Blog ArchivesGetting to Know the NPHTI Faculty (and my final post as webmaster)by
For my final post as Webmaster of this site (since 2012!), I asked our current faculty, “What did you want to be when you were 6 years old?* (and to include their name, the year they took their first clinical hypnosis workshop, and the year they started teaching with NPHTI/SDBP!)” Some faculty chose to remain anonymous — see if you can guess who each one is by visiting our faculty page! And thanks to everyone who’s taken a workshop with us now and in the future, or emailed me via this site, or contributed to this site! It’s been a pleasure to serve.
*Thanks to Sophia Vinogradov, MD, Chair of the Department of Psychiatry at the University of Minnesota, who recently posed this very enjoyable question as an ice-breaker at a joint UMN Pediatrics–Psychiatry faculty meeting.
Solutions and Empowerment: Pediatric Hypnosis in General Pediatricsby
We recently received an unsolicited email from a colleague in Switzerland, Dr. Camilla Ceppi, a former NPHTI workshop participant (and more recently, faculty member!). We present her email below, with her permission. She begins by recounting a story that reminds us how the everyday experiences of children are interwoven with moments of wonder — hypnotic moments that build resilience through self-regulation. She then reviews how her training with NPHTI has helped her to notice, evoke, and utilize these moments in her office to empower young people in the medical setting. We hope that you enjoy reading it as much as we did — and that you, too, will attend an upcoming NPHTI workshop to develop YOUR skills!
NPHTI Commentary and Recommendations about Recent Court Settlement in Floridaby
Recently the Huffington Post offered the following sensational headline: “Families Of Teens Who Died After Hypnosis By Principal Will Get $600,000” Does that get your attention? These tragic events surely got ours in a very negative way.
According to an NBC News article (October 8, 2015 by M. Alex Johnson) entitled, “Florida Schools Settle With Parents of Teen Who Died After Hypnosis,” the school principal, Mr. Kenney, pleaded no contest to practicing therapeutic hypnosis without a license and resigned in June 2012:
It is our intent to to make a strong differentiation between clinical hypnosis training offered by NPHTI (and affiliated professional societies as detailed below) and so-called “hypnosis” as detailed in the recent case in Florida. We want to convey accurate information about the use of clinical hypnosis with young people (children and adolescents). Our comments below are a response to what we think has been irresponsible and inaccurate journalism (both print and internet), apparently designed to sensationalize; and obviously written with inaccurate and misleading information regarding what hypnosis is and is not.
We have carefully reviewed the ‘facts’ as known and reported in the Herald Tribune and other sources, and encourage interested readers to carefully scrutinize those reports for themselves after reading our commentary. Should you choose to read the various reader comments that follow the Herald Tribune article, you will find that none are written by health professionals; all are very ‘reactive’ and as such a testimonial to the risks of sensationalized reporting.
We have concluded that:
Our response at NPHTI to this situation is thus the same as the things we say to our patients and colleagues when we are discussing and educating them about what hypnosis is and is not. As we consistently teach on the first morning of, and throughout, our 3-day Introductory Workshops — we must always focus upon the ethical and appropriate use of hypnosis with our child and adolescent patients: a) by whom, and b) under what appropriate circumstances. For further reading, we suggest an evidence-based review of Pediatric Clinical Hypnosis (e.g., by NPHTI co-founders and co-directors Daniel P. Kohen, M.D.,FAAP, ABMH and Pamela Kaiser, Ph.D., CPNP, CNS, “Clinical Hypnosis with Children and Adolescents – What? Why? How? : Origins Applications, and Efficacy” – free full text link).
Daniel P. Kohen, M.D.,FAAP, ABMH and Pamela Kaiser, Ph.D., CPNP, CNS
Co-founders & Co-directors, NPHTI
Andrew Barnes, M.D., MPH
Webmaster and Listserve Manager, NPHTI
Advancing Health and Careby
We are proud and very happy to announce that NPHTI faculty Laurence Sugarman, MD, is writing a regular column for the popular Psychology Today website. Entitled “On and Off the Spectrum: Helping Children Grow their Minds,” Dr. Sugarman’s blog will be the only regular feature (so far!) on Psychology Today to highlight how children and teens benefit from therapies such as self-hypnosis and biofeedback. A large part of what will be interwoven throughout this ongoing discussion is how self-regulation offers a lens on how to help young people — including, importantly, those who are neurodiverse — identify and use their unique talents and gifts to overcome their challenges. Please take a few moments now to check out (and post your comments about) Dr. Sugarman’s first post, “That’s Why I’m Here,” which emphasizes one of our central tenets at NPHTI: the more that we understand and treat each child as a unique individual, the more we foster their growing-up abilities and their healthy long-term development. (Plus, the list of upcoming posts will surely whet your appetite for more!)
Review Article by NPHTI Co-Founders Describes the “What, Why and How” of Hypnosis for Children and Adolescentsby
Are you looking for an outstanding summary of the past 30+ years of pediatric clinical hypnosis? Well, look no further! — Drs. Daniel Kohen and Pamela Kaiser, co-founders and co-directors of the National Pediatric Hypnosis Training Institute, have just published their review article entitled, “Clinical Hypnosis with Children and Adolescents—What? Why? How?: Origins, Applications, and Efficacy” (Children 2014, 1, 74-98). Their article integrates the history of the field with a fully referenced list of evidence-based applications of hypnosis in child health, and goes in-depth into 4 illustrative case vignettes before concluding with information about how to obtain further training in the field, e.g. through one of our workshops. It’s the perfect introduction to our field and serves as a unique touchpoint for the philosophy of care that we foster at NPHTI.
An Interview on Pediatric Hypnosis with Dr. Leora Kuttnerby
We are pleased to share with you some perspectives from our beloved NPHTI faculty member, Leora Kuttner, Ph.D. Dr. Kuttner is a clinical psychologist in private practice and professor of pediatrics at the British Columbia Children’s Hospital in Vancouver. In 2007 the American Pain Society presented her with the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief, and she is the author of a seminal text in pediatrics, A Child in Pain: What Health Professionals Can Do to Help. Her films, including the No Fears, No Tears series, have won numerous awards. (Portions of this interview have been adapted by Dr. Kuttner from her interview with Mark Jensen, Ph.D., which appeared in Contemporary Hypnosis & Integrative Therapy, June 2013, Vol. 30 Issue 2, pages 77-). What led you to take your first workshop in hypnosis?I first learned hypnosis for adults 1976 in South Africa during my clinical master program from the eccentric, talented psychologist Professor George Wiehahn who was trained in Holland. That was the same year the child psychiatrist Josephine Hilgard presented her groundbreaking research on hypnosis with children (Hilgard & Morgan, 1976). This is nicely synchronistic: Josie had influenced Lonnie (Lonnie Zeltzer) and Sam’s (Samuel LaBaron) research, and in 1981 I drew inspiration from them and Josie’s research to bring hypnosis into BC Children’s Hospital, Vancouver Canada – my new home. Sometime in 1984 or ’85, I met Dr. Karen Olness after giving a presentation on hypnosis for pediatric pain relief. She invited me to join the SDBP [Society for Developmental and Behavioral Pediatrics] Hypnosis Faculty where I met a group of pediatric professionals who became and remain my friends and teaching colleagues to this day! How do you view hypnosis?I experience and know hypnosis to be an extremely natural, effortless experience. It’s a common feature of our lives and of children’s lives– a frequent natural state of focused narrowed attention. Children and teens move in and out of trances more easily than we, adults do. I regard therapeutic hypnosis as engaging with that capacity to further a positive outcome, and develop a desired therapeutic change. With children, I need to pay close attention to my words because hypnosis starts from the moment of our first encounter. I think of hypnosis a tacit agreement, to undertake this wanted change process together by using imagination and focused attention, and by practicing and refining this process until the goal is achieved. How were your first experiences using with yourself — in other words, doing self-hypnosis?I truly can’t remember my first self-hypnosis experiences, but I do recall how for years I’ve turned to self-hypnosis to prepare for any medical, surgical or dental procedure. The first was arriving from England to South Africa where I developed horrid allergies, which required skin testing. I was 6 years old and the nurse was fascinating. She had a little white funny hat ontop of her black hair and was so pretty that I felt nothing of those many little skin injections along my outstretched arms. As I grew older I learned to turn inwards and ‘let go’ into acknowledging, and trusting the bedrock of healing that I have within my body. It feels very simple, but the effect is profound. This releases all the overlay of tension, fear and worries. It’s going to the knowing, and subverting all the angst and fears. But—and this is a big BUT – I have to ensure before hand that I can indeed trust the professional/s doing the procedure. Once that is in place, I breathe deeply and let go with the words, that ‘my healing will be rapid and smooth’ …and that has been the outcome so far! Can you give an example of one of your first successes with hypnosis with a patient?At the beginning of my career in 1979 I used hypnosis for treating children’s abdominal pains. But it was only from 1980 onwards, when working in Oncology that I grew to appreciate what a remarkable therapeutic asset hypnosis could be. Early on I worked with a teen with Ewings Sarcoma, Jenny, for her dreaded IV access. After she gained some mastery she asked to use hypnosis to support her recovery from this nasty disease. I taught her how to use hypnosis to scan her body and bring healing, ease and well-being to every part of her body. Oncology staff raised the concern: ‘I’m really worried about Jenny, because she’s putting so much into this hypnosis, and what if it doesn’t work and she relapses? Will she blame herself for not trying hard enough?’ We discussed that it isn’t about trying hard enough; it’s about using everything to maximize the chances for healing and to gain comfort, peace of mind and spirit. My big lesson here was how to negotiate minimizing uncertainty without giving false hope. Who decides when or how hypnosis would be helpful?The children do their own practice in the way that gives them meaning and contentment. When very ill, it’s remarkable how wise children are—and I learned to take my lead from them. Jenny had used hypnosis as part of her pain management over four years of intense medical treatment. One day she came to clinic and said, ‘I was doing my hypnosis body scan for comfort and I saw something quite different’. I asked, ‘Different how?’ And she said, ‘Well, I thought I better come in and have a bone scan’. She knew before anybody that something wasn’t right, and through her regular self-hypnosis practice picked up a recurrence of tumour growth. So sad! But that developed connection within herself and her body, gave her considerable internal strength and acceptance for the tough road ahead. Jenny was one of my remarkable early teachers about how far teens/children can go in their healing journey, when taught hypnosis early in their treatment and within flexible creative forms. How do you use hypnosis nowadays with your patients and their families?Now, I work with children and teens suffering from complex, ongoing pain conditions, such as complex regional pain syndrome, abdominal diseases and pain, chronic diseases, migraines, persistent headaches, and various painful musculo-skeletal conditions. Because of the persistent nature of these physical pains there are many overlays of emotional, cognitive, social and family issues that compound the pain experience. Often there’s a history of successive failures and withdrawal from school and friends. Hypnosis is my most powerful therapeutic tool, and I want to use it early on while developing the therapeutic alliance, thereby increasing the patient’s capacities to engage more productively with her/his body and life. First I educate about pain: ‘Do you know how pain works?’ They often shake their heads. ‘Has anybody explained how pain is processed in the body?’ Clinicians often don’t have or take the time to explain the brain’s role as a pain modulator to inhibit pain. Hypnosis informs my language while educating about pain mechanisms. “Let me tell you because it’s fascinating!” I use diagrams of pain pathways, anatomy books, charts and model of the brain, or draw on the white board,–whatever is appropriate for the developmental age of the child or teen. For which kinds of problems do you use or suggest hypnosis?Hypnosis is helpful to me working in palliative care. I’m now working with a divine little girl who is living with a relapsed astrocytoma. It’s a disheartening, bumpy process living with a condition that is incrementally killing your brain’s capacity to function. She uses hypnosis to travel to restore her energy, and reconnect with what gives her life meaning. She returns heartened. She says these ‘trips away’ (dissociation) ‘are cool!’ They seem to sustain her spirit and lessen her suffering, loneliness and despair. What do you think is essential or important for hypnosis to be most effective?BE PLAYFUL. All of us learn when we’re engaged and enjoying the experience. Creating that emotional fascination is important. Jokes can be problematic – as a child said, ‘I like doctors to tell jokes, but I don’t like the jokes where the doctor’s the only one laughing!” Those are not child-focused jokes. So I’m not very jokey, but I do find humor in the interaction and play by evoking curiosity, engaging fun and inviting surprise, or rhyming words which I find ‘easy peasy, lemon squeezy’. INVITE THE CHILD TO HAVE THE HYPNOTIC EXPERIENCE. I introduce hypnosis with an invitation. ‘Would you like to travel inside? I wonder what you’ll see? Maybe it’ll be a surprise, maybe it’ll be so different that you’ll start feeling more comfortable, and you’ll certainly be surprised how easy and fun it is.’ l do a lot to soften apprehension of the environment, indirectly providing the message of safety and ease. ENABLE PARENTS TO BE HELPFUL ALLIES. Many pediatric pain problems are compounded by anxiety, poor sleep and accumulated sleep debt that snowballs into stomachaches, headaches, family distress and parental anxiety. For hypnosis to have an effective therapeutic outcome, parents need to be onboard, understand what and why self-hypnosis has a place at home—not to interfere with the child’s initiative and to support follow through. What are some of the things that you do that build rapport or enhance response to hypnosis?Hypnosis unfolds within the relationship. My task is to read, track and attune myself to the child at all times. As the creative potential unfolds through our interaction, I focus on developing a relationship of trust and openness. I feel alive in this process— it’s amazing how much one can pick up in this process, like a highly tuned sort of instrument, attentive, absorbed, hearing information between the child’s or teen’s words and observing spontaneous behavior. I use language very deliberately: ‘When this pain is down’; or with surprise, ‘You didn’t know, did you, that your brain and your bladder can talk directly to each other.. even when you’re asleep they can help keep you dry’; “You are boss of your body. So your brain can be a great boss right now and help close the gates so your body has less and even less, and even less pain. When change is slowed or not occurring, I ask directly “What are the blocks (or barrier’s or things that stand in your way) to you experiencing (your goal)? The more I understand what the child/teens beliefs are about why this negative problem is happening, or how it arose, and what is preventing the needed change, the better I can help shift or resolve it. I would rather spend more time talking and exploring the child/teen expectancy to enhance responsiveness, than repetitively do hypnosis. With this new information I can create optimal more effective hypnotic experience that had previously been distanced by despair or suffering. Are there specific techniques, strategies, or exercises that you have found particularly useful that you use routinely in many or most cases, or in particular situations?I love the Magic Glove as a hypnotic experience for regional analgesia for needle procedures in children 3 to 13 years old. I’ve developed it over the years to address different needle procedures: for blood-work, IM injections, port-a-cath, children with needle phobia and palliative care applications. It is versatile, quick and once learned, can be used by parents. We recently made a video on it. With children, especially of elementary or younger, I find it beneficial to be use direct suggestion outside of an induced trance experience. My language is simple, hopeful and positive. This leads me to restate the problem from the beginning into a workable goal. For example, in the first encounter with a young child who has daily headaches; ‘So you want to have your head feel good and clear so that you can think easily and have fun at school … right?” I redefine the territory hypnotically, stating our therapeutic goal and her potential to get there; ‘Remember when you didn’t have any headaches? That’s what we’re going to help happen again. We’ll work together with you as the “chief detective” so put your detective hat on! I’ll be your expert consultant and Mom or Dad will be the expert parent!’ This means that hypnosis is not only the trance, a private or dissociated state, it’s the moment of first encounter and is embedded in our developing therapeutic relationship. Change can happen quite quickly with hypnosis, so I heighten whatever will move the child through the door to her optimal outcome. I don’t want to work with the same kid for 42 sessions! I will intensify and hearten the child’s experience and absorption in our therapeutic relationship dedicated to making life better. Do you make recordings of your sessions to give to your patients for home practice?Audio recording are a crucial part of my hypnosis work. Children are part of the digital world, and now it’s easy to record hypnotic sessions and know it will be easy for children to listen to them. I record 3- to 8-minute experiences, short enough to do before school or during recess. I use MP3s, CDs, and more commonly now record directly onto their iPods or iPhones. Rare is the time I do hypnosis without recording it. Each session we create another short recording dealing with the next step in the movement towards full recovery and wellbeing. These become stepping stones to self- hypnosis, but for more complex problems the audio recordings are both a ‘security blanket’ and therapeutic aid. Children with complex pain often collect a library with a different name for each recording, and know which works for what problem. There could be one for sleep; when in pain; after school when energy is low; or when homework needs attention and there’s pain; or in the morning when it’s hard to face the day. They let me know what works for when, and we tailor a hypnosis experience to fit, so that they become more independent, relying on their growing resources and practice. I love the analogy of an athlete training her body to work more effortlessly and easily. Athletes only succeed through regularly attending to what needs improving– and doing it (not trying but doing!). Tell us about your favorite research studies about pediatric hypnosis, either things you or others have published or discovered?Olness, MacDonald and Uden (1987) prospective study using single-blind, placebo cross-over design comparing propranolol with self-hypnosis and placebo treatments for children’s juvenile classic migraines is my all-time favorite! It’s a brilliant and elegant study – a real classic. The researchers showed conclusively that children are able to self-regulate physiological processes previously not believed to be subject to voluntary control; that non-pharmacological interventions are preferable and more effective than pharmacological options for juvenile migraines (and which still has not been fully taken up in pediatric neurology) and that there are adjunct benefits of enhanced self-esteem, validation of coping skills and attendance at school. Pretty powerful findings over 30 years ago and still highly relevant today. What else would you like people to know about you?My first career was as a documentary filmmaker for SABC Television while living in South Africa. I went on to do clinical psychology, then left the country on a doctoral fellowship to come to Canada and never thought I would ever make another film. But life has surprises. Through my hypnosis work in Oncology, I’ve had the opportunity to make a film on pediatric pain management and then made four others. First was: No Fears, No Tears (Kuttner, 1986) on eight young children in the oncology pain program. I explored how pain is managed in different areas of a pediatric hospital in the documentary Children in Pain: An Overview (Kuttner, 1990). I made a follow up on the long-term impact of learning hypnosis when so young, in No Fears, No Tears—13 Years Later (Kuttner, 1998). With the National Film Board of Canada we explored the state-of the art of pediatric palliative care, Making Every Moment Count (Kuttner, 2003). I’ve recently completed a short film Dancing with Pain loosely built on Melzack’s ‘Neuromatrix’ exploring teens managing chronic pain. Hypnosis is a key part of all the films. Children and teens are compelling when telling their own stories. Watching them on film allows the viewer to directly hear and learn about children’s experiences, and provide a rich appreciation. Films are after all hypnotic experiences (which makes me appreciate how so many aspects of our lives, which at first seem appear divergent, are in fact intertwined into a coherent whole)!
An Interview on Pediatric Hypnosis with Daniel Kohen, M.D.by
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 techniques – 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.’
Why Our Workshops Workby
We are proud to share the feedback that we recently received from one of our workshop participants, Dr. Ana Verissimo, who is the director of Pediatric Integrative Medicine within the Division of Pain and Palliative Medicine at the University of Connecticut School of Medicine. She writes:
If that resonates with you, then please register for our next workshop now! The sooner you do, the sooner that you, too, can offer these valuable skills to your patients to allow them to better aid their own healing processes. (And, as Dr. Verissimo said, you might get to meet her at one of our workshops yourself!)
An Interview on Pediatric Hypnosis with Karen Olness, MDby
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!
Empowering Kids When They Get Vaccinatedby
How many of us were scared of going to the doctor’s office when we were kids? How often was it because we were worried about getting a shot?
Anyone who’s been to a clinic where childhood immunizations are given knows the difference between a clinic that understands children’s needs for safety, comfort, and autonomy and one that doesn’t. The former clinic is quiet and serene; the latter is full of anxious, cowering, crying, screaming, running-down-the-halls and hiding-under-the-table children.
Now we know how to transform any pediatric clinic into a place where children feel competent and successful at mastering their ability to get a vaccination. Medical clinicians who care for children, and our allies in Child and Family Life Services, Nursing, and Mental Health, can attend a workshop with NPHTI to learn how to make their practice not just kid-friendly and patient/family-centered, but moreover how to help kids grow on the inside.
See how well this works in the real world here at the UCSF School of Nursing page, featuring the work of primary care pediatrician F. Ralph Berberich, MD, an esteemed alumnus of all 3 levels of NPHTI training (Introductory, Intermediate & Advanced). He and his colleagues have already conducted randomized controlled trials that show how effectively children can deal with shots using the skills that we practice in NPHTI workshops — self-control, confidence, and comfort.
We hope that soon you, too, will join us as we use our skills in clinical hypnosis to improve the health and well being of children worldwide!
Hypnotic and Self-Regulatory Approaches to Helping Children with Autism and Their Familiesby
Children and families affected by autism spectrum disorder benefit greatly from using the types of self-regulation strategies that we teach to clinicians who attend our NPHTI workshops. When we use clinical hypnosis and biofeedback with young people and families affected with autism spectrum disorders, we help them learn to ease transitions for themselves and to moderate their reactivity to whatever is stressful for them.
Two weeks ago, one of our faculty and the coordinator of our Intermediate-level workshop, Laurence Sugarman, MD, had the pleasure of doing an hourlong live show with a National Public Radio affiliate, WXXI, in Rochester, NY. As Dr. Sugarman notes, “It was particularly gratifying to demystify hypnosis and biofeedback. The show was so popular that it has been released as a podcast (and is being rebroadcast).” Highly recommended listening for parents and clinicians!
NPHTI Proudly Shines at 7th European Child Hypnosis Congress (Kindertagung)by
Our colleagues in Heidelberg, Germany once again hosted the 7th European Congress of Child Hypnosis: Hypnotherapeutic and Systemic Concepts for Work with Children and Adolescents (Kindertagung: Hypnotherapeutische und Systemische Konzepte fur die Arbeit mit Kindern und Jugendlichen) from October 31- November 3, 2013. Usually held every 2-3 years, this Congress was last held in 2009, and was delayed one year because the International Society of Hypnosis triennial Congress was held in Bremen during the approximately same time in 2012. As in past years, Bernhard Trenkle, Ph.D organized the Congress, with co-sponsorship by the Trenkle Organization and the Milton Erickson Institute of Rottweil.
While in years past this Congress was considered outstanding with attendance of 900, then 1100, this year’s attendance maxed out at 1800 participants! Amazing!
The vast majority of workshop presentations and keynote addresses were presented in German, as most attendees are German-speaking professionals. Faculty are from Germany, Austria, Switzerland, Poland, South Africa, Canada, and the United States. Of the eight faculty from the US, four are NPHTI trained and/or faculty, and we are proud to have been wonderfully well represented at this premier international venue.
Over 100 faculty offered a wonderful potpourri of 3-hour workshops. Workshop presentations by NPHTI faculty included:
Pamela Kaiser, PhD, CPNP, CNS was also an invited member of the faculty and was to present “Children’s Anxiety: Multigenerational Considerations and Implications for Hypnosis Interventions” and “Family-focused Treatment of Children’s Reduced Self-Regulation of Anxiety” but was unable to participate due to illness.
As a perfect ending to this amazing workshop program, the Congress concluded with a huge banquet – dinner and dancing on Saturday night. Held in the Congress venue the Stadthalle (Town Hall, a wonderful, huge old building with 2 balconies) – this has always been a wonderful event.
While a group of Americans and their German colleagues and friends (some old, some new!) were eating, Dr. Trenkle approached Dr. Kohen, and told him he would be sending a young woman over to translate for Dr. Kohen while Dr. Trenkle made “some surprise announcements” during dessert and before the band began to play, and that he would ask him to come to the stage. He proceeded to address the assemblage of over 1500 folks with a history of this Congress, culminating in projecting on the huge screen a photograph and announcement of the “Daniel P. Kohen Preis (Award)” to be awarded to Dan as “the pioneer of child hypnosis therapy,” and presented also to two additional longstanding and highly respected clinicians and educators, Siegfried Mrochen, Ph.D. and Karl-Ludwig Holtz, Ph.D.
Although hard to believe, Dan was indeed speechless as he came to the stage to receive the award.
NPHTI is bestowed with many wonderful faculty who teach professionals all around the world. Going forward, we will continue to post on our website and our Facebook page the teaching accomplishments, awards, and venues where NPHTI graduates and faculty have been privileged to participate.
“Symptoms as Solutions”by
We’re proud to see that longtime NPHTI faculty member Laurence Sugarman, MD, who (among many other things) co-coordinates our Intermediate Workshops, is featured in a recent post at the Rochester Institute of Technology’s website. The article describes Dr. Sugarman’s research at RIT, including the piece that he and his colleagues published just this month in the American Journal of Clinical Hypnosis, “Symptoms as Solutions: Hypnosis and Biofeedback for Autonomic Regulation in Autism Spectrum Disorders” (AJCH October 2013; 56(2):152-173). We commend Dr. Sugarman and his team on their highly integrative and innovative ongoing work, which promises to expand society’s view of those with autism spectrum disorders and other developmental differences; to wit (from the AJCH article):
And so, moreover, we feel grateful that we get to continue to learn from Dr. Sugarman through NPHTI!
The Power of Training with NPHTIby
After our most recent NPHTI workshop, we received a wonderful and gracious (unsolicited!) email from one of our participants, Brian Delaney, Psy.D. He is the director of training for the post-doctoral psychology fellowship program in the Division of Pediatric Psychosocial Oncology at the Dana-Farber Cancer Institute in Boston.
This is really a marvelous testament to our participants, as they take to the next level what they learn in our workshops and integrate these learnings into their clinical practices, improving the lives of their patients in the process!
Webinars with Michael Yapko, PhD
by
Did you know that renowned clinical hypnosis expert Micheal Yapko, PhD (author of the classic text Trancework, now its 4th edition) has made 2 online seminars — “webinars” — featuring NPHTI’s co-founders/directors?
In the webinar “Childhood Anxiety, Fear and Worries: Indiviudalizing Hypnosis for Self-Regulation,” Dr. Yapko interviews Pam Kaiser, PhD, CPNP, CNS to draw upon her vast experiences and expertise in crafting strategic, tailored interventions to help children master their stress responses. In “Kids and Hypnosis: When and Why,” Dr. Yapko has a lively conversation with Dan Kohen, MD about integrating child developmental principles into hypnosis.
Each webinar is wonderful and unique, and we highly recommend them — they have all the practical tips, ideas, and suggestions that you’d expect to discover when listening in on an intimate conversation between innovative masters of clinical hypnosis!
What’s nifty about NPHTIby
One of the best things about NPHTI is that we get to spread the word about how pediatric clinicians can teach children/teens with medical and/or mental health care needs a most valuable lifelong skill (self-hypnosis). Our workshops instill the skills clinicians need to successfully “coach” children to do self-hypnosis — how they can focus their attention inward and give themselves therapeutic self-suggestions. When children learn to do this gentle, easy use of imagination, it gives them new hope and a sense of mastery and competence, as it helps them give themselves:
These are just a few of the reasons that training in pediatric hypnosis is so delightful and energizing — whether attending your first workshop or your forty-first!
Hypnosis for chronic abdominal pain in children works long-termby
We are pleased to announce that our colleague and friend, Carla Frankenhuis, will be coming all the way from the Netherlands for NPHTI 2012 as a new member of our Faculty! Stay tuned for more information on that…. And in the meantime, you can read her recently published, cutting-edge research, “Long-Term Follow-Up of Gut-Directed Hypnotherapy vs. Standard Care in Children With Functional Abdominal Pain or Irritable Bowel Syndrome,” which showed the persistence of complete remission of pediatric chronic abdominal pain after treatment with clinical hypnosis. They found that children between 8- and 18-years-old experienced nearly-complete pain relief upon first learning hypnotic techniques (documented in their previous study), AND that more than 2 out 3 of these children remained pain-free after 3-6 years (and counting!) of follow-up (whereas only about 1 in 5 of the children who received “standard medical treatment and supportive counseling” remained pain-free over the same time frame). It’s something that those of us who use hypnotic methods in our clinical work with children have come to appreciate — clinical hypnosis during childhood can have a long-term positive impact as children grow up. When you’re ready to begin using these highly practical, long-lasting skills in your practice, or to keep getting better at using them, REGISTER FOR THE NPHTI 2012 FALL WORKSHOP! Go to www.cmecourses.umn.edu, scroll down to September 20-22, 2012, pick your course – INTRODUCTORY, INTERMEDIATE or ADVANCED, complete the forms and start the process… we’ll look forward to seeing you sign up!
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