Last updated: 5 November 2015
During one of my recent webinars, someone asked me a question regarding working with clients in a clinical setting who are suffering from chronic pain or psychiatric disorders, and who also have a general mistrust of medical professionals – hypnotherapists included.
I’m glad someone asked me this question.
Not only to help the professional experiencing the issue, but also as it has given me the opportunity to share my response to this very valuable question with this community.
While my answer pertains primarily to the question below, I believe this approach is applicable (and so important) when doing any change work with clients.
Q (from Stephen): I work in a clinical setting with patients who have chronic pain and chronic psychiatric disorders.
They often have lots of trust issues from the military and “medical care” trauma, which results in a general mistrust of hypnotherapy. So the problem that I’m experiencing is that no matter what change work I try with them, I can’t get it to stick.
Lately, I’ve been trying to teach them how to build on temporary successes by building nested loops from session to session. But do you have any suggestions that would help me ? I would really like to learn how to help them overcome trust issues.
Me (Igor): Hi Stephen. Thank you for your question.
I will do my best to try and help – only it is hard to analyze what might be going wrong without a clearer picture of the interactions.
So I’ll do my best to offer you some educated guesses.
1. The first thing that typically goes wrong in a relationship like this is the actual relationship.
Most people I know are in a hurry to fix things and ironically, this tends to have the opposite effect.
The medical model in particular is guilty of this – doctors won’t listen, they interrupt and essentially treat the patient like a lump of meat – a biological machine that should just shut up and let them get on with fixing it.
I exaggerate, but you get the idea.
2. Related to this issue is the problem of being pushy.
Therapists and doctors sometimes think they always know what is best for the client so they just tell them… “Do X, Y and Z!”
This can be deeply insulting, especially when the client has a perfectly good reason why they cannot do as the doctor or therapist is instructing.
For example, a medical reason that the professional does not know about because they did not bother to listen or find out. Being in a hurry to fix the problem often ends up making the problem worse – many times over.
It’s a case of more haste less speed. So the first thing that needs to happen to show you are different, is kind of nothing. By which I mean, take time to unravel the client and their worldview before diving in and trying to fix stuff.
Find out about them.
Ask who they were before the trauma, what happened to them, and who they are now.
And of course, understand who they want to be. Who they are when they are not “doing” the problem.
With some people who have been chronically ignored, this step alone can reduce the symptoms dramatically.
It may take an hour or more (although, it usually doesn’t), but it is a huge step.
So step back. Listen. Appreciate them. Sympathize with their pain…but not too much – as too much sympathy sub-communicates that they are broken.
But just the right amount acknowledges the fact that they have suffered and that this was not right, fair or decent. Very often just a simple and genuine:
“I am very sorry that you had to go through that. It is not fair and nobody should have to endure that kind of treatment. I am sorry that you were treated that way.”
You’ll be surprised how that can drain an incredible amount of pain from a person!
Listen like they are the most important person in the world, and like their every word is precious and a piece of heritage that needs to be witnessed, remembered and honored.
In doing so, this will start you off on a very powerful base.
Milton Erickson sometimes spent hours taking a detailed personal history with people. I used to wonder why he would do that with some clients and not with others.
Since doing this myself, I get it:
The more trauma they have had, the more they need to vent, the more they need to be heard, the more they need someone to witness their pain, without flinching or being afraid of it.
In doing so, he educated them that their pain (emotional and physical) was not something he was scared of, and subsequently not something that they need to be scared of either.
All through the presupposition of how comfortably, curiously and kindly he listened. But when listening, don’t just witness their pain.
Witness their greatness, too.
This is called the “Gold Mining” process.
Find out who they are when they are bold, confident, happy, successful, admirable, interesting…help them put their life back into perspective.
Not by telling them to.
But by simply asking more about life events that shaped them.
Such as their hobbies, successes and strivings, so you’re essentially surprising them with how competent they were.
When done correctly, this Gold Mining process is deeply therapeutic.
I know of a number of cases where severe issues disappeared just because someone listened with rapt attention, and appreciated the person behind the stories.
One case that springs to mind was a client with chronic pain, severe stutters and a number of other ailments the doctors were stumped by. When the therapist took the time to listen and let the person vent everything in their life – and then start talking about their future, their dreams (this typically won’t be possible until they have vented the pain) – miracles happened.
In this case, the stutter virtually vanished. The pain dissolved. The cramped arthritic joints seemed to unfreeze themselves.
It was so dramatic that this doctor called the therapist to find out what the heck they had done!
So by listening deeply, kindly and keeping a constant flow so clients don’t get stuck on one story or loop, while looking for ways of opening up new and interesting parts of their life (past, present and future)… you set the scene for real change.
3. After you’ve successfully done the above step, you’re ready for the next step – collecting motivation.
Dreams, plans, ambitions, values, things of importance to that person…this is the fuel that gets the work done.
If work is not sticking, chances are high that you have incomplete motivation or blocked motivation (usually because you skipped step 1).
As by the time you have finished this stage, most people should be glowing like a Christmas Tree and purring like a cat! ======================================================================
In response to Stephen’s question, I did my best to “guesstimate” the most likely misalignment with the limited information I had.
But that said, everything above will still be of great value to anyone who is working in the field of change work.