REFRAMING HYPNOTHERAPY

EVIDENCE-BASED TECHNIQUES FOR YOUR NEXT

HYPNOSIS SESSION
DR. RICHARD K. NONGARD
KELLEY T. WOODS
 CONTENTS

About the Authors

Introduction
1. What is contextual hypnotherapy?
2. Relational Frame Theory
3. Challenging the idea of past-tense therapy
4. Mindfulness as a success foundation
5. ACT Therapy Solutions
6. Positive Psychology
7. Solution-focused Brief Therapy
8. Mindfulness-based stress reduction (MBSR) and other mindfulness-based therapies
9. Dialectical Behavioral Therapy
10. DBT Skills Training
11. Metaphor and Story
12. Case application and structure of therapy
Note from the Authors
Bibliography
Copyright © 2018 by
Dr. Richard K. Nongard and Kelley T. Woods
All Rights Reserved.

Edited by James Hazlerig

Cover and Formatting by Rene Folsom

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or
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journals.

Dr. Richard K. Nongard

Peachtree Professional Education, Inc.
15560 N. Frank L. Wright Blvd. B4-118
Scottsdale, AZ 85260
(918) 236-6116

www.SubliminalScience.com | www.HPTI.org
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 ABOUT THE AUTHORS

Dr. Richard Nongard is a licensed marriage and family therapist with a

Master’s Degree in Counseling from Liberty University and a Doctorate in
Transformational Leadership (Cultural Transformation) from Bakke Graduate
University.
He has written a variety of textbooks on counseling and clinical hypnosis.
His books, Medical Hypnotherapy, Speak Ericksonian and Expert Scripts for
the Professional Hypnotist, have cemented his place as the modern thought
leader in hypnotherapy.
The author currently maintains a private practice in Las Vegas, Nevada,
where he sees clients on a regular basis. In the past, his work has included
both inpatient and outpatient psychiatric and substance abuse settings,
exposing him to a wide variety of clients over the years.
Dr. Nongard is a frequent keynote speaker and teacher, and regularly
holds seminars in both his Las Vegas training center and worldwide. He is
the Executive Director of H.P.T.I. (Hypnosis Practitioner Training Institute)
and the International Certification Board of Professional Hypnosis.
Find out more by visiting: SubliminalScience.com

Kelley T. Woods is a Washington State Registered Hypnotherapist, in

private practice since 2002. She serves as a Board Member of ICBCH and
teaches through HPTI, among other venues. Author of several books on
hypnosis, she is the co-recipient of the Excellence in Literature Award from
the International Medical and Dental Hypnosis Association.
Kelley is a co-founder of HOPE Coaching, a team of Mindful Hypnosis
coaches who help people suffering from chronic issues. She is the creator of
an online forum of women who work professionally in hypnosis, Hypnotic
Women. Known for her work in pediatric hypnosis, Kelley is respected for
her creative and passionate approaches in helping clients of all ages.
 INTRODUCTION

The purpose of this book is very simple: my goal is to provide information

that’s going to help empower you as a hypnotherapist or life coach and
become even more effective in your work with clients. But, I also want to
free you from limiting beliefs held by many professional hypnotists.
The first of these is the idea that there is a singular best method or
approach to hypnosis. It is true that some approaches are more effective than
others, and it is true that some approaches are based more in superstition and
tradition than in fact, but research also shows that what is most important is
the value of the therapeutic relationship. It is within this truth that the
explanation lies for how poorly trained hypnotists, or those limited to
methods based in tradition rather than research, are able to produce results.
This idea also gives us freedom, freedom to explore new methods, new ideas
and to borrow from other disciplines the hypnotic methods they use and
deploy them in our work.
The second thing I want to liberate you from is the idea that by using the
methods researched by the psychological and/or medical profession we are
somehow practicing therapy without a license. I am both a professional
hypnotist and a licensed mental health professional. I am also a graduate
school professor at an accredited university (and yes, my academic degrees
are accredited, including my doctorate, by accrediting agencies recognized by
the US Department of Education and CHEA.) and I am well grounded in
research methods and the nature of peer-reviewed studies. I tell you this to
confirm in your mind that I am a multi-disciplinary expert in counseling and
academics so that you will trust me when you hear me state:
Mental health professionals are, in many cases, practicing professional
hypnosis without acknowledging it or labeling it as hypnosis and so the
methods that are discussed in the professional therapeutic literature
(mindfulness, visualization, relaxation, etc.) are not methods exclusive to
mental health counseling, psychology or medicine. In fact, these same
methods are used in many other disciplines, from parenting to sales, to
teaching, ministering or leadership.
In other words, you do not need to fear using the core techniques of
Mindfulness-Based Stress Reduction; the psychology profession does not
own them. In fact, they are borrowed ideas from 5000-year-old traditions of
self-discovery and religion. We need not fear encroaching on the
psychologists’ domain when we use the confrontational methods of
Cognitive-Behavioral Therapy. After all, the creator of CBT, Albert Ellis,
attributed in his own books much of his success and techniques to hypnosis,
not psychology. Yes, the ideas of DBT (Dialectical-Behavioral Therapy)
have been largely applied to treating mental health clients, but the core
principles of educating the client, helping the client value the present
moment, and building community preceded the entire profession of
psychotherapy.
In many cases, when you pick up a book on cognitive-diffusion
techniques, or psychotherapy, much of what you will be reading are hypnotic
techniques that predate the modern professions of psychotherapy and
psychology, and hypnotists should feel free to continue to use these ideas. I
do find it amazing that certain hypnotists worry about teaching a client
mindfulness because it is the domain of psychologists (when in fact the local
yoga teacher’s entire career is based on this) and yet they are fully willing to
delve into open-ended approaches to hypnosis that delve deep into the psyche
and a client’s past just like Sigmund Freud did!
And this bring me to the next point: I want to help you develop freedom
from the idea that regression (which really is the practice of psychology
without a license) is the best approach. There will be many who challenge
this central idea which is a basic theme of this book. But the research just
doesn’t show that regression is the most effective way to help someone make
change. Yes, they can still make change - the therapeutic relationship is far
more important than the technique - but for me and many other modern
hypnotists, the question has always been, “Is there a way to help people make
lasting change without delving into the misery of the past?” And fortunately,
the research backs this up. And this book is full of ideas to help you do
exactly this.
If you are a hypnotist who was trained to do an arm-drop/eye-lock
induction, regress the client to the “cause” of their problem, create a new
narrative about old problems, and end with positive post-hypnotic suggestion,
this book will give you new ways to approach clients. I repeatedly observe on
hypnosis discussion boards that the answer is always “regress them to the
cause”. But life is a cause of many problems. It is a stretch of imagination to
believe we can always find “the cause” and more importantly, even if we did
- there is literally nothing that can be done to change the past. Approaches to
change that are based on the power of Now are effective and supported by
research. The professional mental health community long ago discarded
regression as a primary tool for creating change, and even Freud himself
discarded the idea in his later years.
Another thing I want to free you from is the idea that “deep trance” is
better than “light trance.” We are always in trance; the question is not how
deep the trance is, but how can trance be directed. Hypnotists who learn to
direct trance to resource states rather than simply deepen trance are
hypnotists who have the freedom to use their skills with every clients and in
any situation. I meet hypnotists who blame failure on the client, “They are
blocking access,” or, “They are resistant!”
Realistically, “access” is not even necessary to make change. A client can
respond to hypnotic suggestion in any level of trance, and hypnotists who
expand their skillset learn to use every level of trance as a tool for creating
lasting change. Sometimes, I want my clients in a light level of trance. When
I am teaching them, talking to them, or trying to help them create reframes, a
light level of trance makes concentration and absorption much easier. We can
utilize this state of Mindful Hypnosis in many ways because clients not only
learn but retain valuable experiences and resources when they are actively
participating.
This is important: There is no study that shows one trance to be more
effective than another trance - it is only hypnosis training programs selling an
idea that make this claim. Everything that happens “in” hypnosis happens
“out” of hypnosis. This includes ALL hypnotic phenomena. It is the
experience of hypnosis that is far more important than the depth of hypnosis,
and depth itself doesn’t even exist, it is merely a metaphor and construct that
helps us define the experience, but it is not itself the experience of hypnosis.
We're now in an era of evidence-based treatment protocols. If you're a
more recent graduate of a hypnosis training program like HPTI, or you’ve
been particularly careful in your selection of continuing education courses,
you might have an edge from an academic perspective, but chances are you
learned about hypnotherapy in many of these courses rather than actually
doing hypnotherapy.
I know I am challenging the superstitions and ideas of many
hypnotherapists already. Some might even be ready to put down this book,
but by learning these new ideas you will find new approaches grounded in
research and techniques that can help you with your clients even if you
disagree with me on some of the long-held traditions in our profession.
I asked Kelley T. Woods to contribute to this book specifically because
not only is she a hypnosis practitioner and instructor who is in the trenches
daily, working with real clients, she comes from a non-therapist background.
Yet, she has been able to absorb the concepts of Contextual Hypnotherapy
and integrate them into her work, experiencing high rates of success with her
clients of all ages. Her perspectives in this book will compliment my
academic and professional counseling experience and demonstrate just how
easy it is for you to add these approaches to your work, no matter what your
background is.
This book is both about new therapeutic approaches and how to enact
them with your clients. First, I'm going to focus on an overview of Contextual
Hypnotherapy and, in each successive chapter I'll not only share a theoretical
or a philosophical idea of a therapeutic approach, I'll also describe the
experiences with my clients in my office. I'm going to demonstrate with you
interactively the various processes that are of value to you. All of these are
based on research and are also firmly recognized as hypnotic approaches.
This book will help you to understand the new philosophies of
hypnotherapy based on current research. A lot of therapists like myself
practice daily what we were taught in graduate school and yet there's been so
much more in the last 25 years which has been empirically validated as
efficient treatment for a wide variety of different behavioral psychological
disorders.
I am going to overview philosophies that are based on current research in
contemporary university settings but, don’t worry; it's not going to be all
academic. I'll teach you how to take that research and creatively apply it to
those clients who are in your office. This book is going to help you to
develop a map for navigating tough or unfamiliar therapeutic settings.
 Our work is all about change. We know that change is constant - the
client who walks into our office isn’t the same person who leaves. By
expanding your mindset, you can embrace change and stay abreast of what’s
happening in modern hypnosis. You will be able to keep the tried and true
approaches that you know work for you while adding elements of Contextual
Hypnotherapy so that you are even more effective.
Now and then, I get a call from a client, and the presenting problem is
something that I really don’t have a lot of familiarity with. It's new. It's
unique. It's a different type of issue than I've worked with in the past. I really
enjoy these types of cases because it gives me the opportunity to get out of a
rut - to do something new and apply my skills with a totally different
dynamic. Sometimes, however, in these unfamiliar therapeutic settings or
with a particularly tough client I think to myself (as I'm sure you also do),
“What should I be doing in this session?”
By understanding Contextual Hypnotherapy, you will have the skills
necessary to steer through these situations with confidence and grace. You
will know where to start, what to do in that first session with that client, what
can be done over the next six to eight weeks to assist that client. You're going
to feel confident in your ability to help those people who come to you for
help. As a result, this book is going to help you re-ignite your passion for
your work by helping you to develop specific skills and processes for
effective therapy.
When clients ask, “How do you know this will be helpful to me?” you
will have confidence in knowing that you have adopted a set of methods that
are empirically based and are ones that research shows have a greater efficacy
in helping a larger number of people to experience the success for which they
came to you in the first place.
Included in what you're going to be learning in this book are a variety of
different approaches to trauma therapies. Almost every client who comes to
our office has experienced or is in the middle of experiencing significant
trauma; fortunately for all, over the last twenty to twenty-five years
significant amounts of research has really shed light on the best approaches
for helping people resolve trauma. This book is going to focus on giving you
some of those strategies, based on empirical research, that can help you to
help those who are experiencing trauma.
The methods of this book include a set of skills, all with roots in what is
referred to as Contextual Psychology. This includes those most closely
associated with Contextual Psychology: Relational Frame Theory (RFT),
Dialectical Behavioral Therapy (DBT), and Acceptance and Commitment
Therapy (ACT).
Because of my experience in working with personality disorder clients,
I've spent a great deal of time working as a therapist within the context of
substance abuse and the criminal justice system. As a result, I have been a
student of Dialectical Behavioral Therapy since the early 1990s. Dialectical
Behavioral Therapy, published by Marsha Linehan in 1993, called, Skills
Training Manual for the Treatment of Borderline Personality Disorder, is
really one of the first approaches that we could put into the “basket” of
Contextual Hypnotherapy.
That book really started a revolution in the treatment of personality
disordered individuals, but the great thing about the last twenty-five to thirty
years is that those techniques have been applied far beyond the original
context of borderline personality disorder to a wide variety of clients, from
self-mutilators to clients with eating disorders. This process has helped
people who have a variety of different presenting problems experience
success in a way they simply couldn’t before.
Additionally, we are going to teach you how to use metaphor in therapy
and change work. Contextual Hypnotherapists almost always have one thing
in common: the ability to recognize the value of language and language
patterns in change work. You, too, are going to gain that ability, and you are
going to learn how to use metaphor in a way that’s meaningful to help you
communicate more effectively with your clients.
This course will also teach you the principles of Mindfulness-Based
Stress Reduction (MBSR). Jon Kabat-Zinn, at the University of
Massachusetts, in his pain management program almost 30 years ago, began
studying the efficacy of Mindfulness-Based approaches in psychotherapy in a
secular and non-religious setting. I'm going to share with you the ideas of
Mindfulness-Based Stress Reduction and how they can be useful to the
clients whom you work with in your office.
Mindfulness is a strategy that is really at the core of many of the different
approaches of Contextual Hypnotherapy. I've always been a big fan of
Solution-Focused Brief Therapy (SFBT), which is another evidence-based
treatment protocol that has demonstrated efficacy with a wide range of clients
and when we can utilize the principles of Solution-Focused Brief Therapy,
like the Miracle Question to help us determine what the most effective
outcomes and treatment are going to be, we can be even more effective in
therapy.
Although I've been familiar with Positive Psychology as a therapeutic
technique for a long time, it wasn’t until my doctoral studies at Bakke
Graduate University that I began to use a process called Appreciative Inquiry
in organizational management and consulting. The organizational or
management approach to Appreciative Inquiry is really an adaptation or an
outgrowth of the ideas of Positive Psychology that we can utilize with our
hypnosis and coaching clients.
Sitting on my desk right now is one of my favorite resources: The Oxford
Handbook of Methods in Positive Psychology. It was edited by Anthony Ong
and Manfred von Dulmen. It's a tremendous resource that I keep on my desk,
and it's got dog ears, underlines, and yellow stickies all over it. I'm going to
be sharing with you the things that I've yellow stickied, the things that I've
dog-eared, and the things that I've underlined so that when you have a client
in your office at 4:15, you will know what to do with them, based on
empirically validated approaches.
The ideas of Positive Psychology are completely different than our
traditional diagnostic or pathological model of psychology. Of course, one of
the first evidence-based treatment protocols was Cognitive Behavioral
Therapy (CBT), associated with Albert Ellis and Aaron Beck.
CBT is the therapeutic approach that I focused on during graduate school
in the late 1980s. The reality is, though, that cognitive therapies have made
significant improvements and changes over the last 20 to 25 years. Some of
the best CBT research comes from the University of Toronto, along with
current research into mindfulness-based cognitive therapies, which are so
relevant to what we do in hypnotherapy.
I'm also a big fan of Experiential Theater as Don Gibbons, a psychologist
from New Jersey and a former president of the New Jersey Chapter of the
APA, calls it. He and Kelley wrote a book, Virtual Reality Hypnosis,
detailing how easy and effective it is to use a metaphor of the Multiverse to
help clients improve. I'm going to be sharing with you some of the techniques
of experiential therapy where we don’t just interview our client, reflecting
back what we heard them say, but instead, we create an opportunity for them
to take action in our office through experiential processes that they can
practice between our sessions.
I'm a firm believer in therapeutic homework. My clients know what they
should be doing between now and next week, and experiential therapy gives
us a great toolbox to draw from in helping our clients through the larger
umbrella of Contextual Hypnotherapy. And, not only is it easy for them to
use, it’s fun!
The material in this course is based on empirically supported treatment
approaches. It’s vital to know and use what psychological research has shown
us to be most effective. This is what is required in the era of managed care.
More importantly, using evidence-based approaches helps you feel even
better about the work that you do, knowing there's a greater likelihood that
your clients are going to experience the results they seek. You'll be learning
what really is the subject of current research and you'll be learning the
specific processes and methods of using these strategies with clients in your
office.
Now, let's move from future pacing what you are going to learn and begin
learning. In fact, one of the themes of this book is the only time that you have
is right now. Yesterday is gone. Tomorrow is not yet here. And so, living in
the present is really one of the key characteristics to helping our clients
experience success through Contextual Hypnotherapy.
 1

WHAT IS CONTEXTUAL HYPNOTHERAPY?

T HE APPROACHES PREVIOUSLY MENTIONED IN THE INTRODUCTION FIT BENEATH

the banner of Contextual Hypnotherapy. Broadly, Contextual Hypnotherapy
is evolved from Contextual Psychology, which involves the application of
therapeutic philosophies that interprets an event as an ongoing act,
inseparable either from its current or its historical context and in which a
radically functional approach to truth and meaning is adopted.
In Contextual Hypnotherapy, we believe that:

Rather than resolving the past, we live fully in the present.

There is no need to look back because the present context is really
all we can resolve.
Any presenting problem is a multiplicity - not only of problems
but of interpretations, experiences, behaviors, thoughts, feelings,
actions, sensations.
These things need to be addressed to find resolution and establish
a goal or pathway for our clients.

The context for Contextual Hypnotherapy is right now, this moment -

which is the only experience that we can impact. In other words, Contextual
Hypnotherapy differs from the approach of Neo-Freudianism in that
regression (or regression-to-cause) in resolving the past is not viewed as the
central approach to therapy. This is, of course, logical. In the present time, it's
impossible for me to change the past. Yet the current approach that many
hypnotherapists have to therapy is to spend time “processing the past”.
 The reality is that we can process the past forever. We will never be able
to change the past. One of Freud’s central ideas was that we could go back
into the past to find the cause of today’s issue. He thought we could resolve
that past problem through a series of different processes and then experience
life more fully in the present. It made for a great theory in the early 1900s,
but the evidence shows us that we can't impact the past at all. In fact, the
evidence shows us that memory isn't particularly accurate or even useful in
many cases; as a result, regression to a specific cause and resolving that cause
is an ineffective method as contrasted with those approaches of Contextual
Hypnotherapy.
One of the most amazing effects of using Contextual Hypnotherapy is
how we figuratively change the past by changing the present. It's not because
the past is altered or because it's even resolved, or because somehow the past
is different. Rather, through the processes of acceptance which you will learn
in this book, we can change either the importance of the past or our
interpretation of the past. The result is that we are no longer enmeshed with
the troubling past, instead enjoying this present moment to its maximum
potential.
Although in the term “contextual behavioral psychology” we have the
word behavioralism, it differs from classic behavioralism - that of B.F.
Skinner and others - in that it doesn’t try to explain why people act as they
do. One of the primary goals of early behavioralism was really to figure out
the why. What is the mechanism that causes this? I believe that life is a cause
for many of the complexities that my clients experience and that we can work
with clients, session after session after session, trying to find the mechanism
or the cause for why they do something. And, even if we do understand the
why, they remain afraid to fly or they continue to be depressed; why still
changes nothing.
The focus of Contextual Hypnotherapy is not why do I do this, but
instead how do I live fully in the present moment? For example, Acceptance
and Commitment Therapy (ACT Therapy) differs from other CBT
approaches in that, rather than trying to teach people to better control their
thoughts, using what Albert Ellis called “thought stopping techniques,” ACT
therapy teaches them to avoid fusion and enmeshment with thoughts,
feelings, and sensations.
One term you need to familiarize yourself with is cognitive fusion. The
idea here is that a thought or emotion becomes tied to an experience. In
hypnosis we often call this anchoring. To some extent this is similar to
classical conditioning, there is a cue (experience) and a response that is
automatic (thought). Fusion occurs when people subconsciously attach these
thoughts or emotions repeatedly. For example, anxiety is cued up when there
is an experience of boredom. Smokers might manifest this as an issue in
anticipating withdrawal. Or a weight loss client might be fused with the idea
of satisfaction when eating their favorite empty calorie food. These fusion
states can be broken, and the mind can be rewired through cognitive defusion
techniques. This can be accomplished through direct suggestion, experiential
hypnosis, or by replacing anchors.
This is really a huge shift in psychology. In the era of pharmacology,
psychiatry gives people a false belief: If you take this pill, you will become
un-depressed. If you take that pill, you'll become un-anxious. If you take this
pill, you will become un-psychotic. The expectation in our instantaneous
world is that when we go see a therapist, we will stop having those
experiences, so most people present in counseling with the desire to “stop”
something.
ACT therapy does not have as its goal the stopping of anything, but
instead promotes the acceptance of those thoughts, feelings or sensations; it
uses the process of avoiding cognitive fusion and enmeshment with troubling
thoughts, feelings or sensations rather than the goal of stopping them. This is
the ultimate in paradoxical therapy: Through the paradox of acceptance, true
freedom is ultimately found. The paradox here is that when something is
accepted as being just what it is, it then has no power.
Depression, loneliness, hunger, fear, or even withdrawal become
unimportant when accepted. When it becomes unimportant, it becomes just
what it is. It is then something experienced rather than something that I hate,
or I fight or I'm restricted or obsessed with. I can find freedom from suffering
through that acceptance. Depression is not a problem. I work with a lot of
obese clients, and hunger, once accepted, is not problem. I work with a lot of
addicts who learn that withdrawal is not a problem. Loneliness is not a
problem. An emotion, an experience, is only a problem if my client makes it
one.
What these emotions do is to let me know that I'm a human being, not a
human doing. I've said before happiness would suck if life had no depression.
Security would suck if we had no fear to put it into perspective. Difficult
times and experiences are part of any valued path. Difficulty and pain for our
client are not to be avoided if one wants a truly meaningful life. They're
simply things to accept because in acceptance we give them no power to
control. What our problems do then is form parts of the pathway to becoming
a full human being, participating fully in life.
Acceptance seems like it's such a difficult thing for us to move our clients
towards, yet there are specific strategies and techniques that we can use with
our clients to help them move towards a process of acceptance. Acceptance,
by the way, does not mean, “I like something, I endorse it, I wish it would
happen, or I want it to happen to other people.” That’s not what it means at
all. It simply means, “I can live fully in the present despite where I've been in
the past.”
The reason we can move our clients to this point, even though some of
their experiences are truly awful, is that when we teach them the context of
the present, it gives them self-control - which is what most of our clients are
seeking through their unhealthy manifestations of symptoms and distressing
behaviors.
Contextual Hypnotherapy differs from other hypnotic approaches in
several ways. Our goal is not to use a magical, somnambulistic pill to resolve
the problem. It's to help our clients be fully human by living in their problem,
which paradoxically brings a tremendous amount of freedom. Additionally,
our cause is to equip our clients with skill-building tools that they can apply
for not only their current challenge, but also into their future.

From Kelley:
Ironically, many of my clients have become stuck in self-
perpetuated traps because they are resistant to giving up their
freedom to problematically smoke, drink, gamble, eat or otherwise
engage in self-destructive behavior. When I use Contextual
Hypnotherapy approaches to demonstrate to them that they have
actually sublimated their freedom to these habits and then show them
the way to liberate themselves, it’s like a light bulb illuminates the
way!

Contextual Hypnotherapy is distinct in that while it uses therapeutic

process, diagnostic labels are far less useful and often become unimportant.
You can imagine the impact this makes for a client who has been chasing
diagnoses for years! Chasing that why can be exhausting, expensive and
hopelessness-creating. When we help a client accept what is, for now, they
often quickly find relief and new perspectives that cause automatic
improvement.
It was probably at least 25 years ago that the National Association of
Social Workers (NASW) began developing an assessment tool that they
called Persons In Environment (PIE). It was really a major project within
social work for about 20 years. For many years, the Persons In Environment
manual was on the main page of the NASW national organization website.
I've always been a big fan of PIE because it is an excellent alternative to
the Diagnostic and Statistical Manual. Instead of pathologizing people with
problems, it assesses people within their environments to help us as
professionals find the solutions that would be most helpful to them. That
approach is consistent with the principles and goals of Contextual
Hypnotherapy.

What’s the role of the practitioner in contextual hypnotherapy?

Contextual Hypnotherapy is largely an educational endeavor. I see myself

- and you are going to begin seeing yourself - fulfilling the role of a guide, a
mentor, a teacher, or a coach to your clients.
I'm a big fan of the coaching model within counseling and social work for
a very simple reason: It is far more powerful to do something with the client,
to introduce something to the client, than to do something to them.
This is often not what the client expects. They expect that we will use our
mystical, magical, hypnotic processes that we learned in our certification
training and make them un-depressed or un-anxious or un-scared. We will
wave our hypno-wands, and they will stop doing all the things they want to
stop and start doing all the things they want to do. Sounds great, right?
I've never found a way to change my clients. What I found instead is that
when I do something with my client, it changes the client - not because of my
power, but because I've helped them to discover the power within themselves
to make those changes. And filling the role of guide, mentor, teacher, or
coach is really one of the central themes throughout many of the different
approaches to Contextual Hypnotherapy.

From Kelley:
 I share Richard’s view on our role as teachers and mentors. I
once compared myself to a Sherpa on a client’s journey, lightening
their load as they submit their challenges. During this journey, we
serve in many ways and one of the most important is to determine how
much of that load a client can carry themselves. Strategies from
Contextual Hypnotherapy help us assess that, along with providing a
client tools to make their ascent easier.
Richard mentioned earlier the value of homework. When we think
about the way that many people arrive at states of chronic depression,
anxiety, obesity and other emotional and physical suffering, we know
that repetition was at play. The repeated patterns of thought, emotion
and reactions hardwire into the brain and nervous system these
“stuck” states. It is through repetition that these clients will find their
way clear and be able to move forward into a better life experience.
Using brief, solution-focused tools on a regular basis will promote
this type of re-wiring and also support the work that we do in our
sessions together.
So, a big part of our role in helping a client involves inspiring,
challenging, luring or otherwise motivating clients to take active
responsibility for their own success. This is how people move out of
hopelessness and helplessness: through experiencing even small
victories. Learning that they can use the approaches we are sharing
with them provides them with solutions to current challenges and
beyond.

One of the chief characteristics of Contextual Hypnotherapy, especially

Positive Psychology, is that it really tries to look at what's right rather than
what's wrong. It builds on and utilizes the client's strengths instead of fixing
what's wrong.
As a marriage and family therapist, I've worked with some couples over
the years who have so many problems, it would be impossible for me to fix
what is wrong with their marriage. As an alternative, I try to help them
discover what is right and to utilize that as a tool for changing the present. It's
so much easier to focus on what is right than it is to fix what is wrong.
I can't change the past, but what I can do is give this assignment to every
couple I work with: I tell Bob and Bertha that when they leave my office
what they're going to do is stop at the store and they're going to buy a
notebook, a spiral notebook like a high school you might take to class. One
book, two people. And each day they're going to write down in that book one
thing about their partner that they value. It could be one word, one sentence
or a short paragraph. Anything more than that is probably too much. One
book, two people.
I tell them to put it in their bathroom - or in their garage, in the kitchen, in
the bedroom, wherever it is that each of them walks through or passes by
each day. I have them write their last name on the front, for example, they
can write, “Smith Family Treasure Chest.” They don’t have to do this
assignment together, but with one book for two people, they can see what
their partner wrote.
I can't fix what's wrong with their partner, but most couples have been
saving up what are called marital green stamps. They’ve been focusing on
what's wrong with their partner, waiting to cash that in with adultery or
divorce or rage or whatever it is people cash those emotional and behavioral
green stamps in for, rather than saving up treasures which they can cash in for
something valuable to themselves and to their partner. And so, rather than
fixing what is wrong with the couples whom I've worked with, I help them
take what's right and utilize that as the way to compensate for the deficits that
are important. It's amazing how, when they focus on what is right with their
partners, what's wrong with their partners becomes so unimportant.
Over the years, I've worked with a lot of personality disordered
individuals. In fact, I've done a lot of training and a lot of workshops on
personality disorders, and it's interesting to me the feedback I get. People say,
“I don’t know how you can work with personality disordered folks. They're
so difficult to work with.” In fact, before the DSM-5, back in the days of the
DSM-4, we had them on their own axis. That is not true in the DSM-5, which
doesn’t have a multi-axial system, but we had them coded differently than
our other psychiatric clients. The reason for this was the belief that
personality really doesn’t change and that if they're personality disordered
client, they’re always going to be a personality disordered client.
Perhaps because my training occurred during an era when that belief was
dominant, I stopped trying to fix them. But what I did do was to make an
effort to tap into what was right with each of them so that they could use that
strength or core aspect of their personality to compensate for the deficits that
were present. For example, my paranoid clients were cautious. I wish more of
my clients were cautious. Caution is a great attribute that can be a strength.
 My schizotypal clients, although they were bizarre, strange or eccentric,
often were able to express themselves in unique and interesting ways, very
creatively. I'm convinced that many of the great inventors of our time were
schizotypal, and that creativity was a strength of that personality. Sure, they
wore stripes with plaids, but they invented all kinds of amazing technology.
The schizoid individuals want their strength. They're autonomous.
They're able to function alone. The borderline personality causes so much
grief, particularly in the inpatient treatment setting, but they're flexible,
mercurial, and adaptable. Those are awesome personality traits. The anti-
social: if you’ve ever led group therapy and nobody is talking, call on your
anti-social. They’ll kick start the group. You may have to do some clean up,
but they have some great personality strengths in being able to communicate
exactly what they need, want, or feel.
The dependent personality-disordered personality individual is loyal, and
loyalty is a tremendous problem-solving attribute. The narcissistic client is
named for the story of Narcissus who was enamored of his own reflection.
He’s looking into the pond and, of course, eventually falls into the water and
destroys his own reflection. There are lots of problems with the narcissistic,
but I wish more of my clients had high levels of self-esteem. This is not an
area where I need to work with these clients because they understand their
own self-worth and their own self value. That can be a strength in therapy.
The histrionic clients know how to express themselves, and they do want
to express themselves. I wish more of my clients would communicate how
they feel or what they want or what they need. The avoidant client can work
alone, and that’s really awesome. My obsessive-compulsive clients are able
to function within rules, structure, and order. All of these are great
personality traits, especially for somebody like me who’s worked with clients
often in the context of criminal justice work.
Positive Psychology looks at what's right rather than trying to fix what's
wrong. Taking an approach in therapy where we only focus on the assets
present, rather than the problems present, makes therapy so much more
enjoyable not only for me as the therapist, but for my clients in my office as
well. Let me share with you a couple of recent clients whom I've worked with
and cases that I'm familiar with.
One of the clients I was in my office recently was a 400-pound, 56-year-
old obese attorney. He’s tried every approach to weight loss possible, every
diet under the sun. At 56 years and 400 pounds, if he doesn’t lose half of his
body weight in the next 18 months, he is going to die. That’s predictable
result of being so obese. My primary approach with him is based in
Contextual Hypnotherapy. Mindfulness and the art of mindful eating are
techniques that I'm going to talk about and anchor in the successive sessions.
For him, the success has not only been numerical - his weight on the scale or
the size of his clothing -but has also been in his ability to function in his
marriage and in his job as a corporate attorney.

From Kelley:
I’ve worked with many obese clients and I’ll testify that they need
more than direct suggestion to change the many dynamics that
maintain their overweight status. The more tools we can give them so
that they can take charge of their relationship to food, the better they
do. Some of these clients are surprised that such a simple approach as
Mindfulness can make such a big difference, yet they consistently use
it for repeated success.

A nine-year-old suicidal girl whose father committed suicide a couple of

years back has reported some of her own suicidal ideas. She’s been seeing a
psychiatrist for the past two years who’s been medicating her, perhaps under
the belief that she somehow has a Prozac deficiency. She has been working
with the same therapist for the past two years as well. I asked the mother
what the results of two years’ worth of therapy had been and she said,
“Really, not much.”
So, I said, “Well, what is she doing as homework between sessions so
that she can practice what she’s learning in therapy and apply it to her real
emotions in the real world?” And the mother said, “She’s not getting that in
therapy.” I said, “Then it's time to find a therapist who can teach the skills of
emotional self-regulation and acceptance and help her to define and develop a
valued path, even at nine years of age.”
Another recent client of mine was a 40-year-old amputee. He came to me
for smoking cessation. I see a lot of people for smoking cessation. His most
recent amputation had been a few weeks beforehand. It was still healing. He
came to me for smoking cessation because it was not healing correctly. For
him, smoking cessation was a matter of life or death. But when he came in,
he was not only suffering the difficulties of his recent amputation, he also
very clearly was heavily medicated by his physician.
 And I thought to myself, “I'm not even sure that I can work with this
person in my office because of his cognitive state.” I spent probably thirty or
thirty-five minutes interviewing him, and at that point I really was ready to
make a referral elsewhere, not sure that I was going to be able to really help
him with the type of strategies that I provide. Then I looked at his intake form
and saw that the only hobby he listed was Bible stories.
I thought to myself that that was a rather odd thing to write down, so I
said to him, “What type of Bible stories do you like?” He answered, “Oh,
really, I just sit around all day long being disabled, but these missionaries
come by, and they leave me literature with Bible stories.” It was real clear
that my religious faith and his religious faith were two entirely different
things. But my goal in therapy is not to make my client the best me that I can,
but I help them become the best them that they can be.
I asked him a question. I said, “What stories are most interesting or
important to you?” And he told me a couple of stories, and because I have
degrees in ministry in addition to therapy, I knew the historical roots of these
stories and so I spent the next two sessions with him using a metaphorical
and story-based process which we're going to examine extensively in this
book on Contextual Hypnotherapy. He ended up not only stopping smoking
but healing quickly from that amputation. He was able to move towards a
state of acceptance related to the next medical procedure that he was going to
have to endure. He left my office not only physically better but emotionally
better. His wife was extremely grateful for the time that he had spent in my
office.
I worked with a 32-year-old medical patient who was afraid of needles
and medical procedures. A recent diagnosis had resulted in her having each
week to endure certain medical procedures that involve phlebotomy and
needles, and this was causing her a lot of anxiety and panic. In one session I
was able to help her find a significant level of relief that allowed her to
undergo the process the next week. In my second session with her, I was able
to ratify the change that she had made. In simply two sessions, she
experienced the success that she needed to continue with her medical
treatment.

From Kelley:
One of the coping mechanisms for people with chronic pain is
denial of the pain. They learn how to ignore it as much as possible.
 Unfortunately, this often means that they dissociate from many of the
valuable messages their body is providing, including physical hunger
or satiety, pleasure from intimacy, even the urge to urinate or move
the bowels, the need to relax and rest or release tension, etc.
A marine veteran who suffered greatly from not only his physical
pain issues but from his perceived neglect by the Veteran’s
Administration spent most of his energy gritting his teeth trying to
overpower his body’s pain signals. Within a couple of Contextual
Hypnotherapy sessions, he was living in a lighter way, able to
acknowledge and then manipulate those sensations to find comfort.
Using theories from ACT and Mindfulness Therapy help clients
come to terms with their pain - often so that they are aware that they
have it, but it doesn’t bother them anymore. This allows them to get
back in touch with the valuable two-way communications that exist
between mind and body.

As you prepare to learn the ins and outs of Contextual Hypnotherapy, you
can begin to think about how you will use these ideas and techniques with
your hypnosis clients.
 2

RELATIONAL FRAME THEORY

W HEN I WAS TELLING ANOTHER COLLEAGUE ABOUT THIS BOOK , THEY

imagined that Relational Frame Theory would be the last thing I would
address because it's a little on the obscure side. But Relational Frame Theory
is really the starting point for understanding the methods of contextual
behavioral therapy.
No matter what approach you use, the relational frames that your clients
create are really the heart of our focus in change work. Relational frames are
the reason that, in couple’s counseling, two marriage partners have entirely
different interpretations of the exact same experience. Relational frames
produce the automatic behavior that we see in our clients which are related to
unhealthy coping. This ranges from drinking, smoking and inappropriate
eating behaviors, to cutting and self-mutilation, to isolation from others and
just about every other automatic, unhealthy self-defeating behavior.
Relational frames are the cognitive evolutionary trait that puts mankind at
the top of the food chain. They are what separates us from the other mammals
and other species on the planet Earth.
Relational frames, at the same time, are perhaps our greatest cognitive
deficit. These are the things that keep people from reaching their greatest
level of potential. It is the relational frames that our clients create that bring
them to our office seeking change. And this brings up an important question:
What are relational frames?
Relational frames are the mental and often subconscious/unconscious
constructs that support an idea, a belief, an experience, an interpretation, or
an action.
When you think of a tent, you probably think of the canvas. You're sort of
picturing it in your mind, looking at the canvas of a tent. Maybe it's orange
canvas or maybe it's green canvas or some other color of canvas tent that you
think of as a tent, but it's the aluminum tubes that are the frames supporting it,
holding it up, and making it the experience of a tent. Without that frame,
without those aluminum tubes supporting that canvas that comes to mind
when we think of a tent, it's just a pile of canvas.
Without mental constructs, mental frames, ideas are just ideas.
Experiences are just what is, and feelings are just feelings. Have you ever
thought about what makes anger feel angry? It's really a great question. It is
the frame that we've created for understanding anger that makes anger angry.
Anger means different things to different people because of the various
relational frames that they put that anger on.
For our different clients, anger can mean any of these things:

I'm sad
I'm hurt
I must cut on myself
I’m being treated unfairly
I'm bad
I'm worthless
I am right

Have you ever had one of those watches with the different colored,
interchangeable bezels or the different bands? I have a daughter and I bought
her an interchangeable watch band bezel set. It's very colorful, and she has
enjoyed playing with it.
It's the same watch, though, no matter what band or what bezel is on it.
But when the frame changes, it changes the watch. This is really an analogy
or a simile that can help us to understand relational frames. Relational frames
can be kind of tough to get our heads around because relational frames are
often subconscious, arbitrary, and something that we've learned. And when
we talk about learning, we're talking about something that we've learned
really on a lifelong basis.
As a family therapist, I observe how my clients learn these relational
frames on an intergenerational basis. Anger meant the same thing to Grandpa
that it meant to Daddy that it means to my client. So, when I tell my client
that that is not what anger means or how anger should be expressed, they
look at me like I'm from Mars. I spent the first ten years of my career in
counseling, working with drug addicts and alcoholics, and when I told them
the way they drank or the way they use drugs was not normal, they said,
“What do you mean? This is the way everybody drinks” or, “This is the way
everybody uses drugs.” I had to explain to them how it's only the way
alcoholics and drug addicts drink or use drugs. This was a learned pattern,
and they believed because they learned these relational frames that that’s
what normal was.
As hypnosis practitioners, I guarantee that you deal with relational frames
from pretty much the moment you start working with a client, no matter what
the presenting issue. How often have you heard limiting statements such as:
“My whole family is overweight.”
“I must just be unlucky in life.”
“My fear of _______.”
“I feel like an outsider.”
These frames are ones under which clients have been operating for quite
some time, whether they are aware of them or not. Helping them gain
awareness that not only are they perhaps limiting but that they can create
new, helpful ones, is a giant first step toward creating solutions.
Let me come back to the word arbitrary because I think that’s important.
In fact, arbitrariness is one of the most unique features of the human mind.
It's what lets us be creative. It's what gives us ingenuity and has evolved
mankind from the Stone Age to the Computer Age. Arbitrariness is what
corporate trainers seek. They're always looking for somebody in corporate
training who can “think outside of the box." The problem is that this talent
also seems to happen indiscriminately.
We are always mentally scanning the warehouse of the subconscious
mind to find the right frame to hang our present experience. This is often the
context in contextual therapy. We do this without thinking about thinking.
Probably the best example of this is a fish. A fish does not know that it is
swimming in water. It has always been in water. A fish does not think about
water or know what being wet is, because a fish exists only in water.
Similarly, we're swimming in our thoughts. It's what we always do. These
thoughts we are swimming in are searching every second of our waking life
for the frames to make sense of our experiences and what's going on around
us.
So, what does this have to do with helping people in hypnotherapy? It
sounds kind of interesting from a theoretical perspective, but our primary task
in Contextual Hypnotherapy, our primary task in coaching and change work,
is really to help people un-frame their thoughts, un-frame their feelings and
un-frame their sensations. Why?
Well, because they're often wrong. The frames have been arbitrarily
created and applied to the experiences, and this creates cognitive errors.
We've all learned in the past that the basic task of Cognitive Behavioral
Therapy is to counter cognitive errors, but how can this be done if the client
still holds on to the arbitrary frame that they’ve hung the experience on?
Even if we use confrontational Gestalt therapy and confront the present
cognitive error -think of old-time substance abuse counseling where we had a
round circular group and put somebody on the hot seat, so we could confront
their denial or their cognitive errors - our client is likely to hang the next
experience on that same frame. This is where relapse comes from.
As a hypnotherapist, have you seen these types of relapse?

relapse into substance abuse

relapse into depression
relapse into chronic pain
relapse into panic after being on medication for a long period of
time
relapse into panic after being in therapy for a long time
relapse into obesity
relapse into old patterns of communication and fighting (in
couple’s therapy)

If you have seen this, learning how to deconstruct relational frames is as

important as any other task in the hypnotherapy and coaching process.
I always tell people that my job is un-hypnotizing people as much as it is
hypnotizing them. As a matter of fact, I spend much of my time as a
hypnotherapist doing un-hypnosis with people, breaking these relational
frames. As a therapist, my job is to help people let go of their thoughts as
much as it is to help them create new thoughts. In community counseling or a
social work setting, our job is often to help people and organizations to find
new frames - those compatible with the organization and community goals.
Our job is often to help an organization, or a client, recognize that just
because a frame exists, it doesn’t have to be used.
 Understanding Relational Frame Theory in the context of cognitive
behavioral therapies leads to a therapeutic approach that is flexible because it
moves with your clients’ thoughts. As a therapeutic approach, it is great
because it fosters curiosity: not only curiosity on my part, but my clients
learn to be curious about themselves.
RFT leads to a therapeutic approach that is mindful, one that is focused
on the present because when we slow down enough to truly experience this
moment, then we don’t have to quickly and arbitrarily create frames that may
or may not be useful. Relational Frame Theory leads to a therapeutic
approach that is solution-focused. It's focused on a specific outcome that’s
beneficial to our client, change work that truly has meaning.
Understanding RFT will help us teach our clients skills that can be
replicated. My goal in therapy is not to help my client come back next week
for another session. Ultimately, my goal in therapy is to get rid of my clients.
I've spent a lot of time learning how to do effective marketing, and I've
shared those techniques in business development classes for therapists of all
types. Every now and then I'll meet somebody who will say to me, “Why the
emphasis on marketing?” and I say, “Because that’s how I know I'm a good
therapist. I know I'm a good therapist because my clients don’t come back to
me.”
The reason I use that as a benchmark for success is because my goal in
therapy is to teach my clients something that they can do on their own apart
from the therapeutic process, which is why my clients get homework
assignments.
Additionally, Relational Frame Theory as a therapeutic approach really
helps me to be empathetic. When I understand Relational Frame Theory, then
I can see people as they are, rather than as they should be or could be or
ought to be. It removes judgment from the process, helping me to recognize
that even those who find themselves in extremely difficult circumstances - in
many cases because of their own choices - are people who deserve to be
worked with. There's hope for helping those people make tremendous
amounts of change.
While writing this chapter, I encountered an interesting example of a
relational frame. Stephanie, who is my company's administrative and
technical support genius, called and asked me for some documentation -
documentation that she already had.
I knew that she had the information because it's in a folder that she uses
daily with the instructions for the other courses that we offer. When I directed
her to that folder, she laughed and said, “You’ll have to be gentle with me
today. I just put my son on a plane.” Her son would be spending the next six
months overseas in a training program for a missionary group called Youth
with a Mission. Now that's exciting, but as any parent knows, sending your
nineteen-year-old overseas for six months to study can be difficult.
The relational frame that Stephanie created was completely arbitrary. She
realized rather quickly that the reason she was the absent-minded professor
that day was because she was dealing with emotions related to empty-nest
syndrome.

Experiencing Relational Frames

Do you want to test your mind’s power to create relational frames?

Relational Frame Theory can be complex from the psychological perspective,
so I often use an exercise as an easy way to wrap our head around Relational
Frame Theory. It comes from one of my favorite client resources, Get Out of
Your Mind and Into Your Life, by Steven Hayes. This exercise will show your
own ability to create these arbitrary relational frames. You'll need a piece of
paper and something write with.

1. Pick out any two objects that you can see right now.
2. Write them down on the paper.
3. Write down your answer to this question: How is the first object
like the other object?
4. Write down your answer to this question: How is the first object
better than the second object?
5. Write down your answer to this question: How is the first object
the parent of the second one?

For this exercise, I picked two objects: the first is headphones, the second
one is car.
And so, question number one: How is the first object like the other
object? I thought about it for a moment and I realize that you can listen to
music with either of them. This is an example of our mind’s ability to come
up with an answer for almost any question.
 Now, question number two: How is the first object better than the second
object? I came up with the answer that you don’t have to buy gas for
headphones. It's not expensive. Again, that relationship is completely
arbitrary.
Finally, question number three: How is the first object the parent of the
second object? The answer I came up with might be bizarre, but it is this:
You listen to headphones sitting in the chair that the father sat in on the TV
show, Leave It to Beaver.
It may be a bizarre answer, but it's the answer that’s satisfactory to me.
The first object is the parent of the second object because it is used in the
chair that father sat in on the TV show, Leave It to Beaver.
No matter how bizarre your answer is you can always come up with an
answer. Your abstract thinking skills create an answer that, at least on some
level, will make sense within your mind.
Now, let's apply some logic to this. Can everything be the parent of
everything else? Of course not. It's not possible - and yet in our own minds,
we have the ability to create these relationships even when they aren't logical,
even when they don’t make any sense.
This is what happens in the hypnotherapy room. This is where cognitive
errors come from. This is the heart of problem-solving in many approaches to
Contextual Hypnotherapy. It may be an awesome ability to create these
relational frames, but it can also be a huge liability for the clients on our
caseload.

Delving Further into RFT

Let me at this point turn this into rocket science and explain Relational
Frame Theory a little bit further.
The main proponent of Relational Frame Theory is Steven Hayes, a
psychologist from the University of Nevada who’s published an incredible
amount of peer reviewed literature on the efficacy of ACT therapy. He
considers RFT a foundation for understanding how to do Contextual
Psychology.
His purpose in exploring relational frames was to go beyond the work of
B.F. Skinner, who never could really explain how language fit into the
equation. Humans express very complicated ideas. They can often do this
with very little communication; the mystery as to how that can happen was
always really the thorn in the side of B.F. Skinner and classic behavioralism.
To explore RFT a little bit further, we need to understand some of the
principles of language. The meaning of a word is truly arbitrary. It is assigned
by collective agreement. In my home, there are four different languages
spoken - maybe five if you want to count my wife’s tribal language - so I
have a lot of experience listening to people who use different words to mean
the same thing.
Mom means mom because that is what the culture decided would mean
mom and really for no other reason. The meaning of words truly is arbitrary.
The meaning of words is not inherent. Meanings are inferred, and because of
relational frames we can identify relationships between words and meaning,
so anger means something, or depression means something else through
inference.
Just like the meaning of words, the answers to the three questions in the
earlier exercise come entirely from imagination and inference. They might
make sense only to the individual playing the game, and only in that moment,
and yet our minds reach those sudden inferences almost effortlessly.
According to B.F. Skinner's operant conditioning, we learn only from
experience, from repetition. RFT shows us that we also learn from the
creative nature of the subconscious mind. Those familiar with Cognitive
Behavioral Therapy may recognize this as the foundation of self-talk.
Perhaps the easiest way to explain Relational Frame Therapy is by
thinking about a child and a dog, and the differences in their language, ideas,
and abstract abilities. If you give a dog a biscuit and you say biscuit when
he’s munching on it, the dog now associates the sound biscuit with the treat.
All you need do now is say biscuit, and the dog will come running even from
the other room.
Now, you and I know that a biscuit is also a treat. We understand this
because we're human, and we use language. So now suppose that you stand in
one room and yell out treat! Unless you’ve previously associated the sound
treat like we did the word biscuit through repetition, the dog is probably
going to ignore you and stay in the other room, continuing to look for the cat.
After all, the cat is far more interesting than a sound the dog has never heard
before.
Now, give a child a biscuit. I suggest giving him one of those awesome
Biscotti biscuits. Those are my favorite. That’s a double big cookie. So, if
you give a child a biscuit and you say biscuit, the child will now associate the
sound biscuit with the treat. Now, go into the other room and yell biscuit, and
the child will come running, even from the other room just like the dog did.
Later, you can yell out treat, or dessert, or sweets, and the child will come
running.
The dog didn’t do that, but the child did. Why? Because the child
arbitrarily creates a relational frame so that many other words that we might
use will be arbitrarily associated with the delicious taste of the Biscotti
biscuit.
So, think about some of the words we hear in hypnosis:

pain
hurt
fear
lonely
withdrawal
support
alone

What the words mean to our clients are a function of their relational
frames. These words are meaningless to a dog, which is why perhaps we
don’t have dog therapists, but they're meaningful in hypnotherapy and may
even have different meanings to each client that we're working with.

From Kelley:
I have found that when we put these theories into context, it
becomes easier for lay persons such as myself, who have no formal
psychology education, to understand how to use them. Helping clients
adjust their relational frames is one of my go-to approaches – in fact,
some people have called me the “Reframe Queen”!
The best way, in my experience, to promote using this approach to
help clients is to develop that skill for yourself. You can do this in
your everyday life: whenever you find yourself noticing something
that annoys, irritate or otherwise bothers you, challenge yourself to
find another way to perceive it. Look for something right about it. As
you do this, you systematically begin to restructure those automatic
tendencies to focus on the problem, rather than the solution. This will,
 in turn, develop your ability to help clients do that, too. Keep in mind
that the best reframes are the ones that come from your client.
Here’s an example of how I did this with a recent client. This
fellow arrived in my office leaning on his cane, grimacing from the
pain of having walked from his car to my office. He even had a sheen
of sweat on his brow and the sense of hopelessness literally reeked
from his body. Now, my office is on the second floor of a historic
building in the downtown section of a quaint tourist town. There is no
elevator, a fact that my client knew ahead of time. It was no surprise
that he was physically taxed after climbing the esthetically pleasing
but demanding stairs to my office.
As he recovered in a comfortable chair, he apologized for his
pain. Really, he apologized to me for hurting. I said, “Well, thank
goodness my office isn’t on the third floor - that would have really
hurt me!”
He laughed out loud for quite some time.
Now, I’m known for being a bit provocative and obviously I was
with this fellow because I suspected correctly that he could use a bit
of levity at that time. But, my comment was also intended to reframe
his ordeal and give him a bit of perspective. It also served as a
pattern interrupt to the painful experiences he had suffered up to this
point and opened the door for something different.

Even though RFT is a theory, not a therapeutic method, understanding

Relational Frame Theory enables us to understand the cognitive processes
that trip up our clients. RFT underpins the treatment plans we use when
working with individual clients or their family systems. My hope is that by
exploring the concept of Relational Frame Theory, you can learn how
important words are in the therapeutic process., as well as how important
meaning is.
Contextual Therapy can be understood as a process of creating
interventions will help our clients break non-resourceful relational frames and
avoid the creation of new unhealthy relational frames. As a therapist, my job
is to un-hypnotize people. It's to move them from arbitrary subconscious
associations really to the power of conscious living. And the rest of this book
will be devoted to the techniques that can help us do that.
 3

CHALLENGING THE IDEA OF PAST-TENSE

THERAPY

B EFORE WE GO ANY FURTHER IN OUR STUDY OF C ONTEXTUAL H YPNOTHERAPY ,

let's challenge a predominant viewpoint in therapy. In the hypnosis
community, it is called regress-to-cause, but it has other names and crops up
in many different forms throughout the various therapeutic profession.
Sigmund Freud originated the basic idea of going back to an emotional
root cause and creating change by provoking catharsis. At its essence, this is
past tense therapy.
Now, I recognize that most of us don’t identify as Freudians, but his
influence was pervasive across many years in our profession and continues to
be. To a large extent, the ideas of Sigmund Freud are still a part of everyday
vocabulary in the counseling office, not to mention a part of the frame our
hypnosis clients often bring with them. For example, do you use these
questions or phrases with your clients:

So, tell me what happened?

Let's go back and look at that, what it felt like.
How did you feel when...?
Go back now maybe a week or two, maybe a couple of months,
maybe a couple of years, maybe to a specific event or feeling or
emotion and let's talk about when that happened.
And what did you do when...?

These are past tense approaches to therapy. These are questions that
therapists ask because at some level there remains the belief that for me to be
okay I must go back into the past and either resolve or relive or have catharsis
or re-experience or reinterpret something that already happened. This whole
philosophy is based on the ideas of Sigmund Freud: that somehow our past
controls our present. Freud believed that neurosis is caused by unresolved
conflict in the past and that revisiting the past will change the present.
The primary mode of operation that Freud used then was catharsis related
to those events. Josef Breuer was a contemporary of Sigmund Freud, an
Austrian physician as well. The Breuer and Freud theory held that symptoms
are caused by repressed emotions, not repressed as in forgotten, but
underlying in the subconscious mind.
Freud writes in Studies in Hysteria, “Each individual hysterical symptom
immediately and permanently disappeared when we had success in bringing
clearly to light the memory of the event by which it was provoked and thus
arousing its accompanying effect.”
In his later work, Freud looked back on these early cases and he really
wasn’t completely satisfied with the results of catharsis. In fact, by the end of
his career he was even dissatisfied with the whole cathartic component of
therapy.
Freud’s major contribution from a theoretical perspective - the ego, the id,
and the super ego - was made in his latest years of life, but it seems as if his
early theories of repression and catharsis are still the predominant legacy of
Sigmund Freud.
In the early 1970s, Arthur Janov elaborated on Freud’s ideas. He claimed
that if infants and children are not able to process painful experiences fully -
for example to cry, sob, wail, and/or scream in a supported environment -
then their consciousness splits.
Pain gets repressed to the unconscious and reappears later in neurotic
symptoms and disorders later in life. According to Janov, painful experiences
become stored. They need to be released in therapy by relieving and
discharging suppressed feelings. Janov claims that cathartic emotional
processing of painful early life experiences and the process of connecting
them with the memory of the original event could fully free clients from
neurotic symptoms.
But Janov and certainly his predecessors Freud and Breuer, as well as
others, were just theorists. These were not empirically validated techniques,
at least not by today’s contemporary peer-reviewed standards. In fact, the
majority of Sigmund Freud's writings are simply case studies, observations
that he made.
In contrast, when we're talking about contextual behavioral psychology,
we're talking about evidenced-based treatment. We're referring to literally
thousands of peer review journal articles measuring the efficacy of the
therapeutic approaches. While contributions from people like Janov, Freud,
and Breuer do have value, the reality is these approaches are now regarded as
defective approaches.
Here are some of the problems with these past-tense approaches whose
legacy still lives:

Regression: Regression is only a metaphor. It's not actually a

reality. It's impossible to see things today from the same vantage
point as yesterday. The whole idea that we can go back, see
something, and experience it as we experienced it then is just a
metaphor. It's not an actuality.
Memory: Memory itself in unreliable. It's flexible and adaptable.
Elizabeth Loftus from the University of Washington has
established in numerous studies that what the mind cannot recall,
the mind will create. Because of this, you can have two siblings
who have an entirely different recollection of memory of what
their childhoods were like. Memory is notoriously unreliable, not
only for adults reviewing what happened when they were
children, but also in the couples who are reviewing what happened
last week.
Narcissism: It's rather arrogant to suppose that the awesome
hypnotherapist will be able to review a person’s life and their
history to pinpoint “the cause” of today’s distress. It's really a
rather narcissistic presumption in hypnotherapy. In fact, it's my
belief that life is the cause of the problems. For my clients
presenting problems there's usually not a single cause, but a
multitude of causes. Contextual Hypnotherapy tells us that cause
is not something we really need to be concerned about to
experience change.
Lack of Effectiveness: The research shows the methods of
psychoanalysis and free association to be only moderately
effective. They have been discarded in large part by psychiatry,
psychology, and medicine for most of the last fifty years. To
 continue to embrace what I call “past-tense therapy approaches”
really denies logic, history, and the overwhelming evidence of
today’s research.
Labor-Intensity: Focusing on the past is a labor-intensive
endeavor. It's not consistent with short term therapy. We live in
the world of managed care. Sigmund Freud’s idea was if the client
comes and sees a therapist twice a week, every single week, for a
period of ten years, at the end of the ten years, the client and
therapist will have restructured the client's personality. Supposing
for the sake of argument that was a possibility, the reality is that in
this era of managed care, limited time and limited resources, none
of us have the time to focus on the past.

So then, what is the alternative?

Present-Tense Therapy is the alternative - or, as it's better known,
Mindfulness.
 4

MINDFULNESS AS A SUCCESS FOUNDATION

C ONTEXTUAL H YPNOTHERAPY IS THE ANTITHESIS OF S IGMUND F REUD ’ S

approach. Contextual approaches are present-focused. They don’t search for a
cause, but rather they train the client in a new skill, the skill of acceptance.
While many traditional approaches to therapy have dwelled on the past, the
foundation for Contextual Hypnotherapy is helping our clients to live fully in
the present.
Mindfulness is an important skill taught to clients. To most of my clients,
I teach a basic strategy for Mindfulness within the first thirty minutes of the
first session.
Interestingly, the importance of Mindfulness is not usually obvious to my
clients during the first session. None of them say, “Wow, that was incredible,
Richard. That was the most awesome experience I've ever had.” In fact, when
I'm done in that first session teaching them a basic strategy for Mindfulness,
they almost always respond with, “Well, I guess that was relaxing,” or “Uh-
huh, I guess I can see how that could be helpful.”
The value in Mindfulness is not in guiding a client through a basic
process in our office; it is in teaching them a skill that they will practice on
their own between sessions so that they cultivate living fully in the present.
In the second, third, or fourth session when they come back, there comes
a point when they say, “Because I've been practicing every day, I now
recognize why the first session was so important. I'm living mindfully. In
situations where I used to automatically become anxious, I am automatically
being mindful. In situations where I would respond with an impulsive
behavior, I'm responding with mindful awareness.”
So, it's important to keep in mind that Mindfulness exercises are not the
point. Learning to live mindfully is the point.
Mindfulness is not a new idea. In fact, the basic tenets of mindfulness are
probably 5,000 years old. However, the application in psychology is new,
because psychology is new. Up until a hundred years ago, we always
understood human behavior in context of religion and theology. Buddha did
not know that he was starting a religion called Buddhism. Buddha really was
to a large extent one of our first psychologists. (Indeed, many Buddhists
insist it is not a religion, but a philosophy.) Buddhism, being one of the first
attempts to understand the human mind, recognized the value of cultivating
Mindfulness, and so sometimes when people hear about Mindfulness, they
think I'm going to be teaching Buddhism.
Usually by the way, it is not my clients who wonder this, but usually it's
other therapists who wonder if I'm a Buddhist psychotherapist. I'm not a
Buddhist psychotherapist. In fact, if I were to teach Mindfulness to those who
are Buddhist, they would say that’s not Buddhism. Teaching an idea, a
technique, or a strategy for problem resolution that originated within a
theological frame of reference is not the same as teaching that religion.
Simply put, we've been trying to understand ourselves for the last 5,000
years and most people throughout history have tried to understand that
through a theological lens and so it's no great mystery to me why Buddhism
addressed a subject that really is ultimately about psychological health. By
the way, Buddhism certainly isn't the only religion to address the concept of
Mindfulness: It is present in the work of Jewish meditation, Kabbalah,
Islamic meditation, Christian meditation, Sufism, the ancient Roman Stoics,
and many other schools of wisdom.
In fact, when Jesus talks about the lilies of the field not needing to worry
about what clothes they will wear (Matthew 6:28), it’s really the same
concept of Mindfulness that other religions have talked about. So,
Mindfulness is not in and of itself religious, even though religions from
around the world have certainly employed the concept of Mindfulness.
Here are some definitions of Mindfulness:

Bringing one’s complete attention to the present experience on a

moment-to-moment basis.
Mindfulness is paying attention in a particular way, on purpose, to
the present moment and nonjudgmentally.
The first component of Mindfulness involves the self-regulation
 of attention so that it's maintained on immediate experience,
thereby allowing for increased recognition of mental events in the
present moment. The second component involves adopting a
particular orientation towards one’s experience in the present
moment.
An orientation characterized by curiosity, openness, and
acceptance.

The last one is really my favorite definition of Mindfulness because I

think it describes fully what my clients need to know to experience change in
therapy.
The idea of Mindfulness and staying in the moment might sound simple,
but these are skills that need to be taught to a client. It is not something that
happens organically just because they come to therapy each week. A big part
of the homework that I assign to my clients is to practice two minutes of
Mindfulness with intention every day between now and their next session. By
the way, that’s that great thing about Mindfulness. It's not about meditating
for thirty minutes while assuming funny postures or wearing funny clothes.
In fact, a person doesn’t even need to be still to practice Mindfulness.
You can mindfully shop at the grocery store. You can mindfully walk.
You can mindfully be still in a chair for some time, and you can mindfully
eat raisins. Mindfulness is not about a specific style or vantage point of
meditation, and it certainly is not about clearing one’s mind. The goal in
Mindfulness is not to empty one’s mind or to stop thinking. To the contrary,
it is to simply give us time to allow ourselves to observe ourselves swimming
in our thoughts.

A Basic Mindfulness Meditation

While you could read volumes about Mindfulness, the best way to learn
about it is to experience it. I will provide a script like the process I use with
my clients; to truly learn about Mindfulness, you should, with intention,
practice Mindfulness every day, twice a day for the next seven days. That’s
the same assignment that I give my clients, and I guarantee that if you do the
assignment then you will find what my clients find: when they cultivate
Mindfulness, the value of it is incredible.
 This is the Mindfulness Meditation Week One Practice. Like an athlete or
musician, practice is for a performance. Mindfulness meditation is our daily
practice for living life to its greatest potential.
There are three components to the practice:

First, the practice of directing your attention to your breath.

Second, practicing how to return your attention to your breath
anytime you notice feelings, thoughts or sensations. The goal is
not to stop thinking, stop feeling or to stop having sensations. The
purpose is to simply note when you do this and to practice
bringing your attention back to a focal point, in this case the
breath.
The third part of this practice is to begin to notice how easy and
natural it is to stay in the present when we notice our attention
drifting into either the past or the future. Notice during this week
times when you mindfully and intuitively return from distressing
thoughts, feelings, or sensations back to your breath into the
present. As you sit in your chair with your body relaxed and your
posture in alignment, close the eyes and breathe in noticing what
it feels like to breathe in.

Scan your body and loosen any muscles that are holding tension. Relax
the jaw and let the shoulders drop and you can let your eyelids and hands be
heavy with relaxation as you just breathe. You don’t have to try to speed up
or slow down the breath during this exercise. All you need do is breathe and
pay attention to your breath. There's not really a right way or a wrong way to
do this exercise. It's simply the practice of bringing your attention to your
breath.
Observe the breath, noticing the tempo of your breath, the temperature of
the air. Observe how the air flows in, and what it feels like to flow out. We
breathe everyday often without noticing it and by practicing an awareness of
the breath, we're really practicing an awareness of this moment. After all.
this moment, this breath is really all we have, and of course as long as we're
breathing in this moment, we're okay.
As you breathe in and out, label the breath. Call it by its name. Label the
in-breath “in” and call the out-breath “out.” Say to yourself “in” and “out.”
Notice the air as you breathe in and the point where the air in your lungs
turns around and becomes an exhale. As you pay attention to the breath,
you'll also notice you are aware of sounds, sensations, and experiences apart
from your breath. The practice is not to stop noticing those things, but rather
when you notice thoughts and awarenesses, outside of the task of paying
attention to the breath, simply note that you're doing that and return your
attention to the breath.
If you notice yourself thinking about anything at all, you don’t have to try
to stop thinking; rather just note the thought instead of following it. Simply
say to yourself that is a thought. Bring your attention back to the breath. If
you become aware of an emotion or a feeling during this time, it's okay to
have them. The practice here is not to suppress them, but not to follow them,
to simply note them and say “that is a feeling” and return your attention to
the breath.
Likewise, if you have any sensations, if your body feels something, you
can simply note that is what my body feels, that is a sensation and experience
and without becoming engaged in it or following it just use it as a cue to
return your attention to the breath noticing what it feels like to breathe in and
out. Over the next two minutes, continue to breathe in and out paying
attention to your breath.
The practice is of course to simply note when your mind begins to follow
a thought or a feeling or an awareness of sensation and to gently, without
judgment, return your attention to the breath. It doesn’t matter if you need to
do this many times. The value is in the developing the practice of returning to
this moment by returning your awareness to this breath and begin now.
Spend about two minutes doing this, and then pay attention to the next
breath, reorienting yourself to the floor below you, the air in the room
around you and opening the eyes.
Note: I have an audio version of this posted on YouTube, which you can
access and even share with clients by visiting: http://youtu.be/VEDPsFznX3s
Although almost everyone can see the value in this exercise, most will
discover the real value comes with practice. During this week as you practice
this exercise, begin to be aware of and notice when you intuitively practice
Mindfulness and mindful awareness of the moment and other situations
during the week. For example, if you're stressed in traffic, you might notice
when you become aware of the stress that you can automatically focus on
your breath rather than letting the stress become a thought you follow.
By the end of your first week of practice, you'll notice how natural and
easy it is in a variety of different situations and places to mindfully focus on
one minute at a time, one moment at a time.

From Kelley:
Mindfulness is a perfect path for helping people get out of
unhelpful states. I often teach clients how to use a model from the
RSA video, The Secret Powers of Time. In this video, people are
described as existing in one of six places on a timeline that contains
the past, the present and the future. They can be in either a positive or
negative state on any of those time zones.

For example, if a person is being regretful, they are in the past in a

negative state. If they are feeling nostalgic, they are in the past in a
positive state. If they are anxious, worrying about what might happen,
they are in the future in a negative place. If they can’t wait until the
weekend when they get to go to the beach, they are in the future in a
positive place.
Sometimes, bad stuff is happening in the present, but for the most
part, we are okay wherever we are. This timeline model can help us
stay in the moment instead of suffering needlessly. Now, if a client is
experiencing some uncomfortable or unhelpful mood, they can assess
where on that timeline they are existing and then move themselves to
one that would be more conducive to feeling better and healing better.
By keeping this time model in mind, your client can easily
interrupt unhelpful mental states. And, for a client who is
experiencing chronic or acute pain, being able to get out of the
present moment of suffering and visit a more comfortable time and
place is a wonderful thing.
And, at the very least, one can use the affirmation, “If I am
breathing, I am okay,” to help move through any distress and
discomfort!

Mindfulness as an Evidence-Based Practice

 What does research tell us about Mindfulness? You'll find for almost
every area of clinical work, there is a mountain of evidence showing the
efficacy of Mindfulness-based therapies in helping people experience
success. Rather than review the most current research at the time of writing
this book, I'm going to tell you how to find the most current research when
you read and re-read this book.
Go to www.scholar.google.com, which gives you only peer-reviewed
journal articles, textbooks, and other academic publications. This is a great
resource for any therapist. You can search the current literature. You can
search the history of literature.
I don’t know what type of clients you work with, but just enter the type of
client you work with and the word Mindfulness. For example, I work with
smokers, so I might search “smoking cessation Mindfulness” in the
www.scholar.google.com. If I type it in the regular www.google.com, I'll get
a bunch of people selling meditation CDs, but if I go to
www.scholar.google.com, I'll find out what the research says about using
Mindfulness as a strategy for helping people stop smoking.
Here are some of the universal outcomes of teaching Mindfulness to
clients. It seems like a simple strategy, but I've learned that sometimes what's
simple is the most effective for my clients. Clients who are taught and
practice Mindfulness reduce their rumination. Now, again, because I'm a
marriage and family therapist, I'm quite familiar with the problems of
rumination. With most of the couples I work with, their problems are directly
tied to one or both parties ruminating about the other for the past five to
fifteen years.
My depressed clients are ruminating about their depression. My anxious
clients are ruminating about their fears. Mindfulness reduces rumination, and
the research shows that. It reduces stress. That’s important for my medical
clients.
I see a fair number of medical clients with significant complications. In
fact, the book I wrote on medical meditation quoted 297 different studies that
demonstrated that those who learn Mindfulness prior to surgery have three
predictable outcomes:

One, it decreases complications.

Two, it increases the speed of recovery.
Three, it decreases the dependency on medications.
 Think about the diabetic clients you work with. Think about the clients
with chronic pain. Think about the clients who work in a stressful job
situation. For those of you doing hypnosis in corporate settings or doing
executive coaching, Mindfulness is going to be one of the most effective
strategies you can teach clients. Mindfulness actually improves memory
function. It enhances focus.
I don’t work with adolescents anymore, but I did for years. The only
adolescents whom I do see are top-performing students who need help with
test-taking anxiety. I use Mindfulness to help them enhance their focus.

From Kelley:
Kids are typically living in an embodied way, experiencing life
through somatic processes, rather than cognitive ones, so mindfulness
is a natural conduit to helping them gain awareness and ability to
better regulate their responses. Parents appreciate alternatives to
medications for children who suffer from anxiety, excess-stress and
other debilitating issues. Mindfulness approaches are particularly
helpful for kids who present with attention problems.
In addition to accessing people like you for help, there are a
plethora of free apps available to help kids and teens engage in
mindfulness meditations. Our job is to introduce them to the power of
mindfulness and make the case for using it regularly.
Other good news is that more schools are currently adding some
type of mindful-based training into their curriculum. One school is
even using a Mindful Moment Room as an alternative to detention!
http://www.dailygood.org/story/1703/genius-school-replaces-
detention-with-meditation-isabelle-khoo/

Mindfulness, the research shows, decreases emotional reactivity. Think

about the clients whom you work with. Do you wish that they could decrease
their emotional reactions to the experiences they have? Many of our clients
are in our offices because they don’t have the emotional control over their
reactions, yet the research shows those who learn Mindfulness have
decreased emotional reactivity. They have greater cognitive flexibility.
They're able to consider new and different options. Those documented
researches show that those who learn Mindfulness improve their
relationships. This can be and should be a chief strategy in marriage and
family therapy.
There are lots of journal articles on applications of Mindfulness to pain
control, eating disorders, ADD, ADHD, impulsiveness, marriage counseling,
anxiety, personality disorders, depression and many other commonly treated
issues in therapy.
When therapists practice Mindfulness with intention, do they derive a
benefit in their therapeutic practice? There's research to show it increases a
therapist’s self-efficacy, their ability to develop attentional processes to
increase their own patience and intentionality with clients. It helps them
develop skills, which makes them more effective.
Hypnotherapists who practice Mindfulness become excited to pass along
this strategy to others while developing skills that make them more effective:
increased empathy and the development of nonjudgmental compassion. For
that reason, I'd like to encourage you to practice the Mindfulness exercise in
this chapter twice a day for the next seven days.
Further Reading on Mindfulness:

Full Catastrophe Living: Using the Wisdom of Your Body and

Mind to Face Stress, Pain and Illness by Jon Kabat-Zinn. Jon
Kabat-Zinn is a neuropsychologist at the University of
Massachusetts Medical Center who’s been working in the area of
chronic pain for the past 30 years.
Here You Are: Discovering the Magic of the Present Moment by
Thich Nhat Hanh, a Nobel Peace Prize nominee and Buddhist
monk who lives in France. One of the things that I really
appreciate about Thich Nhat Hanh is that he explains the ideas of
Mindfulness in a very non-religious way.
Mindfulness in Plain English by Bhante Gunaratana is another
textbook which is often recommended by people. It is a book that
I have found particularly useful as well.
 5

ACT THERAPY SOLUTIONS

[Editor's Note: Steven Hayes has stated that even though ACT Therapy
stands for Acceptance and Commitment Therapy, it is an acronym
pronounced “ACT Therapy” like “actor” as opposed to the initialism “A-C-
T. Therapy,” pronouncing each letter.]

A CCEPTANCE AND C OMMITMENT T HERAPY (ACT) HAS BEEN DEVELOPED IN

large part by Dr. Steven Hayes, a researcher at the University of Nevada.
Extensive studies verifying its efficacy have established it as an evidenced-
based treatment protocol.
There really are no gurus in Contextual Psychology or in Contextual
Hypnotherapy. Certainly, there are researchers whose research we might
quote, but that doesn’t make them gurus. In fact, Steven Hayes in Acceptance
and Commitment Therapy is the perfect example of a transformational leader
in our profession. Why? Is it because he’s gotten everything right?
Absolutely not. At various points, his work has certainly faced a wide variety
of challenges from an empirical perspective.
Steven Hayes is a great exemplar for transformational leadership because
he hasn’t said, “This is about me.” Instead he has trained a cadre of leaders
who are experts in taking ACT Therapy to the next level. It's always amazing
to me whenever I see Steven Hayes has published a new book. It is almost
always a collaborative effort with other researchers in the field. There are
usually three to six co-authors with him in his materials. The folks he has
trained in evidenced-based protocols are then developing new ideas and
testing those in evidenced-based treatment.
The goal of Contextual Hypnotherapy is to help the client function apart
from therapy. The goal of Contextual Hypnotherapy is not to have them keep
coming back week after week, but to take what they’ve learned between the
sessions, apply it, test it, find out what works most effectively for them in
their unique context, and then ultimately to be able to function apart from
having to go back to the therapist.
Hayes' research into human emotions began by studying the problem of
social anxiety, a very common psychological problem that can be debilitating
for many people. Hayes observed that the tools we use to solve problems lead
us further into traps that create suffering. This is where Relational Frame
Theory really fits into the picture. Our ability to create arbitrary meaning is
an evolutionary trait in psychological evolution that means humans rule the
planet rather than giraffes; however, this otherwise useful tool can also lead
us into further traps that create suffering. One of the basic premises of ACT
therapy is that fighting pain just makes it worse. That’s counterintuitive.
It really doesn’t seem to be logical, but the research shows that fighting
pain does make it worse. Probably one of the simplest explanations is that
you direct your attention to that which you are fighting. Many of you have
probably explored this thought experiment:
Don't think about a yellow jeep. Don’t think about its yellow hood, or the
yellow doors, or the yellow mirrors. Don't think about how the black tires
look against the yellow body of that yellow jeep. Don't think about the
chrome bumpers on that yellow jeep.
Now, what are you thinking about? What are you picturing? A yellow
jeep, of course.
The idea in ACT therapy is not to become un-depressed or un-anxious or
even un-angry, but rather to see our thoughts as just thoughts, our emotions
as just emotions. The goal is to help a client to detach from the relational
frames that cause so much distress.
Here's the definition of ACT therapy offered by the Association for
Contextual Behavioral Sciences:
ACT is an approach to psychological intervention defined in terms of
certain theoretical processes. Not a specific technology.
In theoretical and process terms, we can define ACT as a psychological
intervention, based on modern behavioral psychology including Relational
Frame Theory, that applies Mindfulness/acceptance processes and
commitment/behavior change processes to the creation of psychological
flexibility.
 I recently co-wrote a book titled Counseling People Who Have Killed
Other People with my colleague, David Parke. Related to his work with
military veterans and in leadership positions when he was serving in the
military, David Parke talked about developing resiliency as one of the keys to
mental health. This is part of psychological flexibility, an important aspect of
ACT therapy that it makes it particularly useful for a wide variety of different
types of clients that we work with.
In Get Out of Your Mind and Into Your Life, Steven Hayes points out five
psychological truths. They are based on research, yet they are counter-
intuitive to the way most of us would think about psychology and emotions.
The first truth is that you cannot deliberately get rid of your psychological
pain, but you can take steps to avoid artificially inflating it. Pain and
suffering are two distinct states, and by inference they do not need to coexist.
You can have pain without suffering. I work with a lot of pain control clients,
and at first that idea is difficult for them to grasp. Nonetheless, when they do
learn the distinction between pain and suffering, they find it tremendously
freeing.
This is true for our clients with emotional pain as well. One of the other
truths outlined in Get Out of Your Mind and Into Your Life is that you do not
have to become your suffering. One of the most difficult of all the presenting
problems is that our clients become fused with their problems: they have in
fact become their anxiety. They have become their anger. They have become
their depression. They have become their failure.
Hayes' research at the University of Nevada shows that paradoxically
accepting your pain is the first step into ridding yourself of suffering. And he
points out something else that really flies in the face of everyday thought; that
psychological pain is normal. It's perfectly normal to experience
psychological pain. He calls it important and says that everybody has
psychological pain.
Clients often come to us with the unrealistic belief that other people do
not have depression. Other people don’t have anxiety. Other people don’t
have these problems. The reality is everyone has psychological pain. It is in
fact normal.
Mindfulness is a key concept in Acceptance and Commitment Therapy
because it is a primary way to separate pain from suffering and to take steps
to avoid artificially inflating psychological pain. Acceptance is the notion that
trying to get out of our pain only amplifies it. Trying to get out of your pain
entangles you in it. That’s what produces trauma paradoxically. The
alternative here is acceptance.
The paradox of quicksand is applicable here. Now, I have never actually
been stuck in quicksand, but that they say that if you find yourself in a pool
of quicksand, your natural inclination will be to try to pull yourself out of it.
However, every time you step up, you create a hole. The suction underneath
pulls you deeper, until you eventually drown in the quicksand.
The only way to get out of quicksand is quite counter-intuitive: You must
make yourself as still as possible to float to the top. Then you can roll
yourself out of the quicksand rather than fighting the quicksand. You go with
the quicksand rather than to go against the quicksand.
In our profession, we have almost no training in modalities that help
clients to achieve acceptance. In fact, page 449 of the Big Book of Alcoholics
Anonymous is the closest thing we have. It teaches us:
Acceptance is the answer to all my problems today. When I'm disturbed is
because I find some person, place, thing or situation, some fact of my life
unacceptable to me and I can find no serenity until I accept that person,
place, thing or situation as being exactly the way it's supposed to be at this
moment. Nothing, absolutely nothing happens in God’s world by mistake and
until I could accept my alcoholism I could not stay sober. Unless I accept life
completely on life’s terms I cannot be happy. I need to concentrate not so
much on what needs to be changed in the world as on what needs to be
changed in me and my attitudes.
The commitment part of Acceptance and Commitment Therapy is
comprised of course values and values-based living. To understand values-
based living, Hayes poses several questions to the reader, and these are
questions we should pose to our clients:
Are you living the life that you want to live right now?
If the answer to that is, no, for you or for your clients, then the solution is
to right now put yourself where you want to be. If you're not happy, put
yourself in a state of happiness or contentment. It's amazing to realize that we
have control over our own states. I can be happy even if I experience pain.
That is something that my clients do not know and needs to be taught to
them.
Is your life focused on what's most meaningful to you? If not, what action
can you take today to drive meaning?
Shifting from uselessness to mental management to life engagement is a
process of values-based living. It's our mental games, our relational frames,
which keep us from experiencing life engagement in the now.
One of these mental games is the belief that something must be resolved
or happen before we can experience or make a change. Those are faulty
mental premises.
There are six core processes within Acceptance and Commitment
Therapy. This chapter does not present exhaustive coverage of Acceptance
and Commitment Therapy, but a summary of these core processes that will
serve as an introduction. These six core processes provide a conceptualization
for a complete therapeutic process with a beginning middle, and end.

Core Process One: Acceptance

Clients often present trying to get rid of pain: “I don’t want to be anxious
anymore. I don’t want to be afraid to fly. I don’t want to smoke anymore. I
don’t want to be obese.” They often want to be rid of pain, or to forget the
past. Too often, they come in trying to change something that is
unchangeable.
Acceptance is not about liking something, hoping that it happens to other
people, or wishing that it happens again, but simply recognizing its existence.
As the quote from Alcoholics Anonymous says, acceptance is the answer to
all of my problems today.

Core Process Two: Cognitive Defusion

Clients come to us because their previous strategies have failed. The

previous strategies to problem solve have made things worse. By paying
attention to the pink elephant in the room or the yellow jeep, they have
become fused to their thoughts. They now believe what they think, even
though thoughts and facts are often two different things. As a result, they're
aware only of the pink elephant in the room or the yellow jeep that they're
trying not to think about. Cognitive defusion techniques train your client to
no longer be fused with troubling thoughts.

Core Process Three: Being Present

 In my sessions, being present is one of the first things I teach my
hypnosis and coaching clients, because it takes time for them to practice
before they really understand what the value of being present.

Core Process Four: Self as Context

This is really all about using a strategy to help a person become their own
observant self. This is one of the reasons why we focus on the breath. It's to
practice observation rather than enmeshment. See, my clients are just angry.
They don’t observe anger. My clients are just depressed. They feel it. It
permeates them. They don’t observe depression.
If you have studied Neuro-Linguistic Programming, you may be familiar
with first, second, and third perceptual position. The first position is me as
me, but in dissociation we can also move to a second perceptual position.
This is where I would be an observer seeing me in a situation. In the third
perceptual position, I am dissociated even further to where I'm an observer
watching an observer watch me. By taking our clients through processes
where they step out of themselves and observe themselves as if from above or
from a new vantage point, they can really begin to practice seeing themselves
in context of a situation rather than as the situation.

Core Process Five: Values

This process is about choosing a direction and establishing willingness.

Willingness is really a key word in ACT therapy, and in the next chapter, I'm
going to share with you an exercise I have adapted from Get Out of Your
Mind and Into Your Life called “The Willingness Dial”. This exercise helps
your clients to identify willingness and motivating values. Willingness is not
resignation. It is also not the same thing as wanting. It is a willingness to
experience, to accept in the face negatively-valued emotional states.

Core Process Six: Committed Action through Practice

Each of my clients are prepared every session to build on the learnings of

the previous session so that when therapy concludes, they can continue to
practice these things in a committed action towards a valued path. This
creates context of not just an internal experience but as an outside observer
being mindfully present in that world directly - not fused or meshed with
their emotion - and accepting that life is sometimes difficult.
These six core processes can become the foundation for a structured
program in ACT therapy or classes in ACT therapy; or it can be modified
based on an individual in different formats of therapy, hospitalization, partial
hospitalization, outpatient therapy, counseling, coaching, or strategic
hypnotherapy intervention to maximize the potential of our client.

ACT Exercises

Perhaps the best way to understand these processes is to experience them.

Now typically, I lead clients with my voice and ask them to close their eyes,
but as you are reading, I will lead you through several of these as eyes-open
processes. Of course, you can close your eyes after reading each one to
enhance your imagination, or you can simply experience them with your eyes
open.
So, these three exercises that I'm going to guide you through are
experiential processes. I use these with my clients sometimes in a formal
process of hypnosis, but generally without such a formal process. I'll be
talking to my client, interviewing my client, discussing with them their
valued path, discussing with them their thoughts, their feelings or
experiences, and then I'll guide them through a process:

Finding Your Valued Path

Imagine that you’ve just received a present. Imagine that present is a

surprise. You don’t even know who sent it, but you are now holding it. It
won't be a simple gift, but rather a magical gift, the one thing that you want
more than anything else in life. Maybe it's big or perhaps small or maybe it's
too big to actually hold. It's your present, so you can see it any way you want
to. You can even hear the present.
When a child is trying to figure out what's inside of a gift, they often
shake it. You can do that in your own mind, hearing the gift inside of the box.
Feel the shape of the box. Is it square, rectangle or even an odd shape? Of
course, this is your gift, I don’t want to hold you back, so at this moment you
can begin to open the gift using that creative imagination, finding inside the
wrapping exactly what you wanted more than anything else.
Perhaps it's the deed to a vast and beautiful land or a diamond worth
millions of dollars or even a winning lottery ticket. It's your gift. You can
create it as you want it, so go large taking this opportunity to discover what
you would want more than anything if you are to receive a magical gift.
Allow yourself to dream big, to open the present and enjoy that magnificent
gift inside. Now, the papers that you opened, wrapping papers are lying to
the side. You're holding that unwrapped gift in your hand or place the gift out
in front of you and just breathe.
See your gift and imagine all the changes in life as a result of getting that
gift. And note how life will change because you got that gift. How will you
feel? What experience will it bring? Perhaps a sense of freedom, maybe a
respect from other people. Will you be able to help others now that you have
received this gift? Will the gift help you to be more secure or even to be more
important? Take a moment and explore this idea in your mind, the idea that
you have this gift and some of your deepest needs can be met.
What are those deepest needs? Become aware of them. Note the words
that come into your mind that describe these needs and notice the feeling that
you associate with having imagined receiving this gift. Take in a breath. Feel
fantastic. Think of two or three words that describe the gift and say them
aloud.
It's interesting how what we truly value or need is often represented by an
object or something tangible, in this case the gift. What was actually inside of
that box? But with little reflection you soon discovered what is most
important is not the gift itself, but those words that you just said what the gift
represents. You described what you valued most as blank and blank. This
exercise has helped you to identify your core values. This is your valued
direction.
Of course, you can use this with your clients, and you will adapt and
tailor it to each client: the speed, the rate, what it is that you focus on, and
how you follow up with it. But this is really a great exercise for helping
clients use the resource states that are within them to identify those core
values that can help them to identify a valued direction. When you have
clients who are stuck in therapy, this is a great exercise. I've done this with
couples where Bob and Bertha are sitting next to each other, both with their
eyes open, both coming up with different gifts, both coming up with different
words, not even processing with them the exercise, but simply taking notes to
determine what our valued path in couples counseling is going to be.
From Kelley:
I first learned Richard’s Values as a Gift exercise years ago and since
then, it’s been a staple in my hypnosis toolbox. Helping a client gain clarity
about their deepest values is priceless: with this knowledge we can further
explore what it is that is preventing them from living congruently with their
values.
For example, a client may present with weight loss goals but in
discovering that their desired value is companionship and love they may
realize that they’ve been eating due to a sense of isolation. From there, we
can address the real need directly, perhaps finding realistic solutions to that
loneliness, which automatically improves the eating behavior.
I might even add the following patter when I use this approach:
And now that you have even more clarity about what it is that is so
valuable to you, you have a wonderful tool at hand. Every day, you make
choices in life. From this moment on, from this breath, whenever you are
getting ready to make a decision, you can ask yourself, “Does the choice I
am making bring this value into my life...or does it keep me from having it?”
And in this way, you will find yourself making the choices that are congruent
to what it is that you really want...

W ILLINGNESS D IAL
Remember when you were a kid, and you might have had one of those
toys called The Chinese Finger Trap? It was toy many people played with; it
was made of straw braided together into a tube. And when you put your index
fingers of each hand into the ends of the tube, it constricted in such a way
that when you try to pull them out, it created a virtual finger cuff. It became
impossible to remove them by pulling them out.
The harder you try to pull out, the tighter the braids on that straw
became. Of course, to finally get out of the finger trap - the way to finally free
the fingers - was to stop pulling to break free, to stop resisting the trap.
That's counterintuitive to say the least, which is why the Chinese finger trap
toy was not used as a child’s toy, but an ancient torture device. The only way
to find freedom from Chinese finger trap was to let go of the struggle.
Years ago, there was a song by a Presbyterian minister named John
Fisher and the lyrics of the song said, “Losing is winning when it turns you
around. It all looks clear with your feet on the ground. You walk out a
winner.”
One of the great paradoxes of the mind is that the more we struggle to
solve a problem, the more constricting it becomes. And the true freedom often
comes from submission. And this of course brings up the subject of
willingness and you must ask yourself, how willing am I to stop resisting the
struggles? How willing am I to stop resisting depression, anger, anxiety?
Willingness to change and commit to a valued direction is really where
you are right now. Of course, by being willing to stop to struggle, it doesn’t
mean that you will lose. To the contrary, it means you'll give up the suffering
- and that’s where you will find freedom. So, I'm going to ask you. How
willing are you to give up control of your internal thoughts and feelings?
How willing are you to just let fear be fear, to let sadness be sadness, without
struggling to stop it, control it, or direct it?
Imagine in front of you a dial with 1 on the low end and 100 on the high
end. To what degree, essentially to what number are you willing to give up
control? Think about that number now. To what number on that dial - 1 at
the low end, 100 at the high end - are you willing to give up trying to control
your husband, your wife, your anxiety, your fear, your drinking, whatever it
is? If you chose a low number, you are holding the idea that a low number
means that you'll experience much less pain.
But of course, that’s not what experience has taught you. If that were
true, the resistance and thought suppression was effective, you wouldn’t be
here. So, consider your score and your willingness to increase the number,
from a 5 to a 10, from a 10 to a 20, from a 20 to a 40, from a 40 to a 50, even
for a 50 to an 80 to 90 or even maybe 100 being willing to give up trying to
control that drinking spouse, fear, depression, and find that when you
increase that number, you increase the acceptance of pain.
Paradoxically, your suffering can be released forever. And so now I'm
going to ask you, at what number from a scale of 1 to 10 are you willing to
stop resisting and to simply accept.
It is at this point if I'm with a real client that I'm probably going to be
bridging into some real issues for the therapeutic process. This is probably
going to be one of those breakthrough points in this particular session where I
use a process like The Willingness Dial.
This is incremental therapy. Instead of moving from here to here, we're
simply moving from here to a willingness to be somewhere else. In the movie
What About Bob, Richard Dreyfuss plays a psychiatrist. Bill Murray plays
his client, and the fictional book that the psychiatrist Richard Dreyfuss wrote
was called Baby Steps. It was a great movie and taught something that was
actually true: we don’t need to make all of the changes today. Today only
requires willingness. When we achieve willingness, we'll move to where we
need to be.

From Kelley:
I love the ACT Therapy Willingness Dial. For those readers who
are into hypnotic fun-omena, imagine expanding this idea into some
ideomotor play:
You can suggest that your client’s hand will rise to the level of
willingness they are currently experiencing. This is a powerful tool to
use in pretalk with a smoking cessation client - when their hand floats
up to the ceiling, you know they are ready for change! And, if it’s less
enthusiastic, you probably have a bit of extra priming to do.
I’ve used willingness calibration by telling a client to think of
their fingers as numbers, with the pinky on the left hand being One
and the pinky on the right hand being Ten. When they are ready, they
can let their subconscious indicate with the finger it chooses just how
willing it is to allow for change.

Looking in the Box

This process of understanding and experiencing acceptance uses the

imagination. Imagine that you're in a large conference room. All the chairs
surround the large table, and you're sitting in the executive chair at the end.
The other chairs in the conference room are unoccupied. Imagine you're the
only one in the room.
A large box sits in the middle of the table. The box on the table holds
those things that you’ve not wanted to look at or see, whether because of pain
or fear or for any other reason. But you are safe, not only in the conference
center that you’ve created, but in this actual office here.
You’ve come here to move forward, and so this is your opportunity in the
safety of this office to begin unpacking these things from the box and placing
them on the table. So, step up to the box and open the box and one by one
unpack those items from the box, looking at them without judgment or
attachment simply acknowledging what those things are and placing them on
the table. See yourself doing this or hear those items landing on the desk as
you take each item out and simply place the items from this box on the table.
There may be only one or two things or maybe five or six things. Maybe
there are many things. But when the box is unpacked, look at those items. See
them, but rather than sitting again, simply stand at the end of the table,
taking as much time as you need in silence to simply see those things out on
the table.
[If it's too painful at this point, you can always have a client move into a
second perceptual position, being an observer, possibly from the other side of
the glass seeing themselves looking at those things on the table.]
Of course, you're safe. You're the only person in the room observing the
table. When you’ve looked long enough at all of the items on the table,
imagine you approach the doorway leaving those items exposed on the table
not packing them up again. Turn out the light. Walk through the door, closing
it behind you. Those things, feelings and experiences are neither hidden nor
neglected, but as you walk out the door and into the light of this new chapter
of life recognize that they were there and that by living fully in the present
you’ve developed a sense of acceptance, simply seeing life as it is and
practicing the new art of living fully in the moment.

Deliteralization

There are many ACT Therapy methods which will help us defuse from
our unhealthy thoughts. Deliteralization is particularly useful, as well as
being silly and fun. What it does is separate a word from its meaning, which
can be a real powerful change.
Suppose for example you have a client who’s enmeshed with hurt, the
pain of the hurt is so deep they are a hurt person, and that is almost at this
point their identity. They literally own the word, hurt. It happens in couples
counseling all the time. It happens when I'm counseling children of
alcoholics, whether adults, adolescents, and even young children. Their need
is to defuse from that word, to put some space between them and that word
because that word has become so powerful to them.
What you're going to do is you ask the client to say the word that they are
fused with out loud, mindfully observing the word, saying it as quickly as
they can, but still able to enunciate it and pronounce the word. This process is
a silly process, but it's an amazing process. Give your client 45 seconds to do
this, never less than 45 seconds, never more than 60 seconds. When they're
done with the exercise, ask them to really check if by now saying that word
feels different than it did a few moments ago in any way, shape, or form.
Your client will almost always say yes, as they have put some space between
themselves and the word.
Don't just read about this process. Try it yourself and experience the
change.
By the way, try this exercise in deliteralization in couples counseling with
the name of the mistress or the mister that’s been part of the enmeshment of
the wounded or hurt spouse. That is a powerful, a powerful strategy in
couples counseling.

Changing Self-Talk by Using Submodalities

Albert Ellis taught us that damaging self-talk can drag us down

emotionally as we repeat cognitive errors to ourselves. Of course, positive
affirmations that counter those cognitive errors can be helpful to many
clients, but when our clients are too caught up in their own negative beliefs,
positive affirmations can be too great a stretch and can reinforce our clients'
depression or anxiety.
The next two methods are ideal for clients who aren't ready for positive
counters to negative self-talk, instead providing defusion from those
cognitive errors. In other words, we remove the power of a thought or
emotion.

Slow It Down

You’ve said you feel like you're not a worthwhile person. Usually when
you say that to yourself, you just hear that voice in your mind maybe even
screaming it or shouting it at you. Now you're going to practice changing
that voice and all of those self-defeating errors and putting some space
between you and the thought. Either out loud or in your own mind, say, “I am
not a worthwhile person,” but this time say it softly and slowly, not as you
usually hear it in your mind.
This is a great counter to that negative self-talk that Albert Ellis talked
about. Did you notice you responded to that familiar self-talk a little bit
differently by making your voice softer and by slowing it down? Try it again
this time even slower. Very slowly say, “I am not a worthwhile person.” In
fact, say it again even slower, almost so slow that it doesn’t make sense
anymore. “I am not a worthwhile person.” Now, ask yourself, how is my
experience of this thought different now than it has been in the past?
Of course, it is—because you’ve created some space between you and the
thought. You’ve changed the submodalities of it, and you're no longer going
to automatically respond to that negative self-talk with impulsive choices, but
this time you will respond when noting these thoughts by slowing them down
and changing the experience of the thoughts.

From Kelley:
When I use this process, which I like to call, The Slow Motion Fix,
I ask a client to say the thought or phrase that they believe is hurting
or limiting them. Then, I tell them I am going to repeat it back to them
and I want them, in turn, to repeat it back, exactly as I speak it. With
each rendition, I intentionally delay the speech, slowing it down
gradually and they mimic my version.
It doesn’t take long, often less than 4 or 5 turns for some
impressive state shifting to occur. Most people start smiling as I
sound more and more ridiculous; they even giggle when it’s their turn
to say it in slow motion. I can anchor that laughter response so they
can access it later, if needed, simply by giving a suggestion that if
they are ever bothered by that unhelpful thought or phrase again, they
will remember how ridiculous it really is!
This is an excellent technique to use with those teen clients who
have put up a stone wall by the way. Even the most stoic can’t keep a
straight face watching me speak in slow motion.

Negative News Channel

A NOTHER IDEA YOU CAN USE IS TO IMAGINE THE NEGATIVE THOUGHTS IN YOUR
head being broadcast from a Negative News Channel.
You can imagine that this Negative News Channel is broadcasting from
your mind. It's even okay to have a little bit of fun with this, to even smile as
you hear your negative self-talk through the NNC, the Negative News
Channel. Go ahead. Start thinking of what the NNC might broadcast tonight:
“This is the NNC, Negative News Channel broadcasting 24/7, 365 days a
year. Today, I'm fat, I'm ugly, and I'm a bad person.” Go ahead. Identify
some of your own negative thoughts and hear them through the voice of the
announcer of the NNC:
“I'm stuck in this situation. I can't do anything right. I'm going to screw
up the future.” Go ahead. Hear it again even in a radio announcer’s voice.
Listen to the Bad News Radio. It's absurd, isn't it? See, in the past, you
automatically bought into the thoughts that you created, but creating the
absurd NNC, you heard them played through another person’s voice and can
now recognize those thoughts as just thoughts, about as meaningless to you
as the real nightly news.
Of course, these exercises need to be adapted to your personality, to your
particular clients, your particular situation. My hope is that you can find ways
to creatively adapt to the scripts that have been provided. For example, a
practitioner I knew had a Catholic client who found that she couldn't allow
her negative self-talk to sound silly in her head, but she could find relief and
distance by imagining a cathedral choir singing her negative self-talk; in that
way, she could release it to God.
 6

POSITIVE PSYCHOLOGY

O VER THE PAST DECADE OR SO , P OSITIVE P SYCHOLOGY HAS BEEN RESEARCHED

from an academic perspective, allowing it to move into the category of
empirically-based treatment approaches.
Martin Seligman, Past President of the American Psychological
Association and one of the chief proponents of Positive Psychology, defines
the approach in this way:
We believe that a psychology of positive human functioning will arise
which achieves a scientific understanding and effective interventions to build
thriving individuals, families, and communities.
Positive Psychology is really the antithesis of our traditional approaches,
which have a pathological orientation, looking at what is wrong with our
clients. In contrast, Positive Psychology looks at what is right rather than
what is wrong. It is primarily concerned with researching psychological
theory and intervention techniques to understand the positive, adaptive,
creative, and emotionally-fulfilling aspects of human behavior.
In other words, traditional approaches have tended to say, “Oh, my gosh,
what's wrong with you? Look at all of these horrible things that have
happened.” Positive Psychology says, “Wow, what have you done to survive?
It's remarkable that you’ve made it in light of all of these difficulties to the
point that you have.” It really is a complete change of pace from the
traditional problem-oriented model of psychology.
I remember back in the late 1980s learning what a psychosocial
evaluation was and writing my first psychosocial evaluation. Back then, I'd
write twenty or twenty-five pages. That was before computers, so I had to
write most of it by hand. After spending two hours interviewing a new client
for inpatient treatment, I would write page after page about all of the
problems they had: their legal problems, political problems, health problems,
family problems, sexual problems, emotional problems, problems, problems,
and more problems.
The last question on the psychosocial evaluation was always, “What are
the client’s strengths?” By the time we got to the last question on the
psychosocial evaluation, I would be so tired of writing and so tired of
interviewing that I’d write something just to fill in the blank: “They have cool
shoes” or “They have nice hair” and then I’d move on.
Then one day it occurred to me that this was actually the most important
question on the psychosocial evaluation. So, I moved that question from the
bottom of the evaluation to the top. It became the first question.
Over the years, it's really become the only question that I concern myself
with. The intake form in my office is very short. It's about two pages long, in
really big type, so the intake form really doesn’t have very many questions.
The reason why is because I'm uninterested in what's wrong with my clients.
I want to know what's right with them, because I use an approach based on
the methods of Positive Psychology articulated by Seligman.
Positive Psychology is not, by the way, Norman Vincent Peale's Power of
Positive Thinking. There's nothing wrong with that, but Positive Psychology
is something different. It is concerned with psychological theory, research,
and intervention - finding those techniques which are adaptive, positive,
creative, and emotionally fulfilling, rather than simply employing positive
platitudes.
Likewise, Positive Psychology is not about the Law of Attraction or
positive confession. It's not about thinking only positive thoughts and thereby
attracting positive things. That’s not what Positive Psychology is all about. It
is not a fad.
Positive Psychology is not about ignoring the existence of problems;
rather it's about recognizing that some of our clients’ problems are so
catastrophic there's probably zero that can be done in the context of therapy.
For most of my clients, those problems are a result of their histories - and
history can never be changed.
Positive Psychology is not a simplistic approach. There are volumes of
resources that have written. One of the best is the Handbook of Positive
Psychology, which includes hundreds and hundreds of pages of techniques,
ideas, and strategies, all based on solid research.
 It is a non-pathological model or approach not unlike Person In
Environment (PIE), identifying the person’s strengths or resources. It
recognizes that it's a lot easier to strengthen the resources that exist within a
client than it is to create new strategies that to this point have not yet existed
in almost every one of my clients. In fact, I can honestly say that although
many of my clients have had tremendous problems, I've never yet met anyone
who had no strengths and no resources to draw from.
They may have been limited. They might not have known how to use
them, but every client I've ever worked with has had strengths and resources
available to them. Positive Psychology is a set of strategies that can be
applied both to individuals and to families as well as organizations.
The process known as Appreciative Inquiry, which is an outgrowth of
Positive Psychology, has been used with community service organizations as
well as huge multinational corporations. It is an application of Positive
Psychology to community development and is very useful for social workers,
ministers, corporate consultants, and organizational psychologists.
A small social service agency in Phoenix, Arizona, called Neighborhood
Ministries, has used Appreciative Inquiry as a process for developing
community over the last 30 years with tremendous success and efficacy in
their work.
After September 11th, British Airways used Appreciative Inquiry as a
process for changing their organizational culture. They experienced financial
success in a time when many airlines, particularly international airlines, were
having tremendous difficulty.
People familiar with the corporate story of Jack Welch and General
Electric will know that Appreciative Inquiry was used as a consulting process
with all of the employees of General Electric during Jack Welch’s tenure.
So, Positive Psychology has applications far beyond individual therapy.
Positive Psychology is a non-threatening approach. It doesn’t seek to
embarrass or humiliate by exposing what is vulnerable and what is wrong,
but instead by valuing what is right. It is motivational, so it is a great thing
for those therapists who are following a coaching model in that ultimately it
seeks the highest level of performance.
The word often associated with Positive Psychology is flow; and flow is
being in that zone of happiness. A lot of happiness research has been done in
the last several years by those interested in Positive Psychology. Flow is also
described as that state of absorption in which one’s abilities are well matched
to the demands at hand.
Positive Psychology is really concerned with three main issues: Positive
emotions, positive individual traits, and of course, positive institutions. There
is an acronym for the goals of Positive Psychology as articulated by Martin
Seligman: PERMA.

P stands for Positive Emotions—feeling good, feeling happy,

feeling a sense of flow.
E stands for Engagement. Our goal in therapy is to help our
clients to become completely absorbed in the activities that
promote flow or health or wellness.
R stands for Relationships. While the Internet through social
media can give us connections to perhaps more people in the
current era than we ever could have connected to in the past, many
of our clients still lack authentic connection to others. The
techniques of Positive Psychology are designed to support that
goal.
M stands for Meaning. Just as Steven Hayes emphasizes a valued
path, Seligman discusses purposeful existence.
A stands for Achievement. This is really about a sense of
accomplishment and success. We all need to feel that we are
valued, that we have accomplished something, that we are
successful. Think about the important life events that you’ve had.
Those life events are probably things that have been related to
your own personal success or an accomplishment: building a new
home, graduating from college, doing whatever it is that you did
that brought you a sense of achievement. Have you ever won an
award for anything? We value that sense of accomplishment and
success. It's not enough to simply make change without deriving a
sense of accomplishment and success from that change.

The hallmarks of Positive Psychology include self-efficacy. This is really

the belief in one’s own ability to accomplish a task. There are strategies that
we can use with clients to help them create a sense of self efficacy, a sense
that not only have they accomplished something, but it was through their own
efforts that they’ve reached their goals.
One of the other hallmarks of Positive Psychology is personal
effectiveness. This is primarily concerned with planning and implementing
methods of accomplishing those things that are important to them.
Flourishing is another hallmark of Positive Psychology. Although the
concept is tied to Seligman, Fredrickson gives us a great definition:
It is optimal human functioning. It comprises four parts: Goodness,
creativity, growth, and resilience.
Now, think about the hypnotic work that you’ve been doing over the last
years in your office, when clients are with you - Is that work focused on
goodness? Is it focused on creativity? Is it focused on growth? Is it focused
on resilience?
Or has much of that work been negative? We're trying to solve problems,
but the main focus has been on what's wrong. Positive Psychology helps us to
flourish in therapy by focusing on optimal human functioning rather than
what has been wrong.
Yet another key element of Positive Psychology is Mindfulness -
intentional focused awareness on one’s immediate experience.
Elevation, another important element of Positive Psychology, is defined
as that pleasant moral emotion involving the desire to act morally and to do
good. For those readers familiar with Kohlberg’s Stages of Moral
Development, Elevation is that highest level of moral development. So that
we can achieve our highest level of potential, Elevation is something that we
strive to accomplish in Positive Psychology. That’s different than most
approaches in therapy, which in the current managed-care era of limited time
and limited resources, simply try to help people move from a pre-crisis level
of functioning back to an adequate level of functioning.
By employing approaches of Positive Psychology, we can move people to
Elevation. This is important not only to our clients, but to our own survival as
professionals. When you are home at the end of the day having elevated
people rather than simply supported them, it makes a huge difference in your
feeling of your own self efficacy, personal effectiveness, flow, flourishing,
and mindful awareness.
To accomplish these things, Positive Psychology really asks the question
differently than traditional hypnotherapy. Traditionally, we might ask the
question, how can the client become less depressed or how can the client
become less anxious or how can the client become less angry. In Positive
Psychology, we say although the client is angry, he’s experienced happiness,
so let's do the opposite of anger. Although the client is angry, he’s
experienced serenity before. The question is not, how can we stop anger, but
how can we increase serenity.
So, the therapeutic approaches are about increasing serenity, not about
decreasing anger. Instead of asking our client, what can you do so that you're
not depressed, we will ask our client, what can you do to feel happy. By
changing our focus in this way, we automatically inspire clients to operate
from a different, more helpful perspective.
Some of the specific methods of Positive Psychology include of course
teaching our clients positive thoughts, how to reframe thoughts, how to find
that which is positive. One of my favorite approaches helps my depressed
clients who say, “I can't be happy.”
I will say to my client, “You know, a lot of people in their house have a
photo album, or maybe a baby book, or a family photo album or something
like that - could you bring that in here next session?” And then when they
come in to that next session, I go through the pictures with them. There might
not be many pictures where they look happy, but I have always found at least
one picture where a client looks happy, so I'll say, “It's amazing - in this
picture, you look happy. What was going on then?”
And they’ll say, “You know what, that was the last time I was happy. It
was 28 years ago, but it was on that day because this is what happened. This
is what happened. This is what happened.”
I point out, “Now, we know that even though you're not happy, you have
the capacity to be happy. We know that because you’d been happy in the
past. So now the question is not why is it that I can't ever be happy, but how
was it that I can increase happiness that I've felt before.”

From Kelley:
A note about happiness. The whole idea of a happy place can be a
turn-off to clients who have chronic illness, pain, depression or
anxiety or are stuck in prolonged grief. It’s just too hard for them to
conjure up a happy moment. If you have clients who are suffering like
this, suggest that they think of contentment, instead.
Feeling content is a wonderful thing. It’s in alignment with
Eastern philosophies and releases our Westernized expectation of life
needing to be one constantly amazing, happy experience. Being able
to find a sense of contentment with a good meal, a nice sunset or
sitting and petting a cat or dog is usually more realistic and
 sustainable.

Affirmations

Back in the 1980s, Stewart Smalley, a character on Saturday Night Live,

used to sit in front of the mirror and say, “I'm good enough, I'm smart
enough, and doggone it, people like me.” That was his affirmation to himself.
It was a Saturday Night Live skit that really spoofed self-help programs and
the whole affirmation movement. I actually love affirmations. I think that
they can be a tool in Positive Psychology. I think that Stewart Smalley may
have been funny, but Stewart Smalley also got it right.
I teach my clients the art of using affirmations. Affirmations, when used
well, are extremely effective. The reason why is simple: Anybody who’s
been practicing Cognitive Behavioral Therapy knows that we need to counter
cognitive errors. The most effective way to counter cognitive errors is with
the truth, and those truths can become affirmations.
Outside of any Twelve-Step meeting, you'll see cars with bumper stickers
reading, “Just for Today,” or “One Day at a Time.” Those are affirmations.
Those affirmations have become one of the most important elements of the
success of Twelve-Step programs. Why? Because they are effective counters
to cognitive errors.
At the current time, our cultural awareness of the value of affirmations
has moved beyond Stewart Smalley to the Law of Attraction in The Secret.
You may recognize some of these phrases: Like attracts like or birds of a
feather flock together or this one, it is done unto you as you believe. These
are examples of affirmations, and there seems to be in pop culture right now
renewed interest in affirmations, probably in large part because of The Secret.
Now, at the beginning of this chapter I wrote that Positive Psychology is
not the Law of Attraction or The Secret. But because our pop psychology
culture is aware of that movement, when we ask our clients to learn skills
related to affirmations, they are going to relate it to The Secret. It's okay if
our client comes to us with a set of experiences or knowledge or beliefs to
utilize that resource. Of course, there are a lot of clients who’ve never heard
of The Secret.
Similarly, a lot of my clients are familiar with the power of the Word
from their study of the biblical creation account. It begins in Genesis with
God speaking, and this creation story is reflected both in Christian tradition
as well as the stories of other cultures. In Buddhism, one aspect of the
Eightfold Path called the Sama Vaca is often translated to English as Right
Speech. The more accurate rendering is Wise Speech or even Skillful Speech,
which hopefully suggests speech that is acquired through practice.

The power of affirmations

Not only does our culture, whether via Saturday Night Live, The Secret,
or religious scriptures, talk about the power of the spoken word, philosophers
and metaphysicians in the past hundred years have written profoundly on this
subject. Charles Haanel, who is an industrialist and the founder of the St.
Louis Post Dispatch Newspaper, wrote these words:
Thought is energy. Active thought is active energy. Concentrated thought
is a concentrated energy. Thought concentrated on a definite purpose
becomes power.
A century before The Secret movie was ever produced, Charles Haanel
really understood the essence of this aspect of the spoken word.
William Walker Atkinson, a metaphysician and philosopher from the
early 1900s, wrote that the best way to overcome undesirable or negative
thoughts and feelings is to cultivate the positive ones.
Much more recently, Sports Psychology Journal in 1991 published an
article that was fascinating. They found that healing from injury most
significantly correlated to goal-setting, positive self-talk, and the use of
healing imagery. In the book I wrote a few years back titled Medical
Meditation, I discussed the techniques of goal-setting, positive self-talk, and
healing imagery as aspects of promoting wellness, whether it was a sports
injury or any other kind of injury.

Where do we come up with affirmations?

When we listen to our clients, they will tell us what affirmations they
need to make. On my intake form, I ask clients to list three strengths that they
have, and I'll use those strengths as a basis for eliciting affirmations.
You're going to elicit affirmations from your clients by reversing their
deficits or their presenting problems.
If you are familiar with the Miracle Question from Solution-Focused
Brief Therapy, which will be covered later in this book, the answers to the
Miracle Question provide fantastic ideas for affirmations and positive
visualizations.
When I'm talking to my clients, I help them elicit the affirmations rather
than giving them their positive affirmations. I encourage my clients to write
down their affirmations using the five Ps:

present tense
positive
personal
proactive
passionate

How Do We Use Affirmations?

Of course, affirmations can be repeated daily, like a rosary, but there are
many other ways to use affirmations.
None of my clients ever leave my office without this set of instructions: I
give them a dry-erase marker, saying take this dry-erase marker home and
write this positive affirmation, this truth on the bathroom mirror. That way,
the first thing they see in the morning, the last thing they see at night, and
something they see repeatedly throughout the day is the counter to their
cognitive error, staring back at them in their own handwriting.
This can become a powerful technique, a simple method for helping our
clients make change. If you don’t have a drawer full of dry-erase markers, go
buy them in bulk from an office supply store. I guarantee you even if they
don’t believe it when they wrote it, they will test the affirmation to find if it's
true. It will almost always result in dramatic change.

From Kelley:
Richard’s suggestion to have clients write affirmations on their
mirror is such a good one. MRI research shows that hand-writing
such messages not only helps further imprint them, but it also
activates neural regions of the brain in ways that are similar to what
meditation does.
 I also ask my clients to put them on a screen saver on their computer. You
can create your own screen saver in about two minutes nowadays.
Affirmations can be shared as a Facebook status. It's amazing how the social
reinforcement, the “likes” that a client receives in response to posting a
positive affirmation, can make that affirmation come alive. Interestingly,
there's a ton of research showing that that’s true. Those “likes” are a very
important part of psychological phenomena.
Affirmations can be recorded by my clients as an MP3, something they
can use as part of a meditation or, really, any other form of repetitive input.
On the topic of affirmations, I should add that a few studies suggest that
positive affirmations can exacerbate depression or anxiety. It's important to
recognize the need to take baby steps - an affirmation that conflicts too
greatly with your client's beliefs can simply lead to self-talk that reinforces
the negative belief. However, this does not mean affirmations should be
abandoned as a tool, but rather that we should use them wisely.

APE Method

Positive Psychology provides an approach to questioning with clients

where we're going to search for alternatives. The acronym for this method is
APE:

Accuracy: A more accurate way of seeing this is _____________

Perspective: The most likely thing to happen is ______________
Evidence: I know this will happen because ______________

This technique helps us to challenge and confront those cognitive errors,

taking the negatives and asking them to be reframed as positives.

Scaling and Changing Emotions

Scaling the emotions into a Likert scale can be an effective way to help
your clients develop positive emotions. Nearly all my clients come in and say
they're either angry or depressed or anxious. They’ve never learned that
they're anxious at a level 8 or depressed at a level 6 or angry at a level 7.
The Likert scale is a scale that measures equal intervals on a scale of 1 to
10. We're all familiar with the Likert scale, even if we didn’t know its name.
If you’ve ever had a client who makes a mountain out of a molehill or makes
a molehill out of something that ought to be mountain, then scaling emotions
into a Likert scale can be a very useful tool.
Another idea for helping our clients develop positive emotions is to help
them become aware of co-existing emotions. When they tell us how they feel,
ask what else they feel. Ask, “Is there another word that describes how you
feel?” Ask your clients to identify coexisting emotional awarenesses. Many
of our clients are unaware that depression and happiness can coexist or that
anxiety and acceptance can coexist.
When we ask them to practice identifying coexisting emotional
awarenesses, our clients easily see that while they may in fact be depressed,
they were missing that part of them that is happy. One of the primary
methods for helping my client become skilled at doing that is to help them
learn adjectives that describe human emotions. I find that many of my clients
have a limited repertoire of words to describe how it is that they feel.
The fourth idea for scaling emotions or developing positive emotion is a
technique from Neuro Linguistic Programming called a State Control Pattern.
What I'm talking about here is not Arkansas, Missouri, or New York - what
I'm talking about regarding NLP states are the experience of an emotion. It's
more than just a descriptor of an emotion, but a praxeological vantage point
of what it is that they're feeling at that time.
See, there's something important my clients don't know: They don’t know
that they have the same pants to get glad in, that they have to get mad in. So,
I literally practice with my clients helping them to develop a state, a resource
state, in my office.
For example, if the desired resource state is serenity, I'll take five minutes
with them and help them become aware of serenity, amplify that sense of
serenity, increase the feeling of serenity or whatever positive emotion it is. I
then teach my client that if they were able to create that here in my office,
they can also take it to go and they can recreate that anywhere they like to.
You can watch a YouTube lecture I created on this subject and these
techniques here: http://youtu.be/EQTwPaTyiDA
Seligman gives us an exercise called Three Good Things. It's really an
exercise in journalism. He asks his clients each night before they go to sleep
to cultivate the practice of identifying those things which are positive. He
says, “Think of three things, three good things that happened today. Write
them down in your journal and then a paragraph or two reflecting on why
those good things happened.” When a client keeps a journal like this, at the
end of thirty or forty-five days, they then possess their own recipe book
containing strategies to help them create good things. These become the
resources that have come from within the client rather than things that I've
given to the client.
This practice creates a habit of doing good things. One of our goals in
Positive Psychology is to teach our clients that they can accomplish
something and because they can accomplish this, they can accomplish that.
Baumeister tells us if you can do anything that requires self-regulation it
makes it easier for you to have self-regulation in everything else. So, for
example, suppose you have a client who comes in and says, “I need help. I
am a pathological gambler. I have no ability to self-regulate. I go down to the
casino every time I get paid, and I blow all my money.” Or suppose you have
somebody who comes in and says, “I'm a sex addict, and my marriage is
over. My life is out of control. I've been impulsive sexually, and I don’t seem
to be able to stop no matter what I do.” The basic psychological principle that
Baumeister argues is that when we can develop self-regulation in one area,
like a muscle our self-regulation becomes stronger; it becomes something
that’s strong enough to apply in any situation.
And it turns out that our grandmother was correct: Sit with correct
posture. Hold your head up. Put your shoulders back. Hold your tummy in.
Good posture. It's important. But of course, good posture is one of those
things that takes self-regulation.
So, when I have a client who comes in with a gambling compulsivity,
sexual compulsivity, or really any other of the impulse disorders ranging
from trichotillomania to kleptomania, I might work with them during the
session to cultivate a positive habit, to learn how to self-regulate something
as mundane as posture. If the client can master that, they’ve really worked
out that self-regulation muscle, and they’ll be able to apply the strength of
that muscle either consciously or subconsciously to any other area of life they
may have found themselves previously struggling with.
Further Reading:
Flow: The Psychology of Optimal Experience by Mihaly Csikszentmihaly
Flourish: A Visionary New Understanding of Happiness and Well-Being
by Martin Seligman
 7

SOLUTION-FOCUSED BRIEF THERAPY

S OLUTION -F OCUSED B RIEF T HERAPY (SFBT) IS ONE OF MY FAVORITE

modalities. It is something that I probably incorporate at some level into
almost every session I do with my clients -whether it's through the
assumptions contained within Solution-Focused Brief Therapy or aspects of
the role of the therapist or the questioning approach that we can use,
particularly during the assessment process. Of course, like the other
contextual approaches presented in this book, Solution-Focused Brief
Therapy is an evidence-based protocol with many empirical studies that
demonstrate its efficacy.
Solution-Focused Brief Therapy, which holds a similar philosophy as
Positive Psychology, has much to recommend it:

It is a strength-based approach.
It focuses on solution-building rather than problem-solving.
It is a competency model that minimizes emphasis on problems of
the past and instead highlights the client’s strengths and prior
successes.
It operates under the assumption that our clients have had success
in something prior to being in our office, and by applying the skill
sets and the experiences that they have already had to the present
scenario, they're going to be far more likely to succeed.
It is founded on the idea that there are exceptions to every
problem.
It teaches that by exploring the exceptions and having a clear
picture of the desired future, solutions can be generated by the
 client and therapist working together as a team.

Here's an interesting story I ran across just the other day about the George
Bush Intercontinental Airport in Houston. There were a lot of complaints
about the wait for baggage. At first, they added staff. They took other
measures to speed things up, and they even succeeded in reducing wait time
by eight minutes.
Even though they took these expensive measures, the complaints
persisted. So, what they did next was to move the baggage claim further away
from the terminal, resulting in a longer walk to the baggage. It took people
longer to get to the baggage claim, but it reduced the complaints to almost
zero. People spent more time walking, which meant their bags were waiting
for them when they arrived.
That’s a phenomenal story for Solution-Focused Brief Therapy because
what we're looking for here are the solutions that really are outside of the
box. Ultimately, we are looking for what works.
There are basic assumptions or a world view approach within Solution-
Focused Brief Therapy, beginning with the idea that therapy is briefer when
focused on strengths and solutions.
In the era of managed care, limited time, and limited resources, we're
really looking for the shortest path to success. We're trying to limit cost to
decrease hospital stays to decrease the weeks in outpatient therapy. This
makes Solution-Focused Brief Therapy especially pertinent today.
In the late 1980s, a text book by Gerard Egan called The Skilled Helper
was used in many graduate school programs. Now, Gerard Egan was not
known as a Solution-Focused Brief Therapist, but his ideas align with this
approach. In the book, he proposed a three-scene counseling process,
involving the present scene, the preferred scene and the programmatic scene.
Each of those three scenes had three stages, so it was really a nine-step
counseling process. In other words, what are you going to do to get from
where you are now to where you’d like to be?
The first of his steps in the counseling process was, “So, tell me your
story.” What that means is that we don’t ignore the past, but we put it in the
perspective: It is one-ninth of the counseling process. It is simply the starting
point for our clients, how they got to our office. The bulk of the process,
eight-ninths of the process, should be focused on the future.
From Kelley:
This is my version of a 3-step NLP approach called The
Director’s Technique which helps a client first gain better awareness
about an unwanted habit or reaction, then applies desired changes
and finally, provides mental rehearsal for success. It applies Solution-
Focused Brief Therapy within a hypnotic context and can be done in
waking state or within interactive formal hypnosis.
Guide client to a theater, indoors or out - they choose. It's empty
of other people; have them take a seat and focus on the stage, where a
scene from their life is about to be performed. They design the set for
this scene, which is going to depict how it HAS been for them (the
presenting issue or event). Have them add elements of lighting, sound
effects, other mood descriptors...anything that lends to the
atmosphere of failure, anxiety, etc. they have presented to you.
Next, tell them an actor (actress) is walking on to the stage. This
actor may look just like the client, or like someone else, again, they
choose. Then, tell the client they are the director of this performance
and they need to instruct the actor on the role. Get specific about
things like body language, emotions, etc. Make sure the client
understands this scene is showing how it USED to be (expectation
and belief of change planted here).
When the client is ready, have them call out ACTION! and go
through the performance. The client can interrupt anytime and direct
the actor. They can bring in other characters, etc. I set up a finger
signal to indicate when they have gotten to the end of the scene.
It's not necessary for them to verbalize anything to you - you will
see the activity going on!
Step 2: return to the beginning and tell the client this is Take 2
and it will now be a different scene from this play of their life...the one
showing how they WANT it to happen!
Have the client create the changes on the stage that will help -
lighting, etc. Then, they instruct the actor on how they will be feeling,
speaking, acting, etc. Once again, when they are ready, the client
starts the action. Within this scene, I suggest they use any tools they
have learned from me: anchors, breathing, mindfulness, etc.
Tell them also to bring in challenges, unexpected problems and
see how easily the actor deals with them. Continue to the end and
 wait for the signal that they have completed. Check that they are
satisfied with the performance and if so, they can thank and dismiss
the actor. If not, they can rewind and correct.
Step 3: Now it's time for the client to step onto the stage and go
through the scene themselves. This lays the mental blueprint for the
future. Have them make any changes, improvements they need from
that perspective and lead them through the successful event. From
that point I move them right off the stage to deepening and input of
positive suggestions.
As you can see, this process is powerful and empowering. It can
be used for habit change, test or performance anxiety, etc.
It's easy, because all you need remember is the 3 stages! Literally!
LOL

In Solution-Focused Brief Therapy, we believe the clients have a wealth

of resources and solution behaviors that are already present. To a large extent,
this is a carryover from the Rogerian idea that our clients have within them
all the resources they need to resolve problems.
There is, of course, the exception to every problem, and in Solution-
Focused Brief Therapy we are looking for these exceptions. There are times
when a problem didn’t even exist or a problem was less troublesome for a
client; in evaluating those experiences, we can find solutions for our clients.
One of the other assumptions is that therapists help clients find solutions
to problems. That’s our job. Our job is to really explore with the client to help
them find solutions to problems. We help them set small goals, knowing that
incremental goals lead to success at larger goals. Solution-Focused Brief
Therapy's really all about goal setting to a large extent.
In Solution Focused Brief Therapy, therapists show clients how to view
their problems in a different way. Your depressed client has never thought
about why it is that they still have a job. A lot of depressed clients don’t get
out of bed, don’t go to work, but some have maintained their employment for
ten, fifteen, or twenty years. So, what gives them resiliency to go to work
every day, even though they have depression? That’s something they've never
thought about before, but in thinking about things from a different
perspective, our clients discover solutions that are truly useful.
The final assumption in Solution-Focused Brief Therapy is that the clients
want to change and have the skills to make changes. This is really important.
I meet a lot of therapists each year, and quite a few have to some extent
become cynical about the work. This presupposition is very encouraging.
Clients come to us in therapy ultimately because they want to make
changes. And people often do have the skills to make changes. The research
shows that. They might not have the same resources all other clients have or,
that you have. They might not solve problems in the same way we do, but for
each of our clients, there is a solution to their problem deep within them.
And, it is usually expressed in actions that they have previously taken in
other situations and scenarios.
In Solution-Focused Brief Therapy, the role of the therapist is really kind
of unique. Along with the belief that people are resilient and have the
strength and resources to change, therapists adopt an attitude that is
respectful, positive, and hopeful. The therapist helps clients look for times
when a problem wasn’t present, and then asks, “Why wasn’t the problem
present? What were you doing then that was working for you?”
In Solution Focused Brief Therapy, we engage in exception-seeking,
looking for times when a problem could have occurred, but didn’t. In my
relapse prevention work with alcoholics and drug addicts, I've often said to
my clients, “Is there a time in the past year or two when normally you would
have gotten drunk, or you would have gotten high, but for some reason you
didn’t?” And for almost every one of the addicts I've worked with, I've said,
“Even though you might drink on a daily basis, there probably was some
period of time, for whatever reason, when you did maintain sobriety for a
couple of days, even unintentionally.” And then I can find in that situation or
scenario what resources were working for them. Why didn’t the problem
occur even though it normally is occurring?
In Solution-Focused Brief Therapy, even though we do a lot of
questioning, therapists rarely interpret the answers. There is not a lot of
confrontation or challenge in Solution Focused Brief Therapy. Again, I am
trying to help our clients become the best them they could be, rather than the
best me that they can be.
Solution-Focused Brief Therapy is future-focused and compliments the
client. It encourages clients to continue doing what is already working for
them highlighting their strengths.

Stages of Change
 One of the things that I really appreciate about Solution-Focused Brief
Therapy is that it is stage-oriented. In other words, it looks at the counseling
process with a beginning, a middle, and an end. As therapists, we ask
ourselves what stage the client is currently in, because at different stages of
experience, our clients have a different set of solutions that are useful to
them.
During therapy, clients may move in and out of what Solution-Focused
Brief Therapy refers to as stages of change. It's important to recognize that
these are guides, that clients can move forward and backwards in the stages.
They can even move forward in some areas and stay the same in other areas.
But, I like having a model of change that sets out stages because when I find
myself at the stuck point in therapy, it's at this point that I ask myself what
stage my client is in. That question yields for me clues about what
interventions I should be using with the client.
The first stage is pre-contemplation. At this stage, a client has no
intention to change or to take any action towards the near future. They're
unaware of the consequences of their behavior and avoid talking about their
behavior. They're likely to underestimate the advantages of changing and
overestimate the cost. These clients are not usually reaching out for
hypnotherapy at this point even though they are being encouraged perhaps by
family or friends to get some help. There is, however a change process at
work, as during this stage they may have tried a variety of different solutions
and experienced various levels of success. So, when they finally make an
appointment and come to your office, you can review what most likely has
been the pre-contemplation process in the weeks or months that preceded
their visit. This is a great place to explore solutions.
Next, we have the contemplation process. This is where clients intend to
change in the next couple of months. They're somewhat more aware of the
advantages of changing. They're more accurately informed about the cons.
They might be ambivalent about their situation or not quite ready for action-
oriented treatment. Clients sometimes come to us in the contemplation stage
because they're looking for information and exploring resources. They're
really trying to prepare for a struggle that they perceive they might have. One
of the most effective interventions here is to let our clients know that they’ve
already found the solution and that by coming to your office, they’ve already
embarked on the process of change. At that point, asking them the question,
“Wasn’t that easy?” can be a truly powerful tool for change.
 The preparation stage is the stage where clients are really planning to take
action in a concrete way in the next couple of days, weeks, or months. They
are where they need to be to change, and they're ready to act on it. This is a
great time to be goal-setting in Solution-Focused Brief Therapy. It is where
most clients end up coming to us in hypnotherapy for the first time.
Then we have the action stage: Clients have taken specific actions to
modify their lifestyles within the preceding couple of weeks or months, so
they are now in the process of making changes. We can support them as they
continue to discover new things about themselves, tapping into even more
strengths or running into challenges.
Through a series of actions, strategies and action steps, changes are
implemented, so we find ourselves in the maintenance phase, in which clients
work to maintain changes in their life and to prevent relapse. They have
developed strategies to continue their changed lifestyle, and they're feeling
more confident to continue.
Every therapeutic process has a termination stage. Ideally, our goal was to
get rid of our clients. And in this stage, clients are at the place where they
have little temptation to revert to previous behaviors. They're confident.
They're self-efficient and they're ready to move forward. In the termination
phase of therapy, we want to make sure that our clients realize that while they
can continue to regard us as a resource, they should be encouraged to employ
solutions apart from hypnotherapy.
Clients move to these stages at various times in their life with various
issues. It's common for clients to move back and forth, though, and by
evaluating or assessing what stage of change our client is in, we can gain
valuable information about what questions to ask and what processes to
utilize.

Goal-Setting

What is a goal? A goal is concrete. It's clear. It's specific. It's time-
oriented. It is beneficial. Most therapeutic approaches aim to develop clear,
specific, and achievable goals for the client. In Solution-Focused Brief
Therapy, the therapist attempts to make small goals rather large ones. The
clients are encouraged to frame goals in a solution-focused way.
I do not write goals for my clients, by the way. In fact, I quit writing
treatment plans I think in the early 1990s. Instead, I have my clients write
their own treatment plans. I teach them how to goal-set, what goal-setting is
all about, and what objectives and goals are. I teach them that goals are
always written. If they're not written down, then it's just an idea or a dream.
That’s where our goals come from, but goals are written. If I have a client
who in talk therapy establishes a goal, I reach over to my desk, I grab an
index card and have them write that goal down.
I tell my clients to take that goal to tape it to their bathroom mirror. The
reason why, again, it's the first thing they see in the morning and the last
thing they see at the end of the day. I've done this with many clients, telling
them, “I want you to get in the habit of writing goals, so I want you to take a
stack of index cards and write a goal for each day, every day, for the next
thirty days. Then just tape each goal to your bathroom mirror and don’t take
them down.”
Now, it does not matter if my client never reaches any of those goals.
They will reach some of them while others will be forgotten the minute they
walk out the door in the morning. The purpose of this assignment is not so
that they reach all the goals that they set. It is so they get in the habit of being
a goal-setting person.
I think that this is probably one of the most powerful strategies in
interventions that I use in my therapeutic processes. In fact, if you take
nothing out of this book, take that assignment with you because it is a
powerful tool for change, whether you are working with an individual,
couples or families.

Identify Your Client's Strengths

An important role of the hypnotherapist in the Solution-Focused Brief

Therapy model is to identify the client’s strengths and resources. I created a
tool called the Nongard Strength and Resources Inventory, which is available
on my website. It is one of the forms my clients complete during the intake
process and it tells me what they perceive as their strengths, what they
perceive as their resources; that’s my starting point in that very first session
with the client for helping them make change.
Strengths are those internal attributes that help a person to be successful.
For example, are they trustworthy, loyal, helpful, friendly, courteous, kind,
obedient, cheerful, thrifty, brave, clean, reverent? Resources are the specific
things that are available to me to solve the problem. For example, if I am
unemployed and looking for a job, and I have a cell phone, that means I can
take the call when somebody calls me for an interview. I have a car, so I can
get to an interview. I have a resume that has advanced degrees on it. I have a
professional license that allows me to work.
Clients might not have the same resources that I have or that you have,
but I've never met a client yet with no resources at all. Identifying those
resources is part of effective Solution-Focused Brief Therapy.
We can also take a questioning approach. Ask your client, “What are you
good at? What would your wife, father, child, or other person close to you
say that you're good at?”
Clients might be stumped by those questions. Often, when filling out my
intake form, clients leave the inquiry about strengths unanswered. During a
session, the first thing I do is flip over to that page and see if they filled it out.
If they didn’t, I let them know this is the most important question on the
form, and I press them for an answer. Sometimes, I have clients whom I see
doing the intake form, and they're just sitting there. They have written down
one or two things down. They're trying to come up with a second or third
thing.
My clients have often never thought about what they're good at. They
only think about what's wrong. In fact, I don’t believe that I can fix most of
the problems in my clients’ lives. Their problems are just way too deep and
way too difficult, but what I can do is help them use the resources that exist
in their life to compensate for those deficits.

The Miracle Question

Solution-Focused Brief Therapy is probably best known for the Miracle

Question. The Miracle Question is probably the leading technique in
Solution-Focused Brief Therapy. As some clients have difficulties
articulating a goal, the Miracle Question is a way to ask for a goal that the
client comes up with by considering a preferred future.
The Miracle Question is a technique that helps clients to think broadly
about new possibilities for the future and to imagine how their life would be
changed if the problem was solved. I also think the Miracle Question can be
used as a tool for measuring success, but we'll come back to that in a
moment.
Here is the question:
 Now, I want to ask you a strange question: Suppose that while you're
sleeping tonight, and the entire house is quiet, a miracle happens. The
miracle is that the problem that prompted you to talk to me today is solved. It
just goes away. However, because you're sleeping, you don’t know that the
miracle has occurred. So, when you wake up tomorrow morning, what will be
different that will tell you that a miracle has happened and that your problem
has been solved?
That really is a complex question, but it's a great focusing question. The
premise of the question is, of course, that a miracle happens and because
you're asleep you don’t know that it happens, so when you wake up, you're
going to have to observe, feel, note, or think something different to know that
a miracle occurs. What is that? What's different? And this can help us to
establish a goal.
Likewise, the Miracle Question can also help us to define success because
a lot of clients don't realize when they have made tremendous progress. They
forgot the Miracle Question I asked in that first or second session. Now, I'm
in the fifth or sixth session and they're feeling stuck. But, I remember what
their answer was, so I ask them about those things that I now know are
different. That way, I can help my client to accept where they are today and
the progress that has been made even though they have not yet attained
perfection.
There are follow up questions that we can ask after the Miracle Question,
and these are really descriptions of preferred future needs. They can be
broken down into smaller details and then translated into smaller goals.
Here are some examples of questions that could be asked following the
Miracle Question:

How will that be different?

What will be different to you?
What will you be doing instead when you are not doing
________?
When you stop doing ________, what will you be doing then?
When you are feeling ________ (the antithesis of the problem),
what will you be doing? [That's a great question to connect an
action to a positive emotion.]
If someone were making a documentary film about you, how will
she or he notice what you are feeling?
 Who else will notice you being more ________?
What will they do when you ________ (stop smoking, quit
drinking, stop chasing cars, whatever it is that they changed)?
What will you do when she or he ________?
What would be the first sign that he or she ________?

Any of these questions can be followed with “What else?” So that our
client can really generate further alternatives at a deeper level. To some
extent, this is very similar to the approach of Virginia Satir in family therapy.
Unlike Milton Erickson, who asked the broadest, most general questions
possible, Satir would ask the most detailed and specific questions possible.
The Miracle Question can also be presented with the metaphor of a
magic wand. I have a magic wand in my office and I don’t limit its use for
pediatric clients! I might reach for it, tap it in the air and ask that magic
question, “What will be different for you when ____?” Later, I can use the
physical prop or even refer to it in hypnosis to compound suggestions of
change. For example, I might mention that a client’s running shoes are their
“magic wand” or that they can now use a magic wand in the form of a
cookbook of healthy recipes.

Progress Questions

In a previous chapter, I wrote about scaling questions - using a Likert

scale to ask clients to rate their position on a scale of 1 to 10. That is certainly
a part of Solution-Focused Brief Therapy as well. Asking our clients progress
questions in subsequent sessions is a great idea to use.
For progress questions, the hypnotherapist asks the client again where
they are on a scale to see if there has been progress, and then asks questions
such as, “What's different since the last time we met? What has changed
since our last meeting?”
Notice this is different than the typical introductory therapy question.
Often the first question of therapy is, “So what would you like to work on
today?” or “So tell me what's happened since our last session?” Asking
what's happened since the last session is really living in the past but asking
the specific question about what is different since the last meeting is a
comparison that stays in the present. Some practitioners even begin each
session with, “What's better than it was last time we met?”
By using scaling and comparison questions, the hypnotherapist can then
get a detailed description of what's better and how clients were able to
implement the changes. Even if they didn’t move from a level two of success
to a level ten of success, we can use that scaling and that small change to ask
questions looking for even more solutions:

Now, that you're at a four, how are things different?

What is it that you're doing differently?
Who else might have noticed you being at a level four?
How did it happen that you went from a three to a four on the
scale in just one week?
How did you decide to do that?
How do you know you can do more of that?
What needs to happen so that you can do more of it?
As you continue to do good things for yourself, what difference
will that make to you from tomorrow?

These all provide opportunities for the hypnotherapist to compliment the

client on being able to make things better and solidify change.

Exception Questions

Exception questions aim to empower clients to find solutions for their

problems. With these specific questions, the hypnotherapist can help the
client to identify times when things have been different for them. Exception
questions often flow from the Miracle Question once a detailed picture of the
preferred future has been attained.
It's important in the role of the therapist you are continually screening the
client for talk about previous problem-solving in exception behavior. This of
course requires attentive listening to skillfully identify the client’s previous
solution behavior.
Here are some other great exception questions in Solution Focused Brief
Therapy:

Tell me about the times when you haven’t been depressed.

 When was the last time you feel you were coping better?
Was there ever a time where you and your partner communicated
well?
Can you think of a time when this problem was not in your life?

It is vital to get details about the exceptions to help the client explore how
they managed to be without that problem in the past.
You may be amazed at how easy it is to begin incorporating Solution-
Focused Brief Therapy into their sessions. I suggest that you print some of
the questions out on a note card and just set them on your desk, so you'll
easily be able to glance at them.
 8

MINDFULNESS-BASED STRESS REDUCTION

(MBSR) AND OTHER MINDFULNESS-BASED
THERAPIES

P OSITIVE P SYCHOLOGY CERTAINLY IS PREDICATED ON M INDFULNESS , AS IS

ACT therapy, Dialectical Behavioral Therapy, and additional strategies
addressed in this book. But, I often hear people talk about Mindfulness-Based
Stress Reduction (MBSR) as if it were a therapy.
Mindfulness-Based Stress Reduction is not therapy. It is the specific
name of an eight-week training program that’s advocated by the University of
Massachusetts Medical Center as it was developed by Dr. Jon Kabat-Zinn at
the University of Massachusetts. Its efficacy - its impact on those who
graduate from the eight-week training program - has been meticulously
documented. MBSR can also refer to an intensive five-day inpatient training
module offered by the University of Massachusetts. This model of an eight-
week outpatient training program or an intensive five-day inpatient training
program has been adapted as a resource in pain control programs throughout
the country, in almost every oncology center throughout the country, and in a
wide variety of psychiatric settings.
A Ph.D. neuroscientist, Jon Kabat-Zinn employs an approach of training
and teaching clients rather than a counseling them. He began his work by
treating those in the chronic pain program at Massachusetts General Hospital.
The success in that arena led to empirical studies of its utility with a wide
variety of clients in varying contexts.
What is Mindfulness? Well, Mindfulness, as mentioned earlier, is the art
and practice of paying attention to this moment. There's a famous saying that
really captures that idea well. It's credited to Eleanor Roosevelt, but many
people heard it recently from the great Master Oogway in the animated film,
Kung Fu Panda:
 Yesterday is history.
Tomorrow is a mystery.
Today is a gift,
and that's why we call it the present.
Mindfulness is about staying in the present and experiencing the gift of
this moment.
Mindfulness meditation may focus on anything, but we often focus on the
breath, because the breath is always with us. Also, if we are breathing,
something is going right. Every time I work with somebody who has a fly-o-
phobia, a fear of flying, I teach them Mindfulness because if they are
breathing, they are okay. Really, if we are breathing right now, no matter
what else is going on around us, we're okay!
In this exact moment, we're whole, complete, and safe. Mindfulness in
clinical practice helps the client detach from fear, trauma, impulsiveness, and
self-defeating thoughts. It's a strategy that trains a client in a new way of
experiencing life, thoughts, emotions, and physical sensations.
There is a ton of evidence to back the efficacy of Mindfulness as either a
primary treatment strategy or as a complementary strategy in any form of
psychotherapy and medical treatment. There's a great deal of research into
both religious and secular forms of Mindfulness Meditation, but research in
the clinical setting has shown that Mindfulness practice improves the immune
system. It alters activation symmetries in the prefrontal cortex, a change
previously associated with increase in positive affect and faster recovery from
negative experience.
Essentially, Mindfulness activates resiliency, which is why the U.S.
Military has become very interested in preventing PTSD through resiliency
training using Mindfulness techniques. A University of North Carolina at
Chapel Hill study demonstrated correlation between Mindfulness practice in
couples and enhanced relationship qualities. Mindfulness-Based Stress
Reduction programs have decreased relapse into depressive episodes by over
30 percent.
The core concepts of Mindfulness are certainly a part of ACT therapy,
Mindfulness-Based Cognitive Therapy, Dialectical Behavioral Therapy, and
Contextual Hypnotherapy. Mindfulness provides a set of training techniques
and strategies that integrate well into virtually any treatment approach.
The purpose of Mindfulness is to put space between our clients’ thoughts,
their emotions, or their sensations. Chronic pain clients become their pain, so
Mindfulness as a strategy helps them to put some space between them and
their pain. As Steven Hayes says, pain is unavoidable. Putting some space
between them and their pain might not stop the pain, but it can make all the
difference in the world. Our depressed clients need some space between them
and their depression. They become fused to that depression.
Because the word meditation is often used with Mindfulness, many
people misunderstand Mindfulness. People think that meditation is about, you
know, sitting in a funny position, holding your arms out, saying a mantra, and
trying to clear the mind. Mindfulness meditation is different from mantra
meditation or transcendental meditation, which aim to clear the mind. The
purpose of Mindfulness Meditation is not to clear the mind, and it is not to
stop thinking. It's to practice simply noting when you do think and returning
the mind back to the present.
Meditation is the process that is most often used to teach Mindfulness.
However, meditation is not the goal. People are not better Mindfulness
meditators because they spend thirty, forty, sixty, or even one hundred
minutes a day in meditation. It doesn’t matter if the meditation is thirty
seconds or two minutes, or if it's done walking, sitting, or eating - because the
meditation time or setting is not the goal. The goal is to learn a strategy. The
goal or the purpose of Mindfulness Meditation is to develop certain traits that
then can be applied in other contexts. The point of Mindfulness Meditation is
to increase clarity and equanimity - evenness of temper even under stress.
Mindfulness practice literally trains the nervous system in self-regulation.
That’s why there are so many tremendous benefits for our clients with
physical difficulties. It's almost like a form of mental biofeedback, training
the nervous system in self-regulation.
The purpose of Mindfulness is not only to ameliorate physical or mental
symptoms, but to produce fulfillment in physical and mental processes. It's
not simply to make what is difficult easier to accept, but it's to make life more
wonderful.

My Personal Mindfulness Experience

Now, I'm going to share with you a personal story of how I developed a
state of Mindfulness and understood what it was after many years of practice
on the South China Sea.
I've been teaching and practicing Mindfulness Meditation for years, yet it
wasn’t until 2008 that became personal for me. You see, I found myself on a
charter boat ride in the South China Sea, which was a perk for staying as a
guest at a resort hotel. The vessel was a tiny sailboat. It was operated by a
life-long fisherman who earned extra money giving rides to hotel guests.
Before we got on this boat, I thought to myself, “Hey those clouds don’t
look so great.” Having lived in tornado country all my life, I understand what
dangerous clouds look like, but he assured me everything was fine. Trusting
that he was a professional and an expert in local weather, I got in the boat
against my better judgment.
Before long, the sky grew darker, and the seas got rougher. It soon
became clear that he had lost control of the boat, and we were in danger. As
each wave doused us with powerful blasts of water and the rain began to hit
my face, I started to panic. I knew I was way too far out to swim back to land,
and the seas were so rough, I surely would have been swallowed up anyway
if I jumped overboard. When I looked at the boat captain, this man of the sea,
and I saw fear in his eyes, I knew death was soon to arrive. We drifted further
and further from land and as control over the boat became nearly impossible,
I could feel my body shaking in panic. In my own mind I saw anguished
images of my children, mourning my death and asking why I was on the darn
boat right in the first place.
I felt sad. I was fearful. I looked backwards and forwards wondering if I
should jump. I looked to the sky, and suddenly I got pelted by this huge
raindrop. It was a giant, and it was hot. It was a big, hot raindrop. It was
tropical rain, so it was salty and hot. With the boat moving, each raindrop
splashed with a full force, the heat stinging my face. And it was in that
moment that I really felt the drops, the salt, the heat, and the force of the rain,
and it truly hurt.
The sea was white below my seat. It was a mesh seat, and the water was
splashing underneath me as the wind blew ferociously. As I felt those things,
I realized in my thoughts that I'm going to die. And I thought, “I don’t want
to die on this boat. I'm not ready to die today.” The thought of my kids
continued to pass through my mind. I could even see them standing with
frowns and tears in my memorial service, and I was really suffering anguish
on this boat with death probably just a few minutes away - and then I got hit
by another raindrop, hot and salty.
And again, I noticed it and I said, “That was hot.” In noticing that, I
recognized at that moment that what I had always told my clients was true.
No matter what else is going on if you're breathing, this moment is okay. So,
I breathed, and unintentionally I did what I have asked my clients to do in
difficult situations: I took another breath. I didn’t try to speed up or slow
down the breath. I just breathed. And again, I breathed, paying attention to
the wet, salty breath.
I noticed my fear, as well as my powerlessness over my fear, and I
learned what acceptance was, simply accepting my fear as fear. I took another
breath, breathing in, breathing out, fearful but breathing, breathing each
breath into each moment that was left. Soon I noticed the feeling of the waves
below my seat, the feeling of the wind on my face, and in that moment, I was
amazed by the beauty of the rough churning seas despite the impending doom
that they would bring. I breathed again, and I felt the hot rain.
I hardly noticed when I stopped following my thoughts of panic, and I
just experienced each moment not knowing which one would be the last.
Then I noticed that my heart rate had slowed. Although my panic was there it
became unimportant because I paid no attention to it. I accepted death, simply
noting my awareness of mortality, and in that moment, I felt human. I felt a
part of the sea. And I just breathed again, and I understood Mindfulness
experientially, connecting each moment in just being okay.
I still have no idea how the boat captain got the boat under control but,
somehow, we made it to a small little island dot, and I was safe. We stayed
there for a long period of time on the shore. We just sat in the rain. I breathed
again, paying attention to the breath that one single moment - and I smiled.
And this is what will happen to your clients when you teach them
Mindfulness in your office. They will come a point where what you have
been teaching them becomes something they own. Every time I teach
Mindfulness to clients, none of them says, “Wow, that was earth shattering
and dramatic: that was just crazily life-changing.” They almost all say, “That
was okay. I can see how that can be helpful.” Or they might say, “Yeah, I
found that relaxing.” But after practicing Mindfulness every day, there will
come a time where they’ll recognize and realize that they have been
intuitively mindful. It's at that moment that they will own Mindfulness - and
they will own Mindfulness from that point forward as well.

Day-to-Day Mindfulness

Let me give you a couple of thoughts about Mindfulness in daily tasks:

 You don’t have to strive to overcome anything. Mindfulness is
about helping a person to overcome things, not through striving to
do it, but by just being fully present. The result of Mindfulness is
that overcoming just happens. It's a natural outcome of being
present in each moment.
Mindfulness can be done in different ways. Paying attention to
daily activity, you can mindfully brush your teeth, mindfully eat a
raisin, mindfully walk, or mindfully sit and breathe.
Mindfulness really is the practice of redirecting our attention. It is
learning a technique for being able to say, “That’s a thought,” or
“That’s emotion,” or “That’s a sensation.” Instead of simply
following that experience mindlessly, you can recognize that that
thought, feeling, or emotion is present, and then use it as an
indicator to bring your attention back to the present.
Mindfulness Meditation is ultimately about learning how to note
spontaneous and intuitive Mindfulness. There's an old Zen
teaching that says the most important thing is remembering the
most important thing. And that really is the essence of
Mindfulness.

Singing in the RAIN

Now, the mindful presence that helps release emotional suffering is

summarized with an acronym in Mindfulness-Based Stress Reduction. I think
it's real appropriate based on my story in the South China Sea. and that
acronym is RAIN:

Recognize when a strong thought, emotion, or sensation is

present. When I teach clients how to practice Mindfulness, I'm
teaching them how to note their thoughts and feelings non-
judgmentally. The reason our clients become fused or enmeshed
with their thoughts is that they judge. They assign meaning: I felt
angry, and that’s bad or I felt angry, that means this or I felt
angry, and this is what happens when there's anger. Those are
relational frames. The relational frames are really our mind
following a thought, feeling, or emotion. Non-judgment in
 Mindfulness-Based Stress Reduction is about training our client to
simply note a feeling, note a thought, note a sensation, then return
their thoughts to the present.
Allow, acknowledge, or accept that the thought, emotion, or
sensation is there. So much of what happens in our life is really
from the subconscious mind and even the unconscious mind and
practice recognizing what is arising, fear, hurt, sensations,
thoughts and then allowing those things to be present, to be with
it, to be in the same room as hurt or anger or fear to allow it to be
present.
The “I” stands for investigate in a non-analytic way of getting to
know the body, the heart, the mind and experience those energies.
Investigate the thoughts, emotions, or sensations. When I work
with pain control clients and teach them Mindfulness,
investigation is very important. I want them to investigate their
body in the present moment, and they’ll almost always discover
something. They’ll almost always discover that when pain is
present, so is comfort somewhere else in the body.
Non-identify with the thought, emotion, or sensation. The point of
non-identification is that you're not having your sense of being
defined by, possessed by, or linked to any emotion. In other
words, you're not taking it personally. Think about how many of
your clients particularly in couples counseling need to learn this.

Characteristics of Mindfulness

In his book Full Catastrophe Living, Jon Kabat-Zinn gives us eight

qualities or characteristics of Mindfulness:

1. Non-judgment: Simply allowing a thought without having to

believe something about that thought.
2. Patience: Appreciating this moment rather than longing for a
future moment.
3. Beginner’s mind, curiosity: Approaching the familiar with a sense
of curiosity. (That’s why I love teaching clients Mindfulness
based on the breath. You know we've been breathing since the
 first day of life and we breathe until the end of life, yet we never
think about breath.)
4. Trust: Honoring your feelings, intuition and trusting yourself.
5. Non-striving: We're not really trying to get anywhere with
Mindfulness. We're just trying to be mindful.
6. Allowing: Letting the present be experienced without an agenda
or goal.
7. Acceptance: Seeing things as they really are in the present.
8. Letting go: It's how we go to sleep at night. It's how many people
go to work - at least those who do work that they don’t
particularly enjoy. If we go back to Solution-Focused Brief
Therapy, letting go is probably a skill most of us already have.
Being able to apply it in the context of other situations can be a
particularly useful strategy.

I don’t know where I heard this, but somebody said that when we're old
and in our death bed looking back on life, there will be one hundred days that
defined us, the days that made us who we were. Most people will not
recognize those hundred days until they look back on their life in retrospect.
Mindfulness is all about teaching a person to recognize those hundred days
when those days are happening.

Mindfulness in Action

Let me give you an example of how Mindfulness can be useful. A few

years back I was driving from Tulsa to Wichita with my son. It's a three-hour
drive, and there's not much between Tulsa, Oklahoma, and Wichita, Kansas.
But at the halfway mark there is a gas station and convenience store on the
turnpike, and of course there is a McDonald’s there. Now, my son and I
usually try to eat healthy food, and we were looking forward to eating at a
delicious Thai vegetarian restaurant in Wichita. However, we had left in the
late afternoon, so we were certainly nearing the dinner hour when we were
still a hundred miles away from Wichita.
When I stopped to buy gas, my son said to me, “Hey, Dad, I'm hungry, so
I'm going to go in and get a burger from McDonald’s real quick.”
And I said, “Okay, if you want to be judgmental.”
 “What?” he said.
I reiterated, “I was just pointing out that you were being judgmental.”
He said, “What do you mean being judgmental?”
I said, “Well, you said you were hungry.”
“Right, I am,” he answered.
I said, “Then you said you were getting a cheeseburger, right?”
He said, “Yes.”
“Well, you know we're going to be eating at the delicious Thai vegetarian
restaurant in Wichita in another hour and a half or two hours.”
He said, “Yeah. I'm just going to get something that tide me over.”
“Okay, you know, I was just pointing out that you're judgmental,” I
commented.
And he said, “What kind of therapy stuff is this, Dad? I'm not being
judgmental.”
So, I said, “Well, you had a sensation, right? Hunger?”
“Yeah, I'm hungry.”
“So, when you had that sensation," I said, "instead of just being hungry,
you judged the hunger and you decided that you must solve it now. You came
to the judgment that hunger is bad, so you need to eat something immediately
so that this feeling goes away. That’s judgment, and I just wanted you to
know that that’s why you're getting a cheeseburger. It's because you’ve been
judging your sensations.”
He kind of looked at me with this puzzled and yet semi-enlightened look
as he said, “What am I supposed to do about it?”
I replied, “Well, you can do whatever you want to do about it.”
He said, “Well, I want a cheeseburger.”
I said, “Okay. Well, then go grab a cheeseburger and be judgmental.”
“So, what else am I supposed to do?”
And I said to him, “Well, here's what you could do: You could just be
hungry. You could observe hunger and instead of attaching meaning to it or
judging it and taking an action based on the feeling, you could just see it as it
is: hunger, which is simply a natural part of the digestive process.”
He said, “How am I supposed to do that?”
And I said, “Here, go ahead, close your eyes. Now, take in a breath;
breathe in and out. Pay attention to the breath, and now notice that place in
your body where you're feeling hunger. Really become mindful of the
sensation of hunger. Observe it. Breathe in and breathe out. With each breath,
really focus on that feeling of hunger in the body.
"Now when you notice that feeling or sensation, rather than following it
and saying to yourself, I need a cheeseburger, or this is bad, or this is
intolerable, instead just say, I note that sensation. That is hunger. Just call it
by its name and say, that is hunger, that is hunger and just breathe and be
hungry without being judgmental. Say to yourself even this is what body
does. It digests. This is how digestion feels. Call it by its name. This is
hunger.
“Breathe in, breathe out, and simply note what hunger feels like. If you
notice your mind wondering to the thoughts of a McDonald’s or a
cheeseburger just note that thought–you don’t have to judge it. You don’t
have to say it was bad. Say that was a thought and bring your attention back
to your breath or to that place in your body where you feel hunger. Even if
you have to do that whole bunch over the few minutes, that’s okay. Just be
fully present, and note that in the present moment, you're hungry.”
Of course, we were standing in the doorway of a gas station and probably
looked a little bit silly, but when he opened his eyes, he had a big smile on his
face. His affect had changed. He looked fantastic. I walked towards the car. I
noticed he was walking right behind me. He got in. I started the car up, and
we drove off.
We got onto the turnpike, and he said to me “Hey, you tricked me.”
I smiled and laughed. I said, “No, I helped you understand Mindfulness.”
So, you can learn to experience Mindfulness in a variety of ways. You
don’t have to go on a boat to the South China Sea. You can go to the middle
of nowhere, Oklahoma, stop for gas, and learn these things. Mindfulness is a
skill that is taught.
I've worked with a lot of eating disorder clients over the years who need
to learn that hunger is just a part of digestion. It's not something they need to
interpret or act upon or get rid of. When my clients with eating disorders or
my obese clients trying to lose weight learn that, they experienced success at
weight loss no matter what kind of diet they're on.
Mindfulness can be practiced in many ways. We can do a walking
Mindfulness Meditation. I often take a walk, and I'm aware of my feet and
I'm aware of my walk and the temperature. It's great even though I walk
around the same neighborhood every night. In the neighborhood where I live
I almost always discover something new when I'm mindful.
I use the Raisin Meditation with my clients because I treat a lot of obese
clients, and so this is one way that I teach my clients some wonderful things
about Mindfulness and about their eating.
I learned about the utility of Mindfulness for weight control back in the
early 1990s when I was a part-time family therapist in the William Rader
Eating Disorder Treatment Program. Up to that point, I had never thought
about my own eating habits. I was number five out of seven in a large family,
so I learned to eat fast because if I didn’t snag as much pizza as I could as
fast as I could, I probably wasn’t going to get a second or third piece.
So, when I started working as family therapist, I was expected not only to
conduct group, but to also eat dinner with them. Dinner was scheduled from
5:30 to 6:30 - an entire hour. The first day I was there I wolfed down my
meal in about three minutes like I was used to. All the clients just sort of
stared at me. One of the other therapists explained that dinner time was in
fact therapy time, and that we were going to learn that the purpose of eating
dinner together as a group was to learn to pay attention to our eating and to
eat slowly to change those unhealthy habits. I learned the value of eating
mindfully way back then, and I've worked to internalize those concepts in my
own life.

The Raisin Meditation

If you don’t have a raisin, you can do this with a small piece of chocolate.
Dark chocolate is of course healthier. You could do this with an M&M. You
could do this with really a small piece of fruit or anything.
Hold a raisin in your hand and really bring your attention to that raisin.
Chances are pretty good in the past you’ve just grabbed the raisin and
chowed it down. You've probably done that with a whole handful of raisins.
In fact, you’ve probably never eaten just one raisin before. But observe that
single raisin as if you’d never seen one before. Touch the raisin with a finger.
Is it rough or smooth, thick or thin, hard or soft?
Feel the raisin, the texture between your fingers. Feel the weight of the
raisin and even notice with your eyes the colors of the raisin. Each raisin has
multiple colors. Notice if you have any thoughts you might have about the
raisin or any feelings of liking or disliking a raisin. Note the color of the
topography, the scent of a raisin. Look into the valleys and peaks, the
highlights and the dark crevices of the raisin. Now, lift the raisin under your
nose and smell it. What does a raisin smell like?
 Bring the raisin to your lips, being aware of the arm moving the hand to
the position to correctly feed yourself a raisin. Mindfully be aware of the
mouth salivating as the body is anticipating eating. Feel the emptiness of
your mouth. Note the sensation of no sensation since you haven’t eaten the
raisin yet.
Now, take the raisin in your mouth and just allow it to sit there for a
moment. Don’t chew it. Move it slowly around with your tongue.
As the raisin lies in your mouth, notice whether the raisin is warm or
cold. Notice the texture. Notice the rough edges and notice the smooth
surfaces of flavor. Notice, the subtleties of the flavor.
Now bite down once into the raisin. Hold it between your teeth. Notice the
sweetness. Notice if you have a thought. Notice if you have an emotion.
Notice a breath. Mindfulness is about noting things, becoming aware of
things. And as you separate your teeth, what did you notice about the
texture?
And as you bite down again, chewing again, notice how the texture
changes as you chew. Are you aware of how warm the raisin has become?
Has it become juicier? Notice any anxiety or stress you might feel by not
swallowing the raisin yet.
And now slowly finish chewing and when the raisin is all but dissolved,
go ahead and swallow and breathe and you can even say to yourself, “I have
eaten a raisin.”
I use this Raisin Meditation with my clients - not only for my bariatric
clients, but really for many different clients to teach them the art of
Mindfulness. Mindfulness is taught to clients by helping them to do
something they have never done before: to become a full observer in the
moment.

From Kelley:
I’ve had great success using a variation of the Raisin Meditation
for clients who wish to curb their alcohol consumption. Clients find
that they can easily limit themselves to just one glass of wine or beer
when previously they were consuming several, simply by drinking
mindfully!

Defusing Techniques
 Defusing involves seeing thoughts and feelings for what they are (streams
of words, passing sensations), not what they say they are (dangers or facts).
STOP, STEP BACK, OBSERVE
(the thoughts and feelings, what’s happening to/for the other person).
Notice what’s happening - your thoughts, physical sensations, emotions,
images, memories. Notice the way you’re interpreting what they mean, and
how that’s affecting you.
Notice the unhelpful thoughts. What am I reacting to? Perhaps say the
thoughts very slowly, or very quickly, in a squeaky or comic voice, or write
them down.
Identify the emotion you’re feeling, and label the unhelpful thoughts

an evaluation
a prediction
a feeling or sensation
a memory
an unhelpful thinking habit: mind - reading (believing we know or
what others are thinking), negative filter (only noticing the bad
stuff), emotional reasoning (I feel bad, so it must be bad),
catastrophising (imagining the worst), the internal critic, etc.

Learn more and practice mindfulness so that you can be aware of when
you are in the present moment rather than being ‘in your head’ - perhaps the
past or future. Notice what you don’t normally notice - sights, sounds,
sensations, thoughts, textures, etc.
Use metaphors try to see things differently. For example:

P ASSENGERS ON THE B US
You can be in the driving seat, whilst all the passengers (thoughts) are
being critical or shouting directions. You can allow them to shout, whilst
focusing on the road ahead.
P LAYGROUND B ULLY
(our thoughts can be our own internal bully)
Victim 1 - believes the bully, distressed, reacts automatically (bully
carries on)
Victim 2 - challenges the bully (bully eventually gives up)
Victim 3 - acknowledges then ignores the bully, changing focus of
attention.

T HE R IVER
Items floating down the river - perhaps leaves or bits of mucky debris
(thoughts, feelings,
images) - instead of struggling to float, we can stand on the bank
watching it all go by.

T HE B EACH B ALL
We try to stop thoughts - we hold the ball under water, but it keeps
popping up (thoughts). We can allow the ball to float around us, just letting it
be.

T HOUGHT T RAIN
We can sit on the train, watching the scenery (thoughts, images,
sensations) go by, or stand on the platform watching the thought train pass by
- we don’t have to jump on it.

T HE T UNNEL
When we get anxious driving through a tunnel, the best option is to keep
going rather than try to escape. This feeling will pass - there is an end to this
tunnel.

T HE M OUNTAIN
Whatever the weather, or whatever happens on the surface of the
mountain - the mountain stands firm, strong, grounded, permanent. We can
be like that mountain, observing thoughts, feelings and sensations, knowing
inner stillness.
 9

DIALECTICAL BEHAVIORAL THERAPY

D IALECTICAL B EHAVIORAL T HERAPY (DBT) HAS BEEN QUITE POPULAR SINCE

the early 1990s, and like all the other approaches in this book, DBT is an
evidenced-based treatment protocol. There is a mountain of evidence to show
its efficacy in what it was first designed to treat: Borderline Personality
Disorder.
Most therapists and counselors have been extremely frustrated by
personality disorder clients, almost viewing them as untreatable. However,
that simply is not true. We can help our borderline clients move to a higher
level of functioning by applying DBT in areas such as eating disorders, self-
mutilation, and other fairly aggressive psychiatric conditions. DBT is a form
of therapy that combines cognitive behavioral techniques and Mindfulness to
teach clients to regulate their emotions, tolerate distress, and to improve
relationships. Those are really the three chief goals.
I have always thought that one of the most important areas in psychology
or counseling is to help clients learn how to tolerate distressing situations.
Scott Peck made millions of dollars in the 1970s writing his book The Road
Less Traveled. It's not a particularly good book, but it made lots of money
because it had a great opening line: Life is difficult. People opened that book
and said, “Oh my gosh, this book is about me. I'd better spend the $10 and
buy it.”
Most people need to learn how to increase their distress tolerance skills
and DBT is a therapeutic approach that specifically does that. Dialectical
Behavioral Therapy was developed by Marsha Linehan in Washington and
published in 1993 as Skills Training Manual for the Treatment of Borderline
Personality Disorder. By the way, the book was not called “Dialectical
Behavioral Therapy” because the publisher didn’t feel that would sell.
Linehan recognized that the established Cognitive Behavioral Therapy
structure had a limited effect on treating the core problems in personality’s
function. She observed that something was missing in CBT, particularly
when dealing with individuals who engage in self-injurious behaviors and
suicidal idea tendencies.
The additional techniques of Mindfulness which we've discussed teach
people with borderline personality disorder to regulate their emotions more
effectively, especially helping them deal with overwhelming negative
emotions, which are characteristic of that disorder.
In contrast to Cognitive Behavioral Therapy, Dialectical Behavioral
Therapy offers patients an extended therapeutic framework rather than a
traditional brief therapy approach. Sometimes people say to me, “What about
long term care?” and as I mentioned, there are some clients who have more
catastrophic difficulties than others. Even though I tend to favor a brief
therapy model, DBT is one of those models of Contextual Psychology that
we can use on a long-term basis with our clients.
There's tremendous support for Dialectical Behavioral Therapy as a
structured program. Like Mindfulness-Based Stress Reduction, DBT is a
specific training protocol. It is a structured program that has been well
researched and documented; thus, it is certainly considered an evidenced-
based approached to therapy.
People who complete DBT programs have been found less likely to
engage in deliberate self-harm and suicidal attempts over a year of
observation. Participants in DBT have been found to have fewer inpatient
psychiatric stays than those who didn’t engage in the program, and this was
also largely maintained in a one-year follow up. That’s relevant for those who
work with catastrophic mental illnesses. Individuals with Borderline
Personality Disorder who underwent a protocol of Dialectical Behavioral
Therapy had lower depression scores, less deliberate self-harm and
improvements in anger, hostility, hopelessness, and dissociation.
Think about the clients you work with: if you could implement techniques
that could reduce feelings of anger, hostility, and hopelessness, while
ameliorating self-harm and decreasing depression, wouldn’t you want to
implement those strategies?
In this chapter I'm going to share the structure of Dialectical Behavioral
Therapy and the stages of therapy, but I'm also going to address specific
methods that can be useful to help you help your clients experience success.
Now, in a traditional program of Dialectical Behavioral Therapy there are
two components and they're viewed as equally important: individual therapy
and group therapy.
However, many hypnosis professionals in private practice do not
facilitate group therapy, and this could be for a variety of reasons. Their
offices are too small. They don’t feel like they can get enough clients together
to form a group where it would be worth the time and commitment to the
group for the financial rewards that may be available. Nonetheless, many of
us do offer group therapy in the context of our private practice offices, and
certainly in outpatient and hospital settings that is going to be one of the
norms.
In Dialectical Behavioral Therapy, the individual therapy component
involves the therapist and patient having an ongoing discussion about issues
that come up during the week and recording it in a journal. That’s important.
I'm a firm believer that when we write something down it becomes reality. I
wrote about affirmations in a previous chapter. A thought needs to become
words, and words need to become written.
Deliberate self-harm and suicidal behaviors are the first priority in
individual therapy. One of the things I love about DBT is that it does not try
to tackle every problem at once. It ranks the problems that clients have as part
of the assessment process. Skills that are learned during group therapy are
further reinforced during individual therapy, which is usually structured on a
weekly basis during the first twelve months, then tapers off as people practice
and implement these ideas on their own. It's important to remember that even
when working as an integrative team member with a client with a more
catastrophic set of conditions or diagnosis, they're still ultimately our goal.
Ultimately, we still aim to have them leave our caseload, to be able to
function independently.
Group therapy is generally provided about two-and-a-half hours a week
over a twelve-month program. Some groups might run bi-weekly. The goal of
groups really is skill training. That’s the main focus of group therapy, with
the underlying group dynamics and cohesion coming into play. In a lot of
therapeutic modalities, underlying group dynamics and unanimity of the
group is the goal. In DBT, it's really more of a patient education setting. Even
if clients are at different functional levels, or enter or exit the group at
different times, resulting in decreased cohesion, group therapy is still
successful.

Stages of Therapy

DBT incorporates a model of treatment that identifies four key stages. Its
approach prioritizes problems that are urgent and addresses these at various
points in therapy. One of the core goals of DBT is to help clients create a life
that is worthwhile to them at the same time as dealing with the task of
gaining control over problem behaviors, especially those that are self-
destructive.

Stage 1: Gaining Control of One's Behavior

The first stage of DBT is about moving from experiencing uncontrollable

behavior to taking control of behavior. During the assessment process, a
ranking of what behaviors are most important to address is made:

Suicidal behaviors
Behaviors that interfere with therapy
Behaviors that impact on quality of life
Behaviors to be addressed with skills training

For example, if your client has suicidal thoughts and actions, you deal
with those first. Unless you are a licensed mental health professional, that
means that you refer them to one and work only as part of an integrated
approach. Suppose your client is an alcoholic who gets drunk and comes to
therapy - that is a behavior that interferes with therapy. If your client will not
get out of bed and go to work they won’t have enough money to pay their
bills, and they won’t likely make it to your hypnosis sessions. Neither Kelley
and I work with people who aren’t detoxed; although hypnosis is certainly a
modality that can help them once they have gone through that process.
Finally, stage one of my work involves teaching my clients certain skill to
help them develop awareness, improve relationships, understand their
emotions, and tolerate emotional pain.

From Kelley:
 I like to tell the story about a young man in his twenties who was
referred to me by his mother, whom I had previously helped via
hypnosis. This smart, outwardly-appearing healthy guy had a heroin
addiction. He was curious about whether hypnosis could help him
beat it. I agreed to provide him a hypnotic experience to satisfy his
curiosity, following which, he paid for another session...and I never
heard from him again.
A year later, his mother called me to book an appointment to
come see me and mentioned casually that following our session, her
son had checked into a Christian-based rehab program and had been
clean ever since!
Did our session make that happen? We’ll never know for sure, but
I tend to think that helping a client safely gain awareness and a
different perspective of themselves also promotes a shift of some kind.

One of the things I love about DBT is the first question therapy is really a
question for me. I know that a lot of therapists who say to their clients, “So
what would you like to work on today?” or “What has happened since last
week?” But really the first question is “What does my client not know that
they need to know in order to choose to do something different?” It's my
responsibility in the therapy session to teach my clients those skills.
These skills can be categorized like this:

Core Mindfulness Skills

Interpersonal Effectiveness Skills
Emotional Modulation Skills
Distress Tolerance Skills

I've worked in a lot of drug and alcohol settings, and I have met clients,
believe it or not, who really don’t know how to not drink. They don’t know
how to say no to others. I work with clients who, when they're depressed,
really don’t know how to do anything other than pull a sheet over their head
and stay in bed. I have met clients who, when they find themselves in crisis,
literally do not know any other way to call for help other than suicidal action.
So, I ask myself, “What does my client need to know in order to choose to do
something different?”
 At times, the answer to that question points to skills that may be very
practical. For my client to change their life, maybe they need a job, so I may
need to be teaching them how to get a job. There are clients who really don’t
know what they need to say on an interview, how to be assertive, how to kind
of get their foot in the door and move from the receptionist to that person
who can actually hire them. So, skills training really is important.
I have balanced a lot of checkbooks with couples during couples
counseling because they literally did not know how to manage money, and
money became the therapeutic issue that was presented.

Stage 2: Experiencing Emotions Fully

Stage 2 of DBT is about helping my clients to experience emotions fully.

The second stage aims to help clients experience negative emotions without
reverting to dissociative, avoidant behavior or being overwhelmed by
symptoms of trauma. The therapist works with the client in this stage to teach
them how to experience all of their emotions without the emotion taking
over. Techniques from a number of other contextual therapies could be
particularly helpful at this stage:

Mindfulness-Based Stress Reduction

ACT Therapy
Deliteralization
Cognitive defusion

Cognitive defusion is especially important, helping clients to experience

negative emotions without being overwhelmed and relapsing into impulsive
and destructive behaviors. Those who work with PTSD clients find that
during this stage, the client learns some basic self-control—something they
felt had been taken away from them because of the trauma.

Stage 3: Managing Everyday Problems

In Stage 3, the goal of Dialectical Behavioral Therapy is moving towards

managing everyday problems. Once they manage their emotions and have
control over their destructive behaviors, clients can work towards managing
ordinary everyday problems: those associated with relationships, work, study,
finances. The client is given more space from therapy to try their skill out in
the real world. This provides them with the space to synthesize the skills they
have learned and develop healthy problem-solving strategies. Stage three
aims to increase the client's self-respect and self-efficacy, thereby improving
quality of life.

Stage 4: Being Connected

You know, nobody ever got well alone. An important focus in therapy
needs to be moving our clients towards a state of connection with others,
which is why Stage 4 of the DBT process is about being connected.
The final stage of DBT involves assisting a client to feel complete and
connected to their world. Some clients might find that even though they’ve
moved through stages 1, 2, and 3, and they might have their life to some
extent the way they want it, they still feel empty or disconnected. So the
fourth stage involves synthesizing the success of the former three stages into
the client’s identity. We can even draw from Solution-Focused Brief Therapy
to do that.
Progress through the stages is not linear and will overlap at times during
the therapeutic alliance. The purpose of DBT is to encourage the patient to
acquire a set of skills to a sufficient level that they will have satisfactory
quality of life and control over their behavior.

Mindfulness in DBT

We've talked about Mindfulness throughout this book—and for good

reason. Within each of these different modalities of Contextual Psychology,
there seems to be a foundational recognition that Mindfulness is a skill that
can be taught to clients and a skill that they respond to effectively.
In DBT there are three primary states of mind that Mindfulness is used to
address:

Reasonable Mind. This is when a client thinks logically, using

focused attention when approaching problems, for example:
planning for an event in advance.
 Emotional Mind. A client is in the emotional state of mind when
their thoughts and behaviors are heavily influenced by their
feelings.
Wise Mind. When a client is in this state, their reasonable mind
and emotional mind are integrated. They have intuition and a
sense of what feels right and wrong. This comes from practicing
Mindfulness. It doesn’t come from attending a lecture. It doesn’t
come from earning a psychology degree. It actually comes by
practicing Mindfulness with intention on a daily basis.

Mindfulness Skills

Dialectical Behavioral Therapy teaches specific Mindfulness skills:

Observation: The observant mind is the part of the mind that

observes experience in the current moment. That’s why we focus
on the breath: It's something to observe.
Description: The next part in learning Mindfulness is to describe
the experiences that come into awareness so when the thought or
emotion arises, the client learns to put words to it. I encourage my
clients this way: When you have anger, simply say to yourself,
“That was anger.” If you have fear say to yourself, "That was a
fear." Thich Nhat Hanh teaches that the name of something is
important, and so when we breathe in call it in; that’s its name.
And when we breathe out, call it out.
Participation: Another Mindfulness skill to cultivate is
participation. To develop mindful awareness, the client needs to
practice the skills and so whether in group or individual therapy,
participating fully is important.
Non-judgment: Being able to focus on the what and not the
interpretation of the sensation is the essence of non-judgment.
One Mindfully: This is really a core Mindfulness skill that crosses
the spectrum from Buddhism to psychology to every approach
within the discipline of Contextual Psychology. It's a core
Mindfulness skill that teaches clients to focus only on the present
moment one thing at a time. By the way, things are not unique to
one discipline and one discipline only. Some of you will recognize
this from the Alcoholics Anonymous mantra, "One day at a time."
Effectiveness: This aspect of Mindfulness teaches the client to
focus on what works and what is most effective.
10
 DBT SKILLS TRAINING

T HE APPROACH OF D IALECTICAL B EHAVIORAL T HERAPY IS TO A LARGE PART

predicated on skills training. (Skills training is not psychotherapy. It is not a
domain owned by licensed professionals. Trained hypnotists can and should,
train clients in self-hypnosis skills. DBT cloaks this in therapeutic language
but, make no mistake, teaching is not therapy and many of these techniques
are hypnotic.) That’s why the first book that Linehan wrote focuses on three
things:

Interpersonal Effectiveness
Emotional Modulation
Distress Tolerance

Interpersonal effectiveness is one of the most important skills to teach.

This is because it can be used in a variety of contexts:

Attending to Relationships: Effective interpersonal skills can be

used to end damaging relationships, ask others for help, say no to
situations, resolve conflicts, and address problems before they
become overwhelming.
Balancing Priorities vs. Demands: Learned skills help the client to
prioritize more effectively and reduce or defer things that are a
lower priority. It also allows them to ask for help when needed
and say no if they are feeling overwhelmed.
Balancing the Wants and ‘Shoulds’: There are various things the
 client may want to do because it will instigate change or because
it is enjoyable. There are also things that they should do because it
needs to be done or they feel it is expected of them. (This overlaps
well with Albert Ellis's Cognitive Behavioral Therapy.)
Building Mastery and Self-Respect: Skills will help the client to
feel competent and effective when interacting rather than helpless
or dependent. They will be assertive and heighten their self-
respect, an important quality I think is often underrated.

Building self-esteem and self-respect are probably the most effective

skills that can be taught, and yet they are among the least often taught skills
in psychology. These skills help our client feel competent and effective when
interacting, rather than helpless or dependent. I love teaching my clients
assertiveness.

From Kelley:
I often use a personal frame when helping clients strengthen their
feelings of self-worth. This comes from my Finnish heritage and is
contained in the word, “sisu”. Sisu, a national word of Finland that
depicts an indefinable perseverance, a dogged refusal to give up, was
fostered during a long history of resisting attempts by neighboring
nations to overpower that small country.
I make a point to help my clients develop their own sense of sisu
by exploring in hypnosis times when they were resilient, courageous
and persistent, along with projecting them with future pacing to times
when they tap into those traits to win the day.

In fact, back in the 1990s, I was training probation officers in a variety of

subjects related to mental health, and I wrote a book called The Getting Along
Workbook. It was a workbook to help clients learn to master the skill of
interacting with others in a non-helpless and non-dependent way by using
assertiveness. It is helpful in couples counseling, with criminal justice clients,
with substance abusers, and with many other clients.

Interpersonal Skills
 There are three main goals in relationships and interpersonal effectiveness
skills training:

Objective Effectiveness

The goal of objective effectiveness is for the client to use interpersonal

skills to obtain something that they want. Although it is not a guarantee that
they will get what they want, it does teach clients to be assertive and resolve
interpersonal conflict as well as have their opinion taken seriously.
Objective effectiveness skills are taught in DBT using the DEARMAN
acronym.

D Describe
E Express
A Assert
R Reinforce
M Mindful
A Appear confident
N Negotiate

Dialectical Behavioral Therapy, like some of our other approaches, seems

to love acronyms. I have a dry-erase board in my office, so when I'm doing
individual therapy with couples, I will often actually get up out of my chair
and write on that dry-erase board: DEARMAN. That way I can teach them to
communicate object effectiveness by describing, expressing, asserting,
reinforcing, being mindful, appearing confident and negotiating. This is a
great thing to teach the couples you work with at couples counseling.

Relationship Effectiveness

The goal of relationship effectiveness is to use skills effectively to

maintain or improve a relationship. Clients learn that they can get what they
want while maintaining a relationship with someone.
Relationship effectiveness involves:

Behaving in a way that makes the other person want to comply

 with your requests.
Behaving in a way that makes the other person feel good even
though you have said no to their request.
Balancing short-term goals in terms of what is best for the
relationship. The goal may be to have the other person stop
rejecting them or to approve of them; in these cases relationship
effectiveness aims to do this in a way that improves (not damages)
the relationship.

To balance short term goals with the longevity of the relationship requires
interpersonal effectiveness. Attacking someone or being verbally abusive
towards someone is a short term relationship gain that would risk the
relationship in the long term. Relationship effectiveness skills can be taught
using the GIVE acronym.

G Give
I Interested
V Validate
E Easy Manner

Self-Respect Effectiveness

The goal of self-respect effectiveness skills training is for the client to

effectively maintain their self-respect. It aims to maintain and improve a
client’s positive feelings about themselves and respect their own values and
their own beliefs. In the context of getting their needs met, they may learn to
act in ways that fit with their morals and make them feel worthy. Self-esteem
effectiveness is also taught with an acronym, in this case, FAST:

FAIR
APOLOGIES
STICK TO VALUES
TRUTHFUL

The acronym DEARMAN can help clients improve their self-respect and
sense of mastery as they learn to balance what they want with the other
person’s needs. GIVE skills enhance a client’s self-respect, and these skills
can be used at different times or in conjunction with each other. Our clients
do need help prioritizing what is most important in each situation, whether it
is getting what they want, maintaining the relationship, or having self-respect.
Traditional approaches to therapy can help clarify those things but
teaching these skills to your clients will help them take better care of their
relationships, take better care of themselves, balance their priorities, and
build self-respect.

Emotional Modulation

Emotional modulation skills are very important in DBT. In order to

modulate their emotions, clients must learn how to understand what an
emotion is, how it functions, and how to experience emotions without being
overwhelmed. Overwhelm is one of the greatest frustrations our clients face.
It's what precipitates crisis for many of them. Emotional regulation skills also
help the clients recognize more clearly what they feel as they learn to observe
each emotion without becoming overwhelmed.
Emotional regulation skills are designed to substitute destructive coping
strategies with more effective strategies. Essentially what we're doing is we're
replacing an old pattern with a new pattern. That’s why the skills need to be
practiced. A popular rule of thumb states that it takes twenty-one days to
make a habit, which is why I often give clients the assignment to practice
something daily for the next seven days - and then I'll have them continue
that for the next seven days, and then for another seven days until we reach
twenty-one days. It's my assumption that on the twenty-first day of practice
they probably have incorporated the new skill into their lifestyle.
The goal of these skills is for clients to modulate their feelings without
behaving in a reactive or destructive way. And the easiest way to stop a
reactive or destructive behavior is not to try to stop it. That only creates a
greater urge. This is the paradox of the yellow jeep exercise from Acceptance
and Commitment Therapy. The only way to eliminate a reactive or
destructive manner is to replace it and to have the replacement behavior
practiced so that it becomes the new norm.
One of the main skills taught in emotional regulation is understanding
emotions. We use words to describe emotions, yet these words really don’t
have a meaning to our clients. They have become their anger; or they have
become their depression; or they have become their anxiety. For every
adjective that we use to describe a feeling, the emotion could be experienced
as either a primary emotion or as a secondary emotion:

I feel hurt, but that’s because I'm scared (the secondary emotion).
I'm angry, but that’s because I'm hurt.
I'm happy, that’s because I'm connected.

And so, for every primary emotion there's always a secondary emotion
and asking my clients to describe their emotions with an adjective and then to
look for the accompanying emotions is a simple exercise, but a powerful
exercise in helping my clients to see how these things are really coexisting
and relating.
Another skill is teaching clients how emotions function. I explain that
emotions exist for three reasons:

To communicate to other people

To motivate me to action
To be self-validating

The non-judgmental attitude of Mindfulness helps clients to avoid

becoming overwhelmed. Emotions are neither good nor bad. They just are
what they are. I let my clients have and own whatever emotion that they feel
because that self-evaluation is important. I teach my clients how to
experience emotions without feeling a sense of overwhelm. One of the ways
to do that is to have your client practice Mindfulness to put some space
between them and their emotion, to experience emotion as an observer rather
than experience it from that first perceptual position.
Reducing emotional vulnerability is another key emotional modulation
skill. Dialectical Behavioral Therapy tries real hard to make an acronym for
this, and the acronym is PLEASE MASTER. It just doesn’t make any sense
to me; it's so hard to remember the acronym then you may as well just teach
the attributes.
DBT tries to make an acronym out of the following:

treat PhysicaL illness

 balance your Eating
avoid mood Altering drugs
balance your Sleep
get Exercise
build MASTERy of emotions

Setting aside the tortured acrobatics DBT uses to make this acronym,
what we're really talking about here is what Alcoholics Anonymous has been
saying for years. In 12-step meetings, we have heard HALT - never get too
Hungry, Angry, Lonely, or Tired:

Hungry
Angry
Lonely
Tired

That’s an easy acronym to remember, but the concept here is the same.
We are only as well emotionally as we are physically.
I got certified probably about ten or twelve years ago as a personal fitness
trainer. Not because I was planning to work with clients in a gym or in some
sort of fitness setting. In fact, up to that point in life, I really hadn’t gone to
the gym. I hadn’t exercised. I hadn’t worked out. But I recognized as I was
getting a little bit older that I probably needed to go to the gym, so I joined
the gym.
When I joined the gym, I got two free sessions with a personal trainer,
and he was so helpful and valuable to me that I purchased more sessions with
him. One day I was working out with him when I noticed that all the way
across the gym there was a trainer standing next to a treadmill. On the
treadmill was a person who was about four hundred pounds. They were just
slowly walking on that treadmill, one painful step at a time, for about forty
minutes.
Now, since I treat obesity in my office, I recognize that it is a clinical
issue for psychology counseling and social work. However, on the drive
home, I thought to myself, “Wow, that personal trainer actually just did a
therapy session, but instead of talking to a client about the change they could
take when they left the office, that trainer actually was participating in change
with the client.”
And I thought to myself (metaphorically, of course), “What if we
replaced the therapy couch in our office with a treadmill? Even if I'm not
treating obese clients, even though I'm treating depressed, addicted, or
anxious clients, people only are emotionally able to function as well as they
are physically.” I became so intrigued by the idea I thought, “Forget about the
metaphor; let's actually put a treadmill in the office!”
I never did put a treadmill in my office, but I did become certified as a
personal fitness trainer because I wanted that base of knowledge to help me
make the connection between physical wellness and emotional wellness.
Another skill for emotional regulation is helping our client to build
positive experiences. Part of the therapeutic process should be entering into
positive experiences with our clients so that they have a basis for
experiencing positive experiences in our office, which translates into an
ability to build positive experiences outside the office.
Another strategy for emotional modulation is the “opposite-to-emotion”
action—an action that is completely the opposite of what the client is feeling.
So, if a client feels sad, we encourage them to smile, laugh, and dance. The
paradox here is that when we instruct clients to act on the opposite of the
emotional urge they feel, it can help them to gain emotional regulation. Now,
this is not something you were going to use with those who are high
functioning clients who have a very few difficulties at this point or nearing
the end of therapy. When we have clients in the beginning of therapy who are
very impulsive, very quick to anger, who think, who act before they think,
teaching them simply the paradox of acting the opposite of their urge is a
great way to help them enter into the practice of modulating their emotions.
Of course, another technique is to help our clients check the facts. I tell
my clients, “When you feel something, check the facts. Check the facts by
asking. Check the facts by observing. Check the facts by stepping back from
a situation before you take action. Try to see a whole or a bigger picture, or
even put yourself in the vantage point of somebody else.”
There is a popular saying, coined by Robert Heinlein: “Pay it forward.”
Well, Dialectical Behavioral Therapy has this concept in relation to
emotional modulation: “Cope ahead.” In other words, rehearse what it is that
you can do when you find yourself in difficult situations.
I see a lot of clients for fear of public speaking. I live in an area where of
the country where there are a lot of oil companies that employ people who are
both geologists and attorneys. What's interesting about them though is that
for the most part they have been writing scientific journals about oil and gas
exploration, or they have been writing policy related to environmental
concerns from a legal perspective. Even though they're licensed as attorneys,
few of them ever are in a courtroom. A few of them ever have to testify in
public. Most of those whom I've worked with are quietly writing documents
and other things for the oil companies where they work.
Years ago, I actually had one of them call me up and say, “I've been a
lawyer for twenty-five years, and I've never been in court. Now, on behalf of
the oil company, I'm having to appear in court, and I'm afraid to speak in
public.” This is a guy with a Ph.D., who’s an expert in his subject. So, I
worked with him to overcome his fear of public speaking. Since then I've
built a large number of referrals, particularly in the oil and gas industry:
executives and lawyers who for one reason or another have a fear of making
presentations, testifying before Congress, trying a case in court, defending
their positions in a public forum, or whatever it is that they need to do.
With nearly all of these clients, I guide them through a process of coping
ahead, of visualizing themselves succeeding. This really is the same
technique that coaches use in athletics to help a person experience winning
the game before the game takes place. If I can help my client to experience
success in a future problem, I can help my client to modulate distressing
emotions. This is called by many different names, including Future Pacing (in
hypnosis and NLP), Cope Ahead (in Dialectical Behavioral Therapy), and
Mental Rehearsal techniques (in coaching and personal fitness training).
Finally, problem-solving skills contribute to emotional modulation in
DBT. After all, if a distressing problem is resolved, it is no longer distressing.
To sum up, here is a list of the Emotional Modulation skills in DBT:

Understanding Emotions
Learning How Emotions Function
Experiencing Emotions without Overwhelm
Reducing Emotional Vulnerability (HALT)
Building Positive Experiences
Checking the Facts
Coping Ahead
Problem-Solving
 Distress Tolerance Skills

In Dialectical Behavioral Therapy, there are really two types of distress

tolerance strategies. First of two types is acceptance. We've talked about that
a great deal in Acceptance and Commitment Therapy, and really the ideas in
DBT are similar.
In DBT, the idea of acceptance is developing the ability to accept the
situation and oneself without judgment. This strategy assumes that emotional
suffering is a part of life and that avoiding this reality leads to increased
emotional suffering. Acceptance is learned through breathing and awareness
exercises.
Belly Breathing is one of my favorite techniques to teach clients who are
experiencing distress. While it's easier to teach this in person, we can still
explain it here in this book:
Just take in a deep breath right now. Take in a deep breath; breathe in,
and now exhale. Now, I can't see you, but chances are good that you just did
what I did the first time I tried this exercise. Chances are pretty good you
puffed up the chest a bit. You breathed through your nose. When you exhaled,
it's likely that your body collapsed a little bit.
What's interesting about that is that we tend to almost always breathe like
that when we take a deep breath. When we're told to take a deep breath, we
puff up that chest. We push that neck back a little bit. We breathe in.
But when we breathe with the chest, we actually only get air to the top
part of the lungs. We don’t get oxygen in the lowest part of the lungs. We also
tense up those muscles in the neck and shoulders. That’s where the collapsing
comes from.
So, I'm going to teach you a technique that you can teach your clients. If
you're not already, sit comfortably in a chair with your back and spine
aligned and erect. You don’t have to puff out the chest at all. Just let your
arms rest to the side for a moment and pay attention to the belly. In fact, you
can even rest your hands and put them across the belly if you’d like.
Now, imagine that inside of your belly is a balloon like a kid might have,
a healing-filled balloon, but imagine there's no air in it. It's just an empty
balloon inside of your belly. Now, the way I want you to breathe right now is
to breathe by imagining that you're filling that balloon up with air. Go ahead
breathe in. Imagine that you're filling that balloon up with air. And notice
how the chest stays the same and the belly fills up. Now exhale by just letting
the air out of the balloon. Again, breathe in by filling up that balloon. Fill it
up with air all the way in and then exhale by letting the air out of the balloon.
Do you notice the huge difference? Chances are you feel wonderful from
that burst of oxygen that you’ve just experienced going all the way to the
lowest part of the lungs without increasing any tension or stress in the
shoulders or neck.
That’s a simple strategy, but it's a strategy that I teach to every one of my
clients who is quitting smoking.
Most of my clients say, “Yeah, in the morning I need a cigarette or two to
get going.” Nicotine is a vasoconstrictor; for them it's a stimulant that
provides energy. So, they are probably dependent on nicotine for their energy
just like other clients are dependent on carbohydrates or caffeine. Since they
don’t have a cigarette anymore and need that energy, I teach my client to start
the day with a couple of breaths like this because when oxygen goes to the
deepest part of the lungs and then goes through the heart and through every
cell of the body, they get a blast of energy as powerful and more powerful
than that produced by the drug nicotine.
Besides acceptance skills, crisis skills are important for our clients. These
strategies focus on finding new ways to survive and manage the moment
without resorting to problem behavior. There are really four sets of crisis
survival skills that clients learn in DBT:

Distracting
Self-Soothing
Improving the Moment
Thinking about the Pros and Cons

Distraction Methods

Distraction Methods are really based on the idea of paying attention to

something other than what is causing the distress. This is of course a factor in
Mindfulness: When you are paying attention to the breath, you are no longer
paying attention to your distress.
Acceptance strategies for distress tolerance are usually addressed within
the Mindfulness techniques that we've discussed throughout this course, but
Dialectical Behavioral Therapy uses an acronym to tie together the crisis
management strategies that incorporate acceptance principles. The acronym
used is ACCEPTS:

Activities
Contributing
Comparisons
Emotions
Pushing Away
Thoughts
Sensations

Activities: Clients are encouraged to distract for themselves with pleasant

activities, hobbies, going for a walk, cooking, gardening, watching a movie,
playing a sport. Have your clients write down a list of pleasant activities that
they like to do. Borrowing from ACT therapy, ask them to commit to the
valued path to engaging in one of those activities when they find themselves
in crisis.
Contributing: Contribute to others to the world around you. By focusing
on helping someone else, your clients may often find relief from their own
problems. This is one of the premises again of Alcoholic Anonymous. They
say if you're new to a meeting, what should you do if you're a newcomer?
Well, you should stack chairs and empty ashtrays. Similarly, my musician
friend, James Hazlerig, found that he often became sad and lonely at the end
of music festivals, so he began focusing on helping other people pack up their
camps as the festival was drawing to a close.
Comparisons: Your clients may benefit from comparing how they're
doing now as opposed to one or five years ago. (Often, simply being aware of
the problem is a big improvement.) They may also compare their own
problems to those of people facing monumental disasters. After all, being
stuck in traffic seems rather minor when compared to being stuck in a
hurricane.
Emotions: Clients may scale their emotions to gain perspective or may
decide to pursue an emotion opposite of what they are feeling at the time. For
instance, clients may listen to happy music when they are feeling down. By
the way, especially if you work with adolescents, find out what they're
listening to and change their play list. That doesn’t mean they have to stop
listening to that sad, depressing music they love. They can still do that when
they're doing fine, not when they're experiencing crisis.
Push Away: Rather than be constantly confronted by a distressing
situation, clients can learn to “push it away” and come back to it later. For
instance, when it's time to go to work, a client may visualize putting problems
into a box until after work. Or clients may push away a situation until they
are emotionally and physically prepared to deal with it. Mindfulness
exercises are very helpful for developing this skill. Of course, it may not be
healthy to avoid problems forever, but this strategy helps clients to function
without being consumed by their distress.
Thoughts: Clients learn to distract themselves with thoughts other than
negative and distressing ones. They may count to ten or focus on the stars in
the sky, anything that keeps them focused away from their negative thoughts.
This is a useful strategy in crisis situations when the client needs to access a
strategy to manage the distress quickly. Other thought distractions include
reading, watching movies, writing a journal, and doing crossword puzzles.
Sensations: There's a saying, “If you want to feel something different, feel
some thing that is different.” Clients are taught to distract themselves form
emotional turmoil through other bodily sensations such as holding ice or
flicking a rubber band on their wrist. These sensations produce shock and can
distract from emotional pain. These sensation exercises are more helpful
ways of managing distress that cutting and other self-injurious behavior.
Other sensations could be listening to loud music or taking a cold shower.
Following a sensory distraction, the client may then engage in an activity
distraction.

Self-Soothing

I teach my clients body scan meditations, similar to those called

Shavasana in yoga classes. Progressive muscle relaxation is another basic
strategy that can be used to teach people self-soothing techniques.

Improving the Moment

Sometimes a client comes into my office and they're experiencing crisis,

so I ask them this very simple question: “I recognize that you're in crisis, and
that’s painful and difficult. Is there anything you can do right now to improve
the moment?”
That’s something they’ve never thought about before. Sometimes that
question catches them off guard, but they will often come up with an answer,
if I'm quiet and patient. (By the way, one of the hardest things for therapists
to do is to be quiet and wait for the answer. I've had to learn that as a strategy
in my therapeutic interviewing, but it's a strategy that’s been quite helpful to
me.)
Sometimes clients come up with some of the ACCEPTS strategies, and
sometimes I suggest some of those strategies. But another strategy for
tolerating negative emotion is to improve the moment by staying mindful.
IMPROVE is another acronym in Dialectical Behavioral Therapy and it is
used to remember these skills:

Improve mental imagery.

Meaning: Find that which valuable to you in the moment.
Prayer: a useful way within the context of our client’s faith to be
in the moment.
Relaxation: Relaxation techniques are extremely useful and
helpful to our clients. Relaxation is the basis of developing the
skill of taking physical control over the emotional. Progressive
muscle relaxation and autogenic training in particular are two
excellent skills for doing that. I'm surprised at how many
therapists do not teach clients progressive muscle relaxation,
autogenic training, and self-hypnosis. The efficacy of these
approaches is extremely well-documented. Many of you may
remember Herbert Benson, a Harvard psychiatrist who in the
1970s wrote a book called The Relaxation Response, documenting
the many benefits of deep relaxation.
One thing at a time.
Vacation: maybe not a real vacation, but a mental vacation. Step
outside for a moment. My back patio at my house is my place for
a vacation. Sometimes I decide I'm just going to take the laptop
out there and work, or maybe work out there on my porch. A
couple of weeks ago, my 6-year-old step-daughter and I decided
to go outside, make lemonade with fruit in it, simply sit out there,
and have a little mini vacation—and that’s exactly what we did. It
was fun, and the lemonade was good, too.
 Encourage positive self-talk: Do you remember the little engine
that could? I think I can, I think I can, I think I can. I want my
clients to use positive affirmations as described in earlier chapter,
and that approach fits well within the ideals of Dialectical
Behavioral Therapy.

A Relaxation Exercise

This is a script you can use with your clients, and of course, I urge you to
read through it several times so that you can then guide yourself through the
process.
Find a comfortable spot where you can relax. You can lie on the floor.
You can sit in your chair. This session is not designed to help you sleep. It's
designed to help you use the principles of relaxation to help you end any
feeling of anxiety, anger or depression.
You can come back to this often and you can learn how to practice these
principles by going through this exercise in a future date as well. Many
people who use the principles of relaxation find that by taking a moment in
the middle of life’s turmoil to re-center themselves. It's a great way to relax.
And you might even wonder can something so simple really help you and the
answer is yes. There is hope for ending depression, and it comes from the
desire to be happy that’s already within you. You can find calm from anxiety,
and you can even give up stress, anger or frustration by really practicing
these simple ideas.
And so, as you relax, close your eyes and picture in your mind a relaxing
waterfall or a moving pool of water. Then simply scan your whole body, and
anywhere that you're holding the tension of the day, let those muscles become
lose and relaxed. Often, we don’t even notice where we're carrying the
tension until we notice it and make a conscious choice to relax those muscles.
As you mindfully focus your attention on the creative part of your mind to
imagine a waterfall, let the water flow and let any immediate stress or
anxiety flow with the water from you and into a foreign distant place. And
imagine for a moment the feeling not only of the water moving, but also your
stress moving with it.
Many will find that easy to do, but others won't find this an easy thing to
do. Perhaps that’s because the stress has been a part of life for so long and
letting it flow is something that takes time for some people, and that’s
perfectly okay as well. But notice how by just using this visualization your
mind has become more relaxed. Your bodies become more relaxed. Your eyes
have become tired and heavy. In fact, you'll find that even though you know
you could open your eyes if you wanted to, it just feels so good to keep them
closed. You'll just let them stay closed as you continue to use your
imagination to drift into the scenery of a waterfall or pool of water or calm
sea.
Now, notice your breath, smooth and rhythmic. It isn't even something
you’ve tried to do, but something that has come naturally to you by taking a
moment for yourself and letting go of any obvious tension. And as you rest
your hand on your lap, notice the sensation of relaxation and calm you've
already achieved, and say to yourself the word “warm.” Focus on your
hands letting your hands feel a sense of warmth. Create that warmth and say
to yourself, “My hands are warm.”
And as you do, notice the sensation of warmth in those hands that you’ve
created and now say the word “heavy” and notice how heavy your resting
hands are, and say to yourself, “My hands are warm and heavy; my hands
are warm and heavy.”
Now, focus on your feet, saying to yourself, “My feet are warm and
heavy; my feet are warm and heavy.” It's amazing how as you say this, you
can begin to feel a sense of warmth from within and a sense of heaviness.
This is really your first learning in this relaxation exercise that you can
control the way you feel. It's true of physically and mentally, no matter how
difficult life’s situations are. And that sense of warmth and heaviness brings a
sense of relief from the weariness of life, letting you recharge the mind and
body in the time that we have in this session.
Now, again, notice your breathing, smooth and rhythmic, relaxing even
deeper with each breath, and although it might feel magical to relax as
deeply especially since you haven’t felt this calm in a long time, this is a
totally natural state.
It's one that you have created rather than one I've created, and because of
that you can re-experience it at any time, and I will teach you how to do that
in a moment. But right now, focus on your desire to be free from panic or
anxiety by feeling a state of calm. Notice how the sense of heaviness is like a
calming anchor allowing you to feel physically calm even if your mind might
wander or race. Perhaps you desire hope rather than depression, and there's
a simple exercise of creating warmth and heaviness.
 You can see how you have the ability within you to not only create those
sensations but also a state of hopefulness. I don’t know why, but water
always makes me feel hopeful, maybe because it reminds me that nothing
stays the same or perhaps because of its power and energy to revitalize my
spirit.
Do you desire freedom, success? Take a moment in creating affirmation
that reflects your heartfelt desire. You could say something like this: “I'm
free from stress" or "I can create hope from inside."
You could even focus on a single word like happiness or calm or
forgiveness. It's amazing how creative our minds are. You can actually hear
the water in the background as you take a moment to focus on that word:
happiness, calm, forgiveness, or that affirmation that you’ve created. And
repeat it in your mind, sing the letters as you do, spelling it out, hearing
yourself speak those words and noticing the feeling that these positive words
or affirmations bring.
It really is amazing how simply saying something manifests it as reality
but remember everything that is now was a thought first. To be hopeful or
calm and forgiving, you must begin with a thought, and you can truly
experience this more and more each and every day.
A great way to reinforce this thought, which like rain fills the stream and
leads to the river and results in the formation of a powerful waterfall, is to
write that affirmation on a card or a sticky note and tape it to the bathroom
mirror or your dashboard or to the monitor of your computer.
Let it be a constant reminder despite other factors in life of your ability to
turn your thought, your mental energy into emotions and success, and relax
even deeper noticing how remarkably easy it's been to set aside a few
moments to re-energize, and even though life requires action you now have a
starting point for re-energizing during difficult times and a starting point for
creating thoughts which turn into results. In fact, you can even congratulate
yourself for taking the time to invest in your success by starting this process
of hope, calm, and happiness.
Continue to relax. Enjoy just another moment or so of this state that
you’ve created, never asleep, but deeply relaxed, enjoying your ability to
experience serenity and creativity, and to let any temporary stress pass
without escalating.
As we end - near the end of our time - you can open your eyes at any
point, or you can keep them closed for another moment or two where you feel
the floor below your feet and the air in the room around you. Maybe even
take another moment to continue to see or hear that waterfall that you’ve
created, but since it's time to conclude, begin to feel a sense of energy to let
the muscles in your body and your spirit feel energized. If your eyes aren’t
open yet, it's now time to open the eyes feeling refreshed, energetic and ready
to be positive in every situation in every way each and every day.
One, two, three, eyes open, feeling fantastic.
That is a simple process of relaxation training that incorporates a number
of different strategies including direct suggestion, progressive muscle
relaxation, autogenic training, and a number of other approaches.
There are other strategies which I utilize with my clients all of which are
predicated on helping them to feel awesome, not only at physical level but an
emotional level as well. My hope is that you will take the script and use it
with your clients so that they can derive the benefits of these evidenced-based
protocols as well.
11
 METAPHOR AND STORY

O NE OF THE THINGS THAT ’ S INTERESTING ABOUT C ONTEXTUAL

Hypnotherapy is that the value of metaphor and storytelling is recognized
across traditions within this arena, although obviously, this isn't something
restricted to this methodology.
I remember when I was first learning how to be substance abuse
counselor, which was my first job in this profession. I was at an old-
fashioned treatment center, complete with chain-smoking chemical
dependency counselors and orange vinyl furniture. Every new client was put
on the hot seat. This was before the existence of managed care, and it was
assumed that everybody magically got well on the 28th day - nobody on day
29 and nobody on day 27.
At the center there was an old-school counselor named Sam who had
quite a reputation for grilling clients in the hot seat. Graduates of the program
often got bumper stickers that read, “I survived Sam.”
Now, Sam was somebody who recognized the value of the stories in the
big book of Alcoholics Anonymous. In fact, most of the big book is taken up
with stories that really teach some important lessons. Sam would regularly
tell clients those stories from the big book of AA because he knew the value
of the story in therapeutic counseling. It was perhaps because of my
experience in substance abuse counseling that I recognized right off the bat
that stories are powerful agents of change.
I love to tell stories to my clients, and I do so on a regular basis. One of
the reasons why I do this is because I'm not very good at confrontation. Some
of those old-time substance abuse counselors would put a client on the hot
seat and get up on their face like a bad Fritz Perls video. They would even
swear at them and they would make them “get in the now” as we used to say
back then. It's just not my personality to get up into somebody’s face and tell
them like it is. I'm more diplomatic than that.
And I remember thinking to myself, “I'm not going to be a good
substance abuse counselor like Sam because I can't get up in their face. I can't
make them get in the now. I can't be six inches away from them like a drill
sergeant and confront, confront, confront.”
However, I recognized that, even though my personality was certainly
different from Sam's personality, I could be an effective substance abuse
counselor, that I could be effective at confrontation, if I learn to use stories as
a way of confronting clients.
Here is one of my favorite stories. It's paraphrased from Leo Tolstoy:
A bishop and several pilgrims traveling on a fishing boat from Archangel
to the Solovetsk Monastery. During the voyage, the bishop engages the
fisherman in conversation after overhearing them discuss a remote island
nearby and he asked him to change course because this island nearby has
three old hermits living a Spartan existence.
These old hermits are seeking salvation for their souls, and several other
fishermen claimed to have seen them once. The bishop then informs the
captain that he wishes to visit the island, and the captain attempts to dissuade
him by saying the old men are not worth your pains. I have heard it said that
they are foolish old fellows who understand nothing and never even speak a
word, but the bishop insists, so the captain steers the ship towards the island,
and subsequently sets off in a row boat to visit where he is met ashore by the
three hermits.
The bishop informs the hermits that he has heard of them and of their
seeking salvation. He inquires how they are seeking salvation in serving God,
but the hermits say they don’t know how. They only pray simply: “Three are
ye, three are we, have mercy upon us.” Subsequently, the bishop
acknowledges that they have a little knowledge, but are ignorant of the true
meaning of doctrine and how to properly pray. He tells them that he will
teach them not a way of his own, but a way in which God and the Holy
Scriptures has commanded all men to pray to Him, and then he proceeds to
explain the doctrines of the incarnation and the Trinity.
He attempts to teach them the Lord’s Prayer, the Our Father, but the
simple hermits blunder and cannot remember the words, which compels the
bishop to repeat the lesson late into the night. After he becomes satisfied that
they had in fact memorized the prayer, the bishop departs from the island
leaving the hermits with a firm instruction to pray as he had taught them. The
bishop then returned by the row boat to the fisherman’s vessel anchored
offshore to continue the voyage.
While on board, the captain notices that their vessel is being followed—at
first thinking a boat was behind them but soon realizing that the three hermits
had been running across the surface of the water as though it were dry land.
The hermits catch up to the vessel. As the captain stops the boat, the hermits
inform the bishop, “We have forgotten your teachings, O Servant of God. As
long as we kept repeating it, we remembered, but when we stopped saying it
for a time, a word dropped out and now it has only gone to pieces. We can
remember nothing of it. Teach us again.”
The bishop was humbled and replied to the hermits, “Your own prayer
will reach the Lord, men of God. It is not for me to teach you; instead, I ask
you to pray for us sinners.” The hermits then turned around and walked back
to their island.
This story by Leo Tolstoy has long been one of my favorites, not just
because it is a classic in literature, but because the story teaches so many
valuable lessons. This is exactly why a story should be told or used in
therapy: because it's a method of teaching and a method of confrontation.

Story Elements

Let's talk about the elements of a story. Pretend this is a literature class
for a minute. What is a story? It's an imaginary or a real account of people
and events. There's a protagonist, a main character, a hero with whom the
audience usually identifies, and this is quite important because when we tell
stories to our clients, they see themselves in those stories.
One of my favorite stories from the big book of Alcoholics Anonymous is
a story of Jim, the car salesman. Jim, because of his own alcoholism, ends up
working as a salesman for a car dealership that he used to own. Many of my
clients, even if they’ve never owned or worked in a car dealership, can relate
to the main character in that story because they too have sometimes suffered
humiliating consequences because of their drinking.
Every story has three different types of scenarios in it: an antagonist or a
challenge or a conflict. And every story has a resolution. Stories are great
because every story is ultimately about change. If there is no change in the
story, then there really is no story. Stories have themes and morals. The
message of the story may be explicit, or it may be implicit, but it's still there.
Metaphors make for excellent stories. One type of metaphor is a
comparison or analogy stated as equivalence, for example Road Hog, Couch
Potato, Rug Rat. And parables are something we're all familiar with, both
from Christian Scripture as well as Eastern Scripture: a story or short
narrative designed to reveal allegorically some principle, moral lesson,
psychological reality, or general truth.
Hypnotherapy is an activity or interaction intended to bring about
rehabilitation or social adjustment, and stories, being about change, are
excellent tools for accomplishing those goals because stories are natural
hypnotic inductions, natural trance inducers. Trance is a state in which
internal perception has become more important than external perception or in
which a limited aspect of external perception has become so important as to
preclude the rest of the external perception.
And trance happens naturally through the process of storytelling. My
mother is a Montessori preschool teacher. When I observe her classroom,
kids will be all over the room doing their own thing in their own different
corners, but sometimes she brings them to the line. The line in a Montessori
classroom is where kids learn things, and sometimes on the line she will tell
them a story. Even though they've all been doing different things, they
become a single focused group during story time, their eyes all watching my
mother as though they were mesmerized.
It's amazing how kids who are so busy doing other things can set all of
that aside to enter a trance state where internal perception - the story they are
imagining as it is told - has become much more important than external
perception. So, trance is not something unnatural. It's not something
mysterious. It's something we all experience on a regular basis, and
storytelling is a great way to induce trance in therapy.
Why would we tell a story or a metaphor in hypnotherapy, for example,
the story of the old hermits of Leo Tolstoy? Well, stories shift the filters of
our perception. They have unconscious meaning. They bypass conscious
resistance. If I tell somebody what they should do, there is a power struggle,
but if I tell them or share with them a story, it bypasses conscious resistance
to the message. It is a great way to conceal a confrontation.
As we've been talking about in ACT therapy, a story can break old
relational frames and create new relational frames. I love stories that are
based on metaphor and ACT therapy recognizes the value of metaphor. A
metaphor is like a seed. It plants an idea in our unconscious mind. It
germinates in the subconscious mind and comes to action in our conscious
mind.
Here are some examples of short metaphors:

Life is a journey.
Purposes are destinations.
Means are routes.
Difficulties are obstacles.
Hypnotists are guides.
Achievements are landmarks.
Choices are crossroads.
A lifetime is a day.
Death is sleep.
A lifetime is a year.
Death is winter.
Life is a struggle.
Dying is losing a contest against an adversary.
Life is a precious possession.
Death is a loss.
Time is a thief.

There are just so many different metaphors and each one of those
metaphors can be very powerful and activate subconscious learning. They
bypass critical or conscious resistance and our clients will attach unconscious
meaning through these things. You might even think of metaphor as being the
language of the subconscious!

Passengers on a Bus

As I mentioned, metaphorical stories are an important part of ACT

therapy. One group of ACT students made short animated videos of some of
these stories; they can be found on the Internet and are easily shared with
your clients: http://youtu.be/Z29ptSuoWRc
One of the earlier ACT metaphors, and one of my personal favorites, is
called “Passengers on a Bus.” This could be told to a client in either of two
ways:

Explicitly: telling them what the metaphor is all about

Implicitly: letting them attach their own meaning to it.

From Kelley:
Younger children (usually 7 and under) need the explicit version –
they haven’t yet developed the ability to map across from metaphors
and are still interpreting them literally. This can also be true of older
kids and adults who are on the autism spectrum.

Let me share with you an introduction to both ways. Explicitly, I might

say this:
I'm going to share with you a story about being a bus driver. And when I
talk about picking up passengers at different bus stops, this is really like our
mind picking up thoughts.
Then I can go into the story with the meaning already explicitly stated.
Alternatively, I could let the meaning by implicit:
Let me share with you a story. Imagine that you are a bus driver. [I like
to make the client the main character.] Imagine that you're driving your bus,
and as you drive your bus, you stop at various bus stops, to pick up
passengers.
Notice I've begun the story just by setting up the story, but I haven’t told
them what it's all about. In implicit storytelling, I trust that my client, through
his own or her own reservoir of knowledge, will attach the meaning and
significance to the story that’s most important to them. This really is very
similar, btw, to the tradition of Milton Erickson, who was a master
storyteller.
Imagine that the chair you're sitting in is the bus driver’s chair. In fact,
you can even hold your hands up if you want to as if they're on the steering
wheel and imagine that you're driving the big bus.
As you go to the first bus stop, you're going to be picking up some
passengers. Of course, you didn’t choose the passengers that ride the bus.
They choose to ride the bus, and they might not necessarily be the passengers
that you want on the bus. Maybe one of those passengers is called self-doubt.
Maybe one of those passengers is called criticism. Maybe one of those
passengers is called despair. But as you drive the bus, you're going to be
stopping at another bus stop and picking up even more passengers.
And again, some of these passengers may be passengers you enjoy,
maybe a passenger of joy or a passenger of calm. But maybe you'll also pick
up a couple of other passengers you don’t really want on the bus. And as you
continue on to the third stop and the fourth stop, picking up more and more
passengers, the bus begins to fill. And as you drive the same old route picking
up passengers, you noticed there are other places you could go. You could go
the scenic route, or you could go the interesting way, or of course, you could
just continue on the similar route.
If you decide to make a turn and deviate from the same old route, maybe
some of those passengers will speak up. They’ll start talking to you. Maybe
self-doubt will say, “Are you sure you want to do this?” Maybe criticism will
say, “That’s not the best way to go.” Maybe anger will say, “Hey, get back
on the same old route. We don’t want to be over here.”
Some of those passengers might actually have something nice to say: “
I'm really glad that you decided to take the scenic route today. I'm really
enjoying the interesting way today.”
As the bus driver, it's impossible to listen to the direction from all 60
people. So, you of course get to pick and choose who it is that you’d like to
listen to. Or, maybe as the bus driver, you’ve decided that they're simply
passengers on a bus and you don’t have to listen to any of those passengers.
You can simply drive the bus wherever you would like.
Now, there's an example of a metaphorical story from ACT therapy.

The Tomato Story

Milton Erickson, who revolutionized hypnosis and made a huge influence

on modern therapy, told a lot of stories, including personal stories, in his
therapeutic work. One of my favorite stories is a story that Milton Erickson
told, but I tell it from my own perspective because I think that Milton
Erickson and I must have had the same grandmother. In fact, I'm going to
share this story with you. Perhaps you even had the same grandmother as I or
the same grandmother Milton Erickson had. I often ask my clients to close
their eyes and just relax as I tell this story:
When I was a kid, my grandmother had a garden, and I'd love to go out in
the garden and help my grandmother work. It was one of my favorite things
to do as a kid.
My grandmother always had flowers in her garden. She had vegetables in
her garden as well, and she even had fruit trees. Growing up in Chicago, I
always look forward to the melting of the springtime snow when my
grandmother could plant the seeds for the new year. She would take two
stakes and a string and stretch it out and plant her seeds. Now, I remember I
would just lie there on the earth and watch each and every day as my
grandmother cared for her plants and cared for her seeds, waiting for those
seeds to begin to germinate.
It was always exciting when they would start to come out through the
earth, and they would begin to grow, and the vines would grow a little bit
longer and a little bit larger, and the vines would begin to have little yellow
flowers on them. I would watch those flowers until eventually they would melt
away, and a small green bulb would emerge. That green bulb each and every
day seemed to get a little bit bigger and bigger and bigger. My grandmother
would prune the garden, and she would water the garden, and she would
clean anything out of the garden that had made its way in there that
shouldn’t have been in there. She would fence the garden to keep the rabbits
away.
She cared for her garden each and every day, and each and every day
those green bulbs became larger and larger until eventually they began to
change color: a little bit orange and eventually red. And by the end of the
summer, my grandmother’s garden was yielding the most beautiful and
delicious tomatoes I've ever eaten in my life. In fact, when I was a kid, one of
my favorite things was before dinner when my grandmother would go out in
the garden and pick some of those tomatoes, and she would cut them up and
put them on a plate with a little tiny bit of oil and a little tiny bit of balsamic
vinegar. She’d add a little bit of sea salt and a whole lot of pepper. We would
have those fresh tomatoes before a meal as a salad or an appetizer.
It occurred to me one day long after I was an adult those tomatoes never
had to ask my grandmother, “How much rain from the sky should I drink?
How much nutrition from the soil should I absorb?” Each and every spring
my grandmother would plant the seed. She would tend her garden, and the
tomatoes never spoke to her. They never asked her anything. The tomatoes
simply did exactly what a tomato is supposed to do, yet by the end of the
summer, they were absolutely the perfect size, the perfect texture, the perfect
color, and completely delicious.
What's the point of that story? In this story, I was mostly implicit rather
than explicit. Whom could that story help? Remember, I work with obese
clients. When I tell the story to my obese clients, I usually tell it with long,
lean cucumbers rather than tomatoes. But I tell the story with tomatoes as
well on a regular basis. What does this tell an obese client?
Listen to your body. Our bodies will tell us what we need.
What other type of client might benefit from this type of story? Think
about it for a moment. There are a lot of different messages that our clients
could attach to such a story, and stories like these are excellent things to share
with our clients to teach them both implicit and explicit truths.
Milton Erickson shared wisdom in his stories. He told stories and
metaphors to confront and he used stories as a way of making suggestion.
In addition to ACT therapy and Ericksonian hypnosis, where are stories
used? Well, of course, the big book of Alcoholic Anonymous starts out with a
story and a poem about the war. Likewise, Jung in psychotherapy certainly
was predicated in large part on the mysticism of stories. Pastoral counselors
in their sermons are often using stories, the parables of Christ.

Why are Stories Therapeutic?

In a story, there is an identity. You become the story. In a story, I can see
a bigger picture and how my experiences might be related to others. For
example, the story of my grandmother told from my personal perspective.
The application here is that there's somebody who cares about you that will
take care of you. Maybe the lesson is there's somebody who can teach you.
The therapeutic value of a story is to help clients choose a valued path (as
they say in ACT therapy), to adapt morals that are consistent with the values
that are most important to them, and in many cases to teach self-control.
(Many of Aesop’s fables are about self-control.)
Stories provide a vicarious experience. Just last night as I was setting up a
new laptop that has Windows 8 on it, I noticed that Microsoft provided me
with a tile called “Travel.” Although I have had the opportunity in years gone
by to travel all throughout the world, it has been years since I've done much
traveling, so I noticed that tile and pressed the button. I kept scrolling through
and looking at all the places. For about an hour I enjoyed this webpage
provided by Microsoft and had a vicarious experience that didn’t require any
airfare, air travel, international hotels, passport controls, or bed bugs. Stories
do the same thing. They can provide a vicarious experience, which can be
particularly useful both to couples and individuals.
If you choose to implement storytelling into your repertoire of techniques
and strategies in hypnotherapy, there are a couple of cautions, and one of
those is only tell stories you're familiar with. If you want to tell a new story,
simply practice it. One of the interesting things about therapy is that we don't
think we have to practice it. A musician practices his instrument. A singer
practices his singing. A hockey player practices his hockey sticking. A
basketball player practices his free throws, but in therapy school we’re never
told to practice our therapeutic technique. Yet we need to practice in order to
be successful. So become familiar with stories. Make sure you know the story
and practice those stories.
If you are telling stories to clients and letting the meaning be implicit
rather than explicit, make sure the client whom you're working with has
abstract reasoning skills.
Of course, it's important not to break rapport by telling a story.
Storytelling should only be told to increase rapport, to engage your client, to
draw them in. Tell a story that clients can relate to if you choose to tell a
story. For example, I never tell my clients religious stories unless they have
already told me that those stories are important to them.
Not too long ago, I had a smoking cessation client. He needed to quit
smoking because he was not healing well after an amputation, and of course
smoking reduces circulation. It causes complications in healing from those
types of surgeries, so when he came to see me, he was in bad shape. I didn’t
know where to start with this guy, but on my intake form, he had written that
he liked Bible stories.
It's the only thing he had written. For those who don’t know, my
bachelor’s degree is in ministry, and much of my education has been
religious education, so I'm very familiar with Bible stories. Because he
brought that to my office, I shared with him the story of creation in Genesis,
in which God creates by speaking. And then I moved into affirmations so that
he could create the state of being a non-smoker.
I try to tell stories my clients can relate to. Maybe if I have a client who’s
got a Master’s Degree in English Literature or Russian Literature, I'm going
to share Leo Tolstoy’s story, or if I'm talking to somebody who’s about my
age and they tell me their favorite thing was watching Saturday morning
cartoons, I might tell them one of Aesop’s fables.
If you are telling a story, don’t get the details wrong. It's important not
only to remember your story, but also to make sure that you're a good
storyteller who can cover all of the details. By the way, there is nothing
wrong with reading a story to your clients. Absolutely nothing wrong with it.
In fact, I keep a selection of story books on my shelf, and even though they're
stories I'm familiar with and have read many times, I'll sometimes say to the
client, “Let me read for you a short story.” And I'll then pick a book and read
a story, even one out of Alcoholics Anonymous.
Where do you find stories? They're everywhere: mythology, folks tales,
dreams, movies, fables, parables, TV shows, history, life, Milton Erickson,
Chicken Soup for the Soul, the big book of Alcoholics Anonymous. A story
doesn’t have to be true. It doesn’t have to be perfect. It can be a joke. It can
be humorous. It can be funny. However you choose to tell a story, recognize
that that story can be quite valuable to your client.

Seven Steps to Good Storytelling

According to my friend James Hazlerig who is a master storyteller in

Austin, Texas, there are seven steps in good storytelling. He has a Master’s
Degree in English Literature, and he earns his living telling stories at
Renaissance Fairs. He also sees clients in the Austin area. The Seven Steps
are as follows:

Learn to enjoy and collect stories. Every time you go to the

bookstore and you think you're going to buy an important self-
help or therapy book, also buy a story book or a poetry book.
Know the structure of a story. Every story has conflict and
resolution. Most traditional stories use three events to establish a
pattern.
Adapt and improvise on a story if needed to meet your client
where they are, for their particular needs.
Make eye contact when you tell a story.
Use the voice as an instrument. Find your rhythm and cadence,
using tonality that punctuates, and always remember that silence
can be as valuable as a spoken word in telling a story.
 Show a story with your words. Don’t tell it. Use sensorial
descriptions: sights, sounds, scents, touches, flavors.

Metaphor, story, parable - all can be effective components of therapy, and

all are employed in Contextual Psychology. It's my hope that this chapter has
inspired you to collect a repertoire of therapeutic stories to use with your
clients.

Co-Creating Stories

One of the best things that happens through studying and using hypnosis
as a helping modality is that we get to improve our creative abilities. Whether
that is using our own subconscious resources to find and utilize effective
techniques for our clients or we use them to help ourselves personally, “going
there first” is a great idea.
While you have learned above the value of using narrative approaches
with clients, imagine taking it to the next level when you involve them in
creating stories that find solutions. If you reflect on one of our main goals
when helping clients - empowering them by teaching them skills - you then
become aware that including them in the story process does just that.

Reverse Metaphor

Story telling and story making speak directly to the subconscious and this
happens organically - without conscious volition. If we ask a client to create a
story about their specific challenge, the conscious mind can easily get in the
way, though, especially if there is any trauma connected to their problem.
Here’s a solution to that dilemma. It’s easy to do:
Ask you client to tell you a story, any story. You can suggest they start
with “Once upon a time”. As they create the story, you take notes,
paraphrasing salient points. Once they have finished, you read it back to
them, asking if they want to change anything.
Once they are satisfied with their story, you start at the beginning, reading
the story back again, this time in sections. Ask if there is anything or anyone
in their life that is relates to the story. They will often identify with the
protagonist in the story, for example.
 Continue on, moving through the story, asking your client to map across
to situations, people or events in their life. They will be surprised at how their
creative imagination came up with some perfect metaphors for what’s
happening in their lives and they will also gain new awareness and
perspective, and maybe even some solutions!
12
 CASE APPLICATION AND STRUCTURE OF
THERAPY

L ET ME SHARE WITH YOU TWO CASES IN WHICH I USED THE METHODS OF

Contextual Therapy over the last couple of months. Of course, I've changed
the clients' names and other demographic information to preserve
confidentiality.

Suzie's Case

Suzie is a 35-year-old female who came to me with pre-surgical anxiety.

In fact, when she called she basically said, “Look, I need to see you as soon
as possibly can because I'm going to be having surgery two weeks from
now.” She got my number from another client whom I had previously helped.
But she didn’t hear about me until just a couple of weeks prior to surgery.
What I had time to do during those two weeks was three sessions, and this is
very important. Most therapists traditionally schedule sessions one week
apart. Why? Because that’s what therapists do. For how long? For fifty
minutes. Why? Because that’s how long a therapy session is. I almost always
spend at least ninety minutes with my clients in a first session, and I'm not an
avid clock watcher. Sometimes I will spend thirty minutes with a client in a
follow up session, and other times I'll spend another hour and a half when
they're in a follow up session. That really depends on the client and what the
presenting issues are. Rather than trading my time for dollars, I sell solutions.
So, I scheduled three sessions with her in about a ten-day period. I
recognized that I only had three sessions to work with her. Because anxiety
was the number one issue, I spent my time teaching her first-session, second-
session, and third-session core skills of Mindfulness Meditation and exercises
of Acceptance.
Earlier on in this course, I took her through an exercise where a person
pictures themselves sitting in a conference room table. No chairs are around.
It's just them and a box in the middle of the table. They could take those
things out of the box, put them on the table, and simply observe that they're
present. I used that imagery with this client who was having a very hard time
accepting the physical condition that she was in and the experiences she was
about to, being just thirty-five years of age.
Notice I did not ask her in what other areas of life she was experiencing
anxiety. Because three sessions are not a long period of time, I kept our work
tightly restricted to the immediate problem: Twelve days from our first
meeting she was going to be having a surgical procedure, and she was scared
out of her mind. And that fear might have caused her to make decisions that
are unhealthy, maybe even in the extreme canceling the necessary surgery,
which was something she was contemplating.
And by using a combination of Acceptance exercises plus basic
Mindfulness training in that first session, she was able to experience at least
the hope that she would be able to manage her anxiety better between then
and the surgery. In session two, she was still having a lot of physical
symptoms associated with anxiety, even though she reported that the
Mindfulness exercise was tremendously helpful to her. She was one of those
clients who found it so helpful that, instead of practicing with intention twice
a day as I often ask my clients to do, she said she practiced three or four
times a day.
Four or five days following that first session I had the second session with
her. She certainly was improved, but anxiety was still so bad that it was
making her physically sick. This time, I taught her Progressive Muscle
Relaxation, which was pioneered by Edmund Jacobson in 1928. I am sure
that nearly every hypnotherapist learns about Jacobson’s Progressive Muscle
Relaxation at the beginning of their career. The research validating the
effectiveness of Progressive Muscle Relaxation is incredible.
I did not take forty-five minutes to go through a process of Progressive
Muscle Relaxation with her. I didn’t go through all sixteen of Jacobson’s
different muscle groups. What I did was what I do with most of my clients
when I teach them Progressive Muscle Relaxation. I teach it in a very non-
threatening and simple way, and I usually take about ten minutes to go
through the basic process. I use a process of passive relaxation rather than
having them tense and relax, tense and relax each muscle, the way the
Jacobson did. I do, however, start out with a tense-and-relax cycle for the
fists before starting at the top of the body and going through the various
muscles of the body: the shoulders, the arms, the belly, the back, the seat, the
thighs, the shins, the calves, and even the little muscles of the feet.
I find that Autogenic Training blends well with Progressive Muscle
Relaxation, so with this anxiety-ridden client, I taught those strategies as well
in the second session.
In my third session with her, I reviewed her practice. I asked her some
solution-focused questions from Solution-Focused Brief Therapy, and then I
had her future-pace her wellness. What is future-pacing wellness all about?
It's all about really what I talked about in the Positive Psychology chapter of
this book: Creating a thought that produces an experience.
Additionally, I gave her homework assignments for after her surgery:
some MP3 Autogenic Training and Progressive Muscle Relaxation sessions
that I have prerecorded. Her instructions were to continue practicing these
things after the surgery was over because the research shows us that these
strategies of Mindfulness, Progressive Muscle Relaxation, and Autogenic
Training when applied before surgery and then utilized after surgery do three
things: reduce complications, decrease dependency on drugs, and increase the
speed of recovery.

Bob's Case

Bob was a 56-year-old obese male. His scale maxes at 350, so he was
guessing he probably weighed around 400 pounds. He presented with a lot of
work-related stress. Having been remarried now for three years, he had
teenagers in the home including step kids and biological children. He
recognized that at 56 years of age, unless he loses about half his body weight,
his weight is going to kill him.
In fact, he expressed surprise that he was still alive. He had come to me
following a series of tests because he was considering bariatric surgery. For
whatever medical reason though, he was ruled out as a candidate for bariatric
surgery, so he came to me stressed, obese, and depressed - catastrophically
depressed, obese to the point where he was at risk of imminent death, and
stressed out from remarriage, children, work-related obligations and other
things in life.
I worked with him for six sessions. (When I'm done talking about Bob,
I'm going to share with you why Suzie was three sessions and why Bob was
six sessions.) In my initial session with him, I had him identify his presenting
problem, but also the strengths that he possessed. I inquired about his
physical condition and his medication to rule out any health-related
contraindications and to make certain that his physician knew that he was
going to be addressing these issues with me. It's very important when we
have somebody who is at such imminent risk of heart attack, stroke, or other
health-related complications due to their physical condition that we make
sure that they continue to work with a physician on these issues. And then I
had him do a self-assessment of his strengths using the tool that I wrote
called The Nongard Strength and Resources Inventory.
In that first session, I taught him Mindfulness. I remember he was one of
those clients who said to me, “Okay, I can see how that would be helpful, but
I'm not sure that’s really going to change everything.” And I said to him,
“Well, you're right. Doing that right now here in my office probably didn’t
really change much. But your assignment is to practice that exact same
exercise every day, three times a day between now and your next session. In
fact, I'm going to email an MP3 to your cell phone - that's what I do with my
clients - and you're going to practice this with intention every day between
now and our next session, which is going to be a week from now.”
When he came in for session number two he said, "Wow, as far as my
stress level, that Mindfulness exercise has been amazing. I did it for the first
two or three days, and I thought to myself, 'Oh, I can see how this would be
helpful,' but about halfway into the week, I began to find myself sitting in my
car or even at my desk and being mindful rather than stressed out. That’s
been really helpful."
To extend his Mindfulness practice, we did the Raisin Exercise described
earlier.
Now, one of the things that was interesting about him is that he was also
an adjunct university professor, and he loved teaching at that level. He taught
one class a semester, but he’d been doing that for more than twenty years,
and he really enjoyed contributing to his field by educating young people. So,
I took my dry-erase marker and my marker board, and I did a fifteen-minute
lecture on Relational Frame Theory for him, teaching him what I taught you
in our chapter on relational frames. Then I spent some time with him looking
at some of the frames that he’d created. Next, I asked him to practice
breaking relational frames with Mindfulness, both in the session and over the
next week.
I used the Miracle Question during session number three. I often ask the
Miracle Question during the first session, but I waited until the third session
with him because I wanted to establish some goals related to his work stress
and related to his marriage. Also, I wanted to develop some rapport with him
before I really began a questioning process. I could tell just by his personality
that teaching him some skills that he could immediately apply was going to
be agenda number one and then going back for a questioning approach would
be something that would be more effective after developing therapeutic
rapport.
Maybe it's because I'm an educator, maybe it's because I'm a personal
fitness trainer, or maybe it's because I recognize that people only do what
they know how to do - in any case, I spent part of session three teaching him
again. I taught him, not a complete course in nutrition and multiple food
choices, but a couple of healthy food choices that he could make.
I often ask my clients, “What is it that you are eating? What do you have
for lunch today? What did you have for dinner last night?”
People always think that what they're eating is healthy, but rarely is it, so
I can help them with their food choices. With him, I also gave him some
ideas for preparing for those days when he was going to be unable to eat at
home and was going to have to eat out.
I also gave him some shopping instructions. This is something I teach to a
lot of people whom I see for bariatric counseling. A lot of the clients whom I
work with shop like Americans, not like Europeans; if you want to be
healthy, you'll shop like a European or an Asian rather than an American.
In America, we usually get the Thursday newspaper. We cut out all the
coupons. We wait until Friday payday and then we take our cart to the
grocery store that always has everything and is never out of anything, and we
load up two carts with the stuff that we can possibly use our Thursday
coupons for with our Friday paycheck. Then we buy it all and put it in the
deep freezer, and we eat that over the next two weeks before we repeat the
process with new coupons and a new paycheck. When people shop like that,
they're purchasing unhealthy foods: prepackaged, frozen foods that can be
stored rather than food that is fresh and healthy.
I spend a fair amount of time in Eastern Europe and in Asia as well, and I
have noticed something interesting there. Never once did we go to the
grocery store and buy food for a week.
Instead, at the end of every day, we would go to the market before dinner
and buy everything we needed for dinner tonight and that which we needed
for breakfast tomorrow. What that meant is we were always buying fresh
food. We were going to be eating the food tonight that we were buying right
now and only storing food until the morning because we were going back to
the market again tomorrow.
(If you watch British television, you may notice that characters coming
home are always carrying a bag of groceries. That's because they shop and
eat European-style, not American.)
I tell clients to shop daily for groceries rather than weekly for groceries. It
makes a huge difference in the quality of foods that they will be eating.
In session number four with Bob, I reviewed how his Mindfulness
practice had resulted in automatic mindful awareness, and he reported that his
stress level was dramatically decreased at work. I used a Likert scale, and he
had gone from an 8 or a 9 in week one down to a 3 or 4. The stress related to
his marriage and his home life had also improved; although he still found it
stressful at a level 6 or a 7, when he came to see me he said it was an 8 or 9
and heading for a 9 or a 10. So that's an improvement of several points.
Bob found this course of treatment to be so useful to him that he wanted
to share it with somebody. So, in session number five, he brought his spouse,
not to fix her, but because he wanted her to hear from me the things that I had
taught him that he thought would be helpful to her. In other words, he didn’t
bring her saying, “You know, my wife is screwed up, and she needs a
therapist, too.” He brought her because he wanted to say, “Honey, wow this
guy has really helped me by teaching me some things, and maybe they're
useful to you, too.” So, in session number five, I really went back to lesson
number one because this was her starting point and for him it was a great
review.
In session number six, we talked more about food preparation, food
choices, and other practical things related to weight loss. Most of my clients
do not go on a diet. What they do is they make substantial changes in their
food choices, the way that they prepare food, and the way that they eat their
food. I generally follow the recommendations of a nutritionist lifestyle.
I'm not going to call it a diet because it's not something my clients are
ever going to end. There are a lot of great books in this area. Some of you
may be familiar with John McDougall’s books. Those are something that I
certainly recommend. My favorite book to recommend is one that I keep in
my office and give to all of my bariatric clients: Joel Fuhrman's Eat to Live. I
buy copies ten or twenty at a time, stack them in the bottom shelf of my
bookcase in the office, and give those away to clients all the time.
In session number six, Bob decided to follow up our six sessions by
participating in our eight-week online Mindfulness Meditation Development
Program.
After our initial six sessions, I probably saw him for four or five more
sessions on a monthly or quarterly basis. When I have clients who are that
big, I want to make sure that they're staying on track. In the past year and a
half, he has come very close to the weight loss goals which he had
established for himself, and he is continuing to improve.

Notes on the Case Studies

When working with these clients, I did not attempt to discover why they
were anxious or obese. I simply dealt with that which they could change: the
present. Both clients found they could change the present by applying the
ideas of Mindfulness, Acceptance and the other approaches of Contextual
Hypnotherapy discussed in this book.
Now, I mentioned that I would share with you a structure of three or six
sessions. I offer my services as brief therapy. I want my clients to know that
therapy doesn’t last forever. I let my clients know that there may be situations
and scenarios where they might want to access my services in the future. For
my bariatric clients who are losing so much weight, we might meet on a
quarterly basis. But I typically schedule my clients and have them commit to
either three or six session packages.
The reason for this is important as I want my clients to be invested in the
process, so I want them to commit depending on the nature of the presenting
problem to three or to six sessions. I do a lot of work with cigarette smokers,
and I see them for three sessions. When I see somebody for pre-surgical
anxiety, three sessions are a great number. When I'm dealing with somebody
like severe obesity, six sessions and additional follow ups are probably
useful.
If I have a client who has a lifelong history of catastrophic depression or
bipolar disorder, probably six sessions to really make sure that they can focus
on these things between sessions is important.

From Kelley:
When working with clients who have chronic issues, and anxiety,
depression, obesity, many illnesses and related pain all qualify as
chronic, it’s vital to equip them with skills they can use to continue to
lift themselves out of these states of being. Contextual Hypnotherapy
provides these skills. We can teach them in relatively few sessions,
which is a wonderful change from what they may have previously
been trying.
 NOTE FROM THE AUTHORS

Although much of this book was originally published as a training manual for
psychotherapists, our hope is that the practical information contained herein
has been of value to you as a hypnotist. Conventional counseling borrows far
more from the traditions of hypnosis and medication than is credited. By
using the techniques and ideas that we promote in this book you will be
creating actionable strategies you can use in your next hypnosis session. You
can go now into your next session with a plan, with the ability to seize the
power of Now to create lasting transformation in your sessions.
I am reminded of how even the simple things can create transformation.
Years ago, I was having a rough day. I had finished a keynote speech and
headed to the airport only to discover than I had missed my flight, the last
flight of the day. I had already turned in my rental car, and so I hopped the
bus to the airport DoubleTree Hotel. I was feeling overwhelmed. I was tired, I
was dreading a wasted day of extra travel and I was concerned about the
expenses. But when I sat on the bed and bit into the famous DoubleTree
cookies that were waiting for me, like the warm chocolate inside, my
problems just melted away.
How did those problems just melt away? The cookie was therapy. It
literally brought me out of my head and into the moment. And while the
cookies are great, my hope is that the skills in this book will have lasting
impact for your clients. By using the techniques in this book, you will
literally be creating a healthier alternative - therapeutic cookies comprised of
mindfulness.
There are a couple things Kelley and I really want you to take away from
this book. First, in applying Contextual Hypnotherapy approaches, you will
find far more power in the Now than in the past. In fact, in many situations it
is not important to delve into the past at all. As hypnotists we are activating
the resources within, and those resources are sufficient to resolve almost any
chronic issue, physical, emotional and even metaphysical.
Second, we want you to take away the idea that just because one
discipline has adopted a specific technique, it does not mean that discipline is
the only one entitled to use it. Long before psychology existed as a domain
for helping people, living in the present (mindfulness) was being taught as a
strategy for better living to ancient civilizations.
Third, we hope that this book has empowered you to leave behind the
limitations of outdated methods or the unhelpful belief that there is only one
way to do hypnosis. Regression to Cause is not the only way and, it might not
even be the best way.
Fourth, Kelley and I hope you go back through this book and take some
notes. Doing this will cause you to create scripts and outlines you can use in
training and teaching your clients the skills of Contextual Hypnotherapy.
You now have an opportunity to join those professionals who have
moved beyond the simple approaches of hypnosis taught in a basic class and
elevate to the expert level by positioning yourself as a practitioner who is
able to use new research and new ideas, integrating them into your hypnosis
practice. How are you going to conduct your next session? I suggest by
adding mindfulness training skills to your pretalk, and by using the methods
of cognitive behavioral therapy to structure suggestions. You can draw on
positive psychology in crafting your suggestions as well. And the best part?
You can now use the ideas of patient education that psychotherapists have
found so useful and use these as experiential processes with your clients.
If you have any questions, Kelley and I are both available to answer them
for you. We would love to hear from you. Feel free to post any questions at
any time on our forum at HypnoticAnswers.com.
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