Cognitive Hypnotic Psychotherapy – A Unifying approach to Psychotherapy

Cognitive hypnotic Psychotherapy is a unifying approach to psychotherapy that focuses on practical and seamless integration of all major approaches to psychotherapy i.e.:

1. Cognitive
2. Behavioural
3. Humanistic and
4. Psychodynamics

With techniques from Hypnosis, Metaphors, Mindfulness and NLP

In short, it is the most comprehensive course for psychologists looking at developing advanced therapeutic skills.

Cognitive Hypnotic Psychotherapy is not about simply using individual techniques from these approaches but being able to simultaneously work with multiple techniques in a way that they integrate seamlessly. For a client it is a single, seamless, customized process that helps them achieve their objectives in the most effective manner.

There are existing sample processes that are based on integrations of these approaches and there is also a possibility of creating a completely new set of processes depending upon the session flow and challenges faced during the session.

These processes can be based on integration of any or all of the approaches mentioned above.

1. Thought restructuring done in a hyper-suggestible (hypnotic) state in combination with emotional anchoring (NLP process based on the principle of conditioning from behavioural psychology)
2. Combination of Meta Model from NLP, Systematic desensitization and thought restructuring with inner child therapy.
3. Using Free Association to induce a hypnotic state where client is regressed back to childhood memories, works with these memories using inner child therapy and finally changes the emotional association with these memories using emotional anchoring.

These are some of the existing sample integrations that Cognitive Hypnotic Psychotherapists practice. But in most cases, the practitioners work with customized processes based on the session requirements.

Each of the approaches have their own strengths and yet are limited in their own ways.

Cognitive approaches are structured and are very effective when working with thoughts and beliefs that clients can become aware of but may at times come across as too mechanical and confrontational. 

Behavioural approaches can be very effective with conditioned emotions and behaviours but do not really focus on working with thoughts, beliefs and past experiences. 

Humanistic approaches are very person centric and can work with extremely complex emotional issues yet the results may not be very tangible or observable. 

Psycho-dynamics can do wonders with intense suppressed emotions, unconscious defence mechanisms and even repressed memories but takes a really long time. Another key challenge of using an individual approach is the chances of relapses.

The reason for creating a unified approach is that we can benefit from the strengths of each of these approaches and can overcome the limitations.

Let us take the example of relapses.

One of the primary reasons for relapses is that a symptom may be a result of problem that is multi-layered. These layers may include dysfunctional thoughts, conditioned emotions, underlying beliefs, unconscious secondary gains, suppressed emotions resulting from repressed memories.

None of the individual approaches actually work with all of these layers and hence the layer that has not been addressed can cause the relapse.

Since a unified approach like Cognitive hypnotic psychotherapy allows you to work with each of these layers systematically, the chances of relapse is highly unlikely.

In the rare event a relapse occurs, the unified approach is designed in a way that the relapse itself acts an indicator of the next step in therapy. And the likelihood of the relapse of a relapse is almost nil.

The integration is based on the understanding that in the end, all therapeutic techniques require a client to be able to accept and implement a change, not just at a conscious but also at an unconscious level. And that the client needs to be in a highly receptive state for them to naturally be able to accept this change and act upon it without any internal conflict or resistance.

To help you understand this, let us look at an example:

Let’s say a client visits you for a session because they want to quit smoking.

The fact that the client comes for the sessions, out of their own free will, shows that consciously they are willing and receptive. Yet when it comes to quitting, the client tells you that they are just not able to.

It is almost like something inside them compels them to smoke. They experience an internal conflict, an unconscious resistance resulting from an automatic urge that they are not able to control consciously.

Given that the urge is generated automatically, in our understanding the source of this is unconscious.

This means that when we are working with clients, while consciously they are willing and receptive, the key hindrance to change is actually at the level of unconscious. So for change to be effective and sustainable, it needs to be accepted at not just the conscious but also at the level of unconscious.

And if you really think of it, all approaches to psychotherapy attempt to do this. 

In behavioural psychology, for example, the process of repetition along with the reward and punishment cycle is being used to condition a new behaviour or emotion. The fact that we are talking about conditioned behaviours and emotions, we are talking about behaviours and emotions that are being triggered unconsciously, automatically.

Even when we talk about cognitive approaches, we are talking about restructuring our thoughts which are generally automatic and thus, repetition is required to make the new thought as automatic, hopefully, as the old one.

Psychoanalysis, talks about suppressed emotion and repressed memories which may be a part of the unconscious.

This clearly shows that all of these approaches are looking at creating a change at both the conscious and the unconscious level. They may be using different strategies or techniques to do that, but the end objective is the same.

And while I am using these 3 approaches as an example, if you were to think of it, all approaches to therapy for creating a sustainable change, need to be able to influence both the conscious and the unconscious.

Once we understand this, we realize that receptivity on the part of the client is required at both conscious and unconscious level. The more receptive the client is, at both these levels, the higher are the chances of success in resolving the problem, not just in the short run but also in the long run.

This higher degree of receptivity in clients is also known as hyper-suggestibility. Helping clients get into a hyper-suggestible state and using an integration of these approaches with the understanding that all of them are trying to achieve the same objective, is the basis of a truly eclectic approach to therapy.

In short, the state of hyper-suggestibility can act as a thread to integrate each of these approaches and any other approach that can help clients create a change.

By definition, Hypnosis is a state of hyper-suggestibility and hence, understanding hypnosis and how it can integrate with each of these approaches individually becomes the first step.

Once that has been achieved,  hypnosis can also help us connect the other approaches with each other – for example, the cognitive and the psychodynamics approach.

For more details check out this complete guide on what is hypnosis.

While Cognitive Hypnotic Psychotherapy is a person-centric approach (steps are customized based on the requirements of the case), the following is the framework that will be useful in most cases.

Step I – Defining the problem

Step II – Defining the desired outcome

Step III – Exploring the impact of the desired outcome on the client’s future

Step IV – Identifying the observable steps that need to be taken or behavioural changes that are required to achieve the desired outcome.

Step V – Identifying the different layers that needs to be addressed to resolve the problem or to overcome the reasons that are stopping the client from making the required changes naturally. These layers include:

1. Current Thoughts
2. Current Emotions
3. Beliefs, Values, Defence Mechanisms and Unconscious Secondary Gains
4. Suppressed emotions or trauma
5. Past experiences including repressed memories

Step VI – Working with Current thoughts and Emotions

Step VII – Working with Beliefs, Values, Defence Mechanisms and Unconscious Secondary Gains (if required*)

Step VIII – Working with Suppressed Emotions and Traumas (if required*)

Step IX – Working with Past Experiences and Repressed Memories (if required*)

Not all problems will have all the layers and hence the therapist may not have to work with all the above-mentioned layers but as many layers as may be required to create a sustainable change.

The therapist uses a combination of techniques to work with each layer and in many cases, multiple layers may be worked upon simultaneously.

While the therapy focuses on creating changes in the layers mentioned earlier, the effectiveness of the therapy is ascertained by sustainable observable changes in the client’s behaviours.