Handbook of Hypnotic Techniques, Vol. 2: Favorite Methods of Master Clinicians: Voices of Experience, #5

By Mark P. Jensen

Hypnosis has proven efficacy for helping individuals make important changes in their lives. In Vol. 2 of the Handbook of Hypnotic Techniques series, master clinicians from around the world describe an additional set of 11 favorite hypnotic strategies and techniques that they have found to be most effective in their own clinical work.

• Language: English
• Publisher: Denny Creek Press
• Release date: Jul 2, 2021
• ISBN: 9781005290115

Mark P. Jensen

Mark P. Jensen, Ph.D., is a Professor and Vice Chair for Research at the Department of Rehabilitation Medicine, University of Washington, in Seattle, Washington, USA. He has been studying chronic pain and helping individuals better manage chronic pain for over 30 years. He has been funded by the National Institutes of Health and other funding agencies to study the efficacy and mechanisms of various treatments for chronic pain, including hypnosis. He has published extensively (six books and over 500 articles and book chapters) on the topics of pain assessment and treatment. He has has received numerous awards for his writing and scientific contributions including the 2004 Roy M. Dorcus award for Best Clinical Paper from the Society of Clinical and Experimental Hypnosis, the 2009 Clark L. Hull award for Scientific Excellence in Writing from the American Society of Clinical Hypnosis, and the 2012 American Psychological Association Division 30 Award for Distinguished Contributions to Scientific Hypnosis. His book on the use of hypnosis for chronic pain management (Hypnosis for Chronic Pain: Therapist Guide, published by Oxford University Press) won the 2011 Society of Clinical and Experimental Hypnosis Arthur Shapiro Award for Best Book on Hypnosis. He is also a popular international speaker and workshop facilitator.

Book preview

Praise for Handbook of Hypnotic Techniques, Vol. 2

In this book a remarkable, international group of senior clinicians shares a wide array of strategies and techniques to integrate into hypnotherapy. These techniques are rich and innovative and presented with thoughtful detail and clinical examples. There are also provocative and creative insights regarding the clinical process and therapeutic action. Collectively these contributions illustrate the crucial importance of tailoring treatment to the individual personalities, styles, and dynamics of each patient as a core component of effective interventions in hypnotherapy, or in psychotherapy of any type. Both new and seasoned colleagues will find many treasures here to help them achieve this goal.―Elgan Baker, PhD, Clinical Associate Professor, Indiana University School of Medicine, and Past President of the following societies: the American Society of Clinical Hypnosis, the American Psychological Association’s Society of Psychological Hypnosis, the Society of Clinical and Experimental Hypnosis, and the American Board of Psychological Hypnosis.

Mark P. Jensen did it again, bringing together a ‘dream team’ of scholars and seasoned practitioners from all over the world of hypnosis, to address different clinical situations with knowledge and experience. Two different important ideas are addressed here: ‘No one is an island’ and ‘Every human being is unique.’ In this volume, one will find unique tools to address specific clinical situations, combined with the latest in neuroscience research. Warm connections and cold knowledge are mixed together into a tasty food to savor slowly, facilitating transformations for patients at their own pace. A journey where readers will encounter Rossi hands and quantum physics; a book full of inspirations and reflections. Enjoy this wonderful trip.―Gérard Fitoussi, MD, President-Elect of the European Society of Hypnosis, President of the Confédération Francophone d’Hypnose & Thérapies Brèves, President of the Association Française d’Hypnose, and member of the Board of Editorial Consultants, International Journal of Clinical and Experimental Hypnosis.

"The 11 ‘favorite’ techniques described in Hypnotic Techniques, Vol 2, means that they are the best of many. This is not only true for the techniques themselves, but also for the authors, who come from around the globe. And if the ‘best’ practitioners share their preferred and most effective techniques, these will certainly become some of the favorite techniques of the readers, as will the current volume."―Katalin Varga, PhD, author of Communication Strategies in Medical Settings, Phenomenology of Hypnotic Interaction, and editor of Beyond the Words: Communication and Suggestion in Medical Practice.

You’ll find many pearls and therapeutic treasures in the words of these international master clinicians from Italy, Israel, UK, New Zealand, USA and Turkey. Their creative hypnosis techniques illustrated with case vignettes will inspire you to adopt some of these exciting, innovative approaches into your own work to help your patients heal with hypnosis—a potentially rich and worthy process!—Leora Kuttner, PhD, Clinical Professor, British Columbia’s Hospital and University of British Columbia, and author of A Child in Pain: How to Help, What to Do.

About the Voices of Experience® series

Research demonstrates that experienced hypnosis practitioners obtain better outcomes than hypnosis practitioners who are relatively new to the field. For example, Barabasz and colleagues found that the participants in a study of smoking cessation who were treated by clinicians experienced in the use of hypnosis evidenced over four times greater treatment response than participants who were treated by clinical psychology interns with minimal training (Barabasz et al., 1986). Although this finding may seem intuitively obvious, clinician experience has not been found to play a role in treatment outcome for many other (nonhypnotic) psychological therapies (Berman & Norton, 1985; Durlak, 1979; Shapiro & Shapiro, 1982).

Thus, hypnosis outcomes appear to be particularly sensitive to the benefits of experience. This makes sense, given that hypnosis involves the creative application of specific techniques for enhancing patient readiness to accept new ideas (i.e., the hypnotic induction; Jensen, 2017), as well as the skilled use of language to develop and offer suggestions for changes in how a patient feels, thinks, or behaves. By observing the patient’s immediate and longer-term response to treatment, clinicians discover and refine effective techniques and hone their use of language. Through this process they learn what works and what does not work.

Given the widespread use of hypnosis, clinicians in some regions will likely discover and develop techniques that other clinicians may not have (yet) discovered. Thus, there are master clinicians worldwide who are using effective methods that clinicians in other parts of the world may not have heard of or discovered yet.

Unfortunately, while many of the world’s most experienced clinicians facilitate workshops in their own countries, they do not always teach at international conferences such as the tri-annual World Congress of Medical and Clinical Hypnosis (www.ishhypnosis.org). Nor is every practicing clinician able to participate in workshops that are offered around the world. The purpose of the Voices of Experience® series is to give practicing clinicians access to the wealth of knowledge held by master clinicians throughout the world, in order to increase the ease and efficacy of treatment.

To make this information easily accessible, in the chapters contained in the series’ books, the authors describe the theory or ideas that underlie their favorite hypnotic approaches and techniques. They also provide a transcript or script that illustrates the technique or approach they find useful, along with commentary. Thus, each chapter is much like having an opportunity to participate in a workshop offered by the authors. I hope and anticipate that readers will enjoy learning, and then incorporating into their practice, the wisdom and experience shared in this series.

Mark P. Jensen

Editor, Voices of Experience®

References

Barabasz, A. F., Baer, L., Sheehan, D. V., & Barabasz, M. (1986). A three-year follow-up of hypnosis and restricted environmental stimulation therapy for smoking. International Journal of Clinical and Experimental Hypnosis, 34, 169-181.

Berman, J. S., & Norton, N. C. (1985). Does professional training make a therapist more effective? Psychological Bulletin, 98, 401-407.

Durlak, J. A. (1979). Comparative effectiveness of paraprofessional and professional helpers. Psychological Bulletin, 86, 80-92.

Jensen, M. P. (2017). The art and practice of hypnotic induction: Favorite methods of master clinicians. Kirkland, WA: Denny Creek Press.

Shapiro, D. A., & Shapiro, D. (1982). Meta-analysis of comparative therapy outcome studies: A replication and refinement. Psychological Bulletin, 92, 581-604.

Also available in the Voices of Experience® series…

Book 1. The Art and Practice of Hypnotic Induction:

Favorite Methods of Master Clinicians

In this volume, 11 master clinicians with over 350 years of combined clinical experience discuss the key factors necessary for effective hypnotic inductions and provide specific examples of the inductions they have found to be most effective.

Praise for The Art and Practice of Hypnotic Induction:

"The Art and Practice of Hypnotic Induction is a treasure trove of inductions with an exciting variety to accommodate patients’ and clinicians’ personal styles, to find the right voice."

―Elvira V. Lang, MD, FSIR, FSCEH

"This is a rich read. The Art and Practice of Hypnotic Induction encompasses hypnotic language, the therapeutic relationship, and conceptual and systemic underpinnings—the very fabric of therapy."―Leora Kuttner, PhD

A fundamental reference for both the tyro and the expert. This entrancing collection is a must read for those interested in contemporary hypnotic practice.―Jeffrey K. Zeig, PhD

Book 2. Hypnotic Techniques for Chronic Pain Management:

Favorite Methods of Master Clinicians

In this volume, written by and for clinicians, 13 highly experienced physicians, psychologists, and therapists from around the world describe the hypnotic strategies they have found to be most effective for chronic pain management.

Praise for Hypnotic Techniques for Chronic Pain Management:

"The contributors to Hypnotic Techniques for Chronic Pain Management are well-known pioneers and innovative practitioners from America, Europe, and Asia. The book provides an abundance of ideas for chronic pain treatment, which even very experienced pain specialists will find inspiring and useful." ―Bernhard Trenkle, Dipl Psych

"Hypnotic Techniques for Chronic Pain Management offers an impressive number of tools for addressing the critical psychological and psychosocial issues underlying chronic pain." ―Howard Hall, PhD

"It is truly a pleasure and enlightening to learn from the outstanding master clinicians who contributed to Hypnotic Techniques for Chronic Pain Management."―Stefan J. Friedrichsdorf, MD

Book 3. Hypnosis for Acute and

Procedural Pain Management:

Favorite Methods of Master Clinicians

Hypnosis has proven efficacy for reducing the pain associated with acute injuries and medical procedures. In this edited volume, written by and for clinicians, 10 highly experienced physicians, psychologists, and therapists from around the world describe the hypnotic strategies they have found to be most useful and effective for acute pain management.

Praise for Hypnosis for Acute and

Procedural Pain Management:

"Looking for a way to change minds about clinical hypnosis? Hypnosis for Acute and Procedural Pain Management reads like a TED talk, gathering international expert voices into one concise and practical volume. For clinicians, beginners and experienced alike, it provides theoretical fundamentals and a diversity of techniques to communicate the calm, safe, ego-strengthening climate that alters the mind’s perception of pain."―Julie H. Linden, PhD

"The outstanding Hypnosis for Acute and Procedural Pain Management is a welcome addition to the field—and to my own library. Each chapter is packed with practical advice and specific hypnotic strategies that I can immediately apply to help my patients be more comfortable and empowered."―Elvira Lang, MD, FSIR, FSCEH

Book 4. Handbook of Hypnotic Techniques, Vol. 1:

Favorite Methods of Master Clinicians

Hypnosis has proven efficacy for helping individuals make important changes in their lives. In this edited volume, written by and for clinicians, 11 master clinicians from around the world describe hypnotic strategies and techniques they have found to be most effective in their own clinical work.

Praise for the Handbook of Hypnotic Techniques, Vol. 1:

A fascinating, enriching, and practical book that illustrates the many complex roads that lead to the heart of Hypnotic Therapy.―Camillo Loriedo, MD, PhD

Like a road sign, good clinical technique points to something beyond itself—to the core competencies of an effective therapist. In this book, a team of master clinicians describe and then beautifully illustrate essential skills for engaging the mind’s hidden resources and growth potential.―Dan Short, PhD

"This latest entry into the superb Voices of Experience® series features an exceptionally talented group of internationally known clinicians who each generously share their favorite hypnotic techniques. It’s easy to see why these techniques are regarded as favorites."―Michael D. Yapko, PhD

CONTRIBUTORS

Ran D. Anbar, MD, FAAP

Center Point Medicine

La Jolla, CA

[e-mail]

Rubin Battino, MS, LPCC

Private Practice

Yellow Springs, OH, USA

[e-mail]

Consuelo C. Casula, Dipl. Psych.

Private Practice

Milano, Italy

[e-mail]

Rebecca N. Cherry, MD, MPH

Deep Well Health Care

Fort Washington, PA

[e-mail]

Kevin J. Hall, MSc

Private Practice

Vienna, Austria

[e-mail]

Richard Hill, MA, MEd, MBMSc

Private Practice

Gordon, NSW, Australia

[e-mail]

Mark P. Jensen, PhD, FASCH

University of Washington

Seattle, WA, USA

[e-mail]

Julie H. Linden, PhD

Private Practice

Philadelphia, PA &

Rangeley, ME, USA

[e-mail]

Kathleen Long, MD

Private Practice

Glasgow, Scotland, UK

[e-mail]

Patrick McCarthy, MBChB

Private Practice

Wellington, New Zealand

[e-mail]

Shaul Navon, PhD

Private Practice

Tel Aviv, Israel

[e-mail]

Ali Özden Öztürk, MD

Private Practice

Istanbul, Turkiye

[e-mail]

Dan Short,

Private Practice

Scottsdale, AZ, USA

[e-mail]

Laurence I. Sugarman, MD

Rochester Institute of Technology

Rochester, NY, USA

[e-mail]

Contents

Praise for Handbook of Hypnotic Techniques, Vol. 2

About the Voices of Experience® series

Also available in the Voices of Experience® series…

CONTRIBUTORS

CHAPTER 1: Introduction

Mark P. Jensen

CHAPTER 2: The Hypnosis Skill Set:

Julie H. Linden and Laurence I. Sugarman

CHAPTER 3: Five Principles of Interpersonal Alchemy  for Enhancing Rapport and Eliciting Responsiveness

Kevin J. Hall

CHAPTER 4: Mirroring Hands: A Practice and an Approach to Therapy

Richard Hill

CHAPTER 5: A Technique for Enhancing Resilience

Consuelo C. Casula

Chapter 6: Rapid Reversal Therapy: Looking for the Pearl

Kathleen Long

CHAPTER 7: Sailing with the Life Wind: The Art of Living and Enjoying

Ali Özden Öztürk

CHAPTER 8: Stuck Situations in Therapy: The Dual-Track Interventions Paradigm in Hypnosis

Shaul Navon

CHAPTER 9: Brief Therapy via Guided Imagery and Hypnosis

Rubin Battino

CHAPTER 10: Communicating with the Subconscious: Ideomotor and Visualization Techniques

Ran D. Anbar and Rebecca N. Cherry

CHAPTER 11: The Special Place of Bliss Technique

Patrick McCarthy

Chapter 12: Integrative Automatic Writing for  Hypnotic Exploration

Dan Short

ABOUT THE EDITOR

CHAPTER 1

Introduction

Mark P. Jensen

This is the fifth book in the Voices of Experience series and the second handbook of hypnotic techniques in that same series. The reader might ask, Why publish a second book on hypnotic techniques? The short answer is that the book provides 11 additional unique and powerful therapeutic strategies, developed over decades of clinical practice by master clinicians. Clinicians will find that the use of these techniques can help them become even more effective in their clinical practice.

The longer answer is that research supports what clinicians have known for years: different patients respond to different therapeutic strategies. While it is true that findings from controlled clinical trials support the conclusion that highly standardized and manualized hypnotic treatments are effective on average, we also know that treatment response to highly standardized treatments is variable (Jensen & Patterson, 2014). There are always individuals in any clinical trial who do not respond to, or who sometimes report adverse responses to, standardized (i.e., not tailored) treatments. In order to be most effective, clinicians would do well to learn, and then adapt as appropriate for their practice, many therapeutic approaches and techniques.

In part because of this variability in treatment outcomes, clinical researchers are beginning to conduct studies to identify the factors that might distinguish patients who respond more, or respond less, to different treatments. For example, my colleagues and I have been examining measures of brain activity as assessed using electroencephalogram (EEG) as potential predictors of response to different pain treatments. In one study, we found that individuals with chronic pain who evidence more theta power on EEG are able to respond more to hypnotic suggestions for pain reduction/increased comfort (Jensen et al., 2014). These are individuals who show a pattern of brain activity associated with improved access to memories, which might facilitate an ability to respond to suggestions that make use of prior experiences and sensations (Jensen et al., 2015).

Among the most important implications of these findings is that clinicians should not always provide the same treatment to every patient presenting with a specific problem. Because different patients will respond more or less to different treatments, clinicians should have a large variety of tools in their toolbox―that is, a number of different strategies and approaches that could be used to address the same presenting symptom or concern. Having a variety of tools makes it easier to flexibly switch to a new approach—or to use a new technique—when or if the initial therapy is not effective for a patient.

This precision medicine (or precision therapy) approach requires that the clinician be well-versed in a variety of techniques. The current volume, indeed the entire Voices of Experience series, is designed to provide clinicians with the resources needed to allow for flexibility. The more techniques that a clinician understands―the more tools they have in their toolbox―the better. In the current volume, master clinicians describe, and then demonstrate via one or more case studies, 11 additional hypnotic approaches and techniques that they have developed to address a variety of presenting problems and symptoms.

In the first chapter after this Introduction (Chapter 2), Julie H. Linden and Laurence I. Sugarman present a model of hypnosis and neuroplasticity that they describe in greater detail in their excellent book, Changing Minds with Clinical Hypnosis: Narratives and Discourse for a New Health Care Paradigm (Sugarman & Linden, 2020). Starting with clear definitions of trance (as a process of psychobiological plasticity) and hypnosis (as a discipline of communication that uses trance to promote change), they describe four basic clinical hypnotic skills that can be used individually or together to facilitate trance (i.e., neuroplasticity). They then go on to describe four foundational principles that inform the mindset of clinicians when using hypnosis effectively. In two clinical vignettes, Linden and Sugarman demonstrate how the therapeutic skills and principles they describe can be applied first to help an adolescent who had become withdrawn in response to possible bullying at school, and then to a woman feeling overwhelmed with multiple family and work responsibilities in the context of having a history of cancer.

In Chapter 3, Kevin J. Hall describes the critical importance of an emotional connection (aka rapport) between the clinician and the patient for enhancing treatment response when using hypnosis. He describes five principles that effectively promote rapport (i.e., positive regard, attention to physical and emotional temperature, pacing, moving in small steps, and utilization) as well as the specific clinical strategies associated with each of these principles. His case study beautifully demonstrates how these principles and techniques can be used together to empower a patient with a presenting complaint of depression.

Richard Hill describes Mirroring Hands in Chapter 4, presenting it as both a specific hypnotic technique and a general approach to psychotherapy. As he notes, the Mirroring Hands approach involves coming to the encounter with an orientation of curiosity, including being curious about what the client is bringing into the session. This increases mutual engagement and an openness to being responsive to what is most meaningful for the client. As with each of the previous chapters, Hill identifies a set of principles that underlie his approach. In this case, they include language principles (e.g., use of incomplete sentences, expressions of surprise and wonder), sensitive observation, awareness and utilization of natural rhythms and creative cycles, and utilization of a patient’s ideodynamic responses. In his fascinating case study, he models how he used the Mirroring Hands approach to help a client resolve a long-standing issue that had been interfering with her ability to maintain positive relationships with others.

In Chapter 5, Consuelo C. Casula notes that resilience facilitates flexibility and growth and can therefore be targeted in treatment to improve a patient’s overall quality of life, as well as to enhance response to hypnotic suggestions. She also points out that resilience is both an adaptive response to a specific stressful situation, and is a trait that can be nurtured and enhanced over time. Dr. Casula describes three key pillars of a hypnotic approach for enhancing global resilience: a secure therapeutic attachment; a retrospective view of the presenting problem; and the importance of the epistemic emotions associated with resilience, such as curiosity, trust, hope, wonder, and surprise. Purposefully incorporating each of these pillars into a hypnotic session enhances the patient’s ability to manage both the presenting and future problems. The chapter contains a description of a nine-step approach based on these pillars, and provides a script as an example of an induction, including permissive suggestions for using this approach.

Kathleen Long is a general physician who has used hypnosis in her clinical practice for over 30 years. In Chapter 6, she describes one of her favorite techniques―Looking for the Pearl―for facilitating a rapid resolution of a presenting symptom or concern. She notes that many presenting symptoms have a single and specific key issue (the pearl) that serves as an anchor for the problem. Once that issue is identified, it can often be effectively addressed in a single hypnosis session. The four steps she uses to search for, identify, and then address the pearl to resolve the presenting issue involve: (1) building rapport, (2) listening carefully, (3) observing everything to identify the pearl, and (4) using traditional hypnotic techniques, as appropriate, to change the patient’s perspective on the key issue causing their distress. She ends the chapter with demonstrations of how she used this approach to treat a patient presenting with depression and a patient with anger-management difficulties.

Chapter 7 describes the Awareness Under Conscious Hypnosis (AUCH) method, which is an active-alert hypnotic approach first developed by Hüsnü İsmet Öztürk in the 1950s. Ali Özden Öztürk has developed the method further and uses it either as a stand-alone treatment or in conjunction with other medical and psychological interventions to treat a large variety of presenting problems and conditions. Central to the AUCH method are three steps (the Making Acceptance with Your Awareness, induction, and autohypnosis steps) and three goals (becoming more aware, differentiating, and utilizing feelings) for each of these steps. The approach differs from many more traditional approaches with its emphasis on conscious awareness and patient control of each step. A clear purpose of this emphasis is to enhance patient self-efficacy and to empower the patient to take charge of the management of his or her own presenting problems.

In Chapter 8, Shaul Navon describes a number of techniques that can help patients become un-stuck when the therapeutic process reaches an impasse. Noting that stuck situations are often the result of inflexibly holding on to a single view or approach to the problem, he introduces the idea of undermining this mono-track approach by using one of six dual-track interventions: introducing the illness/non-illness model; the split-screen technique; conscious/unconscious dissociation induction; the confusion technique; paradoxical interventions; and the future questions, future maps approach. Five of these are classic hypnotic approaches or techniques for helping patients achieve their therapeutic goals, while one of them (the illness/non-illness model) was developed by Dr. Navon. However, all of these approaches can be effective for facilitating movement from a monoideistic or stuck place in therapy towards change and growth.

As Rubin Battino notes in Chapter 9, guided imagery was initially developed as a cancer treatment over 40 years ago. However, over the years Dr. Battino has learned that guided imagery can be effective for addressing the concerns and challenges faced by many, if not most, patients in psychotherapy. He notes that guided imagery is an easy technique to learn and use, and yet it can be a powerful method for enhancing the patient’s own resources for change; especially when the patient is trained in its use and then practices guided imagery between sessions. When using this approach, Dr. Battino starts by eliciting three essential pieces and (sometimes) one optional piece of information from his clients: (1) the client’s preferred way of relaxing; (2) details regarding that client’s safe haven (i.e., a real or imaginary place where they feel most safe and secure); (3) a preferred modality for healing or change (i.e., a helping person, image, or entity that will aid their growth in the session); and (4) the optional piece―specific information about the client’s presenting challenge or concern. The case studies he presents clearly demonstrate the flexibility of a guided imagery approach for addressing multiple clients concerns, from depression to weight control.

Several of the authors in this volume of hypnotic techniques describe how they incorporate ideomotor signaling as a component of the technique they present. In Chapter 10, Ran D. Anbar and Rebecca N. Cherry describe in detail a variety of strategies―including ideomotor approaches―for communicating with the client’s unconscious. These include classic arm strength testing, use of finger movements, the Chevreul pendulum, automatic talking, automatic writing, automatic word processing, imagined whiteboard/computer screen, inner advisor, and resource room techniques. These strategies can be particularly helpful when the presenting problem or symptom is related to a conflict that is outside of the client’s conscious awareness. Drs. Anbar and Cherry model how these techniques can be applied to address a number of presenting symptoms, including psychosomatic breathing problems in an adolescent, fear of the dark and associated difficulties falling asleep in a child, and a student’s uncertainty about his college major choices.

Patrick McCarthy has incorporated hypnosis in his family medical practice for close to 30 years and has developed and taught numerous hypnotic techniques. Among the most well-known, practical, and flexible (for addressing a large variety of presenting symptoms and issues) is his adaptation of the classic special/favorite place technique called the Special Place of Bliss (McCarthy, 2005), described in Chapter 11. This technique allows patients to travel to a place where they can experience a state of bliss and then imagine all of their worries and problems related to the past, the present, and the future as stones in a backpack that they carry. They are then invited to unload the stones from the backpack, one by one, and―if they choose―to leave behind the stones they no longer wish to carry. Among the many strengths of this technique are its respect for the privacy of the patient (the patient is not asked to share any details about the stones), its marked permissiveness (the client gets to choose which problem to continue to carry with them, and which to leave behind), and the joy that the strategy facilitates for patients. Like the Finding the Pearl technique described by Dr. Long in Chapter 7, this technique can result in a very rapid (i.e., single session) resolution of a patient’s presenting concern.

In the twelfth and final chapter of this volume, Dan Short describes a specific automatic writing technique he has developed―the Integrative Automatic Writing (IAW) technique―for addressing behaviors that are clearly irrational and nonproductive, but which patients are unable to control. He includes in the chapter a scholarly and fascinating summary of the history of automatic writing and other facilitated communication strategies used in psychotherapy. This history, and what we know about the effects of words and their meaning with respect to physical position and movement, informs the application of the IAW technique.