Case taking in hypnotherapy and the importance of observation

The Therapeutic Interview: in which your client teaches you what you need to know – Rachel Kennedy

Going through some papers of David’s, I came across some handwritten notes he was making on the Utilisation Approach to hypnotherapy. In those notes, he made the statement:

“This approach is client-centred, and highly dependant on the momentary needs of the individual.”

The underlining was his. What did he mean by ‘momentary needs’?

I cannot know for certain what he meant, but knowing how he worked I think what he was talking about was working with what you are given by your client, in the space of the therapeutic relationship – without assumptions, without extrapolation, without judgment.

Lofty ideology for anybody. Possibly not possible. But worth aiming for? I think so.  

The Utilisation Process

The Utilisation Process is the term Ernest Rossi & Erickson came up with for Erickson’s approach to therapy. It was based on the principle David made a note on – knowing the needs of that client as an individual. Not Mary the “smoker”, the third client for the day you’ve seen for smoking; and not John for IBS, the 2nd client with IBS you’ve seen that week as a result of your targeted advertising campaign because you’ve just learned this new IBS protocol and want to put it to use. But knowing John’s needs, and Mary’s needs. Knowing a little bit about who they are and how they negotiate their world.

This is what Erickson did. It is evidenced in the incredibly idiosyncratic work he documented. Read his transcripts and some of the things he said seem random and/or mysterious, but they make sense for his clients because he paid attention to them and spoke to them in the language of their dis-ease.

Observation

Although it sometimes seems otherwise, Erickson wasn’t a mindreader. Case-taking must have been a big part of his work, and yet when you read the transcripts of Erickson’s cases there’s not a whole lot of ‘case-taking’ recorded, so we don’t really know if he had a process. But we do know he was a master at observation, particularly pattern recognition, and I’d guess that this was the heart of any process he had.

The success of a hypnotherapists’ clients rests not so much in how good the hypnotist is at hypnotising, nor even how good they are at using artful therapeutic language, but rather how good they are at observing their clients.

It requires quite a lot of trust (in yourself, and in your client). And much practise. But it starts with observation.

Case-Taking

Case-taking can be asking the right kind of questions, or asking no questions at all but finding other ways of allowing the right information to present itself. It is noticing the right things – or at least, noticing what has the potential to be the right thing; it is not making assumptions, and not trying to make the client fit the therapy but rather the other way around: paying attention to their momentary needs.

And then translating that into therapeutic communication.

Refining your own case-taking process: learning from Samuel Hahnemann, 1755-1843

“The sole mission of the physician is to cure rapidly, gently, permanently / Not to construct theoretical systems, nor to attempt to explain phenomena”. – Aphorisms 1 & 2, The Organon of Medicine by Samuel Hahnemann

Whatever your opinion of homeopathic medicine, we can nonetheless learn a lot from Samuel Hahnemann, the German physician who was its creator, and his great work “The Organon of Medicine”. If we were to extract all the sections (‘Aphorisms’) regarding the Materia Medica (the homeopathic remedies themselves) The Organon is otherwise a timeless and wise guide in how to take a case. For example:

Aphorism 83: Observe (and keep your opinion out of it)

“This individualizing examination of a case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease”.

and 84: Pay Attention to What Is Said (and don’t presume you know what it means)

“The patient details the history of his sufferings…the physician sees, hears and remarks by his other senses what there is of an altered or unusual character about him…keeping silence himself he allows them to say all they have to say, and refrains from interrupting them unless they wander off to other matters.”

and 98: Pay Attention to What Is Not Said (but don’t presume you know what that means)

“Now, as certainly as we should listen particularly to the patient’s description of his sufferings and sensations, and attach credence especially to his own expressions wherewith he endeavours to make us understand his ailments…so certainly, on the other hand, in all diseases…the investigation of the true, complete picture and its peculiarities demands especial circumspection, tact, knowledge of human nature, caution in conducting the enquiry, and patience in an eminent degree.”

You do you – some ideas

  • Having a system and a plan can take the pressure off, so by all means have an intake form, requesting things as name, age, occupation. You may wish to include such details as if your client has a spouse, any children, if they’ve had any experience with hypnotherapy before. And of course, make a note of their presenting issue. It’s right and proper that you learn all of these details from your client, but just don’t assume that this is enough information to direct your work.
  • You may begin by asking the simple question, “And how might I help you in our work today?”, or you might simply make the statement, “Please tell me what brings you here today”.
  • If you already know the reason someone is seeking your help, perhaps you might ask them, “How can I help you make this change?”, or “I understand you are wanting some help with xyz, how do you believe I will be able to assist you?”.
  • If you find your client is not forthcoming with information, you may wish to simply observe their responses and reactions to your own communication. It is at times like this it is helpful to have a few ‘therapeutic metaphors’ or stories up your sleeve. Many good examples can be found in Havens & Walters “Hypnotherapy Scripts”, or in children’s fairy tales: Aesop; Mother Goose, Hans Andersson, The Brothers Grimm…stories are the universal currency of all therapeutic work.