Utilizing Hypnotic Patterns and Strategies in Sex Offender Groups

UTILIZING HYPNOTIC PATTERNS AND STRATEGIES IN SEX OFFENDER GROUPS


Bruce W. Cameron, M.S., LPC-S, LSOTP, CASMark S. Carich, Ph.D.

January, 2012

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IntroductionHypnotic and dissociative behavior is naturally

occurring phenomena in the human condition (Erickson & Rossi, 1976, 1979; Erickson, Rossi & Rossi, 1976; Wilson, 1985; Rossi, 2009, 2003, 1986; Carich, 1990a, 1990b).

Furthermore, people exhibit hypnotic and dissociative behaviors throughout the day, rooted in the unconscious process (Havens, 1985; Carich, 1990a, 1990b; Rossi, 1993, 2009). Likewise sex offenders exhibit dissociative- and hypnotic-related behaviors as well (Carich, 1994; Carich & Patrick, 1994). In previous papers, the same author's pointed out clinical and theoretical observations concerningvarious dissociative and hypnotic patterns involving sex offenders (Carich and Cameron, In Press).

These behaviors are exhibited throughout the offense process or patterns. Sex offenders appear very dissociative, especially when talking about their offense patterns and disclosing offenses, and within group settings.

Based upon clinical observations and utilization approaches, therapists can help clients tap into their unconscious hypnotic states and utilize them in group therapy. Within any given group process, there are natural hypnotic moments that can be utilized to enhance the client’s movement toward completing treatment goals. There

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are several windows of opportunity to help clients access resources while they tend to be more receptive.

The purposes of this paper include: (1) Define both; dissociation conscious process and hypnoticbehavior or phenomena; (2) Identify hypnotic patterns and behavior; (3) Outline two basic approaches to access and/or tap into hypnotic phenomena displayed, exhibited or expressed within the group;(4) Present and emphasize indirect approaches to elicit and facilitate hypnotic experiences within the group process.

HYPNOTIC, UNCONSCIOUS & DISSOCIATIVE PROCESSES

Hypnosis is related to both unconscious anddissociative constructs and best viewed as a stat andprocess (Rossi, 1993; Havens, 1985; Carich, 1994, 1996,2004, 1990a, 1990b; Erickson, Rossi & Rossi, 1976; Carich &Metzger, 2004). Both hypnotic process & dissociation arerelated to the unconscious process, and are brieflydiscussed below. Hypnotic applications to sex offendershave been briefly discussed by a few authors ( Carich &Metzger; 1999a, 1999b; Carich and Patnider, 1994; Carich,1999).

Unconscious Process

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Although the concept of the unconscious is not readilyused throughout ex offender treatment, it is still a veryrelevant construct (Carich & Metzger, 2004). For example,awareness can be arbitrarily divided into three segments:conscious or immediate awareness; subconscious or pre-conscious – indicative of material that can be accessed andbrought into conscious awareness; and unconscious –materials, processes, memories, etc. that are accessible butout of immediate awareness ( Carich, 1993, 1996, 2004).

Only a small part of our experiences are conscious. By“unconscious” we mean below the level of awareness (Dewey,1978, p.3). It is a hypothetical construct encompassingmaterials and data that are not readily accessed byconscious awareness. It includes deep-level memories andexperiences stored outside of immediate awareness. It isbest considered a process (Carich, 1994, 2004, 1996; Carich& Metzger, 2004; Erickson, Rossi & Rossi, 1976; Havens,1995).

The unconscious is used to describe right hemisphericbrain processes. These include: material (data, memory,experiences…), behavior, responses, etc. that are not inimmediate awareness. It is a process, storehouse and set ofresources that governs bio-physiological processes.

DissociationDissociation is a sense of detachment and a non-

psychotic state; but yet at some level detached fromimmediate external reality. Dissociation is the commonbuilding-block of hypnosis or states. A brief list ofdissociative behaviors includes ( Carich & Cameron, InPress) :

Sense of detachment Fixation of attention

(entranced) Total self-

concentration

Inner (internal)focusing of attention(highly focused)

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Fantasy-sensoryvisualization orimagery (pretending)

High intensity offocusing

Oblivious to others Possible regression Appears to be in a

trance state Out-of-body

experiences (hiddenobserver)

Possiblecatalepsy/limbrigidity

Depersonalization Perceptual distortion SDML&B system – State

Dependent MemoryLearning & Behavior(context-specific)

Anesthesia/numbingcould occur

Many of these behaviors resemble hypnotic behaviors because they are at the same unconscious level of awareness and similar phenomena (Rossi, 1993; Erickson, Rossi & Rossi,1976; Yapko, 1984).

Hypnotic Behavior/StatesA hypnotic trance can be defined as a suspended state

from immediate awareness or reality, requiring some degree of internal absorption, creating an altered state of consciousness (Carich, 1990a, 1996; Havens, 1985; Erickson, Rossi & Rossi, 1976; Rossi, 1993; Kroger, 1977; Yapko, 1984).

Hypnosis may be defined a number of ways, including internal/external absorption; heightened, focused awareness;internal/external concentrated absorption of specific stimuli, with at times behavioral suspension, within the altered state of consciousness and right hemispheric functioning.

In essence, it is a fixation of attention on some specified internal/external stimulus, thus suspending immediate awareness resulting in creating a state. Characteristics of trance states involving the concept of state dependence include:

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Internal absorption, or focusing on selected stimulus Heightened focus on specified stimulus Fixated focus of attention Suspended immediate conscious awareness Altered state of awareness or consciousness State of higher suggestibility/receptivity Possible suspended behavior (catalepsy or

rigidity/immobility of limbs) Oblivious to immediate surroundings Both process & state via imagery & dissociation State of relaxation

Recently, Rossi (2009) referred to naturalistic trance states as “response attentiveness,” a naturalistic trance state involving a fixed stare or glare. He emphasized every90-120 minutes the body tends to enter a rest state called a“basic rest activity cycle” involving ultradian rhythms.

Hypnotic states often involve imagery. Imagery is theinternal envisioning or visualizing process involvinginternal, mental representation (stimuli imagery) and mayinvolve all sensory modalities (auditory, kinesthetic,olfactory, task and visual) (Bandler & Grinder, 1979;Lankton, 1980; Lankton & Lankton, 1985; Aroaz, 1985).

There are a number of hypnotic behaviors found in Table#1, on the next page.

TABLE #1HYPNOTIC BEHAVIORS

Totally absorbed Totally focused Oblivious to current surroundings Catalepsy or rigidity/immobility of limbs Non-sleep dream state Daydreaming Basic rest activity cycles

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Age regression Age progression Pseudo-time distortion Ego states Minimal speech Amnesia Anesthesia Hypnotic hallucinations & illusions Imagery Ideo-motor dynamic behaviors Glove anesthesia Arm levitation Dissociation

It is safe to say that there are different hypnotic expressions and myths. The myths of hypnosis have been previously discussed in the literature (Carich, 1990a, 1990b; Hammond, 1988, 1990; Yapko, 1984; Kroger, 1977; ASCH,1973) and briefly below.

Myths & MisconceptionsThe myths discussed below are commonly held and false

beliefs. Key myths include:

Hypnosis is unnatural and evil; Subject loses all control; Subject will do anything while in a trance; Subject is weak and gullible; Subject is prone to divulge secrets; Only a certain kind of person can by hypnotized; Trance is a sleep state; Trance equals therapy.

These myths are countered by the facts presented below:

Hypnotic or trance states consist of behavior that everyone experiences through the course of a day;

Hypnotic behaviors stem from right hemispheric functioning (Lankton & Lankton, 1984);

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Hypnotic states are not deep-sleep states, according tosleep research (Yapko, 1984; Kroger, 1977);

Subjects are in full control of the trance experience. They make choices concerning their experience.

Naturalistic Trance StatesRossi (1993, 2009) has long suggested that trances

occur in states, and are naturalistic. In fact, afterstudying with Milton H. Erickson for eight years, he studiedthe nature of trance states and concluded one of the bestdescriptions involved in state-dependent phenomena. “State-dependent” refers to contextually-based information. It issuggested by Rossi (1986, 1993) that learning occurs instates involving memory and can often reliably accessmemories. At one level, many states of learning aregeneralized across contexts, while others are not.

The underlying process is a State Dependent MemoryLearning & Behavior system stemming from the hypothalamiclimbic system of the brain, and may be considered a psycho-bio-physiological link between the mind-body processes. Itseems to be the core of learning, as well as trance states.

Interestingly, Godin (1991, p. 63) outlined three typesof trances, which can be viewed as “levels:”

1) A “common trance” state, which would correspond to thestate of absorption of daydreaming into which wespontaneously fall several times during the day.

2) An amplified trance state. This state of amplifiedtrance seems to be of the same nature as the commontrance, but thanks to the help of somebody else whoamplifies, of feeds back what is desirable, the degreeof absorption seems to be much greater. The otherperson also helps by guiding psychological responses.

3) A somnambulistic trance state. Such a state cannot beachieved by everybody and may not always be desirable.

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The common trance occurs every 90-120 minutes (Godin,1991; Rossi, 2009), while the amplified trance is moreintense in nature.

Related Hypnotic PhenomenaThere are related and inter-related phenomena that can

be considered similar to, if not the same as, hypnoticstates. These include: guided imagery, deep musclerelaxation protocols, deep breathing exercises, mindfulnessand other relaxation exercises. These are all pathwaysreaching hypnotic states at some level.

DISSOCIATIVE HYPNOTIC BEHAVIORS & SEX OFFENDERS

There is still not much in the literature concerning dissociation and hypnotic behavior pertaining to sex offenders, except for a few articles written by the first author and some scattered writings (Carich & Metzger, 2004; Carich, 1994; Carich & Calder, 2003; Carich, 1994).

Sex offenders appear very dissociative and hypnotic in nature. They often appear detached. Furthermore, offending has been characterized in patterns or pathways (Carich & Cameron, 2008; Carich, Grey, Rombouts, Stone & Pithers, 2001; Ward & Hudson, 1998) often reflecting dissociative-hypnotic behaviors throughout the offense process (Carich & Cameron, 2008). This especially pertains to offenders chronically in active pathways, as defined by Ward & Hudson (1998), Yates (2005), and Yates & Kingston (2005).

A brief list of related behaviors includes (Carich, 1994; Carich & Cameron, In Press):

Depersonalizing victim as an object and re-personalization to fit fantasies and needs;

Deviant fantasies; Turn off/on switch (SDML&B); Regress back into offense states;

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Hidden observer phenomena (sees self commit offense); Ego state switch; Absorbed and focused on offending:

* Oblivious to others* Fixated on offense

Specific applications include when the offender’s frameof reference (mind) is fixated or victim-related stimuli, thus internally absorbed on deviancy, they tend to shut out the outside world and become oblivious to external reality or surroundings. Other related behaviors may include: age regression/progression, psychotic distortion (going back into previous state and/or moving forward), imagery, daydreaming-related fantasies, and feeling detached.

In essence, they are highly-focused, deviant stimuli oblivious to external surroundings. Especially for the high-risk offender, these appear to be characteristic of the offense process (Carich & Cameron, 2008; Carich & Stone, 1996, 2001; Carich, 1994).

In typical sex offender groups, many offenders exhibit trance states, especially when talking about offenses and fantasies via offense disclosure. In fact, sing hypnosis, one can experience a wide variety of phenomena. It is important to understand that subjects will not divulge secrets unless they want to. They will not behave out of their value system. Lastly, hypnotic interventions are onlypart of the treatment process. They are not usually the entire process.

In an extreme example, one child molester/adult rapist was intensely describing the rape of his 14-year-old stepdaughter and entered a spontaneous trance state for 45 minutes, keeping his arm extended in mid-air spontaneously (referred to as hand/arm levitation and catalepsy). He was intensely recalling and describing the experience of the assault, as he partially regressed back into the events thatnight. The experience (meaning his responses) perplexed

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group members. However, the dissociated/hypnotic experience was utilized in-group by providing aversive suggestions “crashing” or collapsing deviant arousal states and emphasizing the horrid experience of his stepdaughter. Manyoffenders accessing memories, either offense-related or traumatic, tend to enter trance states, usually ignored by group therapists.

There are two basic ways to access hypnotic windows of opportunity: (1) direct suggestion and (2) indirect suggestion. These are discussed further in the next section.

HYPNOTIC INDUCTION/SUGGESTIONAND THERAPEUTIC PROCESSES

For the most part, there are two basic approaches to inducing hypnotic experiences and deliver suggestions, direct an indirect. The direct method refers to the use of internal and naturalistic, spontaneous, trance states. Bothare briefly discussed to illustrate the skill levels and approaches to deliver suggestions when offenders are receptive, along with creating windows of receptivity. There is nothing magical or mysterious, simply recognition and technique. Language is the key, including the non-verbalaspects ( Erickson, Rossi & Rossi, 1976). Through language,accompanied by non-verbal behavior, evokes hypnotic responses with the group.

Direct Suggestion and InductionDirect trance induction involves a series of steps in

using specific protocols or procedures to formally induce orfacilitate a hypnotic experience. A typical format includes:

1. Trance preparation2. Trance induction3. Hypnotic questioning4. Intervention selection

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5. Delivery6. Monitor immediate outcome7. May have to re-do Steps 3 or 68. Trance exit9. Monitor outcome.

The essence of the strategy is to help the client fixate on some selected stimulus and facilitate a trance state following several protocols. Within the process entails suspension of immediate awareness. Trance protocolshave been discussed thoroughly over the years (Hammond, 1990; Asch, 1973; Carich, 1990a, 1990b; Kroger, 1977; Yapko,1984).

Likewise, direct suggestion simply refers to giving or providing suggestions throughout the process, including directing therapeutic responses.

Indirect Hypnotic Induction/SuggestionIndirect suggestions and inductions have similar

elements as direct. The difference is in the delivery. The approach involves informal, non-direct delivery through bothverbal and non-verbal communication. It all remains therapeutic communication; it is the delivery modality that remains different.

Elements of the approach are outlined below:

1. Define problem and develop goals;2. Gather data;3. Re-calibrate goals;4. Select indirect trance induction technique;5. Delivery;6. Monitor immediate outcome;7. Trance exit (if necessary);8. Monitor outcome.

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At times, spontaneous trance states can be recognized and/or induced by the following characteristics: glazed eyesand lazy responses; starting into space/a fixated stare; dissociative or detached response and/or behavior; glassy eyes; day-dreamy responses; heavy eyelids; blinking more than usual; nodding, etc. Rossi (1993, 2009) refers to this as “minimal behavioral cues indicating trance readiness.”

Rossi (2009), in a recent interview, describes Erickson’s view of “light trance” as waking trances or responses or attentiveness, when one appears to be in a trance and simultaneously awake. Rossi (2009) further emphasizes that response attentiveness during the general waking trance evokes psychological experiences or conditionsof “novelty, enrichment and exercise” that neuroscientists use to “turn on” activity-dependent gene expression and brain plasticity” (p.34) actually evoked via probing/accessing questions, metaphors and other tools utilized in therapy.

For many years, E.L. Rossi has been investigating the neuroscience basis for trance experiences and therapeutic processes (1993, 2009, 1986, 1987). He traces the experienceto molecular exchanges within the brain, emphasizing the cascading effect of genetics. Rossi (1993, 2009) emphasizesdialogue between the mind process and genes, as he states, “many genes are called ‘activity dependent’ because they areonly activated when they are turned on by important sensory-perceptual signals from the outside, such as light, smell, touch, hearing, warmth, nutrition, psychosocial stress, etc.” (Rossi, 2009, p. 23). Key points include molecular communication between the mind-genes and outcomes are modulated by the environment and are a two-way street. Rossi (2009, p. 23) also states, “creatively-oriented, positive human experience in therapeutic hypnosis is assessed by modulation of gene expression at the molecular level.” It is postulated that it is perhaps the molecular basis for offending. There are cascading effects throughoutthe mind-body processes, behaviorally, the cellular

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interactions can be described or dissected as stimulus-response and response-stimulus sequences.

INFLUENCING THE CLIENT VIA HYPNOTIC INTERACTION

It has been previously discussed that therapy consists of communication – relaying information between two or more people – which is the exchange of behavior in a specified context in which roles are designated, such as therapist (helper) and client (the one being helped).

The goal involves the therapist helping the client makechanges or complete treatment goals. The aim is to help influence the client toward change based upon treatment targets. The therapeutic context involves a therapeutic relationship or alliance (i.e., rapport) and group cohesion ( Carich & Calder, 2003; Marshall, 2005; Yalom, 1985).

Therapeutic communication is an ongoing process of messages delivered and received in the form of behavior exchange. Based upon this, it has strongly been suggested that any given treatment session can be dissected and/or segmented into therapeutic interventions and client responses ( Carich, Dobkowski, & Selehanty are submitted forpublication). Furthermore, the therapist continuously influences the client, delivering therapeutic messages and interventions through both verbal and non-verbal means, including hypnotically.

Within the process, most clinicians or therapists utilize, and more skilled therapists create, client windows of opportunity to change receptiveness. Likewise, many therapists, if not all, use a variety of forms of hypnotic influence, whether they know it or not. There are numerous hypnotic tactics used with or without formal trance inductions (Hammond, 1990; Asch, 1973; Kroger, 1977; Carich,

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1990a, 1990b; Erickson, Rossi & Rossi, 1976; 1985 a, 1985h; Havens, 1985; Yapko, 1984).

Some basic and advanced tactics include:

Relaxation Metaphors, including symbolic imagery writing (Carich,

1990c,d) Suggestions Imagery Pseudo-time distortion Age regression Age progression Hypnotic imagery journey Ego state & affective bridge Deep breathing

Basic Hypnotic Techniques

The above basic hypnotic techniques can be utilized within any group session. They are briefly described below.These are only interventions to help evoke change responses with group members.

Relaxation Techniques

Basic relaxation techniques involve anything from deep breathing to deep muscle relaxation exercises ( Carich, 1989, 1990a, 1990b;Carich ____________). The essence of these techniques involve having clients create states of relaxation. _________ protocol described elsewhere could include the following steps or demands:

Specific protacals facilitating states of relaxation Deep breathing exercises Imagery of pleasant comforting relaxing scenes Deep muscle relaxation ( push-release, tighten-

release)

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Metaphors

Metaphors are commonly used in therapy across the spectrum ( O' Halon, 1987, Lankton & Lankton, 1983). They are very hypnotic in nature and can be used in direct or indirect trance work ( Carich, 1990a, 1990b; Havens, 1985; Hammond, 1990). Metaphors are forms of parallel communication or symbolic representations, in which one element is (symbolically) transformed to another. Typically, therapist utilize animal images, scenes, objects,events, ...that represent something or has another meaning. Clinically, metaphors operate at multiple levels of awareness, including unconscious levels, can be utilized a basic association processes and unconscious searches for meaning (Bandler & Grinder, 1979; Lanton & Lankton, 1983; O'Haulen, 1987; Aroaz, 1982, 1983).

Imagery and Imagery Journeys

Imagery can be considered a hypnotic behavior capitalizing on envisioning processes within self, typically, through visual modalities. People continuously use various forms of imagery, throughout the day. Imagery is commonly within the therapy community (Lankton & Lankton,1983; Bandler & Grinder, 1979).

Typically, tactics are combined to get the results delivered informally within the group process.

Hypnotic Imagery Journeys

This tactic is a combination of the above techniques and can be used as group experiences and/or with individual group members. The key aspect involving taking the client on a specific journey using relaxation, imagery, suggestion,etc.

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An example of protocol includes: Introduction and Hypnotic/Relaxation Induction Induction Techniques:

1. Journey to the wall-Imagine a journey and a wall. Wall represents distortions or defenses.

2. Journey through the wall- Take down wall. Go through the wall.

3. Journey beyond the wall-Take responsibility and access feelings. Look into victim's eyes and notice painful impact. Enhance harm recognition and empathy.

4. Futuristic Behavior/ Re-orientation- Reinforce empathy for victim ( Post-hypnotic suggestion). Re-orientation to current time frame. ( carich, 1989, 1990a, 1990b, 1999; Carich & Patrick, 1994a).

Many hypnotic communications and suggestions are phrased in gentle, non-authoritarian ways found in Appendix A. A summary of typical phrases used formally and/or informally include:

1. Non-verbal – focused, relaxed, low monotone voice,pacing & leading, mirroring (matching)…

2. Verbal phrases. Examples include:*And you can wonder…*Can you notice…?*Perhaps noticing…*I’d like you to begin allowing…*And if you wish…*And you can wonder what…*And in an interesting way, you’ll discover…*And that’s fine…*I wonder if you’ll be reminded… by just noticing…*That’s okay…*I wonder if you’ll be interested in learning how to…

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The key is keeping verbal responses simple, concrete (unless creating confusion), smooth in delivery, rhythmic, calm, etc.

Hypnotic techniques and responses can easily be appliedto sex offender groups. Many offenders continuously move inand out of trance states, at varying levels, as most therapists actually use hypnotic interventions without awareness (i.e., early recollections, offender disclosure via re-living offending and other memories or experiences, future projection, relaxation/mindfulness, etc.). Helping offenders meet primary needs appropriately and any form of RP self-regulations requires a projection into the offender’s future, which is all hypnotic in nature, involving pseudo-time distortion, imagery, etc. Any type of relaxation protocol/exercise, imagery, fantasy work, past memories/experiences, etc., all involve hypnotic realities at some level.

Hypnotic interventions or techniques are those directly/indirectly involving hypnosis via unconscious and dissociative processes or altered states. It is not the entire treatment, however; only a set of interventions used to achieve a therapeutic goal or goals.

Hypnotic intervention can be arbitrarily divided into the following stages of delivery Carich, 1990a, 1990b):

Trance preparation; Trance induction; Hypnotic depth; Subconscious questioning; Ideo-dynamic motor signaling; Working/intervention stage; Exit/Re-orientation/Awakening stage.

Perhaps the best ways of influencing hypnotically involve Milton H. Erickson’s approach of informal trance induction and suggestion. Williams (1985) discussed the

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finer points of Erickson’s multi-level communication, influencing in the most subtle ways.

Williams (1985, p. 183) states: “…Erickson utilized multi-level communication. He made use of non-verbal communications… Erickson was a master at skillful manipulation of body postures, gestures and voice qualities such as tome, rhythm, inflection and pitch in dealing with his patients…

“…you secure the patient’s attention. You talk to them; express ideas. It isn’t necessary to tell them to relax or feel sleepy, or to close their eyes slowly… you merely speak in such a way that you command their attention more and more. And when they give you their full attention,they become immobile, unresponsive to a lot of unimportant stimuli…” (Williams, 1985, p.182).

Emphasis is placed on the fact that trance states occurfrequently within therapy (Wilson, 1985; Erickson, Rossi & Rossi, 1976). Wilson (1985) reiterates Erickson, Rossi & Rossi’s (1976) definition of hypnotic phenomena as the dissociation of any behavior from its usual context. “Each time the client lapses into a hypnotic state, he or she offers the potential for a special class of interventions toencourage unconscious reorganization.” (Wilson, 1985, p. 167)

Wilson (1985) outlines several hints concerning facilitating trance states indirectly: (1) presentation of therapeutic metaphors; (2) recognize the client’s shift intotrance; (3) recognizing cues (i.e., unconscious search, dissociation, amnesia, age regression, time distortion, etc.); (3) enhancing trance readiness states, by noting client’s movement between internal and external focus of attention by utilizing specific language in rhythmic deliver, and providing suggestions interspersed to invite unconscious responses; (4) hypnotic language includes words

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such as “wonder,” “suppose,” “imagine,” “understand,” “explore,” etc.

The essence involves non-verbal communication and verbal skills. Williams (1985, p. 179) states, “the sophisticated use of language and interpersonal behavior wasa trademark of Erickson’s approach to psychotherapy.”

Erickson was a master of communicating on multiple levels, by using implications, indirect suggestions, parallel or symbolic communication, ambiguity, paradoxes andconfusion. Use of these and other techniques can evoke hypnotic and change oriented responses. The words clinicians use within therapeutic conversations actually evoke images and hypnotic responses. This includes nonverbal responses for behaviors emitted by the therapist. However, it seems that these processes and the strategic importance in evoking, changes responses.

The Essence of Inducing group Trances

The keys to inducing trances in groups can be summarized by utilizing responses with hypnotic language ( i.e., wonder, suppose, imagine, understands, explore...) that evoke trance states and/or behaviors. Likewise, utilizing responses to evoke images, memories, experiences, etc... via:

Therapeutic metaphoric images Recognizing trances and utilizing them Shifting focus or attention onto selected stimuli Develop and use (pace matching & lead) rhythmic

patterns to evoke hypnotic responses Stories and other metaphors that capture attention Following the hypnotic responses to develop or help

unfoldMore specifically, various methods also include:

Creating unconscious searches Utilizing time distorted responses Evoking futuristic responses/experiences

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Using ambiguity ( creates unconscious searches and focusing on selected stimuli)

Confusion Paradoxical interventions Use metaphoric symbolic responses Triggering memories Utilizing deep breathing tactics

CONCLUSION

In therapy as well as sex offender treatment, the goal is to help the client create change or make a difference in their life, without re-offending. This typically encompasses a range of treatment targets.

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The essential elements of contemporary treatment include:

Responsibility and Cognitive Restructuring Empathy:

*Victim-specific*Global

Regulation (coping) Skills*Sexual arousal*Mood management*General intervention/regulation skills

Change Maintenance Strategies (RP related)*Offense/dysfunctional patterns/processes & regulation (coping) skills

Interpersonal (skills, issues, attachments) Needs & Issues

*Esteem/worth*Related motivational issues

Global themes may include:

Cognitive Restructuring Empathy (perspective-taking) Regulatory (coping) Skills Change Maintenance Skills Motivational Core Issues Interpersonal Issues and Attachments

Treatment involves therapy to some degree, although it is controversial at times how clinicians influence clients to change at some level. Therapy is simply an exchange of communication within a therapeutic context. The therapeuticcontext involves the therapist influencing the client to change through therapeutic interaction between the therapistand client/group.

Therapeutic communications/interactions occur in multiple levels and contextual frames, as the therapist helps the client facilitate change. Dynamic change,

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including skill incorporation, helps the offender reduce risk levels, develop a quality of life and a non-offending lifestyle.

Influence is the key theme in treatment, which occurs in multiple levels within the therapeutic interaction and context. Any given individual, family or group session can be demarcated or dissected into interactions within the therapeutic dance, in terms of therapeutic interventions andclient responses. Sex offender groups consist of a network of interactions between the therapist and group members. The therapist choreographs the group via interventions. It was suggested by Carich & Dobkowski (2007) and Carich, Williamson & Dobkowski (2008) that any response or set of responses emitted by the therapist can be defined and interpreted as an intervention, whether or not it is effectively delivered.

There are numerous techniques in the world of therapy. Likewise, a set of interventions, many largely ignored within the field for a variety of reasons. Many of those ignored are hypnotic in nature, yet trance behavior is natural. Everyone experiences trance phenomena throughout the day, including within treatment sessions. Hypnotic interactions or exchanges occur throughout the group session. It largely goes unnoticed by professionals, as they typically do not look for minimal cues indicating such behavior.

People naturally go into hypnotic states every 90-120 minutes, which are called basic rest activity cycles within the ultradian cycle. These are natural windows of rest and client receptivity that can be utilized in group sessions. Accessing, creating and delivering hypnotic interventions, either formally or informally, involve both verbal and non-verbal language patterns.

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There are numerous ways to direct the therapeutic influence within the therapeutic session. The days of simple, aimless confrontation are over. Skillful approachesto treatment are necessary.

The key is integrating other therapeutic tactics, including hypnosis, into contemporary cognitive-behavioral (dynamic) therapeutic approaches. By using a holistic view,the unconscious process can be recognized and further used, as it is a part of the human condition (Carich & Metzger, 2004). This includes hypnotic and dissociative behavior, as most offenders appear very dissociative. The authors postulate that much of the group process occurs at multiple,unconscious levels.

Hypnotic suggestions are a part of the hypnosis process. Hypnotic interactions occur throughout the session, and can be utilized to evoke change responses. Formal and informal hypnotic interventions can be used and are viable options with some specific training.

Appendix A

Hypnotic Phrases(Hammond, 1990, pgs. 40-41)

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And you can wonder… Can you notice…? And you can be pleased… (not sure to use) And you can begin to wonder when… With your permission… Now I’d like you to have a new experience… …in a way that meets your needs I want you to enjoy this experience… (has to be related

to resolution) And you will be surprised at… (not sure to use) Now of course I don’t know for sure what you’re

experiencing. But perhaps you’re… And I would like to have you discover…(referring to

some experience) Perhaps even taking a special kind of enjoyment (in your

ability to)…(about resolution or appropriate behavior And sooner or later, I don’t know just when…(planting

double-bind on resolution) And I wonder if it will surprise you when… I wonder if you’ll be curious, as you notice… You already know how to… Perhaps you wouldn’t mind noticing… I would like you to discover something… One of the things I’d like you to discover is… And I want you to notice something that’s happening to

you… I wonder if you’d like to enjoy… (don’t use) I wonder if you’ll be curious about the fact that you… Perhaps noticing… Perhaps beginning to notice… And maybe you’ll enjoy noticing… I wonder if you’ve ever noticed… Maybe it will surprise you to notice that… I’d like you to let yourself become more and more aware

of…(p. 140) I’d like you to begin allowing… And your unconscious mind can enable you to… I wonder if you’ll decide to… or… In all probability… Very likely…

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And would you be willing to experience…? You don’t need to be concerned, it… It’s so nice to know… And do you notice the beginning of…? It may be that you’ll enjoy… At times like this, some people enjoy… One of the first things you become aware of is… And it appears that already… Give yourself the opportunity (to see if)… Perhaps sooner than you expect… And if you wish… And you can wonder what… And, in an interesting way, you’ll discover… And it’s very rewarding to know that… And, NAME______, you know better than anyone that… It’s very positive and comforting to know… You’ll be fascinated and feel a strong compulsion to… And that will probably remind you of other experiences

and other feelings you’ve had… I would like you to appreciate the fact that… I wonder if you’ll be reminded… I wonder if you’ll be pleased to notice… by just

noticing… I wonder if you’ve ever noticed… And while you wonder that, I want you to discover that… I’d like you to begin allowing… What’s important is the ability of your mind to… I want to remind you of something that you probably

already know, which is… And as that occurs, you really can’t help but notice… So that it’s almost as if… Almost as though… Kind of like… And that’s just fine… And that’s all right… That’s okay… All that really matters… All that’s really important… I don’t know if you’re aware of these changes, and…

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It doesn’t really matter… I wonder if you’ll be interested in learning how to… It may be that you’re already aware of… The really important thing is just to be fully aware

of… (Hammond, 1990, p. 41)

References

ASCH (1973). Syllabus on Hypnosis & A Handbook of Therapeutic Suggestions.

Des Plains, IL.

Aroaz, D.L. (1982). Hypnosis & Sex Therapy. NY: Brunner/Mazel.

Aroaz, D.L. (1988). The New Family Hypnosis in Family Therapy. NY: Brunner/ Mazel.

Carich, M.S. (1991a). A Progressive Relapse Intervention Model: A Brief Review. INMAS Newsletter, 4 (2), 3-9.

Carich, M.S. (1990a). Basics of Hypnosis and Trance-work. Individual Psychology, 46 (4), December p.401-410.

Carich, M.S. (1994) Dissociative & Hypnotic Elements of the Offending Mode. INMAS Newsletter, Vol. 7 (3), 8-9.

27


Carich, M.S. (1999). Hypnosis in a Contemporary Sex OffenderTreatment. The American Society of Clinical Hypnosis Newsletter. Vol. 40 (4) Fall, p.5,8.

Carich, M.S. (1990). Hypnotic Techniques and Alderian Constructs. Individual Psychology, 46 (2), June, 166-177.

Carich, M.S. (1990a). Hypnotic Techniques and Alderian Constructs. Individual Psychology, 46 (4), 217-224.

Carich, M.S. (1989). Pus-Release Technique. The American Society of Clinical Hypnosis Newsletter, 30 (3), December, p.3.

Carich, M.S. (1990d). Symbolic Imagery: The Dial Box Shrinking Technique. In C. Hammond (Ed.), Handbook of Hypnotic Suggestions and Metaphors (p.400) New York: W.W.

Norton & Co.

Carich, M.S. (1991)b). The Hypnotic "As If" Technique: An Example of Beyond Adler. Individual Psychology, 46 (4),509-514.

Carich, M.S. (1998). The Sex Offender Treatment Program Psycho-Educational Module: Orientation to Sex Offender Treatment (unpublishe manuscript).

Carich, M.S. (1990c). The Symbolic Imagery Letter Writing Technique. In C. Hammond (Ed.), Handbook of Hypnotic Suggestions and Metaphors (p. 400) New York: W.W. Norton &

Co.

Carich, M.S. (1994). "Unconscious Processes", In R. Corsini (Ed.), Encyclopedia of Psychology. NY: John Wiley & Sons.

28


Carich, M.S. (1996). The Unconscious. In R.J. Corsini & A.J.Aver Bach (Eds.), Concise Encyclopedia of Psychology (2nd Edition). p.919-920 NY: John Wiley & Sons.

Carich, M.S. (2004). The Unconscious. In W.E. Craighead andC.B. Nemeroff (Eds.), The Concise Corsini Encyclopedia of Psychological & Behavioral Science 3rd Edition,

Volume IV. Pg. 1013-1014.

Carich, M.S. & Adkerson, D. (1995). Adult Sexual Offender Assessment Packet. Brandon, Vermont: The Safer Society Press.

Carich, M.S. & Adkerson, D. (2003) Adult Sexual Offender Assessment Report. Safer Press.

Carich, M.S. & Calder, M. (2003). Contemporary Treatment of Adult Male Sex Offender. Dorset, England: Russell House.

Carich, M.S. & Cameron, B.W. ( In Press). Hypnotic Dissociative Elements of the Offense Process: Theoretical Observation.

Carich, M.S. & Junge, K. (1990) A Pulse-Rate rapid HypnoticInduction. The American Society of Clinical Hypnosis Newsletter, 31 (2), October, p.2.

Carich, M.S. & Metzger, C. (1999a). Hypnotherapy. In R.E. Watts and J. Carlson (Eds.) Interventions and Strategies in Counseling and Psychotherapy. (p. 43-81) Philadelphia,

PA: Taylor & Francis Group.

Carich, M.S. & Metzger, C. (1999). Utilizing Ericksonian Hypnotic Techniques with a Sexual Offender. The Milton H. Erickson Foundation Newsletter, Vol. 19 (2), p. 6,7.

29


Carich, M.S. & Metzger, C. (2004). Rediscovering & Utilizingthe Concept of the Unconscious in Contemporary Sex Offender Treatment. The Forum, XVI (4).

Csarich, M.S. & Mussack, S.E. (2001) (Eds). Handbook for Sexual Abuser Assessment & Treatment. Brandon, VT.: The Safer Society Press.

Carich, M.S. & Parwatiker, S.D. (1992). A Mind-Body Connection A Sex Offender Switch Box: A brief review. INMAS Newsletter, 5 (2), 5-7.

Carich, M.S. & Patrick, K. (1994). A Hypnotic Protocol: A Guided Imagery Journey Into Victim Empathy. Forum Newsletter, 6 (3), 9-11.

Hammond, C. (Ed.) (1990). Handbook of Hypnotic Suggestions &Metaphors. NY: Norton.

Havens, R. (1985). The Wisdom of M.H. Erickson. NY Irvington.

Kroger, W. (1977). Clinical & Experimental Hypnosis. Philadelphia, PA.: Lippincott.

Lankton, S. & Lankton, C. (1983). The Answer Within: A Clinical Framework of Ericksonian Hypnotherapy. NY: Brunner/Mazel.

Metzger, C. & Carich, M.S. (1999a). The Eleven Point Treatment Plan for Sex Offender Programs. In M. Calder (Ed.) Assessing Risk in Adult Males Who Sexually Abuse

Children. Dorset, England: Russell House Publishing Limited, p. 293-311.

O'Hanlon, W. (1987). Taproots. NY: Norton.

30


Rossi, E.L. (1986/1993) The Psychobiology of Mind-Body Healing: New Concepts of Therapeutic Hypnosis. NY: Norton.

Spiegel, H. & Spiegel, David. (1978). Trance & Treatment- Clinical Uses of Hypnosis. 2nd Edition, (2004) New York:Basic Book, Inc. Publishers.

Williams, A.J. (1985). Erickson's Use of Psychological Implication. In J.K. Zeig (Ed.), Ericksonian PsychotherapyVolume II: Clinical Applications ( pg. 179-184). New York,

Brunner/ Mazel.

Wilson, R. (1985). Interpersonal of Hypnotic Phenomena within the Ongoing Treatment. In J.K. Zeig (Ed.), Ericksonian Psychotherapy, Volume II: Clinical Applications (pg. 115-178). NY: Brunner/Mazel.

Yapko, M. (1984). Trance Work: An Introduction to ClinicallHypnosis & Psychotherapy. NY: Irvington.

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