HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS: THE PERSPECTIVE OF SOUTH AFRICAN PSYCHOLOGISTS Janine Kerri Leask A research report submitted to the Discipline of Psychology. Faculty of Humanities, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Education (Educational Psychology) Johannesburg, South Africa November 2012 | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Abstract Hypnotherapy has been utilised with children and adolescents for more than 200 years. Despite this fact, there has been no documented research on the use of hypnotherapy for children and adolescents in South Africa. This research focused on the perspectives of qualified South African psychologists on the use of hypnosis as a therapeutic technique for children and adolescents. The aim of the research was to expand on current knowledge and understandings of hypnosis and hypnotherapy, to explore how the technique has been adapted to a South African context and to identify drawbacks found in the use of this technique. The research sample comprised eight qualified psychologists who utilise hypnotherapy with children and adolescents. The research design for this study adopted a qualitative approach in which semi-structured interviews were utilised. Although the technique largely relies on foreign practises that have not been adapted to the South African context, it still proved highly valuable. While the psychologists opinions differed on the ages and conditions for which hypnotherapy could be applied, this seemed to be based on their personal experiences and success rates rather than on inherent limitations of the technique. The educational psychologists who specialised in treating children and adolescents found that there were no limitations on the use of the technique and they were confident in its application for all ages. There was also a prevailing belief, on the part of the psychologists, that black individuals appear to be more responsive to hypnotherapy than other races. The overall findings of this research study suggest that hypnotherapy is a beneficial therapeutic technique for children and adolescents in a South African context. The research aimed to further educational psychologists’ knowledge on the applicability of this technique to children and adolescents. With an awareness of its benefits, training by these professionals may be undertaken or the opinions of specialists trained in this area may be sought. Key Words: Hypnotherapy, Hypnosis, Therapy, Children and Adolescents and Hypnotherapy, Children and Adolescents and Hypnosis, Educational Psychologist in South Africa i | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Declaration I, Janine Kerri Leask, declare that this is: A Research project submitted in partial fulfilment of the requirements for the degree of Masters in Education (Educational Psychology) in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 23rd November 2012. And that this research project is my own, unaided work. It has not been submitted before for any other degree or examination at this or any other university. Signed: ____________________________ Date: ____________________________ Janine Kerri Leask ii | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Acknowledgments My gratitude must go to a number of individuals who have aided me in the completion of this research report: Firstly, special thanks must go out to my supervisor Dr Zaytoon Amod. Without your generous offer to take me on for supervision, when I was unable to find another supervisor with a background in Hypnotherapy, this research project would never have been possible. Your guidance and advice have been invaluable in the production of this report. I really appreciate all the hours you put into helping me make this research what it is. Thanks must also be given to the eight psychologists who willing and freely gave up their time to participate in my study. Thank you for your kindness and openness in sharing your experiences and perceptions in Hypnotherapy. You enhanced my understanding of hypnotherapy and the respect I have for those who take pride in helping individuals to the best of their abilities. A huge thank you goes out to the Wits Library Loan Department and its staff who spent their time gaining access to numerous journals on Hypnosis and Hypnotherapy to enhance my study. You made my research that much easier. Finally to my family and friends who have provided me with endless support throughout this year. You gave me that extra boost I needed to get this report done. Thank you for standing by me and understanding my absence over the past year. iii | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Table of Contents Abstract ....................................................................................................................................... i Declaration ................................................................................................................................. ii Acknowledgments.................................................................................................................... iii Chapter 1: Introduction .............................................................................................................. 1 Chapter 2: Literature Review ..................................................................................................... 3 2.1 History & Misconceptions .............................................................................................. 3 2.2 Children, Adolescents and Hypnotherapy .................................................................... 10 2.2.1 Hypnotic ability in children and adolescents ........................................... 10 2.2.2 Developmental considerations ................................................................. 13 2.2.3 Psychological applications ....................................................................... 19 2.2.4 Adaptations............................................................................................... 25 2.2.5 Benefits, restrictions and limitations ........................................................ 26 2.3 Techniques .................................................................................................................... 26 2.3.1 Induction techniques ................................................................................ 27 2.3.2 Training .................................................................................................... 30 2.3.3 The role of the parent ............................................................................... 30 2.4 Conclusion .................................................................................................................... 31 Chapter 3: Methodology .......................................................................................................... 32 3.1 Research Design ........................................................................................................... 32 3.2 Participants .................................................................................................................... 33 3.2.1. Participant characteristics ........................................................................ 34 3.3 Interview Procedure ...................................................................................................... 36 3.3.1. Developing the research questions .......................................................... 36 3.3.2. Developing the research interview schedule ........................................... 37 3.3.3. Interviews ................................................................................................ 38 3.4 Data Analysis ................................................................................................................ 38 3.4.1. Thematic content analysis ....................................................................... 38 3.4.2. Analysis procedure .................................................................................. 39 3.5 Quality Criteria ............................................................................................................. 41 iv | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS 3.5.1. Credibility/ Authenticity ......................................................................... 41 3.5.2. Transferability ......................................................................................... 42 3.5.3. Dependability .......................................................................................... 42 3.5.4. Conformability ........................................................................................ 42 3.6 Reflexivity .................................................................................................................... 42 3.7 Ethical Considerations .................................................................................................. 43 Chapter 4: Results .................................................................................................................... 45 4.1 An Understanding of Hypnosis..................................................................................... 45 4.1.1 Individual views and perspective on hypnotherapy ................................. 45 4.1.2 The effect of age on the application of hypnotherapy .............................. 47 4.2 Perceived Advantages and Disadvantages .................................................................... 49 4.2.1 Psycho-education: An initial key to success ............................................ 50 4.3 Application in South Africa .......................................................................................... 52 4.3.1 Induction techniques ................................................................................ 52 4.3.2 Hypnotherapy as an adjunct to other therapeutic techniques ................... 53 4.3.3 Psychological disorders treated (and not treated) by hypnotherapy ........ 54 4.4 Ways in which Hypnotherapy has been Adapted in South Africa ............................... 55 4.4.1 Adaptation of language ............................................................................ 55 4.4.2 Adaption of induction techniques ............................................................ 56 4.5 Influence of Cultural Factors on Hypnotherapy in South Africa .................................. 57 4.6 Ethical Practise versus Exclusivity ............................................................................... 57 4.7 Conclusion .................................................................................................................... 59 Chapter 5: Discussion .............................................................................................................. 60 5.1 Understanding Hypnotherapy and its Application: A Matter of Perspective ............... 60 5.2 Use of Hypnosis in South Africa .................................................................................. 62 5.3 Adherence to Foreign Hypnotherapy Practices ............................................................ 64 5.4 Cultural Implications .................................................................................................... 65 5.5 Belief: Its Influence on the Acceptance and Success of Hypnotherapy ....................... 66 Chapter 6: Conclusion ............................................................................................................. 67 6.1 Research Findings ......................................................................................................... 67 6.2 Limitations of Current Research ................................................................................... 67 6.3 Suggestions for Future Research .................................................................................. 68 v | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS 6.4 Concluding Remarks ..................................................................................................... 69 References ................................................................................................................................ 70 Appendix I: Participant Information Sheet .............................................................................. 76 Appendix II: Consent Form (Interview) .................................................................................. 77 Appendix III: Consent Form (Audio Recording)..................................................................... 77 Appendix IV: Interview Questions .......................................................................................... 78 Appendix V: Supervision Contract .......................................................................................... 81 Appendix VI: Ethical Clearance Letter .................................................................................... 83 List of Tables Table 2.1: Myths and misconceptions……………………………………………………….. 8 Table 2.2: Why children respond more to hypnosis than adults…………………………..... 12 Table 2.3: Developmental stages and hypnotic interventions………………………………. 16 Table 2.4: Hypnotic techniques for stabilization, building rapport, and ego strengthening... 21 Table 2.5: Hypnotic techniques to uncover and explore trauma……………………………. 21 Table 2.6: Hypnotic techniques for securing and maintaining gains……………………….. 21 Table 2.7: Induction techniques by age……………………………………………………... 29 Table 3.1: Phases of thematic content analysis……………………………………………... 40 Table 4.1: Age preference for the utilisation of hypnotherapy……………………………... 48 Table 4.2: Induction techniques…………………………………………………………….. 53 Table 4.3: Adjunctive techniques………………………………………………………….... 54 Table 4.4: Psychological conditions treated, not treated and mixed success……………….. 54 vi | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Chapter 1: Introduction Hypnotherapy has been implemented as a therapeutic technique since before the theoretical works of Freud. Yet despite the permanence of this approach, it has remained largely unused by psychological professionals when compared to other, more popular therapeutic approaches. However, this issue of underutilisation has decreased in recent years as hypnotherapy (including child hypnotherapy) has achieved “greater acceptance by health professionals and the general public” (Kohen & Olness, 2011, p. 95). The continued existence of this approach seems to imply that there is value in its methods that some professionals are perhaps unaware of (Kohen & Olness, 2011). Hypnotherapy, more often than not, has had negative connotations and misconceptions attached to it due to varying ideas about its techniques and a lack of knowledge regarding its nature. However, an increasing portion of qualified psychologists have taken up this approach and incorporated it into their own practises and the underutilisation of hypnotherapy has perhaps given way to excessive enthusiasm and inappropriate utilisation (Kohen & Olness, 2011; Wester & Sugarman, 2007). Overseas, particularly in the United States, Europe and Australia, the increasingly positive reputation of this approach is evident in the growing body of research and increased use of this technique for therapy. Kohen and Olness (2011) report on the successful training and implementation of hypnosis and hypnotherapy for children in countries such as Germany, Norway, Sweden, France, England, Thailand, Bali and Canada, with many experts to be found in these countries, as well as in Australia, Italy, Indonesia, Saudi Arabia and Turkey. The professionals in these areas are reported to have “contributed substantial research related to hypnosis with children” and adolescents (Kohen & Olness, 2011, p. 400). However, despite the fact that this technique is being utilised in South Africa by qualified psychologists, research into its use in South Africa appears to be severely limited. A lengthy search of SABINET, JSTOR and EBSCO Host revealed a total of five research articles written in South Africa over roughly the past three years. In addition, this search revealed that there are no documented research articles that have been completed in South Africa on the use of hypnotherapy for children and adolescents. This study was conducted with the aim of beginning to fill this current gap in documented research in South Africa. There are numerous reports from overseas, as mentioned previously, on how hypnotherapy 1 | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS can benefit children and adolescents, not only psychologically but also academically (Kohen & Olness, 2011). If this proves to be true in the South African context as well, then hypnotherapy could be a very useful technique for educational psychologists to employ. Educational psychology focuses on how children learn and develop. If hypnotherapy proves beneficial in assisting children’s academic improvement, as well as their psychological development, the training of postgraduate educational psychologists in the use of this technique could add to the effectiveness of their future interventions. Educational psychologists could also then refer to other psychologists who have specialised in this area when requiring further assistance. The aim of this research was to explore the perspectives of eight qualified psychologists on the use of hypnotherapy for children and adolescents in the South African context, as well as to provide an in-depth view of the use of hypnotherapy by these psychological professionals. The findings of this study show that, as in other countries, hypnotherapy has proven to be beneficial when applied to children and adolescents. However, the level of training received by individuals that utilise the technique was seen as a crucial factor in its ethical applicability, and the psychologists who contributed to this study believed that only individuals trained in the psychology of the mind should be permitted to use hypnosis for therapeutic reasons. Additional findings will be discussed at greater length in further chapters in this report. Chapter Two of this research report will analyse past and current knowledge on hypnosis and hypnotherapy. It begins with a brief background history of the uses of hypnotherapy before examining how it has been applied and adapted to use with children and adolescents. Chapter Three then provides an overview of the research methodology employed and discusses how the present study was operationalized. It begins with an explanation of, and motivation for, the selected research design. This is followed by discussion of the sampling and data collection procedures and a brief description of the sample. Finally, the data analysis procedures and the ethical implications of the study are examined. Chapter Four offers detailed analysis of the research findings, while Chapter Five provides a discussion of the implications of the findings of the research study. The limitations of this study and suggestions for future research are discussed in the concluding chapter. . 2 | P a ge HYPNOTHERAPY FOR CHILDREN & ADOLESCENTS Chapter 2: Literature Review This chapter provides an overview of the literature on hypnosis and hypnotherapy. This is done in order to appraise current knowledge on hypnotherapy by including substantive findings and theoretical contributions. The chapter begins with a brief history of hypnosis and hypnotherapy, and mentions a few of the misconceptions that have arisen in relation to this approach. Thereafter, the chapter turns to the application of hypnotherapy, paying particular attention to the ways in which children and adolescents’ respond to this approach, the importance of developmental considerations in applying this approach and how this technique has been adapted to suit children and adolescents. Finally, this chapter examines how hypnotherapy techniques have been applied, what induction methods have been utilised and what factors need to be taken into consideration when attempting to apply this technique to children and adolescents. 2.1 History & Misconceptions Hypnotherapy with children and adolescents is often regarded as a recent therapeutic development. However, this view is inaccurate, as hypnotherapy has been used with children and adolescents for more than 200 years (Fromm, 1987; Kohen & Olness, 2011). Kohen and Olness (2011) attribute this misconception to the recent increase in interest in the use of hypnosis in therapeutic work and the greater availability of training workshops in this field. The use of hypnotic techniques has an extensive history dating back to ancient times. Over time, hypnosis has been adapted into the form in which it is used today. A more modern history of hypnosis begins with Franz Anton Mesmer (Kohen & Olness, 2011). It is believed that how individuals live, think and feel can significantly affect their health (Hartman & Zimberoff, 2011). Hypnosis, or an initial form thereof, was first developed by Mesmer more than 200 years ago. Mesmer believed that by influencing the magnetic forces in the human body, it was possible to heal diseased patients. This belief was based on Mesmer’s theory of ‘animal magnetism’ (Gordon, 1967; Kohen & Olness, 2011; Onn, 2008). This theory posits that all objects in the universe contain a magnetic fluid, which connects all objects in the universe to each other. Disease in the human body is seen as the result of disequilibrium in this magnetic fluid. In order to cure his patients, Mesmer would employ various techniques to restore magnetic balance in the human body (Kohen & Olness, 2011). Mesmer’s techniques ranged from the use of magnetic rods to simple hand gestures 3 | P a ge