Hypnotic strategies utilizing transitional objects as a means of fostering internalization & self soothing
The therapist trance as a generator of
associative techniques in therapy
J. Shaul Livnay (Weisbrot) PhD
Upon perusal of the literature, I came upon Jordan Zarren’s use of the marble as an induc- tion technique (Zarren & Eimer, 2002). As I began using the induction, I found it extremely useful, as it seemed to touch much deeper levels of meaning. The marble seemed to func- tion as a transitional object (Winnicott, 1953), enabling the patient to “take the therapist in his pocket or her handbag”. Thereby, the patient was able to internalize therapeutic sug- gestions, aspects of the patient-therapist relationship and to enhance a sense of control, as well as developing his or her capacity for self soothing. This seemed to provide a useful mode for furthering progressive autonomy in the patients .
When I come upon a new technique or approach (similar to a child, upon learning a new word, begins to try it all of the time, in over-inclusion), I tend to try it out frequently, with many different patients and in different situations, Through this process, I thereby begin to discriminate for whom does it apply, for whom it is positive and beneficial, and how does it foster independent use (self hypnosis)?
Zarren (2002) emphasizes that the use of the marble involves both the visual and the tactile-kinesthetic modes of information processing. He contends that the latter is especially useful in dealing with physical and medical problems, enabling externalization of the bothersome phenomenon (whether a drug side-effect, pain, or other physical discomfort). Foremost, he emphasizes the capacity to create significant relaxation, and through practice, to create an instant anchor to relax by just squeezing the marble. He reminds us that many cultures have incorporated similar stimuli, such as worry beads!
While Zarren emphasized the role of externalization, I became impressed with the potential of internalization. The wonder of our Hypnosis community is that each practitioner adds something new (value added!) to what he or she was exposed. Likewise, I began to add more elements to Zarren’s script: I introduced an auditory element in the form of the sound (shhhh....), emphasizing the voice of the primary caretaker during childhood, the latter becoming a further anchor for self-soothing! Furthermore, I introduced a second phase following the phase of relaxation. I suggested that the marble (similar to our smartphones) has a built in compass, to help negotiate our way ahead through various issues at hand. I remind the patient of the American expression: Hey man, have you lost your marbles? insinuating acting "crazy", losing one’s balance, and translating this into Hebrew as misplacing the north! "In this way, your marble can serve as a guide to help you find your way ahead in issues that emerge each time you practice".
As I emphasize internalization, it is time to inspect the writings of Winnicott (1953) the introducer of the concepts of transitional object and transitional space.
Winnicott described the object as the first not-me possession, within an intermediary area between oral satisfaction (fingers, fit in mouth) and true object relation (ie. teddy bear). He contended that the substance of illusion becomes the basis for future fantasy and creation. A personal pattern is developed. While thumb sucking, an external object (such as a sheet or a blanket) is taken into the mouth (ie. Linus’s security blanket: Peanuts). It is held or sucked. there is plucking and collection of wool for caressing, with mouthing along with babbling. These transitional phenomena are vital for going to sleep and reducing anxiety as well as dealing with loneliness. The soft object becomes a transitional object. The parents begin to recognize this and to keep it around. A word may be given for the object.
Winnicott delineates the special qualities in the child’s relationship to the object. There is an assumption of rights with an abrogation of impotence. It is affectionately cuddled, excitedly loved and mutilated. It must never change. It must survive instinctual loving & hating. It must seem to give warmth, move, have texture that seems to have a vitality of it’s own. It is not an hallucination, it doesn’t seem to come from without or within. In time, it fades away & loses it’s meaning.
The following is especially relevant for us as hypnotherapists: Winnicott furthermore introduced the concept of good-enough mothering. Devotion is an essential basis. There is an active adaptation to needs which gradually fade along with the child’s tolerance of frustration. There is movement from illusion to disillusion. The child’s experience is retained in creativity, religion and in the arts.
Next, Winnicott defines transitional space. The mirroring and holding by the mother serves as a container wherein the infant feels safe and powerful enough to develop a stable self. The impression is created that he is safe and has the power to create something: a potential space where self & others meet. Fantasy and reality overlap, forming a basis for play and creative development. It seems obvious that the trance state serves exactly as such transitional space!
The present use of the marble
As remarked above, I tend to use the marble frequently in the early stages of the hypnotherapeutic process.
I find it to be helpful to introduce the experience of trance state. The very combination of accessing the visual, auditory and kinesthetic modes of a patient’s experience provides a solid and steady base. Furthermore, it provides access to developing both "negative" and "positive" anchors: the initial stage of transferring unwanted emotions and sensations (anxiety, stress, pain etc.) is "conditioned" by squeezing the marble within the fist. The second stage of using the compass to negotiate one’s way, consolidating positive resources and ego strengthening, is conditioned as well.
I begin by inviting the patient to select a marble from a clear jar containing a wide collection of marbles. I observe the selection process: what is the section style like? Impulsive, obsessive, etc. Once having chosen a specific marble, the patient is invited to inspect the selection: the color, composition, texture and so forth. The patient is encouraged to bring the marble as close to the face as is comfortable, to induce eye fixation. With pacing and leading, the patient is invited to close the eyes once signs of tiredness, heaviness of the eyelids appear from prolonged staring. Next, the marble is taken into the palm of one of the hands, which is rested in the lap. The patient is invited to then track the process of the transfer of disturbing, undesirable contents (sensations, emotions, anxiety, tension etc.) from their base (head, throat, chest, stomach etc.) across to the shoulder, down the arm until reaching the marble lodged "safely and securely" in the hand. The patient is encouraged to concentrate upon the flow into the marble, with mentions of the marble’s capacity to absorb as large a quantity as is necessary. Such a small object is capable of absorbing so much, a pure example of nano-technology! The content of the flow usually consists of different forms of anxiety or pain, emotions or physiological processes. This stage can take quite a while, so patient is encouraged to continue until all or most of the "substance" is transferred. While the visual and tactile modalities are emphasized, I add the sound "shhh..., a voice and sound which you discovered very early in life from one of your parents, as they attempted to soothe you in times of distress!" This becomes a basis of reinforcing the capacity of self-soothing. Once the signs of relaxation appear and continue (breathing, muscle tone, blood flow), the second stage is begun by the introduction of the compass. Just as in most of today’s smart phones, your marble has a compass integrated within! Remember the American expression have you lost all your marbles? Meaning have you lost your senses? (In Hebrew, it literally means have you misplaced the north, or have you gone crazy!) So following that little needle which is ever searching for the north will next enable you to make your way ahead, according to and within the various issues which might subsequently emerge. And each time you decide to practice with your marble, you’l be able to choose an issue which you need to work on. You will then discover that the compass function within the marble is quite indispensable, allowing you to adjust and regain your bearings. The patient is invited to choose a topic or issue to concentrate and develop during the next few minutes. "That’s right, finding your way to deal with the issue, to make progress"...
Another benefit of the technique is the facilitation to encourage self hypnosis. As men- tioned above, an anchor is provided for it's reuse. During the stage of emergence from the trance state, the post hypnotic suggestions are given to practice at home and at work by repeating the identical procedure used during the therapy session. I do a short review of the procedure at this point, reinforcing the patient's ability to use the marble on their own. Interestingly, though I emphasize at every step of the way " this your marble, the marble you chose", at the end of the same session, almost all of the patients spontaneously go to place the marble back in it's jar. I thereupon re-emphasize that once chosen, the marble is theirs for autonomous use. I have even coined it "the marble-to-go", stating that it's real value lies in the fact that it is so simple to take home (as opposed to the Gong, see Livnay (1995b, 2011) and use on their own.
At the beginning of the following session, I inquire about the way the patient has practiced during the week. If the answer is positive, I get a detailed description of the experience, using the opportunity to reinforce or emphasize various aspects. If the experience has been useful and positive, we discuss how to continue it's application. In case the patient has not found the time or opportunity to practice, we explore the reasons to attempt to de- crease any resistance. Often, this is the point where the patient reveals not remembering what exactly to do. If the inclination to use it is positive, I repeat the procedure, or invite the patient to use it in my presence, by themselves. All of the foregoing is common to any pro- cedure of self-hypnosis. If however the patient raises reservations or reluctance about it's use, I emphasize that many different roads "lead to Rome". We want to find which method of entering trance is most conducive to that particular patient. We increase the motivation. by emphasizing the patient's ability to choose the most suitable approach.
Some clinical examples
Maddy was a young teacher, highly critical of others, and most about herself. She was filled with a self loathing which kept her from getting closer to others. As we began working with the marble, she seemed to internalize a positive, encouraging voice alongside the usual negative voices populating her inner world. I encouraged the co-existence of the dif- ferent voices (live and let live). After a period of working together, her contract in Israel ended and she returned to her home country. She wrote me after a while, remarking that the shhhh had accompanied her all the way home, enabling her to relax and feel better about herself each time that she was overwhelmed by her negative introjects. She met a man whom she eventually married. Her last letter contained a picture of her daughter. Yes, she had dared to become a mother herself, trusting herself to become nurturing and pa- tient. (Would she allow her daughter to eventually play with her marble??)
Ami was an allied professional who had been previously trained by me in hypnosis. He was presently suffering from considerable low back pain as a result of damage to a lower spinal vertebrae. Applying hypnotherapy began to ameliorate his suffering. Beginning to apply the marble technique became especially effective for him. He took to carrying the marble with him all of the time, taking care to squeeze it whenever he felt debilitating pain, with very positive effects.
Yari came in a state of extreme anxiety, which was affecting all aspects of his functioning, to the point of turning absolutely into his symptoms, at the expense of his work and family. Not surprisingly, he turned out to be highly hypnotizable, responding positively to hyp- notherapy. He raised another complaint: extreme itching in his skin. We used to marble quite effectively for the various symptoms of anxiety, while he chose a second marble for his skin affliction, to his complete satisfaction. From then on, he became "two-gun Yari",al- ways carrying his two marbles with him. Just knowing that they were at hand provided the desired effect.
In many cases, the desired effect wears off with time, requiring some « recharging" which adequately serves the purpose. They then go on with their lives, benefiting from having a tool ready at hand. It seems especially useful for those who benefit from a concrete stimu- lus as a useful reminder to continue to internalize the therapeutic effects of the treatment. It should be noted that many patients find it a bit difficult that they emerge from psy- chotherapy sessions without any concrete results. having been offered a marble seems like a very small thing, but serves as a tactile reminder to generalize the therapeutic effects in every day life. One may ask are we fostering dependence upon a concrete object? The patient has the opportunity to take ownership of both the marble (remember the hesitation which I notes above about returning the marble at the end of the session!) and the conse- quences of its use.
Livnay, S. (1995b) The Issues of Using a Gong in Psychotherapy & Hypnotherapy. In Kleinhauz et al (Eds) Jerusalem Lectures on Hypnosis & Hypnotherapy. Hypnosis In- ternational Monographs 1. Munich: M.E.G, 167-180.
Livnay S. (2011) Non-Verbal means to Working Through in hypnotherapy: The Issues Involved in Using a Gong and non-Verbal Methods in Psychotherapy & hypnotherapy. Contemporary Hypnosis 28 (1) 46-61.
Winnicott, D. (1953) Transitional objects and transitional phenomena, International Journal of Psychoanalysis, 34: 88-97
Zarren, J.I., & Eimer, B.N. (2002) Brief Cognitive Hypnosis: Facilitating the change of dys- functional behavior. Springer Publishing Company,