Psychic Experience and Problems of Technique

Harold Stewart

• Publisher: Routledge
• Year: 2003
• Topic: Psychology
• eBook ISBN:
  9781134929283
• Subtopic: History & Theory in Psychology
• Index: Psychology

Harold Stewart, a distinguished psychoanalyst of more than 30 years' experience, began his medical career as a general practitioner. He was drawn first towards hypnotherapy, then to psychoanalysis, as a more sensitive, productive and far-reaching method of exploring patients' problems.

In this book Stewart draws deeply on his own clinical experience to focus on changes in the patient's experience of inner space, and to record the growth of his own understanding of the patient's experience and how this can change. Beginning with a vivid account of the role of collusion in the myth of Jocasta and Oedipus, he goes on to a theoretical discussion of thinking, dreams, inner space and the hypnotic state, in the context of extensive clinical experience. The second part of the book centres on practical clinical issues and problems of technique, tackling in particular the role of transference interpretations, other agents of change, and the problems encountered in benign and malignant types of regression.

The wealth of clinical material and the author's informality and openness in presenting his experiences of working with very disturbed patients will be of immense practical value to other practitioners. Psychic Experience and Problems of Technique will help psychoanalysts and psychotherapists to understand the nature of clinical problems which are often encountered but seldom acknowledged.

PART ONE

Theory

A On collusive relationships

B Changes in inner experience

1

Collusion and the hypnotic state¹

My introduction to the therapy of emotional disorders occurred soon after my qualification as a doctor in 1947, when I took my first post as a House Physician at Oldham Royal Infirmary, a hospital in Lancashire. One of my chiefs was a local General Practitioner who was interested in therapeutic abreactive techniques in psychiatry, and one day he suggested that I might like to watch him abreacting a patient. She was an elderly woman and all I remember of her was that she could speak only in an incomprehensible babble. He injected a small dose of Pentothal, which put her into a light sleep, and then suggested to her that she would now speak clearly and he asked her to recite the nursery rhyme, ‘Mary had a little lamb’. She did so very clearly and distinctly and we were both impressed by this. He then suggested to her that when she awoke, she would be able to speak clearly and normally, yet when she did awaken, she disappointed us by relapsing into babbling. In this experience, I learned of the power of unconscious resistance, of its circumvention by abreactive techniques, and the relative uselessness of direct simple suggestion.

Some time after this, I became a General Practitioner myself outside London and rapidly became acquainted with the vast amount of emotional problems, expressed either psychically or somatically, which affected the bulk of patients I saw. At that time there was almost no psychotherapy available in the National Health Service outside of the few specialized centres in London and the only help to be obtained from the local psychiatric outpatients’ department seemed to be the suggestion that patients be given barbiturates to sedate them, or, if that did not help, amphetamines to stimulate them. At about this time, in 1952, I read in the British Medical Journal of the successful treatment of a case of congenital ichthyosis, a rare skin disease, in an adolescent boy, by A.A.Mason (now a psychoanalyst) using hypnotic suggestion, and this suggested to me a way in which I might be able to help patients. Following a course of instruction in the technique by him, I started to use it in my practice and in this lay the seeds of my psychoanalytic career.

At first I used hypnotic techniques for the purpose of direct suggestion, but later I used it more for the attempt to recover repressed memories of traumatic experiences with the emotions attached to them, as first described by Breuer and Freud in Studies in Hysteria (1895). In a number of cases where I could pinpoint the trauma, this was very successful, but I soon discovered that either I could not reach such experiences or that patients had not had such experiences. Patients would talk in the trance states if requested but I had little appreciation of what they were trying to convey to me by doing so, with the inevitable result that no therapeutic help occurred. I then read books on hypnoanalysis, which recommended that the hypnotherapist have personal therapy in order to help him understand. Interestingly enough, it was psychotherapy and not hypnotherapy that was recommended for the hypnotherapist. I followed up this suggestion, but gradually I gave up using hypnotic techniques and hypnoanalysis as I became progressively psychoanalytically orientated, yet it was my clinical experiences in this intervening period that helped me formulate new concepts of the psychodynamics of the hypnotic state and its phenomena (1963, 1966, 1969).

Before proceeding with these clinical experiences and my own theoretical concepts, I would like first to give a brief account of the main psychoanalytical theorizing on the hypnotic state and relationship from Freud onwards. Freud’s first statement on hypnosis was contained in a footnote in his book, Three Essays on the Theory of Sexuality (1905), where he stated that the credulous submissiveness of the hypnotized subject ‘lies in an unconscious fixation of the subject’s libido to the figure of the hypnotist, through the medium of the masochistic components of the sexual instinct’.

Ferenczi, in his essay on ‘Introjection and transference’ (1909), suggested that the hypnotic state is an expression of the early child-parent relationship, with the subject being the small child and the hypnotist being unconsciously regarded as either its mother or father. He differentiated between the ‘maternal’ form of hypnosis, where the means of induction into the trance state are gentle and persuasive, and the ‘paternal’ form, where the means of induction are forceful and authoritarian, such as the eye-stare technique. He thought that the maternal form was based on love and the paternal on fear.

Freud’s later contribution to theory was in his book, Group Psychology and the Andysis of the Ego (1921). He compared hypnosis with the state of being in love, but with the important difference of there being no sexual satisfaction. He described the hypnotic relationship as a group of two people and suggested that in the unconscious, the hypnotist is put in the place of the subject’s ego-ideal. However, he felt that his explanation was insufficient to account for all the observed phenomena.

Ernest Jones, in a paper on ‘The nature of autosuggestion’ (1923), proposed that the hypnotized subject projected his superego onto the hypnotist. In this way the hypnotist has to fit in with the demands of the subject’s conscience and morality—that is his superego, to a fair extent—and if his suggestions offend too much against them, the subject will not obey them.

Paul Schilder (1922) added to these the concept of a masochistic identification of the subject with the hypnotist. The subject, by submitting and abasing himself to the hypnotist in a masochistic manner, identifies himself with the supposed power and authority of the hypnotist which he himself has projected onto the hypnotist.

So far, all the theories have been based on erotic submissiveness and identification, but, with the establishment of the structural theory of the psyche by Freud in The Ego and the Id (1923), more attention began to be paid to what is now called ego psychology with the various concepts of the development of the ego and its functioning. L.Kubie and S.Margolin (1944) suggested that hypnosis did not necessarily involve any hypnotic relationship between two people, as a trance-state could be induced by entirely physical means producing sensorimotor deprivation. This meant that the hypnotic state could be entirely accounted for in terms of a regression of ego-functioning, with the subject gradually failing to distinguish between himself and the outside world and so regressing to a primitive infantile state.

This concept was contested by M.Gill and M.Brenman in their book, Hypnosis and Related States (1959), in which they maintained that the hypnotic relationship, even if physical manipulations were used for the induction of the trance, was an essential component of that induction. They also agreed that the regression of ego-functions to more primitive modes of behaviour certainly occurred. Thus, the two mechanisms seem necessary—the sensori-motor reduction for the subject and the psychodynamics of the relationship between subject and hypnotist.

Prior to this, Brenman and Gill together with R.Knight (1952) had written on the topic of the subject’s hostility towards the hypnotist. They studied fluctuations in the depth of hypnosis of patients in hypnoanalytic treatment and observed changes in depth if the material produced by the patient suggested hostility to the hypnotist. They put forward the hypothesis ‘that the hypnotic state involves not only the gratification of pregenital and Oedipal needs but also a constantly changing balance between such needs, experiences of hostility, and defences against both these sets of instinctual impulses’. They further emphasized the more subservient role of the hypnotist in this respect, and it is on these aspects of the hypnotic state that my own theorizing has been elaborated, although at the time when I had been making my own observations and speculating on them, I had not known of this prior work of these authors.

I, too, had found that when I asked patients in the trance-state to free-associate, I noticed that if I interpreted their associations in terms of their hostility to me, the hypnotist, the depth of the trance would considerably lighten. If I persisted in continuing for some time to interpret the negative transference, the patients eventually could no longer be induced into a trance-state at all. I noticed that this phenomenon did not occur if my interpretations were of the positive transference. The conclusion I drew from this was that the hypnotic state could exist only as long as the hostile feelings of the subject towards the hypnotist were not made explicit.

A second observation, a subjective one, has not previously been described in the literature as far as I am aware. Usually I had the feeling as work progressed that I was in control of the patient within this relationship and this made me feel both powerful and elated. However, there were also times that I had the very strong feeling aroused in me that the patient was in control of me and that I was being swept along as a helpless observer by the patient. The only other times I have since had these intense feelings of being so helpless have occurred in the analysis of a chronic schizophrenic patient; for example, he described feeling as though he were a fly being swept along on a giant’s foot, and at that moment, that was just the way I was feeling. I am sure that I would not have become aware of these counter-transference feelings of helplessness with my hypnotized patients if I had not been in analysis to help me to become aware of the whole range of my own feelings in my own therapy.

This reference to counter-transference takes me to a brief aside. In 1962 when I presented these views on hypnosis to a Scientific Meeting of the British Psycho-Analytical Society, there was a different atmosphere from the present one on the topic of counter-transference. Although Paula Heimann had published her paper on the subject in 1950, which presented counter-transference as an unconscious communication and not solely as an unanalysed resistance in the analyst, this had not yet been assimilated by the Society. The result was that my courage deserted me in presenting my counter-transference feelings as part of my findings and led to their omission in my original paper on hypnosis, something I now rather regret.

The third element for my speculations is the fact that although the hypnotized subject feels and says that he is under the control of the hypnotist and has little or no volition of his own—that is, that he feels that the hypnotist and not himself is the prime mover in the production of these phenomena—it must be, as Ferenczi (1909) pointed out, that unless one believes in magic, the hypnotic phenomena are primarily the product of the subject’s psyche and not of the hypnotist’s. This raises an interesting issue; that if the hypnotist were to tell the subject that hypnosis results from the subject’s belief in magic and in the supposed omnipotent qualities of the hypnotist, would the subject then go into a hypnotic trance-state? The answer is supplied by L.Wolberg, when he writes:

During the early phases of hypno-analysis it is unwise to try to alter the patient’s fantasies of the magic that he expects from the hypnotic process. To do so will cause him to respond with resistance and will block the emergence of other transference reactions. What he seems to want unconsciously from the relationship is to be able to depend upon a kind and omnipotent person. To inject interpretations at this stage may create panic or such contempt for the analyst as to interfere with achieving the proper trance depth and with the interpersonal relationship itself.

(Wolberg 1945:240)

To account for these three observations, I am proposing the hypothesis that the hypnotic state is based on a collusive deception between the subject and the hypnotist, a deception based on an unspoken secret agreement that the hypnotist must pretend to the subject that he is omnipotent, all-powerful. Only in this way will the subject go into the trance-state and remain in it. What, then, is the meaning of this secret deception to the unconscious of the subject, which is ‘aware’ of the pretence? The answer I suggest is that, with the hypnotist’s collusion, the subject feels that he is omnipotently forcing the hypnotist to this deception by projecting his own superego and feelings of omnipotence into the hypnotist and is thereby in control of this situation. The hypnotist meanwhile passively accepts these projections (projective identifications) and glories in them in a manic fashion, by his feelings of magical omnipotence in his prowess as a hypnotist. It is only with analytic self-awareness that the hypnotist comes to recognize his feelings of being controlled by the subject and that he has been projecting his own helpless and controlled feelings into the subject. In this dynamic, far from the hypnotic relationship being only a passive, masochistic identification and surrender on the part of the subject, the unconscious content also includes these omnipotent, controlling, hostile aspects of the subject which are being acted out. The hypnotic state can be conceived as a collusion between hypnotist and subject to deny this hostile attack, and, at the same time, it is an expression of this attack. This formulation makes this state comparable to a hysterical symptom with the repression or denial of the impulse and its expression in another form, but, in this instance, with the necessary condition of the hypnotist’s collusion. This aspect makes it resemble a folie-à-deux.

This hypothesis of the more active unconscious controlling mechanisms working in the subject’s psyche would account for the fact that the hypnotized subject cannot be made to produce phenomena that he resists. The situation resembles that in the fable of the frog and the ox whereby the ‘frog’-hypnotist is being omnipotently transformed by the subject into the ‘puffed-up ox’ hypnotist. An analogy of the situation as that of one aspect of the British Constitution. Here there is a monarch who has all the trappings of power, with a parliament that swears allegiance and subservience to the monarchy, whereas the true situation is, of course, that the power is really in the hands of the subservient parliament with the all-powerful monarch being unable to do anything without its consent.

If this hypothesis is correct, there should be evidence of anxieties in the patient about the outcome of this hostile attack on the hypnotist, and these anxieties would be either of a persecutory type from fear of retaliation by the hypnotist, or of a depressive type from fear of the guilt engendered by the attack. It is a commonly observed fact that occasionally there are spontaneous outbursts of anxiety in the hypnotized subject for no apparent reason and these can be manifestations of either type of anxiety. It can also help to explain other observable phenomena encountered in the trance-state, such as the subject’s capacity for considerably heightened performance, in the subject’s ability for reality testing at the hypnotist’s suggestion, and the subject’s ability to produce various forms of hallucinatory phenomena, which deny reality testing, such as visual hallucinations, anaesthesias, aphonia, and so on. It is clear that the subject fits in very strongly with the hypnotist’s suggestions in an almost compulsive fashion in order to avoid the anxieties that would otherwise be aroused. It is noticeable that if the subject does not comply with the hypnotist’s suggestions, intense anxiety is aroused in the subject, a situation akin to the anxiety aroused in an obsessional patient if he does not carry out his obsessional rituals. Since these obsessional activities are regarded as being of a reparative nature, to undo the damage caused by the patient’s unconscious hostility, this lends support to the notion of the hypnotized subject’s compliance being of the same order. In this way the guilt of the subject will be a powerful factor in reinforcing the hypnotic state.

This dynamic would also help to explain observations made by Wolberg which arose when he did interpret the subject’s hostility to the hypnoanalyst but at a much later stage of the therapy. He wrote:

The question may be asked whether an analysis of the hypnotic interpersonal relationship may not remove the very motivations that make hypnosis possible. In the vast majority of cases it has no such effect; usually a peculiar dissociation exists. The patient continues to react to hypnosis, going into trance-states while at the same time manifesting hostile feelings towards the analyst. Rarely does resistance developing out of analysis of the transference become so intense that the patient refuses to enter hypnosis.

(Wolberg 1945)

I would suggest that the ‘peculiar dissociation’ that he describes implies a split in the ego, and that this split has occurred because the accumulation of guilt in the patient towards the hypnotist has reached such an intensity that the hostility can be explored only by means of such a split. This will mean that this split-off area cannot be explored in the course of a hypnoanalysis, which means it is doomed from the start to be incomplete.

A further observation frequently observed is that when a subject emerges from the trance-state, he tends to use certain types of phrase such as ‘I feel marvellous’, ‘Never felt better in my life’, and the tone of a rather manic euphoria in these statements is unmistakable. This manic state may well reflect feelings of triumph experienced by the subject following on the successful attack on the hypnotist. Furthermore, the occasional headache, paraest...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgements
• Introduction
• Part One: Theory
• Part Two: Technique Issues and problems in effecting psychic change
• Bibliography
• Name index
• Subject index