The girl had been through CBT, and introduced to the idea that she had a ‘worry bug’, and that the way to rid herself of the ‘worry bug’ was to ‘climb the fear ladder’. The ‘fear ladder’ being a graded hierarchy where her mother would gradually ease away from her side when going off to sleep. The problem being that this little girl kept waking as her mother left the room – and would start to panic. At 11 years old, this wasn’t exactly the best thing for her, given that girls like to go to sleep-overs!
Apparently this young girl had always been slow to get off to sleep, somewhat sickly, and quite fearful of being sick. Her mother had spent a lot of time helping to settle her at night, rubbing her tummy and often getting into bed with her to help her get off to sleep. You can see how easy it would be for this to reinforce the daughter’s anxiety about getting off to sleep! And the CBT approach is certainly one way of going about helping her to become more able to cope by herself – but it seemed that the process was taking a long time, and progress had halted because of the girl’s waking when her mother left the room.
Leora Kuttner is a very experienced psychologist, with a fun and playful approach with children, engaging with their imaginations – and that’s a big part of what hypnosis is all about. Hypnosis offers an opportunity for the ‘critical mind’ to switch off, and the playful imagination to be in front. It’s easy to see how children would be readily engaged in this process, especially an anxious child! After all, anxiety is the ability to imagine ‘as if’ it was happening now.
The intervention started with a hypnosis tape to help the child fall asleep – the usual breath regulation approach, with suggestions of ‘sweet sleep seeping in’ and the child finding it ‘easy and comfy’ to go off to sleep. This was used the first week – but once again, the girl heard her mother leaving the room and woke herself up feeling anxious and calling her for her mother. Now this is where I think creativity and playfulness came in!
Leora identified that the girl needed to feel competent, and to find a way for her to challenge her own anxiety about getting off to sleep. To do this, she asked the girl what her favourite home activity was – baking! So the pair carefully described the mixing and preparation of a cake – but as the girl described putting the cake carefully in the oven, Leora said ‘No you don’t! You drop it SPLAT!’. This puzzled the girl – she said ‘No I didn’t, I put it in the oven’. Leora then used a fantastic image straight from the girl’s own world to help challenge her sense of incompetence at sleep:
If you put the cake in the oven then there’d be no problem, and it would settle into the warmth easily, sleep the whole night through, and rise when done. But . . . you don’t let that happen, . . . you stop it . . . drop it . . . and all your good work goes splat on the floor! What a waste and what a mess − and surprisingly you’re actually a very neat kid, who doesn’t like messes!
The story goes on – ‘she was stunned, still and highly receptive. In that moment I sensed that she had got it. There was little more to say except to bring Mom into the picture, but in a very different role − one of supporting her daughter’s competence, instead of providing security for sleep’
Needless to say, it worked.
What was so hypnotic about this? Well – as the girl was caught up in the moment of describing her activity as if it were happening, she was in a trance – the perfect time for a suggestion to be made. The suggestion was that she was interrupting her own sense of competence by ‘dropping the cake’ just when it was ready to be baked.
I wonder if this is something we could use more often in therapy – helping someone change their own story by asking them to describe something they’re already competent at, then inserting a suggestion that challenges the way they’re managing their pain. A bit like suggesting that they’re fighting against themselves, scoring an own goal, driving the wrong way up a one way street, planting weeds instead of flowers or veges.
I think you need to choose the patient, and be comfortable yourself in your own sense of imagination – but what a powerful way to indirectly challenge an underlying unhelpful thought.
Kuttner, L. (2009). CBT and hypnosis: the worry-bug versus the cake Contemporary Hypnosis, 26 (1), 60-64 DOI: 10.1002/ch.375