I’d helped create the cheeseburger in his imagination, but the boy in front of me appeared to be suffering from an extreme reaction, one that, if allowed to worsen, could have catastrophic consequences.

“STOP IT!” I exclaimed.

Mercifully, he did.  I thought he might have been joking, but Paul looked as frightened as I felt, and he insisted his symptoms had been real—just a real as the ones that had landed him in the hospital many times in his young life.

 

A Layer of Glass

Paul and I sat together, both wrestling with what had happened.  One thing I knew for sure was that he hadn’t feigned the attack. Was Paul’s imagination uniquely powerful? Or was there some kind of power in my suggestion (which seemed unlikely since all I’d done was ask him to think of a cheeseburger)?  Had he thought his way into what appeared to be a near medical emergency?  I considered it, dismissed it, then circled back.  What other explanation made sense?

“Are you okay?” I asked.

Paul nodded. “I’m fine now. But I don’t get it.”

The sum total of my knowledge of hypnosis at that moment was based on what a physician friend had told me.  She’d done workshop training, but hadn’t even used it with her patients yet.  Still, I knew hypnosis can be triggered with imagery.  That idea fit, albeit oddly, with what had just occurred.

On a hunch, I decided to test the possibility that imagery was at play by suggesting that Paul experiment with a different kind of image.

“I’d like to try something, if it’s okay?” I asked.   

He nodded.

“Good,” I began, “Put your hand out, palm up.”

He extended his right hand.

“Now, close your eyes and imagine there’s a glass plate covering it,” I said.  “The glass is pretty thick.”

“Okay,” he said, following the instruction.

“Now, tell me if you feel me touching your hand,” I said.  I brushed his palm with my finger, and he made no response.

“Anything?” I asked.

He shook his head.

I pinched his hand lightly.  “Do you feel that?”

“No,” he replied softly.

I reached into a pocket for my Swiss army knife and folded out its sharp-tipped corkscrew. I applied the tip rather forcefully to his hand.

“How about now?  Can you feel this?”

“No,” he replied even more softly. He was completely calm, breathing easily, showing no sign of the respiratory crisis that had ended just minutes earlier.   

I was vaguely familiar with the phenomenon of kids who can use this kind of hypnotic technique to help them overcome needle phobia, but I had never seen it in person.  Still skeptical, I asked, “Can you feel this?” and pressed the corkscrew into Paul’s left palm—the one not covered by an imaginary plate.

“Ouch!” he protested, snapping his arm back.

Huh. I asked Paul to open his eyes, and he gave me a glare.    

“You really didn’t feel it when I touched your right hand?” I asked.

“No,” he replied.  “No, but you hurt my left hand!”

“I’m sorry. Are you okay?”

“It’s no big deal,” he said. “Just thought you’d want to know that hurt. On the left.”

There was no question in that moment, or in the year that followed during my relationship with Paul, that his immune system was abnormal and his allergic response alarmingly intense. But after that day I couldn’t let go of my wonder about what had happened, or the essential question it raised: “If you can think your way into disease, can you think your way out?”  

 

The Next Natural Step

Seeing how amenable Paul was to suggestion, I offered to refer him to a psychologist in my community who could teach him to use hypnosis.  I hoped that instruction might help him learn how to control some of his scary breathing problems.  At the time I didn’t realize Paul’s anxiety was a major cause of his medical issues, or that hypnosis could provide him with tools to better cope with it.   

Paul made it clear he was interested in the hypnosis, but not the referral.

“I don’t want another doctor,” he told me. “I’ve got plenty of those. Besides, I trust you.”

I had no idea if it was possible for me to facilitate hypnosis, but I promised to look into it. I’d majored in psychology in college and was interested, but that certainly didn’t qualify me as a practitioner. I didn’t want to waste Paul’s time or complicate his already troubling issues.

I reached out to Dr. David Keith, a friend and child psychiatrist at my medical center, to ask what he thought of the idea. Dr. Keith was a well-respected clinician who was unconventional in his therapeutic approach, focusing on whole family dynamics rather than individual work with the children in his care. I trusted both his expertise and his instincts.

Because we had done a number of family therapy sessions together for families who had children with cystic fibrosis, as part of my pediatric pulmonary practice, Dr. Keith had frequently observed my interactions with patients and parents.  Afterwards, he’d encouraged me to start providing therapeutic counseling within the framework of conventional medical treatment, which I had done.

When I asked about Paul, he expressed confidence that my experience as a clinician working with critically ill patients would guide me in assessing whether this therapy had value (or not) for my patient. Dr. Keith told me that he felt all good clinicians use psychotherapy as part of their practice, whether they realize they’re doing it or not. He also promised that if hypnosis raised psychological issues that were out of my depth, he’d see Paul himself.

Lastly, he suggested that learning more about hypnosis would likely make me a better physician for all my patients, and that it would enhance my communication skills.

With the knowledge that I had well-qualified backup, I told Paul we could work together to find out if he could help himself. I cautioned him that I was not an expert in hypnosis nor psychiatry, saying, “There’s a lot that I don’t know about this.”

“That’s what I like about working with you,” he said with a slight grin.  “I don’t have to worry about you overanalyzing me.”

His enthusiasm and Dr. Keith’s reassurance were enough encouragement.  I bought and borrowed several books on clinical hypnosis and dove in.   

 

Learning to Relax

Paul and I met for the first of many hypnosis sessions with two hours on the clock and uncertain expectations.

Often, the first step of hypnosis is relaxation, and there are many different ways to get there. Slow, deliberate breathing can help. Focusing inward or on a fixed object or location can, too. For Paul’s first session, we agreed that he would think of the most relaxing place he could imagine and I would help him figure out how to get there with hypnosis. After having read a number of techniques, I settled on one that seemed like a simple and logical “recipe” for relaxation.

In my office, I asked Paul to close his eyes, to breathe deeply, and to imagine himself going down a staircase as I counted slowly down from ten. He nodded silently, and I watched intently for any response I could interpret as I slowly spoke the numbers.  I noticed that his facial muscles relaxed when I got to seven, his shoulders slumped at six, and that his eyelids flickered at four. When I got to zero, I suggested to Paul that he had reached the bottom of the staircase where he imagined a door. Behind that door he could find a special place, one that made him feel relaxed and well. Once there, I invited him to describe what he perceived to me.   

In the years since I began practicing hypnosis, I’ve had children tell me their relaxation places are as far away as Mars, Rivendell or Hogwarts, and as close as their own beds or backyards. Many choose the ocean or the mountains. The beach was a particular favorite among my patients in chilly upstate New York. Paul found his hypnosis home on the water. From the first day we practiced, he imagined being immersed in the same scene when he reached the bottom of the stairs. He was alone in a small boat, fishing at the center of a deep, clear lake. When I asked what he could see, he described the glint of the sun reflecting off the blue water. When I asked how it smelled, he said the air was clean, and that he could smell the pine needles on the trees along the shoreline. I wondered if there was anything he could taste and he smiled and said he had a crisp green apple.  Asked what he felt, Paul described a warm breeze, and then, with a slight wave of his hand, he reported that the water was cool—too cold for swimming. He said he could drop a pebble in it and watch the ripples spread across the water toward land.

It certainly sounded like Paul’s mind had conjured a truly relaxing, idyllic place to experience hypnosis. Some kids decide to change their location as they progress in hypnosis, to move on to spaces that better suit their wants, but Paul’s lake quickly became his refuge—a peaceful place where he felt in control of every aspect of his experience.

During that first session, after Paul described what he experienced with all five senses, I talked him through imagining his body relaxing from head to toe.

My goal for this first session was to help Paul feel more capable of managing his own anxiety—to hopefully give him a tool he could use at will to relax. If it worked, I hoped we could move on to controlling his perception of pain in future sessions.

I told Paul he could stay in hypnosis for as long as he liked and to let me know when he was ready to come back by nodding his head. After five minutes, he nodded slowly.

“Great,” I said.  “Let me count you back up the staircase from your lake. By the time you reach the top you can come completely back here.”  As I counted, Paul ascended the stairs slowly, and then opened his eyes without being told to do so.

“What was that like?” I asked.

“It seemed so real,” he exclaimed. “It felt like I was there for hours.”

“Do you feel relaxed?”

He grinned, “I don’t think I’ve ever been so relaxed in my life.”

That’s when I knew something important had just occurred.

Now alert, Paul looked calm and self-possessed—a far cry from the stressed-out young man he’d been in my office during the cheeseburger incident. I praised him for how quickly he’d figured out how to embrace the technique.