Clinical & Experimental Hypnosis: In Medicine, Dentistry, and Psychology, 2nd Edition

5.Suggestibility Tests

There are tests that presumptively can determine the degree of susceptibility to suggestion. Evidence has been presented that a hypnotic induction profile (HIP) has value in predicting hypnotic susceptibility.2,3 Sophisticated hypnotherapists seldom use these, however, as they are time-consuming. Nevertheless, it is a good idea for the beginner to use any one of the following suggestibility tests. If he doubts his ability to hypnotize a patient, under the pretext of testing, he can proceed immediately with an induction technic instead. If hypnosis is obtained, one can say, “I started to test you, but I recognized that you would be an excellent subject. Therefore, I continued hypnotizing you.” Contrarily, this can be a welcome face-saving device for the novice in case hypnosis is not obtained.

THE HANDCLASP TEST

The handclasp test is excellent for quickly selecting suitable volunteers when using group hypnosis. Patients can be either in a standing or a sitting position and are instructed to clasp their hands firmly together, either above their heads or at eye-level. Before beginning, the operator clasps his own hands in the desired manner, explaining where the subjects' hands should be placed. Then they are asked to close their eyes tightly.

The following verbalization is used to determine which subjects will, in all probability, be hypersuggestible: “Please lock your hands tightly together. Press your fingers tighter and tighter together. Imagine, if you will, that your hands are glued together; that they are sticking tighter and tighter together … and the tighter they stick together, the better you will respond to all suggestions. I am going to count slowly from 1 to 10, and with each number that I count, and with each breath that you take, you will find your fingers sticking tighter and tighter together. When I reach the count of 10, if you really wish to follow all other suggestions, you will feel your hands sticking tighter and tighter together. The tighter you can imagine that your hands are sticking together, the better you will be able to follow all other suggestions. Your fingers are locked so tightly that it would be difficult to pull your hands apart.” (Here there is a pause of a second or two.) “Now, your hands are tightly locked together.” If a subject has difficulty in unclasping his hands, this indicates a high degree of suggestibility.

There are modifications of this test, one of which is to have the subject place his hands above his head with the fingers interlocked and the palms facing outward. Either of these methods will test the subject's ability to concentrate, as well as his capacity to respond to suggestion. A direct authoritarian approach or a permissive one can be used. The latter is preferred.

THE BACKWARD POSTURAL SWAY TEST

In the postural sway test, the subject is asked to stand erect with his feet together, his hands at his sides, and his eyes closed. The operator stands behind the subject with the palms of his hands resting lightly on the subject's shoulders. “I am going to count from 1 to 10, and you will feel yourself falling backward, backward. One, you are falling backward, backward. Two, your body is getting rigid from your head to your toes. Three, you are falling backward! Your body feels stiff and rigid. Four, as I relax my hands on your shoulders, you will feel yourself being pulled backward … b-a-c-k-w-a-r-d. Five, you are f-a-l-l-i-n-g … f-a-l-l-i-n-g. …” The hands now can be drawn backward; at this point the subject usually begins to sway backward and, as this occurs, the tempo of the suggestions is increased. “You are falling backward, backward. You are beginning to lose your balance. You're beginning to fall! I will catch you. That's right. Let yourself go.” Naturally, one must be ready to catch the patient as he falls backward. Before beginning the test, have the subject fall backward 2 or 3 times for assurance that he will be caught.

The ease and the manner in which he falls indicates whether or not the subject is trying to resist the operator's suggestions. A good subject will fall backward without any difficulty. By placing his hands lightly on the subject's shoulders, the operator can detect readily the slightest sway of the body. If the subject sways forward when the command to fall backward is given, or vice versa, this indicates either that the subject is not cooperating or that he has much involuntary resistance.

A variation of this test is for the operator to extend his arms, with his fingertips in front of the patient's face, as he stands directly behind the patient. As mention of falling backward is made, the hands are moved forward slowly, producing the illusion in the patient that he is actually falling backward. This modification is especially valuable for resistant subjects.

THE FORWARD POSTURAL SWAY TEST

Like its counterpart, the forward postural sway test is useful for “crossing up” the resistant subject. The verbalization is as follows: “Close your eyes and listen to my voice. If you really wish to go into a nice, deep, soothing, pleasant state of relaxation, you will notice yourself falling, falling forward, forward, forward.” Any slight forward sway indicates positive suggestibility, provided that the movements are not voluntary on the part of the subject. If there is resistance, he will sway backward. At this point, to circumvent patient negativism, one can “reverse the field” and say, “You are falling backward.” If he starts to sway backward, then the operator can remark, “See, you are falling backward.” This increases the subject's suggestibility and also utilizes his resistance to achieve positive suggestibility.

THE EYEBALL-SET TEST

The eyeball-set test is not only a suggestibility test but also an important one for rapid establishment of belief in the operator's “power” or suggestions. The subject is asked to look at a spot directly above his forehead. He is told to stare intently at this spot. The following verbalization is used: “Your eyes are getting heavier and heavier, and the heavier you can think, feel, and imagine your eyes getting, the sooner you will close your eyes. The more relaxed your eyes get, the more deeply relaxed you will become. Your lids are getting heavier and heavier.” If the patient begins to blink, one should say, “Your eyes are blinking, blinking. That is a good sign. It shows that your are beginning to relax. Your eyes are blinking still more, as you relax deeper and d-e-e-p-e-r. I will now count from 1 to 3. Promptly, precisely, and exactly at the count of 3, if you really wish to learn how to relax deeply, you will close your eyes tightly together … One, your eyes feel as though they are closing. Two, your eyes are closing … c-l-o-s-i-n-g. Three, shut your eyes together and let your eyeballs roll up into the back of your head for just a few seconds.” Then the following is said all in one sentence: “You can feel your lids sticking tighter and tighter together, and the tighter they stick together, the better you will be able to relax and follow my suggestions. You can feel your lids sticking tighter and tighter together. See, the suggestions are beginning to work! Your lids are really stuck tightly together.”

This test is actually based upon physiologic factors rather than psychological ones. The patient does not realize that it is extremely difficult to open the lids with the eyeballs rolled back into the head; he thinks that the effect is due to the operator's suggestions. This initiates the compounding of belief into conviction.

Another variation of this test is to have the subject turn his eyeballs upward as far as possible and close his eyes tightly. One can lightly press the forefinger of each hand on the subject's forehead just above the eyes and instruct him to “Look up at the spot where my fingers are placed.” While he is doing this, one suggests, “Keep looking at this spot. You will find that it is extremely difficult to open your eyes now.” Simultaneously, several downward passes over the closed eyes by the open palm reinforce lid closure. If the individual is unable to open his eyes, this generally indicates that he will be an excellent subject. This, in part, together with hand levitation, constitutes the essence of Spiegel's hypnotic induction profile (HIP).3

THE HAND LEVITATION TEST

The hand levitation test can be used not only as a means of determining whether or not an individual will make a good hypnotic subject, but also for the indirect or permissive type of induction of hypnosis by hand levitation. The subject is told: “Place your hands in your lap. Would you mind looking steadily at one or the other of your hands? And as you keep looking at them, you will soon feel some type of sensation in one hand or the other. Perhaps at first it might be a prickly sensation, or a numb feeling, or perhaps one of your fingers will begin to move or separate. Or perhaps one of the fingers may begin to twitch. Do not interfere in any way with the movements of your fingers but simply observe any and every sensation that occurs.” One might remark, “You can speculate about the texture of the cloth of your trousers. Perhaps, as you keep pressing down, you can feel the warmth of your skin. As you keep pressing down and building up tension in your fingers, you may even begin to notice that one of your fingers will move.” Call the subject's attention to even the slightest movement of his fingers. Invariably, some movement of one of the fingers will occur in time. Naturally, the subject does not realize this. To facilitate levitation, one can explain that the finger is beginning to move because it wishes to respond, and that the opposite of tension is relaxation (a perfectly logical remark). “As your finger gets more relaxed, it will begin to rise up into the air” (another logical remark). “As your finger begins to lift, it will get lighter and lighter—so light, in fact, that the other fingers will also get lighter and lighter. See? Your fingers are beginning to lift up, up, up … lighter and lighter, Your hand now is getting lighter and lighter, and pretty soon the arm will begin to get lighter and lighter. And, as the arm gets lighter and lighter, it will lift higher and higher.” The operator continues to suggest lightness, rising, or floating sensations. Then he suggests that the hand will continue to lift until it touches the face. Perhaps the subject might be willing to accept the suggestion that, when any portion of his hand touches any part of his face, this will be a signal that he will drop into a deep state of relaxation. If the rising of the hand is slow, smooth, and steady, this usually indicates that the subject is cooperating. If the hand and the arm are lifted rapidly, or if the movements are spasmodic or jerky, it usually indicates resistance. One should always attempt to correlate the lifting of the arm with the subject's breathing and state: “As your arm lifts higher and higher, your breathing becomes slower, deeper, more regular … slower, deeper, more regular.” If the subject carries out these suggestions and his arm drops back into his lap with a thud after it has touched his face, one can be reasonably certain that the individual will be an excellent subject.

THE HAND-DROP TEST

The hand-drop test is an excellent method of choosing likely subjects from a group. The following instructions are given: “Would you all put your arms out in front of you? Now, close your eyes and visualize in your “mind's eye” or imagine that you have a 10-pound bag of sugar on the back of the palm of your right hand. Now, you can feel it getting very, very heavy. It is so heavy that your right hand is beginning to fall, beginning to get heavier and heavier as the heavy bag of sugar is getting heavier and heavier, very, very heavy.Your right arm is getting very, very tired because it is so difficult to support this heavy weight.” (Positive suggestibility is indicated by the right arm's being well below the other.) “Now open your eyes. See, there is a difference of at least a foot between the right and the left arm.”

THE THERMAL TEST

Even the heat- or the cold-illusion test can be used to predict the degree of suggestibility. An ordinary block of wet wood such as a child's wet alphabet block will suffice for this test. The subject is asked to close his eyes and extend his hand forward, palm down. The block is placed on the back of the palm and, in a confident tone of voice, the operator remarks, “I am placing this ice cube on the back of your hand. It is getting colder and colder. You can feel the chilling, paralyzing numbness of the ice cube as it begins to melt. You can feel your skin getting numb.” The block is then removed. If the individual is convinced that this was an ice cube, he has a high degree of susceptibility.

In order to produce the illusion of heat, one can strike a match and tell the subject, while his eyes are closed, that a quarter or a half dollar is being heated. After a few seconds, the coin is placed on the back of the subject's hand, while his eyes are shut tight. If he winces or withdraws his hand, one can be fairly certain that the subject is susceptible.

This test can also be performed in another manner. The subject is given a coin to hold in his clenched fist. Remark, “The coin is getting warmer and warmer. It is now getting hotter and hotter, and the longer you hold it, the hotter it will get. It is getting hotter all the time. It is actually getting very, very hot. Don't hold it too long as it is apt to burn you. If it gets too hot, let the coin drop to the floor.” If this happens, the subject is obviously a good one. The test can be made more plausible by explaining that the heat of the metal is produced by the sweat of the hand.

THE OLFACTORY TEST

The olfactory test also is an excellent one for choosing good subjects out of a group. For this test, a stoppered perfume bottle, filled with colored water, is used. The operator holds the perfume bottle up so that everybody can see it and, as he takes the stopper out, he says, “The odor of this perfume is drifting toward the back of the room. It is beginning to become more and more pronounced. Will those who smell this odor please raise their hands?” As a rule, those who do so make excellent candidates for hypnosis.

THE KOHNSTAMM “TEST”

The Kohnstamm “test” is actually a maneuver, which produces a favorable mind-set. It involves physiologic muscular mechanisms rather than suggestion per se. It is very convincing and enables the subject to understand the mechanism of arm levitation. The subject is instructed to press the back of his tightly clenched fist against the side of a wall, with his entire arm held very stiff. He is informed that he should try to push against the wall only with his arm and not with his body. After several minutes he is asked to step away from the wall and allow his arm to hang freely at his side. The arm will begin to rise spontaneously until it reaches a horizontal position. It will feel weightless as it is rising. This is known as the Kohnstamm phenomenon. The subject does not know that contraction of the muscles of the arm naturally follows relaxation. He believes that the arm lifts because of the operator's suggestions; this heightens his susceptibility to further suggestions. This is a good technic to employ as a precursor to induction of hypnosis by an arm-levitation technic.

CHEVREUL'S PENDULUM TEST

To perform Chevreul's pendulum test, one must have a heavy ring or a glass ball on a string, which the patient holds in his hand, arm outstretched, over a piece of paper upon which is drawn a circle about 8 or 10 inches in diameter with a cross inside. The subject is told not to make any conscious attempt to help or hinder the movements of the ball (or ring), but that the ball will move spontaneously by just thinking about it. He is informed that the mere concentration upon the ball's moving from left to right, forward or backward, clockwise or counterclockwise, will cause it to swing in accordance with his thoughts.

The subject is instructed to let his eyes travel around the circle, or up and down the cross, or from one side to the other of the horizontal line. It is again suggested that he will not be able to control the swing of the ball. If the ball follows the operator's suggestions, this indicates a positive suggestibility. When the swing is well developed, the subject is asked to concentrate on the ball's swinging in a clockwise direction. After this has been accomplished, it is suggested that it might swing in a counterclockwise direction or up and down. Individuals who are extremely susceptible to suggestion react in full accordance with the suggestions because of involuntary ideosensory activities. This is also the principle of the Ouija board. However, it should be emphasized that, regardless of the degree of his reaction to the suggestions, the subject's suggestibility can be enhanced by remarking convincingly, “Your reaction definitely shows that you will make an excellent subject. I know that you can be hypnotized.”

DISGUISED TESTS

For patients who remark, “I doubt if anyone can hypnotize me,” there is one disguised test that is particularly suitable for the physician's use. If the outcome of the “test” is successful, a favorable mind-set leading to positive suggestibility is produced. This ordinarily facilitates induction.

This disguised test is based on prestige suggestion. When the patient comes into the office, he is immediately given a placebo with the casual remarks: “This drug facilitates hypnotic induction. It takes exactly 30 minutes to act. Let me see, it is now 11 A.M. If you will wait in my reception room for one half hour, you will be ready to go easily into a nice relaxed state at that time.” This, of course, generally produces an expectant attitude, with subsequent hypersuggestibility. In about half an hour, the patient, who in the meantime has been sitting in the reception room building up his expectancy level, comes into the office. Then the right or the left eye is inspected in the following manner: The operator places his thumb just below the outer canthus of the eye to evert the lower lid. With the patient either sitting or standing, he carefully scrutinizes the conjunctiva in a professional manner. After looking intently at the eye for several seconds, he nods his head approvingly and exclaims confidently, “Yes, it's beginning to work. You will be an excellent subject.” The patient naturally does not understand how this conclusion was reached; yet he cannot fail to be impressed by the operator's self-assurance and confident demeanor.

One can use other disguised tests to determine susceptibility to hypnosis. The following one makes use of ideomotor and ideosensory activities. One places the bloodpressure cuff around the patient's arm and remarks, “Now as I relax the pressure and as you hear the air escaping, you will go deeper and deeper relaxed. You will go deeper and deeper relaxed.” (The subject closes his eyes.) “That's wonderful. You are going deeper and deeper relaxed! That's fine.” Now, as the cuff loosens and the air escapes simultaneously, the ideomotor effect of the deflated cuff and the sound of the escaping air (ideosensory) are conducive to even deeper relaxation. Usually, as the pressure falls, a good subject will relax readily. The effects of this test are dramatic.

This test can also be extended into an induction technic: “Now that's fine. I want you to relax still more; you are going deeper and deeper relaxed. As the pressure drops and as the cuff loosens still more on your arm, you are going deeper and deeper relaxed.” Here, one can test for arm catalepsy.

Meares has described an interesting disguised method that is based on the repeated elicitation of the tendon reflexes which, in itself, aids in relaxation.1 The method has the advantage not only of estimating suggestibility, but also of acting as a reliable guide to the best technic for the induction of hypnosis. The patient is unaware that he is being tested for hypnosis. If he proves to be unsuitable, the subject of hypnosis need not be discussed. The patient is not disappointed, nor does the therapist lose face. Since the rapport is not broken, the therapist is free to use another method. The association of the reflex movement of the limb with the verbal suggestions of movement accustoms the patient to the involuntary motions of his limbs in response to suggestion, and so paves the way for hypnotic suggestibility.

SUMMARY

The fact that subjects respond positively to suggestibility tests does not imply that every one of them will enter the hypnotic state. However, where there is no response, this is presumptive evidence of negative suggestibility. Most of these tests depend on elicitation of ideomotor and ideosensory activities and, since hypnosis is contingent on other factors, such as confidence and expectation, all tests have certain deficiencies.

Furthermore, they do not indicate what method will enable the subject to be hypnotized effectively. Also, they give little information as to what may be the deterrent factors contributing to negative suggestibility. Various modifications of most of the above tests have been described by others.1,2,3

If all tests are unfavorable, this naturally interferes with the rapport. Often there is a distinct disadvantage in using tests to determine the subject's degree of susceptibility, because many subjects might have been hypnotized readily without them. However, irrespective of the subject's reactions to the tests, he always should be informed that he responded favorably, and that he will do much better the next time!

Finally, the best test is a trial induction of hypnosis. The preinduction talk, described in Chapter 12, establishes good rapport, particularly if the commonly held misconceptions are removed. Then, too, the suggestibility tests are influenced by the prestige, expertise, confidence, and skill of the operator.

REFERENCES

1. Meares, A.: The clinical estimation of suggestibility. J. Clin. Exp. Hypn., 2:106, 1954.

2. Spiegel, H.: Manual for Hypnotic Induction Profile: Eye-roll Levitation Method. (rev. ed.) New York, Soni Media, 1976.

3. Spiegel, H., et al.: Psychometric analysis of the hypnotic induction profile. Int. J. Clin. Exp. Hypn., 24: 300, 1976.



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