The Power of Suggestion
Nevertheless, the very idea that GMM, just like hypnosis, incorporates active, directed suggestion to a client by the therapist strikes many mindfulness practitioners as tantamount to heresy, a betrayal of the “purity” of the practice itself. Mindfulness is typically introduced in the context of a therapeutic relationship by a clinician convinced of its merits, who directly says to the distressed client that “this will help,” and then begins the experience by conducting a guided mindfulness meditation. The GMM attempts to engage the client’s attention and help him or her focus on certain suggested experiences, whether they involve breathing, scanning the body, meditating on acceptance, awakening to the truth, or cultivating compassion. Finally, the point is made, either implicitly or explicitly, that this experience will have some lasting impact on the client’s well-being and that repeated practice will facilitate the desired effects. Is there any part of this process that does not rely on the use of suggestion to attain therapeutic results?
To acknowledge the inevitable role of suggestion in mindfulness is to acknowledge the principles and methods of clinical hypnosis. Hypnosis encompasses the study of how to compose and deliver suggestions that engage the client’s attention, foster a deep experiential absorption, and “spontaneously” elicit different kinds of empowering subjective experiences, such as analgesia or anesthesia for pain management or increased bodily and sensory awareness. Hypnosis, like mindfulness, encourages awareness and acceptance, especially an awareness of the personal resources one can bring to bear on a situation. Virtually all of the modern neuroscience of clinical hypnosis, like that of mindfulness, focuses on attentional processes and directing focused attention in clinically useful ways. When a mindfulness practitioner talks about “attention without intention” and tells the client to “let go of goals” and “stop being a human doing and instead be a human being,” he or she is paradoxically suggesting a new goal of having no goals. Whatever the client’s experience from either GMM or hypnosis, the therapist’s actively directed suggestions lead the way. If mindfulness-oriented clinicians want to be effective in the work they do, it’s important that they strive to better understand how their methods—their suggestions—are structured and delivered, and discover what role the quality of their suggestions plays in the clinical results they obtain.
Clinicians also need to ask tougher questions. What, actually, are the differences, if any, between mindfulness and clinical hypnosis? We know that the neuroscience of mindfulness and hypnosis is parallel, causing changes in brain activation of the same magnitude. Both feature cortical inhibition as revealed by slowed EEG theta waves, and both show higher levels of activity in areas where theta is prominent, such as the frontal cortex and especially the anterior cingulated cortex. But it’s still too early to draw many conclusions about the meaning of such neural activities.
To highlight impressive brain changes presumably justifying mindfulness meditation, some neuroscientists identify a much-touted thickening of the cortex following repeated meditation. But what’s the evidence that a thicker cortex actually makes for a smarter, happier, better, more effective human being? None yet! What does it indicate that some research suggests a thicker cortex may be associated with autism? The fact that experience, including meditative and self-hypnotic experience, changes brains in measurable ways is fascinating, but it raises far more questions than answers about the psychological impact of these changes.
More important to the understanding of mindfulness and hypnosis, though, is the evidence that what a brain scan reveals depends on what the client is being asked to do. GMMs typically have different focal points associated with them than do hypnosis sessions. In fact, it may be that all that differs between GMM and hypnosis is what the person focuses on and how that focused mind-state is used. The effects of suggesting global and spiritual experiences to people—feelings of acceptance, forgiveness, or overall serenity—will be quite different to those of providing clients with specific ways to accomplish a particular goal, such as overcoming depression or anxiety. Clinical hypnosis is openly and unapologetically goal-oriented, while GMM is equally goal-oriented, but its practitioners are still uncomfortable defining themselves as such.
The similarities of clinical hypnosis and GMM are stronger by far than their differences. The methods of both stimulate unconscious processes that produce automatic or nonvoluntary, but meaningful and helpful, responses—even though GMM practitioners may not use this language to describe what they do. How are these “spontaneous transformations” accomplished? Mindfulness practitioners will typically respond with a global answer of an “awakening” or a spiritual answer of “enlightenment.” However, a more realistic answer is to be found in the neuroscience of attention and, more specifically, in the capacity to influence unconscious processes in dissociated states.
Dissociation: The Driving Force
Both GMM and clinical hypnosis use suggestive methods to elicit beneficial, nonvoluntary responses—suspension or amelioration of pain, “spontaneous” feelings of compassion, acceptance, or transcendence, and so on—that can’t simply be willed. During a course of meditation, a wide range of responses can seem to arise as if from nowhere. For example, a mindfulness practitioner has the client focus on her breath by suggesting that she “become aware of the breath, the rise and fall of the chest, the warm or cool temperature of the air,” and the client’s breathing may slow down, even though the practitioner hasn’t suggested that she slow her breathing down. The client says it “just happened.” Similarly, a person undergoing GMM reports an “amazing transformation of my anger to forgiveness” or proclaims “my self-hatred turned to self-love.” These aren’t responses you can consciously generate on demand. They’re nonvolitional but subjectively powerful. It’s not surprising that a client will have the feeling that something “magical” just happened.
What may seem magical to people who haven’t analyzed this phenomenon in depth is actually one of the most intensively studied aspects of clinical hypnosis. People can have dramatic sessions in a wide variety of ways, and these can have powerful enduring effects. One of the most common observations documented in the hypnosis literature is how a new perceptual or behavioral response can be readily absorbed and then repeatedly acted upon for a time span ranging from a short while to an entire life—even on the basis of a single hypnotic experience.
Even more intriguing, during hypnosis, people are typically fully aware of the suggestions being given them and their responses to the suggestions. But they’re not aware of how they’re able to respond nonvolitionally—how they’re able to develop pain-relieving numbness in a limb, for instance. Understandably, this gives many the feeling that something remarkable “touched their soul,” outside the context of the hypnotic relationship. The same thing happens with GMM, during which people may be aware of and respond powerfully to suggestions for “loving-kindness,” for instance, but have no idea how they did so. So, they feel that “something amazing happened!” It’s curious and puzzling to observe such responses; it’s hard to try to explain them. What about the unconscious allows automaticity of responses—responses that seemingly “just happen” involuntarily, outside of or beyond our willed control, as a result of well-crafted suggestions from the therapist or guide?