One of the founding members of the National Pediatric Hypnosis Training Institute, Dan Kohen, M.D., recently sat down to share his perspectives on pediatric hypnosis and his own personal history within the field. Dr. Kohen is a behavioral pediatrician who is now in private practice, having retired in 2013 from his long-time academic position at the University of Minnesota Medical School. He is the co-author of the premier text in the field of pediatric hypnosis, Hypnosis and Hypnotherapy with Children, which is currently in its 4th edition. (Portions of this interview have been adapted by Dr. Kohen from his interviews with Mark Jensen, Ph.D., which appeared in Contemporary Hypnosis & Integrative Therapy, December 2012, Vol. 29 Issue 4, pages 363-; and Maria Escalante de Smith in the European Society of Hypnosis Views-Reviews-Interviews Newsletter, 2013 Issue 2, pages 18-).
What was your first experience with hypnosis?
I was in my 3rd year of undergraduate /pre-med at the University (Wayne State University, Detroit, Michigan) when I was invited to a “Rush Party” (a recruitment social event to consider joining a Fraternity). The “Entertainment” was a “stage hypnotist”, indeed a PhD clinical psychologist. I don’t remember much of his “act” but I do remember going into (what I called then!) a relaxed state quite quickly and some time shortly thereafter I “found myself” up at the front of the audience of about 60-75 people as one of 5 picked out of the audience, apparently because I was “such a good subject”. I have a clear memory of doing “silly” things, like responding to the suggestion that we were all riding on a bus on a very bumpy road – and bouncing about in my chair; and I also remember being asked if I “drank”, said I liked “gin and tonic”, and he gave me a glass of what he said was gin and tonic and asked me to drink it and then sing a song. I have a clear memory of singing “My Bonnie lies over the Ocean” and sounding “drunk” and also feeling embarrassed. The following day my picture – looking “asleep” in the audience – was on the front page of the University newspaper (no one asked permission in those days.)
So, it was not a particularly positive experience. I did in fact end up joining that fraternity. Then, some 4 years later I was actively involved in our professional medical fraternity while I was in Medical School and we were having a recruiting event and several of us thought of inviting this same clinical psychologist – I remembered then and do today recall his name, Tony Rogers, Ph.D. – a very large fellow, 6’5” tall (1.95). He came to the home of one of the medical alumni who hosted the social event, and he was much less flamboyant and more subdued (likely because of the “medical audience”) and did a number of demonstrations including one on smoking cessation with the post-hypnotic suggestion that from that time forward the lighting of a cigarette would smell like burning rubber and be impossible to tolerate. He did not present any data.
What led you to your first workshop?
In 1977 I was interviewing for a new position at the Minneapolis Children’s Hospital, to be the associate Director of Medical Education and as such, the partner of a woman named Karen Olness, M.D. At that time I had no idea who she was or how famous she was. The rest, as the joke goes, “is history”. Our interview got interrupted while she took a phone call and I waited patiently. I noted on her desk a several page document titled “Hypnosis in Children – Selected References.” I immediately thought “Uh-oh, what am I getting myself into?!” After she finished her phone call I asked her “Do you do this…?” and she casually said “Yes”, and offered me a copy of the references. I thanked her, enjoyed the rest of the interview and went back to my home in Arizona. I obtained several of the key references and began reading. Two months later she called and offered me the position to be her Associate; and we have been close friends and collaborators in teaching and writing for the 36 years since then.
Dr. Kay Thompson, Dr. Erickson’s close friend, student, and colleague was my first and most beloved hypnosis teacher, and my first small group leader at my first Workshop. Thereafter we invited Kay to teach for our Minnesota Society of Clinical Hypnosis Annual Advanced Workshop as often as her schedule would permit, and she came here every 3 or 4 years. In every one of our many, many conversations Kay personified and taught Erickson, and I was privileged to listen.
Tell us more about the first training workshops that were specific for pediatric clinical hypnosis?
Ahh, memory! Well, the first SDBP [Society for Developmental-Behavioral Pediatrics] Pediatric Hypnosis Workshop was 1987 in Anaheim, Disneyland! It came about via Candace Erickson who was the Education Program Director (or something such!) for SDBP that year. Though I don’t recall precisely, I’m sure that she recruited Karen [Olness] and me as major presenters. Jud [Reaney] was also on that Faculty as were Franz Baumann and Leora [Kuttner]. I’m not sure if Howard Hall was, he might have been. I think Jim Warnke joined the faculty a few years later.
We met Leora at the 1984 Annual Meeting of SCEH [Society for Clinical and Experimental Hypnosis] in San Francisco. She and I were on the same Panel…she was presenting on Hypnosis for Pain, I was presenting on Hypnosis in Pediatric Emergencies.
How do you view hypnosis?
If I were to write a definition of hypnosis, I would say it is ‘an alternative state in which our concentration is narrow and focused and which is induced for the purpose of achieving some goal, such as solving a problem or mastering a skill’. You’ll note that I say nothing about relaxation, because hypnosis does not have to involve relaxation.
How do you use hypnosis nowadays with your patients and their families?… For which kinds of problems do you use/suggest hypnosis?
Well, I’m a pediatrician, so I mostly use hypnosis to help children address the host of problems for which they may come to pediatricians. The only exception to this is, now that I’m older, some of the patients who were children when I first treated them have contacted me as adults for additional care. Also, because I work in a university environment, I see the occasional medical student, resident, or colleague for a very circumscribed problem. Another exception is the growing number of adults who decide, in the context of meeting with me around the care of their children, that they’re the ones who really need the help. But mostly I see children and adolescents.
And for what kinds of problems do your clients see you?
At this point I see children with more specific behavioral and developmental problems, such as habit disorders (e.g. thumb-sucking, nail-biting) and the more complex versions of those (e.g. hair-pulling, bed-wetting), which can also be understood as a habit-like problem.
I also see children with the full spectrum of tic disorders to severe forms of Tourette’s syndrome. Although I see some children for acute pain, I do less of that now because I am no longer the director of an emergency room. But I do see children with chronic and recurrent pain syndromes; kids with recurrent abdominal pain, migraine and other chronic headaches, and pain associated with repeated procedures. I see kids with all kinds of chronic illness including juvenile rheumatoid arthritis, cystic fibrosis, renal disease, cancer, diabetes, and growth hormone problems. Kids with the latter two problems have to learn how to give themselves regular injections, and they can use self-hypnosis to make that substantially easier.
I also see children with the whole range of affective disorders: anxiety problems of all kinds, sleep problems (which are not usually sleep problems per se but are more of- ten anxiety problems), phobias, obsessive-compulsive disorder, depression, adjustment problems, and anger problems. Hypnosis is very effective for helping children manage all of these emotional difficulties.
Increasingly, I am asked to help kids with gastrointestinal (GI) problems, like Crohn’s disease or irritable bowel syndrome. Unfortunately, though, I don’t see as many of those kids as I could and would like to; we’re just not on the referral radar of many of the GI doctors at the moment. This is unfortunate, given the fact that there is good evidence supporting the value of hypnosis to pediatric patients with irritable bowel syndrome and functional abdominal pain.
What do you think is essential or important for hypnosis to be most effective?
Positive outcome expectancies and motivation are very important. But more important than anything is rapport. Just about everything I do — almost all the questions I ask and responses I make — are meant to assess, manage, and integrate rapport, expectancies, and motivation.
What are some of the questions you ask or things that you do that build rapport or enhance response to hypnosis
Building rapport with children comes from genuine interest. Milton Erickson said that hypnosis is done with a child, not on them; and we extrapolate that to mean what Erickson implied… that is, “Go with the child”. Rapport comes from paying attention and greeting the child “where they are”. I want to know who this child is long before I want to talk about how come they came over, or about the details of their bedwetting, their tummy aches, their worries about going to sleep, etc. That comes from asking if they go to school, who lives in their house, drawing a picture of their family (a ‘pedigree’), learning about their pets, their best friends, their favorite things to do, what they are best at playing as well as what they are best in at school.
Are there specific technique – strategies – exercises that you have found particularly useful that you use routinely in many or most cases, or in particular situations?
I have been fond of saying for many years that there is no one easier to help with Hypnosis than the patient in acute pain in the ER whom I have never met. The “only” thing we are challenged with, then, is to come up with the right language and strategy that will allow us to quickly gain the patient’s attention en route to their trust and to their ultimate paying of attention to what we say, how we say it and what we suggest.
I find that “Truisms” are very helpful in developing attention and then helping it to shift. For example, a child is screaming, staring at his fractured and dislocated forearm while parents are trying to demand he stop screaming. Upon entering the room I am likely to introduce myself and say something obvious like “I am really glad you came over … that was really smart. Boy, that sure seems to hurt a lot…and it’s going to keep right on hurting until it stops.” He hears “It stops”, or, the implication “it will stop”. “I wonder what you’re going to do first when you get home later”. This implies clearly that he will be going home, and “Later” implies today (whereas it’s likely that amidst the pain and fear that he was terrified that he’d be staying in the hospital).
What about the use of audio recordings? Do you make recordings of your sessions to give to your patients for home practice?
It depends. I almost never make a recording the first time I meet with somebody. I think that’s a mistake. If somebody else wants to do it, and they can justify it to themselves and explain it, that’s fine, but I think the risk of doing that is to create dependency. After the first experience, we debrief it and then we talk about how they would do this at home. I always include self-hypnosis training and post-hypnotic suggestions on how to do it at home as part of the first hypnotic experience. One of the really satisfying things about this work is hearing from the children I worked with years after I saw them. They say things like, ‘Oh, yeah, you know it changed my life’ or ‘Yeah. I used it. I know when I saw you it was headaches, but I used it for my pregnancy.’
Or a previous client called me when she was 21. I hadn’t seen her since she was 11. She used to have migraines. She didn’t have any migraines for 10 years and then when she was 21 she got a migraine. She asked me if she could see me. So she came in and said, ‘You know, I think I figured out why I had it. I’m a senior now in college. And I’m graduating soon. I really don’t know where my life is going. And it is very stressful. So I sort of want a refresher.’ I said, ‘Well, if you need a refresher once every 10 years to keep the headaches away, that’s not so bad.’ I asked her, ‘When we practice do you think we should make a CD?’ She says, ‘No. I still use that tape you made me.’ I said, ‘Megan, you’re 21!’ She says, ‘Yeah. I know I was 11, but it’s okay. It’s fine.’ It’s so interesting.
For other kids, I made a recording when they were 7, and then they tell me when they’re 10 that it was for a 7-year-old, so they want a new one. I asked her, ‘Are you kidding me? You don’t want a new recording?’ ‘Yeah, I was 11 and now I’m 21. But I still like that tape.’