INTRODUCTION

Working hypnotherapeutically with children can be a richly rewarding experience. It offers the opportunity to help the child utilize their own capacity to make beneficial changes and to tap into their limitless creative ability. The underpinning philosophy within this chapter is a belief that each individual child has, within themselves, all the resources they need. It offers suggestions for both therapists and child care practitioners to adopt a child-centred, flexible, responsive approach, whereby the therapist/clinician uses whatever the child brings to the therapeutic encounter to enable the child to achieve their goals.

The term ‘practitioner’ will be used throughout this chapter to be inclusive of both therapists (psychologists, counsellors, etc.) and clinicians (doctors, nurses, etc.). As Sugarman (2007) points out, hypnotherapy is a skill-set and strategy that bridges both physiological and psychological in both intent and outcome.

Research into hypnosis with children suggests that they are generally very good subjects for hypnotherapeutic intervention. It also suggests that they are often more hypnotically responsive than adults. They respond well to creative visualization, metaphor and pretending. In general, children have active imaginations and come along to sessions without many of the preconceived notions about hypnosis. They also tend not to analyse themselves or the process to the extent that adults do. Hilliard (1979) suggests that most of the variables suggestive of hypnotic responsiveness in adults have their precursors in the creative, affective and play experience of childhood.

There are several distinctions between working with children and adults. While adults commonly close their eyes during hypnosis, children, particularly those under the age of 10, seldom do. They often associate instructions for eye closure with being told to go to sleep and may equate it to loss of control. They are curious and do not want to miss anything. This can be somewhat disconcerting for therapists who often regard eye closure as validation of the trance experience and a sign of intensity of the hypnotic experience. This can be initially uncomfortable for the practitioner, as it moves them out of their comfort zone of eye closure and requires modification of their usual practice. Children also have a tendency to fidget and move around more than adults in hypnosis and this can be misinterpreted as a sign that the child is not in trance. Children generally learn hypnosis more easily than adults because they are frequently in and out of altered states of awareness as part of their normal development (Kohen 1990).

There is a well-documented link between hypnotic ability and stages of child development. Children aged between 4 and 6 years tend to be more responsive to a kind of ‘protohypnosis’ which is an absorption in fantasy games related to the external world rather than detached internal fantasy. Between the ages of 7–14 hypnotic ability is thought to be at its peak and decreases during adolescence (Hilliard & Morgan 1978). However, it is important to note that individual children vary greatly in their speed of development. Success in working with children requires the practitioner to be aware of development issues and therefore to adapt inductions and suggestions to not only the age of the child but also to be consistent with the individual child’s level of intelligence, understanding of language and their cognitive and perceptual skills.

CREATIVE FLEXIBILITY

There has been a general shift over the past few decades from the authoritarian, direct approach in the field of hypnotherapy to more indirect permissive approaches pioneered by the work of psychiatrist Dr Milton Erickson. He developed an indirect style of induction, characterized by words such as ‘allow yourself’ and ‘imagine, if you will’, using ambiguous and cooperative, rather than directional language, to guide the unconscious mind into trance. Erickson used a non-directive approach, using stories and metaphors in order to distract the conscious mind, making indirect suggestions to the unconscious mind. He believed that the unconscious responds to metaphor, symbols, images and artfully vague language. His work influenced many practitioners in the field, including Dr Karen Olness, Professor of Paediatrics (foremost authority on the application of hypnosis with children). She is the co-author of the classic text: Hypnosis and Hypnotherapy with Children (Olness & Kohen 1996). The recipe for a successful hypnotherapeutic intervention with children, according to Olness, is using induction techniques which are permissive in nature, emphasizing the child’s involvement and control and encouraging their active participation in the process of experiencing and utilizing the hypnotic state.

Hypnotherapy training courses commonly teach hypnotherapeutic techniques as a series of ordered steps: introduction, induction, deepener, therapeutic suggestion, reorientation, ratification and reflection. This process has been likened to a ‘vessel’ approach to hypnosis, whereby the subject is dipped into a vessel full of hypnotic trance and some subconscious change occurs during immersion. The subject then floats back to the surface, is removed from the vessel and wiped down (Teleska & Roffman 2004). This vessel approach is a useful protocol to use with adults, but less useful with children, as successful hypnotherapeutic intervention with children relies on the practitioner being creative, flexible and going with the flow. Children often arrive for consultation in their own everyday trances, drifting between fantasy and reality. This provides the opportunity to tap into their natural state of being. It can be highly effective to go with the flow of their fertile imaginations and allow the child’s tenacious and self-protected autonomy to dictate the order and flow of the therapeutic outcome (Sugarman 2007).

ETHICAL CONSIDERATIONS

Working with children requires care and consideration, as children are still in the process of developing their own construction of reality. Fordyce (1988) suggests that two questions should be at the forefront of the therapist’s mind when working with children. First, ‘What am I teaching my client by what I say and do?’ Second, ‘What is my client learning?’ These questions arise from the need to maintain a self-supervisory capacity and reflect sensitivity to the ongoing process of the therapeutic session.

Working with children requires the practitioner to have either formal training in paediatrics, child psychology or have taken sufficient postgraduate training and supervision with children in their respective discipline and area of expertise before using hypnosis. It also assumes appropriate training and certification in the use of hypnosis in general and its application to children (Wall 2007).

The practitioner working with children must stay within their own professional remit and know when to refer on to another appropriate professional (see Ch. 3). Children, who present with problems such as pain or enuresis, should always, without exception, be medically evaluated before commencing with hypnotherapy sessions. This is also applicable when dealing with issues such as psychological trauma, whereby the child should be referred for assessment of a child psychologist.

Contraindications to using hypnosis with children are: risking physical endangerment, risking aggravation of emotional problems, hypnosis for entertainment outside the therapeutic relationship and when more effective treatment is available (Olness & Kohen 1996).

PARENTAL INVOLVEMENT

A consideration when working with children is having parents as a contributing factor. The role of parents is significant in the overall process. Their words and actions can support or undermine the hypnotherapeutic work. The child’s problem may even be due to the parent’s behaviour or exacerbated by them. Kohen et al (1984) in a study of over 500 hypnotherapy sessions with children found that negative outcomes were correlated to parental over-involvement. Autonomy is required for children to effectively develop self-mastery techniques and parents ‘nagging’ appeared to negate the autonomy necessary for the child to take ownership of their own self-hypnosis.

The role of the parent is central to the work the practitioner does with the child. From the onset, the practitioner is dealing not only with the child but also with the parent, therefore it is vital to establish rapport with both the child and the parent. There is a fine balancing act between keeping the parents feeling they are part of the process, while also respecting the child’s right to be able to speak to the practitioner about their concerns in confidence. It is important to establish open challenges of communication with parents from the beginning to ensure all concerned are working towards a common goal.

Although there are numerous benefits to using hypnotherapeutic approaches with children, there can be reluctance on the part of some parents to seek out hypnotherapy due to widespread misconceptions about hypnosis. This often comes from the perceived connotations relating to lack of control associated with stage hypnotism. This fear can be allayed by spending time to explore the myths with the parents and offer them reassurances that hypnosis is a very safe and effective therapy and the client is always in control. They may even wish to experience hypnosis themselves so they can feel comfortable with the process.

THE INITIAL CONSULTATION

As the initial point of contact comes from the parent, this provides an opportunity for basic information gathering such as the nature of the problem, family dynamics, child’s health history, etc. This initial discussion also gives the practitioner the opportunity to establish the ground rules in terms of how the therapy sessions will be conducted. In practice, the author finds it useful to conduct this initial consultation with the parent via the telephone or in person prior to meeting the child. This allows for the initial contact with the child to focus upon directly addressing them individually; giving the child the opportunity to express their perception of what is happening to them. It also gives the practitioner the opportunity to establish the child’s level of motivation to change.

The initial consultation with the child enables the practitioner to gather information about the child’s interests, hobbies and experiences. This information can be used later in the hypnotherapeutic process. The language used when addressing the child should be pitched at their level and should avoid being too simple, and therefore patronising, or too complex for the child to understand. The practitioner can enhance rapport by taking into account the child’s perceptual and conceptual skills with regard to both the problem and the possible solutions.