Most therapists, it seems, have taken their clinical practices online, conducting their sessions through their computers. I have been asked the question many times in recent weeks, “Are there any special considerations to take into account when doing hypnosis in virtual sessions?” The answer is yes and this blog briefly addresses those issues that I hope will be helpful.
The first consideration is to address the question, “why do hypnosis?”
Here are some compelling reasons:
• Empirical evidence hypnosis can enhance treatment outcomes
• Provides insights into subjective experience – how someone generates issues
• Highlights the malleability of experience – shifting from static to dynamic
• Enhances one’s sense of personal control and can help clarify what’s controllable
• Multi-dimensional applications – physical, cognitive, behavioral, affective, social, spiritual, etc.
• Enhances cognitive, behavioral and emotional flexibility
• Helps improve coping skills – teach self-hypnosis
• Helps reduce the drive for certainty during uncertain times
• Has both treatment and prevention value
Suggestions for How to Approach Doing Hypnosis Online
In the same way that clinicians and clients were initially reluctant to change from in-person to online telehealth sessions, the experience of doing hypnosis online is yet another change to adjust to as we work with clients.
Despite what most clinician’s intuitively believed, research has shown that telehealth, and other approaches that are not ‘in-person’ can provide as much value as those in-person experiences. So, it’s time we embraced the new technology, adjust our expectations, and get over any discomfort we may have in order to and engage with our client’s in whatever way that will benefit them.
The intake forms that provide client contact details and emergency contact information become particularly important when working online. If there is an emergency in your office, you are present and able to act, but if there is an emergency online your prompt action will require contacting others for assistance.
For this reason, it is important to review the actual physical location of your client when participating in your telehealth session and the relevant phone numbers on file for the client and their emergency contact person(s). If clients suffer a medical emergency in your office, you know to call emergency medical assistance, but if they are not in your office, you want to know where to send emergency medical personnel.
If it is a new client, it would be wise preventively to have a phone number or some other way to contact someone else in their immediate vicinity (a roommate, friend, or family member) that can assist in case of an unexpected and extreme reaction you can’t handle well from a distance but may not require calling in emergency personnel. This would be an extremely rare, but not impossible, scenario. Review the safety plan and expectations with the client before beginning treatment.
USE OF PHONE and INTERNET
I am assuming you’re going to do the session on a visual platform so you can see the client. That is best, especially when doing hypnosis. Make sure the camera is positioned so that you can see the client’s face and upper body. Keep your focus on them throughout the session in order to observe any reactions you might want or need to respond to.
An additional preventive consideration before beginning the hypnosis is to have the client on an open telephone line in addition to the visual platform. This helps in case the video/audio freezes or wifi is interrupted. By having the client use a phone, they will not miss any of the hypnosis session even if the wifi connection is interrupted. The various telehealth platforms typically have a phone number that can be used in addition to the visual option. Use this, or if this isn’t available, you can call the client or the client can call you.
NEW vs EXISTING CLIENTS
If you have done hypnosis before with the client and you know their way of responding, that is best and will likely be most comfortable for you and your client. Starting hypnosis with a new client when you don’t know them requires more thoughtful consideration on your part to assess how to best work with that new client and introduce hypnosis.
With a new client, keep the first hypnosis session relatively short and superficial in order to gauge their style of responding. What is their attention span like? Do they stay with the ideas or do they drift more easily? Are they inclined to take in only one idea or can they process more information without getting overloaded? Do they physically shift more often or are they still? Do they fall asleep easily and you need to keep them engaged? These are just a few of the observations one needs to make in assessing a client’s response style.
With new clients, especially ones with past trauma or concerns about closing their eyes or doing hypnosis, suggest that they keep their eyes open for the initial hypnosis session. Or suggest that they can open and close their eyes throughout the process as they wish.
Anticipate and utilize distractions if and when they arise (e.g., dogs barking, kids intruding, etc.). Be aware that you don’t want to or need to acknowledge every distraction. This is going to be about your clinical judgment and what can enhance the experience or detract from it. Also, check in more frequently with the client regarding their ongoing experience during the hypnosis session to keep it on track. Unfortunately, there are still many people I know that do hypnosis that do not ‘check-in’ with their clients. By ‘checking-in’ I’m referring to asking the client for feedback during the session and asking them to respond directly by verbalizing, head nodding or finger signals. If you do not ‘check-in’ with your clients, you are missing a significant piece of feedback that can enhance your session. That goes for in-person as well as on-line interactions.
Even with past clients you’ve done hypnosis with, it’s a good idea to start slowly until you see how they respond to an online format for sessions.
If you use finger signals, it is fine to ask the client to raise their hand so you can see the response provided. Engaging clients in talking or moving during a hypnosis session does not generally affect the experience of hypnosis negatively. In fact, you may have to ask your client to repeat something because you couldn’t hear what they said or it got briefly interrupted by the internet connection. That’s okay. The information obtained is more important than the potential lightening of the hypnotic state or the uncomfortable moment of asking the client “can you please repeat that, I couldn’t hear your response.”
AUDIO RECORD YOUR SESSION
Record your session on a digital voice recorder (DVR) and send them the audio file after the session so they can continue to work with the session and more fully absorb its messages. Tell the client in advance in you will do this to assure them they will not “miss” any of the session and will continue to benefit from listening to it again and again.
The general guideline in the US is that the online platform you use be a platform that is able to protect the client’s confidentiality (HIPAA compliant platforms such as those below). This requirement has been relaxed a bit during the pandemic but is still a good idea. Different states and countries may change these rules as time progress. Check with your local state licensing board or national organization that you belong to for more information that may be relevant to your particular circumstances.
HIPAA Compliant Video Communication Products* Include
• *Skype for Business
• *Zoom for Healthcare
• *Google G Suite Hangouts Meet
• BloomText (bloomtext.com/HIPAA/video)
• Thera-link (thera-link.com)
• TheraPlatform (theraplatform.com)
• WeCounsel (wecounsel.com)
*As specified by the California Board of Psychology, April, 2020
Resources for Telehealth Practice
• American Psychological Association Telehealth Information
• The Telebehavioral Health Institute; Training and Consultation
https://telehealth.org Tel.: 619-255-2788
• Center for Telehealth and eHealth Law
• State-by-state licensing waivers to service providers
Photo Credit: Aleksandr Davydov @123rf.com