IN ACTION PROFESSIONAL ARTICLE

A RATIONAL EMOTIVE BEHAVIOUR APPROACH TO HYPNOSIS.

DR. STEPHEN PALMER

FIRST PUBLISHED IN THE RATIONAL EMOTIVE BEHAVIOUR THERAPIST, 5, 1, 34-54, 1997.

Copyright, 1999, Palmer

REBT HYPNOSIS: AN ARTICLE FOR USE BY EXPERIENCED PROFESSIONALS ONLY

Stephen Palmer

INTRODUCTION

Most rational emotive behaviour therapists will probably have experienced a client requesting hypnosis. It is likely that many therapists would have either referred the client elsewhere or would have attempted to persuade the client that rational emotive behaviour therapy (REBT) would be more effective (Ellis 1986). Unfortunately, the latter approach can increase the rate of attrition, i.e. early termination of therapy. Obviously, if this occurs then the client is not going to benefit from REBT. When clients have a strong belief that hypnosis will help them handle difficult situations, relieve stress and anxiety or overcome somatic problems unless hypnosis is contraindicated it has been found to be a particularly useful intervention (see Lazarus, 1973; Palmer, 1993; Palmer and Dryden, 1995). Hypnosis has also been recommended as a technique that can be used within rational emotive behaviour stress counselling although it does have limitations (Ellis et al., 1997).

Ellis (1986;1993) has highlighted a number of similarities hypnosis has with REBT. For example, traditional methods of hypnosis usually involve clients being given powerful coping statements whereas REBT shows clients how to dispute their irrational self-defeating beliefs and change them to rational self-helping and constructive beliefs. Both traditional hypnosis and REBT are 'highly active-directive, they emphasize homework assignments and in vivo desensitization and urge clients to actively work against their low frustration tolerance (LFT) and self-defeating behaviours. Because of this degree of overlap between some of the basic theories and practices of REBT and hypnotherapy, Ellis sometimes combines REBT with hypnosis' (Ellis et al., 1997:92). (However, it is worth noting that not all forms of hypnosis encourage clients to work hard or challenge LFT.)

REBT is considered as 'multimodal' in that the approach will, when necessary, flexibly incorporate techniques taken from a range of different therapies to enhance therapeutic outcome. Therefore REBTers may seriously wish to consider using rational emotive behaviour hypnosis with clients having a strong desire to use the technique who would otherwise terminate therapy. This paper gives examples of REBT based hypnosis scripts and provides information about the different stages of traditional hypnosis.

HYPNOSIS SCRIPT

In this section a typical hypnosis script is described and, for convenience, has been divided into the conventional hypnosis stages.

Preparation and Preliminary induction

In the preparation stage, the therapist ensures that the client is put at ease. This may involve answering any questions that the client may have about hypnosis. Typical questions asked are (Palmer, 1993):

What is hypnosis?

How will I know if I've been hypnotised?

Will you take control of my mind?

What will you be doing?

What happens if I don't come out of hypnosis?

Will I tell you all my secrets?

It is useful to explain that hypnosis can be considered as a form of relaxation where the mind is receptive to rational self-helping suggestions. Hypnosis will only occur if clients want it to happen. They will be in control and if they want to wake up they will be able to. They will not reveal any secrets if they do not want to.

At the preliminary induction stage, the client can be told that it is quite normal during hypnosis to feel tingling, warm or heavy feelings in their hands and limbs. It is recommended that the client either lies on a couch or is seated in a comfortable chair with a headrest. The room should be at a reasonable temperature as some clients feel cold during hypnosis (or relaxation). The counselling room preferably needs to be located in a quiet part of the building. It is usually more comfortable for clients if they remove their contact lenses or glasses.

The preliminary induction part of the hypnosis script is designed to encourage a state of hypnoidal relaxation. Whether a 'hypnoidal' state actually exists is debatable. However, this is not relevant as client expectation that hypnosis will prove helpful is probably the most important component in effective hypnosis (see Lazarus, 1973). In the script described, unlike the more traditional methods, the therapist does not 'will' the client to close his or her eyes as this may increase resistance and be counter productive in some cases.

Deepening

The deepening stage of hypnosis is designed to increase the depth of relaxation. The method described later in the hypnosis script uses a counting and breathing technique. This method can be used in most cases except where clients experience breathing difficulties, for example, smokers. In those cases or with clients who can easily visualise scenes, an imagery method may be preferable. If imagery deepening is selected then a particular suitable relaxing scene would need to be elicited from the client beforehand. Imagery that involves the client imagining going down something such as a hill, a lift, flight of stairs, a beach or a country lane is ideal. It is advisable to avoid imagery that may trigger anxiety as this will not help the relaxation process; for example, instructing a client who is phobic of lifts to imagine using a lift.

A typical imagery deepener is described below. It has been found helpful for the counsellor to gently emphasises the trigger words 'DOWN' and 'NOW' as this seems to induce a deeper state of relaxation in clients.

Optional imagery deepener (Palmer, 1993:28-31)

I want you now to imagine that you are at the top of the hill that you described to me earlier

Pause

Just look at the view. Notice the colours of the plants in the fields

Pause

As you look down the hill you can see the cows in the meadow at the bottom of the hill

Pause

You can feel the warmth of the sun on your face

Pause

In a few moments time

Pause

But not quite yet

Pause

You are going to take three steps DOWN the hill, one at a time

Pause

And by the time you take the third step you will be at the bottom of the hill in the meadow

Pause

And every time you take one step DOWN the hill you will feel more and more relaxed than you do NOW

Pause

In a few moments time, you are going to take your first step DOWN the hill, but not quite yet, and when you do, you are going to feel so very relaxed

Pause

Take your first step DOWN the hill NOW

Pause

NOW you are feeling more relaxed than you did a few seconds ago, a few minutes ago, a few hours ago, a few days ago, even a few weeks ago

Pause

NOW that you are one third of the way DOWN the hill, notice how your view has changed

Pause

Take your time and just look at the view that you know so well. And as you look around, notice how very relaxed you are now feeling

Pause

Can you see that you are now closer to the bottom of the hill. Your view of the meadow has improved

Pause

In a few moments time, I'm going to ask you to take your second step DOWN the hill, and when you take that step you are going to feel even more relaxed than you do NOW

Pause

Take your second step DOWN the hill NOW

Pause

NOW you feel even more relaxed than you did a few moments ago, a few minutes ago, much more relaxed than you did a few hours ago

Pause

Your view has altered again as you approach the bottom of the hill. The meadow looks much closer. If you look back up the hill, notice how far away the top of the hill now seems

Pause

Look in the fields at the plants and the cows. Notice the smells of the flowers in the hedgerow.

Pause

You are feeling so very relaxed now, it feels that you are really there in your favourite countryside walk

Pause

In a few moments time, but not quite yet, you take your last step DOWN the hill, and when you do, you will feel so very relaxed when you arrive in the meadow

Pause

Take your last step DOWN the hill NOW

Pause

NOW you are feeling so very, very relaxed. More relaxed than you felt a few moments ago, a few minutes ago, much more relaxed than you felt a few hours ago

(At this point, continue with the ego-strengthening script.)

Ego strengthening

This is the key part of the process where the therapist challenges the client's (previously assessed) irrational self-defeating beliefs and behaviours and inserts powerful rational self-helping statements (see Ellis et al., 1997). It is recommended that the coping statements are targeted directly at the client's irrational beliefs. The script can be altered to take into account any general condition from which the client may be suffering such as migraines etc. It is also useful to reiterate the positive effects of hypnosis outside the therapeutic hour (Palmer, 1993). This may have a beneficial post-hypnotic effect which is an important component of hypnosis.

Coping imagery can be included to help the client to deal with difficult situations such as giving presentations or dealing with phobias (Palmer and Dryden, 1995). Rational-emotive imagery can be used to demonstrate that clients can stand difficult situations and events and how to change unhealthy negative emotions to healthy negative emotions. Forward time projection imagery can be used to highlight that the client can stand current adverse situations and that seldom are events 'awful' indefinitely (Lazarus, 1984; Palmer and Dryden, 1995). However, it is important to select the appropriate imagery technique for a specific problem.

In the script, the 'pauses' help to underscore the ego-strengthening suggestions and enhance their effect (Palmer, 1993).

Symptom removal

The symptom removal stage is used if the client is experiencing difficulty dealing with a particular psychosomatic or physical symptom. If this stage is left out, then the termination script can be inserted at this point. Symptom removal is targeted at specific symptoms the client may be suffering from such as allergies, anxiety, asthma, habits (e.g. over eating, smoking), headaches, insomnia, migraine, pain, panic attacks, phobias, tics, skin disorders, and speech disorders etc. (Palmer, 1993). The script illustrated in the text may help with the alleviation of migraine and tension headaches. Hartland (1971) can be consulted for a wide range of symptom removal scripts.

When dealing with clients with so called symptoms of stress or physical pains it is important to ensure that the client does not have an underlying organic condition. An appropriate referral to a medical practitioner may be necessary.

Termination

The termination stage is the last part of the hypnosis procedure. If clients open their eyes before hypnosis script has been completed then they are asked to close their eyes and the termination stage is executed.

Debrief

It is useful to discover what the client thought and felt about the experience and to answer any queries that may have arisen during the session. If the client wants to receive hypnosis again in a later session then it is useful to ask whether he or she would like any part of the script altered.

HYPNOSIS SCRIPT

Preliminary induction (adapted Palmer, 1993:33-6)

Can you make yourself as comfortable as possible in your chair

Pause

And if you would just like to close your eyes

Pause

If you would like to listen to the noises outside the room

Pause

And now listen to the noises inside the room

Pause

These noises will come and go probably throughout this session and you can choose to let them just drift over your mind and choose to ignore them if you so wish

Pause

You will probably notice how these noises and the sound of my voice will become softer and louder and softer again during this session. This is quite normal and will indicate that you are in a state of hypnosis

Pause

Let your whole body go limp and slack

Pause

Now keeping your eyelids closed and without moving your head, I would like you to look upwards, keep your eyes closed, just look upwards

Pause

Notice the feeling of tiredness, sleepiness

Pause

And relaxation

Pause

In your eye muscles

Pause

And when your eyes feel so tired, so very, very, tired, just let your eyes drop back DOWN

Pause

Notice the feeling of tiredness, sleepiness and relaxation in your eyes

Pause

Let this travel DOWN your face to your jaw

Pause

Now just relax your jaw

Pause

If your teeth are clenched, then unclench them

Pause

Now relax your tongue. If it's touching the roof of your mouth then just let it fall down

Pause

Let the feeling of relaxation slowly travel up over your face to your forehead

Pause

To the top of your head

Pause

To the back of your head

Long pause

Then slowly DOWN through the neck muscles

Pause

and DOWN to your shoulders

Long pause

Now concentrate on relaxing your shoulders, just let them drop DOWN

Pause

Now let that feeling of relaxation in your shoulders slowly travel DOWN your right arm, DOWN through the muscles, DOWN through your elbow, DOWN through your waist, DOWN to your hand, right DOWN to your finger tips

Long pause

Now let that feeling of relaxation in your shoulders slowly travel DOWN your left arm, DOWN through the muscles, DOWN through your elbow, DOWN through your wrist, DOWN to your hand, right DOWN to your finger tips

Long pause

And let that feeling of relaxation in your shoulders slowly travel DOWN your chest right DOWN to your stomach

Pause

Notice that every time you breathe out, you feel more and more relaxed.

Pause

Let that feeling of relaxation and tiredness travel DOWN from your shoulders DOWN your back, right DOWN through your back muscles

Long pause

Right DOWN your right leg, DOWN through the muscles, DOWN through your knee, DOWN through your ankle

Pause

To your foot, right DOWN to your toes

Long pause

Let the feeling of relaxation and tiredness now travel DOWN your left leg

Pause

DOWN through the muscles, DOWN through your knee, DOWN through your ankle

Pause

To your foot, right DOWN to your toes

Long pause

I'll give you a few moments now

Pause

To allow you to concentrate on any part of your body that you would like to relax even further

15 second pause or longer if necessary

Deepening (adapted Palmer, 1993:36-8)

I want you now to concentrate on your breathing

Pause

Notice how every time you breathe out, you feel more, and more, relaxed

Pause

With each breath you take you feel so relaxed, so very, very relaxed

Pause

Breathe in slowly through your nose and slowly out through your mouth

Pause

With each breath you take

Pause

Every time you take a new breath of air

Pause

You are becoming more and more relaxed

Pause

Gradually you are drifting away as you become more, and more,

relaxed

Pause

On every out-breath you are becoming more, and more, sleepy

Pause

More and more deeply relaxed

Pause

Notice how, as you relax, you are breathing more, and more, slowly

Pause

And more, and more, steadily, as you become more, and more, deeply, very deeply, relaxed

Pause

You are drifting DOWN into a deep state of relaxation

Pause

Your whole body is becoming more, and more, relaxed, every time, you breathe out

Pause

I'm slowly going to count to five, and as I do, you will feel even more relaxed than you do now

Pause

One

Pause

NOW you are feeling more and more relaxed than you did a few minutes ago. More and more relaxed than you did a few seconds ago

Pause

Two

Pause

Notice how you are feeling so relaxed, that you are finding it so difficult to concentrate on my voice all the time

Pause

Three

Pause

NOW every time I say a number, every time you breathe out, you feel more and more deeply, very, very deeply relaxed. An overwhelming feeling of tiredness and relaxation is descending upon you as you listen to my voice

Pause

Four

You are feeling even more relaxed NOW than you did a few minutes, a few seconds ago. In a moment when I say the number five, but not quite yet, you are going to feel so very deeply relaxed...

Pause

Five

Pause

NOW you feel even more relaxed than you did a moment ago, more relaxed than a few seconds ago, much more relaxed than you did a few minutes ago, and very much more relaxed than you did a few hours ago.

Pause

Ego-strengthening (adapted Palmer, 1993: 38-41)

You are now so relaxed, so very relaxed, that you are becoming very aware of what I am saying to you

Pause

You are so aware that your mind is open to any positive suggestions I may make for your benefit

Pause

You are feeling so relaxed that when I make positive suggestions about your health, you will accept these suggestions, and gradually over a period of time you will feel better and better, even though you will not be here with me

Pause

My suggestions will just drift over your mind and you will be able to remember all the relevant ones that will influence your feelings

Pause

Your thoughts

Pause

And your behaviour

Pause

As you feel more and more deeply relaxed during this session, you will find new energy to help you cope with any problems you may have had recently

Pause

New energy to lessen any fatigue

Pause

New energy to help you concentrate on your goals

Pause

A new strength of mind and body to deal with internal and external pressures

Pause

Gradually, you will become absorbed in life again, looking forward to every day

Pause

An as every day goes by, you will become more relaxed, and much calmer than you have been for some time

Pause

And each day, you will feel far less tense, and far less concerned with unimportant matters

Pause

And as this happens, your confidence will grow as your old fears become a distant memory

Pause

Week by week, day by day, hour by hour, minute by minute, second by second, your independence will grow

Pause

Any anxiety or depression or guilt or stress will fade away as you learn to cope with life

(NB Target relevant emotion or physical state according to the client's presenting problem.)

Pause

You will be able to stand difficult situations much more easily

Pause

You will no longer hear yourself saying 'I can't stand it', but instead you will realistically say to yourself, 'It's unpleasant but I CAN STAND IT'

Pause

As you learn that you can stand situations, you will procrastinate less often and you will be able to start and continue your tasks more easily

Pause

You will question whether things are really awful. They may be bad but are they really awful?

Pause

As you realise that you can stand situations, and that things are seldom awful, you will be able to face your fears much more easily

Pause

If you fail at a task, you will not condemn yourself as a total failure or stupid

Pause

All it means is that you did not achieve your target

Pause

No more, no less

Pause

You will learn to accept yourself more for the person you are and not just for your achievements

Pause

Your internal demands, many of those unnecessary, inflexible musts and shoulds

Pause

Will change to preferences and coulds and subsequently your anxieties will lesson

(Target relevant emotion according to the client's presenting problem.)

Pause

Gradually, as time goes by, you will feel better and better and your life will improve

Pause

And your recent worries will be a thing of the past

Pause

And you will be able to put them behind you

Pause

An example of symptom removal (adapted Palmer, 1993: 42-3)

Day by day, week by week, month by month

Pause

As you become much more relaxed

Pause

And far less tense

Pause

Gradually, the tension in your shoulders

Pause

And in your neck will fade

Pause

You will stand and sit in a very relaxed manner

Pause

And as you do, you will feel so comfortable that any pain will become a distant memory

Pause

If you concentrate now on your face

Pause

On your head

Pause

And on your neck, notice how, as you relax even further

Pause

Gradually your head and face, are starting to feel warm

Pause

As this feeling of warmth increases, you are starting to feel even more relaxed than you did a few minutes ago

Pause

And day by day

Pause

As you feel less tense, in your body and mind, this state of relaxation will help to prevent headaches occurring

Pause

And as the pain is normally related to stress and tension

Pause

Day by day, as you become more relaxed

Pause

And less tense, the pain will diminish

Pause

And if you ever feel the headache returning

Pause

You will be able to sit down, relax your shoulders

Pause

Relax your neck muscles

Pause

Relax your face and head

Pause

And the pain will just drift away

Pause

Termination (adapted Palmer, 1993: 43-4)

In a few moments' time, but not quite yet, I am going to count to three, and when I do, you will open your eyes and wake up, and feel relaxed and refreshed

Pause

You will be able to remember or forget whatever you want to of this hypnosis session

And you will be in full control of your body and mind

Pause

And wake up today on (insert here: day, time, location)

Pause

As I count to three, you will wake up

(NB Counsellor starts to speak louder with each subsequent number)

Pause

One

Pause

TWO

Pause

THREE

Pause

Open your eyes in your own time

ANOTHER EXAMPLE OF AN EGO STRENGTHENING SCRIPT

It is recommended that the ego strengthening part of the script is adapted according to the problems that the client is suffering from. The following example is from a paper Ellis (1986) wrote about a female client with borderline personality disorder suffering from anxiety about anxiety and a range of other problems. Only a section is included just to illustrate how REBTers can be creative and strongly dispute irrational beliefs during hypnosis:

'Nothing will kill me. Anxiety won't kill me. Lack of sex won't kill me. There are lots of unpleasant things in the world that I don't like, but I can stand them, I don't have to get rid of them. If I'm anxious, I'm anxious - too damn bad! Because I control my emotional destiny - as long as I feel that I don't have to do anything, that I have to succeed at anything. That's what destroys me - the idea that I have to be sexy or I have to succeed at sex. Or that I have to get rid of my anxiety.' In your regular life, after listening to this tape regularly, you're going to think and to keep thinking these things. Whenever you're anxious, you'll look at what you're doing to make yourself anxious, and you'll give up your demands and your musts. You'll dispute your ideas that 'I must do well! I must get people to like me! They must not criticize me! It's terrible when they criticize me!' You'll keep asking yourself 'Why must I do well? Why do I have to be a great sex partner? It would be nice if people liked me, but they don't have to. I do not need their approval. If they criticize me, if they blame me, or they think I'm too sexy or too little sexy, too damn bad! I do not need their approval, I'd like it, but I don't need it. I'd also like to be unanxious, but there's no reason why I must be. Yes, there's no reason why I must be. It's just preferable. None of these things I fail at are going to kill me.'

'And when I die, as I eventually will, so I die! Death is not horrible, it's a state of no feeling. It's exactly the same state I was in before I was born. I won't feel anything So I certainly need not be afraid of that!'....

In commenting about whether hypnosis helped the client, Ellis stated that the client believed that she made greater progress using REBT hypnosis than she had previously made in REBT. Ellis also agreed with her findings (see Ellis, 1986).

Ellis has found that the depth of the trance achieved by his clients made little difference to the effectiveness of hypnosis. Therefore a deep trance state may be unnecessary and in some cases counterproductive if the client does not concentrate on the ego strengthening stage. It is recommended that clients record the hypnosis session and regularly listen to the tape at home. Ellis encourages clients to listen to the tapes on a daily basis for one or two months to enable the REBT messages to get through (Ellis, 1986; 1993). Ellis often only uses hypnosis for a single session. Wherever possible, Ellis prefers not use use hypnosis at all, but will use it with REBT if necessary. He stated in an interview: 'When people ask me for hypnosis I often talk them out of it. Why? Because they have usually read somewhere that it does magic and it will help them enormously with very little work on their part. I therefore try to help them see that this isn't so and try to get them to use REBT without hypnosis' (Dryden and Ellis, 1995:49).

INDICATIONS AND CONTRAINDICATIONS

Hypnosis is indicated for a wide range of unhealthy negative emotions, psychosomatic and stress-related disorders, including anger (damning), anxiety, asthma, allergies, behavioural problems (e.g. smoking, tics, over-eating and weight control), blushing, common and classic migraine, depression, guilt, hurt, hypertension, insomnia, irritable bowel syndrome, pain, phobias, physical tension, shame, skin disorders, (e.g. eczema), stress, speech disorders (e.g. stammering) and tension headache (see Hartland, 1971; Palmer, 1993; Palmer and Dryden, 1995).

Hypnosis has been used since the turn of the century, if not longer, for 'shell shock' or 'traumatic neurosis' (see Edgell, 1926; Pfister, 1917). These conditions are now commonly known as post traumatic stress disorder (PTSD). However, research indicates that hypnosis may not be the intervention of choice for PTSD as cognitive restructuring by itself or combined with exposure is more effective (see review in Penava et al., 1995). Interestingly, supportive therapy is the least effective intervention whereas brief psychodynamic therapy is on a par with hypnosis. More research is needed in this area because it is possible that if the hypnosis included imaginal exposure/implosion and REBT restructuring methods, then the technique would be more effective. A similar but less directive method has been discussed elsewhere (Moore, 1993).

Palmer and Dryden (1995) caution against using hypnosis if the client is under the influence of drugs or alcohol. Hypnosis is contraindicated in clients suffering from severe psychiatric disorders. It is not recommended for hysterical and conversion reaction symptoms unless the client is also receiving therapy to resolve any underlying conflicts. Palmer and Dryden also suggest that care needs to be taken when using hypnosis with clients who suffer from asthma, epilepsy or narcolepsy as hypnosis (or other forms of relaxation) may in rare cases exacerbate the condition.

CONCLUSION

Hypnosis as a therapeutic adjunct to REBT has been found beneficial for many individuals although it does suffer from some shortcomings (Ellis, 1986). Depending upon how it is applied, the key disadvantages are that hypnosis:

1) is not considered an elegant intervention from a REBT perspective

2) does not necessarily help clients to think for themselves

3) can encourage magical thinking

4) may reinforce low frustration tolerance (LFT) i.e. life should be easy, etc.

5) and may discourage hard work and practice.

Although one of the goals of therapy maybe to help clients shift from being LFTers to HFTers, in other words, to have a high frustration tolerance (HFT), if the only intervention applied is REBT hypnosis, then in my experience, clients may only become MFTers (moderate frustration tolerance). However, taking a pragmatic stance, as some clients find hypnosis advantageous and in certain circumstances it may reduce rates of attrition, then the technique may be worth using under appropriate supervision. Ellis and associates conclude (Ellis, 1997:97): Hypnosis is by no means an elegant therapy, but when combined with REBT it can significantly help clients who resist using REBT's cognitive, emotive and behavioural methods to become less distressed about the stressors in their lives'.

REFERENCES

Dryden, W. and Ellis, A. (1995) Dilemmas in giving warmth or love to clients. In S. Palmer, W. Dryden, A. Ellis and R. Yapp (eds), Rational Interviews. London: Centre for Rational Emotive Behaviour Therapy.

Edgell, B. (1926) Mental Life: An Introduction to Psychology. London: Methuen.

Ellis, A. (1986) Anxiety about anxiety: The use of hypnosis with rational-emotive therapy. In E. T. Dowd and J. M. Healy (eds), Case Studies in Hypnotherapy (pp. 3-11). New York: Guilford Press.

Ellis, A. (1993) Rational-emotive imagery and hypnosis. In J. W. Rhue, S. J. Lynn and I Kirsch (eds), Handbook of Clinical Hypnosis (pp. 173-86). Washington, DC: American Psychological Association.

Ellis, A., Gordon, J., Neenan, M. and Palmer, S. (1997) Stress Counselling: A Rational Emotive Behaviour Approach. London: Cassell.

Hartland, J. (1971) Medical and Dental Hypnosis and its clinical applications. London: Bailliere Tindall.

Lazarus, A. A. (1973) 'Hypnosis' as a facilitator in behavior therapy, International Journal of Clinical and Experimental Hypnosis, 21: 25-31.

Lazarus, A. A. (1984) In the Mind's Eye. New York: Guilford Press.

Moore, R. H. (1993) Traumatic Incident Reduction: A Cognitive-Emotive Treatment of Post-Traumatic Stress Disorder, in W. Dryden and L. K. Hill (eds), Innovations in Rational-Emotive Therapy. Newbury Park: Sage.

Palmer, S. (1993) Multimodal Techniques: Relaxation and Hypnosis. London: Centre for Stress Management.

Palmer, S. and Dryden, W. (1995) Counselling for Stress Problems. London: Sage.

Penava, S. J., Otto, M. W. and Pollack, M. H. (1995) An effect size analysis of treatment outcome studies for post-traumatic stress disorder, paper presented at the World Congress of Behavioural and Cognitive Therapies, July, Copenhagen.

Pfister, O. (1917) The Psychoanalytic Method. London: Kegan Paul.

Stephen Palmer is Director of the Centre for Rational Emotive Behaviour Therapy and Centre for Stress Management, London. He is a Fellow of the British Association for Counselling, an Associate Fellow of the British Psychological Society and the Albert Ellis Institute for Rational Emotive Behavior Therapy in New York and is a certified REBT supervisor. He is a member of the British Society of Experimental and Clinical Hypnosis. He was formerly Vice-chair of the Association of Rational Emotive Behaviour Therapists and recently became a Fellow of the Association.

Correspondence

Centre for Rational Emotive Behaviour Therapy

156 Westcombe Hill

London

England

SE3 7DH

Copyright S. Palmer, 1997.