Communication, Observation, Feedback, Nocebo
Natural rapport is a consequence of the unconscious interpretation of the body language expressed between individuals. Observation of our patient is paramount both in and out of hypnosis and feeding back to our patient that we have noticed, and maybe what we have noticed, will also improve rapport. Phrases such as “Yes…that’s right” and “Hmmm” can be useful!
One could say that our language expresses our conscious ‘reality’ whereas our internal imagery and our body language express our unconscious feelings.
If someone is very anxious or in shock, they are already in an altered, semi-hypnotic or emotional state where they are more suggestible and your words may be more powerful than you think.
Anything an anxious patient can see or hear is communication, even if it’s not directed at them and if two interpretations are possible, an anxious patient will automatically choose the more negative.
Why do you think that is?
First, listen to the recording from Dr Ann Williamson below, based on suggestions from Dr Paul Slater. Notice how you feel when you hear all those words – imagine you’re really there waiting for your operation.
Now, lets think about nocebo.
To avoid negative suggestion, we need to be more careful about the way we say things. We need to focus the patient’s attention on what we (and they) want and we need to remember that when in an altered state we do not process negatives easily. Nocebo is when a benign word can introduce negative effect. It is well evidenced, and yet still its effects are largely ignored.
So, how could you re-phrase these?
- “Just a sharp scratch”
- “I’ll give you some pain killers”
- “Don’t worry…”
- “This won’t hurt”
Useful Links
If this is a subject that interests you, have a listen to the short (<10minute) introduction to word considerations from RCEMLearning, or a slightly longer webinair from BSCAH, together with the NJEM article, and the placebo book.