American Journal of Clinical Hypnosis

ISSN: 0002-9157 (Print) 2160-0562 (Online) Journal homepage: http://www.tandfonline.com/loi/ujhy20

Two are Better Than One: Dual-Track Interventions

in Hypnotherapy

Shaul Navon

To cite this article: Shaul Navon (2018) Two are Better Than One: Dual-Track
Interventions in Hypnotherapy, American Journal of Clinical Hypnosis, 60:4, 348-356, DOI:
10.1080/00029157.2017.1312261

To link to this article: https://doi.org/10.1080/00029157.2017.1312261

Published online: 27 Feb 2018.

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American Journal of Clinical Hypnosis, 60: 348–356, 2018
Copyright © American Society of Clinical Hypnosis
ISSN: 0002-9157 print / 2160-0562 online
DOI: https://doi.org/10.1080/00029157.2017.1312261

Two are Better Than One: Dual-Track Interventions in

Hypnotherapy
Shaul Navon
Hypnotherapy and Psychotherapy Clinic, Tel Aviv, Israel

The current article provides clinical conceptualizations of six dual-track interventions for dealing
with stuck and resistant situations in hypnotherapy. Dual-track interventions are based on the
assumption that patients habitually regard their problems as one-dimensional and thus, tend to
become rigid in their attitudes toward these problems. Dual-track interventions constitute hypnother-
apeutic processes for transforming patients’ negative and rigid perceptions of their problems into
more positive and functional mental states that provide a dual-dimensional view, thereby offering
patients more options and freeing them to contend with their problems more effectively. We
introduce a novel hypnotherapeutic tool from the Illness/Nonillness Model (Navon 2014). This
tool, known as the differentiation tool, can transform negative perceptions of psychological and
emotional conditions to positive and hopeful perceptions.
Keywords: clinical hypnosis, cognitive hypnotherapy, duality

Monoideism, Duality, and Contradiction

Monoideism

Monoideism is a state in which the mind is concentrated or the attention is fixed on one
idea. It is a state of prolonged absorption in a single idea, as in mental depression,
trance, and hypnosis (Merriam-Webster Dictionary, 2016). For example, a patient with
obsessive–compulsive disorder (OCD) may insist and believe that his healthy mother
will live and not die only if he washes his hands 28 times every day. This belief is a
monoideistic idea and an obsessive idea, encompassing one, and only one, thought or
belief. This patient cannot see any alternative to washing his hands 28 times per day.
The only chance for this to change is for the patient to commence therapy. For example,
if as the result of therapy, the patient washed his hands only 3 or 5 times a day rather
than 28, this would be regarded as a positive psychotherapeutic change representing a
new flexible alternative for the patient’s monoideistic view of hand washing. The
patient’s single-frame view of the problem would be transformed to a two-frame view

Address correspondence to Dr. Shaul Navon, Hypnotherapy and Psychotherapy Clinic, 6a Hamagid Street, Tel Aviv
6522436, Israel. E-mail: snavon@netvision.net.il
 DUAL-TRACK INTERVENTIONS IN HYPNOTHERAPY 349

—a dual (or even plural) state of mind (Navon, 2015). Any monoideistic view of a
patient’s problem generates a stuck and resistant situation in therapy. Turning a stuck
and resistant situation into one of cooperation requires a dual-track intervention (DTI).

From Monoideism to Duality

Duality

The discipline of philosophy has always been heavily steeped in arguments concern-
ing duality (sometimes plurality), and contradictory elements have dominated the realm
of philosophical thought, reasoning, and knowledge. As suggested by the word “dual,”
duality refers to having two parts, often with opposite meanings, as in the dualities of
good and evil, peace and war, love and hate, up and down, and black and white.

Contradiction

Duality creates contradiction. In classical logic, a contradiction comprises a logical

incompatibility between two or more propositions. Contradiction occurs when the
propositions, taken together, yield two conclusions constituting logical and usually
opposite inversions of each other.

DTIs

In psychotherapy and hypnotherapy, DTIs consist of two paired concepts or two frames
that come together. The first frame includes the problem presented in the patient’s
narrative verbal expressions at the beginning of therapy, usually characterized as a stuck
problem/situation. The second frame constitutes the therapist’s alternative verbal
expression, which is intended to liberate the patient’s stuck problem/situation. The
relationship between these two frames is dialectical. We use the term “dialectical” in
its Hegelian sense in that these interventions consist of two coordinated contrary
movements that may be thought of as thesis and antithesis. Thus, the human
mind invariably moves from thesis to antithesis to synthesis, using each synthesis as
the thesis for a new opposition to be transcended at a higher level, in a perpetual waltz
of intellectual achievement (Mueller, 1958).
At the onset of therapy, patients usually consider their problems in a completely
negative light. They see only one aspect of the problem and feel stuck and helpless to
bring about a change. DTIs are intended to “liberate” patients from their stuck version
of the presenting problem by creating an alternative narrative that utilizes patients’
words and narratives. In this way, DTI bring about a sense of mastery and control over
patients’ lives and at the same time generate the desirable therapeutic change without
threatening their subjective perception.
350 NAVON

DTI is comprised of six hypnotherapeutic interventions: split-screen technique;

conscious/unconscious dissociation induction; confusion technique; paradoxical inter-
ventions; future questions, future maps; illness/nonillness model.

Split-Screen Technique

To help patients differentiate a negative frame from a positive frame, we utilize the
Spiegel split-screen technique (Spiegel, 1989, 1996, 2010). This technique is particu-
larly useful in helping patients see traumatic situations from different points of view.
The technique enables them to give themselves credit for what they did to protect
themselves or someone else. It facilitates the restructuring experience and provides a
generic framework that can be used with many types of problems experienced by
patients. According to David Spiegel:
(The technique) provides the patients with an opportunity to review a traumatic event in a way that is
less intensive than reliving it directly, so you can use this technique to cool things down a
little. Second, it carries with it the idea that we can separate our psychological experience from
our physical experience. (Spiegel, 2010, p. 35)
The split-screen technique is a typical hypnotherapeutic DTI. The patient commences
therapy with one option, the negative “erroneous” sinistral screen on the left, followed
by the alternative “correct,” dextral, positive screen on the right. These left-hand and
right-hand screens constitute a DTI.
Example:
A 45-year-old patient was in a car accident. He is now wheelchair bound and hospitalized in a
rehabilitation center, where he is undergoing intensive physiotherapy to rehabilitate his walking
ability and motoric independence.
Patient: “Every day, when I wake up in the morning, I see a visual picture of my car accident and my
injury. It frightens me and I become anxious and highly stressed.”
Therapist (while patient is in a trance): “Now you can see two screens in front of you: a large screen
on your left and a large screen on your right. The left screen shows your visual picture of your car
accident and injury. This picture has not yet changed and unfortunately shows no improvement.
Now, look at the right-hand screen. See how your picture will change for the better when you are
able to walk again on your own two feet. See yourself waving goodbye to the devoted rehabilitation
staff. See how your health has changed for the better … ”
This vignette demonstrates a DTI that transforms the patient’s problem from a
monoideistic view to a dual view (two screens), thus releasing him from his stuck
mental condition. As therapy continues, the patient becomes more and more optimistic
concerning his mental and physical condition.
 DUAL-TRACK INTERVENTIONS IN HYPNOTHERAPY 351

Conscious/Unconscious Dissociation Induction

Another DTI in hypnotherapy is called Conscious/Unconscious Dissociation Induction.

In contrast to the conscious mind, Erickson saw the unconscious mind as related to both
the left and the right hemispheres of the brain (Erickson &, Rossi, Rossi, 1976, p. 277).
Erickson often used voice tone variations to reinforce this dissociation: “I use one tone
of voice to speak to the conscious mind and another to speak to the unconscious … you
are establishing a duality” (Erickson & Rossi, 1976, pp. 159–160). In his detailed
article, Lankton (2016) offered an in-depth description of the use of conscious/uncon-
scious dissociation in the induction process, including a transcript of a hypnosis session
and demonstrative examples.
Example:
A 30-year-old pianist suffers from performance anxiety and stage fright. He refrains from performing
on stage and had cut down his musical career.
Therapist (while patient is in a trance): “While you are now on stage playing the piano, and as you
listen to my voice, your conscious mind listens to my suggestions while your unconscious mind
helps to deepen my suggestions, even deeper than that of your conscious mind … Your conscious
mind will feel more secure and more confident while playing the piano on stage, and your
unconscious mind will liberate you from any social fear and anxiety … So, both your conscious
mind and your unconscious mind are getting together to make you feel better relaxed, better
concentrated on the music better perform on stage … Conscious and unconscious, two are better
than one…”

This example demonstrates a DTI by directing the patient’s attention to his conscious
mind (first track) and to his unconscious mind (second track). During subsequent
sessions, the therapist fluctuates between the concepts of conscious and unconscious
to help enhance the patient’s cooperation and transform his performance anxiety into a
better-controlled and calmer psychological state of mind.

Confusion Technique

Erickson (1964) wrote the following about his confusion technique:

Two words with opposite meanings are used. For example, one may declare so easily that the present
and the past can be readily summarized … To illustrate this example: “Today is today but it was
yesterday’s future even as it will be tomorrow’s past.” Thus are the past, the present and the future all
used in reference to the reality of today. (Erickson, 1964, p. 183)
Example:
A 30-year-old woman who suffers from a sleep disorder.
Therapist (while patient is in a trance):”You are right. You have the right to sleep at
night, right. Sleep tight tonight and all other nights. To wake up at night—it is not right,
but sleep is right and good night is right. During night, feel heavy or light, both are right
to sleep tight, and know no worry during night, when you’ll write from left to right
352 NAVON

“good night” even if you are left at night—that’s right and wake up bright in the
morning light to do what’s right.”
This short vignette of the confusion technique demonstrates a two-track hypnother-
apeutic intervention by using double-word meanings and homophones. The commu-
nication of suggestions are both reasonable and unreasonable. The Confusion Technique
is:
a play on words or communications of some sort that introduces progressively and element of
confusion into the question of what is meant, thereby leading to an inhibition of responses called for
but not allowed to be manifested and hence to an accumulating need to respond … It is reminiscent
of the childhood word games such as “if it isn’t not raining then it is raining. (Erickson, 1964,
p. 206)

Paradoxical Interventions

During the 1980s, paradoxical psychotherapy (Weeks & L’abate, 1982) rapidly became
one of the most important approaches to family therapy and psychotherapy. Clinicians
are attracted to paradoxical psychotherapy because it is short and produces immediate
change. Paradoxical psychotherapy meets the conditions of a DTI. Symptoms need to
be understood in terms of bipolarity, opposition, or contradiction (Rychlak, 1976).
Learning to find and emphasize the positive is only the first step in a paradoxical
approach. The second step is learning to reframe or re-label symptoms to achieve a
positive therapeutic outcome.
Example:
A 30-year-old man who is confused and feeling even more helpless because of his confusion might
be told that his confusion constitutes a breakdown in preparation for new growth. This statement will
have the effect of hypnotic suggestion in helping the patient accept his confusion, freeing him to
work on his specific problem. He will expect to change in some positive way.

Therapist (while patient is in a trance): “Your experience of being confused in many areas of your
life has made you a specialist in life’s confusion. It has taken you some years to gain that experience.
Therefore, only now are you sufficiently mature, prepared, and ready to move forward and gain new
experience by making a change in your life, reaching better decisions, and living your life more
efficiently.”
This vignette demonstrates a DTI. The first track is the present negative interpretation
of the patient’s subjective perception of his confusion. While the patient remains in this
same state of mind of “confusion,” the therapist introduces a second track—a new
positive reframing of the patient’s confusion. Thus, the patient’s negative perception is
transformed into a new, optimistic, and positive view of his confusion and helplessness.
 DUAL-TRACK INTERVENTIONS IN HYPNOTHERAPY 353

Future Questions, Future Maps

In an interesting article titled “Feed-Forward: Future Questions, Future Maps,” Peggy

Penn (1985) described a novel technique based on the notion that families/patients are
free to construct or imagine a different set of alternatives to their dilemmas in the future.
Pragmatically, future questions combined with positive connotations promote the
rehearsal of new solutions, suggest alternative actions, foster learning, discard prede-
termined ideas, and address the patient’s specific change model (Penn, 1985). In
particular, future questions are useful in coping with physical illnesses in which the
concept of future time is often frozen. The questions contrast and separate the patient’s
ongoing stuck solutions in order to free him to anticipate his possible recovery or
stabilization. The future question technique helps physically ill patients construct their
individual map of their future. This technique is typical of a DTI since it contains both
opposites within a dual approach: present versus future, freezing versus progressing,
suffering versus hope, illness versus recovery. The future questions, future maps
technique can be utilized in hypnotherapy. The following is an example of the use of
this technique with a patient with cardiovascular disease:
Therapist (while patient is in a trance): “I hear and understand how you describe and explain the
causes of your cardiovascular disease now. If you recover sooner than you expected, how will that
make a difference for you?”

Patient: “If I’ll recover sooner I’ll get going back to work sooner and become alive again.”
Therapist: “What will be the first and early signs of your recovery?”
Patient: “The first and early signs of my recovery will make me mentally and physically better
and more optimistic for gaining life again.”
Therapist: When did you begin to explain your recovery this way?”
Patient: “Few days ago, when I have done successfully all my rehabilitation program
exercises.”
Therapist: “When your cardiovascular condition will improve more, how will this condition
look?”
Patient: “It will look like God blessed me and gave me more life to years and more years to life
and happiness.”
This vignette demonstrates a DTI: present versus future, illness versus recovery,
present illness perception versus hopeful future illness perception. Future questions
during hypnotherapy generate a fruitful dialogue between patient and therapist in
order to produce a change in the patient’s attitudes, beliefs, and behavior regarding
the illness. This change will facilitate recovery or stabilization of the patient’s condition
in the future.
354 NAVON

Illness/Nonillness Treatment Model

The first version of a DTI was described as part of the Illness/Nonillness Model (Navon,
2005a, 2005b, 2015, 2016; Waxman, 2005). This model was formulated for use in the
context of psychotherapy with physically ill patients. Later, the Illness/Nonillness
Model was modified into the Illness/Nonillness Model for hypnotherapy (Navon, 2014).
During hypnotherapy, physically ill or disabled patients generally use both the
language of illness and the language of nonillness. The dialectic between these two
forms of language is based on three rules:

Duality

Two types of verbal expression—illness talk and nonillness talk—coexist in the

verbal expressions of physically ill patients during hypnotherapy.

Contradiction

Illness and nonillness are also involved in a relationship of contradiction. Indeed, the
prefix “non” serves to negate the word that follows it. A patient can use either the
language of illness or any other language that is not the language of illness, with the two
concepts clearly differentiated.

Complementarity

Illness and nonillness also complement each other. The illness motif follows a
nonillness motif and vice versa. Such a shift takes place because the relationships
between illness and nonillness are interrelated, dependent, and complementary.
These three major rules constitute a dual-dialectical conceptualization—a novel
theoretical conceptualization in psychotherapy (Navon, 2014). The Illness/Nonillness
Model also utilizes a novel and fundamental tool know as Differentiation/Integration.
Here is an example of a patient with diabetes mellitus.
Therapist (while patient is in a trance): Tell me what is happening with your illness?
Patient: I’ve had enough of coping and struggling with this rotten illness, day in, day out … I feel
trapped … bogged down … I feel weak and fatigued … I must give myself insulin
injections twice a day … I focus on my body all the time … I’m not sure about my
future … When will I have respite from my suffering? … I devote too much energy to
food … I’ve got social problems … I’m already an outsider … different from healthy
people … I have to give myself injections at fixed intervals and I hate it … I’m
desperate … how will it end?
By means of differentiation work, the therapist helps classify the patient’s statements
into expressions of illness and expressions of nonillness:
 DUAL-TRACK INTERVENTIONS IN HYPNOTHERAPY 355

Patient: “I’ve had enough” (nonillness); “ coping and struggling with this rotten illness” (illness);
“I feel weak and fatigued” (illness); “I give myself insulin injections twice a day”
(illness); “I focus on my body all the time” (illness); “I’m not sure about my future”
(nonillness); “When will I have respite from my suffering?” (nonillness); “I devote too
much energy to food” (illness); “I’ve got social problems” (nonillness); “I’m already an
outsider” (nonillness); “different from healthy people” (nonillness); “I have to give
myself injections at fixed intervals” (illness); “and I hate it” (nonillness); “I’m despe-
rate…how will it end?” (nonillness).
To help physically ill patients differentiate between illness and nonillness, the
therapist can utilize any of the six described DTI techniques.

Discussion

The current article is a first attempt to put forth a clinical treatment protocol involving a
dual-track approach to hypnosis. The conceptualizations of the six interventions aim to
overcome impasse situations and stuck problems and to avoid cul-de-sac and dead-end
therapeutic results.
One point of emphasis in DTI seems to be that when patients commence hypnother-
apy, their pathology is described by a single frame of reference, offering only one
choice or one option. After the therapist introduces an alternative frame of reference,
two frames now exist. These two frames or two alternatives are engaged in a dual,
contradictory, and complementary relationship with each other. Thus, when the therapist
offers alternatives to a patient’s presenting problems, the patient changes his views
concerning the presenting problem. The existence of two frames enables the patient to
fluctuate between the two. Previously, at the beginning of therapy, the patient experi-
enced the problem as everything, as complete, as “reality” without any alternative. Now
the patient can experience freedom of choice.
The novel differentiation tool in the Illness/Nonillness Model (Navon 2005a, 2005b,
2014) involves the art of looking for dual alternatives in the patient’s narratives based on
the rules of duality, contradiction, and complementarity. The prefix “non” as in “no-pain
”/“nonillness” creates a positive connotation for the patient. This “nonillness” expression
is very similar to how physicians use the verbal expression of “no abnormality detected”
(NAD), indicating that the patient is fine and does not have any medical problem.
Additionally, DTI turns patients into active participants in the hypnotherapeutic
process without forcing them to leave their perceptions of reality behind. The problems
they bring to therapy are usually stuck and one-sided. Hence, the therapist must propose
DTI that can liberate the problem to generate a change.
At the onset of hypnotherapy, patients usually believe their problems are completely
negative. They see the problem from one perspective only and feel “stuck” and helpless
to bring about a change. The therapist liberates patients and enables them to change
their thoughts, emotions, and behavior patterns.
356 NAVON

DTIs help patients differentiate between behavior patterns and enable them to choose,
thus bringing about a sense of mastery and control over life. By employing the
diagnostic perspective of the medical model, clinicians can introduce nonillness talk
into the medical encounter, thus bringing about a shift in patients’ perceptions about
their illness (Waxman, 2005).
From the perspective of clinical experience and practice, DTI may be regarded as
offering some major advantages for stuck and resistant patients. Any such benefits
should be the topic of further investigation.

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