We recently had the privilege of reflecting on the practice of pediatric clinical hypnosis with long-time NPHTI faculty member, Karen Olness, MD. Dr. Olness, in addition to being one of the founders of the Society for Developmental and Behavioral Pediatrics workshops that were forerunners to NPHTI, is a professor of pediatrics, family medicine and global health at Case Western Reserve University, as well as a Fellow of the American Academy of Pediatrics, the American Society of Clinical Hypnosis, and the Society for Clinical and Experimental Hypnosis. She is also Past-President of the American Board of Medical Hypnosis, the American Society of Clinical Hypnosis, the Society for Clinical and Experimental Hypnosis, and the International Society of Hypnosis. Along with Dan Kohen, MD, she is co-author of Hypnosis and Hypnotherapy With Children, now in its 4th edition.
What was your first experience with hypnosis?
I first became aware of hypnosis when I was working in Dr. Robert A. Good’s laboratory as a medical student at the University of Minnesota. One of his research projects was to determine if hypnosis could change delayed cutaneous hypersensitivity reactions in some of his grad students. I thought this was a silly project, not “real science” of the type I was doing. (He finally described his work in the forward of Robert Ader’s text, Psychoneuroimmunology, in 1980 or ’81).
How were your first experiences using hypnosis with yourself, in other words doing self-hypnosis?
Nine years after medical school (1968), I was leaving a job in Laos. The man who replaced me, Dr. Walter Majewski, told me that he wanted to give me a gift. I wondered what that could be. He said that he wanted to teach me self-hypnosis and he proceeded to explain how he had used self-hypnosis throughout the years that he was in general practice. I was skeptical. However, I admired him and said that I would learn for myself. If I believed that it was helpful for me, then I would take workshops.
I had a conditioned stress response, epigastric pain, from childhood. I remember, during early morning surgical rounds (my internship) that I would dash into the treatment room to grab a swig of Maalox. Dr. Majewski taught me a hand levitation induction. He suggested that I practice every day and I did. After two months the conditioned pain response was gone. It has never returned.
What led you to your first workshop?
We were overseas for two more years after leaving the job in Laos, and then moved to Washington, DC. We stayed in touch with Dr. Majewski and saw him occasionally when he came to the US. He recommended the New England Society of Clinical Hypnosis workshop. That was my first workshop, in 1971. I remember that faculty included Esther Bartlett, William Kroger, Calvin Stein, Paul Sacerdote and Larry Staples. In 1972 I took an American Society of Clinical Hypnosis-sponsored workshop in the Washington, DC area. I remember meeting Kay Thompson, Robert Pearson and Erik Wright. I especially remember receiving positive feedback from Erik.
How do you view hypnosis?
I view hypnosis as a therapeutic tool that facilitates positive psychological or psychophysiological outcomes. Having learned and practiced “mindfulness”, “meditation”, “imagery”, etc. I see little difference between them and the hypnotic state. I see the difference in the purpose or desired outcome from the practice.
While I can teach or coach a child or adult in hypnosis, success depends on the willingness of that person to practice self-hypnosis and to reinforce the therapeutic suggestions. Most of us who teach or coach children have had the wonderful experience of working with the child once and then hearing from the parents that the symptom or habit has disappeared immediately. However, that is the exception. An important part of our communication with the child and family is to emphasize practice and to help the child find practice enjoyable.
Can you give an example of one of your first successes with hypnosis with a patient
During the time of my early hypnosis workshops, I was in general pediatric practice. Many children had enuresis, and I began teaching them self-hypnosis. Most were able to use hypnosis successfully and I wrote a paper on the first 40.
Who decided hypnosis would be appropriate/potentially helpful – did the patient or family request it? Was it your idea? Were they referred FOR hypnosis?
At that time it was I who suggested that hypnosis might be helpful. No one else in the Washington DC area was teaching hypnosis to children. After few years I began to receive referrals specifically for hypnosis.
In those first years I knew only two child health professionals who were teaching hypnosis to children. One was Franz Baumann in San Francisco. He had a general pediatric practice. The other was Gail Gardner, PhD, a child psychologist in Denver.
Can you describe your thoughts and reactions or feelings when you became aware of their success in doing and applying hypnosis?
I thought that it was important to document the clinical outcomes and also to work toward controlled studies in which hypnosis with children would be compared with other interventions. In my HMO practice in Washington, DC we had an epidemic of teenage obesity. My first effort to do a controlled study was with 90 very obese teenage girls there, randomized to one of three groups: 1) control, no intervention; 2) providing all nutritional and behavioral interventions possible; 3) providing all nutritional and behavioral interventions possible plus training in self-hypnosis. We followed them closely for one year and then saw them again at the end of the second year. The girls in groups two and three lost an average of about 6 pounds the first year. At the end of the second year the girls from group two had regained the weight and more. Six girls from group three, the self-hypnosis group, had continued to lose and achieved their desired weight and maintained that weight.
What were the keys to their success? They described very clear images of themselves having achieved the desired weight. They described how life would be different for them when they had lost weight. Also, they had no evidence of depression.
What do you think is essential or important for hypnosis to be most effective?
A focus on future outcomes and practice is essential. Franz Baumann, in his teaching, emphasized the importance of including “a focus on the future” in teaching self hypnosis to children, saying for example, “Imagine yourself next year when you have had dry beds for a long time and you enjoy knowing that you did this by yourself and for yourself.”
The girls who lost weight successfully would describe shopping for size 6 or size 8 jeans, and they could also describe how the jeans looked as well as positive feedback they received from friends and family.
How do you use hypnosis nowadays with your patients and their families?
I no longer see many patients in the US. It is my strong belief that every child with a chronic illness and the ability to learn should be taught self-hypnosis. He or she should be told that this tool belongs to him or her to be used when he or she chooses.
I often hear from former patients who are now 30 to 40 years old; they document that children, as adults, retain their skills in self-hypnosis, although they use hypnosis for different purposes.
What do you do to build rapport or enhance response to hypnosis?
I think that the best way to build rapport with a child is to learn about his or her world and to express interest in what interests the child. Taking time to learn about the child then guides your induction of hypnosis and your suggestions.
Are there specific techniques that you have found particularly useful that you use routinely in many or most cases, or in particular situations?
I think that letting techniques or strategies “become routine” leads to less clinical success. Each child is different and one has to select a technique or strategy that matches that child. The need to use the same techniques in doing hypnosis with children in research was always a confounder in our research.
What about the use of audio recordings? Do you make recordings of your sessions to give to your patients for home practice?
I often made recordings but never at the first visit. I needed to know the child’s opinion about the self-hypnosis I taught at the first visit. Sometimes the child wanted to use a different approach. I sometimes made recordings over the child’s favorite music if that was the child’s preference.
Please tell us about your favorite research studies about pediatric hypnosis, either things you or others have published or discovered?
My favorite research studies are the early ones we did when we were able to document that children could intentionally change or control autonomic responses. I remember attending a Department of Pediatrics picnic in the late ‘70s and excitedly telling a colleague about our documentation that children could change fingertip temperature. His response, “I wouldn’t believe that if I saw it,” still rings in my ears. This was discouraging.
A short time later I was at an American Board of Pediatrics meeting where we were writing exam questions. I had never met Dr. Robert Haggerty, Chair of Pediatrics in Rochester, NY and also President of the American Academy of Pediatrics, until we were sitting around a long table having dinner when, suddenly, there was a tall man behind me and he tapped me on the shoulder. He said, ”I know about your work on children and self regulation. Please keep it up. It’s very important.” I was amazed, and I continued our research work, often without financial support.
I also like to remember the study Tim Culbert and I did to learn whether or not children could change salivary IgA responses. Eventually, the study was completed and accepted for presentation at the annual pediatric research meetings. I listened to Tim’s excellent presentation and the discussion after, and then I raced out to catch a plane. As I reached the door of the room, Dr. Robert Haggerty stopped me and said, “I’ve been waiting 30 years for this!”
What else would you like people to know about you?
That I have three current obsessions:
1) I think that training in self-hypnosis should be made available in all resource-poor areas of the world where children do not have access to medications for pain. The lack of access may relate to unavailability of medications, or to lack of money to pay for meds or to fact that available “medications” are fakes. I believe that there are millions of children (and the adults they have become) who suffer life long PTSD from trauma suffered during medical, surgical or dental procedures.
2) I think that training in the special needs of children in disasters should also be made available throughout the world. Disasters, both natural and manmade, are increasing in terms of numbers of people affected. During the past five years, on any day, more than 20 million children and adolescents are displaced by disasters. Research documents that the majority of children will suffer long term physical and/or psychological consequences. I spend a lot of time planning and teaching in workshops on how to help children in disasters. We recommend that all relief workers learn self-hypnosis for stress reduction when they work in disasters. My colleagues and I have just completed the third edition of a manual on “How to Help Children in Disasters”. It will be available electronically and free on the International Pediatrics Association website and hard copies can be purchased on Amazon.
3) I am concerned about the largely unrecognized pandemic of cognitive impairment that begins before birth or in the first 2-3 years, during the period of rapid brain development. In resource-poor areas much of this is still caused by early malnutrition, including calorie deprivation or micronutrient deficiencies such as iron deficiency. Other causes, in both poor and wealthy countries, include early exposure to alcohol, lead, pesticides, or infections affecting the central nervous system. Such early brain injury leads to learning problems that are often not recognized until the child is in grade school (reference 40 year follow ups of malnourished infants by Janina Galler of Harvard). Very often, by the time the child is having behavior and learning problems in school, parents and teachers may have forgotten or have never known that the child experienced early brain injury. At present there are between 500 and 700 million persons experiencing the effects of early brain injury with serious socio-economic implications for the individual, the family, community, and the world.
I have proposed the idea of Cognitive Watch programs in which local or national governments would evaluate most common causes of early cognitive impairment and develop prevention programs.
I have found self-hypnosis helpful for many of my own pain, surgical and medical issues.
For the past six years I have belonged to a Granny basketball team. This has been a special joy for me. Another special joy is playing with grandchildren, writing stories for them, and organizing treasure hunts for them.
Finally, the wind beneath my sails remains Hakon, my beloved husband of 51 years!