Mental Imagery vs. Hypnosis
PHENOMENOLOGY AND THERAPEUTIC APPLICATION
In the last thirty years, both hypnosis and mental imagery, once recognized as powerful tools in the healing arts and then repudiated for centuries, have been finding their way back into the practice of health practitioners. While these two modalities share certain similarities, they are fundamentally different. They are different phenomenologically and they are different in their psychotherapeutic significance. The practitioner's skill in recognizing the uniqueness of hypnosis and mental imagery can significantly alter the therapeutic process.
Phenomenology of Hypnosis and Mental Imagery.
Studies with electroencephalograph recordings reveal that hypnotized subjects show random alpha waves (which are associated with mental and physical relaxation), along with more prominent beta waves (which are associated with a state of arousal to outside stimuli) (Hirai, 1974). Conversely, during the imaginal experience, there is predominance of theta brain activity. In the theta state, the brain waves exhibit a low frequency, which means that the subject is minimally aroused by outside stimuli. According to Brown et al. (1982), during the mental imagery process, a person is "..more likely than in hypnosis and meditation to lose the sense that he/she is actually creating the experience" (Brown, Forte, Rich, Epstein, 1982). That is, during the imaginal activity, a person is inactive in relation to the outside world, but hyper-active and hyper-attentive in relation to his/her subjective inner experience. We see here two quite different phenomena. One (hypnosis) is of inner passivity and hyper-receptiveness to the outside reality, another (imagery) is of outer passivity and hyper-receptiveness to one's inner reality.
Out of this phenomenological difference of the two processes comes the difference in their therapeutic application.
Hypnosis.
One of the masters of modern hypnosis, Milton Erickson, identified hypnosis as a "state of intensified attention and receptiveness and an increased responsiveness to an idea or to a set of ideas" (Erickson, 1958). Hypnosis has also been described as a “state of selective hyper suggestibility” (Weitzenhoffer, A., 1957).
Therefore, hypnosis is a particular state of consciousness in which a person responds to his/her own suggestions or those from others. A suggestion is commonly defined as an idea offered to oneself or another for uncritical acceptance.
The premise of this technique is that the suggestions will bypass the patient's conscious critical judgment and become a part of his/her subconscious mind. This is the part of the mind believed to motivate one's thoughts, feelings, and behavior.
In the case of substance abuse, for example, the patient may associate the use of a substance with pleasurable, carefree, confident state. There also may be a belief from the patient that they " can not go without it,” that if they “do not have it, they will die.” The therapist gives suggestions to the patient about the negative effects of the substance on the patient's life and the positive consequences of giving it up. Through the use of suggestion, the therapist also might create a conditioned response between a particular word and a feeling of a commitment to becoming abstinent. The suggestion may be: "any time you feel the desire to use the drug, take a deep breath and say to yourself ‘freedom.’" A patient is asked to do this in the therapists office while he/she is relaxed and committed to becoming free, and then again whenever they are faced with challenging life situations.
The use of such techniques comes from the belief that once a suggestion reaches the patient's subconscious mind, the patient will extinguish the old conditioning (in the presented example: substance-pleasure, substance-carefree life), and create a new conditioning (in the presented example: abstinence-freedom, abstinence-self-respect...).
Mental imagery.
Mental imagery is a process of directing one's sense organs commonly used for the exploration of outer (objective) reality, toward one's inner life. It is a "a flow of thoughts we can see, hear, feel, smell, or taste" (Rossman, 1987).
While spoken words are a product of the intellect and can be used to edit, rationalize, fragment, deny, or misrepresent the reality, spontaneously appearing mental images always display a complete and unbroken reflection of one's inner experience. Put another way, "images may have a greater capacity than the linguistic mode for the attraction and focusing of emotionally loaded association in concentrated forms: verbal logic is linear; whereas the image is a simultaneous representation. The quality of simultaneity gives imagery greater isomorphism with the qualities of perception, and therefore greater capacity for descriptive accuracy" (Sheikh, Panagiotou, 1975). In the imaginal reality, a person "loses perception of creating the experience,” detaches from the outside objective reality, and silences his/her critical judgment (Brown, 1982). Therefore he/she is free to fully see, feel, and experience the inner reality. As Epstein (1994) noted, “imagination is the enzyme of the mind, analogous to a physical enzyme that catalyzes a physiological process. The inner mental enzyme speeds up inner transformation by showing us the way and giving us direction."
By discovering images appearing in response to a particular "journey theme,” a patient can see his/her belief systems embodied in images. Once the belief system is discovered one can choose to "re-member the adverse images in a new way" (Epstein, 1994). By doing so, the patient can alter the emotional memory of particular experiences.
For instance, a woman who experienced childhood abuse can use the imagination to "stand up" to her perpetrator. Although her factual memory of the event does not change, her emotional memory of helplessness is transformed into a new emotional memory of self-reliance, courage, and confidence. After the imaginal correction, the woman is less likely to shape her current reality based upon the influences of the past. She has changed her past. With a different past she has a different now.
Psychotherapeutic Application of Hypnosis vs. Mental Imagery.
Let us consider a patient who is overweight. By choosing hypnosis as a therapeutic modality, the therapist can implant suggestions into the patient's subconscious mind about eating less, eating healthy food, or exercising. These suggestions, particularly when reinforced, are can alter the patient's behavior towards food and health overall.
In some cases, this intervention works. And in many cases, it does not, or it does, but temporarily. Why do we see this variation?
It is well known that people who develop undesirable, hard-to-break habits tend to exhibit (or describe themselves as having) "addictive personalities.” The suggestions given by a therapist address a particular habit or a set of habits. They do not, though, deal with the client's underlying belief system. In the case of anorexia nervosa, for example, the belief "I am fat" is so strong that it even defies an objective reality test, and in extreme cases people die. Behind this “I am fat” belief, there may be another belief in place, such as "no matter how much I work- I will not succeed.” People may go through life developing new addictions whether it be to substances or to dieting or to relationships. They may go to see a therapist for another "fix" only to develop a new dependency. Some people succeed in making a particular change and then slowly go back to their old habitual way. They often say the suggestions "wore off." Once again, it is not that the suggestions wear off but the belief system about the old habit never changes, and a powerful stimulus from the outside triggers the old way of responding. So, why can’t suggestions change some individual’s belief systems?
The answer to this question lies in the fact that the belief systems underlying and motivating one's behavior are not as discernible as the behavior itself (i.e., overeating, smoking, fighting, self-sabotage etc.). A belief system is not a linear, logical concept that one can rationally "figure out." Rather, it is one's inner prism of perceiving reality which affects the way one consciously thinks, feels, and behaves. This prism can be identified only through the totality of one's perception. Such an organ of perception is imagination. There are specific mental imagery techniques, which are designed to uncover one’s unconscious beliefs and if deemed necessary, change them to more appropriate beliefs.
Case Illustrations.
Case A.
A., age 37, was overweight from the time she got to junior high school. She also shopped compulsively and had a history of short relationships which always ended because, as A's boyfriends said, she was "clinging too much." Before coming in for a consultation, she had been through "herds of psychotherapists." Her treatment ranged from discovering that she was "stuck" in the oral stage of her development to direct hypnotic suggestions that fattening food was poison. In spite of years of searching for cure A. continued to follow the same habitual patterns.
After a 30 minute interview, A. was introduced to the idea of mental imagery as a therapeutic technique, and was introduced to the concept that "in the world of imagination, everything is possible and freedom is unlimited." She was asked to imagine herself eating all the food she wanted and then to become small and to descend into her body along with the food. At first, A. saw only the big pieces of food that she just ingested, but then she slipped down and fell into a very deep and big cave. In the corner of the cave, A. discovered a cage with an emaciated man who was crying and begging, saying, "do not leave me! I am starving! I am here all alone! Please, do not leave me here.” A. was able to break the cage and free the man. She helped him to climb out of the cave and they surfaced in the field of flowers. With the first blow of the wind the man was lifted in the air and became a cloud. As the cloud burst into a rain, A. felt all her suffering and all her fat being washed away. She danced in the rain. She felt light, free, and happy. The "journey" was over. The whole experience lasted eight minutes.
A. was instructed to do a 30-40 seconds imagery exercise of dancing in the rain every morning for twenty one days. Shortly after the session A. started effortlessly losing weight. She decided to take time off from dating so she could "get to know herself.” A. came for five additional sessions three weeks apart for the purpose of "cleaning up" other issues and "developing the muscle of voluntary will."
Today, four years later A. is at her desired weight, she no longer shops compulsively, and, for the last two years, she has been involved in a loving and stable relationship.
Case B.
B., age 41, was married for seven years. She had severe headaches for three years prior to seeking help. She underwent a series of biofeedback sessions and took a course in self-hypnosis. Both produced only temporary relief. During the initial interview she complained about the unfairness of her life. She said that although she never did anything bad to people, and never said a negative word about anyone, yet her suffering never ended. She also noted that during the "most beautiful times" of her life on holidays, times when all of her "big lovely family would get together,” her headaches were unbearable. B. was asked to go inside of her head and to meet and befriend the ache, which appeared to her as a "big sad blob." B. invited the ache to go to the bank of a river (B.’s identified most favorite place)— and there, the Ache told B. that it hated her mother-in-law. It hated when the mother-in-law called almost every day telling B. how to raise her child. It hated when on holidays her mother-in-law controlled "every breath of everyone present." B. was instructed to thank the ache for coming and sharing this with her. Then, B. said good-bye to the ache as it sailed away down the river.
After the imagery exercise, B. made a commitment to being aware of and being accepting of her hateful feelings toward her mother-in-law, and to learning to stand up for herself when she felt intruded upon. B. was assigned to meet her ache daily for three weeks through mental imagery. During the imagery exercise, her new friend “the ache” shared a lot of valuable information with her, and B.'s headaches subsided. At the end of the three week period her "ache" did not show up. B. has been headache free for one year at follow up.
The issue of personal autonomy.
Another major difference between hypnosis and imagery relates to the issue of personal autonomy.
Many of the problems addressed in hypnotherapy deal with issues of personal mastery such as problems with one’s relationship with food or other substances, phobias, self-esteem, lack of confidence, and stress. It is important to note that if a person has one of these problems, it exemplifies their hyper-suggestibility. In the case of low self-esteem, for example, a person is receptive to self-suggestions and/or suggestions given by others about his/her qualities such as: worthlessness, inferiority, incompetence.
In the case of fears of public speaking, a person successfully gives him/herself suggestions about how he/she will fail at doing the presentation. Even in the case of overeating, one is responding to a suggestion of a well established pattern, whether it is eating when angry, eating when lonely, eating when unable to deal with feelings. So, here he/she is, sitting in a comfortable chair, responding to suggestions given by a therapist to whom he/she has delegated responsibility for making a life change. As was discussed above, the suggestions may or may not affect the patient's belief system, and they may or may not change the patient's emotional and behavioral responses.
However, for the sake of discussing personal autonomy, let us assume that they do respond. Most suggestions have to be reinforced by a client coming for a series of sessions or listening to a recording made by the therapist walking them through a hypnotherapy exercise. Even when the suggestions do produce a desirable change, the method through which the change was accomplished— the suggestion— increases the patient's suggestibility, thereby enhancing the very weakness that it intended to eliminate.
This is an important point — as people's suggestibility increases, their ability to use their free will, and to exercise their conscious critical judgment, declines. They become more and more likely to fall prey to their own negative suggestions, suggestions coming from others, consumer adds, frightening news, political scare tactics, and other such sources.
In contrast to hypnosis, mental imagery is an active and creative process of using one's free will as one uses one's sense organs turned inward for exploring their inner reality. By using imagination, one does not need an outside authority. After receiving proper instruction, an individual can do the work of self-discovery and self-transformation on his/her own.
There is also a possibility of using guided mental imagery within the framework of a hypnotic session (Kroger, Fezler, 1976). Practitioners are invited to experiment with omitting the hypnotic induction altogether, simply asking patients to close their eyes, breath out gently, and then lead them into the imaginal experience. Practitioners might discover that this change will enhance the patient's ability to journey.
Conclusion.
Both hypnosis and mental imagery are useful tools in psychotherapeutic intervention. Their similarity begins and ends with the reality that both are: a) altered states of consciousness, b) capable to effect one's psychological and physiological states, and c) can elicit images. However, they are different in their phenomenology and their psychotherapeutic merit.
Hypnosis is a valuable technique in working with someone who has problems with focusing or with difficulty in using will to conduct his/her own imaginary journey. A woman in labor, for example, might have difficulties using imagery for pain management because of experiencing fear and/or pain. In this case preliminary hypnotic suggestions can establish a conditioned relaxation response.
There are also people whose habitual behavior is so ingrained and overwhelming that they do not believe that they can effectively produce a change on their own. In this situation, which is often seen in cases involving substance abuse, hypnotic suggestion can be a helpful jolt, a jolt that can be reinforced later on by a person's own imagery and willful behavior.
Mental imagery is an unimposing, inner-directed process of discovering and, if necessary, can also be used to correct one's limiting belief systems. It is a method in which a therapist can be a guide and an educator without intruding on a patient's personal freedom and personal responsibility for his/her own healing.
BIBLIOGRAPHY
Brown, D., Forte, M., Rich, P., Epstein, G. Phenomenological differences among self-hypnosis, mindfulness meditation, and imagination, Imagination, Cognition and Personality, Vol. 2 (4), 1982, p.291-308.
Epstein, G. Lecture at the American Institute for Mental
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Erickson, M. Hypnosis in painful terminal illness, American Journal of Clinical Hypnosis, 1958, p. 1-117.
Hirai, T. Psychophysiology of Zen, Igaku Shion, Tokyo, 1974
Kroger, W., Fezler, W. Hypnosis and behavioral modification: Imagery conditioning, J.B.Lippincott Company, Philadelphia, 1976
Rossman, M. Healing yourself, Pocket Books, New York, 1987
Sheikh, A., Panagiotou, N. Use of mental imagery in psychotherapy, A clinical Review, Perceptual and motor skills, 41, New York, 1975
Weitzenhoffer, A. General Techniques of Hypnotism, New York, Grune & Stratton, 1957, p.32.
