Book Reviews

A Child in Pain

Kuttner, Leora. (2010), A Child in Pain: What health professionals can do to help
Carmarthen, Wales: Crown House Pub. Ltd.

Book Review by David M. Houghton published in Autumn 2011 Newsletter

Written by a paediatric clinical psychologist, this is a valuable resource for health care professionals working with children. It comprises three sections: Part 1- how to understand, assess and communicate with a Child in Pain, Part 2 – psychological, physical and pharmacological treatments of pain, and Part 3 – pain and anxiety management in paediatric practice.

In Part 1, an illuminating first chapter discusses insightfully pain in children’s lives, followed by three clearly written chapters on how pain works, communicating with children in pain, and methods of assessing and measuring pain in infants, toddlers, pre-school and school-aged children, and teenagers. The chapter, How Pain Works, provides a straightforward and informative account of the process, including Melzack’s neuromatrix theory of pain. Following chapters provide a rich source of ideas for ways of communicating with children in pain and for assessing and measuring that pain.

Part 2 describes creative and useful ways of relieving pain psychologically (including hypnosis) and physically. A chapter is devoted to each of psychological, physical and pharmacological methods of relieving pain in children. The discussion of hypnosis and imagery might have been strengthened by reference to recent findings in the neuroscience of hypnosis. That might have provided a useful validation of the effectiveness of hypnosis both in itself and in preference to the use of imagery per se.

The final chapters, comprising Part 3, focus specifically on the management of children’s pain and anxiety in hospitals and in the surgeries of physicians and dentists. Leora Kuttner calls attention to important differences between fear and anxiety when considering their part in children’s expectations of medical and dental procedures and treatments. Her suggestion, that child, parent and health care professionals should function as a team, is a message that needs to be heard across the health care fraternity. Throughout, the book provides a holistic approach to understanding and treating pain in children. This is signalled in the opening pages (p. x): “Today a child’s pain (particularly the more complex and chronic pains of childhood) cannot be properly appreciated or treated without applying a biopsychosocial model that incorporates all aspects of the child’s world.” The interrelationship between the psychological and physiological facets of pain and its effects on the experience and treatment of children’s pain are clearly described. The book is replete with practical suggestions for identifying and treating children’s pain experiences, and which acknowledge children’s developmental differences and needs. Leora Kuttner writes (p.7): “... breakthroughs in scientific research have increased our understanding and treatment of childhood pain. The goal of this book is to make this information easily accessible to those working directly with children.” By the end of the book, in scholarly, informed exposition and readable prose, she has achieved that goal. Anyone working in health care with children in pain, and some parents of those children, would benefit from having it on their bookshelf. 7th June, 2011

The Art of Therapeutic Communication

Thompson, Kay. (2004) The Art of Therapeutic Communication Crown House Publishing Ltd. ISBN: 190442428-7

Review by Ann Williamson published in Oct 2012 Newsletter

This is a book which contains many pearls of great price – Kay Thompson was a great teacher, wordsmith and therapist and this collection of her writings, workshop extracts, presentations, vignettes and tributes from eminent therapists in the hypnosis field is a fitting memorial to her.

I so thoroughly agree with so much that Kay says; that hypnosis is “an interpersonal communication in which the hypnotist would utilize the client’s own resources to promote behaviour change”, and that the hypnotic ability of the client is in large measure related to motivation. I also wish that all therapists would, like Kay, not “utilize others’ predetermined approaches like frozen entrees” as although she “may start with the same cookbook” she “must work with the ingredients on hand” and “have a taste for what is simmering with this one patient, different from any other” that demands “a new adaptation of any recipe.”

When talking about inductions Kay believed in trusting the unconscious to find the words she needed. But whilst trusting her unconscious, study and practice underpinned all that she did. By using the internal question “Why did I say that?” after for instance suggesting a hand getting lighter and lighter and then responding out loud “So that your fingertips will rise off your leg” and repeating this “Why? – So that” pattern, not only is the patient motivated to respond but fluency develops in the therapist.

I love Kay’s description of alert trance as a “bright-eyed bushy-tailed” trance (as opposed to a calm relaxed state) and I love her examples of playful word play. And it really is play – having that flexibility that so many of us begin to lose as we grow older and wiser.

There are many varied and vivid metaphors in this book, some short, some long. My favourite is of the small flower found on a mountain climb at lunchtime. Telling stories involves the listener almost despite themselves, bypassing any resistance and there are nice examples of Kay using conversational inductions. Kay regarded metaphors as a vehicle that had to be adapted to each client’s needs to engage with their unconscious resources.

Kay’s work with pain features in several chapters and the one phrase I will take with me and remember to use is “when everything that can be done and should be done has been done then there is no longer any reason to have the pain”. She shows teaching a patient to separate hurt from feeling and showing them that they can have far more control than they thought possible over their pain. An effective phrase she uses with those clients who are afraid to trust themselves to let go conscious control is “When you really have control, you don’t need control because if you have control, you can get it back whenever you want it. It’s only when you don’t have control that you have to have it all the time, because if you lose control when you don’t have it, you won’t be able to get it back”. She had an elegant way of protecting a patient from inappropriately removing pain by saying “You can be pleasantly surprised at how comfortable you will be as long as normal healing is progressing.”

Kay challenged assumptions such as posthypnotic suggestion only being that given formally in trance to be carried out after trance was terminated. She had a much broader view that “the patient might accept anything we say as a posthypnotic suggestion” that “Everything you do or say is in fact a posthypnotic suggestion” and that all the work the patient does at home on the material they have been dealing with during the session is in fact a posthypnotic suggestion. Kay firmly believed that to be therapeutic, whether in formal or informal trance, conversation with a client needed rapport, motivation and expectation, and an ethical background of confidentiality and respect for the client. She endeavoured to teach this both through her writings and presentations and by an example that we would all do well to follow. Practice, patience, creativity and commitment – “I am not what I was, nor am I what I will be, but I am becoming, satisfied with the moment and the movement.”

Beliefs – Pathways to Health and Wellbeing

Dilts, Robert., Hallbom,Tim., Smith, Suzi. (2nd edition 2012). Beliefs – Pathways to Health and Well-being
Crown House Publishing Ltd. ISBN 978-184590802-7

Review by Greta Ross MB BS, MRCGP., published in October 2012 Newsletter.

The key to this book is in the title: ‘beliefs’, for it is through our personal beliefs about the world that we interpret our place in it and our relationships within it. The degree of skill in “managing” our beliefs affects the degree of personal control with which we react to events and interact with people (and hence manage change). The skill described in this book is mainly (but not exclusively) NLP.

Negative belief systems and ‘interference’ beliefs limit and unconsciously sabotage growth and fulfilment, so, identifying these obstructive beliefs and learning how to deal them becomes the key to effective change. The book takes the reader through a discussion about different belief types with case illustrations, anecdotes and transcribed workshop therapy demonstrations, together with follow-up questions and answers. The examples are detailed, very readable, and the book certainly offers strategies and reframing techniques that can be applied to any ‘non-NLP’ clinical hypnosis work. Many of the approaches in the case histories in fact demonstrate a combination of ‘traditional’ Ericksonian hypnosis and ‘traditional’ NLP, and the inference is that the two, in fact, overlap and are synergistic.

As Dilts says in his introduction, “the primary purpose of the book is to provide the “how tos” of belief change”, and this book can thus be looked upon as a ‘descriptive workshop’. It is easy to read and is intended for a wide readership, ie learners new to NLP and change management, and not just experienced practitioners; however it does not exclude the general public, and in this way the book may encourage some individuals to seek further professional help from hypnotherapists. I found the book an interesting ‘workshop/seminar’ and a refresher on the importance of uncovering those deep, obstructive beliefs that can get in the way of success in therapeutic work.