The following are some clinical case examples of depressed patients who were treated with future-focused therapeutic interventions enhanced with hypnosis.
Case 1: Jessica
Jessica (not her real name) was a 16-year-old high school student who was suffering from depression associated with bulimia nervosa. She lived in a dys-functional family with a cold, rigid, withdrawn, and depressed father and an overinvolved, controlling mother. Jessica’s mother saw her daughter as a narcis-sistic extension of herself and had very poor boundaries in her relationship with Jessica. Jessica had previously been in treatment with several counselors and one psychiatrist. A variety of treatments had been used, such as various antidepressant medications, cognitive behavior therapy, family therapy, interpersonal therapy, and psychodynamic therapy. However, Jessica continued to remain depressed, and her feelings of helplessness, hopelessness, and futurelessness persisted and dominated her clinical presentation. When asked to describe how she sees her future, she answered, “What future? … Life sucks … this is hell, there is no future.” I asked her if she would be willing to learn how to improve her methods of daydreaming as a way of escaping her hell. She answered, “You mean day-dreaming is not bad? You can actually teach me how to do that better?” Jessica readily learned how to formally use imagery of being at the beach as a way of temporarily escaping her stressful environment at home. She regularly practiced the beach scene imagery, enhanced with self-hypnosis, and was soon able to
quickly activate a state of calmness, relaxation, and tranquility. The following is a transcript of what was said to Jessica:
Jessica, please go ahead and take a deep breath … and as you exhale, let your eyelids close and let your body float. … Keep on breathing comfortably in and out at your own pace [I match the words in and out with the patient’s actual breathing, saying the word in when the patient inhales, and saying the word out when the patient exhales]
… as you continue to sit here … breathing comfortably in and out … with each breath that you take … as you inhale, in comes the calmness … and as you exhale … out goes the stress and the tension. … As you listen to my voice and focus on the words, you may know that you were born with a deeply endowed wisdom for creative imagination … which you already have used on your own to escape and detach yourself from difficult and stressful situations at home and at school. … As we discussed before, you may wish to take a special trip to the ocean beach … as a way to relax and recharge your batteries … and gain a new perspective. … Allow yourself now, if you wish, to experience your special ocean beach. … It is a beautiful day in early summer [the season is chosen by the patient in the prehypnotic discussion] … the temperature is comfortably warm, just right, the way you like it. … The sky is clear and blue … as you look at the sky you wonder to yourself … with awe at the endless depth of the blue sky. … You look at the ocean, and you can wonder on the similarity and differences … between the color of the sky and the color of the ocean.
… You look at the two as they merge together at the horizon, far, far away. … Now take a look at the ocean again and notice the waves as they are breaking and receding, white and foamy in rhythm. Look at the beach and notice the color of the sand … is it yellow? … is it white? … is it gray? … or perhaps a blend of two or three of these colors. … You may look around and notice … can you see any seagulls floating up and down with the currents of the air? … Can you see some of them diving down into the waters of the ocean to catch their fish? … If you look closely, you may see some of the seagulls are standing together … in a group on the beach at a distance
… basking in the sun. … As you zoom in closer … you may wonder at the color of their beaks … are they white, gray, or orange in color? … Some may be standing on only one foot, and others on both feet … some have orange-colored feet and others have gray feet. … Isn’t it interesting how much variability there is in nature, and yet all these seagulls are healthy and normal? … And now, you may wish to experience your special ocean beach with your sense of hearing. … Listen to the sounds of the waves as they are breaking and receding in rhythm … the surf of the ocean is so predictable and calming. … Listen to the seagulls … can you hear their special chatter as they communicate with each other? … And now, you may wish to proceed by experiencing this ocean beach with your sense of touch. … Allow yourself to touch the dry sand with your bare feet … notice the sensation of the sand under your feet, over your feet, and between your toes. … Notice the sand as it is soft, dry, and comfortably warm. … Allow yourself, if you wish, to be playful about it … you may even touch the sand with your hands and fingers. … You may now proceed by taking a walk on the sand toward the waters of the ocean. … Notice as you get close to the waters of the ocean … the waves are breaking on the beach. … Notice how the sand becomes more wet, not as dry and more firm, not as soft and more cool, not as warm as the dry sand. … Isn’t that change interesting in the sensation you experience under
your feet? … If you wish, you may now allow yourself to be touched by the waters of the ocean where the waves are breaking on the beach. … Notice the sensation of wetness and coolness on your feet touched by the waters of a breaking wave. … Compare it to the rest of your body that is exposed to the sun … where you experience the sensation of dryness and warmth from the sun rays touching your skin. … Notice the contrast of sensations, wetness and coolness on your feet compared with a dry, warm sensation on the rest of your skin touched by rays of the sun. … You may keep on walking gently on the beach … and as you do, notice the breeze of clean and fresh ocean air touching your face and your hair. … And as we move on, you may now experience the ocean beach with your sense of smell. … Take a deep, deep breath through your nose, and as you do, inhale this fresh, clean ocean air … notice the unique scent of a blend of aromas combining the smell of seaweeds, fish, salt, and much, much more than that … which is unique to ocean beaches. … And as you keep on walking … gently and comfortably … on the beach, you may now experience your ocean beach with your sense of taste. … Allow yourself, if you wish, to touch your lips with your tongue … as you do, you may notice the special salty taste on your lips so typical to ocean beaches. … Now that you have experienced your special ocean beach with all of your five senses … you may find yourself a nice comfortable spot either in the shade under a beach umbrella … or in the sun sitting comfortably and looking at the ocean … seeing the waves breaking and receding in eternal rhythm … watching the seagulls soaring and floating in the air. … Notice the sensation of inner calmness, tranquility, and peace … and remember that you can do this exercise on your own
… Any time you wish to take a break in a safe place where you can close your eyes safely … you can visit this ocean beach and recharge your batteries for calmness, tranquility, and peace … The more you do this exercise, the easier and easier it becomes for you … and the more it has a lasting effect of calmness on your mind, body, spirit, and soul. … As you continue to practice this exercise on your own everyday … in every way you are getting better and better … healthier and healthier, stronger and stronger … your mind becomes more clear, your thoughts are more focused … your feelings are more positive … you find yourself using this gift to ease yourself into natural sleep at night … you find yourself smiling spontaneously, know-ing that you have this special gift of hypnotic imagery that always stays with you … and you can shift your focus and visit your beach where it is safe. … And now … whenever you are ready … we can count back from three to one … and you can return from the ocean beach back to this office … and as you do, you bring back with you these wonderful gifts and memories of calmness, inner peace, tranquility, and new hope. … And now let’s count together. At the count of 3, you get ready to shift gears into the regular state of consciousness … at the count of 2, you look up with your eyes while you keep your eyelids closed … go ahead and do so now, and at the count of 1, you let your eyelids open … that’s right … notice your eyes come back to focus … you become fully alert and awake right here in this office. … You are ready to assume all the regular functions of day-to-day living in the most adaptive and healthy way. …
Jessica was then asked how she had been feeling. Her response was “Relaxed and comfortable,” which she said with a smile. She was given the opportunity to ask questions about the exercise and get any clarifications she might need. Jessica
was asked to practice this exercise at home at least twice a day, and then the session was ended.
At the following session, Jessica came in with a report on how well she did her exercise and how well this worked for her in reducing her anxiety and improving her sleep at night. We then proceeded with a future-focused interven-tion. This began with a discussion whereby Jessica was able to participate in describing a particular time in the future when she had already moved out of the house, seeing herself as a 20-year-old college student, living in her own apartment, and attending college. This phase of the therapy is very important because it is the task of a responsible clinician to assess whether the patient’s desirable future is realistic and obtainable. The therapist must be careful to support only realistic, plausible scenarios with the future-focused imagery interventions.
One way to secure a positive, plausible future is by using imagery within a set of highly structured positive suggestions. The unstructured approach has within it the potential risk of being drawn into the patient’s negativism and hopelessness. By asking the patient to describe these states of negativism and hopelessness in detail, the therapist may indirectly and unintentionally reinforce them.
The following is an example of a future-focused intervention using the “Back from the Future” technique with Jessica:
Now, Jessica go ahead and put yourself in a comfortable position as you are sitting in this chair. … Take a deep breath … and as you exhale, go ahead and guide yourself into a meditative state of calmness and tranquility. … You may take a trip to your ocean beach and experience it with all of your five senses. … On the ocean beach, you regain your sense of total tranquility in your mind, body, spirit, and soul. And now, you may wish to open up a new channel of concentration … whereby you focus on taking a special trip into the future. … Experience yourself in your special imaginary time machine. … You can now push the button that takes you into the future when you are 20 years old. … You have already successfully grad-uated from high school … this is your second year of college … you were successful in completing your first year of courses you chose to study. …
You feel proud of your grades. … You moved out of your parents’ house, and you now live on your own, in your own apartment. … You managed to decorate it using your creative style and taste. … You found a part-time job earning an income that allows you to support yourself … and you have spending money to meet your extracurricular needs. … You have found a circle of friends that make you feel accepted … they treat you with respect and dignity … they appreciate your company as well as the delightful ways of your personality. … You may want to focus now on an activity whereby you have been chosen to be the leader of a group project assigned by one of your professors. … This group project involves gathering research data … comparing the data with other sources from the literature … putting together a hypothesis, and then integrating the results of the data that test the veracity of the hypothesis. … All of this has to be put in writing and submitted
to the professor. … There is an activity meeting in your own apartment. … Six other students are there with you, and all of them report on their material based on the tasks that have been assigned by you as the project leader. … Notice how well the dialogue and conversations flow … including the creative exchange of ideas inter-laced with humor and fun. … Experience the sense of mastery, pride, and comfort with yourself on how well you are guiding, coaching, and leading the group members in bringing the project to its successful completion. … At some point, the group takes a break … pizza has been ordered with soft drinks, and the doorbell rings … the food has been delivered and the table has been set for the meal. … Notice how well you handle the food in a comfortable, natural way, without any of the discomfort that used to accompany eating when you were living in your parents’ house. … Notice how much you can enjoy the taste of the food … and as you chew the food and swallow it, you experience a gradual satisfying sensation in your stomach … giving you the feelings of fullness and satiation. … At that point, you comfortably stop the eating and continue to interact with your friends in a social, appropriate manner. … Experience the sense of inner comfort and joy in your accomplishment.
… Internalize these feelings and physical sensations. … Internalize your feeling of mastery and control, delight in your accomplishment of leading the group to the completion of the project … including the typing of the final manuscript, which is submitted on time by the assigned due date. … Now take a deep, deep breath again
… and as you exhale, reexperience your enhanced tranquility … and get ready to travel back from the future in your imaginary time machine. … As you come back, bring with you all of these positive experiences of joy, comfort, delight, and accom-plishments in college and with your friends. … Bring them back as your special gifts from the future, and let them stay with you consciously and subconsciously … guiding you on your own journey of healing and maturation. … And now, your time machine has arrived to the present, and you can now come out with these special gifts that you have brought with you. … We are going to slowly count from 3 to 1.
… At the count of 3, you just get ready to shift gears; at the count of 2, with your eyelids closed … you look up with your eyes … go ahead and do so now … and at the count of 1, you let your eyelids open … and as your eyes come back to focus
… you become fully alert and awake … ready to continue with the tasks of the day in the most adaptive and healthy way. …
This was followed by a discussion with Jessica about her experience and what it was like for her. She verbalized her experience using the past tense by such statements as “When I was there, I felt in charge; I knew it was just right for me to be with these friends” and “It was so good to live on my own and to be away from my parents.” She was then asked to write an essay about her experience and bring it in for the next session. In her written essay, Jessica continued to use the past tense in describing her future-focused imagery experience. In my experience, when the patient uses the past tense about a future-focused event, that typically indicates the patient’s internalization of the experience on a subconscious level.
The patient then begins to transform day-to-day living by beginning to act and behave differently as if the future has already happened.
Case 2: Michael
Michael (not his real name) was a 36-year-old married man and the father of three children ages 12, 10, and 8. He was diagnosed with severe depression associated with suicidal thoughts. He had a history of previous treatments that included a combination of antidepressants with some supportive psychotherapy.
In the process of the evaluation, it was found that his depression was characterized by feelings of hopelessness with a sense of futurelessness. He specifically felt discouraged due to the fact that several trials of antidepressant medications in various combinations had not worked for him, in part due to intolerable side effects and in part due to the lack of a therapeutic response. In the process of establishing rapport with this patient, I found that a previous therapist told him that he would never recover from his depression unless he fully remembers all the details of his childhood abuse growing up in a dysfunctional family.
When Michael consulted me for psychotherapy, he was focused on his past, assuming this focus would eventually help him resolve his feelings about the childhood abuse he suffered. However, on the contrary, the more he focused on all of the unpleasant memories of his dysfunctional childhood, the more depressed and hopeless he was feeling in his present day-to-day living. At times, he was afraid that he might act upon his suicidal thoughts and end up killing himself by an impulsive act of momentary desperation and anger. Thus, orienting Michael to a positive future with new coping skills was an essential part of his treatment.
He learned to use the structured guided imagery I taught him, which focused him on the beach scene using all his five senses to induce a state of calmness. That self-soothing strategy also helped him to reach an improvement in the quality and length of natural sleep at night. He was pleased with these results because it gave him a new sense of mastery. He regained some trust in his inner
He learned to use the structured guided imagery I taught him, which focused him on the beach scene using all his five senses to induce a state of calmness. That self-soothing strategy also helped him to reach an improvement in the quality and length of natural sleep at night. He was pleased with these results because it gave him a new sense of mastery. He regained some trust in his inner