HYPNOANALYSIS AND ANALYTICAL HYPNOTHERAPY VOL 2

TABLE OF CONTENT
1. THE USE OF THE P-TAPE IN MEDICAL HYPNOANALYSIS: DANIEL ZELLING 1
2. THE SECRETS FROM YOUR SUBCONSCIOUS MIND:
THE KEY TO YOUR MIND’S POWER: RYAN ELLIOT

4
3. HYPNOANALYSIS: THE LIGHT HEART CENTER

17
4. THE THEORY AND PRACTICE OF HYPNOANALYSIS:
DANIEL BROWN & ERIKA FROMM

18
A. UNCOVERING THE UNCONSCIOUS SOURCES OF CONFLICT

23
B. DREAM INTERPRETATION

24
C. DEALING WITH DEFENSES AND RESISTANCES

26
D. TRANSFERENCE
 27
E. FURTHER HYPNOANALYTIC TECHNIQUES

34
5. CLINICAL APPLICATIONS OF HYPNOTHERAPY AND HYPNOANALYSIS:
DANIEL BROWN & ERIKA FROMM

38
A. PHOBIAS

40
B. WE RECOMMEND A THREE-STEP TREATMENT PROCESS

41
C. HYSTERIA: CONVERSION REACTIONS

48
D. DISSOCIATIVE SYMPTOMS

51
E. HYPNOTHERAPY WITH SEVERELY DISTURBED PATIENTS

53
 F. HYPNOTIC VISUALIZATIONS THAT AID BOUNDARY FORMATION 55
G. THE HYPNOANALYSIS OF PATIENTS WITH DEVELOPMENTAL DEFICITS 58
H. HYPNOSIS AND POST-TRAUMATIC STRESS DISORDERS

64
6. A LONG-TERM CASE OF HYPNOANALYSIS: CHILD ABUSE AND EARLY RAPE:
DANIEL BROWN & ERIKA FROMM

83
7. HYPNOANALYSIS: WILLIAM KROGER & WILLIAM FEZLER

108
8. BACK TO ISE: DUNCAN MCCOLL: PRECISION THERAPY:
HYPNOANALYSIS TECHNIQUES

112
9. HYPNOANALYSIS: WILLIAM S. KROGER

113
A. CONTRAINDICATIONS AND INDICATIONS

114
B. HANDLING RESISTANCES

115
C. OTHER UNCOVERING HYPNOANALYTIC TECHNICS

116
10. I BELIEVE THAT THE USE OF HYPNOSIS SHOULD NOT BE
LIMITED TO PHYSICIANS AND DENTISTS: FRANK S. CAPRIO
 119
11. RELATIONSHIP THERAPY (MEDICAL HYPNOANALYSIS)

120
12. THE KEY ANALYTICAL HYPNOTHERAPY: HYPNOANALYSIS
EDGAR BARNETT

122
13. A SYSTEM OF BRIEF HYPNOANALYSIS: LESLIE M LECRON & J BORDEAUX 126
14. SPECIAL INTAKE QUESTIONS FOR HYPNOANALYSIS:
DABNEY EWIN & BRUCE EIMER

131
15. TREATMENT PLANNING: ANALYZING THE HISTORY:
DABNEY EWIN & BRUCE EIMER

135
16. HYPNOSIS IN PSYCHOANALYTIC THERAPY (HYPNOANALYSIS):
LEWIS WORBERG

138
A. HYPNOANALYTIC PROCEDURES

143
 B. HYPNOSIS AND FREE ASSOCIATION

144
C. AUTOMATIC WRITING

145
D. DRAMATIC TECHNICS

146
E. PRACTICAL APPLICATIONS OF HYPNOANALYSIS

147
17. RATIONAL SUGGESTION THERAPY: A SUBCONSCIOUS APPROACH
TO RET: RICHARD A. BLUMENTHAL

150
18. THE PRISONER: ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT

154
A. THE PSYCHOSOMATIC DISORDERS

155
B. THE HABIT DISORDER
 158
C. EMOTIONAL DISORDER

159
19. EXAMPLE OF AN ANALYTICAL PROCEDURE FOR REFRAMING: BARNETT 161
A. RELINQUISHING THE REPRESSED AND REPRESSING EMOTIONS 162
B. CASE EXAMPLE

163
20. THEORY OF ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT

165
A. THE EMOTIONS

166
B. CHILD, PARENT, ADULT

168
21. PRINCIPLES OF ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT

171
A. THEORETICAL CONSIDERATIONS
 172
B. FIRST OF SIX PRINCIPLE

173
C. SUMMARY OF ANALYTICAL PROCEDURE

178
22. UNCOVERING TECHNIQUES IN ANALYTICAL HYPNOTHERAPY

179
A. INDUCTION OF HYPNOSIS FOR ANALYTICAL HYPNOTHERAPY 180
B. AGE REGRESS

181
C. IDEOMOTOR QUESTIONING

182
D. INDIRECT METHODS OF UNCOVERING

183
23. THE IDEOMOTOR QUESTING TECHNIQUES IN
ANALYTICAL HYPNOTHERAPY

185
 A. IDEOMOTOR SIGNALING

186
B. ESTABLISHING IDEOMOTOR SIGNALS

187
24. AN ANALYTICAL PROCEDURE: EDGAR BARNETT

194
A. CASE HISTORY

201
B. REFRAMING

207
C. CASE HISTORY

210
25. THE NEGATIVE BIRTH EXPERIENCE: EDGAR BARNETT

217
 A. PRENATAL CRITICAL EXPERIENCE

221
B. CASE HISTORY

221
C. ANALYTICAL HYPNOTHERAPY AND PREVIOUS LIFE EXPERIENCES 229
26. DIRECT AND INDIRECT SUGGESTION IN ANALYTICAL HYPNOTHERAPY
EDGAR BARNETT

231
 1

HYPNOANALYSIS AND ANALYTICAL HYPNOTHERAPY VOL 2

1. THE USE OF THE P-TAPE IN MEDICAL HYPNOANALYSIS: DANIEL ZELLING
Many people over the years have asked me, "What's is a P-tape?" It is a "personal tape"
made for a patient giving all the salient points of the analysis. However, this is still not
satisfactory for most readers. For this reason, I want to give you a verbatim transcript of a P-tape
made (only the name has been changed) of a twenty-nine year old male executive, who eight
weeks prior to his consultation visit, had been diagnosed with Multiple Sclerosis. His symptoms
started while on vacation in Vermont when he tried but could not write a postcard. An
emergency visit to the hospital that same day revealed a neurologist's diagnosis of Multiple
Sclerosis. This was confirmed with a C.A.T. Scan. Which showed several lesions. When he first
heard the diagnosis (verdict), his symptoms started flooding in. panic attacks were followed by
weakness and numbness in his leg, burning sensations in the right side of his head, and in the left
chest area. He stated that his symptoms came and went. He felt incredible despair when
symptoms were present. As many patients do when first diagnosed with a disease, he read
hundreds of pages on the subject of Multiple Sclerosis, exploring all avenues of treatment. His
father-in-law had been treated and cured by me for Torticollis two years earlier and suggested he
come and see me, which he did immediately.
The standard medical hypnoanalytic history was done. The W.A.T. (Word Association),
dream interpretations and appropriate age regressions were done. The patient was taught
self-hypnosis. On his eleventh session, the following P-tape was made. He was treated for a total
of twenty-four sessions. The patient listened to his P-tape a total of four times while in trance,
followed by appropriate suggestions pertaining to his particular problem.
As I do with Cancer, AIDS and MS patients on his first visit he was asked to make two
drawings, one depicting his problem and two, depicting life in general. Just before making his
P-tape on his tenth session, he was once again asked to draw a picture of his disease and one of
life in general. To demonstrate the value of the P-tape, I am presenting a verbatim transcript.
 2

P-TAPE: Floatingand driftingand dreamingBecoming more and more relaxed

with each easy breath you take There is healing in relaxation. If a person breaks a leg, we put it
in a cast so it can rest and heal. Now, you have been given a gift and the gift is the alleged
diagnosis of MS.  Yes  It is a gift. Bernie Siegel refers to it as a reset button. Your life has
changed. And you are changing. When you came in and I asked you, "What is your problem?"
You said, "real simply, I am twenty-nine years old, a healthy male, just diagnosed with Multiple
Sclerosis and I believe I can cure myself in my mind." And you told me about your father-in-law
and how we helped him overcome his problem You said, "I quit smoking when I got
diagnosed." I feel I can help myself. I quit smoking; I walk three miles a day; I'm on a low fat
diet; and I listen to relaxation tapes." You said, "Everything I did in the past I do different today.
I changed around. The doctor feels that I have taken the diagnosis well" Bullshit! You are not
taking the diagnosis well. You're fighting it  And you are winning the battle with my help. You
are a strong person, and you can overcome it. When I took your history, I gave you a little task of
drawing a picture of your illness and of your life in general. And what does that man draw? He
draws a guy in a wheel chair, tears streaming out of his eyes, the sun behind the clouds and
entitled, "Life is Unfair." Oh, yes. And in this picture of the illness you draw a nerve sheath and it
is in multiple colors - there is green and yellow and purple and blue and orange and the colors
dominate the picture and then on the right side of the MS there is a little bit of brown and this is
not so hot. Well, on some level, MS is an immune disease and we know a few things about those.
As a matter of fact, we know a great deal about immune disease. Norman cousins wrote a book,
and it is called Head First. Interesting little book. And in it he describes people with very minimal
symptoms that get diagnosed and a flood of symptoms start to occur because they believe that
they are ill. It says in the book, "As a man thinketh in his heart, so is he." Now you are changing
your thinking. Remember when you came in, we took a very, very extensive history. When I
asked you about your family history, about your childhood you said, "It was unhappy until age
thirteen, except when I was with my uncle", and I asked you about your Uncle who, indeed was a
very caring man. I asked you about your mother and your stepfather. I asked you about the
relationship. I asked you about your sisters, Janet and Marie. I asked you about what you know
about your mother's pregnancy with you and your birth I need to know that because you told
me that the origin of your problem was your birth experience. You did not say: "I've been
recently diagnosed with MS" No, you said, "Real simply, I'm twenty-nine years old," and with
that you referred to the very beginning that's right. So we already knew that, and you
confirmed it in many, many ways. I asked you about your past illnesses; I asked your about your
early sexuality, your present day sexuality - oh, I just kept on asking and asking and asking.
Now, we know that in the development of cancer, and in the development of immune
disease, and autoimmune disease, usually something happens two to three years prior to the
development of the illness. Ok. What happened to (patient's name), two or three years before he
developed this illness? Now that was simple. You told me you lost your job. As a matter of fact,
in the word association exercise, I said: "I was near death when" and you answered, "I lost my
job" but you see, that wouldn't do it. No. No, it wouldn't. That would not do it because lots of
people lose their jobs. No, no, no, no. That is only the Symptom Itensifing Event. And so we
need to find all three: The Initial Sensitizing Event, The Symptom Producing Event, and the
event that lead to the development of the illness called the Symptom Intensifying Event, which
for you was losing your job. All of that got confirmed in the word association exercise. I said, "If
 3

I describe my problem in color, it would be the color" and you said "black." Later on in the word
association, I said, "The color black to me means" and you said "death." OK. The problem is
death. To a certain extent, you have been a Walking Zombie. That's right. I said: "I sometimes
feel stuck at the age of" and you said, "I was nine years old." That is correct. The
symptom-producing event occurred when you were nine years old. I said: "When I was born" and
you said, "I was unhappy."Oh, yeah, you knew; you knew. You knew all these things. Your
inner mind knows. However, your inner mind also knows about the cure. I said: "Basically" and
you said, "I am a good person. Your certainly are. I said: "My greatest need is" and you said, "to
be in control." Yes. You have been out of control, and you're going to get your control back
You are right now right now. I said: "At the very bottom of it all." You said, "happiness." I
said: "twenty years from now" and you said, "happiness."  This is not the picture of a
wheelchair  Hell no! I said: "This time I will be successful because" and you said, "I am
committed." Sure you are. You are committed and you are in control. I said: "Underneath it
all" and you said, "I want to laugh." Ha. Ha. Ha. Ha. (Therapist laughing). That's right,
underneath it all, you want to laugh, "to live and be happy."
And we took you back. The first time you went back, you went to age nine. You are in
Atlanta, playing in the schoolyard throwing the ball and just playing. And then this guy is
going to take you for a ride, your sister and you - through the city. You end up at Grandma's, and
your sister starts crying because she tells you the guy you're with is your real dad. You said,
"that's were I got unglued." Unglued. That's right. That's where your nerves got frayed. Your
nerves  Yea that's the disease it attacked - your nerves, and they got frayed. And that is when
it really got started - that is the Symptom Producing Event. We took you to the Initial Sensitizing
Event that set you up for it. We knew that because you told me it was a birth experience - and so
we took you there. You're inside the womb - five months - feelings from mother: scared,
uncertain - How am I going to handle it? You got up to seven months inside the womb - more
scared - mother is worried - there is more fear. How can we be sure? And then the birth process
begins. Your head is going first - it's tight - it's hard - breathing fast and then you are out
They are picking you up; they are putting you down; they're wrapping things around you. They're
cutting the cord; there is heat, there is light - and your mother isn't close to you and you don't feel
loved - you have always been loved. You're a child of God; loved by God. Twenty-four hours a
day seven days a week, year in and year out Life - the purpose is you and then that dark
cloud that was over you disappears and the sun begins to shine. And there is happiness.
Then we just wanted to reconfirm some of these things, and we did a Box Test. There
were three boxes; the origin of the problem, the maintenance part of the problem, and the
solution. Out of the box with the origin of the problem came a stuffed animal. It was a scary
animal - big eyes - gremlin-like. That was your self-image as a fetus - inside the womb. It was the
birth and pre-birth and it made sense. Out of the next box - a miniature bicycle. That represented
childhood. And then there was the box with the solution - and it was a picture of flowers and the
sun That's right It is light and life. And know, in your minds eye, the death-like suggestions
are removed from your mind. You didn't die when you lost your job. As a matter of fact, you
have a much better job now. It can get even better, and it will! Losing your job was a death -like
situation. That set you up for it, and so things begin to make sense. The Initial Sensitizing Event
was birth. And now you are born free - free from the past - free at last. You are free and you
 4

can grow. And you are free from the terrible information that you had when your Grandma told
you at the age of nine. Those nerves got frayed - that's why it attacked your nerves. You are free
from loosing your job. It is a blessing in disguise.  And strangely enough, this alleged label of
MS is a blessing in disguise, because you have changed; you are changing, and you will continue
to change and there is happiness - twenty years from now - happiness. That's right. And ha, Ha,
Ha (therapist laughing). You want to laugh Yes and the death-like feelings are removed, and
you are full of life and life's desires. You are alive. Full of love and life. And there is a tiny drop
of that magical substance - a tiny, tiny little drop. That medication is called: Faith that's right
Faith. The glues the myelin to the nerve. As strong as it ever was before - as strong as it is with
everyone else on the planet. That little drop of faith spreads through your entire being, from the
top of your head to the tips of your toes. That tiny little drop - glues the myelin sheath to the
nerve, and they remain attached and healed.  You know, it only takes the faith of a mustard
seed to move a mountain All you need is that tiny little drop of faith. And the fear is gone and
you are alive and living, and you are normal in all respects. Ok, you can have some symptoms
from time to time, so do I, and so does everybody else. And it doesn't bother you anymore
Now relax feeling well in body, mind and spirit (Added by AHS) Let these suggestions sink
deep into your inner-conscious to become a part of you as you live life full of happiness.
Prior to publishing patient reported he is doing fine. He state: "Every once in awhile I get
a little twitch in my right leg, but who cares?" the neurologist who saw him once a month initially
and then every three months later, now only wants to see him once a year. [Daniel A. Zelling,
MD Ohio Institute of Medical Hypnosis, Inc.]

2. THE SECRETS FROM YOUR SUBCONSCIOUS MIND: THE KEY TO YOUR MIND’S
POWER: RYAN ELLIOT: [originally published in 1991 as Wide Awake, Clear-Headed and
Refreshed: Medical Hypnoanalysis]
INTRODUCTION: THE KEY TO YOUR MIND’S POWER: Acknowledgments and
Author's Notes: I wish to thank the following people for their help and loving support:
TomWatson, who unfortunately died during the editing process; The american Academy of
medical Hypnoanalysts; Patricia Honiotes, M.S. and the late George Honiotes, MD;John Scott,
Sr., PhD; the late Dr. William Jennings Bryan, Jr., MD, a man I would have been honored to
have known; Gene Owens and Nido Quebein, a Lebonese immigrant who inspired me to write a
book in English. I would also like to thank my best friend, Larry Todryk, Psy.D, my good friend
and business partner Renee’ Ryan, and all the others who have helped and supported me over the
years. Most of all, I thank my clients who have volunteered their stories, backgrounds and the
intimate details of their lives, especially those who have had the guts to stick out the long -dark
night of the soul --- I tip my hat, because it was through their courage that this book is in our
reality. Due to the confidential nature of the material, names have been changed and other tell
tale facts distorted inorder toprotect clients without diluting the basic elements of their cases.
In several situations, the third person personal pronoun he is used and should be read as
he or she. My intention was to present an overall description of the hypnoanalytic process as well
as other useful information on subconscious management of external forces that affect one’s
mental state. For brevity, some of the concepts are underdeveloped. If more information is
desired, a curious reader may research the bibliographic sources cited in the chapter notes.
However, it is important to note that Secrets is only one of two books written about The Bryan
 5

Method of Medical Hypnoanalysis, and the only one designed for the layperson and potential
client. The other book, The Handbook of Brief Psychotherapy by Hypnoanalysis, written by John
Scott Sr., describes the work in detail for professionals. I have made every effort to document
my sources, but some quotations, which I especially treasure, are not cited in the chapter notes. I
have gleaned them over the years from books, articles, speeches, and seminars. Preface to the
Second Edition: This second edition was born of my last 15 years in practice and symbolizes a
complete turnaround in my orientating from a strictly medical model to an approach
incorporating both medical and alternative methods of problem-solving. It also illustrates a
complete turnaround in my own life situation. Several episodes from the story of my The Secrets
From Your Subconscious Mind: The Key To Your Mind’s Power own personal growth have been
included with the wish that this book will now be even more accessible to readers, thus making
its overall impact more powerful. I want to inspire hope for cure in a time when drug therapy or
doomed shortcuts only increase the suffering of those who have suffered enough. In addition,
please indulge my paraphrasing of a familiar phrase in order to provide additional meaning to
this book: “Happiness cannot exist when the right to be free is not guaranteed.” I feel deeply
about this concept, especially today, when events in the world seem to be dark in nature.
Freedom from one’s limiting beliefs and one’s history is the most important kind of freedom one
can attain. I position this freedom near the top of my list, right near and almost equal to political
liberty. Because, I feel, being able to enjoy our liberty is only truly possible when we experience
freedom fromour historical proscriptions, both personal and societal. Introduction Are You in
Control? “Let us define mental health as the adjustment of human beings to the world and to each
other with a maximum of effectiveness and happiness. Not just efficiency or just contentment, or
the grace of obeying the rules of the game cheerfully. It is all these together. It is the ability to
maintain an even temper, an alert intelligence, socially considerate behavior, and a happy
disposition. This, I think, is a healthy mind. Dr. Karl A. Menninger, Are You Free to Take
Control? Frequently, people ask me how they can take control of their lives. The question most
often asked is how can I teach them to stop or change unwanted feelings, which come up in
response to both internal and external conditions in their lives. I usually say something like this:
Life is a do-it-yourself project. Our thoughts and feelings are the tools with which we construct
our lives and our circumstances are the product so four thoughts and feelings, especially those
that have long been forgotten in our subconscious minds. In a sense, our feelings are like our
children. If we ignore our children for a time, what happens? Well, in severe cases, neglect
equals child abuse. Therefore, it follows that to control or extinguish our feelings constitutes
self-abuse. We must carefully examine what bethink and feel because we set ourselves up for
what we get.
We do, in fact, create reality in our minds. In other words, we get what we expect to get,
especially when our expectations originate in fear. Fear creates those conditions that are
necessary to shape “reality” from the very things we are afraid of. All this happens on the
subconscious level of mind, which is the mechanism behind everyday existence. Think about it:
Everything you believe and emotionally embrace whether positive or negative has manifested
itself in your life everything! We create our realities based on how we think and how we
program our minds. The philosophy of personal responsibility means that our subconscious,
fear-based programming influences the events in our lives here and now. By “personal
responsibility” I mean that others, parents, society, friends and lovers are not responsible for our
 6

circumstances. Personal responsibility means that the buck stops with us. Our subconscious minds
have accepted suggestions and dictated our feelings and behaviors, both wanted and unwanted.
By bringing programming from earlier periods of life into our awareness, by understanding and
reinterpreting that programming, then letting go of it, we can free ourselves to be the way we
really want to be. We can take charge of our do-it-yourself project. We can exert control over
our lives. To develop personal control over one's life takes a commitment and a decision to
follow through with whatever action is necessary to achieve our goals.
The most important part is the decision to do it. After making that decision, the “how”
follows almost as if by magic. You develop personal power by balancing and directing your
creative energy. You can make your life different if you want to because you have the power to
bring about change in yourself and in your environment. You've created what you have now, and
you can make your life come out any way you want. The Secrets from Your Subconscious Mind
will help you discover why you are where you are and give you one model of how to get where
you want to be. Through this process and by developing your mind power, you can change. This
book is for you if: You have a habit or behavior that is getting the best of you. Your self-esteem
isn't what it should be. You have good habits you would like to strengthen. You're depressed,
anxious, or fearful.
You want to become more competent, confident, and successful in your life. You
experience useless or neurotic guilt. You want to be more at ease in situations that currently
make you uncomfortable. You want to unlock mental powers that you have never used. You've
had difficulty knowing who you are. You want to know more about the role your past has played
in your present. You’re dedicated to connecting with your higher self or God but have been
unable to find them. Although I was only using hypnoanalysis during thetimeI was writing the
first edition, I have since incorporated several other types of subconscious analysis into my
treatment: EMDR techniques, Assisted Light Therapy with the aid of a Schneider Brain Wave
Synchronizer, and different forms of body and energy work. Hypnoanalysis is analysis of
subconscious programming through the use of hypnosis, a natural state of mind. Hypnosis opens
the door to the subconscious; analysis opens a person's understanding to the cause of the problem
and the analyst redirects his energy toward a solution, hence, the term “hypnoanalysis.” Although
I will discuss the history of hypnosis and hypnoanalysis in Chapter Two, let me just say here that
hypnosis was recognized by the American MedicalAssociationin1958 as a legitimate approach to
solving medical problems. Today, more and more doctors, health professionals and patients
recognize the idea that the mind and body interact to cause physical illness as well as
psychological, emotional, and behavioral problems. Mind, emotions, and body are integrated
parts of a whole, and a change in one part affects the other, the chicken-or-egg dilemma. This
situation seems to be due to the fact that everything is energetic in whole or in part. In other
words, everything vibrates. You vibrate, I vibrate, the earth vibrates at therate of 7.8
cycles/second or Htz. Actually, the vibrational rate of the earth, called the Schuman resonance,
has increased to 8.6 Htz. in the last few decades--- but that’s another story. (Please read Gregg
Braden’s book called Awakening To Zero Point.)Along with its vibratory increase, the earth’s
magnetic field is decreasing due to the gradual slowing of the earth’s rotation. In the last
twenty-two years, there have been 20 “leap seconds,” which means we have lost a second almost
every year. The nuclear clock that keeps the official time had to be adjusted back to
accommodate this decrease. Twenty seconds doesn’t sound like much, but in terms of
 7

astronomical time, it’s a lot. What does this mean to you and me? Here’s what Mr. Braden says:
The consequence is that the subconscious mind is becoming closer to consciousness. In terms of
brain wave frequency, the boundary between conscious and subconscious was very close to 7.8
Htz. Now, with the earth vibrating at a much higher rate, we seem be in tune to this vibration.
This may account for the recent profusion of craziness we see in the news every day, i.e.
Columbine shootings, Tim McVey, 9-11, war ad nauseam etc.
I won’t presume to be an authority on vibratory or energy medicine, but it seemed
important to mention this now. Very often, blocks to our emotional energy and our spiritual
energy interfere with our ability to live life creatively. Once these negative suggestions, ideas, or
blocks are nullified, then life beyond mediocrity can be achieved. Dr. Walter Russell says it
much better than I can hope to: Successful men of all the ages have learned to multiply
themselves by gathering thought energy into a high potential and using it in the direction of the
purpose intended. Every successful man or great genius has three particular qualities in common.
The most conspicuous of these is that they all produce a prodigious amount of work. The second
is that they never know fatigue, and the third is that their minds grow more brilliant as they grow
older, instead of less brilliant.
Great men’s lives begin at forty, where the mediocre man’s life ends. The genius remains
an ever-flowing fountain of creative achievement until the very last breath he draws. The
geniuses have learned how to gather thought energy together to use for transforming their
conceptions into material forms. The thinking of creative and successful men is never exerted in
any direction other than that intended. That is why great men produce a prodigious amount of
work, seemingly without effort and fatigue. The amount of work such men leave to posterity is
amazing. When one considers such men of our times as Edison, Henry Ford, or Theodore
Roosevelt, one will find the three characteristics I have mentioned common to every one of
them.
Hypnoanalysis is a comfortable, reassuring way to help you change your mind about
yourself, about the people you relate to, and about the world. We really are evolution in process.
Through hypnosis, we concentrate our minds and affect our realities. By affecting our minds
and by changing ourselves, we can change our evolution. Hypnosis is one of the best tools
through which you can accomplish understanding and change, open with which you can write a
new life plan. By harnessing your mind power through hypnosis, you can raise yourself out of
poverty, unhappiness, misery, alcoholism, sexual problems, and drug addiction. You can give up
smoking, lose weight, and overcome fears and phobias. It is possible not only to overcome
diagnosable diseases such as depressive and anxiety disorders, but also to balance your mind and
body chakra system, simply by learning to make use of this ancient method of relaxation.
Medical hypnoanalysis solves emotional and psychological problems by going after the
underlying causes. The difficult part of the process is the analysis of the subconscious, reaching
into the subconscious mind and pulling out negative suggestions that have lodged there,
nullifying them and replacing them with positive suggestions. That's where a qualified
professional hypnoanalyst can help. And although hypnoanalysis is neither magic nor a panacea,
it is a powerful method for improving the human condition. Remember that the subconscious
automatically remembers events from early periods of our lives’ memories that affect who we are
and what we do today. We may need the help of a professional hypnoanalyst to recall and review
memories. It is important to remember that subconscious memories are not readily available to
 8

waking consciousness. The hypnotic state creates an inroad to the subconscious. Recognition vs.
Removal "Isn't it enough to know where the problem came from to stop it from bothering me?"
asked a seminar attendee. My answer? “Yes and no.”
Recognizing the underlying cause of a problem, attitude or feeling may be all that is
needed to eraseits power over us. However, the simple understanding of why we eat too much,
why we smoke, why we are afraid of heights, may not be adequate to eliminate many of our more
intense problems, feelings or behaviors. Problems such as alcoholism, depressive states, mind
control, and sexual abuse symptoms require more than recognition. In such cases, hypnoanalysis
can be helpful. While we are in a hypnotic state, we are more receptive to change and to a
therapist's positive suggestions that can reprogram our thinking. Moreover, treatment of severe
and diagnosable conditions can take awhile to resolve. Healing the mind and emotional body
takes time, patience, and most of all, love. Therapy is phenomenological---not static---and
difficult to quantify. The difference between a hero and heroism is the phenomenon of acting the
part of hero orheroine. Even though we know that heroism exists, we cannot see it. Heroism is a
phenomenon similar to the process of therapy. Something happens between client and therapist
that cannot be one-hundred percent quantified, measured, or even seen except by the experience
of the client, but its results can be felt and observed. Actually, the word “therapy” comes from
the Greek word therapeia, which means, literally, “the work of the gods.” Doing the work of the
gods is not the same as being a god -- living up to godhood is very difficult, indeed. However, the
work of the gods, in my opinion, is simply helping people change by providing a loving
environment through using one’s self, a formidable but hugely rewarding task! Another
important consideration I’d like to briefly mention is discussed thoroughly in an article written
by an acquaintance of mine, Ofer Zur, Ph.D., who teaches at the California School of
Professional Psychology. Zur states that effectiveness of treatment resides in the relationship
between client and therapist. In his own words, Research that has examined “common factors" in
effective therapy across orientations, therapists, and patients may be more illuminating. These
"common factors" are ingredients in all effective therapy. The most critical of these factors is the
presence of a positive therapeutic alliance between therapist and patient. This alliance includes
warmth, mutual understanding, trust, and respect.
What disparate therapists such as Freud, Jung, Kohut, Ellis, Rogers, Perls, and Haley
have in common is obviously not their theoretical orientation or any specific intervention. To
complement their knowledge and expertise they allow the power of personality and their passion
to guide them in their relationships and interventions with their patients. They did not use
techniques or interventions as if they were tools drawn mechanically from a toolbox. What they
drew upon flowed flawlessly from their relationship with their patients in a way that was
congruent with their individual personalities and styles. In this light, therapeutic skills are seen as
not merely tools, but part of the therapist's essential being. It is in accordance with Zur’s opinion,
I believe, that the effective hypnoanalyst must proceed. In hypnoanalysis, a trained therapist uses
gentle suggestion to help remove limiting beliefs and thereby allow constructive, positive,
life-affirming ideas to form naturally. Whatever goal is set through therapy is decided upon and
self-directed by the client with the therapist acting as a guide. Through the following steps, a
hypnoanalyst guides the client in uncovering the origin of a problem, undoingthe subconscious
tie, and freeing the person to live a healthier, more productive life:
1. Relaxation: By learning to relax and let the mind go, you can concentrate and allow
 9

an opening to your subconscious. The next step then becomes possible. Difficulties stem from
negative thinking and feeling suggestions. By recognizing the source and understanding the
power of your programming, you can learn to restructure those problem attitudes and create the
outlook you desire.
2. Re-education: Re-education helps you recognize the difference between the
underlying cause from the past and the conscious problem/belief. When the underlying cause is
part ofyour past, it can be removed by direct suggestion --- and by realizing the past is past and
that your need for the problem has passed, too.
3. Rehabilitation: Through hypnotherapy, you will get new information and positive
suggestions, and will have time to correct bad habits, time to rehabilitate your thinking and
practicey our new thought patterns.
4. Reassurance: You gain reassurance through a number of avenues. Family or friends
mayindicate that you're getting better. You experience a decrease in symptoms. Your analyst will
take advantage of any change, no matter how slight, to remind you of the improvement.
5. Repetition: Repetition is necessary to implant positive suggestions in the soil of your
subconscious. The more you repeat something, the more permanently implanted it becomes in
your mind.
6. Reinforcement: By developing your skill in self-hypnosis, you will be able to support
thepositive suggestions you've received from the analyst, enabling you to continue the growth
begun in the office.
7. Responsibility: Once the first seven steps have been accomplished, accepting
responsibility foryour life is the natural outcome. This approach to problem solving owes a debt
to Freud, Mesmer, and Dr.William Jennings Bryan, Jr. Researchers have for several years been
validating the concepts through their clinical observations. From an informational reading
exercise, you can turn this book into a transformational experience. It will: Acquaint you with
the process of hypnoanalysis and instruct you in inducing a self-hypnotic state. Show you how to
program your mind for improved, increased performance. Challenge you to take control of your
circumstances and in as little as 30 days, create change.
The Secrets From Your Subconscious Mind will show you how to make things happen to
you instead of just watching them happen to others. While deep-seated problems will require aid
from a qualified hypnoanalyst, you can effect many changes in your life through the practice of
hypnotic self-suggestion. As you learn more about the power of your subconscious mind, you
can see and feel how suggestion and self-hypnosis can improve the quality of your life, both
physically and emotionally. It's up to you, just as your entire life is up to you. Remember, you
are in control. Or are you? If not, it's high time to take control. Your Life is Unique. Have you
ever thought very much about what makes you “you”? About whatmakes you like or dislike
certain food, music, people, etc? You came into this worldwithout any conscious awareness of
yourself. With your consciousness in neutral, yoursubconscious mind was ready to rev up.
Notwithstanding genetic considerations, youwere similar to most other newborns in your ability
to perceive and respond to your reality. You were born with two fears, the fear of falling and of
loud noises, plus all ofyour physical needs: for warmth, food, hunger, stimulation, and nurturing,
etc.Instantly, that began to change. From the first moment of your life, you started on a unique,
individual journey. Your mind started recognizing and retaining memories of your varied
experiences. From infancy through the present, the tracings on your mind's “slate” have filled one
 10

day after another. By now, you've accumulated literally thousands of yesterdays and a wealth of
knowledge to apply to the rest of your future. Those experiences are what make you a unique
person. While people in a given peer group might share similar experiences, no two people in the
world have perceived identical pasts. Because of that, even individuals sharing the same
developmental experience might walkaway with different perceptions. Three witnesses of an
automobile accident, for example, might sound as if they were describing three totally different
events. The reality of the accident does not change, but that reality is perceived differently by
each of the three witnesses. The old story of five blind men describing an elephant also comes to
mind. The first one held the elephant's trunk and declared the animal to resemble a hose. The
second held its tail and insisted that an elephant was really like a rope. The third touched the leg
and concluded that the animal was like a tree. The fourth touched a near and believed that the
creature amazingly resembled a huge leaf. The fifth, touching the massive side, concluded that his
companions were all wrong: An elephant, obviously, was like a wall. None of them changed the
reality that stood before them. But each perceived the reality from a different perspective.
Therefore reality can be described as a trance (daydream, reverie, fog, fantasy, nightmare, etc.)
of sorts, depending on your feelings about it and experiences with it. And, as such, many of the
experiences and beliefs about who we are, who all those others are, and what we’re doing here
have been implanted in our minds not by our own volition but by parents, caretakers, teachers,
the popular culture, etc. Consequently, our trance has to a certain extent been determined by
others and may not be to our liking, or it may not be working because of faulty ideas and beliefs.
It’s from the basis of change that we must examine how we got to be the who and what we are.
Since you are the product of your experiences, your past plays a strong part in
determining how you perceive every incident in your life. Your subconscious mind is the
storehouse of all your experiences. It records every hurt and trauma you experience, even while
the conscious mind chooses to forget life's earlier incidents. It is a warehouse of memories and
lessons that you can apply to the present and future. Yet, even more important to the quality of
your future than the memories you've accumulated is the power of the subconscious mind in
which they're stored. Although the subconscious is subservient to the conscious mind (when one
decides to make it so), it is much more than a storage container for memories. The subconscious
controls the nervous system, which controls the operation of the body's involuntary functions.
Often called the irrational or reactive mind, it actually keeps you alive. Without your
subconscious, your heart, lungs, kidneys, and other vital organs would not function. The
subconscious can make the body move into many unhealthy coping actions. Frank, a
50-year-old, two-pack-a-day smoker, started puffing as a teenager because it was the “cool” thing
to do at the time. Now, of course, he's hooked. His nicotine addiction is a physical reality, but
there's something else that makes cigarettes so hard to give up. Every time he lights up, Frank's
subconscious still tells him he looks like James Dean, that cool, idealized image he tried to live
up to as a teenager. The old memory sent to the subconscious keeps coming back to keep him
lighting up one cigarette after another. The subconscious also is responsible for many other
functions. We experience life through our five senses. We see, hear, taste, touch, and smell.
We may or may not enjoy our experiences, based on our perceptions, which trigger our
emotions, located in our subconscious minds.
The subconscious, including superconsciousness --that mental state commonly referred to
as the connection with the mind of God, is sometimes referred to as the right brain, although it is
 11

not conclusively located in the right hemisphere of the brain. It is responsible for creativity. All
literary and musical compositions, creative inventions, and original ideas are the outputs of the
creative, subconscious mind. The same is true for intuition. When an incident occurs that you
sensed beforehand, your extra sensory perception (ESP), that is to say your right-brain or
subconscious, has been at work. Does this mean that the subconscious has magical powers? Yes
and no, depending upon how you define “magical.” The subconscious does have a lot of power,
more power than most people even dream they have at their disposal. Creativity, intuition, and
imagination are functions of the subconscious mind, and the results in reality depend upon the
information stored in the subconscious. When your intuition leads you to predict someone's next
move, it's because your subconscious mind is reviewing its knowledge of that individual and
responding with a logical orexpected reaction. When you imagine a particular scenario, you are
creating a thought based on your knowledge of similar settings. For example, even if you've
never been to the Adirondack Mountains, you still could develop a mental picture of what you
think they look like, based on your experience with other mountains. Whether your mental image
really looks like the Adirondacks is not important here. Right or wrong, your imagination, in
your subconscious still creates a visual image. Albert Einstein is credited for saying, “Imagination
is more powerful than knowledge.” With 90 percent of your brain devoted to the subconscious
mind, you can imagine how much information you can store in it. Some experts believe that the
average human being has enough brain power to master some 40 foreign languages, commit a
complete set of encyclopedias to memory, and even complete full-course requirements from a
dozen universities. This is because the average brain, which weighs just under four pounds, is
able to house up to two quintillion bits of information. In a figure, that is
2,000,000,000,000,000,000. McDonald's at its current rate won't sell that many hamburgers for
another 875 million years, give or take a few centuries, of course.
The Workings of the Conscious Mind: Before anything can be stored in your
subconscious mind, it must first pass the objective or conscious mind. The conscious mind,
which deals with outward things,
islogical,mathematical,andorderly.Becausetheconsciousmindfilters information to the
subconscious, everything you've ever learned or experienced is stored in your subconscious
mind. Since 90 percent of the brain is devoted to the subconscious mind, this means that only 10
percent is involved with conscious thought. One can't help developing an appreciation for the
power of the subconscious. The conscious mind is analytical by nature and controls conscious
activities such as thinking, speaking, writing, arithmetic, planning, organizing, judgment, and
reading. The conscious mind, through imagination, is often called the gateway to the
subconscious because only the conscious mind can access information stored in the subconscious
and bridge the gap between reality and the subconscious mind. You are using your conscious
mind right now to read the words on this page. When you recall this information tomorrow, it
will be because your conscious mind has retrieved it from your subconscious storage department,
commonly called memory. Because the conscious mind can retrieve information from the
subconscious, we can function as productive human beings. Even though reading requires
conscious activity, the knowledge of vowel sounds, phonetics, and word definitions stored in
your subconscious allows you to read quickly, without conscious thought. The same applies to
mathematics. It requires conscious ability, for instance, to multiply 365 by 4.
If you've committed multiplication tables to memory, your subconscious, you know that
 12

45 times 4 equals 20, 6 times 4 equals 24, and 3 times 4 equals 12. After adding and carrying the
appropriate figures, your conscious mind can determine the answer: 1,460. Almost everything
we do involves cooperation between our conscious and subconscious minds. Although the
subconscious is receptive to suggestion, nothing goes into the subconscious against the will or
evaluation of the conscious mind. However, a couple exceptions exist against this generalization:
through emotions such as trauma or joy and through hypnosis. (Did you know every time you
turn on the TV, you go into hypnosis?) Your subconscious cannot make comparisons or
judgments. It does not reason through information or determine truth, but simply reacts to
impressions transmitted to it from the conscious mind. The formula or instructions for any action
you execute repeatedly become fixed in your subconscious, and the information becomes
available upon conscious command. Routine actions from tying your shoelaces to operating a
motor vehicle become second nature through the power of the subconscious. So does operating a
typewriter, computer, calculator, or any other machine you regularly use. The advertising
industry implants its messages in the public's subconscious mind through repetition. This is why
you can remember popular commercials years after the media have stopped running them.
(Winston tastes good like a cigarette should!) If you can recall things you learned in grade
school, or even yesterday, it is because the conscious mind has retrieved it from the subconscious.
Activate the Right Association and Out Comes the Information: Why do you
sometimes have trouble recalling something? For example, you might have a clear picture in your
conscious mind of the face of a former school teacher, even though you can't recall his or her
name. Or sometimes you can remember the first two lines of a poem or a song, but you can't
remember the rest. Does that mean that the information is gone? No. Considering the almost
limitless storage capacity of your subconscious mind, it's highly unlikely it will ever be filled to
capacity. Much of the information about our past is not readily available, however, because the
conscious mind does not have the proper stimulus to retrieve it. For example, the poem you
cannot remember might come back to you if someone gave you the first word or two of the
forgotten portion. Or the name of the instructor might come to you instantly if someone gave you
the initials. No information in your subconscious is ever “forgotten.” Obscure information deep
in the subconscious often needs a “hint,” a priming, to bring it back into the conscious mind. In
contrast, there are experiences you can easily remember. Both happy and sad memories of close
relationships never seem to fade. The same is true for memories of very pleasant or very
miserable events. That is because information of high emotional impact is instantly and firmly
committed to your subconscious mind.
Although, emotionally troubling memories or information can be and often is blocked out
of consciousness due to their painful nature. Basically, two motivations exist, or rather one side
of the motivational coin imparts the pain-avoidance imperative and the other side dictates
moving towards the pleasure principle. Escaping pain is always one of the culprits when it comes
to understanding undesirable thoughts, feelings, and behaviors.
Perceived Truths Translate Into Beliefs: The adult who craves sweets may be allergic
or may have acquired the craving as a child. Without self-discipline, such a craving can lead to
an overweight problem by the time the child reaches adulthood. Recognizing the disadvantages
of obesity, a person might consciously decide that sugar is not a good thing at all and that it
should be avoided whenever possible. By this time, though, the subconscious may be hooked.
Cutting out sweets isn't an easy thing to do. This is similar to what may happen when a person
 13

starts smoking, except that nearly all smokers will tell you that cigarettes taste terrible at first.
Still, new smokers consciously light up (for reasons that we'll discuss in detail in Chapter Seven).
In time, the cigarettes begin to taste good until, one day, they are too good to give up. The
subconscious is hooked (This doesn’t take into account the twenty minute half life of nicotine in
the blood).I've dealt with many clients who have wanted to give up sweets or cigarettes. They
have sought my services after finding they couldn't win the battle without professional help.
Although they had consciously decided they wanted to kick their psychological if not physical,
addictions, they found that their subconscious minds put up too tough a battle. Once your
subconscious mind establishes a bit of information as a “truth”, that sugar or cigarettes are good,
for example, there is often hell to pay if you try to change that position. That is why ex-smokers
often refer to their first days(if not weeks) without cigarettes as going “cold turkey.” The
psychological torture that the subconscious inflicts can be too much for the conscious mind to
bear. Many would-be sugar or nicotine quitters finally cave in and indulge themselves with a
vengeance. They consciously realize the undesirable consequences of resuming their habits. Yet,
that realization makes no difference to the subconscious, mainly because the pain-killing ability
of the addiction is too tempting. Only a dose of what it is accustomed to receiving can satisfy it.
When the conscious and the subconscious minds are in conflict, the conscious mind will almost
always lose the battle. Susan's story illustrates the personal trauma she experienced in her attempt
to lose weight.
Sweets Were Her Fix: Dear God . . . PLEASE make this the last time,' I thought, as I
drove to the local bakery. “Iwas already stuffed from a full lunch at a nearby restaurant. But
being stuffed was irrelevant. I wanted more. I knew a few sweet rolls would go down real well
and I'd still be on time for my 3 P.M. appointment with Ryan Elliott. I was desperately hoping the
yo-yo cycles would end, but I was VERY skeptical. How could he do what I had been unable to
do since the age of 7? But I had made up my mind that this was to be the last binge. I bought two
doughnuts, two creme horns and one petit-four pastry and zoomed back to the car. I headed
toward Winfield, shoving the `illegal' goodies into my mouth, watching crumbs flying
everywhere as I ate. What an awful trip. Sweets were my fix. For me the `drug of choice' was
Hostess Suzy-Qs and anything from the bakery. Compulsive eating or compulsive binging had
become a way of life. I wanted OUT. Why couldn't I be normal, eat normally and control my
weight like the rest of the world? I was plenty miserable by the time I pulled into the parking lot
and entered the office. I'd tried therapy before. `What would make this time different?' I
wondered, as I was escorted to a small consultation room. His secretary took some pretty
mundane information, which she wrote on my file folder, and told me to wait for Ryan. Several
minutes elapsed and I really wondered, `What am I doing here?' I had a real uneasy feeling.
`Maybe I'm coming down from my sugar high. I'm an invincible person. I can stand anything . . .
even this.' I was already frightened at the thought of admitting I was out of control and this
`superwoman' couldn't solve her own eating problem. Ryan began to take my case history,
probing all sorts of areas that I, quite frankly, would rather not talk about. He asked about my
childhood, my parents (both deceased), siblings (none), and my sex life.
What sex life? People who are fat and ugly don't have sex lives. He should know better.
Finally, he explained that the program would take 30 sessions, twice a week for 15weeks. He
strongly recommended an up-front payment so when the `going got rough' I'd have a financial
investment and would continue the program. I made a mental note that I'd have absolutely no
 14

problem. I'm strong. I'm invincible. He wouldn't get to me, others, yes, me, no. The first
hypnosis treatment followed. Blindfolded, headset in place, vibrating chair turned on. I was
ready. That first session was an introduction to hypnosis and how to do self-hypnosis to support
the office treatments. Imade two appointments for the coming week before leaving. Iwanted to
succeed more than anything. And, I was MOTIVATED. I stayed on a veryreasonable eating plan
and dropped two pounds by my next visit. Then came the visit that was to change my life. It was
Friday. Time for the word-association test. I was hypnotized as usual. By now, the blindfold,
headset, and vibrating easy chair were becoming routine. Then, oh! Oh!The chair stopped its
normal vibrating and there was an awful silence. And, I heard Ryan's voice. Simultaneously, my
stomach tightened and I had a sickening feeling. `Oh, no! This guy is going to get to know the
real me.' I can't describe how terrifying the thought of full self-disclosure was. Ryan gave mea
word and I was to respond with the first word or thought that cameto mind. And, oh,the words! I
was mortified at my responses. I left the office thinking, `I NEVER want to come back.’
Awkward,' `embarrassed,' `horrified' only hint at the way I felt. My depression grew with every
passing hour. I drove home. Had dinner. Went to bed. I was even more depressed when I awoke.
I struggled to get out of bed. `If I go to my exercise class, I'll feel better,' I thought. My body was
sluggish. I didn't want to exercise. I didn't want to eat. I didn't want to do ANYTHING. The
feeling in my gut was awful a feeling I'd never experienced before. This had to be a severe case
of depression: I certainly had all the symptoms. I sat on the stairs by the phone and stared into
space for an hour. Two voices were fighting in my head: Superwoman kept saying, `This is
ridiculous.
You can control any situation. Get hold of yourself. The other voice said, `You feel
awful. You need reassurance. Call Ryan. I picked up the phone. And put it back. The pattern
repeated for several minutes. Finally, I realized that I was not Superwoman, that I very, very
much needed someone, and that someone was Ryan. He was the only person who would know
what was going on in my head and heart. Finally, I made probably the most significant phone
call of my life. Being Superwoman is an awesome responsibility to carry all the time. It was
wonderful to have someone be there and take the burden. Ryan assured me I wasn't crazy and the
depression would go away. He asked what I was feeling. I'd just begun to learn what it was to
FEEL anything. At that moment, I realized that I ate to hide from the world and from my own
feelings. Food was my only friend. I used food to escape from life and to keep people and
experiences out. When the overeating was removed from my life, I began to experience emotions
and feelings, like other people experience every day.
Suddenly, it occurred to me that if I could feel depression, I could also feel joy a
delightful thought to consider. Ryan got through the wall of fat and emotion. At times the
process was painful, butit was a necessary part of making me well. Although the therapy was not
always pleasant, the benefits were a thousandfold better than the pain, so I continued with the
treatment, gaining insights into my reasons for eating. Negative suggestions which contributed to
my desire to overeat were removed through hypnosis. I ate reasonable-to-small quantities of
food, and, surprise, I was FULL!!! Through hypnosis, Ryan also worked on improving my
self-esteem and confidence. Very slowly I began to emerge from behind the wall of fat. My
outlook shifted to POSITIVE. I started loving myself. I learned to give and receive emotional
feelings. Does the story have a happy ending? Well, this is real life, but I think so. Working with
Ryan, I lost 27 pounds, making me a total of 50 pounds thinner than last year. I feel wonderful.
 15

Compliments abound. The best part of the change, though, is what I gained: self-love and
self-esteem. I'm not perfect, but I don't expect to be. I just have to be me, and now, I know that's
ok. I certainly don't need food in the addictive way I did before. Therapy is a slow process a little
bit of insight at a time. The benefits have been over whelmingly positive in my life. It's fun to
get high on people and friends rather than on food. The world looks different and wonderful
because Ryan and I changed ME! God heard my prayer. Thank you, God. Susan. Susan’s
revealed many subconscious secrets during her analysis. Her most penetrating feeling of seeming
undesirable to her mother by first “recalling: how unhappy her mother felt during her pregnancy
with Susan. Compounding her intrauterine sensations was the subsequent indifference her mother
held toward Susan’s need for warmth and acceptance. Regardless of how her mother actually
acted, only a video camera could verify the truth, Susan felt, experienced, and believed her
secrets to be true. This and only this is what counts in recovering from serious emotional and
psychological problems.
If You Think It's True: Much like Susan, many people go through life acting on “beliefs”
that aren't true. Reality isn't as important as perceived reality. Individual reality is an extension or
projection of consciousness. Many people in the world today do not live up to their potential
because they believe they lack certain abilities. They believe they aren't intelligent, capable,
skilled, or talented enough to achieve their ambitions. Individuals who believe they are
inadequate usually act that way. A conscious belief eventually becomes committed to a person's
subconscious mind, regardless of whether the belief reflects true or false information. Once an
erroneous belief is developed, an individual will generally react or adapt to it. People who suffer
from anorexia nervosa commit a slow form of suicide. They literally starve themselves to death
because they believe they are too fat. Among tribes and cults that practice voodoo, there are
documented cases of people who died within a half hour after a witch doctor placed a spell or
curse upon them. There was no foul play involved. The individuals simply believed they were
going to die while under the spell of the curse, and they did. These people programmed their
minds to engineer their own deaths. So doesn't it stand to reason that if the mind can be
programmed to engineer death, it can also be programmed to enhance life? Most emphatically, it
can! The subconscious mind is strictly impartial. It doesn't discriminate between right and
wrong, life or death, success or failure. It will simply function the way it’s programmed to
function given its hierarchical nature.
The Mandatory Hierarchy of Human Needs: First, let's talk about what motivates
human beings. Psychologist Abraham Maslow identified five levels of motivation, which he
called the “hierarchy of human needs.” According to Maslow, every person starts at the bottom of
this hierarchy and works upward through the levels as they progress through life. Only after
mastering the lowest level will they focus on another, he contends, and, if at any time security on
a lower level is threatened, the individual will drop back and reestablish there before moving up
the ladder. Let's take a look at these five levels.
1. Survival. When our physical survival is in question, nothing else matters. People will work
long and hard to obtain food, water, clothing, and shelter. These are the basics of life, and it's
hard to become excited about lofty ambitions or social standing when you're hungry and need to
work to earn money for your next meal.
2. Security. Once survival is assured, people usually concentrate on their security survival on a
long-term basis. Security translates into peace of mind, safety, stability, savings, a nest egg so
 16

that survival is not threatened. It is difficult to find peace if you are constantly concerned with
whether you and your family will eat regularly.
3. Social. Only after assuring their survival and establishing security do people turntoward
developing relationships for social gratification, for love, and for a sense of belonging. Most
people develop “support systems” for emotional needs ranging from spiritual growth to
recreational activities.
4. Ego. Once people satisfy their basic physical and social needs, Maslow says, they are ready to
turn their attention to gratifying their egos, gaining recognition. They direct their efforts toward
becoming good at what they do so others will notice and approve. People work to satisfy ego
needs onthejob, in their relationships, and in community andvolunteer arenas.
5. Self-actualization. After meeting all other needs, people then are free to turn their attention
toward self-fulfilment, satisfying their greatest ambitions, doing not just what it takes to survive
or even to have a good life, but what they really want to do. Not everyone in life reaches a level
at which he or she can do the things that give him or her most pleasure. Generally, a person's
rise through these levels will not be steady but will involve stops and starts, a couple of steps
forward, and one or more backward. Also, there is no guarantee that once an individual achieves
a certain level, he or she can forget about that one and focus on challenges further up the
developmental ladder. Jerky progress is the norm. For example, a person working toward
self-actualization might fall all the way back to working toward survival should he or she get
wiped out in a stock market crash or a bad investment. It doesn't matter so much what levels you
have reached in the hierarchy. More important is that you be continually challenged and involved
and keep moving toward self-actualization. Your motivation will be controlled by the difference
between where you feel you are in your climb and where you would eventually like to be.
The Order of Importance: The late Dr. William Jennings Bryan, Jr., M.D., co-founder
of the American Institute of Hypnosis and originator of the Bryan method of hypnoanalysis, also
developed a hierarchical scale. Bryan's assessment of what is important to human beings varied
greatly from Maslow's, however. Bryan, a medical doctor, psychologist, lawyer, and
hypnoanalyst, stressed the following forms of survival and their relative importance to human
beings:
1. Spiritual survival. An individual's connection to God, to an infinite power, or to a universal
intelligence topped Bryan's list of important factors. While admitting that earthly physical
well-being is important, Bryan insists that physical security pales in comparison to spiritual
well-being. He contrasted Maslow's basic survival level of security to spiritual well-being
through Jesus Christ's words, “What good will it be fora man if he gains the whole world, yet
forfeits his soul?”
2. Even if you don't believe that your spirit will survive for all eternity, there is still value in
respecting and practicing truth, he contended. People will give their lives for someone or
something they love, whether it is a person, a country, or a belief. The most miserable people in
any society, Bryan said, are those who live lives based on physical survival only. Analytical or
mind survival. Next in importance is our ability to make our way in the world, develop
self-esteem and establish personal identity. The ability to reason, to discern, and to exercise
judgment is of utmost importance, second only to our spiritual survival. As I mentioned earlier,
the left brain, or conscious mind, is analytical by nature. It controls such activities as thinking,
speaking, writing, arithmetic, planning, organizing, judgment, and reading. A fear much worse
 17

than death for many people is the loss of analytical powers, which would turn them into
“vegetables.”
3. Physical survival. With our mental and emotional faculties assured, physical survival is next
on the list of priorities. A major fear with people as they age is that they will lose their physical
abilities while their minds are still alert. Physical survival was Maslow's number one priority,
you will recall. The fact that smoking is a threat to physical survival does not prevent great
numbers of people from puffing away. Using Bryan's order of importance, the personal
enjoyment or emotional satisfaction gained from smoking would not outweigh the activity's
potential physical harm. Physical survival has three components: air, water, and food. A person
can go without air for only moments, water for a few days, and food for a month or so.
4. Territorial survival. As we go through life, we stake out certain “territories” that become very
much a part of our identities. Our homes, our jobs, and our social outlets are territories that we
won't give up without a fight, unless we have already secured new territories
to replace them. This motivation al level corresponds to Maslow's security and social levels.
5. Sexual survival. Surprisingly, sexual survival is lowest in importance to most people.
Despite America's apparent obsession with sexual activity, as manifested by the mass media, it
ranks on the bottom of the list. Although we might not like the idea of survival without sex, most
people would agree that they would give up sex before giving up their identities, their bodies,
their minds, or their spirits.
Given the choice between food, water, or sex, a starving person will opt for the food and
water first. Medical hypnoanalysts usually help people by using the Order of Importance
developed by Dr. Bryan. Now, with the ideas above about what motivates you and of what you
hold important, let me ask you a question: Could your life be better than it is now? You are the
only person who can change it. External events that affect your life often are beyond your
control. However, the quality of your life is of your own making. Your personality, your health,
your marital and employment status, and your social standing are all within your control. With
hypnosis and the God-given power of your mind, you can change undesired behaviors, feelings,
thoughts, whatever. Whether it is getting up early in the morning or developing greater
creativity, learning to love yourself more or changing addictive behavior, hypnosis, and
self-suggestion can help you change your way of life for the better.
First, however, it's important that you know more about what hypnoanalysis is and about
the exciting personality changes that people can make once they are aware of the true cause of
their problems. Recognizing and releasing negative suggestions, repressed emotions, and the
secrets from your subconscious will result in great changes in your life. Chapter Two explains
more about this science and its practice.
Key Concepts: Disregarding genetics, at birth you were similar to any other newborn in
your ability to perceive and respond to reality and in your capability to develop your God-given
ability to choose. Since you are the product of your experiences, your past plays a strong part in
determining how you perceive each incident in your life. Your subconscious mind has stored all
your experiences. It records every hurt and trauma a person experiences, even when the
conscious mind chooses to forget negative incidents. The subconscious, which includes the
superconscious, is responsible for creativity. Creativity, intuition, and imagination are functions
of the subconscious mind, and the results of these functions depend upon the information stored
in the subconscious. The conscious mind is analytical by nature and controls conscious activities,
 18

such as thinking, speaking, writing, arithmetic, planning, organizing, judgment, and reading.
When the conscious and the subconscious minds are in conflict, the subconscious mind will
almost always win out. Reality is not as important as perceived reality. The impartial
subconscious mind doesn't discriminate between success or failure. It will simply function the
way it has been programmed, or the way you program it now based on the order of importance
of things. Through hypnosis and natural mind power, you can change undesired behaviors,
feelings, and thoughts and initiate and adopt new ones.
We live according to our survival in the following areas of life, in descending order of
importance:
1. Spiritual (love)
2. Identity (self-esteem)
3. Physical
4. Territorial (property, money, etc.)
5. Sexual Growth
Exercise1. Cite examples of how your past experiences that you know about are influencing
your life now.
2. Remember a time when your subconscious mind solved a problem with a spontaneous creative
solution?
3. Did you ever have an ESP experience?
4. Name a feeling, behavior, or pattern you have that goes against rational thought?
5. What or whom would you give your life for?
NOTE: Use your answers for more understanding of your subconscious at work.

3. HYPNOANALYSIS: THE LIGHT HEART CENTER

What is Medical Hypnoanalysis? Medical Hypnoanalysis is a specialized method of
hypnosis and psychotherapy which utilizes hypnosis to bring about a solution to the problem
presented by the patient. This therapy is dynamic, short term, and directed. The Medical
Hypnoanalyst will examine the symptoms and then seek to find the root cause or basic negative
suggestion of the problem. Treatment will remove the symptoms after the cause has been
discovered.
Is Medical Hypnoanalysis Safe? Yes, it is very safe when used by a trained and
experienced professional. Ryan Elliott is Board Certified by the American Academy of Medical
Hypnoanalysts, has helped thousands of clients and 35 years experience in the helping
professions, the last 22 years in the field of Hypnosis. Medical Hypnoanalysis is a specialized
method of subconscious analysis which utilizes hypnosis to bring about a solution to the problem
presented by the patient. It is dynamic, short term, and directed.
Most people can handle many of their problems by using logical thinking. When logic
doesn't seem to bring about solutions, then the subconscious needs to be accessed for results.
This is a safe method of changing the ideas in the subconscious which have been limiting the
patient. For permanent change to occur, it is often necessary for the cause of the problem to be
discovered, corrected, and removed thereby allowing the client free access to his or her feelings
and a greater range of life options.

4. THE THEORY AND PRACTICE OF HYPNOANALYSIS: DANIEL BROWN & ERIKA

 19

FROMM: HYPNOTHERAPY AND HYPNOANALYSIS: LAWRENCE ERLBAUM

ASSOCIATION: HILLSDALE, NJ: 1986
The hypnotherapist begins the treatment of most patients by employing symptomatic,
hypnodynamic, (hypnoanalytically oriented) approaches, or both. If these short-term approaches
work, they will save the patient time and money. If they do not work, the therapist may decide to
use hypnoanalysis, a relatively long-term treatment. It is modified psychoanalysis conducted
while the patient, at least for part of the time, is in the hypnotic state (25% to 70% of the total
treatment time). Because hypnosis enables the patient to make contact more easily with
unconscious material and also intensifies the transference, hypnoanalysis works faster than
psychoanalysis alone. What can be accomplished in psychoanalysis in 3 years usually can be done
in hypnoanalysis in 1 year.
Hypnosis is not employed during every hour, or necessarily for the full duration of any
therapy hour because the hypnoanalyst must help the patient work through the material in the
waking state, too. Insight, we feel, is more effective and leads more readily to permanent change
when it becomes fully conscious and does not occur only in unconscious or preconscious
awareness. In addition, the transference in the hypnotic state may not be the same as that in the
waking interaction between the patient and therapist, and both need to be interpreted. In some
hypnoanalyses, trance is used only sporadically, at intervals of several months.
THE PSYCHOANALYTIC THEORIES AND THEIR APPLICABILITY TO
SPECIFIC NOSOLOGIC CATEGORIES: Psychoanalysis has existed for a century now. It
originally revolved around the libido theory and was modified as other psychoanalytic (196)
theories were added. By now a broad braid of four strands constitutes the fabric of
psychoanalysis: the libido theory; ego psychology, which Freud (1923) also originated; object
relations theory, which began in England in the late 1940s and in the United States in the 1 950s;
and the theory of the self, or the theory of narcissism, starting in the 1960s. According to the
libido theory, the motivation behind all behavior is pleasure-seeking; ego psychology stresses the
seeking of the joy that comes with the mastery of difficulties; object relations theory views
pleasure-seeking behavior as the seeking of an "object," that is, making relationships, finding
someone to love and be loved by; whereas self theory supplants libido theory by holding that the
motivation of behavior is the development of self-experience and self-actualization, and the
seeking of admiration. Depending on the nature of the patient's illness, one or another of these
theories-more often a combination of all or some of them-will form the base of the hypnoanalytic
treatment of a particular patient.
Classical Psychoanalysis - The Libido Theory: In the late 1890s, Breuer treated Miss
Anna 0, a classical case of hysteria, which was of great interest to Freud, with whom Breuer
frequently discussed it. From Anna o's case, Freud discovered the existence of the unconscious,
and psychoanalysis was born (Breuer & Freud, 1895/1955).
Classical psychoanalysis is to be understood as a reaction to the time in which it arose. It
was a revolt against the Victorian era, with its stifling, too proper, too restrictive rules of behavior
and its denial of the existence of female and infantile sexuality. Freud fought for the recognition
of sexuality and its acceptance as an instinct, an all-human need, a vital drive. He believed it to be
the source of all human energy. The libido theory states that all energy comes from the id and that
the aim of the drives is to seek pleasure and avoid pain.
Freud postulated that the unconscious is the reservoir of the drives and that there were two
 20

basic inborn drives: libido, the erotic-sexual drive and aggression. Accordingly, the basic human
emotions, which express these drives, are love and hate.
Classical psychoanalysts believe that the two sources of all conflict are environmental
taboos and the person's own superego, which is the internalization of external moral demands.
Freud (1 908/I 959) believed that conventional "civilized" morality led to repression of instinctual
needs and wishes, preventing them from coming into consciousness and achieving normal
gratification. In his Topographical Model, the first model of the personality he developed, Freud
(1900/1953) conceived of the personality as consisting of the unconscious (the deepest layer), the
preconscious, and the conscious. (197) His method of therapy was based mainly on helping the
patient make the unconscious become conscious; that is, helping the patient to bring repressed or
otherwise defended-against wishes, feelings, thoughts, and memories into conscious awareness
and squarely face them.
Ego Psychology: Between 1917 and 1923, Freud became aware that the Topographical
Model of personality was inadequate. He (1923) therefore developed the Structural Model of the
personality, comprising the id, the ego, and the superego. The id is totally unconscious; the ego
and the superego has unconscious, preconscious, and conscious parts.
The ego organizes and structures information in relation to the outside world, such as
perception, thinking, memory, and erects and maintains defenses. (For further elaboration, see A.
Freud, 1936, and Hartmann, 1968.) The superego-the conscience-represents the internalization of
parental prohibitions and values, what one feels one ought to do or ought to be. The ego ideal had
earlier been introduced as that part of the personality representing the person that one aspires to
be.
A new strand was being woven into psychoanalytic theory, namely, ego psychology.
Psychoanalysts became interested not only in uncovering unconscious material, but also in the
structure of the personality, particularly in the ego's role as intrapsychic mediator between the id
and the superego and between the id and the outside reality. Psychoanalysts also became more
interested in the inner strengths of the patient and the strategies their patients used to adapt to
reality, to cope with it, to master it, or to change it into a better reality for themselves and others.
Object Relations Theory: By the late 1940s, a third strand was being added to the
psychoanalytic braid-the theory of object relations. Object relations theorists (Fairbairn, 1952;
Fraiberg, 1969; Guntrip, 1969; Kernberg, 1968, 1976; Modell, 1968; Mahler, Pine, & Bergman,
1975; Winnicott, 1953; Jacobson, 1973) believe that libido is not primarily pleasure-seeking, but
rather object-seeking: We forever seek someone to love and be loved by. It is relationships with
people that constitute true libidinal goals, not simply relief of tension or pleasure. The
impressions and internal images we form from our interactions with people are "object
representations." Object representations constitute an integral part of psychic structure. The
internal matrix of images of others is the "representational world." In an object relationship a
person invests his feelings of love or hate in another. To be able to make permanent object
relations requires stability of the internal representation (198) of "the other" (Erikson, 1984), that
is, object constancy. Object relationships develop from impressions of early infant-caregiver
interactions as the infant begins to move away from the early symbiotic mother-child
relationship. Mahler and her associates (1975) regard the entire life cycle as a more or less
successful process of distancing oneself-and internalization of-the lost "good" symbiotic mother
people are eternally longing for. In object relations theory, the process of separation and
 21

individuation (Mahler et at., 1975) is much more important than conflicts about gratification of
instinctual needs. But it does not totally eclipse them.
The Theory of the Self: Beginning in the 1960s, a fourth strand was added to the
psychoanalytic braid of theories: the theory of the self (Kernberg, 1975; Kohut, 1966, 1971,
1972, 1977; Lichtenberg, 1975; Ornstein, 1974). Ego psychology had concerned itself for 40
years with the four parts of the personality (id, ego, superego, and ego idea!), as if they were four
separate people living together and fighting among one another within one house, the total
personality or the "self" The self has a certain identity throughout its life cycle (Erikson, 1968).
Psychoanalysts became aware that even though they knew a good deal about the components of
the personality, they knew very little about the whole, the self.
Moreover, they no longer were seeing many patients suffering from neuroses; most
patients had personality disorders. The narcissistic personality emerged as a new diagnostic
phenomenon in the 1960s and 1970s. These patients complained of feelings of emptiness and lack
of self-worth. But beneath their conscious feelings of worthlessness, they had unconscious
feelings of grandiosity.
Particular times produce particular emotional illnesses. Just as the Victorian Age, which
did not allow women and children to become aware of their sexuality, produced the hysterias, so
the post-World War II era produced the narcissistic personality as a general phenomenon among
the young. Children born after 1945 have never known a world without the atom bomb and the
abysmal fear that the nuclear holocaust will come before they have a chance to grow up and take
their place in the world. Many of these people come from affluent homes, where they were
materially indulged but emotionally deprived. The nuclear family and family closeness were in a
state of disintegration during their early childhood. Their parents had lived through the
Depression and war. They were upwardly mobile and had developed strong expectations of the
kind of life they wanted for their children. But they failed to attune themselves to their children's
early separation-individuation needs (Mahler et al., 1975) and to (199) show admiration for the
accomplishments of their developing childrenespecially when these needs and accomplishments
were at odds with the parents' expectations. The effect on the children was impairment of self-
esteem. In the late 1960s, psychoanalysts began to analyze narcissistic and borderline patients and
learned a great deal about the development of the self as an integral part of psychic structure. The
most important authors in the development of this new area of psychoanalysis are Kohut (1971,
1977), Kernberg (1975, 1976), Masterson (1976, 1981), Bach (1977), and Adler (1981, 1985).
Applicability of the Four Psychoanalytic Theories to Specific Nosologic Categories:
Contemporary hypnoanalysis uses any or all four strands of psychoanalytic theory, depending on
the case. In working with neurotic patients who present with relatively circumscribed symptoms,
the hypnoanalyst helps the patient into trance and then conducts an uncovering therapy based on
classical libido theory and ego psychology. With narcissistic and borderline personality disorders,
that is, patients who suffer from developmental arrests (Stolorow & Lachman, 1980), the
hypnoanalyst puts the main emphases on correcting deficits in psychic structure, on working
through conflicts around separation-individuation, and on developing the twin capacities to form
stable object relations and maintain a cohesive self Object relations theory and self theory address
directly these issues. In working with psychotic patients, the hypnoanalyst does not attempt to
uncover conflicts but does try to facilitate ego building or "progressive structuralization" (Gedo &
Goldberg, 1973), by combining therapeutic methods based on ego psychology, object relations
 22

theory, and self psychology. All four psychoanalytic theories can be used in hypnoanalysis. the
emphasis on one or the other depending on the case. Frequently more than one of the four
psychoanalytic theories will underlie the hypnoanalytic treatment of the same case at different
points.
DIFFERENCES IN MENTAL FUNCTIONING BETWEEN THE WAKING STATE
(PSYCHOANALYSIS) AND THE HYPNOTIC STATE (HYPNOANALYSIS): Primary
Process and Secondary Process: Freud (1900/1953) differentiated two modes of mental
functioning, which he called primary process and secondary process. Primary process is the
mental functioning typical of early childhood, before reality orientation and language have
developed. The small child lives in a world not yet (200) structured according to the reality
principle. He thinks and acts as if anything were possible, even the impossible. Logical
contradictions do not exist for him yet.
The main form of thinking in primary process is preverbal imagery (Ehrenzweig, 1953).
In primary process functioning, energy is highly mobile and can be readily shifted. Functioning is
stilI fluid and undifferentiated, and "interpenetrating condensations ... can therefore ... reconcile
incompatible things" (Ehrenzweig, 1964, p. 381). Several ideas are often represented by a single
image or, if language is used, by the possibility for a double meaning of a word or phrase. These
phenomena are common occurrences in nocturnal dreams and in hypnosis, states in which the
GRO has faded, and in jokes. (See the example of the pea "pot" and "pod" in this chapter.)
Slowly, as the child learns more about the reality around him, a new mode of functioning
develops, the secondary process. Secondary process thinking is logical and sequential. Most often
it is thinking in words and sentences, in language rather than in imagery. It results from the
impact of reality and is reality oriented.
Primary process thinking is not given up when secondary process thinking develops. Both
continue to interact: even in the adult waking state, our thoughts are hardly, if ever, devoid of
some minor form of imagery; and even during nocturnal dreaming or in deep states of hypnosis,
some traces of realism and logic can be found.
In the hypnotized adult, the typically strong increase in imagery over that in the waking
state represents a reestablishment of the dominance of primary process functioning, with a
regression in the service of the ego to the mode of cognitive activity characteristic of the early
period of life. It is a shift downwards on the continuum from secondary process towards primary
process (Fromm, 1978-79).
The Modes of Ego Functioning: Ego Activity, Ego Receptivity, Ego Inactivity, and
Ego Passivity: The psychoanalytic theory of activity and passivity of the ego was initiated by
Rapaport in 1953 (in Gill, 1967, pp. 530-568) and Hart (1961), and extended by Fromm (1972)
and Stolar and Fromm (1974). The concept of ego receptivity, an important and exciting concept,
was later added to Rapaport's scheme by Deikman (1971) and discussed with regard to the role it
plays in hypnosis by Fromm (1976, 1977, 1979). Rapaport differentiated ego activity and
passivity from active and passive behavior. He thus advanced psychoanalytic theory and provided
an exciting, important distinction. Hart showed that the feeling of choicelessness is the center
element of ego passivity. The ego is active or autonomous when the person (201) can make an
ego-syntonic choice; it is passive or lacks autonomy when the person is overwhelmed by
instinctual drives (Rapaport, in Gill, 1967, pp. 530-568), by demands coming from the
environment (Fromm, 1972), or by the superego (Stolar & Fromm, 1974).
 23

Essentially, the issue of activity and passivity of the ego is tied to the concept of coping or
failing to cope. There are two forms of coping: sovereign, masterful coping and protective, or
defensive, coping. In both, the ego is active and maintains autonomy. In masterful coping, the
ego actively meets the demands coming from the instincts, from reality, and from the superego
and handles them creatively, or at least sovereignly, at its own pace and convenience. In
protective coping, the person defends against these demands, but the action lacks free, smooth,
and sovereign mastery. It presents only mastery of a lower order, namely, the best that can be
done under the circumstances-a compromise. We define ego activity with regard to hypnotic
trance as a volitional mental activity during trance. It is not the same as behavioral activity. Each
can occur without the other. In heterohypnosis it can be a decision not to go along with what the
hypnotist is suggesting or to go along with it because one wants to do it. In self-hypnosis, it can
be a self-suggestion.
When the patient submits to ego-dystonic demands coming from the instincts, from the
external world, or from the superego, the ego is passive. The patient goes along with the
demands, even though he does not want to or because he feels overwhelmed and experiences that
he has to submit. Both are forms of ego passivity. Ego passivity of the latter type occurs
characteristically in psychoses, panic, catastrophic reactions, and brain washing; and in
heterohypnosis when an authoritarian hypnotist forces a patient into doing, feeling, or
experiencing something he definitely does not want to experience (Fromm, 1972). We define ego
passivity as a state in which the patient feels overwhelmed or helpless and is unable to master the
situation or exert active ego control. It is usually accompanied by unpleasant affect.
However, not all states in which active control and voluntarism are relinquished are states
of ego passivity. Many are characterized by ego receptivity. In ego receptivity, critical judgment,
strict adherence to reality orientation, and active, goal-directed thinking are held to a minimum,
and the person allows himself to let unconscious and preconscious material float freely into his
mind. There is an openess to experiencing, which William James (1892/1961) would have
characterized as watching the stream of consciousness flow by. Ego receptivity is the prevailing
state in heterohypnosis; it also occurs frequently in self-hypnosis (Fromm, Skinner, Lombard, &
Kahn, in preparation). In heterohypnosis, the patient opens himself to the hypnotist and is more
receptive to the therapist's suggestions than he would be in the waking state. Hypnotic
suggestibility (202) really is nothing more than heightened ego receptivity (Fromm, 1979). For
self-hypnosis, we are defining ego receptivity as the patient's heightened ability to let unconscious
or preconscious thoughts, feelings, or imagery come into awareness. Ego receptivity implies that
the" gates" to primary process thoughts and images have opened more widely than they do in the
waking state. Ego receptivity generally is an ego-syntonic state.
In the active ego mode, the organism is able to manipulate the environment. On the other
hand, the receptive mode is organized around intake from the environment rather than its
manipulation. In the receptive mode, one allows things to happen; one does not make them
happen. Cognitively prelogical thought and imagery predominate over formal conceptual thought.
The barriers between conscious awareness and the unconscious and preconscious are lowered,
leading to a greater availability of unconscious material.
A fourth mode of the ego, which to our knowledge has not been reported before in the
scientific literature, is ego inactivity. We do not know whether it exists in heterohypnosis, but we
have come across it in our research on self-hypnosis (Fromm, Skinner, Lombard & Kahn, in
 24

preparation). It is the subject's feeling that while he has been in trance, nothing has been going on
in his mind, and he has been doing nothing. A subject reporting about a self-hypnotic session, for
instance, may say, "For 20 minutes nothing happened" or "I remained in trance without
suggesting anything for quite a while, and I experienced nothing."
PRACTICE:
Hypnoanalysis with neurotic patients has three parts:
(a) uncovering unconscious conflicts, memories, affects, thoughts, and so on, against which the
patient is defending himself-without piercing defenses too quickly; and
(b) the "working through," which leads to
(c) integration, mature coping, and mastery.
In psychoanalysis, transference, a regressive phenomenon, is considered to be one of the most
important tools for helping the patient. It is important also in hypnoanalysis, in all three parts of
the hypnoanalytic process, the uncovering, the working through, and the healthy reintegration.
UNCOVERING THE UNCONSCIOUS SOURCES OF CONFLICT: Classical
psychoanalysis employs mainly four techniques for uncovering, all of which can be used in
hypnoanalysis.
They are:
(a) free association;
(b) dream interpretation;
(c) interpretation of defenses and resistances; and
(d) transference analysis.
Free Association: The hypnoanalyst uses free association very similarly to the
psychoanalyst, except that in the hypnotic state associations more frequently appear in the form
of imagery. Imagery is primary process mentation. It comes more directly from the unconscious
than do most verbal associations given in the waking state. Conflicts, wishes, and defenses are
more thinly disguised in hypnotic imagery, and thus the therapeutic process is accelerated
(Reyher, 1963). Like the imagery of the nocturnal dream. hypnotic imagery-unless it is quite
reality oriented-is the form in which free association takes place in altered states of consciousness
(Fromm. 1984, p. 67). Patients who do not spontaneously report images should be encouraged to
become more aware of all the different images that go through their mind in the hypnotic state
and to report them, regardless of whether or not there seems to be a logical connection between
them. Free association-mainly through images, but also through free verbal association-occurs in
the uncovering process as well as in the working through and integration processes in
hypnoanalysis. The following vignette is an example of how imagery in hypnosis can sometimes
help a patient more than verbal free association in the waking state.
A graduate student at one of the Big Ten universities had become disenchanted with
studying and wanted to leave the university. He felt vaguely depressed and listless and could not
concentrate. The night before his hypnoanalytic hour, he dreamt that he saw a pot full of peas. In
the waking state he was asked to free associate to it and said, "All peas look alike" and "I don't
like pea soup." No other associations ensued, and he said he could not figure out the dream.
When helped into trance, he produced a dream in which he dived into a lake. At first the water
seemed to be muddy, but as he dived deeper, it became clearer and clearer. (The increasing
clarity pictured his coming closer to understanding the dream.) At the bottom of the lake was a
beautiful palace with a throne room. The throne was empty, but there were many people in the
 25

room; vassals, knights, beautiful ladies, and also many contenders for the throne. In the hypnotic
dream, the patient tried very hard to get onto that throne, to win it for himself. He felt a strong
need to be the king and struggled hard to get up to that throne ahead of all other contenders.
Suddenly he said, "Oh, I know what this image and my dream oflast night mean: I want to be
better than everyone else. I want to be admired; I want to be the 'king.' But here at this university
I amjust one among many. We are all like peas in a pod. We are all more or less equally gifted. I
want to be better than everybody else. I am depressed because I do not get the adulation of my
peers, as I did in high school and in the small college I went to. I am not 'the best.' " Then, as an
aside, he gave a verbal association, saying, "Isn't it interesting (204) that in the dream there
appeared a pot full of peas, in hypnosis a pod. Apparently I played with words without knowing
it. "
Dream Interpretation: The second classical psychoanalytic technique is dream
interpretation. Freud (1900/1953) called the nocturnal dream "the royal road to the unconscious."
In dream interpretation one differentiates between the manifest and the latent content of the
dream. The manifest content is what the dreamer actually sees or hears or does in the dream; the
latent content is the unconscious or preconscious thought processes underlying the manifest
content. Freud compared the total dream work to a mountain range partially submerged in the
ocean, with the manifest content representing the tops of the highest mountains visible as islands
above the surface of the sea. The latent content is comparable to the part of the mountain range
that is submerged below the ocean's surface. In dream work, symbolism, condensation,
displacement, and substitution are used rather than logical and formally organized thought.
Therefore, the meaning of a dream often seems quite unintelligible at first.
The dreams of patients in therapy deal with conflicts-mainly, in Freud's view, with
unresolved childhood conflicts. According to Freud (1900/1953), dreams represent a "primary
wish-fulfilling process," which is interfered with by the "dream censor," that is, the conscience. In
Freud's view, the motivating force for the dream is the instincts, which strive for expression and
gratification; but the instincts are in conflict with the conscience.
Thomas French and Erika Fromm (1986) place more emphasis on ego processes in the
dream and on its cognitive structure. They conceive of the dream as an ego function, a
problem-solving attempt of the unconscious and the preconscious ego. The thoughts closer to
consciousness show up in the manifest content; the more deeply unconscious thoughts are hidden
beneath the surface, in the latent content. French and Fromm have also demonstrated that dreams
are reactions to, and expressions of, a current conflict, a "focal conflict," that is, one in which the
dreamer is involved in his present life situation. The dream may have roots in the past, but people
do not dream about the past as such. The past has to be reactivated in the present, in the
interrelationship of the patient with real-life figures, here and now. It is the here-and-now
situation that gives rise to a disturbing wish within the patient. This disturbing wish in turn leads
to and is in conflict with a reactive motive-guilt, fear, pride, shame, or a counterwish. Every
dream contains one or more successful or unsuccessful attempts to solve the conflict (Fromm &
French, 1962).
In initial attempts to interpret the dream, the psychoanalyst or (205) hypnoanalyst often
finds himself in a situation like that of Monsieur Broussare when he discovered the Rosetta Stone.
The message of the dream-or parts of it-are written in hieroglyphs (the language of the patient's
unconscious). It must be translated faithfully into the language of the waking state (the language
 26

of the conscious). How does the interpreter go abou: this task?

The interpreter should not just decode "symbols," for example, think that every oblong
object is a penis symbol. Like the good translator of poetry from a foreign language and culture,
who faithfully and artistically tries to recreate in the language of the translation the specific poetic
atmosphere and quality of the original poem, so the dream interpreter must also recreate the
dream's specific elusive atmosphere in order tc make the dream meaningful to the patient's
conscious mind.
Dream interpretation, like the understanding of the hypnotic patient's verbal and
nonverbal communications, calls upon intuition. It requires also scientific self-discipline and the
willingness to evaluate critically ane conscientiously the ideas and hypotheses one has arrived at
intuitively The therapist must constantly check and recheck whether his intuitin hypnotheses
about the meaning of the dream are really supported by the manifest content of the dream and the
associations, need modification or refinement, or should be discarded because they are wrong.
In dream interpretation, the hypnoanalyst erijoys a distinct advantage over the
psychoanalyst, who must wait, often for weeks, for the dream reports the patient brings in. Often
there are none for quite a while. And psychoanalysts are always faced with the fact that much of
the content of dreams-even those remembered-has been repressed, forgotten, or distorted. In
hypnosis, however, there are a number of tools available tc facilitate and improve working
with dreams:
1. The hypnoanalyst can hypnotically induce dreams during the hypnotic session, dreams that the
patient reports immediately after they are dreamt.
2. The hypnoanalyst can suggest that the patient dream about a particular conflict or problem the
therapist is trying to help him solve.
3. If the patient has not come to a solution by means of the dream, the hypnoanalyst can ask him
to dream it again-perhaps with a differen: manifest content-and to try again to cope with the same
problem, either in a different manner or on a different level. The therapist can encouragingly tell
the patient that he will find better and better solutions in hi~ continuing attempts at re-dreaming
(Sacerdote, 1978).
4. The hypnoanalyst can suggest that the patient will be better able tc understand the symbolism
and meaning of his dreams as time goes on. (206)
In addition to these four useful ways of employing hypnotic dreams, the hypnoanalyst has
two other valuable techniques at his disposal. First, in hypnoanalysis (in contrast to
psychoanalysis), the analyst recourse to the posthypnotic suggestion. The hypnoanalyst can give
the patient a posthypnotic suggestion that during the week to come he will dream some important
dreams at night, which, even if he should forget them, will rise into consciousness and be
remembered by him as soon as he steps into the therapist's office the next week. Then the
therapist can explore with the patient the full dream product and interpret it, rather than being
forced not to work with dreams because the patient forgets them.
Finally, it happens not infrequently in hypnoanalysis that when the patient-particularly
one who is only in light trance-is asked to dream during the current hour, he will
hypermnestically remember an old nocturnal dream he had never reported before. Usually this is
a very important dream he had earlier repressed. Or he may produce a hypnotic daydream, which
also can be gainfully interpreted.
As Freud (1900/1953) said, the dream is the royal road to the unconscious, but the dream
 27

is only one of many roads. Hypnosis is another. The psychoanalyst, whose patient is not in
hypnosis, talks to the conscious ego, and only through the dream and slips of the tongue does the
patient's unconscious communicate directly with the psychoanalyst. When the patient is in
hypnosis, particularly in deep hypnosis, the hypnotist can also get directly to the patient's
unconscious by means of imagery, age regression, and hypermnesia; and the patient's
unconscious can answer directly. Therefore, hypnosis can bring about improvements or cures
more quickly.
DEALING WITH DEFENSES AND RESISTANCES: The interpretation of defenses
and resistances, an essential part of psychoanalysis as well as of hypnoanalysis, should be handled
carefully, gently, and respectfully. While often it is clear quite early what the patient is defending
against, defenses should not be pierced too quickly. Like underlying wishes, defenses often are
expressed through imagery. The following case, as reported by one of the authors (E. F),
illustrates:
A highly sensitive, artistic graduate student, who wanted to become a writer or a
musician, came for hypnoanalysis because he wanted to know whether he was a homosexual. He
had both homosexual and heterosexual fantasies but never dared to approach either men or
women and led a totally celibate life. He told me about his father, a Midwestern farmer, who
wanted his son to step into his footsteps and who objected to the son's choice of profession. (297)
Consciously it was clear to the patient that his father conceived of his artistic interests as
being 'feminine.' But I had the feeling that much more was involved in this patient's doubts about
his sexual identity and his need to keep away from any sexual contact. V sing the Theater
Technique, I suggested, when the patient was in a rather deep trance, that we would gc to a
theater, sit down in our seats, and see a play that in some ways was connected with his problem. I
described the beautiful red velvet curtain that was now being pulled up. As it was going up, the
patient suddenl: said, "Vh-uh, the rope broke. The curtain has fallen down." I tacitly recognized
this as a defense. The patient was not yet ready to look more deeply at his problem. I explained
that he could relax some more while the curtain was being repaired, a process I described in
elaborate imagistic detail. A little later I said that the rope was now repaired, the play could
begin, and the curtain again was being pulled up. When the curtain was halfway up, the patient
informed me that the rope had broken again. Not only that, he said, but now a gold-colored metal
curtain had come down. too, totally shutting the stage off from vision. Thus, through imagery, the
patient told me in unmistakable terms that he still needed to protect himself from finding out
more about the roots of his problem, that he was not yet ready for such uncovering. It would have
been wrong to pierce this defense at that time. So I dropped the subject for a while.
A month later we again went through the imagery of going to a theater. This time no
curtain fell. The patient saw on the stage an older man who was sexually attacking a young boy.
This brought up a hither to totally repressed memory from when he was between 9 and 12 years
old. He had had to sleep in the same bed with his grandfather who a number of times attempted to
abuse him sexually. The patient could now see the deeper dynamics of his homosexual fears: his
grandfather's incestuously abusing him in preadolescence.
In psychoanalysis the most common forms of resistance are blocking and coming late to
an appointment. In hypnoanalysis they are: refusing to go into trance or avoiding it, not allowing
oneself to "let go," lightening the trance, blocking, and the production of imagery that symbolizes
resistance (e.g., an iron curtain falling down).
 28

In hypnoanalysis, interpretation of resistances is not necessarily pursued as assiduously as

it is in psychoanalysis. At times the hypnoanalyst interprets resistances, but more often, he
accepts their existence silently and does not draw them into the focus of interpretive activity. The
hypnoanalyst notes the patient's resistances, and he notes when the patient resists. Then the
hypnoanalyst tries to think of ways to word his therapeutic suggestions so that the patient does
not need to resist. Only if this does not work does the hypnoanalyst draw the patient's attention to
his resistance so that they can analyze it together. On the whole, in (208) hypnoanalysis one
makes somewhat less of resistance as a cornerstone of therapy than one does in psychoanalysis.
Moreover, because in the hypnotic state the subject or patient characteristically has a strong wish
to cooperate with the hypnotist and to please him, resistances are not quite as frequent as they are
in waking-state psychoanalysis.
TRANSFERENCE: Transference is a psychoanalytic term indicating that the patient
distortedly perceives, unrealistically feels about, and behaves toward his therapist according to
the impressions formed about significant figures in childhood. He sees his therapist-who is part of
his current worldthrough the tinted glasses of the past. Whether the glasses are rose colored or
dark, the patient unconsciously tries to re-enact with his therapist important relationships he has
had with others earlier in life (Fromm, 1968). In psychoanalysis one speaks of positive and
negative transferences: A patient who is in a period of positive transference loves and idealizes
his therapist; in a negative transference he hates him. Both kinds of transferences have to be
worked through.
Transference feelings, very strong in psychoanalysis, are even stronger in hypnotherapy
and hypnoanalysis. Hypnosis brings into focus, even more rapidly and more deeply than
psychoanalysis does, conflicts and repressed affects associated with internal object
representations.
There are three major general categories of transference:
(a) neurotic transferences;
(b) selfobject transferences, and
(c) psychotic and borderline transferences. For the best advantage to the patient, each category
requires a separate method and procedure.
The Neurotic Transference. Neurotic transferences are based on stable internal
representations of self and others, in which patterns of repetitive maladaptive behaviors are
associated with affective distortions in the perception of others as well as with disavowal of
certain of one's own impulses and affects. Neurotics do form stable object relationships-an ability
lacking in borderline patients and in psychotics. But neurotics have difficulties in these
relationships. The reason is that they often unrealistically transfer to people in their current
environment feelings they had toward their parents or siblings in the past.
In neurotic transferences, three subtypes can be found:
(a) infantile dependency transferences,
(b) oedipal transferences, and
(c) sibling transferences.
The hypnotic situation tends to foster infantile dependency transferences, especially in the
beginning. Frequently the patient who comes for hypnotherapy expects the hypnotist to take care
of him, to solve all his (209) problems, while he, the patient, is "asleep." Such a patient wants to
be dependent. Unrealistically, he sees the hypnotist as the omniscient, omnipotent parent. He may
 29

fantasize that he is being held in the therapist's arms, nursed, and rocked. Transference feelings
are unrealistic; in the transference the patient may overlook such "minor" details as the real sex of
the therapist. He can make a man into a mother figure, a woman into a father figure. In either
case, he may want the hypnotist to make decisions for him, as his father or his mother used to do
when he was a child. The patient expects to be taken care of, either as he was taken care of in his
early childhood by his parents or as he wishes he had been.
The oedipal complex has two sides: the desire to have a love relationship with the parent
of the opposite sex and the desire to win the object of one's love away from the parent of the
same sex, whose wrath one fears. Similarly, the oedipal transference in hypnosis can take two
forms: seduction (ingratiation) or fierce competition coupled with death wishes. In hypnoanalysis,
all of these archaic feelings are transferred to the hypnotherapist. A female patient may fantasize
that the male hypnotist lures her to him, holds her in his strong arms, seduces her. Another may
bring a lawsuit against her male hypnotherapist for supposedly having attacked her sexually while
she was in a trance. In the latter instance, wish and fear have merged into one fantasy, which to
the patient has in turn become a psychic reality. When such a woman patient was between the
ages of 3 and 5, she experienced the normal oedipal wish of every little girl: that her father take
the initiative and have a sexual relationship with her. But she has not resolved this oedipal wish;
in her unconscious it keeps throbbing, and later she transfers this wish to the hypnotist. She
wishes to be seduced by the male hypnotist. In bringing suit, she is unconsciously revenging
herself on the therapist/father for not having seduced her. She blames the seductive wish on the
hypnotist, transferring to him the unfulfilled hope she had for her father. Being in trance,
"asleep," and not actively doing the seducing, makes it more possible in her own mind to rid
herself of the responsibility.
Frequently in hypnoanalysis the patient acts out old sibling rivalries through a
transference. The patient becomes very competitive. For example, one of the authors (E. F.) had a
hypnoanalysis patient, a woman in an allied profession, who had one sister. The patient never
went into more than a very light trance with me. In her first hour she asked me to teach her
autohypnosis. I did. Subsequently she told me several times that at home, when practicing
autohypnosis, she could get herself into a much deeper state than I could help her enter. Clearly,
sibling rivalry here reared its head: "I can do better than you can."
Would it have been helpful to interpret the sibling rivalry to the patient (210) in hypnosis?
I do not think so. She would have felt uncomfortable, ill at ease, guilty. Competitiveness can
become a useful tool, provided the therapist does not feel the need to be the patient's savior. If the
patient also can use autohypnosis effectively, why not let her? In traditional psychoanalysis, one
analyzes all transference phenomena. In hypnoanalysis it is sometimes wiser not to make the
patient aware of every transference feeling that comes up. At times one can do more constructive
work by utilizing transference feelings in hypnoanalysis than by analyzing them. In the case of
this patient with the need to outshine me, I praised her while she was in heterohypnosis for her
competence in autohypnosis. I told her how pleased I was that she was learning to help herself go
into trance, and I even suggested that at home, in the evening, she put herself into a much deeper
trance than I could put her in-and that memories and images would come to her that would shed
new light on her major problems, alcoholism and compulsive overeating. Moreover, what she
would bring in during each hour following self-hypnosis would furnish ample material for the
hypnoanalysis. Later I could suggest to her that she would soon find herself as competent in
 30

dealing with her problems as she was in putting herself into trance.
In addition to the three above-named general categories of neurotic transference, there are,
of course, more specific transference feelings and reactions worthy of examination. For example,
a patient whose mother had suddenly died one night when he was 4 years old and asleep had great
difficulty going into anything but the lightest stages of trance. Every once in a while he exhibited
in his light trances a curious, minute, pulling-up movement of his head and shoulders-as if he
wanted to alert himself or prevent himself from going down into a deeper trance. At the end of
most of his hypnotic sessions, he would become very solicitous about me, asking me how I felt,
wondering whether I was tired, remarking that he must be a strain on me. As he was my last
patient of the day, we often left the building together, and he would always insist on carrying my
brief case or my books to my car. At first I thought this was gallantry, but then I realized that the
behavior, both in and out of trance, was an expression of the same transference reaction: The
patient pictured me as weak, was afraid I might die and leave him ... as his mother had done.
Further hypnoanalytic work revealed his unconscious fantasy that his mother had died because
she had had to work too hard to support him. The father had deserted the mother a few months
after the patient was born.
When he next made this curious head and shoulder movement in trance, I quietly said to
him, "You don't need to be afraid of making demands on me. I am strong. I am not going to die."
The patient heaved a great sigh, relaxed, and immediately went into much deeper trance. I then
interpreted to him that he imagined he was responsible for his mother's death. (211)
In the hypnoanalysis of patients on the narcissistic-borderline-psychotic continuum, the
therapist takes on a much more active role in making himself into a transference object that
fulfills the particular needs of these patients-and even their changing needs at different times-than
he does when treating the neurotic patient. Only in that way can he help them correct their
developmental deficit and move on to growth and maturation.
The Selfobject Transference of the Narcissistic Patient. Patients with narcissistic pathology
superficially function well in relationships. But they suffer from a deficit in self-esteem and
associated feelings of worthlessness. They compensate with an unconscious grandiose self-image
and feelings of elation. If in the rapproachement period (ages 16-25 months) of the
separation-individuation phase of development (Mahler et al., 1975) the caregiver frequently was
unable to gauge and gratify the toddler's alternating needs for autonomy and dependency-which
can change from moment to moment-and to admire the child's attempts at coping, mastery, and
self-expression, lasting deficits in self-esteem result.
Narcissistic personalities form transferences characterized by this developmental failure.
The narcissistic patient's self-esteem is highly vulnerable to the therapist's limitations and
occasional failures in empathy. The mildly narcissistic patient reacts to these failures with
disappointment and anger; highly narcissistic patients, with disillusionment and rage (Kohut,
1972). Nevertheless, the narcissist is capable of forming a stable self-object transference (Adler,
1981, 1985; Kohut, 1971, 1977; Gedo & Goldberg, 1973). A self-object is a person the young
child selects and uses to provide functions that are essential for the development of self-esteem.
functions he as yet is unable to provide for himself. Narcissists suffer from a developmental
deficit in self-esteem, for which they attempt to compensate by obtaining from the therapist,
through the self-object transference. what they have not yet internalized, namely, feelings of
self-worth and healthy pride in their own accomplishments. To the extent that the therapist
 31

provides "mirroring" (Kohut, 1971) and admiration, the narcissistic patient experiences
well-being; whenever the therapist fails to do that, self-esteem plummets, and the patient becomes
depressed. The self-esteem of narcissistic people is dependent on what others think of them.
The hypnoanalyst must actively put himself in the role the mother did not fulfill
satisfactorily in the patient's preoedipal childhood. At least for a while, he must empathically be
the always available mother, who thinks so highly of her child and admires the child so much that
the patient can begin to develop solid self-confidence.
The Borderline Transference. The patient with borderline personality organization
manifests a deficit in the integration of object (212) representations. Failures in the two earliest
subphases of the separation-individuation period (Mahler, 1972)-via the repeated extremes of
emotional abandonment or overprotectiveness (Masterson, 1976) on the part of the caregiver and
considerable inconsistency in the caregiving (Mahler et al., 1975)-contribute to deficits in the
structuralization of the internal world. Object representations remain poorly integrated or are
split. "For the borderline personality, the choice in close relationships is between attachment that
symbolizes engulfment and loss of identity, and separation that evokes feelings of loss and
abandonment" (Copeland, 1986, p. 158). In borderline patients, object representations are highly
unstable and vulnerable to fragmentation. Borderline patients form transferences characterized by
these developmental failures. Unlike narcissistic patients, borderline patients are unable to form
stable self-object transferences (Adler, 1981, 1985). The transference is, instead, characterized by
boundary diffusion, splitting (Kernberg, 1975), panic states (Buie & Adler, 1982), and transient
loss of or fragmentation of self- and object representations (Giovacchini, 1979). The
hypnoanalyst must provide a safe and facilitating environment in which the patient can
recapitulate the development of the early subphases of the separation-individuation period
(Mahler et aI., 1975) with a better parent figure and in which he can explore his own self, in the
relationship with the hypnoanalyst, in a safe climate, or what Winnicott (1965) has called a
"holding environment." The hypnoanalyst must provide soothing when the patient is anxious; he
must help to develop object constancy and overcome "splitting"; he must freely and unstintingly
give a great deal for a long time. The hypnoanalyst should provide for the borderline (and the
psychotic) patient an emotional environment that is nurturing, stable, protective, and constant. He
must "hold" the boundaries of reality as the good mother does when she holds the infant, so that
the patient can fully internalize a sense of demarcation between the "me" and the "not-me," the
self and the other.
Baker (1981), Fromm (1984), and Copeland (1986) have found that the hypnoanalyst
must be much more active and directive in building up the therapeutic scenario for the borderline
and the psychotic than for the neurotic or even for the narcissistic patient. By asking the
borderline patient to visualize the distorted bad self- and object representations that have been
internalized, the hypnoanalyst can help the patient bring these representations into awareness and
find ways to deactivate them or integrate them with the good ones in healthy ways. As a
transference object, starting at a somewhat earlier developmental level than he needs to do with
narcissistic patients, the hypnoanalyst must help the patient to overcome splitting and develop
solid object and self-constancy. Once progress in treatment has made possible the internalization
of the hypnoanalyst as the good object, the therapist also at times must put himself in the position
of the sometimes frustrating mother figure who cannot fulfill (213) all of the patient's demands.
He can do that only when the patient's ego structure has become stable enough so that the
 32

hypnoanalyst is integrated' in the patient's inner life and is perceived as a constant object, in place
of the alternating good and bad object of earlier phases of treatment. In chapter 8 we discuss the
newly developed methods for the hypnoanalysis of narcissistic, borderline, and psychotic
patients. To repair the developmental deficit, the therapeutic process with such patients should
parallel the phases of normal preoedipal development.
The Psychotic Transference. The psychotic patient forms a transference based on poorly
developed object representations (Modell, 1968) and a lack of a cohesive sense of self. The
boundaries between the internal representations for self and others are barely differentiated (Blatt
& Wild, 1976; Jacobson, 1973). At times the psychotic is unable to distinguish clearly between
the self and the other, or between the self and the world. His representational world is poorly
differentiated and poorly integrated. Unassimilated internal representations, or introjects, often
carryon a quasi-autonomous existence. A variety of these unintegrated introjects become
activated at different times and influence the psychotic's perception of others in a fluid and
unstable manner (Volkan, 1976). The internal images on the basis of which the psychotic
perceives the therapist during the hours are often distorted, frightening, grotesque, and
fragmented; at other times, the therapist may be perceived in equally unrealistic, idyllic terms
(Blatt, Schimek, & Brenneis, 1980; Smith, 1977). These highly unrealistic perceptions are
rudimentary adaptive attempts by the patient to construct a positive, albeit distorted,
representational world by forming a psychotic transference. The psychotic patient creates for
himself an illusory environment oriented around his own needs and wishes (Modell, 1968).
Until recently it was generally assumed by psychoanalysts that psychotics can form
neither object nor transference relationships. Therefore, it was assumed, they could not be
analyzed. Burnham, Gladstone and Gibson (1969) opened up new vistas for the psychoanalytic
treatment of psychotics. Although the object relations of the psychotic are at times very distorted
and unstable, he nevertheless still has some capacity for object relationships. The psychotic
patient does form a different type of transference. Burnham and his associates have
conceptualized the basic problem of the psychotic transference by calling it the need-fear
dilemma. The psychotic needs others in order to define himself as a person, apart from them.
However, the psychotic fears that by making contact with "the other" (Erikson, 1984), he will be
swallowed up, lose his own weakly established boundaries, and merge with the object. Because
he fears this, he attempts to withdraw from all object relationships. But, then again, by (214)
withdrawing, he loses "the other," whom he so desperately needs to preserve the self. The
dilemma of the psychotic is that he continually alternates between seeking self-definition through
an external object and fearful withdrawal from it. He behaves in the same way in his relationship
with the therapist. Like transference manifestations with other types of patients, this pattern of
relationship can be interpreted and worked through in the transference in hypnoanalysis.
Countertransference: Therapists, too, sometimes look at patients through the distorting
lenses of the past. They may feel for and about certain patients, and react to them, as if these
patients were important figures from their own past. If, when this occurs, the hypnoanalyst does
not become aware of his own unconscious countertransference feelings toward the patient, the
therapy suffers. The therapist must either analyze his countertransference immediately and
resolve it quickly, or he must transfer the patient to another therapist (Fromm, 1968).
A few years ago, a college student came to me (E. F) with a request for hypnotherapy. He
could not concentrate, he said. He could not do his homework. In a few weeks he would have to
 33

pass his comprehensive examinations. I liked the boy on sight, and I took him on for therapy.
The patient had little hypnotic talent and experienced only extremely light stages of
trance. In general, I had the impression that he felt it was all up to the hypnotist; she could do the
work for him, both his homework and the hypnotic work. I saw him three times and tried with all
means at my disposal to help him go into trance. During the second hour it occurred to me that
the boy's head looked from the back like that of one of my brothers. I also became aware of a
feeling of slight resentment toward the boy. The resentment was mixed with a feeling of
fondness.
When in the third hour the feeling of resentment grew, I decided that I had to do some
self-analysis after the hour. The physical resemblance to my brother struck me more and more:
the boy had black hair and large, light, luminous eyes-like my brother. He looked as my brother
had looked as an adolescent. And suddenly it dawned on me why I felt resentment. For years my
brother had induced me to do his homework for him. He had been a very difficult adolescent, and
in his quarrels with the authority figures-our parents-I always had to be the go-between who
would pull the "chestnuts out of the fire" for him.
I had analyzed the countertransference, and under normal circumstances I would have
been able to continue to do therapy with this young man. But at that time circumstances beyond
my control made me particularly careful about perhaps unresolvable reminders of such a (215)
countertransference. Just a few weeks before, my brother, who lived on another continent, had
suddenly become seriously ill. I knew his illness was terminal and progressing rapidly. Chances
were that his death would throw me into another countertransference reaction to the patient,
namely, that I would transfer all my love for and resentment towards the lost brother onto the
patient (at least during the mourning period). For these reasons, it was in the best interest of the
patient to transfer him to another hypnotherapist.
The story has an epilogue. The countertransference danger I had thought might possibly
occur, indeed did occur, as an unconscious process. Three years later, while driving my car, I
noticed a young man on a bicycle. I thought I recognized him as a hypnotic subject whom one of
my students had used once in class half a year before. I also thought I remembered that the young
man had indicated he would like to be a subject in other experiments. I honked my horn,
beckoned him to come over, stopped the car in the middle of the street (holding up traffic), and
asked the young man whether he would be willing to come and be an experimental subject for
me. I did not recognize him as a former patient until he said something about therapy. Then I
suddenly remembered the "resemblance" to my brother, which had been clear to me then, but
which was not really much of a resemblance.
It is not usually my habit to beckon young men on the street, nor to collect experimental
subjects in this way. I unconsciously had attempted to revive a relationship with the object of my
brother-countertransference, in order to replace the relationship with my brother, who had died 3
years earlier.
Pregenital Parent Countertransference. Several main kinds of countertransference
feelings and attitudes occur in therapists. There is the hypnotist who has never quite given up his
early childhood belief in the omnipotence and omniscience of parents. He transfers this devout
attitude of God-likeness from his parents onto his patients and feels they know all he thinks about
while he is hypnotizing. If he is an experimental researcher, he may be unrealistically convinced
that his subjects can sense his hypotheses and what results he hopes to obtain in his hypnotic
 34

experiments. He may insist on double-blind procedures in his hypnotic experiments. Although

unconscious communication between the hypnotist and the patient or subject can exist, it remains
to be examined in each case whether unconscious communication or the hypnotist's
countertransference fantasy was at work.
Another form is the Oedipal-Sexual Countertransference. The male hypnotherapist who
talks to most patients in a seductive manner, regardless of what the patient's needs are, belongs in
this category. As a (216) hypnotherapist, he is a Don Juan. He has never overcome the
disappointment of his mother's oedipal rejection and now seeks to seduce many instead of the one
who did not accept him in his father's stead when he was 3 or 4 years old.
A variation on this theme is the objectively competent hypnotherapist who is subjectively
plagued by self-doubt. He fears that he cannot help a patient or that the patient will see through
him and recognize him as a "fraud." The little boy who played doctor when he was 5 years old or
the little girl who dressed up in her mother's dress and high heels indeed was a "fraud." They
pretended to be grownups and feared being "cut down to size" after a while by the real adults in
their environment.
The hypnotist constantly plagued by self-doubt can also be a narcissistic personality
suffering from feelings of lack of self-worth. The other side of the coin is the narcissistic
hypnotherapist, who grandiosely thinks he cures all of his patients within a few hours (and does
not follow them up).
A third form, Sibling Countertransference, can be found in the hypnotherapist
who--again, regardless of the patient's needs-turns every hypnotherapy hour into a contest he
must win. He must win by getting the patient into deep trance, even though the patient prefers or
needs only lighter trances; and win by wresting away all of the patient's secrets, symptoms, and
conflicts without respecting the patient's more healthy defenses or the patient's need for different
timing. Frequently this countertransference attitude goes back to competition with the father or to
sibling rivalry and the childhood wish to be the winner in the peer group. There are, of course,
other types of sibling and parent countertransferences. As Gruenewald (l971b) has shown, the
hypnotherapist's unresolved dependency needs, unconscious conflicts about aggression, and need
for power and control can impede effective hypnotherapy.
Transferences are useful material in hypnoanalysis. The hypnotherapist uses them to point
out to the patient that he stands with one foot in the past-which makes it difficult for him to walk
in the present, cope with his current situation, and enjoy life to the fullest. Countertransferences
are obstacles to helping the patient, because, when unrecognized and unconscious, they cause the
therapist to see the patient unrealistically, as if the patient were partially a re-edition of a beloved
or hated figure out of the hypnotist's past. The hypnotherapist must recognize, analyze, and
resolve his countertransferences without delay, or he cannot help his patient.
Countertransferences When Treating Narcissistic, Borderline, and Psychotic
Patients. Working with narcissistic patients is always difficult and easily can lead to a number of
specific countertransferences (see Doraff, 1976; Giovacchini, 1972; Kernberg, 1975; Kohut,
1971). Kernberg (217) conceives of a continuum of countertransference reactions ranging from
those related to the neuroses to those in response to psychotic reactions, "a continuum in which
the different reality and transference components of both patient and therapist vary in a
significant way" (Kernberg, 1975, p. 54). However, there is a qualitative difference between
therapists' countertransferences to neurotic patients and their countertransferences to the severely
 35

narcissistic, borderline, and psychotic patients. With patients in the latter three categories, the
therapist's reaction is not so much due to specific problems in his own past as it is to the patient's
intense or chaotic transference violating the therapist's boundaries and privacy. The tremendous
demands the narcissist makes upon the therapist's time and patience, the patient's unwillingness to
"let go," and his exploitativeness (of which the patient often is quite unaware; see the case history
in chapter 9, this volume), his unconsciously attempting existentially to annihilate the therapist
(Doroff, 1976) cause anger and resentment in the therapist. Frequently they bring him to the point
where he loses his patience or becomes so fed up that he gets rid of the patient prematurely. Some
therapists are unable to impose any limits and consequently accumulate more and more
resentment against the patient, which certainly does not help the therapy. Such patients in their
transference activate primitive object relations and in turn evoke in the therapist a strong
emotional response. The therapist feels that the patient is imposing on him for very long times the
preoedipal role of the mother who is supposed to have no other interests than caring for him and
mirroring his achievements. Like many mothers of very young children, the therapist feels robbed
of individuality and freedom, tied down by the patient, resentful of the patient's wanting to chain
the transference object to himself, and fears he will lose his identity as a person in his own right.
Such emotions may temporarily interfere with the therapist's neutrality.
Thus, what usually in the literature is called the countertransference to psychotic,
borderline, or narcissistic patients is really the therapist's hereand-now reaction to patients who
attempt to take away his freedom and autonomy. In the current psychoanalytic literature such
feelings toward patients who suffer from developmental deficits also are called
countertransference. We think this is a misnomer and would prefer to restrict the term
"countertransference" to its original meaning, namely, the therapist's seeing the patient in an
unrealistic way by transferring onto him characteristics of people who were important to the
therapist in his own childhood.
The hypnoanalytic methods described so far in this chapter derive from psychoanalytic
uncovering techniques for neurotics or psychoanalytic techniques for helping patients suffering
from developmental deficits. That (218) is, we have described so far how the hypnoanalyst uses
psychoanalytic tools while the patient is in trance. These tools are strengthened by the increased
production of imagery and primary process (Gruenewald, Fromm & Oberlander, 1979) that are
essential features of the hypnotic state, as well as by the possibility of giving the patient
permissive, open-ended suggestions to encourage him to employ more of his inner potential for
problem solving and growth than he ordinarily makes use of in the waking state.
FURTHER HYPNOANALYTIC TECHNIQUES: In addition to employing the four
classical methods derived from psychoanalysis (free association, dream interpretation, dealing
with defenses and resistances, and transference analysis) as well as principles based on object
relations theory and self psychology, hypnoanalysts make use of phenomena specific to the
hypnotic state or to altered states of consciousness in general, which enable them to help their
patients faster than would be possible when the patient is awake and reality oriented. We are
referring here to such hypnotic phenomena as age regression, hypermnesia, automatic writing,
dissociation, and heightened imagery. They have been invested by hypnoanalysts with
psychoanalytic substructures that serve as guidelines for their use in hypnoanalysis and in
dynamically oriented hypnotherapy.
The most important of these techniques are:
 36

(a) Age Regression

i) for the recovery of repressed memories and affects
ii) for tracing earlier developmental stages of personality organization
(b) Hypermnesia for the recovery of repressed memories
(c) Guided imagery and spontaneously arising heightened imagery (d) Dissociation of the
observing ego from the experiencing ego
(e) Automatic writing, drawing, and painting
They are genuine phenomena of the hypnotic state, phenomena that hypnoanalysts use
psychodynamically to help the patient uncover, face, and integrate disturbing material previously
held under the repression barrier or otherwise defended against. Because these techniques are
used in the same way in hypnoanalysis as they are in psychoanalytically oriented, more
short-term hypnotherapy, we shall not describe them again in this chapter. (219)
THE PROCESSES OF INTEGRATION, GROWTH, AND MASTERY: Once the
therapist has helped the patient gain insight into his conflict, he must help him resolve it. He must
help him gain the strength to master and overcome his difficulties so that he can build for himself
a new, productive, joyful life. The real purpose of hypnoanalysis is to facilitate maturity and
continued growth.
Classical psychoanalysis originally conceived of maturity as a final plateau of growth
reached by the healthy person at the end of adolescence. Through Erik Erikson's work (1950;
1984), however, psychoanalysts have learned that growth continues throughout the normal life
span. In full adulthood, even in old age, it still can be either facilitated or hampered.
Certain ego psychological concepts can be applied in hypnoanalysis to facilitate personal
growth. They are:
(a) the use of imagery and fantasy,
(b) the Ego Ideal Technique, and
(c) coping, mastery, and the joy offunctioning at one's full level of competence.
The Use of Imagery and Fantasy, and the Rehearsal Technique:
Human beings have two types of fantasy:
(a) symbolic fantasy (imagery), which is the cognitive mode of the unconscious ego, and
(b) reality-testing fantasy, the fantasy one uses to plan ahead for realistic situations, thinking out
what one might say or do in a difficult situation one has to face.
The hypnotherapist employs both types of fantasy. He makes use of symbolic imagery in
hypnotherapy by, for instance, symbolizing to the patient the process of his movement from
illness towards health as a wide and turbulent river the patient has to cross or as a mountain he
has to climb. Reality testing in fantasy may be used to deal, for example, with a flying phobia.
The hypnotherapist may describe for the patient, step by step, the details of his driving to the
airport, checking his bags, going through the security check, entering the plane, settling himself
down comfortably with a book, and finding that book so engrossing that throughout the whole
trip his attention is riveted to it and he is not aware of any discomfort about flying. Or, in
hypnosis, the hypnotherapist may put a patient who is afraid of being interviewed for a new job
through a rehearsal of that dreaded interview, step by realistic step. By putting him through such
a rehearsal several times, that is to say, by testing reality in fantasy in the hypnotic state, the
therapist can help him to gain mastery in reality. Reality testing in fantasy in the presence of the
supportive hypnotherapist leads to the development of coping mechanisms previously not
 37

available to the patient (Frankel, 1976). In his imagery in hypnosis, the patient gains mastery over
(220) the feared situation. This mastery enables him then to approach the realistic situation with
greater courage and with much more confidence about being able to handle it. Thus, the patient
transfers the sense of success from the imagined to the real situation on the basis of the simple
principle, "Nothing succeeds like success."
Why and how can fantasy in hypnoanalysis help the patient find better solutions to his
problems? In the normal course of healthy growing up, a central regulating factor arises, which
Hartmann (1958) has called the "inner world"-the world of imagery, fantasy, memory, and
thinking. The inner world makes possible a two-step adaptation process: temporary withdrawal
from the external world followed by return to the external world with improved mastery. The
inner world allows one to step back, look, and think things over-and then to act with improved
mastery. Hartmann called this process an "adaptive regression;" Kris (1952) called it "regression
in the service of the ego," a psychoanalytic concept on which Gill and Brenman (1959) based
their theory of hypnosis. For the limited duration of the hypnotic hour, the patient lets reality fade
into the backgound of his awareness, engages in his inner world of imagery, gains insight or
relaxation, and then returns to the world of reality, frequently with improved mastery.
In the ordinary waking state one must be reality-oriented and must think mostly in
reality-oriented, logical ways. Hypnosis, because it is an altered state rather than the
reality-oriented waking state, gives the therapist a better chance to use fantasy (i.e., imaginative
thinking in visual, auditory, or other sensory forms) instead of or in addition to logical, sequential
thought. This is so because in hypnosis the patient functions much more frequently with his
unconscious ego than he does in the waking state. Learning to go into hypnosis can be compared
to learning to snorkel. To the beginning snorkeler, a whole new world opens up: the brilliant,
colorful world of life below the surface of the tropical oceans-an enchanting new world.
Similarly, to the person in hypnosis or in self-hypnosis a totally new world, his own inner world,
opens up. If he is healthy, he will get enormous enjoyment from looking at his inner world. If he
is emotionally sick, the experience may not be so enjoyable, but hypnoanalysis can help him to
deal with and tame his inner-world monsters. It may also help him to become aware of resources
and assets within himself which before may have lain untapped and unrecognized below the
surface.
The Ego Ideal Technique: Another psychoanalytic concept we have found most useful
to work with in hypnoanalysis is the Ego Ideal. Psychoanalytic ego psychology differentiates
between the superego (the conscience) and the ego ideal. "The (221) superego's main function is
to set boundaries; the ego ideal sets goals" (Stolar & Fromm, 1974, p. 301). The ego ideal
represents what one hopes to be or strives to be. If one does not reach one's level of aspiration,
one feels shame-shame about not being as grown up, or as competent, or as perfect as one would
like to be.
The hypnoanalyst can help a patient learn to cope with something he dreads by literally
bringing the ego ideal into the therapy, as if the ego ideal were a real person. For instance, the
hypnoanalyst may suggest to the patient that someone who looks very much like him and who is
the person the patient would like to be, steps into the room, sits down at the other end of the
couch, and tells how he has joyfully and competently mastered the goals the patient would like to
reach. Here is an example: Kate, a female medical student, had a fear of blood. She fainted
whenever she saw it, but she wanted to become a physician. The hypnoanalyst brought into the
 38

office her ego ideal (whom they named Melissa), a competent young woman physician, able to
bandage a child's bleeding wound or to do surgery when needed. "Melissa" told Kate that she had
scheduled surgery for a patient and that she must now go over to talk to the patient for a while
and see that he was wheeled into the operating room. Then it was suggested to Kate that she felt
an irrepressible urge to move into the body of "Melissa" and that safely encased in "Melissa" she
was going to watch the surgery "Melissa" would perform on the patient. After repeating this
scenario, with variations, in the next therapy hour, the hypnoanalyst let Kate feel so relaxed about
the operation while watching from within "Melissa's" body that she now could step out of
"Melissa" in the (imaginary) "operating room" and assist "Melissa" with the surgery. Still later,
the patient was encouraged to perform the surgery in imagination by herself and then told that she
would be able to do it in reality "when the right time would come." She did 2 weeks later, and has
been able to do so ever since. The ego ideal can be an excellent tool to help hypnoanalytic
patients achieve competence and mastery of fear or conflict.
Coping, Competence, Mastery, and the Joy of Functioning: People feel pleasure
when efficient action enables them to cope with challenges and to master them. Coping refers not
only to a person's attempt to deal with conflicts, but also to the manner of dealing with novel
situations and with challenges in the environment (Murphy, 1962). Coping is the successful
meeting of challenges. And challenges are the spice of life. It is this pleasure in competence and
mastery that the hypnoanalyst attempts to stimulate in the patient during the integration phase of
the therapy.
In supportive therapies, including many types of hypnotherapy, part of (222) the therapist's task is
to help the patient to alleviate anxiety, tension, and conflict. However, not all tension in life is
undesirable. Quite the contrary. Tension can be joyful, as is the tension in foreplay and in the
sexual act. And joyful tension is at least part of what one experiences in the creative process, the
ecstasy part of the "agony and the ecstasy." Any theory of personality that leaves out the pleasure
of functioning, the joy of being able to do something well, ignores a multitude of processes that
are characteristically experienced by children and by dedicated adults. One may teach, do
research, climb mountains, ski, playa strenuous and hard game of tennis, or row in a race-not
because it is one'sjob and one is paid to do it or because one thinks one ought to do it for one's
health, but because it is fun, because it is exciting, because one passionately wants to do it. There
is joy in ego functioning at increasingly higher levels of competence.
CONCLUSION: The hypnoanalyst has several advantages not available to the
psychoanalyst. In psychoanalysis, improvement or cure is brought about by a three-fold
procedure: uncovering, working through, and new integration. The same three procedures are
essential in hypnoanalysis, but the arsenal of dynamic techniques that can be employed to help
the patient change is larger, because methods not available in the waking state (or, in the case of
imagery, less available), such as age regression, hypermnesia, imagery, dissociation, and
automatic writing can be used. In hypnoanalysis the therapist helps the patient to go back and
uncover the historical roots of conflicts. In the transference situation he allows the neurotic
patient to reexperience repressed memories and disavowed affects, bring them into conscious
awareness, and cope with them productively. In addition, he makes it possible for the patient with
developmental arrest to develop more mature internal self- and object representations (see
chapters 8 and 9, this volume). He helps patients work through their difficulties by means of the
transference relationship, guided or spontaneously arising imagery, suggestions that the patient
 39

dream consecutive dreams leading to increasingly better solutions of his problem, dissociation of
the observing from the experiencing ego, the Ego Ideal Technique, and the testing of reality in
fantasy-until the patient eventually arrives at a solid new personality integration. On the other
hand, when the hypnoanalyst has decided that relatively short-term, hypnoanalytically oriented
hypnotherapy will suffice, he does not go back to uncovering all or most of the historical roots of
conflict, but can take a here-and-now or teleological approach, and work with hypnoanalytically
oriented methods only. (223)
The trance state adds a new dimension to psychoanalytic treatment. Hypnoanalysis is
based on psychoanalytic libido theory and ego psychology and is now adding the major newer
developments in psychoanalytic theory (object relations theory and Self Psychology) to its
armamentarium. On the other hand, hypnoanalysis is contributing to the elaboration of
psychoanalytic theory in several respects, namely, increasing the understanding of primary and
secondary process operations and the nature of ego receptivity, ego activity, and ego passivity
(Fromm, 1972, 1977b, 1978-79, 1979; Gill & Brenman, 1959; Gruenewald et aI., 1979; Levin &
Harrison, 1976).
In hypnoanalysis many more tools can be employed to bring about cure than in
psychoanalysis. The hypnoanalyst attempts to help the neurotic patient achieve new harmony
within himself; that is, among his drives, conscience, ego ideal, and ego. He tries to help the
patient with a developmental deficit to gain object constancy and benevolent internalized object
representations and to establish a cohesive self so that he can grow and develop further. He can
help patients in both categories develop new methods of coping so they can master their
environment-perhaps even improve it-or adapt to it joyfully.
Hypnoanalysts have borrowed some of their treatment procedures (such as dream
interpretation and the analysis of the transference and countertransference) from psychoanalysis.
But they have also taken phenomena that can be produced only in a altered state of consciousness
(e.g., age regression, hypermnesia, heightened imagery) and creatively employed them in the
service of uncovering unconscious sources of conflict and suffering, working through the
problems, and integrating and mastering them. (224)

5. CLINICAL APPLICATIONS OF HYPNOTHERAPY AND HYPNOANALYSIS: DANIEL

BROWN & ERIKA FROMM: HYPNOTHERAPY AND HYPNOANALYSIS: LAWRENCE
ERLBAUM ASSOCIATION: HILLSDALE, NJ: 1986
HYPNOTIC TREATMENT OF NEUROTIC SYMPTOMS: Anxiety States and
Anxiety Neurosis: Anxiety states are characterized by cognitive, visceral, and motoric changes
(Zilboorg, 1933). The anxious patient presents with a distinctive feeling of apprehension or
dread. He also typically reports a variety of autonomic symptoms: shortness of breath, increased
heart rate, dizziness, flushes or pallor, hot flashes or chills, a dry mouth, sinking feelings in the
stomach, and stomach cramps. Alternations in motor functioning are also common: shaking,
tremors, weakness of limbs, and restlessness. When patients are anxious, attention and
concentration are impaired. Thinking becomes less clear. According to Schur (1953), anxiety
reactions involve a regression in cognitive functioning. On the one hand, anxiety represents a
regression in evaluation; situations that are potentially only mildly dangerous are interpreted as
being traumatic. On the other hand, "resomatization" occurs (Schur, 1955); like the infant, the
patient reacts to real or fathomed danger primarily with somatic discharge and temporarily loses
 40

the capacity for secondary process thinking about the potential danger. Anxious persons seldom
articulate their reasons for feeling so anxious, but they experience strong visceral reactions.
Anxiety states must be distinguished from normal, purposive fear (Rosenberg, 1949).
Most learning necessitates an optimal level of arousal. The normally anxious person experiences
optimal tension and prepares for the challenge of learning. The pathologically anxious patient is
overcome by a debilitating anxiety state he is unable to master. These anxiety states are often
attack-like in nature. The normally anxious person experiences an increased arousal appropriate
to the situation, such as an examination or before an operation. The pathologically anxious person
usually (225) does not know the source of his anxiety, or if he believes he knows the cause
consciously, his perception is often incorrect. Because the source is unclear, anxiety is
accompanied by excessive worry.
The numerous theories regarding generalized anxiety disorders and panic states fall into
three categories: psychodynamic, behavioral, and biological. According to Freud's (1926/1959)
classical psychodynamic theory of anxiety, anxiety is a "response to internal danger." However,
for defensive purposes (Rosenberg, 1949), patients frequently attribute the anxiety to external
sources. Fenichel (1945) used the analogy of a dam to explain the mechanism of defensive
operations against forbidden impulses that strive towards discharge. Anxiety is felt when
impulses threaten to break through the dam of defenses and flood into consciousness.
Psychodynamic treatment of anxiety neurosis, therefore, aims at uncovering of unconscious
conflicts that cause the anxiety symptoms.
According to the behavioral learning theories (Levis & Hare, 1977; Watson & Raynor,
1920; Wolpe, 1958), anxiety states are a result of conditioning. Patients "learn" to be anxious
through repetitive pairing of initially neutral stimuli with an autonomically arousing event until
the neutral stimuli themselves elicit the anxiety response. Some patients "learn" anxiety
vicariously by watching others being excessively anxious (Bandura, 1969). Clarke and Jackson
(1983) suggest that learning to be anxious is most likely to occur when the threat to survival is
great. Behavioral treatment is based on reduction in autonomic arousal or on counterconditioning.
Systematic desensitization (Wolpe, 1958) combines both features into a single treatment.
Biological treatment is focused on the disregulation of the autonomic nervous system in patients
vulnerable to panic attacks. For these patients who may manifest deficits in the metabolism of
limbic neurotransmittors, certain antidepressant medications, notably Imipramine, have been
effective (Carr & Sheehan, 1984).
Unfortunately, there are as yet no adequate means to predict which approach is best suited
to the treatment of anxiety disorders. Perhaps there are distinct subgroups for which specific
dynamic, behavioral, or pharmacological interventions work best. A combination of treatment
approaches is indicated for some patients. Psychodynamic conflicts or biological vulnerability
may originally have caused the anxiety, and conditioning factors may later have contributed to
maintaining it. Only a combination of treatments brings relief for such patients.
Hypnotic treatment begins with the exploration of the efficacy of direct suggestions. Some
patients respond readily to simple, graded posthypnotic suggestions. The patient is told, "After
you awaken from hypnosis you will find yourself becoming less and less anxious as time passes"
(Stein, 1963). The Clenched Fist Technique is another direct approach. For (226) example, a
32-year-old married man came to the clinic in an acute state of panic. He worked in a factory that
made machine parts. He had recently agreed to change the nature of his daily work activity by
 41

switching to piecework, for which he was paid by the quantity of parts made successfully during
a given span of time, rather than by the hour. Although he experienced piecework as added
pressure, he felt that he had to take the job because his wife was expecting their first child. The
patient's father had worked in the same factory until retirement and also had done piecework.
Because the patient was unsophisticated about therapy and desired immediate relief, the Clenched
Fist method was used. The patient entered hypnosis by means of eye fixation. Trance was
deepened with the staircase technique, following which the patient imagined floating on a couch.
He was instructed to dream about his anxiety. Then he was told to make a fist and to imagine all
the tension in his body flowing into his hand until the hand made a tighter and tighter fist. When
the patient reported that all the tension had been stored in the fist, he was instructed to let the
tension go quickly and imagine it being released outside of him. The patient was also given a
posthypnotic suggestion that whenever he noticed the onset of anxiety at work, he should leave
his machine, imagine the tension flowing into his nondominant fist, and then release it. A
6-month follow-up showed that the single session had helped him find relief. The anxiety still
occurred, but he was able to use the method to control it. The patient's history and the hypnotic
dream had suggested that the impending birth of his first child, along with his taking the same job
as his father, activated unconscious oedipal conflicts. However, the quick success of the Clenched
Fist method made it unnecessary to explore these conflicts in extended hypnotherapy. More often
than not, anxiety symptoms can be treated by brief interventions aimed at symptom alleviation.
Typically, anxiety symptoms are treated by some form of anxiety management training
(Suinn & Richardson, 1971). Behavioral therapists have demonstrated the efficacy of training
patients in methods that attempt to help patients to cope with anxiety. The patient first is taught to
relax and then to produce relaxation in a variety of imagined anxiety-provoking situations.
Emphasis is on learning a way to cope with the anxiety as it is experienced. For example, a
24-year-old married female reported panic attacks. She was also anxious about being hypnotized
and was unable to concentrate with an eye fixation induction. After being reassured that she could
leave her eyes open, she responded readily to various ideomotor suggestions (magnets, arm drop,
and arm levitation), after which she spontaneously closed her eyes. She was able to achieve a
deep state of relaxation when waves of relaxation flowing over her were suggested. In her next
session, she was able to enter trance readily with nothing but the waves of relaxation method. She
was also taught to control anxiety by (227) regulating her breathing. In the third session, she was
asked to imagine herself in situations in which she felt anxious and then to use the tools she had
learned to control her anxiety. She was given a posthypnotic suggested to use the waves of
relaxation and deep breathing whenever she noticed the onset, or increasing levels of, anxiety
symptoms in everyday life. She was also encouraged to strengthen her anxiety management skills
through daily self-hypnotic practice. In the fourth session, suggestions were given to increase
anxiety during trance, following which she was told to use the techniques she had learned to
alleviate anxiety. She did this confidently and terminated the treatment.
Sometimes it is necessary to explore unconscious conflicts associated with anxiety
symptoms. For instance, a 35-year-old married female reported debilitating panic attacks that
occurred when her husband was away from home on a business trip. Hypnotically induced waves
of relaxation and deep breathing brought little relief after six sessions. The Theater Technique
was introduced as an uncovering procedure. In trance the patient was told that she would see a
play, which "would somehow be about her panic attacks". In the first act she saw a frightened
 42

woman alone in a big house. A burglar was breaking into her bedroom. In the next act she was
told she would learn "something more about her panic attacks." She saw a woman meeting a
strange man in a park. Later in the act a woman was flying a kite. Asked to focus of her feelings
while watching the play, the patient said she felt "excited." After three additional hypnotherapy
sessions, the patient came to realize her wish for an affair. She had always suspected her husband,
who was often away on business trips, had numerous affairs. She, however, could not allow
herself the same "excitement." The anxiety symptoms diminished as she gained insight into her
sexual wishes and subsequently negotiated a different relationship with her husband through
couples' therapy.
PHOBIAS: Phobias are characterized by a disproportionate amount of anxiety generated
by the phobic object or situation. Unlike generalized anxiety reactions and panic states, where the
precipitating events are unclear and unpredictable, phobic reactions are associated with
well-defined stimuli and situations. When confronted with the phobic object or situation, the
person predictably becomes anxious or panics. There are various ways to classify phobic stimuli.
Marks (1969) distinguishes between external phobias (animal phobias, social phobias, e.g.
speaking phobias), miscellaneous situational phobias, (such as flight phobias and fear of heights),
and agoraphobial and internal phobias (fear of illness, such as cancer (228) phobia, and
obsessional fears, e.g. fear of being contaminated or fear of making obscene gestures). Although
phobic stimuli vary, all phobias share certain common features: fear and avoidance (Rachman &
Hodgson, 1974) and worry (Liebert & Morris, 1967). Intense fear is experienced with contact or
anticipated contact with the phobic stimuli. Avoidance refers to the behavior associated with the
phobias. Phobic patients restrict their behavior to avoid contact with the phobic stimuli. The
extent of avoidance may be limited to specific stimuli, or there may be more generalized patterns
of inhibition. While attempting to avoid the phobic stimuli, phobic patients are nevertheless
preoccupied with the object of their phobias and sometimes unconsciously seek contact with these
stimuli (Laughlin, 1967). Worry characterizes the patients' cognitive state. Patients may worry
excessively about coming into contact with the feared animal or about encountering the feared
situation; so much so that it may interfere with their ability to think clearly. Worry about
successful performance is especially problematic in test anxiety and in public speaking phobias.
As with the anxiety disorders, psychodynamic, behavioral, and biological theories have
been advanced to account for phobic symptoms. All contain some degree of validity. According
to the psychodynamic theories, phobias are symptoms formed to compensate for inadequate
repression. They represent an attempt to bind anxiety by displacement and projection. For
example, in Freud's (1909/1955) famous case Little Hans, Hans developed a phobia of horses.
The underlying oedipal conflict was between Hans' wish to kill his father and his fear of
retaliation. The death wish was displaced onto the phobic object, in this case a horse, and then
projected: The horse had the death wish and would kill him by falling on him. As long as the
phobic objects or situations can be avoided, the anxiety is bound. The phobic person who comes
in contact with or anticipates contact with the feared stimulus suffers an anxiety attack.
According to learning theory, phobic behavior is a learned, conditioned emotional
response. In John Watson's famous case, Little Albert is an 11month-old boy conditioned to fear
rats. Watson repetitively paired an anxiety-producing noise with the presence of a tame
laboratory rat until the rat also caused anxiety (Watson & Raynor, 1920). According to the
biological theories, the phobic state represents a deficit in neurotransmitter metabolism associated
 43

with the function of the autonomic nervous system. Each theory represents a partial truth, and
both are more or less applicable to certain populations. There are many patients in whom
unconscious conflicts have caused phobias and in whom the phobias are maintained by
conditioning. This subgroup of patients, the largest subgroup, presents the greatest challenge,
because it is difficult to decide whether to begin with a symptomatic intervention based on
learning theory, for example, desensitization, or to use a direct, dynamic,(229) uncovering mode
of hypnotherapy.
WE RECOMMEND A THREE-STEP TREATMENT PROCESS;
(a) direct hypnotic suggestion;
(b) symptomatic hypnotherapy; and
(c) dynamic hypnotherapy or hypnoanalysis.
Direct hypnotic suggestions can be useful with phobic patients. Marks, Gelder, and
Edwards (1968) gave their phobic patients "a forceful suggestion" that their phobias would
gradually disappear. Naruse (1965) suggested to champion athletes who suffered from stage
fright that they would among other things, become indifferent to the opinions of others. S.
Horowitz (1970) hypnotized snake phobics and gave them suggestions that they were "no longer
frightened by harmless snakes" (p. 106). In each case, simple, directive hypnotic and
posthypnotic suggestions proved effective for certain patients.
Where direct suggestions are ineffective in the first treatment sessions, the therapist
switches to hypnotic desensitization. Frequently it is unnecessary to explore the underlying
dynamics, as many phobias can be effectively treated with brief symptomatic interventions. The
therapist begins by constructing a hierarchy of phobic situations. The patient is hypnotized and
taught deep relaxation by means of waves of relaxation or deep breathing. After the patient has
attained some proficiency in relaxation, he imagines a phobic situation low on the hierarchy.
Hypnosis offers an advantage over nonhypnotic desensitization because the capacity for
visualization is enhanced (Deiker & Pollock, 1975; Glick, 1970). It is advisable to teach the
patient a scale for the degree of anxiety experienced during the procedure. The patient may use a
fear thermometer (Walk. 1956) reporting a number from 0 to 10, from complete calm to absolute
terror. Both patient and therapist can thus assess the degree of anxiety elicited during any stage of
the imaginary exposure. It is important for the patient to visualize the phobic situation in detail
(Clarke & Jackson, 1983 i and for the therapist to extend the duration of the imagery for as long
as the patient can tolerate it. If the patient becomes distressed, suggestions for relaxation are
given. In subsequent sessions the patient imagines encountering progressively more fearful
situations higher on the hierarchy until he achieves the goal of deep relaxation during
visualization of even the more feared situations. Many patients show improvement before they
imagine the most anxiety-provoking items on the hierarchy (Lang. Lazorik, & Reynolds, 1965;
Marks et. aI., 1968). Direct feedback about the progress attained while maintaining relaxation in
the face of the imagined anxiety situation is a crucial element in the treatment (Lang et aI., 1965).
It is also very important to give graded suggestions for actual contact witt the phobic situations on
the hierarchy. When the patient shows some response to imaginary contact with the phobic
situation (hypnotic desensitization) the therapist gives posthypnotic suggestions to utilize the
(230) re-laxed state when encountering real-life phobic situations lower on the hierarchy than
those currently mastered in imagination. Hypnotic desensitization offers an advantage over
nonhypnotic behavioral desensitization because posthynotic suggestions can influence the patient
 44

to make contact with the phobic stimulus in real life (Deyoub & Epstein, 1977; Gibbons,
Kilbourne, Saunders, & Castles, 1970).
Clarke and Jackson (1983) distill the clinical wisdom gained from the hundreds of clinical
experiments on phobias to three points: "(1) get the patient to reenter the phobic situation; (2) let
him do it under the right conditions; and (3) let him remain there until there is a noticeable
decline in anxiety" (p. 195-196). Hypnotic systematic desensitization has proven successful with
flight phobias (Kroger & Fezler, 1976; Rosenthal, 1967); animal phobias such as snake phobias
(Daniels, 1976; Lang el at., 1965; O'Brien, Cooley, Ciotti, & Henninger, 1981) and dog phobias
(Spiegel & Spiegel, 1978); injection phobias (Daniels, 1976); a bleach phobia (Deiker & Pollock,
1975); and test anxiety (Spies, 1979). Successful outcome is indicated by reduced anxiety and
related changes in dream content and, above all, by reduced avoidance behavior.
It is not always necessary to carry out step-by-step desensitization with hypnotizable
patients. Whereas Kroger and Fezler (1976) emphasize that the therapist must desensitize the
patient one step at a time, others have demonstrated that the hypnotizable patient can be
introduced to a number of progressively more anxiety eliciting stimuli within the same session,
sometimes all at once (Deyoub & Epstein, 1977). Because information processing in hypnosis is
nonsequential, the patient may be able to master progressively more difficult items on the
hierarchy simultaneously. Some (Gustavson & Weight, 1981; Spies, 1979) have argued that for
this reason hypnotic treatment usually proceeds much more quickly than nonhypnotic behavorial
desensitization. Spiegel and his colleagues (Spiegel, Frischholz, Maruffi, & Spiegel, 1981;
Spiegel & Spiegel, 1978) described a successful approach to flight phobias. The patient imagines
the plane to be an extension of his body and then imagines himself pleasantly floating. He is
given instructions to practice "floating with the plane" and viewing the plane as an extension of
his body in self-hypnosis until he gains a sense of mastery and control. In hypnotic sessions,
Deyoub and Epstein (1977) and Shaw (1977) had their flight phobia patients imagine the entire
flight in its chronological sequence (not in hierarchical progression of least to most
anxiety-eliciting events). Deyoub and Epstein claim that hypnotizable patients are able to develop
a "new Gestalt" for successful mastery of the entire sequence of behaviors involved in flying.
All-at-once rehearsal places emphasis on successful mastery. Surman (1979) had his hypnotized
patients rehearse phobic situations as if beginning from the point of having (231) mastered the
situation without becoming anxious. In addition, he used suggestions to give the patient
confidence. He calls this approach "postnoxious desensitization."
The Television Technique is especially useful in rehearsal. For example, a 15-year-old
boy who was failing mathematics and Spanish came to hypnotherapy for test anxiety. He
responded readily to hypnosis. The patient imagined sitting in front of the TV set, watching a
program that absorbed his attention and made him feel very relaxed. He was told to switch
channels and look at another program in which he would see himself sitting at his desk at school,
somewhat anxiously, about to take an examination. Suggestions were given to amplify the affect
until he felt as anxious as he usually felt at the onset of an examination. He was then told to
switch the channel to a relaxing program and stay with it until he became relaxed. On another
channel, he was told, he would see himself studying with careful attention and a clear mind.
Posthypnotic suggestions were given that whenever he noticed the anxiety, he would
automatically imagine his relaxing television program and then imagine the show about studying
with a clear mind, until he was able to recall what he had studied as appropriate to the
 45

examination questions. The patient practiced selfhypnosis daily between examinations and
utilized weekly quizzes for practice. He mastered his examination fear in four hypnotic sessions
and received a C in mathematics and a B in Spanish .
An analogous approach entails Hypnotic Time Distortion. Tilton (1983) described treating
a case of flight phobia by using pseudo time orientation, and Deiker and Pollack (1975) describe
the treatment of a patient with a bleach phobia in which the patient was asked to imagine herself
sometime in the future as if leaving her last therapy session after having overcome her former
fears. Logsdon (1960) age regressed a patient to a time prior to the onset of the phobia so that the
patient could recover the memory of successful coping. In such cases the patient uses the new
orientation in time to gain a sense of mastery over the phobia.
Another approach to mastery is through Hypnotic Flooding Techniques. The hypnotized
patient is exposed to the most intensely anxietyeliciting stimuli imaginable until the anxiety is
diminished. The therapist suggests vivid images of the most feared situations. Cancer phobia
(O'Donnell, 1978) and homophobia (Scrignar, 1981) have been successfully treated with
Hypnotic Flooding. However, flooding methods should be used only infrequently and then with
caution. They are generally not liked by patients and carry the danger of overwhelming the
patient.
Still another approach to mastery is the Ideal Self Technique. A singer with stage fright
imagines herself as a successful opera singer performing perfectly on stage. Posthypnotic
suggestions are given for the patient (232) gradually to become more and more like the ideal
image (Mordey, 1965). Especially for patients lacking in feelings of efficacy the" My Friend
John" approach (Erickson, 1964c) is an alternative to the Ideal Self Technique. The patient thinks
of someone else who unlike the patient is able to effectively cope with the phobic situation. Bakal
(1981) used this approach successfully with flight phobias. The hypnotized phobics were taken
stepby-step through the entire flight.
Hypnosis can be combined with cognitive therapy for phobics who are worried about test
performance and for whom this is a critical issue. Defeatist thinking and excessive worry greatly
exacerbate test anxiety (Meichenbaum, 1972). Boutin (1978) used a method called rational stage
directed hypnotherapy to treat test anxiety patients. The therapist helps the patient in the waking
state to identify defeating and irrational thoughts associated with taking tests. Then the patient is
hypnotized and rehearses taking the test in fantasy. During the rehearsal, the patient engages in
"cognitive restructuring," in which he develops self-enhancing thoughts to counteract his usual
negative thoughts about taking the test. The patient then practices cognitive restructuring in real
life while taking examinations.
Bakal (1981) has illustrated how the news media subliminally reinforces negative thinking
with regard to flight phobias. Airline travel is fraught with death imagery from the "final
boarding call" to the airline "terminal." Hypnotized patients rehearse in fantasy the stages of a
flight, during which the hypnotist points out such negative words. He teaches the patient to be
aware of these words and not to let them become detrimental suggestions; then he helps the
patient develop a more rational perspective.
Another cognitive hypnotherapy approach is to help the patient adopt a new perspective
on his fears. Spiegel and Spiegel (1978) treat agoraphobic patients by giving them the following
message in hypnosis: "(I) Gravity can be my security; (2) my feet lock me into this magnetic
gravity; (3) this downward pull stablizies my movement" (p. 269).
 46

Similarly, they help patients with dog phobias to restructure their fear of dogs and
distinguish between tame dogs and wild animals. Sometimes humor is helpful (Clarke & Jackson,
1983). Cohen (1981) successfully treated a male patient who had a fear of bovine sounds by
suggesting that the patient see humor in the situation. The therapist handled the patient's
avoidance behavior by having the patient in trance imagine he was making a documentary movie
on cows. Eventually the patient was able to come into close contact with cows without becoming
anxious.
We recommend using hypnotherapeutic imagery to facilitate coping. The phobic patient
should imagine a relaxing scene, followed by one in which he encounters the phobic object or
situation and becomes anxious. After returning to the relaxing scene, the patient is told that
another scene (233) or series of scenes will come to mind which "will suggest effective ways of
coping with the phobic situation." The patient symbolically communicates coping strategies in
these scenes. The material from these hypnoprojective images and narrations is used to refine
coping strategies, which can be suggested to the patient in trance and incorporated into successful
rehearsals in fantasy as well as into posthypnotic suggestions encouraging real-life encounters
with phobic situations.
The majority of phobias can be successfully treated in ten sessions with hypnotic
systematic desensitization, all-at-once rehearsal, or any of the methods previously mentioned. It is
not always necessary to uncover unconscious conflicts associated with the phobia. The goal of
most hypnotherapeutic treatment of phobias is mastery, not insight (Spiegel & Spiegel, 1978).
Cohen (1981), for example, successfully treated his patient with the bovine-sound phobia in two
sessions by using a symptomatic approach, even after the patient had alluded to the relationship
between the bovine-sound phobia and his conflicts with women.
Sometimes, however, resistances arise, and symptomatic treatment reaches a plateau.
Then dynamic hypnotherapy is indicated (Edelstien. 1981). The hypnotherapeutic techniques
discussed in chapter 6 are useful.
Wolberg (1948) treated a woman with an anxiety neurosis by giving her hypnotic
instructions to dream and then to produce associations to the dream. Through such explorations
the patient gained insight into the relationship between discovering her husband's affair and the
onset of her anxiety symptoms. 0' Brien et. aI., (1981) recommend posthypnotic dreaming to
overcome plateaus in the treatment of phobic patients. Often the nature of the conflicts, as well as
potential resolutions, are contained within the dream content. Schneck (1966b) used the Theatre
Technique and hypnotic dreams to uncover an incest experience associated with the development
of a germ phobia. Crasilneck and Hall (1975) recommenc regressing patients to the age when the
sympton first appeared. Van de:Hart (1981) used ego state therapy to treat a patient with a fear of
deac birds. Clarke and Jackson (1983) recommend a "scene-within-a-scene technique" (p. 225)
for extremely anxious patients. The patient is instructed to have a daydream about the phobic
situation within a relaxing scene. For example, he may imagine lying in the sun on a beach until
he feels very relaxed. A daydream about the phobic situation is then suggested. If the patient
becomes upset, he is reminded that he is at the beach, pleasantly relaxing. Gustavson and Weight
(1981) used the Theater Technique and age regression to uncover fears associated with a slug
phobia. Scott (1970) treated a patient with a bird phobia by age regressing the patient to the
childhood event associated with the phobic anxiet:. Subsequently the patient was desensitized
following a procedure similar to (234) that previously described. We utilize the combination of
 47

dynamic hypnotherapy and hypnotic desensitization for many patients.

There is very little controlled-outcome research on the hypnotic treatment of phobia. In
his review, McGuinness (1984) concluded that hypnosis is an effective adjunct to the treatment of
phobias, but that methodological pitfalls prevent accurate assessment of the results. Most studies
use a very small sample of patients (e.g. Glick, 1970). Exceptions are the Spiegel et al. (1981)
study of flight phobias which reported some improvement in 52% of the patients, and the studies
on agoraphobia by Van Dyck, Spinhoven, and Commandeur (1984a, 1984b). Lang et al. (1965)
compared hypnotic desensitization and a pseudotherapy control in the treatment of snake phobias.
Only the hypnotically desensitized patients (not placebo controls) showed reduction of fear; but
the positive treatment outcome was not related to hypnotizability. This experimental study
counters Kazdin & Wilcoxon's (1976) claim that desensitization contains no specific therapeutic
ingredient beyond expectation of change. Other studies have shown treatment outcome to be
related to hypnotizability (S. Horowitz, 1970; Spiegel et al., 1981). Still other studies have
compared nonhypnotic behavioral desensitization to hypnotic treatment of phobias. In these
studies, nonhypnotic desensitization worked out better than direct hypnotic suggestion (Marks et
al., 1968) or guided imagery (Melnick & Russell, 1976). However, results showed improvement
over nonhypnotic systematic desensitization when hypnosis was used as an adjunct to
desensitization (Woody, 1973) or when all-at-once rehearsal was employed as the hypnotic
intervention (Gibbons et al., 1970). In another study by Spies (1979), nonhypnotic systematic
desensitization and hypnosis were equally effective, but hypnotic treatment was faster.
Several investigators have identified patient characteristics and particulars in the treatment
procedure which predict a successful outcome: patients who are monosymptomatic and not
debilitated by pervasive anxiety (Daniels, 1976); patients who show a successful response to the
majority of items on a desensitization hierarchy (Lang et al., 1965); and patients who show
positive changes in their dreams during the treatment (O'Brien et al., 1981).
AGORAPHOBIA: Agoraphobia, literally fear of the marketplace, has more accurately
been defined as fear of being away from a place or object representing safety (Snaith, 1968).
Snaith proposes that the term agoraphobia be replaced with the term "nonspecific security fears".
He argues that intense anxiety is the central factor in agoraphobia and that the phobic content is
secondary to
(235) the anxiety. Agoraphobics manifest panic in a wide variety of settings ranging from wide
open spaces to confined places. Although the situations in which the anxiety is experienced vary
markedly, agoraphobia, nevertheless, constitutes a specific syndrome distinct from other types of
phobias (Snaith, 1968). The cluster of symptoms common to agoraphobics include: intense and
unpredictable panic states (Clark & Jackson, 1983); generalized free-floating anxiety (Burglass,
Clarke, Henderson, Kreitman, & Presley, 1977); depression (Burglass et al., 1977);
depersonalization (Roth, 1959); obsessions and compulsions (Snaith, 1968); and hypochondriasis
(Snaith, 1968). Like other adult phobias agoraphobia is often associated with a history of an
unstable family background and school phobias (Snaith, 1968). More than other phobics,
agoraphobics have a greater incidence of childhood behavioral problems, such as nightmares, fear
of the dark, difficulty in making friends, and sensitivity to emotional hurt (Thorpe & Burns,
1983). A high proportion of agoraphobics (83%) associate the onset of the syndrome with a
traumatic event that threatened their health, life, or security; another 13% report onset associated
with pregnancy and childbirth (Roth, 1959).
 48

Agoraphobia may constitute a kind of "separation phobia" (Clarke & Jackson, 1983).
Emmelkamp (1979) reports that agoraphobics typically come from stable but overprotective
families, a history that may contribute to a conflict over dependency. Agoraphobia may be a
manifestation of underlying conflicts over abandonment (Chambless, 1978). Goldstein and
Chambless (1978) have provided the most comprehensive explanation of agoraphobia. In
their combined psychodynamic and behavioral reformulation of the agoraphobic concept,
they cite four general features:
1. Fear of fear: A slight fear acts as a stimulus to additional fears, and the patient becomes afraid
he will lose control (faint, get a heart attack, etc.).
2. A low level of self-sufficiency: Agoraphobics are highly dependent and sometimes cannot
venture into the world without a familiar person (called a phobic partner), a walking stick, a
bicycle, or other transitional object (Marks, 1969).
3. Misapprehension of the causal antecedents of uncomfortable feelings: Agoraphobics have little
understanding of their internal lives (unconscious and preconscious motivations).
4. Onset of symptoms in the climate of notable conflict: Agoraphobics often are unaware of
interpersonal conflict but usually experience an attack following interpersonal strife.
According to Goldstein and Chambless's (1978) approach combining psychodynamic and
behavioral principles and Clarke and Jackson's (1983) hypnobehavioral approach, treatment must
address both the panic attacks and the extreme avoidance behavior. Systematic behavioral (236)
desensitization to anxiety-eliciting situations (Goldstein & Chambless, 1978; Wolpe, 1958) and
cognitive behavioral therapy (Clarke & Jackson, 1983; Emnelkamp et.al., 1978) have been
consistently ineffective with agoraphobics. In rare cases where systematic desensitization has
been successful, the treatment was very lengthy (Thorpe & Burns, 1983). Some clinicians have,
therefore, tried to adapt desensitization techniques to the needs of the agoraphobic. The
agoraphobic needs to find ways to alleviate he intense panic and fear of losing control. Zaccheo
and Palmer (1980) have constructed a desensitization hierarchy not to phobic situations but to the
fear of loss of control itself. Goldstein and Chambless (1978) recommend constructing
hierarchies for the sensations of fear and panic themselves. Cognitive therapeutic approaches may
be useful when the patient is taught to make statements about increased self-control in hypnosis
(Clarke & Jackson, 1983). Clarke and Jackson also recommend helping the patient to discover the
role of hyperventilation in maintaining the panic state. They recommend teaching the patient
breathing techniques to counter this tendency. In any event, the patient must learn some means of
irectly alleviating his panic and the thoughts associated with it.
The main emphasis of treatment, however, relates to the agoraphobic's avoidance
behavior. According to Wilson (1984), all successful treatment methods for agoraphobics have an
"instigating function" by facilitating “corrective activity" (p. 93). In other words, the treatment of
agoraphobia, contrast to other phobias, must stress real-life exposure. The treatment begins with
the construction of a hierarchy of easier-to-more-difficult environments (Clarke & Jackson,
1983). Construction of the hierarchy should take into consideration the distance from safe and
familiar areas, cess to safe places and support from phobic partners; and contingencies at might
prevent return to safety during exposure (p. 315). An excellent ample of a hierarchy for the
hypnotic treatment of the agoraphobic is found in Clarke and Jackson (1983, Appendix B). The
patient is hypnotized and taught coping skills for managing anxiety states, for example, waves of
relaxation, deep breathing, imagery of safe and familiar surroundings. The patient may also
 49

choose to use a transitional object, such as a walking stick, for the initial life exposure. Next, the
patient actually ventures out into the feared environment. In graded life exposure, the patient first
ventures into easy environments (for example, looking out the of his home), and then he really
goes out. If the patient is unable to tolerate any real-life exposure, treatment begins with
preparatory hypnorehearsal in fantasy. In a self-management approach to life exposure, patient is
instructed to stay in the designated environment for an ended period, say, 90 minutes, which is
more effective than brief exposure (Stern & Marks, 1973). The patient learns to tolerate the situa1
until his fear diminishes. He is not allowed to terminate the exposure (237) except under extreme
duress. An alternative approach is to have the patient walk away from the clinic or the office until
he becomes anxious. Or, in the therapist-centered approach, the patient ventures into the feared
environment accompanied by the therapist. Whatever the approach, feedback, and encouragement
by the therapist are essential in the initial stages of real-life exposure (Leitenberg, Agras,
Thompson, & Wright, 1968). If the patient becomes anxious, he is instructed to utilize coping
strategies to manage the anxiety (Clarke & Jackson, 1983). Posthypnotic suggestions, previously
given, increase the likelihood of the patient's remembering to draw upon coping strategies during
anxious moments. If the patient becomes overwhelmed and retreats before anxiety diminishes, the
treatment will not necessarily be set back, provided the therapist helps the patient view the event
as a learning experience and adopt a positive set in the subsequent treatment sessions (Thorpe &
Burns, 1983). Treatment always proceeds along the hierarchy from easier-to-more-difficult
environments until the patient is able to tolerate being in difficult environments for extended
times without experiencing anxiety.
If the treatment reaches a plateau, it may be necessary to use dynamic hypnotherapy to
uncover unconscious conflicts associated with the agoraphobia. According to classical
psychoanalytic theory, the conflict in patients suffering from agoraphobia usually is an
exhibitionistic-seductive one; Unconsciously they wish they would (and fear they will) expose
themselves on the street to strangers and seduce them sexually. More contemporary
psychoanalytic studies suggest conflicts associated with separation-individuation. Gruenewald
(I971a) describes the hypnoanalytic treatment of a 58-year-old female with a 40-year history of
agoraphobia. The patient was unresponsive to hypnotic suggestions for sympton relief, which
involved rehearsal in fantasy of exposure situations. She did, however, respond favorably to
suggestions to strengthen her coping mechanisms and to suggestions designed to uncover feelings
and memories associated with the agoraphobic symptoms. Typically, hypnoanalysis of
agoraphobia reveals conflicts around both separation and fear of inability to control impulses.
The outcome studies on nonhypnotic behavioral treatment of agoraphobia with graded
real-life exposure are impressive. Wilson (1984 states that improvement rates range from
660/0-84% in the many studies he reviewed. Barlow, O'Brien, Last, and Holden (1983) report a
68% success rate. Chambless and Goldstein (1978) report a 22% success rate, which increased to
71 % at a one-year follow-up period. Other studies hme likewise reported increased improvement
in the months and years following successful treatment (Emmelkamp & Kuipers, 1979).
However, few, patients are ever completely cured (Wilson, 1984). Instead, with behavioral and
hypnobehavioral treatment, patients learn skills to tolerate separation, fears and venture into the
world. Further venturing into the world provides positive feedback to maintain the treatment gain
and assists in the resolution of the separation fears. Real-life exposure works better than placebo
treatment (Wilson, 1984) or systematic desensitization (Emmelkamp, 1979). Although claims
 50

have been made for antidepressant medication in the treatment of agoraphobics, 20% of the
patients refuse medication (TeIch, Teaman, & Taylor, 1983) and 270/0-50% suffered relapse
after termination of medication. Medications clearly diminish depressed mood, but they are less
effective in reducing the panic attacks and avoidance behavior associated with agoraphobia
(Mavissakalian & Barlow, 1981). Unfortunately, there are as yet not enough reliable outcome
data comparing the hypnotic and nonhypnotic treatments of agoraphobia. Although Clarke and
Jackson (1983) give a detailed protocol for the hypnotic treatment of agoraphobia, they do not
report outcome statistics, and it remains unclear whether hypnosis offers any advantage over the
established behavioral treatments other than the obvious advantage of providing relief at a faster
rate.
HYSTERIA: CONVERSION REACTIONS: Conversion reactions are symptoms
involving voluntary musculature and special senses (e.g. vision and hearing) (Charcot, 1886).
They differ from psychophysiological disorders in that they pertain to defenses against conflictual
impulses (Breuer & Freud, 1893/1955) or painful affects (Ziegler & Imboden, 1962). The body
becomes the arena for the symbolic expression of these impulses and the defenses against them.
The somatic symptom itself both reveals and conceals the underlying impulse. There are many
types of conversion reactions. The most common conversion symptoms involving the
musculature include: psychogenic seizures, contractures, tics, partial or complete paralyzes, and
aphonia. The most common conversion symptoms involving the senses include focal blindness,
hysterical deafness, anesthesia, conversion pain, and conversion skin disorders.
Because of the involvement of voluntary musculature and the senses in conversion
symptoms (Charcot, 1886; Janet, 1889:), dynamic hypnotherapy has been the treatment of choice
since Charcot (1892) and Breuer and Freud (1883/1955). Because a variety of ideomotor and
sensory alterations can be produced in hypnosis, the clinician is able to affect directly and exactly
those organ systems implicated in the conversion reaction. Moreover, inasmuch as hypnosis is a
means gaining access to memories, fantasies and affects not readily available to consciousness,
hypnosis becomes the main tool for uncovering the nature of these conflicts. An uncovering, not
a behavioral, approach to hypnotherapy is generally indicated when one is dealing with
conversion symptoms. In certain cases, hypnosis also can help in validating the diagnosis of
conversion because (238) conversion symptoms generally respond to hypnotic suggestions,
whereas organic symptoms do not. For example, Schwarz, Bickford, and Rasmussen (1955) used
hypnotic suggestions to elicit seizures from hypnotized patients who had psychogenic but not
genuine (EEG-validated) seizures. During seizure activity, the hysterical patients had normal
EEGs. Patients with hysterical blindness "see" in trance under certain conditions .
Patients with psychogenic seizures usually manifest movements and convulsions that
superficially resemble an epileptic seizure but are different from it in several important respects.
The patient with psychogenic seizures does not lose consciousness and resists attempts to open
his eyes. Reflexes are normal during the seizure. Moreover, the patient usually avoids bumping
into objects during the seizure and more often than not has the seizures in the presence of others.
During the seizure, the patient exhibits muscular rigidity, twitches, convulsions, and peculiar
postures, bodily movements and facial expressions. He is also disoriented. The movement during
the seizure is often a characterization of sexual intercourse or resembles aggressive posturing.
This is so because the seizures are associated with conflictual sexual and aggressive impulses.
The goal of hypnotherapy is to uncover and work through the conflicts associated with the
 51

seizures. After the patient becomes familiar with hypnosis, various hypnotherapeutic methods are
utilized, such as hypnoprojective methods, hypnotic dreaming, free associating, and age
regression. Rosen (1953) described the treatment of a 30-year-old woman with psychogenic
seizures. Hypnoprojective methods, notably the Theater Technique and hypnotic intensification
of affect, were used to explore the seizures, which were found to be a form of sexual acting out.
Similarly. Bernstein (1969) described the treatment of adolescent girls whose seizures were
associated with conflicts about sexual relationships with boyfriends. Glenn and Simonds (1977)
described the treatment of a 13-yearold girl whose seizures began during the heightened sexual
awareness of early adolescence. They were able to induce seizures with hypnotic suggestions.
The patient was encouraged to produce imagery and to learn to express conflicts in fantasy rather
than somatically. She also was given posthypnotic suggestions to prevent subsequent seizures by
pressing her thumb and forefinger together at the onset of an attack. Whereas the conversion
seizures in each of these cases were associated with the activation of infantile neurotic conflicts
about sexual impulses, seizures can also begin subsequent to traumatization (Schneck, 1959).
LaBarbera and Dozier (1980) describe a number of cases in which the seizures in adolescent girls
initially appeared after an incest experience and subsequently were precipitated by sexually
charged situations. Caldwell ane Stewart (1981) present a case in which latent homosexual
conflicts were activated in a young man following traumatization by rape. The patient's (240)
seizures cleared up after brief hypnotherapy. However the patient did not disclose his homosexual
conflicts directly nor work through the traumatic experience during the hypnotherapy. Caldwell
and Stewart remind us that seizures can sometimes be treated without dealing with the dynamics.
Of course, not all psychogenic seizures are associated with sexual impulses. Lindner (1973)
describes two cases in which age regression was used to revivify the feelings experienced during
the first convulsive experience. Lindner was also able to evoke and terminate the seizures with
direct hypnotic suggestions. In each case, the uncovering made it clear that the seizures occurred
because the patient had disavowed aggressive impulses.
Less dramatic disturbances in the musculature can occur, for example, conversion tics and
contractures. Wolbery (1948) traced a nasal tic in a 13year-old boy to an unconscious desire for
anal attack and the rejection of this impulse. Gardner (1973) described the symptomatic treatment
of an 8year-old girl with frequent eye fluttering episodes. The patient was given direct hypnotic
suggestions and posthypnotic suggestions to "keep her eyes open more and more." To aid this
process the girl was given several tasks in which she had to watch things very attentively.
Trenerry and Jackson (1983) used direct posthypnotic suggestions effectively to treat a patient
with involuntary spasms of the neck and back. In each hypnotic session, the patient was told she
would experience the spasms for progressively shorter periods of time. Treatment continued until
the spasms had disappeared.
Direct hypnotic suggestions are sometimes useful in treating hysterical paralysis. Bryan
(1961) treated a patient who had "lost" the use of his legs by giving him posthypnotic suggestions
that he would be able to walk satisfactorily after 10 days had elapsed. Fogel (1976) treated
several patients who suffered from asomatognosia (inability to recognize the existence of parts of
the body) by giving them direct hypnotic suggestions to become aware of that part of the body as
part of the self and that it would continue to belong to them. Moskowitz (1964) used hypnotic
suggestions to increase arm strength in treating a patient who had lost the strength of his arm.
Erickson (1954) describes several cases of hysterical paralysis treated by symptom substitution.
 52

In each case the suggestions were given to reduce the paralysis of the arm to a weakness in a hand
or finger. Abraham (1968) used guided imagery to treat a patient with hysterical paraplegia. The
patient imagined himself at a beach, with very cold sea water touching his feet. He imagined
contracting his feet to avoid the cold and became so absorbed in the fantasy that he actually lifted
his legs. Once the patient was able to lift his legs in the waking state, he was rehypnotized, and
cognitive restructuring was used so that the patient could consciously accept the use of his legs.
Spiegel and Spiegel (1978) describe several cases of paralysis having been precipitated by
traumatic events later uncovered in hypnotherapy. (241)
In hysterical blindness the subject believes himself to be partially or totally blind yet is
usually able to negotiate the world adequately. The hysterically blind patient defends against
'seeing' something in his unconscious and learns to maintain the blindness through operant
conditioning (Brady & Lind, 1961). As with other conversion reactions, a dynamic uncovering
approach to hypnotherapy is indicated in most cases. Greenleaf (1971) describes a case, rich in
detail, in which the blindness was associated with conflicts about getting angry ("seeing red").
Wilkens and Field (1968) present two cases where age regression, scene visualizations, and
hypnotic dreams revealed the blindness to be associated with conflicts around dependency and
helplessness. In a number of cases of blindness, the hypnotic uncovering disclosed a relationship
between the symptoms and a previous traumatic incident. Patterson (1980) treated a young man
whose loss of vision occurred after a traumatic incident in which his sister was blinded. Wolberg
(1948) used hypnotic dreaming and associative techniques to trace the blindness of a 27-year-old
woman to several layers of trauma: first to a dormitory fire and then to the original traumatic
event. witnessing a train crash and seeing someone die. Incest can provoke hysterical blindness. A
l0-year-old girl was referred to the clinic for psychological testing with a diagnosis of focal
blindness of unknown origin. Her inability to generate images other than butterflies on the
Rorschach or to tell stories other than naming the characters on the TAT suggested massive
repression. While she was drawing, it was suggested that she was drawing with a magic pencil.
The "wiggly pencil" was able to draw all b) itself She was told that the pencil knew all about her,
knew even things that might otherwise upset her, but that she need not concern herself with these
things because the wiggly pencil could take care of itself by drawing. Over the next few sessions,
the girl produced a series of drawings about incestuous involvements with her father. As she
gradually became conscious of the meaning of the material uncovered through the automatic
drawing, the blindness cleared.
There have been fewer reported treatments of hysterical deafness. Hurse (1943) and
Kodman and Pattie (1958) used direct suggestions. Patients were instructed to listen more
attentively, and the hearing loss was explained as a problem of not listening. Malmo, Davis, and
Barza (1954 were able to cure a 19-year-old girl with hearing loss through nonhypnotk
conditioning and waking suggestion. Pelletier (1977) describes an interesting treatment of
aphonia, or the inability to speak, with a combination of dynamic hypnotherapy and conjoint
couple's treatment. The patient was able to recover her ability to speak only in hypnotic age
regression. Tht regression failed to reveal any childhood conflicts associated with tht aphonia but
did reveal marital conflicts. The patient literally felt unable tc speak to her very busy husband.
Therefore, Pelletier initiated conjoint (242) couple's therapy in which the husband learned ways
to help her speak to him.
Other sensory alterations may occure anaesthesias, conversion pains, skin diseases. For
 53

example, a 30-year-old woman with chronic pain of 15 years' duration was hypnotized to learn
pain coping strategies. When treatment reached a plateau after several sessions, the therapist
switched to an uncovering approach to hypnotherapy. The Theater Technique disclosed a history
of child abuse and several episodes of abandonment by the mother. The patient also reported an
intensification in pain during separations from her family. The pain literally was her way of
abusing herself. The physical pain also necessitated her living with her mother on account of her
disability and thus prevented the emotional pain of separation. In this sense the pain, being a
direct expression of conflict, constituted a conversion symptom.
Another patient, also 30 years old, was seen in hypnotherapy for recurrent lip sores. The
therapist first approached the treatment symptomatically. The hypnotized patient was asked to
imagine applying a special hallucinated salve to the sores. Though the application of the
imaginary salve resulted in immediate relief, the sores usually returned. After three sessions the
therapist switched to an uncovering approach. Hypnoprojective procedures revealed that the
patient had been in an unhappy marriage for more than 10 years. She and her husband had sexual
relations only infrequently. Because of her strict Catholic background, she sought the counsel of a
priest. She did not feel it proper to divorce her husband. The priest, who had had some counseling
training, saw her regularly over a number of months. The patient developed an intensely
eroticized transference toward the priest but could not reveal her fantasies to him. She abruptly
left treatment with him and developed the lip sores shortly afterwards. The conflicts associated
with the symptom formation became clear to the hypnotherapist from the uncovering work,
although the patient could not consciously accept this knowledge. The lip sores represented a
wish to kiss the priest (displaced upwards from a wish for genital intercourse with him). As the
hypnotic uncovering proceeded, the patient also abruptly terminated treatment with the male
hypnotherapist after a total of six sessions. She told the hypnotherapist in a follow-up telephone
conversation that she had achieved some symptomatic relief through acupuncture. She did not
seek additional psychotherapy nor had she contacted the priest.
DISSOCIATIVE SYMPTOMS: Dissociative symptoms involve alterations in
consciousness and memory. The alterations in consciousness include fugue states and hypnoidal
(243) states. The memory alterations (amnesias) may apply specifically to certain events or
periods of time or may be generalized and encompass one's sense of identity. Dissociative
symptoms are manifestations of defensive operations in which the contents of experience are
actively removed from memory recall or consciousness. Dynamic hypnotherapy or hypnoanalysis
are the treatments of choice. The hypnotherapy techniques described in chapter 6 allow the
conflictual material to emerge gradually into consciousness in a symbolic form until it can be
integrated and no longer needs to be disavowed.
Amnestic episodes are frequently associated with neurotic conflicts. For instance, a
psychologist was seen for constantly misplacing his beeper. He was given direct suggestions for
hypermnesia along with suggestions for hypnotic dreams about the location of the lost object. He
was able to locate the beeper after a single hypnotic session but also learned about the conflicts
associated with its loss. The psychologist was treating a severely disturbed patient who called his
office many times a day. The psychologist "lost" the beeper in an effort to stop the calls and was
unaware of his anger at the patient. The uncovering work enabled him to gain insight into the
countertransference feeling he harbored toward the patient. Of course, amnestic episodes can also
be associated with trauma. For example, Crasilneck and Hall (1975) describe the treatment ofa
 54

17-year-old girl who became amnestic after being raped.

Hypnosis is also useful in treating various alterations of consciousness. Symptomatic
treatment can sometimes be effective. A student asked for hypnotherapeutic treatment of a
symptom that bothered her: in many of her classes she would "fall asleep." Some probing by the
hypnotherapist made it clear that the patient in these instances was neither bored by the lecturer
nor overtired and sleepy-she was dissociating, going into a hypnoidal state. But why? We were
puzzled to find that the patient had these dissociative episodes only in the classroom and in the
library, never anywhere else. Further questioning revealed that she came from a lower class
family of little education and that she felt she would alienate herself from her beloved parents by
getting a higher education. This was discussed with her in and out of hypnosis. In addition, the
posthypnotic suggestion was given to the patient that she would hear an alarm clock ring any time
she felt the prodromal signs of the dissociative state come up. She improved rapidly. The entire
treatment took two sessions.
When symptomatic treatment of disturbances in consciousness fail, it is sometimes
necessary to explore the underlying dynamics. Kaplan and Deabler (1975) used age regression in
the treatment of a 25-year-old man with "blackouts" associated with violent rage attacks. The
patient was regressed to the time that each episode had occurred in order to explore the events
preceding the spell. In each instance, the blackout was associated with the patient's fear of his
aggressive impulses. In another case, a (244) patient was treated for" spaciness." The Theater
Technique revealed the spaciness was related to his fear of oedipal strivings. The patient
subsequently realized that he became spacy just prior to sexual intercourse or when speaking with
his boss at work.
Obsessive-Compulsive Symptoms: Hypnosis has a poor success rate with
obsessive/compulsive symptoms. When symptoms are embedded in the rigid
obsessive/compulsive personality structure, the prognosis is poor; symptoms are relatively
circumscribed, the prognosis is better. For example, a 28-year-old woman, somewhat overweight
but not really obese, wanted to lose weight and get rid of a compulsive symptom: every afternoon
at 3 p.m. she felt compelled to leave her job and get herself a large milk shake, even though she
really did not like milk shakes. In an age regression via the Affect Bridge (Watkins, 1971)
utilizing the affect of craving, she found herself at various points between the ages of 2 and 5
lying in a darkened room on a hard sort of table under a big machine after having had to drink a
very large glass of something that looked like a milk shake, but "tasted awful." She now
relived-and in the waking state remembered-that as a child she had had a congenital malformation
of the stomach for which she had to have periodic X-ray examinations. The hypnotherapist age
progressed the patient to her real chronological age and interpreted to her in trance that the milk
shakes represented the barium solution she had been required to drink before the X-rays were
taken and that she still wanted to be the obedient little girl who drank the barium solution even
though it "tasted awful." This interpretation was also made to the patient in the waking state.
After 3 hours of further hypnotherapy, the compulsive craving for milk shakes totally ceased. It
never returned. And within a couple of months the patient, without any further therapy, lost the
weight she wanted to lose.
DEVELOPMENTAL HYPNOTHERAPY WITH SEVERELY DISTURBED
PATIENTS: The treatment of psychotic, borderline, and narcissistic conditions: Several
theoretical advances in psychoanalysis in the past decades have contributed to the recent interest
 55

in the hypnotherapy of severely disturbed patients. These advances are loosely tied together
within the perspective of "developmental lines," a theoretical focus that began with Anna Freud's
classic paper of 1965, "The Concept of Developmental Lines." The viewpoint that grew out of
this seminal paper has been (245) equated with structural psychoanalytic theory (Gedo &
Goldberg, 1973) and, clinically, with the treatment of developmental arrests (Stolorow &
Lachman, 1980). It attempts to synthesize important aspects of object relations theory, self
psychology, ego psychology and affect development theory into a comprehensive framework for
the clinical assessment and treatment of psychotic and borderline patients.
Each of the many versions of a developmental lines approach has its own terminology,
despite attempts at an integrative view (Blanck & Blanck, 1974; Gedo & Goldberg, 1973).
Nevertheless, it is possible to draw certain basic assumptions. Each line of development charts the
emergence of a specific developmental potential through a sequence of epigenetic stages. Thus,
we may posit separate lines of development for the consolidation of a sense of self (Kohut, 1971;
Lichtenberg, 1975; Ornstein, 1974), for internalized object representations (Horner, 1979;
Jacobson, 1972; Kernberg, 1968; Mahler et. aI., 1975; Modell, 1968), for affect (Brown, 1985;
Emde, Kligman, Reich, & Wade, 1978; Isaacs, 1984; Sroufe, 1979), and for the defenses
(Vaillant, 1977). Each developmental line is thought to contribute to the formation of psychic
structure, and human development in toto is seen as "progressive structuralization" along multiple
lines (Gedo & Goldberg, 1973). Freud (1933, p. 84) used the metaphor of crystal formation to
illustrate how psychic structure proceeds from a fluid, undifferentiated state to a solid, structured
state to build what has since been called the "representational world" (Sandler & Rosenblatt,
1962).
Psychopathology, especially that of those illnesses now called "severe disturbance"
(schizophrenia, affective psychosis, and personality disorders), is reconceptualized as a failure in
normal human development along one or more developmental lines. Developmental deficits are
sometimes associated with genetic-maturational difficulties but more often are connected with
repetitive maladaptive interactions with the holding environment (Winnicott, 1965), so that
psychic structure fails to form properly. Psychological conflicts and defenses against these
conflicts may also contribute to failures in the normal progression of developmental lines. A
severely disturbed patient's seemingly bizarre symptoms or behaviors can, then, be interpreted as
adaptive, as compensatory structures (Kohut, 1971). For example, a patient's self-destructiveness
may be an attempt to feel alive (Perry, 1980); command hallucinations may be ways to develop
an executive function (Larkin, 1979). Such a view of psychopathology is radically different from
the consensual symptom descriptions of the DSM III (American Psychiatric Association, 1982).
Assessment of deficits in self- and object representations or in affect is not as clear cut as the
observation of symptoms, and can be made only through an evaluation of an unfolding
therapeutic relationship (Kohut, 1971; Ornstein, 1980-81). (246)
The concept of developmental arrests has profound implications for therapy. Outcome
studies of nonhypnotic therapy with severely disturbed patients (schizophrenics) have
convincingly shown that dynamic uncovering therapies, which focus on interpretation of
symbolic content, are not very effective (May, 1968). In contrast, a therapy that focuses on
failures in structure formation instead of content interpretation holds considerable promise. The
therapist who has formed a stable therapeutic relationship with a severely disturbed patient can
use this relationship to establish a common language through which both patient and therapist can
 56

come to understand the nature and experience of the patient's structural deficits the lack of a sense
of self, unintegrated representations of others, and incapacity for awareness and tolerance of
affect-and work toward the goal of helping the patient develop mature psychic structures. From
this perspective, it is more accurate to speak of the therapist's primary task as structural
interpretation (or ego building) rather than dynamic interpretation, and the patient's internal
process as adaptation and assimilation, not defense against impulses. Symptoms and behaviors,
for example, hallucinations, may not be something to rid the patient of, but to understand, even
utilize, for what they disclose about the developmental task(s) the patient must still accomplish.
Furthermore, in the therapy of severely disturbed patients, structuralization can take place
only in the context of a stable therapeutic relationship in which there is a solid alliance, a realistic
perception of the interaction, an opportunity for working through the specific
transference-whether a psychotic transference (Burnham et al., 1969), a borderline transference
(Adler, 1981; Kernberg, 1968; Masterson, 1976), or a narcissistic transference (Bach, 1977;
Kohut, 1971)-and an opportunity for internalization of certain qualities of the therapeutic
interaction, which contributes to structure formation (Leowald, 1973; Meissner, 1981).
The Use of Hypnosis in the Treatment of the Severely Disturbed Patient: Although
originally it was believed that severely disturbed patients were not hypnotizable (Abrams, 1964),
we know now that they do not differ essentially from normal people in their susceptibility to
hypnosis. In fact, some severely disturbed patients are sufficiently hypnotizable to merit the
consideration of hypnotherapy as an intervention.
The position set forth here is that hypnotherapy can indeed be useful in the treatment of
the severely disturbed patient-with some qualifications: Only highly hypnotizable patients should
be selected; hypnotherapy should be well embedded in the context of a stable ongoing therapeutic
relationship; and hypnotherapy is set within a developmental framework. (247)
When these qualifications are taken into account, hypnosis can indeed be useful primarily
because of the patient's great access to sensations, imagery, and memories (Fromm et a!.,
1981)-precisely those processes that play the largest role in the formation of psychic structure
(Sandler & Rosenblatt, 1962). Imagery, sensory awareness, and memory are important tools in
the hypnotic work with severely disturbed patients in conjunction with the ongoing (often
nonhypnotic) working through of the transference. They facilitate internalization.
Boundary Formation. Implicated in severe disturbance, especially schizophrenia, is a
developmental deficit in boundary formation, "the capacity to maintain a separation between
independent objects and between representations of independent objects" (Blatt & Wild, 1976, p.
6). According to Blatt and Wild, the normally developing child passes through a sequence of
discrete stages in boundary formation (articulation of the perceptual field, or segregation of
space; differentiation of inside and outside; segregation of categories for developing concepts
about the perceived world). The child who has mastered these stages has achieved stable
boundary formation, which is a prerequisite for the development of both the intellectual
operations outlined by Piaget (1969) which take as their foundation grouping and categorizing
operations associated with boundary formation, and the internal self- and object representations
described by Jacobson (1973), Kernberg (1976), and Modell (1968), which presupposes boundary
differentiation between self and others.
Since the development of both thinking and internal self- and object representations
presupposes boundary formation, it is not surprising that the manifest symptoms of schizophrenia
 57

include disturbances in both of these areas. A significant developmental failure in boundary

formation contributes to the lack of differentiation characteristic of chronic undifferentiated
schizophrenia. The fragmentation of boundaries or ego dissolution characteristic of acute
psychosis (Bowers, 1974; Federn, 1952) could be interpreted as the achievement of a degree of
boundary formation that is unstable and breaks down under stress.
Schizophrenics with boundary deficits develop various compensatory strategies. Just as
normal children segregate spaces for themselves to form psychological boundaries, some
schizophrenics use the walls of rooms as coextensive with their bodies in the attempt to shore up
boundaries. Walking out of an interview could be understood as using locomotion to establish
greater distance to preserve unstable boundaries. The negativism characteristic of some
schizophrenics could also be seen as an attempt to establish boundaries.
Using hypnotic visualizations, one can help highly hypnotizable schizophrenics to
capitalize on such compensatory strategies to further the (248) development of boundaries. Such
a patient was a 32-year-old chronic paranoid schizophrenic who constantly felt that he was under
the influence of others or that others deliberately wanted to harass him in public situations. He
first learned in nonhypnotic therapy to use locomotion literally to establish distance from others,
for example, by walking to the other side of the street when he feared others would walk into him
or by leaving a restaurant when he was afraid others would harass him. In subsequent hypnotic
therapy he learned to visualize himself floating inside a protective bubble with solid, durable
boundaries at a sufficient distance from the therapist to preserve his own boundaries so that he
would not need to fear he would merge with the hypnotherapist. He visualized the bubble at
various distances and locations in imagined and real interactions, first with the therapist and then
with others. Although in the beginning the bubble tended to break up readily, later it collapsed
only in intense emotional interactions. Eventually, he learned to judge spatial distance so as to
keep the bubble intact, without fragmentation, in most daily interactions. At that point he
responded to the hypnotist's suggestion to "fit the bubble around the skin" as a step toward the
formation of a stable body image. Such visualizations practiced repeatedly in hypnosis and
self-hypnosis contributed to the patient's feeling "more real than I ever have." Another hypnotized
patient, a borderline, visualized herself capable of expanding and contracting the walls of the
therapy office until she found a safe and comfortable distance between herself and her therapist.
HYPNOTIC VISUALIZATIONS THAT AID BOUNDARY FORMATION INCLUDE:
1. Safe Space Imagery. The patient repeatedly visualizes a series of safe and protected imaginary
environments until he is consistently able to generate, upon a signal, the experience of being
contained within a safe and protected space.
2. Regulation of Closeness and Distance. The patient in trance visualizes himself in relation to
the therapist (and others). Each time, he is instructed to regulate the imagined distance between
himself and the therapist (and others) until he finds the distance that is most comfortable to him.
For example, the patient imagines floating in his bubble at various distances from the therapist
until he locates just the right distance. Or he may imagine expanding and contracting the imaginal
space in which he and the therapist are contained until he discovers the right distance. The patient
is symbolically given control over the distance between himself and the therapist.
3. Barrier Imagery. The patient uses imagery to clearly demarcate boundaries around the body,
for example, solid boundaries around the imagined bubble or protective barriers around the safe
space. These (247) visualizations must be practiced repeatedly until signs of boundary formation
 58

can be observed.
Body Image Formation. Also implicated in Schizophrenia is a deficit in the formation of
the body image, that visceral/kinesthetic representation derived from enteroceptive, tactile, and
kinesthetic impressions. Like the development of boundaries, the formation of the body image
requires a passage through several stages from the formation of representations for bodily
experience, to the coalescence of these into partial body images, and ultimately to the
development of an integrated whole-body image with clearly demarcated boundaries (Brown,
Sands, & Jones, 1985; Lichtenberg, 1978; Mahler & McDevitt, 1982).
A developmental deficit in body image is reflected in the inability of those most severely
disturbed to develop representations for bodily experience, of those moderately disturbed to
develop only a partial and fragmented body image, and of those least severely disturbed to
develop a body image that, although cohesive and integrated, is nevertheless unstable. Regardless
of the level of body image development, the body image is vulnerable to further disintegration
during psychotic episodes (Bychowski, 1943). Schizophrenics who fail to develop even partial
body images may compensate with stereotypic posturing and grimacing, which can be understood
as repetitive proprioceptive and sensoriperceptive stimulation so as to form fleeting memory
impressions of bodily experience. Somatic delusions, however inaccurate, may be attempts to
form more elaborate memory impressions of bodily experience, something akin to the formation
of partial body images in the normally developing child. For schizophrenics who form unstable
whole-body images, collecting body products (clipped nails or hair and feces), skin picking, and
mirror gazing, may be attempts to counteract their fear of bodily disintegration.
Hypnosis can be used to stimulate the processes that lead to the formation of the normal
body image in patients. Preparatory nonhypnotic therapies-yoga (Clance, Mitchell, & Engelman,
1980), physical exercise (Darby, 1970), and especially movement and sensory awareness training
(Mosey, 1969)-are indicated for patients who are deficient in forming memory impressions from
bodily experience. For highly hypnotizable schizophrenics, the hypnotist can combine sensory
awareness and imaginal methods to enhance the development of a normal body image. He can
suggest a series of fantasies involving body surface stimulation, such as being cuddled, bathed, or
played with, or he can give suggestions to increase awareness of internal body sensations, such as
being hungry or in pain. The patient is asked to identify and describe the resulting surface and
internal bodily sensations evoked by the imagery.
The development of partial body images can be facilitated in hypnosis (250) by having the
patient repeatedly focus attention on certain body parts and on different internal body areas (left
and right, top and bottom). The patient should try to discriminate the sensations associated with
the inside and outside of the body. The patient is also instructed to scan the body surface
systematically to identify the changing sensations. It is important for the patient to practice the
body scan until he can readily "outline" the body's surface through immediate sensory experience.
The development of the whole-body image can also be stimulated in hypnosis by having
the patient describe sensations associated with a series of movement exercises he imagines
himself doing, movements that become progressively more complicated and purposeful. He also
can fantasize dancing in front of a mirror and describe sensations evoked by making the imagined
coordinated muscle movements. These hypnotic visualizations may be supplemented by real
movement and sensory feedback exercises. For patients with unstable body images, barrier
imagery can also be suggested. (A more detailed discussion of the stages of hypnotic
 59

reconstruction of the body image can be found in Brown, Sands & Jones, 1985.)
Development of Object Representations. A developmental deficit or regression in object
representations has been implicated in the various types of severe disturbance-schizophrenia
(Bychowski, 1952; Modell, 1968; Volkan, 1976), affective psychosis (Jacobson, 1973), and
borderline personality disorder (Kernberg, 1968). Having successfully negotiated the several
stages in the structuring of object representations, or internal representations of others, the child
develops the ability to integrate and retain the positive and the negative schemata of the self as
well as those of the other. The child no longer needs to see people as either "all good" or "all
bad." He now is capable of ambivalence and can love people, notwithstanding their faults, and
can accept himself for what he is.
The schizophrenic, on the other hand, fails to develop a stable, integrated representational
world, as can be seen in a variety of clinical phenomena: fluidity of representations and doubles
(Volkan, 1976), freefloating introjects (Bychowski, 1952; Kernberg, 1976), the re-fusing of self
and object representations (Jacobson, 1973), auditory hallucinations (Modell, 1948), and splitting
off the "bad" parts of the self and externalizing them in order to prevent "contamination" of the
good part of the self by the bad. High functioning schizophrenics and borderlines do develop an
integrated representational world which, nevertheless, is unstable and may disintegrate under
stress like a crystalline structure breaking into pieces (Modell, 1968). Patients with personality
disorders presumably form a stable representational world, but the internal representations are
split (Kernberg, 1968, 1976). (251)
Severely disturbed patients formulate a number of compensatory strategies in their
attempts to construct a representational world. Just as during the symbiotic stage the normally
developing child constructs the representational world through fantasies of merger (Jacobson,
1973) and omnipotent investment of the physical world with the contents of wishes (Modell,
1968), so does the schizophrenic patient attempt to compensate through psychotic fantasies
(Jacobson, 1973). In these fantasies the therapist's sole purpose (in the view of the patient) is to
meet all the patient's needs. He becomes the patient's entire world, and the patient hardly
differentiates between himself and the therapist. Such fantasies signify regression to the very
early mother-child relationship. Schizophrenic patients often harbor these psychotic fantasies
outside the patient-therapist interaction (Blatt et al., 1980) and resist disclosing them to the
therapist (Smith, 1977). Although the psychotic transference is commonly viewed as a potentially
negative therapeutic reaction, some writers (Blatt et al., 1980; Little, 1960) have interpreted them
as adaptive attempts to recapitulate the normal developmental task of the symbiotic stage,
wherein merger in fantasy and omnipotent wishes are the means to establish a base of positive
images from which the representational world can be (re)constructed. In a similar vein, others
(Larkin, 1979; Modell, 1948) have interpreted auditory hallucinations as a revival of aspects of
wished-for interactions in an attempt to create a gratifying internal world. Patients with lower
level personality disorders, who presumably have developed an integrated but unstable
representational world, utilize transitional objects and transitional modes of relationship (Arkema,
1981; Horton, Lovy, & Coppolillo, 1974) in order to stabilize that world. While patients with
personality disorders at a higher level have a stable representational world, they fail to internalize
certain functions (e.g., the regulation of self-esteem) and form dependent relationships to provide
the missing functions by means of narcissistic object choice (Kohut, 1971; Reich, 1973).
THE HYPNOANALYSIS OF PATIENTS WITH DEVELOPMENTAL DEFICITS:
 60

Elgan Baker (1981), a psychologist-hypnoanalyst, has devised a protocol of seven consecutive

steps for the hypnoanalytic treatment of psychotic patients. Fromm (1984) has extended it by one
step and has shown that the more advanced steps can be used in the hypnoanalysis of borderline
and narcissistic patients. Copeland (1986) has refined it.
The eight steps of the protocol are:
Step 1. Hypnosis is induced. When the patient shows posturally or verbally that he feels relaxed,
he is helped to imagine that he is alone and involved in some pleasant activity of his choosing.
Throughout the (252) hypnoanalytic hours in this phase, the hypnoanalyst suggests from time to
time feelings of comfort and well being.
Step 2. Because the psychotic patient wishes to merge with "the other" (Erikson, 1984) but also
fears the other person would destroy him or abandon him, it is important to let the patient
recognize that the therapist is (peacefully) present even when he is not seen. The hypnotized
patient again is instructed to visualize himself after he has closed his eyes and is in trance feeling
comfortable, then after a while to open his eyes and look at the hypnoanalyst for a moment and
close them again. Both Steps 1 and 2 may have to be repeated over quite a few hours.
Step 3. While continuing to give suggestions for feelings of relaxation and well being, the
hypnoanalyst now asks the patient in trance to develop visual images of the therapist. Frequently
that is difficult, especially, for psychotics and borderlines. In such cases, the hypnoanalyst should
ask the patient to produce images that can serve as symbols for the therapist or as imaginary
"transitional phenomena" (Winnicott, 1965). For instance, the hypnoanalyst may suggest that the
patient imagine an object from the therapist's desk or the hypnoanalyst's name written on a
blackboard; only after this visualization has been achieved regularly and easily, is the patient
asked to imagine seeing the hypnoanalyst himself. The purpose is to help the patient eventually to
develop visual images of the therapist as a separate person, alive and whole. It is the initial step
toward object constancy.
Step 4. Here the measure of proximity between patient and hypnoanalyst in the patient's imagery
is left to the patient. Initially, psychotics and borderlines often imagine therapist and patient on
opposite sides of a lake or on separate mountaintops with a chasm between them. It may take
several weeks before they can visualize themselves in the same room with the hypnoanalyst. But
gradually the hypnoanalyst can help the patient decrease the distance in the image while
maintaining relaxation and comfort.
Step 5. This is perhaps the most important step in the whole series. It requires the hypnoanalyst
to prove himself to the patient for many months, and sometimes years, to be a nurturing,
protecting, supportive, empathic, and gratifying "good" parent figure, who sees the patient's good
and admirable sides. Interactional fantasies can be suggested in which the hypnoanalyst takes the
role of the "good" object. This role must be taken on by the therapist actively and with real
empathy and sincerity. It is a step that will help the patient begin to introject the good object and
to see himself as a "good me." In the imagery, interactional fantasies should be emphasized in
which the hypnoanalyst provides the nurturing, "holding environment" (Winnicott, 1965) for the
patient. For quite a long time the (253) hypnoanalyst has to provide soothing and comfort.
Toward the end of this period, the patient's adult ego can be enlisted to help provide the soothing
and consolation for the suffering-child part of the patient. This is often done in connection with
spontaneous or induced age regression.
Step 6. In this step, the hypnoanalyst helps the patient to externalize, in a controlled way, and
 61

rework distorted object representations. The patient is asked in the hypnotic state to visualize the
"bad" object representations he has internalized, and to externalize them and let them go. For
instance, the patient may be told that now he can look deep inside of himself, as with an X-ray,
where he can see the old image of the "bad" parent. When he sees it clearly, he is told that he can
take the image of the "bad" parent out from within himself and find a new place for it, sometimes
to integrate it in a new way, sometimes to let it go. For example, he may attach it to a balloon that
he can allow to float away, or he can put it into a box and "shelve it" for good. The hypnoanalyst
should also suggest to the patient that he keep within himself those parts of the parent that he can
now recognize as good. And it can be suggested that the patient now visualize himself in the
mask of the "bad" child, who sometimes may have provoked the parents' anger and thus became
deprived, but who now can tear off the constraining mask of the "bad" small child and really
grow and unfold all the good potential he has within himself (Eisen & Fromm, 1983). In general
it is preferable, as much as possible, to let the patient's own imagery and visualizations come up
and then to guide them in the therapeutic direction.
Step 7. As stability of ego functioning grows, other significant love and hate objects appear in the
patient's hypnotic imagery. Continued emphasis is placed on the integration of positive and
negative interpersonal experiences, and on achieving solid, separate self- and object constancy.
Step 8. This step helps the patient to gain control over splitting as a defense, to integrate love and
hate objects solidly, and to consolidate the gains made. The therapist explains to the patient in the
waking state that a mother cannot always gratify a child's needs, that some frustration of
dependent wishes leads to the child's moving towards autonomy and growth, that all people have
both good characteristics and bad ones, and that people can be giving even when they withhold.
He can help the patient to see that the world is not black and white. He can now point out how the
patient has transferred to the hypnoanalyst and other people in his current adult environment his
early defense of splitting the beloved parent (who sometimes had to frustrate him) into an
"all-good" and an "all-bad" object; and how unrealistic it is to see people at times as allgood and
at other times as all-bad. Unrealistic feelings and fantasies that have a destructive effect on the
patient and his environment can now be (258) talked about and made ego dystonic, so the patient
will not revert to this defense in the future.
In the hypnotic state the patient may be asked to look carefully at these unrealistic feelings
in imagery, to bundle them up, put them in a can marked "trash," throw them from a bridge into a
fast-flowing river, and let them float away. Or various fantasies and guided images can be used in
hypnosis that emphasize bonding the "bad" image of the mother with the now safely internalized
good image of the therapist. In this phase, the patient must constantly be shown that the good
relationship with the therapist is not destroyed by this merger and that the therapist continues to
stand by him.
The purpose of Step 1 is to allay the patient's fear of being engulfed and annihilated by the
therapist; that of Step 2 is to lay the groundwork for the concept of separateness of object and
self. Step 3 serves to help the patient develop visual images of the hypnoanalyst as a live, whole,
and separate person; Step 4, to aid the patient to imagine himself and the therapist comfortably
together. In Step 5, the hypnoanalyst takes on a very nurturing, protective stance, so that the
patient can conceive of him as a gratifying "good" object that he internalizes and that helps him to
gain a positive self-image. In Step 6, the hypnoanalyst helps the patient to externalize distorted
self- and object representations; in Step 7, to integrate love and hate objects; and in Step 8, to
 62

achieve solid, separate self- and object constancy and to gain control over splitting as a defense.
This eight-step protocol for the hypnoanalytic treatment of patients who have suffered a
deficit along the developmental line of the self is a real innovation in the practice of
psychotherapy. Although the underlying ideas about the different types of transferences and the
different grades of developmental deficits in the psychotic, the borderline, and the narcissistic
patient clearly stem from psychoanalytic object relations theory and self theory, the technique
itself is a contribution made to the field by hypnoanalysis.
Psychotics are afraid of entering interpersonal relationships because they wish to merge
with the other person but at the same time fear that they either will be engulfed and destroyed by
the other or destroy him. With psychotic patients, hypnoanalysis therefore should start with Steps
1 and 2.
The borderline patient is farther along the road to object constancy than the schizophrenic.
Therefore, hypnoanalytic work with borderlines can be started with Step 3 or 4. But in all
hypnotic work with psychotics as well as with borderlines, it is imperative to start each hypnotic
session with the induction of relaxation and comfort. With the narcissistic patient, the sequence
can begin with Step 5. (255)
The Development of Self-Representations: According to Lichtenberg's (1975)
integrative theory of self-development. the three discrete groupings of self-representations-the
body self, the differentiated self- and object representations, and the grandiose self-converge at a
critical point of development into the cohesive sense of self The development of the cohesive
sense of self in childhood (Lichtenberg. 1975) and its later reformulation as a sense of identity in
adolescence (Erikson, 1959) mark a milestone in normal human development. The experiential
consequences of the cohesive sense of self are profound: it lends coherence to personal
experience (Kohut, 1971), it provides a stable frame of reference ("1") around which to orient
experience in the world (Spiegel, 1959), and it gives continuity to experience over time and
across changes in state and context (Lichtenberg, 1975).
Developmental arrest or regression, which results in failure to synthesize or keep
synthesized a cohesive sense of self, is present in psychosis (Kohut, 1977; Wexler, 1971). Some
psychotics, especially chronic schizophrenics, fail to develop a cohesive sense of self; others,
some acute schizophrenics, have an unstable sense of self or a false self (Winnicott. 1960), which
easily fragments under stress and under the developmental task of identity formation
characteristic of adolescence (which presupposes an intact self-structure) (Bowers, et al., 1961).
Lacking this sense of self, the psychotic's experience does not cohere. The patient has no personal
frame of reference. He experiences the world from the outside in rather than from the inside out.
Experience is discontinuous, each moment entirely new and strange. A clear sense of personal
history is absent.
Hypnosis is a useful adjunct to ongoing therapy when the goal is the construction of a
cohesive sense of self and the psychotic is hypnotizable. First, it aids the establishment of an
internal frame of reference. Bowers et al, (1961) nearly 30 years ago described an hypnotic
treatment designed to help the psychotic patient to make contact with the "sense of '1 am,'"
believed to be hidden and protected. She called this poorly developee frame of reference the
"little me." Hypnosis provided a permissive COiltext along with explicit suggestions to foster the
growth of this selt~ experience. Spontaneous experience of genuine needs and feelings ane
encouragement of the ability to play in trance were vehicles to develop the sense of self as a
 63

frame of reference.
The self psychologist Khan (1972) has described a very similar process in nonhypnotic
psychoanalytic treatment to facilitate growth of self-experience for patients suffering what he
called "the privacy of the self." Self-denying attempts to comply with the analyst and use the
analyst as 2frame of reference were interpreted until the patient was able to "disregard" the
analyst in favor of playful exploration of the self. (256)
Hypnosis can be used, too, in developing a sense of continuity in life experience and
identity. Bowers et al. (1961) described the use of age regression in the full service of structural
repair. Age regression to various points in one's personal history is a means of bringing a variety
of emotion-laden life experiences to conscious awareness. The structural work can be enhanced
on termination of the trance. The therapist and patient must work to organize these life
experiences into a continuous life story.
Through repetition of hypnotic age regression and nonhypnotic ordering of the recovered
experiences, the patient gradually comes to realize the continuity of a personal history. Patients
can be encouraged to make the developing sense of continuity concrete by writing these events
into an autobiography.
AFFECTIVE DEVELOPMENT. Still another deficit to be found in schizophrenic and
borderline patients is in the area of affect, whose development first occurs as a dimension of
perceptual maturation-the child is intensely interested in novel, complex, and changing stimuli.
Proceeding through the various stages of this domain, the child learns to sustain interest in
processing discrepant stimuli (Izard, 1977) and to regulate internal tensions (Greenspan & Lourie,
1981) by manifested states of pleasureable or unpleasurable activation. In the symbiotic phase,
during which the child forms a bond with the caregiver, the child develops selfawareness (Lewis,
Brooks, & Haviland, 1978). As the autonomic nervous system matures, the child applies this
self-awareness to distinguish between internal and externally caused sensations, as well as to
discriminate a variety of visceral changes as the capacity for primary emotional experience
develops-moods (Tronick, Ricks & Cohn, 1982) and the 8-month anxieties (Campos et al., 1978).
At some point an important integration takes place and primary affective experience
becomes associated with developing self- and object representations, on the one hand (Em de et
a!., 1978; Kernberg, 1968; Novey, 1959), and becomes organized within a matrix of affective
memories and concepts, on the other (Klein, 1967). As cognition develops, the nascent visceral
experiences are given greater specificity. A variety of specific emotional states gain definition.
The infant now possesses the capacity for a wide range of affective experiences and later
develops the capability for affective tolerance through internalization of the repeated soothing
responses given by the caregiver (Mahler et a!., 1975; Tolpin, 1971).
If a developmental failure occurs at the earliest stage, the schizophrenic may lack the
fundamental sense of aliveness from which a sense of existence and motivation are derived
(Perry, 1980). If the failure occurs during the stage of discrimination of visceral experiences, the
schizophrenic may manifest a failure in the capacity for emotional experience.
Self-destructive behavior such as cutting or burning, compulsive (256) masturbation, and
violent or bizarre sexual activity are attempts to compensate for affective failure. Such behavior
creates, even for only brief moments, a sense of aliveness. Schizophrenics also try to infer
internal affective states through symbolic reading of external cues, such as changes in others'
facial expression or gestures and through their own observable tension level (Perry, 1980).
 64

Hypnosis can facilitate the development of affect. Highly hypnotizable schizophrenics can
learn to acquire a state of intense interest in which they carefully scan the body surface and the
internal milieu to identify the stream of novel and changing sensations for longer and longer
periods. They also learn through practice to feel these sensations with greater and greater
intensity.
For one such patient, the result of months of such hypnotic practice was a sense of
aliveness and awareness of intense energy shifts within the body. Continuous practice resulted in
spontaneous panic attacks, a yet unmodulated form of anxiety. The patient then learned under
hypnosis to identify internal sensory perceptions in a more refined way, that is, to specify various
patterns of bodily sensations and their different bodily locations (Mason, 1961). Hypnotic
suggestions evoked spontaneous vivid visual imagery, memories, and thoughts in association with
the patterns of bodily sensations. Thus the patient learned to link differentiated somatic
experiences with cognitive processes eventually to integrate affective experiences. At that time
she reported that her usually racing thoughts had slowed down. A number of specific affects
became available in association with specific life events, for instance, sadness and anger, and later
pleasurable affects related to a sense of well being. With the aid of posthypnotiC suggestions to
reinforce the work, she was taught to gain quick access to a variety of specific emotions and
associated fantasies and memory material. It was then possible to treat her further in ongoing
nonhypnotic therapy. (For a more complete discussion of the specific hypnotic techniques to
develop affective experience, see Brown, 1985.)
Treating the Seriously Suicidal Patient with Developmental Hypnotherapy: People
make serious suicide attempts for essentially two reasons: They lack a sustained sense of
connection to others, and they lack internal mechanisms to soothe and comfort themselves. The
socially isolated and interpersonally impaired patient is at the greatest risk of suicide (Fawcett,
Leff & Bunney, 1969). These patients complain of being incapable of loving and being loved.
They are unable to find gratification in relationships, even truly caring relationships.
Relationships are a source of discomfort, not of pleasure. This deficit in human connection
probably (258) represents some form of impairment in the development of object relations
(Maltsberger & Buie, 1980).
Patients at high risk for suicide also complain of experiencing an unusual degree of pain
in daily life. They live in constant fear or misery, from which they find little relief. This inability
to find comfort and peace probably signifies an underlying deficit in affect tolerance and in
selfsoothing mechanisms. The normal child develops soothing mechanisms during the
separation-individuation phase of development by internalizing the comforting provided
repeatedly by the caregivers during affective storms (Tolpin, 1971). Adults vulnerable to intense
panic and distress states presumably have failed to develop adequate self-soothing mechanisms.
Even when they are not in an affective storm, the world is seldom experienced as a safe and
secure place.
According to Maltsberger and Buie (1980), there are three motives for suicide: revenge,
riddance, and rebirth. Revenge suicide is object relatedthe patient is trying to manage aggressive
impulses by getting back at someone. When revenge suicide is attempted, it may be lethal but is
not consistently fatal. Because the patient maintains his sense of connection to others, he may
survive the attempt even if the connection is through intense hatred. Riddance suicide, the most
common of serious suicide types, is motivated by the desire to rid oneself of the pain of
 65

existence. Rebirth suicide patients seek soothing in fantasy and believe that other realms, or death
itself, will provide the soothing that is lacking in human existence. They actively seek death as a
compensatory strategy to resolve the deficit in self-soothing and to disengage from relationships.
From a developmental perspective, treatment of the seriously suicidal patient entails
correction of the deficits in relatedness and self-soothing. Hypnosis can serve as an adjunct to the
therapeutic work by presenting the patient with a series of structured visualizations designed to
facilitate the repair. It goes without saying that management of acute suicidal behavior is through
hospitalization and medication, where indicated. Beyond this, the ongoing treatment of the
seriously suicidal patient begins with an assessment of the patient's soothing capacities, by asking
how he finds peace and comfort. Some people utilize transitional objects and related behaviors to
gain the soothing they seek; personal journals, reading, music, shopping, and substance use are
among common soothing objects and activities. Others rely on transitional space. They feel
secure only in a dark, safe place, or in wide, open spaces, or in a natural environment (like a
forest or the oceanside). Still others utilize transitional modes of relatedness: identification with
characters in novels, relating to an imaginary companion, developing a crush on someone,
relating to a pet, or finding a relationship with God through prayer.
These transitional modes of relatedness are adaptive in that they allow (259) the
individual to sustain a sense of connectedness to others at a safe distance from the conflicts
experienced in real, everyday relationships. The therapist first lets the patient name for him all the
transitional objects and phenomena he has utilized at various points in his life and then lists them
in hierarchical order. The patient is hypnotized and asked to imagine a comforting scene until
some degree of comfort is attained. Often the patient will need to repeat the visualization many
times to generate any sense of comfort. The therapist may also need to experiment with various
types of soothing imagery until he hits upon the most effective. Seriously suicidal patients at first
have difficulty experiencing any soothing, and, of course, the difficulty itself exemplifies the
developmental deficit. Because of the hopelessness and helplessness accompanying serious
suicidal wishes, the therapist must actively structure the exercises and convey the expectation that
they will in time be effective.
Eventually even the highly suicidal patient should find some form of soothing imagery. If
not, the therapist can directly introduce transitional objects to the patient. These are durable
objects or activities that provide a sense of soothing-a paperweight, writing in a personal journal
or listening to music when upset. The earliest visualizations typically involve transitional space
rather than people. The goal at this stage is to establish some experience of soothing at an
imaginal level. The patient learns to retreat to his safe and protected place whenever he
experiences discomfort. The patient is encouraged to practice self-hypnosis and to generate the
safe internal place as needed, even many times a day. Once the patient acquires some skill in
imagining a comforting, safe space, the therapist introduces new imagery, telling the patient to
imagine other ways of feeling safe, comfortable, and at peace. The therapist also encourages
fantasy involvement, for example, finding comfort by the ocean or in the forest. The aim is to
expand the range of soothing imagery available to the patient.
At some point, a shift from transitional space to transitional modes of relatedness is
indicated. The patient begins to imagine soothing derived from some form of relatedness-God, a
pet, an imaginary companion, a once trusted friend. The patient practices generating a soothing
experience through imaginal relatedness. The patient becomes able to imagine soothing in
 66

association with the therapist and the process of therapy. He reports thinking about the therapist,
the process of therapy, or the hypnotic trance when upset and then feeling some comfort. Later
the patient is able to develop an internal capacity for self-soothing and a sense of connectedness
to the therapist. Then, the patient and the therapist examine more closely the vicissitudes of
self-soothing. They scrutinize the situations in which the patient was or was not able to sustain a
sense of (260) comfort. The goal is to help the patient maintain self-soothing in a more continual
manner and in a variety of life situations without relapse.
As the sense of connectedness to the therapist and then to others strengthens and
self-soothing mechanisms have been internalized, the patient's suicidal risk greatly diminishes.
This structural repair happens in the context of an ongoing therapeutic relationship, through
which internalization occurs. It is difficult to apportion the relative contribution of the therapeutic
relationship on the one hand, and the series of hypnotic visualizations on the other, to the overall
outcome of the treatment.
Conclusion: All that has been discussed in this section suggests that it is time to
reconsider hypnosis in the treatment of the severely disturbed patient. In the past 10 years the
hypnotizability of some schizophrenics has been well documented (Lavoie, Sabourin, &
Langlois, 1973; Pettinati, 1983). Yet, it has not been clear how to utilize hypnotizability for
clinical gain with such patients. The recent convergence of psychoanalytic ego psychology, object
relations theory, self psychology, and affect development theory into a more comprehensive
developmental lines perspective for the treatment of severe disturbances offers the needed
theoretical rationale for such treatment.
The usefulness of developmental lines theory in hypnotherapy with severely disturbed
patients depends primarily on the accuracy of the developmental assessment. To the extent that it
is possible, the therapist must understand which lines of development are deficient and at which
stage(s) the deficits occured. Subtle developmental assessment of this sort is not as easy to make
as are the descriptive symptomatic assessments that are used in the DSM III (American
Psychiatric Association, 1980). Development is best assessed by evaluating how the clinical
material unfolds over time in the therapy relationship (Kohut, 1971). Since hypnotherapy with
severely disturbed patients is advocated only after preparatory nonhypnotic therapy, the therapist
is likely to have a wealth of clinical material available to make such an assessment. Furthermore,
the therapist can be guided by the spontaneous compensatory strategies evident in the patient's
behavior. The goal in each phase of therapy is to match the hypnotic interventions with the
specific developmental tasks the patient is trying to accomplish.
We have advocated here using hypnotherapy after preparatory nonhypno tic therapy, that
is, where conflicts around control in the psychotic transference (Burnham, et aI., 1969) are offset
by a strong alliance or have been otherwise worked through. Others introduce hypnosis early in
the (261)
treatment of the severely disturbed patient, using special parameters to reduce complications
(Baker, 1981; Scagnelli, 1975, 1976, 1977). The goal of hypnotherapy with severely disturbed
patients is genuine structural change, for example, the formation of boundaries or a stable body
image, the development of differentiated and stable self- and object representations, resulting in a
cohesive sense of self, and the capacity to experience and tolerate genuine affect. Structural
change means the alleviation of psychotic symptoms (first-rank symptoms and thought disorder)
and behaviors associated with borderlines (the incapacity to tolerate aloneness and panic states).
 67

The schizophrenic patient develops a subjective sense of aliveness and connectedness to others.
Behaviorally, these patients develop the ability for meaningful work and for sustaining caring
relationships beyond the therapy. The borderline patient develops a more realistic capability for
relationships and the capability to bear intense affects. Such changes, felt subjectively by the
patient, can be identified by the therapist and recognized by significant others as well.
HYPNOSIS AND POST-TRAUMATIC STRESS DISORDERS: Traumatic neurosis,
and post-traumatic stress disorder (PTSD), are syndromes arising from exposure to
extraordinarily stressful situations. According to DSM III (American Psychiatric Association,
1980), PTSD is induced by events generally outside the range of normal human experience,
events so stressful that they can produce symptoms in almost anyone exposed to them. Events
that typically cause PTSDs fall into two classes: natural disasters (tornadoes, earthquakes,
volcanic eruptions, storms, floods, fires, and animal attacks); and human aggression (assault,
rape, burglary, kidnapping, hijacking, political incarceration and torture, war, and holocaust).
These situations are so removed from ordinary, everyday experience that therefore even the
healthiest of people are ill equipped to cope with them.
Exposure to extraordinary circumstances produces a predictable cluster of symptoms,
though not always pathological. With respect to many traumatic events, the course of these
symptoms is typically short lived. These symptoms represent the patient's attempt to adapt to the
unusual circumstances and to integrate the experience. Horowitz (1976) has described the typical
course of recovery from stress. According to his information-processing model of traumatic
response, many of the symptoms of PTSD are biphasic. The initial reaction of outcry is typically
followed by either denial or the intrusive state. Over the course of time, the patient alternates
between denial and the intrusive state until the (262) experience is worked through. The
frequency and intensity of the symptoms gradually diminish, and, on completion of this process,
the symptoms disappear.
Sometimes the duration of symptoms is prolonged, their manifestation is excessively
intense, or their working through is blocked (Horowitz, 1974, 1976). The normal post-traumatic
response can become pathological, when (a) the patient's degree of control over the symptoms is
called into question, (b) he becomes excessively preoccupied with the symptoms, or (c) the
symptoms have a severe impact on the various areas of his life functioning (Green, Wilson, &
Lindy, 1985). The diagnosis of pathological PTSD is made when the normal process of recovery
is blocked and the symptoms remain for prolonged periods of time, sometimes decades.
The typical symptoms of PTSD include cognitive, affective, and behavioral
manifestations. During the denial phase, cognition is restricted. The patient is virtually incapable
of fantasy productions and is amnestic for significant events in his life history. General affective
numbing is the hallmark of PTSD during the denial phase. Severe trauma affects the ability to
utilize affects as signals (Krystal, 1984). PTSD is also characterized by a generalized behavioral
inhibition in many life spheres. The patient tends to restrict activities, narrows his range of
interests, and withdraws from social interactions. He may become quite detached from life. In
cases of extreme trauma, such as the Nazi holocaust, the patient may seem to be a "walking
corpse" (Niederland, 1968) and responds as if "dead to the world" (Murray, 1967). During the
intrusive phase, the patient suffers from intrusive, unbidden recurring thoughts and ruminations
and from hypermnestic flooding. Affect storms, for example, panic and rage attacks, frequently
overwhelm the person. Traumatization can impair the capacity for affect tolerance. Behaviorally,
 68

there is a strong tendency to reenact the traumatic situation in current life. The risk of repetition
extends beyond the individual. The intergenerational risk subsequent to traumatization is well
documented for children of incest survivors (Gelinas, 1983) and of holocaust survivors (Danielli,
1985). Table 8.1 summarizes the typical phasic alternation between denial and intrusive
symptoms.
PTSDs are characterized by a variety of other symptoms. Chronic anxiety or depression is
extremely prevalent (Krystal, 1984; Niederland, 1968), so prevalent in fact that PTSDs are often
misdiagnosed as depression in those patients who present during the denial phase. Poor self-care
is an outcome of severe traumatization (Krystal, 1984). Substance and alcohol abuse are
extremely prevalent among traumatized persons, who use the substances in an attempt to cope
with intolerable affects (Brende, 1984; Lacoursiere, Godfrey, & Ruby, 1980; Nace, Meyers,
O'Brien, Ream, & Mintz, 1977). Somatization is also very common. There is a high incidence of
conversion reactions and psychophysiological disorders (263) among PTSD patients (Krystal,
1968). Traumatization may also contribute to a variety of more or less serious cognitive deficits,
such as impaired concentration, forgetting, cognitive disorganization, and confusion, and, in
children, learning disabilities. Dissociative states are another hallmark of PTSD. Whether in the
denial or in the intrusive phase, traumatized patients have an atypical sleep and dream life. A
history of repetitive nightmares or, less frequently, frightening day images whose content is
associated with the trauma are the most reliable signs of PTSD (Kramer, (264) Schoen, &
Kinney, 1984). People with PTSD are also prone to lapse into dissociative states, such as
flashbacks, in which they re-experience the trauma when exposed to events that resemble or
symbolize some elements of the actual traumatic situation. Acting out (Pynoos & Eth, 1985) and
antisocial behavior (Scurfield, 1985) are often signs of PTSD, especially in adolescents.
[TABLE 8.1 Typical Manifestations of PTSD:
I. Information-Processing Model: Cognitive, Affective and Behavioral Symptoms
A. Symptoms of the Denial and Intrusive Phases of PTSD
Phase
Psychological Mode
Denial
Intrusion
Cognition
amnesia

hypermnestic
flooding
Affect
numbing
affect
storms
Behavior
inhibition

compulsion to
repeat
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B. Other typical symptoms

1. Atypical dream life
2. Dissociative episodes
C. Symptoms Prevalent in Disguised PTSD
1. Chronic anxiety and depression
2. Substance and alcohol abuse
3. Somatization and conversion reactions
4. Cognitive impairment
5. Acting out and antisocial behavior
II Psychobiological Model: Autonomic Hyperactivity
A. Conditioned hypersensitivity to stimuli
B. Sensation-seeking
C. Addiction to trauma
C. Structural-Developmental Model: Fluid Character Pathology
D. Impaired relationships; estrangement from others
E. Arrested self development (restriction of interests and activities)
C. Complicated mourning reactions and rage reactions (associated with loss of real and
transitional modes of relatedness)
D. Internalization of Negative Introjects (killer-self, victim-self introjects, identification with
death)
E. Self-as-object experience
F. Primitivization of group relationships
IV. Structural-Developmental Model: Disregulation of Impulse
A. Hypo- and hypersexuality
B. Extreme inhibition of aggression (chronic passivity); chronic irritability; episodic
assaultiveness. (264)]
There are a number of psychological sequelae of exposure to extraordinarily stressful
events. Traumatization often shatters some of the basic assumptions one holds about the world
and about human relationships. Most normal persons perceive life as meaningful. Most have
relatively intact self-esteem. Most people also think of themselves as invulnerable to harm and
persist in the belief that tragedy always happens to the other person. Exposure to a traumatic
event shatters these ordinary beliefs (Janoff-Bulman, 1985).
Most natural disasters are unpredictable; most traumata caused by human destructiveness
are senseless. Whether or not a particular person is directly affected by a trauma is often purely a
matter of chance. Survival or death in combat, natural disaster, or holocaust occurs more or less
on a random basis. The randomness and senselessness of these events disrupt the everyday belief
that life is meaningful and that events are causally related (Krystal, 1968). Survivor guilt is the
typical consequence of the person's difficulty in accounting for his chance survival and other's
harm or death (Krystal, 1968). The experience of survivor guilt becomes all the more
complicated when the person was forced to make unnatural moral decisions about who would live
or die (Krystal, 1968).
People often experience unusual degrees of helplessness during the trauma, an experience
that erodes the normal tendency to view oneself as an effective and esteemed person.
Traumatized people live in fear of recurrence of disaster (Burgess & Holmstrom, 1974;
 70

Janoff-Bulman, 1985; Krystal, 1984) or expect abuse from others (Summit & Kryso, 1978). Their
basic trust in the world is shattered (Lifton, 1968). The most common experience is of
vulnerability and unsafety (Davis & Friedman, 1985). They may overreact to or even
catastrophize everyday hassles. This catastrophizing of everyday life occurs because their
fundamental perception of control over the environment has been destroyed (Kelman, 1945), and
dissonance has been created between the perception of ordinary reality and that of the traumatic
reality (Shatan, 1985). It becomes very difficult, for example, for a survivor of incest experiences
or of a political holocaust to reconcile the previously held perception of a just world with the
extraordinary tragedy to which he has been exposed.
Not all psychological sequelae, however, are negative. Because of the extraordinary
nature of their encounters, survivors of severe trauma can teach fundamental truths about evil,
injustice, human dignity and higher (265)values (Scurfield, 1985). Some gain a rare wisdom and
compassion while suffering and find the strength to endure it in order to tell their story to the
world. However, this outcome, contingent upon healthy recovery, is rare. The more common
psychological outcome is the "conspiracy of silence" characteristic of most post-traumatic
adjustment (Krystal, 1968; Lister, 1982).
The aforementioned symptoms, typical of most prolonged PTSD, represent only part of
the overall domain of post-traumatic sequelae. The list of diagnostic criteria for PTSD in DSM III
(American Psychiatric Association, 1980) is strongly biased toward patients who present intrusive
symptoms (Laufer, Brett, & Gallops, 1984). Many people exposed to trauma manifest a disguised
presentation (Gelinas, 1983). Their only obvious symptoms are chronic low-grade depression,
substance abuse, somatic complaints, and sometimes, when detected, a disturbed dream life.
Horowitz's (1974, 1976) biphasic stress response model conveys more of the scope of the typical
stress symptoms. However, both models fail to account for the more serious consequences of
traumatization, namely, enduring biological and characterological alterations. The DSM III and
Horowitz's accounts of PTSD limit the description of effects largely to the cognitive, affective,
and behavioral spheres. Recent research has shown that the overall domain of traumatic effects
should include at least several additional areas: biological consequences and characterological
effects.
Exposure to extraordinarily stressful stimuli can produce persistent changes in biological
response mechanisms. The organism responds to threatening stimuli with sympathetic arousal.
Chronic repetitive exposure to especially overwhelming stressors can cause a sustained
hypersensitivity to stimuli (Bychowski, 1968). The person is readily prone to startle sensitivity.
He becomes vulnerable to sympathetically mediated increases in heart rate, systolic blood
pressure, and muscle tension and the release of a cascade of humoral agents (norepinephrine,
dopamine, endogenous opioids (Anisman, 1978; Van der Kolk, Boyd, Krystal, & Greenberg,
1984). This enduring "physioneurosis" represents a "presistent defect in the emergency control
system" (Kardiner, 1941, p. 987) in which the organism has become conditioned (Dobbs &
Wilson, 1960; Kolb & Mutalipassi, 1982) to produce sympathetic arousal at slight or no
provocation. Some people remain in a chronic state of sympathetic andrenergic hyperactivity.
Others may also actively seek additional traumatization in order to recreate the heightened sense
of arousal Voluntary sensation seeking, addiction to trauma, and mistreatment are common in
populations of certain severely traumatized people, such as Vietnam veterans (Van der Kolk et
al., 1984).
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For the normally developing child, the formation of the representational world depends on
an average expectable environment (Hartmann, 1958), a (266) "good enough" maternal holding
environment (Winnicott, 1965), and consistent mirroring interactions with the primary caregiver
(Kohut, 1971). Within this context internalization can take place (Meissner, 1981), through which
the child assimilates qualities of the interaction with others and develops a cohesive self and a
matrix of internal representations of others. "Progressive structuralization" occurs (Gedo &
Goldberg, 1973). The maintenance of psychic structure also depends on an average expectable
environment and "holding" (Winnicott, 1965) interactions with others. Certain man-made
traumatic situations, notably wars and holocausts, are circumstances in which neither the
environment is predictable nor people act as human beings ordinarily do. These traumata
represent total destruction of the structures of the world (Lifton, 1968). War and holocaust set the
conditions for psychic destructuralization-a reversal of growth along the normal developmental
lines of self- and object representations and of affect. Regardless of whether the premorbid
personality adjustment was normal or pathological, an unpredictable, severely terrifying, and
dehumanizing environment can precipitate the development of "fluid character pathology"
(Parson, 1984) in previously normal people. In other words, even when the boys who are sent off
to war come home alive and physically healthy, they may come home as very disturbed boys.
Evidence suggests that certain environments may cause character disorders or even psychoses.
Psychotic decompensation and permanent character change were reported, for example, in a
subgroup of Nazi holocaust survivors (Bychowski, 1968; Niederland, 1968; Venzlaff, 1968).
Characterological changes are especially likely to occur when the traumatized person has had the
experience of being made into an object, that is, has been treated in inhuman ways (Krystal,
1968), or finds himself acting in ways that challenge his idealized self-image (Kelman, 1945).
Wars, holocaust, and sometimes other forms of victimization result in a loss of
relationships and transitional modes of relatedness (Fox, 1974; Haley, 1985a). During war and
other chronically life-threatening situations, people tend to form intense narcissistic relationships
with peers and authorities to cope with the fear of annihilation. Because war buddies or fellow
victims of a political holocaust are likely to die, rage reactions and complicated mourning
reactions are quite common (Fox, 1974; Meerloo, 1968). For Vietnam combatants,
disillusionment with commanding officers and with the government and resultant lethal rage
reactions (Fox, 1974), and for holocaust victims severe inhibitions toward aggression and
assertiveness, are all too common experiences.
Persons who have experienced war and holocaust repeatedly bear witness to humans
behaving in nonhuman ways. Watching or participating in murder or repeatedly being the victim
of torture or starvation has a profound impact on the ongoing development of the representational
(267)
world. A person may internalize a killer-self after being given permission to kill during a war
(Brende, 1984; Parson, 1984) or a victim-self after exposure to traumatization (Krystal, 1968;
Parson, 1984). During the traumatic episode he may experience primitivization of group
relationships, in which he is reduced to a mindless member of a primal horde in a regressed
combat unit or may become a blind and ruthless perpetrator of atrocities on his own people in a
holocaust camp (Meerloo, 1968). Where the person is exposed to daily life threats, as in guerrilla
warfare or a holocaust camp, death itself is introjected. Identification with death is a common
reaction in such instances, a presence that colors everyday experience (Niederland, 1968; Shatan,
 72

1973). Pathological introjects such as these tend to become split off from the conscious matrix of
representations and maintain a quasi-autonomous existence. Such splitting interferes with the
overall integration of the psyche. Furthermore, certain life events can reactivate these introjects
years later. The person may find himself repeatedly acting out the victim role in relationships or
lapsing into a dissociative state, in which he assaults another.
A chronically unpredictable and dehumanizing environment disrupts the process of
self-development. Arrested self-development (Parson, 1984) can take many forms: identity
diffusion (Parson, 1984), lesions in the selfconcept (Buchenholz & Frank, 1949),
depersonalization (Jacobson, 1971), fragmentation of the self (Parson, 1984); impaired autonomy
(Brende, 1984), and alteration in the structure and content of the self-representations (Parson,
1984).
One of the most common results of dehumanizing traumatizationswhether rape or
holocaust-is the experience of the self-as-object (Parson, 1984). As repeated experience of the
self-as-object becomes assimilated into the self-representation, the individual undergoes a number
of personality changes: increased emotional detachment (Lifton, 1968), chronic passivity
(Krystal, 1968; Morrier, 1984), severe impairment of healthy competitive strivings (Krystal,
1968), inhibition of intellectual pursuits, restriction in the range of life activities (Krystal, 1968;
Kilpatrick, 1985), impaired attachment behavior (Krystal, 1968; Parson, 1984), and impaired
self-care (Krystal, 1968, 1984).
Chronic exposure to life-threatening events may precipitate the formation of pathological
self-representations, such as the "slave self" in holocaust survivors (Krystal, 1968) or
identification with death in the life of Hiroshima survivors (Lifton, 1968). Another is the illusion
of invulnerability (Parson, 1984). Combatants are sometimes observed to develop defensive
grandiosity. They unrealistically believe that they cannot be harmed by the enemy and
unwittingly put themselves in extreme danger.
Traumatization that occurs during childhood may result in a premature acceleration of
development. A common pattern associated with (268) childhood incest is parentification, in
which the incest victim is selected to bear the roles and functions of the parents in numerous
ways. Parentification interferes with the spontaneous use of childhood play, which is important in
the development of self. Another common consequence of childhood trauma is role confusion
within the family. Traumatization during adolescence may cause arrested adolescent development
(Haley, 1985b; Krystal, 1968). When it occurs during adulthood, the individual may, in an effort
to restore continuity to self-experience, resort to overidealization of his life history prior to
traumatization (Futterman & Pumpian-Midlin, 1951). The overall result of severe traumatization
is an arrest in the development of the self, a reversal in the development of the self, or
pathological selfdevelopment.
Repeated exposure to unpredictable and dehumanizing traumatic situations may impair
affective development and drive regulation. For example, the systematic challenge to social
inhibitions against the expression of aggression encountered, in basic training, followed by the
permission to release rampant aggression during active combat, may significantly alter the
otherwise normal regulation of aggressive impulses in soldiers. A typical consequence of war
experience is chronic irritability (Kardiner, 1941; Kolb & Mutalipassi, 1982), and where
homecoming ceremonies designed to resocialize the returning veteran fail, as they have with
Vietnam veterans, an enduring outcome may be vulnerability to episodic violent outbursts and
 73

sadistic behaviors (Fox, 1974; Krystal, 1968, 1984). In the extreme situation where the normal
expression of aggression is repeatedly suppressed, as in a Nazi holocaust camp, the long-term
outcome for the survivor may also be "chronic reactive aggression" (Hoppe, 1962). Whenever the
traumatizing environment repeatedly forces extreme inhibition or release of aggression, the
impairment to the normal regulation of aggression may long outlast the traumatic situation.
Similarly, repeated traumatization may interfere with the normal regulation of sexual
impulses. The overstimulation of a child by incest or molestation may result in a condition of
sexual hyperarousal and a sexualization of behavior. If the child is not treated, this disregulation
of sexual functioning may persist into adulthood and take the form of either hypersexuality or
extreme inhibition of sexual desire (Burgess & Holstrom, 1974; Donaldson & Gardner, 1985;
Gelinas, 1983). Sexual dysfunction as a consequence of exposure to a terror-ridden environment
has also been reported for a subgroup of adult Vietnam veterans (Figley, 1978) and for holocaust
survivors (Krystal, 1968).
The overall domain of post-traumatic sequelae includes cognitive, affective, and
behavioral symptoms and also enduring biological and characterological effects. It is useful to
distinguish between simple PTSD and complicated PTSD. Simple PTSD is based on the principle
of cognitive
(268) processing of the traumatic experience. The typical cognitive, affective, and behavioral
symptoms of simple PTSD are time limited. When normal cognitive processing of the traumatic
experience is blocked, simple PTSD symptoms sometimes are either prolonged or delayed.
Nevertheless, simple PTSD rests on the assumption that resolution can occur if the conditions are
established that facilitate processing of the event. Complicated PTSD, or post-traumatic decline
(Titchener & Knapp, 1978), rests on a different assumption, namely, that resolution is impaired
so that even where cognitive processing of the trauma is not blocked, recovery does not
necessarily occur. In complicated PTSD, enduring and perhaps irreversible changes have
occurred in the regulation of the autonomic nervous system and of impulse control, and in the
structuralization of the ego. Recovery from complicated PTSD is possible only in the context of a
longterm therapeutic relationship where internalization takes place.
We are gaining increasing understanding of the conditions that contribute to the
development of both prolonged or delayed PTSD, on the one hand, and complicated PTSD, on
the other hand. These factors are summarized in Table 8.2. According to Horowitz (1974), the
extent of the symptoms is a function of the intensity and duration of the traumatic situation. We
define the intensity of a traumatic situation by the degree of disorganization it causes the
individual in any area(s) of his life. Traumatization may occur when there is displacement from a
familiar place to an entirely new and unpredictable or terror-ridden environment (Gieser, Green,
& Winget, 1981; Parson, 1984), such as the environment of guerrilla warfare of Vietnam, the
Nazis' disrupting ordinary life and displacing the Jews to death camps, or the total destruction of
the known "world" in Hiroshima (Lifton, 1968). Traumatization may also involve the complete
breakup of a known community, a fact well-documented in the 1972 Buffalo Creek dam disaster
(Erikson, 1976; GIeser et al., 1981; Newman, 1976), or the loss of cultural belief systems, as in
POW and brainwashing experience (Lifton, 1961).
Certain types of traumatic situations also disrupt normal social relationships. A common
contributor to acute PTSD symptoms is the loss of wartime buddies (Haley, 1985a). In some
wars, like Vietnam, the intentional discouragement of a wartime buddy system and the
 74

consequent extreme isolation of combatants were significant factors in the prevalence of delayed
PTSD (Laufer et al., 1984). In fact, the severity of symptoms is directly related to the extent to
which loss is experienced (Lindy, Grace, & Green, 1984; Wilson, Smith, & Johnson, 1985).
Clinical research on PTSD strongly suggests that social support and the response of the people in
the recovery environment are key factors in recovery (Burgess & Holmstrom, 1976; Figley, 1978;
Green et al., 1985; Haley, 1985b; Janoff-Bulman, 1985; Lindy et al., 1984; Scurfield, 1985).
More pervasive is the loss of normal (270) social supports, which occurred in the Nazi and
Cambodian holocausts, with the systematic decimation of entire families. The Nazi and
Cambodian holocausts, Hiroshima, and Vietnam stand out as the greatest incidences of delayed
and complicated PTSD, it seems to us, because each situation caused extreme disorganization in
every sphere-environmental, communal, and social.
[TABLE 8.2: Factors Contributing to Complicated PTSD:
I. Intensity of Trauma
A. Degree of disorganization of: environment
community
cultural belief systems social supports
B. Meaning
natural vs. human disaster
degree of moral conflict
II. Duration
Ill. Speed of onset of trauma; coping during traumatization IV. Frequency (cumulative trauma)
V. Developmental time
VI. Coping style
A. Availability of coping strategies
B. Degree of perceived control
C. Agency/role during traumatization
VII. Exposure to death, destructiveness, and atrocity
A. Threat to life; fear of bodily injury
B. Exposure to atrocity and abusive violence
C. Extent of dehumanization (271)]
Others have attempted to define the intensity of a traumatic situation in terms of the
idiosyncratic meaning or appraisal given to the situation by the individual (Green et al., 1985).
Speed of onset, duration, and frequency also affect the seriousness of the symptoms. The
person who is suddenly exposed to a traumatic situation without time to prepare is more likely to
manifest symptoms than someone who is able to predict and therefore mentally prepare for
possible tragedy (Wilson et al., 1985). The duration of traumatization is also significant. For
example, length of combat exposure alone correlates significantly with severity of PTSD
symptoms (DeFazio, Rustin, & Diamond, 1975; Laufer et aI., 1984). Whereas most disastrous
events are time limited, some people (e.g., soldiers) exposed to repeated trauma develop a virtual
(271) trauma career (DeFazio et al., 1975; Wilson et al., 1985). Frequent trauma is cumulative
and is more damaging than a single traumatic experience (Khan, 1963; Laufer, Frey-Wouters, &
Gallops, 1985; Niederland, 1968; Scurfield, 1985; Wilson et al., 1985). Living with the constant
threat of a "potential for recurrence" (Wilson et al., 1985) may be as harmful as an actual
occurrence. The effects of real or potential cumulative incest or child abuse illustrate this point.
 75

A strong predictor of the severity of PTSD is the developmental stage at which

traumatization occurs. More pervasive cognitive, affective, behavioral, and characterological
changes are likely to occur when a person is traumatized during the formative years and when the
individual is in the midst of a normal developmental transition. For example, incest is more
damaging to characterological and cognitive development in younger than in older children
(Pynoos & Eth, 1985). Sending troops off to war during the normal phase of adolescent identity
formation contributes to complicated PTSD reactions, for example, arrested development of the
self and identity consolidation (Haley, 1985b; Wilson et al., 1985).
One's style of coping with trauma bears a significant relationship to the manifestation of
PTSD. The availability of coping resources and the degree of perceived control determine the
extent to which the traumatic situation is or is not processed. One's role at the time of the
traumatic event also plays a part. For example, some of the most severe sufferers of PTSD are
those required to playa passive role in the face of extreme exposure to grotesque bodily damage
as in the case of body counters during natural disasters and war, and POWs who endure torture
passively. The degree of moral conflict inherent in the situation, for example, deciding the life
and death of others, also predicts complicated PTSD (Haley, 1985b; Wilson et al., 1985).
Numerous studies have shown that the severity of symptoms is a function of the degree of
threat to life and fear of bodily injury (Adler, 1943; Lindy, et al., 1984; Wilson, et al., 1985).
Exposure to grotesque bodily damage, as in the case of jobs requiring repeated contact with death
(e.g., grave registration, medical combat evacuation, body counting, and bagging), greatly
increases the likelihood of complicated PTSD (Laufer et al., 1984; Taylor & Frazer, 1982). The
single, most important predictor of complicated PTSD, however, is exposure to abusive violence
or atrocity (Haley, 1985b; Foy, Sipprelle, Rueger, & Carroll, 1984; Laufer et al., 1985; Strayer &
Ellenhorn, 1975). The extent of dehumanization entailed in the passive witnessing of or active
participation in atrocity completely reverses the normal conditions of holding and mirroring
relationships required for the maintenance of structuralization of the ego. Atrocity stands out as
the primary risk factor for complicated PTSD. (272)
Traditional hypnotherapeutic treatment of PTSD is based on abreaction. Hypnotic
abreaction has a long history. It was pioneered in the 1870s by Janet (1925) and in the 1880s by
Breuer and Freud (1983) for the treatment of hysteria. It was used to some degree in the treatment
of" shell shock" victims in World War I (Brown, 1920) and to a much greater extent in the
treatment of "war neurosis" in World War II (Buchenholz & Frank, 1949; Fisher, 1943; Grinker
& Spiegel, 1945; Kubie, 1943a; Leahy & Martin, 1967; Silver & Kelly, 1985; Simmel, 1944;
Watkins, 1949; Wolberg, 1948) as well as the PTSD of Vietnam veterans (Balson & Dempster,
1980). Abreaction assumes an hydraulic model of the personality. According to this model, the
symptoms of PTSD are believed to be a consequence of repressed emotions. The goal of
treatment is therefore to facilitate free expression of pent-up emotions. Watkins (1949), for
example, likened hypnotic abreacation to lancing a boil. A related goal is the recovery of
amnestic material or memory reconstruction. Hypnosis is used to gain access to the repressed
emotions and to allow the patient to re-enact the traumatic situation(s). Often the traumatic events
must be "relived" a number of times in trance before resolution is achieved.
Although hypnotic abreaction may be of limited use in certain cases of acute stress
symptoms, we do not recommend this treatment; in particular, we do not recommend that the
therapist intentionally encourage dramatic emotional expression. Since PTSD is characterized by
 76

an alternation between denial and intrusion, the hypnotherapist who encourages emotional
expression is increasing the patient's risk for intrusive experiences. The patient may become
overwhelmed or fear being overwhelmed and may terminate treatment prematurely. Since most
PTSD patients fear loss of control, the therapist's encouragement of emotional displays merely
intensifies that fear and does not facilitate working through of the trauma. In the transference, the
therapist is seen as trying to retraumatize or otherwise inflict pain on the patient. The prevalence
of negative therapeutic reactions is extremely high in abreactive hypnotherapy of PTSD (Spiegel,
1981). There are more failures in the treatment of PTSD than in many other therapy areas
(Kelman, 1945), mainly when the abreactive model is employed in the treatment of complicated
PTSD.
We strongly agree with Horowitz (1973) that the primary emphasis of the treatment
should be integration, not emotional expression. Facilitation of conscious emotional experience
(something different from emotional expression) is useful at a certain phase of the treatment, but
emotional experience must be regulated so that the patient can handle the disavowed affects
(Buchenholz & Frank, 1949; Horowitz, 1973; Lindy et aI., 1984). More recent hypnotherapeutic
treatment of PTSD has tended to emphasize progressive uncovering, working through, and
integration, which (273) enable the patient to gain a sense of control over the intrusive
experiences while he completes cognitive processing of the trauma (Brende & Benedict, 1980;
Silver & Kelly, 1985; Spiegel, 1981).
Treatment begins with a careful assessment of the nature of the PTSD.
Because PTSD patients present with either denial or intrusive symptoms, they are easiest
to diagnose during the intrusive phase of the illness. In fact, if strict DSM III (American
Psychiatric Association, 1980) criteria are used, a definitive diagnosis of PTSD is possible only
during the intrusive phase. However, it is easy to miss a diagnosis of PTSD when the patient is in
the denial phase. Many patients manifest disguised PTSD. Because PTSD patients may be
amnestic for significant portions of their personal history, the clinician may fail to detect
evidence of trauma when taking the history.
Hypnosis can be a useful diagnostic tool for cases of disguised PTSD. Patients with
disguised PTSD often have unusual reactions to the initial hypnotic experience. Sometimes when
the patient is first hypnotized, the traumatic memories dramatically intrude into consciousness, as
if the patient were re-enacting the trauma with its full emotional intensity. Patient and therapist
alike may be surprised by the appearance in consciousness of the previously forgotten trauma.
Sometimes the patient does not remember the trauma but experiences a generalized anxiety upon
being hypnotized-the ideational content of the trauma has been defensively dissociated from the
affect connected with the trauma. In either case, the patient experiences very intense affect in the
first hypnotic sessions before developing any sense of control over the hypnotic experience. He is
likely to become frightened of hypnosis and may avoid future hypnotic experiences.
Sometimes the patient is able to ward off intrusion of the traumatic experience into
consciousness by suppressing hypnotic ability. While some therapists have observed no
difference between the hypnotizability of normals and that of PTSD patients (Spiegel, 1981),
others claim PTSD patients are more hypnotizable than normals (Brown, 1920) because of the
shared elements of dissociation in both PTSD and hypnosis. We have observed that, at least for a
subgroup of disguised PTSD patients, hypnotizability is suppressed. These patients initially
appear to be poorly hypnotizable and become increasingly restless during the hypnotic induction.
 77

However, once the trauma has been identified and partially integrated into waking consciousness,
they show dramatic improvements in hypnotizability. The extremes of very poor hypnotic
responsiveness and agitation, on the one hand, and very quick response with the sudden
emergence of intense affect or traumatic re-enactment, on the other hand, during initial hypnotic
experiences are often diagnostic of disguised PTSD. To prevent the patient from developing a
negative attitude toward (274) hypnosis, or having a harmful experience with hypnosis, it is
important in such cases to delay the use of hypnosis in favor of waking imagery. The therapist
helps the patient to understand the untoward reaction to hypnosis as an example of PTSD
symptomatology.
The primary goal of treating simple PTSD is to facilitate normal cognitive/affective
processing of the trauma so the patient can recover (Horowitz, 1973). The treatment is phase
oriented. The therapist helps to establish the conditions under which to reconstruct the traumatic
events and make sense out of the experience. The working through process is gradual. In the first
phase the therapeutic work is conducted in the waking state. It begins with a discussion of the
patient's current symptoms. An occasional patient may during the interview recall all or part of
the traumatic situation so that hypnosis is unnecessary (Futterman & Pumpian-Mindlin, 1951). In
such a case the patient continues to rework the traumatic experience in the waking state until the
symptoms subside.
In most other cases, hypnosis is introduced first as a means of relaxation. The therapist
intentionally builds in a delay to intrusive recall by telling the patient explicitly that hypnosis will
not be used at this point to recover the events of the trauma. Waves of relaxation and relaxing
imagery are then introduced. The patient is encouraged to use self-hypnosis to generate a relaxed
state whenever he is tense or uncomfortable. U ncovering the memories and affects associated
with the trauma is approached indirectly with hypnosis. Guided imagery is introduced. The
therapist avoids suggesting scenes in any way associated with the trauma. The patient is
encouraged to allow the seemingly neutral imagery to emerge spontaneously. The sequence of
images that unfolds over one or more sessions usually occurs as a series of representations of the
trauma in progressively less and less disguised symbolic forms. Guided imagery eases the patient
into cognitive/affective processing of the trauma at the symbolic level. Gradually the patient
achieves partial recovery of the traumatic memories and some conscious memory or
re-experiencing of the affects associated with the trauma. Emphasis is given to waking integration
of the partially recalled experience. Other indirect hypnoprojective techniques are used, such as
cloud gazing and anagrams.
As the patient begins to make sense of the experience and the symptompicture stabilizes,
the therapist approaches uncovering more directly. Now each hypnotic session can begin with
guided imagery. The therapist looks for those aspects of the imagery experience associated with
anxiety or other salient affects. Then the therapist amplifies the affects and uses the Affect Bridge
Method to explore earlier times when the patient felt much the same way. Further aspects of the
traumatic situation reveal themselves. Emphasis is again on waking integration of having
experienced the trauma. The experience is reworked a number of times until the (274) cognitive/
affective processing approaches completion and the PTSD symptoms fully disappear. In some
cases, such as those involving mugging, this can be done in five sessions.
The goals of treating complicated PTSD are multiple. Treatment is designed to correct the
dual pathology, that is, both the cognitive/affective symptoms and the enduring characterological
 78

(and sometimes biological) changes. Treatment occurs in stages (Brende, 1984; Parson, 1984;
Scurfield, 1985).
The goals are:
(a) stabilization of the symptom-picture; in order to
(b) facilitate cognitive/affective processing of the trauma; and
(c) facilitate structuralization, correcting the damage to self-development and of object
representations, and the integration of drives; a further goal is
(d) to reduce the biological vulnerability to stress response. When treating complicated PTSD, it
is necessary to adopt a stage-model of treatment. Table 8.3 summarizes the five stages we have
identified in the treatment of complicated PTSD.
The first goal of treatment is to assist the patient in stabilization (Brende, 1984; Parson,
1984). Patients who do not have a disguised form of PTSD are vulnerable to disruptive intrusive
experiences-overwhelming affective storms, eruption of intrusive memories, flashbacks and
disturbed dreaming, somatization, and the compulsion to repeat the trauma in everyday behavior.
Surprising as it may seem, these patients, although aware of the trauma, seldom associate the
symptoms with the experience of a past trauma. The therapist must educate the patient about the
nature of the recovery process from stress (Scurfield, 1985). According to Leventhal and Everhart
(1979), anxiety is a function of inefficient information-processing. In some patients, anxiety
greatly diminishes when they are provided with accurate information regarding the nature of their
symptoms.
Hence, disaster victims are given a description of the typical PTSD symptoms and are told
that such a traumatic event would produce similar symptoms in anyone. The therapist openly
discusses the typical psychological consequences of PTSD-shattered illusion of invulnerability,
loss of control over everyday events. The patient is encouraged to read about the traumatic events
and about others' typical reactions to these events. For example, patients read the popular and
professional literature about the Vietnam war, adult rape, and so forth. Tne aim is to provide the
patient with a conceptual framework for his symptoms, with the hope of alleviating anxiety.
Beyond patient education, the first therapeutic interventions are directed toward the
manifest symptoms themselves. Patients are taught to keep a daily record of typical
symptoms-anxiety attacks, somatic reactions, nightmares, and the like. Patients discover the
impact of these symptoms on their everyday lives. They also develop a repertoire of coping (276)
strategies. The therapist assesses the patient's typical means of coping with these symptoms,
reinforcing the patient's most effective coping strategies and helping the patient devise new
coping strategies. A concrete problem-solving approach is used, or what has been called
"limitedobjective therapy" (Tanay, 1968). The patient is also taught some means of relaxation,
which may entail progressive muscle relaxation (Brende, 1984; Brooks & Scarano, 1982; Keane,
Fairbank, Caddell, Zimmering, & Bender, 1985) or self-hypnosis. A regular program of exercise
may also be introduced. Where the patient fails to stabilize, pharmacological interventions may
be indicated (Kolb, Burris, Cullen, & Griffiths, 1984; Van der Kolk, et aI., 1984). Every attempt
is made to give the patient a sense of control over his symptoms and restore his sense of
confidence. The treatment model used at this stage is a combination of behavioral stress
management and supportive therapy, sometimes together with pharmacotherapy.
[TABLE 8.3 Stages of Treatment of Complicated PTSD
Disguised Presentation:
 79

1. Stabilization of symptoms
Nonhypnotic Methods:
Patient education Self-monitoring of symptoms
Learning coping strategies
Stress management
Pharmacotherapy
Supportive therapy
Group therapy
Establishing a therapeutic alliance
Hypnotic Methods
Hypnodynamic therapy is contraindicated during this phase
Exploration of coping strategies
Hypnotic and Self-hypnotic relaxation
Ego-strengthening
II. Integration
A. Controlled uncovering
Nonhypnotic Methods:
Supportive therapy
Hypnotic Methods
Protective and soothing imagery
Transitional imagery
Waking guided imagery
B. Integrating introjects
Nonhypnotic Methods:
Transference work
Hypnotic Methods
Symbolic working through with:
Guided imagery
Hypnoprojective methods
Dissociation of observing and experiencing ego
Suggested partial amnesia
Affect amplifications and attenuation
Age regression
Suggested hypermnesia
III. Development of self
Nonhypnotic Methods:
Playful exploration
Autonomous pursuit of new interests/activities
Self-object transference
Reassigning responsibility for the traumatic event(s)
Differentiation of values
Hypnotic Methods
Hypnotic imagery
Age regression
 80

Ego state therapy

Rehearsal in fantasy of new
interests/activities
IV. Drive integration
Nonhypnotic Methods:
Neurotic Transference
Adjunctive Assertiveness training or sex therapy
Hypnotic Methods
Working through body image distortions
Ideal self transference
Ego-strengthening
V. Enduring biological sensitivity
Nonhypnotic Methods:
Pharmacotherapy
Learned psychophysiological
control (biofeedback)
Hypnotic Methods
Hypnodynamic uncovering (277)]
Providing the patient with concrete tools to stabilize his symptoms is the first major step
in establishing a working therapeutic relationship based on trust (Haley, 1974). Because trust in
the world has been shattered for the PTSD patient, it is especially important for the therapist to
provide a tangible basis for this trust. Over the weeks, months, or sometimes years it take the
patient to stabilize, the patient is beginning to internalize a good object relationship. Because
PTSD patients experience isolation from others, it is advisable, whenever possible, to encourage
them to attend a survivors' group, such as a Vietnam rap group (Brende, 1984; Shatan, 1973) or
an incest survivors' group (Herman & Schatzow, 1984). Group therapy provides a sense of
community; it enables patients to overcome feelings of stigma by encountering others with
equally extraordinary experiences. In the accepting environment of the group, members work
together to understand the impact of traumatization (Scurfield, 1985).
Hypnosis is used with great caution during the stabilization phase, if it is used at all. An
uncovering approach in hypnotherapy and certain other nonhypnotic methods, such as implosion
therapy, are contraindicated because any method that facilitates uncovering at an early phase can
lead to further disorganization (Van der Kolk et al., 1984). If the patient persistently
re-experiences intrusions, hypnosis is to be avoided altogether at this stage in favor of waking
therapy.
Otherwise, hypnosis can be used in a limited way as an adjunct to supportive therapy. One
use of hypnosis is to facilitate the exploration of coping strategies for symptoms. Another
involves teaching the patient a skill in self-hypnotic relaxation (Brende & Benedict, 1980). Still
another involves the repeated use of ego-strengthening suggestions to enable the patient to
increase his sense of control and restore lost confidence (Silver & Kelly, 1985). If hypnosis is
used, the therapist must be alert to the (278) potential for recurrence of disruptive intrusive
experiences. Hypnosis is not always indicated at the early stage of treatment of complicated
PTSD. Patients sometimes communicate this to the therapist by declining to use or continue with
hypnosis at some point early in the work.
 81

The second phase of the treatment, after stabilization, is the uncovering phase.
The decision to initiate uncovering is based on
(a) some alleviation of certain PTSD symptoms, for example, anxiety;
(b) restoration of a modicum of control and confidence;
(c) return of interest in hypnosis; and
(d) spontaneous return of memories and affects associated with the traumatic event. Sometimes
several years of nonhypnotic therapy are required to achieve stabilization.
Furthermore, uncovering does not happen all at once. It occurs as a progression in which
the patient is exposed to varying "doses" of disavowed affects and memories as he is able to
process and integrate them into conscious experience (Horowitz, 1973; Lindy et aI., 1984).
Fluctuations are characteristic of the unfolding treatment. The patient uncovers a bit and steps
back to process it. This stepping back should not be construed as resistance but as an adaptive
attempt to further the processing. The patient uncovers some material in hypnosis and then takes
a number of sessions of waking therapy to assimilate it before returning to hypnotic uncovering.
Weeks, months, and sometimes years pass before the patient returns to hypnotic uncovering. The
therapist must accept this as the natural course of therapy with complicated PTSD patients. Each
episode of uncovering is a partial recall. The overall uncovering phase entails a continuous
working and reworking of the partially recalled material until the entirety of the disavowed
experience can be integrated into ongoing everyday life. Some clinicians have described the
uncovering process as a type of "controlled regression" (Brende, 1984; Spiegel, 1981). Hypnosis
offers an advantage over narcotherapy by permitting finer control over the uncovering process
than is possible with drugs (Silver & Kelly, 1985). The therapist is advised to use hypnosis only
for a part of each therapy session and to allow ample time for waking integration. He may also
alternate between short periods of trance and waking therapy a number of times in the same
session and over a number of sessions. Further, some patients, especially Vietnam veterans who
were "conditioned" to be hypervigilant, prefer open-eyed trance experiences.
Uncovering therapy begins with a preparatory period during which the therapist teaches
the patient how to use hypnosis safely. First, hypnosis is used to explore protective and soothing
imagery. The patient is told to imagine a place where he feels especially safe and protected. A
series of such scenes is explored. The patient is encouraged to generate and enjoy safe and
protected scenes in daily self-hypnotic practice until he develops skill at quickly generating a
variety of soothing experiences. The Vietnam (278) veteran might imagine a special "hootch,"
safe from mines and sniper fire; the incest victim might imagine a safe room or a small island that
no one has access to. The safe place is subsequently used for the induction of hypnosis. This Safe
Place Induction symbolically conveys to the patient that hypnosis can be a safe, not a frightening,
experience.
Transitional imagery is also used. The hypnotized patient imagines scenes with people
who can be trusted. Images of war buddies, fellow survivors, friends, and therapists typically are
reported. Sometimes pets and god-imagery are reported. The use of transitional objects is
encouraged. For example, patients may use personal journals as a kind of transitional object.
They are instructed to write their experience in a journal when they experience anxiety. The
journal is a concrete representation of the continuity of personal experience throughout the
symptomatic period.
With patients who are vulnerable to disruptive intrusions, the therapist proceeds slowly
 82

and cautiously. The therapist should not proceed with controlled uncovering until a repertoire of
safe imagery is clearly established. The best approach is indirect, with the therapist using guided
imagery not directly associated with the traumatic event. The imagery is allowed to unfold
spontaneously over a number of sessions as the aspects of the trauma are slowly revealed and
accepted into consciousness. By helping the patient first to work through the traumatic
experience(s) on a symbolic level, the hypnotherapist (respectfully) works with the defenses but
does not challenge or pierce them too early. If the patient becomes symptomatic, the therapist
returns to waking, nonhypnotic imagery, which allows less precipitous access to repressed
material than hypnotic imagery. With patients with complicated PTSD it is not uncommon to
conduct months of therapy without hypnosis but with guided waking imagery. Hypnosis is
reintroduced as the symptoms diminish or when the patient once again requests it.
Hypnoprojective methods such as the Theatre and Television Techniques are also quite
useful. The therapist suggests that the patient see a safe and protected scene on television or a
stage. Then the therapist suggests that the patient see "something that he is ready to understand
about the trauma" on another channel. Spiegel (1981) recommends envisioning a split screen in
which the traumatic scene is viewed on one side and a scene involving something the patient can
do to protect himself on the other side. Silver and Kelly (1985) suggest an imaginary videotape
with which the therapist can suggest stopping the action or instantly replaying a part of the scene.
In any event, the use of an hallucinated television, theatre, or videotape allows the patient to
experience aspects of the trauma at a distance.
We also suggest that the patient use an hallucinated remote control (280) device to
regulate the volume of the television and turn the channels. The patient is told that he can turn to
the safety and protection channel whenever he wishes. He also is told that by turning the volume
dial of the control device up or down he can regulate the intensity of emotions associated with the
trauma as needed. Thus he learns to control the intensity of emotional experience. Sometimes
patients develop images and other signals to assess the intensity of the affects and warn of the
possibility of becoming overwhelmed: a meter with an arrow that can move from a safety zone to
a warning zone, an ideomotor signal (a designated finger that lifts automatically just before the
experience cannot be tolerated), a protected vehicle that transports the patient to the traumatic
scene and returns to a safe sanctuary as needed.
Dissociating the observing from the experiencing ego is standard procedure with PTSD
patients. The observing part of the ego is asked to remain calm and attentive while the
experiencing part relives certain aspects of the traumatic situation. The hypnotherapist can
carefully regulate the degree of dissociation in the service of uncovering and of integration. He
may suggest greater dissociation when the material has the potential of becoming overwhelming.
As the patient demonstrates ability to cope with the material, the therapist may suggest remerging
of these two facets of the ego to facilitate integration.
Another means of regulating the uncovering process is the use of suggestions for
posthypnotic amnesia. With PTSD patients it is absolutely necessary to close each hypnotic
session with the suggestion, "You'll remember only what you are ready to remember" or "You
will come to understand this over time as you are ready to understand it." Suggestions for partial
posthypnotic amnesia can be balanced against suggestions for insight, such as, "You will come to
understand the implications of these events for the meaning and course of your life."
PTSD patients go through periods during the uncovering and the integration phases in
 83

which defenses are strong. They may report a paucity of associations, lack of fantasy productions,
or inability to remember anything. There may be a distinct lack of affect. Depression and
somatization may predominate during these periods. When these episodes occur, the therapist
places greater emphasis on uncovering techniques, while not losing sight of the protective
procedures employed throughout the therapeutic work. When working with guided imagery, for
example, the therapist employs suggestions to amplify the emerging affects and then uses the
Affect Bridge Technique to trace these affects back to the traumatic situation(s). Age regression
can be introduced for direct recovery of aspects of the traumatic experience. Systematic age
regressions to different developmental periods preceding, during, and following the (281)
traumatization(s) reinforce the sense of continuity disrupted by traumatization and also situate the
trauma within the context of the overall life development of the patient.
When resistances are encountered, direct suggestions for hypermnesia are sometimes
used, but with caution. Kolk and Mutalipassi (1982), working with narcotherapy, suggest using
external stimuli to trigger the memory of the trauma, for example, the sound track of a battle for a
wartraumatized patient. When the patient responds to uncovering with increased somatization, the
therapist works more vigorously with imagery to help facilitate rechannelling of the conflictual
affect away from the physiological processes and into fantasy productions. Each step toward
uncovering is followed by additional integrative work.
`Sometime during the uncovering process, specific split-off introjects become activated,
such as a "killer-self, an immortal self, a bad self or a victim self" (Brende, 1984; Parson, 1984).
These usually represent aspects of the traumatic situation that resonate with sadomasochistic
impulses and contribute to the formation of new pathological representations in which the
sadomasochistic impulses find an outlet. These impulses are not acceptable by conscious moral
standards. The introjects are split off from conscious experience and typically remain inactive
(except during flashbacks) at the expense of psychic integration. During the uncovering process,
these introjects become activated. The veteran of a guerrilla war, for example, discovers the
excitement and pleasure experienced during violent acts (Shatan, 1973). The task of the therapist
is to help the patient integrate these dissociated aspects of the self (Brende & Benedict, 1980),
while minimizing the potential acting out and somatization, which are high when the dissociated
introjects become activated.
Hypnosis helps the patient gain access to these experiences and integrate them into the
overall self-concept. Sometimes these introjects become activated spontaneously during guided
imagery or during age regression. In such cases the therapist helps the patient accept and make
sense out of these impulse derivatives in the overall context of the traumatic situation. Sometimes
the therapist can intentionally direct the patient toward dissociated aspects of the self with ego
state therapy. The therapist suggests, for example, that the aspect the patient associated with, say,
the killing or badness should now speak. To facilitate integration, it is sometimes advisable for
the patient to visualize the different aspects of the self coming together into a whole self.
The overall course of the uncovering phase of therapy is characterized by seemingly
alternating forward and backward movement. It is not unusual for complicated PTSD patients to
go through periods of intensification of symptoms (somatization, acting out, depression,
substance abuse). They may be unable to produce any fantasy or affect, or they refuse (282)
outright to use hypnosis. The therapist who anticipates these periods as part of the typical course
of working through complicated traumatization is less likely to become impatient. The traumatic
 84

memories, affects, and dissociated self-experiences must be continuously worked and reworked.
Often the patient and the therapist together discover "layers" of traumatic events. Those that
involve loss and grief become manifest early (Shatan, 1973; Spiegel, 1981); those involving
threat to life or bodily harm, next; and those that involve moral conflicts, such as participation in
atrocity or decisions about the life and death of others, manifest much later (Haley, 1985b).
A number of signs indicate when the uncovering process has reached completion.
Symptoms diminish consistently. The emergence of new memories and fantasy productions
associated with traumatic situations wind down. Sleep and dream life stabilize. Nightmares cease.
Depression lifts. Many patients perceive themselves as "better" at this stage, and a number,
unfortunately, terminate therapy.
The next phase of the therapy facilitates development of the self, which was arrested by
the traumatization, and the integration of the traumatic events as a fact of one's life. The
adolescent traumatized by war duty is not likely to have completed the normal process of identity
formation (Haley, 1985b). The victim of childhood incest probably missed out on the normal
playful explorations of childhood due to parentification (Gelinas, 1983). This phase of therapy if
characterized by a playful therapeutic atmosphere in the context of which the patient explores
dimensions of the self that were heretofore inhibited or kept private (Khan, 1963). In hypnosis the
patient unleashes a wealth of fantasy productions not associated with the trauma and in daily life
engages-albeit tentatively at first-in new activities. The therapist employs hypnotic imagery to
help the patient discover new interests and activities. One goal is to help the patient overcome his
restricted life style by actually engaging in new intersts and through them to achieve more
pleasure as well as greater autonomy (Brende, 1984). Another goal is to help the patient become
less passive, more healthily assertive with others with regard to his needs, or more sociable.
Hypnotic rehearsal in fantasy and posthypnotic reinforcement of participation in new activities
are the standard tools of this phase of treatment. For incest survivors, working through negative
attitudes toward the body and correcting distortions in the body image may be indicated (Freytag,
1965). We also recommend the Ideal Self Technique for exploring new dimensions of the self.
It is especially important that the therapist function as an effective self-object (Kohut,
1971) for the patient during this phase of treatment. To provide the patient with an emotionally
corrective experience, the therapist must show active support in and realistic praise for the
patient's (283) discoveries and accomplishments. The therapist must also be willing to participate
in the playfulness of the relationship. Most of self-development is achieved not by specific
hypnotic techniques, but through the quality of the relationship between the patient and the
therapist. This is not to minimize the contribution of hypnosis. Ego strengthening suggestions, for
example, should be used routinely at this stage of the therapy (Silver & Kelly, 1985).
During this phase patients begin to experience themselves and the traumatic events in a
new way. They undergo a process by which they reevaluate responsibility during the trauma. As
they explore their own values and self-ideals, they achieve greater differentiation from the values
(and lack of values) of those who participated in the traumatic event. Incest survivors lose their
sense of badness. They may develop a conviction that the parent failed in responsibility as a
parent, or they may come to see the wider context of the incest as a manifestation of family
pathology or the repetition of transgenerational abuse. Vietnam veterans who participated in
atrocities may come to view themselves as "dumb kids" who could not have been expected to
challenge authority. They may come to hold the commanding officers and the government
 85

responsible (Haley, 1985b). The therapist helps the patient examine the total context of the
decision making associated with the traumatic event (Silver & Kelly, 1985). As a consequence of
the working through process, it is not uncommon for PTSD patients to show increased interest in
political action and social advocacy during this phase of the treatment (Shatan, 1973). It is also
common for the patient to discover positive consequences of traumatization (Scurfield, 1985),
such as the strength of having survived, the depth of appreciation for human kindness, and the
compassion that comes from having borne witness to dehumanizing destruction and greed.
The outcome of this self-development and integration phase is healthy self-esteem,
autonomous pursuit of a range of work and recreational interests, and a reinvestment in
relationships. Although the patient is considerably improved, residual problems in the regulation
of drives may remain. The patient may still manifest the chronic irritability and propensity toward
episodic rage attacks characteristic of complicated war traumatization (Kardiner, 1941; Kolb &
Mutalipassi, 1982). Or the incest survivor may show some form of continuing sexual dysfunction.
The therapist once again switches to an uncovering mode of therapy. At this stage, the patient
typically presents in a neurotic-like manner. Using a dynamic treatment model, the therapist can
help the patient actively to explore fantasy productions associated with the expression of
aggression and sexual impulses in the context of the neurotic transference. To provide an
emotionally corrective experience, the therapist avoids the extremes of giving permission to the
expression of these impulses, on the one hand, (284) while helping bring them to the patient's
conscious awareness, on the other. Presumably the disregulation of impulses had occurred
because of overstimulation during the traumatization. The therapist's neutral and consistent stance
is now directed to the patient's reworking of impulse control in the context of the therapy.
Sometimes behaviorally oriented assertiveness training or sex therapy serves as a useful adjunct.
Even where the patient successfully achieves the goals of each stage of the treatment, the
biological sensitivity may endure. We have observed that the most successfully treated
complicated PTSD patients retain some degree of hypersensitivity to stimuli. While trauma and
sensation seeking may decrease, the vulnerability to startle and the autonomic hyperactivity
remain. Behaviorally, desensitization has been strikingly ineffective in the treatment of the PTSD
stress response (Kolb et a!., 1984). Medications that block andrenergic response show some
promise (Kolb et a!., 1984; Van der Kolk et a!., 1984). Learning voluntary control of
physiological processes with biofeedback may also aid autonomic stabilization. (This is described
in Brown & Fromm, 1986.) However, these techniques should not lead one to disregard the fact
that the biological vulnerability may to some extent be permanent.
The treatment of complicated PTSD is one of the most challenging areas of hypnotherapy
and hypnoanalysis. It usually takes years, and there are many pitfalls along the way. The therapist
is required to adopt very different treatment models at different stages of the treatment. For
example, a cognitive-behavioral model is useful in the earliest stabilization phase of the
treatment; a dynamic-developmental model, during the uncovering phase; a self psychology
model, during the self-development phase; a classical dynamic, conflict-defense model, during
the drive integration stage; and a biological conditioning model, during the stress sensitivity
phase. Table 8.3 summarizes these stages in the overall treatment. Unfortunately, there are no
systematic outcome studies of hypnotherapy in either simple or complicated PTSD yet. We hope
this chapter and the next will stimulate further interest in this area. (285)
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6. A LONG-TERM CASE OF HYPNOANALYSIS: CHILD ABUSE AND EARLY RAPE:

DANIEL BROWN & ERIKA FROMM: HYPNOTHERAPY AND HYPNOANALYSIS:
LAWRENCE ERLBAUM ASSOCIATION: HILLSDALE, NJ: 1986
Most hypnoanalytic patients are seen once a week for a 50-minute hour and can be helped
in 3 to 12 months. In chapter 7 and elsewhere (Eisen s.. Fromm, 1983; Fromm, 1981, 1984), we
have discussed examples of shorterm hypnotherapy. But some patients need more time: in
particular borderline and narcissistic patients, and those with posttraumatic stress disorders
(PTSD). In this chapter we present such a long-term case. (Durbin: I have found that most people
can be helped in 6 or less visit but agree that some can take much longer.)
ANAMNESIS: Jessica was a big, gawky, badly dressed 38-year-old woman, a
psychoanalyst working in a large psychiatric teaching hospital. She had been in psychoanalysis
three times. The first analysis lasted 3 years; the second also 3 years; and the last she had broken
off after 2 years. Her training analysis, the second of the three, had been very good, she felt. But
she had never been able to develop a real relationship with her most recent analyst; he was "too
rigid," she said.
Asked why she had gone into a third analysis when her second analysis had been so good,
she said she felt the need to talk more about the severe child abuse she had been subjected to by
both of her parents throughout her childhood. But the third analyst did not understand her, and
now she wanted to try hypnoanalysis.
The patient had grown up in Montana in a Calvinist family to whom according to her
description, all pleasures were forbidden. Her father (286)managed a small business; her mother
was principal of a grammar school. Both parents were enormously strict. Jessica could never do
anything that would please them and was beated by both of them, particularly by the mother,
practically every day. Her mother conceived of all sexuality as bad and sinful and was always
afraid the child was in danger of being sexually seduced either by her playmates or by adults. She
therefore severely restricted Jessica's play with other children and being with adults outside the
house, even her teachers. Throughout her childhood and later, Jessica thought that her parents'
home was like a concentration camp and identified in her fantasy with concentration camp
victims.
In childhood Jessica had had many respiratory illnesses, including allergies, during which
she felt her mother had not taken care of her well enough. She said her mother had rejected her
since birth (which statement the hypnotherapist later came to doubt as far as the first year of life
was concerned, because Jessica herself was a very good and caring therapist).
The patient had a sister 7 years her junior. And until she was 11 years old, she said, she
knew nothing of the existence of her half brother, 8 years her senior-the child of a previous
marriage of her father. The half brother became a highly successful chemist and was the only
member of her family with whom she has maintained a good relationship.
In her sophomore year in college, she went out with a man, held hands with him, and had
a passionate sexual desire for him, which she could not stop. She thought having such intense
feelings meant she was crazy and sinful. She prayed to God to take her sexual feelings away, but
God did not. After the young man left her, she did not allow herself more than petting and
necking with other men she fell in love with, even though she experienced intense sexual desire.
At age 20, feeling she had "held out" against her sexual desires as long as she could, she had
intercourse on alternate nights with two different young men she had dated simultaneously during
 87

the preceding 4 months. A few months later, she married one of them and had intercourse with
him four or five times daily. Her grades in school improved as the inner sexual pressure was
somewhat reduced, but the obsession with sexuality continued. She felt her sexual drive had been
exceedingly strong. At first I saw this sexual obsession as counterphobic behavior; a month later,
when I recognized the patient was a PTSD, I came to see it as an expression of the denial state in
PTSDs.
The patient was orgastic with her first husband, but the marriage deteriorated because,
unlike the patient, the husband did not have any real intellectual or artistic interests. She divorced
him and went to medical school, where her grades were excellent. She also went into her first
psychoanalysis.
(287)
She met another man, "very handsome, very tall." They experimented with and enjoyed
all forms of sexuality "except kinky, sadistic things." He was a "macho" male, who yelled and
shouted at her for such things as walking barefoot at home. She enjoyed being yelled at, took the
submissive role, and dressed and felt very feminine. After a while she felt the young man drank
too much and hurt her physically with his "oversize penis," so she dropped him. The enormous
and unremitting sexual drive that had bothered her so much continued unrelentingly.
She felt emotionally very ill, often suicidal, particularly when thinking of her parents. Her
analyst advised her never to have anything to do with her parents again. For the next year she
went to bed with many graduate students, tried to "control" her sexual drives, smoked pot
occasionally, and "fell in love and went to bed with every man I met." During her residency, she
went into her training analysis, which she felt was very good.
Eventually she met her current husband, an intellectual quite a bit older than she, and
lived with him monogamously for a number of years before they got married. After 3 years of
marriage and joyful sexual relations with him, suddenly, "after a D and C," she said, she found
herself terribly frightened of getting "hurt" in intercourse. And while continuing to sleep in the
same bed with her husband, she would no longer allow him to touch her except for giving her a
goodnight kiss. She often felt as if she were fragmenting and went into panics.
As an adult, Jessica had a horseback riding accident in which her pelvis and femur were
fractured. Since her father's death from a heart attack 5 years before she came to see me, she
feared that she, too, would die of a heart attack. She was very hypochondriacal.
The patient was aware of being in a constant rage against her mother, against institutions
of higher learning, against her superiors, and against her peers. She could not form any real
relationships, she felt, except with her patients.
This was how things stood when the patient came for hypnoanalysis. She lived in a town
some 300 miles away where there were no hypnotherapists, wanted to have a hypnoanalysis, and
thus proposed to fly in to see me (E.F.) once a week. She diagnosed herself as a borderline but
actually was a severely narcissistic personality with borderline features.
From a descriptive perspective, she met most of the diagnostic criteria for narcissistic
personality disorders in DSM-III (American Psychiatric Association, 1980).
The criteria are:
I. Grandiosity.
2. Preoccupation with fantasies of unlimited success, power, brilliance. (288) beauty, or ideal
love.
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3. Exhibitionism (the person requires constant attention and admiration).

4. Cool indifference or marked feelings of rage, inferiority, shame, humiliation, or emptiness in
response to criticism, indifference of others, or defeat.
5. At least two of the following characteristics of disturbance in interpersonal relationships:
(a) entitlement (expectation of special favors without assuming reciprocal responsibility);
(b) interpersonal exploitativeness;
(c) relationships that characteristically oscillate between the extreme of overidealization and
devaluation; and
(d) lack of empathy (inability to recognize how others feel).
The patient certainly did not lack for empathy with her patients. She was very sensitive to
how they felt. Grandiosity and fantasies of unlimited success were present to a minor degree. All
the other diagnostic criteria were fully met, particularly rage in response to criticism, the need to
have her self-esteem bolstered by constant support or admiration, the entitlement, the
exploitativeness of taking advantage of others in order to indulge her own desires, and the lack of
regard for the personal rights of others.
I (E.F.) considered hypnoanalysis with a developmental perspective to be the treatment of
choice for this patient. Like Adler (I 981, 1985), the authors do not view borderline and
narcissistic personality disorders as totally separate entities. We conceive of them as being located
along a continuum on the developmental line of the self, with the borderline patients at the lower
end of the continuum and narcissists of more or less pathology distributed over the upper end.
Borderline patients more easily split the (love) object into a good and a bad one, experience
severe fragmentation of the self, or have serious difficulties in maintaining selfcohesiveness and
stable "self-object transferences" (Kohut, 1971). They fear annihilation and disintegration.
Decompensation can proceed to psychosis.
In contrast, patients suffering from pathological narcissism have achieved a higher level
along the developmental line of the self. Except for transient, but not seriously disintegrative,
periods of fragmentation, they are able to maintain self-cohesiveness. Their self-object
transferences are relatively stable. Narcissistic patients have great difficulty with feelings of
self-worth. They vascillate between severe lack of self-esteem on the one hand and feelings of
grandiosity and entitlement on the other. They, too characteristically, have not fully reached the
developmental stage of maintaining object constancy (Mahler et aI., 1975), tend to see people as
either "all-good" or "all-bad," and react to even slight frustrations, particularly (289) to real or
fancied abandonment or lack of recognition, with intense fury and anger-"narcissistic rage"
(Kohut, 1972).
Phase 1 (November 1973-July 1974): Screen Memories; Establishing the
Hypnoanalyst as a Gratifying, "Good" Object: The patient showed excellent hypnotic ability.
She achieved a score of ten on the Stanford Hypnotic Susceptibility Scale, Form C
(Weitzenhoffer & Hilgard, 1962). In and out of hypnosis she talked endlessly about her "bad
mother," who had abused her in childhood. Jessica's hatred for her parents was fierce. The only
time she had gone home was for her father's funeral. She had had no contact with her mother or
with her sister since the age of 20.
Within the first month of starting hypnoanalysis, she found herself at home "in a strange
state, drawing feverishly." It was a spontaneous dissociative state? She had had no intention to
draw and did not know what she was drawing. It was as if her hand was drawing by itself
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(automatic writing). Very upset, she brought me the picture and told me that the picture showed
her mother giving her an enema and holding her down. She said she never wanted to see this
picture again. She could not bear to look at it. The picture (Fig. 9.1) showed a 3- or 4-year old
little girl, lying on the bathroom floor, terrified, struggling and screaming, while a somewhat
larger, half-nude person is kneeling over her in a coital position. All around the two figures were
stabbing, sharply printed words: from the little girl, "No, no, no, no," emanated. "I don't
understand; no words, no words; hot, wet; pain, pain, pain; throbbing, stabbing, hurt; rage, rage"
seemed to belong to the girl too. The words "My will, my will; shut up; I'm your mother; do what
I say; don't fight back; you'll get more" were placed closer to the other person. Above both of
them one could decipher the words "silence, rushing, entering, gushing"; and ''I'll help you, I'll
help you."
Jessica said the picture showed her mother giving her enemas and her own terrible fear of
the cruel mother and the enemas. On the side of the picture, in her own adult handwriting (deleted
here for reasons of confidentiality), she had written, "There were no words; there were just (290)
rushes of feeling-cold, naked on the floor-didn't dare kick her. She'd slap me again. I remember
the cold, wet bathroom rug under me, and her indescribably ugly face-felt betrayed, isolated-what
did 1 do to deserve this? Every cell, every inch of me shivered, trembled, and shook." As an
afterthought the patient also had written in a corner of the picture, "1 found myself doing the
writing unexpectedly. Why, 1 don't know."
Mothers do not usually bare the lower parts of their own body when they give enemas to
children. It seemed perfectly clear to me that the drawing Jessica called the "Enema Picture"
represented a screen memory, and a covert hypnotic communication to me of a deeply repressed
sexual attack by a male, which she must have suffered in childhood. But Jessica undoubtedly also
had suffered much physical abuse from her parents, especially from her mother.
The patient spoke a great deal in the waking state about the weekly (291) enemas and the
beatings her mother had given her two to three times a week because the mother felt Jessica was
stupid and bad. Because the internalized representations of the mother-and the father-were such
bad internal objects, and because the patient at this stage seemed to be very close to being a
borderline case, I decided to treat her as I would treat a borderline in hypnoanalysis, namely,
according to the principles described by Baker (1981) and by Fromm (1984). (See chapter 8, this
volume.) I had to become the "good mother" Jessica apparently had never had; then help her
internalize that good object, so that she also could develop self-love; and subsequently assist her
to achieve object constancy and self-cohesiveness and gain control over splitting. I hoped to help
her progress from the near-borderline state of a severely narcissistic personality, through the less
severe stages of narcissism to a neurosis, or perhaps even to full health.
In the first phase of hypnoanalysis, therefore, I took on the role of a totally accepting,
gratifying, and nurturing mother figure, was always protective and soothing when Jessica began
to be overwhelmed by affect, nearly always took her side when she complained about being
treated "badly" by colleagues and supervisors, and always showed her, with "the gleam in the
mother's eye" (Kohut, 1971, 1977), how proud I was of her when she achieved even minute
successes in real life or any kind of gain in her therapy. I thus attempted to help the patient take
the beginning steps towards object constancy and the acquisition of healthy self-esteem.
One day I induced an age regression in order to get more historical material. With strong
affect, Jessica brought up the experience of a dog nibbling at her toes. She was a little girl. In
 90

great fear she pulled her feet up under herself while sitting on a couch in her parents' home. But
her father laughingly egged on the dog to lick her feet. In the hypnotic experience, the mother
walked out of the room without saying a word and did not protect her daughter from the father
and the dog. I silently wondered about incest and the patient's defense against recognizing it by
displacing the possible sexual molestation downward from the genitalia to the toes. I gently urged
Jessica to give me more material about her father. She clammed up. It become clear towards the
end of Phase 1 that the patient had always had very lusty, heterosexual feelings and was afraid
she would be overwhelmed by them.
Phase 2 (July 1974-September 1974): Respecting for a While the Newly Developed
Defense Against Going Into Trance: For most of the first year of therapy (Phases 1-3), Jessica
stormed into my office in the typical rage of the narcissist (Kohut, 1972), angry about (292)
something that had happened to her outside the therapy and that she experienced as an injury to
her self-esteem. Occasionally she was furious because in the preceding hour I had given her only
5 or 10 minutes' overtime. She felt "entitled" to more.
For weeks, she avoided going into trance by filling up her hours with talk (in the waking
state) about her anger about her colleagues and her teachers, who she thought did not treat her
well. If we were to use hypnosis, she said, she would need double hours, the first one to talk
about her daily life and the second for hypnoanalysis. She was given two consecutive hours but
soon demanded very long inductions, and eventually she filled up even the second hour with
talking in the waking state about her daily life. She talked about the troubles she had with her
peers and older colleagues at the clinic, all of whom were "bad." Only her hypnoanalyst was
"good." She could not write reports for the clinic at which she was working. Too much was
"demanded" of her by the "bad" people. The "bad" people, she felt, in many ways were like her
mother: they made constant demands. She thought she was a much better therapist than any of her
colleagues and teachers.
I avoided pointing out the reality that Jessica was indeed quite a good therapist but not as
good as in her narcissistic grandiosity she thought she was. Developmentally, Jessica was in the
"splitting" period of the separation-individuation phase (Mahler et aI., 1975), and seeing herself
realistically as "Good-and-Bad-Me" was as yet not possible.
I decided to go slowly in the therapy. The patient had not as yet developed object
constancy. I understood that she was: (a) afraid of losing the "good mother," the hypnoanalyst, if
hypnoanalysis helped quickly; and (b) unconsciously afraid of going into deep states of trance
because in them she might face the childhood rape or incest problem, which was still deeply
repressed.
Jessica now took on a hobby of photography and became quite creative with it. I
supported this, praised and encouraged her, and shared her pride in this new achievement. Thus, I
was the "good mother," whom she needed to internalize. I even showed her that I did not mind
her buying expensive photo equipment instead of paying her therapy bills on time. Photography
symbolizes looking, and I hoped that the looking outside eventually would turn to looking in a
more focused way inside. It did a year or two later.
Phase 3 (September 1974--November 1974): Working Toward Internalization of the
"Good Object": Jessica continued to avoid hypnosis after she had had a nocturnal dream about
having homosexual contact with me. In waking hours too such fears were voiced. I made it very
clear to her that such feelings occur in many (293) analyses and hypnoanalyses and that thoughts,
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fantasies, and dreams do not equal actions. I also told her very clearly that I would protect her
from acting out homosexually with me and that I did not feel she was a homosexual. Her whole
orientation had been heterosexual. I interpreted to her that the homosexual thoughts or dreams
expressed her need to be held and hugged affectionately in the way she had wanted her mother to
hold and hug her.
Jessica constantly tested-and exploited-the "good mother" figure by writing volumes of
letters in between hours, which took me countless extra hours of unpaid reading. She still allowed
hypnosis only rarely, and then only with much fuss: every crack in the venetian blinds behind her
had to be shut carefully, and if someone was typing in the office above mine, she would refuse to
go into trance.
She did tell me about her half brother, 8 years her senior, who was the only good love
object she had had in the past. He had lived with his mother in another town. She remembered
that when she was II years old she had found on her father's dresser a postcard written by
someone who signed himself "Tim," announcing his impending arrival. She did not know who
Tim was but was strangely agitated. When Tim did come and she met him, she felt great sexual
excitement. He was so handsome in his ROTC uniform. He took her out on walks and \1layed
with her. They had had a warm interpersonal relationship ever since, even though they did not see
each other more than a couple of times a year. She felt that without having this warm relationship
with her half brother, she could never have survived emotionally. Without any connection being
apparent to her, she then started to talk a good deal about her own interest in patients in whose
family there was incest. She had developed this interest in the last few years and wondered why.
I began to wonder whether incest had occurred with the brother (rather than with the
father) or whether the patient simply had had preadolescent sexual fantasies about the brother.
Still, in order not to influence the patient's hypnoanalysis by my incest hypothesis, I was very
careful not to mention a word about it to her. Hypnotherapists must be extremely cautious not to
give overt or covert suggestions that might influence the patient to produce material that would
confirm the therapist's hypothesis.
Phase 4 (November 1974-September 1975): The Brother's Death; the Hypnoanalyst
Providing a "Holding Environment": At this critical point, during the months Jessica talked
lovingly about her half brother, the brother died suddenly of a heart attack. Many of the therapy
hours of the next few months were spent in my helping her-in the waking state and in trance (by
means of imagery and free association)- (294) through the four phases of mourning (see Fromm
& Eisen, 1982). In January 1975, Jessica produced a hypnotic fantasy in which her brother
climbed over a high wall, came back, put a ladder against the wall, and asked her to climb up and
jump down to the other side with him. She was ready to do so. I felt this was an unconscious
suicidal fantasy, expressing a wish to join the brother in death. Thus, for once in an authoritarian
voice (to prevent the possibility of suicide), I told her to turn around and come back down the
ladder to the side where I was standing, waiting to take care of her and nurture her. At this point,
to act as a permissive hypnotist would have been wrong.
A month later (February 1975), Jessica wrote me a letter, which, however, she did not
give to me until a full year later, in February 1976. In this letter she said that the hypnotic hour
with the ladder and her brother had been an extremely important one for her. My saying, "I am
aware that you want me to take control of the choice" (between life and death) had been very
important to her. She continued in the letter: Freedom is sometimes an awful burden. You have
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recognized where I am and have made the choice for me .... Now I am in a safe emotional
backwater, where things can more safely swim around and be looked at. You are a hovering
Winnicottian presence that is providing a holding environment where things can grow. I trust that
the pain will not become too great because you can tend to the carbon rods in the reactor pile and
lower or raise the intensity of the atomic reactions within the uranium core. [The symbol of an
atomic pile shows the tremendous fear the patient had that her affects would fragment her and
lead to total annihilation of herself and others.] When there is an excess of neutrons, someone
knows when to push the neutron-absorbing carbon rods in and the therapeutic energy is
maintained, but at an optimum (not a maximum) level. It seems like the only chance I have ever
had where I could relax and look without having to make things safe for myself. ... I feel that the
depressed child has been picked up, held, loved, and told we will look at the world. I do not
mourn for something that should have been. It is probably more than a bit of merger, idealization,
and twinship. I can have it if I want within a circumscribed sphere. And someday I will let go,
look longingly at the therapy situation and go on, painfully say the last goodbye, but go on.3 You
and your husband got out from under the Nazis. I feel that you have made, of course, a
contribution to "the field." But I feel, if for no other reason, you were saved for me. [This
sentence shows the patient's enormous narcissistic need and grandiosity.] All I care about is what
you mean in my life. (295)
Toward the end of Phase 4, Jessica began to gain real object constancy. She could admit
to herself that I, the overidealized mother figure, made mistakes sometimes and had my faults,
and she could playfully tease me about my forgetfulness or my accent. She was able to tolerate a
5-week absence of mine without discomfort or fear of loss and abandonment. On rare occasions
she would produce hypnotic imagery in which she saw and felt herself being an infant held in the
arms of her mother, who looked at her fondly, and thus she would come to recognize that her
mother was not an "all-bad" woman and had loved her as a baby.
Phase 5 (September 1975-February 1976): Return to Hypnosis and Careful Attempts
to Let Repressed Memory of Childhood Rape Rise Closer to Consciousness: While Jessica
continued to fill the first three-quarters of her double hours with talking about her own patients,
her supervisors, and so forth, she also became more willing again to use hypnosis. In fact, she
pushed for it.
I frequently suggested now while she was in trance that some hypnotic imagery would
come up that would give us a clue to understanding why for the last 2 years she had been so
afraid of sexual arousal. But the hypnotic imagery she produced-defensively-always related to her
mother's strictness and child abuse. Imagery produced by the patient herself rather than age
regression induced by the hypnoanalyst was employed at this time, because the latter is more
intrusive and confronting and I feared it would shatter her still quite weak ego structure.
Then one day in hypnosis Jessica herself produced a spontaneous, highly affect-laden
regression, or hypermnesia, to age 3 or 4, in which a young soldier from a nearby army base
stayed in her parents' home. He put her on his lap facing him, "felt" her "up with his long, narrow
hands," made her "ride up and down," and caused her to be utterly overwhelmed with sexual
excitement.
From the context in which this hypnotic material arose, I felt that the "soldier" probably
was a screen memory for her half brother and that perhaps there had been some incestuous play
between the two children. But my careful probing did not confirm this hypothesis. In and out of
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trance Jessica insisted the soldier was the soldier and no one else. She reiterated that she had not
known her half brother-nor even known of his existence-until he came to visit them for the first
time when she was 11 years old. A few weeks later, in a self-hypnotic trance, she drew a picture
of herself (296) as a 3- or 4-year-old being held tightly on the soldier's lap. She emphasized her
inability to escape by drawing next to it another picture of herself as the little girl being encased
in a tight, metal drum.
Phase 6 (February 1976-August 1976): Consolidating Object Constancy and
Self-Constancy: This period was spent mainly in helping Jessica to consolidate object constancy
as well as a cohesive, nonfragmented self (Kohut, 1971, 1977; Ornstein, 1974) and developing
the insights that people, she and others, are neither "all-good" nor "all-bad" (Kernberg, 1975).
Gaining control over splitting needed to be achieved before further uncovering of traumatic
material could be attempted.
In late February 1976 Jessica gave me a letter in which with great shame-but with
confidence that it would not make me turn away from her-she told me about sexual practices and
fantasies she had had between ages II and 12, that is, in the year she said she had first met her
half-brother and felt sexually excited by him:
1. While playing on the floor with her dog, which butted against her and sniffed her crotch, she
became sexually so excited and "swept away" that she pulled off her underwear, pulled the dog
closer to herself, and let him lick her genitalia.
2. While babysitting with a l½ -year-old boy, she read True Story magazines lying around the
house and was "utterly swept away" into sexual arousal. She lay down on the boy's parents' bed
and fantasized pulling the little boy on top of herself, using his whole body for masturbatory
purposes.
Jessica became aware of feeling a little more friendly lately towards her husband, though not able
yet to really show him that. But there was less anger towards him and a greater desire to do things
for him and with him.
When I asked her what was preventing her from resuming sexual relations with her
husband, she said that she had abruptly terminated them when her husband asked her to take the
superior position and insisted that she be more active and sometimes seduce him into having
intercourse. She also complained that her husband would not cuddle her.
It was now clear why the patient had stopped having sexual relations with her husband.
When he asked her to take the superior position, and to seduce him, the whole traumatic
experience of sexual abuse in childhood was reactivated unconsciously and threw her into a sex
phobia. The "soldier" had put the 3- or 4-year-old little girl on his lap, most likely opened his
pants, penetrated her, and made her ride up and down on his (298) penis. The attractive little girl
had probably felt she had seduced him, and, in any case, felt torn up, damaged, abused. In
addition, the child felt overwhelmed by her own sexual excitement. When Jessica was asked to
assume the vertical position, it unconsciously to her was the equivalent of "sitting on the lap" of a
man (the husband), and she again became terrified of being torn up and injured. But she did not
know why. I interpreted the connection to her, and she accepted it.
Jessica, who for a long time had not been willing to do any self-hypnosis for fear of being
overwhelmed by what might come up from her unconscious, now asked me to teach her
self-hypnosis (again), so she could use it and bring more material into the therapy hour. Also, she
now said she no longer needed lengthy induction techniques (on which she had insisted before
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and on which she later would insist again). She even said that she now expected soon to solve her
sexual problem and end the therapy successfully. She knew she then could face life
autonomously, without constant dependency on me, knowing I would always remain her friend
and, as she said, "somehow inside of me." She was internalizing me as a person who appreciated
her, and she was gaining healthy self-confidence.
At the start of the hypnoanalysis, Jessica has been close to being a borderline personality.
By now she had improved greatly and had moved squarely into the developmental realm of
narcissism. Because in any kind of therapy such patients frequently regress again under even
minor stress, I continued to proceed slowly and carefully, never suggesting that as a child she had
perhaps been raped by a member of the family. However, by pointing out that in and out of
hypnosis she frequently talked about her father or her brother right after talking about the abuse
by the soldier, I rather frequently gave her the chance to make that connection herself, if it existed
and if and when she was ready to let it come into consciousness. She did not become aware of
it ... for more than a year, despite the fact that as a professionally trained psychoanalyst, Jessica of
course knew that there often are important unconscious links between free associations given
consecutively. The incest quality of the rape continued to be deeply repressed. I could not yet risk
piercing the defense of repression because, at this stage, that most likely would have led to
fragmentation of the self (Kohut, 1971). She was giving evidence that reliable self-functions
(Kohut, 1977) were still missing: the ability to monitor affect and anxiety, to calm and soothe
herself, and to regulate self-esteem. Further hypnoanalytic work was required for her to withstand
the shock of possibly having to recognize an incestuous assault as a fact of her life.
We embarked on hypnotic experiences in which the patient could gain feelings of safety,
inner enjoyment, and unity within herself. For instance, I induced trance with the image of a
peaceful plastic sphere that surrounded Jessica and protected her from harm from anyone on the
outside world as (299) well as from being overwhelmed by her own affect. She could look out
from that plastic sphere wherever she wanted to. She could also just float in it and allow feelings
of relaxation, joy, and comfort to rise in her and sweep over her from her toes up through her
legs, thighs, genitalia, torso, limbs, and neck into her head and all the way back down again,
leisurely and pleasurably. Previously, when the Progressive Relaxation method was used for
trance induction, I had always carefully avoided mention of the pelvis or the genitalia because
Jessica had been so afraid of being overwhelmed, "driven out of her mind" by any sexual
feelings. Now she could tolerate them.
And an interesting thing happened. At first in trance, and then later in the waking state,
Jessica talked about the positive meaning of the childhood bed and the room she had occupied
until the age of 8. Lying on her bed, she could look out on a grove of trees and rose bushes, smell
their fragrances, and fantasize beautiful things. Looking through the window into nature, she had
found tranquility as a child. I interpreted to her that at these times she had created for herself her
own" inner world" (Hartmann, 1958), a world in which imagery and the aesthetic enjoyment of
nature provided her with the strength she needed to go on with life and not to despair at being
treated so harshly by her parents. So, many hours were used to make the patient aware of her own
inner resources, of fantasy, and the enjoyment of nature, which could serve her now and in the
future even better than they had already in childhood. This was done for the purpose of ego
strengthening and had an interesting effect half a year later. There arose in the patient a very
strong desire to have a little farmhouse out in the country, surrounded by groves of trees into
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which she could look.

When Jessica was a child, her mother had tried to wean her away from her transitional
object (Winnicott, 1953), a blanket, by cutting pieces off it day after day, until nothing was left.
In childhood, it is important that the child keep his transitional object (blanket, teddy bear) for as
long as he needs it to soothe himself when pained, lonely, or tired. Eventually the child is ready
to give it up by himself. Jessica's mother forcefully tried to wean her away from her blanket
before she was ready to give it up. So, in hypnosis it was given back to her. Sometimes, when she
was very upset by reliving a childhood experience in hypnosis, I suggested that she imagine or
hallucinate she had a blanket she could pull up and snuggle into. Or I put a real blanket over her.
In trance, the adult part of the patient's ego felt deeply sad for the little girl, who was afraid that
the blanket might be taken away from her. Jessica said that this fear had been much greater at
night than during the day. At night, when she was asleep, anything could be taken away from her.
She related to this the many months when she had been so afraid of hypnosis that she had not
allowed me to use hypnosis with her. "I was afraid that you might take something away from me
while (300) I was 'asleep'. That, of course, was a transference reaction. You are really not at all
like my mother."
During Phase 6 I gave Jessica a little birthday present, a pin. She wrote me a note: Thank
you so very much from a place that feels like the inside of a 4- or 5year-old girl with blond curls
and white shoes, who feels like a good child that without effort is recognized as that and has
perhaps at last the feeling that her mother is proud of her. In my childhood home, birthday gifts
and Christmas gifts were given only if you were good enough, and I always lived with the fear
that I wouldn't be good enough and maybe would not get anything.
Perhaps in gratitude, in the next session she went into a very deep trance very quickly and
had a spontaneous age regression, in which she voiced the wish for some pretty clothes. I
suggested that some very pretty dresses for a little girl were lying "over there" on a chair; they
were all for her. Could she see them (i. e., I "gave" them to her in trance)? One of the dresses,
Jessica said, had a soft, velvety feeling both inside and outside and a beautiful purple color.
Because her mother prematurely had taken her transitional object-the blanket-away from her, I
wanted the patient to feel that she could "keep with her" and use whenever she wanted to this new
transitional object, the velvet dress that made her feel so good. I told her that the dress would
grow with her, and she could keep it forever.
Off and on, it helped her better tolerate the times of separation from me necessitated by
my lecture tours. Another stone had been laid for the foundation of the patient's re-educational
traversing of the separation individuation period (Mahler et aI., 1975), one of the most conflictful
periods of her life. As Jessica said, "There is a lot of hope now. Eventually I will grow up and
separate-and even look forward to it." But Jessica not infrequently fell back into angrily resenting
my necessary absences or wanting to have me all to herself Frequently she still felt that she
wanted to, and was going to, force me to keep her in therapy "forever."
There was a short time during Phase 6 when Jessica began to feel some sympathy for her
mother. She told me that her mother had always been overworked, holding a full-time job, and
then being "abused" by the father, who made her work too hard at home. Getting to the root of
the sexual problem was not accomplished as quickly as I, as well as the adult part of Jessica, had
hoped it would be. During the summer of 1976, I found myself quite unwilling to use hypnosis
with Jessica, partly because I was very overworked at that time (and hypnoanalysis puts more
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strain on the therapist than does psychoanalysis). The other reason I hesitated to use hypnosis at
this time was that I wished to avoid the possibility of influencing the patient's recollections in
(301) hypnosis through my own hypothesis. I was fully aware that I still felt Jessica had been
raped in childhood either by her father or, more likely, by her brother. But I also knew that this
could be a wrong hypothesis. Perhaps the rapist had indeed been the soldier, or perhaps she had
not been raped at all but only "felt up," as she said. Also, the rape or incest could have been
purely a product of the patient's imagination, an oedipal fantasy. On the other hand, it was also
possible that Jessica simply was not ready yet to face the incest question and thus resisted it for
(valid) self-protective reasons.
In any case, I felt that if hypnosis were used at this time, the danger of the patient's
accepting my hypothesis rather than coming to her own correct insight-whatever it might turn out
to be-was too great. From my research I knew that hypnotic subjects like to oblige the researcher.
When they know what the therapist's hypothesis is, they frequently produce the data that fit it. At
this point it seemed safer to use waking-state therapy only, which we did for the next two months.
But it also turned out to be less productive. Jessica spent the next 2 months obsessing again about
her "bad," "rigid" teachers, her "malicious" peers, and, above all, her "bad" mother. I wondered
why she had to hold on so tenaciously to what she felt had been bad experiences and to talk about
them over and over again. The way Jessica talked about her mother and herself contained a great
deal of self-pity and anger at the mother. For weeks it was like running the needle of a record
player in the same groove. Only after 2 months did I realize that Jessica was also complaining
about me, and with some good reason: like her mother-partly for selfish reasons (overwork)-I was
"rigidly" withholding hypnosis from her. To some degree I had acted like her ungiving, bad
mother.
In between the (waking) psychotherapy sessions of the last few weeks, Jessica, apparently
in self-hypnotic states, had been drawing bright red, round flowers with blue centers, from which
black and brown lines emanated. She said these violent, flower like structures represented her
genitalia. The black and brown lines were "lines of pain." The center of the flowers, she said,
looked like targets. I had no doubt that these drawings represented defloration and penetration,
and inasmuch as I felt that Jessica's ego was now strong enough to face more uncovering, it was
time to agree to her request to reinstitute hypnosis. Jessica explained why she thought she could
now get at deeply repressed and anxiety-arousing material in hypnosis better than in the waking
state. She said, "In trance I now give the anxiety to you to hold. And then, with that security that
you will hold the anxiety and will not let me be overwhelmed, I can proceed and get at the
difficult material." I also agreed to see her for two double sessions a week instead of one. Jessica
wanted to double the number of her therapy hours so she could terminate in 3 or 4 months. We
used (302) roughly one half of the hours for hypnosis, the others to work through in the waking
state the material that had come up in hypnosis.
Phase 7 (September 1976-January 1977): Further Uncovering of Repressed Material
With Regard to Rapes Suffered in Childhood: Jessica associated the violent flower drawings
to masturbatory activities in which she was currently engaged. Up to this time she had
masturbated exceedingly infrequently because, as she said, she felt it was sinful. As it turned out,
however, the drawings really did not refer to masturbation. They referred to the traumatic rape
experiences of her childhood that now began to come into sharper focus in the hypnotic sessions.
As an induction technique, we now used the Deep-Sea Diving Technique in which the
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patient was safely enclosed in a heavy, transparent capsule that could be lowered thousands of
feet into the depths of the ocean. Jessica understood that the "depths of the ocean" symbolized the
unconscious. She was not alone in this gondola. With her were oceanographers (symbolizing the
therapist), who had taken similar trips with others many times before and who would assist her in
exploring what was going on under the surface, perhaps even in making new discoveries. When
Jessica was in at least medium-deep trance, I suggested that she could now look inside herself.
Images and memories would come up that were connected with the sexual trauma that had
happened to her in childhood.
Until then we knew with certainty only that the soldier had once "felt her up," when she
was 3 or 4 years old. Perhaps he had also penetrated and deflorated her. At her very early age she
had felt terrified and also overwhelmed by strong, pleasurable sexual feelings. Two other sexual
traumata now emerged in the hypnosis sessions; both were clear-cut rape experiences.
In one of the hypnosis hours Jessica cried a good deal and saw a child, 3 or 4 years old,
lying in bed, frightened, curled up to protect herself. When I asked where the child was afraid of
getting hurt, Jessica tearfully said, "Up between the legs." I asked her what made the child fear
that the area between the legs would get hurt. She said, "Somebody hit there." As the genital area
certainly is a strange place to be hit, with some surprise in my voice I asked, "Hit there?" Jessica
replied, "Oh, the child always got hit, always, everywhere. There, was the worst." After a while
she said, "Something there is very bad. That's why the child got hit. I don't like to talk about this."
And she clammed up. I empathized with her, saying I understood how difficult it was to talk
about it, but urged her to face the problem. Supportively, I took the patient's hand in my own.
Jessica then (303) saw a shadow of a figure coming into her room, a figure that would hurt her.
She felt like sliding down under the bed. I encouraged her in the hypnotic fantasy to do so, but to
look up at the approaching figure and to see who it was. Jessica cried a good deal, pitifully, and
in a child's voice said that she was curling her fingers and her toes into the metal springs under
the bed so that nobody could pull her out or hurt her. She still only saw a shadow of a person, "so
tall, very tall, almost as tall as the door," and said, "it feels like it is that soldier." Encouraged to
look at the figure again, she looked, but all she could see were "black shoes, khaki pants."
Although I encouraged her, she could not look up any higher than to see large feet and a strip of
khaki pants above them. She still needed to defend herself against bringing the traumatic events
into more than partial awareness-a defense that had to be respected. Therefore, I suggested that
the person in the khaki pants was now walking out of the door of her room. Perhaps some other
day she could look again and see who it was. Jessica calmed down a bit and then asked, "Why did
they (her parents) let him into the house? Why did they not protect me?" After a while she said, "I
don't know what happened, but I do know he had something to do with whatever happened."
Again, she was told to let him go for now. Within the next few weeks what had happened would
become clearer. The child could cry it all out here in therapy in the weeks to come and work it
through. After a few minutes of silent crying, Jessica-still in trance-said, "The child is all right.
She is sitting in bed reading. He is gone. She is bigger now. She is 7 years old. She is reading
fairy tales. " The patient also created a big, protective glass bubble, with the glass closed towards
the door but open towards the window, from which she could look out and escape into her trees.
In earlier hours she had made it clear that trees, like reading, to her represented her own inner
world of fantasy, a world that was safe. But she said there was also the fear that the glass might
shatter, and then she would be crazy. This hypnotic image clearly mirrored the patient's fear that
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under the impact of bringing the traumatic events into consciousness, she would fragment and
become psychotic.
In this hypnotic hour Jessica also talked about not being able to get away from her mother
when her mother beat her, because her mother's hands were so strong and she would hold her by
the arms. But the mother usually beat her on the back of the calves. So the hitting in the genital
area, in front, does not really refer to what the mother did to her. It does refer to the sexual
assault. It refers directly to the "soldier." But, in some way, child abuse and sexual abuse were
connected in the patient's mind.
During the next 2 weeks Jessica, in trance imagery, played with a protective fantasy, a
shell in her childhood bed into which she could crawl when someone threatening would enter her
room. The shell had magical qualities. With the patient in it, it could become so small that no one
could
(304) find her, or it could vanish through an invisible trap door in her mattress, and she would be
safe, curled up in it. She said the shell could read her mind and would come to her whenever she
was anxious and needed it.
Jessica now had an added tool of self-protection at her disposal. I asked her to see herself
again at "3 or 4 years." When she felt herself to be in her childhood bedroom, I said:
T: Now the door is opening and someone comes in. Let's see who it is. Perhaps it is a friendly
person. Perhaps it is not. Let's see who it is.
P: I can't see the face. I can't see the face at all.
T: Can you see the figure?
P: Part of it.
T: Is it a man or a woman?
P: It's a man.
T: Can you see the trousers?
P: More than that. It makes me very cold. Scared. That's why I don't like to sit in chairs. [This is a
hint of the penetration experience in childhood while she was sitting on the lap of the "soldier,"
who sat on a chair.]
T: [Backing off for a moment to use an ego-strengthening procedure]: Go back into your shell for
a minute, gain strength, and then come out again and look him square in the face. Who is it?
P: It's a ... , it's not a clear picture. It's something I'm aware of, but I don't see it as a picture.
T: Well. Whatever it is. Who is it?
P: [Blocks] ... that soldier.
T: What is he doing?
P: I don't talk about it. I am afraid [said in the voice of a little girl]. I hate chairs [spoken in a
reflective adult voice].
T: As the minutes go by, it will become easier and easier to talk about it.
P: I just want to run away [little girl's voice]. (306)
T: Go back in your shell and gain strength.
P: I just want to run away.
T: Gain new strength and come out again.
P: ... pain all over and over [little girl's voice]; I don't want to do that! [adult voice.]
T: Once you can face it, things will fall into place and will become better.
P: It just can't be! [adult voice, unbelieving].
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T: It can be .... And, unconsciously, you have known it all along. It is now trying to come into
full consciousness. I am with you. I will not let it overwhelm you.
Two days later Jessica dropped me a note saying, "Don't worry. I am upset, but I can handle it."
The vacillation between little girl and adult voice indicated that while the patient during
that hour was in a spontaneous age regression, in which she re-experienced one of the deeply
traumatic events of her childhood, her adult ego, was not fully out of commission and
simultaneously worked on recognizing and repressing or denying who the rapist really was.
During the week following the hour just reported, the patient again masturbated a good
deal and found herself in a self-hypnotic state during the masturbations. She felt very frightened
while masturbating and told herself that this probably had some connection with what she was
working on in her hypnoanalysis. She decided to let imagery come up in her mind. An image of
the lower part of a man's body in khaki pants came up, with his head hovering over his pubic
region. In her next hour she reported:
What kept trying to come into my awareness during that self-hypnotic state was actually
the image of ... the bad image ... [blocks] ... the image of the phallus. And then I had a lot of
questions about whether it (the rape) really had happened.s What then came into my awareness
was a sharp feeling of pain in the vaginal area. I said to myself, "Well, maybe it really did
happen." And then what came next was "Oh, this is why I am so afraid."
At the end of this waking hour, Jessica asked whether what she had brought up about the soldier
in the heterohypnotic trance sessions and in (306) self-hypnosis was a figment of her imagination
or whether childhood rape really had happened. I told her I did not know for sure; only her
unconscious knew. However, she would know the truth consciously when she was really ready to
find it.
In the next hypnotic hour, Jessica saw the full figure of the soldier, who, she said, had
raped her as a child. At first, she was very upset. Then, as a protective measure, she erected a
glass wall between herself and the soldier, a wall of very strong glass through which, she said, he
could not attack her. Eventually she changed the glass into a sort of one-way mirror through
which she could see the soldier but the soldier could not see her. By the end of that session, I was
more convinced that the soldier was not a screen memory but the real rapist.
A couple of weeks later, Jessica asked me to let her re-experience with their full force the
affects she had had during the childhood rape(s). As I felt she was now strong enough to do so, I
age-regressed her to "3 or 4 years." In trance she experienced great fear, coupled with a tense
state of sexual arousal and a feeling that everything was frozen. She had the sense of sitting on
someone's lap in her pretty pinafore, held tightly, facing him, and being moved up and down. She
felt a piercing pain. There was blood on the floor. Everything went dark. She could not say who
the "someone" was. She could not escape. He held her tightly. It was as if there were a fence
around her. All she could do was kick him with the back of her shoe. But it also felt to her as if it
were a game between her and whoever the "someone" was on whose lap she sat. The image of the
fence crystallized into a feeling of being strapped by the arms of the person who was holding her
on his lap.
I asked her who the person was on whose lap she sat. She couldn't say. I used a visual
metaphor for communicating with her in primary process language, saying, "It's a puzzle. Let all
the pieces of the puzzle fall together." She said: "I cannot. I am trapped. Why don't you let me get
away?" I told her that the time had come when she needed to look at the person, to look at his
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face, in trance, and to recognize him, because I trusted she could do it now. Jessica did look, and
said, "It's very confusing. I thought he was my friend." I agreed, "Very confusing, and very hard."
Jessica cried and said, "My arms and legs don't work. I can't run away, I can't push him away. " I
empathized with her feeling helpless and thinking that it was either the soldier or the father-said
that was so because the patient was a little kid and he was a grownup. At that point in trance,
Jessica shifted into a different ego state and put more accent on the adult ego. In a way she
returned to the metaphor of the pieces of the puzzle, and said, "I cannot pull it all together. It's
just all pieces." I gave her the posthypnotic suggestion that as the days of the following week
proceeded, the puzzle would become clearer and clearer and the pieces (307) would fall more and
more together without her being overwhelmed. She shook her head and said, "No. The pressure is
too much." She was told that we would end the trance in a few minutes and that she could bring
up with herself as much of the repressed material as she would be able to face in the waking state.
I also told her that as time went on and we continued to work with trance, she would be able to
face more and more of it, both in the hypnotic and in the waking state .
After awakening, Jessica said the hour had been very difficult. In the trance her words had
seemed to her to come from very far away, and a part of herself felt, when she listened to herself,
that what she said wasn't so but that the words came anyway (cf. Fromm, 1965a). She felt as if
she were two separate people, the child and the adult. Strangely, she said, the little child felt
almost more real to her than the adult part, the part that was "trying to make sense out of it all. "
In the waking state the patient reported that, throughout this session, she had had the
feeling that in trance part of her had wanted to keep that experience repressed, to push it away,
not to know about it. But it was like fog rolling in from under the door, anyhow; I could no
longer keep it away. I didn't want to know about it. But it came into my consciousness in trance
anyhow. Now it is foggy again. It's very, very confusing. In trance there were many me's: the
person who was observing, the child who was experiencing, the person that is trying to listen, the
person who doesn't want to hear it, and the voice of the foggy awareness that comes rolling in
under the door.
The fog rolling in under the door shows the attempted "Return of the Repressed" (Freud,
1939/1964), while, with "Now it is foggy again," the patient also expressed the defense against it.
The double use of the fog symbol is interesting.
In both of these heretofore repressed childhood experiences recovered in trance, the
"soldier" who had "felt her up" was also the attacker. The session reported earlier, in which he
had sexually attacked her on the floor and she had tried to hide under her bed, actually occurred
somewhat later than the rape on the chair.
It now became clear emotionally to Jessica, too, why she panicked and stopped all sexual
relations with her husband after the husband had asked her once to take the upper position in
connubial intercourse. She could see now that deeply unconsciously it had stirred up the
childhood experience of sitting on the soldier's lap and being deflorated and raped.
During the following week, Jessica stated that only within the last year had she begun to
suspect that she had been raped as a child. I had suspected it for 3 years, practically since the
beginning of the (308) therapy- that is, ever since the drawing of the "mother" giving her an
enema because what the patient had designated as the figure of the mother was a half-nude
person, kneeling in a coital position over the child on the floor.
In another session, Jessica produced a hypnotic fantasy of a square box with razor-sharp
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edges that could cut anything coming near it. The box was whirling around in the air. Out of its
sides extended metal arms with many bends and sharp claws that would cut deeply into the flesh,
and streaks of blood of an invisible victim were running from the razor blades. She described her
mother as having been like a hard box, with razor-sharp edges that persecuted her, hit her and
hurt her, no matter where she was or what she would do. In the trance fantasy she tried to run into
a closet, but the box followed her. She said she had never thought before of her mother as a box,
but that was what the mother really was-a large box with razorsharp edges. I suggested that she
could take the box and put it on a shelf, where it would stay so she could look at it, but that the
box needed no longer be part of her life and hurt her. At first she said that was impossible, the
box was too heavy, she could not heave it up onto the shelf. But then suddenly she could. She
filled in the holes from which the metal arms protruded and made them smaller and smaller till
they finally became like pinholes. Then she saw the box shrinking, until it was no more than 6
inches long, 4 inches high, and 4 inches wide. It remained on the shelf where she had put it, and
she could walk away from it. She heaved a sigh and said, "It's no longer dangerous; my mother is
no longer dangerous to me. " When I told her that now she could wake herself up, she grinned
and said, "I started that already, before you told me. I was a naughty child today-I opposed you
twice. First you told me to bring up the picture of the soldier, and I decided instead to bring up
the picture of my mother. Then I decided to wake myself up before you even had told me. Are
you angry at me?" (Said with a laughing face.) I said I wasn't angry at all; in fact, I appreciated
her autonomy. That she could oppose me showed that she now had learned not all women were
like her mother. And this was progress.
The next time, she drew a picture, which she entitled "Inside the Empty Box-Empty of a
Real Mother." Inside it were a number of things: a large clock, which could activate a set of gears
that could set in motion control and discipline, and a box with colored button handles, which, if
pressed, would cause suffocation. Inside that box was another box labeled "trash box of mother,"
which contained things the patient felt her mother had disapproved of or robbed her of: her
childhood blanket, torn into pieces; the face of a bright-eyed little girl; a fetus-like soft structure,
near which the words "joy," "sex," and "softness" were written; and the torso of a woman with the
word "good" written between her bare breasts. Although Jessica had been able to verbalize in the
waking state that she understood (309) her mother had her own severe neurosis to contend with
and, on top of it, had been badly harassed by the father, the two box images she had in hypnosis
certainly did not indicate any forgiveness. But perhaps a child who has been so abused and beaten
by her mother can never really fully forgive her.
One of the characteristics of Jessica's trances was that she never could let the GRO fade.
She would close her eyes and go into a medium trancerarely as deeply as she was able to go-but
she would hear every slight noise in the building. I pointed out to her now that perhaps she had
developed this vigilance as a consequence of the childhood rape and that, in a way, she was still
afraid the soldier might come into the room. Therefore, she had to listen for footsteps.
One week, in trance, the patient re-evoked in memory the traumatic event of the rape, but
this time less as an image than as a feeling (hypermnestic recovery of affect). And while she felt
the helplessness of the poor child who was held tightly by the soldier and could not escape, she
also said that the child now was kicking and screaming. Thus, in hypnosis she tried to work
through the trauma by taking the more ego-active role of fighting the aggressor than she had done
in the real event in childhood. I encouraged her to kick, kick hard. Suddenly she brought up a
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third experience with the soldier. It had occurred at night in her room: the soldier, she felt, was
sleeping on a cot in her room. He had gotten up from the cot in the middle of the night and had
raped her again, in her bed. She became even angrier at her parents, particularly at her mother,
than she had been before: How could the parents let the young man sleep in the same room with
the little girl? How could they be unaware of the little girl's attractiveness? How could they fail to
see that he might sexually attack her? How stupid they had been! By letting the soldier sleep in
the same room with her, she felt, her parents had, stupidly though not intentionally, set her up for
being raped.
She then also brought up another memory, namely, that since she was 5 or 6 years old, she
had had the job of hanging up the laundry behind the house. She always felt a mixture of fear and
revulsion when hanging her father's shorts on the laundry line. The rest of the laundry did not
bother her. But she could hardly stand to touch the shorts. Again I thought:
Perhaps the rapist was the father, but I said nothing to that effect to Jessica.
During the next month, Jessica began to see some positive characteristics in her parents,
characteristics with which she had identified. For the first time, she began to talk about her father
separately from her mother. She could see her father as an intelligent, able businessman, who,
though he himself did not earn much, as an employee of his firm dealt with vast amounts of
money in an efficient and able manner; and she felt that (310) her mother had always displayed
great generosity towards the neighbors. She felt she had identified with the attitudes of both
parents in these respects.
She still was angry at both of her parents. They had beaten and abused her. To some
degree her anger now also turned toward her former analyst, the one she had seen for 2 years
prior to coming to me for hypnoanalysis. Why did he never discover that she had been raped?
Why did this male psychoanalyst not fully believe her when she told him that she was physically
and emotionally abused by her parents? I pointed out that sometimes deeply repressed, very
traumatic material can be brought into waking consciousness only through hypnosis.
By this time Jessica had developed a mild desire to have a sexual relationship with her
husband again. But still she could not tell him that, because she felt it would be "unfeminine."
After inducing trance, I suggested to her that she picture herself in bed with her husband and
reach out and touch his hand or shoulder. Jessica refused to imagine herself reaching out. She
said that in any sexual relationship the man had to take the initiative. I pointed out that it was she
who had rejected the husband for the last 4 years and refused to have intercourse with him; how
could he fathom that now she wanted it? She freely admitted that she had not given him the
slightest hint of her changed desires or feelings but expected him to sense, to divine, her change
in attitude, "just as a caring mother senses a child's needs." I interpreted that she was demanding
he be the "good mother" she never had had and that a husband could not be a mother.
I then gave Jessica a simple, purely relaxing hypnotic experience in order to help her
when in bed with her husband to become more relaxed, less angry, less vigilant or fearful of
attack (which I said was a transference from the soldier experience), and less demanding that he
be omniscient. After a while, the patient angrily said that this was a waste of time. But, in the
months that followed, she changed her appearance: she went on a diet, lost a good deal of weight,
and dressed more femininely and with good taste.
One day Jessica reported that in a nocturnal dream she had seen blood on the floor. She
wondered whether it had something to do with her first menstruation. I thought it referred to the
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defloration and told her again, in the waking state, that there could be more to the childhood
molestation than we knew about. Immediately Jessica felt a painful rush of sexual feelings come
up. I helped her into trance with the Deep-Sea Diving Technique, which she understood as being
a technique that facilitates exploration of unconscious and repressed material. She saw two people
swimming underwater effortlessly. Then she started to cry in trance and said, "I can't be involved
with men. My father won't let me. He always takes the good things for himself." Again I felt
some suspicion arise that (311) perhaps the father, rather than the brother, had molested the child
and committed the rape. But again I did not say anything.
Then, still in trance, Jessica talked about the time when she was about 13 and her mother
went to work, on a 3-11 p.m. shift. She was alone with her father and baby sister and was
frightened of her father. The fear clearly was related to her own oedipal wishes for the father. But
I asked, "Frightened of what?" And Jessica defensively said, "Of his yelling at me or hitting me."
She said that, as a child, for many years she desperately had wanted to run away from home, and
she had wanted to kill her parents. She had no place to run to. Again, she compared her childhood
to being in a concentration camp. Already, at age 7, she had wanted to get her father's pistol and
shoot both parents. She had fantasies of killing them and then killing herself, but, even more, she
just wanted to run away. But she never did. As the hour drew to a close, Jessica was still
extremely upset. In order to help her reintegrate before leaving, I suggested that she see herself
now as the child lying on her bed in her childhood home, looking out into the trees and creating
again her own "inner world," which had given her strength before. Jessica calmed down and left
less upset. I told her she could call me anytime that day or in the following days if she needed
me, an offer that had been made often at other times too.
Later that afternoon Jessica wrote me a note telling me she felt: ... very whole. One thing I
thought of as I left was that although I suffered deeply in trance today, I can now see that child
not just as a victim or to be pitied. I see that child's experience as different from the experiences
of concentration camp inmates. I also see her as a stronger child than I saw her before. Before, I
saw me as a helpless victim in my family, crazy, depressed, distraught. Now, I see myself clearly
as a child who helped herself and who must have had that capacity but did not recognize it. I also
know now that I am an adult who probably won't regress again. And I realize the bed I had until I
was seven was a primary soother for me. After seven, it became a secondary soother, and reading
books became primary ones.
In the next hour Jessica speculated, in the waking state, that in her mind somehow the two
diparate traumatic areas, child abuse and sexual abuse, had become connected with regard to the
affect involved. But she stated that the rape had not been committed by the father, and the child
abuse (beating) had been committed by both parents. As later developments in therapy revealed,
she was right. The father had not raped her.
Because more uncovering was needed, some weeks later, after inducing trance, I again
suggested to Jessica that an image would come up that related to the sexual trauma she had
suffered in childhood. Jessica saw herself as a child, playing in an airy, roofless castle, running
around with little boys. After being asked to go deeper in trance, she felt that the boys (312) and
she were running downstairs, deeper and deeper into the castle. The castle was very light, even in
its deepest recesses. One could see into the bottom, the dungeons, which no longer were dark and
scary, as she knew they had been in the past. There used to be monsters in the dungeons in that
castle, but even the dungeons were fully light now. I interpreted to her while she was in trance
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that the castle represented her unconscious, which was no longer so frightening and full of
monsters. The round, open, light castle also represented the childhood problem of being
encircled, but no longer imprisoned by the "soldier's" arms.
Jessica's fantasy then changed: There was no longer any monster but only little boys with
whom she could run and play. In most of the fantasy Jessica, too, was a little boy. At other times
in the fantasy, she was the queen who lived in the castle. There was hardly any furniture in the
castle, and she knew that she had to make the furniture for it. The stones from which the castle
was built were so light and so clean. Even the straw in the dungeons was clean. It was springtime
around the castle, warm and pleasant; birds were singing. Jessica commented that the new castle
must have been built on the foundation of an older, constricting castle, the only remnants of
which were the dungeons. But even the dungeons now were cleaned up, and the chains that had
been used to manacle prisoners to the wall now were ropes, tying up no one any longer. The old
castle either had been destroyed or had fallen down block by block. Suddenly she said, "It is as if
I didn't want to know about the catacombs down there." I urged her to go down and look at them.
The patient, in trance, went down and said, "That's where I killed the soldier."
What she referred to were recent hypnotic fantasies and three drawings executed in
self-hypnosis, in which she had taken her revenge on the young man by cutting his heart out of
his chest and castrating him on an Aztec altar; by manacling him and whipping him so he would
bleed to death; and by letting him hang from his bound feet in an isolated tower in the desert,
starving and dying of thirst. She let his body shrivel in the dry desert wind, which blew his ashes
into oblivion. In these fantasies she also relived and brought into consciousness her terrible anger
at the "soldier," an anger which until that time she had repressed. The patient felt that the rape
experiences were "sort of like catacombs," and said she could bury these experiences now, get rid
of them, and go up to the new castle, the light castle, in which she could run around and play.
Because I still believed that the brother, not the "soldier," had raped her, I urged her to let
even more light shine into the catacombs and look at what was in there. Perhaps there was more
in these catacombs, I said, than the rape and the soldier; or someone else; and perhaps that was all
there was in it. Jessica saw a child in there who kicked and experienced the horror that she had
gone through as a child when she was raped. She felt (313) angry and sad. And betrayed. But she
brought up the "soldier" again. As a small child, she had trusted the soldier, she said, and her trust
had been betrayed. She saw the child crying, lying in a corner of a room all crumpled up. But she
could not get really close to the child. I suggested the adult Jessica see herself, as a grownup, go
over to that corner where the child was lying, crumpled up, and comfort the little girl. Jessica
replied that she was picking up something that was frozen, cold as stone. It was the little girl. In
the fantasy, the grown-up Jessica sat down in a chair and wrapped a blanket around little Jessica.
She held the child gently in her "open arms," just rocking her. The child began to thaw and
became alive again.
In the waking state, Jessica herself then interpreted that this is what the rape experience
had done to her: It had turned her almost to stone. Right after making this interpretation, she said:
Why can't I see fully what happened? Why can I only see a bit here and a bit there, but I can't see
it all at one time and put it together? I can see the lone kid in the corner; I can see the kid that
kicks and screams; I feel like the child that was torn apart inside, and I feel like the child for
whom there was some pleasure. I also feel like the lonely child. There is a sliver of this and a
sliver of that, but I can't put them all together.
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I helped Jessica back into trance and suggested she take a strong magnet that would pull
all of the slivers together. Instead, Jessica imagined a screen on which she saw a body pinned to a
wall of ice and fire. It felt as if a thunderbolt had gone through that body. There was screaming,
and fire, and shattering all at once. But she could see it only far, far away. To calm her and help
her gain control over the frightening affects, I put my hand on her arm, a nonverbal hypnotic
communication of emotional support. Then I suggested that she let the image get closer, so that
she could see and feel it fully. After a very long pause, the patient said, "I can't. It's too scary." I
suggested that "out in the woods" (which always had been a source of comfort to Jessica and now
had become a symbol of her own good and comforting "inner world"), she could hear the
woodpeckers; and as she heard the woodpeckers, the fragmented picture could come together,
come closer, and not be so scary anymore. Jessica said, practically inaudibly, "Not today, not
yet." So I asked her to return to the waking state.
But Jessica did not want to leave hypnosis and the airy, light part of the castle yet. She
wanted to stay a while longer in the part of the castle where there was "good, eternal spring." I let
her do that, even though it meant running overtime a good deal. In trance Jessica now
remembered many good parts of her childhood, "wonderful things," such as making sand castles,
stealing apples from trees, prowling around the stacks of the library.
Eventually she woke herself up. I asked her what she thought it meant (314) that she
could see light in the dungeons. She said it meant she was getting better. She also clarified
another item: in the dungeons there had been only ropes lying on the ground, not chains. "Ropes
can be cut, not chains. That, too, means that I am getting much better. "
She felt that this was a very important hour. And while she remembered right after
waking up all that had gone on in the hour, she was afraid that she soon would repress it, in a day
or two, as she had done with many other important hours.
Phase 8 (September 1976-January 1977) Who Was the Real Rapist? Toward the end
of the third year of hypnoanalysis, Jessica seriously wished to finish the hypnoanalysis soon. She
asked to be given 4 hours instead of 2 during the next 3½ months in order to work through the
loose ends of the therapy and to terminate. In particular, she wanted to do more work on the rape
experiences and her feelings about them. It had been a long hypnoanalysis, but the patient had
come a long way: she had moved from a narcissistic character disorder with borderline features to
a neurosis (a sex phobia). She wanted to finish therapy within 3 to 4 months and buy herself a
cabin on a wooded piece of land in the country. I felt her plan to terminate was feasible. The
woods had personal significance for her as her private world of fantasy; trees had meant and
given her inner strength in childhood.
However, Jessica was also ambivalent about termination. She vacillated between needing
to show me that she was still ill and reproaching me for wanting to "push" her "out of therapy" on
the one hand, and, on the other hand, really feeling much better and wanting to separate from the
therapist-mother, be an autonomous adult, and go on with her life. That this patient had made
enormous improvement was attested to by many outside sources: her husband, friends, and
colleagues (even her former psychoanalyst, whom she had met at a party). In the summer of
1976, the patient wrote me the following note:
Something different I have noticed lately-I have begun to be able to feel good about
something I have done, within myself. When people responded well to the work I had done, when
you said good things about me, and when my supervising analyst complimented me today on a
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particularly difficult piece of work I had done very well, I knew without a doubt they were right.
It was a quiet, assured, solid feeling, no longer narcissistic grandiosity. I also do not fly into rages
anymore.
Thus, in September 1976 a termination date for the end of the year was set, and I strongly
urged Jessica to use self-hypnosis again in between hours. She did, but far less often than
requested.
(315)
At the end of September, Jessica had a nocturnal dream she correctly related to
re-experiencing in hypnosis the trauma of being raped by the "soldier" at the age of 3 or 4 and her
fear that he would kill her in penetrating her. In addition, the dream contained the conviction that
once this trauma was worked through, she would gain a full womanly identity, become an adult
woman, and leave the hypnoanalyst's office. To leave me made her feel sad. She felt exhausted.
But she said, "It is a good exhaustion. "
During the next month, Jessica again relived in several age regressions in trance her lying
under the bed as a child, trembling, because she knew someone was going to come in who would
hurt her. I asked her to look up from under the bed to see who it was. Again she said she could
see only his feet and the lower part of his trousers ... khaki trousers, and she started to sob. I felt
that she by now had gained enough ego strength to face the trauma fully.
Thus, over several sessions I encouraged Jessica to come forward from under the bed,
look further up higher and higher, and eventually see the face of the intruder. I continued to
vacillate between thinking that the rapist had been the brother or perhaps the father and believing
that she really was right when she said it was the soldier. The khaki color of the uniform
remained the same, and eventually the face turned up over and over again as that of the soldier.
Still, I had doubts and thought it was the brother, because Jessica had been so agitated and
sexually aroused when as an 11-year-old she found a postcard announcing the visit of "Tim,"
whom she supposedly did not know and had never heard of. I knew that Tim had worn a uniform,
too: throughout his adolescent years, he had been in the ROTC; later he was in the Army. But
whenever 1 probed about the brother's uniform, Jessica pointed out that the trousers of an ROTC
uniform are not khaki but gray with a slightly pinkish overcast, and the jacket is olive drab. Up to
January 1977, there also occasionally were indications that the incest could have been committed
by the father. One such indication occurred when Jessica in hypnosis talked about what kind of
person her father was and felt sexual excitement. She did not tell me this at the time, but only in
the following hour, and said, "I feel like a mole that is quickly going underground, with you
reaching after it but not being able to catch its tail or its feet. It is a form of an unharnessed,
playful, wriggling away from 'mother.'" As a toddler, Jessica had been harnessed by her mother
so she would not run away. She had always resented this harness, and, even when thinking about
it as an adult, she had felt "badly abused." She was surprised her feelings had changed so much.
The feeling of passively having to endure immobilization (as she had to during the rape on the
soldier's lap) or restriction (in the harness the mother put on the toddler or the many prohibitions
imposed on her throughout her (316) childhood by her parents) now had changed to a feeling of
ego activity and playfulness, in which she mischievously and playfully ran away from the
transference figure of the mother-therapist, who was trying to catch her but did not succeed. The
patient was intrigued and pleased when I said that these fantasies and behaviors indicated
emotional growth and playful attempts at mastery and autonomy.
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A few weeks later, Jessica was willing for the first time to look at the "Enema" picture
again. I explained to her that this drawing and her panic-stricken unwillingness to look at the
drawing again, which had lasted for 3 years, had caused me from early on to suspect a deeply
repressed childhood rape in her background. A mother would not be lying bare-buttocked on top
of her child when administering an enema! The patient could smile now ... and agreed. She
understood now that the drawing referred to the repressed childhood rape experiences she had
wanted to keep repressed but also wanted to disclose in hypnoanalysis, so that she could free
herself of the emotional burden of this trauma. And she said now that her mother had given her
an enema only once in her whole life, not two or three times a week, as she had told me so often
before. Jessica felt that the hours of the last 3 months, October-December 1976, had been the
most important hours of all the 12 years she had spent in her four therapies (three psychoanalyses,
one hypnoanalysis).
But even though the traumatic experiences with the soldier had been brought to
consciousness, Jessica tenaciously held on to the fear that in intercourse with her husband she
would become damaged, torn apart, hurt, a phobia she had developed 4 years earlier, when he
asked her to take the upper position in intercourse. She continued to sleep in the same bed with
him without allowing him to have intercourse with her. Jessica had shown a similar tenacity to
hold on to bad experiences in her relationship to her mother earlier, during the 3-year
hypnoanalysis period of enormous anger at the mother and self-pity.
I wanted her not to repress the childhood sexual traumata again, but to leave them behind
and move on to a mature and happy sexual life. In a hypnotic session, remembering that Jessica
herself had felt totally fenced in when the soldier grabbed her and held her so tightly, I used a
fence symbol to help Jessica free herself from the emotional grasp of the two men who had
abused her, the rapist "soldier" and the physically abusive father. I suggested that Jessica erect in
her childhood home state a corral that would surround her father and the soldier, a high fence that
would encircle them and from which they could not escape. She should padlock it, and then go
eastward, to the state where she currently lived, to the place in the country where she had bought
the house surrounded by woods. There, her husband or some other person she loved or could love
was waiting for her tenderly, I said. To help her not to repress the sexual (317) traumata again, I
suggested that while walking away from the corral that enclosed her father and the soldier, Jessica
could look back at them anytime, but they did not need to be part of her life any longer. She
could leave them behind and turn to a better future, in her own "woods," her own inner, happier
world. I asked Jessica to use this fantasy in selfhypnosis three times daily.
She called that evening to tell me that she had repressed the content of the fantasy she was
supposed to use in self-hypnosis. On the telephone I encouraged her to think about it, and
together we reconstructed the fantasy.
The next week, Jessica brought in some drawings she had made depicting the content of
several self-hypnotic sessions during the preceding days. The most striking one (Fig. 9.3) showed
on the left side a 3- or 4-year-old little girl riding on her tricycle around a closed tepee. Jessica
had closed the open stockade of the corral I had suggested to her in the preceding hypnotic
session, by leaning the vertical poles towards the middle of the structure so the corral now looked
like a tepee. The child in that drawing is not able to get inside the tepee or to see what is in it. On
the right hand side was the same "tepee" with what seemed to be an open flap, but Jessica
described it as "what one could see through a small, keyhole-like opening in the wall" of the
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tepee. Inside this tepee-corral a young boy, about 12 years old, was strapped to a stake. Just
outside the tent, on a stone, the initials of Jessica's half brother or father were carved. They had
the same initials, she said. It was utterly clear now to me that the patient was saying her half
brother had sexually attacked her when she was 3 or 4 years old and he was 12, that is, during his
first visit, the memory of which she had totally repressed by the time of his second visit, when
she was II years old.
Jessica said that she could not explain why she had put her brother's or father's initials on
the stone. I probed by saying that the soldier had been older than 12, he had been 25 years old
when he came to their house, and that Jessica had always drawn him with curly black hair. When
I pointed out that the boy in the tepee had straight hair, Jessica flatly said, "I cannot draw curly
hair." This was not true. She had always drawn both the soldier and herself with curly hair. I
probed and probed, but Jessica could not make any connection between the letters and the boy at
the stake. I was struck by this because the meaning was so obvious and the highly sophisticated
patient, a psychoanalyst, could not see it. I began to feel that it would be cruel to lead or force
Jessica to recognize that the soldier had been a screen memory and that the attacker had really
been her brother. The brother, after all, had been the only person with whom she had had a
positive, warm, and enduring relationship. He was her idol. Clearly, Jessica had indicated, over
and over again, that she could not face losing this positive introject. I did not want to run the risk
of destroying the one (319) scientist in me, who wanted to get at the full truth, and the therapist,
the caretaking, protective mother figure, had been in conflict about how far to press; that each
time I had probed, the patient had reacted with utter denial, and that, therefore, I finally decided I
had no right to press any further but must respect the patient's protective defense. I also explained
that some defenses simply should never be lifted [such as the defense against bringing into
consciousness mercifully repressed, unbearably horrible experiences from concentration camps
(Wilson & Fromm, 1982)], and that, partly on the basis of that, I had decided to insist on
termination. Jessica, who always compared what had happened to her in childhood to the
concentration camps, understood that and said she appreciated my wanting to protect her from
fragmenting under the impact of the insight that the rapist was her brother. Several months later
she admitted that she had been able to accept this realization so calmly because she experienced
"a tremendous sense of gratification" in feeling that she did, indeed, "possess" her brother in some
way or had possessed him. No one could take that away from her. The memory of fusing with the
beloved brother in the sexual acts, the symbiotic aspects of the relationship, was so important to
her that it made up for the traumatic aspects. This, of course, was possible only because the
patient had worked through her anger, hostility, and disappointment at the rapist-brother on the
screen memory of the "soldier" in Phases 7 and 8.
Up to this point, Jessica had never been able to let the ORO fade, even when she went into
very deep states of trance. In particular, she was always vigilant about footsteps out in the hall.
As soon as she allowed herself to realize that the dead brother had been the childhood rapist, she
experienced the fading of the ORO every time she went into trance. She no longer needed to
guard herself against an (unknown) intruder who might force himself physically upon her or
whose identity she might become aware of prematurely if she would fully let go in trance and not
hold on in some ways to current reality.
Phase 9 (August 1977-December 1977) Termination Proper: Termination had been
indicated and worked at since February, but throughout the spring and most of the summer,
 109

Jessica refused to set a termination date towards which we would strive. She also clung to her sex
phobia. But termination was overdue. So, in August I told her I would set a termination date for 3
months hence. I told her in the waking state that I felt she was engaging in a sit-down strike with
me, preventing herself from making or improving object relationships with others (her husband,
friends, and colleagues) by being able to hold on to me, the mother figure. I said I could no
longer allow her to do that. A good mother lets her child (322) go and become independent.
Through hard and conscientious work in the hypnoanalysis, she had acquired the ego structures
she did not have before, namely: the ability to regulate anxiety and affect, libidinal as well as
angry and hostile affect, so they no longer overwhelmed her; the ability to soothe herself; and
more realistic self-esteem. She also had shown that at her competent disposal she now had a tool
for further growth: selfhypnosis. Her ego strength had increased so much and stabilized that I
knew she could now use it autonomously without danger of fragmenting.
I told her the gains she had made in the work we had done together would not vanish; they
were the basis from which she could and would continue to grow. This meant, I said, that it was
up to her now to do her part in re-establishing a sexual relationship with her husband, whom she
did not want to leave and who was trying to help her. She had to make the relationship one of
mutual give and take. Above all, I said, I knew she now had enough ego strength to withdraw
cathexis from me and invest it in the relationship with her husband and in making new and lasting
friendships with other people or improve old friendships.
Jessica had come a long way. From a near-borderline, who was always afraid she would
be overwhelmed by her affects and become psychotic, she had traversed successfully the vast
terrain of preoedipal narcissistic development (Adler, 1981, 1985; Gedo & Goldberg, 1973), had
achieved object constancy and healthy self-esteem, and had reached the developmental level of a
neurosis (sex phobia). While working on her other problems, we had also continually worked on
the sex phobia and uncovered its repressed, underlying cause, the childhood rape. For 2 years she
had now consciously known that she had been raped in childhood and even had realized (without
regressing into fragmentation!) that it was an incest. That she did not go to pieces when she
realized it was an incest committed by her beloved brother, or within a few months after she had
gained that insight, I told her, proved that she really had developed great ego strength and
maturity. Yes, she still had not overcome the sexual phobia of the last 5 years. But when patients
with phobic symptoms cling to their fear after all is analyzed, there comes a time when one
cannot allow them to remain in the understanding analytic environment and go on talking about
the symptom endlessly. One must force them to go out so they will confront their phobia and act.
Jessica obstinately fought to prolong the hypnoanalysis by 6 months, but I remained firm.
She refused to let me help her with her mourning work and went into an angry depression for a
month after termination. She came out of it feeling liberated and joyfully and creatively engaged
in research and writing, which she always had insisted she simply could not do.
A year after termination she wrote me, "You did the right thing when you insisted on
termination at the time you did," and detailed the internal (323) post-therapy progress she had
made. More of her narcissism, grandiosity, and especially her feelings of entitlement had "burnt
away"; she had "practiced trying to listen to nonpatients and be interested in their point of view.
If I can be the soul of tact with my patients, I can learn to be that with others, too." She could
now give emotional warmth and understanding to her husband when he had problems that
depressed him. She had made new friends, and old friends told her she had changed very
 110

favorably. Selflessly, she now began to be able to give to younger colleagues.

Furthermore, Jessica wrote: Now for the first time in my life, consistently day after day, 1
feel that my Self is my own, and no one else is responsible for it. And instead of this being an
onerous burden, it is a quiet and fulfilling pleasure. I now have a cohesive sense of self. For the
first time in my life, without doubt 1 can say, "1 am healthy." 1 know that no matter how bad the
vicissitudes of life may be which 1 may have to face, there is a solid sense that 1 will hang
together. Things have become something to master instead of to fear.
Since termination, the patient also has developed a new area of specialization for herself: the
treatment of perpetrators of incest. She handles these patients with great skill and understanding.
SUMMARY AND CONCLUSIONS:
This chapter has illustrated two clinical treatment issues:
(a) hypnoanalysis with patients along the borderline-narcissistic continuum and
(b) hypnoanalysis with post-traumatic stress disorders (PTSD).
In addition, it has attempted to show the process, the flow, of hypnoanalysis in a difficult,
long-term case.
The case study is an example of hypnoanalysis with severely disturbed patients.
Hypnoanalysis with neurotic or psychosomatic problems usually takes somewhere between 3
months and a year. But hypnoanalysis with patients arrested at or regressed to
preoedipallevels-the borderlines and the severely narcissistic patients-takes much longer. This
case report exemplifies the use of hypnoanalysis to foster growth along the developmental line of
the self, that is, along the continuum from borderline pathology to narcissism and eventually to
neurosis or full health (Adler, 1981, 1985; Gedo & Goldberg, 1973). The chapter demonstrates
the use of hypnoanalysis in effecting changes in the nature of the representational world, the
world of internalized object and self-images. At first Jessica could see herself and other people
only in black and white, either as "all (324) good" or as "all bad." Her parents, her colleagues,
and her current teachers were all "bad." She saw herself consciously as far superior to them, but
unconsciously she felt she, too, was "all bad." Particularly during the first four phases, but
actually even through Phase 9, I took on the role of the nurturing, always giving mother, and that
of the mother who with great joy noted and talked about every tiny bit of progress, every little,
and certainly all big, successes the patient had in real life or in therapy. This "gleam in the
mother's eye" was emphasized so that the patient-whose mother had not been proud and fond of
her during the separation-individuation period (and later)-could incorporate the hypnoanalyst as a
good mother figure, internalize her, and gain self-esteem. The patient needed to feel that there
must be good parts in herself, or else the hypnoanalyst-whom she esteemed and loved-would not
love her. It was necessary for the patient to learn that not all people are like her bad mother and to
bring together the split image of the "all good" and "all bad" self-representations so as to make
for a more cohesive sense of self and for healthy self-esteem.
In the next few phases (the end of Phase 4 through Phase 6), we worked on object
constancy. That is, I tried to get the patient to accept that people are not all good or all bad and
that I was not that over idealized person, without any faults, that Jessica had made me into in the
early phases of her therapy. I pointed out my typical forgetfulness, which had upset Jessica many
a time, to show her that "good" people have a bad side too and that even though they have their
faults, one can love them. Also they do not abandon you when they have to go on trips for a
while. And I showed the patient, for instance by teaching her self-hypnosis and by applauding
 111

every attempt at autonomy that she made, that I did not resent her striving for autonomy, but
hoped to stimulate it as healthy progress on the way toward individuation and growing up.
The hypnotic techniques employed for achieving these goals were partly imagery and
fantasy production and partly the nature of the hypnotic relationship. My own empathic
mothering and mirroring stance served the patient as the basis for internalization and the building
of psychic structure.
The case report also shows how to use hypnoanalysis to treat patients with post-traumatic
stress disorders, in particular, patients who have suffered early incest and child abuse. As is
characteristic of post-traumatic stress syndrome cases, the patient first produced a disguised
presentation (the enema picture). This was followed by a screen memory (sexual abuse by the
"soldier"), which was held on to and worked over and over before the incest component, that is,
the full extent of the sexual trauma, finally could be recognized. Much of the working through of
the trauma was done on the screen memory (the horror, the feeling of helplessness, the feeling ,of
perhaps having contributed to the incest by being pretty, cute, and (325) flirtatious; the fury
against the perpetrator of the crime and the murderous rage against him). The screen memory of
the soldier was needed for so long because the brother was a very beloved and admired figure,
whom the patient, even after his death, could not afford to lose as an internalized love object and
ego ideal, a stance with which the therapist agreed. By working through all these feelings on the
screen memory of the" soldier," Jessica could be helped to retain that internalized good and
beloved part of the brother that had given a family feeling of stability and warmth to her
adolescence and adulthood, a feeling her rejecting and physically abusive parents had not been
able to provide.
The case also demonstrates that with PTSDs, more than in any other emotional illness, it
is necessary to respect the defenses, particularly the tenacity of the repression, and to understand
the fear of being overwhelmed by affect. In many PTSDs there is an ever-present danger of
acting out, which, however, in this case was not nearly as strong as the fear of being
overwhelmed.
In the hypnoanalysis of post-traumatic stress disorders, intermittent resistance to trance
characteristically occurs. Often material will come up for a while, and then the patient does not
want to work with hypnosis any longer for either short or long periods of time. If one comes
close to uncovering the actual trauma and the patient is not ready for it, hypnotizability and the
willingness to work with hypnosis decrease markedly. When the patient again becomes willing to
close in on the trauma, he or she will ask to use hypnosis again, and hypnotizability increases,
often returning to its original level or exceeding it.
The case thus illustrates some of the special parameters and practical considerations of
working with PTSDs and other traumatic neuroses. In such cases one must proceed much more
slowly than in most hypnoanalyses. The case exemplifies some of the more difficult clinical cases
one can handle with hypnoanalysis. Treatment of post-traumatic stress is technically one of the
most difficult types of hypnotherapy or hypnoanalysis that one can undertake. It necessitates
more symbolic handling of the material that comes up than do many other kinds of cases. The use
of fantasy and age regression involving screen memories rather than the original trauma, the use
of drawings and anagrams, and building in delays and not pushing are all techniques that can
allow repressed material to unfold at the patient's own speed. Even when the hypnoanalyst for a
very long time is aware of the trauma that the patient has gone through, he must not overwhelm
 112

the patient by confronting him with "the truth" or pushing him to become aware of the full truth.
In cases of repressed traumatic experiences, hypnoanalysis usually proceeds from the
disguised presentation to the uncovering; first the uncovering in terms of screen memories (the
"soldier" in the three childhood rape incidents) and then the uncovering in terms of the original
(326)
trauma. If there is a danger of the patient's fragmenting under the impact of having to face the
original trauma in all its starkness-that is, if the patient's ego is not strong enough to withstand
such disclosure-the material is better worked out on the screen memory only. After the material
has been uncovered and worked through, there follows a phase of liberation, increased
self-development, and autonomy; and, after that, the working through of the sexual dysfunction,
in or out of therapy.
This chapter also illustrates the ebb and flow of the process of hypnoanalysis, the working
through of the material over and over again, which is characteristic of long-term cases in
hypnoanalysis as well as in psychoanalysis. But note that with eight years of psychoanalysis, with
very fine and competent psychoanalysts, the incest had remained so deeply repressed that none of
the psychoanalysts even suspected it; in hypnosis, on the other hand, it rose so much closer to the
surface and manifested itself in drawings, screen memories, and symbolic imagery so clearly that
the hypnoanalyst could recognize it within the first month of the hypnoanalysis.
The hypnoanalytic methods employed in this therapy were: being a good, empathic
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7. HYPNOANALYSIS: WILLIAM KROGER & WILLIAM FEZLER: HYPNOSIS &

BEHAVIOR MODIFICATION: IMAGERY CONDITIONING: J. B. LIPPINCOTT CO:
PHILADELPHIA: 1976
Hypnosis and psychoanalysis can be used together (Wolberg 1945). This combined
method is referred to as hypnoanalysis. Every therapist knows that (50) alterations in awareness
are constantly taking place during every session. Neurophysio10gists agree that the brain's
attention span varies from second to second. Therefore, patients and therapists themselves are
never in a static state but rather they fluctuate along the broad continuum of the
sleep-wakefulness cycle. Thus, they can be alert (wakefulness), super-alert (hypnosis), or less
alert (sleep). Psychoanalysts have observed that at times the patient may appear to be in a trance
like state that has been compared with the feeling states experienced during free association.
Freud, who learned the technic from Liebeault, a French hypnotist, reported that he sometimes
reassuringly placed his hand on the patient's forehead suggesting that this would increase
relaxation, facilitating free association and dream recall.
When hypnosis is used with psychodynamic procedures, deeply repressed material is
readily abreacted, and with the appropriate technics the meaningfulness of this material can be
integrated into sensory awareness. This also more readily allows the patient insight into the
 132

hidden reasons for his behavior. Psychoanalysis derives from hypnosis incisive tools that speed
up what ordinarily is a slow method.
Applicability: Nearly all individuals can be hypnotized to a degree. Those who attain
deeper stages make the best subjects for the sophisticated hypnoanalytic technics described
below. It is estimated that about 20 per cent of the population fall into this classification.
However, another 20 per cent can be trained to develop many of the phenomenological responses
associated with deep hypnosis, such as somnambulism.
Contraindications: Hypnoanalysis should be used only by psychotherapists trained in
psychodynamic theory and practice. They must be capable of dealing with highly charged
emotions when these appear. Cases for hypnoanalysis also must be carefully selected. The fearful
individual with weak and inadequate characterological defenses also requires careful handling.
Those likely to be overwhelmed by the intensity of their verbalizations likewise require careful
consideration. Presence of a severe psychosis is a prime contraindication to hypnoanalysis.
Indications for Hypnoanalysis: Hypnoanalysis is indicated for those who do not
respond to short-term therapy. It is very valuable for the poorly motivated patient. Posthypnotic
suggestions can bind such patients to therapy. This allows time for rapport to be established. Even
though dependency is fostered deliberately in such instances, it can be worked through and
resolved during later sessions. This approach can shore up a weak ego and hold a symptom on
leash until the need for it in the patient's emotional economy is worked through.
Hypnoanalysis has been particularly effective in the treatment of phobias and
compulsions. An indication for hypnoanalysis is extreme depression and suicidal tendencies in a
patient. On more than one occasion we have used age regression to revert the patient to a point in
his life in which he was not depressed. A protective posthypnotic amnesia for the traumatic
material is engrafted and removed only after the patient improves.
Methodology: Others, particularly those suffering from severe psychoneuroses, with
diligent training can be taught to follow posthypnotic suggestions to develop amnesia, age
regression, and revivification of past experiences. At each step the subject can be questioned as to
his emotional reactions experienced while entering hypnosis, being in it, or coming out of it.
As in a classical analysis, the transference neurosis, resistances, and defenses can be
analyzed. The process makes full use of the technics of free association, dream analysis, and
interpretations by the therapist. An advantage of hypnoanalysis is in the handling of marked
resistances. These are not removed through direct hypnotic suggestion per se, but rather are
handled through discussion, interpretation, and evocation of the reasons for maintaining these and
other defensive mechanisms. The reasons for the desire to maintain the chronicity of the
symptom, for example, for secondary gain, and the ability to abreact traumatic events often can
be facilitated by hypnoanalysis.
In good hypnotic patients, recovery of repressed or forgotten memories can be obtained
by the "interim phenomenon" (Lindner 1953). In this interesting technic, a posthypnotic amnesia
is engrafted for the repressed material obtained during hypnosis. The patient is then slowly
prepared to assimilate the information at nonhypnotic levels. The usual cause for repression of
traumatic material is anxiety. However, in a relaxed, anxiety-free state, harmful thoughts filter to
consciousness and can more readily be worked through. In other words, the patient is now
prepared to accept what he formerly defended himself against. Generally, repressed material for
which the amnesia was imposed may slowly filter into awareness either after the termination of
 133

the hypnotic session or during the subsequent visits. Importantly, the patient participates with full
awareness. A distinct advantage when working with highly charged material is that patients can
be instructed that if the material is too traumatic to discuss during a specific session, it can be the
basis for a dream between now and the next visit. Thus, if a symbolic correlation results between
the highly charged material and the dream content, the validity of the exhumed material can be
cross-validated by this approach.
(52)
Posthypnotic suggestion can be used to help the patient resolve difficult situations. Such
suggestions can be used for helping in the dissolution of the transference relationship. As
mentioned, since the rapport during hypnosis is closer and more intense than with conventional
therapy, suggestions are more readily carried out. It is this feature that accounts for the rapidity
with which exploration of deeply repressed material can take place in hypnoanalysis. Freud
(1955) denied the use of suggestions in his therapeutic approach. Despite this denial or lack of
awareness, he stated:
Thus, it becomes possible for us to derive entirely new benefits from the power of
suggestion; we are able to control it; the patient no longer manages his suggestibility to his own
liking, but insofar as he is amenable to its influence at all, we guide his suggestibility.
Horizontal Exploration: Horizontal exploration of the nature of a symptom-complex
can be obtained by sensory recall under hypnosis. In this approach the therapist identifies himself
as a friend of the parents. The patient can be asked, How did things go with you today? or, What
seems to be bothering you today? If the therapist can engraft an amnesia for his own identity and
assume the role of a sibling, friend, teacher, employer, or parent, the patient's verbalizations and
behavior will often reveal the way he felt toward such significant persons in his life at different
age levels.
Vertical Exploration: Vertical exploration can be used to trace the development of
specific attitudes. By interweaving the chronological past with the present, one can rapidly assess
earlier attitudes. In this technic, age regression is used. In good hypnotic patients, an individual
can be asked "You are eight years old now are you not? Tell me what you are doing this
afternoon." The richness and detail of the recalled material often is dramatic.
Age "progression" may be used to advance an age-regressed individual through earlier
years of development. Love, hate, fear, and other attitudes toward significant figures in the
individual's life can be elicited. Considerable light can be shed in the genesis of these emotional
attitudes, and how these affected the personality structure to produce symptoms.
Automatic Handwriting: Though we seldom use this technic, it can be of distinct value
for those patients who are affect-blocked, and also for ascertaining the reasons for a specific
conflict. Posthypnotic suggestions are given that the hand will be (53) "dissociated" and will
write answers to specific questions while the patient is being engaged in conversation far
removed from the desired answers. Here, too, automatic writing, in reality a form of "doodling,"
can be combined with age regression. Posthypnotic suggestions can be used to help interpret what
looks like unintelligible writing. All patients should be "restored" to their present chronological
age and the dissociated hand "returned" to normal. A protective amnesia can be employed if the
automatic writing contains material too traumatic to be faced at the present time.
Projective Hypnoanalysis: In this technic, psychometric materials such as Rorschach
ink blots are presented within what seems to be nonsense material. Since the patients are not on
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guard, highly significant verbalizations can be elicited. The Thematic Apperception Test, in
which subjects are asked to imagine and tell a story from various picture cards, can also be used
for this purpose. However, Watkins (1949) points out that the less structured the eliciting
stimulus, the more significant the data gathered from it.
Hypnodrama: These methods are similar to those used in psychodrama. The conflict
situation can be dramatized while the person is under hypnosis. The therapist or professional
actor can play one of the roles. Posthypnotic suggestions can be given to the patient to play a
specific character having relevance to conflicts in his life. Both the patient and the therapist can
help dramatize the situations in which the inner conflicts of the imaginary character with whom
the patient has identified are portrayed.
The personality structure can be dissociated for separate study. The patient can act out
both roles. The dissociation should be along the lines of the inferred conflict. In this way the
patient actually reenacts his own inner conflicts. Age regression, automatic handwriting, and
anyone of the projective technics can be used with hypnodrama. For a fuller explanation of this
approach, the reader is referred to Greenberg's (1974) excellent book on the subject.
Abreactions: Reenacting past traumatic experiences with resultant release of affects can
readily be obtained in good hypnotic subjects. This approach is helpful for reduction of hysterical
or severe anxiety reactions of recent origin. The nature of the repressed impulses can be studied
to determine their purpose. Following release of inhibited aggression, guilt, and fear impulses,
emotional integration can be readily accomplished. (54)
Affect-Bridge: Watkins (1971) describes this as a technic whereby a patient is moved
experientially from the present to a past incident over an affect common to the two events rather
than through an overlapping "idea" as is usual in psychoanalytic practice. The current affect is
vivified and all other aspects of the present experience hypnotically ablated. The patient is then
asked to return to some earlier experience during which the affect was felt and to relive the
associated event. Significant conflict material so secured can be "brought forward" to the present
to achieve "insight" and "work-through" conflictual material to produce an emotional abreaction.
The technic also resembles sensory recall. This approach should be used only by experienced
hypnotherapists.
Narcohypnoanalysis or Narcosynthesis: Skillful hypnotherapists seldom use drugs.
However, occasionally a refractory patient may be given a small amount of sodium pentothal; this
often allows the patient to talk more freely. The patient who benefits most by this approach is the
one who states, "I doubt if I can by hypnotized." Other individuals, who associate hypnotizability
with gullibility, respond well to various drugs such as scopolamine. Such patients are merely
looking for some excuse not to directly respond to the suggestions of the therapist; they do not
feel stigmatized by drug- induced "hypnosis."
Artificial Induction of Dreams: Meares (1960b) describes special procedures to
facilitate hypnoanalysis. He makes use of dream analysis through directive or nondirective
posthypnotic suggestions. He has found that this technic is valuable where age regression or
abreaction cannot be induced.
Induced Hallucinations: Conflicts inaccessible to hypnoanalysis often can be revealed
by suggesting positive hallucinations wherein the individual visualizes himself on a theatre or
television screen. Analysis of the hallucinatory experiences may often provide considerable
insight into the nature of the repressed conflicts.
 135

Unstructured Hallucinations: Unstructured hallucinations are induced without

structuring the therapeutic situation. Merely by asking the subject, while he is in a deep hypnosis,
to relate what is happening may reveal significant material, and spontaneous regression and
abreaction often occur. (55)
Production of Experimental Conflicts: Through posthypnotic suggestions an artificial
situation that resembles the patient's conflict situation may often provide him with insight as to
how and why he is reacting to his own conflict. He reacts to the elicited emotions with his own
specific behavioral response. Posthypnotic suggestions are directed toward recall of those
experiences and feelings that the patient had while hypnotized. Thus, while observing the reaction
to an imaginary conflict, the therapist gains insight into the nature of the conflict.
Hypnography Meares (1957) describes hypnography as a "technique in hypnoanalysis in
which the hypnotized patient projects psychic material in black and white painting." He believes
that graphic expressions of conflicts has a greater therapeutic effect than verbal expressions of the
same conflicts. Suppressed and repressed material is disclosed more readily, and there is greater
emotional participation of the patient in the treatment. Symptomatic improvement manifests itself
by a change of the paintings. For a more complete account of hypnography, the reader is referred
to Meares' (1957) excellent monograph on this subject.
Hypnoplasty: In this technic, the hypnotized patient uses clay to model whatever he
wishes to make. His conflicts find expression in plastic rather than graphic form. Specific
meanings and the nature of the conflict that has motivated the making of a particular model are
brought to light when the patient is asked to associate to the model. Meares (1960) presents a
more complete account of hypnoplasty. This specialized technic has been described in more detail
by Raginsky (1962). (56)

8. BACK TO ISE: DUNCAN MCCOLL: PRECISION THERAPY: HYPNOANALYSIS

TECHNIQUES: CROWN HOUSE PUB: UK 1995
1. Back to ISE ... (Physical influence to release) ... follow through on the linkages ...
ISE/compounding, all parts benefiting.
Forgiveness (not necessarily excuse) integrate the child within, always in your heart.
2. Ask subcon - Anything else needs to be clarified? - Clear through dreams and experiences.
- Notify changes in habits and behavioural patterns.
- Maintaining channel open ... keyword 'relax'.
3. Have you any questions for me ... or subcon?
Thank subcon.
Future pace to disturbing/similar event ... test keyword. Relax - and you know you will attain to
spontaneous right action ... now ... and in the future.
More at ease with yourself (etc.). You are freed from self-
limiting influences of the past the past is freed from you.
Relax and forgive ... live and let live.
4. Everything useful that you have experienced today is part of your everyday living reality and
those experiences that upset or inhibited you in the past now serve to increase your self-
confidence and success in life.
5. So what are we all- we are all children of stardust - and all the joy and love and hope in the
world is yours ... and now you will be more poised, more serene, more loving and (24)
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compassionate than ever before. You do better than well- you excel. When you open your eyes in
a moment, you will know that you have established contact with your own control mind and this
two-way communication channel will serve you well.
6. With a smile on your face and a song in your heart - come back to this world of everyday
living reality at the count of five rejuvenated - revitalized - renewed - and notice how good you
feel ... and the number is one ...
7. Test anchors, future pace. 'I excel' ... convince me. (25)
AGE REGRESSION TO THE INITIAL CAUSATIVE EVENT: DUNCAN MCCOLL:
PRECISION THERAPY: HYPNOANALYSIS TECHNIQUES: CROWN HOUSE PUB: UK
1995
(Repeat the client's words). Right - so you're four years old ... it's night-time ... you're alone ...
you're in your bedroom ... tell me now ... tell me ... what's happening now? Now at the count of
three ... go to another time when you had similar feelings ... 1 ... 2 ... 3 ... (*) there you are ... tell
me what's happening now.
Indoors or outdoors ... night or day ... alone or with someone.
Infancy
... All right now ... you're an infant child
... Tell me ... do you love your mother?
... Does your mother love you?
... Do you have brothers and sisters (same theme).
Gestalt:
This time ... when I click my fingers ... your father is going to be standing six feet in front of you
(*). There he is ... what do you call your father ... Dad? (Yes) ...
All right ... I want you to talk to him right now. I want you to say to him 'Dad ... there are some
things I want to ask you and I want a straight answer ... '
Say that to him in your own words.
Now say this to him ... 'What kind of a father do you think you were to me' - say it ... Now,
change places ... be your father ... What do you say to your son (etc.). (71)

9. HYPNOANALYSIS: WILLIAM S. KROGER: CLINICAL & EXPERIMENTAL

HYPNOSIS: J. B. LIPPINCOTT: PHILADELPHIA: 1963
Watkins contends that the hypnotic concept of "trance" and the psychoanalytic concept of
"transference" are essentially identical. Even though many subjects are in a deep state of
hypnosis, this does not necessarily imply that they are in a static state, but, rather, as emphasized
in this book, they fluctuate up and down the broad continuum of what is referred to as
consciousness (the sleep-wakefulness cycle) . This will vary from second to second. Thus, when
such hypnoanalytic technics as automatic writing, projective technics and crystal-gazing are
employed, and the patient is required to talk, the patient inevitably shifts from deeper stages to
lighter ones. For those hypnotherapists who wish to follow psychoanalytic technics, there is an
extensive bibliography on the subject.
When hypnosis is used with psychoanalytic procedures, the entire process can be speeded
up, and there is no such undue dependency as compliance. Also, significant emotional
participation occurs when deeply hidden material is released and, with appropriate technics, the
meaningfulness of this data can be integrated into full awareness. If one wishes to work with
 137

resistances, these can be analyzed as in an orthodox analysis. Hypnoanalysis thus derives from
hypnosis "a penetrative technical instrument that obviates many of the time-consuming elements
which often render ordinary psychoanalysis objectionable and in some cases impossible."
APPLICATIONS OF, CONTRAINDICATIONS AND INDICATIONS FOR
HYPNOANALYSIS APPLICABILITY: Anyone who can be hypnotized can be hypnoanalyzed
to a degree. Individuals who (322) can attain deeper stages of hypnosis are the best subjects for
hypnoanalysis. This limits the method to less than 20 per cent of the population.
CONTRAINDICATIONS: Those who can enter a sufficiently deep state and who are
able to bring forth highly charged emotions require a competent and well-trained psychotherapist
to deal with the material. Therefore, cases must be selected. The manic-depressive, with wide
mood swings, is seldom a good candidate for hypnoanalysis, as his disorganized mental state
results in inadequate concentration. It is virtually impossible to treat detached schizophrenics,
who are not in contact with reality, by this method. The lack of reality perception is a prime
contraindication to hypnoanalysis. The fearful individual, with weak and inadequate
characterologic defenses, who is likely to be overwhelmed by the intensity of the therapy, and
those who are too preoccupied with their negative fantasies, or those who fear an attack on their
homosexual strivings, should not be treated by this approach.
INDICATIONS FOR HYPNOANALYSIS: Hypnoanalysis is particularly indicated for
psychoneurotics who do not respond to brief hypnotherapeutic procedures, or for those who
already have had some type of unsuccessful psychotherapy. It is particularly suited for the poorly
motivated patient such as the psychopath. Here utilization of posthypnotic suggestions to "bind"
the patient in therapy is a distinct advantage until a healthy rapport is established. Though an
extreme degree of dependency is fostered deliberately, it can be worked through and dissolved
during later sessions.
Hypnoanalysis is both an investigative and a therapeutic technic in the refractory obese
individual, the narcotic addict and the alcoholic. This approach can lend support to the healthy
aspects of the personality until the need for the symptom is worked through and controlled.
Hypnoanalysis also has shown considerable promise in the treatment I of phobias and
compulsions.
Appropriate safeguards, such as enabling I the patient to remove his own maladaptive
responses through sensory-imagery conditioning and other technics, as a rule, prevent recurrence
of the phobic or compulsive reaction. Rosen has described how age-regression was
hypnotherapeutically induced in several patients as an emergency measure to prevent suicide.
METHODOLOGY OF HYPNOANALYSIS: Patients are first trained in hypnosis,
autohypnosis and other phenomena of the deep state. This may require 20 sessions or more. The
number varies with the type of emotional involvement, the motivation of the patient, his inherent
ability to achieve a deep state, and the effort he puts forth.
At the end of the preliminary training period, the following criteria should be met:
(1) The patient must be capable of entering a hypnotic state upon a given posthypnotic signal or
through autohypnosis.
(2) He should be able to follow posthypnotic suggestions readily, especially those which produce
amnesia and age-regression.
(3) Through revivification he must be able to re-experience events long since forgotten.
Stillerman emphasizes that steps must be taken in the first few sessions to understand the
 138

patient's reaction to the therapeutic situation, that is, his anxieties, his reactions to the
hypnotherapist, and why and how he is defending himself and thus resisting change and progress.
Before attempting induction, he questions the patient regarding his reactions either to observing
or to experiencing hypnosis and how he feels about being hypnotized. Next, the subject's
reactions to either physical or mental activities are closely observed, and he is immediately asked
what he is thinking about. After the initial induction, the various emotional reactions experienced
while entering hypnosis, being in it, or coming out of it are elicited. In subsequent sessions,
dreams as well as verbal and nonverbal productions are included.
Following the training period, the analytic phase may be instituted. The resistances and
the defenses are clarified by development of the transference neurosis. This phase of
hypnoanalysis closely parallels the standard psychoanalytic procedure. The process utilizes free
associations, dreams, analyses and recollections, all of which are interpreted by the hypnoanalyst.
(323)
HANDLING RESISTANCES: Whenever marked resistances are encountered, the
patient can be deeply hypnotized and the resistances in question undercut. The efficacy of
hypnoanalysis, according to Lindner,15 is not reduced by undercutting resistances, nor is this
merely superficial therapy. All the resistances are not dispelled through hypnosis. As mentioned
in the preceding chapter, the blocks are handled through discussion, interpretation and evocation
of the reasons for the various defensive mechanisms employed by the patient. This includes the
more serious resistances which relate to the character structure, and the symptomatology of the
patient, such as loss of memory for traumatic events and defense mechanisms, character
malformation and distortion through symptom-formation.
HANDLING SYMPTOM-FORMATION: Many hypnoanalysts believe that, for lasting
therapeutic benefits, a protective amnesia for each hypnotic session must be induced in order to
guarantee that the entire personality will participate in the therapeutic process. Lindner, the chief
protagonist of this approach, has described how the imposition of posthypnotic amnesia is used in
the recovery of lost, repressed or rejected memories or in the disintegration of resistances. He
terms this the "interim phenomenon." Briefly, once repressed material has been divulged during
hypnosis, the patient is slowly prepared to receive this information at nonhypnotic levels. Lindner
states:
In other words, in the interim between the disclosure of significant but repressed memories or
other resistance-forming material and waking free association, the ego is readied for the reception
of what it had formerly rejected, for anyone or a combination of possible reasons. Actually, this
obviates the lengthy and controversial "analysiS of resistances" which plagues so many
psychoanalytic sessions. The saving in time is considerable, and the patient is prepared to accept
what he formerly defended himself against.
A spontaneous flow of the material for which the amnesia was imposed filters up into
awareness either after the termination of the hypnotic session or during a subsequent visit.
Therefore, nothing of importance to therapy is lost and, more important, the patient participates
with full awareness in the therapeutic processes. Finally, through posthypnotic suggestions, the
patient can be instructed that some of the material which was too traumatic for him to face during
the session can be the basis for a dream between now and the next visit. Thus, if there is a
symbolic correlation between the revealed data and the dream, the validity of the exhumed
material can be cross-checked via this approach.
 139

Posthypnotic suggestions, used for reinforcement, help bolster the changes in the personality
organization. Hence, adaptation to new and difficult situations becomes less painful and
time-consuming. Hypnosis may also contribute to the dissolution of the transference relationship
which is managed as in a routine analysis. The energies that were formerly of pathogenic
significance and monopolized by the symptom can be redistributed along the line dictated by the
entire course of the therapy.
Since the accord between patient and analyst is closer and more intense than in other
forms of psychotherapy, the tools for therapy are sharper, more incisive. This undoubtedly
accounts for the rapidity with which exploration of deeply repressed material can take place in
hypnoanalysis. It is unfortunate that hypnoanalysis is too often ignored, as it is a valid therapy
even though limited to those patients capable of entering deep hypnosis.
OTHER UNCOVERING HYPNOANALYTIC TECHNICS HORIZONTAL
EXPLORATION: Horizontal exploration of the personality structure can be utilized at various
levels through hypermnesia. Here, the therapist identifies himself as a friend of the parents, or
acts as one of the parents. The patient can be asked, "How did things go with you today?" Or,
"What seems to be bothering you?" Or, after engrafting an amnesia for his own identity, the
skillful therapist assumes the role of a sibling, a friend, a teacher, an employer, a lover or a mate.
In this situation, the patient's verbalization and (324) behavior will reveal the way he felt toward
significant persons in his life at different age levels.
VERTICAL EXPLORATION: Vertical exploration can also be used to trace the origin
and the development of specific attitudes. Interweaving of the chronologie past with the present
rapidly assesses earlier attitudes. This seems to be a function of the interpretative cortex, in which
past events timelessly blend with current realities. Regression is attained by stating, "You are
looking at a large calendar on the wall. Instead of numbers for each day and month, you will see
numbers of the years. \Vhenever you wish, you may tear off each page. The first one is 1961.
Now 1960, 1959," etc. (until the desired age is attained). The statements must be in the present
tense, as, "It is now 1941. Do you know that today is your birthday? You are 8 years old now, are
you not? What are you thinking of doing this afternoon?"
Other attitudes such as love, hate, fear and sexual ones can be traced by age-progression.
For instance, if a patient who has regressed to age 7 mentions that at age 5 he was extremely
bitter toward his mother, he can be told, "You are no longer 5. With each breath you take, you are
growing older. Now you are 15 years old. How does it feel to be in high school?" IT the answer is
in the present tense and the person appears to talk and act in accordance with the suggested age,
the age-regression is valid. He is now asked, "Do you love your mother?" If the answer is
affirmative, the hostility in all probability is deeply repressed and it will require other and more
complex methods such as projective technics to uncover the genesis of emotion. If the answer is
negative, considerable light on the origin and the development of the hostility can be obtained.
(325) hand are dissociated, the patient, upon direct questioning, may give one answer while his
hand is writing something else. This is because the dissociated hand is released from cortical
control. The written material can be a clue for the cause of the patient's anxiety.
Illustrative is the case of a frigid 44-year-old woman who had an intense hostility toward
her husband, who symbolized a father-figure whom she hated. The onset of this attitude was
evinced by the following material, obtained under automatic writing.
When asked to explain the writing, after dehypnotization, she stated that she was very
 140

angry toward her father when she was 8 years old because he sent her to boarding school. The
automatic writing reactivated a long-forgotten incident, and also revealed the cause of her hostile
attitude toward her husband. She remarked, "My husband is just like Dad. He is always so bossy
and opinionated. I just can't stand him."
Each patient should be "restored" to his present chronologie age and the hand "returned"
to normal before dehypnotization. While still under hypnosis, the patient should be instructed to
remember everything that was written. Protective amnesia can be instituted if the material is too
traumatic to be faced at this time. An explanation of the written material, intelligible only to the
patient, can be facilitated by posthypnotic suggestion, provided he really wants to explain it.
PROJECTIVE HYPNOANALYSIS: Such psychometric tests as the Rorschach, or
other stimulating situations, are presented in the form of what seems to be nonsense material.
Here, while not on guard, patients project significant conflicts. Variations such as the theater
technic, crystal-gazing, or scene-visualization obtained by gazing at a blank card, often reveal
inner feelings which can be discussed after dehypnotization. However, as Watkins has mentioned,
the more the
Another useful technic is the Thematic Apperception Test (TAT.), which consists of the
presentation of various pictures about which the hypnotized patient is asked to imagine a story or
a theme suggested by them. In the Jung Association Test, the patient is requested to give the
association evoked by the next stimulus word. Each response becomes the stimulus for the next.
Regression can also be used. In an unreported series with Helen Sargent, the author has validated
Watkins' contentions.
HYPNODRAMA: The methods introduced by those interested in psychodrama also can
be employed (326) while the patient is under hypnosis. The whole conflict situation can be
dramatized, and the therapist or a professional actor can play one of the roles. While the patient
is under hypnosis, a posthypnotic suggestion is given that he play the part of a specific character.
The two then dramatize a situation in which the inner conflicts of the imaginary character with
whom the patient has identified are portrayed.
The personality structure also can be split or dissociated for separate study: the patient can
act out both roles. Naturally, the dissociation should be along the lines of the inferred conflict. In
this way the patient actually re-enacts his own inner conflicts. Regression, dissociated
handwriting and any of the projective technics can be used in conjunction with hypnodrama.
ABREACTION: An emotional reliving or re-enacting of traumatic experiences, with a
resultant release of energy, can be obtained in good hypnotic subjects. This approach is valuable
for anxiety and hysterical reactions of recent origin, particularly those associated with war
neuroses. The nature of repressed impulses can be studied to determine their purpose. Following
release of the inhibited guilt, rage or fear impulses, intellectual as well as emotional reintegration
can be accomplished.
Experience with these methods in a military setting indicates that, through enactment of
the conflict, the original frustrating situations are brought to a more satisfactory and realistic
solution. It is believed that:
An emotionally corrective experience is undergone which "completes" the un1lnished
strivings, which are the repetitive core of the neurosis and relieves the need to continue its
symptomatic manifestations.
THE AFFECT-BRIDGE OR IN-AND-OUT METHOD: Watkins makes use of yet
 141

another interesting technic wherein a hypnotically well-trained patient is given a revealing

statement while hypnotized. After the patient is dehypnotized, the material is discussed and then
he is rehypnotized for further discussion and questioning to ~scertain whether or not his
understanding is complete. The entire session may develop into an in-and-out interview for
uncovering new material or understanding old points. Weaving between hypnotic and
nonhypnotic levels of awareness helps the patient to reintegrate concepts at both levels. In other
words, bridging of the "unconscious to conscious" achieves a more lasting change in the
personality structure.
INDUCTION OF DREAMS: Meares, in an excellent presentation, describes special
procedures to facilitate hypnoanalysis. He makes use of analysis of dreams produced through
direct or indirect posthypnotic suggestions. This is a useful technic for cases in which regression
and abreaction cannot be induced.
INDUCED HALLUCINATIONS: In a fashion similar to that in the technics described
by Watkins, hallucinations are suggested without suggesting their nature. Conflicts ordinarily
inaccessible to hypnoanalysis are revealed by this technic. The induced hallucinations are
produced by suggesting that the subject visualize himself on a theater screen, or in a house in
which he has been at one time, or that he "see" images which will appear in a crystal ball
(crystalgazing). The analysis of the content of the induced hallucination often throws
considerable light on the repressed conflicts.
UNSTRUCTURED HALLUCINATIONS: Unstructured hallucinations are induced
without structuring the therapeutic situation. Merely by asking the subject, while he is in deep
hypnosis, to relate what is happening, significant material may be revealed, and spontaneous
regression and abreaction often occur.
PRODUCTION OF EXPERIMENTAL CONFLICTS: An artificial situation which
resembles the patient's conflict situation often can afford sufficient insight as to how and why he
reacts to his own conflict. The patient is led to experience the appropriate emotion and he reacts
to it with his own particular neurotic behavior. Posthypnotic suggestions are directed for recall of
those experiences and feelings which the patient had while (327) hypnotized. Thus, while
observing the reaction to an imaginary conflict, insight is gained into the nature of his conflict
situation. This approach should be used only by experienced hypnotherapist.
NARCOHYPNOANALYSIS OR NARCOSYNTHESIS: Skillful hypnotherapists
seldom use drugs. However, occasionally a refractory patient may be given a small amount of
Pentothal Sodium; this often allows the patient to talk more freely. The patient who benefits most
by this approach is the one who states, "1 doubt if 1 can be hypnotized." Other individuals, who
associate hypnotizability with gullibility, respond well to various drugs such as scopolanline.
Such patients are merely looking for some excuse to respond to the suggestions of the therapist;
they do not feel stigmatized by drug-induced "hypnosis."
HYPNOGRAPHY: Meares uses a form of graphic expression which has a much wider
application than automatic writing in hypnoanalysis. Hypnography is integrated with verbal
hypnoanalysis and waking psychotherapy. He has described hypnography as a "technique in
hypnoanalysis in which the hypnotized patient projects psychic material in black and white
painting." While under hypnosis, the patient associates to the painting. Meares feels that it is
useful for patients who do not talk readily in hypnosis. He believes that graphic expression of
conflicts has a greater therapeutic effect than verbal expressions of the same conflicts, as it speeds
 142

up hypnoanalysis. Suppressed and repressed material is disclosed more readily, and there is
greater emotional participation of the patient in the treatment. The patient is less apt to defend
himself from his emotions, and greater emotional participation usually leads to spontaneous
regression and abreaction. This approach is particularly indicated for those who cannot adjust to
current reality conflicts. The reason for this is that, when the patient is actually confronted with
the problem which he expresses in hypnography, he develops a greater tolerance Jf the conflict.
As a result, he is not so disturbed by it and makes a better adjustment to reality.
Often, however, when the elicited material is presented to the patient at nonhypnotic
levels, it leads to anxiety manifestations. With somatic improvement, the patient slowly gains
insight through the ventilation of traumatic material by hypnography. Often without any "waking
psychotherapy," further symptomatic improvement results, which manifests itself by a change of
the paintings. Partial amnesia often occurs after the sessions. Since conflicts are being expressed
graphically and verbally by associations, hypnography facilitates hypnoanalysis. For a more
complete account of hypnography, the reader is referred to Meares's excellent monograph on this
subject.19
The dangers here are that the sudden and permanent recognition of the signi6.cance of the
repressed material may result in an attack of acute arL'dety. This necessitates a deeper stage of
hypnosis. Meares points out that an unconscious misinterpretation of the therapist's behavior can
result in the patient's not being able to be dehypnotizeda sort of defense reaction which calls for
an elastic ("psychodynamic") handling of the hypnosis.
HYPNOPLASTY: This technic in hypnoanalysis resembles hypnography. The
hypnotized patient uses clay to model whatever he wishes to make. The patient's conflicts find
expression in plastic rather than graphic form. He is asked to associate to the model, and the
disclosed material is used in his psychotherapeutic handling.
When the patient talks about the shapes which he has made, the speci6.c meanings and the
nature of the conflict which has motivated the making of a particular model are brought to light.
Meares believes that this is an excellent approach for the resistant patient, and that hypnoplasty
has a real place in hypnoanalysis. For a more complete account of hypnoplasty, the reader is
referred to another fine monograph. (328)

10. I BELIEVE THAT THE USE OF HYPNOSIS SHOULD NOT BE LIMITED TO PHYSICIANS AND
DENTISTS: FRANK S. CAPRIO: BETTER HEALTH WITH SELF HYPNOSIS: PARKER
PUB CO. NEW YORK: 1985
Hypnosis is a rapidly growing specialty. In 1958 there were no more than
two hundred dentists and physicians in the United States using hypnosis. There
is at the present time a minimum of 15,000 dentists and physicians using
hypnosis.
Most of the instruction in hypnosis is now being given by teams of
traveling dentists and physicians who offer three-and four-day and one-week
post-graduate courses in dental and medical hypnosis. These courses are open
to practicing dentists and physicians and persons in related fields.
I believe that the use of hypnosis should not be limited to physicians
and dentists. It is a proven fact that many qualified and ethical
hypno-technicians are capable of achieving successful therapeutic results.
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Lectures regarding hypnosis and self-hypnosis. should be made available

to the general public. The inestimable value of self-hypnosis should inspire
everyone to apply self-hypnosis to day-to-day self-improvement.
Hypnosis and self-hypnosis are gaining increasing importance in the
lives of all human beings. The potentials are unlimited. I predict hypnosis
will become a great force for the prevention of wars. War is a form of
insanity, caused by hate sickness, irrational fears, uncontrolled
aggressiveness, and unresolved conflicts arising from religious and other
differences which account for the widespread violence we are presently
witnessing. Hypnosis is based on the control of man's intellect over his
emotions. Man's greatest triumph some day will be the conquest of himself so
that he may teach others it is better to love than to hate.
It was J .B.S. Haldane, British scientist, who substantiated this when
he stated: (182) "Anyone who has seen even a single example of the power of
hypnosis and suggestion must realize that the face of the world and the
possibilities of existence will be totally altered when we control their
effects and standardize their application. " (183)

11. RELATIONSHIP THERAPY (MEDICAL HYPNOANALYSIS): APPLIED

BEHAVIORAL HEALTH CARE
All human beings are involved in relationships, often several simultaneously. Whether
such involves child-parent, husband-wife, employer-employee, teacher-student, lover-lover,
friend-friend or individual-group, relationships can and do develop problems,
mis-understandings, differences, changes of feelings or other disturbing elements. Relationship
problems can affect home life, work, education, health, attitude, and motivation, even the desire
to live. Symptoms may include anger, sadness, hurt, and loss of self-esteem, depression and
even violence.
Medical Hypnoanalysis can ferret out the causes of such problems, bringing the healing
power of understanding. Medical Hypnoanalytic therapy can eliminate feelings of rejection,
hurts, frustration and resentments. Communications can be re-established, confidence required
and creative solutions developed. Perhaps the most important problem in relationships is
communication. Merely talking things out is an indispensable feature, but it is much more simply
said than done. Why? The response is that numerous people do not communicate efficiently. It
is not that they don't desire to-they may urgently desire to work out problems, clarify viewpoints,
and talk about differences. The difficulty may be that they cannot communicate since even with
sensitive ears they cannot hear!
For the most part people fall into one of two likely categories of suggestibility-active
suggestibility or passive suggestibility. In point of fact, each person has characteristics of both,
but one is usually dominant. These characteristics have a great deal to do with how people hear.
Some Medical Hypnoanalysts deem active suggestibility to be to some extent parallel to an
extrovert type of personality, while passive suggestibility relates more to the introvert type. The
point is that people tend to listen in agreement with their personality make-ups. People hear in
the same way in which they speak. Those with conflicting types of suggestibility have more
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difficulties with communication.

One couple came into a Medical Hypnoanalysts office to talk about grave relationship
problems. The husband proved to be a genuine loudmouth, shooting at his wife as well as the
Medical Hypnoanalyst. When his shy and gentle wife asked him if we could discuss this matter
quietly, he simply continued to shout. He didn't hear her request. And she certainly was not
hearing (in the sense of comprehending) his message. The Medical Hypnoanalyst asked the
husband to speak more softly. The shouting continued. Finally the Medical Hypnoanalyst
shouted in an equally loud voice: "Now just shut up for a while or get out!" There was the risk
that the client would become annoyed, get up and walk out-a premeditated peril. Nevertheless
the husband looked around piercingly and asked, "Was I speaking too loudly?" He had no idea
how he sounded. His temperament was to converse at full volume, and while his wife (trying to
shun what she felt would be a conflict) failed to respond, he assumed she was not hearing him
and shouted even more vociferously.
Suggestibility can be altered: After illuminating the communications problems- the
wife could not respond to loudness and the husband was unresponsive to softer language-the two
were hypnotized sitting side by side. They were regressed to the early days of their marriage
allowed to feel again the caring feelings and love that existed in the establishment of the
relationship. They were programmed to comprehend and modify their mode of listening and
communication. As a final point, under hypnosis, the husband was instructed to reach over, take
his wife's hand, while both of them re-lived the experience of early love.
The Medical Hypnoanalyst anticipated that five or six sessions would be required to
resolve the feelings, adjust the suggestibility and institute solid communication. The clients
cancelled their following meeting, advising that they had re-discovered each other, and
considered the predicament resolved. It is essential to keep in mind that every one receives
communication in much the identical form that is used to send them. Bearing in mind the
magnetism of opposites, it is not to be unanticipated that actively suggestible people often marry
passively suggestible partners.
As the preliminary novelty and gentleness fade with passing time, the predisposition
grows to lapse to the form that is distinctive for the suggestibility type. Communication troubles
turn out to be in effect unavoidable. Problems as expected can amplify further with the
awareness that people, in addition to active or passive suggestibility, are affected by the reality
of active and passive sexuality.
Sexuality vs. Suggestibility:
Suggestibility reflects learning characteristics. Sexuality reflects performing distinctiveness
(sexual or otherwise). Where partners have visible sexual incongruity, an appraisal of sexuality
type is reasonable. Where the types of sexuality fluctuate considerably, response tendencies have
a propensity to generate troubles.
In the endeavor to evade hurt, misunderstanding or disagreement, an individual may
intentionally adjust either sexual or suggestible behavior and develop incongruent behavior
(where suggestibility is in the unnatural position of being contrary to the person's sexuality), This
can produce misunderstanding and communication collapse resulting in severe relationship
conflicts plus inner chaos within the individual exhibiting the incongruent actions. The Medical
Hypnoanalyst can gauge both sexuality and suggestibility, and where differences are
comparatively negligible, partners will have an adequate amount of flexible - communication in
 145

the course of periods of strain or turmoil. Where one partner, for instance, is 80% active and the
other is 80% passive, difficulties are practically predictable.
Medical Hypnoanalysis may consist of measuring suggestibility and sexuality, seeing
partners independently at first. If not the participants may differ on the evaluations, in view of
the fact that they will see responses in a different way. Consequently the partners may be seen
jointly, at which time suggestibility and sexuality may be explained, so that partners appreciate
why they see or hear things in a different way, discussing the literal style of communication of
the actively suggestible and the inferential style of the passively suggestible. Medical
Hypnoanalysis can bring about an understanding of relationship communications, attentiveness
to the promise of modifications of attitudes and suggestibility and sexualities, and the
significance of and need for creating feelings of confidence and security in and concerning the
relationship itself.

12. THE KEY ANALYTICAL HYPNOTHERAPY: HYPNOANALYSIS: EDGAR BARNETT:

UNLOCK YOUR MIND AND BE FREE: LANE & ASSOCIATES: LE JOLLA, CA: 1979
This book is not about hypnosis. It concerns the use of hypnosis in a particular sphere of
human experience-emotional distress and disorder. Hypnosis has probably been praised and
decried more than any other medical treatment since it was first given notoriety by Dr. Anton
Mesmer under the name of animal magnetism.
Many students of hypnosis have claimed that the process will produce marvelous cures,
whereas others have countered that hypnosis simply does not exist! So long as we continue to
seek for a specific state of mind which we can confidently label hypnosis, this confusion will
continue and the controversy about what hypnosis can achieve will rage unabated. Hypnosis
cannot and should not be regarded as a clearly definable state similar, regarded as a clear
definable state similar to anesthesia.
We know that when a specific dose of an anesthetic such as ether or chloroform is
administered, certain predictable results occur. The patient becomes drowsy and eventually loses
consciousness, no longer capable of responding to stimulation. If he is administered an overdose,
he will die.
Ever since determined efforts to define hypnosis have been made, a general understanding
of it has been hampered by attempts to draw parallels between hypnosis and anesthesia. This is
unfortunate since there is no similarity whatever between the two. We still speak of "going under"
hypnosis, even though there is never any loss of consciousness. No one goes to sleep in hypnosis,
no matter how similar the conditions may superficially appear.
Many of our difficulties in understanding hypnosis have arisen from the use of it as
entertainment on the stage, in novels and on television. When we witness a stage demonstration
of hypnosis, we observe many phenomena which suggest that the hypnotist is exerting great
powers over his subject. He appears to be able to command his subject to do anything he wishes.
Many novels employ this theme of the domination of one person over another through hypnosis.
We even use the word "hypnotized" to indicate a state of powerlessness.
In reality, these entertainments teach us little about the true (91) nature of hypnosis. A
person in hypnosis taps the immense ane. largely unexplored powers of his own unconscious
mind, not those or the mind of the person who administered a hypnotic suggestion. Ironically,
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few people have realized that this power resides within themselves, not within the hypnotist. In
truth, all hypnosis is self-hypnosis.
Strange myths have been exploited and enlarged by the story teller and the stage
hypnotist, but the truth is far stranger than the fiction. I hope in these pages to give you some
understanding of the real wonder of hypnosis.
Human beings have achieved their dominant status in the animal world by developing the
brain to encompass a far superior intelligence. Much of the brain is anatomically and
physiologically similar to that of lower animals, but the cortex of the brain is so highly developed
that it possesses rational qualities unmatched by any manmade computer and unsurpassed by
anything known in the rest of the animal kingdom. This thinking, critical brain has developed
from a far less critical but nevertheless highly complex primitive nervous system whose potential
has never fully been realized.
In hypnosis the activity of this highly critical part of the brain is somewhat suspended.
Hypnosis occurs naturally during great stress or whenever the deeply imaginative resources of the
unconscious mind are called upon. This also happens when we are in concentrated thought.
Whenever we turn to these highly imaginative parts of the mind and temporarily suspend the
critical parts, we are employing the process of hypnosis.
For some reason, at present not understood, five to ten percent of the population can
switch off their critical mind completely. These deeply hypnotizable people, able to accept
suggestions quite uncritically, are those who have been the subject of exploitation for
entertainment purposes by the stage hypnotist. They have given hypnosis a reputation it really
does not deserve. Such people can readily imagine things that are suggested to them so that when
the stage hypnotist tells them they are going to sleep, they simulate the act so well that they
believe themselves to be asleep.
Ninety percent of the population does not possess this remarkable facility to entirely
dismiss the critical faculty. Only a small minority of deeply hypnotizable subjects can switch off
the conscious mind so completely that they do not recall what transpired during that period.
Fortunately for the hypnotherapist and his patients, the majority of people are able to
reduce their conscious critical mental activity sufficiently to allow the unconscious imagination to
function freely. (92) This enables suggestions to be accepted and acted upon. When they are
readily accepted, we refer to the subject as being suggestible.
We must not confuse suggestibility with gullibility. The gullible person exercises a poor
and inadequate critical faculty at all times, whereas the suggestible person may have an excellent
critical faculty but is able to dismiss it to some degree when he so chooses.
Hypnosis is not a state but a process. It allows us to communicate ideas or suggestions to
the inner and unconscious imaginative part of the mind.
By studying the ability of the very highly imaginative people who can completely dismiss
the critical mind, we have been able to learn much about the potential of the unconscious
imagination. It can do many wonderful things in controlling the body. For instance, it can accept
the idea of anesthesia and produce its effect in a designated area of the body as powerfully as any
chemical. When the unconscious mind has accepted the idea of pain relief, it can readily
accomplish this. The process of communicating the idea is hypnosis.
The communication of any acceptable idea, its unconscious acceptance and the subsequent
action is the process of hypnosis. By this means the tremendous resources of the unconscious
 147

mind can be tapped. At this point I would like to express my belief that the great future advances
in medicine will focus strongly upon the significance of hypnosis. The unconscious mind contains
vast and seemingly unlimited resources for healing which are yet to be exploited.
In this book we are concerned with the ability of the unconscious mind to uncover
memories of experiences which have been recorded by the brain but retained well below the level
of ordinary conscious memory. Every experience that we undergo is faithfully recorded
somewhere in the unconscious mind.
Any technique which permits or facilitates communication with the unconscious mind is a
technique of hypnosis. We often hear of the marvelous meditation practices of the Far East which
enable the practitioners to control the heart rate, lower the body temperature or survive some
unusual ordeal. Transcendental meditation also enables people to feel healthier and more at ease.
Any technique which relaxes the conscious mind sufficiently will enable the unconscious mind to
employ its resources in improving mental and physical health.
Hypnotherapists employ many different methods to facilitate this communication with the
unconscious mind. Whatever technique is used, the prime objective is to relax the conscious mind
so that it will not interfere with the natural responses of the unconscious. The more involved the
subject becomes in the process of relaxation. the easier (93) the responses to suggestion.
It should be emphasized that some people have great difficulty ir. relinquishing voluntary
control of their minds and cannot become deeply involved in the hypnotic process. They may feel
that they have not been influenced by suggestions in any way. It sometimes comes as a surprise to
these people that the unconscious mind is taking some heed of the suggestions and eventually
makes appropriate and effective responses.
Hypnoanalysis: I have found that certain important steps must be completed for
effective hypnoanalysis to occur.
1. Location of the first critical experience: Once the appropriate communication has
been established with the unconscious mind, the first step is to discover the patient's initial critical
experience. The unconscious mind must be directed to locate the very first event which evoked
feelings of guilt, shame or embarrassment. Prior to the advent of hypnotherapy, this approach was
virtually impossible because the experience was so rarely accessible to the conscious memory,
particularly when the first critical event was natal or pre-natal.
This earliest critical experience is usually associated with uncomfortable feelings, some of
which the patient may become aware of for the first time. Occasionally the experience is so
discomforting that perception of it is extremely limited. However, a frightening or painful feeling
must be faced with courage. The unconscious mind has located this experience by the simple
process of tracing the uncomfortable feeling to its source.
The patient mayor may not be able to determine the details of this experience at a
conscious level. Apart from satisfying his curiosity, his detailed conscious knowledge of the
actual circumstances is not necessary for the next essential step.
2. Identification of the repressed feeling: When the critical experience has been
located, the repressed emotions-sadness, anger, fear or a combination of any or all of these
feelings-will emerge. Sometimes the feeling has all the intensity of the original event, and it is
very important to allow an experience to fully release its associated feelings. An intense feeling
reaching (94) conscious awareness is called an abreaction since it is a reaction from the original
cause of tension, free from any repressive action.
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3. Acceptance of the repressed emotion: The originally repressed emotion has been
unfelt and has therefore not been accepted. This next important step in therapy is the acceptance
of this repressed emotion. If the patient has been able to experience the emotion in its original
intensity, he has also been able to admit it. It is an emotion that is rightfully his, and he need no
longer be ashamed of it. This acceptance marks an important step forward in the release from
prison. By accepting the emotion, he has dealt with the greatest fear that underlies the guilt
feeling-the threat of abandonment. Repressing an emotion does not cancel it. In fact, such a
response will ensure that it persists long after the need for it has disappeared.
4. Recognition of the current irrelevance of the previously repressed emotion: Now
that the patient has been able to accept the emotion, it is time to determine whether there is any
further need to retain it. The emotion is only necessary if it serves to protect him from danger. In
nearly every case the original danger has long since passed and the emotion that has resulted is no
longer requisite for protection. The patient must apply his new understanding to determine
whether he still needs that emotion. A strong effort is necessary to relinquish an emotion that has
probably been active for many years below the level of consciousness.
5. Relinquishing the unnecessary emotion: Merely deciding that an emotion is no
longer necessary may not be enough to dispel it. A new solution must be developed for the
problem which was originally dealt with by the repression of the unacceptable emotion. This new
solution will vary with the problem and the person dealing with it. Usually certain fixed
ingredients are available for any such solution. First, there is a recognition that the problem no
long provokes fear. The patient now has the resources to care for and protect himself. Second, he
must recognize that the original threat of abandonment was probably never likely, for his parent
cared more for him than he had originally believed. Third, he (95) must understand that all
human beings have a right to their feelings so long as they are properly controlled. Finally, the
patient must recognize that he had done nothing in this particular critical experience to alienate
himself permanently from other members of the human race.
The patient always attains a profound sense of peace at this stage. When he has found a
satisfactory solution, he will develop a sense of self-acceptance and wholeness which he had
previously lacked. He will be able to say that he is as good and as important as any other human
being-and he will now feel that this is true.
If any part of the mind has difficulty accepting its essential "O.K.-ness," other critical
experiences must be subjected to hypnoanalysis. They must be located and examined and the
repressed emotion recognized, accepted and relinquished. Only when all repressed emotion has
been freed will the patient be free. This phase of hypnoanalysis must be completed with care and
thoroughness.
In stage 1 through hypnosis we have initially made contact with all the memories of
events contained in the three ego states. In stage 2 the Child ego state yields repressed feelings.
Any guilt we discover is caused by the Parent ego state, which reminds the Child ego state that
the expression of certain emotions may bring about the real parent's disapproval. If the emotion at
the recollection of this experience is intense, as in an abreaction, then the Parent ego state's
repressive forces have failed. The patient's realization that the disaster forecast by the Parent does
not follow is therapeutic in permanently freeing the previously repressed emotion.
In stage 3 indications that the repressed emotion has now been accepted usually follow
Adult intervention on the Child's behalf, pleading to the Parent that this emotion is indeed
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permissible. The Adult has been able to persuade the Parent that he need no longer prevent the
Child from expressing that feeling .
In stage 4 recognition of the current irrelevance of the previously repressed emotion
follows the Adult reasoning with the Child that things have now changed, that he is grown up. He
can deal with the problem in a more mature manner so that the particular emotion which no
longer serves a useful purpose can be discarded. Stage 5 may required all of the ingenuity of the
Adult ego state to find a means to give up an outdated emotion. This stage is very important.
Whatever means the Adult ego state finds, it must be acceptable to both the Parent and the
Child and must be utilized by them before the conflict over this particular issue comes to an end.
At this juncture hypnoanalysis proper is also completed. (96)

Throughout the hypnoanalytical procedure, the fundamental assumption maintains that the Adult
ego state can find a solution underlying the Parent/Child conflict provided it is given sufficient
information. The hypnotherapist must skillfully use these techniques to pry such information
from the unconscious memories of the Parent and the Child. He must also persuade both the
Child and the Parent that the resolution of their conflict is in their mutual best interest.

13. A SYSTEM OF BRIEF HYPNOANALYSIS: LESLIE M LECRON & JEAN BORDEAUX:

HYPNOTISM TODAY: WILSHIRE BOOKS: HOLLYWOOD CA: 1947
ALL TYPES of psychotherapy having now been considered, some conclusions can be
reached. As indicated, each system has certain advantages and each can claim some positive
resuYts. The neuroses, among ,the most prevalent of all diseases afflicting civilized man, may
often be overcome no matter whether the method used is persuasion, suggestion, psychoanalysis,
hypnoanalysis, or perhaps faith alone. Probably only in shock treatment is there a physical as well
as a psychological effect. On the other hand, failures are common to ail methods. The neuroses
are universally regarded as difficult to cure. No psychotherapist acknowledges the percentage of
sterile results although it is admittedly large in every system. There is much greater knowledge of
etiology than of successful therapy.
With our present understanding of the elusive neuroses and an appreciation of the need for
a more efficient therapy, if a method can be evolved which does not require a great deal of time
in most cases and which brings good results, then it could be generally adopted. In our opinion,
specific features from the various systems can be selected and combined to form a satisfactory
method. In the following pages we describe a procedure formulated by taking the most suitable
and helpful elements from several systems and combining them to make a reasonable, logical
plan. Basically it is psychoanalysis, (220) though not of the orthodox type, with the addition of
some points taken from other schools of psychotherapy and the supplemental application of
hypnotism. It embodies nothing new, merely being a logical arrangement of known facts, but it
emphasizes some which have been ignored in modern psychotherapy. It aims essentially at
brevity, but brevity depends on the particular case, and perhaps thorough study and analysis of
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the patient's entire personality will be required, involving up toa hundred hours of treatment. But
principally it is directed at the less acute cases which sometimes can be successfully treated in
only a few sessions.
The aim of hypnoanalysis should be to secure complete and permanent results as quickly
as possible. A careful study of the patient's personality and case history will give the therapist
some idea as to the rate at which he can proceed. As he makes progress, susceptibility to
hypnosis, resistances displayed, and the patient's ability to accept education and to develop a new
viewpoint and ego strength will determine the length of treatment. The uncovering of repressed
material is, of course, indeterminate in time. A few cases may be satisfactorily terminated in five
or six sessions, but in mild cases ten to thirty are more often required and many more may be
necessary when the condition is severe and of long standing.
According to our belief in the possibility of cure (in the sense in which we use the word)
whenever the patient becomes convinced that he is cured, as in faith healing, a neurosis may be
relieved in one session, though such brevity certainly is not advisable unless the circumstances
are exceptional, and relapse is likely unless there is analysis and education.
Bordeaux once treated a stutterer in such a brief way, through necessity. This was a man
thirty-eight years old who had been afflicted since early childhood. Living in a distant (220)
though not of the orthodox type, with the addition of some points taken from other schools of
psychotherapy and the supplemental application of hypnotism. It embodies nothing new, merely
being a logical arrangement of known facts, but it emphasizes some which have been ignored in
modern psychotherapy. It aims essentially at brevity, but brevity depends on the particular case,
and perhaps thorough study and analysis of the patient's entire personality will be required,
involving up toa hundred hours of treatment. But principally it is directed at the less acute cases
which sometimes can be successfully treated in only a few sessions.
The aim of hypnoanalysis should be to secure complete and permanent results as qllickly
as possible. A careful study of the patient's personality and case history will give the therapist
some idea as to the rate at which he can proceed. As he makes progress, susceptibility to
hypnosis, resistances displayed, and the patient's ability to accept education and to develop a new
viewpoint and ego strength will determine the length of treatment. The uncovering of repressed
material is, of course; indeterminate in time. A few cases may be satisfactorily terminated in five
or six sessions, but in mild cases ten to thirty are more often required and many more may be
necessary when the condition is severe and of long standing.
According to our belief in the possibility of cure (in the sense in which we use the word)
whenever the patient becomes convinced that he is cured, as in faith healing, a neurosis may be
relieved in one session, though such brevity certainly is not advisable unless the circumstances
are exceptional, and relapse is likely unless there is analysis and education.
Bordeaux once treated a stutterer in such a brief way, through necessity. This was a man
thirty-eight years old who had been afflicted since early childhood. Living in a distant (221)
conflicts. Some psychotherapists such as Fink, who are much in minority, believe that causes
sometimes activate symptoms which through repetition tend to become either habits or
conditioned reflexes. Also, they believe that symptoms may possibly generate as a result of
suggestion. The authors find themselves in accordance. This does not mean that the neurosis itself
arises from suggestion or is a habit or conditioned reflex. The neurotic pattern must be present
and causes may be a complex matter, but some symptoms do seem to originate or continue in this
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way.
As an example, Mr. N- came to LeCron to be rid of some neurotic difficulties. The main
symptom was a continually dry mouth with an ever-present bad taste in it. After examination, his
physician had informed him that there was no physical cause for the trouble. It was functional
only.
Mr. N-- was a very successful fifty-five-year-old businessman. His history showed no
previous neurotic troubles, he had no apparent problems, and he seemed well adjusted. No deep
insight was needed to find the precipitating cause of the symptom. Although himself innocent, he
had become involved in a case of blackmail and bribery which ended in court. Called as a
witness, he was afraid that he would be asked a question which he intended to answer truthfully,
and his business would then have been ruined. For two weeks he waited to be called or was on
the witness stand and was under great emotional strain throughout the period. Figuratively, as he
had commented at the time, the whole matter left a "bad taste in his mouth." By the time the
situation ended with the question still unasked, an actual bad taste had appeared, wholly symbolic
and apparently a result of suggestion. The condition had now persisted for three years.
Mr. N--'s figurative oral bad taste was impressed on a mind influenced by a combination
of fear, disgust and anger, (224) all strong emotions. The common figurative expression
suggested an actual bad taste, which then appeared. Maintained for a time, it developed into a
habit. Suggestion thus may generate a symptom which is kept alive by habit after repeated
occurrence.
It has been an axiom of standard psychoanalysis that the actual causes of a neurosis must
be learned so that the energies generated by the repressed conflict and memories can be
discharged by the patient as a part of cure. Undoubtedly a knowledge of causative factors is
valuable, for it aids both patient and analyst to understand the situation. When they are known,
these factors may be worked through and the patient given insight and taught to readjust. If the
cause, such as an environmental matter, is still active, there will either be a relapse or no cure will
be effected unless the cause is uncovered. But causes may extend back into childhood and be
completely inactive though still motivating behavior. If dynamic energy is still being generated,
this would explain the presence of symptoms arising out of such old causes, and it would be
necessary to remove them through knowledge of the causes. However, if they are considered as
being still exhibited because they have become habits or conditioned reflexes, the case is different
and it is not so important to know the causes, though it would still be desirable.
This would seem to be substantiated by cures made in faith healing, where causes remain
unknown and entirely disregarded. The same is true of cures wrought by the old-school medical
hypnotists by direct suggestion. There is a tendency to ignore such cures or question them as
temporary only, and many relapses do occur because there is no insight and the underlying
neurotic trends have not been affected. But such cures cannot be shrugged off, and many are
permanent, if we confine the definition of "cure" as relief from distress and (225) ability to exist
comfortably while carrying on an occupation. Brenman and Gill mention the effectiveness and
frequent permanence of the old-style hypnotic cures. Alexander and French accept the actuality
of faith cures and believe that they " may result from "benign traumata" which "occur
occasionally in the form of intensive emotional experiences during treatment or by chance in
ordinary life," with permanent changes
of the ego resulting. Janet's study of the cures at Lourdes is particularly impressive. In all such
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cases it would indicate that no dynamic force activates the symptoms (after they have been
established), for such a force would inevitably make them reappear, or perhaps the "benign
traumata" permanently discharge the energy.
It therefore seems logical to believe that some visible symptoms may be generated by an
outside influence or situation or by an emotion or thought. If through repetition they have become
habits or conditioned reflexes, direct hypnotic suggestion may be of material aid in dislodging
them and breaking up the pattern.
During psychotherapy the patient's nervous condition is often overlooked or disregarded
or considered as something which will disappear with other symptoms as treatment progresses.
Many neurotics are more or less nervous; some are under extreme nervous tension. Nervousness
is a study in itself and is the subject of many books and articles. It is a frequent accompaniment of
anxiety. Jacobson Fink, Pierce and others have devised systems of relaxation exercises, some of
them extremely complicated, to teach control of nervousness. They are based on the principle that
physical tension in the muscles prevents discharge of nervous energy and so relaxation relieves
the feeling of nervousness. But hypnosis automatically brings a physical relaxation which is far
greater than can be voluntarily achieved. After a sitting, the (226) therapist who uses hypnosis in
treating nervous patients often hears the statement, "I seem to have lost all my nervous tension."
Mitigation of nervousness is highly beneficial, and many patients look forward to their trance
sessions because of the relief felt thereafter. The effect may be increased by suggesting that the
patient's nervousness will disappear while he sleeps and that he will awaken refreshed and
invigorated, free from tension.
When coming to a practitioner, the neurotic patient seeks relief and wants it quickly
though his condition may be of long standing. The way is paved for acceptance of belief in cure if
symptoms can be eliminated or diminished, and nothing is more conducive to this than to reduce
the nervousness which may exaggerate or even generate some symptoms. As nervous tension
lessens and symptoms begin to abate, the patient feels that better and more rapid progress can be
made in analysis and treatment.
One of the great advantages in hypnotic psychotherapy is that hypnosis is invariably
found a pleasant matter. It is a new and interesting experience to be hypnotized, and the subject
quickly discovers enjoyment in it, particularly in the release from nervous tension. Frequently he
mentions looking forward to his periods of hypnotic treatment.
The neurotic person always is a victim of a vicious circle of thought, emotions and action.
He has become intensely introspective, usually spending most of the time thinking about himself
and his troubles, both neurotic and economic, and feeling sorry for himself. He may be unable to
work and thus gains more time for brooding. The more he thinks about his illness the more the
symptoms are stimulated and intensified, and the more exaggerated his neurotic trends become
the worse he feels. The worse he feels, the more he worries and thinks about it. He enters into a
vicious circle difficult to (227) overcome. As a result he becomes more and more nervous and
may have physical reactions such as digestive upsets or any of' a host of new physical symptoms.
Horney has mentioned these vicious circles as being one of the most important processes
in neuroses and the main reason why severe neuroses are bound to become worse, even though
external conditions are unchanged. She cites other examples of their operation: anxiety causing
excessive need for affection and love; a sense of having been rebuffed and frustrated if the need is
not met, which is followed by intense hostility; then hostility must be repressed, owing to fear of
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losing affection, and this provokes rage, increased anxiety and need for reassurance. The circle
continues with ever-increasing anxiety.
One of the important phases of psychoanalysis is to uncover these circles and to change
their direction of flow. Insight and education bring this about, but it may be extremely difficult to
stop and reverse them even when they are recognized. Hypnotic suggestion can aid materially in
accomplishing this. Sometimes autosuggestion and autohypnosis may be used to supplement the
therapist's suggestion, their main value being in enabling the patient to participate and to practice
the advice of the analyst in directing thoughts into proper channels.
In some cases autohypnosis can be helpful in treating a neurosis. It will aid in overcoming
nervousness and during reeducation may aid in building ego and in developing selfconfidence.
But it must be used discreetly, for no patient is qualified without technical guidance to be his own
therapist. Those who suffer from hysteria are not qualified to learn it, and it should be taught only
to some few intelligent neurotics who do not have acute chronic disturbances.
Many psychoanalysts deem it unwise for the patient to (228) have much knowledge of
psychoanalytic theory until an analysis has progressed for some time, believing that such
knowledge might influence the patient's revelations and mislead the analyst. But in lighter cases,
we believe that the sooner the patient obtains a correct understanding of his conditions, the
quicker a cure can be effected. Of course the personality and intellect of the patient must be taken
into consideration, and too much knowledge may lead to resistances and to criticism of the
analyst's methods.
To aid a patient in understanding his condition and also to effect a saving in time, some of
the good popular books on nervousness and neurotic conditions may be recommended for
reading. (Such bibliotherapy also should include good books on general subjects.) Here again
there must be discretion, for a suggestible person reading about neurotic disturbances might apply
too much of the information to himself, or it might do harm by lulling him or convincing him that
he is being helped when such is not the case. But bibliotherapy can be of value if carefully
handled and if accompanied by discussion and interpretation with the analyst.
In our consideration of brief hypnoanalysis, we have mentioned some matters not
concerned with either hypnosis or psychoanalysis but which can be incorporated supplementally
to advantage in the treatment of many cases. And if medicine can also be employed, as is
sometimes possible, then by all means it should be used. The main thing is to bring relief to the
patient no matter what the means. Essentially the method of psychotherapy being outlined is
hypnoanalysis, but nothing which can be of service should be overlooked or neglected.
Basically, hypnoanalytic treatment is modified psychoanalysis with inclusion of
hypnotism for brevity. All the hypnotic phenomena described in the previous chapter are vital
(229) to the brief method being presented here, but their application need not be discussed again.
To obtain the lifting of repressions and the recall of buried memories resort can be made to age
regression, dream induction and analysis, automatic writing and drawing, crystal and mirror
gazing, and direct inquiry under hypnosis. Resistances are overcome, the '" transference dealt
with as desired, and the hypnotic situation and hypnosis itself directed and employed according to
plan and to situations as they arise.
In general, a patient should arrive at insight and knowledge by his own understanding
developed through educational processes. He must learn to comprehend his instincts, drives,
urges, his complexes and conflicts. He should understand why his symptoms have appeared and
 154

why he behaves as he does. Reeducation is continued throughout the analysis with new habits of
thought and new viewpoints developed. Insight and education teach him to resolve his conflicts,
to ease his guilt feelings and to face reality. In the process his "vicious circles" are broken,
anxiety is relieved and self-confidence is gradually gained as ego strength is built.
Everyone responds to honest praise and the analyst must point out to the patient his good
points in character and personality. Judicious compliments are helpful. During this "build-up" of
ego, the fact must be stressed that the patient will cure himself and that cure lies entirely within
himself, though not through mere wishing. (Rank even believes that cure may be volitional.) The
knowledge and experience of the therapist are at the service of the patient to aid him cure himself
while the analyst guides him along the proper path. To make an analogy, proper hypnoanalysis is
a tandem bicycle whose rear seat is occupied by the strenuously pedaling patient, while the
therapist rides in front to steer and to help pedal. (230)
Just how far personality analysis should proceed is always a problem for the analyst. In
the most serious cases probing may be deep and long continued, but in those neuroses which are
lighter a complete understanding of every detail is unnecessary. Few normal, well-adjusted
people have more than a glimmering of insight into their personality and behavior. Frequently
treatment may be ended with expectancy of the development of further insight in the course of
normal living. When the road has been properly paved, ego strength and adjustment will continue
to improve. This is frequently observed after a lapse of time, when a check of progress is made.
Throughout hypnoanalysis there is not only resort to the phenomena which have been
described but suggestion is continually directed at promoting insight and increasing ego strength.
The hypnotic instigation of conflicts has been mentioned as one way of showing the mechanism
of emotions and behavior as a result of conflicts. Resistances and the transference are
hypnotically controlled, and progress may be checked by test situations hypnotically produced.
Frequently the analyst finds that he must not only deal with the patient but endeavor to
revise the mental attitude of his family. Family and home environment can defeat all
psychotherapy, and perhaps the situation is such that a cure is impossible, for generative factors
in the neurosis may be active and not subject to change. This may be a matter of finances or of
improper family life. The problem may involve marital relations, which brings up the question: Is
the therapist warranted in suggesting divorce? He might then face a damage suit if his patient's
spouse learns that such advice has been given. Such problems can be decided only in each
individual case. Every therapist must make his own decisions.
Concluding the treatment is not usually difficult with (231) hypnoanalysis, particularly if
there has been brief treatment. Dependence on the analyst has been controlled and the patient has
been taught to stand on his own feet. In standard analysis, he has been closely associated with the
analyst over a period of months or even years and sometimes is panic-stricken at the thought of
severing the connection. Termination is recognized as a period of danger of relapse. With brief
hypnoanalysis, there is no reason for further treatment when self-confidence has been stimulated
through insight and bolstered by hypnotic suggestion and when symptoms have disappeared and.
the patient, with new found ego strength, has learned to face reality. Then he feels no need to
continue. Convinced of his cure, he is ready to go his own way. (232)

14. SPECIAL INTAKE QUESTIONS FOR HYPNOANALYSIS: DABNEY EWIN & BRUCE
EIMER: IDEOMOTOR SIGNALS FOR RAPID HYPNOANALYSIS: CHARLES THOMAS:
 155

SPRINGFIELD, IL: 2006

Obviously, we need factual information about the presenting problem (left brain
information). We also need emotional information right brain information). We need to ask
questions to make a double diagnosis. The presenting problem, such as asthma or chronic pain,
may be the main symptom and reason for the visit. However, we also need to formulate a
psychodynamic diagnosis of the underlying fixed idea that is producing the symptom. If you can
change the fixed idea, you can change an illness. That is the reason for asking the following
special intake questions.
1. Tell me about your problem. This is not a question. It is a direction and is literal. We already
know what an asthma attack is like, or a headache, or being overweight, or having irritable
bowel. We are interested in learning about the problem. The patient will often give an answer that
if taken literally, will describe the ultimate subconscious diagnosis. Consequently, this should be
written down verbatim or audiotaped. The ptient may volunteer a gratuitous clause, a repetitive
phrase, or an apparently irrelevant reference in answering this question.
For example:
* Doctor it's hard to answer this question. You hypothesize he probably has a sexual problem .
* To be perfectly concrete, I don't know what the problem is. We didn't ask about concrete and
the patient volunteered a phrase that subsequently turned out to relate to a fall on a concrete
sidewalk.
* I get the urge and go out and drink and drink and drink, or I get the urge to eat and eat and eat.
It may turn out that the patient is sexually starved. “Urge" is a sex word-the urge to merge. (25)
* I can’t quit smoking. Obviously anyone can quit smoking. All you have to do is put them on an
island where there are no cigarettes. This statement of belief typically reflects that the speaker is
carrying out the common fixed idea or imprint, "Don't start, you'll never be able to quit smoking."
The symptom is protecting the patient all the time, and the underlying problem is usually
sitting right there on top of the brain ready to bounce out, if someone just listens literally to the
patient! This initial directive is very different from "how can I help you?" or "why are you here?"
because these questions don't elicit any subconscious information.
2. When did it start? The true answer should be a date. Often the patient says something like:
"Ever since I was in the hospital," or "Ever since my accident," or "Ever since my parents
divorced," and then may not even give an approximate date until asked. Our notes should include
these volunteered clauses because that is the emotional input. If the patient gives an exact date,
follow up with What was going on in your life at that time? As opposed to a date, if the patient
relates it to an incident, follow with What change took place in your life at that time? Keep in
mind that the patient is unlikely to volunteer that psychodynamically important information
unless you ask for it!
One blinding headache patient answered "About 6 months after my sister died." This was
obviously not grief at his sister's death which should have started immediately. His reply to the
question about what change took place in his life when his sister died was "that's when mother
came to live with us." Remember, in working up the case, you are like a detective searching for
clues. You have to think like Sherlock Holmes. Ask yourself: What would I have to believe and
feel to say what the patient just said?
3. When did it become a problem? Sometimes a symptom that has been a minor discomfort
gets exacerbated into a major problem by an illness or incident that exposes a weakness or
 156

vulnerability. This is often an issue with an incorrigible smoker who has a heart attack or is put
on oxygen for pneumonia or CO PD and is confronted with the fact that he must stop smoking,
but it is not happening. It also can occur when a parent who smoked dies of cancer. The patient
may be identifying with the parent and daydreaming that they used to smoke together, and so it
brings up a pleasant memory. The patient cannot keep (26) mom or dad alive, but he can keep the
relationship alive in reverie by smoking (trance logic-obvious incongruity). Patients often do not
see smoking as a problem [it's a solution] until all of a sudden they have to "quit" and they have
trouble "quitting."
When a patient uses the word "quit," we ask him to take that word out of his
conversational vocabulary because the goal is going to be to stop, not to quit. We are taught from
childhood on, not to be a "quitter." Quitting school, a job, or a marriage are big decisions. We
"stop work at 5 o'clock," or "stop at a red light" with very little emotion (even though some
people may get road rage when having to stop at a traffic light!). The word "quit" is typically
associated with a lot of resistance because it is associated with violating a universal fixed idea.
4. What makes it better? Aside from medicines, are there circumstances, times of day, times of
the week, times of the year, certain dates, when it's better? Is it better on vacation? Better at
work? (If it's better at work, there is probably something going on at home!).
5. What makes it worse? As above, except that if nothing makes it better and nothing makes it
worse, you are going to need to look for a perceived "near-death experience." This is because if a
person is emotionally "dead," nothing makes any difference.
6. If you were cured, what would you do that you cannot do now? The answer to this question
tells you what the symptom keeps the patient from doing and what problem it seems to be
solving. If the patient says "I wouldn't do anything different. I would just enjoy life better by not
being bothered by it," then the patient is not motivated to have the symptom. He is just being
aggravated by it. If the patient answers the question with things he would do if he didn't have the
symptom, then, it will likely show up later as a secondary gain. If the patient gives you a list of
things he would do, the last one is the one he least wants to talk about and therefore the most
important.
At this point in the interview, we are getting ready to ask a series of emotional, right brain
questions. Up until this point, the questions have been left brain and emotionally neutral. Now we
want to get on a more intimate level. We ask the patient, What do you like for your friends to call
you? and whatever the answer may be, we ask: May I call you that?
This is very literal. We have learned though long experience that many people don't like
their names, or too much informality. A man named Joseph may not like for people to call him
Joe. A woman may (27) have a pet name like "Missy" that she likes for special people to call her.
When you ask permission to use the name the patient likes for his friends to call him, it's also an
indirect suggestion that you would like to be thought of as a friend (because you are getting ready
to ask some very intimate questions that he might not confide to anyone but a friend).
Before each question, we say the patient's name.
7. <Name>, in your entire life (pause), what's the worst thing that ever happened to you?
Often, the answer is not something that actually happened to the patient, but describes a situation
in which the patient experienced helplessness, perhaps for the first time (e.g., a parental divorce, a
sibling's death, the trauma that brought on the symptoms, etc.). Whatever the answer, it usually
has life changing emotional stress. After asking the question, you can almost see the patient
 157

momentarily go into spontaneous trance, perhaps doing a reflexive eye roll as the patient accesses
a devastating experience.
After a few seconds, say: First thought? so that the patient does not shift back into left
brain analysis of trying to analyze the first worst and the second worst and the third worst thing
that ever happened. We are interested in what comes to mind as a first thought-what is sitting on
top of the brain.
8. <Name>, in your entire life (pause), what's the worst thing you ever did? This question
accesses the kind of thing that makes the patient feel guilty. Sometimes the patient will balk, or
say "nothing." This usually means that's the problem (i.e., it is repressed). Later on, in trance,
using 1M signals, we will want to ask again Would it be all right to know if this symptom is a
form of self punishment? Sometimes the patient will report some childish or childhood
transgression like, "I stole a candy bar from the drugstore." This tells us what a highly developed
conscience the patient has about stealing. You can safely leave your wallet on the desk if that's
the worst thing he ever did! Almost everyone has stolen something trivial as a child. It's the ones
that get caught that will answer the question in this way, because getting caught early on
emotionally imprinted that YOU DO NOT STEAL! They probably don't even pocket sweeteners
at Starbucks!
9. <Name>, in your entire life (pause), what's the most frightened you've ever been?
Adrenaline release imprints memories (Weinberger et a1., 1984), and the answer is often
informative. There is a strong sense of helplessness that goes with being afraid. It is the most (28)
unpleasant of all the emotions, and causes the physiological changes of fight or flight-increased
blood pressure, faster heart rate, cold sweat, increased blood sugar levels, etc. These are potent
imprints.
10. <Name>, in your entire life (pause), what's the most angry you've ever been? Be alert to
the knowledge that the emotional energy of fear is often transduced into anger because we are
more comfortable with anger than we are with fear. At least we can release it by cursing or suing.
11. <Name>, in your entire life (pause), what's the most embarrassed you've ever been?
This is particularly poignant for patients who limped or stuttered or were fat as a child, because
children are naturally cruel to each other, and even take delight in making fun of other children.
Frequently, the answer to one or more of questions 6 though 11 will coincide with the time that
the symptom started, which gets our attention.
12. <Name>, have you ever known anyone with the same or a similar problem? This
question is asked because patients model their symptoms and behavior after people who are
influential in their lives. This may give a clue to the origin of the patient's symptom complex.
Note however, that if the patient brings up someone who has no personal emotional meaning or
attachment in their lives, then the answer is unlikely to be pertinent. You wouldn't model after
somebody like that.
13. <Name>, what's the best thing that ever happened to you? We use this later in ego
strengthening and optimistic expressions of the patient's future. A healthy ongoing relationship is
a useful predictor of a good outcome. If the patient answers, "Nothing good ever happened,"
that's a bad prognostic sign of severe depression and taking away the symptom may be taking
away the last solution the patient has got! Such patents may need to be referred to a
hospital-based psychiatrist. They may be suicidal. They may not be good candidates for hypnosis.
14. If I had a magic wand, and one wish would come true, 'what would you wish? If the
 158

patient says "world peace," we note that and give the patient another wish. However, later on, we
can use this again in ego strengthening by pointing out what a fine person the patient really is to
have such an altruistic wish instead of something selfish. What we are hoping the patient will
really wish for is to get well. We need the patient's attention focused on the problem. If the first
three (29) wishes don't include getting well, we ask, How many wishes would 1 have to give you
before you wished to get well?
This usually brings the patient back into why we are having the session. If he answers
something like 14 wishes, we usually give a direct suggestion for symptom removal and dismiss
the patient with the counsel that if that does not suffice, to come back at a later date when the
wish to get well moves up to number one. In such a case, we are dealing with a patient who is not
very motivated, or who might even be negatively motivated.
15. Is there anything else you think I ought to know? This is the most important question of
all. If the patient answers it, he is telling us what the subconscious problem is. In effect, his
subconscious is saying, "you had an hour to ask the right question, and since you didn't, I'll go
ahead now and tell you what the problem is!" If his answer is "No," his subconscious is saying, "I
have already told you, and what's important is already in the answers to the previous questions."
Here are all 15 intake questions without the explanations. An intake worksheet is provided
in Appendix 2 for your clinical use.
1. Tell me about your problem.
2. When did it start? [What was going on in your life at that time?
What change took place in your life at that time?]
3. When did it become a problem?
4. What makes it better?
5. What makes it worse?
If you were cured, what would you do that you cannot do now? [What do you like for your
friends to call you? May I call you that?]
7. <Name>, in your entire life (pause), what's the worst thing that ever happened to you?
8. <Name>, in your entire life (pause), what's the worst thing you ever did?
9. <Name>, in your entire life (pause), what's the most frightened you've ever been?
10. <Name>, in your entire life (pause), what's the most angry you've ever been?
11. <Name>, in your entire life (pause), what's the most embarrassed you've ever been?
12. <Name>, have you ever known anyone with the same or a similar problem? (30)
13. <Name>, what's the best thing that ever happened to you?
14. If I had a magic wand, and one wish would come true, wha1 would you wish?
15. Is there anything else you think I ought to know? (31)

15. TREATMENT PLANNING: ANALYZING THE HISTORY: DABNEY EWIN & BRUCE
EIMER: IDEOMOTOR SIGNALS FOR RAPID HYPNOANALYSIS: CHARLES THOMAS:
SPRINGFIELD, IL: 2006
When you get a block on any of the emotional questions (Questions 7 though 11, see p.
28) while taking the history, it means the patient feels so bad about that feeling, that he cannot
even talk about it, and resists even feeling it. In trance, this will be something that has to be
addressed.
We formulate a treatment plan by listening to our patient. After the intake, we take a
 159

break to look through our notes. We review the intake notes we took and use a red pen to circle
phrases that the patient has used more than once, or that carry emotional impact. We pay attention
to special words that reflect ABSOLUTES, such as, "constant," "always," "all my life," and so
forth.
* A constant symptom cues us to look for a psychological "death." This is heard in answers like,
"Nothing makes it better or worse," "I live with it," and "It never goes away." It means the
symptom is associated in the subconscious with being alive; to be without it, means to die.
* "All my life" tells us we are going to have to regress to birth.
* "As long as I can remember" tells us the imprint was probably laid down before age three.
* Words such as "urge," "satisfied," "scared stiff," "on and off," "it's hard," "it comes in spurts,"
"heads or tails," and "stuffed," cue us to look for sexual issues.
* A sigh after a phrase negates the phrase. A sigh before the phrase indicates that the patient
didn't want to say it because it had a lot of emotion in it. The polygraph studies taught us that.
* We look for volunteered negatives, for example; "I don't steal" (You'd better keep your hand on
your wallet!). In response to the question, (32)
"What's the worst thing you ever did?" if the patient answers, "I've never killed anybody!" he's
probably thinking about it! It's not responsive to the question. We didn't ask the patient what he
never did; we asked him what he did.
* We look for conditional clauses, particularly statements that negate, or undo, what the patient
just said, such as "I guess," "I suppose," and so forth. For example: Question: "How do you feel
about having this operation?" Response: "Okay, I guess." The "I guess" leads us to wonder about
what the patient's fears and reservations are, and relieves him from having lied by just saying
"Okay."
* Nonresponsive answers include volunteered negatives and vaguely related, oxymoronic or
tangential associations. For example, the stutterer who is asked "When did it start?" and answers,
"All my life," is giving an illogical answer, since he couldn't talk at birth.
We have to go through the intake notes as if we are analyzing the data from a projective
test such as a TAT or Rorschach Inkblot Test. We are making connections between outstanding
and repetitive phrases, and forming hypotheses about the hidden meaning of these phrases.
From all of that, we formulate a tentative psychodynamic diagnosis. For example, we may
be looking for a "sex" problem, or a "psychological death" problem.
We also place the problem on a time line (e.g., "When did it start?"). If the puzzle begins
to fit together by the response to "What's the worst thing that ever happened to you?" coming
right before "When did it start?" we associate this trauma with the symptom.
The IM analysis with regression in trance validates or invalidates our presumptive
psychodynamic diagnosis. If we need more information, we conduct an inquiry of the seven
common causes of psychosomatic disorders (see Chapter 7). In trance, we conduct the IM
questioning using the "seven keys" (Cheek & LeCron, 1968). This is akin to doing a "lab
work-up." It helps us prove or disprove our clinical-presumptive diagnosis. If our presumptive
diagnosis is incorrect, the IM questioning using the "seven keys" will frequently lead to the
correct diagnosis. The correct diagnosis will lead to the appropriate treatment options.
The essence of Rapid Hypnoanalysis is to listen to the subtleties and to listen with your
"third ear.” Sir William Osler, the father of modern medicine said, "Speech was given to conceal
thought," meaning listen to what the patient doesn't say or leaves out. He also said, "Listen to
 160

your patient, he's telling you his diagnosis," meaning listen to what he does say. (33)
The "Anamnesis": "Mnesis" means memory in Greek. "Amnesia" means no memory.
Anamnesia is what the patient didn't repress or forget. What the patient tells us is the anamnesis,
not the history. We call it a history when the patient tells us what happened, but in truth what the
patient tells us is what he didn't forget or repress. Regarding repression, if the patient tells you a
series of things, it's the last thing the patient told you that matters most because it was saved until
last. For example:
I (DME) was treating a woman who said her children were driving her crazy for the past
two weeks. I asked "How many do you have?" and she replied, "three boys, 14, 12, and 16," My
question then was, "What's wrong with the 16-year-old?" (the one she obviously did not want to
talk about!) She replied, "He was expelled from school two weeks ago for drugs".
If the patient answered the last intake question ("Is there anything else I need to know?"),
that is most likely to be the core of the problem. If the patient didn't answer it, then we better go
through our notes carefully again.
Basic Steps of Rapid Hypnoanalysis:
These are the basic steps of rapid hypnoanalysis which represent the essence of the
technique:
1. Do your intake and have the patient tell you about "the problem." Then conduct further
questioning to find out: when did it start; what was happening at the time; what makes it better
and worse; what difference a "cure" would make; what name the patient likes his friends to call
him; the worst thing that ever happened to him and the worst thing he feels he ever did; what was
the most frightened, angry, and embarrassed he's ever been; if he ever knew anyone else with a
similar problem; the best thing that ever happened to him; one wish; and if there's anything else
you should know.
2. After the intake, orient the patient to trance.
3. Induce trance and set up the ideomotor (1M) signaling system (see Chapter 5).
4. In trance, obtain permission to help the patient with "the problem." (34)
5. Regress the patient to the onset of the problem and have the patient do a subconscious review
using ideomotor signaling.
6. Regress the patient to the onset of the problem and have the patient do a conscious review with
1M signaling and verbalization of memories.
7. If necessary, use 1M questioning to identify which of the "seven causes" of psychosomatic
symptoms are active (see below and Chapter 7). Regress and review active causes.
8. Using 1M signaling, have the patient subconsciously and then consciously review the original
and/or sensitizing experiences.
9. Restructure or reframe the experience/sand active causes.
10. Give direct suggestions in hypnosis (DSIH) for healing. 11. Return to the present and alert the
patient.
Sidebar. In essence, if we have a good working diagnosis from our intake, that is, we
have a good guess about what we are likely to find, we go for that first in regressing the patient.
However, if we do not get it, we then go for the "seven causes" or "seven keys" (see Chapter 7).
Regress to the onset of the problem. In trance, we in essence do an ''Affect Bridge"
(Watkins & Watkins, 1997) by first bringing up the negative emotion and then saying to the
patient: "Orient your mind back to the first time you experienced this feeling." Even though the
 161

affect may have been experienced many times since, the important affective experience to access
is the first time the affect was imprinted in state dependent memory.
Subconscious review of the experience. Ideomotor signals (1M) are finger movements
chosen to nonverbally indicate a positive or "yes" feeling by raising one finger, and a negative, or
"no" feeling by raising another. These are analogous to nodding the head "yes" and shaking the
head "no" in nonverbal response.
The hypnotic subconscious review involves raising the "yes" finger as the subconscious
mind begins to review its perceptions about the experience, raising the "no" finger every time
something emotionally important to the patient occurs, and signaling with another finger (usually
the thumb) when the subconscious review is complete.
We must do at least one or more subconscious 1M reviews before the patient can bring the
material up to consciousness. Patients cannot usually verbally describe the incident until they
have done the subconscious review. If they could, they would have given it to us in the waking
history!
(35)
When the patient begins his subconscious review, we usually observe autonomic changes
in breathing, neck pulse, and/or facial skin color, indicating that emotions are being accessed. The
muscular IM signals tend to follow the autonomic activity. The way we know we are getting into
a good review is when we first see the autonomic changes noted above.
Conscious review with verbalization of memories. Mter several subconscious reviews,
the question is asked: Would it be all right to bring this up to a conscious level so you can tell me
what happened? When the answer is "yes," a standard regression with verbalizations of memories
is done.
Reframe the fixed idea. The most propitious time to reframe a fixed idea is when the
patient has just given a verbal description of the problem. Good common sense and training in
psychology need to lead the therapist in teaching the patient to take a lemon and make lemonade.
Return to the present. Note that when a patient is regressed and we say "return to the
present," or "return to today," the regressed patient is in what he perceives as the present and
today. Therefore it is best to specify the actual date. For example, we say, "Return to today, April
2, 2005.
FOUR IDEOMOTOR SEARCH METHODS:
The "Seven Causes" or "Keys": David Cheek (1994) credited Leslie LeCron for developing
the method of using ideomotor signals to explore the "seven common causes" of psychosomatic
disorders (Cheek & LeCron, 1968). Cheek pointed out, and it has been our experience, that many
events located as the beginnings of a problem have been preceded by earlier events that made the
patient vulnerable or sensitized. Therefore he recommended that, following discovery of the first
reported incident, it is judicious to check for earlier sensitizing events by asking, Is there an
earlier experience that could have made you vulnerable or sensitive to what you have just told
me? (36)
Retrograde Search: This method, which Cheek (1994) also credited to LeCron, allows the
latient to gradually move back in time to a traumatic event. It gives the patient protective
distance, and also, enables the patient to do multiple subconscious reviews which can have a
desensitizing effect. The method is illustrated in our transcripts wherein we ask the patient in
trance to answer with the fingers questions pertaining to the age when the causal event happened.
 162

For example, using ideomotor signals, ("T" is the therapist and "IM" is the patient's IdeoMotor
signal):
T. Was it something that happened before you were 20 years old?
M:Yes.
T. Before you were 15 years old?
IM: Yes.
T. Before you were 13?
IM: No.
T. Were you 13 years old?
IM: Yes.
In this example, the patient would have had to have done four subconscious reviews.
Chronological Search: This method involves finding a safe starting point from which to have Ie
patient go forward in time to the moment when something imp ornt related to the problem is
happening. Then we progress forward in ne from one significant event to another.
Direct Approach: The "direct approach," which we often favor, involves telling the ltient in
trance to go directly back to something we hypothesize might ~ important. We base this on the
information we have gathered in the take. With the direct approach, it is still necessary to ask the
patient "if ere might be some earlier experience that could have set the stage or eated a
vulnerability to the initially selected trauma" (Cheek, 1994, 92). (37)

16. HYPNOSIS IN PSYCHOANALYTIC THERAPY (HYPNOANALYSIS): LEWIS

WORBERG: MEDICAL HYPNOSIS VOL 2: GRUNE & STRATTON: NY: 1948: 1960
EDITION
Palliative psychotherapy reinforced by hypnosis may be eminently successful in certain
cases. It may provide a patient with methods by which he can improve his relationships with
people. It may teach him how to pattern his life around his weaknesses, expanding his latent
talents and aptitudes. It may desensitize him to stress, and aid him in achieving a more peaceful
and productive life.
In many patients the basic personality structure is not too abnormal and has permitted the
individual to function efficiently up to the time of the current upheaval. In such cases the goal in
therapy need not be too extensive. The aim is to restore the habitual personality patterns that
existed prior to the breakdown. Often all the patient requires is simple advice regarding a
situation in which he is so subjectively involved that he is unable "to see the forest because of the
trees." An objective point of view given by an unbiased authority can suddenly clarify the issues
and enable the person to face his problem in a mature manner. Where the ego structure is
relatively intact, one may rightfully feel that the chances of readjustment to the customary life
pattern are good with relatively short treatment, employing such technics as ventilation,
reassurance, guidance, persuasion and desensitization.
Palliative psychotherapy is also indicated in persons with more profound personality
disorders who are either unable or unwilling to undergo more extensive therapy. It is (305) useful
in psychotic conditions, prepsychotic states and in individuals whose personality structure is so
weak that they are unable to tolerate the anxiety and stress associated with analytic treatment. The
aim here is to enhance personality assets to a point where they overcome the liabilities, and to
help the patient arrange his life so that his emotional problems will neither handicap nor hurt him.
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Yet in a considerable number of cases, palliative psychotherapy may fail to make a

significant impression on the individual. There are many persons who seem incapable of
adjusting themselves to their weaknesses, who cannot be desensitized to fearful situations no
matter how judiciously the appropriate technics are applied, who get themselves into the same
difficulties with people despite adroit guidance and environmental manipulation, who gain
neither security nor self esteem, in the face of the most persistent and conscientious efforts on the
part of the physician.
In such cases the personality problem is usually severe, the individual possessing so many
contradictory character strivings that he is at the mercy of a never-ending psychic tug-of-war. He
may, for instance, have inordinate expectations of himself, and possess perfectionistic impulses so
pronounced that whenever he performs in any way below these expectations, he responds with
panic. An investigation of his aptitudes may disclose that they tall far below his desired goals. His
turmoil seems to be dueto the disparity between his perfectionism and his performance abilities.
As part of the therapeutic process, he may be advised to scale down his ambitions in order that he
may attain success. It may then develop that success, in line with the more mediocre goals, is as
devastating as complete failure-perhaps more so. Failure may actually be the lesser of two evils.
Discussion and ventilation may disclose inimical situations in the environment that call
for immediate correction. Instead of making the patient more comfortable, this effort (306) serves
merely to plunge him into panic. The person may actually feel more comfortable in an
environment that provides him with some objective excuse for his inner distress and permits him
to rationalize his discomforts and to project his rage. Guidance and advice, may, in some cases,
serve less to direct the patient toward a freer expression of his needs, than to precipitate an inner
paralysis and a confounding helplessness that robs him of vitality and self-sufficiency. It may
even provoke an anxiety reaction, the patient insisting that his independence is being taken from
him. Attempts to externalize the individual and to divert his energies into social and recreational
channels may strike a stubborn snag; the patient persisting in his detached, inhibited way of life.
No matter how thoroughly one tries to train some patients, they will be unable to master
their symptoms. They may temporarily learn to conquer phobias, compulsions, and anxiety states
by such technics and evasions as the recitation of certain formulas, the enactmen t of pseudoscien
tific rituals, the forceful substitution of joyous for painful thoughts, or the adoption of a spurious
optimism. These devices may serve to keep them more comfortable for a short while. However,
their symptoms will continue to weigh inexorably upon them, necessitating more and more
vigorous neutralizing technics. Interpersonal relationships will remain disturbed, and attitudes
toward the self will be distorted and contemptuous.
The reason palliative psychotherapy is so frequently unsuccessful is that the most
important determinants of behavior are of unconscious origin. As a result of past inimical
experiences and conditionings, the neurotic person harbors within himself impulses, attitudes, and
emotions which are repressed because they conflict with accepted standards as embodied in the
conscience. Although repressed, these attitudes and impulses constantly filter into the conscious
life (307) in a disguised form, influencing the person's feelings, values, and behavior. To his
consternation, the individual may be motivated to react in a way diametrically opposed to
his ,,,,',Jo rational self.
So long as destructive, unconscious motivations persist, maladaptive behavior will plague
the person, will power and good resolutions to the contrary. Assertiveness, activity, and creative
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self fulfillment will be impeded, preventing the ego from attaining proper strength and stature.
Fears of the world and of people will continue, conditioning compulsive strivings for
dependency, submissiveness, affection, power, superiority, perfectionism and detachment, which
will further complicate the person's relationship to others. The sole hope of bringing the person's
destructive patterns to a halt lies in determining and enucleating their source. This is the primary
aim of psychoanalysis.
In psychoanalysis the ultimate objective is to bring about a change in the ego which, up to
this time, has been so involved in maintaining its defenses against anxiety that it is unable to
mediate the legitimate psychobiologic needs of the person. Wedged in between unconscious
impulses, whose acknowledgment is dangerous or repulsive, and an overwhelming conscience,
that supervises the person's actions wi th relentless vigilance and tyranny, the ego has elaborated a
system of barriers and evasions to protect itself from hurt. The elaborated defenses, however,
although calculated to protect the ego from anxiety, often prove to be a tremendous handicap to
the individual, especially by interfering with normal relationships with people. Psychoanalysis
strives to persuade the ego to give up its defenses against unconscious conflicts, or to modify its
defenses to conform better with reality. The eventual hope is that the ego will become more
tolerant of the needs of the person, and more capable of entering into gratifying relationships with
other human beings. (308)
The medium in which ego change occurs is the interpersonal relationship with the analyst.
This relationship is a two-edged sword, for, on the one hand, it precipitates destructive irrational
transference feelings, and, on the other, it is the nucleus around which the person reintegrates his
attitudes toward people and toward the world. The analyst becomes a living symbol onto whom
the patient projects his fears, hopes and demands as well as his deepest strivings and impulses.
The relationship with the analyst is surcharged with emotion as irrational attitudes and feelings
precipitate out. The experiencing of such feelings, and the understanding by the patient that they
are the product, not of present day reality, but of previous conditionings acts as a fulcrum for
insight. The tolerant attitude of the analyst even tually undermines the hypertrophied conscience
and permits the individual to investigate repressed drives and memories he could not
acknowledge previously. Freed from the tyranny of his conscience, and from the threat of being
overwhelmed by repressed fears and conflicts, the ego is strengthened to proportions where it no
longer requires neurotic defenses and subterfuges in order to function. It can then attend to the
legitimate demands of the individual, and can seek out in the environment the appropriate means
of fulfilling basic biologic and social needs.
The therapeutic process, however, is constantly jeopardized by resistances which the
patient mobilizes in his attempt to sabotage his progress. He comes to regard the analysis as a
threat to the canalized system of defenses which constitute. for him the sole means of bolstering
his security and self esteem. The analyst becomes a foe, against whom he pits himself with
facades and subterfuges to keep his system of values intact. The struggle which ensues between
the patient, who seeks to retain his compulsive neurotic trends, and the analyst, who strives to
motivate him toward more mature reaction patterns, is intense and prolonged. As a (308)
consequence, psychoanalysis is apt to require many months, and in some cases years, of persistent
work.
The time element is perhaps the chief drawback of psychoanalysis. Therapy is also
extremely expensive, and the number of patients the psychiatrist can handle is restricted. Many
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persons who could derive benefits from psychoanalytic therapy are consequently unable to avail
themselves of treatment.
In recent years a number of attempts have been made to cut down the time that is required
for psychoanalysis. Brief psychotherapeutic methods have been evolved which employ the basic
psychoanalytic principles. The question that may be rightfully raised is whether the dynamic
psychic changes which are brought about by psychoanalysis can be accomplished by briefer
psychotherapeutic methods.
In psychoanalysis we may distinguish two processes which go on side by side. The first is
involved with "uncovering" those unconscious motivational patterns which determine the
individual's values and behavior. The second phase of therapy is associated with reconditioning
and re-education, and concerns the substitution of mature habit patterns for neurotic infantile
ones. Because the ego is menaced by the unconscious material, and responds with resistance to
the anxiety aroused by an awareness of unconscious trends, the uncovering process may extend
over a long period of time. Resistances are manifested toward any influence that stimulate5
awareness of unconscious fears and conflicts. This is why the transference is so painful to the
patient when it begins to precipitate out latent attitudes and feelings. Resistances will
consequently be displayed toward the analyst in the attempt to ward him off or to discredit him.
There will be efforts made to maintain control and bolster up the waning, repressive defenses.
An awareness of unconscious impulses and trends in itself does not guarantee recovery,
since neurotic defenses and (310) symptoms may possess values which dwarf normal
psychobiologic goals. The patient may be unwilling to relinquish the secondary gain in his
neurosis even though he has insigh t into his illness. A long re-educational period may be
necessary before the patien t is willing to exchange his compulsive patterns for the happiness a,nd
security of normal interpersonal relationships.
Work by Erickson, Erickson and Hill, Erickson and Kubie, Eisenbud, Kubie, Lindner,
Gill and Brenman, Fisher, and Wolberg, has indicated that hypnosis lends itself to a facilitation of
the psychoanalytic process. A most important effect of hypnosis is its power to remove those
resistances that prevent awareness of unconscious material. Whereas months may be consumed in
attempting to remove such resistances during psychoanalysis, hypnosis is often able to achieve an
almost surgical removal of barriers to the conscious appreciation of repressed elements of the
personality.
A number of objections may be voiced against hypnosis as an aid to psychoanalysis. The
first objection has to do with the matter of hypnotizability. Hypnoanalysis requires a deep and
preferably somnambulistic trance. Not all patients can achieve somnambulism. This was the chief
reason why Freud many years ago abandoned hypnosis as an avenue to the unconscious. The
second objection involves the validity of the material brought up during hypnoanalysis. As is well
known, a characteristic feature of hypnosis is the motivation to comply with the demands of the
hypnotist. When the patien t senses that he is expected to bring up things, he is apt to invent
material in order to please the hypnotist. The third objection concerns the effect of hypnosis on
the transference. One may suspect that hypnosis introduces a foreign element into the analysis
which may interfere with the therapeutic aim. The last objection deals with the possible
obliterating effect of posthypnotic amnesia on the hypnotic experiences. (311)
The first objection, of hypnotizability, is an important one. Although most patients are
probably hypnotizable, not all are capable of achieving a somnambulistic state. This puts definite
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limi tations on the use of hypnosis in psychoanalysis. However, with an improved technic the
number of somnambuies may be materially increased. A slow systematic induction and the
removal of resistances as they arise may produce desired results. Narcotic drugs also may be
utilized as an adjunct for increasing hypnotic depth, posthypnotic suggestions being given the
patient to the effect that he will be susceptible to ordinary hypnotic suggestions later on.
Fortunately not all hypnoanalytic procedures require a somnambulistic trance. Free association
during hypnagogic reverie is possible during a light trance. Dream induction and automatic
writing can often be accomplished in a medium trance.
Replying to the second objection, it is, of course, possible that the patient may falsify
material on the basis of complying with what is expected of him. One way of dealing with this
problem is to get the patient to understand that the material he brings up is subject to his own
evaluation, and that he can accept or reject it in accordance with whether he feels it to be true or
false. During the final stages of hypnoanalysis, the dissolution of the last vestiges of the patient's
dependency may have an important effect upon validating the material he has brought up.
The third objection, that of the possible obliterating influence of posthypnotic amnesia,
may be answered by the simple statement that the amnesia, if it exists, is an artifact. The learning
process, which a number of observers believe is accelerated during hypnosis, is not subject to
annihilation on the resumption of waking life. This may be proven experimentally by establishing
a conditioned hand withdrawal to a buzzer during the trance state and noting that hand
withdrawal persists in the waking state in spite of amnesia for the experiment. Hypnotic
experiences carryover into the waking state in a similar manner. (312)
By far the strongest objection to hypnosis is its possible deleterious effect on the
transference. In psychoanalysis the analyst assumes a passive role in order that the patient may
project toward him various inner impulses and strivings which have no basis in reality. Rooted as
it is in faith, hypnosis would seem to limit the patient's feelings and attitudes to those associated
with the phenomenon of hypnotizability, namely, to dependency on the omnipotent hypnotist, to
masochistic submissiveness, or to a desire to identify with the hypnotist thereby achieving
magical power.
This objection is invalid because the patient always reacts to the hypnotist, not only with
dependency and masochistic submissiveness, but with the full range of his inner wishes,
demands, fears, and impulses which are the product of his character structure. When one analyzes
the patient's free associations and dreams, one is convinced that the hypnotic situation does not
eliminate spontaneous feelings or emotions which develop in a manner similar to their
developmen t during psychoanalysis. As a matter of fact, hypnosis catalyzes such feelings.
However, in the traditional hypnotic induction, and where hypnosis is used as an adjunct to
palliative psychotherapy, the patient is motivated to repress feelings as they develop in order to
win bounties which he believes will accrue from the assumption of a passive state. In some forms
of hypnoanalysis, an important innovation consists of the analysis of the patient's transference
attitudes and feelings as they develop before he has had a chance to repress them.
During the orthodox employment of hypnosis, the subject maintains an inert role. This is
unlike psychoanalysis in which the patient is expected to be active and assume the responsibility
for much of the analytic work. As is well known, the activity of the patient is an aid to self
growth. Hypnosis would presumably eliminate activity. The answer to this objection is that in
hypnoanalysis the patient is not expected to be passive. Indeed, activity is encouraged (313)
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during the hypnoanalytic procedures, and intellectual, emotional and motor functions are all
vigorously enhanced. The patient engages in verbalization, dramatization, play therapy, writing
and drawing without the inhibitions that exist in the waking state. This innovation in therapy has
an important effect in opening up motor pathways which have, up to this time, been blocked to
unconscious feelings and attitudes. It eliminates the intellectualization of the analytic process.
Hypnoanalysis thus tends to stimulate expressiveness and assertiveness.
The dissolution of the hypnotic transference would seem difficult at first glance, since one
would assume that the patient may, during hypnosis, render himself so dependent upon the
analyst that he develops a need for prolonged guidance. Under the circumstances, we would
expect that once hypnotic therapy is terminated, the patient will abandon his therapeutic gains and
will take refuge in his customary neurotic defenses. This objection is not valid because the
constant analysis of the hypnotic transference eventuates in the dissolution of the dependency
ties, and results in a strengthening of the ego, enabling the patient to function under his own
power. With a proper technic no difficulty will be encountered in the handling of the
transference.
One of the chief drawbacks of hypnoanalysis is that the patient may not be motivated
toward the analytic method. He may desire a directive authoritarian relationship in the form of
guidance or persuasion. He may see no sense in connecting his symptoms with his personality
problems, in investigating unconscious conflicts, or in participating actively in the therapeutic
procedure. There are some persons who cannot be brought around to a point where they will
accept the type of relationship or the technic essential in hypnoanalysis. They will refuse to work
in a nondirective, nonauthoritarian medium, or to develop values or goals within themselves
toward productivity and independence. In other (314) patients the ego strength may not be
sufficient to tolerate the anxieties liberated by the release of unconscious conflict. However, a
skillful therapist will be able to create incentives tor change, working within the boundaries of the
existing ego strength toward preparing the patient for hypnoanalysis. (315)
HYPNOANALYTIC PROCEDURES: Hypnoanalysis presupposes an aptitude on the
part of the patient to enter a trance sufficiently deep to make possible the enployment of the
various hypnoanalytic procedures. The ability to verbalize during hypnosis without awakening is
mandatory. A somnambulistic trance is essential where such technics as drawing, play therapy,
dramatics, mirror gazing, regression and revivification, and the creation of experimental conflicts
are to be used. Free association, dream induction and automatic wri ting often require no more
than a medium or light trance.
As has been indicated, not all patients are capable of being hypnoanalyzed because they
cannot tolerate the anxiety associated with the release of unconscious material by the various
hypnoanalytic processes. The strength of the ego must be carefully appraised before
hypnoanalysis is attempted. Where the individual is unable to stand hypnoanalysis, palliative
psychotherapy may be employed in the hope of building up adequate ego strength to make later
hypnoanalysis possible.
GENERAL PROCEDURES: A daily training period for about one to two weeks
usually precedes the beginning of therapy. During this time the patient is slowly and
systematically inducted into deeper and deeper trance states with the object of reaching, if
possible, somnambulism with posthypnotic amnesia. The patient should be trained to enter into a
trance state immediately at a given signal. The last part of the training period is spent in teaching
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the patient to verbalize and to associate freely in the hypnotic state, to dream on suggestion, to
write automatically, to revert memorially to earlier periods oflife, and to engage in play therapy,
drawing, dramatics and mirror gazing. Elsewhere directions for instituting these technics have
been outlined in detail. (316)
Following the training period, the patient is instructed in the technic of free association,
and he is reminded of the urgency of reporting his dreams and his atti tudes and feelings toward
the analyst. The patient may sit up in a chair at each session or, preferably, may lie down on a
couch as in psychoanalysis. As a general rule, the first fifteen or twenty minutes of each session
are spent in free association, the content of the patient's associations being noted for clues to the
later framing of hypnotic suggestions. Hypnosis is then induced and the various hypnoanalytic
procedures are employed as indicated. The actual period of hypnosis will range from twenty
minutes to one half hour. Before awakening, the patient is instructed to sleep for five or ten
minutes. This time may be used to induce dreams relating to important current problems. The
remainder of the hour is spent discussing the patient's reactions or the material brought up during
the trance. A one and one half hour treatment period is generally more satisfactory than the
traditional hourly session, and, sometimes, an even longer period of time may have to, be allotted
to the patient.
HYPNOSIS AND FREE ASSOCIATION: Free association is an extremely important
technical procedure. Unconscious trends usually manifest themselves in the stream of speech in a
more or less discursive manner. However, many resistances may arise to waking free association,
some of which are conscious and others unconscious in nature. Hypnosis can be used to facilitate
free association. Hypnagogic reverie, as Kubiel5 has shown, may bring about a surprising
elucidation of unconscious material. Lindnerl6 makes use of hypnosis to overcome resistances to
waking free association by inducing a trance whenever the patient manifests blocking in speech.
The mere induction of hypnosis may eliminate many resistances to free association. The material
flows freely, and (317) the results of one session are often equivalent to weeks of waking free
association. It is often helpful to have the patient visualize scenes in his mind as they appear. He
may become quite emotional and dramatic as he describes his thought images. Hypnosis may also
be used to analyze resistances that prevent waking free association. The hypnotic state, however,
cannot in itself dissolve all resistances to free association, and, in some cases, the patient will be
unable to verbalize his thoughts even in the deepest somnambulism with the most persistent
urging. Occasionally material may be brought up by instructing the patient that, at the count of
five, he will have a thought, or visualize an image.
The question may be asked as to what value free association during hypnosis can have, if,
on the assumption of waking life, the usual resistances begin to function. The ability to verbalize
during hypnosis will not in itself produce an immediate change. However, a corrosive process on
the resistances seems to be set up which ultimately may result in a breaking through of
unconscious impulses and feelings in to awareness.
DREAM INDUCTION: Hypnotic stimulation and interpretation of dreams playa very
important part in hypnoanalysis. As in psychoanalysis, the patient's dreams indicate the character
of the repressed material, the nature of the transference, the manifold disguises that resistance5
assume, and the stages of therapeutic progress.
Dreams may be stimulated by suggestion under hypnosis, or they may be posthypnotically
induced. The nature of the problem to be dreamed about may also be suggested. Hypnotic dreams
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have all the characteristics of spontaneous dreams and are dynamically as significant. The dreams
which spontaneously follow the first attempts at hypnosis are tremendously important and often
contain (318) the essence of the entire problem. Spontaneous dreams are stimulated by the
material brought up during the trance, by resiS'iance, and by the emotions aroused in the in
terpersonal relationship.
The ability to dream under hypnosis must be trained. A medium trance is usually required.
Unconscious ideational processes of a purposeful nature may be stimulated by dream activity, and
frequently the patient may work out an insight through dreaming when it is suggested that he do
so. Dreaming under hypnosis or posthypnotically may also be used as a means of understanding
attitudes and feelings that are not yet conscious and which cannot be verbalized. In this way
attitudes may be divulged which reveal trends in the transference. Dream activity may also aid in
the dissolution of resistance. An important use of hypnotic dreaming is in the recovery of dreams
which have been forgotten, as well as specific portions of dreams which have either been
repressed or have been subjected to secondary elaboration. Dreaming under hypnosis may also be
used to help the recovery of forgotten memories and experiences.
Dreams revealed under hypnosis, as a general rule, should not be in terpreted in the
waking state. If an in terpretation is indicated, it should be made during hypnosis, and the patient
should be enjoined to accept or reject the interpretation in accordance with whether he feels it to
be true or false. Frequently the patient will be able to interpret his own spontaneous or hypnotic
dreams while in a trance, since the symbolic meaning is more apparent in hypnosis than in
waking life.
AUTOMATIC WRITING: Automatic writing is a splendid means of gaining access to
unconscious material that lies beyond the grasp of conscious recall. The technic of automatic
writing is easily taught by placing a pencil in the hand of the patient during the trance (319) and
suggesting that his hand will move along automatically without his being aware of what he is
writing. The product of such writing is usually an illegible jumble of letters and words which
constitute a cryptic communication. Occasionally the writing is somewhat more coherent and will
contain condensations, neologisms, phonetic spelling and other devices which can be translated
only by the patient during hypnosis.
The patient is usually instructed to translate his automatic writing by opening his eyes
during the hypnotic state and writing the full meaning of his communication underneath the
automatic writing. Should he be unable to open his eyes without awakening, a posthypnocic
suggestion may be given to him that the meaning of his automatic writing will be clear to him
after he awakens. Because the automatic writing is so fragmented, it is best to permit the patient
to do the translating himself in order to supply missing material that he has eliminated or
condensed.
By an involved technic it may be possible to create a hysterical dissociated personality
through the medium of automatic writing which aids the physician in getting across to the patient
important interpretations and insights. This artificially created personality usually lies closer to
the unconscious and is capable of tolera ting repressed ma terial wi th less anxiety than the
customary personality. The alter ego is highly protective of the patient and acts as an in
termediary between the physician and the patient's habitual ego.
HYPNOTIC DRAWING: Drawing may be stimulated under hypnosis and is another
important way of getting at significant unconscious problems. Patients who have a resistance to
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draw in the waking state usually enter into hypnotic drawing with great enthusiasm. It is best that
the patient be able to achieve a somnambulistic trance in order that he can open his eyes without
awakening. (320)
The topics to be drawn may be suggested to the patient, or he, himself, may be given free
range to draw whatever subjects he desires. He may delineate attitudes towards members of his
family, toward his mate, or toward the physician, or he may illustrate an important dream or
experience. Sometimes story-telling technics are combined with drawing, the patient being
requested to make up a story about his drawing. Hypnotic drawing can also be advantageously
utilized during regression with reorientation to earlier age levels, the patient bringing up attitudes
and feelings that are repressed at the adult level.
PLAY THERAPY: The usual resistances that the adult displays toward play therapy
may often be effectively eliminated during hypnosis. The patient usually plays with the materials
with great vehemence as soon as he realizes that he is not expected to be inert, nor need wait for
specific directions from the physician. Both active and passive play technics may be used.
Play therapy may be employed at both adult and regressed age levels, and, in the latter
state, the physician may be able to recapture inklings of the conflicts the patien t suffered as a
child. The directions given during play therapy must be specific and may have to be repeated
several times. If one has a general idea of the chief incidents in the patient's life, regression to the
age level of these incidents, and setting the stage with appropriate materials, may facilitate the
therapeutic process.
DRAMATIC TECHNICS: Dramatization of inner feelings and importan teven ts in the
past life may be readily effected during deep hypnosis. The resistances to dramatization that exist
in the waking state are readily removed under hypnosis when instructions are given the patient
that he act out certain feelings or situations. (321) The emotional reaction elicited by such
instructions may be intense and considerable abreaction may be achieved. One of the best
examples of dramatization may be seen in the treatment of war neuroses when the patient is
instructed under hypnosis to relive the battle scene. The response to such a suggestion may be
extremely vivid, the patient reliving his intense rage, anxiety and fear in a most realistic manner.
The analyst ma y pIa y a passive role during dramatization, permitting the patient complete
freedom, or he may play an active role becoming a part of the scene. In the latter instance, he
may serve as a significant personage in the individual's lite, encouraging the patient to express
certain feelings, or else acting with him in the dramatization of an important event. Dramatic
technics may sometimes be combined with story telling. These permit the patient to elaborate on
his motor performances.
REGRESSION AND REVIVIFICATION: Two types of regression are encountered
during hypnosis. The first type has to do with current conceptions of the patient toward an earlier
age period, viewing the past with present day attitudes and judgments. There is here a simulated
reproduction of a past period of life. The second type of regression is an actual return to a
previous epoch with a reliving of the same pattern that existed originally. This is regression in the
true sense, and in this state the individual is capable of recapturing and reliving events and
impulses which have been forgotten or repressed.
To induce regression the patient is inducted into an extremely deep trance, and then he
may slowly be disoriented to time and place. He is then reorien ted to earlier and earlier age
periods by appropriate suggestions. The specific age period to which regression is desired maybe
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suggested to the patient, or he may, himself, be given a choice of a significant period. Where he
displays a certain symptom, he may be (322) instructed to remember and to live through the time
when he first developed the symptom. Regression increases the hypermnesft effect of hypnosis to
a marked degree, opening up pathways to forgotten memories and experiences which would not
be available to the individual at an adult level. Many of the reports in recent literature have
involved the utilization of this method. Regression may be used in conjunction with other
hypnoanalytic technics, such as in dream induction, play therapy, drawing, dramatics, automatic
writing and mirror gazing.
CRYSTAL AND MIRROR GAZING: Crystal and mirror gazing will require an
extremely deep state of hypnosis inasmuch as the patient will have to open his eyes without
awakening. Where a crystal is not avail£1.ble, a mirror may be used, so placed that it reflects the
blank ceiling. Under hypnosis the patient is requested to gaze intently into the mirror and to see
visions which he is to report to the physician. Visual hallucinations that come up by this technic
frequen tly consist of forgotten or repressed inciden ts that have happened in the past. The
visualization of these events often produces intense emotional reactions and considerable
abreaction. Frequently the technic may be utilized to consolidate insights obtained through other
psychoanalytic procedures which have not been fully absorbed and integrated.
INDUCTION OF EXPERIMENTAL CONFLICT: An experimental conflict offers a
method of demonstrating to the patien t the workings of his unconscious. Often it will inculcate
insight where no other technic succeeds. Many resistances prevent the acknowledgment by the
patient of certain unconscious drives. Only by experiencing them in actual operation can the
patient realize how they are influencing his behavioral and attitudinal patterns. For instance, a
(323) person may have a problem involving an inability to express hostility which he turns on
himself, with the development of a psychosomatic illness. During therapy, the patient may
become aware of the fact that he feels hostile, but he may be unable to see how his hostility
produces his somatic symptoms. An experimen tal neurosis created during the hypnotic state, in
which a fictitious situation is suggested associated with feelings of hostility, serves to mobilize
the same somatic patterns that develop when he spontaneously feels hostility. Under such
circumstances it may be possible to demonstrate to the patien t how certain emotions are
responsible for his symptoms.
Experimental conflicts may involve significant incidents in the patient's life or may deal
with the transference relationship. The wording of the experimental conflict is important as
Erickson has pointed out. The patient is told that he will remember an incident that actually
occurred to him, but which he had forgotten because the memory of this incident had been
frightening or painful. An incident is then elaborated which brings out the particular situation or
pattern that is important at the time. The patient is then told that he will, when he awakens,
remember the emotions relating to this situation, but he will completely forget the situation itself.
Upon awakening, the reactions of the patient are carefully noted as are his spontaneous responses.
Repetition of the experimental conflict may be essential. Eventually an explanation to the patient
under hypnosis of the meaning of the experimental conflict, with directions to recall it in the
waking state, may reinforce the understanding of his problem.
PRACTICAL APPLICATIONS OF HYPNOANALYSIS: For practical purposes
hypnoanalysis may be employed in three ways. The first use permits the development of a
transference neurosis with its analysis in the traditional (324) psychoanalytic sense. The second
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use is for purposes of desensitization, aPbwing the patient to become aware of and to adjust to
repressed elements of his personality. The third use involves the re-education of the patient
through psychoanalytic insights. In hypnoanalytic desensitization andreeducation, a neurotic
transference is avoided as much as possible. (325)
HYPNOANALYSIS WITH ANALYSIS OF THE TRANSFERENCE: Hypnoanalysis
lends itself admirably to the development and analysis of a transference relationship. The
transference develops rapidly, and its significance may be studied in a facile way through the use
of the various hypnoanalytic procedures. Through the analysis of the transference, the patient is
brought to a realization of his deepest repressed conflicts, and the manner in which they distort
his present day behavior. The relationship the physician attempts to establish with the patient here
is as permissive and nondirective as possible.
Because hypnotic therapy has traditionally been associated with an authoritarian
relationship, an analysis of the relationship may occasion some surprise, since it would seem to
jeopardize the very foundations on which hypnosis depends. Nevertheless, such an analysis does
not interfere with hypnotizability even though the motivations which condition trance
susceptibility may be subjected to investigation.
Hypnosis is an intimate interpersonal relationship and is bound to incite profound
emotional feelings in the patient. At the start the latter will display his customary demands,
expectations and fears which he habitually demonstrates in his relationships with people. In
addition to these habitual responses, he will experience an onrush of irrational transference
feelings which frighten him and which he will strive to repress. The latter are the product of past
experiences and conditionings so anxiety laden that they have been relegated to unconscious
oblivion. In his ordinary interpersonal contacts, he is able to throw up various defenses against
such feelings, to detach himself or to replace his strivings with those of a more acceptable nature.
Resistance against these feelings is intense. In psychoanalysis a main task is (326) dissipation of
transference resistances. Many months may pass before the p1tient permits himself to come
sufficiently close to the analyst to experience irrational attitudes and impulses.
In hypnoanalysis, the resistances to the deepest interpersonal feelings are cut through
almost from the start, and these reveal themselves through the various hypnoanalytic procedures.
The experiencing and the understanding of unconscious inner drives are of utmost importance in
tracing the genetic development of the neurosis, and in demonstrating to the patient that his
present symptoms are caused by them. As soon as the patient relieves himself of guilt and
hostility, he becomes cognizant of a new element of congeniality and productiveness in his
relationship with the analyst.
The ability of the patient to express himself freely during the trance, to utilize motor and
ideational pathways which are not available to him in waking life, to vocalize and dramatize his
trends and conflicts, acts as a stimulus to activity and self assertiveness. The ego, finding that it
has not been devastated, is better capable of relinquishing repression and of permitting insight to
filter into waking life. Above all the patient discovers in the intimate interpersonal relationship of
hypnosis that he is not destroyed and that he does not destroy the physician. Instead he feels an
element of peace and security which has been foreign to him in his habitual interpersonal
contacts. This unique relationship experience acts as a bridge toward more vitalizing experiences
with others. In detached and schizoid persons, especially, the hypnotic relationship may be the
first close interpersonal experience, and may lead to a more realistic approach toward the world.
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Trepidation may be expressed by some that the hypnotic relationship is bound to enhance
dependency strivings. Such a fear is not at all justified because the hypnotic relationship is not
utilized in an authoritarian way as it is during the various palliative hypnotic psychotherapies.
(327)
In hypnoanalysis, a most remarkable innovation in therapy is the directing of the patient
toward activity and productiveness in both ideational and motor spheres. The release from the
traditional restraints has a most important effect upon the individual's inner evaluation of
authority as restrictive and condemning, and upon his own feelings of assertiveness and self
confidence.
Resistance occurs in hypnoanalysis in the same way as in psychoanalysis, whenever the
patient is confronted with anxiety, or is threatened with the loss of a gratification he values
highly. The management of resistance during hypnoanalysis depends upon its character and
function. Those resistances which oppose the penetration into awareness of repressed emotions
and memories can often be dealt with surgically by urgent demands to the patient, during trance
states at adult or regressed age levels, to talk about his inner conflicts or to remember a forgotten
experience. The effect of this recall is to lessen conscious resistances to a point where the patient
eventually brings up the material in the waking state, presenting it as the product of a spontaneous
discovery. Resistances which issue out of the transference are much more difficult to deal with
and call for a painstaking analysis along the lines of orthodox psychoanalytic technic,
demonstrating to the patient the presence of resistance, its purpose, and, when possible, its
historical origin. Various hypnoanalytic procedures may facilitate the dissolution of transference
resistances. However, such dissolution may require a considerable period of time, particularly in
the character disorders.
Psychic change is brought about not merely by a disgorging of unconscious material, but
by a rational understanding and digestion of this material on the part of the ego. During
psychoanalysis, insights are arrived at slowly as resistances are gradually resolved. The ability of
the patient to tolerate his unconscious drives goes hand in hand with the strengthening of his ego.
During hypnoanalysis, many resistances (328) are swept aside. This effect is not at all automatic,
but probably is due to the temporary strengthening of the ego during the trance as a result of an
alliance with the hypnotist, and a replacing of the archaic tyrannical conscience wi th a more
tolerant one patterned around the injunctions and commands of the hypnotist. One need not
assume from this that the superego is entirely dissolved during the trance. Even in the deepest
trance states it may continue to function, inhibiting the appearance of repressed unconscious
material. The degree of superego replacement during the trance is an individual matter being
most marked in hysterical conditions, and least apparent in the character disorders.
In the trance state, consequently, the individual may bring up emotions, conflicts,
memories and strivings which are dynamically important in maintaining behavior patterns of a
neurotic nature. The degree to which the patient becomes cognizant of these trends varies. In
some cases important material may be directly verbalized. In other patients repressions prevent
the accessibility of the material to speech. Here, indirect technics, such as play, drawing,
automatic writing, and dramatics may disclose the material in a more or less symbolized form.
The manner in which the material is interpreted to the patient and its timing are
tremendously important. As a general rule it is useless to present the patient in waking life with a
verbatim account of his hypnotic productions. Unprepared as it is, the conscious ego will reject
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the validity of the material, will respond with resistance, or will, when the motivation to comply
with the hypnotist is sufficiently strong, intellectually accept the material with no associated
emotional benefit. Interpretations are given the patient during hypnosis, and in the waking state
are phrased according to his awareness of a problem. Where he has an inkling of a trend, an
interpretation will be beneficial. Where no such awareness exists, the interpretation may be worse
than useless. It is especially essential to be cautious with (329) interpretations where the patient is
capable of bringing up the unconscious material only through the indirect hypnoanalytic
procedures.
In some patients the elucidation of unconscious drives during hypnosis serves in itself to
dissolve many conscious resistances to the acknowledgment of these drives. In the trance the
patient lies closer to his unconscious. He will understand his dreams and his behavior patterns
with much greater accuracy than in waking life. It is thus possible to be relatively active in
interpretations, always tempering these to the existing degree of understanding. Authoritarian
injunctions to accept material must be avoided. Rather the patient is enjoined to work on the
interpretation and to accept it in the waking state only if and when he feels it to be true. In this
way the patient participates in the analytic process and there is less chance that he will accept the
interpretation on the basis of faith. Insight gained in a medium where the patient feels he can
accept or reject an interpretation in accordance with whether he feels it to be true or false is
usually irreversible.
Another important factor in hypnotic interpretation is to avoid regarding present day
behavior as a stereotyped repetition of past happenings. Even though character traits and behavior
patterns are evolved as a result of conditionings and experiences in relationship with important
past personages, the individual does not carryon an automatic repetitive process in his
interpersonal relationships. Character traits determine present needs and strivings and generate
reaction tendencies of a compulsive nature. All behavior, however, is dynamically motivated to
propitiate essential needs, and it is essential to see what needs the individual seeks to fulfill in his
present day setting. What we desire to interpret is the purpose behind the patient's present
behavior rather than its genetic determinants.
The matter of the handling of the symbolisms which emerge from the unconscious mental
strata is also important. The language of the unconscious is frequently couched in (330) terms of
organ functions-in feeding, excretory, and sexual activities. Phallic symbolism is extremely
common, and one may get the erroneous impression that the patient's difficulties are entirely
centered in a sexual sphere. One can easily be led astray if he accepts such unconscious
symbolisms at their face value. It is essential to understand and to reinterpret the symbolisms in
terms of basic motivational activities. To bombard the patient with symbolisms usually does little
except confuse him, inasmuch as the language of the unconscious may be inscrutable to his
conscious mind.
An important aid in the interpretive process is the creation of an experimental conflict
which is patterned around the patient's personal conflict and arouses emotions and behavior such
as he customarily experiences. Many patients are able to gain insight through the medium of real
experience when they would be unable to understand their difficulties intellectually. Another
technic is to urge the patient during hypnosis to work out a certain problem in detail until he
understands it thoroughly. Much activity of an unconscious nature may be stimulated by this
method.
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Unfortunately, the use of hypnoanalysis with analysis of the transference requires special
skills in the physician that can be gained only through training in the psychoanalytic method,
including a personal psychoanalysis and supervised control work. This is necessary in order to
analyze the most significant trends in the interpersonal relationship, to avoid the pitfalls of
countertransference, to handle resistance, and to make appropriate interpretations.
While a personal psychoanalysis with adequate supervised control work is essential for the
physician in those forms of hypnoanalysis which depend upon the analysis of the transference as
the predominan t technic, there are some technics of hypnoanalysis which the unanalyzed
physician may use, which restrict the development of a neurotic transference. These technics are
first, desensitization, with revival of repressed memories and conflicts; and second, re-education
utilizing psychoanalytic insights. (331)

17. RATIONAL SUGGESTION THERAPY: A SUBCONSCIOUS APPROACH TO RET:

RICHARD A. BLUMENTHAL, M.S.: MEDICAL HYPNOANALYSIS: APRIL, 1984: [The
author acknowledges with gratitude the critical comments made by Dr. Daniel L. Araoz and Dr.
Albert Ellis in the preparation of this article.] ABSTRACT: The effective use of suggestion is
important to all who practice clinical hypnosis. In this article, the therapeutic goals and
philosophical foundations of RET are combined with the principles of cognitive suggestion,
producing a hybrid therapeutic approach, Rational Suggestion Therapy. Three phases
comprising a total treatment are explained, while exploring some of the historic and current
theories of suggestion and rational thought. Pertinent concepts are drawn most notably from the
works of Ellis, founder of Rational-Emotive Therapy; Baudouin, practitioner and author at the
original New Nancy School: and Araoz, modern proponent of the New Hypnosis. Other
references and extrapolations attempt to join these independently effective approaches into a
coherent mode and encourage the use of the subconscious in psychotherapy.
INTRODUCTION: In recent years the rational ideas of Albert Ellis and others of the
Institute for Rational-Emotive Therapy have served as a definition of mental health for a large
segment of American counseling and psychotherapy (Heesacker, Heppner and Rogers, 1982;
Smith, 1982). Since its inception, two ongoing concerns of RET have been the speed and
effectiveness of treatment, and many varied techniques are employed in the pursuit of therapeutic
efficiency. Perhaps this willingness to expand its horizons combined with the adaptability of
RET's theoretical foundations are responsible for its continued success and wide use. Much of
the effectiveness of RET depends on the completion of homework assignments designed to act as
relearning devices (Walen, DiGuiseppe and Wessler, 1980). To be learned are ideas deemed
appropriate substitutes for irrational ideas. It is the aim of RET to enable the client to have at
his/her disposal ideas which comprise an appropriate philosophy of life - an elegant solution to
psychological difficulties (Ellis and Harper, 1975). If the client eventually is able to experience
spontaneously an appropriate emotion or behavior without conscious deliberation, it seems proof
of a breakthrough in treatment. The rational philosophy serves as preparation for situations as yet
unencountered and may be considered as a consciously arrived-at body of autosuggestion. It has
been theorized that autosuggestion, rational or not, forms a subconscious predisposition to
specific emotional and behavioral reactions (Araoz, 1981). We seem to be in a continual process
of suggestion-reaction-suggestion. Autogenic Therapy (Luthe and Schultz, 1969), coping
statements (Meichenbaum, 1977), rational disputation (Walen, DiGuiseppe and Wessler, 1980)
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and other self-talk techniques are effective methods of conscious deliberate attempts to intervene
in unhealthy suggestion cycles. These may be supplemented with subconscious therapy, the
rational suggestion.
CONDITIONAL SPONTANEOUS AUTOSUGGESTION: Of the work at the New
Nancy School in the early part of the twentieth century, one of the greatest contributions was the
recognition of conditional spontaneous autosuggestion (Baudouin, 1922). Emile Coue reported
numerous cases in which he brought remarkable relief after one or two sessions to individuals
who suffered physical or emotional symptoms, experienced in association with activating
conditions. Each time the conditions were experienced the same symptoms surfaced. Coue
theorized that perhaps the first time the event took place the reaction may have been due to a
genuine physical disorder. Thereafter, the expectation of the symptom alone was strong enough
to repeat the first reaction spontaneously. This expectation Charles Baudouin (1922) called
conditional spontaneous autosuggestion. An idea learned from prior experience had been
employed without conscious deliberation when triggered by key conditions similar to the original
experience. With each subsequent experience, the autosuggestion became more and more a part,
of the event, and soon an entrenched habit was formed. By using a counter-suggestion to replace
the original autosuggestion, thus forming a new and purposeful conditional autosuggestion, Coue
showed the power of autosuggestion as it reaches out from the subconscious (Baudouin, 1922).
It would appear that the principle of conditional spontaneous autosuggestion is at work to a more
or less degree in every problematic situation which could be the focus of an RET treatment.
Even under previously unexperienced conditions, autosuggestion will arise from actual or
imagined similarities to prior conditions. Reintegration learning theory (Hulse, Deese and Egeth,
1975) shows that a part of either the stimulus (conditions) or the response (learned
autosuggestion) is enough to elicit the entire learned stimulus/response pattern. For this reason,
ideas translated into autosuggestions may have extremely wide applications. This is especially
true of ideas concerning the self.
It is desirable to attempt to alter un- profitable autosuggestion with rationally developed
autosuggestion in advance of anticipated conditions. This technique may be used for the
immense benefit of the individual whose current ideas are working against his/her own best
interest.
The aim of Rational Suggestion Therapy (RST) is to master autosuggestion by using the therapy
arena to enable the individual to control the source of autosuggestion. The conscious self
becomes the source. A rational decision is made by the client to seek a change in ideas. We may
call this decision-making process, the first of three phases in RST, the theoretical phase of
treatment. In the light of RET, the client with the aid of the therapist imagines and agrees to
more appropriate ideas. The practical phase is next, offering the new ideas to the subconscious.
This is followed by the spontaneous phase which occurs outside the treatment arena, during in
vivo experience, The spontaneous phase is the measure of success of the treatment because it is
in this phase that the client either experiences the desired spontaneous autosuggestion or not.
THE THEORETICAL PHASE: RST is a cognitive technique making a basic
assumption: that suggestions be aimed at ideas rather than behavior or emotion. The idea is the
genesis of emotional or behavioral expression (Ellis, 1973). RST does not block expression. It
attempts to improve the ruler of expression, ideas. If the symptom alone is blocked without a
fundamental improvement in the causal idea, that idea will exert influence on another area (Ellis,
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1973), seeking to establish a new association of conditions and behaviors, as real and imagined
alternatives become available to the individual.
Because the suggestion is a rational idea (Ellis, 1973), its use may have positive results in
more than one set of conditions, wherever the idea may he applied. The subconscious finds a
means for the in vivo realization of the suggestion, even if the specific means has not been
suggested. This is known as the law of subconscious teleology (Baudouin, 1922), and explains
the movement of ideas implied by one experience and applied to a different one. For example, an
idea assimilated in childhood may be the cause for adult behavior because of the symbolic yet
logical nature of sub- conscious thought. No matter the dissimilarities of the material conditions,
if autosuggestion is at work, the subconscious will find a way to make the idea suit the event
symbolically and achieve the suggested outcome.
It is therefore imperative that suggestions deal in ideas which may be usefully applied to
many possible situations. If an idea is truly to work for the person, it will work in the most
extreme applications, and in conjunction with other rational ideas. Rational suggestions agree
with and support one another, creating a rational philosophy. In RST, the therapist's function is
not to trace the original conditions of the autosuggestion, simply identify the autosuggestion
and, if need be, enable the client to replace it. It is also important to note that RST involves an
exchange of ideas, not only the elimination of an inappropriate one. Without a new idea to take
the place of the un- wanted one, there is no telling where the new autosuggestion will come from
and the results will probably be lacking.
THE PRACTICAL PHASE: Once the new ideas are agreed upon by the client and the
therapist, the practical phase of RST begins. Conscious opposition to spontaneous
autosuggestion is difficult. There appears to be a direct conflict between the conscious and the
subconscious. Baudouin (1922) called this the law of reversed effort, observed time and again at
the New Nancy School. Attempting to force the acceptance of a new idea against the wishes of
the sub- conscious, has the reversed effect of obsessively concentrating the mind on the
undesired idea, frustrating the individual's willful efforts.
If we are to resolve this conflict between conscious and subconscious, the subconscious
must be appealed to in order for it to conform to the will of the rational conscious. It is
postulated that induction into a suggestible state of consciousness is actually focusing the mind's
attention on the creative, imaginative part of the brain, the right hemisphere (Araoz and Bleck,
1982). When right hemisphere focus is attained and the individual is dissociated from the
surrounding reality and engrossed in an inner reality (Araoz, 1982), the subconscious mind is
accessible. This outcropping of the subconscious (Baudouin, 1922) becomes an alternate, though
no less cognitive, state of consciousness (Fromm, 1977). During the outcropping, suggestibility
is heightened and the subconscious may be addressed directly and purposefully.
SELF-PERMISSION: While the conscious mind has difficulty willing away unwanted
thoughts, it is with relative case that most people can be shown the difference between rational
and irrational ideas (Ellis and Harper, 1975). It is the willingness to accept a new idea as
desirable, not necessarily the self-discipline to consciously practice it (though this of course is
also welcome) that is necessary in RST. If the client accepts the idea to the point of wishing to
possess it, earnest per- mission by the client to be placed in a suggestible state for the expressed
purpose of learning and employing the new idea, will enable the therapy to be effective (Araoz,
1982). The degree to which permission has been granted seems to be in direct proportion to the
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satisfaction of the conditions contained in Daniel Araoz's (1982) TEAM acronym (trust,
expectations, attitudes and motivation), required for hetero-hypnosis. In this sense, there is no
suggestion, only autosuggestion as Coue believed (Baudouin, 1922). Permission may be used as
the start of any ritual model for hypnotic induction, and is implicit in the subtle New Hypnosis
induction techniques (Araoz, 1982). TEAM-work is sought throughout the three phases of RST.
THE LANGUAGE OF THE SUBCONSCIOUS: Using the language of the client's
subconscious will help in the creation of effective induction and suggestion. Observation of the
client's idiosyncratic communication patterns, is a means for determining what language will
reach the subconscious mind. Clues are found in the nature of the images exhibited. Araoz
(1983) points out the necessity for the therapist to set aside personal preferences for imagery and
concentrate on the client's inclinations. Words, figures of speech, analogies and other
communication forms which reveal subconscious representations belonging to the sensory
apparatus of sight, taste, smell, hearing and kinetic sensations, including skin contact, may be
observed and used by the therapist in "connecting" with the client (Araoz, 1983). This
client-centeredness is the essence of the New Hypnosis (Araoz, 1982), which does not recognize
any individual as unhypnotizable. The New Hypnosis paradigm need not be limited to hypnotic
induction, and may serve well for wording the actual suggestion, using terms and phrases which
will connect with the individual.
THE SPONTANEOUS PHASE: Following the observation of in vivo experience, the
client reports on the results of therapy. If no change has occurred, it could mean that the
application of the suggestion is too limited and the applicable conditions did not arise. Since
nearly every day presents us with some form of adversity or dissonance, it would seem that the
troubled individual would find reason to employ newly acquired rational ideas in a short time.
This does not mean that the suggestion had not been absorbed, it is merely a case of suggestion a
longue echeance, in which the suggestion is subconsciously stored until the moment the
suggested activating conditions are met (Bernheim, 1884). Poor results could also mean that the
selected idea was not the true cause of the symptom, or was couched in obtuse language. In any
case, the client's observations become the new presenting problem for a return to the Theoretical
Phase. If the required suggestion remains the same, reinforcement is needed. Tapes and
autosuggestion training are helpful.
CONCLUSION: Otto Rank (1936) in his challenge to the practice of psychoanalytic
therapy, addressed the psychoanalysts' fear of suggestion, an "undesirable" they accused Rank of
fostering by his utilization of the present in Will Therapy (Rank, 1936). Rank exclaimed: "One
does not escape suggestion, however, because one refrains from consciousness of it or denies it
completely. However passive the analyst may keep himself otherwise, in the last analysis his
interpretations are suggestions, for he suggests to the patient a definite ideology or attitude...If I
could heal by means of suggestion, I should do so without being ashamed of it" (Rank, 1936, pp.
110-111). Richard A. Blumenthal, M.S.

18. THE PRISONER: ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT: UNLOCK

YOUR MIND AND BE FREE: LANE & ASSOCIATES: LE JOLLA, CA: 1979
The prisoner in his cell spends long hours brooding over his past and dreaming about
freedom. But the grey walls and the prison bars bring him back to reality before his fantasies
afford him any relief.
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Once he tried to escape. He laid elaborate schemes for eluding the guards and slipping
through the door to freedom, but he was unsuccessful. The guards were not fooled by his ruses,
and the chains that bound him withstood his assaults. Now with all hope gone, his sentence seems
to stretch on endlessly ahead of him.
If you feel like this prisoner, you are fully aware that the only way to leave prison forever
is to gain a complete pardon. All other escapes provide but a temporary release. A full pardon
involves a reassessment of the crime for which you have been imprisoned. The evidence for
conviction must be reheard, and all of the arguments against your imprisonment must be
vigorously presented by a well informed advocate. Hypnotherapy is an excellent means by which
this may be accomplished.
If you are not certain whether your mind is imprisoned, carefully review the case histories
already described. Persons who suffer from psychosomatic disorders are imprisoned. Anyone
who is stricken by inexplicable anxieties and depressions, phobias or any of the physical disorders
which are known to have an emotional origin or component is also imprisoned. Medical
practitioners today acknowledge an important emotional component in the cause of such illnesses
as heart disease, arthritis, hypertension and even cancer.
It is fairly obvious that anyone suffering from a drug addiction is imprisoned. The
addiction itself is an additional chain that restricts and binds the sufferer. Anyone who is unable
to function satisfactorily in normal, social or sexual settings is a mental prisoner. In each of these
circumstances the mind is imprisoned by an idea which cripples and prevents it from functioning
freely.
You may have recognized yourself in one of these categories, but perhaps you are still not
sure. How can you determine whether or not you are imprisoned? Ask yourself, "Do I feel free?
Am I able to express my full potential? Do I feel content with the person that I am? Do I like
myself?"
If you can answer "Yes" to all of these questions, you enjoy great (99) freedom. I trust that this
book will enable you to direct others who are not so fortunate.
Should you recognize yourself as a prisoner, however, you need to act. The escapes that
you have read about have been engineered with the aid of hypnosis. I believe that anyone who
wants to break free should seek the help of a reputable hypnotherapist, who will help him
discover those experiences which have led him to lock up a part of his feeling mind so that he
now functions well below his potential.
Unfortunately, very few people have access to a skilled hypnotherapist or to any therapist
who can help them in this way. All is not lost, however. You can do a great deal for yourself to
locate your prison and identify the means of escape.
In each of us there is an impartial part of the personality which assesses information and
experience in a rational, non-judgmental fashion. Our Adult ego state is continuously gathering
new information about the world we live in. This ego state recognizes inconsistencies in our
views and helps us to make intelligent, reasonable decisions.
Some of the life decisions we base our present views upon were made long before this
part of us was in possession of the vast amount of information it now possesses. Whenever it is
called upon to do so, our Adult can render an updated opinion on an old decision. It can always
help us revise a decision that has resulted in mental imprisonment.
Self-Worth: Do you feel that you are as good and as important as every other human
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being? If you are a mental prisoner, you probably do not feel that good. At times you may feel
like an intruder, an outsider-no sense of belonging, no secure habitation.
Yet you know that this cannot be true. You are a human being and have as much right on
this planet as anyone else. Perhaps you lack some physical attributes enjoyed by others, but you
can readily see that all human beings have some imperfections. You may not be as gifted as some
of your friends, but neither are you as dull or uninformed as others.
Despite the fact that you "know" you are as good and as important as others, you are
unable to feel that way. Why? Because you have been imprisoned for a crime resulting from your
experiences, and your Parent ego state is constantly summoning up your guilt, which prevents
you from feeling as good as you have a right to feel.
There is no denying that you once acted in a way that was unacceptable to someone close
to you, or you vented a feeling that (100) could not be admitted. But was that really a crime?
Even if it were, must you continue to punish yourself after these many years? Guilt ensues when
you lock up a part of your mind so effectively that it cannot accept your proper worth. You would
like to heed your Adult, which gives assurance that you are just as good as anyone else, but guilt
feelings interfere. Until you can find out why you still feel guilty, you cannot accept the liberated
feeling of being a worthwhile human being.
How can you reach the source of the problem? Hypnosis can best help us obtain the
information we seek. Even light hypnosis is extremely effective in this respect, and since
ninety-five percent of the population can enter this state, hypnoanalytical techniques can be used
with the majority of mental prisoners. Before we examine how to do this, however, let us look
more closely at the face of the prisoner.
The Face of the Prisoner: The troubled prisoner usually turns to a physician or some
other counselor for help. But the emotional element of his problem may be so well concealed that
it escapes the detection of the most astute observer.
1. THE PSYCHOSOMATIC DISORDERS: All psychosomatic disorders are by
definition the result of mental imprisonment. The list of illnesses which can be termed
psychosomatic grows longer every day. Such disorders masquerade as purely physical illnesses
but are directly related to emotional problems. Although all illnesses probably have an emotional
component, this element is the precipitating factor in psychosomatic illness.
Migraine and Tension Headaches: Along with tension headaches, migraine is the
commonest problem for which the help of hypnotherapy is sought. Migraine is believed to result
from the effects of tension upon the blood vessels of the head. This tension initially causes the
vessels to contract, but relaxation at a later time allows them to dilate, causing the typical pain.
When the muscles of the head rather than the blood vessels contract, tension headaches. result.
Conventional therapy is restricted to administering rest or drugs (101) for the relief of
pain and tension. Ergot and its derivatives are used specifically for migraine because of their
ability to contract the painfully dilated blood vessels, relieving the pressure from tender nerve
endings in the head. By contrast, direct suggestion in hypnosis stimulates the healing powers of
the unconscious mind. These powers can duplicate any of the useful effects of drugs without
causing side effects.
Physicians recognize that treating a migraine headache after it has become established is
much like closing the stable door after the horse has bolted. They attempt to prevent attacks by
counseling the patient to avoid conflicts which create tension, or they prescribe drugs which keep
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the patient relaxed. The analytical hypnotherapist recognizes that the tension which precipitates
migraine is present for a good reason, even though that reason is probably out of date and out of
step with the patient's present adult life. The victim is unaware of the emotional trap in which he
is imprisoned. Only when he has unlocked his mind can he be free from the headaches.
All analytical hypnotherapy patients are taught self-hypnosis so that they may use
autosuggestion during an attack to relieve pain. However, we do not feel that therapy is totally
successful until the migraine sufferer is completely free of headaches. The patient can then use
his self-hypnosis to get in touch with his own vast unconscious resources for other useful
purposes.
Migraine sufferers are usually trapped in the prison of anger.
They stubbornly retain old repressed anger about which they still feel guilty. Whenever
they find themselves in a situation in which they experience normal human anger, it too is
repressed with guilt. The resulting tension causes the initial contraction of the blood vessels of the
head, and migraine naturally follows.
Rarely do migraine sufferers realize the poverty of their lives until they resolve their
tensions. Suddenly they begin to experience a joy in living that they had not previously known,
including an increased sense of self-confidence and well-being.
Asthma: Asthma is generally considered an allergic condition. The bronchial tubes of the
asthmatic, responding in an overly sensitive manner to substances in the air, contract so strongly
on meeting these substances that they block the sufferer's flow of air, making breathing difficult.
The noxious substance is effectively kept out, but so is vital oxygen. Asthma is a classic example
of a protective response which has become harmful. (102)
Although asthma is considered to be primarily of allergic origin and thus may be
controlled by drugs, I include it here because attacks of asthma can be precipitated by purely
emotional factors. In fact, almost any allergic response can be reproduced by purely emotional
factors, and all allergic illnesses may be associated with a more or less significant emotional
element.
Unfortunately, the asthma sufferer is usually unaware of the existence of any emotional
problem. He is frequently misled into restricting his search for the cause to allergic factors where
few or none really exist.
When the significance of the emotional factors has been recognized, doctors warn patients
to avoid conflicts and prescribe sedatives or tranquilizers. This approach is sometimes effective
but is rarely completely satisfactory.
Analytical hypnotherapy enables the asthma sufferer to locate the emotional causes of his
asthma so that he can deal with them in an appropriate way. Meanwhile, the asthma sufferer can
be taught to use self-hypnosis to control the spasm of the bronchial tubes during attacks.
The asthmatic is trapped in a prison of pain and sadness. He is not allowed to feel his hurt.
He is unable to cry, for his bronchial tubes are holding back his tears by their contractions. Any
situation resembling that in which he unconsciously feels hurt or rejection may precipitate this
repressive mechanism.
Peptic Ulcer: Stomach and duodenal ulcers strike nervous individuals. All of us have
experienced "butterflies in the stomach," and we all have been aware of tension in the abdomen.
Some people will even vomit or have diarrhea when they are emotionally disturbed. Therefore it
is easy to understand how stomach ulcers occur in those who are constantly tense.
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The usual therapy for peptic ulcers consists in the administration of medicines and a diet
which reduces the acid content of the stomach. Tension-reducing tranquilizers are also frequently
administered. Ulcer sufferers are advised to avoid conflict.
Direct suggestion in hypnosis can often duplicate the accomplishment of drugs.
Analytical hypnotherapy patients additionally benefit from learning to use self-hypnosis for these
effects, while simultaneously discovering the source of the tension responsible for their stomach
disorder. Most of these patients are locked in the prison (103) of anger.
Colitis: There are many names for the different disturbances of the bowel in which
recurrent diarrhea, constipation and abdominal pain are present. Some of these have a definite
organic basis, but the majority can properly be considered psychosomatic. Such cases will
probably respond temporarily to the relaxing effect of direct suggestion in hypnosis, but
successful hypnoanalysis will produce more permanent results.
When the patient is freed from his prison-likely one of fear-he is once again able to have
normal bowel function without discomfort and can dispense with the drugs which have
previously played such an important part in his therapy.
Cardiovascular Diseases: The greatest killers in modern times are the cardiovascular
diseases, including diseases of the heart and blood vessels. Some of these are due to infection or
to some structural or congential deformity, but the majority are, at least in part, psychosomatic.
A certain type of personality, distinguished by his attitude toward life, is most susceptible
to high blood pressure and heart problems. He is likely to be a hard driving, ambitious individual.
High blood pressure, normally occasioned by extreme tension, is physiologically achieved when
the heart works extra hard and the blood vessels contract so that it is harder for the blood to flow
throughout the body. When increased blood, flowing to certain organs, is urgently required for
extreme physical exertion, this is a normal response, but it is certainly unnecessary for the
business man sitting in his office. Although he does not need raised blood pressure, his body
works extra hard in direct response to the same suppressed emotion which makes him ambitious
and intense. He is likely to have excessive cholesterol in his blood, which will cause his blood
vessels to harden prematurely and become constricted, with a tendency to block up. Blockage of
the blood vessels in the heart will cause a heart attack.
Hypnosis can lower the blood pressure and slow the heart rate. It acts upon the nervous
system through its communication with the unconscious mind. These effects, though useful, tend
to be temporary in the patient who is a candidate for cardiovascular disease. He must alter his
attitude towards himself for more permanent results. In (104) order to do this, he must first
escape from the prison in which he is trapped. The commonest prison is that of guilt. Such a
person does not feel that he has the right to exist. He must constantly prove that he should have
the privilege of life.
Analytical hypnotherapy will help such a person to accept himself and allow him to relax
and enjoy his existence as a normal human being. When he has accomplished this, he can permit
his blood pressure to return to normal and his heart to slow down since the need to drive himself
will have vanished.
Skin Diseases: Some skin diseases result from external irritation. Scabies is caused by a
small parasite which invades the skin. Certain allergic skin disorders are brought about by the
skin's oversensitivity to a mild irritant. In most cases the patient aggravates the damage by
scratching the itch.
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Other skin disorders are caused by internal disturbances. These skin disorders are
psychosomatic, and doctors usually treat them with soothing applications or tranquilizers.
Hypnotherapy will help these skin conditions when direct suggestion is used. However,
this approach will rarely be permanently effective until the reasons for the underlying tension
have been dealt with.
Hypnoanalysis frequently enables skin disease sufferers to escape from their prison of
anger from which their repressed hostility directed at the self, is usually expressed through
scratching.
Menstrual Problems: Many readers may be surprised that I have listed menstrual
disorders among the psychosomatic diseases, but in a great number of cases no organic cause can
be found for painful conditions of irregular, excessive or absent menstruation.
Hypnosis can be used to correct these disorders by the simple method of giving direct
suggestions. The improvement will be temporary when the underlying emotional problem
persists, but analytical hypnotherapy can resolve these problems, which often are due to
self-rejection and incarceration in the prison of guilt.
Sexual Dysfunction:
In women sexual dysfunction includes frigidity, failure to achieve (105) an orgasm and pain
during intercourse. The latter might be so severe as to cause a spasm of the vagina, called
vaginismus, which prevents normal sexual intercourse. In men sexual dysfunction includes failure
to achieve or maintain an erection, premature ejaculation or failure to ejaculate. Almost
invariably sexual dysfunction is the result of guilt; hypnotherapy offers the best hope of release
from this prison.
2. THE HABIT DISORDERS: Compulsive behavior creates a great range of problems
harmful to the individual. Bedwetting, nail biting and thumb sucking are compulsive activities
which are not serious but become the source of discomfort.
Other habits pose a real health hazard, yet compulsives often resist every effort to end
them. Excessive smoking, drug addiction and alcoholism are the most common examples.
Victims may recognize the consequences of their habits and yet be powerless to forego them, for
the habit serves a purpose so vital to unconscious emotional needs that the attainment of good
physical health remains secondary. I have seen patients whose smoking had caused severe heart
disease, whose alcoholism had damaged their livers, and whose drug taking had brought them
within inches of death persist in these habits in a compulsive manner.
Why should this be so? All of these unfortunate people are locked in a prison of pain and
sadness. Not permitted to accept these repressed feelings, they can only experience them at a
deeply unconscious level and keep them from consciousness by means of the devices which form
the bad habit. They have been condemned to their habit as their means of tolerating life, even if
such behavior shortens life or renders it extremely uncomfortable.
By locating the critical experiences causing unconscious pain and sadness and by allowing
acceptance of that pain, analytical hypnotherapy can permit patients to escape to freedom from
their prison. The drugs, the cigarettes, the alcohol used to repress the pain are no longer required.
Obesity: Obesity is such an extremely common problem that I am treating it separately.
It mixes features of a psychosomatic as well as a habit disorder. (106) As a general physician I
have treated many people for obesity, using all kinds of diet programs, medications, and
exhortations. I have bullied,. cajoled, used injections and made direct hypnotic suggestions. Many
 184

patients have initially lost weight quite well, and some have even reached their target weight, but
sad to say, nearly all of them regained their previous weight and sometimes even more after a
year or two.
Since I have confined my practice to a purely hypnoanalytical approach, I have finally
realized why the obese experience such difficulty in losing weight and staying slim. Almost every
obese patient is unconsciously afraid to be slim and is deliberately eating in order to remain fat!
Such people may consciously stay on a diet for a while, but when they start to lose weight, the
fear of being thin becomes so strong that they are impelled to eat and put the weight back on
again. At a conscious level, of course, they are only aware of another failure. So long as this fear
of becoming thin persists, they are doomed to failure.
Most obese people expect the hypnotherapist to cure them by giving their unconscious
mind a suggestion not to eat. In my experience this approach has never worked. A post-hypnotic
suggestion of this kind rarely persists for any length of time simply because it will not be
acceptable to the unconscious mind of the obese patient until the fear of becoming slim has been
confronted.
Why are the obese afraid to become slim? They have learned to use their fat as a
protection from the danger of expressing a forbidden feeling. Without the fat they will be
exposed to the imagined dangers that the revealed feeling will incur. The fat is the physical
expression of the mental walls that imprison the mind. In a small proportion of cases of obesity
food is strongly associated with comfort and is used to assuage unconscious feelings of rejection
and deprivation. In these cases such feelings must be recognized and relinquished if a successful
reduction to a reasonable eating pattern is to be established.
When the patient is free to feel his previously concealed emotions, he no longer has the
compulsion to overeat. At the same time, he may lose the driving need to shed weight which
threw him into the seesaw of weight changes over the years. He will usually accept a new and
more sensible pattern of eating, gradually and perhaps imperceptibly losing weight. One day a
slimmer individual will recognize that he need not be anxious about his dieting.
3. THE EMOTIONAL DISORDERS: This third group of prisoners is extremely
important. Depression, (107) anxieties, phobias and obsessions are some of the emotional
disorders responsible for an immense amount of human misery.
Depressions: Those of us who have suffered from a deep depression know how trapped
one feels within it. There seems to be no escape, no hope, no future. Nothing seems to be of value
or importance, and only a sense of duty keeps one going. For some very depressed people even
this becomes inadequate to provide them with sufficient motivation to carry on, and thus they
experience a strong temptation to drop out of life altogether.
The depressed patient is suffering from a strong parental rejection. He has probably
attempted to excel and may have succeeded, but whenever he fails, he finds himself face to face
with his self-rejection and once again believes that he has no right to be. He is bad, unloved and
unlovable. He knew this in the beginning, and despite all of his efforts, nothing has changed.
Analytical hypnotherapy gives the depressed patient the opportunity to reexamine his original
assumptions about himself. He has the chance to apply to himself some of the wisdom that he
would offer a colleague or a friend. He can see himself as he really is and recognize the need to
break out of his burdensome prison for good. Hypnoanalysis does this by locating and dealing
with the parental rejection which lies at the source of all depressions.
 185

When the depression sufferer is able to get in touch with the real pain which his defenses
have successfully concealed from him, he is at last able to relinquish it and accept himself despite
his parent's rejection. He is at last free.
Anxiety: All of us experience fear at some time, but the anxiety sufferer is in an almost
constant state of fear. He is walled in by his problem. He worries about everything-yesterday,
today, tomorrow. Whatever you can name he has worried to death long ago. This constant state of
anxiety may be associated with specific phobias which have their own particular brand of
paralyzing anxiety. The sufferer from anxiety is always tense and reflects many of the symptoms
that are popularly associated with tension. He will often respond surprisingly well to direct
suggestions for relaxation given in hypnosis, which attests to the power of the unconscious mind.
Such relief is usually short-lived, however, unless the true cause of the anxiety is discovered and
dealt (108) with permanently.
The victim of anxiety is obviously living in a prison of fear-in dread of fear itself. When
he is brought face to face with the true cause of his fear, his mind is capable of handling the
pressure once he has allowed himself to be really afraid. He now recognizes that he has a right to
be afraid-as well as a right to relinquish that fear once it has served its purpose. At last he can
accept the idea that he no longer needs it. It is outdated and totally irrelevant to the present.
Phobias: Most of those who suffer from a phobia do not talk about it. Ashamed of their
problem, they dread the possibility of having their weakness exposed in public. They may fear
elevators, airplanes, certain animals, spaces, heights, etc. The list goes on and on. How did it
originate?
Most probably an extremely frightening experience happened which made the patient feel
very guilty-so guilty that he was no longer able to feel his fear. Certain events precipitate his fear
in the most intense manner, yet the intensity of the phobia prevents him from knowing and
feeling the original fear about which he experiences so much guilt.
Although the phobic victim is extremely afraid, he is never consciously aware of his
original fear, which is repressed by guilt and the phobia. In hypnoanalysis he can uncover the
critical experiences and the guilt associated with them. When the phobia is no longer necessary,
the subject will know his true fear and no longer feel guilty about it.
Obsessions: Obsessive or compulsive behavior is again a protective device to repress the
knowledge of something about which the patient feels guilty. Once he can let himself know about
it, he can make progress towards not feeling guilty and eventually control his compulsive
behavior. Much of our discussion of the different problems that a hypnotherapist sees in his
practice may make the solution appear very simple. In reality, solutions are often simple. The
greatest difficulty lies in discovering the solution and knowing how to apply it. (109)

19. EXAMPLE OF AN ANALYTICAL PROCEDURE FOR REFRAMING: E. A. BARNETT,

M.D.:
INDICATIONS AND INTRODUCTION: The following excerpts illustrate a method
referred to as ego-state reframing (Hammond, 1988f; Hammond & Miller, in press) for the
(537) working-through and reframing of feelings. This method may be used following the
identification of a problematic. past experience. It is recommended that an abreaction be
 186

facilitated prior to using this reframing technique. When abreaction is done without cognitive
restructuring the therapist runs the risk of simply creating a transitory emotional release. On the
other hand, when emotional experiencing of the event does not precede the conceptualization
process, the experience becomes over intellectualized and may well be ineffective.
Barnett's method illustrates the manner in which a therapist may use the metaphor of an
adult ego state helping a child ego state to work through negative emotions. It is essentially a
method, following catharsis, for facilitating self-healing. It will be apparent that Barnett uses a
transactional analysis model for conceptualizing this process. For further cletails about the
rationale of this method and additional examples, consult Barnett (1981).
Note in the case example how Barnett initially determines the primary emotions involved
in the incident. He subsequently encounters initial resistance and, therefore, begins by facilitating
a more dissociative regression and gently moves the patient into a partial regression. There is then
greater affective involvement on the part of the patient. After obtaining the details of the
experience and at least some emotional release, the reframing process is illustrated. (Ed.)
UNDERSTANDING THE REPRESSED EMOTION(S) AND THE ASSOCIATED
FEELINGS OF GUILT: "I would like you to give all of your 49 (present age) years ofwrsdom
and understanding to four-year-old John, and when this has been done, the yes finger will lift. ... "
"Is there more information that needs to be divulged before full understanding can be ate tained?"
If so, this information should be imparted to the 40 year-old John (Adult) by the four -year-old
John (Child/Parent) ego complex, and this can be done at an entirely unconscious level with the
ideomotor signals as the only evidence that this has been accomplished.
RECOGNITION OF THE CURRENT IRRElEVANCE OF THE PREVIOUSLY
REPRESSED EMOTION: “Four-year-old John, with the wisdom and understanding that you
now have, do you still need to keep those old tensions?" At this point the specific emotions
identified as being repressed can be enumerated individually ....
"Are you keeping those old out-of-date uncomfortable feelings for protection?" A yes
answer to this question means that the therapist must renew his efforts to persuade the Adult of
40-year-old John to convince four-year-old John that he (40-year-old John) is now able to protect
himself and he needs no further protection from four-year-old John's outdated feelings.
Four-year-old John needs to be reassured that 40-year-old John has ready access to his own
protective emotions should the need arise. If necessary, four-year-old John can be asked to hand
over all his outdated, uncomfortable feelings and responsibilities to 40-year-old John, who is now
quite capable of protecting every part of the personality complex. If 40year-old John has been
sufficiently convincing, the question as to whether these old tensions are necessary should now
receive a no response. This procedure may have to be repeated before this reply is attained.
Sometimes four-year-uld John remains convinced that he must retain his old protective emotions
for one reason or another. He should then be asked, "Do you need to keep these uncomfortable
feelings all of the time?" A no to this question should be followed by a direction to four-year-old
John to be certain of the kind of circumstances when he feels that he needs all of his
uncomfortable tensions and confirm this fact with ideomotor signals. He is then asked to be
equally certain of those circumstances where the uncomfortable feelings are not necessary and be
persuaded to discover means of relinquishing these feelin~s at such times. This maneuver does
not abolish (538) symptoms but it does establish considerable control over them.
"Are you keeping these tensions to punish yourself with?" A more difficult situation arises
 187

when old tensions are deemed to be necessary not for protective reasons but for self-punitive
reasons. When the Parent remains convinced that it is still its duty to punish the Child (in spite of
the intervention of the Adult), a renewal of this intervention is called for. The objective is to
convince the Parent that the Child did not do anything that could bt; fegarded as bad, even though
it may have originally merited parental disapproval, and the punishment so far meted out by the
Parent should now be regarded as having been more than adequate. To aid the Parent, the
therapist can make such statements as the following: “I know that you have done a great job in
disciplining four-year-old John and have done so to the best of your ability, but the time has
come for you to forgive him. I believe that you can do this if 40-year-old John will make sure
that all will go well and if four-year-olc1. John can assure you that he really did not mean to
create so much distress by his behavior." In this way the Parent is given a means of relinquishing
hIe arduous responsibility of maintaining a punitive stance toward the Child and can then be
encouraged to take care of four-year-old John in other, more appropriate, protective, nurturing
and loving, parental ways.
RELINQUISHING THE REPRESSED AND REPRESSING EMOTIONS: While the
Parent ego state has agreed to stop punishing the Child (and the Child has recognized that the old
outdated feelings need no longer be retained), it must nevertheless be empowered to discover
means of relinquishing its repressing activity. It may need to obtain permission from other parts
of the personality to accomplish this; it also needs to find improved ways of relating internally
with the Child. All of these new behaviors must be discovered if the Child/Parent conflict is to
come to an end. The Adult ego state is that part of the individual's personality with the resources
and the communications -within the personality to accomplish this task. With ideomotor
questioning, it is easy to switch from addressing the unconscious Adult to communicating with
the Child/Parent ego state complex simply by labeling states by their respective ages.
"Four-year-old John has agreed that these old tensions are no longer necessary.
Fortyyear-old John, using all 9f your wisdom and understanding, I would like you to find a way
for four-year-old John to let go of all of these unnecessary, outdated, useless old tensions. When
this has been accomplished, the yes finger can lift to let me know." Fortunately, this state is
usually accomplished readily,' even though it may take some time for the unconscious mind to
find an appropriate solution. It is wise to assure, the patient that the solution need not be known at
a conscious level. In some cases, rio solution is found. Invariably this is because a strong Parent
has decided to retain a punitive position.
RECOGNITION OF THE RESOLUTION OF THE CHILD/PARENT CONFLICT:
At this stage, a solution of the conflict between the Child and the Parent has been found but not
yet applied. It is now necessary to apply this solution to see if it is acceptable to all parts of the
personality.
"Four-year-old John, 40-year-old John has now found a means by which you can let go of
all of the old, out-of-date, unnecessary tensions that you have been keeping. Please use that way
right now and let go of all of those tensions. When you have done so, let me know by raising the
yes finger." In most cases the yes finger is promptly raised and the therapist knows that the
conflict is probably at an end. Nevertheless, he should then confirm that the tensions have been
relinquished by saying, "If you have really let go of all of the old tensions, John, you should now
be feeling very comfortable inside, more comfortable than you have felt for 36 years. If you are
really very comfortable, the yes finger will lift again." (539)
 188

An even better confirmation of this relief from tension comes if there is a spontaneous
smile. A simple confirmation of this -inner comfort is ,the smile test, in which the previously
distressed ego state complex is asked to indicate itsuelief by smiling, as follows: "Fouryear~old
John, if you are really feeling comfortable, you can give me a nice smile to let me know." The
presence of a really happy smile is excellent proof of total relief from the original tension.
Conversely, any difficulty in giving that smile will alert the therapist to the probability that some
old tension remains.
CASE EXAMPLE: [This dialogue follows suggestions for age regression to "the first
experience that has anything whatever to do with" a problem of anxiety attacks.]
Dr.: When you are at that very first experience that has anything whatever to do with ityou do not
need to become consciously aware of it- but when your deep inner mind is there, your head will
nod for yes. [Head nods.] Now I want you to go through that experience just in your deep inner
mind - your conscious mind doesn't need to know about this - and when you have done that,
again your head will nod for yes. [Head nods.] That experience you have just gone through ... is it
a scary experience? [Head nods.] Makes you feel sad? [Nods~Je Makes you feel angry? [Nods.]
Guilty? [Nods.] Is it sexual? [Head shakes.] Are you five years of. age or younger?
Pt.: About five.
Dr.: You're five years of age. Okay. Fiveyear-old Vera, what's happening? What's happening at
five years of age? [The patient is beginning to look extremely sad and is obviously on the verge
of tears.] You're feeling very sad, scared and angry. What's happening there? Five-year-old Vera,
if it is okay to talk to me about it, just nod your head. If it is not, shake your head. [Head shakes.]
Okay, you needn't talk about it. Does 28-y.ear-old Vera know all about it now? [Shakes.] Can
you tell her all about it? [Nods.] Will you tell her? [Nods.] Okay. [Pause] Does she know all
about it now? [Nods.] Can she now feel all of that scared feeling and all of that sad feeling and all
of that angry feeling? [Nods.] She can? Oh, good. Do you think that you are going to be able to
tell me anything about it at all? [Nods.] Okay, five-year-old Vera. It is really scary, is it? [Nods.]
And sad? [Nods.] Okay, bring it all forward. What's happening now? Where are you?
Pt.: I'm waiting at home. [Tearfully.] Dr.: You are? What for?
Pt.: For my Mum.
Dr.: Oh?
Pt.: She's late.
Dr.: Oh, dear.
Pt.: I'm afraid of being left alone.
Dr.: I see. What are you afraid of?
Pt.: I don't know w'here to go if she doesn't
come home.
Dr.: Yes ... what happens?
Pt.: Well, I cry.
Dr.: Is there anyone about?
Pt.: No.
Dr.: Are you in the house?
Pt.: Yes. [Looking frightened.]
Dr.: Very scared? Do you cry for a long time
before she comes?
 189

Pt.: No.
Dr.: Does she come soon?
Pt.: About five or ten minutes.
Dr.: And how do you feel when she comes?
Pt.: Relieved. [With a sigh.]
Dr.: Did she say anything that bothers you?
Pt.: No.
Dr.: Does she ask you how you are? [Nods.] Does she give you a cuddle? [Nods.] Do you feel
safe? [Nods.] Okay, 28-year-old Vera, did you hear all of that?
Pt.: Yes.
Dr.: There is five-year-old Vera still feeling scared and still feeling hurt. Would you please, give
her all of your comforting, your wisdom and your understanding? When you have done that, nod
your head for yes. [Nods.] Five-year- old Vera, (540) now you've heard that, do you still need to
keep that scared feeling, that hurt feeling, that angry feeling any longer? If you do, nod your head
for yes, but if you don't, then shake your head for no. [Shakes head for no.] Okay, 28-year-old
Vera, five-year-old Vera has told me that she doesn't need to keep that old scared feeling any
longer. Would you please find, a way for her to let go of it? When you have found a way, nod
your head for yes.
Pt.: [Nodding.] I've found a way.
Dr.: Five-year-old Vera, there is a way now. There's a way you can let go of that scared feeling
right now. You can feel safe to change that sad feeling into a happy one. Let that old angry
feeling go and be loving. When you have done that, let me know by nodding your head. [Pause.]
Five-year-old Vera, can you do it? [Shakes head slowly.] Okay. [Pause.] Now, 28-year-old Vera,
five-year-old Vera can't do it yet. She is still keeping some uncomfortable feelings. I want you to
really understand what it is she is keeping. Maybe, five-year-old Vera, you can tell me what it is
that is making you feel so bad. [Pause.] You haven't told me about something that is bothering
you. What is it? [Pause.] Are you still angry with her-with Mum for not coming? [Pause.] Do you
feel guilty about being angry with her?
Pt.: [Sighs.]
Dr.: Do you feel guilty about being angry with her? [Nods.] Is there anything else that you want
to tell us, five-year-old Vera? If there is, nod your head for yes; if there isn't, shake your head for
no. [Pause.] [Shakes.] Okay, 28-year-old Vera, talk to five-year-old Vera again and see if you can
get her really to feel good. When you have done that, nod your head for yes. [Pause.] [Nods.]
Five-year-old Vera, now you've heard that, do you still need to keep those old, out-of-date,
uncomfortable feelings any longer? [Pause.] [Head shakes.] Good. Twenty-eight-year-old Vera,
five-year-old Vera now says she doesn't have to keep those uncomfortable feelings anymore.
They're out of date, they're finished with. It's all past. It's over, and I am going to ask you to
please find a way for her to let go of those uncomfortable feelings for good. When you have
found 'a way, nod your head for yes. [Pause.] [Nods.] Five-year-old Vera, you can now let go of
those uncomfortable feelings. Let go of those uncomfortable feelings right now, and when you
have done that, just nod your head to let me know that you have done it. [Pause.] [Nods.] Now if
you really have let them all go, five-year-old Vera, you should be feeling very good inside. Good,
comfortable feelings, so good to let go of all that pain and unnecessary uncomfortable feeling.
When you are feeling really good inside, perhaps you can give me a smile which says, yes, I am
 190

feeling good.

20. THEORY OF ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT: ANALYTICAL

HYPNOTHERAPY: WESTWOOD PUBLISHING CO, GLENDALE, CA: 1989
In theory, the location and uncovering of the original causes of emotional problems would
seem to be the logical first step to diagnosis and treatment in psychotherapy. However, in
psychotherapy as in much of orthodox medicine, treatment is usually directed only to the
amelioration of symptoms. If the uncovering of emotional problems is logical in theory, why is it
not then more widely practised? It is because the analytical approach has often proved to be
inordinately timeconsuming and has not had the justification of results superior to those therapies
directed only at symptom removal. In 1935, Freud had already expressed disappointment with his
earlier use of the analytical approach. He had thought that the presentation to the patient of
recovered memories of childhood traumas would certainly bring the neurosis and its treatment to
a rapid termination. He stated that 'it was a severe disappointment when the expected success was
not forthcoming. How could it be that the patient who now knew about his traumatic experience
nevertheless still behaved as if he knew no more about it than before?' It was this disappointment
which encouraged him to look for other approaches to treating neuroses and to become
entrenched in a system of therapy whose duration is commonly measured in years.
Adler (1924), Jung (1928), and Stekel (1940), all had expressed their conviction of the
sterility of an approach which concentrated solely upon the uprooting of infantile memories.
Rado (1939) also stated that the retracing of early memories was discouraging, since, like the
fabled Hydra, as soon as one was dealt with, two others appeared in its place.
Bibring (1937) also joined the forces mounted against uncovering old memories when he
questioned the value of abreaction. He believed that although it lessened tension it did not
necessarily influence the (72) deep problems which continued to generate it. Often he found that
patients would uncover many interesting and crucial experiences but would, nevertheless,
continue to cling to their neurotic attitudes.
While Wolberg (1964) accepted the position that an exclusive preoccupation with the past
imposed definite limitations in therapy, and that a knowledge of the historical roots of a disorder
was in itself insufficient to produce a cure, he maintained that such knowledge was still of
tremendous value in therapy because it enabled the neurotic individual to gain self respect when
he had mastered old fears. He believed such mastery of anxiety to be a great enhancer of ego
strength and that hypnosis not only enabled unconscious material to be brought to a level at
which it could more readily be dealt with, but also that, as previously stated by Kubie and
Margolin (1944), hypnosis enabled the patient to gain strength directly from the therapist.
If hypnosis did nothing more than raise self-esteem and strengthen ego - as Wolberg,
Kubie and Margolin state - it would be performing no small service to patients. But it is the
purpose of this book and the intention of this author to demonstrate that hypnosis can, if properly
practised, do much more. Hypnosis is unquestionably a powerful tool for the uncovering of
memories, but such uncovering is only the first step. Freud was right to observe that knowledge
of a traumatic experience is not sufficient in itself to provide a change of behavior. After
identification of the conflicts, the therapist and the patient must work through to a resolution of
such conflicts so that the symptoms arising from them can be removed. While it is freely
admitted that, frequently, this can be accomplished without the application of the direct
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techniques of analytical hypnotherapy, this author would argue that the use of these techniques
results in a far higher proportion of success than is achieved by nonanalytical therapies.
Every therapist strives to formulate a theoretical construct for his therapy and the
analytical hypnotherapist is no exception. The failure of the psychoanalytical approach to produce
significant therapeutic results for patients presenting with symptom complexes has cast doubt
upon the value of uncovering the historical antecedents of such complexes. We shall demonstrate
that it is really the inadequate application of the information so gained that is responsible for the
poor results. In order to understand how analytical hypnotherapy can be effective, we need to
have an understanding of what is happening to those who are suffering from an emotioJ1al
problem. So that we can better do this, let us examine the function of normal emotions. (71)
THE EMOTIONS: Emotions are at their most primitive in the early stages of life and
hence can be more easily studied at this time. Immediately after birth, we can observe that the
infant already has the capacity to feel discomfort and gives evidence of this sensitivity by crying.
This observable response is clearly a protective one, essential for the infant's survival, since it
enables him to inform others of his discomfort in the hope that they will find the means of
relieving it. His cry summons someone to his aid, usually mother. If she is able to respond
satisfactorily to his needs, he will cease to cry. The infant has few other defences at birth except
for this obvious expression of hurt or discomfort. In the majority of cases his crying will suffice;
if he is cold, his mother will wrap him up; if he is wet, she will change his diaper; if he is hungry,
she will feed him. In other words, whenever the infant is uncomfortable, his cry will lead to his
obtaining the care necessary for his survival. Mother represents security, comfort, and peace and
it is she upon whom the helpless infant must rely to identify and rectify any problem that creates
discomfort. Any individual who responds to the infant's cry for help functions as a surrogate
mother in that instance.
Sometimes the distress that the infant experiences may be severe or prolonged before the
mother can intervene to relieve it. In this case the infant's cries become more insistent, more shrill
and more urgent. The infant's movements may become more vigorous and it becomes evident that
he is experiencing something more than discomfort and hurt. We are aware, perhaps by empathy,
that the infant is experiencing another emotion, namely, fear. Fear is that feeling which
supersedes hurt when the source of the discomfort is perceived as life threatening. The infant is
helpless and can only cry more loudly and shrilly until mother comes to deal with the source of
the distress and the danger. She finally reassures the child that all is well. An older child is able to
take a more positive course of action when experiencing fear and move away unaided from the
source of his discomfort. He will endeavor to crawl or run to a place where he believes that he
will be safe from the danger, but will tend to move towards mother (or a mother figure) where he
knows that comfort and security exist. Until he feels he is safe from the danger that threatened
him, his emotion of fear will persist.
Still later in life, a third important defence mechanism appears.
More certain of his actions and their probable results, the child becomes venturesome and
will endeavor to deal with the source of his discomfort and danger by attempting to destroy or
repel it with whatever means he has at his disposal. Yelling, hitting out, and other (74) strategies
are used to attain this end. When the danger is no longer evident he once again feels comfortable;
he has learned how to use the emotion of anger for his own defense.
Thus it is that every human being has the three primary emotions of hurt, fear and anger,
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each of which has an important role to play in maintaining the individual's survival. Hurt is the
awareness of discomfort and pain. In human beings, this is often experienced as sadness an
awareness of persistent hurt. Feelings of rejection, loneliness, and isolation are manifestations of
this emotion of hurt. Fear derives its strength from the memory of hurt so that the individual
strives to avoid further hurt when danger is imminent. Fear can masquerade as anxiety, terror, or
panic, since these words merely serve to describe degrees of intensity of fear. Anger, the third
emotion, protects the individual by either scaring away the perceived danger or by annihilating it.
It is seen as aggressiveness, hostility or resentment. Each emotion is therefore designed to enable
the individual to deal with perceived danger; each is vitally necessary if he is to survive in a
world full of hazards. When these emotions fulfil their rightful function there is no emotional
disorder. Thus if the child is hurt, he cries and obtains help. Or perhaps he is afraid and runs away
from the danger to a haven of security. If this is not advisable or possible, perhaps he can use his
third defense, anger, to destroy the source of danger so that all is well. However, should these
emotions be denied their rightful expression, they will persist unrelieved. Any emotion is always
accompanied by the physiological changes necessary for its functioning; consequently,
unexpressed emotion creates an emotional disturbance which can easily have physical effects as
well as mental ones.
Mother's Role in Emotional Disorder: Normally, if he is not successful in obtaining help
when he is hurt or senses danger, the child can use the emotion of fear to escape it or can become
angry and repel or destroy it. The question that the hypnoanalyst asks is this: What happens if the
source of the hurt or danger is mother herself? In this context anyone who functions in the role of
mother (e.g. father, grandparents, siblings, etc.) in relationship to the child must be considered the
mother. If mother, or the mother surrogate, is the source of hurt or danger, the normal emotional
responses are confused. They are no longer protective and become valueless. To cry will only
attract more hurt and so the emotion of hurt cannot be expressed. If the expected secure place has
itself become dangerous, the child cannot employ the emotion of fear since there is no secure
place to escape. (75) Neither can he use the emotion of anger to destroy the source of his hurt
since, even if it were possible, he would, at the same time, destroy his source of security. He has
no alternative but to block his emotions - to repress them. Emotions, however, do not disappear
when repressed but remain to create symptoms for which therapy is sought. For the analytical
hypnotherapist it is the repression of normal human emotions which is reponsible for the
emotional disturbances presenting for therapy.
Sullivan (1953), in his discussion of the origin of emotional problems concluded that an
infant learned to disown parts of itself as a consequence of mother's disapproval. But we are more
concerned here with maternal disapproval causing the disowning of normal emotions. The
mechanism for the repression or disowning of the emotional part of the self needs to be better
understood. Also, we need to understand how it results in emotional distress.
Berne (1961) propounded a theory of human functioning upon which the therapies of
transactional analysis are based. In brief, he stated that each of us acts at different times with
separate viewpoints because of individual states of mind with their related patterns of behavior.
Each of us has been a child and retains substantial relics of childhood surviving as a complete ego
state. We also have a normal brain which is capable of reality testing and this functions as another
discrete ego state. Finally, each individual has had parents or others in (76) loco parentis and the
information derived from our relationships with these important people exists as another ego
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state. Thus each individual has at least three ego states: the Child, the Adult, and the Parent. In
Berne's view, a happy person is one in whom each of these three ego states has important aspects
which are syntonic with one another. These ego states differ from the Freudian concepts of
superego, ego and id (Freud, I933) in that they are all observable manifestations of the ego
representing visible behaviors rather than
(77) hypothetical constructs. Since it is useful for our understanding of emotional disorders,
we will here review Berne's theory of ego states.
The Child: The Child ego state results from the experiences the individual undergoes in
his early development probably dating from conception onwards. During this period he is
recording everything that he feels, hears, and sees, and thereby accumulates a body of
information which gives him his awareness as an individual. It is the Child that is the ego state
primarily concerned with the emotions and the awareness of them. It is the Child that is the
repository of these emotions and which is directly affected by any repression of them. It is
therefore the Child part that feels disowned when any emotion is repressed. In order to adapt to
its environment, the Child develops an additional ego state whose function is to gather
information about his immediate environment for his additional protection. This ego state,
initially part of the Child, becomes the Parent ego state.
The Parent: The Parent ego state records all of the information that can be gleaned from
those upon whom the child must be dependent. Thus it is that the Parent ego state models itself
upon the real parents. It gathers information from them, such as their expectations of the child.
This is done through all of the earliest parental communications (e.g. their tone of voice, facial
expressions, and all of the verbal and non- verbal rules and regulations with which they surround
him). Some of the information that the Parent gathers is positive and approving of the Child;
some of it may be negative and disapproving. Like the real parent, the Parent ego state may be
nurturing and loving, or it may be critical and punitive, depending on the qualities of the true
parent upon whom the Parent ego state is modeled. In hypnoanalytical theory and therapy we are
mainly concerned with the negative attitudes of the Parent ego state culled as they are from the
real parent. These are the source of the motivation for repression of the Child's normal emotions
and are responsible for its emotional difficulties.
The data in the Parent is taken straight and without editing from the parents. It includes
therefore all of the admonitions, rules and laws that the child hears from his parents and parent
surrogates. It includes, as well, all of the signs both of approval and disapproval. These are
recorded as truth and this is a permanent recording. Through its coercive, sometimes permissive,
but more usually restrictive, pressures (78) upon the Child, such data have a powerful effect
during his life. The voluminous collection of data is essential to the individual's survival within
the group and helps him to avoid those dangers which he has not experienced and of which he
can have no personal knowledge. Much of the data in the Parent appears in the 'how-to' category
and is acquired by observing how the real parents and parent surrogates deal with things. In this
day and age it is of interest to reflect on what influence the parent surrogate, television, might
have on the development of the Parent ego state.
Repression: So that the Child becomes and remains acceptable to the true parents, the
Parent ego state seeks to modify the Child's behavior by repressing non-acceptable aspects of it.
This is an admirable and proper role for the Parent ego state since it thereby functions to maintain
the Child in such a way that the parents, upon whom the Child depends for survival, will not
 194

abandon it. It is, in effect, protecting the Child from the wrath of the real parents. Thus a critical
and punitive parent will be reflected in a critical and punitive Parent ego state which maintains
the Child by repressing its unacceptable behaviour resulting from unacceptable emotions.
Guilt: The parent ego state maintains its repressive influence over the Child by means of
the constant reminder that some of its behaviour and emotions are unacceptable to the real parents
and that any expression of these might well result in the abandonment of the Child. It is this fear
of abandonment which, often very intense, is expressed and felt as guilt. Whenever an individual
experiences the feeling of guilt, there is an underlying fear of abandonment. Furthermore,
whenever there is guilt, there is a repression by the Parent of part of the Child's normal emotional
functioning. This results in a persistent Parent/Child conflict. It is this conflict, always
accompanied by feelings of guilt, that may be deeply unconscious and only accessible to skillful
analytical hypnotherapy. This conflict is at the center of all emotional disorders seen by the
analytical hypnotherapist; such disorders can be cured only after this conflict has terminated.
The Parent/Child Conflict: Branden (1972) held that repression began as a flight from
inner experience - from feelings of pain, fear, frustration, helplessness and rage, and, in fleeing
from these feelings, a portion of the being is denied or disowned. This self alienation must be
eliminated before self esteem can be constructed. It is this self (79) alienation which is typified by
the Parent/Child conflict because the Child is being prevented from expressing his normal
emotions, whether they be hurt, anger or fear. He may also be prevented from expressing pleasant
feelings if these too are unacceptable. If his very existence is not acceptable, then all of his
feelings may be repressed. But unexpressed feelings are never obliterated; they always persist in
some more acceptable form. For example, repressed anger can be responsible for depression;
repressed fear can be the source of anxiety and phobias; repressed sadness is also a cause of
depression. Any emotion, when repressed from normal expression, may seek an abnormal
expression via the body in the form of a psychosomatic illness. It is interesting to note that Perls
(1969) could not accept the term 'repression' since he was very much aware that nothing can be
totally repressed. For him, alienation of part of the personality was more of a 'disowning into the
unconscious' than it was repression.
Resolution of the Parent/Child conflict removes the need for repression and a previously
blocked emotion can once again be properly expressed. When this occurs the symptoms directly
resulting from the repression of emotion can be more readily relinquished. How then can this
stubborn Parent/Child conflict be terminated? For Berne (196r) the answer was simple:
'deconfusion of the Child by using the decontaminated Adult ego state as a therapeutic ally' was
the course for the therapist to take. Consequently, analytical hypnotherapists must take a closer
look at the Adult ego state in order to make full use of its potential.
The Adult: This is the third clearly defined ego state which develops early in life from
the Child (although probably at a later date than the Parent). At any rate its development in the
early years is slower than that of the Parent. The infant begins to learn that he can manipulate his
environment. He learns, for example, that he can decide whether or not a particular object will
fall simply by initiating actions which are totally under his control. This interaction with his
environment gives him a self actualisation which is the beginning of the Adult ego state. Adult
data accumulate as a result of the infant's ability to find out for himself about life. This is
different from the data so uncritically accepted from his parents by the Parent ego state. It also
differs from the instinctive and feeling data which are the essential components of the Child ego
 195

state. In fact, the Adult develops a thought concept of life based upon data gathering and data
processing.
In early life, the Adult has little information with which to challenge the commands of the
Parent ego state or to aid the emotions of the Child ego state. In most people, however, the Adult
ego state matures by concerning itself with transforming incoming stimuli into pieces of
information which are stored and processed in relationship to other relevant previous experiences.
Thus the Adult serves as a means whereby the child can begin to recognise life as it really is,
instead of being restricted to evaluating it through the parents' eyes as the Parent does, or through
the eyes of the Child's make-believe world. The Adult is, in effect, a data processing computer
which can and does reach decisions after computing information from all available sources
including the Parent and the Child. It can reexamine data in the Parent to see whether it remains
applicable or whether it no longer matches with the facts. It can also examine the data in the
Child to determine whether the feelings there are appropriate or irrelevant.
It is on the presence of an intact and mature Adult that all successful psychotherapy
depends. This is particularly true for analytical hypnotherapy which cannot succeed without the
aid of an effective and cooperative Adult ego state. It is upon the Adult that the analytical
hypnotherapist calls to examine the Parent/Child conflict and find new solutions to it. The
persistence of symptoms prior to therapy is probably due to the fact that the true nature of the
Parent/Child conflict remains concealed from the wisdom of the Adult. It is the hypnotherapist's
task to uncover that conflict and expose it to the understanding of the Adult. This kind of
uncovering demands considerable skill and takes the therapist to the limit of his ability to
facilitate (81) the cure of emotional problems.
The hypnotherapist, then, plays an important role, for without his or her assistance, the
deeply buried Parent/Child conflicts would remain beyond the reach of the Adult. The Adult's
immense resources, culled from the business of observing life realistically, would be unavailable.
The greater portion of this book is devoted to detailing the skills necessary for locating these
conflicts, thus ensuring that they are fully exposed to the resources of the Adult ego state for their
resolution.
The theory of analytical hypnotherapy may be succinctly summarized as follows: mental
illness and emotional disorders are assumed to be due to the ongoing and outmoded conflict
between the 'I want' (The Child) part of the personality and the 'I ought' (The Parent) part. This
conflict can be resolved only by the application of the 'I will or I can' (The Adult) arbitrator in
that conflict. The conflict is terminated when both the Parent and the Child accept the arbitration.
Szasz (1961) argued that the very concept of mental illness should be discarded since it
promotes a confusion with physical illness and assumes that an external event(s) is responsible
for the symptoms. He believes that mental disorders, unlike physical illnesses, are not diseases
because they are internally determined. If he is correct in his assumptions, then analytical
hypnotherapy, by its emphasis on the use of internal resources for therapy, can properly be
regarded as a nonmedical therapy which accomplishes its results without direct external
intervention. (82)
It is probable that, as a result of hypnotic suggestion, the Adult ego state points out to the
Parent ego state that the repression of the Child and his emotions (initially important for the
individual's survival) is no longer necessary. In adult life survival is no longer dependent upon
approval of parents; they are no longer in the protective and supportive position vis-a-vis the
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child that they were in during the onset of the conflict. In fact it may be that the parents
themselves are in need of the child's protection, or that they no longer are alive. The Adult may
make it clear to the Child that the repressed emotion, although acceptable, is probably no longer
necessary and need not be retained since the experience responsible for it has long since been
completed.
Central to the whole concept of therapy is the belief that in the presence of an intact Adult
there are adequate resources for the resolution of the Parent/Child conflict. Once it is resolved,
we can reach the happy position in which Berne (I96I) described the Adult, the Child, and the
Parent as existing with all important aspects syntonic one with another. At such time, the
individual can function as an integrated unit without any of the symptoms which had been a
necessary part of his existence prior to therapy. (83)

21. PRINCIPLES OF ANALYTICAL HYPNOTHERAPY: EDGAR BARNETT:

ANALYTICAL HYPNOTHERAPY: WESTWOOD PUBLISHING CO, GLENDALE, CA: 1989
Berne (1961) regarded therapy as a battle involving four personalities: the Parent, the
Child, the Adult (always written with a capital first letter to distinguish them from the usual
meaning of these names), and the therapist - with the therapist functioning as an auxiliary Adult.
If the patient's Adult can be enlisted alongside the therapist's Adult as a therapeutic ally, then the
odds for success are increased. If the therapist can also appeal to the patient's Child, the odds
against the Parent are then three to one. This alliance allows an even greater chance of success
since, in most of the neuroses, Berne considered the Parent to be the prime target for therapeutic
intervention. In hypnosis, the Parent and the Adult are temporarily decommissioned and in
regression analysis, the Child is being directly appealed to while maintaining the advantage of
retaining the Adult and the Parent. Selavan (1975) agreed with this view, adding that direct
communication with the Child in hypnosis allows for the reexamination of critical moments in its
life which are still affecting present behavior. The Adult, present at this communication, can then
enable a new decision to be made with a consequent modification of behavior.
James and Jongeward (1971) claimed that an individual's behaviour is governed by a
psychological script which contains the programme for his life drama. The programme is based
on the messages the individual, when a child, receives from his parents, and it is therefore largely
a function of the Parent ego state. These script messages can be either productive and constructive
or non-productive and destructive. To the extent that these script messages are out of tune with
the real self (the Child) and its real potential, they can create a pathology which varies from mild
to so severe that the individual becomes an absurd caricature of his real self. Some scripts serve
the function of giving the individual a realistic idea of what he can (86) accomplish with his
talents; others misdirect him to follow unrealistic goals; still others programme the Child for
destruction and negate his will to live. James and Jongeward further declared that, when there is
an inner conflict between the inner Child and the Parent, the Adult can intervene in the conflict. It
can referee, arbitrate, discover compromises and make new decisions for the fuller expression of
the inner Child. It can also modify the Parent by accepting or rejecting Parental assumptions on
the basis of reality and appropriateness. In order to achieve this integration of the personality, the
Adult must gain knowledge about the Child and the Parent ego states.
Branden (I972) advocated the therapeutic value of communicating with the repressed
Child and his feelings, observing that one does not destroy an emotion by refusing to feel or
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acknowledge it (that is merely to disown a part of oneself). If we acknowledge and permit

ourselves to reexperience our painful or undesired feelings - without self-pity and without
self-condemnation - we facilitate the process of healing integration.
While the analytical approach to therapy would clearly seem to be the most rational one,
Freud, as mentioned previously, expressed considerable doubt regarding the therapeutic
effectiveness of direct unconscious communication using hypnosis. He felt that hypnosis did not
in fact penetrate repression but only masked it, so that cures, though frequently spectacular, were
nevertheless temporary. Conn (1977) reiterated this view and every experienced psychotherapist
has now come to accept it as a clinical fact: the patient's knowledge of the reason for his behavior
does not spontaneously lead to a cure of it. He went on to assert that it is this fact which has led
psychotherapists to forego their previous obsessive and apparently futile search for traumatic
infantile memories.
In the face of this kind of opposition to the analytical approach, d~e analytical
hypnotherapist needs to understand why it is that sometimes the approach fails so dismally
whereas, at other times, in cases where non-analytical methods have failed, it is extremely
successful. This author believes that when analytical hypnotherapy fails, it is frequently due to
the fact that its underlying principles have not been fully understood and therefore have not been
applied in their entirety.
In spite of Freud's reservation, many analysts have continued to assume that the mere
location and identification of the origin of emotional problems would suffice to enable the patient
to deal with and become free of such problems. Occasionally, this has indeed proved to be true,
and the resulting dramatic cure has been attributed (87) entirely to the patient's insight gained
from the presentation of the previously hidden material to consciousness. When such cures do
occur following the uncovering of previously concealed important material, they provide a
striking demonstration of the potential effectiveness of analytic hypnotherapy. But, unfortunately,
these very cases obscure the mechanism whereby insight has been effective. Often, the initial
dramatic response is shortlived, and the long term results prove to be disappointing. It would
appear from such ineffectual results that greater time spent on a purely behavioral approach might
produce more permanent results and one can understand criticisms like Conn's, that the
uncovering of the causes of emotional problems is a waste of time. But a number of analysts who
share the author's viewpoint believe that the behaviourist approach must always remain
incomplete since it attempts to manipulate only the external environment. Every analyst believes
that the internal environment is of equal importance and must likewise merit the therapist's
attention. All hypnotherapists in the course of therapy, whether or not it is analytical, inevitably
modify the internal environment; but it is the analytical hypnotherapist who must carry out this
process in a structured and systematic manner. The rest of this chapter is devoted to a detailed
examination of the principles which underly the most successful analytical approaches to therapy.
THEORETICAL CONSIDERATIONS: We have considered how the structure of the
personality is viewed by the Transactional analyst and how the behavior responses of the
individual are governed by three main groups of learning. Maladaptive behavior, evidenced by
the presenting symptoms, has presumably been learned in an environment where such behavior
was considered by the individual to be the most appropriate that he could devise at that time.
Such learning has become so deeply ingrained that the individual does not respond appropriately
to changes in the environment and persists with a behaviour pattern which is clearly maladaptive.
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Such is the nature of Parental script messages. When a patient presents for therapy symptoms of
which he consciously wishes to rid himself, we can safely assume that they arise from an
unconscious conviction that this was the best response available to him. At the level from which
his symptoms originate, the patient's environment is being perceived as it has been, rather than as
it truly is. Consequently, the response creating the symptoms unconsciously appears to be
appropriate and thus the maladaptive behaviour persists. It is the revelation of (88) the
Parent/Child conflict (i.e. the unconscious reality), which gives the therapist an understanding of
the rationale for the symptoms.
To illustrate this further, let us take the case of a patient with snake phobia so intense that
even the drawing of a snake sends her into a panic. She is unable to move into any environment
which, by any stretch of the imagination, could possibly be inhabited by snakes. She is frequently
subject to attacks of panic because there are so many things that remind her of them. Clearly, she
is not responding directly to the environment (which is relatively harmless and certainly does not
warrant such an intense fear response), but rather, she is responding to a set of frightening
memories that are evoked by the thought of a snake. Such memories are more real to her
unconscious mind than the actual environment. For her, this phobic response is therefore entirely
appropriate.
In order to help this patient, the analytical hypnotherapist persuades the patient to review
in detail, through the medium of regression, those experiences which were responsible for the
symptom producing behavior. Having identified these experiences, and all of their associated
emotional responses, he then activates the Adult within the patient to examine the current
inappropriateness of such responses and encourages him to discover improved ways of behaving
in the present. It has consistently been the author's experience that, where uncovering has been
possible, an inappropriate emotional response has been always discovered to be due to an
unresolved Parent/Child conflict. In such a conflict, the expression of the individual's natural
response has been repressed because of unconscious guilt due to fear of parental disapproval.
By returning to the critical experiences and reviewing them in the light of his present
(Adult) wisdom and understanding, the patient is persuaded to reassess these experiences and then
find the resources with which to formulate more effective behavioral responses to the stimuli
previously responsible for symptoms. Location of the critical experiences is therefore crucial to
therapy, even though it is only a part of the analytical hypnotherapist's task. In order to achieve
the cure of symptoms, not only must the therapist enable his patient to recognize the
inappropriateness of his responses at the level from which they originate, but also, he must
encourage him to discover more effective responses which will ultimately enable him to function
more effectively. It is the failure to achieve this latter objective that has been responsible for the
recurrence of symptoms in the face of apparently successful therapy. (89) Analytical
hypnotherapy can be broken down into several stages, each of which depends upon an important
and logical principle; failure to observe each principle is likely to jeopardize the successful
outcome of therapy. These stages and the principles underlying them are as follows.
First Principle: Identification of the Critical Experience(s): It is this first stage which
has always been regarded as the essential one in analytical hypnotherapy. Unfortunately it has
also been erroneously held to be the only important one by too many therapists. Much time and
effort have been expended in devising increasingly effective methods of uncovering critical
experiences; all too frequently, the successful location and identification of these experiences
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have been equated with successful therapy. In truth, therapy has only commenced when this stage
has been reached. Furthermore, many analysts have been so readily satisfied by the mere location
of these critical experiences that they have remained totally unaware of the pressing need to
identify clearly all of the associated emotions that have been repressed which need to be
understood and accepted. The failure to complete properly this portion of the first stage of
therapy has frequently resulted in the continued concealment of vitally important facets of the
critical experience. This concealment remains responsible for the persistence of symptoms.
Therefore, no matter what uncovering technique is used, if therapy is to be successful, it is
imperative for it to be a technique that enables every detail of the critical experience to be
identified and reviewed. It should be noted here that a critical experience is one that, for the
individual, has been responsible for a crisis in which a critical decision has been made; upon this
decision future behavior will depend.
Let us now return to the case of our middle-aged female patient suffering from snake
phobia to illustrate further the importance of the correct handling of this first stage. It is not
enough to uncover the fact that, at the age of nine years, she had been approached by a young
man in a deserted spot who had exposed his erect penis and had asked her to masturbate him. Not
only do we need to know that she was extremely frightened by this experience and was always
unconsciously reminded of it by anything snakelike in appearance, but we also need to know
about the excessive feelings of guilt evoked by the experience. These guilt feelings were the (90)
result of the pleasurable sexual fantasies that she began to weave around the incident. It was her
natural curiosity (which she considered sinful) as to what it might have been like had she
complied with the young man's request that was responsible for these intense guilt feelings. As a
devout Roman Catholic, she found herself unable to own to this curiosity and was therefore
unable to relieve herself of this guilt in the confessional.
In this first phase of analytical hypnotherapy, the uncovering techniques are used to locate
the Parent/Child conflict(s) responsible for the symptoms. In this case of snake phobia the
conflict is clearly one between the Child's pleasurable sexual feelings and the Parent's recognition
of their inadmissability. It is the guilt that this conflict engenders which is the source of the fear
in the snake phobia. It is interesting to note at this point that, although guilt is always an element
of all Parent/Child conflicts, it is never more intense than in the phobias.
Second Principle: Understanding the Repressed Emotion and the Associated Feeling
of Guilt: Unacceptable emotions experienced at the time of the critical event are repressed by the
Parent ego state since their expression would meet with profound parental disapproval and the
possibility of abandonment, if not physically then at least emotionally. It is the fear of this
rejection and the possible parental abandonment which gives to guilt its intense power to control.
It is therefore imperative for therapy to be directed at the elimination of such guilt. In order to
accomplish this there has to be full acceptance of these repressed emotions as normal and proper.
So long as feelings of guilt persist, emotions are rejected and repressed as being improper. It is
only when, with the assistance of the Adult's full understanding, the Parent can be assured that the
Child is no longer in danger from the expression of its true feelings, that guilt can be withdrawn
and the repression that it represents removed.
It is in this stage that the Adult first applies its understanding and wisdom to the
Parent/Child conflict. While appreciating that the Parent's strictures were correct and wise at the
time they were applied, the Adult is able to convince the Parent that the Child's feelings are
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indeed normal, proper, and in the present context, totally acceptable. To return to our snake
phobia example. Our patient needed to be persuaded that her sexual curiosity at nine years of age
was not abnormal. She was able to understand, in the context of her faith, that these feelings are
God-given and did not really emanate from the devil, (91) as she had previously supposed. Her
own experience as a parent enabled her to accomplish this fairly readily and she was able to
pardon herself for her supposed crime and accept the normal healthy sexual feelings of a nine
year old girl.
Third Principle: Recognition of the Current Irrelevance of the Previously Repressed
Emotion: An emotion which has been located, identified and accepted, needs, before it can be
relinquished, to be recognised as currently irrelevant to the present environment. The present
situation must be seen to be different from that responsible for the original emotion. Furthermore,
the past protective nature of the emotion must be seen no longer to be necessary since the
individual now has for his defence access to his normal emotions.
Thus our snake phobia patient had to recognise that her fear had not been entirely of
snakes nor even of the penis which snakes symbolise. It had been, essentially, a fear of her own
sexual interests and of the disaster that she had believed would surely befall her should she
acknowledge them. Since her intense fear had not really been of snakes, she could then accept
that she need no longer retain that conscious manifestation of her real fear, nor her anxiety about
her sexual interests. She knew that she need only keep a normal fear of snakes which she could
rely on herself to draw upon if ever it became necessary. In this phase, the wisdom of the Adult is
used both by the Child who has hung on to the fears for protection, and by the Parent who has
been maintaining the fear of abandonment inherent in the feeling of guilt.
Fourth Principle: Relinquishing the Repressed and Repressing Emotions for Good:
Although at this stage of therapy there really appears to be no reason for the retention of
symptoms, much still remains to be done before the emotions causing them can be relinquished.
For years, the Parent/Child conflict has been a way of life for the patient, and thus a means has to
be discovered to end the conflict so that these ego states can live in harmony. Once again the
Adult is called upon to deliver its wisdom in the task of terminating this conflict. It is at this time
that the Parent ego state is further aided to understand that its role of controller of the Child can
now be modified since the Adult has information adequate for the task. This may be difficult to
accomplish because the (92) Parent, in the Child's best interests, had been programmed to
maintain the controlling feeling of guilt. It will require much encouragement to relinquish this
role.
Fifth Principle: Recognition of Resolution of the Parent/Child Conflict: A critical
experience, and the Parent/Child conflict resulting from it, cannot be regarded as having been
satisfactorily dealt with until it is certain that the conflict is indeed at an end and all of the
associated, outdated, uncomfortable and unnecessary tensions responsible for the symptoms have
been relinquished. So long as the conflict remains, so will the tensions resulting from it. Should
tension still remain, it is probable that the Parent has not relinquished its role as controller of the
Child by the purveyance of guilt. If this should be the case, a further review of the critical
experience is necessary to determine the reason for the persistence of uncomfortable feelings.
Once again, the wisdom and understanding of the Adult is enlisted and applied to a further
examination of the conflict in order to discover what is still unreconcilable in the feelings of the
Child or the opinions of the Parent. When ultimately successful, there is always a feeling of
 201

profound relief which marks the completion of this stage of therapy. In the case of our snake
phobia patient, she experienced a comfort previously unknown to her and it was this absence of
her old tensions that confirmed that she had at last resolved her problem and could remain free
from her phobia.
Sixth Principle: Rehabilitation: It is one thing to resolve a problem but it is still another
to keep it resolved. Rehabilitation indicates that this is the final but certainly not the least
important stage of therapy. It is the phase necessary to ensure that the patient makes the essential
post therapy readjustments in order to remain free from the symptoms. The world of the patient
without his symptoms is vastly different from that with them. Many secondary gains have gone
unrecognised during the persistence of the symptoms; they must either be abandoned or new
ways found of obtaining similar gains. Once the patient is symptomfree, there will remain a
constant temptation, not consciously recognised, to return to the security and familiarity of old
patterns of functioning rather than dealing with new problems in more appropriate and beneficial
ways. The judicious use of posthypnotic suggestions to give appropriate ego strengthening and to
provide training in (93) assertiveness is an essential part of this rehabilitation phase. It ensure.
that the patient will return to his world equipped to deal with it and remain symptom free.
Our snake phobia patient had to find other legitimate reasons for not going on trips into
the countryside when for one reason or another, totally unconnected with her previous snake
phobia, she did not wish to go. She had to learn that she had a right to consider and express all of
her feelings and opinions without any unnecessary feelings of guilt.
The following excerpt from a tape recording of a session of therapy is given to illustrate
the use of the principles of analytical hypnotherapy in practice. The patient is a thirty-eight year
old man who has come to therapy because of a lack of self confidence and a compulsion to
overeat. The patient entered hypnosis easily.
DR. I would like you to see if there are There is good ideomotor
communication
any other Kevins who do not feel using the head to signal 'yes'
and 'no'. One
comfortable. If you find any, your critical experience has already
been dealt with.
head will nod for 'yes'. Head nods. First principle - the
identification of the
How old are you there? critical experience -
has begun to be put into
PT Fourteen
operation.
DR Fourteen year old Kevin,
something is happening there that's
really bothering you. What is it?
PT I was drinking again.
DR Drinking again?
PT It's my cousin. What's bothering
me is that I think he's having
some kind of affair with my mother.
 202

My father is out drunk in the field ...

DR How are you feeling? Mere location of the
critical experience is not
PT Ashamed, scared, bitter. .. enough. All the circumstances
that render it a
DR How do you feel about your cousin? source of conflict must be identified.
(94)
PT Very angry at him.
DR How are you feeling about your mother?
PT Angry.
DR Real angry! Is there anything At this point, all of the
relevant
else to know? If there is, your head information regarding the
critical experience
will nod for 'yes'; if there isn't, your and the Parent/Child conflict
it has
head will shake for 'no'. engendered is now
presumably accessible to
Head shakes. the
Adult.
Thirty-eight year old Kevin, fourteen The Second Principle -
understanding the
year Kevin has told us about something repressed emotion (of the Child) and
the
that is really bothering him. associated feeling of
guilt (repressive force of
I want you to help him. I want the Parent) - applies the
resources of the Adult
you - he's feeling so hurt and guilty to the Parent/Child conflict.
and angry and ashamed and scared
- I want you to give him all the help
that you can. You've got thirty-eight
years of wisdom and understanding
to comfort him. When you have
done that nod your head for 'yes'. Nods. Third Principle - recognition that the
Fourteen year old Kevin, now that you repressed emotions are no longer
relevant -
have heard that, doyou still have to go has been applied.
on feeling bad up here in 1980?
PT No.
DR Okay, thirty-eight year old Kevin,
fourteen year old Kevin has said that,
now that he has listened to you,
he doesn't need to go on keeping
 203

those bad feelings any longer. .. Again the Adult is being

called upon to apply
He's been keeping all of them for its resources as the Fourth
Principle is being
twenty-four years. I want you to invoked: relinquishing the
repressed and
find a way for him to let go of repressing emotions. There is
no need to
these unnecessary, out of date, uncomfortable enquire into the means (95) discovered, since
feelings that he has been keeping for so long. it is often too complex to verbalize. After an .
When you have found a way to do that your acceptable means has been
discovered, it must
head will nod for 'yes'. Head nods. be proven to be effective.
There you are, fourteen year old Kevin,
you can let go of those uncomfortable
feelings now. You don't need them any more.
Finished with, done with, past, over, gone.
Let them go. When they've all gone, you can feel
they've all gone and when you're sure they're all
gone, nod your head for 'yes'. Head nods. Good. Fifth Principle - recognition of the
resolution
Now, fourteen year old Kevin, you should of the Parent/Child conflict - has now
been
be feeling so good now that you've applied and evidence that the
conflict resulting
let go of all of those old uncomfortable feelings. from this particular critical experience is at
an
You don't need them any more. If you really end is being sought.
feel good, please give me a smile. Smiles.
Feels good eh?
At this juncture, the session goes on to deal with other critical experiences relevant to the
symptomatology. It is later, when all of these have been satisfactorily dealt with, that the Sixth
Principle rehabilitation (which includes suggestions for ego strengthening and assertiveness
training), is invoked. This will be dealt with in greater detail in chapter fourteen, but the excerpt
from this session was as follows:
PT No, I don't - I didn't like myself. DR But now, you do like yourself?
PT Yeah.
DR And are you going to go on liking yourself?
PT Yeah.
DR Going to keep yourself trim?
PT Right.
DR And healthy?
PT Right. That's the main thing. (96)
DR For yourself and for the family?
 204

PT For the family especially, yeah.

DR Yes. Are you smiling inside all of the time?
PT I really feel very good, yes.
DR Will you please tell Kevin, up here in 1980, how to do that because he needs to know ...
When you have told him, let me know ...
PT Hmmmm - take the bull by the horns.
DR Okay, now Kevin, here in my chair, will you do that?
PT Yeah.
DR Definitely?
PT Yeah.
DR Right now?
PT Right now.
DR Take the bull by the horns?
PT Yeah.
DR Feels good, eh?
PT It does really.
DR Yes. You're just as good as anybody else, aren't you?
PT Yeah.
DR You like yourself?
PT You bet.
DR You don't need to feel ashamed any more?
PT No.
DR Good. You're going to respect Kevin all the time?
PT Yeah.
DR Can you now say, 'I like Kevin?'
PT Yes.
DR Great. You're going to take care of him, eh?
PT Right. (97)
DR And keep him safe?
PT Yes.
DR Okay. He is the most valuable piece of property that you've got, Kevin, so take good care of
him. Right?
PT Right.
It is of interest to note that the patient's Adult appears to have discovered what he needs to
do to remain free of symptoms: 'take the bull by the horns'. The patient's determination to do just
this made it unnecessary for him to revert to any of his previous symptomatology. He is now able
to implement a way of living that he knew about, but because of his emotional conflicts, had been
unable to establish.
SUMMARY OF ANALYTICAL PROCEDURE:
Principle

U
n
 205

c
o
n
s
c
i
o
u
s

P
r
o
c
e
s
s
e
s

O
b
j
e
c
t
i
v
e
s

Identification of the

Communication is
established with
Rendering all
aspects
critical experience unconscious
part (ego state
complex) of the
 206

Child/Parent
with relevant information. conflict
accessible to
Resistance to that communication Adult
resources
(i.e. hostile ego state) must be dealt with.
Critical experience is labeled with age of
that part with its memory. All emotional
components of the critical experience
identified whether or not it is
consciously available.
Understanding the Application of
unconscious resources
Strong
Adult/Parent
and the associated guilt repressed emotion of
understanding,
interaction
wisdom, forgiveness, compassion, loving
comfort, etc., to the unconscious distressed
ego state.
Recognition of current Adult intervention is
concentrated
Confidence of
the
irrelevance of upon
the Child to relinquish
negative Child in
future Parent-
repressed emotion feelings with
Parental agreement
and Adult support
in
approval.

t
h
r
e
a
t
 207

e
n
i
n
g

s
i
t
u
a
t
i
o
n
s

m
u
s
t
b
e

o
b
t
a
i
n
e
d

(
9
8
)
Relinquishing the and the Parental pressures will
have to be
Relief from
guilt
repressed emotions dealt with by the Adult. The
and the repressed guilt Parent’s perceived need to retain
 208

a punitive role may create difficulties.

Confirmation of re- Comfort at the
site of previous
Parent, Child,
and
solution of Parent/Child Parent/Child conflict is
felt and
Adult are in
harmony
conflict demonstrated by the 'smile test'.
Rehabilitation Secondary
gains previously
resulting
Ego
Strengthening -
from the symptoms must be
Adult/Child
interaction
abandoned or obtained in new,
non-symptom producing ways.
Also a means of handling life Assertiveness
without previous symptoms must Training -
be found and established.
Adult/Parent
interaction
Review Careful
follow up to discover
and
Prevention of
any
deal with any remnants of relapse
into previous
Parent/Child conflicts and to dis cover symptoms or
any active concealed ego
unwanted
behavior
state complexes.
pattern (99)

22. UNCOVERING TECHNIQUES IN ANALYTICAL HYPNOTHERAPY: EDGAR

BARNETT: ANALYTICAL HYPNOTHERAPY: WESTWOOD PUBLISHING CO,
GLENDALE, CA: 1989
It is a fundamental premise in analytical hypnotherapy that the brain is able to record
indefinitely every event perceived by the individual throughout his life and that these recordings
 209

are stored away essentially unaltered. This assumption is supported, not only by the clinical
experience of every hypnotherapist, but in particular by the work of Penfield (1952) in which
stimulation of the cerebral cortex evoked intact memories. This evocation indicated that
everything is stored in detail in the brain and is capable of being played back in the present. Not
only are the past events themselves recorded but also the associated feelings occurring at the time.
It is this seeing, hearing, and feeling body of data that comprises much of the Child ego state.
Another fundamental premise is that the persistence of the strong emotion associated with
the critical experience is responsible for the symptomatology. Thus it is that the prime task of the
analytical hypnotherapist is to locate the experience(s) responsible for the symptoms in order that
appropriate therapy can be applied to modify them. There have been many techniques, using
hypnosis, which have been devised to accomplish this objective. Although the critical experience
is always one associated with much distress, for unconscious reasons, the memory of part or all of
it has usually been deeply buried in the unconscious mind with barriers erected to prevent its
recovery. The techniques to be described here have been designed either to circumvent these
barriers or to persuade the unconscious mind to remove them.
Memories would seem to have been filed chronologically; yet the unconscious mind does
not appear to do what we are consciously aware of doing when attempting to retrieve a memory
of a specific experience. At a conscious level we use the process of association to bring a
forgotten memory to consciousness. We start off with one (108) remembered event and
gradually, by process of association with other events, rebuild the lost memory to a greater or
lesser degree of completeness. For example, if we are trying to remember what occurred on a
certain day, we first recall something significant about that day; other events associated with that
day will then come to mind until the event that we are seeking is recalled. The unconscious mind,
on the other hand, seems to require only one specific detail about an event in order to gain
immediate access to all of the other relevant aspects of it.
For the analytical hypnotherapist, this ability is of great importance since the one essential
aspect of the critical experience readily available is the emotional disturbance associated with it
and which is responsible for the presenting symptoms. All uncovering techniques depend on the
association of the concealed experience with either a particular emotion or a specific time. The
techniques to be described owe their effectiveness to their ability to locate either an emotion or a
specific time. This location in turn unconsciously isolates the associated experience and therefore
permits it to be subjected to the examination necessary for therapy.
Every uncovering technique relies upon communication with the unconscious mind and is
therefore a manifestation of the hypnotic process. All emotions arise from a deeply unconscious
level and, whenever experienced, indicate that unconscious communication has been established.
It is part of the hypnotherapist's skill to be able to recognize when an emotion is being
experienced, since this immediately puts him in touch with his patient's unconscious mind. Such
physiological signs of emotion as flushing of the cheeks, watering of the eyes, increased
respiration and nervous body movements, indicate to the therapist that an emotion is being
experienced and such signs can then be used to identify the memory of the experience responsible
for them.
INDUCTION OF HYPNOSIS FOR ANALYTICAL HYPNOTHERAPY: In order to
uncover the critical experience(s) responsible for symptoms, it is necessary first of all to establish
the unconscious communication which is the essence of hypnosis. Standard techniques of
 210

induction can, of course, be used, but it is well to remember that whenever there is an
unconscious response to suggestion, there is already the unconscious attention necessary for the
acceptance of further suggestions. The experienced analytical hypnotherapist will often move
directly to uncovering as soon as he is aware that the unconscious attention he is seeking is
present. Frequently, this may mean that an (109) incisive uncovering technique is put into
operation long before any of the generally accepted signs of hypnosis are seen to be present. In
any case, such evidence of unconscious response as relaxation, eye closure, catalepsy or good
visual imagery etc., is sufficient to indicate that an uncovering technique can be initiated.
AGE REGRESSION: Fundamental to all uncovering of forgotten memories is the
notion' that, in order to reach them, one must regress in time to the experience that has to be
recalled. We have discussed, in chapter four, how we believe that all hypnosis is in fact
regression at an unconscious level to the memory of a previous experience. However, there are
certain popular techniques of uncovering which depend for their effectiveness on encouraging the
patient to return to a previous experience with such vividness that it has the appearance of reality.
Such techniques are termed age regression techniques.
Counting: An example of an age regression technique requires the patient, in hypnosis,
to count backwards from his present age to a preselected age, responding meanwhile to the
suggestion that at each number he will feel himself to be at the age that the number represents.
When he is at the predetermined age, he is encouraged to experience everything that is going on
at a specific time at that age. For example, should a birthday be selected, he will then be asked to
be at his birthday celebrations and to describe them in detail. When the memory of this
experience has been validated and it is clear that the patient is indeed uncovering the specific
experience, he is then asked if the present problem exists at that time. If it does, then he is further
regressed by counting backwards until a time is located when the current problem has not yet
arisen. He is then brought forward in his memory to the time when something happens which
initiates the problem and this event is explored in detail and subjected to the therapeutic process.
Pinpointing: Elman (I964) described a variant of the above method in which he would
establish age regression to the first grade in school, following the cue of the clicking of his
fingers, and once again would further regress or progress the patient in his memory until the time
of the onset of the problem was located.
These approaches to the location of the critical experience(s) are (110) direct and often
highly effective, but require a level of hypnotic involvement which is not always easy to achieve.
A significant proportion of patients are unable to respond to this technique and appear to be using
a conscious effort at recall. Unconscious recall, on the other hand, is always apparently effortless,
since whatever energy is involved in accomplishing the recall is also unconscious.
The Crystal Ball: Wolberg (1964) described the use of the Crystal Ball with patients
who are able to remain in hypnosis with the eyes open. Such patients can be instructed to gaze
into the crystal and see significant events in their lives which have contributed to the problem. A
glass of water or a mirror reflecting a blank surface can be used equally well and in each case the
objective is to encourage the patient to describe the critical experience(s) in detail so that it can be
dealt with therapeutically. Although this procedure is clearly limited in its application, Erickson
(1954) has advocated a variant of this procedure in which the crystal balls are hallucinated by the
patient. In this case, each experience can be given a different hallucinated crystal ball. The need
to open the eyes is thus obviated so that hypnosis runs less risk of being disturbed. De Shazer
 211

(1978) also reported the successful use of this technique.

Television or Movie Screen Imaging:
A very similar technique which has found popularity with various hypnotherapists is the
hallucination of the television or movie screen. Important episodes in the development of the
symptoms can be reviewed as the subject sees himself on the screen in various situations during
his life. This method has also the advantage of allowing the patient to remain dissociated from the
memory and he is enabled to describe in a more detached manner than with direct age regression.
The disadvantage which occurs with the more direct method of age regressions is that it
involves the subject in an exposure to the memory of what often proves to be an extremely
disturbing experience, resulting in an abreaction with which he must deal. If he is able to deal
with it satisfactorily, he will usually experience a relief of symptoms; on the other hand, he may
not yet be ready to deal with it, and consequently will dispose of this reexperience, which causes
intensely uncomfortable emotion, by repressing it once again - often beyond the reach of further
therapeutic efforts. This repression will result in the persistence of or even an exacerbation of
symptoms which may well prevent him from remaining in therapy. (111)
IDEOMOTOR QUESTIONING: Most of the recent advances in analytical
hypnotherapy can be directly attributed to the increased use of the ideomotor questioning
techniques. These are to be described in greater detail in the following chapter since they provide
the basis upon which the philosophy of analytical hypnotherapy is currently established, but they
will be described here briefly. In this technique, unconscious signals of 'yes', 'no' and 'I don't want
to answer' are established. As a result, a direct communication with the unconscious mind which
is clear and unequivocal (a feature not always present in other uncovering techniques) is
established. Much skill is required in the framing of suitable questions which can be answered
with a yes or no, but all of the resources of the unconscious mind become readily accessible to
this approach. More importantly, the degree of hypnotic involvement necessary for the effective
performance of this technique is much less than that required for other hypnoanalytical
uncovering techniques, and is consequently more likely to be successful with those subjects who
would not be able to respond to other techniques.
To be maximally effective, every analytical hypnotherapist should become familiar with
this ideomotor questioning technique. Its use in light hypnosis with minimal
conscious/unconscious dissociation makes it possible to accomplish satisfactory hypnoanalysis in
almost every case presenting for therapy. At one time, only the subject able to accomplish the
significant conscious/unconscious dissociation normally recognised by the phenomena of medium
or deep hypnosis could benefit from the available hypnoanalytical techniques, but the ideomotor
questioning techniques require very little dissociation to be effective. These techniques are able to
locate very deeply buried unconscious memories and resources, rendering them readily accessible
to the hypnotherapist and his patient.
THE AFFECT BRIDGE: Watkins (1971) gave the name affect bridge to a technique in
which regression is accomplished by means of establishing a direct connection between the
present, in which an uncomfortable emotion exists, and the earlier situation in which this same
emotion was first experienced. In practice the hypnotherapist draws the patient's attention to the
emotion that he is feeling or to the symptom that is present; such emotion is enhanced by
increasing the focus of attention, and when sufficiently strong, the therapist is able to lead the
patient back to its origin and effectively bridge him from the present to the past causative (112)
 212

experience. In this manner the patient is encouraged to deal with the original experience which is
really responsible for the current uncomfortable tensions. This technique requires some skill in
dealing with the strong abreactions which so often ensue as a direct result of its employment.
The affect bridge is indirectly an important factor in many uncovering techniques and
each of those so far described involves the use of emotion to track down the original experience
responsible for it. In each case the therapist is seeking associations in the past for present
uncomfortable feelings. For example, the technique of visualising episodes of one's life on a
screen utilizes the uncomfortable feeling existing in the present to locate the memory projected
on that screen. Also, in using the ideomotor questioning techniques, an affect bridge is constantly
being subtly employed to locate the origin of tensions which may be only partly perceived at a
conscious level. The affect bridge technique illustrates very clearly how the hypnotherapist
depends entirely upon the associative mechanisms of the mind in his task of uncovering the
unconscious origins of problems.
INDIRECT METHODS OF UNCOVERING: Less direct methods of uncovering have
also been developed by (113) analysts who have evolved special skills in their interpretation.
Every analytical hypnotherapist should acquire these skills because they occasionally offer an
alternative avenue of therapy when the direct methods have been rejected by the patient.
Dream Interpretation: Patients will frequently bring to the therapist a recurring dream
which they find to be emotionally disturbing and which therefore has some unconscious
significance in relationship to their problems. Freud (1938) explored the meaning of dreams and
their interpretation as a means of uncovering the factors creating an emotional problem and such
interpretation forms a large portion of any psychoanalyst's skill. But the analytical hypnotherapist
does not require this skill because he can use the patient's more knowledgeable unconscious mind
to provide an interpretation of the dream that it has produced. The patient is asked, in hypnosis, to
review his dream in detail and then to spend time seeking an understanding of it. In many cases
that understanding cannot be verbalized but it nevertheless leads to a change in the behaviour of
the patient and a subsequent modification of symptoms.
Dream Induction: Because of the therapeutic effect that dreaming can initiate, the
induction of dreams either during hypnosis or posthypnotically has been advocated and used with
great effect. Wolberg (I964) recommended that the subject be first given the suggestion (in
medium or deep hypnosis) that he will have a significant dream that night which he will
remember and report at the next session. Such dreams can then be subjected to interpretation
either in or out of hypnosis and often contribute greatly to an understanding of the underlying
problem. Furthermore, patients can be trained to produce a dream in hypnosis which will have
relevance to any problem being dealt with. This can prove to be an effective means of harnessing
the resources of the unconscious mind in the resolution of emotional problems.
When assisting the patient to interpret his dream, the therapist should bear in mind that all
the participants in that dream are likely to be facets of the patient himself and will reveal the
complex feelings he has about himself in relation to the current situation. Sometimes, dreams of
significance will occur during the therapeutic period, particularly on the night before a session.
The opportunity should always be grasped to understand the meaning of such a dream since it
usually indicates that some part of the patient's unconscious mind needs to (114) communicate
something of importance to the therapist. While dreams can be a useful adjunct to therapy, the
analytical hypnotherapist should not rely upon them alone in order to help the patient resolve his
 213

problems because he has little control over the direction they will take.
Automatic Writing: Some therapists seem to experience considerable success in training
subjects to write automatically (unconsciously). Automatic writing clearly requires significant
conscious/unconscious dissociation and the writing hand must be beyond conscious control or
awareness. In the use of this technique, unconscious information is communicated to the therapist
without conscious knowledge. The usual method of accomplishing automatic writing is to
provide the subject with writing materials and a writing board. The suggestion is given that the
writing arm and hand are no longer under conscious control or awareness and that questions
directed to the unconscious mind will be answered in writing by this hand. Meanwhile the
conscious mind is instructed to be busy with other thoughts or to sleep. At times, important
information can be gleaned by this method and the astute therapist is enabled to discover what the
problem is and what the experience responsible for it is. Unfortunately, the writing may be
cryptic and undecipherable except by the patient, who is then asked in hypnosis to examine and
interpret it.
A variant of automatic writing requires that everything be done with hallucinated
materials. The subject is instructed to imagine himself writing upon a notepad or a blackboard
with the appropriate writing materials. He is also warned that he might not immediately
understand what has been written but is encouraged to examine the writing until it becomes clear.
Although this has the obvious disadvantage of leaving no record of the unconscious
communication, it is as effective as other methods of automatic writing and is evidently more
economical of time, materials and energy.
The Unconscious Body Image: Freytag (1961) postulated that the hallucinated
unconscious body image is the picture that the individual forms of himself in his unconscious
mind. Changes in the individual's perception of himself produce changes in the unconscious body
image and therefore can be used as a barometer of psychic change and progress. Conversely, the
induction of changes in the unconscious body image can therapeutically (115) lead to psychic
changes and improvements in the individual's attitudes toward himself.
Freytag suggested to the patient, in hypnosis, that he hallucinate a full length mirror and
see his reflection in it. He was then asked to describe what he saw, and it was explained to him
that this was merely a reflection of his body as it existed in space. He was then told that everyone
has another picture of himself in his unconscious mind which symbolically expresses significant
emotional problems and conflicts. This unconscious body image may be perceived as very
different from the spatial body image. It may be nude or distorted in some way. On a signal, such
as the word NOW, he was told that he would await passively for the spontaneous appearance of
this unconscious body image and to describe objectively exactly what he saw.
It had been Freytag's experience that the unconscious body image usually revealed the
area in which the emotional pathology was located. Therapy was directed at improving the
unconscious body image until it more nearly represented the true mirror image. This was done by
examining the attitudes responsible for the distorted body image and subjecting them to more
mature present-day understanding.
Hypnoplasty and Hypnodrama: Meares (1957, 1960) has developed a technique during
which a patient in hypnosis was encouraged to mold clay or plasticine to express his emotional
conflicts, believing that this was an excellent method for dealing with the resistant patient. It was
claimed that hypnoplasty enabled dissociated material to be tapped more effectively and that
 214

spontaneous regression and abreaction were intensified.

Hypnodrama involves the hypnotised patient being encouraged to playa role in a drama
which parallels his own conflict. In such a manner, he is able to reenact his own inner conflicts
and discover solutions to them. Both hypnoplasty and hypnodrama appear to demand special
skills from the therapist; they may sometimes provide a successful approach to therapy when the
more usual approaches have failed to treat concealed problems. (116)

23. THE IDEOMOTOR QUESTING TECHNIQUES IN ANALYTICAL HYPNOTHERAPY:

EDGAR BARNETT: ANALYTICAL HYPNOTHERAPY: WESTWOOD PUBLISHING CO,
GLENDALE, CA: 1989
The ideomotor questioning techniques are undoubtedly the uncovering techniques of
choice. In the hands of the skilled analytical hypnotherapist, these techniques have the advantages
of accuracy, versatility, and a simplicity unmatched by any other uncovering method.
Furthermore, save for the use of a pendulum in one of these procedures, no additional equipment
is required. With the use of these techniques, access to unconscious information (normally
associated with age regression in deep hypnosis) is facilitated. This can be accomplished in
relatively light hypnosis in which there is little conscious/unconscious dissociation.
Erickson (196r) first observed that certain patients, while explaining their problems,
would unwittingly nod or shake their heads in contradiction to their actual verbalisations. He
surmised that the head movement was an unconscious ideomotor response indicating unconscious
communication. He utilised this observation as a basis for an induction technique particularly
with resistant or difficult subjects. As a simple variation, he suggested that the levitation of one
hand could signify yes and the levitation of the other, no. Hypnosis is present whenever this
ideomotor activity occurs. Erickson also noted that when patients were asked to review past
events, their recall was often accompanied by unconsciously produced ideomotor activity. James
(r890) had earlier noted that 'every representation of a movement awakens in some degree the
actual movement which is its object,' thereby recognising that ideomotor responses can be
associated with unconscious memory. Erickson was more concerned with using ideomotor
responses as an induction technique, although he recognised that different responses could be
assigned different signals very readily. He also noted that the character of these responses was
likely to be slow and deliberate when unconsciously generated. (118)
LeCron (1954,1968) favored the use of Chevreul's pendulum to establish ideomotor
signals in response to questions. Thus the responses yes, no, I don't know and I don't want to
answer would be assigned to each of the four possible movements of the pendulum. In this
manner, by judicious questioning, LeCron found that he could make excellent unconscious
communication and thereby uncover relevant information quickly and easily. Later proponents of
this method of uncovering have tended to eliminate the signal for I don't know since questions
must be those for which the unconscious mind has an answer.
Cheek (1968) found that he could achieve identical results by assigning signals to
individual fingers which would lift as an ideomotor response to questioning. This ideomotor
finger questioning technique is probably the most widely used of the ideomotor techniques at
present. In theory, almost any muscle of the body can be adapted to form an ideomotor
questioning technique, but the hands and the head are normally used since, in the usual
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therapeutic encouter, they are the most readily observable parts of the patient's body.
Theoretical Considerations: As has already been stated, it is only through the
observation of a response to suggestion that the unconscious communication of hypnosis can be
recognised. Such a response may either be sensory or motor and since it is consequent upon an
idea (or thought) evoked by the suggestion, it is termed an ideomotor or ideosensory response.
Ideosensory responses cannot in themselves be observed although the patient is aware and able to
comment upon them. Ideomotor responses, on the other hand, do not require any conscious
intervention for them to be accessible to visual monitoring by the therapist.
It is probable that all suggestions elicit an idea, the content of which will depend upon the
individual's previous experiences and his understanding of the given suggestion. For example,
should the suggestion for lightness be given, the individual's idea of lightness will be unique to
him and will be dependent upon his previous experiences associated with the word lightness. If
the idea of lightness is sufficiently strong, it will evoke memories of lightness which are given
substance by a recollection of the sensation of lightness. Again, if this sensation of lightness be
sufficiently great, muscular movements associated with the lightness ensue, and an ideomotor
response has been induced. This cycle of events can be interrupted by conscious intervention
which is one of the factors modifying suggestibility. However, it is probable (119) that once a
suggestion is allowed past the conscious critical faculty to the stage where it can become an idea,
the ideosensory or ideomotor response can then only be inhibited by unconscious processes which
form the other factors modifying suggestibility.
IDEOMOTOR SIGNALS: An ideomotor signal is one that consistently expresses a
simple idea when it is exhibited. Such a signal is said to be established if it occurs whenever the
idea with which it is associated is present. The most useful ideas for which signals are usually
established are simply those of yes and no. The beauty of the ideomotor signalling techniques is
that they do little more than confirm the presence or absence of another idea by the answers yes
or no, but with judicious questioning, they provide direct access to much information that is
present in the unconscious mind if it agrees to allow an answer.
In ideomotor signalling, a question is presented which acts as a suggestion. This in turn
produces an unconscious idea which, if it matches with a memory, gives a harmonious feeling of
yes, which in turn produces the ideomotor signal of yes. On the other hand, if there is no memory
that matches, there is disharmony and a feeling of no which results in the ideomotor signal of no
to indicate a negative answer. In locating a memory which is presumed to be present, only the
signal for yes is required which indicates that the memory has been located and matches with the
description of it in the question. For example, the suggestion may be given the unconscious mind
to orient back to the first memory that has anything to do with the onset of the present symptoms,
and when it is there, to indicate by the yes signal. When the yes signal is received, the therapist
knows that the memory has been located even though it still remains deeply unconscious.
The ease with which ideomotor signals will allow access to a body of unconscious
knowlege, memories and other resources which are not normally accessible to the conscious
mind, confirms that the conscious mind is bypassed when using this technique. For example, a
conscious answer to a question might well be yes, and yet be dramatically opposed by an equally
emphatic no ideomotor signal. This polarity tends to support Janet's (1889) view that hypnosis is
the result of dissociation in which communication is directly with the unconscious mind
uninterrupted by the conscious mind. Nevertheless, there need be no other evidence of this
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dissociation for ideomotor questioning to be effective. (120)

The unconscious mind appears to find it much easier to indicate whether a specific idea,
thought, or memory is present than to bring it to consciousness. This ready identification of a
memory enables much effective therapy to take place. The locating of such a memory is the
necessary first step in defining it, dealing with it, and perhaps eventually elevating it to
consciousness. The ideomotor questioning technique is therefore the analytical hypnotherapist's
most powerful tool in his task of uncovering. In skilled hands, it can justly be likened to the use
of the surgeon's scalpel in his probing for the source of physical problems.
The prime indication for the use of the ideomotor questioning techniques in analytical
hypnotherapy is to uncover the unconscious reasons for emotional and physical symptoms. The
analytical hypnotherapist also uses these techniques to monitor any response to a suggestion that
he has given in order to discover whether it has been accepted. Such unconscious responses as
those to suggestions for (121) healing, for the relief of pain, amnesia, and the resolution of
conflicts can be monitored by the judicious use of ideomotor questioning.
ESTABLISHING IDEOMOTOR SIGNALS: Finger Signals Since ideomotor finger
signals are easier to recognise as being unconscious, we will first discuss the establishing of these
signals. Every analytical hypnotherapist must learn how to establish, recognize and utilize these
signals effectively if he is to gain the maximum benefit from the uncovering powers of hypnosis.
There are many methods of establishing the finger signals. The objective is to impart the idea that
a given finger will lift effortlessly (unconsciously) whenever the thought yes is present and,
likewise, another will lift when a thought no is present. Similar signals can be developed for I
don't want to answer, etc. The selection of the fingers can be made either by the patient or the
therapist.
The following verbalisation for establishing finger signals allows the patient
unconsciously to make a choice of which fingers will respond. In this verbalization, no formal
induction of hypnosis has previously been undertaken, although we now know that as soon as any
ideomotor response occurs, the unconscious communication we call hypnosis has already
commenced.
Please make yourself comfortable with your hands resting in your lap (or on the arms of
the chair - whichever appears to be most comfortable). I would like to show you how you can let
your unconscious mind answer questions since your unconscious mind has information regarding
your problem that your conscious mind does not have. You have probably noticed how people
nod their heads when they agree with you - just as your head is nodding right now - and you have
also noticed how they shake their heads when they disagree with you. They are usually unaware
that their head is moving at all just as you were unaware that your head was moving until I drew
your attention to it. These movements are entirely unconscious and involuntary and I would like
to teach your unconscious mind how to answer questions by allowing one finger to float up for
yes and another finger to float up for no. Which hand is your talking hand? This is a reminder
that the patient ma already unconsciously use the hand to communicate when gesturing during
conversation. If there is no selection of one hand rather than the other, then the dominant hand
may be chosen. (122)
All right now, just close your eyes and listen very carefully to me and let your hands lie
comfortably and relaxed. I want you to keep thinking, yes ... yes ... yes over and over again and,
as you do so, one of the fingers on the talking (or dominant) hand will feel light and will lift - just
 217

let it lift. Each time you think yes that finger will get lighter and lighter and it will become so
light that it will lift. Yes ... yes ... yes ... , that's it ... each 'yes' makes that finger lift a little higher
until it lifts quite high. There ... Your right index finger (or whichever lifts) is your yes finger.
Now let it float down again. Good. Now begin to think no ... no ... no ... over and over again and
as you do so another finger on the same hand begins to feel light and will lift, just let it lift ...
No ... no ... no ... that's right - just let it lift ... Now your right middle finger (or whichever lifts) is
your no finger.
Perhaps there will be some questions which your unconscious mind would prefer not to
answer and would wish to indicate this. I would therefore like you to have an I don't want to
answer finger. Just repeat to yourself over and over, I don't want to answer. .. I don't want to
answer. .. and another finger or thumb on the same hand will lift ... I don't want to answer... I
don't ... want to answer. .. That's it ... your right thumb (or whichever
lifts) is your I don't want to answer finger.
I will be asking certain questions to which you may have a conscious answer but please let
your unconscious mind do its own answering by lifting the yes finger for yes or the no finger for
no and the I don't want to answer finger for I don't want to answer. Just let it happen and it will
happen.
During this verbalisation, the appropriate fingers have usually been observed to begin to
rise within about a minute. More or less persuasion may have to be given to different individuals
with the more highly suggestible tending to respond quickly. The unconscious ideomotor
response does not commence immediately following a question but only after a variable delay.
An immediate response is almost always conscious and the patient should be exhorted to be
patient and let it happen rather than forcing it to happen as he evidently is doing. The unconscious
ideomotor response is usually a slow and tremulous one and may occur without the subject being
aware of any movement; in fact, he may apologise for the absence of response when a good one
has already occurred.
Sometimes there is an unduly long delay which tries the patience of (123) both the
therapist and the subject and, in spite of much encouragement, no response is seen to occur. In
such cases it is appropriate for the therapist to assign signals to selected fingers and this will often
meet with unconscious acceptance. The assignment of signals is also a rapid and effective way of
establishing them when other hypnotic responses of an ideomotor nature have previously been
obtained (as in a prior induction procedure).
It should be noted that each ideomotor response is in itself evidence of unconscious
communication and must be regarded as part of the process of hypnosis. In the majority of cases,
ideomotor finger responses are readily established, but we will later consider those cases in which
signals are not readily established since these pose special problems in uncovering.
Chevreul's Pendulum: When a pendulum is held suspended from the hand, it can rarely
be held motionless. Movements of the hand eventually become translated into a swinging
movement of the pendulum. It has long been known that these movements can vary with
questions or ideas in the mind of the person holding the pendulum. The movements are clearly
ideomotor and provide an excellent medium for establishing ideomotor signals. A satisfactory
pendulum for this purpose can be constructed from almost any object which can readily be
suspended on about eight to ten inches of thread or string.
In much the same manner as when using the fingers alone, a specific movement of the
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pendulum is designated a signal. There are four readily recognisable different movements of the
pendulum which allow for up to four separate signals. They are: backwards and forwards, side to
side, circular clockwise and circular anticlockwise. A simple verbalisa tion for establishing these
signals could be as follows:
I would like you to allow me to teach your unconscious mind how to signal answers to my
questions by moving this pendulum in one direction for yes and in another direction for no.
Simply allow your elbow to rest on this arm of the chair (or any accessible firm surface) and hold
this pendulum so it hangs comfortably from your fingers. You do not need to make any conscious
effort to move it. Now the pendulum can move freely in any direction. It can move in a circular
motion either clockwise or anticlockwise, or it can move in a straight line either side to side, or
backwards and forwards, in response to your thoughts. I want you first of all to commence to
think yes ... yes ... yes ... over and (124) over to yourself and as you do so, the pendulum will
begin to move in one of the four directions. Just let that happen. Yes ... yes ... yes ... that's
good ... yes ... yes ... yes ... It is now moving in a clockwise direction (or whatever) and as you
keep thinking yes it moves even more strongly in that direction. That means that the clockwise
motion (or whatever) is your unconscious mind's signal for yes.
I would now like you to stop thinking yes and start thinking no ... no ... no ... and as you
do so, the movement of the pendulum changes and begins to move in a different direction. No ...
no ... no ... over and over again ... that's good ... no ... no ... no. There it is now swinging from
side to side (or whatever). That is your unconscious mind's signal for no.
Perhaps your unconscious mind might not want to answer every question that is asked and
would like to have a signal for I don't want to answer. .. I don't want to answer. .. There, the
pendulum is now swinging back and forth (or whatever). That is your inner mind's signal for I
don't want to answer.
At this point, the hypnotherapist is aware that excellent hypnotic communication has been
established. The degree of dissociation is (125) often parallel to the strength of the signal and
there will probably be other signs of deep inner concentration with some evidence of withdrawal
from the environment. This dissociation also denotes that unconscious attention is good and that
the process of hypnosis is taking place. The eyes mayor may not remain open depending upon the
preference of the patient and/or the therapist.
As with the finger signals, the pendulum movements may not become apparent. Again,
the assignment of signals to the different movements can be made by either the therapist or the
patient. As with any other suggestion, the absence of response is often indicative of an
unconscious resistance to the process of hypnosis. Fortunately only a small proportion of patients
attending the hypnotherapist will fall into this category.
Head Signals: Although unconscious movements of the head are already present as
ideomotor signals for yes and no, and can readily be used when unconscious communication has
been established, their common use as a conscious means of signalling yes and no render these
movements readily susceptible to conscious influence and control. Although there is a
characteristically delayed, slow and persevering feature about unconscious ideomotor responses,
it is not always easy to determine whether such a response to a question is truly unconscious.
Head signals in particular are readily obtainable since they are natural unconscious responses and
have the added advantage of being rapidly established and of allowing easy observation of facial
expressions during questioning. While they require a deeper level of hypnotic involvement than
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finger signals to be satisfactory, their use should always be considered with a patient whose
unconscious attention appears to be good. A verbalisation might be as follows:
Please close your eyes, keep them closed and remain as comfortable as you can. That's
good. I would like to talk to the back of your inner mind and I would like you to allow it to
answer my questions by automatically nodding your head for yes or automatically shaking it for
no. Please resist any temptation to move your head deliberately but when it wants to move on its
own, please let it do so.
I would like you to imagine yourself in a place where you are doing something that you
really enjoy doing. When you are there, your head will automatically nod for yes to let me know
that you are there. When your head starts to nod, just let it. It will (126) be your inner mind
telling me that you are relaxing in a place where you like to be. And, as you relax in that place
where you want to be, doing something that you enjoy, your deep inner mind will simply nod
your head for yes to let me know. There ... your head is beginning to nod ... just let it. That's
good. Please continue to enjoy that pleasant place and whatever it is that you are imagining
yourself doing. I would like your deep inner mind to answer my questions by either nodding your
head for yes or shaking it for no. If that would be all right with you, your head can once again
nod foryes. If that is not O.K., then your head will automatically shake for no.
In many cases this approach is sufficient to secure adequate unconscious attention for
spontaneous head movements to occur in response to questions. These may sometimes be very
slight although definite, and are usually slow and persevering. Sometimes further suggestions for
increased relaxation may be necessary before they will occur; if they do not occur, then other
ideomotor techniques should be used. Other ideomotor techniques should also be resorted to if it
seems clear that the head movements are consciously activated. When unconscious head
movements do occur, hypnotic communication is always adequate. The use of imagery, initiated
either by the therapist or by the patient (as above), encourages conscious relaxation so that these
ideomotor movements can more readily be established unhampered by conscious interference.
Furthermore, head signals can be instituted (as can any ideomotor signalling) after
unconscious communication has previously been established by some other hypnotic induction
procedure. The one disadvantage of using head signals is that the subject has no signal to indicate
that he does not want to answer, and so a failure to reply has to be interpreted as being I don't
want to answer, even when answers have previously been given satisfactorily. With all ideomotor
signalling, questions must always be clear and unambiguous and phrased in such a way that only
a yes or a no is required to answer them satisfactorily. How, what and why questions cannot be
used and will create only confusion. Anyone who has observed or has taken part in the game of
'Twenty Questions' knows that there is much information that can be gained from questions
requiring only yes and no answers.
IDEOSENSORY QUESTIONING TECHNIQUES: There are some therapists (notably
Bandler and Grinder, 1979) who (127) advocate the use of unconsciously produced physiological
responses which may be ideosensory or ideovasomotor. Such physiological changes as flushing,
tachycardia, or a feeling of warmth can be used to signal yes or no. For example, an increase in
tension could be accepted for yes and a decrease for no. Hypnoanalytical techniques are applied
in precisely the same way as when using the ideomotor signals. Bandler and Grinder believe that
such unconsciously preferred signals are likely to be more effective than the constructed
ideomotor signals similarly used to make unconscious communication.
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SOME PROBLEMS IN THE PERFORMANCE AND INTERPRETATION OF

THE IDEOMOTOR FINGER SIGNALS: In a significant minority of cases, certain
difficulties will be encountered in the performance and interpretation of ideomotor finger signals.
Technically, it is easier to deal with signals that are restricted to one hand. Earlier methods which
included the assignment of signals to both hands are best avoided by the analytical hypnotherapist
for two reasons. First of all, it is easier to attend to one hand and avoid the effort of having to
repeatedly glance from one hand to the other. Secondly, the free hand can give other signals
should this become necessary. The author's preference is for the right hand, simply because this is
usually the nearer and more easily observed. However, one must always be prepared to use either
hand.
The strength of ideomotor signals bears a direct relationship to the subject's other hypnotic
responses. A subject with clear ideomotor signals is very likely to exhibit other responses of the
good hypnotic subject and conversely, the subject with poor ideomotor responses is also very
likely to have other poor hypnotic responses. As with every general rule, there are notable
exceptions, but the strength of ideomotor signals can give a rough estimate of hypnotizability.
Poor or Absent Finger Signals: Perhaps it is the difficulty of establishing satisfactory
ideomotor finger signals in a significant minority of patients which has precluded the wider use
of the ideomotor questioning techniques. In most of these cases, absent or poor finger responses,
when the technique has been properly administered, is part of a general resistance to the hypnotic
process. This resistance may be either conscious or unconscious. If it is conscious, it is most often
due to a fear of yielding control, whereas unconscious resistance is usually due to a fear of
disclosure. Ideomotor questioning is more likely to be satisfactorily established when such (128)
fears have been adequately dealt with in the preinduction period, as recommended in Chapter
Four.
Absent Signals: A small proportion of subjects, even after every encouragement and
reassurance have been given, still do not develop any ideomotor finger signals. Such movements
as do occur are obviously voluntary and have none of the characteristic tremor and hesitancy of
the involuntary responses. In these cases certain manoeuvres may succeed in initiating an
involuntary response. Raising a finger while instructing the patient to think yes and nod his head
for yes may succeed in encouraging the finger to remain suspended involuntarily as an ideomotor
signal for yes. If successful, the procedure is repeated with another finger while the patient is
shaking his head for no and thinking no. Again, this finger should remain suspended in a
cataleptic fashion.
Should this approach fail, persistent conscious resistance may be the cause and may be
overcome by seeking conscious involvement in the responses. The subject should be asked to
sense which finger feels different when he thinks yes and consciously to lift that finger as soon as
he experiences the yes feeling. If successful, this procedure is repeated for the other signals of no,
and I don't want to answer. During subsequent questioning, the patient should be encouraged to
lift consciously whatever finger feels that it wants to lift in response to the questions. Sometimes
this begins to occur without conscious effort as the hypnotic process becomes more securely
established.
Since some subjects appear to have a poor unconscious kinesthetic sense, another effective way
of establishing signals is to ask the subject to visualise a blackboard on which the words yes or no
appear prominently. He is then exposed to simple questions and asked to raise the yes finger
 221

consciously whenever the yes reappears on his mental blackboard and the no finger whenever the
no appears. Once again, good signals will sometimes become unconsciously established. In other
cases, simple verbal reporting of the answers appearing on the blackboard will render these
ideosensory signals effective.
Poor Signals: Signals may be established but remain poor, being small in amplitude with
the finger scarcely lifting from the arm of the chair, and also so much delayed that there is a long
interval between question and answer. This makes it very arduous for the therapist to observe and
detect them. For delayed movements, nothing but (129) patience on the part of the therapist will
suffice, coupled with reassurance to the patient that things are progressing satisfactorily.
Improved recognition of the very small movements may be accomplished in a variety of
ways. One method which is frequently effective is to allow the signalling hand to hang loosely
over the end of the arm of the chair and to observe the movements of the tips of the fingers either
from the side or from above. Very slight movements of the finger tips can readily be detected in
this manner. Similarly, placing the elbow on the arm of the chair and the forearm in a vertical
position so that the hand hangs comfortably in an almost horizontal position, is another means of
rendering slight movements more readily detectable. In this context, it is the author's experience
that very slight movements of the signalling fingers are as important analytically as larger
movements and should be attributed their full significance.
Sometimes, a slight ideomotor response produces contraction of the appropriate extensor
muscles of the fingers, and although this may be insufficient to produce visible movement of the
fingers, the appropriate extensor tendon can be seen to contract and this contraction provides an
adequate visible ideomotor signal. Gentle palpation of the tendons will sometimes provide an
adequate tactile signal for monitoring of the ideomotor responses. Any method which enables the
therapist to recognise even the slightest unconscious response is of value and should be used.
Occasionally these slight responses can be increased by a conscious rehearsing of the respective
movement in response to commands for yes and no and the unconscious signals then become
sufficiently strong to make communication easy.
Fading Signals: Sometimes, ideomotor finger signals which initially seem to be
satisfactory, fade and eventually disappear altogether, and there is no further response to
questioning. This is always an indication of unconscious resistance to the uncovering process.
Further inquiry indicates that questioning has given rise to unconscious anxiety concerning the
material that has been, or is likely to be, revealed. While reassurance may be effective in
reestablishing communication, experience has shown that these patients often discontinue therapy
because they are aware of an unconscious reluctance to cooperate and consequently become
uncomfortable with therapy.
Confusing Finger Signals: A sure sign of resistance at an unconscious level is evident
when more (130) than one finger lifts in response to questions. Occasionally this may merely
indicate that the question is ambiguous and cannot be answered with a simple yes or no and
rephrasing of the question may meet with a satisfactory response. If it does not, this is clearly an
unconscious attempt to conceal the answer without apparently withdrawing cooperation.
Whenever this attempt to confuse by the presentation of more than one signal persists, it is
probable that the first signal presented is the more meaningful one. It can be assumed that the
presence of one signal, immediately followed by the opposite one, is indicative of the presence of
two directly opposed unconscious opinions seeking expression. It is in such cases that the
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separation of these opposing viewpoints on separate hands can be of great value.

The Other Hand Signals: A fascinating observation is the occasional spontaneous
emergence of signals on the hand for which they had not initially been established. One should
always watch the other hand for the appearance of these spontaneous signals during ideomotor
questioning. This is now the main rationale for confining the original signals to one hand in order
to leave the other hand available for further information.
Signals may appear in the other hand in the absence of responses in the originally
designated hand. They may also appear simultaneously and either confirm or contradict them. In
the author's experience, the meaning of the signals is usually the same in both hands; if the right
index finger has been designated as yes and the left index finger lifts, it also signifies yes. These
other hand signals are usually deeply unconscious and may occur without any conscious
awareness whatever. The wise therapist will note them without informing his patient of their
presence until he has had an opportunity to assess them. These signals lead to the assumption that
a different part of the unconscious mind is seeking communication with the therapist by means of
that hand and may wish to do so without informing any other part of the patient's mind of its
intentions.
This phenomenon has resulted in the construction of a specific technique designed to
accomodate the expression of a different viewpoint coexisting in the unconscious mind. This
technique is of value when, as noted in the previous section, conflicting signals are seen. In such
cases the other hand is stroked and the suggestion is given that a deeper part of the mind would
like to answer questions by using the other hand. These new signals are sometimes more clear
and distinct (131) than the original ones, even when the original signals have become faded or
confused.
Change of Signal: Generally speaking, signals once established tend to remain stable and
unaltered. On occasion, however, confusion arises because signals have become transposed and
the original yes signal has become the no signal and vice versa. So, whenever answers begin to
make no sense, the signals should be rechecked to see if their original meaning has been altered.
Should any considerable interval occur between sessions, or from the last period of questioning, it
is always possible that a change in signals has occurred and it is wise to make the occasional
check simply by asking the unconscious mind to raise the yes finger, etc. A change of signals can
be a sign of resistance, but in most cases analysis proceeds normally and uninterruptedly once
normal communication is reestablished.
Finger Pressure:
Sometimes, a finger bearing a signal may be noticed to be pressing down rather than lifting in
response to a question. This must definitely be interpreted as a strong resistance to disclosure and
the therapist must treat cautiously. It is as if one part is attempting to silence another and this is a
clear sign of great conflict about therapy. Cheek (198 I) believes that finger pressure may be a
yes, but response requesting further information before replying.
Significance of Ideomotor Finger Responses: The unconscious signalling of the
ideomotor questioning technique seems to be controlled by unconscious ego states. It is likely
that the Adult ego state is the usual conscious ego state although it has many unconscious
resources which are available for therapy. During therapy, the conscious part of the Adult is
required to become relatively inactive, and it is probable that the ideomotor responses emanate
from the more deeply unconscious ego states of the Parent and the Child.
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Clinically, it would appear that the more authoritarian Parent usually takes control of the
finger signals and is the ego state responsible for unconscious resistance. When there are
confusing signals or the appearance of signals on the other hand, it is likely that the more deeply
unconscious Child ego state is striving to communicate and to escape the control of the Parent
ego state. It is in such cases that the (132) Child/Parent conflict becomes very apparent and the
issues over which there is great unconscious disagreement between them (probably responsible
for the presenting symptoms) become identifiable.
If this supposition is correct, then hypnosis is really a process of communication with
unconscious ego states, with deeper hypnosis being the communication with the more deeply
unconscious Child ego state to the varying exclusion of the more conscious ego state of the Adult.
This would account for the posthypnotic amnesia experienced by the more conscious Adult which
may have been excluded from the communication with the deeply unconscious ego states during
hypnosis.
Repeated reference has been made to unconscious resistance in this chapter. This
resistance should always be accepted as part of the individual's survival mechanism and therapy,
if it is to be successful, must always take it into account. If a resistant ego state (usually the
Parent) can be identified, and the reason for its resistance to therapy understood, it is possible that
the therapist might be able to convert it into an ally in therapy rather than the foe it would
otherwise remain, ready to destroy any attempt at successful therapy. (133)

24. AN ANALYTICAL PROCEDURE: EDGAR BARNETT: ANALYTICAL

HYPNOTHERAPY: WESTWOOD PUBLISHING CO, GLENDALE, CA: 1989
Ellenberger (1966) conceived of illness as resulting from unexpressed secret ideas; illness,
he maintained, is cured through the expression of such ideas. As he acknowledged, this concept
was first formulated by de Puysegar and was extensively relied upon by the Viennese physician,
Moritz Benedict. Analytical hypnotherapy appreciates this concept of illness, since the
uncovering of the sources of emotional problems is the logical basis of any analytical procedure.
However, as Schilder and Kanders (1927), and Freud before them, pointed out, knowledge of the
historical roots of the disorder is in itself insufficient for cure. Only by strictly adhering to the
principles of analytical hypnotherapy as described in Chapter Six will a significant majority of
patients achieve successful recovery from symptoms. The procedure to be described is one
currently in use by the author.
In this procedure, all of the principles underlying good analytical hypnotherapy are employed. It
will be understood that any analytical hypnotherapist will formulate a procedure which will more
nearly suit his own personality. He can be assured of success so long as the principles of
analytical hypnotherapy are adhered to.
The first step prior to commencing analysis is to establish ideomotor signals. The therapist
can proceed when he is certain that these are functioning as satisfactorily as he can encourage
them to be. The sequence of questions that follows is one that the author has found to be effective
for him, but they should not be imitated without due regard for the therapist's own personality
and the patient's needs.
FIRST PRINCIPLE: Identification of the Critical Experience: Does your
unconscious mind really want me to help? This opening question gives the therapist the
opportunity to observe the kinds of (138) signals which are being given, and also to determine
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whether good unconscious communication has indeed been established. Where the signal is in the
affirmative and is a good one, therapy is evidently off to a good start. This can be a good time to
establish, should there be any doubt, whether the responses are truly unconscious simply by
asking, Did that answer come from your deep unconscious mind? If the answer is no, then ask the
patient to allow his unconscious mind to answer and then repeat the question, Does your
unconscious mind really want me to help? Where the signal is uncertain, there is likely to be
some unconscious resistance to therapy and the therapist should be aware of this. Should the
answer to this question be negative, there is present a great deal of unconscious resistance to
uncovering which may render therapy impossible unless it is effectively utilized.
At this juncture, if there is evidence of unconscious resistance to therapy, there are two
courses of action open to the therapist. First, he should make it clear to the patient that he cannot
help him without his unconscious cooperation and that he can make him do nothing against his
will. This may have the desired effect of reducing unconscious resistance resulting from a fear of
being controlled or directed. An affirmative response may now be obtained to this first question.
Alternatively, the therapist can ask the unconscious mind if there is a part that does want the
therapist to help. If there is, it should indicate this by raising the yes finger on one or other hand,
thus giving the opportunity to a cooperative part to disclose itself. If there is a part seeking help,
that part which is rejecting help needs to be dealt with by asking if it will allow help to be given.
This recognition by the therapist of the power of the unconscious part to sabotage therapy may
appease it and allow therapy to proceed. In any case, the therapist must proceed with care,
knowing that there is some unconscious opposition to therapy, and recognizing that he is
essentially powerless in the absence of unconscious cooperation. He should admit this both to
himself and his patient in order for the expectations of therapy to remain realistic. Let us suppose
that the unconscious permission for therapy to proceed has been gained and the therapeutic
procedure can continue.
Does your unconscious mind agree to cooperate with me? This second question
emphasizes the essentially cooperative nature of analytical hypnotherapy and, if the answer to it
is yes, there is then a far greater chance of success. If there is a negative response to this question
- particularly when a desire for help has been expressed - (139) then it should once again be
emphasized that therapy cannot proceed without cooperation, however limited; if this cooperation
is not forthcoming, therapy will have to be abandoned. Fortunately, this abandonment is rarely
necessary, for once again, the expression of the therapist's dependence upon the unconscious
mind's assistance may be enough to enlist it. With each of these questions, the therapist remains
alert to any conscious interference with the ideomotor responses and, if any is detected, the
patient is exhorted to allow things to happen without interference.
Would it be all right for your unconscious mind to look at unconscious memories
which are beyond your conscious memory? It is always to be hoped that this question is
answered with a yes, since this lies at the heart of the use of hypnosis in therapy. If there is a no,
the question should be modified by asking if it would be all right to look at some unconscious
memories. Frequently the resistance is to the uncovering of certain secrets, although there may be
an agreement to look at other unconscious memories. Later, there may well be a change of heart
about dealing with the secret memories responsible for symptoms. Having arrived at this stage
and having been assured that the ideomotor signals are being entirely unconsciously activated, the
therapist can proceed with the analysis proper.
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Please orient your inner mind back to the first experience which has anything to do
with your present tensions and when you are there your yes finger will lift to let me know.
This is the first direction for uncovering. In those cases where cooperation has been established,
there will eventually be an appropriate response and the yes finger will lift. The directions should
always be repeated at least once so that there is no misunderstanding as to what is being requested
of the unconscious mind. When the yes finger lifts, we know that a critical experience has been
located. Occasionally this may be accompanied by evidences of an emotional response, but
generally, the patient is not aware of anything unusual.
Please review that experience in detail at an unconscious level and when the review is
completed, the yes finger can lift to let me know (or the yes finger can be asked to fall back as
a signal if it remains raised following the previous direction). The first detailed unconscious
review of the critical experience has now taken place and there mayor may not be any awareness
of what has been reviewed. If the responses (140) remain strong, the therapist knows that there is
still good unconscious cooperation and communication, and the next series of steps in this
procedure is directed at defining the emotional characteristics of the critical experience. It is
important to note that each time a question is posed about this experience, a further review and
reassessment of it is being made unconsciously.
Is that experience one that is scary or frightening? This is the first in a series of
questions designed to delineate the emotional characteristics of the critical experience. Other
similar questions follow which ask about sadness (hurt), anger (or resentment) and guilt (or
shame or embarrassment). These are usually readily answered by a yes or a no signal. The
answers may be accompanied by some visible expression of the emotion that is being recalled and
the patient can be encouraged to allow himself to feel any or all of the emotion thus revealed. If
he is indeed able at this stage to allow himself to feel this previously repressed emotion in an
abreactive manner, he is already accepting this emotion as proper. This emotional response is an
excellent prognostic sign and indicates an early reduction of the Parent/Child conflict because the
Parent is permitting the Child to express a previously forbidden feeling. A simple but useful
mnemonic device to enable the therapist to remember to ask about each important primary
emotion is SHAG: Scary, Hurtful, Angry, Guilty.
Is there anything sexual about this experience? Since a very high proportion of
problems are found to be due to guilt feelings arising from a sexual experience, it saves a great
deal of time to ask this question at the outset. An acknowledgment of guilt about a sexual
experience often enables the patient to begin to deal with it.
The critical experience has now been defined as far as its important emotional content is
concerned and at the same time the chronology of the experience should be determined in order
further to delineate and distinguish it from other similar experiences.
Timing of the Critical Experience: A series of questions is now directed to determine
the age of the patient at the time when the critical experience occurred. There are many ways of
doing this, but a satisfactory one is to ask initially about successive five year periods as follows:
Did this experience occur at the age of five years or younger? Did this experience occur at the age
of ten years or younger? When a yes is received, questions are then directed (141) at each
specific year, e.g., Are you six years of age at the time of this experience? Are you seven years of
age?, etc., until a yes defines the year. At this point, the therapist is able to label the critical
experience by the year of age in which it occurred; this is the site of the Child/Parent conflict
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responsible for symptoms. It is the ego state complex formed by this conflict which now needs to
be examined. Only then can the decisions made at that time, which are responsible for the
symptoms, be dealt with and resolved.
It is at this juncture that the critical experience is ready to be dealt with more directly.
Unconscious permission is required if this is to be done at a more conscious level; otherwise all
succeeding therapy with this experience must take place only at an unconscious level. Therapy at
a conscious level may be more effective, and has the advantage of giving the therapist a clear
understanding of the factors involved in the development of the problem, but it must be
emphatically stated here that much excellent analytical hypnotherapy can take place at a deeply
unconscious level without any awareness by the therapist or the patient of the precise nature of
the critical experience to be dealt with.
Would it be all right for John to know about this experience up here in 1981? If so,
the yes finger will lift, to let me know. If not, the no finger will lift. If there is a negative
response to this question, the therapist must respect the patient's wish to keep this information
unconscious. In fact, the therapist has no alternative but to accept any decision made by the
unconscious mind regarding the revelation of information. The therapist can indicate his support
of the unconscious wish of the patient to retain information, and in so doing will inevitably
increase his rapport with the patient. If, on the other hand, there is a yes response to this question,
the therapist can then ask the unconscious mind to bring the experience to a level where the
conscious mind can know about it and to indicate when this has been accomplished by raising the
yes finger.
Would it be all right for John to feel all of the feelings of this experience? A no to this
question must be treated with respect because the unconscious mind, in this instance, feels a need
to protect the psyche from the intense feelings that have been repressed. Later, during the
analytical procedure, these feelings may be allowed into awareness and this will be readily
observable by the therapist.
In the event of a yes answer to this question, the next step is to ask the unconscious mind
to bring these feelings forward to a level where (142) they can be felt and, when each has been
fully experienced, to indicate this by a yes signal. At this time, there may be a significant and
therapeutic abreaction.
Would it be all right for you to talk to me about this experience? This question seeks
permission for ventilation of the whole experience, and there may be an understandable
reluctance on the part of the patient to do this. This reluctance must be respected; in fact, it is a
good idea to remind him that he does not have to talk about anything that he does not wish to. If
he indicated that it is all right for him to talk about the experience, he is then requested to be in
that experience as fully as possible; that is, to feel, see and hear everything that is part of the
experience to be described so that he may discuss it in detail. He should be encouraged to be
present in the experience using the present tense because at such times many patients will regress
fully to the experience. In any case the recall of the experience is usually detailed and the
emotions evoked intense. The therapist who has reached the unconscious level by this prescribed
route need not fear these intense emotions; they are being expressed with the permission of the
patient's own unconscious mind.
If the patient chooses not to talk about the experience, it must then be dealt with at a
nonverbal level, being labeled according to the age at which it occurred (e.g., the experience of
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four year old John). Regardless of whether it can be verbalised, care must be taken to ensure that
all of the relevant material is being dealt with. Such questions as Does forty year old John now
know all that needs to be known in order to understand the experience of four year old John?
should be asked in order to ascertain whether any relevant material has been omitted. If the
experience is verbalized, it is an easy matter to enquire, Is there anything more that we need to
know in order to understand? The identification of the critical experience has now been
completed and yet therapy has barely begun.
Principle Two: Understanding the Repressed Emotion(s) and the Associated Feeling
of Guilt: In this second phase of analysis, the understanding of the Adult ego state is directly
applied to the Child/Parent conflict manifested in the critical experience as it has been revealed so
far. Sometimes this may have already been accomplished and this accounts for the occasional
successes achieved with only identification of the critical experience. (143)
I would like you to give all of your forty (present age) years of wisdom and
understanding to four year old John (labelled critical experience) and when this has been
done the yes finger will lift. This occurs after a varying interval to indicate that the resources of
the Adult have at last been brought to bear upon the critical experience that has been located. If a
no is signalled, this can only mean that the four year old ego state complex at the critical
experience is refusing assistance. The question, Do you really want me to help? should be
repeated in the hope of achieving cooperation. Occasionally a no means that there is insufficient
information for full understanding to be applied to the critical experience. The question, Is there
more information that needs to be divulged before full understanding can be attained? needs to be
asked. If so, this information should be imparted to the forty year old John (Adult) by the four
year old John (Child/Parent) ego complex, and this can be done at an entirely unconscious level
with the ideomotor signals as the only evidence that this has been accomplished.
It is the objective of this stage that the Adult persuade the Parent of the Child's essential
innocence and of his fundamental right to his feelings. The Adult's understanding is
simultaneously applied to the Child so that this ego state can now appreciate that its
uncomfortable feelings, though no longer requiring to be repressed, neither require to be retained,
since the event originally responsible for these feelings has long been concluded. The
achievement of both these objectives must await the confirmation of further analytical
procedures.
Principle Three: Recognition of the Current Irrelevance of the Previously Repressed
Emotion: Four year old John (referring here to the original critical experience) with the
wisdom and understanding that you now have, do you still need to keep those old tensions?
At this point the specific emotions identified as being repressed can be enumerated individually.
If the answer to this question is a no, the therapist can immediately proceed to the next principle.
A significant proportion of cases answer yes to this question, which means that the ego state
complex of the critical experience persists and our four year old John is not yet convinced that his
tensions are irrelevant. Retention of tensions and uncomfortable feelings are not as accidental as
we are sometimes led to believe. The functions of retained uncomfortable feelings are purposeful,
being either protective or punitive. If they are retained for protective (144) reasons, it is because
the Child part of the Child/Parent complex of our four year old John is not convinced that the
forty year old Adult can be trusted to take care of him and therefore he must protect himself. This
lack of trust may be the result of a continued internal dialogue between the Child and the Parent.
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On the other hand, uncomfortable feelings are often retained for punitive reasons by the Parent to
keep the Child repressed. Until the Child is convinced that the Adult is able fully to take care of
him with the aid of the Parent, or until the Parent is convinced that there is no longer any need to
repress the Child with punitive discomfort, the need to retain old tensions remains. The reasons
for retaining discomfort need to be understood and the following questions are directed to this
end.
Are you keeping those old out of date uncomfortable feelings for protection? A yes
answer to this question means that the therapist must renew his efforts to persuade the Adult of
forty year old John to convince four year old John that he (forty year old John) is now able to
protect himself and he needs no further protection from four year old John's outdated feelings.
Four year old John needs to be reassured that forty year old John has ready access to his own
protective emotions should the need arise. If necessary, four year old John can be asked to hand
over all of his outdated, uncomfortable feelings and responsibilities to forty year old John who is
now quite capable of protecting every part of the personality complex. If forty year old John has
been sufficiently convincing, the question as to whether these old tensions are necessary should
now receive a no response. This procedure may have to be repeated before this reply is attained.
Sometimes four year old John remains convinced that he must retain his old protective emotions
for one reason or another. He should then be asked, Do you need to keep these uncomfortable
feelings all of the time? A no to this question should be followed by a direction to four year old
John to be certain of the kind of circumstances when he feels that he needs all of his
uncomfortable tensions and confirm this fact with ideomotor signals. He is then asked to be
equally certain of those circumstances where the uncomfortable feelings are not necessary and be
persuaded to discover means of relinquishing these feelings at such times. This manoeuvre does
not abolish symptoms but it does establish considerable control over them.
Are you keeping these tensions to punish yourself with? A more difficult situation
arises when old tensions are deemed to be necessary (145) not for protective reasons but for
self-punitive reasons. When the Parent remains convinced that it is still its duty to punish the
Child (in spite of the intervention of the Adult), a renewal of this intervention is called for. The
objective is to convince the Parent that the Child did not do anything that could be regarded as
bad, even though it may have originally merited parental disapproval, and the punishment so far
meted out by the Parent should now be regarded as having been more than adequate. To aid the
Parent, the therapist can make such statements as the following: I know that you have done a
great job in disciplining four year old John and have done so to the best of your ability, but the
time has now come for you to forgive him. I believe that you can do this if forty year old John
will make sure that all will go well and if four year old John can assure you that he really did not
mean to create so much distress by his behaviour. In this way the Parent is given a means of
relinquishing the arduous responsibility of maintaining a punitive stance toward the Child and can
then be encouraged to take care of four year old John in other more appropriate, protective,
nurturing and loving, parental ways.
The punitive Parent who resists Adult intervention is the most difficult therapeutic
problem that the analytical hypnotherapist is likely to meet. His ingenuity in finding means of
persuading the Parent to forgive the Child will be tried to the utmost if the patient remains in
therapy. But in most of these cases, therapy is unilaterally terminated by the patient who, at a
conscious level, is only aware that therapy is creating intense discomfort within him. A great deal
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of persuasion, then, will be necessary before a strong Parent ego state will relinquish the role of
the disciplinarian, a role which so often characterizes the Parent in these persistent Child/Parent
conflicts. The Parent will sometimes refuse to give up this punitive role and so the Child/Parent
conflict continues unresolved. However, if the Parent is persuaded, a no is finally received to the
question as to whether the punishment in the form of the retained tensions is any longer
necessary.
Principle Four: Relinquishing the Repressed and Repressing Emotions: While the
Parent ego state has agreed to stop punishing the Child (and the Child has recognized that the old
outdated feelings need no longer be retained), it must nevertheless be empowered to discover
means of relinquishing its repressing activity. It may need to obtain permission from other parts
of the personality to accomplish this; it also needs to find improved ways of relating internally
with the Child. All of these (146) new behaviors must be discovered if the Child/Parent conflict is
to come to an end. The Adult ego state is that part of the individual's personality with the
resources and the communications within the personality to accomplish this task. With ideomotor
questioning, it is easy to switch from addressing the unconscious Adult to communicating with
the Child/Parent ego state complex simply by labeling them by their respective ages.
Four year old John has agreed that these old tensions are no longer necessary. Forty
year old John, using all of your wisdom and understanding, I would like you to find a way
for four year old John to let go of all of these unnecessary, outdated, useless old tensions.
When this has been accomplished, the yes finger can lift to let me know. Fortunately, this stage is
usually accomplished readily, even though it may take some time for the unconscious mind to
find an appropriate solution. It is wise to assure the patient that the solution need not be known at
a conscious level. In some cases, no solution is found and this is invariably because a strong
Parent has decided to retain a punitive position.
Principle Five: Recognition of the Resolution of the Child/Parent Conflict: At this
stage, a solution to the conflict between the Child and the Parent has been found but not yet
applied. It is now necessary to apply this solution to see if it is acceptable to all parts of the
personality.
Four year old John, forty year old John has now found a means by which you can let
go of all of the old, out of date, unnecessary tensions that you have been keeping. Please use
that way right now and let go of all of those tensions. When you have done so, let me know
by raising the yes finger. In most cases the yes finger is promptly raised and the therapist knows
that the conflict is probably at an end. Nevertheless, he should then confirm that the tensions have
been relinquished by saying, If you have really let go of all of the old tensions, John, you should
now be feeling very comfortable inside, more comfortable than you have felt for thirty-six years.
If you are really very comfortable, the yes finger will lift again.
An even better confirmation of this relief from tension comes if there is a spontaneous
smile. A simple confirmation of this inner comfort is the smile test, in which the previously
distressed ego state complex is asked to indicate its relief by smiling, as follows: Four year old
John, if (147) you are really feeling comfortable, you can give me a nice smile to let me know.
The presence of a really happy smile is excellent proof of total relief from the original tension.
Conversely, any difficulty in giving that smile will alert the therapist to the probability that some
old tension remains. In such cases, appropriate questioning usually indicates that a strong Parent
is having difficulty in relinquishing its accustomed disciplinary and punitive role. Should this be
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the case, steps must be retraced back to Principle One to seek any aspects of the critical
experience that have escaped Adult attention. Then, proceed to Principle Two to reapply Adult
understanding and discover if the Parent can be persuaded that the time has now come for
complete pardoning of the Child, and that there are other more rewarding tasks for it to undertake
in the interests of the whole personality. If, at this stage, Parental forgiveness is forthcoming, the
remaining Principles can be applied in fairly quick succession.
Principle Six Rehabilitation: Although we have reached this final stage with
confirmation that old and outdated tensions have now been relinquished in at least one critical
experience, there are usually others that need to be dealt with similarly. This can readily be
accomplished by asking the patient to examine memories before and after this particular
experience already dealt with to see if there are any others which are the source of old tensions. If
so, they are subjected to the same procedure.
It is not sufficient for complete therapy merely to deal with old tensions, because
eradicating these tensions does not give the patient the means whereby he can properly manage
his life. Inevitably, the previous tensions and the symptoms which they have produced have had
many effects upon the patient's environment and the people who inhabit it. Without his
symptoms, the patient's environment must certainly change and he needs to know how to deal
with these changes. While he will have eliminated the disadvantages that his symptoms caused,
there will also be a loss of some of the advantages, those secondary gains of which he may have
been only dimly aware. He needs to learn how to retain these advantages without having to return
to his symptoms for assistance, and a program of rehabilitation in which he learns to do so must
be instituted. This rehabilitation program has an importance that must not be underestimated if
patients are to remain symptom-free. This phase comprises ego strengthening and assertiveness
training, to be described in greater detail in Chapter (148) Fourteen, which are essential if the
patient is not to return to his old symptomatology for the secondary gains that he needs.
When this stage is reached, there are other ways in which the therapist makes certain that
no other sources of unconscious tension remain. In order to discover whether other critical
experiences still remain to be dealt with, the following question should be asked: Is there any
other part ofJohn who is not feeling O.K.?, and Is there any other experience which is still
creating uncomfortable feelings?
If either of these questions is answered by yes, then the previous procedures are repeated
to locate and deal with any critical experience(s). If a no is received, then this indicates that all is
well and every part of John is now feeling O.K. Nevertheless, a further check is prudent in order
to make absolutely certain of this. For example, it can be stated: If every part of John is feeling
good, then every part is smiling inside. If that is so, then give me a big smile and raise the yes
finger. This smile test, if negative, will often indicate an uncomfortable ego state complex still
concealed at the site of a persistent Child/Parent conflict. If the smile test is positive, the
rehabilitation procedures designed to establish and reinforce ego strength and assertiveness are
proceeded with.
Some or all of these analytical procedures may be accomplished at a single session, since
many of the difficulties here dealt with at length occur infrequently in practice. As a rule, several
sessions are required before all of the critical experiences are located and the associated tensions
responsible for symptoms resolved, and it is always advisable to review the progress made in
previous sessions before commencing therapy. This can be accomplished simply by asking the
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subject to Please review in detail everything that we talked about at our last meeting. This can be
done simply and rapidly by your unconscious mind without any conscious effort. When it has
been accomplished, your yes finger will lift to let us know. When the finger lifts, say: If any of
those experiences that you have reviewed are still causing uncomfortable tensions, your yes
finger will lift; if not, your no finger will lift. If there is any indication that a critical experience
previously examined is still responsible for unconscious tension, it must be dealt with precisely as
before. In such cases there has been some guilt retained and further efforts need to be made to
persuade the reluctant Parent to relinquish its punitive role.
Here follows a transcript of an initial session with a patient, a woman of twenty-eight
whom we will call Vera. She is suffering from attacks of acute anxiety which tend to occur
whenever she (149) from home. She recalled that five years ago, at the birth of her son, she had a
great fear of dying, and whenever she thought about dying she would panic. This fear abated for
about three years. Then two years ago, prior to therapy, the anxiety returned and although it was
no longer associated with thoughts of dying, it would occur in crowds, when visiting friends, or
in strange places. Her symptoms were typical in that she suffered from tightness in the chest,
feelings of faintness, loss of control, and difficulty in breathing. These attacks were always
followed by headaches.
The first part of the interview was taken up with listening to a recital of the symptoms and
then discussing how hypnotherapy could help. At first her anxiety prevented her from accepting
any suggestions, but when she was assured that she had full control over her responses, she
relaxed and entered hypnosis successfully. At the commencement of this excerpt, Vera has
already been able to experience good imagery of being by a lake and feeling relaxed.
DR I am going to ask you to let It was felt that she was sufficiently involved
in the
your head listen to me and to let it hypnotic process to use head signals and this
saved .
answer my questions by nodding for the time that would otherwise be spent in
establishing
yes or shaking for no. Let it do this other signals. Her agreement to let this
happen also
automatically. Don't even try to speeded the process.
control it. Let whatever happens
happen. If that's okay say yes.
PT Yes.
DR Now I am going to ask your The first question has been asked in such a
way as to
deep inner mind a question. You promote unconscious/conscious dissociation,
stressing
may not be aware of how your head that she may not be aware of her head
movements
moves in response but it doesn't because of involvement with her imagery.
Further, it
matter because you can enjoy that is suggested that she need not consciously
listen
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place by the water and you don't which probably increases her dissociation.
need to pay any attention to me.
Your deep inner mind is listening all
of the time. I am going to ask your
deep inner mind this question: do
you really want me to help you? If
you do, your head will automatically
nod for yes. Head nods. (150)
Do you think, in the back of your
mind, that you really want to cooperate
with me? Head nods. Listen to Hypnosis is being increased
by increasing the
me very carefully, and when you are unconscious attention; this is
monitored by the
listening to me very, very carefully, ideomotor signal.
your head will automatically nod
yes. Head nods. Now, would it be
all right to look at experiences
which are beyond your conscious
memory? If it would be okay to do
that, your head will automatically
nod yes. If it wouldn't be okay, your
head will shake for no. Head nods. This is the first question
directed at analysis.
I am going to ask your deep inner mind, then to ... Evidence of cooperation is sought here.
Unconscious automaticity is still having
encouraged
At this point, there is an inquiry into the
patient's birth experience which is found to
be a positive one (i.e. she feels good about
having been born.)
Now, I am going to ask you to come
forward from being born to the very
first experience that has got anything
whatever to do with these attacks
of anxiety or tension. When you
are at that very first experience that Location of the first critical
experience has
has anything whatever to do with it - now begun.
you do not need to become consciously
aware of it - but when your deep
inner mind is there, your head will nod The important first critical experience
has
for yes. Head nods. Now I want you to been unconsciously located. Although
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go through that experience just in your deep
inner mind - your conscious mind doesn't
need to know about this and when you
have done that, again your head will nod for yes.
Head nods. (151)
That experience you have just gone
through ... is it a scary experience?
the
head has nodded, there is no conscious
awareness of what this experience is.
The emotional components of
the experience
are being carefully delineated:

Head nods. Makes you feel sad? Scared? Hurt? Angry? Guilty?
Nods. Makes you feel angry? Nods.
Guilty? Nods. Is it sexual? Head
shakes. Are you five years of age or
younger?
PT About five. The location of
the age of the experience has
DR You're five years of age. Okay. been accomplished. The
verbal response
Five year old Vera, what's happening? which replaced the expected
nonverbal
What's happening at five years ideomotor response indicates a
good.
of age? The patient is beginning to involvement in the hypnotic
experience. The
look extremely sad and is obviously therapist is observing a
significant change in
on the verge of tears. You're feeling the patient's demeanor which
clearly indicates
very sad, scared and angry. What's that she is feeling very
disturbed by the
happening there? Five year old unconscious memory she has
located. At first
Vera, if it is okay to talk to me about she is unable to verbalize what
she is
it, just nod your head. If it is not, experiencing.
shake your head. Head shakes.
Okay, you needn't talk about it. The information is still at a
deeply
Does twenty-eight year old Vera unconscious level but is
gradually brought up
know all about it now? Shakes. Can to a cognitive level, then to an
emotive level,
you tell her all about it? Nods. Will and finally to a level where it
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can be talked
you tell her? Nods. Okay ... Does about. It is presumably
reviewed at each level
she know all about it now? Nods. before it is permitted to pass
on to a greater
Can she now feel all of that scared level of awareness.
feeling and all of that sad feeling and
all of that angry feeling? Nods. She
can? Oh, good. Do you think that
you are going to be able to tell me
anything about it at all? Nods.
Okay, five year old Vera. It is really
scary, is it? Nods. And sad? Nods.
Okay, bring it all forward, What's
happening now? Where are you?
PT I'm waiting at home. Tearfully. There is a spontaneous
regression and the
DR You are? What for? feelings of five year
old Vera are being vividly
PT For my Mum.

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PT She's late.
DR Oh, dear.
PT I'm afraid of being left alone.
DR I see. What are you afraid of?
PT I don't know where to go if she doesn't come home.
DR Yes ... what happens?
PT Well, I cry.
DR Is there anyone about? At this point, there is a
feeling of being totally
PT No.
abandoned. This is the most
frightening
DR Are you in the house? feeling that a child can
experience.
PT Yes. Looking frightened.
DR Very scared? Do you cry for a long time
before she comes?
PT No.
DR Does she come soon?
PT About five or ten minutes.
DR And how do you feel when she comes? It now becomes very apparent how
important
PT Relieved. With a sigh. mother is to the child's
feelings of security. The therapist is here
searching for any (153)
elements of discomfort in the experience
which are attributable to mother, but he finds
none.
DR Did she say anything that bothers you?
 238

PT No.
DR Does she ask you how you are? Nods.
Does she give you a cuddle? Nods.
Do you feel safe? Nods.
Okay, twenty-eight year old Vera, At this point the therapist calls
upon the.
did you hear all of that? unconscious Adult ego
state to review
PT Yes.

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DR There is five year old Vera still complex has to communicate.

The Adult is
feeling scared and still feeling hurt. mobilized simply by calling
on it by its label,
Would you please give her all of twenty-eight year old Vera. It
is then asked to
your comforting, your wisdom and make its considerable
resources available.
understanding? When you have Now the five year old
complex is instructed to
done that, nod your head for yes. utilize these resources to
formulate new
Nods. Five year old Vera, now conclusions in the light of this
up-to-date
you've heard that, do you still need information
to keep that scared feeling, that hurt
feeling, that angry feeling any
longer? If you do, nod your head for
yes, but if you don't, then shake
your head for no. Head shakes for no. At this stage, it appears that the old
tensions
Okay, twenty-eight year old Vera, are now regarded as
unnecessary, and the
five year old Vera has told me that Adult is once again called
upon to use its
she doesn't need to keep that old resources to discover a means
of relinquishing
scared feeling any longer. Would long-held tensions.
you please find a way for her to let
go of it. When you have found a
way, nod your head for yes.
 240

PT Nodding. I've found a way.

DR Five year old Vera, there is a Five year old Vera is now
encouraged to
way now. There's a way you can let aged to consider this way of giving (154) up
old
go of that scared feeling right now. tensions. The therapist
continues to give as
You can feel safe to change that sad much encouragement as
possible by making
feeling into a happy one. Let that old the state of being tension-free appear
very
angry feeling go and be loving. attractive. However, she is
unable to accept
When you have done that, let me this solution and it becomes
clear that there
know by nodding your head ... must be some reason for this
which has not yet
Five year old Vera, can you do it? been dealt with. Once again,
the Adult's
Head shakes slowly. Okay ... Now, resources are called upon.
twenty-eight year old Vera, five year
old Vera can't do it yet. She is still
keeping some uncomfortable feelings ...
I want you to really understand
what it is she is keeping.
Maybe, five year old Vera, you can
tell me what it is that is making you
feel so bad ... You haven't told me The therapist's Adult and the
patient's Adult
about something that is still bothering cooperate in the search for something
which
you. What is that? .. Are you prevents the five year
old from relinquishing
still angry with her - with Mum for not old tensions, something that is
responsible for
coming? .. Do you feel guilty old guilt feelings is most
likely, and this
about being angry with her? proves to be the case.
PT Sighs.
DR Do you feel guilty about being
angry with her? Nods.
Is there anything else that you want A careful check is made to
ascertain whether
to tell us, five year old Vera? If there there might be anything else about the
 241

critical
is, nod your head for yes; if there experience which might cause
further
isn't, shake your head for no ... retention of uncomfortable
feelings, perhaps
Shakes. for
punitive reasons.
Okay, twenty-eight year old Vera,
see if you can get her really to feel Once again, the Adult is called
upon for aid in
good. When you have done that, discovering whether five year
old Vera is
nod your head for yes ... Nods. Five ready to relinquish the old
tensions.
year old Vera, now you've heard
that, do you still need to keep those
old, out of date, uncomfortable feeling (155)
any longer? .. Head shakes. Good.
Twenty-eight year old Vera, five This time it appears that five
year old Vera is
year old Vera now says she doesn't more certain that these
tensions are really
have to keep those uncomfortable unnecessary.
feelings any more. They're out of Strong encouragement is
given to five year old
date, they're finished with. It's all Vera to relinquish the
outdated uncomfortable
past. It's over, and I am going to ask feelings.
you to please find a way for her to let
go of those uncomfortable feelings
for good. When you have found a
way, nod your head for yes ... Nods.
Five year old Vera, you can now
let go of those uncomfortable feelings.
Let go of those uncomfortable feelings
right now, and when you have
done that, just nod your head to let
me know that you have done it ...
Nods. Now if you really have let Confirmation of complete
resolution of the
them all go, five year old Vera, you

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should be feeling very good inside. applied since it has been

found to be a reliable
 243

Good, comfortable feelings, so good indicator of unconscious comfort

following
to let go of all that pain and unnecessary the resolution of conflict.
uncomfortable feeling.
When you are feeling really good
inside, perhaps you can give me a
smile which says, yes, I am feeling
good Five year old Vera, smile
please Smiles. Nice, that's nice ...
okay. Now, five year old Vera, I The stage is now set for the
examination of
want you to help us because there other critical experiences (ego
state
are some other Veras that are not complexes) contributing to the
persistence of
feeling okay. I now want you to symptoms. symptoms.
come forward from being five to the
next time that something is happening
when Vera is not feeling okay.
When you are there, nod your head
for yes ... Nods. I want you to go
through that experience and when
you have done that, nod your head
again fur yes ... Nods. (156)
The rehabilitation phase of analytical hypnotherapy is postponed till near the end of the
session when other critical experiences have been adequately dealt with, since this phase will
suffice for all of the experiences.
In this first session, Vera was also able to deal with an experience she had at the age of
seventeen. Her performance as a high school student at that time was so poor that it caused
parental disapproval and brought forth much guilt. An experience at the age of twenty-six, when
she was unable to be with her father while he was dying, produced more guilt feelings and a
marked increase in her level of anxiety. This was directly related to the onset of severe headaches
at that time. At later sessions, she dealt with other experiences associated with feelings of guilt.
With a reduction of this guilt, she was able to relinquish her anxiety and within about four
months of commencing therapy, she was able to function very normally.
It should be noted here that the assumption is made that uncomfortable feelings are always
retained for a reason. Once that reason is recognised as invalid, the uncomfortable feelings can be
reduced, not by a dampening activity such as is supplied by drugs and tranquillizers, but by a
simple release of the feelings, as one would let go of a balloon which then floats away
unhindered. When this is truly accomplished, such old feelings are gone forever. Of course, this
does not preclude the individual from responding to new situations with similar uncomfortable
feelings; but these are new feelings, and have no relationship with the previous cause of tension.
Thus they can be dealt with entirely in the present context of the provocative situation.
REFRAMING: Reframing (first described by Bandler and Grinder, 1979) is the name
 244

given to a technique for promoting a beneficial change in an individual. There are essentially two
types of reframing, the first of which attempts to separate the intention behind a specific set of
symptoms from the symptoms themselves and to reframe (reassociate) that intention in a more
beneficial behavior pattern. The second approach accepts the inappropriate behavior pattern and
reframes it so that it only occurs in a useful context. It assumes that inappropriate behaviour is
only inappropriate because it occurs out of context and that there is always a context in which it is
appropriate and useful. Analytical hypnotherapy should encompass these objectives of reframing
if it is to be maximally effective. These techniques are therefore of value to the analytical
hypnotherapist and add a further dimension to his (157) understanding of the mechanisms
whereby change is able to be effected, and can be applied in whole or in part whenever there
appears to be an indication for their application.
The first type of reframing, probably the more common in practice, is directed at the
intention behind the behaviour pattern which needs to be changed. This type has six essential
steps, all of which rest upon the basic premise (one that is also made in analytical hypnotherapy)
that each patient has adequate resources with which to formulate solutions for his own problems.
A second premise holds that symptoms are the means by which a part of the personality deals
with a problem to the best of its ability and to the limit of its own resources. It does this on behalf
of the whole personality in a somewhat separate manner which isolates it from access to other
resources. These resources are either present at the time of the origin of the symptoms or are
acquired at a later date by other parts of the personality.
In the techniques to be described, the problem is once again exposed to the far greater
resources of the remainder of the personality in the expectation that therein will lie a more
appropriate solution. These six essential steps in this first type of reframing are as follows.
Identification of the Unwanted Behavior Pattern or Symptom Complex: The
unwanted behavior pattern is one that the patient wants to be freed from but is unable to control
or modify. It creates discomfort for him either by taking the form of a compulsive behavior
pattern, or an inhibitory behavior which prevents him from acting appropriately. Once this
unwanted behavior is identified, the therapist moves on to the next step.
Establishing Communication with the Part of the Patient Responsible for the
Behaviour Pattern: Since this part is always unconscious, communication with it implies that
hypnosis is being used. The ease with which this communication usually occurs confirms that the
induction of hypnosis is, technically speaking, rarely a problem for the analytical hypnotherapist.
It is in this stage that the assumption that there is a part of the personality in charge of the
unwanted behavior becomes important. Even though it may be aware of the discomfort that it is
causing, it is in this personality part that the behavior must be maintained for the best interests of
the individual. The therapist should communicate this understanding to the patient so that the
unconscious part responsible (158) for the unwanted behavior pattern is aware that the therapist
respects it as much as any part of the patient's personality. In order to accomplish this
communication with the unconscious part, the patient is told that this part is attempting to do
something positive for him and in producing the symptom complex, is doing so to the best of its
ability. He is also told that this personality part must be satisfied that there is a better way of
achieving the same ends before it will permit a change in the behavior pattern. Such information
engages the attention of the part in question. The patient is then instructed to talk to himself by
going inside and asking the specific question, Will the part of me responsible for the symptoms
 245

(behaviour) communicate with 111e in consciousness? He then awaits and pays attention to any
changes (kinesthetic, auditory or visual) that follow.
In many cases, the response to the question is clearly a yes or a no, which is heard, seen,
or felt in some manner. In other cases, because the response is one which cannot be identified as
yes or no, it is so structured that an increase in the response will stand for yes and a decrease for
no. For example, the response of anxiety can be increased for yes or decreased for no. The
originators of the reframing techniques favour the use of these nonverbal responses (e.g.
sweating, palpitations, flushing, etc.) because they are immune from conscious interference and
represent direct unconscious communication. However, because they are also ideosensory
responses, and are only on occasion directly monitorable by the therapist, they require greater
skill in their interpretation than ideomotor responses. The therapist monitors them by means of
associated visible changes (e.g. flushing), but some reliance must be placed on the patient for
reporting the responses.
Distinguishing between the Pattern of Behaviour that Requires to be Changed and
the Intention Behind it. The objective of this third stage is to retain the beneficial intention
while altering the means by which the benefits are achieved. To accomplish this, the patient is
once again asked to go inside and ask another question of the part creating the symptom: Would
you be willing to let me know in consciousness what you are trying to do for me by this
behavior? Again, the answer may come in words, pictures or feelings which first indicate whether
this communication is indeed possible and secondly, what the intention really is. Sometimes the
intention may appear to be a negative and destructive one, but deeper inquiry will reveal another
intention which is really the positive and (159) essentially productive one. This intention is
acceptable at a conscious level.
Accessing the Patient's Creative Resources for Discovering New Solutions and
Applying Them to the Problem: In this fourth stage, new ways of accomplishing the same
intention by acceptable means are generated. This is accomplished by once again directing the
patient to go inside and ask the creative part of his mind to communicate, at an unconscious level,
with the part responsible for the unwanted symptoms and with it to create other ways of
achieving the same outcome as was intended. From the many options thus generated, the part
responsible for the symptoms is asked to select three which will work at least as effectively as its
present behavior pattern. Without being required to verbalize them, it is asked to indicate, by the
ideosensory response, its selection of each of these three options.
Undertaking to use the New Options in the Future: In this fifth stage, the question is
asked: Do you now agree that these three choices are as effective as the original behavior? If the
answer is yes, then the further question, Will you take responsibility for using these other
behauiours in the appropriate context? is asked.
Ecological Check: This sixth and final stage is so called because a change in attitude in
one part of the mind cannot occur in isolation; the views of the other parts of the personality must
be considered. Thus it is that this important stage defers to every part of the mind in order to
ascertain whether there are any objections to the new behaviors proposed. Since, in any particular
behavior pattern, many parts of the personality are involved, consensus is accomplished by asking
the question, Is there any part of me that has an objection to the new choices? If the answer is no,
the reframing process has come to an end; if the answer is yes, that objection must be dealt with if
success is to be assured. This is done by asking the creative part of the mind to find and generate
 246

new choices that will be acceptable as was done in stage four. Stages five and six are then
repeated.
In the second type of reframing, the task is to identify the context in which the behavior
would be appropriate. The behaviour is then securely attached to this context and limited to it.
This is accomplished by posing questions in stage three to discover the appropriate context, and if
none is found, then stage four will be necessary in order to call (160) upon the creative parts to
create new, appropriate contexts. In stage five, the part responsible for the behavior would be
asked to generate that behavior only in those contexts.
These techniques of reframing have been examined in some detail because much can be
learned from them by the analytical hypnotherapist. It is important to note that there is never any
formal hypnotic induction and yet when reframing is employed, the patient gives evidence of
being in hypnosis. The only instruction for the induction of hypnosis is the one to go inside and
talk to the part which ... etc. Hypnosis occurs without any signs of resistance since the patient is
directing the process himself.
The parts of the personality responsible for the different behaviors are simply called parts.
Presumably, they are ego states that become more clearly identified when using the
hypnoanalytical procedures. The unconscious creative part that is called upon to generate new
solutions is probably identical to the part which we have labelled the unconscious Adult, which
contains the unconscious wisdom and understanding necessary to find a means of relinquishing
unnecessary tensions.
In the final phase of analytical hypnotherapy, rehabilitation is prominent. It is in this
phase that the individual finds ways of coping without his symptoms. It is similar to stage six in
reframing where the ecological check unconsciously accomplishes the same objective.
In the following excerpt from an initial session with a patient, some of the principles of
reframing are used. As the problems unearthed become more complex, the more formal analytical
procedure previously described is employed.
Tim is a thirty year old man who comes to therapy because he is a compulsive gambler
who admits that he gets a high whenever he gambles. He used to feel very good whenever he
won, but prior to therapy, he found that he got the high feeling no matter what the outcome. He
no longer cared whether he won or lost because gambling itself provided him with the thrill that
he seeks. At one time it was winning that was all important to him, and he would experience a
high that would last for days. At present, he says that the good feeling is of very short duration
and lasts only while actually gambling. His response is similar to that of the drug addict who gets
a high at first from his drug, but as tolerance increases, the high becomes more elusive. When not
gambling, Tim gets very edgy; when gambling, he becomes more relaxed. The similarity between
gambling and taking a tranquillizer is very evident. (161)
Tim says that gambling has been a problem from the age of twelve when he first went to
the races with his father. When he first met his girl friend (four years prior to therapy), he had a
remission from the compulsion for six months. He recalls feeling very good with himself at the
time, and did not even think about gambling. Since then, however, the urge to gamble has
increased considerably. He is currently gambling both heavily and often and is becoming
seriously in debt. At the time of therapy, though he does little else but gamble, he does not
understand why he has changed so much. He rationalises that the excitement of his relationship to
his girlfriend has worn off and consequently he has returned to gambling. He describes an
 247

extreme depression that overwhelms him whenever he loses heavily, as he frequently does. Every
time, he resolves never again, but the determination does not last. There are times when he has
seriously contemplated suicide, and on one occasion made preparations for death.
DR Would you agree with me that This is the first suggestion that
there is an
some part of you must know why unconscious part responsible
for the
you gamble?
symptoms and this suggestion is
readily
PT There's got to be an answer somewhere, yes. accepted by the patient.
DR Yes, there must be some part of In this first part of reframing,
the need to
you that knows why you need this identify the part responsible
for the.
high; what it is that makes you feel compulsion is being
established, as well as
so tense beforehand and what there making some early
suggestions regarding its
is about gambling that makes you function in promoting
gambling. There has so
feel relaxed. There is some part of far been no mention of
hypnosis but the
the back of your mind or your unconscious process of communication with the
part
mind which knows these and responsible for gambling is
being discussed.
I would like to try something
simple to help you. We would like
you to feel okay without having to
gamble, but if you did gamble, it
would only be occasionally and
not compulsively.
PT Yes, I would like to be able to Although the patient evidently
wants to be rid
I do now. (162) of his gambling
compulsion, he is relieved to
DR I am going to ask you to close gamble occasionally but not
have to as
your eyes and then I want you to go know that there is no intention
to deprive him
inside and just ask yourself this simple of his freedom to gamble.
question, Will that part of me that makes me The induction of hypnosis is simply that of
gamble) will that part communicate asking the patient to make
 248

contact with an
with me in consciousness? Ask that question unconscious part. The closing of the eyes is .
and see what answer you get. There may be suggested in order to facilitate this
a yes feeling or a no feeling; you may communication. This is the second
stage in
see a yes or a no or you may hear a reframing. A wide variety of
possible
yes or a no. If you get a yes, nod your responses are suggested from which
the
head to let me know; if you get a no, unconscious mind can take its pick.
just shake your head ... Will that
part of me that makes me gamble A modification of the usual
reframing
communicate with me in consciousness? .. procedure is made by the therapist
when he
If you get a yes, nod your head; suggests that the ideomotor
head signals be
if you get a no, shake your head ... used to monitor whatever ideo
sensory
Head shakes for no ... Okay, you are responses are experienced.
There has been no
getting a no. Ask that part that is not attempt to define what the
ideosensory
going to communicate with you in responses are.
consciousness if it is really trying to do
something for you, because I believe Note that even a response of I will not
that it is trying to do something for communicate is itself a
communication. Such
you in some way that only it understands. a response is used to maintain contact
with the
If you get a yes, your head can nod for yes. .. part responsible for the unwanted behaviour
Head begins to nod very slowly. which responds by agreeing
that it really has a
Good. Now, even though you do protective role.
not know what that part is doing for
you, Tim, I want you to thank it. Further indications of the
therapist's
Say, I don't know what it is that you understanding of this role are
given by
are trying to do for me but I thank requesting the patient to thank
that part for its
you for whatever it is. When you've previous help.
done that, when you've thanked it,
just nod your head ... Head nods.
 249

Okay. Now, that part is doing The therapist further

emphasizes this
something for you and I would protective role which
increases the likelihood
think - I would guess - that it is of unconscious cooperation.
This emphasis
protecting you in some way. Let me on the protective role
separates it from the
ask that part, is it protecting you behavior it engenders, (163)
which is the third
in some way? If it is, you'll get a yes stage in reframing.
feeling and your head will nod for
yes, and if it isn't your head will
shake for no. You may not know
in what way it is protecting you, if it is . . .
Head Nods. Ah, you are getting a Some clarification of the kind
of protection
yes. Now, ask that part that's protecting offered is being suggested. It appears
that an
you: Is it protecting me from an extremely uncomfortable
feeling exists which
uncomfortable feeling? .. Head nods. is relieved by gambling. Before the
fourth
Yes, it is. Again will you please thank it for stage of the reframing technique, it is
wise to
doing this for you ... Nods. gain the commitment
of the responsible part to
Now ask if it will consider protecting consider alternative behaviors when
they are
you in a different way than presented.
gambling, if there is a better way to
protect you than gambling, would it
consider using that way instead? ..
Head nods. Yes, sure, it only wants
to protect you in the best way it
knows how ... Okay, now since you
have got that part to agree to protect
you in whatever best way it can,
perhaps it can do this without having to This is the fourth stage of reframing
in which
gamble ... I am now going to ask you to the vast resources of the creative
(unconscious
direct the creative part of your Adult?) part are called upon to
discover new
 250

mind to find other ways of solutions to the

problem of dealing with
protecting you from that uncomfortable discomfort. In this technique, only
three new
feeling than by gambling. Ask it solutions of the many possible
ones are asked
to find at least three ways. You for. This compares with the
stage in the
won't know what those three ways analytical procedure where
only one
are because you do not even know satisfactory solution is
requested.
what it is that you are being protected
from. The creative part of
your mind can find several ways,
but we will ask it to find only three.
When you get number one way, you
will feel your head nod for yes ...
Head nods. I now want you to ask it We shall see later that these
first two solutions
to find number two way ... Head nods. were found almost too easily and that
the time
Good. Now, ask it to find a third way, in finding the third way was well
spent.
and when you have got (164)
three ways, again your head will
nod for yes ... Head nods after a
long interval in which the therapist
encourages him to continue to
search for a third way. Good. Now The importance of gaining the
approval of the
Tim, I am going to ask that part that part responsible for the
unwanted behavior to
has in some way been protecting any proposed change in it
cannot be
you by gambling to look at those overestimated.
three ways which the creative part
of your mind has just found. When
it has done that, it will let you know
by giving you a yes ... Head nods.
Now ask that part that has been This is the fifth stage of
reframing wherein the
protecting you by gambling, Will it therapist obtains a
commitment from the part
 251

use those three ways, either one of

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them or all of them, to protect you

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instead of by gambling? .. Head nods.

I am now going to direct you
to ask every part of your mind
whether it will be all right to use The ecological check - the
sixth and vitally
these three new ways instead of important phase of reframing -
is now made.
 253

gambling. If it's okay to use these Objections, probably based on

the removal of
three ways instead of gambling, you secondary gains by the
proposed changes, are
will get a yes from every part of your freely heard and heeded.
mind. If any part says no, you will
get a no feeling ... There is some In this case a delay suggests
that a deeply
considerable delay at this point in situated part (d. hidden ego
state in next
getting a response during which the chapter) makes its objection
known with some
therapist repeats these instructions evident reluctance. This part
objects to the
carefully and slowly, and the head third way (reached by the
creative part only.
shakes. Okay, there is a part there after long deliberation) which
suggests that it
that has an objection. Ask that part was partly aware of
disagreement
if it objects to number one way and
if it does you will get a yes. Shakes
head. No. If it is objecting to With new information
the creative part is
number two way, ask it to give you a equal to the task of generating
modifications
yes ... Shakes head. No. If it is objecting to any one of its solutions.
to number three way, your
head will nod. Nods. Okay. Again
we will ask the creative part of your
mind to listen to the objection. (165)
There is an objection coming from a
deep part of your mind which says
that it does not accept number three
way; so ask the creative part of your
mind to look at that objection and
to modify that number three way.
When that number three way has
been changed to meet the objection
you will nod for yes ... Nods. Now, Again, every part that is
concerned must be
ask the part of your mind that has consulted, but the obviously
important one is
been making you gamble whether that which has the protective
 254

function. Since
that new change in number three it now approves, the stage is
ready for the
way is okay. Head nods. All right ecological check.
then. Let's go back to every part of
your mind. Does every part of your
mind now agree to those three
ways? .. Nods. Good. Notice
that every part agrees and that's good.
Ask the part of the mind that used to We need to be certain that when
protection is
make you gamble, will it now take required, gambling will never
again be used.
the responsibility for using those
three ways to protect you? .. Nods.
Good. Good. Okay, I am going to
ask you to see yourself at the next
time that you feel the need for protection.
See yourself, feel yourself using
one of those three ways, and
when you can feel that happening,
your head will nod yes ... Head
nods. Okay. Now ask that part of
your mind, will it be okay to use one
of those three ways from now on? If
it would be okay, your head will nod
yes ... Nods. Good. I want you to The total absence of
discomfort indicates the
notice how good that feels. In fact, if resolution of problems and is the
basis of the
it really feels good, your head is smile test which is applied
here in modified
going to nod yes again ... Shakes. Is form, i.e. feeling very good.
there a part feeling uncomfortable?
Nods. Okay, I am going to ask the Projecting into the future,
facing the situations
part that is feeling uncomfortable, responsible for tension, and
testing whether
do you object to those three ways? (166) the new solutions work are excellent
checking devices.
This indicates that all is not as well as had
been
supposed and again a deeply hidden part
Nods. Does it object to number one makes its presence felt. Its
 255

objections must be
way? .. Nods. Number two located. Because this
part feels it cannot
way? Nods. Does it object to accept the first two solutions,
these must be
number three way? Shakes. reprocessed once again
through the creative
It objects to number one and number part.
two ways. Okay, I am now going to
ask that part: please present your
objections clearly and concisely to
the creative part of the mind and
when that has been done your head
will nod for yes ... Nods. Okay.
Creative part of the mind: there are
some objections there to number
one and number two ways. I want
you to look at those objections and
find ways of meeting them because
we can't have Tim doing something
that is going to be objected to by any
part of the mind. We want every
part of the mind to feel okay about
these new ways of protecting Tim. I
want you to find an improved way
for the number one and number two
ways.
Tim, let's deal with number one way
first. When you have modified it so
that all objections have been met
and no part of your mind is made
uncomfortable by it, then nod your
head ... Shakes ... How about The creative part admits to
extreme difficulty
number two then? Nods. Okay, in finding a new solution to
the problem or
number two feels okay? Head nods modifying its original, number
one solution to
again. Number three is okay? Nods. meet the perceived objection
to it.
Okay, then, it is just number one
way that is a problem. Number one
way seems to be really very tricky.
Ask the creative part of your mind
 256

to think a bit more deeply about The creative part is given the
alternative of
number one way. If it can't be modified, constructing a totally new solution as
number
find a new number one way (167) one. It accepts this alternative
and discovers a
that will be acceptable to every part new solution which appears to
be acceptable
of your mind so that there will be to all parts of the mind.
three ways to protect Tim from discomfort.
When you have found a number one
way that is satisfactory, your head will nod yes ...
Nods. Okay, now I want you to check with
every part of your mind to see that
number one way is now okay. Nods . . .
Check with the part of your mind
that has been taking care of you and
protecting you by making you gamble
and see if it is okay with that part.
If so, your head will nod yes ...
Nods. Okay, now I am going to ask Once again, the commitment
to use the .
the part that has been taking care of you: solutions so painstakingly modified,
is sought
would you please now use one or more for and obtained
of those three new ways of protecting Tim
instead of by gambling? .. Nods. Okay. Once again the ecological check.
Check again all the way through your
mind and see if there is now any part that
disagrees with one of those three ways. If
there is, your head will nod yes; if
there isn't and there is no disagreement
whatever, your head will shake no ... Shakes.
Now, there should be a very good Although the ecological check
proves
feeling there. Is there a good feeling, satisfactory, the test for comfort is
also made
a nice comfortable feeling? Nods. and is, at last, positive.
Good. Nice relaxed, calm feeling? ..
Nods. Good. Keep it, keep that As an additional safeguard,
projection into the
good comfortable feeling. Now that
257

f
u
t
u
r
e

t
o

t
e
s
t
t
h
e

s
o
l
u
t
i
o
n
s

i
n

a
c
t
i
o
n

i
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m
a
d
 258

e
.

you've got that good feeling, you The stage is now set for some
routine
can see Tim doing all things that he ego-strengthening and
assertiveness training
wants to do and taking care of himself. suggestions by asking for maximum
I want to give you some important unconscious attention with
little conscious
ideas and I want you to listen to interference. This may be
equated with the
me very carefully with the deepest common concept of deepening
hypnosis.
part of your mind: your conscious These suggestions will be
enlarged in Chapter
mind doesn't need to pay any attention Thirteen.
(168) to me at all because the deepest
part of your mind can listen very
carefully. When the deepest part of
your mind is listening very carefully,
your head will nod for yes ... Nods.
Continue to listen very carefully. I
believe that every human being is
important. And I believe that Tim is
just as good and just as important as
any other human being. If you agree
with that your head will want to nod
for yes. Nods. Good. Now I know
that all human beings have uncom-
fortable feelings as well as comfort-
able feelings and that you have had
feelings of sadness like any other
human being ... ego strengthening
and assertiveness suggestions are
now given in detail here.
Six months later, a friend of Tim's reported that he had left the area, was doing well and was no
longer gambling compulsively. (169)

An Analytical Procedure
 259

169

--------------------------------------------------------

with the common concept of deepening hypnosis.

These suggestions will be enlarged in Chapter Thirteen.
tion to me at all because the deepest part of your mind can listen very carefully. When the deepest
part of your mind is listening very carefully, your head will nod for yes ... Nods. Continue to
listen very carefully. I
believe that every human being is
important. And I believe that Tim is
just as good and just as important as
any other human being. If you agree
with that your head will want to nod
for yes. Nods. Good. Now I know
that all human beings have uncomfortable
feelings as well as comfortable
feelings and that you have had
feelings of sadness like any other
human being ... ego strengthening
and assertiveness suggestions are
now given in detail here.
Six months later, a friend of Tim's reported that he had left the area, was doing well and was no
longer gambling compulsively.

25. CH 12: THE NEGATIVE BIRTH EXPERIENCE: EDGAR BARNETT: ANALYTICAL

HYPNOTHERAPY: WESTWOOD PUBLISHING CO, GLENDALE, CA: 1989
Analytical hypnotherapy has frequently and clearly demonstrated that the critical
experiences responsible for Child/Parent conflicts can occur much earlier in life than was
previously thought possible. We now know that the process of birth can be a very traumatic
critical experience. Furthermore, there is much evidence that the foetus is capable of responding
to prenatal events as critical experiences.
Verney (1977), in his review of the literature on this subject, cited many examples of the
effect of maternal stress upon the unborn child, and pointed out that many investigators attribute
infantile autism to intense maternal anxiety during pregnancy. Sontag (1941) suggested that
chronic fatigue, malnutrition, and strong emotional disturbances may so alter the physiology of
the pregnant woman that the foetus is adversely affected. As early as 1935, Sontag and Wallace
demonstrated that the foetus responds to sound vibrations applied to the abdomen of the mother.
Frank (1966) believed that a woman bearing an unwanted child may be so unhappy and disturbed
that she may be said to have a hostile uterus. Thus, persistent worries, resentment and anxiety
may have an effect upon the unborn child. Prenatal effects are no longer considered to be old
wives' tales and should be considered as possible components in emotional and psychogenic
 260

disorders. There can be little doubt that the emotional impact of birth may be so intense as to
create lasting problems for the individual. Rank (1914) stated that the circumstances of birth
itself, the birth trauma, are imprinted upon the psyche of the infant; Harris (1967) cited evidence
to prove that the events of birth and of infant life are recorded even though they are not
remembered. Cheek (1974), using ideomotor techniques, regressed subjects to the birth process
and observed sequential head and shoulder movements which were identical to the movements
which must have occurred, based on a subsequent study of hospital records, (214) during the
process of birth. In Cheek's (1975) review of birth memories, he concluded that the baby may
respond to maternal stress with feelings of guilt; such feelings are responsible for subsequent
conditioned problems manifested as patterned responses of illness. Chamberlain (1980) compared
birth memories of ten mother/child couples and found them to share a wealth of factual detail in a
very high proportion of cases. He concluded that birth memories are indeed real, although the
possibility of falsification does exist. He believed that the quality and content of birth memories
give clear evidence of the infant's ability to experience, learn, understand and form relationships
from the very beginning of life.
Kubie (1958) declared that very early in life, a central emotional position is often
established, a position to which the individual automatically returns during his life. This position
may constitute the major safeguard - or, conversely, the major vulnerability - of his life. When
that position is a painful one, the individual may spend the whole of his life defending himself
against it. Harris (1967) succinctly described this position as being I'm not O.K., You're O.K.,
which he declared to be the universal position of childhood. The decision to move to the position
of I'm O.K., You're O.K. is made following the receipt of information which is available only
later in life.
Grof (1976) believed that perinatal experiences are a manifestation of a deep level of
unconsciousness and cannot be reached by classical Freudian techniques. Furthermore, he
asserted that Freudian analysis neither permits an explanation of these experiences, nor provides a
conceptual framework for their interpretation. Fodor (1949), on the other hand, suggested that
birth trauma appears later in life as symbolic of the desire to return to the peace and security of
the womb. Raikov (1980) believed that, in hypnosis, age regression to infancy reproduces the
components of infancy; this is neither fantasy nor role playing. Cheek (1974) demonstrated that
deep hypnosis is not necessary for total age regression at the level of the ideomotor response.
This author, in almost every case, has repeatedly confirmed Cheek's discovery in his practice of
reviewing the birth experience. Meltzoff and Moore (1977) have conclusively demonstrated that a
detailed awareness of the environment is present in neonates not more than sixty minutes old;
therefore it is a reasonable assumption that such a highly developed awareness is present at birth.
Prior to establishing the practice of reviewing the birth experience of every patient, the
author was, from time to time, puzzled by the relapse into previous symptomatology by a patient
who seemingly had (215) completed therapy successfully and was apparently cured of symptoms.
All of the critical experiences located in hypnosis had been dealt with adequately at the time of
therapy, and apparently, none remained to create problems. When these patients were asked to
review their birth experiences, however, a high proportion of them expressed unpleasant, not
O.K., negative and guilty feelings associated with their births, which were still present at an
unconscious level, thus preventing them from liberating themselves from these punitive
symptoms. It was presumed that the previous techniques had not been sufficiently exploratory,
 261

thereby omitting the birth experience from the analytical process. When these negative birth
experiences, as they soon came to be called, were subjected to the usual analytical procedures, the
associated negative feelings were, in most cases, erased to be replaced by positive feelings. In
such cases, the return to symptom free status has nearly always been dramatic with more than two
sessions rarely required. This suggests that the birth experience was the single remaining problem
that required remedy to secure the full objectives of analytical hypnotherapy: complete mental
health and well being.
In a negative birth experience, it is presumed that the infant is aware of the parental
distress that his birth has caused. As Berne (I972) has pointed out, the associated guilt is
sometimes reinforced by the mother's telling the child that she has been sick since his birth. The
therapist must persuade the patient to relinquish both the responsibility for his own birth that he
might have previously felt, and the guilt associated with any parental distress. If we regard the
Parent ego state as being that part of the Child whose specific duty it is to care for the infant by
understanding parental attitudes, then any maternal distress at birth would presumably be
interpreted by the Parent ego state as disapproval for which the Child is responsible. This
disapproval is internalised by the Parent ego state which, in its turn, actively disapproves of the
Child. This is the origin of the early self rejection associated with the negative birth experience; it
is therefore the site of a potent critical experience and of a Child/Parent conflict responsible for
many of the presenting symptoms. Such a negative birth experience must be located and dealt
with if there is to be any hope of resolving this conflict.
The importance of this approach will be realized if one examines the results of the
investigation of the birth experiences of 876 patients referred to the author. It was found that 245
or 28% indicated negative feelings about their births. These results are examined in greater detail
in the appendix, but it may be pointed out these patients (216)(the above-mentioned 28%),
without the aid of hypnosis, could not attempt to resolve their problems. Hypnosis is the only
route to the unconscious memories of birth. In order to locate and deal with the birth experience,
specific directions for the uncovering of this experience must be given to the patient. The
following are those currently used with considerable success by the author.
Would it be all right for you to look at memories that are in your unconscious mind but
are beyond your conscious memory? In Chapter Ten we discussed how to deal with a negative
answer to this question, so let us assume that an affirmative response has been obtained. The next
direction is, I would like you to orient your inner mind back through your unconscious memories,
right back before your unconscious memory to a place where your conscious mind cannot go. I
would like your unconscious mind to go back to the very first breath you took just after you were
born and, when your inner mind is there, your yes finger will lift to let us know.
Sometimes the yes finger does not lift even after this direction has been repeated; in such
cases the patient should be encouraged not to try consciously to recall this first breath because it
is impossible for him to do so, but simply to allow his unconscious mind to travel back to that
breath and patiently await the yes signal. This is often effective. Rarely, there still occurs no
response and the patient may even lift the no finger. If this evidently is an unconscious response,
clearly, there is an unconscious resistance to returning to the birth memory. In any case, it is wise
at this time to enquire, Is there something about the birth that makes it too uncomfortable for you
to return to? If this is answered with a yes, it is obvious that, at a deeply unconscious level, the
birth experience must have been reviewed and found to be unpleasant. The nature of the
 262

unpleasantness can be clarified simply by asking, Is it too scary (sad, guilty, etc.) to return to?
The negative birth experience can be identified in this subtle manner as if it were being directly
described.
If a yes signal is received to this direction to return to the first breath, it is a good practice
to ask the patient to advance in time to the very first experience of being wrapped up, warm and
safe in the crib, and to indicate when this is accomplished with a yes signal. This confirms that
the birth experience has been reviewed at an unconscious level. The next direction is, Babies,
when they are born, know many things and the baby, jane, knows many things. One of the things
that she knows is whether she feels okay about being born. If she feels okay (217) about being
born, the yes finger will lift, but if she does not really feel okay about being born, then the no
finger will lift.If the patient indicates that she unconsciously feels okay about being born, then
one can assume that no critical experience has occurred up to and including the time of birth. She
is then instructed to enjoy the okay feeling that she has about her birth and perhaps to indicate her
enjoyment with a smile. A failure to smile may suggest that her birth was not an entirely
satisfactory experience and should be reviewed in greater detail to ascertain whether there remain
some persistent negative feelings about the birth.
Patients with unambiguous negative feelings about their births are encouraged to deal with
this as with any other critical experience. Questions are asked to discover the nature of the
negative feeling, such as, Babies who do not feel okay about being born sometimes feel guilty
about being born. Does the baby Jane feel guilty about being born? This is commonly answered
with a yes; questions are then asked to define the nature of that guilt, e.g., Does the baby Jane feel
guilty about causing mother so much pain? Should the unconscious communication appear to be
profound, then the patient might be asked to review the experience until her knowledge is
complete. She then can talk about it, and indicate when it would be all right to discuss the
experience. In many cases the patient will be able to verbalise the negative aspects of the
experience. For example, she may be aware that her mother is in great distress, or is unconscious,
or her sex is remarked upon with disapproval, and it is clear to the newborn infant that this is a
source of great parental disappointment.
When all aspects of the birth experience have been determined, regardless of whether they
have been verbalised, it is then available for Adult reassessment, e.g. Thirty-five year old Jane,
you have heard how newborn baby Jane feels about her birth. I would like you to give her all
your wisdom and understanding and, in particular, tell her that no baby is responsible for her
birth and that she really should not feel guilty about anything that is associated with it. At this
time the therapist can allow his own Adult wisdom to support that of the patient's by pointing out
that whatever discomfort mother suffered could have been avoided with improved obstetric care,
or that fifty percent of people are female (male), none of whom had any choice in the matter.
When a yes signal is received, indicating that this Adult communication has been completed,
then, as with any ego state, the question is posed: Does the newborn Jane now feel that she needs
to keep those guilty (sad, scared, angry, etc.) feelings any longer? If the (218) answer is still yes,
further application of Adult wisdom to explain to the newborn Jane that birth is a basic human
right, even if one does not arrive at a time and place when and where one is wanted. One does not
ask to be born; one simply has no choice in the matter. In fact, it was much more the parents'
responsibility that one was born; whatever distress mother suffered had nothing to do with the
newborn baby. Furthermore, mother did not do too badly in the long run: she has a child. These
 263

and similar arguments are presumed to be delivered by the Adult to the newborn Child/Parent ego
state complex that is still enduring negative feelings about its birth.
Usually this question receives a welcome no, indicating that the negative feelings need no
longer be retained. However, if the yes persists, it is possible that the critical experience
responsible for the negative birth feelings occurred prenatally. The question that should now be
asked is, Did something happen before birth that makes you feel not okay about being born? The
answer to this question is often a yes, and the prenatal experience responsible for these negative
feelings must be dealt with in precisely the same way as natal and postnatal critical experiences.
We will assume, for the moment, that the newborn Jane has at last accepted her right to
the experience of birth and now feels positive about it. The therapist then directs the Adult to
discover a means of relinquishing the now unnecessary negative feelings and, finally, asks for
indication of full acceptance of positive feelings by the smile test. This acceptance is usually
accompanied by other signs of genuine pleasure and relaxation.
PRENATAL CRITICAL EXPERIENCE: A significant proportion of negative birth
experiences appear to originate before birth. Once again, the unconscious mind is directed to
orient itself back to the relevant experience in which the feeling of guilt or other tension first
occurred and, upon accomplishing this, to indicate by signaling. When this signal is given, the
experience is examined, as is any other critical experience, by defining its attributes (guilt,
sadness, fear, anger, etc.). Once again it may be possible for the patient to verbalize the
experience and to describe it as a vivid scene. "; More frequently, something appears to have been
overheard which indicates that the baby will be a nuisance, if and when it is born. The
circumstances surrounding such rejecting statements can also be clearly identified, as can the
participants in the scene. The experience may not be verbalised in this way; in any event, the
Adult is once again (219) called upon to review the experience and to apply its current wisdom
and understanding to the experience. The usual hypnoanalytical procedure is followed until a
smile reveals that the effects of this experience have been discarded and self acceptance is
established. If satisfactory progress is not achieved, every step so far detailed should be retraced
until therapy is successful. Failure is usually due to a hidden ego state that resists attempts at
communication but makes itself evident by maintaining the persistence of symptoms.
Matthew is an example of a patient with a negative birth experience which has always
affected his life. He was fifty-five at the time of the first interview, an excerpt from which
follows, and reported a history of constant headaches which began as long ago as he could
remember. He described them as an aching pain at the back of the head, which increased with
tension, but never really disappeared. In fact, if he had not experienced two ten minute respites
from pain, separated from each other by an interval of about three years, he would readily have
believed that headaches were a normal part of life, endured by everyone. For these short periods,
he experienced an intense freedom and relief, which he described as sheer joy. Matthew could not
find any causal event to which he might attribute his headaches, although since their onset he
recalled injuries to his head which might have aggravated them. Always tense and anxious, he
suffered from marked insomnia; this he attributed to being awakened by tension and discomfort
in his legs before he could settle down at night. He realized that he possessed a fierce temper,
which he did his best to control, but noticed that his headache became worse prior to a show of
anger. He tended to keep things that bothered him to himself until mounting tension resulted in
explosive anger.

Following suggestions for relaxation during the administration of ACE (on which he
reached stage 2), ideomotor signaling was readily established. The following excerpt commences
after ideomotor questioning had indicated that good unconscious cooperation had been secured.
DR I would like you to let your
inner mind go right back before
conscious memory, right back to the
very first breath that you took just
after you were born, and when you
are there, the yes finger will lift.
Don't try to go there consciously (220)
because your conscious mind cannot
possibly remember this; but
your inner mind can easily go back
to the very first breath and, when
it is at that memory, the yes finger will
lift ... Yes finger lifts after some
delay. Good. Now babies, when
they are first born, know many things.
One of the things that they
know is whether they feel okay
about being born. If the baby
Matthew feels okay about being
born, the yes finger will lift to let me
know. Ifhe does not feel okay about
being born, the no finger will lift.
No finger lifts. Babies that do not
feel okay about being born sometimes
feel guilty about being born. If
the baby Matthew feels guilty about
being born, the yes finger will lift.
Yes finger lifts and the patient begins
to look very distressed and
makes a groaning sound. There is
something about being born that
264
The immediate request to regress back to
birth is
usually complied with readily, as in this case.
However, a delayed response indicates either
unconscious reluctance to deal with the birth
experience (determinable by asking whether
it is
too uncomfortable) or with a patient
determined to
retain control, a conscious interference in
unconscious
regression. (In the latter case, this control must be
relinquished; the therapist must
encourage the patient
to let it happen).
The therapist proceeds immediately to
enquire into the
nature of the birth experience, since it is clear
that
Matthew has readily oriented to it. Matthew
appears
to be extremely uncomfortable.
Strong feelings of guilt are usually
prominent in
negative birth experiences.
The therapist's comments upon Matthew's
evident
 265

feels awfully uncomfortable. There distress increases Matthew's awareness of it.

is something about that very The assumption that his distress is really a
reflection
uncomfortable feeling that is causing pain. of his mother's distress, which he now vividly
Does the baby Matthew feel that he is recollects, proves to be correct. Fear, as well as
guilt,
causing a lot of distress and bother by is in evidence. This fear indicates the probability of
being born? As if he is the centre of a much underlying hurt and sadness resulting from the
lot of trouble? If so, the yes finger will lift. self rejection caused by guilt. A strong Parent/Child
Yes finger lifts. Yes. Does it feel awful conflict had presumably begun during the birth
scary to be doing that to mum? If so, experience.
the yes finger will lift; if not, the no finger
will lift. Yes finger lifts after a long
delay during which tears start to
flow. And does the baby Matthew
feel he is a bad person for causing all
of that trouble? If so, the yes finger
will lift. .. Does he feel bad about (221)
causing all of that difficulty? Yes finger lifts.
Now, you and I, up here in 1980, Having fully defined the nature of the birth
know that no baby is really responsible experience, it is time for the Adult to become
for any of the difficulties that involved in convincing the newborn Matthew
that he
his birth causes, but newborn baby need no longer feel guilty about the distress
caused by
Matthew doesn't know that. He his birth. Any failure to accept the Adult's
counsel
feels that he must be responsible for usually indicates a prenatal critical
experience that
all of the distress that his birth has must first be dealt with.
caused. I would like you to talk to
him with all of your wisdom and
understanding. Do that at a deep
inner mind level and, when you have
done that, raise the yes finger. ..
Yes finger lifts after an interval. Okay.
Now, newborn baby Matthew, now
that you have heard that, do you still
need to go on feeling guilty about
being born? No finger lifts. You
don't need to keep that uncomfortable
feeling? Okay. I would like you to The newborn Matthew had assumed guilt for
the
please use all of the wisdom and whole of his life so now the Adult must
 266

discover new,
understanding that you have up acceptable ways of looking at life.
Fortunately, this is
here in 1980 - fifty-five years of usually readily accomplished since the Adult
has
wisdom and understanding - to profound knowledge of many other life styles
which
find a way for newborn baby are superior.
Matthew to let go of that awful
uncomfortable feeling that he has been
keeping for these past fifty-five
years. When you have found a way
to let go of that uncomfortable feeling,
the yes finger will lift. You can In this case, the considerable delay in
arriving at
tell him that he doesn't need to feel a suitable alternative gives the therapist time
to make
guilty about that because it isn't his suggestions that his own Adult has
knowledge of.
fault, and that you understand, and Eventually, a satisfactory alternative is
chosen.
that he can also understand now.
There are many things that you can
tell him to convince him. When you
have found a way to let go of that
uncomfortable feeling, raise the yes (222)
finger. Yes finger lifts after a delay.
Okay. Now, newborn baby The newborn Matthew is able to
utilise the Adult's.
Matthew, there is a way to let go of point of view and relinquish his negative one,
which
that unnecessary guilt feeling. You is now recognized as outdated and
unnecessary. The
don't need to keep it any longer. guilt feelings evaporate. The therapist takes
this
You have already kept it far too opportunity to inject some strong
ego-strengthening
long. Let go of it. Just let it go. You suggestions since, in the early part of the
interview,
are just as good and important there appeared to be much evidence of very
low self
as any other newborn baby. It wasn't esteem.
your fault that your birth caused
so much distress. When you have let go
 267

of all of that uncomfortable feeling

and are sure that you have done so,
the yes finger will lift. Yes finger lifts
after a long delay. Now, if you have The therapist makes every effort to establish
the
really let go of all of that uncomfortable relaxed and free feeling which Matthew previously .
feeling, there should be a experienced on only two occasions
very nice relaxed feeling there - the
best relaxed feeling that you have
had in fifty-five years. If you have
got that feeling, the yes finger will
lift. It will be even better than the
relaxed feelings that you experienced
on those two occasions. Yes
finger lifts. That's good. I am going The emphasis on enjoyment, free of anxiety
and guilt,
to ask you to really enjoy that good is very important here, since Matthew had
always
feeling - simply enjoy it to the full. unconsciously felt that he was unjustified in
enjoying
It's a beautiful feeling. You've got a himself.
right to that feeling. You did not
know that you have that right. That
feels so good. Let all out of date,
unnecessary, uncomfortable tensions
go for good. Completely gone.
Now, while you are enjoying that Routine ego-strengthening suggestions are
repeatedly
nice, comfortable feeling, I am going stressed to ensure that any changes which occur are
to tell you that I believe that every likely to be permanent.
human being is important and I believe
that you, !V1atthew, are just as
good and just as important as
any other human being. If the baby
Matthew really agrees with this, the (223)
yes finger is going to lift. Yes finger
lifts. Good. What a lovely feeling
that is! I am going to ask you to take Assertiveness Training in self protective attitudes is
as
care of Matthew. Don't let him ever important as the self accepting attitudes
encouraged .
feel uncomfortable again about by ego-strengthening suggestions. The
ideomotor
being born. If you agree to do that, responses serve admirably in monitoring
 268

adequate
the yes finger will lift. Lifts. I want acceptance of these suggestions.
you to really love him and take care
of him and make him feel good.
If you will do that, the yes finger will
lift again. Lifts. Good. Give him all
the love that he really needs and
has never had. When you agree to that,
raise the yes finger. Yes finger lifts.
Good. I want you to really enjoy
that good feeling. Don't ever put
him down again. Don't ever let anyone
put him down again. No one
has a right to do that. You are just as
good as anybody else. I want you to
enjoy the good feelings that you The session continues after a short interval,
for
have, and I shall be talking to you unconscious realignments and readjustments.
In the
again in a few moments. remainder of this first meeting, other
critical experiences are dealt with.
At the first follow up session, about two weeks later, Matthew dealt with another critical
experience, in which he was disturbed by a female cousin while urinating. He was very angry
with her, and refused to speak to her again. When she was killed three weeks later, he was
overcome with feelings of guilt about his harsh attitude. In therapy, he was encouraged to
relinquish this guilt and accomplished this satisfactorily. As a result, at his third visit a month
later, he reported that his headaches had become much less severe and markedly reduced in
frequency. He was sleeping well, worrying less, and had an improved attitude toward himself.
Later sessions emphasised ego strengthening, and brought a further amelioration of symptoms.
The following second example of a negative birth experience is included here because it
illustrates how negative feelings about birth may arise during the prenatal period. At the time of
this first interview, (224) Pamela was forty-five years of age and was attending therapy for help
with multiple, literally crippling, phobias. She was unable to remain in any confined space for
any period of time; such common activities as driving in a car or bus, or travel by air, had
become well nigh impossible for her. Any attempt at these things resulted in intense anxiety with
a tightness in the stomach, difficulty in breathing, and a fear that she would pass out or even die.
Her first marriage had ended after a short time some twenty years ago, and she had recently
remarried. Her second husband was described as a kind and generous man, for whom she had
nothing but love and admiration; still, she was surprised to discover that her symptoms had
become worse since her remarriage. Furthermore, she was puzzled by her frequent feelings of
anger toward her husband, contrary to her expectations of feeling warm and loving.
Pamela described herself as a perfectionist, intolerant of any fault in herself or others. She
recalled that her father had been brutal to her throughout childhood, as was her first husband
during their marriage. She admitted that she was made nervous by all men and that she found her
 269

present husband somewhat dominating and controlling at times. Since this was his only fault, she
thought that she must not complain about it. She slept poorly, which she attributed to her
husband's insistence on closing the bedroom door at night, which increased her anxiety. Previous
hypnotherapy and psychotherapy resulted in no lasting improvement. This excerpt commences
after Pamela had shown good hypnotic responsiveness and had readily regressed to the birth
experience.
DR Babies, when they are first Immediate acceptance of this first statement
indicates
born, know many things, and the that good direct unconscious communication
has been
baby Pamela knows many things. established, since the conscious mind can
have no
She knows whether she feels okay knowledge of the birth experience.
about being born. If she feels okay,
the yes finger will lift, but if she does
not feel okay about being born, the
no finger will lift. No finger lifts. A negative birth experience is indicated, and
the
Okay. Babies that don't feel okay feelings of guilt are first identified.
sometimes feel very uncomfortable
about being born. Sometimes they
feel guilty about being born, and if
baby Pamela feels guilty about being
born, the yes finger will lift. Yes
finger lifts. Is she scared about being Because of the presenting phobic
(225)
born? Yes. Yeah. Is she feeling angry symptoms, the therapist carefully
seeks any
about being born? Yes. Yeah. Even natal source for the fear;
sadness and hurt, the
sad about being born, is she? Yes. inevitable precursors, are
located. The
Yeah, all of those awful feelings. admission of fear of being
born immediately
Now do these awful feelings that suggests the possibility of a
prenatal critical
Pamela is feeling when she is born experience, which receives
ample
start before she is born? Yes. Yeah. confirmation on further
questioning. Pamela
Let's go back then to a time before evinces no difficulty in
locating the prenatal
Pamela is born where something source of tension.
Nevertheless, a review of
 270

happens to make her feel, Hey, I the relevant experience was

thought to be
don't want to be born! When you useful to define accurately the
experience.
are right back to that something
happening, the yes finger will lift ...
before she is born. Yes. Okay. I
would like you to review that experience
at a deep inner mind level and,
when that review is complete,
the yes finger will lift again. Yes.
Now, that experience that you have
just reviewed, can you talk to me
about it? If you can, raise your yes Like any other critical
experience, it is not
finger; if you cannot, then raise the always possible to elevate a
prenatal
no finger. Yes finger lifts. Okay, experience to a verbal level,
but Pamela has
what are you hearing? You are not little difficulty in
accomplishing this.
born yet - what are you hearing?
PT My father. ..
DR What is he saying?
PT He doesn't want me. He's The quarrel between
parents, where the infant
yelling at my mother. seems to be the cause
of the argument, is
DR And what is he saying? a very common
prenatal critical experience,
PT That she is stupid ... that often responsible for a
negative birth
she should not have got pregnant. Sobbing. experience.
DR Aha - that she's stupid, eh? (226)
PT Very distressed.
DR And you feel guilty about that?
PT Yes.
DR Okay. Is there anything else Again the therapist
painstakingly seeks the
that you can tell us about that? I bet source of fear that he believes
must have
you are scared, aren't you? You arisen in this prenatal
experience.
probably don't want to be there.
 271

PT That's right.
DR Yeah. Probably thinking, Hey,
this is no place for me to be, and no
way do you want to come outside
where dad does not want you.
PT No.
DR No way. It is bad enough being Once again, it is time to
summon the patient's
inside, but to be born seems awful. Adult to aid the therapist's
Adult in his task of
Okay. Forty-five year old Pamela, freeing the Child from the
restricting fears of
did you hear that?

the old
Parent/Child
conflict.
PT Yes.
DR There is an unborn baby there.
She's scared to death about coming out
and being born. Can you help
her, please?
PT Sighing, restless.
DR Tell her it's not her fault that

The
therapis
t uses
his own
Adult to

she is there. Tell her that things do encourage the Patient’s Adult
to
turn out all right after all. She does Comfort and support the
Child,
not have to go on being scared because and immediately the Patient’s Adult
she eventually gets through it responds by entering into a
(227)
all very well. Can you tell her all verbal dialogue. This is
relatively uncommon
those things, please? and tends to
occur in the highly susceptible
PT Don't be afraid.
 272

subject,
such as
Pamela.

DR Tell her that you will take care of her.

PT I will take care of you.
DR You will? Okay, how does she feel now, is she still scared?
PT She is scared ... a little bit.
DR She is, eh? Tell her some more, then.
PT Don't be frightened. I'll take Suddenly, the Child interjects her doubts
based on her
care of you. He won't hurt you. adverse experiences.
But he always does hurt. Tearfully.
DR Can you tell her then that she is These are allayed by the Adult's reassurances
that
going to survive all that? things are now different. The old
order has changed,
PT You'll survive ... you'll make it. but the Child and the Parent had not realized
these
DR That's it. Tell her she'll make it. changes.
She'll get through it all.
PT You'll get through it.
DR Is she okay now?
PT I think so.
DR Okay. Let's check. Can we get In this subject, a rapid review of birth is easy.
her being born now? Can you get
her to be born and feel okay about
being born? (228)
PT Yeah.
DR Let's see. Does mum want her?
PT Mum wants her. Pamela recognizes that she
experienced good feelings
DR Does mum cuddle her? from her mother.
PT Mum cuddles her and mum A reminder of these feelings is enough to
generate
thinks she is beautiful. a strong attitude of self worth, which
had been
DR Is she smiling at her? negated by father's rejection.
Nevertheless, the
PT Yes. therapist must remain
wary, lest the paternal part of
 273

DR Great. There you are, you must the Parent ego state remain unconvinced and
return to
remind her of that. the previous self-rejecting
attitudes. The memory of
PT See, she loves you. mother's acceptance clearly helps
Pamela to cope with
DR How does that feel? Feels father's rejection of her.
good?
PT Feels good.
DR Okay, so in fact, it is only dad
who is the problem. It's not mum, is it?
PT Right.
DR Okay. Remember to tell her
that. Mum really wants her.
PT Yeah.
DR It's just dad. Does she feel
all right now?
PT Yeah. (229)
DR Are you sure? Have you got her smiling? Once again, the smile test is invoked, and is
PT Nods.
satisfyingly positive.
DR Now I want you to come up
from being born to the next time
something happens which is still Further therapy is directed at
later critical
scaring Pamela inside. experiences.
One month later, this patient reported that she had been able to take her vacation by air
without any anxiety, and had since comfortably flown on her own. This was something she had
never before accomplished. She had also been able to ride in a car without any anxiety, was
sleeping very well, and was generally much less nervous. She noted that she had become
assertive, in a pleasant way, but her family and colleagues were finding it difficult to adapt to the
striking changes that they perceived in her.
The self acceptance gained through dealing with the negative birth experience removed
the guilt that had hitherto prevented Pamela from being adequately self protective. Following this
first session, she immediately gained access to her many normal resources for safeguarding
herself, which had previously been denied her. The Parent, instead of pursuing its previous
function of concealing the Child, now supports and protects it with the aid of the Adult's vast
resources.
ANALYTICAL HYPNOTHERAPY AND PREVIOUS LIFE EXPERIENCES:
Every hypnotherapist will, sooner or later, be asked about the possibility of regression to a
previous life experience which may be responsible for problems in the present life. There appears
to be an increasing interest in reincarnation, although the history of this belief is a long one
indeed. Also, from time to time, when the analytical hypnotherapist asks his patient to regress to
the critical experience responsible for symptoms, the patient apparently returns to one that
 274

occurred in a previous life. Some hypnotherapists have made a special study of this kind of
regression and Fiore (I 978) has described in detail some of her observations in this regard. While
conceding that her patients' experiences cannot prove the reality of reincarnation, she notes
frequent complete resolution of emotional and other problems following the uncovering of these
previous life experiences. This would indicate that these experiences have some relevance to the
problems presented. (230) Stevenson (1966) also documented twenty such cases which he
believed to support the theory of reincarnation.
Most of the experiences described in the literature have been associated with highly
hypnotisable subjects who have been able to give other manifestati.ons of deep hypnosis,
including amnesia and hallucinations. For example, Bernstein (1956) recorded the previous life of
Mrs. Virginia Tighe as Bridey Murphy. This achieved great notoriety as a book and subsequently
as a film, and appeared to create a sensation in much of the western world. A critical response
detailed striking inconsistencies between the descriptions given by Mrs. Tighe in hypnosis and
the historical facts; in addition, critics pointed to the probable present life sources of information
which were previously thought to have been available only to somebody living before Mrs.
Tighe's life. Iveson (1977) detailed some of the six lives that a Mrs. Jane Evans described in
hypnosis, and discovered that the wealth of detail was historically accurate but nevertheless
accessible in the present. The remarkable thing in this case is that none of this information
appeared to be available at a conscious level; neither did the subject recall ever studying or
reading about these periods of history when the previous lives had supposedly existed.
Taylor Caldwell, the well known novelist, uncovered several previous lives when working
with Stearn (1973), who attributed Caldwell's fertile source of material for her books to these
previous lives. Caldwell herself does not accept this exp lana tion. Kline (1956) demonstrated
how easily material of this sort is obtained in hypnosis. Hilgard (1977) was equally unimpressed,
since he has demonstrated that memories may be readily recaptured in hypnosis without
identification, and be woven into a realistic story which is believed by its inventor. Thus it may
be that this is the true explanation for previous life experiences described in hypnosis. The subject
draws from his vast storehouse of unconscious memories, a myriad of life experiences, the
majority of which have been accumulated without conscious awareness. From these memories,
past life experiences are constructed.
Nevertheless, whatever the true reason for an account of a previous life experience, the
analytical hypnotherapist should be prepared to deal adequately with them on occasion. So many
life experiences are stored at an unconscious level that it is easier to accept the explanation that
past life experiences are, in fact, artificial constructs. A highly hypnotisable subject will, on
request, readily construct a plausible story about any fictitious event and can be persuaded that it
is true. He will then consciously defend it as being true and will add, if pressed, (231) other
elaborations which he also believes to be true. Such a story will bear the stamp of validity since it
will be so carefully constructed as not to conflict with other facts known to the subject. This
creative ability of the unconscious mind, which works best in such highly imaginative people as
Taylor Caldwell, must always be borne in mind when dealing with any memory of an experience
offered by the patient in hypnosis.
Indeed, it may well be that some of the experiences offered to the therapist as critical ones
are products of the imagination, with no real basis in fact. In practice, it must be emphasised that
the validity of a critical experience does not concern the analytical hypnotherapist and this applies
 275

to present life experiences as much as to past life experiences. What is of concern is the emotional
conflict associated with these experiences and the resolution of the conflict. More often in dealing
with the present life critical experience, much of it has been remembered in consciousness prior
to the hypnotherapy; however, the hypnotherapy deals with those aspects of the experience which
have remained responsible for the symptoms. It is also probable that these aspects, crucial to an
understanding of the symptoms and their eventual resolution, cannot be dealt with without
revealing an experience that must be kept hidden deeply in the unconscious memory. Perhaps in
these cases, the unconscious device of offering a similar previous life experience (created
specifically by the unconscious mind for this purpose, the disturbing aspects of which are similar
to those of the present life experience), enables these aspects to be dealt with and the disabling
symptoms removed. Therefore, we can accept that the unconscious mind may substitute one
similar experience for another, in much the same way that dreams carry, in a symbolic manner,
the elements of emotional conflicts.
A previous life experience is dealt with by the analytical hypnotherapist in precisely the
same way as any other critical experience. When a conflict has been identified, but the source is
difficult to locate in a present life context, the hypnotherapist should not be averse to seeking it in
a previous life experience. This can be accomplished by asking the question, Does this experience
occur before birth?, which will locate a prenatal critical experience. If the answer to this is
negative, the next question must be, Does the experience occur in a previous life? If the answer to
this is yes, then it should be exposed to the same analytical procedure as any other critical
experience. Usually, strong feelings of guilt and fear are attached to such an experience. The task
of the therapist is seldom easy in these cases, since the (232) displacement of the conflict into a
previous life may indicate a reluctance on the part of the patient to deal with it, as shown by the
patient's resistance to suggestions for resolution of the conflict. (233)

26. DIRECT AND INDIRECT SUGGESTION IN ANALYTICAL HYPNOTHERAPY:

EDGAR BARNETT: ANALYTICAL HYPNOTHERAPY: WESTWOOD PUBLISHING CO,
GLENDALE, CA: 1989
Many of the criticisms which have been levelled against hypnotherapy have been directed
at the indiscriminate use of direct suggestion in hypnosis. The occasional dramatic response to
direct suggestion and the history of hypnotherapy is replete with such responses - has given
hypnotherapy an unscientific notoriety which has hindered progress in the understanding and
acceptance of it as appropriate therapy. Hypnotherapists have been unable to provide adequate
explanations regarding their success in some instances and failure in others involving the
administration of direct suggestions in hypnosis. Consequently, direct suggestion in hypnosis has
not gained its rightful place in orthodox medicine as a reputable therapeutic tool. This lack of
esteem is due to exorbitant and unsubstantiated claims made on its behalf and also to the
inconsistent results. Esdaile achieved brilliant results while working in India, but was unable to
duplicate them for a critical medical audience upon his return to England; the hypnoanesthesia he
had hoped to demonstrate, which might have revolutionized nineteenth century surgery, was
considered myth rather than scientific fact.
Every hypnotherapist soon acquires considerable first hand experience with the
disappearance of long standing symptoms of variable severity following the administration of
direct suggestion in hypnosis. His inability to explain how this occurs, and why it sometimes does
 276

not, accounts for much of the scepticism exhibited by those who have limited experience of
hypnotherapy. Even those who admit that symptoms can be removed by direct suggestion in
hypnosis may criticise this form of therapy on the grounds that it simply promotes symptom
substitution. Brenman and Gill (I947) maintained, however, that symptom cure by direct
suggestion could be permanent, and that symptom substitution was not prevalent, particularly in
the treatment (250) of those disorders which were relatively peripheral to the total personality.
Reider (1976) reiterated the traditional psychoanalytic view that the rapid symptom resolution
either diffuses the patient's desire for understanding and mastery, or forces the underlying conflict
to emerge in a different, perhaps more serious way. Spiegel and Spiegel (1978) observed that
there have been many successful symptomoriented techniques which cast serious doubt upon'this
theroretical formulation. Hilgard (1977) and Frankel (1976) agreed that using hypnosis in an
ancillary role to lessen or remove symptoms, while attending to the psychodynamic context in
which the symptoms arose and are maintained, appears to be a reasonable compromise. It
therefore behooves us to look very closely at what happens when symptoms respond to direct
suggestion in hypnosis. In any case, the analytical hypnotherapist needs to be aware of the
potential success of nonanalytical techniques of hypnotherapy.
We have already examined the range of resources available to the unconscious mind,
some of which directly affect body functions. The means by which this effect is achieved are
many but are poorly understood at present; it is probable that they mainly involve the humoral or
autonomic nervous system control. Presumably, the exercise of this control produces emotionally
based symptoms via these mechanisms. Furthermore, the voluntary nervous system can also come
under unconscious control with the production of such diverse disorders as hysterical paralyses,
anaesthesia, blindness and deafness. The recognition that symptoms often have an unconscious
origin acknowledges the immense resources of the unconscious mind in its favourable or adverse
influence on the body. Hypnoanalytic theory indicates that emotional mechanisms are involved in
these disorders and thereby provide the rationale for therapy. The success of direct suggestion in
the removal of symptoms would indicate that there is no unconscious resistance to their
eradication. It must therefore be assumed that their manifestation has continued after the reason
for their onset and continued maintenance has ceased, or become minimal. Suggestions given at
this time have merely provided the motivating, force for the unconscious mind to institute the
minimal changes necessary for final termination of symptoms.
The sole difference between the analytical hypnotherapist and other hypnotherapists in the
treatment of symptoms is that the former seeks to discover and deal with the causes of persistent
symptoms prior to giving direct suggestions for their removal. With this approach, the analytical
hypnotherapist hopes to increase his success rate in the (251) removal of symptoms. The direct
suggestions are therefore the same, although the timing of their administration is different; they
usually follow the receipt of evidence of the patient's unconscious readiness for their acceptance.
In the absence of prior analysis, the therapist must rely upon his communication with the patient's
unconscious mind for effective direct suggestion. They must be carefully worded to achieve
maximum effect. To be sure, the analytical hypnotherapist must also possess these skills, but he
has the additional advantage of being assured that unconscious resistance to his suggestions has
been removed prior to their administration.
The logic of this approach is inescapable, and provided that we accept that the
unconscious mind does indeed possess the resources that we have attributed to it, the removal of
 277

symptoms by direct suggestion will become increasingly acceptable to orthodox medicine. In

those cases where an analytical approach is neither feasible nor acceptable, for some reason,
symptom removal by direct suggestion without prior analysis is a plausible alternative approach
and will on occasion be successful when the unconscious resistances are insufficient to impede
their acceptance. In such instances, the degree of success may be surprisingly great. Another
approach is that of the administration of indirect suggestion; here, the idea for the removal of the
symptoms is communicated to the unconscious mind in such a way that the conscious mind, and
perhaps some parts of the unconscious mind, are unaware of the true purport of the suggestions
made and are therefore unable to oppose them. In this latter instance, prior analysis is
unnecessary since it is assumed that any unconscious resistances will be eliminated while
initiating the change resulting in the relinquishing of symptoms.
SYMPTOM REMOVAL BY DIRECT SUGGESTION: There are many techniques
for the administration of direct suggestion for the removal of symptoms. These can be grouped
into specific categories.
Authoritarian Approach: Much of the popular knowledge of hypnosis and its role in
therapy stems from the exhibition of direct suggestion authoritatively administered. In such cases,
suggestions are accepted by individuals who are highly motivated to accept them, and the results
are often dramatic. Symptom removal by authoritarian direct suggestion is sometimes
surprisingly effective; this forms the basis of the faith healer's (252) techniques. Such an
approach mobilises all of the relevant unconscious resources, in these cases, with striking results.
Unfortunately, when it fails, it does so miserably and the technique, hypnotherapy and the
therapist all share equally in the loss of credibility. Therefore, the authoritarian approach is
unacceptable to the ethical therapist who strives not to gain notoriety for himself but improved
health for his patient. Nevertheless, there are a few occasions when an authoritative command to
give up a symptom or to alter a body function is effective. In this context, Cheek and LeCron
(I968) described a case of injury in which the direct suggestion to stop bleeding, authoritatively
administered, was immediately effective.
Relaxation Approach: Relaxation is perhaps the most common means of inducing
hypnosis today. The ability of the unconscious mind to induce physical relaxation is usually an
easy resource to mobilise and much symptom removal is achieved through relaxation. This is
accomplished by associating the idea of symptom reduction with the dIminution of tension. Many
symptoms owe much of their severity to associated anxiety and a suggestion to relax will
considerably reduce these symptoms. For example, pain syndromes such as tension headaches,
back pains and migraine are so often aggravated by tension that relaxation suggestions allied to
direct suggestions for pain relief are often effective. Failure can be attributed to the patient's
inability to relax adequately rather than to the hypnotherapeutic procedure.
This direct approach can properly be used by the analytical hypnotherapist prior to
understanding fully the true nature of the problem. The patient is helped in this way to gain some
control over the symptom in the early part of therapy. However, the goal of complete relief from
symptoms should be observed despite any great improvement that direct symptom removal might
induce.
Anaesthesia and Analgesia: Direct suggestions for the relief of pain are clearly such an
important application of hypnotherapy that they require separate attention. The resource of the
unconscious mind for the reduction of sensation is invaluable in controlling pain syndromes. A
 278

common technique is the induction of a localised anaesthesia by the direct suggestion that this
area will become numb. The use of imagery to recall previous experiences of numbness and
coldness increases the possibility of success in producing such localised anaesthesia.
Hypnoanaesthesia has the (253) useful property of being readily transferable and can be applied
to any area requiring pain reduction. Often, this sliccessfuly produces anaesthesia and pain relief;
unfortunately, there are some patients who, for some reason, cannot be induced to mobilise this
unconscious resource. Possibly, the need to retain feeling or pain overrides the suggestions for its
removal, no matter what technique is used.
Other techniques for pain reduction and removal include suggestjOilS for less frequent
attacks, for the transfer of pain to less disabling sites of the body, and for an alteration in the
quality of the sensation. These techniques may be effective when the need to retain the pain
cannot be relinquished.
Imagery: The unconscious mind's immense potential for imagery can be harnessed in a
less direct manner for symptom removal. Encouraging the subject to imagine himself without his
symptoms in surroundings normally associated with them - and yet, capable of dealing with his
environment - demands that he unconsciously discover means of ridding himself of the symptoms
and of functioning well without them. The use of imagery in this manner is clearly a direct
suggestion for symptom removal, and it is also an indirect suggestion for the means of
accomplishing this. In order to accomplish this, the subject must draw upon other unconscious
resources to handle his symptoms. Frequently, he can continue to use these resources after
therapy, although neither he nor the therapist may be aware of their true nature.
Imagery therefore has a tremendous therapeutic potential due to its ability to mobilise
powerful unconscious resources. Furthermore, satisfactory imagery indicates to the therapist the
possibility of good responses to suggestion. Imagery can be used to discover the goals of the
patient and also his potential for reaching them, by the patient's producing self images of attaining
his goals and then focusing on the pathways to these goals. Such a situation was described by
Porter (1978) when she observed that patients who are told in hypnosis to imagine the ideal self,
free of presenting inhibiting factors, discover for themselves ways of removing these factors.
Imagination is, of course, the normal mechanism of all creativity; hypnosis does no more than
stimulate normal unconscious processes.
Indirect Suggestion for Symptom Removal: Direct suggestion will often meet with
resistance which is probably (254) both conscious and unconscious. Such resistance may be
active in preventing the relinquishing of symptoms as it may prevent any response to hypnotic
suggestions. This may explain the greater response to therapeutic suggestions in those patients
who exhibit a greater response to hypnotic suggestions.
The indirect approach offers an alternative, both in the induction of hypnosis and in the
removal of symptoms, to the therapist who is faced with signs of resistance to suggestion.
Erickson was the greatest exponent of therapy by indirect suggestion and we owe much of our
understanding of the mechanisms and effectiveness of this approach to his many writings on the
subject. In each case that he described, we see that the therapist was able to establish unconscious
communication with the patient and successfully deliver several options to him, the choice of
anyone of which constituted a valid response. Even the failure to respond, if offered as one of the
possible choices, is essentially a response, since it may be assumed that a choice was made.
Erickson and Rossi (1975 & 1979) have deeply explored this approach in their discussion
 279

of binds and double binds, in which the patient is offered suggestions which provide opportunities
for therapeutic gains. A bind is a series of suggestions, the choice of any of which leads the
patient in a therapeutic (or hypnotic) direction. A double bind is similar, except that the options
are likely to be perceived unconsciously. Much of what constitutes indirect suggestion is
essentially double bind, and whether it is motivated toward producing a hypnotic or a therapeutic
response, the unconscious mechanism is presumed to be the same. Suggestions can be given in
this multioption manner without the therapist's exerting any pressure to make a choice. However,
the options that are proposed are such that the acceptance of a least one of them will
unconsciously appear to be preferable to accepting none. This approach has no specific direction
regarding how the patient will deal with his symptoms (or enter hypnosis). Such an approach is a
valuable resource when resistance has been so high that a useful response to effective analysis is
precluded. It may well be that none of the options suggested by the therapist is acceptable; the
options' effectiveness may lie in stimulating an unconscious search for and the discovery of a
preferable means of relinquishing symptoms (or entering hypnosis).
When using this approach, the conversation that takes place with a patient rarely makes
much conscious sense, since it abounds in many undefined and uncertain phrases, such as I don't
know whether, you don't know, I wonder whether, Perhaps you may notice, you may (255)
wonder, etc. Such qualifying words as wonder, whether, may, if, perhaps, are commonplace in
the highly permissive language of indirect suggestion. The therapist is able to hint at a myriad of
possible responses which may be relevant to the patient. There may be some conscious initial
effort to assess these possibilities, but they are too numerous to be processed at this conscious
level; only the unconscious mind is able to formulate a response, which it may institute
immediately or after a varying interval.
When these suggestions are used to induce hypnosis as advocated by Barber (I977), the
proportion of patients who prove insusceptible is much smaller than with the use of direct
suggestion, where some five percent of people are considered to be hypnotizable. When used to
alleviate symptoms, indirect suggestion may be extremely effective, as indicated by deS hazer
(I980) in his treatment of erectile dysfunction. Erickson (I976) believed that because these
indirect suggestions do not arouse the patient's resistances and are outside his usual range of
conscious control to effect therapeutic goals, they utilise unconscious associative structures and
mental skills. It would therefore seem to the patient that his therapeutic goals have been
accomplished spontaneously and in a manner apparently unrelated to therapy. In this context, it is
pertinent to wonder how much successful therapy is inadvertently accomplished through indirect
suggestion outside the therapist's awareness, who is unconsciously responsible for them. In any
case, the analytical hypnotherapist should always be prepared to give indirect suggestions which
are never more appropriate than when direct suggestions are not heeded.
Therapeutic Metaphor: Perhaps the most potent form of indirect suggestion is the
metaphor. It would appear that therapists have always used metaphor as an important part of
therapy, but none has mastered this art better than Erickson. He spent most therapeutic sessions
telling his patients stories which, although extremely interesting, had no apparent bearing on the
problem for which he was being consulted. Haley (I973), for example, related how Erickson
treated a boy for bedwetting by talking about sports, contraction of the pupillary muscles, and
stomach sphincter muscles without ever mentioning the bedwetting which eventually cleared
completely. Through the medium of the symbolic language of metaphor, Erickson elegantly
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conveyed to the boy's unconscious mind ways to control the bladder function. Gordon (I978)
advocated extensive use of metaphor in therapy and suggests (256) that, if the indirect
suggestions implicit in metaphor are significant to the patient, he is unconsciously motivated to
check through his experiences to discover subjective models congruent with the metaphor. He
suggested that the patient accomplishes this by completing transderivational searches. Levine
(1980) was able to relieve childhood insomnia through the process of metaphor contained in
childhood fairy tales constructed especially for the child to deal with his conflicts. Bettelheim
(1976) has illustrated how children employ fairy tales to analyze and resolve inner conflicts; it
may be assumed that adults unconsciously use similar mechanisms when presented with a
relevant metaphor.
Symptom Prescription: Symptom prescription is another application of indirect
suggestion. In this technique, the therapist actually sanctions or encourages symptomatic
behaviour and in so doing, provides a rationale for the symptoms. In effect, the therapist directs
the patient to do exactly as he is already doing; but at the same time, he provides an additional
therapeutic contribution or modification to the symptomatic behaviour. Zeig (1980) described
three different principles espoused by Erickson: meeting the patient within his own frame of
reference; establishing small therapeutic modifications which are consistent with this frame of
reference; and eliciting the cure from within the patient. Thus the patient is assisted to establish
change utilizing his own power and through his own resources. Symptom prescription gives the
patient the opportunity to recognise, evaluate and change his own behaviour either consciously or
unconsciously. Zeig (1980), in another paper, described how complex symptom prescription
could be simplified by breaking the symptom into its elements and confining the prescription to
only one of these elements.
The similar approach of Farrelly and Brandsma (1974), called provocative therapy,
involves the ironic acceptance of all the patient's negative attitudes in such a way that he feels
challenged and is provoked into making a change. The provocation arises because the therapist's
symptom-encouraging attitude robs the patient's behavior of its secondary gains; consequently,
the symptoms must be altered or removed in order to maintain previous gains.
These are but a few of the ways in which indirect suggestion may be effective. When
Alman (1979) compared the effectiveness of direct versus indirect suggestion, he found that in
poorly susceptible subjects, indirect suggestion was far more effective. The analytical (257)
hypnotherapist may experience resistance to analysis with these subjects, and therefore the
judicious application of indirect suggestion may produce symptomatic improvement. (28)