M ic haeMl c Go oL,P CD

, CH
 ADDICTIONS
HYPNOSIS
A Toolkit for ImprovedOutcomes

MichaelS.McGee
LPC, DCH, MS
For thosewho dareto changeandthe professiona
who helpthem.Specialthanksto all thoseclients
whosecourageto changeand/orresistance
to
changemadethis work possible.
Contents

Introduction .........7
Motivation ...................17
Ambivalence ...,......21
Motivational Interviewing and Stagesof Change
Model................. 25
TherapeuticBasicsfor Success.....................37
Step by Step: The I to 4 SessionMode1............53
1 : Asse ssm e n..............................5
S e s s io n t 4
S e s s io 2
n : F e e d b a ck ...............6 9
n : Va l u e s
S e s s io 3 ...................7 1
..................75
Final Session:Plan for Success
Clo s in gT ho u g h ts ..................8 3
References ..........87
A p p e n d ix1 : Scr i p t .................9 1
Appendix2: Forms and Worksheets............97
 In the beginning,we wereall sober.The beginningof our liveswe
andcurious.A little babyhasno usefor alcohol,
wereactive,interested,
drugs, gambling, or sex. We may crave attention, clean diapers,food,
love, andwarmth, but we certainly do not look for mom to give us a beer
or a joint. Our first "addiction"would most likely be breastmilk or
formula.Thatis whatonewould considera healthycravingaswe needit
to survive.As we get a little older,the messages
we receivefrom our
cultureareto get quick fixes for our ailments.Let's face it, if we have
any mediaor predominantculturalinfluence,the message
experienced
appearsto be that somedrug canfix what ails us.

informationtitled "RelapseCulture"on this a few years

I presented
back at a conferencewhere it was very well received. One of the
we are exposedto in this cultureis
dominantsocietalcommunications
drug use,whetheralcohol,prescribedmedication,or someother illicit
substance.It is certainly hard to maintain sobriety in the face of thes€
messages.

Most personsdon't grow up with the ambitionto becomeaddicted.

We may want to be artists, athletes, craftsmen, entrepreneurs,or
scholars.It is pretty obvious that people who becomeaddictedto
were not trying out for the 'fteam"they endup joining.
substances

For yearsI haveworkedwith clientswho are substance

abusersor
substance I havebeena studentof addictionsresearchsince
dependent.
bekrrcgraduateschool.My thesisstudiesconcemedspirioal well being
I
andsubstance useamongcollegestudents.Sincethattime I haveworked needto changeand the combinationof techniquesI will be presenting
with variedpopulationsin communityservice,universitycampus,
and herearethe bestmethodsI know to makethis changehappenno\ir'.Most
pnvate practicesettings. I have used traditionaland
non_traditional of the techniquesI will be discussingwere not developedby me. I just
methodswith these populations.I believe that haditional treatment
hadthevisionto combinethemin a certainway sothat the outcomesare
methodshavetheir placebut aremostlyunsuccessful
as they often rely improved. This is powerful stuff. The methodsI will talk about are
heavily on extemal motivationsand penaltiesfor change.The
AA supportedby research.However,they havenot to my knowledgebeen
approachhasbeenvery helpful.It comesfrom a spiritualmodelthat
has usedin concertuntil now. I beganto combinethem in 2005andfor the
beena benefitto many.However,it alsofalls somewhatinto the extemal ratewith this populationhasrapidlyimproved.
lastfew yearsmy success
motivationcategory.Most personsdo not respondwith long lasting
changeto externalmotivators.Theyneeda reasonwithin to chance.
As I havestated,thereoftencomesa time whena personcandecide
that life as it is no longerworks. Somewill makean immediatechange
llcsenrchsupportsthe ideathat personschangeon their own. you
Somewill evenembracechangeas refieshingor stimulating.However
rrrighllruvehcnr.tl
lhc old songlyrics,..Sick
andtiredof wakingup sick this is oftena time ofambivalenceasmanyofus arehesitantwhenfaced
ntttl tircd". I lirrd thnt nost personswill ,,outgrow,,their use
of with change.Somewill sit "on the fence",in between,interrupted,or
strhsrrrrrccs
.s tllcy growancrcvorvewith life. Thisis moredifficultfor
pausedin life. This book is abouthelpingpeoplechange.The focusis to
tlroscwho stllrt it) cllrly adolcscence.
They do not seemto learnthe inrproveoutcomesfor thosewho want changeas well as thosewho are
appfopriateskillsarrdresponsesneeded to copewith thenormalupsand Nnbivalent.It is about fieedom. I mean freedom from addiction
downsof life. This may be a resultof usingsubstances earlyon to deal Hpecificallyand fieedom to choosegenerally.It is about enhancin
with difficulties and/or as a major meansof having fun. If
this has hypnotictechniqueswith powerful interviewingmethods.It is a path
happened,they may be ,.stuck,,in adolescentdevelopment.
These lowrrdsa new life. It is abouttransformation.
personswill havea lot of growingup to do if they get
sober.This can When I enteredgraduateschool,motivationalinterviewingwas in
makeit evenmoredifficult for themto maintainsobriety.But,
for most Its clcntivebeginnings.Miller & Rollnick's(1991) book had just
ofus, we would tendto out growthe problemas long aswe havenoryer
rcccnlly been publishedand "old school" substanceabusecounselo
reachedfull blowndependence.
rccrrrcd lo view the method with suspicion as it did not use
Doesthis meanwe shouldjust wait for changeto happen? .l.hc that were a mainstayof the moretraditiona
techniques
crrnliorrlulionitl
answeris, "Of coursenot,,.Thereare ways to find the nrotivaliolr Motivational is now
interviewing
rvc lpprorrchin subslanccabusetreatrnent.
 l{lrtglttlt ovct. ill llngultgcsby llsln(1g(5of trainers(Rosengren,2009).
Ilack llrerr.I rrrrs ercilcrl. lhc rnethodstruck a chord with me and I
cnrblircedtlrc lcelrrritlrrcs
eorrrplctely.
I attendedseveraltrainingswith MI
"expcrts"i l(l dcr orlrcrlirn; rcsearchproducedwith the techniques.
I also
understoodirrrntctlirrtc
ly that Mt could be used for a varieq/ of issues
beyondthe substanccabLrse field. [t was clearto me that the processof
eliciting intrinsicnlotivationlo cltangecould make successmore easily
obtainablein many clientsand/orsituations.I felt it was like discovering
the Rosetta Stone of therapy. It showed us the language and
communication that leads to successfuloutcomes. MI is useful across
multiple intelligence levels and styles of leaming. It is a key to
consciously unlock our clients from whatever constraintsstand in their
way. Wherever the client may be on their path to change,MI can assist
them to continue the proc€ss.And, when it is combined with hypnosrs,
the combination of conscious and unconscious intrinsic motivation
cannotfail to elicit chanse.
In this book, I wish to provide a framework in which
MotivationalInterviewing(MI) or MotivationalEnhancement
Therapy
(MET) can be combined with hypnotherapytechniquesto creare
powerfulclientchange.The hypothesisbeingthat asthesetwo therapies
arecombined,we canassistour clientswitl maximumtherapeuticeffect.
I will referenceresearch
that supportsbothmethodsasbeingstatistically
effective.I will thendescribethe techniques
in detailthat haveled to mv
clinicalsuccess
in combining
thesetechniques.
lrl
My first tenyearsof beinga therapistwherespenton the campus
abusers'
of a smallliberalartsuniversityworkingwitlr studentsubstance
I was the only personwho met with the studentsfor a time' I can
I
rememberteachingand meetingwith 177 studentsin one sernester'
would teacha six hour alcohol and drug educationcourse'Then' the
studentswould meetwith me individuallyfor a 30 - 50 minutesession'It
wasa high pressuresituation.This sessionwasmy onechanceto makea
differencein their lives. I can assureyou that no one who enteredmy
programwantedto be thereand most had no intentionof changingl
developeda style of counselingand educationfor thesestudentsbased
on MI. At first, it was difficult to keepmyself from wantingto direct
theiractionsin healthyways.Most personsin the helpingprofessions are
exposed We seewhatthey needto do sowhy don't
to this in themselves.
we just tell them to do it. Think aboutit lf this worked,we would all
whatwe
obeyeverythingour parentstold us to do. Mom andDad knew
shoulddo and we alwaysobeyedthem' Isn't that right? I know I did
cverythingmy parents,teachers,and superiorstold me to do I obeyed
just like my car canfly. Of course,manyof our clients
tlremcompletely,
know exactlywhat to do basedon the valuesof othersand aren'tdoing
it. So,thepuzzlewashow to elicit changefrom within the client'
I wasintroducedto Miller & Rollnick's(1991)first work on MI
you
luboutthis time.I wasexcited.This madesenseGetthe clientsto tell
why they shouldchangeand what they shouldchange'Find out what
nro(ivatcs themandutilizeit. Do not confrontor directthe clients'simply
urrirlc lltcm to find their own path towards change' I noticed an
ll
immediate change in myself and my clients as I began to utilize these
techniques.They actually enjoyedmy educationalcourses.My substance
abuse student class evaluations improved so that the algry or
disinterestedstudentswho enteredthe class reported leaving with new
perspectivesand insights. The actual evaluationswent from 40 - 50 %
positive to 94% positive. This happenedbecauseI began to meet the
studentswhere they were at on the stagesof change.Where was that?
Mostly, they were no where. Most of them were not even thinking about
change prior to the class unless it was how not to get caught again. I
beganat that point. Then, I left no one behind. As their expectationsand
svaluations changed in the classroom, the individual sessionsbecame
cvcr) lnorc productive. There became no need for conflontation.
llcsistlrcc bccurnca signal to do things differently or approachthe client
rl llollrcr wly. lhc scssionsbecamea sort of dance.The client mostly
lcrl rlrrl lrry rvolk gol citsicr. Studentswho received secondalcohol
clrlrgcs rvcrc lcssllrurr20%r.I contparedthat to recidivismratesin other
sultstlrrccrrlrrrscplrgrllrrs alrd lirrrndthat some were as high as 80%. I
wts hookctlon Ml. lhis stLrllrcally workedandworkedwell.
Now, I need to give a little background on myself before
explaining how hypnosis techniquesbegin to play into this scenario.I
was a substanceabuserfor about 20 years. I began early. I was never a
cigarette smoker. I can thank my matemal grandfather for that. I got
caught smoking cigarettesthat we young boys in my social group usedto
steal at local stores. We were 1l or 12 and could not buy them so we
lifted the 25 cent packs and hid out to smoke not thinkine that the snrell
l1
would staywith us. I got caughtand my Grandfatherhad me smokea
pipeloadedfull with flavoredtobacco.Then,I hadto refill it andsmoke
it down again.Needlessto say,I got nicotinepoisoningandwas deathly
sick for hours.That was a quick fix. I still get sick if I smell tobacco
smoke.You could say it classicallyconditionedme to not smoke
tobacco.With alcoholI wasnot solucky.
My first drinkwasa hot beerin a treehouseat age I I andit felt
good.You could saythat right then I was conditionedto enjoy alcohol
You see,the problemwith alcoholis you feelgoodbeforeyou getsickor
you feel goodandneverget sick. So,thereis alwaysa rewardinvolved
Ibr mostpeople.However,I did readthat Tony Robbinsexperienced a
way to ensurethat one getsthe negativeeffectsfrom alcoholfiom his
Motherwho had him "drink like a man" when he first tried beer' He
drankbeer \ruithoutstoppinguntil he threw up and that had much the
sameresultas rny smokingtill I threw up. Thoughnot all personslike
thefeelingfrom alcohol,mostofthe time you canseethat liking alcohol
can be acquiredratherquickly and easilyfor many.I was no exceptlon
too. My grandfather
lundhada family historyof alcoholdependence, had
bnsicallydrankinto deathat an earlyage.Therewasa lot of alcoholism
irr the family tree but my Fathernever touchedit. Mostly, this was
bccausehe had lost his Fatherto alcohol.I however,did not havemy
lruthcr'sgood sense.So, I starteddrinking alcohol and kept steadily
my quantityandliequencyof useover 20 years.At the same
irrcrcusing
lirrre, I began to abuse other substancesuntil I was pretty much
as poly-substance
rlirrgrrosrrblc dependentby age34. The wholetime I
ll
I
for alcohol or any otner
worked,went to the gym, and somehowcontinuedto be functional.My incredible.I stoppedhaving any cravings
wife and childrenbroughtme back to reality or down to Earth. And, s u b s t a n c e a lm o s t i m m e d i a t e l y . I b e c a m e f o c u s e d o n m y n e w l i f e . I
I could really imagine a
indeed,I had stayedso high for so long, it was probablya lot like the envisioned change. Through hypnosis'
wonderfullife withoutusingany substances' The changes'look" And'
feelingofbeing on a crashingplaneas it plummetedbackto terrafirma.
years Fromthenon I wasdetermined to
Suddenly,I wasforcedto look at my self,my choices,andmy behavior. theyhavelastedover seventeen
in counseling'and leam
It wasslow andI
It wastime to change.I had foundmy self-motivation. go back to school,obtaina formal education
This took about5 moreyears
had no help but that intemalmotivationwas all I neededto beginthe hypnosisso I couldhelp othersto change'
changeprocess. andwastruly worth the effort'

I am a believerin my
I did not seekout a counselor.
Unfortunately, Aslmentionedbefore,duringmygraduateschooltraining'Iwas
point l found
owrrubilitiesso I rejectedAA and NA as they indicatedit was beyond exposed to MI techniquesThis wasanothermajortuming
I knew intuitively that
nry c()nlrol.I do not recommendthat othersfollow in my foot steps I systemthat would work for most everyone'
powerfultool for change
lrcurrscAA lnd NA havehelpedmanypeople.Theyaregoodprograms. combiningMI with hypnosiscouldbe the most
This book is the first piecein
I wurt "cold lulkcy". I can honestly say that I have experienced in therapythat anyonecould experience
tlctrrsilienliorr
wi(h rroussistance. anyonedo that
I do NOT recommend thework that shallencompass the entiretyof a systemfor combiningMI

c.illtcr.lt wnr n vcry bud li:w dlys. So, I wassober,alone,andhadno change'

6ndhypnosisfor successful
idcl wlrnlto tkr with nryscllnsnry numberonecopingskill wasto drink
lirr nrostol'20 years.'l'hcrclbre,
I lradto matureanddevelopthe coping
skillsofan adultwithouthelpby rial andenor.It wasnot muchfun but
cameto be very rewarding.I soughtout self helpbooks.I devouredself
help materialsby the hundredsboth on tape(no CD's backthen)and in
print. And, I leamedabout self hypnosistapes.I was really having
difficult timeswith cravings.I mademy first 30 daysby toughingit out.
I was consemedI would not makeit. So, I purchased
a "stop drinking"
selfhypnosistapeandlistenedto it diligentlyeverydayafterwork when
I normally would have attended"happy hour" at the bar. It was

t.l
rl
Motivation

What is motivation?Wheredoesit comefiom? How do we obtairt

it? Theseare someof the questionsthat we might ask ourselves.How
or
"stuck" in someform of maladaptive
manyclients,feelinghopelessly
uncomfortablebehaviorpatternsmust wonder,"Why can't I get the
energy,strength,willpower,or desireto makechangehappennow and
rnakeit last?"Thekey is motivation.

An acceptedpsychologicalmodel of motivation and how one

motivatedto actionbeginswith a need. A needis somethinga
becomes
personrequiresfor removalof an objectiveor subjectiveinsufficiency.
of this needwill resultin the personexperiencing
Theawareness a dliyg.
A drive then is an impulseor consciousmotivationalcondition(e.g.,
hunger,thirst)that leadsto creationofa response. in tum will
A response
of actionswith the intentionof obtaininga
or a sequence
hc behavior(s)
8Qgl.The goal is the intendedresult of motivatedbehavior.However,
ollcn a goalmay alsohavean j!g9!dygfqb9. This meansthatthe goal's
nltroctionto a personis strongerthansimplyits capacityto fulfill a necd.
Irr nrany instances,this is more significantfor successfulchangettr
lrnnspirein a rapidandlastingway.

'l hcrcseemto be threegeneraltypesof innateor inbornmotivesfor

ur rrs lrrrmans,Thereare primary motives. Thesemotivesare inbom.

is in our biologicalneedsandwe mustmeetthemin
llrcir'lirrrrrrlllion
we musteat and drink.Next,thereare
ollu lo srrlvivc,l:or instance,

l() t7
stimulus motives. Again, these motives appearto be innate and activate
us to seek stimulation and information. These needs are key for our
growth and leaming. Finally, there are secondarymotives. Thesemotives
result from experience and they are leamed needs, drives, and goals.
These motives that we learn can be related to our culture and social
interaction.They would be acquiredby growing up in a particular society
or culture and as such are often called social motives. Personsmight also
be motivated by a need for achievement or desire to meet some
subjcctivestandardof excellence.And, often peoplemay find that a need
litl. powu bcconrcsa strong motivator in their lives as they want to have
ittllucrecol corrlnitndover others.
Alrlrrltrrrrr
Mlskrw, ol'lcrrlcl'en.edto as the "Fatherof Motivational
P\\elrr'lo8.t".lrxrk lltc itlcrrol ltcctisnruchf'afther.His is well known for
rlcvckrpirrg
rr lliclrrlclryol llurrranNceds. Maslow'sclassification
of
rrccrlsis llrscd ()l lltcir sul)poscdpowcr or potencyamongus. Therefore,
sorrrclrccdsarc r'norepotcntthan others.Thosemorepowerfulneedswill
influence our thoughts and actions to a greater degree. The first four
levels of needsin Maslow's hierarchy are referredto as the Basic Needs.
Theselower needstend to be more potent than higher needsas they must
be met for basic survival and social interactionto occur. Thesehave also
been refened to as deficiency needsvs. grorth needs.Theselower needs
are called deficiency needsas when one experiencestheir lack it is clear
for there will be uncomfortable physical and./orpsychological reactions
until the needsare sufficiently met. Maslow believedthat lower needsin
the hierarcliy are dominant. Once theselower needsare achieved.we are
Ilt
fiee to explore Growth or Meta-Needs.These needswere consideredto
be ofa higher level by Maslow. Thesehigher-levelneedsassociatedwith
impulses for self-actualizationand self-actualizationitself. Basic needs
must be satisfied before growth motives are fully expressed.Desires for
self-actualizationare reflected in various meta-needs.In moving towards
self actualization,personsbecomemore able to clearly seehuman nature
in all its good and evil with acceptanceand non-judgment.Thesepeople
accept the challenges of life as they come along and actively seek
solutions. They are more concernedwith the good of all humans than
themselves. They seem to understand the need for solitude and
contemplationin finding resolutionsto difficulties. They have a positive
senseofhumor, high ethical standards,and quest for knowledge.In order
for changeto occur, these motives must be active and examples of self
actualizationare often expressesby those personswho reach the stageof
transcendinglimiting behaviorssuch as addictions.
Where doesmotivationcome from? Basically.scicllcclclls ltli llllll
there can only be two sources.Most theoristsbclicvc il crrtttcsliottt
wilhin or without the person.Thesetwo sourccsatc kttowttIls illllillsi(
nnd extrinsicmotivations.Intrinsic Motivation contcs lirrtlt withirl tltc
pcrson(intemal), not from extemal results or rewardsand is olicrl bascd
orr personal pleasure of being involved in an action or task. Extrinsic
Motivation is considered to result from obvious extemal rewards,
obligations,or similarfactors(e.g.,pay, grades).
l9
 My personalopinionis that this is eroneous.Truemotivationonly Ambivalence
comesfrom within. The incentivemay be extemalbut the motivationto
and
theory,
act mustbe intemalfor anythingto actuallychange.In reactance When it comesto change,many of us reactwith hesitation

Brehm (1966) proposesthat when personsfeel that their freedomto ambivalence.AmbivalencederivesfromtheLatinprefixan6i,meaning

the result
chooseis being limited or personalfreedomsare threatened,
will be an aversionto change.Imaginesomeonewho thinksthey know
bestfor you telling you what to do. How manytimeshasthis happened
to us and how did it feel? What goeswrong?We need a reasonto
changebasedon our individualgoalsand/orvalues,not basedon the
advice,criticisms,manipulations,coercions,rewards,or demandsof
othcrs.Brehmbelievedthat externalpressures to changecould actually
rcsrrll irr lcssdesireto change.The personwill becomeparadoxically
is commonto use the word
"both" and valentia, meaning"strength" It
way or the othertowards
"ambivalent"to describea lack of feelingsone
issuesor circumstances. However,this seemsodd as it would seemtlat
strongfeeling/thoughts for more than one choiceare implied' A more
however'would
standardword to use in the instanceof lack of feeling'
the prefix ambimeans
be "indifferent".Properusageis to rememberthat
you haveboth strongpositiveand
"both", so if you are "ambivalent",
feelingsfor both
negativefeelingstowardssomething'or have strong

rrrorcopposcdl() changing.Thereis socialpsychologicalresearchwhich sidesofanissue.Ambivalenceisdefinedastheexperienceofhaving

thing' or
st|l)l)ortslhis hypothcsisand even indicatesthat extemalrewardsfor conflictingthoughtsor feelingstowarda person'
rimultaneous,
gltoice.Ambivalencecanbethestateofhavingthoughtsandemotionsof
bclruviotsthll rtrc intrinsicallymotivatedmay have a harmfuleffect
we
for doingsomething towardsomeoneor somethingOften'
bothpositiveandnegativeaspects
( lirng & I lall. 1995).l hat is. whenrewarded
frequently
already enioy (intrinsically),we tend to decreaseour attractionor pcoplebavemixed feelingsaboutchange'Stayingthe same
that reducesanxiety'Changemight be
providesstabilityand consistency
enjoymentof the activity.This is knownas the overjustificationeffect'
feelingo1'
occurswhenincentivesareusedto bring aboutactions
This phenomenon considereda threat.Commonly,peopleusean exampleof the
personto describc
that would have been done voluntarily without any external hoth aftractionand repulsionor "love-hate"for a
Basedon this information,I believethatthe only valuable
reinforcement. antbivalence.The term also refersto situationswhere"mixed feelings"
uncertainty or
changeis from within.
motivationfor successful ntc cxperienced,or where a person experiences
concerningsomethingThe expressions of "cold feet" and
Itulccisivcness
usedto expressambivalence'Or'
"riltittg,on thc f'ence"arephrasesoften
lirt orrl usltgc.I rccomnrendthat we describeit ashavingstrongfeelings

Iul tttotcllttlttttttcoptionthatinhibitchoice'

al
) ll
 client
Ambivalcncccln bc psychologically whenthe
disagreeable We must assumeambivalenceis presentor else the
assistance'
goodand not so gtxrtllcaturcsol'a subjectare both presentin a would have completedthe changewith no therapeutic
it is often
person's
thoughtssimultaneously.
This can leadto avoidance
or We must not assumethe client is "resistant"when
personis resistant
procrastinationreactions.A personmight also make calculated normalto be ambivalentaboutchange'Whena
ambivalence'
effortsto maketheir mind up concemingthe ambivalence.
When to changeit is very likely that they haveu esolved
such' Change
the conditionsdo not involve the need for a decision,people It would be more conect to label this phenomenonas
conflict I am
encounterlessdistressevenwhenfeelingambivalent.I havenoted is stressful.When I write aboutavoidance/avoidance
gettingoff of
that the standardapproachto ambivalenceindicatesthe choice surethatboth choiceswill leadto stress'The goalfor
involvesstrongpositive and negativeaspects.Most personsuse thefencethenwouldbetoseektheonethatmaybeleaststressfuI.
this narrow definition. However, in psychologicallydefining conflict can lead to stress' For
Even an approach./approach
I have a choice
conflictsof this nature,choicesoften come in three basictypes. instance,if I am working on losing weight and
(healthy) and a rich
The first, as noted in most ambivalenceresearch, is an betweena Caesarsaladwith grilled chicken
eatingboth'
approach/avoidance
conflict. This signifies that there are both pastameal (not so healthy)when I love the taste/enjoy
as I weigh
positive and negative aspectsto a decision. Second is an I will be attractedto both and most likely be ambivalent
with the choice
approach/approach
conflict. Here, ambivalencecan also occur as my choice.Eitherway, my stomachwill be happy
my hungerwill
eitherchoicecan be pleasantand the decisioncan be evenmore but I may think that eatingthe saladwill mean
it moredifficult
difficult. Finally,thereis the possibilityof an avoidance/avoidance rcturnmorequickly or eatingthe pastamay make
will make me feel
conflict in which both choicesseemto havenegativeaspects.In to lose weight. So, even when both choices
Better yet'
any of the threeconflicts,a personmight experience
ambivalence. gutx.l.one must createless distressfor me to decide
I enjoy being
So, we cannotfocusonly on positive/negative
but in eachcasea whnt uboutmarriage?I want to marry @ood)and
well be"'yes"'
decisionalbalancemustbe exploredas to the choicewhich seems ringlc (good).Am I ambivalent?The answermay
decisionThe
the best at the time in order to "set off the fence" aro move Ollcn. nruttypeoplecanbe "on the fence"aboutthis
good The idea
towardschanse. rlrcssctt) bc vcly high andbothoutcomesmay feel
mightoccuraftertheresolution of
Itclcis lltrtlrrltytnd all dccisions

)) 2J
 anrbivalcllcc.No nlaltcr what lhe value of the possiblechoices.
"lLesistancc"rrray irrdccd .iust be the natural consequenceof
ambivalenceto changeand thereforeuselessfor us to consider as
such.
Anxiety or fear is not an abnormalconditionwhen consideringa
major change.Stayingthe sameis stableand safe.Changeinctrcates
a
confrontationwith the unknownor unfamiliar.It is unchartedterritory.
Many personsare reluctantto enterthese"new worlds". Many persons
l would much rather leave the exploringto someoneelse. One key to
helping resolveambivalencewould be alleviatinganxieq,conceming
change.The hypnotherapist
has the advantagehereas relaxationis an
integral componentof the hypnotic process.Hypnotic relaxationis
frequentlya part of therapyfor anxiousor fearfulclients.In theory,the
rela,xed
clientwill be moreinclinedto embracechangeand lesslikely to
be ambivalent.Therefore,I strongly suggesta relaxationexercisein
session
for theveryfirstvisitin orderto assistthisprocess.I alsoliketo
suggesta simpleacronymthat may be helpful to clientsand counselors
alikeat this staee:
o AGA O
. Accept - you cannot solve a problem by attacking it (war
language). Focus on increasine the oositive instead. Takrng
offense weakensus
Gratitude - seekthings to be qrateful for
Allow - opento connectingwith your crealivcintcnti()ns
(AG,4 R)uIt.l'right frotc.lcl)
,,I
Motivational Interviewinq
Our primary method for overcomingambivalenceis increasing
intrinsicmotivationthroughclient interviewingtechniquesMotivational
Interviewing(MI) was first introducedin i983 by Miller' Togetherin
1991,Miller and Rollnick collaboratedto structurethe techniqueswe
knowtodayas MI. The methodwas initially formedas a combinationof
principlesfrom Carl Rogers' (1951) Humanistic
rclationship-building
'l heory with certain Cognitive-Behavioral
therapy strategies(Burke,
Arkowitz,& Menchola,2003).Also, Miller and Rollnickdevelopedthe
lcchniquesin sucha way asto engagethe clientat their particularpoint
ol'motivation basedon the Stagesof Changemodel (Prochaska&
l)iClemente,1984). Motivationalinterviewingis non-judgmental,non-
and non-adversarial.
confrontational The methodassiststo intensif' the
client'sawareness and
of the probabledifficultiescaused,consequences,
risks involvedas outcomesof the behaviorin question Altematively,
lhcrapistshelp clientsimaginea befterfuture,andbecomeprogressively
rnoremotivatedto achieveit This is very beneficialin conqueringour
the strategyassistsclients
llrturaltendencyto be ambivalent'Regardless,
lo lhink in new waysabouttheiractionsandeventuallycontemplate what
tright beachievedthroughchange.
Motivational Interviewing is intentionallymore directive than
approachto counselingthat is
l{ogcrsyct rnaintainsa client-centered
nrolc lircrrscdand goal-directed than nondirectivecounseling'The
ulillinrl irtlcntiotrwas to assistclientsthat might be strugglingwith
to changelt was createdwith four basic
rrlrortloI antbivalence
lr,rrres
25
pdnciplesin mind; expressing
empathy,developingdiscrepancy,
rolling
with resistance,and supportingthe client's self-efficacy. These
principlesare designedto "help free peoplefrom the ambivalence
that
entrapsthem in repetitivecycles of self-defeatingor self-destructive
behaviors"(Miller & Rollnick, 2002). This concept can be easily
expandedto includeany thoughtsor behaviorsthat a clientmay wish to
change.MI is not so muchjust a counselingtechnique,but to a certain
extentinsteadit is an interpersonal
style of communicationthat is not
just restrictedto formal settings.This idea of interpersonalstyle is
essential
to successful
MI andthe mannerin which it is to be employed.
The research on successful change through motivational
interviewingis prettysignificant.Burke,Arkowitz,andMenchola(2003)
foundthat MI was significantlyrelatedto positivechangein studiesof
alcohol,diet, drug use, exercise,smoking,and weight loss. When I
discovered
this and comparedit to resultsfrom hypnosisresearchit was
easyto theorizeon theway thatthesetwo techniques
couldbe combined
holisticallyin order to createa more powerful methodfor treatment.
Much of this effectmay also be relatedto the assistance
of MI towards
enhancingrapport betweenclient and therapist.Again, researchon
therapeuticrapportandtreatmentoutcomesseemsto supportthe useof
thesemethodsas rappot and empathyare powerfultools for effective
communicationand change.(Eagan, 1982; Miller, 1980; Truax &
Carkhuff,19671'Truax
& Mitchell,l97l: Valle,1981).
Firstandmostimportantly,
MI containsseveralkey components.
the motivation to change comes from within the client (intrinsic
motivation).It is basedon theirvalues,intentions,andgoals.Secondly,it
is the client's responsibilityto resolvehis or her ambivalence.The
therapist'sprimary function is to guide the client. This is effectively
by reflectivelistening (Burke, Arkowitz, & Menchola,
uccomplished
2003).The counseloris somewhatdirective,but only in assistingthe
This guidance
client to discoverthe sourceof his or her ambivalence.
towardsdiscoveryis an art that often leadsto resolution.The counselor
nrustavoiddirectpersuasion In fact,it is bestif the
and/orconfrontation.
maintainsa calmstylethat assistsclientsto bring forth their
presentation
own answers.One might believethat directpersuasion
is helpful but it
and getsin the way of progresstowards
oltenresultsin clientresistance
change.One moves throughthe stagesof changewhen readinessis
to changedependsuponintrinsicmotivationand
The readiness
nchieved.
lhc quality of the intetpersonalrelationshipsamong clients and
Therefore,the final elementof MI is the interactionbetween
thcrapists.
llrc client and therapist.This relationshipis intendedto be more like a
pnrtnership role (Millcr
ratherthanan expert/recipient
or companionship
& I{ollnick,2002).
Motivational Interviewing is designedwith the intention of
nrsistingpeopleto navigatethe changeprocess.lt alwaysbeginswith
rrrcclirrgthe client wherethey are in the changeprocess.This is much
of Milton Ericksonwhich will be discussed
liltc thc hypnotictechniques
lltcl on. l hc Stagesof Changearea part of the Trans-theoretical
Model

,t(r 27
 so to
how peoplechangeand is
of Change.lhis nrodcllltcnlptsto describe ambivalence concerningchange'They may still be "on the fence"
behaviors'It maybe
not a theoryof psychopathology(MIA: STEP,2006).Thismodelassists speak.Theymay be wonderingabouttheir habitsor
aboutwhy they
therapistsfrom variouslheoleticalsystemsin finding commonground wonderingabouthow changewould be or wondering
needassistance in
flom where to examineand assistthe changeprocess.The stagesof havestayedthe sameso long' They might certainly
changethey are
contemplation,preparation,
changeare as follows: pre-contemplation, evaluatingthe prosand consof their actionsandof the
changingand
action. and maintenance(MlA: STEP, 2006). Prochaskaand considering.We might considerthe payoffs for not
is a time for self
DiClemente(1986)includea sixth stagewhen dealingwith addictions comparethem with the payoff for change'This
ask themselves'
andthat stageis relapse.I personallydo not usethetermrelapseandwill explorationand finding understanding'They might
might be for me?"
explainwhy whenI describethe stagesin moredetail.I also like to use "Hummm,I wonderif I shouldchangeandhow that
,[herationalmindandtheemotionsmustbebroughtintobalancewitha
for a final stage in which personshave
the term transcendence
their lives in sucha way as to neverbe ableto go backto
transformed focusoncommitmenttochange.Personsatthisstagebegintoseriously
that doesnot
previousdetrimentalbehaviors. considerthe implicationsof change,quitting something
bring benefitsto
rerve their best interest' or taking action in ways that
is a
Let's talk briefly aboutthe stagesof change.Pre-contemplation themselves. They may be on the fencebut they areseriouslyconsidering
6 months'
statewherea personhas no thoughtof changingeither now or later. Jumpingoff within the next
Friends,family, law enforcementor othersmay repeatedlyurge us to
Preparation'
take actionon our problemand yet we haveno intentionof changing. Whena persondecidesto change,thenthey moveinto
The thoughtof this client is most likely somethinglike, "What do you 'l'his is the planningstage.All goalsrequirea plan to be successfulAt
or intention What is
change'Indeed'they
meanchange?"This clienthasnot evenconsidered lhis point, it is key to developa plan of action
guidesan action'The Latin
are not consideringchangingor quittingthe behaviorin at any time in httcntion?tt is a planof actionor an aim that
a bit of discomfort
the next6 months.Often,whenworkingwith personswho havereceived tot)linlenliomeansto stretchtoward'This indicates
courseor mannerof
a first alcoholor drug violationwith the legal system,they are at this nkrrrgwith growth. ln medicalterminology,it is the
strongerthan
stageof change. Itcllirrg a wound Rememberthat healedtissueis always
Intention
lltc original. This also indicatesstrengthand improvement'
in sucha
they havebeganto consider
When a personentersContemplation, ptcccrlcsrtctionand requiresaligningone's consciousdesires
that all clientswrite
success'It is recommended
wnv rrr l(t S,tlilrantee
change.However,at this pointthey arefrequentlystill lcclingt lot ol'

to
.rlt
 are in processof leaminghow tt
plrtttlo bcdiscussed andutilizedfor thehypnoticsesston' simplymaintainingtheir changeThey
downa clrattgc
acl ol ntakingintention concrete' "Ok, I needto make feelstoact/bedifferent.Theyhavebeendoingthingsdifferentlyfora
Thisis a cottsciotts
whilenowandareinaperiodofadjustment.often,theyaleadjustingto
a plan here.What rvill I do'/" It is oftenhelpfulto identirytemptations'
aroundthem' They are dealingwith
the changesas are significant others
removethem, and lind ways to avoid them' The clientsmay needto be
8nyconcerns,new stresses, or difficultiesthatmight arise Theymight
supportsystemsThey may needto plan for
arrangefor interpersotral
or involvedinlearningorutilizlngnewstren$hsandcopingskills.Thiscan
substitutebehaviorsthat assistto effectivelyreplaceold behaviors addsto the
are be uncomfortableat first for somepersonsbut eachsuccess
patternsin sucha way asthey arenot missed'Clientsin preparation
can developa new senseof pride
new positivepictureof life A person
planningto eliminateor changebehaviorssoonoftenin the next 30 days
andselfesteemfrom theirnew successes'
or less.

will no longer be "new"'

Eventually,the processof maintenance
Eventually,personswill beginto actuallybehave,think' and/orfeel
in use for sometime but it is the
Not only has a new behaviorbeen
different, This is the Action stageof change ln this stage'they are
person to behave' When this happens'
actuallydoing the work. The personsbeginto take neededactions
and "normal" way for the
be a "ned' person'
fanscendence hasoccurred'A client is now free to
stepsthatmovethemtowardschange.Theywill mostlikely havecreated
a part of their life but they would
but, producingthe plan may be a form Not only is the behaviorno longer
a changeplanduringpreparation,
habitsor behaviors'It would seem
noverconsidergoingbackto their old
of action,too. Often,changewill not occurwithout a persontakingthe Much like the
themselves'
to be abnormalnow' They havere-invented
time to actuallyplan for success.In a plan,they can describeconcrete
into the butterfly' the client
ways catcrpillaremergescompletelychanged
reasonsfor change,focus on actualstepsto be taken,brainstorm
the processa personmay go back to
![nltot go back. At any point in
that othersmight help them, and plan for obstaclesAs they actively
but not afterward'
prcviousactionsprior to transcendence
implement their plans, they begin to actually practice their new
behaviors.Action stageoccursduring the first 6 monthsof changed person may retum to any
llowever, pnor to ranscendence'a
behavior.
way back to pre-contemplation
ptcviottsstage.They can go all the
thrtrrg|rrhiswou|dbemoredifficultasthememoryofpassingthrough
Once the new behaviorhas been actively consistentfor over 6
the ability to be the "sameold
As the Ittrtrcttrlvttncedstagesinterfereswith
months,a personis consideredto be in Maintenancestage term'It is merelya lapse'a
pntrrrtt".'lhisis not a relapsel detestthat
to "do" andact in newway (s)' theyarcitt lltc pointo1'
continues
Derson

l(l
Ilip, or slrrrrrblc
on tlrc path. It is not failure.It is a retum to the safetyof
thc lirrniliarantl quitc likely a norrnalcomponentof the changeprocess.
It may be very helptirl to lhe processto return to old behavior pattems
and flnd they no longer work. This can result in more rapid and powerful
change. lt is important to support this processwithout condemning or
judging the client. Frequently, they may be their harshestcritic and the
therapist's non-judgmental support can act as a bridge to retum to the
spiral of change.
So you might seehow it is very important to "Do the right thing
at the right time" for hypnosis to be most effective. When seeking to
enhancea client's intrinsic motivation to change,it is imperative that we
identifr activities that modi8/ thinking, feeling, and behaving based on
the client's current stage of change. The therapist will employ diverse
approachesand proceduresin effod to meet the clients' needs basedon
the clients' current stage of change. This model (Stagesof Change) is
based on a progressionthrough the different stages,but not everyone
reachesthe desired change at the same rate and not everyone continues
"forward". Some individuals may cycle back to an earlier stageas part of
their process,others may move forward through each stage and never
look back, while some may recycle through the various stagesseveral
times before achievingtheir goals and maintaining changeover time.
We must gently assistthe client with careful reflectionsand targeted
questioning to access the next level. To conduct an effective client
interview requires that we approach in an enrpathetic.insightful,
l. '
affirming, and motivatingway. Then, hypnotic interventionsmay be
Utilizedthat have the correctfocus for the client's currentand future
stage.Researchindicatesthat this is of primary importance.The
areoutlinedin detailby Prochaska,
beginningapproaches Norcross,and
l)iClemente(1994) in their book titled, "Changing For Good: A
l{evolutionarySix-StageProgram for OvercomingBad Habits and
Moving Your Life PositivelyForward".The initial investigationof the
stagesof changewas completedwith a populationof cigarettesmokers
und the results were impressive(DiClemente,1983; Prochaska,&
l)iClemente,1983; Prochaska,DiClemente,& Norcross, 1992;
l,rochaska,et al., 1994).Thesestudiesshow that using the stagesof
changemodelwill improvesmokingcessationoutcomes.If we look at
lhe researchconcerninghypnosisfor smokingcessationwe find similar
positiveoutcomes. in manystudiesthat mostpersonswho
It is suggested
oxperiencedhlpnosis for smoking cessationhave success(Lynn,
Ncufeld,Rhue,& Matorin,A., 1993). Also, Crasilneck(1990)reported
thntat 12 monthfollow up 81oloof clientswho werehypnotizedto stop
rnrokingwerestill abstinent.
Ifusing motivationandthe stagesof change
in successfuland hypnosisalone is successfulin smoking cessation.
What will happenwhen the two are combined?I was determinedto
oxplorethepossibilities.
'l'he standard"magical m1'th" of hypnosisis that changeoccurs
inrnrctiiately
in onesession
andis long lasting,but themodelof change
rkrcs rrol indicatethat this is necessarilytrue. Particularly,there are
rurrrrrzirrl.l
srrcccss
storiesin the field of hypnosisbut immediate
change
33
doesnot occurin all cases.ln an effort to improveoutcomes,it may be | .I resolvedmy difficulty morethansix monthsago.
prudentto follow a model of changein stagesand developa hlpnotic Yes_ No _
treatmentprotocolthat while directiveis also client centeredbasedon 2,1 have been actively working on the problem in the past 6 months.
the stageof changea client may be in at the time of intake and Yes_ No _
movementtowardseachsuccessive
stageofchange. i.l planto do somethingaboutthis in the nextmonthor so.
Yes_ No _
Oneof the first thingsaskedby intemstrainingwith me wassimply, 4.1 am thinking or planningto do somethingabout this in the next 6
"How do I know what stagea client is in?" It is oftennot very difficult. months. Yes_ No _
For instance,if client's reportthat they have not had any problemor l,l amfinejustasI am. Yes_ No_
issuesfor over 6 months,it is most likely that they have achieved
maintenance. If they are currently involved in some O?e of active to the first four
Pleaseremember,if there are "no" responses
behavioralpursuitof changewithin lessthan6 months,theyareprobably rlatementsor a yes to number 5 the client is most likely in pre-
involved in action stage.If they statean intentionto begin changes or carefulquestioning
Utilizing thesesimplestatements
contemplation.
and/orareformulatinga planfor changein the nextmonthor so,this is a rrd activelisteningwill mostlikely resultin the informationwe require
clear indicationof preparation.If their intentionto changeis not so what stagea clientmaybe in at the time ofour session.
to assess
immediateor if they statethey ale thinkingaboutchangingsometimein
the next 6 months,they aremostlikely in contemplation
of chalge (ald
oftenvery ambivalentaboutit). And, if they do not speakof changingat
all or reportthat thingsarejust fine the way they areright now, this is a
pretty clear indicationof pre-contemplation.
You may even consider
to your intakequestionnaire
addingthe following statements with yes or
no resDonse
indicators:

i,l 35
 qr

The Therapeutic Basicsfor Success

Therapyprovidesa protocolfor using
MotivationalEnhancement
MI in orderto assistthe client in rapidly movingtowardschangewhile
cnhancingintrinsic motivationand was conceptualized
originally for
rpecific use in the area of alcohol abuse/dependence
and researched
duringProjectMATCH (ProjectMATCH ResearchGroup, i997). In a
involving 15 MI Randomizedcontrol studieswhereMI
Meta-analysis
wascomparedwith "usual/brief/standard"
care,directive-confrontational
oounseling,educationalinterventions,skills based counseling,and
cognitivebehavioraltherapyalone,it was indicatedthat MI was most
offectivefor clientchange.

Miller andRollnick (2002)usedthe acronymFRAMESto describe

lhc six elementsthey believeareactiveingredientsin producingchange
ln substanceabusers.FRAMES standsfor feedbackof personalrisk,
cnrphasizingclient's responsibility for change, advice concerning
clrnnge,elicitinga menuof options,expressing
empathy,anddeveloping
rcl['cfficacy. These six elements can be utilized in motivational
lnhrncementtherapy for a majority of individuals,not just those
nrll'cring from substanceabusedisorders(MotivationalEnhancement
'l'ltcrnpyManual,1994).Thetherapistusesstructuredfeedbackregarding
tltc hclrlvior,severityof the behavior,andthe currentstageof the client
Io clicil sclf-motivatedand rapid change.Therefore,this therapy is
Irklirrg l scnseof urgencyand ultimately is "superiorfor enhancing
lo change"(Dunn,Neighbors,
lrurlirrcss & Larimar,2006).

l(r
 We know that MI and MET are successfuland valid techniquesfor
change.The researchon hypnosis parallels MI research.The treatments The MI standards
that will be mosthelpfulfor us astherapists
have
are also for the same client populations, that is, substanceabuse,diet, beenwritten aboutextensivelyby Miller & Rollnick (2002).I strongly
exercise,and weight loss groups (Burke, Arkowitz, & Menchola, 2003; suggestthe readerexam their original works to becomeintimately
Carels,Darby, Cacciapaglia,Konrad, Coit, & Harper, et al., 2007; Dunn, The maingoalsof motivational
l'amiliarwith the detailsof the approach.
Neighbors, & Larimer, 2006; Hutchinson-Phillips,& Gow, 2005; Kirsch, interviewingare to establishrappoft,elicit changetalk, and establish
Montgomery, & Sapirstein,1995; Nigg, Burbank, Padula, Dufresne, commitmentlanguagefrom the client. Keep in mind that rapporthas
llossi, & Velicer, et al., 19991,Pederson,Scrimgeour, & Lefcoe, 1975; beenindicatedas the primaryindicatorof successful
therapyregardless
l)r'ochaska,
Velicer,Rossi,Goldstein,Marcus,Rakowski,Fiore, Harlow, of method(Burke,Arkowitz, & Menchola,2003; Egan, 1982;Miller,
llcrklirrg.lloscnblooln,& Rossi, 1994; Sarkin,Johnson,Prochaska,& 1980;Truax& Carkhuf{ 1967l.Truax& Mitchell,1971;Valle, 1981).
I'tor'lrrrLrr..l(X)l).l)cdcrson,et al. (1975)completeda preliminarystudy 'l he processwe are using is to developa client centeredapproachto
ol r orrrIrrrrrIr,.1
lrrplrrtsiswith cognitive techniquesand found that the cvoke intrinsic motivation.Thefour basic principles are to express
r'lllrrtrt ,,1lrullrtrcrc clrlrllrcctlby theircombination.
I considered
thisto crnpathy,developdiscrepancies,
roll with resistance,and supportself
lrr,rrl tr'\\lrrtl,'l rrr 0 IiIrrrIrIilrrr
llttttI nt st lreon the right track.In order ollicacy(Miller& Rollnick).
Irr r,r'llt tll' ll'.,1prr.,.,rlrlc
r',rIIrIrirrrrIiorr
lirl nry clients'success,
I wanted
lr llrt lllr!( lIr'IIrrrr;rrt
' ', lopellrcr',ll wfls vcry clearto me. If we have Empathyhasmanydifferentdefinitions.They covera broadrange
lrlrrt'rlrrlrrrrrlrtrrllrtirrrll,r
rigrrilicrlrtclrrrrrge
lcsultingfrom both MI and li'om a feelingof concemfor otherpeoplethat producesan intentionto
It\'ltttosis
l11llrcrrsclvcs.
lrorvrliglrl ollr lrcitlnlcntoutcomesimproveif with anotherperson's
Itelpthem,experiencingfeelingsthat correspond
we "I)at.t)" tllo lwo lsclr)i([rcs'Jllclrcc. the motivational hypnosis cnotions, identifring what the other personis thinking or feeling,to
concept fbr change began to cotre logether in my mind. Quickly, I hlrrllingthe line betweenselfandother.For our purposes,
empathyis the
integrated these techniques into my practice and started to talk about llrcmpist'sabilityto accurately
recognizethe client'smeaningandreflect
them with colleagues. After four years of working in practice with the llrc cor'r'cct
understanding
backto the client.Empathyis NOT havinghad
combinedtechriques, I presentedmy first ideas at the American Society lhc sarlc experience
or difficulty.It is not a feelingof identificationwith
of Clinical Hypnosis' 50ft Anniversary Scientific Meeting & Workshops lltc clicrrlor tellingyourown storyasin selfdisclosure.
As described
by
in Chicago, IL, March 2008. The audio version of this presentation ('rrr'lllogcls ( 1959),empathyleadsto correctunderstanding.
Thus,it is
shouldstill be availablefrom the ASCH. llre or thepleasure ashe or sheperceives
of another it andto
"crrrirrp, lririrr

rtt 39
 17

notice the causesthereofas hc or slrc rrcrecirestlrc r. hltl without ever Whenthe client is telling you the reasonthey mustend their addiction,
losingthe awareness
that it is as il'thc lhclrrpistrrcre lrrrr'tol plcased,etc yourpartin the processbecomes
monumentally
lessdifficult.
(Rogers).Rogers(1961) also describcdlror orrc rrrr! eolrbinc empathy
with warmth and genuineness
to enharrcclhc llrcntl)cuticlclationship. Resistance
is a naturalpart of the changeprocess.Remember,
most
Warmth demonstratesunconditional positivc regirld, tl)rrt is, acceptance clientshavemixed feelingsaboutchange.For many,stayingthe same
of a personregardless()l'wllitl llrc personsays or
and encouragement providesstabilityand consistency
that reducesanxiety.Changemightbe
does. It is an attitude that values clients cvcn when aware of their considered
a threat.Therapistswho roll with resistance
demonsrrate
an
failings. The therapist and client must be honest and genuine in this acceptanceof a client's reluctanceto change as natural and not
relationship and empathy assiststhis process.Genuinenesscreatestrust pathological.This will enhancerapport and increasethe odds of
Therefore, the therapist is providing the best possible conditions for successful
change.Ifthe clientis resistantit is your problemnot theirs.It
personal growth to the client. Empathy is active listening with goal of ls a clearindicationthat the therapistis doingsomethingwrong.It often
understanding.However, MI adds a goal direction componentthat was meansthat clientsfeel they are being forced in a particulardirection,
not a part of Rogers' original work. their thought/feelings
are being ignored,or that there is no empathy.
Remember,
resistance
is merelya behaviorand is not reallypersonal.To
Developing discrepancy, guides therapists to assist clients in nvoidthis, we mustbe carefulnot to arguefor change.The clientsmust
appreciatingthe value of change by examining the incongruity between Inlbrmus asto why changeis preferable.Their view is superiorto ours.
how clients currently live their lives to how they would like them to be It is oftena symptomofthe extremedissonance
or ambivalence
theyare
(or between their core values and their day+o-day actions). Remember cxpcriencing.
Resistance
shouldnot be opposeddirectly.It takestwo to
that clients are often ambivalent about change. By developing their [tlrke resistance
work. Resistance
is highly responsive
to the styleof the
awarenessof ambivalenceand these discrepanciesin their behaviors,we lhcrupist.It is a signalto thetherapist.Resistance
is your cueto choosea
shift the decisionalbalancein the direction of change.Wesimply aid the dill'crentresponse
or a new direction.You arenot directingthe changes.
client in determining how the current behavior is blocking or detrimental You ureseekingto aid the clientsin choosingtheir mostappropriate
path
to the person's needs,goals, values,or hopesfor the future. The behavior kr succsss.
The bestapproach
may be simplyto "backoff'and let the
may be a major barrier to their dreamsfor the future. Becoming aware of clicnl cxploretheir own ideasand optionsfor a time. Thus, the
this often allows the person to make their own argumentsfor change. t'alrrliorrship
will notbedamaged
andmutualrespect
is maintainec.

,l{| 4l
 T
Therapistswho support sell clllcru' rrrc crrtlrrncittgclient summarizeback to the client your understanding of what was shared.
Theyrespectthe client'sliglrl lo clrorrrc(c\'('nwllcnclients
autonomy. Also, a final skill that is requiredwould be the ability to elicit talk of
chooseto not change).This assistsclicttlslo rovc lr)wtttdchange changeflom the client.Thesearethe foundationfor this practiceto be
successfully knowingthc dceisiorris thcirown.The
andwith confidence, effective.
personQIIOTthecounselor) fbr chtxrsirtg
is responsible uttl carryingout
change.It is helpfulto reinforceanysmallsucccsscsllortgtlrcway.It is As a trainedcounseloror therapist,we may all know the difference
importantfor the clients to be awareof their own abilitics and ego betweenopenand closedquestions,buq a brief reviewcould be helpful
strengtheningtechniquesmay be utilized to improvc this senseof for clarification.IfI am askinga closedquestionthenit will be limitedto
personalpower. A person'sbelief in the possibilityof changeis an a shortanswer,a yes/noanswer,just the basicor specificinformation,or
importantmotivatorfor this choiceto occur.The tlrerapist'sbelief in sometype of multiplechoicequestion.Theseapproaches
all resultwith
changeis quite importantalso. If a therapistbelievesthe client cannot limitedresponse
options.Theyrestrictthe interviewanddo not allow for
succeed,even on an unconsciouslevel, this messagewill most likely cxpansionor creativityon the client's part. The following are some
becomea part of the client's awareness.So, it is absolutelynecessary cxamplesof closedquestions:
thatthe therapistbelievein boththe possibilityandlikelihoodof change
The client will becomeawareof this on one or more
beingsuccessful. . Do you like to smoke?
levelsandit will affecthis or herconfidence However,in the
to succeed. o Whendid you startsmoking?
end.it all comesdownto the clients. Their choicesandtheir beliefsare . Doesyour family careaboutthis?
thekeysto change. . Do you wantto quit, slowdown,orjust staythe same?

How do we mosteffectivelyusemotivationalinterviewing?Miller llowever, an open ended question will ,,open the door'. liu
,.1
rt
skillsinvolvedin
and Rollnick(2002)wroteof somebasiccounseling cxpnndednarrativeanswers.Open questionsdo not encouragesnon
the Ml processand moving a client from ambivalenceinto actual nnswcrsbut often requirethoughtand allow for the entire story ro De
nlovementtowards change.The first four are directly from Client lltrrrcd.Iixaminethefollowingquestions.
( cnt$ed Therapyby Rogers(1951). These are use open ended
(lttcstions,
nlllrrrrthc clierlt'sactionstowardchangeand usc basicego
. l i z c tc l l c c l i o l t (s rr tl tcl i tl tt' srr i tl r l r tl l ' i sl ), and
stre ngll) c ling lc c l ttti tl ttc s ttti

.l,l 4.'l
 What would you like from treatlllcnt'/ situationin multiple ways.Someinterpretationscanbe
a more helpful than
._(habit or others.
a Where do you see yourself as l'ttl tts
behavior) in 5 years?
(habitor bchuvior)'?
Whatare Most hrTnotherapistsare familiar with ego strengthening
o Tell me aboutyour and client
afhrmation techniques.It is important while conducting
the goodthingsaboutit? Whatarethe not so goodthingsi MI that these
techniquesare used to promote the ability to change.
o Ifyou wereto quit, how wouldyou do it? We must seek
opportunitiesto assistthe client's belief in his or her
own ab ity to make
changehappen.This is doneby ..catchingthem at
Thereare someeffectiveguidelinesfor gettingbetterresultsfrom success,,and making
surethey note it. It is also a function of the language
questions.One, it is always advisableto ask fewer questionsMore the therapistuses.
We want to highlight any client strengths or successes
questionsoftenleadto moreclosedquestionsand lesstime for the client in order to
to promotethe ideaof success andclientself efficacy.We mustbe surethat
to respondfully with their completestory. Two, it is not appropriate
questionsin both we and the clients notice and appreciatepositive
askmultiplequestionsin a row. Ifyou ask morethanthree actions both past
and present.Then, inquire asto how theseactionsmight
it is highly unlikely that you will get answersto all of
rapid succession, be useful in the
future for change.As therapists,we must be genuine.
them.Ifyou do receiveanswersto all of them,it is very likely that they There is nothing
be worsetlan a client finding a therapistto be lessthan
will be incompleteor possiblymiss informationthat may prove to open or honestin
the relationship. Never forget that the client deserves
of therapy.Third, it is very likely that you will have
vital to the success unconditionar
positive regard and be observantfor opportunities
to ask someclosed questionsto fiIl in details and facts during a client to expressthis in
thatthe therapistaskmoreopenthanclosed caring, concemedlanguage.Thesetechniqueswill aid in
interview.BuL it is essential strengthening
thetherapeutic
relationshipanda strong,positiverelationshipis onekey
questions.Closedquestionsareto be usedvery sparinglyandonly when
to success.
you feelthat pertinentdetailsmay be missingfrom the client'snanative
in responseto open inquiries.Finally, it may often be helpful to offer
This allowsan opportunity There are some basic ways to develop ego strength.
doublereflectionsfor eachquestionresponse' One might
llmply commentpositivelyon a client characteristic,
suchas,..you,rea
for one reflectionto be much closerto the meaninga client wishesto
of auong person,a survivor". A therapist could make a
couveyand rnight show that there is more than one interpretation straightforward
openingthepossibility
cvcnts.thcrcli)rc, the
for a clientto alsointerpret like, ,.I appreciate
atltcmentof appreciation, your opennessand honesty
loday", l'hereare many opportunitiesto catchclientsdoing
something

45
 U
I
I
right. One can use simpleego slrcngtlrcrir[\lrl('rtt('ttl\.lirr iustance, I expert and the therapistis striving
for deeperunderstanding without
"Thanksfor comingtoday" "That's lighl". ot "Vt'r\ gorxl".Cenuine shuttingdown any chanceto disagree
; with the reflection.we arsoneed
complimentsakinto, "I like the way yott sttirllltrtl ,rl "l Ittttinlpressed t to be brief. We do not wish
to monopolizethis time with
by the way you handledthat" can bc verl lrclplrrl.( lttcornplicated
l our own

expressions sinrilirrlo, "l ltrr;tclhis weekend

I thoughts.Work to keep reflections
brief and no longer than client,s
of hope,caring,or support, smtement.
the client's
goeswell for you" might be all that is nccdctllo ittercitsc
to do well.
intrinsicabilityandconfidence Reflectionsmay be divided into
five uncomplicated
stylesfor our
purposes.Rememberalways
that we are demonstrating
to a question,an appropriate
After a clienthasresponded reflection that we
understandthe world view of clientswith accuracyalongwith
from the therapistwill often assisthim or her to explorealternativesor the
emotionarcomponents *o n',
look more realisticallyat currentbehaviors.Rememberthat reflections rearity
asirwe
were
rhe
perJl;:; f ff,;ff;,dJ:ffi
ratherthanquestions.
shouldbe mademore in the form of statements A nurt or the pleasureof another
as he or she sensesit. We appear
reflection statesa hypothesisor speculationabout what the person perceivethe causesofthe situation to
ashe or sheperceives them. .l.he
means.The therapistis makinga guessaboutthe client'smeaning.This first,
simple reflectionhas been previously
describedby one method,the
meanthat the therapistis correctthoughideallythis
doesnot necessarily "you" statement. Otherwaysto usesimplereflection
might be ro repeat
will be the case.Appropriatereflectionswill resultin moreinformation and sharethe client,sstatement.
We can also respondwith a metaphor
of the client's subjectivereasoningand
alongwith betterunderstanding thatis a directreflectionand includes
imagery.A clientnrayollijr, .,lt
of eventsinvolved.Often,somequestionsmight be changed
perceptions seemseveryone is againstme,,.A simplemetaphoric
rel)cclionrnaybc.
not a question,think of the
to a reflection.In orderto form a statement, "lt is like you aresurrounded by peststhatkeepbitingal yorr...
questionin terms of somethinglike, "Do you meanthat you-?" Ar:othcr
rctlectionmethodis agreement
f with a shift. lwill olicn shili
Then,you may simplyremovethe first for wordsand say simply,"You rlrc
rsllectionto elicit changetalk.
i For instance,a client rnay srarc.
"Smokingis the only way I can
relax,,.To this I rnightreply,..Up
You will want to modulateyour voice so that your volume decreasesat
until
n(lw' you thoughtsmokingwas your
only option for reraxation",.This
end lor the statement.This allows for the client to feel tlat they are able lcsponseis a reflectionthatallows
for optionsandchangetalk. Third,
to rcspondwith correctionif needbe and helpsto eliminatethe feeling we
nrlv usea doublesidedreflection
to emphasizeambivalence. A client
tlrll y()uirc ccrtirirrol tltcir ntcattittg.lltis ittrplicstlltll llrc elicnl is thc n|lgttlstirlc,..1don,twantto quit
drinkingcompletely,,. To whichI mieht

.16
respondwith, "You can see that therc ttrc llroblcmsrelatedto your
alcoholuse,but you arenot preparedto think uboutcompletelyquitting'
What would help?" Fourth, we may rcliantc a client's negative
of eventswith a positivetwist. lf the client were to say'
interpretation
"Everyoneis alwaysnaggingme aboutmy sntoking".We couldrespond
with, "It soundslike peopleare worried aboutyou even thoughthey
makeyou upset.Maybe,we can help them to showtheir concemsin a
way that is helpfulto you. Whataresomewaysthey canhelp?" Finally,
we may just haveto side with the negative'You must use caution with
If your relationshipwith the clientis not securethis canbe
this approach.
detrimentalto the relationship.The clientmight offer, "I love to drink' I
don't think I canchangeifl wantto." And you couldagree,"Drinking is
more important to you than anything and you cannot quit"' If you use
this method, it can result in an explosion of emotion' Be careful' Use
only asa lastresort.
Onceyou feel that your questionsfor the sessionareexhausted'You
needto put it all togetherfor both yourself andthe client' In a way, this is
sirnilarto makinga collectionof thematerialthat hasbeenexpressed and
returning it to the client in an easily understandableforrn so that the
evolving script is no surprise. A good summaryfor a client who has
cometo you to quit smokingmight soundlike, "So far you've expressed
facility, improvingyour
concernaboutkeepingyourjob in a smoke-free
health,and removingthe odor of smokefiom your car, clotles, and
hontc."You may wish to link something morerecentlyexpressed with
cnrlier...'l'hatsotrndsliltc wltnlyottilli(l flhoutthot
discrrssctl
sontclhintl
anxious feeling you get". We want to put it all together and then
transition."Before we move on to the hypnosissession,I needto ask do
you think we havecoveredeverlthing so far".
Thereare somequestioning,,traps,,to steerclear of and avoid setting
up client resistance(Miller & Rollnick; l9gg, 2002). Always, we are
keepingin mind that the client is most likely ambivalentaboutchange.
Resistanceis merely a signal to the therapists that we are doing
somethingwrong. A client who is not in rapportwith the therapistis not
likely to change,regardlessof tactics, whereas,a client who feels
empathyand understandingfrom the therapistis very likely to succeed,
Firs! we needto be cautiousofbeing ensnared
with the..euestion-
Answer" interaction.In this type of situation,the client merely responds
to questionsand doesnot elaborateon any subject.Avoid askingdirect
closedquestionssuchas:',You,rehereto quit smoking,right?,' ..Doyou
think you smoketoo much?,,,.Whatis your favoritetime to smoke?,,As
you may guess,thesequestionsdo not allow for a narrativeto emerge
and might actuallyshut down effectivecommunication.
This is a sure
tign thatthingsarenot goingwell.
Second, we must beware of taking sides and initiating a
oonfrontation.If a client states,..My wife nagsme all the time ro qurr
drinking." A 'laking sides,,responsemight be, .your wife is worried
tbout your use. It appearsyour drinking is out of control.,,A more
rppropriatereflectioncould be, ..It soundslike your wife is wonied
lhout you, How rnightthingsbe betterbetweenyou?,,This is morelikely
49
 herto accepta label.Somelabelsmay carrypublic stigma. If so,
to reveal motivationsto change. lt will nlso cnhluco the rapport' clients
takinga stancedoesnot allow thc cliclrt liccdontto explorehis with healthyself-esteem would be most likely resistantto them. Any
whereas,
resistancewill not help our cause.We are not looking for a power
or her
struggle.We are looking for intemal client motivationsto change.
own optionsand may createanimosity. Enrpfithyttrldntpportare more
therapy. The client is thc cxporton his or her
F
I
There
seemsto be no importantadvantageto labeling in therapy.Therefore,
importantfor successful we
must keepin our awarenessthat we wish to play down the urges
life. to label
behaviorsandremoveattentionfiom them to enhancereal motivation.

Third, do not get caughtup in your own expertiseAgain,the client

is theexpert.We do not haveall ofthe answers.ln our desireto help,we Fifth, our focusis on our client'sconcems.If we becomeawaxe
of
other difficulties that we feel would be a more appropriatefocus,
may cometo believethat we can clearly determinewhat may be bestfor we
needto disregardour insightsfor the time beingand allow the
our clients.We may feel that whatwe do is in their bestinterest'It may client to
processas neededto developtheir own conclusions.
leadus to "push" them into directionsor behaviorsthat they would never If we wish to fbcus
on a different topic ffom our clieng we are risking a struggle.The
considerand might not be appropriateat all for their life or development' client
This couldmovethe client into a passiverole asthey seekto pleasethe is the expert.Allow thingsto developin tleir frameof reference.
If we
therapistor just wantto be told whatto do. Ifthey couldjust be told what seethat a client would be betterservedby regressionhypnosisand
they
to do they would not be in our office. I am swe that there are many cimplywish to be treatedfor an addiction,we sirnplytreatthe addiction.

clientswho havehadlots of advicefrom well meaning"experts"on what It may cometo light with motivationalinterviewingthat the client
will
they shouldbe doing. We do not want to follow that pattem' We support noticethat somethingfrom the past is activatinga triggerfor their
use.
our clientsto make their own choicesand decisionsconcemingwhat Then,we may simply offer additionalservices.This keepsthe
creative
processof therapist/client
interactionmoreDroductive.
rnaybe bestfor them.

Fourth,we do not want to get into debateswith clientsconcerning Finally,counseling

hasa,,no fault,,policy.We do not wanrro get

labels.If a client comesin to the office and states,"I am an alcoholic"'
thatthey areworkingfrom without
we will acceptthe frameof reference
tlcbatcor disagreement. Labelscan be usefulto somepersonsand
crught up in the "blame game".A client may entertreatrnentblaming
tltoir addictionon their past,their relationships,
their anxiety,or many
othcr lirctors.We can acknowledgethis idea respectfully.However,

t()olhcrs.ll is notour placcto lrrbcltt cliottlttorto gcthim or

ck:trinrcrrtrtI bhtnc is not importantfor our success.
Treatrnentis not a court of law

g-" 5l
where we must lay blame or fault. Lots ol'nccdlcss tilll€ or energy may
be wasted in seeking to make someonc rcsponsihlc. . "l would never
have becomethis way if not for ." Wc arc hcre to treat the
addictionthat is cunentlytroublingthe client.Wc arc seekinganswersto
be implementedin the now. We cannoterasetho past.We cannottreat
someonewho is not present.We can simply reliame. "l cannot do
for this happeningto you. I canonly
anythingaboutwho is responsible
helpyou decidewhatyou aregoingto do aboutit."

The Oneto Four Session

53
Session1: Assessment
This is the opportunityto beginto ttscyottr ncqrtircdrnotivational
interviewingskills. Begin immediatelyaller irltrotlttcingyourselfto the
client to seekthe answersto the questionsregardingchangeand goals
throughyour motivationalinterviewingtechniqueslixplore all events
that recentlyled the client to seektreatment.Striveto useopenended
questionsand seek a total image of the life your clients are currently
living and the life they desireto live. Remember,the clientsare most
likely ambivalentabout change.Seekto compareand contrastthese
imageswhile elicitingchangetalk. Discoverthe languageandthe goals
the
you will usein directivehypnosissothatthey will mostapproximate
exactimageofthe life your clientsareseeking.
A good opening statement that includes the amount of time
involved,the therapist'srole, the client's role, sometreatmentgoals,
somedetailsabouthypnosis,and an openendedquestionwill be most
effectivein gettingthingsstarted.
"Our first sessionwill last about90 minutes.I want to get a deeper
understanding of what bringsyou here.I'll probablyspenda lot of time
listening and gathering information. Then' I will be explaining and
answeringquestionsor concemsabout hypnotherapy'Before we begin
the therapy,I may need to ask some specificquestionsabout details
necessaryfor effectivehypnosis.Now, tell me aboutyour concemsover
smoking?" Or, "Tell what has happenedto bring you here for
hypnotherapytoday?" Somethingto this effect should get things started
nicely.
t1-
Rememberto affirm the client for comingin to seeyou. It take
courageto change.It takes courageto meet with a total stranger
to
discusschange.And, for manythereare fearsconceminghypnosis
tha
mustbe overcome.
Now, the research
hasnot established
the selectioncriterianeededto
determinewhetheror not to usehypnotictherapy. In the end,this
will
requirethe therapist'sclinicaljudgment. However,a numberof issue
mayneedto beconsidered. Clientsmustbe assessed
for:
o Cunentlythreatening
suicideor homicide
o A recordedhistory of self injury or self mutilation that is
currentlyactive
o Exhibits psychosis,is out of touch with reality or actively
hallucinating.
o Cunently in an abusiverelationship(eithervictim or perperrator)
o Hashistory of any trauma(may requireadditionaltherapy.l
Theseissuesmustbe dealtwith separately.The healthand safety
ofthe
client,therapisgand othersmay well be at stakein someinstances.Ifa
prospectiveclient meetsthesequalifoing criteri4 it is appropriate
to
move aheadwith therapy.We need all informationconcemingany
tubstanceabuse/dependencedisorder. We want to make sure we
completelyunderstandthe extent of our client,s use. This includes
dctailedhistoricalinformationandcurrentusepattems.We needto take
mcasures to ensuretheir motivationis enhancedto the highestdegree
possibleand that thereare supportsavailablefor them in dealing
with
lhoir substance
useoutsideofour sessions.We wantto verifl,,that their
 \r-

lr''||r('crvironmenltis stable.If they're homeless,living on the street, lmprovement, possibly by demonstrating regular
afiendance and
gr,lrrgtlrlorrgha divorce,or in an abusivehome environment'this will willingness to participateare often easiestto motivate.

r llrrl\ lrllrrerrccthe tlierapy. It may be that now is just not the right
tlfir. \\'r \\[ l to be sure of their emotionalstability The stressful Clients with personality disorder traits, palticularly
antisocial or
rrrtrtll.,,1 llrctt c virttnntentmay be too much and createan unstable borderline traits, are often not amenable to hypnotic
therapies for
ntrrtrl ll,ulth cptsotletltat tvill be detrimentalto their ability to fully addictions. Antisocial personality traits involve a pervasive
pattem of
rFrlr,rr,l t' ' tlrr' lrr prrollrclapy.Again, our skills with motivational behavior where the rights of others are disregarded
or violated. This
*rtl| llr{ lr! rr tll rrl', rtlli'ellhis situationandassistthe client to be ready disorder is consideredto be in evidencewhen a minimum
of three of the
h rt rlt x ; s gy lollowing traits are exhibited: a) repeatedperformance
of acts that are
l il *r r r r r r r ||r " rl l t| | | ' rtl rtl l l l ]. \Y e w a n t to know i f our cl i ents are groundsfor arrest,b) repeateddeceit or lying, c)
failure to plan aheador
rrr,rllr t lF r l t , , I lr ' r t rl ,r l ,,l tl l i \ l \p c o f tre atment, w e need hi ghl y impulsive behaviors,d) repeatedphysical fights
or assaults,e) reckless
rl r'rlt r at ||l lt ||llt I hr rl r l l rrr,l .l l rc r l l ti l l d c c i d e to l eave l reatment earl y disregard for the safety of self or others,
0 repeated irresponsible
,'t rlr l r r r r lhr r hb t,, l .l l rttl ttrttrl l rr' rrrrrl rl i c ti v cb ehavi ors. Thi s may l eave behavior,such as failure to maintain work or honor
financial obligations.
th rl t| r t r [ , r r r , r br * l rrl l i tttrl l rrttl ttyl l ttttt l rc l o tc the treatment. W e w ant or g) lack ofremorse for harmful behaviorto others.

l | , rll. r r i ll|} t lr ' , ' tr l ,rl rl l r,l l l r' l | fi rl l l l (' l rl rv i tl r cl i ent i n si gni fi cant

,l rtl l l : , lr r , { h ll|| rtt rrl r,,rl l l l ,rrrrl l l tItt rtl l rr \ l l tettl to make a w el l Borderlinepersonalitytraits involvea pervasivepattem
of behavior
t l ,r||||r , l { |t ' l h, r " , rrrl ,l r ,l r,1 ,1 ,,| |r,' trrtl l rl l l l l t l l ttrrgc. Il any cl i ent has (lcmonstratingunstable interpersonal
relationships.sell. inrage. atlct
Itrtl r r lr l, l, , |\ , , 1 t trt ' ,I r r || || | |I l tt l rrttl t\ l l i l l l tl cl l l l )r()S l i l l l ' l s,i t may be crnotions,along with extremeryimpursivebehavi.rs. 'r'hc
dis.r.trcr.is
|| ,' l | |l 1, , \ r ||||r r l ,l r \ r' ,r1 ,l r' { o l tl ' . i ' r (r,l l l rl (l | r' i ot l l l c| api ststo fi nd hou' consideredto be exhibitedwith a minimurn of
live ol. lltc li)ll()\\i g
'
rrr'l l llr r ' , l|' ' r l llr r | ' r(\tr' r\l t trrp rtg c rlttt l tc i l l l l l ct)tof l tow w el l heorshe lllils: a) frantic efforts to avoid real or imaginccl
arbarrdornrcnl,
tr;
l rrrl 1rrrr I rr' r1rrrIr' rI ir l re i rl n te l l . l ' ti rtt r,tte c e stl
s r f' ai l urew i th conventi onal trrslable and intense interpersonalrelationships
where thc orncr rs
tl rtrr r pic sr lr r t s nol rrc c e s s i tti l ti rrd i c a tcth e c l i e n tw i l l reactthe same now . t luuacterizedby extremesof idealizationand devaluation.
c) unstable
l l o rc r c r . il r r r iglr tl rc b c s t u s e d rv i th c l i e n ts w ho are i n the appropri atc rcll irnageor senseof sel{ d) impursivityin
behaviorsthat becomeself.-
slirBc ol clrirrrgc as discussed earlier. Clients who have been rvell- rlrrrrrrrgirrg
(at leasl two of the following, i.e. sex,
spending,substance
i rrl i rlr r r c r l llx r r r l l l rc i t p to b l c n rs rv h i l e s h orvi ng a dedi cati orr t" irlrrrsc.r'ecklessdriving, or binge eating),d) recuning
suicidal or self
|||||| |I/|| ||Ilt bchavior, e) marked reactivity and
instability of mood, fl

.rh
57
 v

ANY health concernsthat may affect treatmentoutcomes.For inshnce,

chronicfeelingsofemptiless'g)inappropriate,intenseanger'orh)
someonewith organicbraindamageor other impairmentmight be a poor
or dissociation'
transient'stressrelatedparanoia candidatefor hypnotic therapy. To recap the selectioncriteria concerns
involvingclinicaljudgmentinclude:
traits will not be a good candidate
Any client demonstratlngthese
issues'A o EstablislrsubstaDceabusestatus
addictions therapy without addressingthese other
for hypnotic
may . Screenfor environmentalstability
childhood or multiple traumas
person who has also expertenced
a "victim" r Screenemotionalstabilityandcopingskills
involve identification with
develop PTSD, which might
and this is a o Suicideideation
safety dominate their lives
mythology where fear and
may be o
for substanceabuse as the client Psychosis
possible deterrentto hypnosls
must also be .
the anxiety and/or PTSD Determinethe motivationlevel ofclient and stageofchange
self medicating' In this case'
We would r
the treatment for addiction Verify social support,cooperation,and problems
relieved or reduced along wlth
o Verify medicalstatus(getmedicalreleasefrom physicianifneeded)
needtoconsidertleatmentforanyco.morbidmentaldisorders.

and
intervention may be ineffective All treatmentbegins with a detailedassessment
to determineif
Also, a poorly timed hypnotic
too
Avoid clients who appear diagnosablesubstanceabuseor dependenceis actually presentand if
increase resistance to treaiment
not seem to
ego boundaries if they do thereare other clinical problemswhich might respondto hypnornerapy.
omnipotent or have unstable
hypnosis may
motivations lt may be that lfyou feel uncomfortablein your abilitiesto assesssubstance
use issues,
respondto seekingtherr own
it may be bestto consultan alcoholand drug abuseprofessionalwho has
allowintenseanger,shame'guilt'self-accus ation'feelingsoffailure'and
that would
Again' these are concems specifictraining in this areabeforemoving ahead. Again, this hypnotic
"What ifl" thoughts to surf'ace
the addiction
before dealing directly with lrcatmentof addiction involves: enlrancingmotivationto change,ego
need to be addressedfurlher
slrcngthening,
and directivehypnosis. The client may also have related
issues.
ploblemssuchas anger,anxiety,depression,
guilt, shame,or relationship
lntrtnstc
are the prominentissue issrrcs.When consideringmotivationalhypnosistherapy,the following
Always' the clielrt's motivations
change
we requirefor lastinghealthy torrditions should be met: Clients must be capable of relaxation,
rrrolivationswill give us the results
approval
we needto get a physician's lirlkrrvinginstructionsfrom the therapistsrelatedto guided images,in
Arrd.adtlrcssinghcalth'ceflainly'
li}l lhet.irp!il'thcrcitrc
caudicl atc tr:lrrlivclvgood health,have a stablehome environmentor strongsocial
llrirlthc clictrtis iln appropriate
slrrtirtg

s0
:l{
 self motivatedto stop abusing consequences,
or use of illegal substances
support,and be (or be capableof being) and the risks that go along
that clients be sober as the with this use. Dependenceis characterized
alcohol or drugs. lt is not always necessary mainly by toleranceand
withdrawal. Tolerance meansthat
result ofthe treatment' over time if takes more and more of
object is to increasesobrietyas a direct
the substanceto get the sameeffects.
Withdrawal indicatesthat there are
will consist of a client negalivephysicalconsequences associated
A basic substanceabuse/useassessment with discontinueduse of the
substance.
including age of first use' feelings Once it is determinedwhetherthe client
history related to ALL substanceuse is merely an abuser
for use (immediate and post)' or actively in addiction or substance
and memories related to tirst use, rewards dependent,we will be able to
that are not a result of the estlmatehow many sessionsare required.
secondary gains (rewards related to use Many personswho are sirnply
users or abusersmay require only
chemicaleffectsofthedrug,ie',socialinteracti ons'income'etc'costs one treatmentsessionwith this
protocol.For thosewho are substance
ofusebothfinancialandpersonal,alongwithquantityandfrequencyof dependent, I stronglysuggesrthe
we are seeking information and therapistcompletethe entire 4 sessions
use. In cooperation with the client' with the client regardless.
always rnoving gently back and
discoveringmotivationsto change' I am
and what may not be I may Another factor that is helpful to explore
forth between what is desirable about use is the family history of use
and its consequences. The client may talk aboutthe past
useanassessmenttoolSuchaStheASI(AddictionSeveritylndex)' or a well placed
open endedapproachsuch as, ,,What
SASSI(SubstanceAbuseSubtleScreeninglnventory)ortheCAGE have beenthe patternsof use
system or where a client's in your lamily?" The srrengrhof use
questionnairein casesthat involve the legal in the family tree mry beiat.cl ro
doubt These tools also provide now easyor not rhe client may find
statementsconcemlng use may be in their abilio/ to quit. A strongfamily
historyof substanceuse difficulties
upon in such a way as to lncrease will most likely indicatemore than
more responsesthat may be reflected
rrnesessionu ill be mosteflective
information is valuable to the rn treatment.
motivation to change All assessment
Be aleft for any clues the client
treatment. Nothing is unimportant
of intrinsicmotivation' In the appendix,I have included
revealsinto possibleavenues10sources some simple tools thar will be
Itclpfulin the assessment process.I have a sampleof the simple
intake
client is a uset' abuser' ot' Irntl assessmentfonn I often use.
We need to discriminate here if the It can be copied or modified as
lrl)propriate
abuse is defined as continued Ltsc for individualtaste.Thesetools are
addicted (dependent) ln substances' not researchbased,thou
professionalobligatit\tls.t|Sc lt| ronrc of the ideasand questions
are definitely relatedto more elegant
desoitea f.ailureto meer personalor
tll. lcgllI lools lbr assessment
that cat] be dangerous,negative interpelsonal
cttvirclrrments
that do have scientific support, such
as those

a rl l oI
 assist o How doesyour family relateto your behavior?
for useoverdaysof the weekcan
mentionedpreviously'The chart . Whatinfluencedoesyour spiritualpathplay in this?
may
be interrupted and triggers that
to determinepattemsthat might o How is your healthaffectedby your actions?
n e e d t o be d isp la ce dthroughtheuseofhypno s is (S e e c h a rt o f d a y s .
questionto help us determineif the What happensto you financially afterwards?
Appendix2). We canusea simple
l often
is intrinsically or extrinsically motivatedto entertreatment
client
the clients These questionswould be basedon what the client rates as most
seekto changethis now?" If
ask, "What hasbroughtyou to
are doing importantto them. Rememberto reflect what you discoverand seek
requiredto be treatedor they
respondby statingthat they are
statementsfor self change. These discoveriesmay be extremely
thistomakesomeoneelsehappy,etc.,thentheyaremostlikelygoingto
amhere importantfor scriptinglater.
If the clientsrespondwith"'I
requirethe full four sessionmodel'
for
gives a internal' personalreason
becauseI am readyto change"and
session We can influencethe client,sability to talking aboutchangefor
are probably ready for a one
taking this action, then he they
to be in "action" phaseof change scriptingwith our interview.We needto look for signsof readinessto
ffeatment.Only a client who appears
for a one sessionattempt' We changein our client'sanswers.We can ,test the waters,,with questions
and is intemally motivatedis appropriate
sesslon suchas,"What areyou thinkingyou,d like to do aboutthis?"or..Where
is not ready to attempt a one
must not allow the client who
tell
will expectfailure' They will also doesthis leaveyou in termsof changingyour
treatment.If they fail once' they
future would haveto be differentfor your life to improve?,,Evenif we clearly
and createexpectationsamong
other the treafinentdid not work
see where a changemay be beneficialto the client, it is nor our
clientsthattheywillnotsucceedinourprogram.oncetheextentof
we can responsibilityto offer suggestions
for change.Leave responsibilityto
numberof sessionsis determined'
substanceuseandthe proposed
phaseof our first session' changewith the clients! Theyaretheir own experts.Theydo not needus
moveinrotle scriptinginterview
to tell themwhatto do. This is theheartof motivationalinterviewingand
helpfulto is very difficult for some personswho work in the substanceabuse
The onepageassessmenr ofvaluesimportancecanalsobe
health' treatmentfield who may believethat theyknow what is bestfor addicted
might value most whetherfamily'
assessexactly what the client
porsons.
will also give the therapist fruitful
money, or spirituality, etc' This
interviewingtechniques'There
informationto explorewith motivational
pictureiwordassessment of valucs We are seekingto discoverany hint of discomfortor disadvantage
are many ways to use this simple
rchtcd to the currentsituationor behavior. We are investigatingwith
suchas:
ratinqs.

62
63
 Ieisure.This assiststhem to practice
ouf c l i e ntsth e p o ssibilitiesofadvantagesto c h a t rg c ' We h o p e t o betweensessionsand helpsinstill
ability to changeOur the ability to selfrelaxwithin the clients.
crlcourage optimism,confidence,andbelief in the This is self empoweringfor the
needto be remindedof their client and may aid in the futurefo
clientshave been successfulbefore and resistcravingsor urges.If the client
have never been successfulat seemsvery analyticalor too stressed
strengths.If a client sharesthat they to respondwell, I will sendhe or
themof their ability to walk shehomewith the CD to practicealone
anything,I beg to differ' One might remind prior to session2.
successfullyFinally' we are
or any other obviousability they express
intention of commitment to Again,I will not risk failureand I
hoping for the client to expressa strong want a positivetranceexperience
whethercompletedin offrce in the office. Ifthe client practices
change.The clienthomeworkassignments' at homewherecomfortableand can
entertrance,they are muchmorelikely
or at home,arefocusedon thesetopics' to be successfulin their second
office visit. If they are not successfur,
we can explorethis furthernext
and changetalk visit and they may requirespecialized
The therapistmay encouragesharingof information countingor confusioninduction
fears'or concemssurrounding techniques. If the client is considered
by inquiringaboutthe clientsanxieties' appropriate for one session.I will
a bit of self disclosureby sharing briefly coverall ofthe homeworkquestions
makinga change.We might evenuse we havenot exploredduring
will demonstrate nonjudgmental the intake and move directly into
our orwnconcernsaboutchange' We the hypnotic s"s.ion 1."" Script in
times to maintain an effective Appendix). However, if the client
feedback or information sharing at all shows that they will need more
alert to discoverany signs of sessions,he or she will be given
therapeuticrelationship'We must keep the first homeworkassignment.If
clientshave completedan assessment
discomfort,interest,andabilitytochangewhilemakingmentalnotesof tool such as the SASSI,I will
Always' we seekto use foregohomeworkand usethe assessment
what might be most useful during hypnosis' as my guide for sessiontwo.
talk Then,we shallutilize scriptingbased
reflectionsand summariesto draw out change on the clients,repliesto my open
ended,motivationalquestionsconceming
their assessment responses.
first sessionlfthe client is This will resultin four sessions.
I tendto useguidedrelaxationfor every If the homeworkis assignedduring
the
hypnosis'it is very helpful to first session, therewill mostlikely only be three
willing and seemsa good candidatefor sessions.
conductabriefrelaxationsessiontocompletetheintake.Thisallowsthe
of the trancestateand leavc The first homeworkconsistsof the
client to experiencethe positiveaspects first six worksheetsin the
that they may take with .ppendix' You may decide to skip
feeling as if somethingpositivehas occurred the pictures labeled ..what is
relaxationCD to use at thcil lmportantto Me?" as page5 of the
them. I also give them a self hypnosis homeworkcoversthe samematerial

64 bi
in openquestionformat.I often usebothwith sonrccliontsas it is most questionnaire
is valuablefor t
importantto havea clearidea concemingthc clicnts' values.The first
scripting.w","y.i,pry.Ji'o'.1'Tr"l'.il.'*fi:ll".,j
sheetwith picturesmay be used to confirm or cstablishsomebasic gamble?,'or ,'How
oftenareyou having
::;":
values.In tum, thesemay be usedto assessreadinessor significant sex?,,In this way, the
be modifiedto obtain form can
valuabl information
reasons
to change. for the treatnrentof
differenfaddictions. many
Again,*.e

For instance,a client ratestheir family as the #1, most important ln,*"_-,"*"*.",,'".]0*I,;:r:_'jj;i;::"TH
two. The choice is
entirely up to the therapist.
value in his or her life. We might simply ask how their useaffectsthe any _.*"r. ,uy
U"
family. The answer may lead the client to expand on how the use ;;ffiilTll*r* answers
mavbeused
rorscripting.
negatively impacts family life. This in tum may be used for scripting ffi could be better?"and
"what would
you like to havehappen
u, ult of hypnotherapy?,,
suchas, 'No longercausingdiscordin the family" or 'T.{ow,bringingthe informadonto assist "."rout canelicit valuable
treatmenl
family together".Thesewill dependon the client'sresponses
but any
itemendorsed
canbe a topicfor explorationby openendedquestions.
If the client is suitable
Following this sheet, we have two assignmentsthat may be a one sessiontreatn.lent
therapistcan pick and "t format, the
completedduring intake paperwork, if we are aware of the addiction the rest ofthe homework
quesflonsthey believe"noor" sheetsany
will br in assistingthe hypnotherapy's
issueand thesemight be appropriateas part of the assessment.
One is success.I would comprete,n. ,""'"uol"
"How much do you drink?" This can be very helpful to assessalcohol
rikethescript,;;" ;;3j::'fi :'r',Jff ;'"..:ffi:
consumption,pattems,andchallenges. 1uch.
completedwith information :*
fi *" motivationalclient
always record the session interview.I
urtt a digitar recorder
Next, we havean assignment
sheetconcemingthe clients'current ,,burn,, and immediatery
a cD of th" ,...io;
;mg t useat homeif they feel
lifestyle. We are seekingto identiry pattemsthat may be disruptedor will needfurtherreinforcem"rr*"^tl""t they
replacedthrough hypnotherapy.We are asking clients to point out areas of the hypnosisl prefer
cD but I alwaysask to usea sleep
the clien
where changeneedsto happen.Any responses
may be expandedand nr;tru;ts
them;,,* ;.;il ;l;Tji,'Jft ;::#:J::
utilized for hypnosisscripting.For otheraddictionsbesidesalcohol,or whatis appropriate
for them.I n
for alcohol if you prefer,the secondsheetis appropriate.It is titled. *,r,nyopinion, il;;#fl:]:::ffi:.',;:::il"H,;:
"How much do you use?" The informationobtainedby this short llsl throughthe night
and becomemore deeply
imbedded.As of this

66
 to supportor refutethis theory' The SecondSession
writing, I am unawareif ther€ is research
I sendthem on their way with The focusof tle secondsessionis determinedby the results
The one sessionclient is now completed' of the
if further' questions'concems'or first. Of course,if clients were appropriatefor a single
the CD and an openinvitation to retum sessionand
seemedsatisfiedwith their hypnosis,therewill be no second
diffrcultiesmightarise. sessionfor
tlem. Secondsessions are for thosewho requireintensivemotivational
a more intensetherapeutic work.
For those clients who appearto require
in addiction or dependence
experience,especiallythose who are truly
repeaters'I assignthe frst To begin,we sirnply do a counselingcheck in with the clients.
and not simply abusersor habitual behavior We
would needto explore the efrectsof self relaxationhomework
homewofksheetstobecompletedandretumedt}refollowingsession.Ifl with the
not respondwell to hypnosis assignedCD. After checkingin with the clients,we would process
am reasonablysure that the client will any
simple values and use sheets documentedassessmenttools. I find that any answers to
without some practice, I will assignthe any valid
(about 15 minutes)' My main assessment
may be expandedupon by reframedopenendedquestionsto
along with an induction/relaxationCD
into trance before the second elicit motivationalresponses. For instance,a "yes,'answerto ,,haveyou
hope is that they will practice relaxing
we will complete our ever felt guilty after using?,'This responsecould be approached
session.Then with the first simple assignments with a
session' simplg "Tell me moreaboutthat.,' This couldreveala treasure
beginningMI andhypnosisin the second troveof
motivationsto quit.

Next we would examine responsesto the basic homework

assignmentsof: What is Important to Me?; How Much do J Drink?:
or
How muchDo I Use?We must makenoteof any information
that will be
usefulfor changein our hypnosisscripting.Thenwe are ready
for our
first motivational hypnotherapy approach as we integrate
clients,
response
intotheirhlpnosisfor change.

Once the hypnosisis completed,we checkin with the client

and
processanythingof importanceor note,especiallyany
thoughtsrelated

68 69
toinspirationsorintuitionsaboutimprovedchange.Again,weare
enlranceor improveour We simplybeginwith a checkin as in all sessions.
seekingintrinsicmotivationsto changethat may If the assigned
to our mutualsatisfaction' worksheetsare not completed,we may elect to
next session.Oncethis processis completed continue and complete
homeworkfor the sheetsin sessionor canceluntil the worksheets
we will begin to explain and discussthe motivational are completed.I
decidedependingon my schedule. However,it shouldbe notedthat ifa
three
session
client doesnot completethe worksheetsit may indicate
a Iack of true
motivationto makechanges.If thereis any intuition
Thehomeworkforsessionthreeconsistsofverybasicmotivational that this is what is
their cunent lifestyle' occuning,the sessionshouldbe cancelleduntil the
assignments.We are asking the client to explore client demonstrates
to discover outlines of willingnessto completethe asslgnments.
schedule,or daily/weekly routine' We hope
by more healthy pattems'
behaviorthat can be mtemrptedor replaced
them and what needsto Ifthe homeworkis in order,we wantto identifi routines
Insist that the client tell you what works for thatarenot
to increase These so healtly or causeclientsdifficulty. we needinformation
change. We 'dant healthy and pleasing activities on how the
with Current vs' Future clients' routine affects their health, finances,
assignmentsare in Appendix 2 and begin relationshrps,and
assignmentthrough achievements. We are alwaysseekingchangetalk. The clientsmay
Lifestyle. Assign all worksheetsfrom this beginning tell
the costsand benefits us how couldlife canbe betterandwhatwouldhave
the FutureIntention assignment'This will include to changefor this to
another important values takeplace.
of changing vs. staying the same and
worksheet.Allfiveworksheetsneedtobecompletedforsessionthree.
to session three The next assignments haveto do with cause/effects,
Remember you may decide to proceed directly What will be
you desireto do so and it seems theresultsof stayingthe samevs. change?Otherprograms
homeworkfollowingthe first sessionif usediflerent
approach' termsthat you might find more appropriatesuchas what
for the client'Thiswouldbe usinga threesession
appropriate is good vs. not
so good or what is desirablevs. undesirableaboutyour
addictronor
behavior?I simply use a cost vs. benefit approach.
Any of these
approaches will work. We avoid usingpositivevs. negativeor good
vs.
badterminologyas this can snareus into confrontation
or taking sides.
The object here is for the client to make a concrete
record of the
Inl'luencesthat result from the addiction.Someclientsmay argue
that

7n 7l
 was no helpfulto establishrapportandsearchfor otheractivitiesthatcanreDlace
is no benefit to use' Gently remind them that il'there
thcre the behavior.This is a very importantsetofexercises.
with
continuedWe tnttstbe honest
bcnefit,the usewould neverhave
stressreductionis a beneftt'
tuurselves. If I smoketo reducestress'then
I might enjoy Next, we would coverthe client'svalues.This may be somewhat
'lhe next questionwould be' what are someother ways
redundant
to the earlierpictureassignment,
stress that are healthier for me? We must seek out the "Whatis Importantto Me?,,,
rclieving However,I discoveredthat this assignmentcan uncovervaluesthat
|notivationorstimulusforlifeimprovement.Therearesomelistedareas might be missedby the simpler "ratings,'version.Here, we ask the
with openquestioning' just in casethe
to coverbe sureto addresseach clientsto brainstorma list of valuesandtraitsthat areimportantto their
health
or her answers'How is your
client did not fully explorehis corebeliefsand improvedself esteem.We askthemto thenidentifythe
resultedor
affectedby your ? What type of legal issueshave
? How does two most important.This is similarto self image/selfesteemwork. We
your
rnightresultin your futurefrom arehopingthe clienthasan ',ideal,'imageofwho they canbe.Then,we
after
are the good things that happen
t'r.tp you. relationship? What ask how they can becornemore in line with their values.The benefitis
good?I try to seekthe
What happensthat is not so
most two-fold, decreased addictionand improvedself esteem.No one can
end on the costs l feel that the
benefitsfor the behaviorfirst and decidethis for the client. After all this you might concludeby asking,
client's
the behaviorwill remainin the
recentor lastthoughtsconcerning
"No one can tell you what to do. Knowing all of this, what would you
consciousness longer,especiallyifthey arenot desirable'
like to have happen?" This will teadto the next and last homework
sheet.
ambivalenceand shift the
We are working here to overcome
of change' Normalize tle clients'
decisional balance in favor Finally, for sessionthree,the last assignmenthas encouraged
the
a m b i va le n ce .Yo umightevenexplainambiv a le n c e a n d t h e client to look to the future. We seekto know the clients' hopesand
are affected by
approach/avoidance conflicts here and how all persons
dreamsfor the future.We want to clearlyunderstand how thesehopes
tlrem.Thewrittenlisthelpstoquantifftheanswersincolumnform. and dreamsare importantto our clients.We are seekingto view their
easierasthe list in favorot
Sometimes, this makesthe decisionto change
samei\ futuresthroughtheir vision,not our own. We mightencourage
may be far largerthan if the list in favor of stayingthe the client
change to brainstormandcreatea list of optionsfor the future.Then,theymight
thc
endedquestionshereto determine
the greatest'Asking more open dccidewhichsuitstheir needsbest. It is vital the clientsexaminecurrent
by the manyprosandconslistcd
"force" exertedon the client'sbehavior bchaviorsandthe relationshipbetweencurrentactionsand likelihoodof
is
why useis attractiveto the clicnt
will alsobe helpful lnformationon

12 73
 Final Session:Self-Efficacv.Intention. and Plan for Success
and we want ro
Some
success. actionsmay leadto success
current
their
t|cvelopthose.Thisissimpletointegrateintohypnosisscripting.The notice that The final sessionputs ever).thingtogether.All of the information
be instructed to lncrease any behavioror simply
clients may that you havegatheredfrom the previoussessions
needsto be gathered
the clients have
are enjoying doing it more ftequently Somethings
they together,combinedwith currentassignments,
and offeredin a powerful
to identi! these
to their dreams'We want
been doing are detrimental closinghypnotherapysession.The client may be well into changeby
surprisedto notice
They may be pleasantly
barriersand remove them' now. The idea is that victory over the addictionis assured.Faith is the
simply disappear. we guidethe clientsto describe
rhatthose behaviors teatment shouldbe strong.When checkingin with the client at the
in that would be
that they would like to becomeinvolved
activities and beginningof the session,startwith a questionstatementsuchas, .,Tell
spent on less helpful actions/behaviors
helpful to replacethe time me aboutyour successes".
Thefocusis to be success.
increasethelikelihoodofmakingtheirdreamscometrue.oncewehave I wantto takea momenthereto explainmy ideasaroundintention.
the scripting
our clients' answers from all of thesesources'
gathered Back when I trainedgraduateinternsin counseling,I would mention
suggestions to reinforcetheir choicesduring
consistsof simplyinserting your intentionand some of my intems would look at me with a blank
to use the clients' own words rather than
hypnosis. Be careful expressionand ask,"What do you meanIntention?"Intentionhasbeen
easily accepted'
Mostly' their own languageis more
reflections. definedin many ways.It is a plan of action or an aim that guidesan
or metaphorsand
if you reflect to the clientby using images
However, use them action.It is alsoknownaswhatsomethingis meantto convey;a meaning
to them' by all means
the client respondsenthusiastically or concepto something.In the medicalfield, intentiondescribesthe
from hypnosis'
the clients' reorientation
during hypnosis'Following courseor mannerof healinga surgicalwound.In a sense,this is an arm
immediately
or concemsThen' move
processany feelings'questions' of repair.In Latin, the word was intentio,,meaningto stretchtoward
this session'
explaining the last set of client homeworkand closing
into (from intendere).
want to create
with client self efficacy' We
The last sessionis concemed Intentionhastakenon a varietyof connotations
recentlysuchasan
thesuccessmindsetbyfocusingonclients,perceivedStrengthsand a concrete' aim thatcausesus to grow,an activeforcein the universe,a forceacting
successes We want to have the client create
previous and on the quantumfield, or possiblyConsciousness
itself.I like to think of
rating their confidence'enthusiasm'
intentionalchangeplan while to intention as the art of aligninq our consciousnesswith infinite
the change Then we simply use hypnosis
onticipationconcerning in order to becomeco-creatorsof our realtv.
consciousness This
successwhilc
the way strengths may be used for cunent
suggest
thestepstheypropose'
directingtheclientto take

75
 the true power of having an Following is a list of questionsthat may
help. you can usethese
m&y seem pretentiousbut it conveys
inquiriesin earliersessionsat any appropriate
intentiontowardschange' time. you will notethat
waswhat they could they may parallelearlierwork. If these
What if all our clientshad everthoughtabout havenot beenansweredbefore,
lives? Now' suddenly'the now is the time. The clientsmust ask themselves
not do or what was missing from their somequestlonsthat
but they haveno clear mightpromotethis intentionthinking such
opportunityis right in front of them to change as:
o Ifyou wereyour,.ideal',sel{
i n t e n t i on s.Wh a tar etheytogrowtoward?Wh a t is t h e g o a l? T h is is whatkind ofpersonwould you be and
movethem into the final stage whattraitswouldyou have?
beyondtheir addictions'This is whatwill
consumed o Whatwouldyou be doingif you
of transcendence. Supposeup until now the client has been lived asyou wantedto?
like wherethey are or' how o What seemsto be missing
with thoughtsof how he or she doesn't flom life or what might you not be
beenthis way' Considerthe getting?
thingscan neverchange,they havealways
no choicesandmust' should'or o Whatappearsto stopyou or getsin your way?
clientswho havebelievedthat they had
that otherswill acceptthem .
haveto behaveas they have in the past so Whatareyou doing now to createthe life what you
want?
to AlbertEllis)'
(apologies o Whatdid you actuallydo thispastweek?
are seekingto plant the
We are askingthem to chooseagain' We o Whatdid you wantto do differentlythis past
week?
seedofbeliefintheclientsthattheycanattract,move,change'and o what stoppedyou fiom doingwhatyou sayyou
wantto do?
with this frightening
choosea new life. Suddenly,they are confronted r Whatwill you do tomorrow?Next week?
freedom.someoneoncesaid,ifyouchangethewayyoulookatthings o How is whatyou aredoingNOW helpful
or harmfulto you?
the sameis safe Ambivalence
andthethingsyou look at change'Staying . Whatareyou doingthatyou reallywant?
without a clearintention'
existsbecauseof this' It is easyto tum back o How areyour actionsworkingfor you?
goal,andPlan. r How doeswhatyou aredoingmatchyour beliefs?
clients in the ability to
In this session,it is critical to assistthe o How committedareyou to change?
to know what they really
becomeclear and focused The clientsneed You mayevenwantto assignthesequestions
good and the good of all earlyon or simplypick and
want. They requirea plan for their greatest choosefrom them to ask during sessrons
of thesethingsand all that to augfirentyour ability to
concemed.This sessionis the clarification improvemotivations.Theyareintentionseeking
in nature.
hasbeenrevealedin sessions before
The homeworkshouldbe approachedin
the samemanneras all
prcviouswork. Theclientresponse
shouldbe expanded uponthroughthe

76 77
 focuson of thesecan be helpful to breakthe "failure mind,'. I am surc that il
motivational questionsOur lirst shcetis the
useof open-ended for creativetherapistcanthink ofmany moreexamplesto use.
We are going to supportself efficacyandexpectation
pastsuccesses. begins So,we setthe scenefor success.
Examinetheassignment.
What ever the intention for change'the seedfbr triumph
success. The client shouldhavelistedsomepositivechangeshe or shehas madeat
ability' We are
We are seekingevidenceof
with an empoweredclient' be sometime in life. Then,theywereto chooseoneof the changes,maybethe
The clients' beliefs about their abilities will
seekingself pride'
onethat was hardestto accomplishor they felt mostproudof, and examine
promoled'
revealedandtheir strengths how they accomplished
this change.Was it all at once?Did it take some
a past time, steps,and planning?We want to know how they did it. We want to
of the assignments is asking the client to recall
The fust emphasize
their abilitiesandminimizedifficultiesashavingbeenconquered.
here'
I have actually been confrontedwith some dfficulties
success. We wantto determinewhatpromptedthemto act.We identi$rtheirthoughts
havenever
of my clients have been absolutelyconvincedthatthey
Many andthe environmenttlat promotedtheir motivation. Finally,we wantthem
three instancesof
I use examplesof tlvo or
beensuccessfulat an)'thing' is for to tell us their currentthoughtsand feelingsaboutthe changesthey made.
good effect' One example I useconcemingsuccesses
success with Useanyrelevantsuccess
sex' they informationto enhance
beliefin abilitynow.
to consider sperm' When their parentswere having
the client be in the The strengthsexercisewill help us to increaseclient self esteemand
the egg' Spermcountcan
werenothinguntil a spermreached living expectationof triumph over addiction.Sometimesclientscan get stuck in
That is one largerace'Anyone
low millions to over 360 million' negativethought patterns,forgettingtheir accomplishments.
that has won that race' The strongest'fastest'and most We need to
lrasa part of them
them to consider remindthemof the ways in which they are personallyshongand powerful.
sperm will win lf that is too abstract'I ask
successful By first acknowledging
their pastsuccesses,
Theydid not this may be easierto do. The
walk' theyhavebeensuccessful
walking.lf they areableto I exerciseasksthem to list their personalstrenglhsand strong points.The
for themselves' "Hey' this crawlingis cool' I think
fall downanddecide
is just too focusofthesefirst exercises
is gainingself-efficacyandselfesteern.As they
just crawl for the rest of my life becausewalking
will spotlighttheir empoweringtraits, we seekto aid them in identiling how
and successful'
Would we just quit?A walkeris determined
difficult." thesetraitswill enablethem to changetheir addictivebehavioreffectively.
about any
of a '7 lo 12 month old
ll' we have the simple drive
ability to We alsowant to identi! andplan for barriersthat may hinderprogress.The
we will prevail' Last' I may use talking The
tundertaking, mostol' clientscandevelopideasabouthow their empoweringtraitswill aid themin
verbally is very complicatedlt is also something
communicate rcmovinganyobstacles
a failureat talking? Any they confronton theirjoumeythroughchange.
us weredetermined to accomplish'Is the client

7l 79
-

able to measureif these favorableoutcomesmanifest?The clients will

planofthe client'sfutureintention'
Next,we will examinethe concrete
describetheir expectations of what will happenas a consequence of the
,|.hisisastandardplanadaptedfromMillerandRollnick(1998).Theclients
change.There should be clear advantagesthat they will obtain fiom
ttrcaskedtolistspeciticareasorwaysinwhichtheywanttochange.They
changing.A proposalfor how they know they are successful
specific goals or targets'They needto includepositivegoalsto begin needsto be in
rcpoft place.
for
positive behaviors' and expectations
creating change, increasing
detail to which this is It is importantto recognizespecificobstacles that may be encountered.
inrprovements or modificationsof behavior'The
If identified,any eventsthat may slow clientsdownor get in the way canbe
seriousnesswith which the client
cornpletedwill often indicate the
circumvented. It is importantto anticipateary situationsor difficultiesthat
to be ill preparedor vague'it is no1
lpproachesthe changelfthe plan seems
questionsto a more detailed might possiblyneedto confronted.It is much easierto stick with a plan
inappropriate to guidethe client throughopen
regardlessof obstaclesand delays if preparationsfor difficulties are
plan.
completedin advance.The idea is to navigateobstaclesand reach our
the most importantreason(s)for
It is critical that the clients identif,
destination.It will be helpful for the clientsto list stepstowardsproblem
place Thesemay have been formulated
wantingthesechangesto take
themostlikel) solutionor reorganizingstrategies that they would use.Also, it is good to
whenclientsdetermined
duringtheirdecisionalbalancework'
identifythosetheywouldapproach for assistanceis needed.
resultsof changingvs stayingthe same'
Weuncoverthereasonsforchangingthatarethemostsignificantforclients
tlrc Finally,the client is askedto usea simpleratingscaleto determinethe
the clientshave also considered
and those closeto them' Hopefully'
in this platt importanceof this changein their life, the confidencethey haveconcernlng
emotionalconsequences of changing.we requirespecificsteps
quicklyarll their abilities, and thet emotionalevaluationof the change.I have a
thatmaybe accomplished
to change.We needbeginningactions
ths worksheetof questionsthat the client may answerbut it is best if the
specificon how' when'andwhere
loDgterm goals.The clientsmustbe
therapistasksthesequestionsbasedon the client's ratings.We needto use
needto recognizethe specificwar"
will makethesestepshappen'We also
ult" thesescalesto reinforceour final determination
clients Help the clientsto identi! ofthe client'smotivationand
otherpeoplecanaid andsupportthe
lr\l use them to make final adjustmentsin our efforts to enhancemovemenr
supporttheir intentions Be surethey
they will seekout to assistand
lowardschange.
family' counselors'etc) canhelp stlpln'rl
snecificwaysthat others(friends'
themin their endeavorsto change'
evaluated'Clientslltttrl ltr"rr If the clienthasmarkedlessthana..5,'rating on the Importancescale
A good plan must be capableof being
In nrrdit is not a zero,thenwhy is theratingnot lower?Why is it not a zeroor
if theirintention is working How will tltc cliertt'
howtheywill detennine

80 8l
 CLOSING THOUGIITS
anumberlower?Asktheclienttoexplainasbestheorshecan.Weneedto As with basic motivationalinterviewing,tle time has come to
improve the
how could it become more important?What could
identifi summarizeall that has beenrevealedby the assignments.
just one more? Like a careful
happento move the rating up
rating?What would haveto arrangement
ofpicked flowers,the fruit oftheselaborsmustbe giftedback
with eachscale lf
a "5"? Repeatthis process
Whatwould makeit become to the clients.We havebeenworkingwith creativescriptingeachsession.
scaleand it
has marked less than a "5" rating on the Confidence
the client The clients have most likely given us appropriatefeedbackas to what
not a zero or a
a zero, then why is the rating not lower? Why is it
is not appearsto be effectiveandwhat is not. We now havethe intentionplan
becomemore
to explain' How could it
numberlower? Ask the client mappedout andcangive concisesuggestions
to happento to targetthe exactmannerin
the rating?What would have
important?What could improve a which the clientswish to directtheir efforts.We alsohavethe barriersto
up just one more? What would makeit become "5"?
movethe rating changeidentified.We insertsimpleideasfor their removalalongthe way
Desire scale
if the client has marked lessthan a "5" rating on the
Lastly, into our words.The clientsaremostlikely in a powerfullychargedstateof
is it not t zeroor
is the rating not lower? Why
andit is not a zero,thenwhy intrinsicmotivation.
anumberlower?Asktheclienttoexplain'Howcoulditbecomemore We begin as with all hypnotherapysessionsby ensuringthe
to happento
What could improve the rating?What would have
important? environmentis quiet,safe,andcomfortable.Beforeproceeding,
becomea "5"? checkin
more? What would makeit
movethe ratingup just one final with the clients'energyandmood.you may needto gentlyremindthem
we haveonly to completethe
Following this gatheringof information' oftheir ratingsof importance,
confidence,anddesire.Rernindthemthat
the material
now put it all togetherand ins€rt
hlpnosis session We may feelingsarealwaysguides.Positiveemotionsconcemingthe changewill
into our hYPnosisscrtPt' act as magnetsthat draw the client towardsthe desiredoutcome.Use
your preferredinductionand maybeinserta specificstatementof the
intention.The script providedallows for mental rehearsalwith vivid
detail of the establishedintentionand the feelingsof successto be
experienced. I might add in tlle end a statementof detachment
suchas,
"This or somethingbetterwill be." We do not want to sabotagethe
possibility that whatever we have determinedfrom our sessions,
somethingevenbettercanmanifestitself in the clients,world.

82 83
 success.Then,we say goodbye.The goal all along
l|inally,Ihavedevelopedanacronymthatluseasmyguidethroughall is to empowerthe
lf the aim client.They arefree to experience
This simplefive letterreminderis AIMSS O
lrypnoticendeavors. the triumphof their own work. They
can move on with strongerego strengthand improved
is truewe shallnot missthetarget' self esteemwith
expectations
of continuedsuccess.
The M and hypnosisapproaches
describedhereare basedon
AIMSSstandsfor: the
work of others.This uniquecombinationis my own.
o A - Attainable The evidenceto
date for both methodsof treatmentis very encouraging.
. I - Involve Positiveemotions We are just
beginningto understand.I am hopefulthat the clinicians
. M - Measurable who usethis
approachwill further researchinto the combinations
o S - KeePIt SimPle of these two
techniquesin a creativeand openmannerthat is helpful
o S - Senses to us all. The
ultimategoalhereis beingableto assistmoreclientsin
AIMSSO (coPYght ProtectedJ the improvemenl
oftheir Iives.

involvethe clients'positiveemotions'
Wc ensurethe goalsareattainable,
ntnkesureoutcomescanbemeasured,keepthesuggestionssimple,and
invo|veallfivesenses.Iftheserequirementsaremet,therecanbeno
is detachmentfrom
lhilure. There will be change' The fmal touch
However'the freedom
spccitics.We havebeenvery specificin ourwork
to allow the unconscious to expresschangein the way that is bestfor the
clientcannotbe understated' Theclientknowswhatis best'always'
consciousefforts
All of our consciouseffortsand all ofthe clients'
stilt rely on the unconsciousmind The resources arewithin the clientto

rnakethe changesnecessary for the goodof all concemed'The seedsol'

the environmentfor
thouglrtlravebeenplanted.The motivationcreates
lcrtilc growth.Theunconscious is the driving'all knowingforce'
processthe clicnts'
Whcn the hypnosisis completed'we
cltrcticttccs.Wcsttmtnarizethetherapysessionwithanexpectat|on(lI

E1 6 :)
Allison,D. B., & Faith,M. S.(1996).Hypnosis asanadjunctto
cognitive-behavioral psychotherapyfor obesity:A meta-analltic
reappraisal.Journal of Consultingand Clinical Psychologt,
61(3'),
sr3-s16.
Burke,B.L., Arkowitz,H., & Menchola,M. (2003).The efficacyof
motivationalinterviewing.A meta-analysis of controlledclinical
trials.Journal of Consultingand Clinical Psycholog, 7l (5),
843-861.

Carels,R. A., Darby,L., Cacciapaglia,

H. M., Konrad,K., Coit, C.,
Harper,J.,et aI.(2007).Usingmotivationalinterviewingasa
supplement to obesitytreatment:A stepped-care
approach.
Health Psychologt,26(3), 369-374.

Chips,A. (1999).Clinical Hypnotherapy:A TranspersonalApproach.

Goshen,VA: EIH Publishing.

H. B. (1990).Hypnotictechniques
Crasilneck, for smokingcontroland
psychogenicimpotence.AmericanJoumal of Clinical hypnosis,
32,147-153.

C. C. (1981).Selfefficacy
DiClemente, andsmokingcessation
maintenance a preliminaryreporl.CognitiyeTherupyand
Resemch. 5. 175-187.

Dunn,E. C., Neighbors,C., & Larimer,M. E. (2006).Motivational

Enhancement TherapyandSelf-HelpTreatmentfor Binge
Eaterc.Psychologtof AddictiveBehaviors,20(1),44-52.

Egan,G. (1982).TheSkilledHelper:A Modelfor systematic

helpingand
Interpersonal
Relating(2d Ed.) Monterey,CA: Brooks-Cole.

f favens,R. A., & Walters,C. (2002).Hypnotherapy

suipts: A Neo-
EricksonianApproachfor Persuasive Healing (2"d ed.).New
York: Brunner-Routledge.

87
 Pederson.
L. L.. W. G..& Lefcoe.N. M. ( t97sl
asanadjunctto _scrimgeour.
S , & Gow,K. (2005).Hypnosis
I lutohinson-Phillips,
eaters
CBT: Treatingself-defeating . Journalof Cognitiveand
5(2)' I 13-l3 8'
;r"fi
3:n',HiilliH.J,:il:,:ffi
.T:,""tff
lmfn,*,
pro'gram.Joumal of Consutriig
BehavioralPsychotherapies' and ctni"ii i?y"iri"s,,, l:,
G (1995)'Hypnosis
G., & Sapirstein, asan
' I., Montgomery,
Kirsch,
a meta-analysis'
psychotherapy:
ud.lutt"tIo cognitive-behavioral
Jiurnal of Consultingand Clinical Psychologt,63' 214-220' Prochaska,
J. O., & DiClemen
srr_cnangeorsm;r;!:,ir:,ir:iil;.rJ:"fi
:HJ::T;:::.
l.ynn,J.L.,Neufeld,V., Rhue,J.W.,& Matorin,A' (1993)'Hy-pnosis and Journot
ofConsutting
andcrinicai iiir"i"'W,"i,iij,.rno_rnr.
' A cognitivebehavioraltreatmentln J W'
smokingcessation:
Rhue,SlJ.Lynn, & I. Kirsch(Eds./Handbookof Clinical a.o.nu.l1,..{.9..l?iclemenre,
C.C.-
&.Norcross, J.C.(1992).In search
Hypnosis.(pp. 555-585).Washington,DC: American peoplechange:Applicationsto of
lorv psychologist, aaaictiveUenlvio.r.
Association'
Psychological American 47(9), I102_ll li.

Miller, W. (Eds.).(19S0).TheAddictiveBehaviors:Treatmefiof Prochaska,

J. O., Norcross,J.C.,& DiClementq
C.C.(1994).Changing
Alcoholism,DrugAbuse,Smoking,and Obesity'New York: ForGood: ARevok,.:y s,:!:,p"i,"i*ij.i
Pergamon Press Bad.Hobitsand Moving your Life ii","o*,,s
york: HarperCollins. Fositiv&y fJrwaia."New

Mif ler.W.. & Rollnick,S. (1998).MotivationalInterviewing:Preparing

Peoplefor Change(1sted.).New York: GuilfordPress'
Prochaska,
J.O.,Velicer,W.F.,Rossi,J S.,Goldstein,
B.H., M.G.,Marcus,
Mif ler,W., & Rollnick,S. (2002).MotivationalInterniewing:Preparing Rakowski, W.,Fiore,C, H".f"*,Li., n".ai,r,e,t
Peoplefor Change(2nded.).New York: GuilfordPress' Rosenbroom, D.,& Rossi,.S.R. A,
decisionalbalancefor tr tisg+;.ii;'el, uno
psychorogt, orobrembehaviors."i"i,"",jJ"
Heaih
Morris,W. (Ed).(1982).TheAmericanHeritageDictionaryof the , ,(r), rr_f,u".,u,
Englkh Language(NewCollegeEdition)' BostoniHoughton
Mifflin. Rogers,c. (1g51).ctient centered
rherapy.Boston:HoughtonMifflin.

Nigg,C. R.,Burbank,P. M., Padula, R, Rossi,J' S"

C., Dufresne, Rogers. A theoryoftherapy.personaliry
acrossten health -C.1.1959).asdeveloped
retalionships, andinrerpersonal
Veiicer,W. F., et al. ( Stages
1999). of change in theclient_cenier.j
The 39(4)'473-
Gerontologist' S. Koch 1Ed.t.psycholil a#"*"* l,
risk behaviorsfor olderadults. (Yot.3'pp.
482. 21t;t84-256).*;* ##jr*'#cience' 2r0-
""#,
l)crly,C..Gclf'and,R ' & Marcovitch, P (1979)Therelevance-of Rogers,C. (1961).On BecomingA person.
Boston:HoughtonMifflin.
cfinical in
strsceptibility the clinicalcotttcxl'krurnalof
fuiogt, 592-60 t Sarkin,J. A., Johnson,S. S.,prochask4
''lhtnnnul I'';1'< '8'9. J. O., & prochaska, J. M. (2001).
ApplyingrheTranstheoretical U"aa'r" *g"1"r."a"#
exercisein an overweightpopulution:
vaii;;;i;"'"nlri"*".
",

|l 89
 changemeasure.P/eventiveMedicine:ln InlernationalJournal
Devotedto Practiceand Theory,33(5),462'469.
effect:A meta-
Tang,S.,& Hall, V. C. (1995).Theover-justification
analysis.Applied CognitivePsychologt, 9, 365'404.
and
Truax, C.B. & Carkhuff,R.R.(1967). TowardEffectiveCounseling
Psychotherapy. Chicago: Aldine.
Truax, C.B. & Mitchell,K.M. (1971).Research on certaintherapist
skill in relationto processandoutcome.In A.E.
interpersonal
Bergin & S.L. Garfield (Eds.)Handbookof Psychotherapyand
BehoviorChange:An EmpiricalAnalysis.(pp.299-344).New
York: Wiley.
functioningof alcoholismcounselors
Valle,S.K.(1981).Interpersonal
andtreatmentoutcome.Journal ofStudieson Alcohol, 42, 783-
790.
VanNuys,D. (1975).On thephrasingofhypnoticsuggestions: a brief
casereport.Pslrcrotherapy:Iheory, Research,and Practice, 12,
302-304.
You know NOW you want to stop_-.. . Yo norvktlr)wtllltt il
is your decisionto stop_. And you alsonow know. lhitt you
can,you will, you must do exactlywltat you ntustdo to stayaway li.onl
any& all . You alsoNOW know, thatyou can,you
will, you mustdo exactlywhatyou mustdo to finally burythis addiction
(o. _) beforethe addictionburiesyou. As you know,you will
only everhaveonebody,onelife for this body,only onemind,unrque
togetherin eachandeveryway.Thetime is now to lovefor your body.
Theone& only bodyyou will everhavedeserves
loveandcare.The
time is NOW to addyearsof healthandaddhealthto your years.As a
new healthy,happy,andrefreshed non- _. That'sright.Years
of healthandhealthto your years.Becominga healthyhappy,& relaxed
person.You knowNOW you wantto stop . You now
knowthat it is your decisionto stop_. And you alsonow
know,thatyou can,you will, you mustdo exactlywhatyou mustdo to
stayawayfrom any& all Your new inner
--.
commitmentis to be ffee.Doingexactlywhatyou mustdo dayafterday,
afterdayto be a non- and feel good. You add years ofhealth
andaddhealthto your years.That'sright, addyearsof healthandadd
healthto youryears.Doingexactlywhatyou mustdo to finally burythis
addiction(or _) beforethe addictionburiesyou.Beingthenew
happy,healthynon-_ you.
9l
 to seeyourself going becomepart ofyour life in the form of permanentbehaviors.So that
Now useyour god given creativeimagination
once and for all how you think, how you feel and how you behaveis
) routine without
tuboutyour daily (evening,weekend,
for the day' living the life ofa non- . You want to be a non-
Getting up in the morning' preparing
juice, or whateveryou chooseto have while . It is your decisionto quit forever.For this moment
havins breakfast,coffee,tea,
. Seeyourself forward,you will stop for the restofyour life. You never
lin'gettingto eventhink about
aboutthis wanl Io againunderanycircumstances.
Doing
whereveryou mightgo withouta careor thought
exactlywhatyou mustdo dayafterday,afterdayto be healthyandfeel
,__-.-. Noticehow goodyou feel Freeandclean'breathing
good.You addyearsofhealthandaddhealthto your years.That,sright,
t|ceplyfromthefreshair.Yougothrougheachandeveryday,dayafter
addyearsofhealthandaddhealthto your years.Buryingthis addiction
day,afterday,without---------- andfeelinggood Goingthrough
(or ) beforerheaddicrion
buriesyou.
Very relaxedand
your eveningactivitieswithout .-'-----------.--'
Love' (lovefor God)'
tranquil.Peacefulandeasyfeeling Filled with
loveforyourfamily,loveforyourbody'Theone&onlybodyyouwill
with [If using a home self hypnosis follow up CD]
love andcare'No longerpoisoningyour body
cverhavedeserves
after day lPlease exhale now and take another nice, long slow deep breath.
Doing exactlywhat you must do day after day'
healthandaddhealthto May I remind you to simply useyour CD in bed at night, over and over
to bc healthyandfeelgood You addyearsof
healthto your and over again. Again, useyour CD in bed at night in bed at night every
youryears.That'sright, addyearsof healthandadd
night over and over and over again for at least the next twenty-one
ycars.Finallyburyingthis addiction(or ) beforethe addiction
nights. This v,ill simply remove any and all desiresfor .
t)rlnes
You.
Finally connolling the one and only you that you will ever haye and

With eachbreath
Now takeanothernice,long,slowdeepbreath
relaxationYou may
you take,simplyallowyour selfto go deeperinto
relaxingto you You
noticethatthe soundof my voicebecomesmore
moreandmorerelaxing
raynoticethatthe soundofthe musicbecomes
more
kr yott, Yotttnaynoticethatsoundsoutsideofthe roombecome
tl c c p c r rv i l l r cttcl tl rrcttl l t'yotr l et thc
Icl l r\i ll8 lo y ot r . n s y o tl g c n tty d ri l l
rI t' 1 ri ttl " \
l i rl l rrr v it t gllt ot t glllsI ttttli tl c l tsc ttl c t
putting yowsef in charge. Putting you in charge ofyour own inner
successthat you possessedfrom birth. Doing exactly what you must do
day after day, after day to be healthy and feel good. You add years of
heahh and add health to your yeors. Ihat's right, add years of health
and add health to your years. Burying this addiction (or
)
hefore the addiction buries you.l
ttttttt ttl i tttltttttl
" ttt

IJ 93
 to do Knowtng thoughtsthatbringyou downor makeyou upset.But, I think you will
That'sright! Finally,doingwhatyou sayyou want
you mustdo day find somethingvery interesting
hasnow happened.
And, your
you aredoingexactlywhatyou sayyou will do' what
addyearsof health unconscious
mind canbe in control.Soyou find your selfthinkingabout
after day, after day to be healthyand feel good You
yearsof healthandadd morepositivethings,joyful things,interesting
thingsthatyou would
andaddhealthto your years' That'sright' add
) beforethe ratherthink aboutor do, newwaysofbeing active,happy,andsocial.So
healthto your years.Buryingthis addiction(or
youforgelto eventhinkabout
addictionburiesYou.
llxhale.
The longeryou stay awayfrom the betteryou will
Relax. JustLet Go.
NOW, you thoughtthatyou needed feel.Focusingon your future.On your goals.On the changes
you are
lMotivationalinsertslUp until
you know makingfor thegood.Suchas,(Homework)
_--- fo. (LIST positiveor "GoodThings")'But now
tlratyou neverneeded-- for anyofthosethings'Fromthis
hasnothingto do with _Day afterdayafterdayfeelingmorehappy,more
rnomentforward,_-==--
(lisQ. . You can content,morein control.Feelinghealthier,morecalm,morerefieshed,
with this morerelaxed.Fromthis momentforward,completelyrefieshed,
alsonow think backon all the problemsandfrustrations
completelyrelaxed.Doingexactlywhatyou mustdo dayafterday,after
rrddiction,yourealizeithadnothingtodowiththegoodpersonyouare.
thatyou are dayto be healthyandfeelgood.you addyearsofhealthandaddhealth
You simplyfeelmoreandmorepositiveandgrateful
you'rereachingan to your years.That'sright,addyearsofhealthandaddhealthto vour
nrovingbeyondthis block in your life now Now
(list years.Buryingthis addictionbeforetheaddictionburiesyou.
Iwareness...that has nothing to do with

1' ).
'l hat'sright.Because vividly all ofthe Any andall desiresfor aresimplydisappearing.
NOW you areremembering
Whatyou havewantedto do is now done.your newdesiresfor
nroblemsanddifficultiesthat arenot sogoodabout
. You canrememberall of the (goalsfor success)
arewhereyou areheaded
(list - stuff)andKNOW thatyou neverhaveto now.Fulfilling your dreamsanddesiresfor a healthy,wonderfullife.

whcn you'll ever- Justexhale,

relax,enjoy,letgo.... . .. FREE. SUCCESS.
HEALTFry.
lccl that way again.And, you don't know
HAPPY.
NOW you arc licc lrlilllr trr lirlgctnllaboutthis
rlrlin. llccittrsc
Yrrttctttllltittklhoscold
lrklieliorr.ll clrt ltc ctttsctlliottl \r'ttt ttttttrl

r 95
-

powerfulimagination'Simply
Oncemore,usingyour unlimitedand
you' goingthroughoutyour days'at
be,simplyimaginethe successful To be usedwith clients to enhancemotivation to change.
work,athome,oratplay,thenewhealthy'happy'clean'pure'refreshed' Thesemay also be used to create directive scripts for
be thatway forever'Please
andrelaxedyou.Feelhow goodit is to change.
imaginethis now.

(REORIENT).

9(t 97
 Substance
UseHistorv:
Date: SubstanceAge of l.tuse Ouantitvthen& now Frequencv
then& now
('llcnt :

Alcohol-drink drunk

Marijuana-
Affect: Mood
SDeech: MotorActivity: s-g!g"
Al)llcllronce: Normal Otherdrugs(list all reported):
Normal Calm (1to l0)
wcllGroomed - DePressed
Soft Agitated.
l)ishc!eled -
Loud HYPeracttve - Anxious
Malnourished - Flat
( )hcsc Pressured - HyPoactlve -
Angry
RaPid Tremom -
- Elated Past30 Days: _ drinking _ drunk _ marijuana other
LA D IIE
--
InaPProPriate
Last Dav Used: Alcohol Quantity
Marijuana_ Quanlity
J"dqT:l:"nt'il,t;"t
llx,rr*hrProcessr
lireid/coherent - ir-'.0
'.,1;?, l8ll3llL,t":
Disoriented
Others
- ll::i"^ I mPaired -
I r\,:e lmpaired ChecklistSA or SD:
lrrrrgential Imparreo
-
otlrcr
_ increased
tolerance_attemptsto control/quit _ financialproblems
self or others?Whcn? Ex
clienteverhad thoushtsofharmins
_ drivenintoxicated _ DIP/DUI _ Hospital/ERvisit

theyarehere' blackouts...How
often? How long?_ Last?
i,r"*"'tr@
Whtt/Wh€n,etc'): _Driving: accidents
_ lossof license TX

siblings' or
alcohol
home' _Annoyed by concemof others_ Feltguilty (drinkingor behavior)
step-parents'
narents'
|frHtrffi "9."i;1ce' Are you concemed
by your drinkingor use?

Legal Charges:

HistorY: Probation
llducation/EmPloYment Name ofPO and location:
Assessmentand Recommendations: (Suicide or homicide ideation
-)
Historv:
lUrdicsl/'PslchiatriciCounselins

(i)unselor signature,title, and date:

99
-

fteasers!g-#l --I! TOTAL

SLIN MON TUES WED THUR FRI SAT

, a 12 ozbee\ aboutoneshotof liquor,or a typicalglassof wine)

(*One drink equals

Health Bingedrinkingquestions:

For Men: In thepasttwo weeks,how manytimeshaveyou had5 or moredrinksin one

daylsetting?_

For Women:In thepasttwo weeks,how manytimeshaveyou had4 or moredrinksin

onedaylsetting?
_

Both:
Education Self Respect/Trust
alcoholin the pastmonth(estimate)?_
How manytimeshaveyou consumed

alcoholin the pastyear(estimatex

How manytimeshaveyou consumed

How muchdo you spendon alcoholper Week? Month? Year?

Haveyou everfelt guilty aboutsomething

thathappened
while drinking?
SpiritualitY Yes_ No_
Freedom
Haveyou evertakena drinkthemomingafterto feel better?Yes_No

or annoyedyou aboutyour drinking?

Hasanyonetold you thattheywereconcemed
Yes

Friends
My SubstanceUse
t/ Haveyou everfelt you shouldcut downor limit yow drinking?Yes_ No _

l0l
 How much do vou use*?
:j"T.::':::"i,jl.t 1o,,@r ionships.
and
i\it IN MON TUES WED THUR FRI SAT TOTAL il;il;ffi ilfi ;;;.
::l:l::^'1,':;.-t:^:yi1-l',-19"'.rir.'.yLNow,pr'u'""6fi
ffiil"",
1.,:T?,:?-{.:I^*i'llclillllesona.,rryi.ard#,,R;;;';;;;;l;.r#;ffi
mightbe involvedin activitiesor behiviorsyou *lsh to
ctrang".-ft tn"
questlons. "i"inr*..
7am 5pm
t 'l )cl crm ine fi6int ofany substan"ein cooperationFor instance, pack of c,Sarettes)
8am 6pm
llow old wereyou whenyou staredto use? Whatwasit like?
9am 7pm
lOam 8pm
l low is it now?
I lam 9pm
Noon lopm
llow many times Per daYdo You use
lpm I lpm
I low manyin thepastmonth(estimatex 2pm Midnighr
llow manytimesin thepastyear(estimatex 3pm lam
I low doesthis makeYoufeel? 4pm ?am+

t. Whatdo you like or enjoythemostaboutyour routine?

Whulcouldbe better?

2. Whataboutyour routineis not sogoodor causes

you difficulty?
PerWeek? Month? Year?
I low rnuchdo YousPendon _-

I l vc you everfelt guilty aboutyour use?Yes- No How come? 3. How areyour health,finances,relationships,
andachievements?

your use?
ll0s ilryonc bld you that they were concemedor amoyed you about 4. How couldthingsbe better?Whatwouldhaveto change?
Y cs No

()l
W lri rlrvrtttltyl ot t lik c lo hav ch a p p c na s a rc s ttl t l l v l )rr()t l rcfl l P y' l

lul 103
 mv current behavior? What are the costs & benefits ofchansinq?
Whrt are the costs& benefitsof rnaintainins

('ost of stayingthe same Benefit of staYingthe same

I lculth-

llclationshiPs- -
RelationshiPs

Career/work-

105
 WHAT IS IMPORTANT'I'O MI': I,'TI'I'T]ITE
INTENTION
(Nig_ht
I rcrvonchasthingstheybelievein, standards to livc b1' ol vitlttcsHowever' & Day dream ofwhrt you intend to do, and what you intend
to be,
.,,:','.ti;',;;';;;in *"vt,nut do notprotectthethittgsrrc r alttc'rost or match and thosedreams will interpret your intentions,let no doubt enter your
,;';;;;;i,;t. we maybeiired,distractedby otherthings'or lir'gctlirlTakesome intentions" - Dr. Wayne Dyer
yourvaluesandrecordthem Hold an Image of the life you want in mind and that image will
tirrrchcrcto remember become
reality.
beliefsandvalues? Forexample' some
I Whtl aresomeofyour strongpersonal
or helping theirfamilies' Often it is helpful to take the time to look aheadin our lives. Having
,,"i; ir;l;;; .t.on!ty in u"ing itonest'assistingothers, an intention
person' or a mentalpictureof how we would like thingsto be in the future
li't',,',,t."sornethingsthatyoubelievemakea persona "good"
", can help us to
.,,,,i,i,,,,"f,rt*.moth;r/fathe;,friend,or student? Ifyou couldbethe best"you" feel lessanxious,help us to maintain directionTfocus,and help
us to ptan our time
wouldyouhave' to move closerto our hopesand dreams.We always move in the direction
r,,,,c,,rrl,lbewhatqualities of our
mostdominantthinking.
|1, r ,, Itrt hereofvitues/tr no*' Youmsvwqnl
th, t-o v
tii,,',l,i,rt-,,irriii-irrtn or" gttn'tiolto vo'
"l ^ott 'i"ht
t;nuutl\'t thL'mso lhal:)ouD lhem in order ofimDortance' I ..What are your hopes, intentions, and dreams for the future? Be
specific.
Fill in the d.etails.Imagine you can have anything you want for yourself.
What
would that be?

2._What_arethingsyou cando lessof to maketheseintentionsa reality?

Whatotherthingswouldyou like to becomeinvolvedin thatwould be helpful
standards? to
.' ls lhcrcanythingthat is gettingin theway ofyour living.by^these replacethetime spenton Iesshelpfulactions/behaviors?
have
wi','i .ti^a ii thewaf of your beingthe bestyou canbe?Whatwould
'",,y lbr you to live moreiloselybi your mostimportantvaluesandbeliefs'/
,,, .i',,"g"

3.,Wlat areyou.doingand canyou do more ofbeginning now in your

life to
nelpyou maKetheseIntentionsreality? What new thingswould you
like to
becomeinvolvedin?

tu6 l(t7
 I AM SUCCESSFUL STRINGTHS
Sometimesweforg.l|'.,,up.,*iffi,eneedto.Let,slookatthe
Inrclimcswe getdisheartened whenwe forgetthetinlcsthotwe havebeen waysin whichwe arc pels()nallystrongandpowerful.
rcccsslllat makingchanges somctlling
in ourlivesor achieving we wanted
ory nruclr.Evervonehasbeensuccessfulat makingchangcs in their life at l List your persorral
strcngthsandstrongpoints:
birth.Let's this
,rrrtcpointor time.Ifyou arealive,you hada successful use
rflcisc to remember your personalsuccesses.

you havemadein your life.

, Lisl somepositivechanges

2. How canthesetraitsassistyou in makingchanges

in your life?
), llgf oneofthe changes you listedabove,maybethe onethatwashardestto
rcconrplishor thatyou feelmostproudof, andlist the following:

r. Whcndid you startthinkingaboutmakingthechange?Whatwashappeningin

yorrrlilo at thetime?

3. Whatcouldhinderyour progresstowardschanee?

b, l)itl you makethechangeall at onceor takesmallsteps?

c, Whotdid you do all at onceor whatwerethe steps?

4. How will your strengths

helpremoveobstacles
to your future?
rl, I low do you feel aboutthe changetoday?

ll[-* 109
 CHANGE PLAN WORKSHEET (explanation/
examplest

The changesI want to make(or continuemaking)are: I int€nd to

List specirtcareasor waysin whichyou want to chqnge.List speciJicgoals or
lint€ndto
@king)are: tqrgets.Includepositivegoqlsfor stqrting & creatingchange,increasing,qnd
Jinal improvementsor modiJications(ine tuning) of behavior.

The mostimportant reason(s)for wanting thesechangesto happenare:

Whatare the mostlikely resultsof changingvs.stqyingthe sctme?
thesechangesto haPpenare: Whatreasonsfor changingare the mostsignilicantfor you and thosecloseto
@g
you? ltthat will be the emotionalresultsof changing?

The specificstepsI plan to take in changingare:

Whatare thestepsin your plan to achieveyour goals? Whatare someof the
rnil.p."in" .t"pt t plan to take in changingare: frrst stepsincludedin thisplan thatyou might accomplishmostquickly?Be
speciJicon how,when,andwhere,youwill mqkethesestepshqppen.
The specilicwaysother peoplecan help and supportme ar€:
Whowill you seekout to qssist& supportyour intentions? List specificwq,s
Th" spatf";"y. p"oplecanhelpandsupportmeare: that others(ftiends,family, counselors,etc.) can help to supportyou in your
"tt*t
endeavolto change.How will you get othersto help out?
I will know my intention is working if th€se favorable outcomes manifest
in my life: Whqt do you expect will happen as a consequenceofthe change?
outcomesmanif€st
I What advantages will you obtain from the change?
What will show you that you are successful?

Somespecificobstacles, thingsthat could slowme down, or things that

couldget in my $tay arerAnticipqteqt ) situqtionsor dfficultiesyou might
orthingsthat
s"@down' possiblyneedto confront. Whatcouldpossiblygo wrong? lfhat v,ill helpyou
could get in mYway are: stick to theplan regardlessofproblems or delqts?How will you nrvigate
obstaclesand reachyour destination?
What I will do if my plan needsto be adjusted or is not completely
effectivei List steps towards problem solution or some reorganizing
or is not completel)
What I will do if mYPlan*-"ot ro n" uojo.t"d strategiesthat youwould use. LI/howouldyou approachfor advice,support,
cffective: or help? Where else might you turnfor answers?

lll
 their
lhe focusofthis programis to assistpeoplein nlakirtp'it clurngein lixamine your Answers
or
bcltitviot's' increase
lives.Often,that chaige is to quit a habit,eliminatc
constructive,helpful activities. However, whatever tltc lirctrsof . Ifyou have lessthan a "5" rating on the Importancescaleand it is not a zero,
is
tlansformationfor you, any improvementin life you arc considering then why is the rating not lower? Why is it not a zero or a number lower than
if
irnportant.Pleasewrite in the spaceprovided below what prinrary change' what you have chosen'/Pleaseexplain as bestyou can.
iuly, you are consideringnow in your life.
( ioal for Change: Ifyou have lessthan a "5" rating on the Importancescaleor a zero, how
could it becomemore importantto you? Then, what would have to haooento
( );tLe fonowing0 -5 scal",please to you of making
ratethesignificance move your rating up just one more? What would make it becomea -3;.?
rlris in
transformation your liie (or continuingone begun)Please
already
circte the number that most closely matchesthe importance of this chanse
to vour life. Ifyou have lessthan a "5" rating on the Confidencescaleand it is not a zero,
then why is the rating not lower? Why is it not a zero or a number lower than
5
what you have chosen?Pleaseexplain as best vou can.
Nrt SigniJicant Most
,.fl lLL Significant
1n
Ifyou have lessthan a "5" rating on the Confidencescaleor a zero, how
could it becomemore importantto you? Then, what would have to hapDento
suti*timffie" areimpoftantto us,we arestill not sure
whettgoals/changes move your rating up just one more? What would make it becomea "i;,?
in ucco-plishingthem' Pleasecirclethenumber
tlr t we canbe su"cessful
lhul most closely matchesthe con{idence vou have that vou can
rnrcossfullv make the transformation vou desire
Ifyou have lessthan a "5" rating on the Desire scaleand it is not a zero,then
0 why is the rating not lower? Why is it not a zero or a number lower than what
you have chosen?Pleaseexplain as bestyou can.
.1 t.4 l l

Ifyou have lessthan a "5" rating on the Desire scaleor a zero, how could it
s,,nr"timar, thoughwe know a changeis importantto us andwe are
becomemore important to you? Then, what would have to happenro move
ccrtrinwe canmakeiihappen,we aren'treallylookingforwardlomakinga
"uen
your ratingup just one more? What would make it becomea.i5.,?
chirngs(or continuingoni ilready begun).Pleasecircleth€numberthatmost
ckrsiy matches how muchvou reallvdesireto makethischanqehanoen
N()W.

0 5
EnergizedAbout
Making the
Change _

I lr a 113
 Michael S. McGee
LPC, DCII, MS

MichaelMcGeehasa Doctoratein ClinicalHypnotherapy, a Master'sDegreein

Counseling Psychology andis a LicensedProfessional
Counselorwith a private
practicein Southwest Virginia.He alsoworksin acutecareofmentalhealthissues
with clientsin a communitysettingwherehe specificallytreatsthosewho suffer
flom anxiety,depression, PTSD,psychosis, suicideideation,andhomicide
ideationin effortto preventtheneedfor inpatienthospitalization
andreducethe
needfor psychiatricmedication.

He is a memberofthe AmericanSocietyofClinical Hypnosis.He is a past

memberofthe International Medical& DentalHypnotherapyAssociationand
theNationalAssociation of Transpersonal
Hypnotherapywith specialized
trainingfor weightlosshypnosis,smokingcessation
hypnosis,hypnoanesthesia,
PTSD,andhypnoticregression.

He is anaccomplished Fesenterandhasconributedprogramsfor theAmerican

SocietyofClinical Hy?nosis,NationalAssociationofTranspersonal
Hypnotherapy,
andCreativeAltemativesin TherapyConferences sponsoredby RadfordUnivenity
for thepasttenyean.Theseincludepresentationssuchas,AddictionsHypnosis,
PTSDteatrnent,Motivationalhterviewing,CognitiveHypnotherapy, Integrating
Spiritualityinto Counseling,
ModemCultureandRelapsePrevention, and
Adolescens& Arche0?es- Transpersonal Therapeutic Approaches.

He hastaughtvariouscoursesin Psychology
at a smallliberalartsuniversity
wherehe educatedmultiplesectionscombinedofAbnormalPsychology,
Adolescent
Psychology, Child-Developmental Psychology, Introductionto
Psychology,
Personality,
andSocialPsychology.

il5
 Addictions
Hypnosis
themostpowerful
Discover techniques
toinhancemotivation
andutilizeclinical
hypnosisto endaddictions.
yourclient'sinternaldrivetowards
makingchangehappen rapidly.lmprove
yourskills
forclientinterviewing and
scripting
in relation
to anyaddictive
Thisbookincludes
behaviors. all the
youmightneed
information to beginto
usethesepowerfulmethodsrightnow.

lsBN 9781518667190

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