ALSO IN THIS ISSUE | Dr. Michael Yapko – Hypnosis and Depression
Insoo Kim Berg [1934–2007] | Western Canadian Conference on Addiction & Mental Health

Suicide: risk assessment and prevention

NOTE: At Jack Hirose's request, I am sharing with you an excerpt from my unpublished psychotherapy book which has the working title, Tools, Not Schools, of Therapy. I hope to publish the book. Therefore, please be advised that this is for your eyes only, and is not to be quoted or distributed in any way. If you have positive or negative feedback about this chapter, I would be pleased to hear from you: david@feelinggood.com. Thanks!

Chapter 8

By David D. Burns, M.D. (with Signe Burns)
©2001–2007

A COLLEAGUE DESCRIBED a harrowing phone call from a depressed 24-year old woman suffering from Borderline Personality Disorder. She explained that she was lying on her dining room table and had just inserted a hypodermic needle into an artery in her right arm. She said, “Right now, I'm watching the blood spurt out and splatter on the wall with each heartbeat. It's entertaining. But don't worry. I'll take the needle out just before I bleed to death. In case I miscalculate and do die, I just wanted to thank you for all the help you've given me. You're the best! By the way, in case you try to call me or contact the authorities, I want you to know that I've just moved to a new apartment and I have an unlisted number, so there's no way you won't be able to track me down. That way, you won't have to feel guilty or upset if I do die. I know I'm not important to you, anyway.” Then she hung up on him.

The therapist spent the next three days struggling with intense feelings of anxiety, guilt, inadequacy, frustration, and anger. His desperate attempts to locate his patient were unsuccessful. Fortunately, she showed up at his office later in the week for her regularly scheduled therapy session. You might argue that her actions actually represented a “suicide gesture” or “plea for help,” and not a real suicide attempt. This line of thinking may be comforting but can be very misleading, because many of these patients eventually commit suicide.

In fact, the experts tell us that as many as 10% or more of chronically depressed patients commit suicide, even if they're receiving treatment. If patients have comorbid problems, such as alcohol or drug abuse, or serious personality disorders, the percentages are even higher. These are sobering statistics. I'm convinced that the vast majority of suicide attempts can be prevented – but it may require a significant shift in how you approach the problem.

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Can hypnosis play a role
in treating depression?

Michael D. Yapko, Ph.D.
Fallbrook, California

FOR NEARLY THREE DECADES, I have been focused on two primary domains of professional interest: Applying clinical hypnosis in brief psychotherapies, and treating depression in individuals, couples and families. At first glance, these seem to be two unrelated phenomena: The former is a means of multi-dimensional therapeutic intervention that represents the original “positive psychology” in its emphasis on expanding hidden resources, and the latter is a multi-dimensional disorder that embodies a painfully negative orientation towards key areas of life experience.

Upon deeper reflection, however, the overlaps between the separate yet related domains of hypnosis and depression become more evident. I’ll describe just a few of these:

1. Both come about and increase in intensity the more narrow your focus;
2. Both are ultimately social processes, greatly influenced by your relationships with others, whether the other is a clinical authority describing the therapeutic merits of exposing you to an induction procedure, or the other is a parent or spouse describing the flaws in your character;
3. Both are a product of expectancy, whether the expectation is one of getting the benevolent corrective message “into your unconscious” through suggestions received in a dissociated state, or whether the expectation is that no amount of your effort will result in a success, thereby giving rise to the apathy so typical of depression; and,
4. Both involve what hypnosis pioneers Theodore Sarbin and, later, Ernest Hilgard, described when they suggested hypnosis is, in part, a “believed-in imagination,” an experience based on the recognition that people can and do get deeply absorbed in highly subjective beliefs and perceptions that quite literally regulate the quality of their lives. These beliefs and perceptions can be altered and amplified during the experience of hypnosis, illustrating the point well how idiosyncratic each person’s sense of reality really is, especially in response to “mere” suggestions.

The notion of an individual’s personal reality essentially being a “believed-in imagination” preceded the origin and development of cognitive therapy by decades, even centuries, and firmly established the relevance of hypnosis in treatment. Cognitive-behavioral therapy (CBT) is, at this time, probably the most well-researched method of therapeutic intervention. It is founded on the premise that people in general, and depressed people in particular, regularly make identifiable errors in information processing, thinking and genuinely believing in their mistaken notions of what truly – and depressingly – seems like reality to them. This process of becoming absorbed in one’s (depressing) imaginings is, indeed, an instructive parallel to what occurs in hypnosis, where a clinician performs an induction and attempts to absorb the individual in alternative ways of experiencing him or herself.

Using hypnosis procedures, the clinician creates a context where the individual can change the direction and quality of his or her focus. Perhaps the suggested focus is on engaging in some new life enhancing behavior, or perhaps on exciting and motivating glimpses of future possibilities, or possibly on re-writing some of the negative internal dialogue, or somehow altering for the better any of literally scores of depressing focal points (e.g., cognitive styles, coping styles, relational styles). What the clinician suggests during hypnosis may not be any more true in an objective sense than what the person previously believed – it may just feel much better and serve the person better.

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Solution focused therapy co-founder
Insoo Kim Berg passes away at 72

Richmond mental health & addiction conference draws more than 500

THE THIRD ANNUAL Western Canadian Conference on Addiction & Mental Health, co-presented by Jack Hirose & Associates, took place Nov. 16 to 18 in Richmond, BC. The more than 500 participants were mostly from British Columbia, but all provinces and several U.S. states were represented.

Continued strong interest in the event has organizers already lining up presenters for next fall. Is there a topic or speaker that would especially interest you or your organization? Please let us know.

Jack Hirose and Associates would like to thank all participants, sponsors and exhibitors who participated in our 3rd Annual Western Canadian Conference on Addictions and Mental Health held in Richmond, BC on November 16-18, 2007. We (Jack Hirose & Associates and Dr. Baker and Healthquest) were extremely pleased to receive support from treatment providers and community organizations. We would particularly like to thank our major sponsors/exhibitors: Edgewood, Bellwood Health Services, Cedars at Cobble Hill, Homewood and Sunshine Coast Health Centre. Thanks to exhibitors: Hazelden Foundation, The Orchard, Axis Intervention Services, InnerVisions Recovery Society, Society for Clinical Prevention & Health Care, South Country Treatment Centre, Central Alberta Recovery Centre, Focus Foundation, Theramed Corporation, Alcoholics Anonymous, Office Depot, Richmond Inn Hotel and Classic Impressions. Thanks also to Odin Books.

The 4th Annual Western Conference on Addictions and Mental Health Conference will be held Nov. 14–16, 2007 (Wed.–Fri.). Confirmed speakers include: Dr. David Burns, M.D., Dr. George Vaillant, M.D., Dr. Don Meichenbaum, Ph.D., Dr. Tian Dayton, Ph.D., Jane Middelton-Moz, M.S., Dr. Gregory Boothroyd, Ph.D. Rob Axsen, B.A., Dr. Joe Solanto, Ph.D. and others. We look forward to seeing you at this fall’s conference!