This article was downloaded by: [New York University] On: 01 February 2015, At: 03:05 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Working Hypnotically with Deaf People a
Gail L. Isenberg M.S. & William J. Matthews
a
a
University of Massachusetts , USA Published online: 21 Sep 2011.
To cite this article: Gail L. Isenberg M.S. & William J. Matthews (1991) Working Hypnotically with Deaf People, American Journal of Clinical Hypnosis, 34:2, 91-99, DOI: 10.1080/00029157.1991.10402968 To link to this article: http://dx.doi.org/10.1080/00029157.1991.10402968
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS
VOLUME 34, NUMBER 2, OCTOBER 1991
Working Hypnotically With Deaf People!
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Gail L. Isenberg and William J. Matthews University of Massachusetts Little attention has been given to the utilization of hypnosis with deaf people. In a recent study, we compared objective and subjective responses to two different hypnotic induction techniques by deaf and hearing undergraduatewomen. We presented hypnosis techniques orally to hearing subjects and visually, using sign-language, to deaf subjects. Results from this study failed to reveal any significant differences on objective or self-report levels of trance depth between the two populations. Our purpose in this article is to examine the similarities and differences of the induction process and hypnotic responses, including trance indicators, between deaf and hearing subjects.
no differences from hearing subjects on objective and self-report measures of trance depth. This data supported the hypothesis that deaf people are as hypnotizable as hearing subjects. There were interesting similarities and differences in hypnotic responses between the two groups throughout the hypnotic process. The purpose of this article is to examine how deaf subjects responded to hypnotic induction in that (Matthews & Isenberg, in press) study. The study involved 17 deaf undergraduate women from Gallaudet University and 18 hearing undergraduate women from the University of Massachusetts. Half of each group received the Stanford Hypnotic Clinical Scale (SHCS) (Morgan & Hilgard, 1978), while the other half received the Indirect Suggestion Scale (ISS) (Matthews, Bennett, Bean, & Gallagher, 1985). In both inductions subjects were given five behavioral suggestions: (1) to have their hands come together; (2) to have a dream;
The use of hypnosis with deaf people has received some attention (Bartlett, 1966; Bartlett, 1967; Cavallaro, 1990; Gravitz, 1981; Isenberg, 1988; Gaston & Hutzell, 1976; Matorano & Destreicher, 1966); however, there has been little if any published research in this area. Recently we (Matthews & Isenberg, in press) conducted a study comparing direct and indirect inductions with hearing and deaf undergraduate women. The results of this study indicated that deaf subjects showed
For reprints write to Gail Isenberg, M.S., RD2, Box 2025, Middlebury, VT 05753. Received April 23, 1990; revised July 13, 1990; second revision October 10, 1990; accepted for publication October 15, 1990.
"The authors would like to express their gratitude to Dr. Neil Reynolds and the faculty of the Department of Psychology, Gallaudet University, for the use of their facilities to conduct this research. 91
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(3) to age regress; (4) a posthypnotic response to cough or clear their throat upon hearing a pen tapped (hearing subjects), to scratch their nose when the hypnotist picked up the pen (deaf subjects); and (5) to have posthypnotic amnesia. One of us (G.L.I.), who is skilled in hypnotic procedures and sign language', did the inductions. We used five dependent measures: (1) a 5-item objective measure of the SHCS; (2) a self-report measure in which subjects rated their own performance; (3) a 7-item rapport scale on which participants rated their experience of rapport with the hypnotist, (e.g., "I felt a positive bond to the hypnotist," l-strongly agree to 7strongly disagree); (4) a 7-item resistance scale on which participants rated their feeling of opposition to the hypnotist, (e.g., "I could not completely trust the hypnotist's intentions," l-strongly agree to 7strongly disagree); and (5) all subjects were asked to rate their subjective experience of trance depth on a 7-point scale: that is, "What was your subjective experience of the depth of trance? L-not at all in trance to 7-very deep in trance." The study was a 2 (hearing vs. deaf) x 2 (direct vs. indirect induction) analysis of variance (ANOVA) design. The twoway ANOVA failed to reveal any significant main effect or interaction differences of behavioral items on the SHCS, for either group (deaf or hearing) or method of induction (direct or indirect). Behavioral data from the SHCS indicated that at least a moderate level of trance was achieved. On ratings of 0 (no trance) to 5 (very deep trance), mean scores ranged from 2.9 (S.D. = .99) to 4.0 (S.D. = 2'fhis author (G.L.I.) is competent in Pidgin sign, which is a combination of American Sign Language and manually coded English.
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1.00). On the Resistance Scale 1 (minimum score of 7 indicating high resistance, a maximum score of 49 indicating low resistance), a significant main effect for group (deaf or hearing) occurred: the deaf mean was 29.88 (S.D. = 6.61) and the hearing mean was 34.28 (S.D. = 5.58) (F = 1.40, DF = 1, P < .04. This would seem to indicate that deaf subjects were more resistant to the hypnotist than hearing subjects. There were, however, no significant main effect or interaction differences for method of induction or group on the Rapport scale, the 5-item self-report measure of subject responsiveness, or self-report trance depth. The specific study with detailed results is reported elsewhere (Matthews and Isenberg, in press). Introduction of Hypnosis and Trance For both hearing and deaf subjects, we took 10 to 15 minutes to explain what hypnosis is and to dispel any myths. Deaf subjects tended to have less experience with hypnosis than hearing subjects. More time was needed to define hypnosis and trance for this group. Establishing an appropriate sign for hypnosis was one of the first issues we addressed. In American Sign Language (ASL) the traditional sign for hypnosis is a hand held in front of the signer's face, at eye level, swinging an imaginary pendulum or object on which to focus. ASL, like all languages, is based on concepts and this sign was not conceptually accurate. There were no designated focal points for subjects to look at other than the hypnotist. We explained that hypnosis is a way to communicate and work with the unconscious. Thus the "hypnosis" sign developed for this study was the letter (H) underneath the opposite palm facing downward, indicating below the con-
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HYPNOSIS WITH DEAF
scious level. The sign for trance was the same, with the substitution of a (T) for the (H). These signs were invented for the researchers' specific purposes and are not established or recognized signs by the deaf community. We described hypnosis as a way to obtain a trance state. Trance was then presented as a natural phenomenon occurring in everyone. To all subjects we gave the example of driving a familiar route and arriving at one's destination, realizing that a segment of the trip was forgotten because the individual was deep in thought (Erickson & Rossi, 1979). This reference was easily identifiable for hearing subjects but not so for many deaf subjects. One deaf woman had recently learned to drive and told the hypnotist that she needed to concentrate on what she was doing behind the wheel. Others just could not identify with the example. The hypnotist found herself having to come up with three trance examples for deaf subjects to appreciate on a personal level. The most successful illustration of trance for these undergraduate women was sitting in a classroom with a boring lecturer and having their mind wander, only to realize that they had missed a portion of the lecture though their eyes were on the instructor the entire time. We believe that the extra effort necessary to explain the hypnotic process to deaf people is not because they lack natural trance experiences, because all subjects eventually identified with at least one example; rather, it is an illustration of the lack of exposure, for whatever reason, this population has had to hypnosis.
Induction In this study we made adaptations for both direct and indirect induction proce-
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dures when working with deaf subjects. These students were hypnotically induced with eyes open, staring at the hypnotist, unlike their hearing counterparts who were instructed to close their eyes and listen. As would be expected, we changed all auditory references on both inductionscales to visual ones. The direction, "Please close your eyes and listen carefully to what I say" (from the SHCS), was transposed to "Please concentrate (on my) signs." , "is" , and "were" (Words such as "on" are not included in ASL. The reference to a pronoun is not necessary either because the hypnotist is the only one signing). The SHCS induction is one of progressive relaxation beginning at the feet and gradually working up to the subject's head. Cavallaro (1990) found that his clients achieved the deepest trance states using this approach with an interpreter. A direct progressive relaxation technique is easy to translate into sign language. The verbal language is literal rather than metaphoric, which enables the signing hypnotist to match the English concept to ASL concept easily. Thus, statements such as .. As we go on you will find yourself becoming more and more relaxed. Begin to let your whole body relax," can be translated to "We progress, you become relax, relax. All body now begin relax."? For the most part, signing adaptations for the ISS were similar to those of the SHCS. Indirect suggestions, though, depend a great deal on language and vocal
3Sign language is not a written language, and examples given are efforts to provide the reader an idea of what changes were made in this study, not exact illustrations. For more information on American sign language, readers are encouraged to contact their state Commission for the Deaf or the National Association for the Deaf, 814 Thayer Ave., Silver Spring, MD 20910.
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delivery. Within a sentence the hypnotist may be including an unconscious instruction that is presented by changing voice quality (Lankton & Lankton, 1983). An example of this would be in the sentence: "Perhaps you'll find that you have already dropped into a trance or maybe you'll find that you can go slowly into a trance as I talk; I don't know which, but I do know that everyone finds their own speed to go into trance." Just as a hypnotist would alter his/her voice for hearing clients by speaking slower and softer when saying those words italicized, he/ she would make similar adjustments of signs. Not only would hand movements become slower, smoother, and perhaps smaller, but in this example the hypnotist could repeat the sign "trance," and by moving the signs progressively downward, unconsciouslyindicate a deep trance. One unresolved difficulty with the ISS was the occasional use of homophones. "And how does a "B" buzz? No, it won't sting you, it's just a letter," does not work successfully in ASL. This is an auditory reference. Deaf people would not necessarily know what a buzzing sound is. What is more important, because the concept for the letter "B" is not the same as the word "insect," the signs are very different. We felt that, even if this statement could be signed adequately, it might hinder the development of a trance state. We eliminated this type of induction technique from the procedure for deaf subjects. Another technique used in the ISS to foster trance depth was the use of counting. In the SHCS the hypnotistcounts from 1 to 20, accurately interspersing suggestions of relaxation and trance development between numbers. In the ISS the hypnotist counts upwards, stating that the count will be from 1 to 20 but begins with
ISENBERG AND MAlTHEWS
the number 4 and at 18 counts backwards to 15 followed by the question " ... and did you experience your reaction fully?" The count then continues from 16 to 20. Hearing clients tend to experience a lightening followed by a deepening of trance during this count. Sounds are presented temporally so that hearing people hold onto them momentarily and can only check for accuracy via echoic and short-term memory. Thus when a hearing client is in trance and the hypnotist begins to count backward the client may become confused but not necessarily sure of what was heard. Signs are presented spatially; thus all a deaf client needs to do when the hypnotist counts in a way contrary to what was indicated is to watch the signs to clarify any confusion. I (W.J.M.) found this to occur with deaf subjects. Not only did they focus attention from the hypnotist's face onto the sign, but the technique seemed to reawaken them. Some deaf subjects reported on the self-report form that the hypnotist counted "wrong." It was not clear, however, if this experience interfered with the entire hypnotic process.
Behavioral Suggestions As with hypnotic inductions, presentation of and responses to each behavioral suggestion differed somewhat for deaf and hearing subjects. The following is a review of the differencesbetween each group on the five items.
Hands Coming Together. In the Matthews and Isenberg (in press) study, 100% of deaf subjects receiving the direct induction and 71 % receiving the indirect induction brought their hands together. This is compared to 100% of the direct and 44% of the indirect-induction, hearing recipients. The question arose as to why so
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many deaf people followed this suggestion. Were they demonstrating a deeper trance state? Was the direct-induction procedure also a more efficacious procedure for both hearing and deaf subjects? There may be other explanations for these results. First, the direct approach had subjects lift their hands in front of them, whereas the indirect method began with hands resting on the subjects' legs. There may have been less motivation to move hands from a resting position than to a place in which hands are holding themselves up. This, however, does not explain why deaf subjects responded so well to both inductionprocedures. What seemed to occur for some deaf clients is that they responded as a form of compliance rather than as a trance indicator. The indirect hand touching suggestion ended with the statement: "Or perhaps your unconscious can be aware of your desires while you consciouslymake the response now. That's right!" Some, not all, subjects seemed to look quizzically, as if to ask: "Oh, you want me to bring my hands together now? O.K." and then they would respond. Hearing subjects with their eyes closed, only aware of the hypnotist's voice and unaware of any facial cues, may not have felt the need to comply with her suggestion. This is not to say that for many deaf subjects this was a good indicator of trance level. Many deaf subjects exhibited slow movements of hands coming together and finger twitching. The two points of concern here are (1) that perhaps direct and indirect approaches to this behavior were not similar enough to assess the effectiveness of one technique over another and (2) that the behavior occurring does not necessarily equate with a trance state, particularly with deaf subjects.
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Dream Sequence. The dream suggestion was the one portion of the entire hypnotic experience in which deaf subjects closed their eyes. To do this, subjects were told before the dream that (1) they could close their eyes for one minute while dreaming, and (2) at the end of the minute the hypnotist would touch their knee and at that time the dream would be finished and they would stay in a comfortable trance. Obviously, deaf subjects would have to open their eyes again at the end of the dream to continue the research protocol. However, the hypnotist did not use the sign "open eyes" to complete the dream experience. The reason for this is that the sign for "open eyes" is the same for "wake up." The signs used instead included "finish," "dream," "stay," and "trance." By focusing on signs that had subjects complete dreams while remaining in a hypnotic state, all were able to reopen their eyes after the minute and continue with their individual level of trance without interruption. Of deaf subjects, 89% direct and 88% indirect induction recipients were able to experience a dream with eyes closed. The limitation of having deaf clients close their eyes is that they are unavailable for continued unconscious communication with the hypnotist until their eyes are reopened. Closing eyes may allow for trance deepening and utilization of unconscious resources by the deaf person. Age Regression. In many ways age regression was the most interesting behavioral response when comparing deaf and hearing subjects. For this behavior, we told subjects exposed to direct induction to regress to the fourth grade. We encouraged those exposed to indirect suggestions to go back to an undefined time
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of their choice, though age 8 was indirectly prescribed. For the most part both induction methods converted well to sign language. At the end of a I-to-1O count, subjects were asked such questions as "Where are you?" "What are you doing?" "How old are you?" "What are you wearing?" and "Who is with you?" Hearing subjects, as with previous behaviors, had their eyes closed during this procedure. All deaf subjects had their eyes open. Though aU subjects were encouraged to find a pleasant past experience, there were some subjects, both hearing and deaf, who age regressed to significant childhood experiences that were not joyful. Seventy-eight percent of deaf direct subjects were judged to have age regressed, while 38% of deaf indirect subjects exhibited appropriate age-regression measures, compared to 89% hearing direct and 100% hearing indirect subjects. The disparity between these two groups may be due to (1) a lack of clarity in the regression suggestions or (2) an inability to find a pleasant childhood experience and an unwillingness to age regress to an uncomfortable time. Those whom we directed to the fourth grade may have been able to focus on a limited period enabling them to choose a positive experience. What these numbers do not show is the depth of trance many deaf subjects of both groups were able to achieve during the age-regression experience.The hypnotist could attend to voice changes, shifting of posture, and limited facial cues of hearing subjects. When asked "Who is with you?" hearing subjects responded by acknowledging names and relationships of people of whom they were aware, and describing the positions of these persons in relation to the subjects themselves. The hypnotist did not know if the subject was seeing a picture of herself or rather placing herself
ISENBERG AND MAlTIIEWS
in the picture experiencing people in the positions stated. With eyes closed, the hypnotist had greater difficulty assessing subjects' experience. Deaf subjects, on the other hand, provided many more behavioral indicators than their hearing counterparts. Several deaf subjects exhibited signs of visual hallucinations when responding to the questions of "What are you wearing?" and "Who is with you?" One subject, wearing white pants with a red print, looked down at her clothes and reported having on blue pants and a gray top. Another very proudly explained that she was wearing a purple dress her mother had made for her. In actuality she was wearing a dark top and blue jeans. When subjectswere asked who was with them, they would place these individuals by sign language consistent with their trance state. Some subjects would look ahead placing one finger in front of them to signify themselves, then point to the positions of others in relation to their selfrepresentation. This seemed to indicate that, though they could see themselves as a child, they were not able to experience the age regression directly. Others would use their body frames as the point of reference and point to the position of others in relationto themselves.One client looked to her left and told the hypnotist that one friend was sitting next to her, and then she looked to her right and reported that her other friend was sitting on that side. These examples seemed to demonstrate that these subjects were able to experience the age regression directly. Other age-regression indicators included counting on fingers to answer the question of how old the subject was, and changes in behavior, such as fidgeting, hands between legs, forefinger to chin, eyes opening wider, and facial expres-
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HYPNOSIS WITH DEAF
sions of affect. One highly hypnotizable subject, with an objective score of 5, produced all of these responses visually, and behaviorally she appeared quite childlike during this experience. She was very animated, telling the hypnotist that a boy on the bus she was riding wanted her to sit with him and that she was very embarrassed. As the hypnotist brought her back to her present age the subject gradually shifted her body to its previous adult hypnotic position exhibiting a flattened affect, which she presented before the age regression.
Posthypnotic Suggestions. As was stated earlier we visually adapted this particular behavioral response for deaf subjects. We told hearing subjects in both direct and indirect fashions that when they heard the pen tap by the hypnotist they were to cough or clear their throat. Not only could deaf subjects not hear a pen tap, but it was also awkward for the hypnotist to sign and hold a pen at the same time. Thus, we instructed deaf subjects to scratch their nose when the hypnotist picked up the pen. The data suggested that deaf subjects responded to this suggestion (78% deaf direct, 50% deaf indirect) better than hearing subjects (56% hearing direct, 33% hearing indirect). This may be misleading in that even though hearing subjects did not cough or make throat clearing noise, many subjects reported later that they swallowed. Because this form of throat clearing was difficult to validate, subjects who swallowed were not included in the positive response category. For deaf subjects it was relatively easy to observe a direct response to the pen stimulus. Amnesia. Posthypnotic amnesia was the final behavioral indicator. Generally, this again was easily converted to sign lan-
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guage, though there were some important auditory references changed to appropriate visual ones. The following is an example from the ISS: "Everyone has had the experience of obtaining a telephone number from information and then being distracted by something so as to forget the telephone number. I wonder if you can remember when you couldn't remember what was on the tip of your tongue?" was changed to "People, people finish experience other give TTY (telephone Teletype machine for the deaf) number, happen something pop-up, forget TTY number. Curious me, maybe remember past happen can't remember what want sign, you?" All subject groups, either direct or indirect and deaf or hearing, responded with approximately 50% manifesting posthypnotic amnesia. Discussion The results of the Matthews and Isenberg (1990) study showed that deaf subjects responded to hypnotic techniques as well as hearing subjects. Deaf subjects presented many traditional trance indicators, that is, flattened affect, change in breathing, glazed stare, and autonomic head nods and finger twitches. They also presented a unique indicator through manual communication. Many deaf subjects changed the manner in which they signed. Some signed very slowly in comparison to their pre- and posthypnotic states. One subject dramatically expanded her signing field. Whereas before and after the trance phenomenon her signs remained in an area around her upper torso, her signs during trance became slow-motion-like in an area extending up to her head and out past her shoulders. Another subject with hands resting on her lap seemed to have difficulty signing or moving her hands at all during trance. Not all
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deaf subjects responded in this manner, however. These shifts in signing style seem to parallel the quality and tone of speech of hearing subjects in trance. It is not unusual for hearing people to speak slower, to produce softer tones, and at times to have difficulty producing words when in trance. Knowing that some hearing people when age regressed change their voice tones to that of a child, it would be interesting to study deaf subjects' signs during early age regressions to see if the signs are equivalent to those a child might produce, or if those whose age of onset of deafness occurred later in childhood would try to use speech. This is admittedly an initial study and one which focused on a small select population, that is, college female students. It is particularly important to recognize that subjects exhibited high cognitive and linguistic skills. The reader is cautioned not to generalize the results is this study to the entire deaf population. The issues and observations presented in this paper need further empirical study. Areas that need further research are (1) male versus female hypnotic responses among deaf subjects, (2) deaf versus hearing hypnotists' effects on subjects' rapport and resistance and trance depth, (3) etiology and onset of deafness, and (4) signing mode, that is, ASL, Pidgin Sign Language, or Sign English as variables effecting the hypnosis experience. More needs to be known about trance indicators. What are the similarities and differences between hearing and deaf people in exhibiting a hypnotic state? Another important area of research that is needed is the therapeutic effectiveness of hypnosis for deaf people. Would this population find hypnosis a successful tool when working to resolve issues such as phobias, chronic pain, unwanted habits,
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etc.? Of particular interest to the authors is the use of multiple embedded metaphors (Lankton & Lankton, 1983) with deaf people. This particular hypnotic technique uses a series of metaphorical stories linked together and presented indirectly while in trance. The purpose of these stories is to access resources within the client to affect therapeuticchange. How would deaf subjects respond to multiple embedded metaphors presented in sign language? What would be the linguistic considerations when using this kind of technique? What impact would ASL have on the presentation of metaphors? These are all interesting questions that need to be investigated. Further research in the area of both direct and indirect hypnotic procedures as a viable tool when working with deaf people can only improve our understanding of hypnosis in general and contribute to the mental health of deaf clients. References Bartlett, K. A. (1966). An instance of trance induction in a deaf mute by pantomime and the patient's needs. American Journal of Clinical Hypnosis, 9,65-67. Bartlett, K. A. (1967). A progress report on further use of hypnosis with a deaf mute.
American Journalof Clinical Hypnosis, 10, 136-138. Cavallaro, L. (1990). Hypnosis with the deaf: Working through an interpreter. Interna-
tionalJournal of Professional Hypnosis, 5, 13-15. Erickson, M. H. & Rossi, E. L. (1979). Hypnotherapy: An exploratory casebook. New York: Irvington. Gaston, C. D. & Hutzell, R. R. (1976). Hypnosis to reduce smoking in a deaf patient.
American Journalof Clinical Hypnosis, 19, 126-127. Gravitz, M. A. (1981). Nonverbal hypnotic techniques in a centrally deaf brain dam-
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aged patient. International Journal of Clinical and Experimental Hypnosis, 29, 110-
116. Isenberg, G. (1988). The therapeutic possibilities of Ericksonian hypnosis and guided fantasy with deaf clients. Proceedings ofthe Eleventh Biennial Conference of the American Deafness and Rehabilitation Association, 14, 78-82. Lankton, S. & Lankton, C. (1983). The answer within: A clinical framework of Ericksonian hypnotherapy. New York: Brunner/ Mazel. Matorano, J. T. & Destreicher, C. (1966). Hypnosis of the deaf mentally ill: A clinical
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study. American Journal of Psychiatry, 123, 605-606. Matthews, W., Bennett, H., Bean, W., & Gallagher, M. (1985). Indirect versus direct hypnotic suggestion: An initial investigation. International Journal of Clinical and Experimental Hypnosis, 33,219-223. Matthews, W. & Isenberg, G. (in press). Direct and indirect hypnotic inductions with deaf and hearing subjects. International Journal of Clinical and Experimental Hypnosis. Morgan, A. & Hilgard, J. R. (1978). The Stanford Hypnotic Clinical Scale for Adults. American Journal of Clinical Hypnosis, 21, 148-169.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Working Hypnotically with Deaf People a
Gail L. Isenberg M.S. & William J. Matthews
a
a
University of Massachusetts , USA Published online: 21 Sep 2011.
To cite this article: Gail L. Isenberg M.S. & William J. Matthews (1991) Working Hypnotically with Deaf People, American Journal of Clinical Hypnosis, 34:2, 91-99, DOI: 10.1080/00029157.1991.10402968 To link to this article: http://dx.doi.org/10.1080/00029157.1991.10402968
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS
VOLUME 34, NUMBER 2, OCTOBER 1991
Working Hypnotically With Deaf People!
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Gail L. Isenberg and William J. Matthews University of Massachusetts Little attention has been given to the utilization of hypnosis with deaf people. In a recent study, we compared objective and subjective responses to two different hypnotic induction techniques by deaf and hearing undergraduatewomen. We presented hypnosis techniques orally to hearing subjects and visually, using sign-language, to deaf subjects. Results from this study failed to reveal any significant differences on objective or self-report levels of trance depth between the two populations. Our purpose in this article is to examine the similarities and differences of the induction process and hypnotic responses, including trance indicators, between deaf and hearing subjects.
no differences from hearing subjects on objective and self-report measures of trance depth. This data supported the hypothesis that deaf people are as hypnotizable as hearing subjects. There were interesting similarities and differences in hypnotic responses between the two groups throughout the hypnotic process. The purpose of this article is to examine how deaf subjects responded to hypnotic induction in that (Matthews & Isenberg, in press) study. The study involved 17 deaf undergraduate women from Gallaudet University and 18 hearing undergraduate women from the University of Massachusetts. Half of each group received the Stanford Hypnotic Clinical Scale (SHCS) (Morgan & Hilgard, 1978), while the other half received the Indirect Suggestion Scale (ISS) (Matthews, Bennett, Bean, & Gallagher, 1985). In both inductions subjects were given five behavioral suggestions: (1) to have their hands come together; (2) to have a dream;
The use of hypnosis with deaf people has received some attention (Bartlett, 1966; Bartlett, 1967; Cavallaro, 1990; Gravitz, 1981; Isenberg, 1988; Gaston & Hutzell, 1976; Matorano & Destreicher, 1966); however, there has been little if any published research in this area. Recently we (Matthews & Isenberg, in press) conducted a study comparing direct and indirect inductions with hearing and deaf undergraduate women. The results of this study indicated that deaf subjects showed
For reprints write to Gail Isenberg, M.S., RD2, Box 2025, Middlebury, VT 05753. Received April 23, 1990; revised July 13, 1990; second revision October 10, 1990; accepted for publication October 15, 1990.
"The authors would like to express their gratitude to Dr. Neil Reynolds and the faculty of the Department of Psychology, Gallaudet University, for the use of their facilities to conduct this research. 91
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(3) to age regress; (4) a posthypnotic response to cough or clear their throat upon hearing a pen tapped (hearing subjects), to scratch their nose when the hypnotist picked up the pen (deaf subjects); and (5) to have posthypnotic amnesia. One of us (G.L.I.), who is skilled in hypnotic procedures and sign language', did the inductions. We used five dependent measures: (1) a 5-item objective measure of the SHCS; (2) a self-report measure in which subjects rated their own performance; (3) a 7-item rapport scale on which participants rated their experience of rapport with the hypnotist, (e.g., "I felt a positive bond to the hypnotist," l-strongly agree to 7strongly disagree); (4) a 7-item resistance scale on which participants rated their feeling of opposition to the hypnotist, (e.g., "I could not completely trust the hypnotist's intentions," l-strongly agree to 7strongly disagree); and (5) all subjects were asked to rate their subjective experience of trance depth on a 7-point scale: that is, "What was your subjective experience of the depth of trance? L-not at all in trance to 7-very deep in trance." The study was a 2 (hearing vs. deaf) x 2 (direct vs. indirect induction) analysis of variance (ANOVA) design. The twoway ANOVA failed to reveal any significant main effect or interaction differences of behavioral items on the SHCS, for either group (deaf or hearing) or method of induction (direct or indirect). Behavioral data from the SHCS indicated that at least a moderate level of trance was achieved. On ratings of 0 (no trance) to 5 (very deep trance), mean scores ranged from 2.9 (S.D. = .99) to 4.0 (S.D. = 2'fhis author (G.L.I.) is competent in Pidgin sign, which is a combination of American Sign Language and manually coded English.
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1.00). On the Resistance Scale 1 (minimum score of 7 indicating high resistance, a maximum score of 49 indicating low resistance), a significant main effect for group (deaf or hearing) occurred: the deaf mean was 29.88 (S.D. = 6.61) and the hearing mean was 34.28 (S.D. = 5.58) (F = 1.40, DF = 1, P < .04. This would seem to indicate that deaf subjects were more resistant to the hypnotist than hearing subjects. There were, however, no significant main effect or interaction differences for method of induction or group on the Rapport scale, the 5-item self-report measure of subject responsiveness, or self-report trance depth. The specific study with detailed results is reported elsewhere (Matthews and Isenberg, in press). Introduction of Hypnosis and Trance For both hearing and deaf subjects, we took 10 to 15 minutes to explain what hypnosis is and to dispel any myths. Deaf subjects tended to have less experience with hypnosis than hearing subjects. More time was needed to define hypnosis and trance for this group. Establishing an appropriate sign for hypnosis was one of the first issues we addressed. In American Sign Language (ASL) the traditional sign for hypnosis is a hand held in front of the signer's face, at eye level, swinging an imaginary pendulum or object on which to focus. ASL, like all languages, is based on concepts and this sign was not conceptually accurate. There were no designated focal points for subjects to look at other than the hypnotist. We explained that hypnosis is a way to communicate and work with the unconscious. Thus the "hypnosis" sign developed for this study was the letter (H) underneath the opposite palm facing downward, indicating below the con-
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scious level. The sign for trance was the same, with the substitution of a (T) for the (H). These signs were invented for the researchers' specific purposes and are not established or recognized signs by the deaf community. We described hypnosis as a way to obtain a trance state. Trance was then presented as a natural phenomenon occurring in everyone. To all subjects we gave the example of driving a familiar route and arriving at one's destination, realizing that a segment of the trip was forgotten because the individual was deep in thought (Erickson & Rossi, 1979). This reference was easily identifiable for hearing subjects but not so for many deaf subjects. One deaf woman had recently learned to drive and told the hypnotist that she needed to concentrate on what she was doing behind the wheel. Others just could not identify with the example. The hypnotist found herself having to come up with three trance examples for deaf subjects to appreciate on a personal level. The most successful illustration of trance for these undergraduate women was sitting in a classroom with a boring lecturer and having their mind wander, only to realize that they had missed a portion of the lecture though their eyes were on the instructor the entire time. We believe that the extra effort necessary to explain the hypnotic process to deaf people is not because they lack natural trance experiences, because all subjects eventually identified with at least one example; rather, it is an illustration of the lack of exposure, for whatever reason, this population has had to hypnosis.
Induction In this study we made adaptations for both direct and indirect induction proce-
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dures when working with deaf subjects. These students were hypnotically induced with eyes open, staring at the hypnotist, unlike their hearing counterparts who were instructed to close their eyes and listen. As would be expected, we changed all auditory references on both inductionscales to visual ones. The direction, "Please close your eyes and listen carefully to what I say" (from the SHCS), was transposed to "Please concentrate (on my) signs." , "is" , and "were" (Words such as "on" are not included in ASL. The reference to a pronoun is not necessary either because the hypnotist is the only one signing). The SHCS induction is one of progressive relaxation beginning at the feet and gradually working up to the subject's head. Cavallaro (1990) found that his clients achieved the deepest trance states using this approach with an interpreter. A direct progressive relaxation technique is easy to translate into sign language. The verbal language is literal rather than metaphoric, which enables the signing hypnotist to match the English concept to ASL concept easily. Thus, statements such as .. As we go on you will find yourself becoming more and more relaxed. Begin to let your whole body relax," can be translated to "We progress, you become relax, relax. All body now begin relax."? For the most part, signing adaptations for the ISS were similar to those of the SHCS. Indirect suggestions, though, depend a great deal on language and vocal
3Sign language is not a written language, and examples given are efforts to provide the reader an idea of what changes were made in this study, not exact illustrations. For more information on American sign language, readers are encouraged to contact their state Commission for the Deaf or the National Association for the Deaf, 814 Thayer Ave., Silver Spring, MD 20910.
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delivery. Within a sentence the hypnotist may be including an unconscious instruction that is presented by changing voice quality (Lankton & Lankton, 1983). An example of this would be in the sentence: "Perhaps you'll find that you have already dropped into a trance or maybe you'll find that you can go slowly into a trance as I talk; I don't know which, but I do know that everyone finds their own speed to go into trance." Just as a hypnotist would alter his/her voice for hearing clients by speaking slower and softer when saying those words italicized, he/ she would make similar adjustments of signs. Not only would hand movements become slower, smoother, and perhaps smaller, but in this example the hypnotist could repeat the sign "trance," and by moving the signs progressively downward, unconsciouslyindicate a deep trance. One unresolved difficulty with the ISS was the occasional use of homophones. "And how does a "B" buzz? No, it won't sting you, it's just a letter," does not work successfully in ASL. This is an auditory reference. Deaf people would not necessarily know what a buzzing sound is. What is more important, because the concept for the letter "B" is not the same as the word "insect," the signs are very different. We felt that, even if this statement could be signed adequately, it might hinder the development of a trance state. We eliminated this type of induction technique from the procedure for deaf subjects. Another technique used in the ISS to foster trance depth was the use of counting. In the SHCS the hypnotistcounts from 1 to 20, accurately interspersing suggestions of relaxation and trance development between numbers. In the ISS the hypnotist counts upwards, stating that the count will be from 1 to 20 but begins with
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the number 4 and at 18 counts backwards to 15 followed by the question " ... and did you experience your reaction fully?" The count then continues from 16 to 20. Hearing clients tend to experience a lightening followed by a deepening of trance during this count. Sounds are presented temporally so that hearing people hold onto them momentarily and can only check for accuracy via echoic and short-term memory. Thus when a hearing client is in trance and the hypnotist begins to count backward the client may become confused but not necessarily sure of what was heard. Signs are presented spatially; thus all a deaf client needs to do when the hypnotist counts in a way contrary to what was indicated is to watch the signs to clarify any confusion. I (W.J.M.) found this to occur with deaf subjects. Not only did they focus attention from the hypnotist's face onto the sign, but the technique seemed to reawaken them. Some deaf subjects reported on the self-report form that the hypnotist counted "wrong." It was not clear, however, if this experience interfered with the entire hypnotic process.
Behavioral Suggestions As with hypnotic inductions, presentation of and responses to each behavioral suggestion differed somewhat for deaf and hearing subjects. The following is a review of the differencesbetween each group on the five items.
Hands Coming Together. In the Matthews and Isenberg (in press) study, 100% of deaf subjects receiving the direct induction and 71 % receiving the indirect induction brought their hands together. This is compared to 100% of the direct and 44% of the indirect-induction, hearing recipients. The question arose as to why so
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many deaf people followed this suggestion. Were they demonstrating a deeper trance state? Was the direct-induction procedure also a more efficacious procedure for both hearing and deaf subjects? There may be other explanations for these results. First, the direct approach had subjects lift their hands in front of them, whereas the indirect method began with hands resting on the subjects' legs. There may have been less motivation to move hands from a resting position than to a place in which hands are holding themselves up. This, however, does not explain why deaf subjects responded so well to both inductionprocedures. What seemed to occur for some deaf clients is that they responded as a form of compliance rather than as a trance indicator. The indirect hand touching suggestion ended with the statement: "Or perhaps your unconscious can be aware of your desires while you consciouslymake the response now. That's right!" Some, not all, subjects seemed to look quizzically, as if to ask: "Oh, you want me to bring my hands together now? O.K." and then they would respond. Hearing subjects with their eyes closed, only aware of the hypnotist's voice and unaware of any facial cues, may not have felt the need to comply with her suggestion. This is not to say that for many deaf subjects this was a good indicator of trance level. Many deaf subjects exhibited slow movements of hands coming together and finger twitching. The two points of concern here are (1) that perhaps direct and indirect approaches to this behavior were not similar enough to assess the effectiveness of one technique over another and (2) that the behavior occurring does not necessarily equate with a trance state, particularly with deaf subjects.
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Dream Sequence. The dream suggestion was the one portion of the entire hypnotic experience in which deaf subjects closed their eyes. To do this, subjects were told before the dream that (1) they could close their eyes for one minute while dreaming, and (2) at the end of the minute the hypnotist would touch their knee and at that time the dream would be finished and they would stay in a comfortable trance. Obviously, deaf subjects would have to open their eyes again at the end of the dream to continue the research protocol. However, the hypnotist did not use the sign "open eyes" to complete the dream experience. The reason for this is that the sign for "open eyes" is the same for "wake up." The signs used instead included "finish," "dream," "stay," and "trance." By focusing on signs that had subjects complete dreams while remaining in a hypnotic state, all were able to reopen their eyes after the minute and continue with their individual level of trance without interruption. Of deaf subjects, 89% direct and 88% indirect induction recipients were able to experience a dream with eyes closed. The limitation of having deaf clients close their eyes is that they are unavailable for continued unconscious communication with the hypnotist until their eyes are reopened. Closing eyes may allow for trance deepening and utilization of unconscious resources by the deaf person. Age Regression. In many ways age regression was the most interesting behavioral response when comparing deaf and hearing subjects. For this behavior, we told subjects exposed to direct induction to regress to the fourth grade. We encouraged those exposed to indirect suggestions to go back to an undefined time
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of their choice, though age 8 was indirectly prescribed. For the most part both induction methods converted well to sign language. At the end of a I-to-1O count, subjects were asked such questions as "Where are you?" "What are you doing?" "How old are you?" "What are you wearing?" and "Who is with you?" Hearing subjects, as with previous behaviors, had their eyes closed during this procedure. All deaf subjects had their eyes open. Though aU subjects were encouraged to find a pleasant past experience, there were some subjects, both hearing and deaf, who age regressed to significant childhood experiences that were not joyful. Seventy-eight percent of deaf direct subjects were judged to have age regressed, while 38% of deaf indirect subjects exhibited appropriate age-regression measures, compared to 89% hearing direct and 100% hearing indirect subjects. The disparity between these two groups may be due to (1) a lack of clarity in the regression suggestions or (2) an inability to find a pleasant childhood experience and an unwillingness to age regress to an uncomfortable time. Those whom we directed to the fourth grade may have been able to focus on a limited period enabling them to choose a positive experience. What these numbers do not show is the depth of trance many deaf subjects of both groups were able to achieve during the age-regression experience.The hypnotist could attend to voice changes, shifting of posture, and limited facial cues of hearing subjects. When asked "Who is with you?" hearing subjects responded by acknowledging names and relationships of people of whom they were aware, and describing the positions of these persons in relation to the subjects themselves. The hypnotist did not know if the subject was seeing a picture of herself or rather placing herself
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in the picture experiencing people in the positions stated. With eyes closed, the hypnotist had greater difficulty assessing subjects' experience. Deaf subjects, on the other hand, provided many more behavioral indicators than their hearing counterparts. Several deaf subjects exhibited signs of visual hallucinations when responding to the questions of "What are you wearing?" and "Who is with you?" One subject, wearing white pants with a red print, looked down at her clothes and reported having on blue pants and a gray top. Another very proudly explained that she was wearing a purple dress her mother had made for her. In actuality she was wearing a dark top and blue jeans. When subjectswere asked who was with them, they would place these individuals by sign language consistent with their trance state. Some subjects would look ahead placing one finger in front of them to signify themselves, then point to the positions of others in relation to their selfrepresentation. This seemed to indicate that, though they could see themselves as a child, they were not able to experience the age regression directly. Others would use their body frames as the point of reference and point to the position of others in relationto themselves.One client looked to her left and told the hypnotist that one friend was sitting next to her, and then she looked to her right and reported that her other friend was sitting on that side. These examples seemed to demonstrate that these subjects were able to experience the age regression directly. Other age-regression indicators included counting on fingers to answer the question of how old the subject was, and changes in behavior, such as fidgeting, hands between legs, forefinger to chin, eyes opening wider, and facial expres-
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sions of affect. One highly hypnotizable subject, with an objective score of 5, produced all of these responses visually, and behaviorally she appeared quite childlike during this experience. She was very animated, telling the hypnotist that a boy on the bus she was riding wanted her to sit with him and that she was very embarrassed. As the hypnotist brought her back to her present age the subject gradually shifted her body to its previous adult hypnotic position exhibiting a flattened affect, which she presented before the age regression.
Posthypnotic Suggestions. As was stated earlier we visually adapted this particular behavioral response for deaf subjects. We told hearing subjects in both direct and indirect fashions that when they heard the pen tap by the hypnotist they were to cough or clear their throat. Not only could deaf subjects not hear a pen tap, but it was also awkward for the hypnotist to sign and hold a pen at the same time. Thus, we instructed deaf subjects to scratch their nose when the hypnotist picked up the pen. The data suggested that deaf subjects responded to this suggestion (78% deaf direct, 50% deaf indirect) better than hearing subjects (56% hearing direct, 33% hearing indirect). This may be misleading in that even though hearing subjects did not cough or make throat clearing noise, many subjects reported later that they swallowed. Because this form of throat clearing was difficult to validate, subjects who swallowed were not included in the positive response category. For deaf subjects it was relatively easy to observe a direct response to the pen stimulus. Amnesia. Posthypnotic amnesia was the final behavioral indicator. Generally, this again was easily converted to sign lan-
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guage, though there were some important auditory references changed to appropriate visual ones. The following is an example from the ISS: "Everyone has had the experience of obtaining a telephone number from information and then being distracted by something so as to forget the telephone number. I wonder if you can remember when you couldn't remember what was on the tip of your tongue?" was changed to "People, people finish experience other give TTY (telephone Teletype machine for the deaf) number, happen something pop-up, forget TTY number. Curious me, maybe remember past happen can't remember what want sign, you?" All subject groups, either direct or indirect and deaf or hearing, responded with approximately 50% manifesting posthypnotic amnesia. Discussion The results of the Matthews and Isenberg (1990) study showed that deaf subjects responded to hypnotic techniques as well as hearing subjects. Deaf subjects presented many traditional trance indicators, that is, flattened affect, change in breathing, glazed stare, and autonomic head nods and finger twitches. They also presented a unique indicator through manual communication. Many deaf subjects changed the manner in which they signed. Some signed very slowly in comparison to their pre- and posthypnotic states. One subject dramatically expanded her signing field. Whereas before and after the trance phenomenon her signs remained in an area around her upper torso, her signs during trance became slow-motion-like in an area extending up to her head and out past her shoulders. Another subject with hands resting on her lap seemed to have difficulty signing or moving her hands at all during trance. Not all
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deaf subjects responded in this manner, however. These shifts in signing style seem to parallel the quality and tone of speech of hearing subjects in trance. It is not unusual for hearing people to speak slower, to produce softer tones, and at times to have difficulty producing words when in trance. Knowing that some hearing people when age regressed change their voice tones to that of a child, it would be interesting to study deaf subjects' signs during early age regressions to see if the signs are equivalent to those a child might produce, or if those whose age of onset of deafness occurred later in childhood would try to use speech. This is admittedly an initial study and one which focused on a small select population, that is, college female students. It is particularly important to recognize that subjects exhibited high cognitive and linguistic skills. The reader is cautioned not to generalize the results is this study to the entire deaf population. The issues and observations presented in this paper need further empirical study. Areas that need further research are (1) male versus female hypnotic responses among deaf subjects, (2) deaf versus hearing hypnotists' effects on subjects' rapport and resistance and trance depth, (3) etiology and onset of deafness, and (4) signing mode, that is, ASL, Pidgin Sign Language, or Sign English as variables effecting the hypnosis experience. More needs to be known about trance indicators. What are the similarities and differences between hearing and deaf people in exhibiting a hypnotic state? Another important area of research that is needed is the therapeutic effectiveness of hypnosis for deaf people. Would this population find hypnosis a successful tool when working to resolve issues such as phobias, chronic pain, unwanted habits,
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etc.? Of particular interest to the authors is the use of multiple embedded metaphors (Lankton & Lankton, 1983) with deaf people. This particular hypnotic technique uses a series of metaphorical stories linked together and presented indirectly while in trance. The purpose of these stories is to access resources within the client to affect therapeuticchange. How would deaf subjects respond to multiple embedded metaphors presented in sign language? What would be the linguistic considerations when using this kind of technique? What impact would ASL have on the presentation of metaphors? These are all interesting questions that need to be investigated. Further research in the area of both direct and indirect hypnotic procedures as a viable tool when working with deaf people can only improve our understanding of hypnosis in general and contribute to the mental health of deaf clients. References Bartlett, K. A. (1966). An instance of trance induction in a deaf mute by pantomime and the patient's needs. American Journal of Clinical Hypnosis, 9,65-67. Bartlett, K. A. (1967). A progress report on further use of hypnosis with a deaf mute.
American Journalof Clinical Hypnosis, 10, 136-138. Cavallaro, L. (1990). Hypnosis with the deaf: Working through an interpreter. Interna-
tionalJournal of Professional Hypnosis, 5, 13-15. Erickson, M. H. & Rossi, E. L. (1979). Hypnotherapy: An exploratory casebook. New York: Irvington. Gaston, C. D. & Hutzell, R. R. (1976). Hypnosis to reduce smoking in a deaf patient.
American Journalof Clinical Hypnosis, 19, 126-127. Gravitz, M. A. (1981). Nonverbal hypnotic techniques in a centrally deaf brain dam-
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aged patient. International Journal of Clinical and Experimental Hypnosis, 29, 110-
116. Isenberg, G. (1988). The therapeutic possibilities of Ericksonian hypnosis and guided fantasy with deaf clients. Proceedings ofthe Eleventh Biennial Conference of the American Deafness and Rehabilitation Association, 14, 78-82. Lankton, S. & Lankton, C. (1983). The answer within: A clinical framework of Ericksonian hypnotherapy. New York: Brunner/ Mazel. Matorano, J. T. & Destreicher, C. (1966). Hypnosis of the deaf mentally ill: A clinical
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study. American Journal of Psychiatry, 123, 605-606. Matthews, W., Bennett, H., Bean, W., & Gallagher, M. (1985). Indirect versus direct hypnotic suggestion: An initial investigation. International Journal of Clinical and Experimental Hypnosis, 33,219-223. Matthews, W. & Isenberg, G. (in press). Direct and indirect hypnotic inductions with deaf and hearing subjects. International Journal of Clinical and Experimental Hypnosis. Morgan, A. & Hilgard, J. R. (1978). The Stanford Hypnotic Clinical Scale for Adults. American Journal of Clinical Hypnosis, 21, 148-169.
