Clinical hypnosis - who's in charge?

The mind is mysterious and powerful. In the popular imagination, those who dabble with it are equally so. Hence the enduring image of the hypnotist as an eccentric swinging a pocket watch or the stage performer who gets 'victims' to do uncomfortable or embarrassing things that they would never do under normal circumstances.

Dabblers do exist. Lesser known are those who use hypnotism in a different way.

Dr Jeff Zeig is a US psychologist based in Phoenix, Arizona. He practises hypnotism, but he is neither an eccentric nor a performer. The hypnotism he practises is a form of psychotherapy. His particular 'brand' is the Ericksonian kind, named after his mentor Milton H. Erickson, a US psychiatrist who pioneered a particular approach to helping people.

One of Dr Zeig's ex-trainees is Mary Anne Agius, a counselling psychologist working in the University of Malta's counselling service. "Traditionally, a hypnotherapist would put ideas into a client's mind," she says. "The Ericksonian hypnotherapist does not force-feed ideas. Instead, he or she uses the client's own inner resources to help that person change, so the approach is less directive and more respectful to the client than traditional methods of hypnotherapy."

Dr Zeig describes the hypnotherapist as being more like a tour guide, showing a person round his or her inner psychological landscape, rather than an archaeologist who digs up the past.

In a recent interview in Psychology Online Journal, he explained how the approach works: "Erickson's model was based upon elicitation - awakening and stimulating dormant resources. If you want to learn to ride a bicycle, then information is not going to help a lot. You learn to ride a bicycle by the experiences you have; it is more of a visceral than cognitive learning."

The bicycle riding analogy is a little confusing at first glance. How can the ability to ride a bike be 'the awakening of dormant resources'? You are either able to ride a bike or you are not, right? Wrong. To continue with that allegory, in Erickson's view you may not know how to ride a bike, but you still possess the ability to do so. It is the hypnotherapist's job to enable you to take hold of that ability and use it to do what you want to do.

For instance, anyone who can walk already has the ability to balance. Learning to ride a bicycle involves taking hold of the ability to balance when walking and apply it to the use of pedals and wheels. Hypnotherapy works in the same way. It helps you move ideas from one area of your life to another.

That observation could leave you scratching your head in puzzlement. Ms Agius' explanation puts the picture into focus. "A person visits a therapist because there is something he wants to do but is unable to do alone," she says. "In psychotherapy, we would say that that person is 'blocked', that something is interfering with his ability to change in the way he/she wants. A hypnotherapist helps the person to get past those obstacles to achieve his/her goal."

She uses the example of elevator phobia to explain her point: "Some-thing makes that person afraid of going into a lift. In his mind, 'lifts' are associated with 'fear'. In hypnotherapy, the therapist tackles whatever it is that makes the person afraid of going into a lift."

If the therapy is successful, the phobic dissociates 'lifts' and 'fear', and is then no longer afraid to use a lift instead of climbing flights of stairs. How successful the hypnotherapy is depends on two factors - the willingness and motivation of the client and the competence of the therapist.

Generally, psychotherapy puts people face-to-face with themselves, requiring them to look inside their mind and challenge their beliefs about themselves and their way of living. It is, occasionally, an unpleasant experience and, as might be expected, people usually resist taking an alternative view of themselves.

The resistance is an obstacle to the therapeutic process and it is the therapist's job to help break it down. In hypnotherapy, resistance is reduced to a minimum, so the therapeutic process takes effect much faster. Ms Agius explains why.

"Hypnotherapy is a tool like any other in psychotherapy. It helps to achieve change because that is where it is directed. In other therapies, the therapist might decide to struggle with the client's resistance. In hypnotherapy, the client is more relaxed from the start, so the relationship is co-operative," she says. Because it is not focused on the past, but on helping the client move forward, hypnotherapy is able to produce results relatively quickly.

Still, the thought of losing control, being put to sleep and having someone else mess around with the contents of your head is enough to make anyone balk at the thought of undergoing hypnotherapy. Those ideas can be traced back to those enduring popular images of hypnotherapists. Ms Agius clears away that myth.

One of the misconceptions about hypnotherapy is that it involves putting a client to sleep. That would mean the person is not aware of what happens during the hypnotherapy session," she says. "Actually, the client is not asleep during hypnotherapy, but in a state of deep relaxation. That means he or she remains aware of what is going on throughout."

That is perfectly plausible. However, might the experience of hypnotherapy be like those nightmares where you know exactly what is happening to you but you can't do anything to stop it, where you scream and no sound comes out of your mouth and, when you try to run, your legs cannot move? Not really, Ms Agius says.

"Responsibility and control belong to the client at all times," she says. "Hypnotherapy can only 'control' the client as far as he or she permits. Compare it to driving a car. Say you are driving your car and for some reason you want me to get behind the wheel.

Does that mean that I take over your car completely? With hypno-therapy it is the same thing. A client realises he or she needs help and asks a hypnotherapist to intervene, but that does not give the hypnotherapist absolute control."

Dr Zeig puts it in a different way. In a recent interview he explained that "we may think of hypnosis as being a state of focused awareness where the person's response is immediately relevant." You could turn that around to say that therapists do not make clients do anything they would not do themselves, which is a reassuring fact. In other words, nobody need fear a properly trained and responsible hypnotherapist, but therein lies the rub.

In an unregulated environment, there are no definitions of what is meant by 'proper training' or what makes one hypnotherapist 'responsible' and another not. Asked how hypnotherapy is regulated in Malta, Ms Agius asks rhetorically: "Is psychotherapy regulated in Malta?" The answer is "no", though pending legislation may yet put some matters straight.

It is difficult to tell how widely hypnotherapy is used in Malta, or how many appropriately trained hypnotherapists are at work here. There is no formal requirement for practise such as a professional licence. What is clear is that without inappropriately training, hypnotherapists could do more harm than good.

"Psychotherapy is never neutral," Ms Agius says. "It is for better or for worse. Hypnosis is a psychotherapeutic tool that you use to systematically take someone into an altered state of consciousness. If the person practising hypnotherapy is not trained, it is dangerous to play around with people's psyche. Picture a doctor who is not a trained surgeon who decides to operate on a patient.

He can open up that patient but would not know how to handle the operation or the complications that result from it. That can be dangerous. It is the same with psychotherapy and, by association, with hypnosis."