ALTERNATIVE MEDICINE * MEDECINE PARALLELE
Hypnotherapy and the GP Ian Simpson, MB, BChir, Dobst Rcog, FCFP
In 1968 the British Tuberculosis Association published the results of a controlled trial involving the use of hypnotherapy to treat asthma patients (Hypnosis for asthma - a controlled trial. BMJ 1968; 4: 71-76). An editorial in the same issue of the BMJ expressed the hope "that more physicians will be encouraged to explore its possibilities" (Hypnosis in medicine. BMJ 1968; 4: 67). Unfortunately, this did not happen. An editorial in Hospital Doctor (1986; 15: 10) stated: "It is surely extraordinary that a technique with such potential should attract so little interest and research." This is still the case. Hypnotherapy is still "on the fringe," even if the medical profession does not greet it with quite so much scepticism as it did a generation ago. If I have one regret in my professional life it is that I was not introduced to hypnotherapy 30 years ago. I practise in Corner Brook, a small city with about 26 000 residents; it has a regional hospital that serves the west coast of Newfoundland, a catchment area of approximately 90 000 people. My major interest had always been obstetrics, but 6 years ago illness forced me to stop this type of work. Before that I had started to attend workshops on hypnoIan Simpson practises family medicine in Corner Brook, Nfld. 908
CAN MED ASSOC J 1991; 144 (7)
therapy in order to use hypnosis in antenatal preparation and labour. In the last 6 years I have been using it to treat a growing number of conditions in other areas.
ypnosis brings an entirely new dimension to practice. It has enriched my professional life enormously.
After initially attending a workshop organized by the Department of Continuing Medical Education at Memorial University in St. John's, Nfld., I attended workshops provided by the Canadian and American societies of clinical hypnosis. All were well organized and helped me develop the skills and confidence I needed; many workshops have different sections for beginning, intermediate or advanced students and they often cater to those with special interests. Currently, workshops are organized regularly in Ontario, Alberta, Nova Scotia and British Columbia by the clinical societies in those provinces.
Being in practice in one community for many years provides several advantages for hypnotherapists. Most of the patients I treat with hypnosis come from my practice. They have already known and trusted me for several years, so the number of resistant, or nonhypnotizable, patients is negligible because the most important conditions needed for successful hypnotherapy - trust and rapport - already exist. The routine work of a family physician provides a broad range of patients and medical problems for which hypnotherapy proves beneficial. Unfortunately, time, or the lack of it, is a problem. Some weeks I have to set aside special hours for this work, periods during which there will be no interruptions. Initial visits are the most time consuming. I usually allow 1 hour for the first visit and 30 or 40 minutes for subsequent ones. The time required varies depending on both the therapist and the patient. Some patients require about 1 hour for each visit, and some physicians find that after the initial visit 15 or 20 minutes is long enough to treat many problems. Dr. John Hartland, an English general practitioner who was influential in encouraging the use of hypnosis by physicians in the United Kingdom, managed to incorporate hypnotherapy routinely during office hours. His book Medical and Dental Hypnosis (Bailliere Tyndall, London, 1971)
--m
is still one of the best introductory texts in the field. It is not generally recognized that numerous patient complaints handled by the average family physician can be treated and helped - often most dramatically - by hypnotherapy. These include such childhood habits as nail biting, hair pulling, thumb sucking and tics; patients with problems such as enuresis and encopresis also respond well, as do those with adult complaints such as asthma, migraine, insomnia and irritable bowel syndrome, and certain skin disorders. Hypnosis is extremely effective in producing relaxation and reducing anxiety and tension and I use it frequently with anxious patients. Agoraphobia and fear of flying have proved amenable to cure with hypnosis. Two professional performers, one an actor and the other a musician, developed stage fright and subsequent insecurity in mid-career, and were grateful for hypnotherapy. They were taught self-hypnosis and rediscovered the ability to face an audience without having debilitating "stage nerves." I recently treated a woman who had suffered from arachnophobia for more than 40 years. Her condition was so severe she would not go through a door if she thought there might be a spider outside. Her husband had to check and sweep away any webs and her social life was in tatters because of her fears - she could not even bear to look at a spider in a book. After about 3 months of hypnotherapy she was able to handle and remove any offending spiders herself. It is heartwarming and rewarding when a physician is able to provide this type of help. Hypnosis can be used for pain relief and is effective for many women in labour. However, for patients suffering from chronic pain hypnosis is unlikely to produce the sought-after cure, although it often provides a tool
that will improve the patient's ability to relax. Hypnotherapy is my treatment of choice for enuresis because the success rate is high and the rewards are great. I begin the sessions after assuring myself that there is no organic problem. I have seen many children come alive as their confidence blossoms because of the treatment's success. Suddenly they can do the things other children take for granted, such as sleeping over at a friend's house or going to Cub or Brownie camp. It is a joy to see this and to witness the parents' reaction as scepticism turns to joy. If I leave the impression that I derive great pleasure from this segment of my practice, I do. It is very satisfying to find that patients who had become dependent on sleeping pills, tranquillizers or other medications can develop the psychologic strengths needed to conquer their problems and discontinue their medications. I do not encourage or offer hypnosis to smokers or overeaters. If these patients insist I treat them reluctantly, partly because I find the cure rate to be rather low. I much prefer to use the time I allot for hypnotherapy to treat more "rewarding" and treatable problems. However, many physicians do treat these patients routinely with hypnotherapy and have good success rates. Most physicians who employ hypnotherapy will have some unusual experiences. I was using it to treat a patient for insomnia and as part of the process asked her to find a happy memory from her past. She recalled her baby's birth and the joy of breast-feeding immediately after delivery. The next day she phoned to say she was lactating and "could carry on breast-feeding as well as on the day she weaned her last baby 10 years ago." This sort of experience convinces me of the reality of hypnotherapy and imagery in psychosomatic disease.
.M
One of my patients had only one session of hypnosis for insomnia, which did not work, but after experiencing a painful shoulder injury while playing hockey he decided to try the same hypnotic induction. He tried to get to sleep, but failed; however, the pain in his shoulder disappeared and he found he could repeat this every night and become free of pamn. Unfortunately, he still had trouble sleeping! This convinced him that hypnosis was effective but that I had pushed the wrong button the first time. He returned and asked me to conduct another session, but to do it properly, "for insomnia this time, not pain relief." A very interesting case, and a strange one. Despite some "mind-boggling" cases, there is nothing magical or demonic (as one of my fundamnentalist patients had categorized the practice) about hypnosis. It is a natural process that almost everyone can use, but most do not. I regard it as an additional therapeutic tool that I can use in the struggle against illness and disease. Who should use hypnotherapy? Are there dangers? Hypnosis is not dangerous in itself, but hypnotists should not stray beyond their areas of expertise and competence. For example, the American Society of Clinical Hypnosis, probably the most influential body in the field of North America, restricts its training workshops to those who have doctorate degrees in medicine, dentistry or psychology. Although the techniques are simple and the risks low, only professionals with this training should practise hypnosis. I would recommend that all physicians, family physicians in particular, consider learning this skill by attending a workshop. Hypnosis brings an entirely new dimension to practice. It has enriched my professional life enormously.CAN MED ASSOC J
1991; 144 (7)
909
Hypnotherapy and the GP Ian Simpson, MB, BChir, Dobst Rcog, FCFP
In 1968 the British Tuberculosis Association published the results of a controlled trial involving the use of hypnotherapy to treat asthma patients (Hypnosis for asthma - a controlled trial. BMJ 1968; 4: 71-76). An editorial in the same issue of the BMJ expressed the hope "that more physicians will be encouraged to explore its possibilities" (Hypnosis in medicine. BMJ 1968; 4: 67). Unfortunately, this did not happen. An editorial in Hospital Doctor (1986; 15: 10) stated: "It is surely extraordinary that a technique with such potential should attract so little interest and research." This is still the case. Hypnotherapy is still "on the fringe," even if the medical profession does not greet it with quite so much scepticism as it did a generation ago. If I have one regret in my professional life it is that I was not introduced to hypnotherapy 30 years ago. I practise in Corner Brook, a small city with about 26 000 residents; it has a regional hospital that serves the west coast of Newfoundland, a catchment area of approximately 90 000 people. My major interest had always been obstetrics, but 6 years ago illness forced me to stop this type of work. Before that I had started to attend workshops on hypnoIan Simpson practises family medicine in Corner Brook, Nfld. 908
CAN MED ASSOC J 1991; 144 (7)
therapy in order to use hypnosis in antenatal preparation and labour. In the last 6 years I have been using it to treat a growing number of conditions in other areas.
ypnosis brings an entirely new dimension to practice. It has enriched my professional life enormously.
After initially attending a workshop organized by the Department of Continuing Medical Education at Memorial University in St. John's, Nfld., I attended workshops provided by the Canadian and American societies of clinical hypnosis. All were well organized and helped me develop the skills and confidence I needed; many workshops have different sections for beginning, intermediate or advanced students and they often cater to those with special interests. Currently, workshops are organized regularly in Ontario, Alberta, Nova Scotia and British Columbia by the clinical societies in those provinces.
Being in practice in one community for many years provides several advantages for hypnotherapists. Most of the patients I treat with hypnosis come from my practice. They have already known and trusted me for several years, so the number of resistant, or nonhypnotizable, patients is negligible because the most important conditions needed for successful hypnotherapy - trust and rapport - already exist. The routine work of a family physician provides a broad range of patients and medical problems for which hypnotherapy proves beneficial. Unfortunately, time, or the lack of it, is a problem. Some weeks I have to set aside special hours for this work, periods during which there will be no interruptions. Initial visits are the most time consuming. I usually allow 1 hour for the first visit and 30 or 40 minutes for subsequent ones. The time required varies depending on both the therapist and the patient. Some patients require about 1 hour for each visit, and some physicians find that after the initial visit 15 or 20 minutes is long enough to treat many problems. Dr. John Hartland, an English general practitioner who was influential in encouraging the use of hypnosis by physicians in the United Kingdom, managed to incorporate hypnotherapy routinely during office hours. His book Medical and Dental Hypnosis (Bailliere Tyndall, London, 1971)
--m
is still one of the best introductory texts in the field. It is not generally recognized that numerous patient complaints handled by the average family physician can be treated and helped - often most dramatically - by hypnotherapy. These include such childhood habits as nail biting, hair pulling, thumb sucking and tics; patients with problems such as enuresis and encopresis also respond well, as do those with adult complaints such as asthma, migraine, insomnia and irritable bowel syndrome, and certain skin disorders. Hypnosis is extremely effective in producing relaxation and reducing anxiety and tension and I use it frequently with anxious patients. Agoraphobia and fear of flying have proved amenable to cure with hypnosis. Two professional performers, one an actor and the other a musician, developed stage fright and subsequent insecurity in mid-career, and were grateful for hypnotherapy. They were taught self-hypnosis and rediscovered the ability to face an audience without having debilitating "stage nerves." I recently treated a woman who had suffered from arachnophobia for more than 40 years. Her condition was so severe she would not go through a door if she thought there might be a spider outside. Her husband had to check and sweep away any webs and her social life was in tatters because of her fears - she could not even bear to look at a spider in a book. After about 3 months of hypnotherapy she was able to handle and remove any offending spiders herself. It is heartwarming and rewarding when a physician is able to provide this type of help. Hypnosis can be used for pain relief and is effective for many women in labour. However, for patients suffering from chronic pain hypnosis is unlikely to produce the sought-after cure, although it often provides a tool
that will improve the patient's ability to relax. Hypnotherapy is my treatment of choice for enuresis because the success rate is high and the rewards are great. I begin the sessions after assuring myself that there is no organic problem. I have seen many children come alive as their confidence blossoms because of the treatment's success. Suddenly they can do the things other children take for granted, such as sleeping over at a friend's house or going to Cub or Brownie camp. It is a joy to see this and to witness the parents' reaction as scepticism turns to joy. If I leave the impression that I derive great pleasure from this segment of my practice, I do. It is very satisfying to find that patients who had become dependent on sleeping pills, tranquillizers or other medications can develop the psychologic strengths needed to conquer their problems and discontinue their medications. I do not encourage or offer hypnosis to smokers or overeaters. If these patients insist I treat them reluctantly, partly because I find the cure rate to be rather low. I much prefer to use the time I allot for hypnotherapy to treat more "rewarding" and treatable problems. However, many physicians do treat these patients routinely with hypnotherapy and have good success rates. Most physicians who employ hypnotherapy will have some unusual experiences. I was using it to treat a patient for insomnia and as part of the process asked her to find a happy memory from her past. She recalled her baby's birth and the joy of breast-feeding immediately after delivery. The next day she phoned to say she was lactating and "could carry on breast-feeding as well as on the day she weaned her last baby 10 years ago." This sort of experience convinces me of the reality of hypnotherapy and imagery in psychosomatic disease.
.M
One of my patients had only one session of hypnosis for insomnia, which did not work, but after experiencing a painful shoulder injury while playing hockey he decided to try the same hypnotic induction. He tried to get to sleep, but failed; however, the pain in his shoulder disappeared and he found he could repeat this every night and become free of pamn. Unfortunately, he still had trouble sleeping! This convinced him that hypnosis was effective but that I had pushed the wrong button the first time. He returned and asked me to conduct another session, but to do it properly, "for insomnia this time, not pain relief." A very interesting case, and a strange one. Despite some "mind-boggling" cases, there is nothing magical or demonic (as one of my fundamnentalist patients had categorized the practice) about hypnosis. It is a natural process that almost everyone can use, but most do not. I regard it as an additional therapeutic tool that I can use in the struggle against illness and disease. Who should use hypnotherapy? Are there dangers? Hypnosis is not dangerous in itself, but hypnotists should not stray beyond their areas of expertise and competence. For example, the American Society of Clinical Hypnosis, probably the most influential body in the field of North America, restricts its training workshops to those who have doctorate degrees in medicine, dentistry or psychology. Although the techniques are simple and the risks low, only professionals with this training should practise hypnosis. I would recommend that all physicians, family physicians in particular, consider learning this skill by attending a workshop. Hypnosis brings an entirely new dimension to practice. It has enriched my professional life enormously.CAN MED ASSOC J
1991; 144 (7)
909
