the Champs Elysées; he would go out to theaters and museums... and not suffer from his tendinitis.
His first trance in my office centered around pleasant memories. He reacts to trance and I suggested he could go into pleasant memories as he does with me and practice self-hypnosis. He leaves my office « a young man », as he says.
Next session, he comes back saying « They are some smells in trains (he worked as a railroad employee) that remind me of ‘not unpleasant memories’. But you know, it’s very difficult for me to find pleasant memories. » It is as if there is some anesthesia of memories. The distraction is effective in my office but not in his every day life.
Second move: the task is to make a collection of good and pleasant memories from now on. Simple ones.
He comes back, isn’t very talkative about what he does and mentions « I have to be honest with you, it seems that my pain is decreasing ». Nevertheless, he rates his pain 6 on a scale from 0 to 10..
While in trance, I make him concentrate on the good sensations of comfort in the right arm and we go on and on to discover those good sensations... so as to progressively transfer them into the left arm. The pain goes to 1.
Next session he tells me he doesn’t sleep as much as he used to do in the afternoon and that gives him time to go out. They went into town near the Tuileries (a park not far from the Champs Elysées) as if it was a trip to a far away country. He talks about plans to go to the theater and see ‘Notre-Dame de Paris’. At the same time, he brings me some pleasant memories of travels and starts to talk to me about the beauty of the Taj Mahal and how much one can be staggered and even paralyzed in front of such beauty. It is interesting to see how he goes into trance by himself. He also mentions he has other personal problems completly aside from his pain problem that he will have to face and solve.
shift/displacement of the pain and dissociation from the pain
William, 18 years old, experiences stomach-ache when he has to do his home-work alone, or even with his supportive grand-parents; when he has a dead-line for an essay or an exercise, and also when he has a date. He lives with his father and his sister in Paris during the week, and with the whole family in Burgundy on the week-ends. He says his father is very concerned for him and he tries to encourage him. William can express himself to his father who accepts his anxiety and takes it into consideration. The mother is the one who gives him ordres, advising him and says: « Do this, do that » . To him, life is the life he leads in Paris during the week: « I’m independant and the three of us respect each other’s lives. I have the impression I understand what life is about . »
He has a computer where he plays and composes modern music. Even then, when he feels he’s in a hurry, he feels he can’t breathe and gets a stomachache. He says when the anxiety feeling is too strong, he goes into another room and/or goes to sleep. « I think too much about school and then I feel butterflies in my stomach. It’s a globus, a ball that paralyzes me. »
William explores the « ball », it’s made of steel, it’s not too large but extremely heavy and sharp like a stitch in the side (point de côté). He listens to it, it’s a note, a musical note which can be played. And as he listens to it, he can listen to the noises and the music that are in the room and to the noises that are in his body ; he can begin to see it on a musical score with many other notes and pauses. The ball is small, it’s a musical sign and a sigh of relief. He plays the music within himself and the rhythm is light, it is one of freedom.
There has been no need to go any further with this ball of anxiety for after a few sessions, using self-hypnosis when needed, William managed to deal with it and make it disappear. And it occured less and less.
There are other examples of anxiety balls or shapes.
Frank comes to see me for some weight problems. He has « a marble in his chest » as when he was in psychoanalysis some years ago. It’s a heavy weight, like an obsession, a mental block. Here we also start from the pain and dissociate from it. In the one session, the pain didn’t disappear but was reduced. In the next session, there was no trace of it but a good memory of the ‘game’: Frank said with a witty smile « I’ve lost my marbles. » (il a perdu la boule) - From this description we should retain the most important point, that of a game which is seen as pleasant and light by Frank. This game aspect has been a key to open up the work on his weight problems.
Yolanda, painter, experiences some stress and aggresivity episodes that can be of an extreme, violent and excessive strengh far beyond reason. She can’t bear the fact that her husband is late most of the time in the evenings and when she waits for him, she goes into a devastating spiral. The first therapeutic move is to make her observe the situations where she feels she becomes demoniac... and at the next session, she comes with a large smile explaining that nothing has happened and that she even managed to have humor with her husband when he arrived late at home. She explains « I have looked at the scene as if I was a member of the audience as soon as I have began to feel some pressure in myself, not letting the spiral to nest in me ».
After three sessions, she comes with a sketch of « the alien » that was nested into her
reframing and transformation of the pain
Benedict, one young man, 30 years old, having gone through all kinds of medical assessments suffers from a permanent back-ache.
He has not been working for over a year, lives in a condominium owned by his grandmother, maintened financially by his mother and gets a pension from the government. He’s been through medical examinations and has a compression of his dics. He’s had sessions of physical therapy and was asked to swim and to play sports to move his body. He’s referred to me by his physician.
Apart from his observed physical pain, he complains about everything in his life, work, relationships, sleep,... He says he does nothing because he’s so exhausted. He asks for a relief from his permanent back-ache.
The first therapeutic move is to question him: « what does this pain allow you to do ? » and to make him observe the pain two times a day at a prescribed time.
He comes back with a long description of the back-ache expressing a feeling of helplessness towards it and toward his own future. At the same time, the answer to the question about his benefits gives information mainly on the fact that he can be free from constraints and free to « see, breathe, feel what’s going on around, to dream, to meet people, to take time ».
In the second session, progressive relaxation is induced before getting to the exploration of the pain in its components. He feels he has a woman’s head watching inside himself... and that’s a nice and warmfull sensation. This woman means protection to him and he wants to keep her inside his back.
Hypnosis in the next session is used to concentrate on the pain and transform it: it’s as a chrysalis and when one has to come out of one’s shell to become a butterfly, it can be painfull and uneasy. The sensations change in meaning and at the same time, change in shape, color, temperature, texture...
Benedict has made some changes in his life: he’s been exploring some definitions and descriptions of different kind of pains, he’s discovered the variety of terms to describe it and he says « I’ve been exploring these books in the Cité des Sciences and the Centre Pompidou (two very large librairies in Paris). I could explore now ways to find a job. » Benedict has been out from his condominium, has directed his attention towards a goal, and been away from his pain.
Let’s think of a party. Here is a group of people talking loudly with exacerbation, there is another group of people involved in a more peaceful conversation. The second group seems to be much more interesting and attractive. It’s impossible to follow two conversations at the same time. We have to make a choice. We have to turn away our attention, to distract our attention from the noisy conversation to be better focused on the more discrete conversation.
Recurring pain can be a noisy conversation with no interest and we have to direct our attention to more peaceful, attractive or stimulating activities.
We can see through the windshield of our car or look at the default of the grains in the windshield and have accidents. In the fifties, in the States, there has been a windshield fail epidemic and Eisenhower has to send the FBI to investigate 254 instances... just to discover... that people instead of looking through their windshield , were to look at and scrutinize their windshield!
reframing and distraction: « as if »
Let us give you an example of reframing and distraction, an « as if » technique that has been described by a French actor, Jean-Claude BRIALY. As a teenager, Jean-Claude BRIALY was being hazed and experienced all kind of tortures. Here is what he wrote:
« My second year in that secondary school was much more difficult. There was only one thing in my mind: playing as an actor and I was dreaming of giving up school to get to Paris. School conditions were harder. Punishments and harassments were being handed out left, right and center and we were frequently hazed by the olders. We were treated to the most various humiliations, being creamed by shoepolish on all parts of our body, being kicked with leather belts, being closed in iron closets. Antonietti and I were trying to escape from such violences in using our imagination. We were becoming heroes of the Revolution, Camille Desmoulins or Robespierre, and we were subjected to every insult, to every abuse carrying our heads held high. Going to church, I was behaving the same way, alone in the aisle, I was imagining myself being the Dauphin (the apparent) on his way to be crowned.
(Jean-Claude BRIALY, Le ruisseau des singes, Robert Laffont/Pocket, Paris, 2001, p55)
In some ways, Jean-Claude BRIALY was already behaving as a « top of the bill », as being in the front the stage (first on the screen) who he has become!
In our work, post-hypnotic suggestion(s) will be used to maintain and follow up the work being done. Self-hypnosis will be taught and recommended to offer new possibilities to do the same work while being an actor.
For BERNHEIM, hypnotism involved the power of suggestion, he called it the « aptitude to transform an idea into an act ».
Léon CHERTOK said that « The hypnotic state appears to be as a modified state of consciousness, in which the operator can induce volition, memory and sensory perceptions distorsions - in this case, in the treatment of the algogenic informations from pain. »
Memory of the pain, muscle tension, attention directed towars the pain, anxiety about the future and anticipation of no end to the pain, feeling of helplessness and powerlessness (the physicians can be considered incompetent), depression, insomnia, inactivity (or no physical activity), all these aspects are to be taken in consideration to treat pain and anxiety.
How does the patient chew his cud, chew up his pain ? (Comment la personne rumine sa douleur ?)
Among the letters Milton Erickson received to thank him about his work and/or about the change he managed to make happen in the life of his patients, many of them have said « Thank you to have taught me the difference between knowledge and knowing ». (« Merci de m’avoir appris la différence entre savoir et connamaissance. ») * Ma voix t’accompagnera, p12