Suggesting Mindfulness

Awakening the Hypnotist Within

September/October 2011

If you talk to mindfulness practitioners about the similarities between guided mindfulness meditation and hypnosis, they tend to react with various degrees of indignation, if not downright revulsion, as if to say, “Don’t get that icky hypnosis all over my nice mindfulness!” Mindfulness practice, they aver, is rooted in the ancient wisdom traditions of the East, dedicated to developing self-understanding, serene acceptance of life’s trials, and spiritual growth. Free of religious dogma or orthodoxy, presumably it imposes nothing, but simply elicits an inner “awakening” of people’s “true selves” and helps them “cultivate compassion,” “awaken from the trance of unworthiness,” and, of course, “attain enlightenment.” Who wouldn’t want to experience these lofty states of mind?

Hypnosis, by contrast, is commonly considered a crass theatrical stunt—an occasion for a hypnotist to exert mind control over a passive subject. In this distorted view, hypnotists impose their will on easily led people, as epitomized in a cheesy Las Vegas stage show where the slick, manipulative hypnotist makes a row of volunteers believe and act as if they were playing musical instruments or pantomime over-the-top lascivious behavior. If mindfulness is symbolized by the Buddha, his soft gaze turned down in serene contemplation, hypnosis is too often represented by Svengali, his fierce eyes fixed on his prey.

But a closer look at the processes, goals, and outcomes of both mindfulness and hypnotism reveals that they share fundamental similarities of purpose and practical knowledge. Within the framework of a trusting therapeutic relationship, attuned therapists now regularly employ Guided Mindfulness Meditation (GMM) in the same way I was trained to use clinical hypnosis. Today’s mindfulness-oriented therapists, like clinicians practicing hypnosis, teach clients self-regulation strategies, such as how to use their breath and employ guided imagery to shift attention and experience the deep power of accepting what’s unchangeable or inevitable.

As mindfulness methods have come to assume a more prominent role in mainstream clinical practice, the common mechanisms that underlie the efficacy of both GMM and hypnosis have become more apparent. To begin with, both involve two people: a guide, teacher, or therapist, who uses suggestion to focus then alter the awareness—cognitive, sensory, relational, and emotional—of a client or student, thereby promoting experiential learning. These alterations in awareness may give rise to dramatic and seemingly spontaneous shifts in perspective and even profound personal transformation as one’s self-definition expands. They may also yield what pioneering hypnosis researchers Theodore Sarbin and Ernest Hilgard called “believed-in imagination.” In fact, the science of clinical hypnosis is highly relevant to understanding how the methods of mindfulness may have even greater impact when used in a psychotherapeutic context.

GMM practitioners could significantly improve their clinical work and produce more focused and effective interventions if they drew upon the findings reported in thousands of studies already done by hypnosis researchers about the many complex personal and interpersonal factors influencing people’s ability to respond meaningfully to suggestion. But to do so, they first need to strip away the philosophical abstractions, Eastern mystical spirituality, and romantic exoticism that currently infuses the entire discussion of mindfulness. They’d be advised to start by considering some basic clinical questions they generally don’t yet ask: What differences are there between mindfulness employed primarily as a spiritual quest and that applied for therapeutic purposes? What role do the therapeutic alliance, client expectations, and therapist’s suggestions play in conducting GMM? How do we determine who’s most and least likely to benefit from such experiential methods? How can we best adapt mindfulness methods to meet the needs of specific clients?

Spiritual Practice Isn’t Clinical Intervention

It seems likely that, barring a few spiritual geniuses (Buddha being one), almost nobody really learns mindfulness alone, in a vacuum. Mindfulness requires a teacher, to provide explicit instruction, encouragement, and leadership, within the context of a trusting relationship. The failure to see the fundamental similarities between GMM and hypnosis stems from the tendency to regard all mindfulness practice—guided or otherwise—as entirely a solitary spiritual practice, undertaken by one person meditating alone, seeking capital-T Truth. In contrast, hypnosis is seen as a kind of indoctrination—an induction into mindlessness too often carried out by quacks with control issues.

Of course, most therapy clients don’t learn mindfulness because they desire spiritual transcendence. Instead, they find themselves trying meditation for more immediate reasons: freedom from pain, depression, crippling phobias, or addictions. Would client X ever have gone to an integrative medicine center to learn how to meditate if he hadn’t been diagnosed with cancer, suffered great pain, and become desperate enough to try almost anything? Would client Y be practicing mindfulness if she’d been able to resolve her eating disorder or depression through ordinary therapy, medications, or any other mainstream solution? It follows that since the two typical reasons for learning mindfulness—as a spiritual pursuit or a clinical treatment—are different, the intentions for using them and methodology followed also should be different. These differences should be well understood by the clinician and clearly articulated to the client.

Therapists who view mindfulness as a private pursuit of deeper awareness tend to remove themselves from the equation, considering themselves “only” guides, as if they were doing nothing more than handing out an instruction sheet. But, what, exactly, does it mean to be a guide, and how does guidance in the form of GMMs in therapy influence the client’s phenomenology and associated clinical outcomes? If mindfulness is to progress as a clinical tool, we need to better understand how it works: how the guide structures and delivers the words to cause meaningful subjective but nonvolitional experiences, such as acceptance and compassion. To do that means acknowledging the powerful role of suggestion in encouraging attention and stimulating (priming) unconscious processes. This is the domain of clinical hypnosis, and the research and methods found there warrant every clinician’s serious study.

Like students of mindfulness who may meditate and spontaneously “cultivate equanimity” or have profound feelings of spiritual transcendence, people in hypnosis routinely experience dramatic suggested effects that defy logic: being able to stem bleeding from the site of a wound, having a “felt sense” of being with someone long deceased (whether a relative or the Buddha), feeling a vital connection to “the inner sage.” Such remarkable experiences illustrate clearly the measurable shifts in physiology, relationship, cognition, affect, and spirit that can arise through hypnotic experiences. These dramatic effects are far better understood in social-psychological terms as the products of suggestion within a shared perceptual framework than as the spontaneous bubbling up of spiritual “truths” in therapy.

When a clinician conducts a GMM, it’s self-deception to believe he or she isn’t the one conducting the session and serving as the catalyst for what transpires. It’s deceitful to suggest to clients that it’s entirely up to them how many steps along the “path to enlightenment” (or “wellness”) they take, as if the clinician’s guidance and the quality of their therapeutic alliance weren’t vital to what happens. Therapy is a shared, goal-oriented process, and both clinicians and clients inevitably contribute to the outcome.

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Tuesday, October 11, 2011 10:09:52 AM | posted by Tim Duerden
I found Michaels article fascinating - and helpful.

I am trained in both mindfulness based approaches and hypnotherapy and would agree with Michael that there tends to be an almost automatic uneasiness in many mindfulness teachers when associations are made between mindfulness and hypnotherapy - or even with guided imagery.
Some of this I think arises from the language used to describe a mindful state as being a state of 'bare awareness' or a state in which there is closer contact with reality. This then makes anything that knowingly alters our experience of 'reality' seem manipulative or a distancing from 'reality'. And yet this manipulation is explicitly present in so most mindfulness guidance offered by teachers as Michael shows in his article - even if it is not acknowledged by the teacher themselves.
These issues are nicely illustrated by common guidance offered for mindfulness of breathing.

Firstly, there is commonly instruction as Michael points out above: "see if we can drop in on the sensations of breathing without fiddling with the
breathing at all". This to me risks setting up an assumption that an 'unfiddled with breath' is somehow a more worthy target of mindfulness than a 'fiddled with breath': when we can be just as mindful of either experience. My hypnotherapy training taught me to be very careful with such biased guidance as it very easily creates a tension as the person tries not to fiddle - and therefore inevitably starts fiddling. From a mindfulness practice viewpoint setting up guidance to induce such tension offers the person the chance to explore being mindful of that tension and so could be argued to be still valid: but this to me risks being an excuse for unskillful and uncompassionate teaching.

Secondly, mindfulness of breathing guidance often contains experientially manipulative kinaesthetic imagery: if I am imagining my breath flowing in and out of a painful area and noticing that the pain starts to be more accessible and bearable I am manipulating my experience through imagery - in this case body based kinaesthetic imagery.

Overall what I took from my hypnotherapy training is the potency of language and how what we say and how we say what we say matters. Yes, those we guide have the opportunity to be mindful of the impact unskillful language has on their state - but this risks being an abdication of professional responsibility. I remember one respected mindfulness teacher [who came from a Buddhist / yoga background] guiding a mindfulness-based stress management group out of a long body scan practice and casually saying: "Sometimes you may feel as if your body is paralysed - but this will pass." [!]
I think the approach taken in Clean Language is a really useful bridge for mindfulness teachers into greater awareness of the power of metaphor in language.

I do think hypnotherapy has much to learn from mindfulness and compassion based approaches as well. When I am training hypnotherapists to be mindfulness teachers I find the hypnotherapists discover a way of approaching their moment-to-moment experience with their clients in a richer and deeper way - as do psychotherapists. The territory is familiar but the route taken fresh and illuminating...
Acceptance and Commitment Therapy also offers a framework that enriches my hypnotherapy practice as it provides a fairly rigorous model with which to assess whether or not the interventions I am making may be supporting avoidant behaviour patterns.

Thursday, October 13, 2011 12:51:15 AM | posted by devon mark
I am a psychologist, educated in both hypnosis (Dr. Erickson was one of my role models) and mindfulness, over the past 30+ years. I found Michael's article clarified for me how the language of hypnosis has become a "meta-language" for me to conceptualize therapy and many life experiences, including meditation. Once again I appreciated his clarity in helping me sort out the various ideas and practices that abound in the therapeutic community.

Friday, October 14, 2011 6:25:07 AM | posted by Tim Duerden
I managed to click submit a little prematurely below - hence a typo or two like an extra 'so' 9 lines or so down.
I also did not make the more critical point I intended that I did not recognise Michael's generalisation that mindfulness teachers attribute the process of therapeutic change that mindfulness facilitates to mystical or spiritual forces. I have never experienced this in the training I have received in the UK (e.g. from Breathworks or the Centre for Mindfulness Research and Practice at University of Bangor) nor do I give this message in the training I deliver. The attribution to efficacy is typically a mix of psychology, psychotherapy and neurophysiology. Buddhist philosophy is used at times but this has been drawn from the aspects of the tradition that more directly mesh with and can illuminate and enhance Western neuro-psychology and psychotherapy. The aspects of certain Buddhist traditions that evoke non-material / spiritual forces have been tucked quietly away and never mentioned...
The only population of therapists I have experienced that do occasionally evoke Michael's mystical forces are spiritual healers who have become interested in mindfulness - such as those who have trained in Reiki. Such folk do often train in hypnotherapy and I wonder if Michael picked up his biased view from such therapists on his own training programmes.

But Michael's characterisation did give me the opportunity to be mindfully aware of my mind's chattery reaction to his generalisation and a little tension in my guts - so at that level I welcome it!

Tuesday, March 20, 2012 11:01:30 AM | posted by Lisa Fogel,LCSW
I find the article interesting and dogmatic. Yapko repeatedly speaks of suggested experiences as if therapist are causing patients to make up experiences that never occurred. It reminds me of the stereotype of therapist causing patients to make up sexual abuse that never occurred. He also assumes mindfulness is treated in a vacuum using no other theoretical orientations. He goes on to say if therapists use mindfulness or hypnosis (he appears to group them together in some ways which I would support) it is important they strive to better understand how their methods (reverts back to suggestion as an insult)and how this plays into clinical results. I find this interesting since I tend to think the methods that work best are the ones that a practitioner has good results. If patients benefit from hypnosis or mindfulness, it can be incorporated into therapy. The patient cannot suggest this if he/she is not familiar with this. His use of suggestion is not clear (and if it is, it is based on erroneous assumptions.) The client cannot learn breathing or ways to slow down their thinking if it is not taught. Part of therapy is education to give coping skills that patients can use on their own. It appears Yapko prefers mindfulness and hypnosis is not used if it is not strictly Freudian. You and I spoke of our similar views on that today.

Having said that I also believe that mindfulness is a form of education and is only one modality. I have never been fully comfortable working with a therapist who is strictly CBT if they do not also engage them in their history and connect this to the present and help them uncover repressed memories. (I may be a bit orthodox in this thinking but we can speak of this another time) Yapko appears to be assuming this is the sole treatment being used. This makes me think of clients who use Reiki. It has been my experience that clients who work with a reiki practitioner have a wow experience immediately following, yet there is no sustained change over time. (my personal opinion). I think mindfulness and most likely hypnosis (though I have not used this method) provide a lasting impression as this allows patients to slow their minds to connect with repressed memories and connect them to current emotions causing a decrease in depression, and as you said open their minds to thinking about things a different way. Yapko goes on to criticize that a practitioner cannot know which client will respond to mindfulness and goes on to arrogantly assume therapist push patients harder to work on mindfulness more to get the intended benefits. He is making assumptions based on ignorance as any good practitioner does not push, but allows a client to understand and use what they learn in a way that makes sense to them.

His comment about a thicker cortex being associated with Autism is a fascinating comment. When it comes to neuroscience, I think we as a society do not have enough medical information to determine what is real and what is constant with each person. I think highlighting impressive brain changes is one area of psychiatry, but not one that I personally base my choice of treatment. I go by experience and by seeing what appears to work and what does not appear to work.

He says it (GMM) raises far more questions than answers. I disagree. I think mindfulness and hypnosis raise far more answers and gives us the freedom to continue to question.