Hypnotherapy and Schema therapy Ultimate Clinician's guide

1.6 Ethical Considerations in Hypnosis

• Informed Consent

• Confidentiality

• Appropriate Use of Hypnosis

Also learn about what is the Role of the Hypnotist:

1. Establishing Rapport

2. Providing Clear Instructions

3. Ensuring Client Safety

Learn what principles used Milton Erickson in his work and examples of how to do it. In later chapters you will dive into it even more, allowing yourself to experience and discover these powerful principles of utilization, indirect suggestion and metaphor in your therapeutic practice!

2.3 Hypnotic Inductions

In general across all literature you will come across three types of hypnotic inductions. These

are:

• Progressive Relaxation: This technique focuses on helping the subject relax progressively,

often by instructing them to focus on and relax different muscle groups in the body. The goal is

to calm both the body and mind, which facilitates a deeper hypnotic state. The process is

typically slow and soothing, and the individual may be asked to focus on their breathing or

visualize a peaceful setting to enhance relaxation. For beginners it is good because it is safe and

has over 80% success rate. It can be combined with visualization or imagery, but it is better to

save it for deepening state.

• Visualization or Imagery: This group of techniques involves guiding the individual to imagine

specific images, scenarios, or sensations, such as visualizing descending a staircase, floating in

water, or walking through a peaceful forest. Success rate is around 60%. The idea is that

focusing on these vivid mental images helps the individual relax and enter a hypnotic state. We

do this with our mind all the time, when our mind wanders away into daydreaming imagination

and our gaze suggests we are “not present” here and now, but somewhere else imagining what it

would be like if we just…

• Rapid Induction: Also known as direct inductions aim to bring about a hypnotic state quickly,

often within a minute. These methods are more direct and may involve physical suggestions or

sudden changes in the environment. It is rarely used in therapy sessions. Rapid inductions are

mostly used on stage Examples include using a sudden command, such as "sleep," or employing

physical gestures (e.g., a hand dropping) to induce a trance. These methods work best with

subjects who are more responsive to suggestion and can be done in a very short period of time.

Be careful here, because success rate is around 40% here.

Learn examples of these hypnotic inductions and learn pros and cons of each and every induction type in hypnosis.

Experience for yourself my favorite type of hypnotic induction object fascination induction.

2.5 Emerging from trance

Emerging from a trance in a therapy session is a gentle and guided process. The therapist

typically uses a series of suggestions to help the client gradually return to their usual state of

awareness. This might involve:

• Counting: The therapist might count upwards from one to five or ten, suggesting that

with each number, the client will feel more alert and awake.

• Deepening Relaxation: Ironically, sometimes the therapist will first deepen the

relaxation slightly before bringing the client back to full awareness. This can help to

avoid any abrupt or jarring sensations.

• Suggestions of Alertness: The therapist will use suggestions that the client is feeling

more alert, awake, and refreshed.

• Eye Opening: The therapist might suggest that the client's eyes will open when they are

ready, or they might give a specific cue, such as "When I reach the number five, your

eyes will open, feeling refreshed and alert."

The key is that the process is gradual and comfortable for the client. The therapist will also

typically check in with the client after they have emerged from the trance to ensure they are

feeling fully present and oriented.

It's important to note that everyone experiences trance differently, and the emergence process

may be slightly different for each individual. Some people may feel fully alert immediately,

while others may need a few moments to fully reorient themselves. The therapist will be attuned

to the client's individual needs and adjust the process accordingly.

2.6 Hypnosis versus IR or hypnosis and IR

Both hypnosis and imagery rescripting are valuable therapeutic techniques that utilize the power

of imagination and suggestion to facilitate healing and change. While they share some common

ground, there are also key differences between them.

Similarities:

• Reliance on Imagery: Both techniques heavily rely on the client's ability to create and

engage with mental images. This allows for accessing and reprocessing emotional

experiences in a safe and controlled environment.

• Induction of a Focused State: Both hypnosis and imagery rescripting involve guiding

the client into a focused state of attention, which can enhance suggestibility and access to

the subconscious mind.

• Potential for Emotional Processing: Both techniques can facilitate the processing of

difficult emotions and traumatic memories by allowing for a revisiting and reframing of

past experiences.

Differences:

• Formal Induction: Hypnosis typically involves a formal induction process, which may

include relaxation techniques, eye fixation, and suggestions for entering a trance state.

Imagery rescripting, while encouraging focused attention, does not always involve a

formal hypnotic induction.

• Depth of Trance: Hypnosis often aims to induce a deeper state of trance, characterized

by increased suggestibility and a detachment from the immediate environment. Imagery

rescripting may involve a lighter state of focused attention, where the client remains more

aware of their surroundings.

• Specific Techniques: Hypnosis encompasses a wide range of techniques, including

direct suggestion, age regression, and parts therapy. Imagery rescripting specifically

focuses on revisiting and modifying distressing memories through guided imagery and

cognitive restructuring.

Other criteria of comparing Hypnosis with Imagery Rescripting

Focus:

o Schema Therapy focuses on long-standing patterns of thought and behavior (schemas)

established from early experiences and emphasizes modifying these schemas.

o Hypnotherapy focuses on accessing the subconscious mind for direct therapeutic suggestions to

modify behaviors, perceptions, or emotions.

Technique:

o Schema Therapy employs cognitive restructuring, emotional processing, and behavioral change

activities as central techniques.

o Hypnotherapy utilizes hypnosis to promote relaxation and facilitate suggestions through an

altered state of consciousness.

Session Dynamics:

o Schema Therapy involves a more structured therapeutic relationship with dynamic interactions,

fostering corrective emotional experiences.

o Hypnotherapy involves a creation of a hypnotic state, with the therapist directing the client

through suggestions and guided imagery sessions.

Outcomes:

o Schema Therapy aims for long-term change by addressing deep-rooted issues and fostering

emotional healing over time.

o Hypnotherapy often seeks quicker remodeling of behaviors and thought patterns and may be

used to address specific issues (like pain reduction or phobias) in a shorter time frame.

Integrating methods of Ericksonian hypnotherapy techniques into Imagery Rescripting:

1. Indirect Suggestions:

o Utilizing Metaphors and Stories: Ericsonians are masters of using metaphors

and stories to convey therapeutic messages indirectly. In imagery rescripting, this

could involve weaving stories about overcoming challenges or creating new

narratives around the traumatic events. For example, a therapist might tell a story

about a character who faces a similar situation and successfully overcomes it,

allowing the client to make unconscious connections.

o Utilizing Indirect Commands: Instead of directly instructing the client to

"change the memory," the therapist might use indirect suggestions like, "Perhaps

you'll notice something different about this memory when you revisit it," or "It

might be interesting to see how this memory could be different."

2. Utilizing the Unconscious:

o Tapping into the Client's Resources: Ericsonians emphasize utilizing the

client's own internal resources and strengths. In imagery rescripting, this could

involve helping the client access their own inner wisdom, resilience, and coping

mechanisms to navigate the rescripting process.

o Utilizing Ambiguity and Paradox: Ericsonians often use ambiguous language

and paradoxical instructions to engage the client's unconscious mind. For

example, the therapist might suggest, "You might find it easier to access this

memory if you try not to think about it." This can lead to unexpected insights and

breakthroughs.

3. Building Rapport and Trust:

o Matching and Mirroring: Ericsonians are skilled at matching and mirroring the

client's communication style, building rapport and trust. This can create a safe and

collaborative therapeutic relationship, which is crucial for successful imagery

rescripting.

o Utilizing Humor and Storytelling: Humor and storytelling can create a relaxed

and engaging atmosphere, making the therapeutic process more enjoyable and

less intimidating for the client.

4. Focusing on Strengths and Solutions:

o Highlighting Positive Aspects: Ericsonians emphasize focusing on the client's

strengths and positive experiences. In imagery rescripting, this could involve

highlighting the client's resilience, past successes, and positive qualities to

facilitate healing and growth.

o Focusing on Desired Outcomes: The therapist can work with the client to cocreate

a vision of a desired future, which can then be integrated into the imagery

rescripting process.

A-Attract attention

B-Bypass critical factor

S-Stimulate the Unconscious mind

Learn why to do it and how to do it in your hypnotherapy or psychotherapy session

Schema therapy identifies three primary coping styles: surrender, avoidance, and overcompensation. Each style represents a different method of dealing with the emotional distress caused by early maladaptive schemas.

Process of change coping strategies that are dysfunctional forms of behavior. How to change maladaptive behavioral patterns.

Schema Mode Listing

INNATE CHILD MODES

1. Vulnerable Child: feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimized, worthless, unloved, unlovable, lost, directionless, fragile, weak, defeated, oppressed, powerless, left out, excluded, pessimistic

2. Angry Child : feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met

3. Impulsive/Undisciplined Child : acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met.; may appear “spoiled”

4. Contented Child : feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous

MALADAPTIVE COPING MODES

5. Compliant Surrenderer : acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behavior that directly maintains the self-defeating schema-driven pattern

6. Detached Protector : cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalized, empty or bored; pursues distracting, self-soothing, or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities

7. Overcompensator : feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, overcontrolled, controlling, rebellious, manipulative, exploitative, attention-seeking, or status-seeking way. These feelings or behaviors must originally have developed to compensate for or gratify unmet core needs

MALADAPTIVE PARENT MODES

8. Punitive Parent : feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.

9. Demanding or Critical Parent : feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others needs before one's own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously. This mode refer to the nature of the internalized high standards and strict rules, rather than the style with which these rules are enforced; these rules are not compensatory in their function.

HEALTHY ADULT MODE

10. Healthy Adult : nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralizes or moderates the maladaptive parent modes. This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, esthetic, and cultural interests; health maintenance; and athletic activities.

Schema Mode Explained

• Schema Modes are the moment to moment emotional states and coping responses that we experience.

• Often schema modes are triggered by situations that we are overly sensitive to – our emotional buttons.

• A schema mode is triggered when schemas are activated.

• Schema modes comprise of strong emotions … rigid coping behaviors that take over and control your functioning.

• The schema mode you are in can change rapidly and modes can overlap with each other.

• This is referred to mode-flipping and it is very common and feels scary, overwhelming and exhausting.

In Schema therapy, a schema specifically refers to an early maladaptive schema, defined as a pervasive self-defeating or dysfunctional theme or pattern of memories, emotions, and physical sensations, developed during childhood or adolescence and elaborated throughout one's lifetime. Learn more about concept of psychological schema in this lecture!

The Schema Domains define 5 broad categories of emotional needs of a child (connection, mutuality, reciprocity, flow and autonomy). When these needs are not met, schemas develop that lead to unhealthy life patterns. The 18 schemas are grouped into these 5 categories, that correspond to specific emotional needs. The six domains are secure base, Exploration and enjoyment, Protest and anger, and Loss, Internal working models, Reflexive function and narrative competence.

Attachment & Relationships-There are eight schemas in this domain: Abandonment/Instability,

Mistrust/Abuse, Emotional Deprivation, Enmeshment/Undeveloped Self, Social Isolation/Alienation,

Subjugation, Self-Sacrifice, Approval-Seeking/Recognition-Seeking.

Self-Esteem & Identity domain, consists out of two schemas Defectiveness/Shame, Negative/Defective

Self-Image.

Domain of Autonomy & Competence: Dependence/Incompetence, Failure, Insufficient Self-

Control/Self-Discipline.

Cognitive & Perceptual: Entitlement/Grandiosity, Unrelenting Standards/Hypercriticalness.

Learn more about Emotional Regulation domain suggested by myself: Vulnerability to Harm or Illness, Punitiveness, Emotional Inhibition.

Guided visualisation is a process whereby your therapist leads you through imagining in your mind's eye a relaxing scenario. experience, or series of images. It is the process of creating a visual image in one's mind (see visual imagery) or mentally rehearsing a planned movement in order to learn skills or enhance performance. The point of guided visualization is to harness the brain's positive response to images to help you manage your emotions and life challenges more effectively. What are the 5 steps of visualization?

• Step 1 — Be clear on the question. ...

• Step 2 — Know your data and start with basic visualizations. ...

• Step 3 — Identify messages of the visualization, and generate the most informative.

• Step 4 — Choose the right chart type. ...

• Step 5 — Use color, size, scale, shapes and labels to direct attention to the key.

Historical Use of Imagery in Therapy

The use of imagery and imagination in therapeutic contexts has long-standing roots in various

modalities. For instance, Psychocybernetics in the early 1950s leveraged visualization

techniques for personal growth, and CBT began utilizing imagery exercises to address PTSD and

schema beliefs. In Gestalt therapy, clients might be asked to imagine doing or becoming

something opposite of their current experience as a way to challenge and expand their selfconcept.

These experiments, often internal (and akin to ImRs), help the client experience and

understand their world differently.

Another historical example is Hypnotherapy, which relies on the power of visualization and the

authority of the therapist. Classical Ericksonian hypnosis focuses on attracting the client’s

attention, bypassing the critical mind, and stimulating unconscious processes to facilitate healing.

It similarly works by guiding clients to revisit distressing events and change their perceptions

and emotional responses.

EMDR (Eye Movement Desensitization and Reprocessing) shares core principles with ImRs,

though it works through different mechanisms. Both aim to alter the emotional and cognitive

responses to traumatic memories. While EMDR is known for producing faster results, ImRs

tends to have longer-lasting, integrative effects. A study by Boterhoven den Haan et al. (2020)

found that both ImRs and EMDR effectively reduced PTSD symptoms, though ImRs was noted

for maintaining its effects over time.

According to Arnitz  work with ImRs  can be applied in general after case conceptualization:

• First step is to identify the feeling during session

• Step two patient closes the eyes and describes in present tense here and now wording

what he/she senses and feels as a child and

• Step three is to identify unmet needs according to feeling felt on scene during the

exercise

• Step four getting into Vulnerable child (core of every mode and behavioral problem)

• Step five is when rescripting is taking place- therapist tells the patient that he/she is

entering the scene and describes how he/she is acting to correct what is happening.

• The patient describes what happens next in the image, and how he/she feels then, and

what he/she needs. Rescripting continues until the threat is under control

• Then the therapist takes care of the Vulnerable Child. Often the child needs to be

soothed. After imagery rescripting the exercise is discussed. The patient is asked to listen

to the recording and to repeat the whole exercise at home.

ImRs is used in case conceptualization frame basic three step process has to be done properly Rafaeli, E., Bernstein, D. P., & Young, J. E. (2011):

(1) Identifying and triggering the patient's schemas

(2) Understanding the childhood origins of the schemas

(3) Linking schemas to presenting problems

Entry points to imagery material can be multiple :

• It can be present feeling, event or situation which leads to schema identification through

affective bridge

• Picture of client from early childhood

• It can be sensation or muscle tension from safe place

• It can be childhood memory or even traumatic experience

To summarize for rewriting narratives

Firstly, Identify the Distressing Narrative:

• Recall the Memory: Begin by vividly recalling the distressing event. Pay attention to the

sights, sounds, smells, tastes, and touch associated with it.

• Identify the Negative Core Beliefs and relate it to schema: What negative beliefs

about yourself or the world does this memory reinforce? (e.g., "I'm not worthy,"

defectiveness or "The world is dangerous," hyper vigilance, mistrust and abuse schema

"I'm powerless." Which can be perhaps self-sacrifice or certainly subjugation)

• Acknowledge the Impact: How does this memory still affect you today? (e.g., anxiety,

depression, relationship difficulties).

2. Rewrite the Narrative:

• Focus on Empowerment:

o Change the Ending: How could the story have ended differently? Imagine a

more positive outcome where your needs were met and you felt safe and

supported.

o Introduce a Supportive Figure: Imagine a caring adult or a positive inner

resource intervening to protect and comfort you.

o Reframe the Meaning: Challenge the negative core beliefs associated with the

memory. What alternative interpretations are possible?

• Use Sensory Details: Make the rewritten narrative as vivid and realistic as possible by

incorporating sensory details. This helps to make it feel more believable and impactful.

• Experiment with Different Endings: There's no single "right" way to rewrite the

narrative. Experiment with different endings and see what feels most empowering and

healing. In this course you will learn to use technique called three of different outcomes

and how you can combine it with ImRs.

• Win the exchange: Do anything to win the exchange against antagonist in the scene

3. Practice and Integration:

• Revisit the Rewritten Narrative Regularly: Spend time revisiting the rewritten

narrative regularly to reinforce the new, more positive beliefs.

• Apply the Lessons Learned: Reflect on how the lessons learned from the rewritten

narrative can be applied to current situations. Become aware of your behavior on real

world and combine ImRs with other techniques for permanent improvements.

• Seek Support: Work with a therapist or hypnotherapist experienced in ImRs to guide

you through the process and ensure your safety and well-being.

Important Considerations:

• Start Small: Begin with less distressing memories and gradually work your way up to

more challenging ones.

• Be Patient and Kind to Yourself: Rewriting narratives takes time and effort. Be patient

with yourself and celebrate your progress.

• Avoid Perfectionism: There is no need to create a perfect or flawless rewritten narrative.

The goal is to create a more empowering and healing version of the original story.

• Do ImRs on sessions until you are stable enough to do yourself

• Use self-hypnosis recordings with Ericson’s phrases and technology to enhance change

• Use affirmations and language suitable for you or your client (if you are working on your

client)

• Use metaphors if client gives you any verbal analogy and make sure you apply it in

visualization and utilize it for change

To avoid all therapeutic mistakes Arnitz, Hayes and Bahary suggest:

• Establishing spatial relations and getting into sensory details enough

• Make sure your client is in optimal state of emotional arousal and optimal level of trance

(light to medium deep trance, from hypnotherapy standpoint)

• If you ever get stuck, ask yourself “What would really good parent do?” and “What

client needs in this situation as goes through this memory?”

• Practice first on yourself and on friends before working with clients. It is better to make

most of mistakes outside of sessions

• Work on your failure, unrelenting standards and defectiveness schema, because these are

very often in therapist’s population

Learn this and much more, including practical ways to do and say an how to deal with various resistances from client during therapy session!

Learn creative way to hypothesize how clients schemas are connected.

Learn everything you need to know about brainwaves, classifications and how these correlate with stages and depth of hypnotic trance.

When using Ericksonian hypnosis phrases in Imagery Rescripting with the goal of identifying

client schemas, the key is to use language that gently guides the client's attention towards

relevant memories and emotional experiences without being overly directive or leading. Here's

how to do it properly and how to do ImRs with clients eyes open, for clients who have a lot of resistance.

Integrating schema-focused interventions within the ImRs process means using the IR technique as

a vehicle to explicitly address and modify schemas using other core principles and techniques

from schema therapy. It's about making the schema work more conscious and explicit within the

experiential context of the imagery.

This approach can enhance the effectiveness of Imagery Rescripting by:

• Increasing client awareness of their schemas.

• Strengthening the Healthy Adult mode.

• Promoting deeper emotional processing and cognitive change.

Learn what to do, how to do and what not to do in therapy sessions and therapy practice, so you can be respected,  legitimized and not judged in a legal sense.

Learn specific dos and donts when it comes to cases with PTSD, Trauma and GAD

Learn how to address anxiety, depression, and other mental health challenges and general guidelines on how to work with specific populations-children, adolescents, and older adults.