Stephen Brooks Hypnosis Techniques – TAKING THE PATIENT’S HISTORY
Taking the Patient’s History.
Information gathering is an important stage in the therapy session and it is also an ideal time to build rapport and build trust. This Unit will teach you how to approach this.
- The presenting problem may not be the real problem.
Sometimes, when Patients enter therapy, they may be afraid to talk about the problem they are most concerned about. Instead they talk about some other peripheral problem that is affecting their lives because they are too embarrassed to talk about their main problem. Often they dare not risk presenting the problem immediately because they are afraid that if therapy is unsuccessful then all will be lost. Sometimes they may want the therapist to test his skills on a less important problem to check out the therapist’s ability to help or to see if they, as a Patient, can respond to treatment. Whilst successful treatment of a peripheral problem is a good way of ratifying the therapist’s skills before the serious work begins, the withholding of information by the Patient puts the therapist at a disadvantage. Problems rarely exist in isolation and, where more than one problem exists, they are usually associated with each other in some way. It is important for the therapist to know about all aspects of a Patient’s problems and to see how they are related and may be reinforcing one another.
A woman in her forties came to see me and seemed reluctant to talk about herself. She was overweight and looked drab. She finally said that she wanted help to lose weight. Her weight problem had apparently started in her teens, yet none of her family had been overweight. She had three brothers, one sister and a psychotic mother and she was no longer in contact with her father. She was seen for a number of sessions over a period of six weeks and despite a few pounds weight loss during the first week she did not respond to any intervention with hypnosis. Despite her failure to lose weight she appeared to still have confidence in me and kept all of her appointments.
After about 10 sessions of unsuccessful therapy she told me she had been abused as a child by her father. Over the next six sessions we worked together on her feelings about her father and the abuse. The weight problem was never mentioned again, yet slowly, as she seemed to come to terms with her feelings about the abuse, she started to lose weight. I didn’t actually notice at first, I just noticed that she started to take pride in her appearance. It became clear to me that by becoming overweight as a teenager she had discovered a way of making herself unattractive to stop her father abusing her. Her fear had generalised itself to all relationships with men and she was never able to lose weight because of her unconscious fear of being abused again. As soon as she was able to learn how to trust men, initially by trusting me, she was able to lose weight.
She was lucky, because she somehow recognised her potential to overcome her problem with me as her therapist and she continued treatment. She could easily have lost confidence in therapy when all of her attempts to lose weight failed repeatedly and then never had the confidence to tackle her abuse problem with another therapist.
- You should not assume that there is an underlying problem but you should be open to its possible existence.
Throughout therapy and especially when you are interviewing the Patient for the first time, you should keep your mind open to other possible problems which may lie behind the presenting problem. If you feel there is a secondary problem then you should ask open ended questions and not suggest in any way to the Patient your suspicions about other possible problems. Remember, the Patient may need time before they are willing to talk about their real problem. If they have an undisclosed problem, and if you try to rush them, they may clam up altogether and you may never see them again. Whenever possible you should let the Patient set the pace, especially at the beginning of treatment.
- The Patient may not be aware of the underlying cause of the presenting problem or aware of any other underlying problem if one exists.
Sometimes although the Patient is not deliberately withholding information, they have no conscious awareness of a different problem to the one they are presenting. However a different problem does actually exist and is at the root of the presenting problem. Any attempt to suggest this to the Patient will usually result in some kind of resistant behaviour on the Patient’s part. Most problems have some underlying cause. The cause may no longer exist in the person’s everyday life. The cause may have only existed in the person’s childhood, however the symptom continues in every day life. Sometimes problems can be solved simply by working on the symptom, because the cause has burnt itself out many, many years earlier. Where the cause still exists in the person’s life then the cause has to be dealt with along with the symptom.
- Sometimes Patients have a need to hold onto a problem.
There are benefits to be had from having some symptoms. A Patient may get used to getting attention from family members when they have their symptoms. Sometimes making the problem disappear also means losing the attention that has been gained because of the problem. When there is some benefit from having a problem the benefit is usually called a secondary gain. A secondary gain is some kind of benefit that happens because of the Patient’s symptom or problem. The secondary gain has hitch-hiked itself onto the presenting problem. When helping a Patient solve their presenting problem you should attempt to identify secondary gains and deal with those at the same time. The needs that are being met by the secondary gains have to be met in some other way by the therapist.
- Do not place emphasis on the word “problem” by repeating it too often.
Here, within the context of this course, we can use the word “problem” as many times as we wish. However, in a therapy session the therapist shouldn’t keep repeating the word “problem” to the Patient. The word “problem” has negative connotations. Instead, the therapist should emphasise positive changes in the person’s life. The therapist should always be optimistic and confident in the Patient’s ability to change.
- Do not give advice, interpretations or solutions at this stage.
At this point you are still gathering information, verbal and non-verbal, and with such little information you should not be giving advice to the Patient. As a Hypnotherapist you should not be giving advice anyway. Any solutions will usually be suggested in the form of metaphors, analogies, tasks or with indirect suggestion. Advice or interpretations given too early in therapy will probably mismatch the Patient’s beliefs or needs. When attempting to identify a solution the therapist should look for patterns. By taking in as much information as possible the therapist should be able to identify patterns regarding dates, behaviours, actions, etc.
- Look for conflicting non-verbal behaviour.
When Patients communicate they communicate on two levels: consciously and unconsciously. They will often say something and at the same time they will use a non-verbal gesture, expression or behaviour that sometimes conflicts with the words they’re using. An example of this is a Patient who says something at the same time covering their mouth with their hand. Another example would be someone who literally digs their heels in when being asked to respond to a particular question. A third example would be a Patient who shakes his or her head when saying “yes”.
- You should attempt to elicit the problem behaviour/symptom or evoke the feelings.
When Patients enter therapy they expect action. The therapist doesn’t do therapy based on the words that the Patient uses, but rather with their behaviour or symptom. If possible you should attempt to get an example of the symptom. You need the raw materials of the problem to work with. If you have good materials you can do good therapy. So for example, if a Patient says they are afraid of spiders, you should ask them to close their eyes and imagine a spider and bring on the feelings. This will give you an example of the physiological change that occurs when the Patient has the problem. If the Patient’s presenting problem is a fear of meeting people and being asked questions then the therapist should ask questions to attempt to evoke the response in the Patient. So when doing this, or attempting to evoke a symptom, the therapist should explain what he is doing to avoid losing rapport with the Patient.