We are now at our final installment of our Exploring Therapy series at Wellness Wednesday, during which we are exploring different treatment modalities to assist readers in recognizing the variety of options available to them to support their needs and move forward towards wellness. We are also featuring the return of our first guest author, Michael Decaire, clinical psychologist, registered psychotherapist, and the founder of FLEX Psychology.
 
When people imagine what therapy looks like they probably picture a leather chaise lounge and a bearded man with a pocket watch. The chaise lounge or “therapists couch” image is a hold-over from the classic Freud-inspired psychoanalysis days of a half century ago, the majority of therapists I work with are women, which tends to impact the beard ratio at the office, and you are going to legitimately struggle to find a therapist who has been trained in hypnosis these days. I, however, love to be a contrarian and a stereotype at the same time, so I do have one of those couches, I definitely have a beard, and clinical hypnosis is part of my treatment toolkit. With the exception of the hypnosis, the rest of these therapy tropes are a bit of a facade. The chaise was purchased for wellness naps when my son was born, and the beard is mainly because I’m from the north and like to look like a lumberjack.
 
The use of hypnosis in treatment is also not all that consistent with the common stereotypes. The idea of using hypnosis to tackles life’s challenges is extremely attractive to some clients and terrifying to others. Those who are attracted to hypnosis often see it as a quick fix for longstanding problems, an idea that is commonly promoted by smoking cessation and weight loss programs (these people also suggest using lasers to treat these things, so I would be suspect of their claims). Those who are fearful of hypnosis worry about mind control and the idea that the hypnosis-informed therapist can make you do something  against your will. Fortunately, both of these are extremely unrealistic perceptions of hypnosis and how it is used in treatment.
 
Hypnosis or hypnotherapy are treatment tools that can be integrated into a variety of other treatment methods. While it can be the main component of treatment, this is relatively rare and applies to only very narrow problems (e.g. a phobia) where a client, for whatever reason, is unable to engage in a more standard course of treatment. In most cases, hypnosis is used as a tool that augments or supports talk therapy. The aim of the approach is to assist an individual to enter a deep state of focus and relaxation that permits one to work on goals without being countered by their negative emotions or worries. Sometimes your internal thoughts can seem deafening. Hypnosis quiets the mind and allows you to do the meaningful work you have been struggling to get to. It allows any place and time to be the “right” place and time to resolve difficulties and move forward in a positive manner.
 
Aside from quieting the mind, hypnosis also uses “suggestions” that can be thought of as a signpost that directs you to a state or experience that you have decided you want to obtain. These “suggestions” are pre-determined between the client and their therapist, as attempts to suggest something an individual does not actually want will undoubtedly result in someone coming out of the focused hypnotic state.
 
The first time a client undergoes hypnosis they rarely report feeling that they are in a “trance” like you see in the movies. While a deeper state of focus and relaxation is possible and that state can look like a “trance”, getting to that level of focus generally requires multiple hypnosis sessions because the client needs to practice getting themselves to that state. The key here is that it requires the client’s efforts and work, as their therapist is really never controlling the situation or the deepness of the hypnotic state. That control always remains with the client. The hypnosis-informed therapist simply provides an opportunity to enter that state if the client chooses.
 
Hypnosis is not the right approach for every client or every problem. I generally incorporate hypnosis into treatment only a few times a year and always assess the benefit it may provide to my clients before I introduce the idea of using this approach to treatment. It is an approach with a efficacy in treating fears and phobias, the management of difficult but rare situations (e.g. anxiety around medical procedures or upcoming events), or providing momentary relief from high levels of stress.
 
If you think hypnosis might be the right tool for you, there is a good list of Ontario-based certified hypnotherapists available at the Canadian Society of Clinical Hypnosis.

For the next few weeks Wellness Wednesday will explore different treatment modalities to assist readers in recognizing the variety of options available to them to support their needs and move forward towards wellness. We will also feature a few guest authors who specialize in different modalities, while #WellnessWednesday's Jessica enjoys a little vacation-based self-care. This weeks guest author is Dr. Jennifer Marcus, Clinical Psychologist and co-director of FLEX Psychology.

A couple weeks ago, we spoke about Cognitive Behavioural Therapy and how therapy can target thoughts and behaviours in order to make changes in our emotional experience. In Emotion Focused Therapy (EFT), the emotions themselves are used to change the experience of emotions. Though this sounds like a more “direct” route if you want to feel less anxious or more happy, in practice it can be a little harder to work directly with emotions.

The premise behind EFT is that our emotional experience can tell us what is important in our lives, direct us to meaningful experiences, and foster growth. However, our past experiences, such as our childhood, relationships, or traumatic events, can influence our ability to attend to and regulate our emotions. When we have had challenging experiences in the past, we can become caught up in emotional states that can cause us harm, such as when we feel guilt, shame, and depression. Often, we push out these primary emotions in favour of emotions that are easier to express, like anger. However, reacting with anger when we actually feel hurt or sadness does not help us to manage these emotions and move past them.

The goal of EFT is to clarify adaptive emotional experiences in a safe space so that we can move forward in a healthier way. This includes bringing attention to the mix of emotions that people experience and increasing connection to emotions on a regular basis. The meaning of different emotions can also be shifted as these are explored more deeply in therapy. Part of EFT also includes counteracting repeated invalidation of emotions that many people experience throughout their lives. To support this, the relationship or alliance that you build with your EFT therapist is very important. It should be a place where you feel comfortable to explore the most uncomfortable feelings associated with key events now and in the past.

Practically, EFT can feel very different from CBT or ACT. Whereas the approaches we have discussed so far have a lot of practical strategies, this is not necessarily the case with EFT. Though some concrete exercises are performed in therapy and individuals usually show an increase in awareness of their own emotions, very little homework is usually given. Instead, sessions can focus on uncovering and reworking emotions and relational patterns that have arisen throughout an individual’s life. Through this change process, they can then act differently in their day to day lives and not be stuck in the patterns that they have experienced in the past.

​Though EFT can sometimes feel challenging when you are not used to attending to emotions and giving them space, it is a very helpful approach that can highlight the strengths and resilience that are present in us. By validating our own negative emotions, understanding where they are coming from, and building our ability to experience positive emotions as well we can move forward in our lives in a more genuine way.