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62
ERIC
P.
SIMON
AND
MOMQUE
M. CANONICO
anxiety about the
LP.
In
addition, the patient was given posthypnotic
suggestions for comfortduring the
LP.
After the terminationof hypnosis
and at the close
of
this initial session, "safe space" imagerywas obtained
from the patient. She gave
two
examplesof
t h i s ,
one of swimming in the
bay when shewas a chld and a secondof swimming in apool,which she
regularly does in her adulthood. Following the recommendations of
Dash
(1981)
and Simon
(1999))
we believed that obtaining safe space
imagery was important, because it was later incorporated into the hyp-
notic induction during the
LP,
serving to decrease procedural anxiety,
discomfort, and distress.
The
LP
Procedure
Three days after the hypnotic preparation
and
rehearsal, Mary re-
turned to thehospital forher
LP.
Shewas seated on abed, slumped over a
bedside table with her arms on a pillow. The neurologist then mapped
the patient's region for the
LP.
Next, Mary was induced into
very
directed
hypnosis with
minimal
pauses,
using an eye-closure induction followed
by suggestions for relaxation and hypnotic deepening, which took ap-
proximately
10
minutes. During the eye closure induction, Mary again
experienced somedifficultymaintaining focuson the spot on the ceiling,
instead repeatedly turning her attention toward the therapist. Similar to
the previous hypnotic induction, the therapist found it effective to redi-
rect Mary's attention
to
the spot on the ceiling, both with verbal direc-
tions and, especially, nonverbal head-motioning in the direction of the
ceiling.We incorporated ahigh degree of direction and minimizationof
pauses in this procedure, assuming that attentional capacities would
be
quite limited.
In
fact, the longest pause may have been
1
or
2
seconds in
duration. At this time, the therapist signaled the neurologist to begin ap-
plying betadine in the
L4-W
interspace.The circular motions on the pa-
tient's back were hypnotically coordinated with circular pressure ap-
plied to the top of her right hand by the therapist, to suggest that she
could direct and redirect the focus of her attention. Her back was then
numbed with lidocaine, which was cognitively reframed as three mos-
quito bites, as she was told a story of how the sweetest children are the
ones commonly sought after by mosquitoes. Mary elicited a very mini-
mal withdrawal response to the first needle prick and displayed no fur-
ther discomfort from this point through the entire procedure. The
LP
needle was then inserted, and the sensation was framed as pressure
rather than pain. Throughout the procedure, the patient was directed
back and forth, from the sensationsin her back, to the pressurebeing ap-
plied to her hand, to her safe space imageries of childhood and present
day. Similar to the technique of interweaving (Kuttner et
al.,
1988),
this
deliberate switchingwas used to invokepleasant and distractingexperi-
ences fromher past.We did thiswith the hope that it would lead to a pro-
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