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Suggesting Mindfulness

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PNSO11-2Awakening the Hypnotist Within

By Michael Yapko

As a clinical intervention, mindfulness is best understood by stripping away its aura of mystical spirituality and understanding the crucial role suggestion plays in the change process.

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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