Advanced Hypnotherapy

Hypnodynamic Techniques

John G. Watkins, Arreed Barabasz

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135912468
• Edition: 1
• Topic: Psychologie
• Subtopic: Hypnose

This book focuses on tested hypnoanalytic techniques, with step-by-step procedures for integrating hypnosis into psychoanalytic processes. In its examination ofthe latest thinking, research, and techniques, the book discusses historical origins of hypnosis as well as how to apply it to current events, such as using hypnosis in the treatment of trauma with soldiers coming out of the war in Iraq. The text shows how hypnosis can be combined with psychoanalysis to make it possible to understand the subjective world of clients. Its accessible nature, rich detail, and significant updates makethe book an invaluable resourcefor the professional who wishes to incorporate hypnosis into his or her practice. With the authors' extensive and impressive knowledge, careful updates, and comprehensive coverage of the proper and appropriate techniques to use, this volume isan indispensable addition to the field.

1

Introduction to Hypnoanalytic Techniques

Psychotherapists who have acquired the ability to hypnotize and apply hypnotherapeutic procedures will likely recognize their need to acquire more complex ways of using hypnotic interventions. A few of the more advanced techniques were introduced or hinted at, but not truly described, in Barabasz and Watkins (2005). As promised in the introduction to that book, this one will carry on where the first treatise left off.

This book teaches sophisticated procedures, practiced within the hypnotic modalities, which are aimed at a more fundamental reconstruction of a patient’s personality. This is the goal of both hypnoanalysis and psychoanalytic therapy. Hypnoanalysis accepts the psychoanalytic principle that neurotic symptoms are generally, although certainly not exclusively, the consequence of intrapsychic conflict. Our aim as therapists is to eliminate or at least reduce symptoms by emotional as well as cognitive restructuring, not merely by social influence, placebo manipulations, or mere suggestion without actual hypnosis per se (A. Barabasz & Christensen, 2006; see Barabasz and Watkins, 2005, pp. 203–206). When the hypnoanalytic process is successful, it is usually accompanied by “insight.”

Accordingly, hypnoanalysis should be regarded as a form or variant of psychoanalysis in its broadest sense. Freud (1953a) explained that any treatment can be considered psychoanalysis if its effectiveness comes from “undoing resistances and interpreting transferences.” Given these criteria, hypnoanalysis is definitely “psychoanalysis” in spite of Freud’s vacillating history with regard to the use of hypnosis, which began with embracing the modality, then rejecting it, and finally depending on it to manage the pain of his cancer in his final days. Hypnoanalysts are very much concerned with undoing resistances and interpreting transferences. The specific step-by-step techniques to accomplish these goals will be made clear as the chapters in this book unfold.

Hypnosis, when applied according to psychodynamic understandings, is a part of the hypnoanalytic strategy. The therapy becomes “hypnoanalytic” when its hypnotic aspects are so naturally applied by the practitioner as to become secondary to the patient’s developing focus on the main objective of achieving reconstructive understandings.

Hypnoanalysts, like psychoanalytic practitioners, attempt to reconstruct and deal with memory material, lift repressions, release bound affects, and integrate previously unconscious and unegotized aspects of the personality. They are also concerned with factors of resistance, transference, and counter-transference as are the psychoanalysts. Similar to Freud (1953a), many hypnoanalysts see dreams as a “royal road to the unconscious” and dream interpretation as a major hypnoanalytic technique. In that sense, their theoretical views of personality structure and neurotic symptom formation closely parallel those of the classic psychoanalysts. The analysis of transference has always been a major psychoanalytic method, along with free association and dream interpretation. Freud simply emphasized its importance.

Free association may ultimately unearth early memory material and ingrained interpretations of early experiences represented as reconstructed memories. Unfortunately, many sessions are required to secure the same data, which within a much shorter time may become apparent through hypnotic hypermnesia, regression, and particularly regressive abreactive techniques. Furthermore, in doing so, there is little if any evidence to support Freud’s contention that the ego is bypassed by hypnosis and his notion that consequently such personality changes would be only temporary. As early as 1979, E. R. Hilgard and Loftus showed that memories reconstructed by hypnotic regression can be distorted, but, of course, Freud had already found that through “screening memories,” these recollections (more accurately termed reconstructed memory material) secured by free association could also be distorted. There is no evidence whatsoever that hypnosis is any more likely to distort memories than numerous other commonly used therapeutic or detective-like questioning techniques. Furthermore, there is no data extant comparing the validity of hypnotically secured memory material versus those elicited through free association.

Dream interpretation has been a valuable psychoanalytic tool, especially in the hands of gift ed and intuitive practitioners such as Wilhelm Stekel (1943c). Hypnoanalysts also employ dream and fantasy analytic procedures (Barrett, 1998). The hypnotic modality provides greater flexibility in the activation, analysis, and interpretation of these creations.

Transference reaction analysis is a very potent psychoanalytic procedure for achieving reconstructive changes in the basic personality. Such reactions appear during an analysis when the patient projects onto the analyst feelings and attitudes that he or she once experienced toward earlier significant figures such as a love for one’s mother or hatred toward a dominating father. As these inappropriate reactions are pointed out and explained to the patient by the analyst’s interpretations, new insights and growth can be achieved. However, without hypnosis, many weeks and months will typically elapse before such responses develop and become manifest in such a relationship.

More significant is the fact that the patient’s regression (Menninger & Holzman, 1973) that brings this about can be far better achieved and appropriately controlled by the use of hypnosis because hypnosis itself is a form of regression in the service of the ego (Gill & Brenman, 1959) or, as Hartmann (1939/1958) termed it, “adaptive regression.” A personal communication (August 11, 2002, to A. Barabasz) from Erika Fromm is referred to in Barabasz and Watkins (2005) (pp. 68–70). Fromm explained that a person suffering from a cold might well curl up in bed “just like a child,” watching hours of senseless lightweight TV programs, letting him- or herself simply be taken care of by others. This regression helps the person to get well, healthy, and independent once again more quickly. She further likened the activity to taking a vacation in which one engages in entertainment, napping, or reading nondemanding materials. Clearly, these regressions in the service of the ego are nonpathological and healthy. Regressive experiences in the hypnotherapeutic relationship can help to bring about self-healing and facilitation of inner strengths (Frederick, 1999b). In a brief period of time, of course, the patient might be willing to engage in the experience under the guidance of the hypnoanalyst.

This book will also focus on hypnodiagnostic procedures and new, revised, and updated approaches to abreactive techniques. Abreactive techniques, which remedy the early criticisms voiced by Freud and Breuer (1953), are still voiced by some hypnoanalysts. We will also explain the use of hypnography and sensory hypnoplasty as methodologies to derive information about unconscious processes that go beyond verbalizations alone. The reader will learn how to hypnotically facilitate dissociative and projective approaches so that an even greater degree of flexibility is offered to the psychoanalytic practitioner. The latest developments in ego-state therapy beyond those described by J.G.W. and H. H. Watkins (1997) will be presented, with extensions of dissociative techniques that provide yet another dimension in psychoanalytic theory. The theoretical origins of ego-state therapy (Frederick, 2005; Frederick & McNeal, 1999; Emmerson, 2003; J. G. Watkins and H. H. Watkins, 1997) stem from the writings of both Paul Federn (1952a) and Edoardo Weiss (1960). In this book, we approach it from the perspective of concepts concerning the structure and functioning of the self as foreshadowed by Kohut (1971) and Kernberg (1972). However, this book is primarily about treatment techniques, not theory.

Hypnoanalytic techniques should not be regarded as competing with the traditional practices of psychoanalysts or those employing psychoanalytically oriented therapy, but rather as a means of complementing their work. Hypnoanalysis can be viewed as merely an extension and an elaboration of the methods by which Freud and his colleagues undertook to explore the fascinating world of the human mind, one that continually influences our behavior and well-being, but of which we are often so little aware.

The enormous time and cost required for traditional psychoanalysis (three to five times a week for several years) limits its use to a very special and typically affluent population. Hypnoanalysis provides a much more rapid and incisive form of psychoanalysis, while also dealing with deep-underlying conflicts. Hypnoanalysis, as described in this volume, is intended to achieve genuine personality reorganization in a much shorter period of time, thus making the enormous capacity of psychodynamic thinking and psychoanalytic therapy more widely available.

Hypnotherapy is much more than a collection of techniques, because its success involves the very “self” of the doctor (A. Barabasz & Christensen, 2006). Therefore, we have attempted to place our procedures in a broad and philosophical context. That is to say, two practitioners may employ “identical” techniques, yet one achieves far better results than the other. In our chapter on existential hypnoanalysis and the therapeutic self, we explain how to integrate our two books using the concept that all “techniques” in psychological therapy must be practiced within a constructive interpersonal relationship and that in the final analysis, our success or failure may depend more on how we relate with the patient than on what we do to the patient.

We hope that those skilled psychotherapists and analysts who have experience in clinical hypnosis will find this book stimulating, in that a number of new and exciting therapeutic techniques can be added to their practice. As behavioral scientists, we must all continue to explore the inner human condition. Hypnoanalytic techniques offer many sophisticated ways of accomplishing this, both in the clinic as well as in the hypnosis research laboratory.

2

Hypnoanalytic Insight Therapy

Rigorously controlled studies show hypnosis is not only an effective adjunctive intervention but also superior to a number of widely employed treatment procedures when applied directly to influence symptoms as reviewed in Barabasz and Watkins (2005) (also revealed by Lynn, Kirsch, A. Barabasz, Cardeña, & Patterson, 2000). Perhaps it is because of this demonstrated efficacy, combined with cost-efficiency in the face of soaring medical costs (Lang & Rosen, 2002), that its potential for even greater contributions to the sophisticated reconstructive therapies involving insight has not been fully appreciated.

Despite there being many variations of psychoanalysis, all are based on the assumption that neurotic symptoms are the external manifestations of underlying conflicts and lifting the repression of unconscious factors and achieving “insight,” will resolve the symptoms. Indeed, the classical psychoanalyst would likely hold that this is true of all neurotic symptoms and that unless insight has been achieved into the underlying dynamic structure of a specific neurosis, no permanent cure can be expected. In the face of now hundreds of studies to the contrary (reviewed by J. G. Watkins, 1992a), this extreme position is no longer tenable.

As discussed in Barabasz and Watkins (2005), many symptomatic conditions respond favorably and permanently to direct hypnotic interventions. Hypnosis has enormous facilitative effects when used in conjunction with standard therapies. For example, two meta-analyses (Kirsch, Montgomery, & Sapirstein, 1995; Kirsch, 1996) showed that the addition of hypnosis substantially enhanced treatment outcomes, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of the clients receiving nonhypnotic treatment. However, there are often neurotic symptoms that do not seem to be permanently relinquished unless unconscious conflicts, at their root, are brought into conscious awareness and reintegrated through that kind of understanding called insight. Therapies that aim at such insight, whether they are person-centered, cognitive, cognitive-behavioral, psychoanalytic, or any of numerous brief psychoanalytic approaches, can often produce lasting results with the addition of hypnotherapeutic interventions.

Intellectual and Experiential Insight

What is intended by the term insight? Much that appears to pass for insight in therapeutic interventions turns out to be nothing more than intellectualizations or intellectual understandings limited to only the cognitive (surface-deep) sphere of personality. Thus, reconstructive alteration of the personality is not possible with such superficial approaches. Even a number of analytic therapies go on month after month without showing significant change, despite the fact that the patient has learned to verbalize the dynamic constellation that underpins his or her neurosis. The point is that the patient has achieved nothing more than superficial insight, which has failed to adequately pervade the entire personality. Such examples fuel the arguments against the use of psychoanalytic therapy by those who are insufficiently educated or experienced to appreciate the issue at hand. These situations are responsible for the time-honored joke that “After 7 years of analysis the patient still bangs his head on the floor, but now he knows why.” Our goal here is pervasive reconstructive change rather than mere superficial self-understanding.

Many years ago, J.G.W. interpreted to a depressed patient that he unconsciously hated his father. The evidence from his associations and dreams was quite clear on this point, so unmistakable that he immediately agreed: “You’re absolutely right, Dr. Watkins. I am depressed because I hate my father. It’s really clear now.” However, no change in his symptoms occurred until several weeks later, when the patient burst into the office. He stood, wild-eyed and with a horror-struck expression, shouting, “I really do hate my father.” That was genuine insight, not his first agreement with the interpretation. His initial understanding had only been at the cognitive intellectual level. Nonetheless, it had managed during the ensuing weeks to work its way through to an emotional level, which at long last mobilized feelings as well. A significant reorganization of his entire perceptual network was the result. Finally, the patient really understood. His depression began to clear. He had achieved true insight, and the symptoms never returned.

Reorganization of the patient’s understanding is more than verbal or cognitive. Insight as we use it here means a thorough-going understanding including an essential alteration at the emotional level, the perceptual level, the motor level, and even the tissue level. It is a “gut” comprehension that, to be successful, must pervade the patient’s entire being in all of these areas: physiological, psychological, and social. It is an alteration in meaning that changes the entire Gestalt of his or her personality. As such, it resolves inner conflicts and thus achieves a permanent impact on the dynamic factors that have maintained the symptoms. Using this definition, insight is a significant and profound experience that genuinely influences the entire lifestyle of the patient. There often remains a presumption that insight is ineffective. This is based on the erroneous, yet pervasive, definition of it as simply an intellectual understanding.

The techniques described in this treatise for achieving insight are intended to teach you how to achieve this greater and more comprehensive objective even though a superficial cognitive understanding is at first attained. The point should always be borne in mind that therapy has not achieved much if you stop at that level. It can, but it is best viewed as a precursor to more permanent changes of feelings and behavior.

Criticisms of Hypnosis by Psychoanalysts

Psychoanalysts have frequently criticized hypnosis because they misconstrue it or assign it to the role of nothing more than symptom suppression through direct suggestion. Anna Freud asserted that, even if some insight may have been achieved, this understanding is “bypassed by the ego” and hence cannot be reintegrative (1946). This criticism has been repeated and believed by numerous analysts ever since. Somehow, it is assumed that when one is hypnotized, the ego is laid aside, that it is not involved in the uncovering process, and that, accordingly, such material as does emerge cannot be absorbed or utilized by the patient for genuine change. The notion is that loss or reduction of symptoms must, thereby, be temporary because no change, or at best only a superficial one, has been made in the basic personality. Therefore, the neurotic conflicts are assumed to reassert themselves, and the symptoms will then return as soon as the influence of the hypnotherapist is no longer present. This position, though unsupported by clinical or empirical findings, has been positively and repeatedly stated in G. Blanck and R. Blanck’s (1974) frequently cited volume on ego psychology.

Hypnotic Depth

It would seem obvious to all but the most casual observer that adequate hypnotic depth should be produced before expecting a hypnotizable participant to complete a task difficult enough to elicit pain control for major surgeries (see A. Barabasz & M. Barabasz, 1992). Nonetheless, achieving great depth does not necessarily require a lengthy procedure. Very brief inductions as well as spontaneous trances can often produce deep hypnosis.

One of many interesting examples appeared in a study involving stringent selection of high and low hypnotizable subjects in an experimentally controlled investigation of the effects of alert hypnosis versus the identical suggestion only on EEG event-related potentials (ERPs) (A. Barabasz, 2000). Consistent with numerous studies of hypnosis and ERPs, the data showed that only the hypnotic induction withefforts to insure adequate depth made it possible for high (but not low) hypnotizable individuals to significantly alter their brain activity in response to a hypnotic induction plus a suggestion, in contrast to the identical suggestion without the induction of hypnosis. This finding added further disproof to the sociocognitive notion that suggestion alone can account for all that can be wrought with hypnosis.

Interestingly, and perhaps of the greatest clinical significance to the findings, was that one highly hypnotizable participant produced almost identical responses in both conditions. He altered his event-related potential brain activity, in both the suggestion-only and the hypnotic-induction-plus-suggestion conditions. Simplistically, this would appear to be a statistically nonsignificant exception to the overwhelming findings of the study, but nonetheless it was an exception supporting the sociocognitive position. However, the postexperiment independent inquiry conducted by researchers not otherwise engaged in the investigation revealed the participant’s strategy. This subject stated, “When I got the instruction to make like there were earplugs in my ears, I just did what I learned to do when I was a kid.”

“Tell me more,” replied the inquirer.

“Well, when I got spanked by my dad, I could turn off the pain just like going to another place, so that’s what I did with the suggestion, same as the hypnosis part.” As discussed in Barabasz and Watkins (2005, p. 85) this could be a classic example of spontaneous hypnosis with apparent dissociation. Alternatively, the suggestion alone constituted the hypnotic induction (Nash, 2005), and the highly hypnotizable subject merely responded with a level of depth sufficient to alter his ERPs.

We recommend that hypnotherapists should always be on the lookout for such behaviors. It is also of imp...