Mindfulness, Hypnosis and Psychotherapy: Where do they meet?

The following is the next in a series of informal conversations between Trudy Goodman, Ph.D., Elisha Goldstein, Ph.D. and Steven Hickman, Psy.D., the teachers for a unique upcoming professional training retreat entitled “Mindfulness in Psychotherapy” to be held October 2-7, 2011 at the Joshua Tree Retreat Center in Southern California. Enjoy! Today, Trudy Steve and Elisha talk about the relationship between mindfulness and hypnosis in psychotherapy and beyond.

Trudy Goodman, Ph.D.

Trudy: (I recently had an opportunity to explore the differences and similarities between mindfulness practice and hypnosis with a client. I thought it might be worth exploring here in our ongoing conversation on mindfulness and psychotherapy.) 

In mindfulness practice, we give our full attention to one subject at a time as a way of training our minds to be attentive to another dimension of awareness, “beneath” the discursive consciousness and the thinking mind (what the hypnotherapist calls executive functioning), and yes – the protective activity of the amygdala can be activated and trained via conscious, mindful breathing for example. Meditation does mirror the receptivity of hypnosis in this way.

In hypnosis, one is led and taught how to drop down beneath the flow of habitual patterns of thinking and perception to a receptive, open state where the therapist’s suggestions can be embedded and incorporated into conscious living. We are doing something similar but different, too. We may also invoke the relaxed, alert, receptive altered state, but we emphasize investigation, inquiry, and looking deeply at what is arising (with the intention to understand, rather than to judge, and the accepting, non-judgmental approach is similar in hypnosis).

One difference is that with mindfulness meditation we are learning how to be both receptive – open, relaxed, alert; and active – forming the intention to stay with experience as it arises and passes away. One goal of MBSR training is to establish and cultivate mindfulness — your ability to direct your awareness intentionally towards what is actually happening, in real time, moment by moment, so you can receive more information, understanding, and compassionate insight as your life unfolds.

There’s no conflict between what your hypnotherapist tells you and what we’re doing because we are actually engaging many capacities of consciousness simultaneously when we focus on one thing at a time – many cognitive and emotional qualities come into play, like the intention to aim or direct awareness, to sustain a close connection with the subject of awareness, AND with awareness of the ebb and flow of mindfulness itself – a kind of meta-awareness – with clear comprehension combined with the suffusion of warmth, acceptance, kindness, even affection, into our mindful awareness of ourselves, others and our world.

So yes, your mind can and does operate on more than one level at a time. What we are doing is bringing more and more of this activity into conscious awareness. We are cultivating strong mindfulness and metta, enabling us to make more conscious choices about the way we relate to experience.  Hopefully, wise choices that result in our living committed, compassionate lives, and enjoying more peaceful, harmonious, loving relationships along the way!

Steve: While I am no expert in hypnotherapy, I do have a strong sense that both mindfulness and hypnosis share an interest in helping people “get out of their own way” in regard to longstanding but dysfunctional, limiting or unskillful habits, attitudes and behaviors. The single-pointed, quiet and patient focus of both practices allows us (both client and therapist) to see these habitual patterns against a plain backdrop of awareness, rather than the cluttered one of everyday busy-ness.

I liken our attempts to make sense of our problems with our typically distracted, multi-tasking minds to trying to watch a movie when someone is trying to carry on a conversation with you at the same time. Both the movie and the conversation might make sense in their own rights, but together they become a mass of conflicting and confusing features that seems completely overwhelming and sometimes discouraging. Mindfulness practice (and therapy) allow the client to develop the attitudinal skills to observe this chaos and respond patiently and kindly, and the attentional skills to direct attention (and psychological resources) toward the “real” issues and perhaps away from imagined or feared ones. This shift can allow a person to see things for what they are, and to recognize where the constructions and stories that we all create are just that: creations, and not facts to be dealt with or resolved.

I am told that hypnosis cannot bring about behavior that is not first desired by the patient or client. If someone does not truly want to change a particular behavior, hypnosis has no magical ability to transcend that desire. Similarly, intention is at the heart of mindfulness in psychotherapy. We seek to tap into the natural intention that each of has to move toward ease, kindness, compassion and fulfillment, by reducing the “obscurations” of habit and conditioning, and thereby reduce suffering. Not much difference between hypnosis and mindfulness in that, is there?

Elisha: I want to make sure we’re differentiating here between mindfulness as a way of life and formal meditation practice. We can practice mindfulness in formal and informal ways and I think the guided formal meditation practice is the one that can be confused with hypnosis. Having been the recipient of both, I would say the big difference for me is that mindfulness is couched within a much larger context and can be seen as a way of life. Not in any dogmatic religious way, but as a philosophy and practice that we can bring into all the things we do.

Mindfulness at its core trains the mind to more actively drop into a kind attention, cultivating a natural warm presence to bring with us throughout our days. In my opinion, this is at the core of self-healing.

Mindfulness also brings people together in community who are interested in living a more present and compassionate life. This may be one of the most important pieces. Ultimately it’s my belief that the most helpful way for people to make change is through a community of peers who support them with this. I see people who engage with mindfulness in psychotherapy and beyond having an inclination toward wanting to be a part of a community that supports a more mindful life.

We invite you to join in this conversation.  Please share your thoughts, questions and stories below. Your interaction creates a living wisdom from which all of us can benefit. As these conversations accumulate, we are collecting them on a separate page of our blog (see the tab above labeled “Mindfulness and Psychotherapy” for the archive) for review and comment. Visit the UCSD Center for Mindfulness Professional Training site for information on Mindfulness in Psychotherapy retreat training.



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10 responses to “Mindfulness, Hypnosis and Psychotherapy: Where do they meet?

  1. I am a clinical psychologist working with individuals with persistent pain. I have thought about mindfulness in a particular way and have been teaching what I call a variation to my patients. What I have been doing is helping them attain a state of diffuse awareness where they strive to observe the entirety of their experience as it is occurring. By this I mean I help them strive to attain a state of awareness where they are simultaneously observing sensations, movement, breath, sounds, thoughts,,images, memories, fantasies, images etc. where they are attending as much as possible to all that is happening as it is happening as an observer.

    It seems that what happens for those who enter into this state is that they cease to be aware of any one thing and therefore the pain recedes into the background along with the myriad other contents that can be experienced. My goal is to help patients disidentify from any experience so that they may observe without becoming.

    After reading what you 3 wrote on the web-site, I am not sure that what I am doing with my patients, fostering this state of diffuse awareness is related to mindfulness at all; even though from a colloquial way it is all about being mindful of this moment as it were. Especially as Trudy wrote “we give our full attention to one subject at a time as a way of training our minds to be attentive to another dimension of awareness”. I seem to be doing the opposite, giving full attention equally to every experience

    I am a past president of the American Society of Clinical Hypnosis and all my publications are about the use of hypnosis. I see Hypnosis as a an exquisite state of highly concentrated awareness where there is a dissociation from all elements of experience except that which is suggested.

    In my own way I thought of Mindfulness as the opposite, a freeing of attention to conditioned patterns of awareness and an openness to experiencing all that was happening as it was happening in real time… Kind of the difference between focused awareness and diffuse awareness.

    It may be in the end that I don’t understand mindfulness …

    But now I am wondering if I am really doing something else by promoting this diffuse state of awareness.

    • I really appreciate your thoughtful exploration of this topic and I hope that Trudy or Elisha will chime in as well.

      I think that Trudy’s line that you quoted is certainly one aspect of mindfulness practice (the ability to give full attention to one object of attention) but my experience tells me that mindfulness practice may be as much about developing the ability to deploy attention in a whole variety of ways, but with clear intention and awareness to that deployment, whether it is single-pointed focus on the breath or a thought or a sensation, or an open “choiceless awareness” of all that is arising. It sounds like what you are encouraging in your patients is something along the lines of choiceless awareness, which is perfectly in line with what I understand mindfulness practice to be.

      My experience with teaching MBSR and working with individual clients, is that this open monitoring state is hard to cultivate without something of a foundation/grounding in the more focused forms of mindfulness practice, so maybe there might be some benefit to introducing the more directive practices (like Body Scan or Awareness of Breath meditations) first and then moving on to the open monitoring state?

      While I tend to hesitate to use the word “skills” when talking about mindfulness in a clinical sense, I do think that whether it is hypnosis or meditation/mindfulness, people are learning how to recognize and work with the natural power and deep inner wisdom of the body-mind. Not bending any of it to a specific purpose, but getting out of its way so it can do what needs to be done to contend with the challenges of life and the impact of suffering.

      What do you think?

  2. Thanks for your reply, it was most helpful
    After I wrote you last Friday I was continuing to think about the issues and called a friend to discuss the issue ; who reminded me of thinking about it as developing choiceless awareness as you also suggested. I tend to emphasize the teaching of choiceless awareness to my patients when I want them to disidentify from their experiences as in being that experience alone (the difference between saying for example I am depressed versus I am aware of a feeling of depression…) and instead to be the experiencer who is not that experience. I use hypnosis with my patients when I want them to identify with a particular experience or an aspect of some experience or to “act as if” and become “X” or “Y”. In some ways I am making choices as to whether disidentification or identification in this moment would be most therapeutic to help the patient achieve a greater state of inner peace or harmony. In the end though it is about teaching how to be a aware of a self that is not identified with roles, thoughts, emotions, sensations etc., etc but from those experiences make choices about how to deal with the various storms that arise in our outer and inner life.

  3. Trudy Responds:

    “we give our full attention to one subject at a time as a way of training our minds to be attentive to another dimension of awareness”

    To be a little more specific, a little less mystical, the “other dimension” of awareness can be the open, panoramic awareness that Phil is guiding his patients to learn how to access. I’d be interested to know how you do this, Phil, without their having much practice at it.

    And, yes, non-identification with experience is a key element of mindfulness practice.

    Thank you for helping to clarify what was written, especially since hypnosis is your area of expertise, one of them at least!

    Warmly,
    Trudy

  4. I appreciate this thread and the work you are all doing very much. Many thanks to you all (including Phil).
    I am a mediator but also teach spiritual work with a methodology based on the Diamond Work, and more recently, trauma sensitive methods of being in the present moment. Practicing this myself and helping others to do it also is important for both conflict resolution and one’s personal work, I believe. Actually, I am starting to understand the two must come together. See http://www.elizabethbader.com/SelfandIdentity.pdf
    Much of the work as I teach it is similar to Phil’s approach: being present to the totality of experience as this helps to not identify but also to go back and forth between that and the specific areas of the body — really it all occurs in the body — and issues that arise there.
    I find making distinctions between mindfulness and a somatically based presence helpful in some ways. It preserves a certain amount of the purity of the various methods. Yet I love the fact that you are open to including all in the work you are interested in and teaching.
    Elizabeth

  5. Thank you Elizabeth. Your articulation of the subtle, but important, differences between mindfulness and somatically-based methods is helpful. I always resist the tendency by some to say “well, what you’re doing is just _____ (fill in whatever they do) with a different name”. Each approach has its own texture, tradition and intention and we should be attending to the commonalities, but also the important differences, so we can appreciate the various threads of the powerful, wide-ranging healing cloth.

  6. Many thanks for such a welcoming response Steve.
    Yes, this is exciting in a way. If we could really understand and know and honor the differences of the subtle but different approaches to the present moment what a wonderful wealth of additional understanding that would bring to us and others. We could be so focused then, and so effective. A very exciting prospect.
    Best to you and all for the work you are doing,
    Elizabeth

  7. I am a long time meditation practitioner and a psychotherapist who has been using mindfulness practices in my work for a while. I have done training in both MBSR and MBRP and recently have been doing training in Ericksonian hypnosis. I have been finding the intersection between mindfulness and hypnosis to be quite fascinating.

    One of the most striking things I’ve noticed is a similiarity in view of each paradigm of helping a natural skill or ability emerge. Mindfulness is, after all, an ability we all latently have–and what we’re doing is helping someone train and harness that ability to help them live better lives. Likewise, much of Ericksonian hypnosis is about helping a person discover for themselves the answer to his or her problem. This is a key notion of Erickson’s work, as I understand it: the patient knows the answer but just needs to find it–needs help letting the answer emerge from the unconscious.

    I’ve also definitely noticed some cross-over between trance state and states people seem to enter doing formal mindfulness practice: sometimes individuals will report trance-like phenomena (for good or bad) while doing the body scan, mountain meditation, or breathing practice. Sometimes people with whom I’m doing hypnosis will also report spontaneous mindfulness awareness–knowing thoughts are simply thoughts, that a memory is just a memory, that they are not their experience, etc–during or after being in a hypnotic state.

    In my experience, the two are quite different–the focus and ways of doing each are quite different, but I’m fascinated by their intersection and how, in my experience, knowledge of one informs my experience of the other.

    Thanks,
    Nick

  8. I finished my doctoral thesis in 2000 on the effects of meditation on respiration and the temporal lobes (particularly the amygdala). My interest was fuelled by the assumption that meditation could be used as an adjunct to psychotherapy and I wondered how meditation can initiate psychological changes. Therefore the statement below caught my eye.

    Trudy writes: “and yes – the protective activity of the amygdala can be activated and trained via conscious, mindful breathing for example”. Could you explain what you mean by “the protective activity of the amygdala”?

    Another issue which I have given some thought is the following:
    “One difference is that with mindfulness meditation we are learning how to be both receptive – open, relaxed, alert; and active – forming the intention to stay with experience as it arises and passes away.” A key concept in Mindfulness meditaiton, as I understand it, is the notion that sensations etc, continually rise and pass away. However, in my experience with mindfulness meditation I have found that behind the thoughts and sensations there is something permanent. In my experience this exercises a strong influence on my behaviour and thinking. In the beginning it was very subtle and easy to miss, but over the past 10 years of meditation practice it has become very tangible. By want of a better word or definition, I have called it a non-conscious tension. It is clearly felt in the body, so I agree with Elizabeth Bader above that “it all occurs in the body”. It is also related to afflictive emotions, like anger, sadness, and fear.
    “Mindfulness at its core trains the mind to more actively drop into a kind attention, cultivating a natural warm presence to bring with us throughout our days. In my opinion, this is at the core of self-healing. (…)
    And, yes, non-identification with experience is a key element of mindfulness practice.”
    My questions are: is it really possible to cultivate compassion when having dysfunctional, conditioned behaviour patterns, and will non-identification with one’s emotional responses heal one?

    I seem to think of Mindfulness meditation as it is used in psychotherapy as a kind of cognitive behavioural therapy, which means that is is an intellectual exercise. And because of that, the body is omitted. But feelings are felt in the body and involve the body. How can a person heal while staying on an intellectual (cognitive) level, without geting in touch with their emotions on a body level ? Does non-identification free a person from conditioned afflictive emotions? It is my experience that it takes a lot of training to develop the ability to dis-identify from one’s emotions, but perhaps it is easier to develop this perspective with hypnosis?

    Best regards,
    Yvonne

  9. Hi Yvonne,
    While it is always difficult to know about another’s experience, your post is interesting to me and touching because there is such specific self-observation in it. it seems to me that what you are discovering that may perhaps be behind it all is or is related to the self. Not everyone agrees that there is a self — or even the possibility of a self — and neuroscience has yet to really find one and may not be able to.

    But as even Anton Damasio had to admit, regardless of the theories human experience includes a sense of self. Leaving it out of the equation may make things appear a whole lot simpler than they are.

    The body and the self — there is a complicated subject. I think if we what we mean by the body can be expanded a bit, it might be accurate to say that in one part of us, one level of our awareness, we can be “mindful” or not identify while at other levels, emotionally, instinctively, there may be other things happening. So I would say that we can indeed not identity with one aspect of our experience while others go on functioning without our cognitive remarking on it. Yet, for integration we need to go more deeply into it all, including the body and the messy stuff like emotions, and also learn to release that element of our experience.

    This is a somewhat long post so I will stop here, I think.

    Thank you for your discoveries and work,

    Elizabeth

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