Moving/Mirroring Hands & AS-IF Approaches & Therapeutic Alliance

 No. 4

Rubin Battino - Matter Class Outline 

May 6, 2024.   6 PM EDT

A. Moving/Mirroring Hands Approach Background

I first learned about the moving hands approach at an Erickson conference where a collaborator of Ernest Rossi (Brian Lippincott) reported on using it with veterans who had PTSD. The research results showed that it worked with the veterans. [I prefer PTS or Post-Traumatic Stress rather than making this a “disorder.”] It is an elegant four-step model where only the client knows what s/he is working on, and in which the client is guided into doing all of the change work. The procedure takes about 15 minutes. 

The main references are Rossi’s book “Symptom Path to Enlightenment,” Hill and Rossi’s book entitled “The Practitioner’s Guide to Mirroring Hands,” and chapter 14 in my book “Expectation.” The Hill and Rossi book contains many up-to-date variations of this approach. My website contains more references.

B. Group Induction for Moving/Mirroring Hands Approach (MHT) (for all who are willing).

1. Before beginning sessions with clients I use Mary Goulding’s opening question, “What are you willing to change today? Just let that question rattle around in the back of your mind during this session.” This sets an expectation for change.

2. Guide the group through the four steps: (1) pick something to work on and use moving hands to establish that you will do that; (2) one hand moves down while you briefly explore relevant history; (3) other hand moves down while you think of two or more ways to realistically handle your concerns; and (4) nod your head “Yes” to let yourself know you will pick one or more of your solutions.

3. Be sure to mention at the beginning the possibility of working on several issues in this exercise.

4. Mention continuing the exercise on your own if I move too fast.

C. Details on What Attendees Have experienced and How to Do MHT

1. Secret Therapy - I obtain little biographical or historical information from my clients about what bothers them. Clients are guided to do internally their own change work. 

2. Being a Guide - I believe that what we do as therapists is to be guides. That is, we guide clients into finding their own ways to realistic changes. Clients know what is possible in their lives—we do not.

3. Occasionally, you will have a client whose hands move apart rather than together. Ask them, “Is there something else going on now that you would rather work on? If that is the case, please continue to the next step.” [An internal review of relevant information from the past.] 

4. Notice the opening step comment of “You may find that you are interested and  willing to work on several issues now. If that is the case, please do so.”

5. MHT is especially effective since it involves kinesthetic things like muscles and arm and hand movements. This locks or anchors the changes into the body.

6. Everybody moves at their own pace. When working with a client you know when to move to the next step. In a group exercise, I have to guess at when to move to the next step, and be sure to incorporate comments about continuing the process on your own.  

7. It is likely that it works with PTS because it is all internal in a safe way that also involves physical movements. One difficulty with some approaches to working with PTS clients is having the client recall (and relive) the PTS event or events.

8. Expectation - my expectation that my client will be able to do this successfully enhances the process.

9. Comments and Questions.

D. Rossi’s Hands Activity (Adapted from “Symptom Path to Enlightenment,” p. 245)

Do as a group exercise - do this internally without client comment - read body language when doing individual work.

Four Stages:

1. Initiation/Sensations - When you are ready to do some important inner work on what troubles you, will you place your hands with your palms up when you are ready to receive something? 

As you focus on those hands in a sensitive manner, I wonder if you will begin to know which hand seems to express what bothers you or expresses some fear or difficulties.

2. Incubation/Arousal/Feeling - Now, I wonder what you experience in your other hand by contrast at the same time. Sense and feel that.

3. Insight/Breakout/Intuition - Stay with those sensations and feelings in both hands. Is anything happening within your mind now? Think inside about what has already been changing as you experience these different sides of yourself.

4. Reintegration - Now, gently bringing your hands together let them work out within you the changes that you need at this time. Perhaps, wonder that somehow, you will discover new ways to feel and react and act. What is different at this time? Then, maybe, you will find your head nodding “Yes” all by itself to let you know that these helpful changes have already occurred within you. Thank You.

5. Comments - This is an interesting way to work with a client, letting their hands incorporate the feelings and changes, and then transmitting them into their body/mind. This can also be done with an individual client by asking them to tell you what is going on at each stage of the process.    GROUP COMMENTS

E. Working with Two Parts or an Internal Polarity

1. Sitting comfortably think about two different, and even conflicting ways, that you think or feel or act. Examples are: fat/thin, positive/negative, “good”/”bad”, happy/sad, depressed or anxious/calm or peaceful. Here is a way to resolve that conflict.

2. Have your hands on your lap or just floating in front of you. Now, for example, think about anxiety being in one hand and being calm in the other. 

3. With eyes closed or unfocussed, have your hands slowly approach each other.

4. When it feels okay, let them slowly approach each other in a meaningful way. Feel, sense, and imagine how and what they wish to communicate and share. They gently touch, and the hand which contains your desired change softly covers the other in a protective manner. Then, somehow, your desired change/goal becomes dominant, so that you know - really know - that this change is okay and permanent for you. Finally, find that your hands gently thank each other and drift apart.

5. Comments?

F. AS-IF Approaches (Some ideas from Trevor Silvester’s “Cognitive Therapy” book. Also see Steve Andreas’s two books on transforming negative self-talk [NLP stuff]. (More on this in a later class on the Miracle Question Approach.)

1. Experiment on acting AS-IF with psychiatrists and actors - describe.  That is, when you act AS-IF you are different and changed, that becomes your reality. Here are some AS-IF approaches from Trevor Silvester.

• Talking Positively to Yourself - What else can I enjoy/learn/appreciate/ love/see more clearly/understand/try right now?

Look around and say to yourself: I am sitting on this happy chair. Here is my happy table. There are those happy windows with happy curtains. This is my happy house. 

Ask yourself every day in the morning: What would I do differently today if my troubles or one of them disappeared? How different would I feel?

Each evening for one week look back over your day and select three positive things that have happened, and write them down. Also write down how you were “responsible” for those gifts occurring.

THREE GIFTS you can give: (1) find three opportunities in any given day to thank somebody for something beyond the run of everyday pleasantries; (2) set aside a period or time every day for savoring, i.e., choose two or three things (food or nature or family member or ...); and (3) do a random act of kindness every day.

G. Discussion of Therapeutic Alliance (Rapport Building)

The first session with a client is a meeting of two strangers even though you might have met over the phone before. The client knows that you are the professional and the trained person, and has an expectation that you will be able to help her/him. [My clients know that I do single-session therapy using hypnosis.] The client’s expectation works in favor of success since such an expectation incorporates the placebo effect. This part of the master class is a reminder of what we have all learned as rapport building, and is my way of telling you how I work to establish a therapeutic alliance. Studies have shown that this is the most effective factor (35-40% or more!) in successfully helping clients attain their goal(s). The second most effective factor is empathy, but at a much lower level. (Wampold, World Psychiatry 2015;14:270-277; Battino, Expectation. The Very Brief Therapy Book, 2006, pp. 33-36; Bordin, E.S. (1979). Psychotherapy: Theory, Research & Practice, 16(3), 252-260 [first article on therapeutic alliance]; Norcross, J.C. (Ed.). (2011). Psychotherapy relationships that work. (2nd ed.). Oxford University Press.) It is important to note that when anyone meets someone new that they make an assessment and a judgment in seconds!

1. Expectation: My clients all know that it is my expectation to be able to help them achieve their goal(s) in one open-ended session. (See Battino, 2006) Effectively, my clients expect that this will likely be the case (they know that it is their choice to see me again). Expectation is essentially the placebo effect.

2. Histories: My intake sheet only asks for a brief statement of concern(s) and what the client wants out of counseling. [Note that I do not use the word “problem” since my clients have concerns or bothers or troubles as these are more amenable to change.] I ask for the smallest amount of history like “How long has this been going on?”

3. Chatting: When meeting a stranger the word “chatting” is the best descriptive of the initial conversation. You each tell little things about yourselves. I do more self-disclosure that most therapists throughout the session since this is how two people learn about each other.

4. Gift: At the end of a session I show my clients a small jar that contains a variety of small smooth objects (mostly stones) and then ask them to pick one to remember what has gone on during the session.

5. Shaking Hands: When appropriate at the beginning and end of a session.

6. Holding Hands: It is occasionally helpful during the hypnosis part of the session to hold a client’s hand (with permission beforehand, and passively on the therapist’s part). This is done to provide the client with special skills or abilities or understandings via saying “Somehow, from me and through me, you will be receiving ...”

H. Rapport Building Skills

As a reminder here is a short list of rapport building skills.

1. Body Language: Erickson was a master at reading body language. Pay attention to your client’s posture, how they sit and move, facial expressions, muscle tension, and especially breathing patterns. When using hypnosis it is most important to match the a client’s breathing pattern. You may notice that your client’s breathing pattern matches your delivery pattern. 

2. Pacing and Leading: When you pace a client’s way of speaking or body language or breathing pattern, you can alter it by subtly changing your pattern. The important word here is “subtly” since large changes are easily detected by a client. Speak a bit louder or softer or slower or faster or cross your legs or arms, etc. 

3. Language Style: NLP (Neurolinguistic Programming) suggests that people have one of three preferred ways of speaking: Kinesthetic (related to objects), auditory (related to sounds), and Visual (related to seeing). In listening to clients, do they use words like seeing or feeling or seeing? Then respond to them using their language style to be sympatico.

4. Speaking Style: Does you client speak slowly or fast or loudly or softly or with a regional accent or a rhythmical one, etc.? Subtly match their speaking style by speaking a bit louder or faster or ... That is, do not mimic them.

5. Empathy: Clients need to have a sense that you care for them, be subtly empathic. Show that you really like working with and helping people.

6. Cultural: If you work with a client whose cultural background is different than yours, it is important to have an understanding of that culture. There is no substitute for not having that knowledge.

7. Humor: Some relevant humor is always helpful!

I. Two Erickson Stories

1.Canoeing - When I started out I couldn’t pull my canoe out of the water. I could swim about 25 feet. I didn’t have a pup tent. I just camped wherever I could. By the time I got back, my chest measurement had increased six inches. I could paddle upstream 50 miles in a day, from six in the morning until ten at night—50 miles upstream against a four-mile current. I had a tremendous shoulder and chest

development. I could swing up my canoe over my head and carry it up to a dam. And going downstream, when I came to a dam, there were always posts around them. I’d shinny up a post and sit there in my trunks and my knotted handkerchief on my head reading a German book that I took along. People would gather at that sight. I’d always tell them I was waiting to get my canoe over the dam. It was always volunteer service. [Laughter] 

2. On Death and Dying—My Father - Psychotherapists have a wrong idea about sickness, handicaps, and death. They tend to overemphasize the matter of adjustment to illness, handicaps, and death. There is a lot of hogwash going around about assisting families in grieving. I think you ought to bear in mind that the day you are born is the day you start dying. And some are more efficient than others and don’t waste a lot of time dying. There are others who wait a long time.

J. Some Further Comments

1. Pause Power - Clients need time to process what is going on in the hypnosis portion of the session. Add many pauses so that they can do this internal work. In essence, they drift off when a particular suggestion is significant to them, and then return to hearing you. 

2. Special Words or Phrases - The “magic” word that I like to use when doing hypnosis is “somehow.” That is, somehow these changes will occur, and the client then fills in how this happens! Other good word are “and,” “when,” and “then.” In Michael Yapko’s 5^th edition of “Trancework” he emphasizes how the query “how” initiates change. That is, “How do you or did you do that.” Example: “How are you depressing yourself (changes a noun to a verb).”

3. Expectation and the Placebo Effect - My expectation and thus that of my clients is that we will be able to resolve what troubles them in one session. Also, note that the Placebo Effect is in the background in ALL therapy sessions, i.e., clients and we expect change!

4. General Characteristics of Well-Formed Goals: (1) small rather than large; (2) salient to clients; (3) described in specific, concrete, behavioral terms; (4) achievable within the practical context of clients’ lives; (5) perceived by the client as involving their hard work; (6) described as the “start of something” and not the “end of something;” (7) treated as involving new behavior(s) rather than the absence or cessation of existing behavior(s). [de Shazer, 1991]

Listeners Comments and Questions

K. Some Rubin Moon Poems

As an addendum, in addition to spending time with important people in my life in person or on the phone or virtually, I have become a bit of a “lunatic.” That is, I cherish phases of the moon, especially the full moon when it shines on my bed and me at night. So, I am adding eight of my three-line poems about this.

full moon tonight   waning crescent of the moon      lying in the moonlight

eerily casting black shadows   awaits morning         beaming through the window

starkly on white snow           barely lighting the night         I was ethereal

I cannot see it                                                                                  scattering long dark shadows

yet I know the moon is there                                                          

the full moon    ghostly shadows    low in the western sky

in the middle of the night     I am caught again                thinnest sliver of the moon

the waning orange moon          in the night light                  and the morning star

burns into me                     of stillness                       infinity!

L. Next Session - Healing Language. Preparation for Surgery, and Hypnosis for Palliative Care

Closing Healing Meditation

THANK ROB and attendees.