behavioural strategies

behavioural strategies

Introduction

The case study describes a ten week intervention utilizing Ericksonian approaches to hypnosis in professional sport. The subject was a professional footballer reporting an inability to experience appropriate levels of activation at the beginning of games and a resulting inability to perform optimally.

Activation Activation may be defined as the cognitive and physiological readiness to respond behaviourally to a task or situation3. Further, such states are task specific4. Mental preparation strategies, for example, self-talk or imagery, and behavioural strategies such as pre-performance routines have been seen to help elite performers modify activation and achieve higher levels of performance2.

Hypnosis in sport Hypnosis has been used to moderate and treat cognitive and physiological states in other contexts for example, anxiety-based disorders and depression5 and promotes lasting cognitive, behavioural and psycho- physiological change6. Therefore hypnosis could be a useful tool in the creation and maintenance of positive activation states for peak athletic performance. Yet the use of hypnosis in sport has not been widely accepted by the sporting community7.

Although positive results have been reported through the use of hypnosis in sport, the details of athletes’ experiences have been scant. Much of the recent research has utilized single-subject methodology necessitating standardized delivery of hypnotic scripts. Pates, Oliver and Maynard8 used a single- subject design to show the efficacy of hypnosis in the creation of flow states in golf putting. The study used Jacobsen’s (1929) progressive relaxation followed by Erickson’s staircase script, regression to a peak performance and natural anchoring, a stimulus-response conditioning which may be defined as “pairing associations of internal states with specific external stimuli”9.

Following the session, the participants listened daily to pre-recorded tapes of the intervention. The paper proposed that the athletes would experience an increase in flow and performance and that the single-subject design would show that this was due to the hypnotic intervention. All five participants recorded an increase in flow and performance. They also reported increased relaxation, confidence and focus. Three recorded an increase in feelings of control. All golfers had relatively high handicaps (11-24) and the trials took place in a non-competitive context.

A second study examining three-point basketball shooting10 and utilizing the same procedures and methods also found increased performance and flow in all five participants (collegiate level players), again in a non-competitive environment. Increases in positive emotional states were reported by at least three of the participants. No follow- up assessment was included in either of these studies, so it is unclear whether efficacy was long lasting.

Barker and Jones11 used hypnosis (as well as technical refinement and self-modelling) as part of a single-subject (A-B) experiment to investigate an intervention designed to increase self-efficacy in a cricketer. They reported significant positive effects post- intervention. Further, these increases were recorded as constant in the follow-up data collected seven months later. The cricketer reported pre-intervention concerns of low self-efficacy and negative imagery and subsequently reported a greater belief in his ability and felt that the hypnosis had contributed substantially toward increasing self-belief during training and competition over time. However, even though the athlete stated that hypnosis was helpful, change could have occurred due to the multi- dimensional nature of the intervention.

The golf and basketball papers recorded the effects of hypnosis on a closed skill and in uncompetitive environments, with collegiate and non-elite athletes. It was necessary therefore to look at the same kind of

The Effects of Ericksonian Hypnosis on Activation

States in a Professional Footballer

Andy Flack, Registered Psychotherapist with United Kingdom Council for

Psychotherapy (UKCP)

Abstract

This paper reports a case study of an intervention based on the presuppositions

outlined in the use of hypnosis by Erickson1 in a professional performance environment.

The intervention took place over a ten-week period during the competitive football

season between January and April 2009 with a follow up interview in June 2009. Data

collection comprised open-ended interviews; the Mental Preparation Profile (MPP)2

questionnaire; and utilization of subject and author diaries kept throughout the period

of the intervention. The subject was a professional footballer reporting an inability to

experience appropriate levels of activation at the beginning of games in order to

perform optimally. Post-intervention, the athlete reported significant improvements in

his ability to control and maintain activation pre- and during performance as well as

increased focus, confidence and satisfaction. The study highlighted the possible value

of non-standardised delivery of hypnosis as well as the value of client-led approaches

in psychological intervention over time.

Keywords

Ericksonian, Hypnosis, Activation, Football, Sport

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Case History

The participant was a 20-year-old male footballer in his third professional season. Following two seasons playing in the Coca- Cola Championship he had been signed with a third division league club. He had no experience of psychological support prior to the study. The athlete’s coach was informed about participation. The athlete reported being open and committed to the process. The athlete had been at three different clubs in the past three seasons. The athlete had also been suffering from some personal relationship problems.

Treatment

The initial needs analysis meeting lasted an hour-and-a-half and was conducted using the MPP questionnaire2, as a starting point from which open-ended questions related to emerging themes were asked18. The MPP invites the participant to contrast best and worst performances and to use the information to create an ideal outcome goal for future performances, cognitively and emotionally. It consists of three sections each containing four items. Section one invites the athlete to consider their best performance, section two their worst and section three their ideal future performance. Items are rated on a 10-point Likert-type scale, rating elements such as determination from one (no determination to achieve goal) to 10 (completely determined). Also, athletes are asked to describe self-talk and points of focus in performance.

The athlete’s main goal was to obtain more consistency in performance and implicitly a more positive activation state. Many of the factors contributing to inappropriate activation and poor performance were extrinsic and related to his perceptions of the appraisals of others. If, for example the manager had been critical, the player would feel pressured to prove him wrong which could increase activation, however if that pressure was not present performance could lessen. He was also conscious of the reactions of the crowd, particularly if he

made a mistake. Activation levels were also related to contextual factors such as the importance of a match or the stage of the season and his subsequent perception of his role in the team. He was easily distracted by issues such as training sessions on the day before a game and pre-game warm ups which he felt were too long. Subsequently, he reported focussing on “possible tiredness in my legs” and on other players’ “annoying behaviour”, factors that were uncontrollable. As a result, he experienced inappropriate activation before and during games. Permission and contracting were agreed. The athlete was given a diary and agreed that content could be used as data.

Three initial sessions of hypnosis were conducted weekly, each lasting an hour. Each consultation began with feedback about the previous session and examination of the events of the week in reference to goal development. Sessions were tailored around initial goals (maintaining appropriate activation) while allowing flexibility to take account of current events. Session one was dedicated to increasing the level of rapport1 and to acclimatising the athlete to the hypnotic state, thus gaining informed consent for hypnosis to create a sense of collaboration which may enhance efficacy14. Further, the relaxation response was anchored to the therapy chair in order to increase efficiency and depth of hypnosis in future sessions. The key aims of session two were regulation of the psycho- physiological elements, referring to the optimal patterns of the emotional mix of the identified activation state. The athlete reported feeling anxiety before performing. However, this anxiety could affect him both positively or negatively19. Positive anxiety was described as “fire in my belly”, a somatic state that also involved feelings of anger. Anxiety was seen as negative when attention was on external factors outside of the player’s control and the player wanted to be able to control the emotional mix before games and training. The optimum state was anchored9 to the athlete’s phrases

intervention in a more ecological, competitive context and with a more open skill. Lindsay, Maynard and Thomas12 also used a single-subject design to examine the effects of hypnosis on flow and performance in three elite cyclists. Two male (21 and 32 years) and one female (23 years) completed a single session of hypnosis each, recalling a past optimum performance, followed by progressive muscular relaxation, involving the tensing and relaxing of muscles, while the subjective sensory experiences of the optimum performance, such as “the feeling of the handlebars, the sight of the finish line” (p.168) were related back to them by the hypnotherapist. Some concessions to individualisation were made. Results were mixed: performance measures, highlighted by the increase in British Cycling Federation points earned in races following the hypnosis increased consistently for one of the three participants, sporadically for a second while the third was not influenced at all.

Erickson believed in non-standard delivery of intervention due to the impact of individual differences13 therefore more individualised approaches should be more efficacious. However, each athlete had only one session of hypnosis and a large part of the intervention was still standardised. Also, relaxation was anchored to past performance and this may not have been the appropriate activation state for each individual athlete2. Further, a prerequisite for effective Ericksonian psychological intervention is the quality and intensity of the therapeutic relationship1 and it seems unlikely that this could be achieved in single session.

Barker and Jones14 also engaged in a longer- term hypnotic intervention with a professional footballer also utilizing single- subject (A-B) design with a single participant. The results revealed increases in self-efficacy and positive affect and reductions in negative affect over the course of the intervention, as well as increases in performance. The researchers used ego- strengthening suggestions to enhance self- efficacy and affect.

Outline of Ericksonian approaches The use of hypnosis in sport has been described as “fraught with difficulties” due to a lack of “accurate definition, ground research and applied practice on specific hypnosis theoretical orientations”7 and it is necessary to outline Ericksonian approaches. Ericksonian hypnosis and psychotherapy may be seen as an approach to psychological intervention with its own principles and frameworks1. Erickson believed that over-emphasis on any one theory of psychological intervention led to rigidity of practice and consequently he adhered to no particular theory of psychotherapy or personality. Erickson’s work was therefore highly individualised and client-centred15 and participants were actively involved in the therapeutic process7. Also, he stressed the importance of building a strong therapeutic alliance1, developed through continuous assessment5. Hypnotic intervention is therefore an ongoing, flexible and adaptable process. Ericksonian post-hypnotic suggestion is less authoritarian than that of traditional hypnosis and is characterised by invitation, questioning and the use of narrative and metaphorical approaches rather than authoritarian commands16. Therefore, flexibility is applied throughout the intervention, with precise knowledge of situational circumstances prioritised over generalizable scientific knowledge17 and interventions are not completely pre- determined13 but created with reference to feedback and original client goals. Therefore, the initial client goal of creating appropriate activation states was considered to be starting point and throughout the 10- week process themes developed which became the foci of the interventions.

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Table 1.

Outline of the 8 session intervention.

Session number Session Content Session goal

Intake interview Semi structured interview. Clarify outcomes. Needs analysis.

Hypnosis session 1 Relaxation and anchoring. Rapport building and acclimatisation to hypnosis.

Hypnosis session 2 Metaphor and indirect suggestion Emotional regulation. for anchoring positive emotional states.

Hypnosis session 3 Metaphor and indirect suggestion Regulation of control for internal loci of control and schemas and concentration. increased focus. Anchors linked to pre-performance routine.

Mid-session interview Updating goals and needs. Clarification of well- Consideration of efficacy. formed outcomes.

Hypnosis session 5 Revivification and anchoring of Reiteration of gains positive past performance states. and anchors.

Hypnosis session 6 Metaphor and indirect suggestion Systemic considerations. around role clarity.

Concluding interview Semi structured interview. Assessment of efficacy.

Results

Post-intervention interview The post-intervention interview was conducted using the MPP2 questionnaire as a starting point, as had been the case during the needs analysis. The interview lasted two hours. The core category identified from needs analysis was consistency of activation state. The athlete reported increased consistency and control over performance and cognitive and physiological aspects of activation state. Further, he reported increased focus, satisfaction and confidence. He described a conscious awareness of the use of anchors to associate pre-performance

routine with channelling attention to relevant tasks. For example, putting on the left boot became associated with “tricks and dubs” and using both feet, while putting on the right became associated with speed, skill and power. Implicitly, these strategies helped with creation of appropriate activation states.

“They were good triggers to have …just before leaving the training room…that’s probably the last thing I did before leaving the training room…putting on my boots… I’d say that the majority of the preparation was done in the changing room, so it set me up for the game”.

and behaviours and pseudo-oriented into the athlete’s next performance.

The third session related to these cognitive elements of the activation state. He wanted to develop an ability to sideline personal issues. The player said that he would like to be less distracted by developing an ability to focus on skills such as crossing, shots off in the last third, linking with other forwards and keeping possession of the ball, thus minimising the effect of distractions and gaining more cognitive control. The goal state of focus and control was anchored to pre-performance routine, specifically putting on his boots (which he did in a certain order). Again the anchor was pseudo-oriented to future performances.

After three sessions a midpoint interview took place. The midpoint interview lasted 57 minutes and had three aims. Firstly, to assess progress and efficacy in relation to the original goals and secondly, to create further goals in line with client-centred and Ericksonian approaches, and thirdly to work through diary input in more detail. The team formation had changed and the athlete did not feel that the system favoured his style of play and his particular qualities, notably an attacking style based on skill and speed and he felt that conservation of his energies to produce attacking moves had been an unconscious barrier to his running back to defend or make tackles in the first third. Also, there were times when he was used as a substitute or played out of position and he felt that this undermined his status and affected his loyalty to the team.

Two further sessions of hypnosis occurred following this. In session four, Vogt’s fractionation method was utilized, whereby the subject moves in and out of the trance state for short periods6. The subject was invited to relive an optimum performance using revivification techniques20 to re- experience the game as if it were happening in the present. The athlete then fed back cognitive, physiological and emotional

elements of the performance. The hypnotic state was then deepened and the anchors that had been previously utilized were strengthened and linked together21. The athlete was then invited to pseudo- orientate22 to his next performance and the anchors were fired21. Time was then allowed for mental rehearsal. Session five was dedicated to changing his perception of his role in the team and to revisiting and strengthening all themes up to this point. There was a management change halfway through the project and the new manager wanted more of a “complete player”. Using alert hypnosis23 the player was invited to put himself in the manager’s position and assess his own strengths and weaknesses from a dissociated position. Answers revealed that the player “needed to work harder off the ball”, that “I’m a player that will spit my dummy out if things go wrong” and the manager “wants to see me working harder for the team”. Also, the player was not as animated on the field as some other team mates and this had been misconstrued as not caring. “I am not loud about the team. I don’t smile a lot.” All of these elements were incorporated into goal setting for the session. The behavioural anchors (pre- performance routines, for example, putting on his boots in a certain order) were reiterated to connect to positive cognitive strategies such as rehearsal of elements of play for example “dubs and tricks, making crosses, taking on players and shooting in the last third”. The athlete had also developed a new anchor during pre- performance routine which involved brushing his shoulders with his hand representing the brushing off of worries and concerns before training.

A follow-up interview was arranged for four weeks after the last intervention to allow a reasonable period of time for an initial evaluation of efficacy to be made. (The season ended at this point). An outline of the intervention in table form is described opposite.

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responses through revivification, anchoring and pseudo-orientation in time (future pacing). One element of the identified outcome was targeted in each session. This outline is, of course, client-centred (as defined by Ericksonian approaches) and specific scripts would need to be developed for specific clients.

In previous studies hypnosis in sport has shown positive effects on emotions, thoughts and perceptions reflecting increases in flow states8,10,12 and self-efficacy11, as well as performance14. However there have been no studies examining the effects of hypnosis on activation specifically. Also, it would seem that single-subject designs have proved inconsistent in assessing the efficacy of Ericksonian hypnosis, specifically as a tool for sport psychology, as any kind of standardization of approach is, by definition, non-Ericksonian24,13. Also, relatively little of the current research has been undertaken in competitive environments. It has been suggested elsewhere that more flexible approaches should be used in hypnosis intervention in sport12, taking into account individual differences and using more permissive approaches. It was considered, therefore that a purer Ericksonian experiment would examine efficacy of individualised hypnotic intervention over time. Also, the case study methodology permits a more detailed account of the athlete experience25.

Reed and Jacobi26, suggest that longitudinal studies allow positive trusting relationships to be developed with clients. To the Ericksonian interventionist the establishment of the therapeutic alliance between client and psychologist is foundational13. When undertaken in any therapeutic context, hypnosis is, by definition, an interpersonal process, and the dynamics of interpersonal processes will inevitably be present in doing hypnosis with a client. Hypnosis therefore, correlates with patterns of social influence present in any relationship that is defined as therapeutic5. The relationship between interventionist and client, along with core skills such as empathetic listening, may be a

more salient factor in therapeutic efficacy than any chosen psychological technique27, including hypnosis. For example, the use of education (implicitly informed consent) and rapport increases hypnotic efficacy and is thus considered to be an important part of the process11,14.

Limitations

One weakness of hypnosis research in general, is that it is not clear whether an outcome is a result of expectation, relaxation, emotional support or the hypnosis itself, although the physiological effects of hypnotic suggestions are seen as more powerful than those of relaxation alone28. However, hypnosis is a multi-faceted process often (though not always) integrally involving suggestions for relaxation29, whose efficacy is partly defined by expectation and suggestion30. Therefore, factors such as level of relaxation, expectancy, quality of relationship and rapport, and social and contextual influence are elements that should be seen as integral to, rather than being extrinsic to, hypnotic efficacy29.

There is also a possibility that improvements were due to participant and researcher expectation and bias as neither party was unaware of expected outcomes and that defining expectations through explicit goal setting in detail may have affected results8,10.

There are limitations to validity when using case study methodology over an extended period. For example, changes in team strategy, management, and personal factors could have impacted activation states. The perceived importance of an event and training plans can be important variables8

and it was noted that the intervention took place during the period of a relegation battle and a successful cup run. However, the player reported a positive attitude toward the hypnosis and attributed its use as a significant factor in increased activation control. Thus, self-report measures reveal changes pre- and post-intervention. The study would benefit from further follow-up

The participant reported using visualization more consciously during the early stages of the intervention but less as the intervention progressed as “it just happened” (implicitly the activation state). Hypnosis can introduce unconscious changes that become integrated as second nature and no longer need to be consciously controlled10, so this revelation is unsurprising. Subsequently, the participant reported being quite focussed during matches and further that this focus was unconscious in the sense that it, also, just happened.

“There wasn’t really that much going on during the game. It was like, not routine but quite natural. It just happened. It wasn’t something I was too concerned about, or something that I was overly worried about. It was quite routine I would say”.

The player reported better activation and performance consistency despite experiencing difficulties in his private and professional life and he developed an ability to sideline such issues at appropriate times by focussing on those elements that were controllable. He stated that the “tools helped me to dictate more and have more control over how I would play regardless of how I was feeling” by developing an ability to “leave everything else (implicitly personal issues) where it was at the time…rather than dragging it all into training”. He developed more intrinsic control and became less distracted by negative input from, for example, the crowd: “… before, when the crowd would react negatively, it would have a negative effect…but instead of beating myself up over mistakes…I could get myself back in control…by concentrating on the next task in hand”. He reported improved focus and increased level of execution of skills such as crossing the ball with more quality and consistency, making eight or nine, rather than five or six out of 10 good crosses. Also, during the intervention period there was a time when the player was suspended and a time when he was dropped from the first team. At these times he was able to amend his attitude to training and “bring it under control. And I had some great consistency

over a two week period where I had been training well” culminating in reselection.

The player reported an increase in confidence correlating with increases in feelings of control. Further, some extrinsic factors such as crowd reaction became less influential.

The player also reported positive feedback from the manager and team-mates around his defensive game, to which he had become more committed and his levels of effort for the team had increased. Also, the player reported less conscious awareness of these requirements and described for example, his tendency to make more tackles as a subconscious element.

Discussion

This case study examined the effects of a hypnotic intervention, based on Ericksonian approaches on a professional footballer who reported an inability to control and maintain activation states as defined by Hardy, Jones and Gould2. Data revealed increases in the ability to control and maintain activation, as well as related increases in confidence and focus. Each of the first three sessions of hypnosis focussed on the cognitive and physiological aspects of the athlete’s goal state for optimum activation, specifically the emotional mix and cognitive elements of focus and control. Metaphors were designed to facilitate and reiterate indirect post- hypnotic suggestions around these desired outcomes. Suggestions were made that these criteria could be anchored to specific behaviours. These criteria were reiterated through revivification and future pacing in session four. Session five was designed to strengthen all of the previous suggestions and to changing his perception of his role in the team through the creation of a metaphor, namely that he was an integral part of a “well oiled machine”.

A meta-view of the treatment pattern would be as follows: creation of specific and well- formed outcomes, indirect suggestions and metaphors reflecting these outcomes and reiteration and strengthening of the desired

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assessment as the last data collected was only one month after the intervention. This was due to the season ending.

Concluding comments

The current study adds to the extant literature which suggests that hypnosis can be used to facilitate feelings and cognitions associated with successful performance10,11,14, by further suggesting that hypnosis may also be beneficial in creating and maintaining activation states in a professional sporting environment.

Elsewhere, the need for the establishment of a clearer definition of hypnosis and further discussion around ethical dilemmas and concerns of the use of hypnosis in sport has been made7. The current study defines Ericksonian hypnosis as a client-centred, flexible process independent of generic scripts that may provide a clearly defined and effective approach to utilization of hypnosis in sporting contexts. Further, it is the author’s belief that the use of permissive, client-centred hypnosis is more ethical than traditional authoritarian approaches, although further discussion in the literature would be beneficial.

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Carmarthen, Wales: Crownhouse. 2002. (pp.35- 63). Geary, B.B. Assessment in Ericksonian hypnosis and psychotherapy. Chapter in B. Geary and J. Zeig (Eds.), The handbook of Ericksonian psychotherapy. Phoenix, AZ: The Milton Erickson Foundation Press. 2001. (pp.1-15).

2. Hardy, L., Jones, G. and Gould, D. Understanding psychological preparation in sport. Chichester, West Sussex: Wiley. 1996. 3. Pribram, K.H. and McGuinnes, D. Arousal, activation and effort in the control of attention. Psychological Review, 1975, vol. 82, pp.116-149. 4. Hockey, R. and Hamilton, P. The cognitive patterning of stress states. Chapter in R. Hockey, (Ed.), Stress and fatigue in human

performance. New York: Wiley. 1983. (pp.331-360). 5. Shih, M., Yang, Y.H. and Koo, M. A meta-analysis of hypnosis in the treatment of depressive symptoms: A brief communication. International

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7. Grindstaff, J.S. and Fisher, L.A. (2006). Sport psychology consultants experience of using hypnosis in their practice. The Sport Psychologist, 2006, vol. 20, pp.368-386.

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15. Ritterman, M. K. The philosophical position of the Ericksonian psychotherapist. Chapter in B. Geary & J, Zeig (Eds.), The handbook of Ericksonian psychotherapy. Phoenix, AZ: The Milton Erickson Foundation Press. 2001. (pp.187-192).

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1995, vol. 9, pp.201-211. 20. Hilgard, E.R.and Guantieri, G. Hartland’s medical and dental hypnosis (3rd ed). London: Harcourt Brace. 1998. 21. Bodenhammer, B.G. and Hall, L.M. The user’s manual for the brain. Carmarthen, Wales: Crownhouse. 1999. 22. Cooper, L.F. and Erickson, M. Time distortion in hypnosis. Williston, VT: Crown House. 2002. 23. Edgette, J.H. and Rowan, T. Winning the mind game: using hypnosis in sport psychology. Camarthen, Wales: Crownhouse. 2003. 24. Edgette, J.H. Ericksonian hypnosis in sport. European Journal of Clinical Hypnosis, 2004, vol. 5, pp.32-37. 25. Yin, R.K. Case study research: Design and methods, London: Sage. 2003. 26. Reed, S. & Giacobbi, P.R. The stress and coping responses of certified graduate athletic training students. Journal of Athletic Training,

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Appe ndix 1.

An outline of the intervention session by session.

Intake interview 1 Semi-structured interview based around Hardy, Jones and Gould’s (1996) Mental Preparation Profile and the

development of clear goals and outcomes for treatment. At this point the problems around the creation and maintenance of activation states were clarified.

2 It was agreed that the author and the client would keep diaries and that the content would be used as data. 3 Hypnosis was explained and informed consent was gained. 4 Results of the needs analysis were fed back to the client for clarification and agreement.

Hypnosis Session 1 1 Further clarification of goals and outcomes. 2 Introduction and acclimatisation to hypnosis. Use of progressive relaxation and ego-boosting frameworks. 3 Anchoring of the hypnotic state to the therapeutic environment.

Hypnosis Session 2 1 Goal clarification: development of emotional regulation. 2 Induction: a shortened version of progressive relaxation. 3 Development of metaphor: ‘the engine room’ in which there are a number of dials that can be set from 1 to

10. Each dial is to reflect one element of the client’s ideal performance state. For example, pressure, anxiety, aggression and the client is asked to set the dial at the appropriate number.

4 The optimum identified state is then anchored through future pacing to some part of the athlete’s pre- performance routine. In this case putting on his boots.

5 Mental rehearsal

Hypnosis session 3 1 Goal clarification: greater cognitive control and increased focus. 2 Induction: relaxation. 3 Development of metaphor: ‘the laser’ where light waves become focussed on one point. 4 Anchoring to future performances and mental rehearsal.

Mid intervention interview Life in professional sport is changeable and a lot can happen in a short time. For example the athlete in this study had undergone a change of management and team formation. At this point a mid-session interview is advised: 1 To assess progress. 2 To revisit goal setting and goal development. 3 To note any systemic changes and influences. 3 To utilise diary input.

Hypnosis session 4 1 Goal clarification: the player had been dropped for a short while and had felt a drop in motivation to train. He

therefore wanted to be able to put aside distracting thoughts, strengthen anchors and generally reiterate therapeutic gains.

2 Induction: fractionation method. 3 Revivification: of previous peak performances in competition and training and identification of associated

cognition and specifically self-talk and resulting emotional regulation. 4 Further anchoring to pre-performance routine, anchor stacking to include affirmations such as “no one is as

hungry as me for this”. 5 Pseudo-orientation in time and mental rehearsal. This was reiterated several times to strengthen the identified

anchors. 6 Silent time was allowed for further mental rehearsal.

Hypnosis Session 5 1 Goal clarification: becoming ‘a complete player’ and a ‘team player’, developing clarification of role. 2 Alert hypnosis: the player was asked to consider his attitude and contributions to the team from the

perspective of manager and team mates. 3 Development of metaphor: ‘the well oiled machine’. The player was aked to imagine himself as part of a

greater whole, a whole that couldn’t work at peak without him, but without which he could not peak. 4 Pseudo orientation into future performances. Time was allowed for silent mental rehearsal.

Exit interview 1 Ending interview and assessment of efficacy. The treatment is developed as a four phase model allowing for regular mutual reflection and reflexive practice. 1 Identification of need (in this case session 1) 2 Work to initial desired outcomes (in this case sessions 2, 3 and 4) 3 Reflection on efficacy and identification of further need (in this case session 5) 4 Work to desired outcomes (in this case sessions 6 to end)

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