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INTRODUCTION

The aim of this assignment is to re-write Hartlands Progressive Relaxation (HPR) script. The original script will be discussed with reference to its suitability with particular patient groups as well as any contraindications that it presents. A critical analysis of the script will be provided, focusing on the use of language, modalities and suggestions that are present. The re-written script will then be introduced with the changes explained in relation to theoretical frameworks that are relevant.

HARTLANDS PROGRESSIVE RELAXATION (HPR)

HPR is considered a permissive induction i.e. where the instructions are not explicitly stated. The permissive approach was successfully pioneered by Milton Erikson, However, Erikson was also prone to using very authoritarian instructions within his practice. Similarly, HPR is permissive in its pace and tone (slow and soft) but in actuality the instructions are very explicit. For example, “…and I want you to let all the muscles of your body go quite limp and slack” and “you can feel a heaviness in your legs”. This combinational approach could have been developed to enable the successful induction of patients who respond to authoritarian inductions whilst still being fitting for those more suited to permissive inductions.

This script works well with a wide range of patients, however, it is particularly suited to patients nervous of or new to hypnosis as it allows them to relax and is very “natural” in terms of it words and instructions. Whilst being appropriate for many, it could be argued that this script is particularly well suited for patients who are logical and analytical as it focuses on the naturally occurring phenomena of relaxation that everyone can relate to or imagine. This is in comparison to more “mystical” scripts, for example, Healing White Light which is arguably more suited to creative and artistic patients who show a propensity for right brain dominance; as well as for patients who have interests in other alternative therapies such as rekhi, colour therapy, and acupuncture.

HPR primarily makes use of the kinesthetic modality which indicates that it would be well suited to patients who respond to feelings based suggestions.

The use of HPR is contraindicated if the patient is experiencing depression. The phrase “heavy as lead” should not be used with patients presenting weight problems. As such the use of the phrase “limp and slack” should not be used on patients presenting symptoms of psychogenic impotence. Finally, due to the focus of attention on self and feelings HPR should not be used on patients who suffer from panic disorder.

CRITICAL ANALYSIS

The use of language in HPR appears dated. Words such as “limp” and “slack” are not commonly used in today’s society. It is suggested that it would be more fitting to replace them with modern words such as “relaxed” and “loose”, this would enable the script to appeal to a much broader audience in terms of age whilst retaining a mellifluent tone. Further, the suggested replacement words would allow the script to be used with patients presenting symptoms of psychogenic impotence thus removing one of the contra indications previously refereed to.

The same could also be said of the words “heavy as lead”. It is suggested that lead is not a common resource so its relevance would be lost on younger generations as well as those who have not had experience with it. These words can be replaced by suggestions of lightness e.g. “lighter and lighter” which would not only allow a greater number of patients to understand and therefore respond; but would also make the script suitable for patients with weight/obesity issues.

HPR is an extremely effective induction when used with appropriate patients, however it is one or the more lengthy inductions. It would thus not be appropriate for use in a situation where the therapy itself takes a considerable period of time. It’s efficacy would be increased if it could be used as a combined induction and deepener. This could be achieved by working on the specific body muscle from top to bottom (as opposed from bottom to top) allowing the feeling of relaxation to continue moving “down” and go “deeper and deeper” thus deepening the trance, as these expression can be used more frequently as you move along the body. Moving up the body does not appear congruent with achieving a deep/deeper trance. The use of the cue word “NOWwww” would further assist in deepening the trance. It is acknowledged that the use of a modified script such as is suggested would still be contraindicated by patients presenting symptoms of depression.

As mentioned previously, HPR primarily makes use of the kinesthetic modality and is thus particularly suited to patients who respond best to feelings based suggestions. This modality focus could be widened considerably so that a more modality-diverse group would be able to respond. The incorporation of several modalities would serve to enhance the success of the script not only as an induction but also as a deepener as there are more elements covered. A phrase such as “the sound of my voice will relax you” would bring in a clear auditory element. In addition, there could be more detail provided around the imagry of the peaceful tranquil scene. For example, making reference to “the pleasant sounds, noises and smells that surround you” relates to not only the auditory but olfactory modalities.

HPR makes no use of the visual modality. This can be incorporated by having the patient imagining a ball of light and having a ray of light that pours out from that ball and travels down over the body. This light could then relax the various muscles of the body as it passes over them. This would not only allow the use of the visual modality to be incorporated throughout the induction, but would also provide an object of focus which could be beneficial to patients with an external locus of control i.e. those who believe that the course of their life is determined by factors outside of their control.

The use of a ball of light could engage the creativity of patients with right-hemisphere dominance as it makes use of their imagination and may allow them to make possible associations with other alternative ideas such a healing lights and colour therapy. However, as it does not make reference to the light having any healing powers it is unlikely that it will disengage the logical and analytical patients to which the original script was said to appeal too.

Theoretically HPR appears to be influenced by the majority of the major theories of hypnosis. Simply getting the eyes to close shuts down the reticular activating system so the patient possibly enters a state of nervous sleep as postulated by Physical theory (Wyke, 1957); or fixes the patients attention resulting in increased sensitivity to being influenced (Modified sleep theory, Braid 1819) . Interestingly fixation of attention is also utilized by Milton Erikson.

The use of the word “relax” could, in some patients, evoke a conditioned response congruent with that word as predicted by Conditioned Response Theory (Pavlov, 1957). On a similar note the patients are encouraged to respond to the suggestions within the script as if they were truisms as put forward by Suggestion Theory (Bernheim, 1886).

As with most scripts (permissive or authoritarian) Role Play Theory (White, 41) could be relevant i.e. a patient acts like they are in (or what they believe to be) a trance state. Noting that this theory does not account for analgesia or anesthesia being experienced by a patient as therapy is introduced into a session.

Dissociation theory of hypnosis refers to a splitting between the conscious and unconscious mind, this is not applied in the HPR script. This could be incorporated by giving suggestions of “floating” and “drifting”. Incorporating the principles of dissociation would increase the likelihood of the actual phenomena being experienced by the patient which would indicate a deep level of trance being achieved. However, it is noted that Dissociation theory claims that the splitting of the two minds results in amnesia, this is not always the case.

Any changes that are mead e to the original script with regards to words and purpose (transforming from induction to induction and deepener) should be mindful of retaining the patients feelings of safety and security and suggestions of such would need to be included.

HPR REWRITTEN

Following the critical analysis of HPR, a re-written version incorporating the discussed changes is provided:

Make yourself comfortable…..and allow your eyelids to gently close…..and as you rest there…with your eyes comfortably closed…I would like you to listen to the sound of my voice….the sound of my voice that will relax you…all the way through relax you….

And as you sit there safe and comfortable with me here today…. you may want to picture yourself in a peaceful and tranquil scene….a scene of your choosing…..it doesn’t really matter where you picture yourself…or the pleasant the sounds, noises and smells that surround you ….all you need to do is to relax….

[pause for 5 seconds]

…and Nowww I would like you to imagine a ball filled with light….the ball is clear…translucent… with an alluring light shining brightly inside…. perhaps the light is white….maybe blue….it really doesn’t matter what color it is …all that is necessary for you to do at this moment… is to focus on that ball of light…feel the warmth that radiates from that light….warmth that makes you feel ever more comfortable and relaxed…

….and Nowww I would like you to imagine that ball floating….drifting to a point not far above the top of your head …..Suspended in mid air….

..and you can notice that that ball of light is opening......opening slowly…releasing a strong yet calming ray of light…see the light slowly coming out of the ball…floating just above your head….focus on how the light travels down….down towards your head….

…and [say patients name]…..as the light passes over your head and down towards your body….. you can feel the muscles in your face beginning to relax…allowing the glow of the light to ease those muscles…the muscles around your eyes…your mouth…..relaxed and loose….

And as the light continues…traveling down towards your neck…your shoulders….bringing with it that wonderfully warm and pleasant peaceful sensation….allow those muscles to now become loose and relaxed….you may notice that as the light travels over your shoulders…. that all of the unnecessary tension that you hold there is released….let that tension go out of your body….allowing you to go deeper and deeper…more and more relaxed….

….and NOwww as the light passes over your chest….. and down over your body…allow those muscles to become relaxed and loose …..

feel the light passing over your arms ….and see it travel down to the tips of your fingers…relaxed and loose….comfortable too…..

….and as the light continues to move down….down over your body…. gliding over you ….over your thighs…allowing them to sink deeper and deeper into the chair….relaxed and loose…..allow the muscles of the legs to loosen….becoming lighter and lighter

….and as this wonderful ray of light continues to move down from your thighs……down to your calves…loose and relaxed…..down all the way past your ankles…down to the tips of your toes…

…and now the ray of light moves past the tips of your toes and down to the floor level….going deeper and deeper into the ground….

….and [say patients name] perhaps you are beginning to notice how light you feel….light all over your entire body……floating and drifting…. so relaxed and comfortable…safe here with me in this room……

And Noww whilst you sit there comfortably I would to talk to you about a matter of great importance….importance to you…….”

CONCLUSION

Hartland’s Progressive Relaxation induction script is suitable for a wide patient group, although it does have certain contraindications (panic disorder, depression, weight issues, psychogenic impotence). It has been suggested that the script is more suited for logical and analytical patients. It’s limited by the modalities it focuses on (kinesthetic) and by its length. Re-writing the script enables a broadening of the modality focuses allowing increased suitability for patients who are more creative and imaginative. By combining it into an induction and deepener, it increases the time allowance for actual therapy to be administered. The re-written script encompasses many of the original theories but also brings in dissociation theory and possibly the phenomena. Patient safety is ensured by including suggestions pertaining to that.
 

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Claire Atkinson

www.hypnotictherapies.net