ERICKSONIAN APPROACHES TO PAIN MANAGEMENT Jeffrey K. Zeig, Ph.D.,
[email protected] The Milton Milton H. Erickson Foundation, www.erickson-foundation.org
Communication Can Alter Lived Experience My introduction to Hypnosis The The Tre Treatm atment of Pain Pain Hypnosis and Hypnotherapy without Trance Thr Three primary ary hypnotic otic techn chniques for for work orking ing with pain ain: Dissociation, Distraction, and Modification The These proces ocesse ses s can can,, and and sh shou oulld be aff affected cted during ing asse assessm ssme ent The The Assessm Assessme ent of Pain Pain P ain is a mult multifacet ifaceted ed experien experience: ce: Phy P hysiology siology and Psycho-S P sycho-Social-C ocial-Cont ontext extual ual •
P ain must must be properly assessed asses sed in order order for it to be treated treated effectively. effectively. Traditionally clinicians often focus on the organic causes
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Ericksonian assessment: Evaluative procedures in and of themselves effect pain control.
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P ain is a com comm munication, not just just a sym sympt ptom om:: Elem E lements ents of Com C omm munication
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Scaling.
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The communication process
Five Areas of Assessment 1. What Does the P ain Mean to to the the Patient Patient? ? Subjective aspects of the pain: Is it: •
Threatening pain, like angina; 1
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The intractable pain of cancer; or
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Spasms of pain, such as those experienced during labor.
Asking about the meaning of the pain subtly encourages the patient to “dissociate” from the experienced pain. 2. Detailed Description By procuring a detailed description of the pain, the therapist can effect experiential division in the gestalt of pain, thereby modifying the experience. The “Farrah Fawcett Principle.” Ask about: size shape texture thickness weight, etc 3. Analogies “What is the pain like?” “What does the pain remind you of?” Analogies allow the patient to change the category of thinking about the experience of pain. If the pain were a color, what color would it be? If the pain were a plant, what kind of a plant would it be? If the pain were a tool, what kind of a tool would it be? If the pain were a vessel to contain water, what kind of a vessel would it be? Metaphoric redefining/reframing methods. 2
Pain is like an alarm. It serves a productive function, but, once the alarm goes off, you no longer needs the warning.
4. Expectations and Motivation Incorporate positive expectations and motivations into the backbone of the treatment plan. 5. Listen for “Key Words” and Metaphors Changing symptom words into solution words: Redefining
Aspects of Pain Another assessment device involves understanding the aspects of pain. P ain is malleable. Learned Aspects Cultural Aspects Temporal Aspects Pain is composed of experienced pain, remembered pain, and anticipated pain. Splits: Pain and Suffering Pain consists of both physical sensations and emotional suffering. Other Splits Harmful and harmless pain Needed and unneeded pain. Contextual and Relational Aspects Pain is a Process, not a Thing Pain as a Habit/as an Identity
Five Principles of Working with Pain 3
1. You do not need an all comprehensive trance. 2. Set the patient on a train of activity that modifies the experience of pain as the patient carries it out. 3. Patients have resources that make pain control possible. 4. Pain is a process, not a thing. 5. Reinforcement is often indicated.
Techniques Seven techniques that are used both traditional and Ericksonian practitioners: 1. Glove Anesthesia 2. Hypnotic Phenomena 3. Displacement If a patient can have phantom pain, the patient can have phantom pleasure. If a patient can displace negatively, he or she can displace positively. 4. Modification Utilize particular strengths and associations of the patient. If the patient is a musician, perhaps the pain could change in tempo. A student can learn something from the pain. 5. Confusion Word plays and ambiguities to help patients with pain. 6. Interspersal Technique Deliver messages on the social and psychological levels simultaneously. 7. Amplification and Deviation The therapist can work to increase the experience of pain rather than diminish it. 4
8. Self-Hypnosis/Make personalized tapes 9. Work from the Periphery I
An Erickson Case Example Erickson: “I don’t mind the pain. What I don’t like is the alternative.” Case of Kathy Lady and the Tiger: Reference experiences
Conclusions Pain control is very much a matter of faith. There are three kinds of faith. Faith that: 1. You can utilize the experiences that patients bring 2. Patients have within them resources that make pain control possible. 3. If you had the problem you could modify it References Erickson, M.H. (1966). The interspersal hypnotic technique for symptom correction and pain control. The American J ournal of Clinical Hypnosis, 8, 198-209. Erickson, M.H. (1980a). The collected papers of Milton H. Erickson on hypnosis, Volumes I - IV. E.L. Rossi (Ed.). New York: Irvington. Erickson, M.H. (1980b). An introduction to the study and application of hypnosis for pain control. In E.L. Rossi (Ed.), The collected papers of Milton H. Erickson on hypnosis, Volume IV, (pp. 237245). New York: Irvington. Erickson, M.H. (1980c). A teaching seminar with Milton H. Erickson. J .K. Zeig (Ed.). New York: Brunner/Mazel. Hilgard, E. R. & Hilgard, J . (1983). Hypnosis in the relief of pain. (Revised Edition). Los Altos, CA: William Kaufman. 5
Thompson, K. (1982). The curiosity of Milton H. Erickson, M.D. In J . K. Zeig (Ed.), Ericksonian approaches to hypnosis and psychotherapy (pp. 413-421). New York: Brunner/Mazel.
Zeig, J .K. (1988) An Ericksonian phenomenological approach to therapeutic hypnotic induction and symptom utilization. In J .K. Zeig & S.R. Lankton (Eds.), Developing Ericksonian therapy. New York: Brunner/Mazel. 6
