Systematic Desensitization Protocol
Hierarchy FORM
Intention
This method developed by Joseph Wolpe, MD is an excellent tool when used in conjunction with hypnosis - remembering that the subconscious doesn’t know the difference between real or imagined. We will use this information for our second session to bring in desensitization for your limited beliefs.
Name
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Mr.
Mrs.
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First Name
Last Name
My Powerful Memory...
Remember a time when you felt really good – happy, confident, successful, pleased with yourself. As you recall that time, and the good feelings that went with it, mentally step back-inside that memory as though you were there, right now. Be fully associated into that memory – seeing what you saw, feeling what you felt, any smells or tastes. Experience the good feelings – inhale deeply through your nose – as if you are inhaling all those good feelings. Immediately, release the breath and the memory. Affirming in your mind: “I feel calm, I feel safe, I feel in control.” Write all details below...
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HIERARCHY FORM
Write out a hierarchy of scenes from 1 - 10 with 1 being the least stressful and 10 being the most anxious. Example might be..... No.1 the plan engines rev up for take off No.2 the seat belt light is on. etc...
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No. 10 (Most Anxious)
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No. 10 (Most Anxious)
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No. 9
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No. 8
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No. 7
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No. 6
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No. 5
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No. 4
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No. 3
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No. 2
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No. 1 (Least Anxious)
YOUR HEROS
Provide three names of people that you believe have the qualities you feel you are lacking as it relates to overcoming your challenge. Include specific strengths they hold.
Hero No. 1
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Hero No. 2
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Hero No. 3
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Submit
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