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In describing his approach to hypnosis, Dr. Patterson emphasizes first that he believes hypnosis should be fit into the context of a larger theoretical approach when used for patient care. A meta-analysis by Kirsch, Montgomery, and colleagues (1993) indicated that hypnosis can increase the effect size when used in combination with a variety of psychotherapeutic approaches. For complex psychological issues, hypnosis is seldom useful as a treatment by itself. Whether the therapist is using psychodynamic, cognitive–behavioral, behavioral, or interpersonal approaches to psychotherapy, hypnosis should be grounded in a thorough conceptualization of the clinical problem. Looking at hypnosis specifically, there are a number of good theories that explain why hypnosis is useful with patients. Dr. Patterson believes in George Kelly's thinking that every scientific theory has a range of convenience. Just about every theory proposed about hypnosis has elements that can be useful in patient care. When using hypnosis with patients, Dr. Patterson usually simultaneously entertains theoretical constructs from dissociated control, Ericksonian, and social–cognitive approaches. In considering dissociated control theories (including Hilgard's neodissociation as well as Bower's more current rethinking), Dr. Patterson makes use of the automaticity of behavior that often comes with hypnosis, or the effortlessness of response to hypnotic suggestions. Dr. Patterson phrases his suggestions in a manner that promotes a certain sense of dissociation for the client. In borrowing from Ericksonian hypnosis, Dr. Patterson would attempt to use the cooperative approach with the client and in particular, attempt to "utilize" whatever he observes occurring with the client. Using a cooperative approach, he tends to follow the patient's lead and view "resistance" as the therapist's problem rather than that of the client. With the social–cognitive approach, Dr. Patterson would try to maximize expectancy with the client and provide contextual queues for what he thinks will benefit the client in the induction. Finally, although Dr. Patterson believes that hypnotizability can be altered through the contextual situation, he believes that there is substantial evidence for individual differences in this variable, and that it is often very useful to have a sense of what a client's inherent hypnotizability is. When he is working with a client, Dr. Patterson is simultaneously considering multiple theoretical approaches. However, the one overarching variable that he views as critical is that he has a good relationship and good rapport with the client. When considering using hypnosis for pain control, there are two types of pain, and making a distinction between them is critical in using this therapeutic approach. Acute pain is intense, short-lived, related to tissue damage and often results from medical procedures. It tends to respond well to biomedical approaches. It is often predictable, and hypnosis can be applied beforehand in a preparatory manner. Hypnosis can be used to remove symptoms of acute pain with little concern about phenomena such as symptom substitution. Chronic pain, on the other hand, is typically of greater than 6 months duration, is often refractory to biomedical approaches, and is often present in the absence of tissue damage. Chronic pain is commonly held in place by a complex array of psychological and biological factors. Hypnosis can be effective for chronic pain, but often effective use of this modality must be couched in a complex biopsychosocial approach. Quite commonly, hypnosis must be used in conjunction with psychotherapy and used over a number of sessions. Hypnosis used for acute and chronic pain often can be considered as happening at different ends of a therapeutic spectrum. |
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