INTRODUCTION

The separation between mind and body exists both in medicine and in hypnotherapy practice. Hypnotherapists do not commonly touch patients during trance; a patient receiving hypnotherapy will expect to have an auditory experience where trance is facilitated by the therapist’s voice and the skilled use of language. A skilled hypnotherapist will observe and involve the patient’s physical responses during treatment, taking cues from the patient’s reactions to make adjustments to the therapeutic approach. Patients may become engaged in trance states that facilitate a discharge of feelings, emotional processing and disclosures of concerns and insights. In turn, these may contribute to the patient identifying what s/he may need to move forward, to become more resilient and committed to his/her own well-being.

Practitioners who use therapies which involve touch, such as massage, reflexology and aromatherapy will recognize states of deep relaxation which can be achieved through ‘hands-on’ work and which may also be recognized as ‘trance’. Dependent upon the skills of the therapist to notice physical cues, or to be curious about physical and emotional responses, a patient may be left to work through emerging feelings or recalled memories with variable support. In complementary therapy, the process where emotion is released, during or after the treatment, is often referred to as a ‘healing crisis’; the occurrence is usually perceived as temporary and judged beneficial in the longer term (Griffiths 1995, Vickers 1996).

Some of the more common physical signs of deep relaxation and emotional processing are given in Box 8.1. This list is not exhaustive; however, it is likely that these signs will be familiar to most therapists. Therapists may refer to this state as relaxation, day dreaming, reverie, or simply ‘chilling out’. It is less likely that therapists will equate the similarities of deep relaxation with hypnotic trance. Most patients enter this state easily without the use of recognized induction techniques or deepeners. There is good argument to assert that all hypnosis is self-hypnosis, a natural ‘altered’ state into which, given certain conditions, most people will find themselves drifting. Signs of deep relaxation and emotional processing which are comparable with hypnotic trance are given in Box 8.1.

BOX 8.1 Signs of deep relaxation and emotional processing during touch therapies

Conversation slows/ceases

Physical relaxation of muscles, twitching, involuntary movements

Head droops if sitting, sinks back if lying down

Changes in breathing, so it may become deeper and slower

Intermittent eye closure

Full eye closure

Rapid eye movement

Change of pallor, e.g. flushing, warming

Relaxed jaw

Increased salivation

Increased peristalsis which may be audible

Moist eyes and tear tracking

Flatus/burping

Yawning/sighing

Post-session emotional release, disclosures and insights.

Are trance states facilitated only by a therapist? We need to remember that children (and some adults) become so absorbed by stories that they lose track of time and forget worries and concerns. Being drawn in by a hobby, book, motorway driving or listening to music can cause individuals to enter a ‘trance’ state. The state can cease when it is interrupted by a thought, a noise or a change/cue in the environment.

Having completed hypnotherapy training and advanced bodywork training, the authors recognize that trance states can occur without establishing a formal contract for hypnotic trance. Therapists may recognize when both themselves and the patient have entered a trance state simultaneously. Milne (1995) has referred to trance as a ‘glamour’ or an expanded state of awareness – ‘a larger me’. In this state, bodyworkers typically become more focused, experience heightened awareness and an increased connection to the patient; time distortion can occur for both the patient and therapist. Physical and emotional states can be sensed, which may not be normally noticed when both patient and therapist are in an everyday ‘busy’ state.

TOUCH: EVIDENCE FOR CHANGE IN MENTAL STATES

The use of touch and the human voice in trance induction is not unusual and can be identified in everyday activities. Stroking and holding babies and children to calm, reassure, promote sleep and provide comfort, all are facets of parental care in both the human and the animal world. Touch therapies alone have been the subject of numerous research studies. Tiffany Field and colleagues (1996) investigated the effects of touch therapies on children. They provided 20 pre-school children with 20 min of massage twice a week for 5 weeks. The treatment group had better behaviour ratings on state vocalization, activity and cooperation after the massage sessions comparing first and last day scores. In a second study by a team (Hart et al 1998), another group of 20 pre-school students received massage with notable changes in cognitive performance for the treatment group. It was identified that massage for children rated as highly strung and anxious, showed greater improvement.

In adults, massage has been found to reduce itching, pain and anxiety in a study by Field et al (2000) with 20 patients with burn injuries. In patients hospitalized for cancer treatment (n = 41), Smith et al (2002) investigated effects of massage with 20 compared with an attention-only control group (n = 21). Significant changes were reported in the massage group for pain, symptom distress and sleep scores. Notably, the control had a marked deterioration in sleep scores.

HEARTS: A COMBINED APPROACH TO RELAXATION AND TRANCE INDUCTION

Sometimes a patient may find relaxation difficult through the use of the therapist’s voice alone and music is often used to aid the process. Similarly, patients experiencing touch therapy may want to ‘interact’; depending on the content of the ‘talking’, the therapy session can become little more than a ‘past-time’. However, Carter (2006) developed an approach to facilitate a relaxation for individuals who find a relaxed state difficult to achieve, either through the use of touch or the voice alone. While working with patients who had cancer and their carers, she developed a multifaceted approach where both the skilful use of touch and the sound of the human voice could be intentionally combined to promote relaxation. She describes this combination of interventions as ‘holding body and mind’, so both can feel relaxed at the same time (Carter 2006). This approach was described as the HEARTS Process; HEARTS being a mnemonic which stands for Hands on, Empathy, Aromas, Relaxation, Textures and Sound. The essence of HEARTS was based on the lines of the poem:

Physical touch is always a constant in HEARTS. The aim is to enable patients to achieve a state of relaxation in the easiest way possible using gentle stroking, holding and varying pressures. If the approaches do not have the desired effect, then the human voice can be introduced to provide very simple diversions for the mind and to reduce the internal ‘chatter’. HEARTS is always given through clothes or an additional covering. The textures of the covering, which can include the patient’s own clothes, bed clothes, a blanket or a large towel play an important role in the process through utilizing the sensory stimulation of the receptors in the skin. Aromatherapy oils can also be used, although this is only feasible where the therapist is a qualified aromatherapist or where s/he has prescribed the oils for individual patient use.

The effects of this process can be profound (see Box 8.2). In this case study and without consciously realizing it, the therapist had carried out a trance induction using the resources of skilful touch and the human voice.

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