Hypnotherapy and Hypnoanalysis

D. P. Brown, E. Fromm

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781317838098
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

First published in 1986. Scientific hypnosis has made great advances particularly since World War II, both as part of basic psychological science concerned with the understanding of brain, mind, and personality and as a professional skill in which knowledge of hypnosis is used to serve human welfare by enhancing the quality of life for those who have the good fortune to benefit from hypnotherapy and the related practice of hypnoanalysis. The reader is brought abreast of these developments through the arrangement of the chapters into two sections of the book, with the first four chapters explaining the basics of hypnosis as an altered state of consciousness interpreted theoretically from several points of view.

II

Clinical Hypnosis

5

Treatment Planning with Hypnosis

The Clinical Efficacy of Hypnosis

In “Lines of Advance in Psycho-Analytic Therapy,” Freud (1918/1955) said of hypnosis: “It is very probable, too, that the large-scale application of our therapy will compel us to alloy the pure gold of analysis freely with the copper of direct suggestion; and hypnotic influence, too, might find a place in it again, as it has in the treatment of war neuroses” (pp. 167–168). Compared with psychotherapy and perhaps also with psychoanalysis, hypnosis—at least permissive hypnosis, though not necessarily directive hypnosis—may be more “gold” than Freud was able to realize. In many cases it takes significantly less time to reach the same goals in hypno-analysis than it would take in psychoanalysis. Hypnosis increases the efficacy of treatment in most instances where the patient is at least moderately hypnotizable (Wadden & Anderton, 1982) and where the patient presents with relatively circumscribed symptoms (Beutler, 1979).

The clinical efficacy of hypnosis is attributable to its being such a powerful means of gaining access to symbolic processes, memories, and feelings, it enhances uncovering, an important dimension of dynamic psychotherapy. For example, it is possible in hypnotherapy to suggest that a patient dream about a specific symptom. The hypnotherapist need not wait for the clinical material to unfold slowly over a series of sessions in order to learn about the dynamics associated with this symptom, as is the case in psychotherapy. In hypnotherapy, the patient is likely to respond to the suggestion with a dream that reveals the dynamic meaning of the symptom, even while the patient attempts to conceal it.

Further, because hypnosis also produces cognitive and perceptual changes in some people (Frankel, 1976; Orne, 1977), and habitual frames of reference can be altered (Rossi & Erickson, 1979), it can contribute to changes in one’s belief system, as Orne (1977) implied in his definition of hypnosis as “believed-in fantasy.” Thus, hypnosis can contribute to the overall task of dynamic psychotherapy, namely, to helping the patient understand and then solve his conflict. It is also possible to give suggestions directly designed to enhance patients’ insight into their problems. The hypnotist may say, for example, “The meaning will get more and more clear to you as you are ready to understand this.”

Through posthypnotic suggestion, hypnosis can also influence the patient’s behavior between therapy hours, allowing treatment effects to be carried beyond the therapy sessions to everyday life. For example, a typical problem in treating a phobic patient with desensitization therapy is whether or not the conditioned relaxation to imagined anxiety-provoking stimuli generalizes to real-life situations that provoke anxiety in the patient. When desensitization is combined with hypnosis, the patient can be given a posthypnotic suggestion to experience spontaneously the relaxation response whenever the anxiety-provoking situation is encountered.

Hypnosis is also a powerful way of altering maladaptive patterns of relationships, because of the intense transference relationship it entails. (Some psychoanalysts mistakenly believe that hypnosis is inferior to psychoanalysis because direct suggestions allegedly interfere with the spontaneous unfolding of the transference.) The criticism that an authoritarian hypnotherapist may evoke an intense parent transference reaction may have been justifiable in Freud’s day, when authoritarian hypnosis was practiced, but it is certainly much less true today, when primarily permissive hypnosis is practiced. Hypnosis is also an adaptive regressive state (Fromm & Eisen, 1982; Fromm & Gardner, 1979; Gill & Brenman, 1959), in which earlier patterns of object relationships are reinstated (Nash, Johnson, & Tipton, 1979). The manifestation of these early patterns of object relations may occur dramatically during hypnosis. Even when less dramatic, these patterns are usually more clearly evident than in the waking state and are, therefore, more accessible to interpretation and working through.

General Indications and Contraindications

Some clinicians believe that hypnosis is useful for just about any clinical problem. In fact, some employ hypnotherapy exclusively in their clinical practice. Our position is that hypnosis is not indicated in all clinical situations. In each case, it is important to assess the patient’s degree of hypnotizability, the nature of the symptom picture, and both the patient’s and the therapist’s motivation for using hypnosis. As a rule of thumb, though not without important exceptions, hypnotherapy is indicated for patients who are sufficiently motivated, are moderately to highly hypnotizable, and present with clearly circumscribed symptoms (in contrast to character pathology or major disturbances in capacity for relationship). The therapist should be guided by available clinical case studies and clinical outcome research in deciding whether or not to include hypnosis in the treatment plan for a particular patient.

General Indications

Susceptibility to Hypnosis. Hypnotherapy may be the treatment of choice for those patients who are moderately or highly hypnotizable, because hypnotizability is positively correlated with treatment outcome (Wadden & Anderton, 1982). About 10% of the population are highly hypnotizable and are likely to make quick and sometimes dramatic treatment gains when hypnosis is used. Most clinical work, however, can effectively be accomplished with patients who have only a medium level of hypnotizability, sometimes even with patients of low hypnotizability. About 60% of the population fall into the range of hypnotizability where hypnosis can be considered seriously as part of the treatment plan, provided other criteria are also met. Sometimes, however, hypnosis is appropriate even for less hypnotizable patients, for example, those highly motivated to use hypnosis, for whom the hypnotic situation has a special meaning that capitalizes on expectation effects, and for whom no other treatment is available, such as pharmacologically sensitive pain patients.

Type of Presenting Problem. From an extensive survey of the clinical literature on hypnosis, we have come to believe that hypnosis is more strongly indicated in the treatment of certain types of psychopathology than in others. In each of the areas for which we feel hypnosis can be usefully employed, either a good number of successful case studies have been reported or clinical outcome research has demonstrated the efficacy of hypnosis in the treatment. These areas are: the neuroses; psycho-physiological disorders; behavioral and habit disorders; and maladaptive patterns of relationship.

Hypnosis is useful in the treatment of anxiety, phobic, conversion, and dissociative symptoms, but less useful in the treatment of obsessive-compulsive symptoms. It is also the treatment of choice for hypnotizable patients with a variety of psychophysiological disorders, provided the hypnotic treatment is integrated with the advances in behavioral medicine outlined in our book Hypnosis and Behavioral Medicine (Brown & Fromm, 1987).These disorders include pain, headache, respiratory disorders (especially asthma), cardiovascular disorders (especially hypertension), gastrointestinal disorders, skin disorders, and immune-related disorders (arthritic conditions and cancer). Hypnosis has yielded mixed results with habit and behavioral disorders (smoking, weight problems, sleep disorders, sexual dysfunction, and substance abuse) because outcome depends on the overall treatment approach in which hypnosis is embedded. The best outcomes occur when hypnosis is integrated with the established advances in behavioral modification—self-monitoring, intervention to alter motivation, stimulus control, behavioral regulation of symptoms, symptom discrimination, cognitive therapy, social support, and relapse prevention, as outlined in that book. The generally poor success rates of the past reflect less on the responsiveness of, for example, smoking and weight problems to hypnotherapy than on the uninformed way the treatment was conducted.

Some clinicians, particularly those working in clinics with diverse patient populations and problems, prefer to limit the use of hypnosis to cases where the patient meets the dual criteria of being sufficiently hypnotizable and presenting with relatively circumscribed symptoms. Patients with character problems and maladaptive patterns of relationships are likely to be assigned to long-term, nonhypnotic dynamic psychotherapy, where an emotionally corrective experience (Alexander & French, 1946) can be provided. In most clinics, hypnotherapy is limited more or less to brief interventions designed primarily to achieve symptom change. This preference for short-term hypnotherapy aimed at amelioration of symptoms may reflect trends in service delivery. In some clinical cases, however, hypnosis is also used as an adjunct to long-term therapy, especially where an ego-supportive uncovering approach to psychotherapy is indicated. Clinicians in private practice are more likely to use hypnotherapy and hypno-analysis in the treatment of character problems and maladaptive patterns of relationships. In such treatment, the nature of the long-term psychotherapeutic relationship is emphasized. Working through the transference and adopting the stance that therapy should be an emotionally corrective experience for the patient are essential ingredients of the therapeutic relationship.

Hypnosis can also be useful in consultation, especially for long-term psychotherapy or psychoanalytic cases that have reached an impasse. A brief hypnotic uncovering approach can be employed for moving beyond the impasse by mobilizing and intensifying feelings in a very ideational patient, by uncovering material to which there has been resistance, and by identifying problems in the interaction between patient and therapist (unexplored transference and countertransference reactions, impairments in the therapeutic alliance, failures of empathy, etc.). Once the nature of the impasse has been identified, the material can be discussed by the hypnotherapist with the patient and the primary therapist, and referred back to the ongoing primary therapy to be worked through.

There are no well-established criteria for deciding whether to use psychotherapy alone, or hypnotherapy (psychotherapy combined with hypnosis). The decision depends in part on the patient’s hypnotizability and in part on the therapist’s preference of the treatment modality.

Contraindications

Low Susceptibility. The main contraindication to using hypnosis in treatment is lack of responsiveness to hypnosis. About 40% of the adult population manifests a sufficiently low level of hypnotic susceptibility to discourage the use of the hypnotic condition in therapy (Hilgard, 1965, p. 215; see Table 2.1, this volume).

Since the level of hypnotizability is related to treatment outcome in a variety of treatment situations (Wadden & Anderton, 1982), low susceptibility means that a trance state is unlikely to make much of a contribution to treatment outcome. Many would argue that since hypnotherapy is not going to contribute much beyond what may be available in nonhypnotic psychotherapy or in behavioral therapy with progressive relaxation, only those two types of therapy should be used with low hypnotizable patients. More conservative clinicians would rule out hypnosis from the treatment plan for less susceptible patients. Others, however, have taken the position that hypnosis may still benefit many low hypnotizable patients. Hypnosis does involve a considerable placebo effect and a special relationship irrespective of the degree of hypnotizability. Thus, low hypnotizable patients may have high expectations of benefit from the use of hypnosis (Barber & Calverley, 1964), or may manifest certain special talents in hypnosis only within a certain kind of hypnotic relationship (Sacerdote, 1982). A factor that may account for positive treatment gain in low hypnotizables is the special meaning of the hypnotic situation, not the condition of being in a hypnotic state (Gruenewald, 1982). Some hypnotists, then, are more willing than others to capitalize on the expectations even low hypnotizable patients have about the efficacy of hypnosis or on the specific hypnotic abilities likely to emerge in the context of a sensitive hypnotherapeutic relationship. These clinicians are more likely to use hypnotherapy, even if the patient is a poor hypnotic subject.

Still others, especially the Ericksonians, take issue with the whole concept of hypnotizability. Erickson devised special indirect hypnotic suggestions specifically for patients difficult to hypnotize or otherwise resistant to treatment. Some Ericksonians would claim that anyone is hypnotizable, provided the right hypnotic communication is used. From this more liberal perspective, hypnosis could be used for almost any patient.

Our own position recognizes the partial truth of each of these three perspectives. We recommend serious consideration of hypnosis with highly and moderately hypnotizable patients. We also recommend more judicious use of hypnosis with low hypnotizable patients if the particular case merits it. And in certain instances, an Ericksonian approach to hypnosis can be effective where other treatment approaches may not be. We do not, however, recommend the indiscriminant use of hypnosis with all patients simply because of a clinician’s interest in it.

Low Motivation. A second contraindication is low motivation for change. A patient may seek hypnotic treatment at the urge of others but may not really wish to change. A spouse may wish the patient to lose weight; a doctor may want the patient to stop smoking. Some patients use their symptoms for considerable secondary gain. For chronic pain patients, for example, litigation proceedings or disability benefits provide a strong incentive for maintaining the symptom. Low motivation is not necessarily a contraindication to hypnotherapy as long as the issue is addressed directly in the prehypnotic interview and in the initial hypnotic work. The issue of motivation, then, becomes the work of the hypnotherapy.

Hypnoprojective methods can be used to explore the systemic and the intrapsychic factors contributing to low motivation. Where motivation is seriously in question, it is advisable to contract for only a few (evaluation) sessions. At the end of these sessions (depending on how these sessions unfold), the patient and therapist will decide whether or not to proceed with hypnotherapy. The outcome of such evaluative work might include confrontation regarding secondary gain, recommendations for systemic interventions or lifestyle changes necessary before hypnotherapy can proceed, or payback contracts, as in the case of habit problems. Sometimes, however, low motivation is a manifestation of deep despair. Such patients do not seriously believe that any treatment can help them. The evaluative sessions may serve to uncover the specific roots of a given patient’s despair. Some patients may begin to develop a sense of self-efficacy from being able to experience hypnosis (Frankel, 1976). They do well with hypnotherapy and are often very gratifying to work with. The rule of thumb is not to rule out hypnosis from a treatment plan because of initial low motivation, without first exploring the reasons for it. Continued low motivation will be evident after a few sessions and reliably serves as a contraindication.

Certain Kinds of Presenting Problems

Organic Brain Syndromes. There are few areas of psychopathology where hypnosis can be readily ruled out as a treatment strategy. An obvious exception might be an organic brain syndrome with a manifest attentional disorder. Because hypnosis requires the ability to direct, focus, and sustain attention, and brain dysfunction makes attention deployment impossible, hypnosis cannot b...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Figures
• List of Tables
• Acknowledgments
• Foreword
• Preface
• I: Basics of Hypnosis
• II: Clinical Hypnosis
• Author Index
• Subject Index