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RH: Michael, thank you very much for writing Chapter 4. It has triggered a lot of interest and fascination and it’s given us at The Neuropsychotherapist a really good reason to bring you in to our little neck of the woods. I’m just wondering, there are a number of aspects I want to look into this more deeply, but if you could just discuss a little bit what led you to include this chapter, The Brain, the Mind and Hypnosis in the 5th edition 

MY: Well, you know the field of hypnosis is built around the recognition that perception is subjective. As soon as you start to consider the deeper questions – what’s going on in the brains and minds of people who are able to demonstrate these remarkable hypnotic phenomena? People who are able to undergo surgery without a chemical anaesthetic; where people who are able to generate these perceptual shifts and response to suggestion, open up creative abilities and therapeutic options and all of those kinds of things. So, you really can’t study hypnosis without having some appreciation that it’s the brain and the mind that filter all the sensory data coming in from the universe around us, as well as generate their perceptions subjectively. This gave rise to many key questions. Are there morphological differences? Are there differences in the actual physiology of the brain of people who are highly responsive to hypnosis versus people who aren’t? Are there brain differences in how people process suggestions and if so what are those differences? How does the brain influence perceptual processes and vice versa? What’s been particularly interesting is over the last 10 or 12 years now because of the advances in brain scanning technologies. We’ve had the opportunity to study these mental processes, the neuroscience of hypnosis, to a degree that we never able to before. When I wrote the 1st edition of Trancework back in 1984, these technologies just didn’t exist, although some of them did in the most rudimentary of forms, but now the fact that we can watch brains respond to stimuli in real time, microsecond by microsecond, is absolutely fascinating. So, it’s really opened up two general areas of inquiry: one is the instrumental approach to neuroscience – trying to understand something about what’s going on in brains of people as they undergo therapeutic suggestions – where you’re really striving to understand something about the relationship between mental processes, perception and mental health, the use of hypnosis instrumentally to help change people therapeutically; and then the other is the intrinsic focus – trying to understand something about the limits of perception. How can we introduce shifts in perception such that a person can be given the suggestion to bite into this red juicy sweet apple, when in fact it’s an onion, then the person takes a big bite out of an onion and they tell you how sweet it is and what a great apple it is? What a fascinating thing to have people respond to these suggested realities instead of the actual realities. That’s part of the intrinsic focus: how does that happen?; when is it out the limits of perceptions?; how far can we take them?; and what does it really mean in terms of information processing and the cognitive part of this relationship between conscious and non-conscious processes? So, as you can tell we can we can go in a 1000 different directions and ask far more questions than we actually have the answers to, but I think that when you operate in the world I operate in, which is the clinical world, to be able to induce hypnosis, guide people into hypnosis, provide them with these suggestions about ways that they can experience themselves differently that will enhance their quality of life, and then see them actually do that, is fascinating. It’s been a long career for me, 45 years now, of watching people go through these procedures that we call hypnosis and generate these remarkable shifts in their experience as a result.

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RH: I’m delighted that you took the time and space in the book to actually describe some of the methods that we look at the brain – FMRI, SPECT, PET – it’s a really great education for anybody, a lot of people involved in neuropsychotherapy will find that section of the chapter really informative. It was delightful.

MY: I hope so. I’ve made the book as thorough as I know how to make it given the space limitations. I could have written 20 volumes out of all the information available.

RH: What’s also delightful in pointing out those various forms of the way we explore how the brain may or may not be working in any given situation, is that you do point out, as I do when I speak, that we’re still a bit club fisted, still a bit clumsy in using these mechanisms. For example, an fMRI is a very noisy experience which is not necessarily conducive when investigating some of the relaxed methods like hypnosis or mindfulness and meditation.This is really good information to bring to our attention. I want to just amplify that you are very thorough. 

MY: Thank you, there’s a lot of work that went into it. You talk about the noise factor in the fMRI, and, of course, that is a factor because you can’t really measure how intrusive it is in terms of the ability to respond and yet, at the same time, that’s not the most confounding factor. The most confounding factor is that we are more than our brains. Even when you are watching someone go through an fMRI and you’re seeing that this part of the brain becomes more active than that part of the brain, which is interesting, but it doesn’t tell you what they’re reactive with. It doesn’t tell you what’s actually going on in there. I don’t know that we will ever reach that point of sophistication, but those are the underlying questions. When somebody is able to demonstrate this remarkable hypnotic capacity – what’s actually going on in there? It’s not just brain activity, there’s something else that we can’t yet define or measure that’s happening. That’s an important point, too. When people try and oversimplify hypnosis, they’ll say things that are just patently wrong. Some say that hypnosis is about delta waves or alpha waves, or that hypnosis is about right hemisphere activity – things have been soundly disproven – I think that the take away message for anybody listening to this is that there is not yet a reliable neurological signature where you can look at a brain in hypnosis being measured by any scanning technology currently available and be able to say, “That person is in hypnosis.” It’s just too variable across people. We’re getting to the point where we’re starting to see tendencies, but we’re still a long way away from being able to identify a “hypnotic state”.

RH: This is the attitude we’re taking at The Neuropsychotherapist, and the Science of Psychotherapy, that what we’re looking at is a development of interesting and potentially useful information which can guide us, perhaps inspire new thoughts and new ideas, and perhaps give us some confidence about ideas that we may well already have, but, as yet, quite a lot of what we’re doing in neuroscience is still altering and changing and shifting, as you say. It’s the idea of continuing to move forward in therapeutic practice hoping to deepen our understanding and improve the nature of our experience. Is that what we are hoping for?

MY: That begins with a premise that this will one day be measurable scientifically and I’m not confident about that. In the same way that we have yet to arrive at a precise definition of love or patriotism, we have yet to develop a satisfactory definition of hypnosis. Here’s something that has been around for how long? Hundreds of years certainly, possibly thousands of years – and we’re no closer to defining it now than we were 10 years ago or 50 years ago. It’s really amusing to me, in a way, because in the world hypnosis the American Psychological Association has an entire division called the Society of Psychological Hypnosis dedicated to the field of hypnosis and roughly every 10 years, or so, they appoint a “blue ribbon panel” whose job it is to define hypnosis. To me, it’s simply amusing that you get these guys together to try and figure out how to define this in a way that’s going to be acceptable to the majority of people. Every time they do this, for the next year everybody spends time shooting it down and arguing why it’s inadequate. Then we wait around for the next nine years for the next definition to come out. I’m not so confident that you’re ever going to be able to define this in a precise way, much less measure it in a precise way.

RH: Absolutely, and I think that, not so much a lack of confidence in actually getting out a clear definition, but that understanding that we keep growing in our understanding is expressed in the fact that this is the 5th edition of your book. That from 1984 there are new things, new shifts. Michael Yapko’s mentalisation of this process has shifted and changed and re-organized, yet the work you do the good work you do was good work in 1984 and its good work now in 2019. I’ve only been watching you since 2005 when I came into the Milton Erickson Foundation’s arena through my mentor honest Rossi, but every time I’ve watched you work I’ve seen you do good work. Quite often, I see you do new and interesting variations, but it’s always good work. That ability to frame yourself around that focus, is that something that we need to teach more rather than teaching methods? I’m not sure how you might define that approach within the practitioner themselves?

MY: Well, I’m not sure I’m any better at defining what I do than anybody else is. I know there is a phrase that I most commonly use – attention with intention. The study of hypnosis really is the study of attention of what happens when people get focused –  when people experience a natural dissociation as they detach from the usual cues that guide their perceptions and make it possible for them to respond to suggested ideas, suggested realities, entirely subjective kinds of experiences. Once people suspend reality testing for a while the same way they do when I watch a good movie or television program or read a good book and start to entertain other ways of thinking about things and other ways of experiencing themselves, a very important perceptual flexibility evolves and of course flexibility is therapeutically the grist for the mill. This is one of the things I think was most useful from Milton Erikson’s work. Not long before he passed away, one of my colleagues asked him, “Dr Erickson you’ve never really formally stated a theory of psychopathology. What do you think causes people’s problems?” and Erickson had a one word answer, “Rigidity”. The goal is flexibility. How can I help this person flexibly behave differently, feel differently, respond differently, view things differently. That common denominator of always reframing is the essence, I think, of any good psychotherapy. The necessity to continually evolve and the necessity to continually adapt is a given. As you point out, the reason there is a 5th edition is because the field keeps changing. It keeps growing as the volume of research grows and the quality of research grows. Just from the 4th edition in 2012 to the new 5th edition, hundreds of studies have been published, high quality studies, that force me to redefine what I think I know. If you look at all the ways ideas change about the nature of therapy, the nature of the therapeutic relationship and the nature of suggestion, then if I was king of the therapy universe I think my first mandate would be that anybody who’s undergoing training in counseling or doing therapy of any kind would learn hypnosis to learn the communication skills and to learn to adopt the perspective that influence is inevitable. Now, how do we influence people for the better?

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This has been an excerpt from The Neuropsychotherapist Volume 7 Issue 5 – for the complete article and more interesting content, please subscribe to our website.