THE USE OF DISSOCIATION AS AN ADJUNCT TO HYPNOANESTHESIA FOR PAIN MANAGEMENT: LAURENCE L. SKOLNIK, Ph.D.

HYPNOTHERAPY FOR THE ALLEVIATION OF PHANTOM LIMB PAIN: LAURENCE L. SKOLNIK, Ph.D.

MIND OVER MOUTH: (BY TOM TORSTROM, SALEM, OREGON STATESMAN JOURNAL, MARCH 18, 1995):

VISUALIZATION: THE NEW NAME FOR "TRADITIONAL HYPNOSIS": SURGICAL SUGGESTIONS USING VISUALIZATION: SUBCONSCIOUSLY SPEAKING: Vol 5 # 6: 1990:

THE USE OF DISSOCIATION AS AN ADJUNCT TO HYPNOANESTHESIA FOR PAIN MANAGEMENT: LAURENCE L. SKOLNIK, Ph.D.: A physician who routinely refers patients to my office asked me to meet with a young woman who had a severe problem regarding the drawing of blood for laboratory work or taking medications that required an injection. When I first met with this young woman, whom I will call Susan, she said her fear of needles was so severe that she would begin to hyperventilate as soon as she was notified that a blood test was required.

Susan’s physician wanted her to take a glucose tolerance test as part of his management of her pregnancy. This test requires repeated blood samples over a three hour period. Needless to say, this young woman was greatly distressed about taking the test that was scheduled for the following week. During the clinical intake interview with Susan she also indicated that even having her blood pressure taken caused her great anxiety and discomfort. During Susan’s first therapy session I guided her into a medium state of hypnosis and suggested that she could picture and imagine her arms to be comfortable placed on her lap. While giving this therapeutic suggestion, I raised each arm and applied gentle pressure much the same as would be felt if she was having her blood pressure taken or a tourniquet placed around the arm during the drawing of a blood sample. While doing this, I repeated the suggestion that her arms were comfortably and securely resting in her lap. Susan did not experience any anxiety or discomfort indicating that the dissociation technique was appropriate to alleviate her fear of needles. The dissociation technique allows the patient to imagine a body part to be in one position when in reality it is in another position or place. In a state of hypnotic relaxation, the right brain sees the body part safely in a lap. If the body part is in a different place, it is perceived as no longer being associated with or a part of the body. It then follows that if the body part is dissociated it can not experience pain or discomfort.

At the conclusion of Susan’s first session I gave her a cassette of the session to use as reinforcement for dissociation imagery and self-hypnosis induction. We scheduled an appointment to meet again prior to the glucose tolerance test.

At the beginning of Susan’s second session, she reported that she had made a routine visit to her doctor and did not hyperventilate or experience unnecessary anxiety while having a simple blood test and was pleased with the result of our session. I guided Susan into the same relaxed state as previously done and repeated the dissociation procedure. This time I simulated the amount of pressure using a dry cloth similar to a blood pressure cuff. This case illustrates the importance of combining many different hypnotherapeutic approaches to help a patient alleviate a given problem. Dissociation for anticipated fear and pain was effective for initial intervention and alleviation of anxiety.

HYPNOTHERAPY FOR THE ALLEVIATION OF PHANTOM LIMB PAIN: LAURENCE L. SKOLNIK, Ph.D.: I recently received a request from a former patient to see his mother and determine if I could help her discomfort associated with phantom limb pain. The medical history obtained from the son and his mother's physicians indicated that this 72 year old lady suffered from a chronic diabetic problem that had resulted in amputation of her left leg below the knee. The son reported that his mother was experiencing extreme discomfort and after trying other modalities, was receptive to hypnotherapy for the alleviation of her phantom limb pain.

Prior to my first session with this delightful and cooperative lady, I contacted Dr. R.D. Longacre and asked him to consult on this case. He recommended that therapeutic suggestions while the patient was in a hypnotic state include imagery that would allow her to replace the missing limb and then imagine alleviating the discomfort with methods she had used previously prior to amputation. These methods might include the use of a heat lamp, massage, warm towels or other treatment prescribed by her physician that initially alleviated her discomfort. Dr. Longacre pointed out that imagery should by nonspecific so that the patient could develop imagery in her subconscious mind that would be the most effective for her. I began formulating therapeutic suggestions following restriction more effective.

In addition to its emphasis on dealing with chronic pain and insomnia as medical conditions, the NIH panel identified a number of other barriers to the broader and acceptance of alternative means of treating them. They include the time-consuming nature of the treatments, the reluctance of insurance companies to pay for them and the question of just who should administer the therapies. The panel said doctors should consider a patients; social experiences with plotting treatment and recommended educating patients about the health benefits and importance of the therapies. It said insures should treat the alternative therapies as they do standard medical treatments and reimburse providers accordingly. It added that treatments can be administered by nurse-practitioners and social worker to reduce cost.

MIND OVER MOUTH: (By Tom Torstrom, Salem, Oregon Statesman Journal, March 18, 1995): Hypnotherapist Laurence Skolnik works closely with patient Nicholas Treadgill throughout his dental procedure. A Root canal without drugs? Hypnotherapist helps patient undergo painful procedures without anesthesia. Nicholas Treadgill of Eugene sank back into the dentist's chair and awaited what for most us is a nightmare -- a root canal. He's allergic to anesthesia and he had to undergo the dreaded procedure without jaw numbing medication. But the dentist, Dr. Ray Lunt of Salem, proceeded as though the patent were fully anesthetized.

The patient didn't so much as flinch as the dentist drilled through the enamel and into the ultra-sensitive roots. For nearly an hour, Lunt drilled and cleaned, and the patient seem to be off on some mental vacation.. The pain to the dental procedure was erased through hypnotherapy before it even began by Laurence Skolnik of Salem, who has a Ph.D. in hypnotherapy, prepared Treadgill for the surgery. "There was not a bit of pain whatsoever," Treadgill said, "It's just amazing to me."

In effect, Skolnik helped Treadgill go on his "vacation" through guided imagery and visualization. During the procedure, Treadgill -- in his mind -- was happily floating on a lake in a canoe, listening to the birds chirping nearby. "We created a hypnotic anesthesia," Skolnik said. Skolnik is a fellow of the National Board of Hypnotic Anaesthesiology, one of only about a dozen in the country. Hypnotherapy, in the hands of a trained professional, is become more recognized as a alterative to conventional anesthesia for those who, for whatever the reason cannot tolerate it.

In hypnosis, clients reach that relaxed, hazy world between consciousness and unconscious called the "altered state," Skolnik said. In that state, the more active unconscious mind is able to to receive suggestions, Skolnik said. It isn't magic, and it isn't pure science either. When the workings of the mind are involved, it's difficult to measure and explain what happens. "I don't know the limitations of the mind," the hypnotherapist said.

He wonders about those seemingly impossible situations we sometimes read about, like how a slight woman can lift a truck off her son after an accident. "What I do primarily is to help people help themselves," he said. "In hypnosis you are always aware of what is happening and you are in control." He said the idea that hypnotists can make people do things they don't want to do is a myth."You can't make them do anything," Skolnik said. "They have to want to do it."

An example is helping a client stop smoking. One woman who came to him was told by her doctor to quit smoking. It wasn't her decision and she didn't like the idea. After the session, Skolnik said he asked the woman whether she wanted a cigarette. "She said yes," he said. And he never saw her again. But on the flip side, hypnosis can work incredibly well for a person who wants it to. A dramatic example: Skolnik successfully helped guide a woman through a Caesarean section birth without the use of anesthesia. He has a videotape of that operation.

The dental surgery on Treadgill, by the way, was a total success -- for the hypnotherapist, the patient, and the dentist.

THE DENTIST'S VIEW: Dr. Ray Lunt said he knew about the use of hypnotism in medicine, but the Treadgill case was the first time he had done work on a patient under hypnosis. "It went well. For me it was real good because the patient was very relaxed and I was able to do more work than we anticipated," he said. "A root canal is usually two appointments -- a half hour to 45 minutes, and another of an hour. We did the whole thing in less than an hour. It was going so well, I said let's go ahead and finish."

The same thing happened on a later visit when Treadgill had more major dental work done. The dentist was able to do more work than normal because of the patient's relaxed state. Under hypnosis, Treadgill was told to put his hand in a bucket of ice water (an imaginary one), and then to touch his jaw area. That would numb his jaw Skolnik told him. It worked. The doctor was amazed at how the patient felt after it was over. Usually a root canal patient is numb, the mouth has been open for a long time, and somewhat exhausted by the procedure.

But when Skolnik counted down to bring Treadgill out of hypnosis, he told him he would feel good and happy and full of energy. "The minute he said, 'five' he had a big grin on his face and he was happy. There was no numbness when he left. That's something you don't usually see after root canal." Lunt said. The dentist said what particularly impressed him was that all during the procedure Skolnik talked with Treadgill, telling him that the patient was in charge of his health care and it was good what he was doing. He said he was working with the doctor to improve his health. "Those things were very positive from a mental point of view," Lunt said.

Lunt's wife, Nancy, works in the office and has been a dental assistant for 18 years. It was a first for her. "That guy comes out of the chair with a big smile -- so big it's like it's painted on his face. And he's full of energy," She said. "It's just amazing. He didn't even flinch. I've never sen anything like it."

TREADGILL'S OPINION: Treadgill, 60, needed a lot of dental work. And anesthetics were out. "It really messes me up pretty bad." he said, He went to three different dentist in Eugene, looking for someone who would allow alternative methods, like hypnotism. "Those guys started laughing," he said, "They said there's not way you can do this -- no way we would do that kind of work in you mouth without putting you under. They wouldn't even talk about it. "I said I would not do it. I said there's got to be another way."

Treadgill heard about Skolnik from someone who had heard him give a talk. He contacted the hypnotherapist. Then Skolnik's personal dentist -- Lunt -- agreed to do the work. Treadgill and Skolnik met a couple of times before the dental work to get the patient ready and to teach Treadgill how to reach the deep level of relaxation needed.

In the dental chair, Treadgill was vaguely aware of what was going on. But he let himself go on a mental trip, he said. "I was on a beautiful, still lake in a canoe, enjoying the sunshine and hearing the sounds of the water." When he awakened he was happy. "I was laughing," he said, "It just felt so good."

FORGET FEAR, BUT CHECK THERAPIST'S CREDENTIALS: Oregon does not require hypnotherapist to be licensed. Hypnotherapist Laurence Skolnik suggests that people be sure of their therapist's credentials and experience when choosing a hypnotist. Both hypnotherapists and hypnotists are listed in Yellow Pages of the phone book.

Hypnotherapy can be use in pain management and control, childbirth, catastrophic illness counseling and other medical conditions. Many hypnotherapists also are involved in behavior control (stopping smoking, self esteem, phobias) and in such areas as improving memory, dream research and stress management. Fees vary, depending on a client's particular needs. A typical visit might cost $80 to $100, with a lower cost for subsequent visits. In Skolnik case, the fee is determine by him and his client during the initial interview and evaluation process.

Skolnik said he rarely needs to see a client more than two or three times in dealing with a particular situation. Salem psychologist Leslie Pitchford sometimes uses hypnotism. She said it's fairly mainstream alternative these days, and there aren't a lot of skeptics. "Hypnotism can really be helpful, to help focus on something," Pitchford said. "It's been too mystified. All it is is relaxing and concentration."

VISUALIZATION: THE NEW NAME FOR "TRADITIONAL HYPNOSIS" LAURENCE SKOLNIK, SURGICAL SUGGESTIONS USING VISUALIZATION: SUBCONSCIOUSLY SPEAKING: Vol 5 # 6: 1990:
Twenty-three years of diabetes had left me in pretty rough condition. Actually, it was probably the Twinkles, the drinking and the general disregard for my disease that did the damage. Either way, both my eyes had already undergone lots of laser surgery (to seal hemorrhaging blood vessels) and a vitrectomy (to remove the vitreous jelly from the eye-cloudy from the hemorrhaging) to restore my eyesight. A little over a year ago, though, I started waking up nauseous most mornings. I was wheezing a lot and having difficulty breathing. The nephrologgists told me that my kidneys were failing. As poisons and excess fluids collected in my system, I was drowning in my own toxic wastes.
Hemodialysis relieved the symptoms almost immediately and nearly a year of treatment came and went with very few complications. Three times a week for three hours at a time, they'd take my blood and filter it externally. There are people (some of whom became fast friends) who live much of their lives on dialysis but the schedule sure puts a dent in one's social and personal life, and job. Luckily, I was a perfect candidate for a kidney transplant. My sister and my father both qualified as possible donors and after seemingly endless tests and tissue cross-matching my old man and I set a surgery date for Valentine's Day.
As February approached though, I found myself growing increasingly apprehensive. What if I rejected the kidney? The body's immune system attacks transplanted organs the same way it might fight an infection. Or suppose the immune suppression drugs work too well and I end up in the hospital every time I catch a cold? What about the side effects of the drugs? How about if it hurts?
My Dad picked up on my fears when we talked on the phone and began to have his own doubts. After all, why go through the trouble of yanking a perfectly good kidney out if the intended recipient is having second thoughts? My sister got wind of this and connected me with a hypnotherapist, Dr.Laurence Skolnik. I was skeptical but realized that I had to do something about my attitude, so I made an appointment.
His office has none of the new age trappings I had feared. The Dr.'s attitude also put me very much at ease: very straightforward, but warm, engaging and concerned. We talked at length and he intuited many fears I hadn't identified. He also did a few exercises to test my suggestibility. One test sort of unveiled the whole concept of hypnotherapy for me. I clasped my hands and interlaced my fingers, then extended my index fingers so that they were about an inch apart. As I concentrated on my fingertips, Dr. Skolnik told me he was putting them in an invisible vise. Try as I might to resist the pressure as he tightened this vise (he informed me), I would find it impossible. I watched as my fingers slowly came together and touched.
In fact, it would not have taken a herculean effort to resist. I could have broken the spell at any moment but I had decided to accept the suggestions.
Hypnosis works by reprogramming or realigning the subconscious bur only with the approval of the conscious, active mind. Hence, one is always in control, even when in a deep hypnotic condition. The only suggestions that get programmed in are the ones you want.
The actual therapeutic hypnosis is only slightly more complex. As I reclined, Dr. Skolnik gave me a series of suggestions. As he promised, I became more relaxed than I had ever been before. This state of relaxation opens the subconscious to suggestions. I received several during that initial session, most of them aimed toward assuaging my panic and convincing me to accept the outcome of the operation no matter what. The Doc brought me back to an alert state of mind. I left the office completely refreshed but not completely convinced. I spent more time that evening analyzing the therapy than looking forward to my operation.
Each optimistic phrase reinforced the others. .. The miracle transformation took place the following morning. I called my sister to relate my experience with Dr. Skolnik and heard myself saying and meaning very positive things about my upcoming (no longer "impending" as in "doom") transplant. Each optimistic phrase reinforced the others, and I consciously went along for this cheery prognostic ride. Pretty soon I was believing not only the results of the hypnosis but also in the inevitable success of my operation. Even I recognized the complete turnaround I had undergone overnight.
Dr. Skolnik taped that first treatment so I could reinforce my new mode of thought. I’d listen to the tape at bedtime and an additional suggestion he put on the tape even helped me sleep better. At a later session, he had me visualize the entire surgical procedure--all in positive terms. I never mentioned "pain" but rather "minimizing the discomfort" I can't say with certainty that everything occurred as I envisioned but I know it helped me to have such upbeat scenario in my head.
One aspect of my scenario did play itself out neatly. A common precaution before this surgery is to have some blood on hand, earmarked for the recipient. Kidney disease often causes anemia, so 1 was not able to donate my own blood. (These so-called autologous transfusions are the safest for a number of reasons. Several of my friends and family donated for me so I was not worried about contaminated blood. However, the more different antibodies there are present, the more likely the immune system will respond by attacking the transplanted organ. In any case, transfusions, though often necessary, can pose problems.) One of the suggestions I got Was to limit the amount of bleeding that would take place during the operation. When I regained consciousness after the surgery, I was pleased to find out that I had bled very little and required no blood.
The surgery was a success and the kidney functioned immediately (In many cases, it takes a while for the transplanted organ to open up.) However, even my blood chemistries started returning to normal, I became very sick. The doctors weren’t sure what caused my stomach cramps or how to get rid of them. Dr. Skolnik came to the hospital and, during a lull in the din in Intensive Care, he help me relax. The same visualization techniques we had employed throughout my treatments allowed me to control the pain - minimizing the discomfort, that is.
I was no longer writhing in a hospital bed; I was basking in tropical sun on a white sand beach. I could smell the salt air, feel the cool breeze, even hear the seabirds calling overhead. Mostly, though, I no longer felt the pain. Amazingly, my blood pressure and pulse (which had both remained extremely high since the operation) came way down. For a while, I was in a blissful hypnotic state and we had numbers to prove it. A passing nurse snapped me back to reality with a blood pressure reading but even after Dr. Skolnik left, I used his methods and felt much better.
I left the hospital a little over a week after the operation. I went back to work two weeks after that (I free-lance, so I was able to schedule short, easy projects). And then my world collapsed. My creatinine level increased (a sign of possible rejection) and I had to return to the hospital. I thought I put a pretty good face on it all but my family and friends convinced me that my new positive attitude was deteriorating And truthfully, even after the doctors controlled the fluctuations, I was terrified of losing the kidney.
Although I felt fine, I began to think of myself as an invalid, poised to keel over at any moment╖ The maintenance routine for the kidney overwhelmed me even though it's really pretty simple. I was beleaguered only by my own apprehensions. When I went to the wake-up call see Dr. Skolnik, he gave me I needed That one additional session taught me to appreciate the good health I was enjoying rather than anticipating what might go wrong. He pointed out that fears can cripple as effectively as disease, so get off my butt and be healthy, by inference. He didn't limit the suggestion to the kidney. so by extension, I have started accept life's vicissitudes more easily.
By the way, my father is doing very well. A single kidney works well enough to keep blood clean and other systems functioning at full efficiency. Three and a half months have passed since the transplant and I'm fine, too. Any acute rejections usually occur within three months. I plan to return to Dr. Skolnik soon to attack my laziness--I promised this article to him long ago. Now that I'm healthy, I've got work to do. Fred Kepler.