Brian Balke

Hypnotherapy and Polyvagal Theory

May 13, 2019May 15, 2019 Brian Balke

In the basic Kappasinian Theory of Mind, we all need balance between adventurous (euphoria-seeking) and protective (fear-avoiding) behaviors. The goal of all therapy is to establish and maintain a healthful balance for the client. In this post, I consider how Kappasinian practices relate to Stephen Porges’ Polyvagal Theory (described wonderfully here).

As emphasized by Porges, our bodies are designed to seek homeostasis (the restful state in which we “feed and breed”). When threatened by unfamiliar or overwhelming experiences, we drop into a simple decision-making process: should we fight (“Can I eat it?”) or flee (“Can it eat me?”). If neither of those tactics resolves the conflict, we simply freeze (conserve energy until an escape presents itself). In the animal kingdom, survivors use shaking and quivering to discharge the residual energy, restoring homeostasis.

These kinds of experiences are traumatic, and if repeated drive us into protective behaviors. On the other hand, in safe social circumstances, those same kinds of experiences can evolve as play. When playing our pretend threats are accompanied with gestures and statements that reassure our partner. The classic pet behaviors are the dog crouching on its fore-paws, or the cat gnawing on our finger in between licks. During play, both euphoria and fear are at elevated levels.

The nerve that mediates our overall physical state (the vagus nerve) has an ancient (reptilian) part that manages the freeze response, and a more recent (mammalian) part that controls excitement. As these responses involve complex coordination among all the body parts, the vagus returns ten times as much information back to the brain as it sends out.

One of the challenges in overcoming traumatic experiences is that fear suppresses our ability to exchange reassuring gestures and statements. This permanently suppresses our ability to feel euphoria, leaving us at the mercy of fear. That prevents us from restoring homeostasis, leaving us in a perpetual state of self-induced stress that damages our physical and mental well-being. If the trauma occurred early in childhood (such as a difficult birth), we may be unable to remember the circumstances, and thus release the trauma.

Porges’ solution is to deal with the problem symptomatically. Exposing the sufferer to soothing sounds, sights or sensations overcomes the blocks to reassuring stimulation. When accompanied by mindful relaxation, the mind learns to tie that reassurance to homeostasis.

The classic Kappasinian therapy for fear and anxiety builds an experience that mixes these same elements – but with the amplifying factor of hypnosis (our optimal learning state).

Therapy begins with a progressive relaxation that establishes homeostasis.

If the trauma is mild, circle therapy is used to walk the client through a remembered experience. If the fear is irrational or of unknown origin, systematic desensitization is used to command the subconscious (the true source of the reaction) to produce the emotion. Ideomotor finger raising is used to control the level of anxiety. When discomfort is visible, the client is told to lower the finger and “pass it,” directing them back into homeostasis. As the process is repeated, the mind becomes confident in its ability to control the transition, and eventually chooses homeostasis.

If the trauma is deep, these practices are preceded with sessions that build a safe haven in the subconscious landscape, ensuring that the learned skills take root in a context free from debilitating memories. For this purpose, today’s practitioners will often use therapeutic imagery, but even they will reinforce that work with a staple of Kappasinian therapy: a staircase deepener that projects a positive, confident self-image into the subconscious.

The final element of Kappasinian therapy is to suggest that the client begin to chuckle and smile as they come out of hypnosis. As the therapist smiles and speaks soothingly, this reinforces the ability to exchange reassuring signals. Of all the suggestions offered by Kappasinian therapists, this is the most playful.

Porges first articulated his polyvagal theory back in the early 1980’s and the therapeutic practices were not popularized until well into the new millennium. Hypnotherapists trained with Kappas’ methods have been performing these therapies since the sixties. Not only do those techniques have the same effect as those offered by Porges, but they are coupled to far broader strategies for overall behavior development.

Relationships, Specializations

Loss and Grieving

May 10, 2019May 11, 2019 Brian Balke

To know loss is to confront change.

People, pets, homes and jobs are not just things – they are the backdrop for our behavior. When we first acquire them, we are conscious of learning to adapt to their presence. Over time, those changes become automatic behaviors managed by the subconscious, woven together as a pattern for our life. Remove one element and the pattern vibrates. It may be a trivial disruption, such as when we lose a penny. Or it may be a near-collapse, such as when we lose a child.

When the loss is great, we may be overwhelmed and seek to avoid change. Most directly, we may deny the loss. We might imagine that the loved one will walk through the door any second, or that after the tornado we’re at the hotel on vacation. When denial becomes a permanent condition, the sufferer should be referred to a licensed mental health professional.

Another strategy is to cultivate dependency. We may expect other people to care for us, take refuge in pleasant experiences, or consume substances (food and drugs) that boost our energy and mood.

Healing begins when we discard denial and dependency to accept that we need to change our lives. Specializing in behavior change, a hypnotherapist can help with that journey.

The mind is always seeking health, and so hypnotherapy works with the mind. In planning therapy for loss, then, we should understand how the mind responds to loss. I cover two accepted frameworks for loss before offering my own perspective.

Kubler-Ross

Elizabeth Kubler-Ross broke ground with her study of how terminally ill patients dealt with loss and grief. In the popular formulation, the process follows five stages, but the middle three stages can become a whirlpool. The stages are:

Denial
Anger
Depression
Bargaining
Acceptance

We’ve already discussed denial and its helpmate, dependency.

Anger is the natural reaction to the realization that there is no answer to “Why?” It can be focused on the self for past misbehavior (such as cigarette smoking) or toward others (the tobacco companies). In the grief process, anger is important because it breaks down neural pathways. It is a mechanism used by the mind to get rid of behaviors that no longer serve us. In the context of a broken heart, this is clearly necessary: we need to stop acting like we did when we had a romantic partner and prepare ourselves to seek a more fulfilling relationship. In the case of a terminal illness, anger prepares us to accept that life as we knew it is going to end.

If the loss is due to illness, persistent anger also has dangerous consequences: it stimulates the sympathetic nervous system, which increases inflammation in our tissues. This can inhibit healing or even stimulate metastases.

Depression is a term in psychology used when we are unable to respond to the world. In severe cases, that manifests as avoidance. The highly depressed person can end up hiding in a darkened room. It is more severe than denial because while in denial we can at least function. What is different is that while in depression we are recovering from the mental disorder created by anger and gathering energy to create a new life.

After anger has softened our old behaviors and depression has allowed us to gather strength, we begin bargaining. This can take two forms. The less helpful is whining: “Dear God, what do I need to do to make this cancer go away?” Whining often loops back into anger and depression. The better is imagining: “If I heal from cancer, I will commit more of my time to charitable work.” Imagining builds new behaviors to replace those erased by anger.

Imagining prepares us to move forward to the last stage: acceptance. Acceptance is a great gift. It is the ability to take life one day at a time, savoring every moment and opportunity, while trying to enrich the experience for ourselves and others. Having achieved that wisdom, you will hear people say that getting divorced (or sick with cancer or arrested or…) was “the best thing that ever happened to me.”

Trujillo

Through his teaching and trauma response work, Timothy Trujillo has developed tools to aid those trying to recover from loss. Where Kubler’s focus is practical (“This is how people grieve”), Trujillo offers a metaphor for healing. Trujillo starts every therapy with the mind/body connection, establishing that it is possible to feel good.

The table elaborates the physical metaphor for psychic healing:

Stage	Physical Healing	Psychic Healing
Whole
Injury
Hemostasis	Stop bleeding	Separation from trauma
Inflammation	Clear damage, fight infection	Release old behaviors
Proliferation	Repopulate with new cells	Evolve new behaviors
Remodeling	Cells organize as tissue	Reconstruct relationships
Adaptation	Compensate for lost function	Deal with unexpected consequences
Recovery	Return to normal

The power of this metaphor arises from the fact that often recovery from psychic trauma is impeded because the wound is projected into the body, causing discomfort to persist. In emphasizing the body’s natural healing powers, the client associates increased physical comfort with psychic healing. In effect, the conscious mind no longer interferes with the subconscious effort to restore balance and harmony.

Confronted by traumatized communities, Trujillo captured this psychological transition as a hypnotic script titled “The Five-Minute Miracle” (https://timothytrujillo.com/projects/five-minute-miracle).

Beyond Healing

If we have a wonderful relationship that falters and fails, do we want to release those cherished memories and behaviors? Or do we want to learn from the failure and expand our vision of future possibilities? Not just sexual satisfaction, for example, but also children and society?

Loss and wounding both have negative connotations. We have seen that at the end of grieving, we achieve a positive resolution – but the steps along the path are dreary, to say the least. With physical wounds, we can be awed and humbled by our natural healing powers, but in most cases after recovery we are less capable than before the injury. The metaphor suggests that the mind will also lose function during grieving. Why should we accept that?

I refer a simpler, positive model. Like Trujillo, I recognize the connection between mind and body, but would emphasize that it goes both ways. The reason we say the old lover’s name is because we remember them when our cheek is kissed. We have associations between physical sensation (the kiss) and old behaviors (saying their name).

The first step in recovery from loss, then, should be creating space within the self. This can be done many ways, but all involve intense physical exertion with focused attention. Shaking our fist at the sky is one example, as is a long, wracking cry. Other methods are possible: I use Sunday dance celebrations to create space within myself; others might go rock climbing. The point is to be aware that we are consciously creating these sensations of exhaustion within ourselves.

The next step is to rest until our energy recovers. Finally we imagine what we can do with this new awareness and energy. That inevitably collides again with loss: we would like to have dinner with lost spouse, but that’s not possible. So we return to creating space inside ourselves, resting and imagining until we have established that it is myself that needs dinner.

How is this space inside created? In my view, it is from the heart. When I weep or dance, I have the sense of something inside bearing witness to me and my loss. If I allow it, it flows from that deep inner source and enters the situation as it is to bring healing – not just to myself, but to everyone that will accept it.

A Hypnotist’s Support

How is this model facilitated by hypnotherapy? When anger (or other negative emotions) are entrenched, I start with a hand clasp induction; otherwise a simple eye fascination suffices. Complete awareness of the self is built through a long progressive relaxation starting at the feet with particular attention paid to expansion around the heart to allow the emanation of light. Gathering all the resources of the being and the represented potential, the progressive passes up the neck and over the back of the head to rest over the forehead, above the prefrontal cortex where all planning is done.

From there the therapeutic strategy depends upon the specific needs of the client. Those in deep grief often need to establish resources in the subconscious landscape through free-form therapeutic imagery. That work leads to reconstruction of their self-image. Those seeking to implement behavioral changes may have fear responses to clear using desensitization.

Between sessions, breathing meditation and mindfulness reinforce personal boundaries. Dream therapy can be used to assess the readiness to change, to release resistance, and to focus subconscious attention to find constructive solutions to specific behavioral problems.

Specializations

Occasional Pain? Look Within…

May 1, 2019May 1, 2019 Brian Balke

I don’t know anyone that doesn’t run their life right up to the edge. Even when we go on “vacation” we fill up the time with sight-seeing and entertainment, rather than sitting still and getting back in touch with ourselves.

When we finally push ourselves over the edge, we get sick – perhaps a migraine, often a cold or flu, not infrequently a muscle strain, and most seriously cancer or joint degeneration.

The point is that it’s not the all-nighter or the move or the argument that brings on the specific illness or injury. The problem reflects the burdens of everyday living that we carry in that part of the body. That move or job change just pushed it over the edge.

So if you have occasional pain that your doctor can’t diagnose, the next place to point the finger is at your lifestyle and attitudes. The pain is a signal from your subconscious that something is out of whack. If the point isn’t clear, through hypnotherapy I can help you encourage the subconscious to be more specific, and then build effective responses to the challenges it’s been trying to manage.

Call me at 805-775-6716 – and Bring Your Whole Self to Life.

Relationships

Birth to Breakup

April 30, 2019April 30, 2019 Brian Balke

Psychoanalysis presupposes that we can reason about our behavior, but our brain adapts to the conditions of infancy long before we can reason. Most importantly, it is in infancy that we decide whether to trust that the world will care for us. In refining his therapeutic methods, John Kappas recognized this split in his clients, a split between “emotional” and “physical.” For clarity, this presentation adopts the terms “protector” and “adventurer.”

As shared within, protectors and adventurers need each other, but also drive each other crazy.

The focus of the presentation is on professional relationships. Complementarity between protectors and adventurers also defines our intimate relationships. There’s much more to be said there – Kappas was a licensed therapist, and shared his views in the book “Relationship Success: The E&P Attraction.”

Birth to Breakup Download

Book Reviews

Ericksonian Elicitation: A Book Review

April 22, 2019April 22, 2019 Brian Balke

Milton Erickson was a titan of psychological research. He’s also a personal hero. His most important paper on trance makes the firm statement that the therapist’s highest priority is to protect the integrity of the subject’s personality. For me, this commitment has been central to the development of clinical rapport. We can analyze technique and method, but I read Erickson’s papers and understand that his intuition was guided by people that wanted to reveal themselves to him. His phrasing of suggestions reflects the tenderness with which he confirmed their invitation.

Erickson’s impact upon his students was profound. One of them – Jeffrey Zeig – peppers “The Induction of Hypnosis: An Ericksonian Elicitation Approach” with personal vignettes. The instruction that follows makes evident his devotion to Erickson’s memory. A whole chapter celebrates his impact on the history of psychology following World War II.

For the professional, the development is a little slow. In part this follows from ambiguity in the definition of hypnosis. For the first six chapters, Zeig offers metaphors and stories in building a procedural definition rooted in the experience of the subject. The subject experiences, in order:

Modified awareness – even something as simple as becoming aware of their breathing.
Altered intensity – noticing the correlations between focused attention and experience.
Avolitional experience – being guided into awareness without conscious ratification.
Avolitional response – responding to experience without conscious ratification.
Ratification of hypnosis – the operator bringing these elements into awareness and labelling them as “hypnosis” or “trance.”

The goal is for the subject to become receptive to suggestions from the operator. This requires agency on both sides: the subject trusts, and the operator builds rapport. On the operator’s side, Ericksonian phrasing makes the transition extremely comfortable. The pattern is pace, lead, and motivate. In pacing, the operator offers truisms – observations that are natural to the situation. Having attained that agreement, the subject is then led into the next step of the elicitation. Finally, they are offered a statement that aligns the step with their motivations. When the step is taken, it seems not only natural but as though it always was that way.

Zeig guides the reader through the grammar of Ericksonian elicitation. This is a finicky subject, and while clearly described, actual use of the grammar requires extended practice. This is emphasized: Zeig cautions that the operator should not be thinking “This would be a good place for a presupposition. Oh, and then I can offer an embedded command!” Instead, the operator is tracking the subject’s descent into hypnosis, and intuitively offers statements that serve the elicitation. To facilitate the development of that intuition, Zeig analyzes transcripts for study – all involving students that offer intelligent analysis of their experience. That is no substitute for immediate practice.

As a professional, I found myself wanting more at the end of the book. Zeig does a detailed deconstruction of a “traditional” model of hypnosis that I would characterize as a “straw man.” Zeig focuses on scripts. While the structure of a session does follow the pattern Zeig lays out, non-Ericksonian therapy does not require scripts – and even when I reference a script I rarely follow it slavishly.

Having demolished his straw man, Zeig promotes a core virtue of Ericksonian therapy: a session begins with elicitation. Unfortunately, the shift to therapy takes us out of the pattern of elicitation, into (progressively) 1) confusion and destabilization, 2) perceptual alteration, and 3) disassociation. The goal is to identify the mechanisms held in the subject’s mind that allow behaviors to be adapted. Sensory metaphors figure prominently, each wrapping a suggestion to create, modify, or delete an experience or behavior. Once disassociation is attained, those mechanisms can then be used to alter behaviors independently of the rest of the mind.

Zeig allows that to survey the subject’s inventory of adaptive mechanisms involves several sessions before therapy can proceed. Unfortunately, that procedure is not developed in depth, leaving the professional to wonder what to do after hypnosis is elicited.

The focus on disassociation is also troubling. Disassociation allows the subconscious to control movement and sensation without conscious awareness. In his writings, Erickson was proud of automatic writing and waking hallucinations. But ultimately the subject must integrate their experience and learnings. That may be accomplished by reinforcement as the subject is brought back into the normal state. Erickson never addressed this point, and neither does Zeig. What Erickson reported was, in fact, that by use of these disassociation he could create long-term syndromes in colleagues .

At the conclusion, Zeig’s writing left me a little flat. In attacking the methods that I use every day, Zeig showed a lack of respect for the work that has been done in the “traditional” model to assimilate Erickson’s central tenet: protecting the integrity of the subject’s personality. That includes:

offering the subject’s conscious mind a simple explanation of the therapeutic process,
the origination of free-style imagery in which the subject has autonomous engagement with their subconscious as the unified mind seeks for healing, and
allowing that the subject may evolve new behavioral development strategies.

More daunting, however, is Zeig’s observation that Erickson seemed to make it up as he went along – and that his most impressive elicitations involved unspoken elements. Erickson may not have been a therapist in the normal sense – he may have been a guru. Zeig steers safely clear of those waters.