In this study, Erzana Szwertak explores the effectiveness of relational hypnosis against fears and phobias. Through a concrete case, she demonstrates how this approach helps to overcome anxieties, revealing its profound impact on personal transformation and mental well-being.
Regardless of how a difficulty began, what is most important is its persistence and it is this that must be understood and addressed. (Fich, Segal, Weakland, 1986).
This case study combining an experience of hypnosis and the systemic and strategic approach took place within the framework of individual therapy. Session after session, I weaved the invisible links between the systemic approach and hypnosis with convincing results. Installed in this dual posture, I was able to have a global and interactional perception in a given context and perceive the issues beyond the problem. This particular case shows the interaction and dynamics set up by this client which locked him in fear, in phobia. The therapy took place in 7 sessions, over a period of 7 months.
The roots of fear
DP is a 28 year old man, married for two years. He is happy, smiling. His wife is pregnant. He likes his new job and is flourishing professionally. He got his license young and, at that time, was the rare high school student who drove to school. A year earlier, he and his wife were returning from vacation, peacefully on the highway. Suddenly he felt unwell with impressive symptoms: his breathing accelerated, his heart pounded, his throat tightened, his legs trembled. Fear completely enveloped him, he could no longer breathe or control himself.
The firefighters had to intervene and he was hospitalized in the emergency room. The diagnosis was surprising, he was healthy and it was “just” a panic attack. And it changed his life because since then, he has experienced other crises. Since then, he has developed a (disproportionate) fear of driving - amaxophobia - and especially on the highway which he never takes again. The car is a closed place and on the highway it seems impossible for him to get out freely (claustrophobia), he feels like he is suffocating. He has managed to organize his life without this phobia bothering him, it does not handicap the other areas of his life. He came to consult because soon he will be a father and would like to travel with his child, show him the world. He considers that he is part of the problem and that he can remedy it.
During the first session, which was long, I bet on the relationship and on tuning, the fundamentals in a therapeutic follow-up. I took care of my communication, I invested in building trust, I worked on security points (here and now), realizing that the secure third party was not in place. I used "strategic dialogue", a kind of interactive "dance" between questions and answers, and answers that influence the following questions, until the interlocutor changes his position thanks to this dialogue (Nardone , Salvini, 2012).
DP taught me to be afraid of losing control of your body. This usually happened in predictable situations and repeated itself whenever he felt like he couldn't escape it. In my questions I keep in mind the systemic grid, watching over our relationship, mutual alliance, in an attentive presence, using reframing and ratifications. I regularly reformulated, checking if I had understood correctly, leaving it correct me when I was wrong. He was collaborative and motivated, confident and felt understood. We talk about his preferred solution, avoidance, and he realizes that his fear is an emotion with a paradoxical functioning, like a ghost. Until now he has tried to avoid her and only succeeded in making her grow. This image of a ghost chasing him tells him that the solution may be 180 degrees, agree to “touch” him so that he dissipates . I used reframing that the fear we avoid converts into panic, the fear we face converts into courage (Nardone, Wittezaele, 2016). During the session we discuss the confrontation of fear, he recalls his experiences and realizes that he knows courage well and that the condition of his existence is prior fear.
At the end of this session, as if it were obvious, I asked him to put in place the prescription of the “logbook” “to broaden the horizon of perception when panic signals arrive” (G. Nardone, 2002, p . 177).
To stop his recurring request for help and get out of dependence I prescribed the task: “the fear of being helped” (G. Nardone, 2002, p. 176).
From this session, I also asked him to put in place “the conspiracy of silence” (G. Nardone, 2002, p.176).
He is very collaborative, also very motivated and accepts all tasks without negotiating. And during this session, very delicately, a “hypnotic” communication takes place. I observe him carefully, every movement of his body, I observe his facial expressions, I reuse his exact words, I speak more slowly, I punctuate with silences and use action verbs, in the present tense. When he talks about his courageous exceptions, the language becomes sensory and dissociative, so that he enters into the experience more easily. I try to make his body speak, relying on the sharing of Julien Betbèze:
I wanted to know a little more about his family background, beyond the symptom. He will soon become a father and if something frightened him, made him insecure. His story is filled with childhood angst, with a father who abandoned him when he was eight months old and an abusive mother. He doubts his "abilities to be a good father", because he built himself in the absence of a model. He has low self-confidence and self-esteem.
Clinical hypothesis – an ambivalence of relational autonomy
He believes that to be a good father you have to feel safe to be able to reassure your child and his family when he himself does not feel safe, despite a rational internal discourse. This insecurity emerges like a storm as soon as he is behind the wheel. He needs to be reassured, to be helped by his wife, which reinforces the contradiction. I start from this double bind as a clinical hypothesis with the aim of working on it to eradicate his phobia.
There is a contradiction between his desire for relational autonomy with the issue of parenthood and his incapacity because he is dependent on his wife. We highlight that his initial request is not so much on the outside, afraid to drive on the highway, but that it resides in his deep interior, with a desire for a relational change that touches him intimately.
As if he were trapped in a double injunction: on the one hand he has the extreme desire to become a worthy father and on the other he is under pressure from this role which he apprehends to the point of losing his means. In this ambivalence, driving, leading his life, becomes a dubious and impossible mission that frightens him, and the highway with the reigning speed, where he has to come to terms with others, threatens him even more. He feels helpless. He is in the logic of avoidance and wishes to find a solution in order to show himself capable.
During this session, I was attentive to his body (very rigid at the beginning), his posture (he was neither anchored nor focused), to his verbal and paraverbal language and I paid close attention to the words he used. and metaphors (which I used regularly).
At the end of this session, here are the main elements of his perception – reaction system:
His view of the world:
To live and survive you have to be courageous. Fears and anxieties weaken. The world can be dangerous and right now there is such a feeling of insecurity in this world; the current context is worrying. A parent must reassure their child in all circumstances. A good father must reassure his family.
The definition of the problem:
He has suffered from panic attacks for several months. He experienced several while driving. He begins by feeling very hot, his body weakens, his breathing accelerates. In these moments he is afraid of losing control of his body. Now he anticipates, he is afraid of a new crisis; increasingly avoids driving and going out.
The relevant system
Who ? : With himself
Where: When driving (especially on the highway), but also in closed rooms.
When ; Since 1 year
Position in relation to the problem: I have a problem and I must solve it. I have to do everything to succeed. I will be a dad soon and I want my child to be proud of me.
The attempted solutions he put in place:
He is very controlling and when he doesn't succeed, he avoids (driving, delegating to others)
Ask for help, easily accept that someone else drives
Socialization (talks with his wife and with all his friends)
With whom: His wife
No exceptions
Sensation, dominant emotion: fear of losing control and sadness
The relationship with his wife is complementary, he is in a “one-down” position and he needs help from his wife (even while pregnant). She is always available to take the wheel sending the subtle message “I am helping you because you are incapable”. In the 2016 book “A Logic of Mental Disorders”, G. Nardone and JJ Wittezaele develop a model to illustrate how the fear of a panic attack always triggers the same response that maintained the problem (Nardone, Wittezaele, 2016, p.110). It is a logic of avoidance that allows us to understand how the problem functions in the present and how it persists.
In the support suite he always respected the instructions and quickly felt different. He managed to stop dodging, even though it was quite a feat. He drove several times. His wife was surprised and proud of him.
The anticipatory fears persisted and accompanied him every time he had to drive. He no longer discussed his fears with those around him and forced himself to think carefully before asking for help. He felt more confident and realizes that he is capable. I valued and encouraged changes that were in the right direction. He noted a few “small” crises, all managed without panic attacks, with an intensity of maximum 4 (scale of 1 to 10)
As he had obtained the expected changes, he was instructed to continue the initial prescriptions and, this time, I offered him the task par excellence, the paradoxical ritual of the "fantasy of the worst", 30 minutes a day with a double objective, to First he must stop avoiding and then he will face his fears, he will seek them out, choose them so as to no longer suffer them. He left with a 300% commitment.
I kept as common thread that his avoidances are the consequence of a problem of relational autonomy (vision of hypnosis). He is afraid of having a panic attack again, of feeling the same symptoms, with the same inability to act. As if he was "dissolving", as if he were no longer in control of his life. This fear was not connected with lived experiences, it was connected with his representations of lived experiences, such as images, thoughts and behaviors.
Questioning techniques inspired by hypnosis
The questioning is inspired by the teachings of Eric Bardot. We work on security, in the present. He sought to identify the elements that connect him with security, with serenity. In my particular way of questioning him, I continue further, to push his imagination and activate more unconscious work.
During the questions I let the silences settle so that the imagination can operate and the scene can appear.
We then work so that the externalization process can take shape and we establish "shared imagination" where both of us visualize a situation (from the past) where he is driving on the highway, carefree, confident and happy, knowing that at At the end of the night his wife waits for him.
In the following sessions, I pushed the experience further and we talked about his representations of the family and its relationships, shared roles, relationships and his necessary criteria. He spoke of his childhood, of missing his father, of the stories he had invented to justify his absence and to reduce his suffering. A situation emerged (he thought he had forgotten it): at school, to play football, an opposing team had been formed with the fathers and he remembered his injury and his loneliness.
Gently, I then invited him to bring back this whole scene which was painful to his mind and to imagine it in my hand and to observe it as if it were a screen (dissociation). I suggest he retouch the scene, using the “mental Photoshop” technique, and modify it so that it is pleasant and acceptable to him (Megglé, 2021). He gets involved, he applies himself and transforms the mental film. He is calm, the new scene was pleasant. He felt it everywhere in his body and especially in his chest.
I accompanied him. He was surprised, his grandfather was there and was able to play football with the adults. He scored two goals and, thanks to him, they celebrated the victory. And, as our memory evolves with our experiences, he “injected” a new memory during the session.
In the therapeutic follow-up, and at each session, I took the time to question the prescriptions and what was put in place. Since my client was in a complementary relationship, he implemented the requested tasks perfectly. He wanted to change. He told me that during his daily meetings with the worst of his fantasies, he was not at ease but that, day after day, he knew how to manage. Once he fell asleep during exercise. He thought he had conquered his fears.
A few weeks later, he had an important meeting with his wife at the midwife. He drove and experienced a major seizure with strong and bothersome symptoms, but this time he continued driving without stopping. He experienced this experience as a failure. I validated his ability to not give up and “integrated” the relapse into the process. It was part of the job and predictable. As a logical continuation and to unblock the system that maintained the fear. The next task was “5 minutes of the worst 5 times, per day”.
During the following sessions, the therapeutic work progressed well. We had a solid and trusting alliance and the results were convincing. We have established a safe and comfortable distance for him.
We then worked on its values and their incarnations: freedom, respect, protection. He learned to welcome his sensory feelings which were linked to his fear. This time we established connections with experiences related to his values and he was able to reconnect with his fears. He saw his grandfather again and they were able to talk, because they share the same values. He had “attachment disorders” according to the work of John Bowlby, this vital need for a secure attachment bond interrupted in early childhood. It's important to work on it. He was locked in this world of insecurity and oscillated between the abandoned world and the world of abuse. He seeks to build a secure relationship with his wife with whom he shares the same values and who is always there for him. He remembered the first time he took the initiative to sign up for a dance class knowing that she loved to dance.
To relive this great experience again:
He closed his eyes, he reconnected with this experience and was proud to have taken this initiative and saw the joy in his wife's eyes again. His shoulders, his head, are straight, he has a broad smile. He was connected with his body, the sensations were pleasant. He feels better and more confident. He had the impression that something had just physically unlocked. From that moment on, he had no more seizures. He drove on the highway several times with a feeling of security.
For his baby everything was ready and he was impatient. His father came and they reconciled. The relationship was still fragile, they needed time. He wanted his child to be surrounded, to have a grandfather. He felt close to this old man. To strengthen his autonomy, he learned self-hypnosis (the 5-4-3-2-1 protocol) known as “Sensory Spiral” from Betty Erickson. I prescribed it to him daily to act on the physiology, to calm his nervous system. To consolidate the results obtained, in a continuum, he had the prescription “the worst 5 minute fantasy” either when he feels the symptoms coming, or in anticipation of a stressful situation
The feedback continued to be satisfactory, the tasks were like a guarantee of his commitment and he respected everything. There was no crisis. He felt happy. Towards the end of the intervention, I asked him with the intention of verifying: this time we are setting up a recent experience, where his mother objected when he decided to change jobs. The relationship with his wife was in place and she supported him. Being autonomous and in a secure relationship he was able to overcome his fears and his phobia.
After following all the instructions, the changes seemed to be installed well. Since he looked the “ghost” in the eye, it disappeared and so did his seizures. On the rating scale of 1 to 10, he is now at 10 (ORS). We keep the last prescription so that the mind integrates the modifications, to stabilize them.
Two months after the last interview, DP became a father, he is in the clouds. He has experienced an internal transformation, he thinks, acts and feels the courage to grow. He took parental leave, wants to take care of his daughter, wants to be the protective father capable of chasing away all fears. I asked an unusual question that comes from problem-oriented therapies: “How to make it worse.”
During this last session, he explains that the relationship with his wife was more balanced. He no longer needed her to drive him. This couple of young parents were doing very well, their little daughter is happy and he takes good care of her. He changed his way of being, he was on leave, more relaxed. He was confident, managed to manage his family life, happily assumed his role as father and husband, and he observed that in his social life he was more open and his relationships became more balanced because he felt that he was love.
The cross-questioning of systemic therapy, hypnosis and narrative therapy made it possible to obtain spectacular changes in a short time (7 sessions). Perhaps fatherhood was a positive factor that contributed to change. He changed his perception-reaction system and his dominant sensations evolved. As if at the start of therapy there was only one light on, like in the theater, that of fear. He managed to “think outside the box” in which he had locked himself and he opened up new perspectives. As Robin Williams in the film “The Circle of Dead Poets” explains to his students: “I stand on my desk so as not to forget that we must constantly force ourselves to look at everything from a different angle.”
CONCLUSION OF THERAPY: THE CONTRIBUTIONS OF RELATIONAL HYPNOSIS IN A THERAPY
We human beings have this wonderful ability to travel through time, we can relive our experiences from the past. We can find and relive the best emotions and sensations through our thoughts. Our brain is also programmed to anticipate the future, to protect us, to avoid dangers, to receive rewards. With technological progress, we have learned to compact time and space, everything happens quickly and in real time. Very quickly we became fond of this concomitant information (text messages, emails, tweets) and social networks (FB, Instagram, Snapchat, Twitter). We have become hyper connected and paradoxically, we have become disconnected from ourselves, dissociated. Our most sophisticated brain, the neocortex, the one that thinks, analyzes and deduces, developed on the ancient brain, the one that is governed by the laws of survival, reproduction, and attachment. How did we go from a skill in foreseeing the future to a pathology of anticipation such as a phobia? Where is the line between a healthy and useful fear and that which is disabling? Does this ability make us anticipate the future and the danger which creates the conditions for a phobia or is it to avoid falling into the traps of an uncertainty that we try to anticipate, predict, calculate, increasing the probability of falling into our own trap again?
Modern life, with its multiple threats, wars, pandemics, global warming, droughts, floods, terrorist attacks, economic problems, pesticides on our plates, are the favorite subjects which impose themselves in our exchanges. How can we resist this anxiety that surrounds us, how can we take a step back? How can we tame our fears and live well with them?
An effective therapy is initially flexible and requires a range of varied therapeutic techniques to be able to adapt to each particularity. Systemic and strategic therapy provides a precise framework, its questioning leads to quickly understand how the problem works now. This information allows the therapist to construct the best problem-solving strategies.
The contribution of hypnosis is to allow the client to work in a secure space, in a living relationship. The goal of an accompaniment is to guide the client towards new, more functional perspectives, towards a lasting change, using suggestions, evocative language, metaphors, aphorisms, so that he can live a corrective emotional experience, in order to to feel differently before understanding.
Where to train in the systemic and strategic approach & hypnosis training
Read also:
- Hypnosis training and systemic therapy with Giorgio Nardone
- Hypnosis training: the basics
- online ericksonian hypnosis training
- Overcome fear and anxiety through hypnosis and self-hypnosis. Michele Ritterman.
- Hypnosis training: A hypnosis lesson with Milton Erickson
- Hypnosis training: the foundations of Ericksonian hypnosis, Interview with Michele Ritterman and Ph.D.By Michael Hoyt, Ph.D.
- Ritterman: human wickedness
- Understanding and healing fears
Also read about anxiety disorders:
- A clinical view of anxiety disorders
- Brief and effective treatment for anxiety disorders and phobias
- Anxiety disorders: In the beginning, how to identify anxiety disorders?
- Anxiety disorders: Can we see both avoidance and control strategies in a patient?
- Anxiety disorders: Obsession, how to analyze it in relational terms in the notion of control?
- Anxiety disorders: Is paranoia part of the category of psychosis?
- Anxiety disorders: Does the anxiety disorder make it easier to stay in the exhaustion of the stress mechanism?
- Anxiety disorders: Faced with pathological doubt, how can you help a person?
- Anxiety disorders: the interval of therapeutic sessions from the first session
- GENERAL - Stress, anxiety and anxiety disorders - By Claude de SCORRAILLE
