HYPNOSIS IN PSYCHIATRY: Part 2

Questions Facilitating Rapport and Trust

What are some of the uses of hypnosis in psychiatry? The first, and I think the primary, use of it should be in establishing a good personal relationship with the patient. Once you have hypnotized patients, they will often feel that they can trust you. And, it is important to give them the opportunity of discovering that they can trust you. Therefore, I usually ask patients in the hypnotic trance some question that I know they should not answer at that time. I ask a question, and before they can possibly hear it, I point out to them that it is a question that should not yet be answered, and that they ought not to answer it until the right time comes along. Then I ask them to think about what I have said. As a result, they realize that they can answer questions freely and easily, but are under no compulsions to answer a question before the right time comes. I make this clear to patients in the waking state as well as in the trance state, because you are dealing with a person that has a conscious mind and an unconscious mind.

Integrating Conscious and Unconscious Learning

This brings us to another important point regarding the use of hypnosis. Because you are dealing with a person who has both a conscious mind and an unconscious mind, achieving good results with a patient in a deep trance does not mean that the patient will benefit from it in the ordinary waking state. There has to be an integration of unconscious learnings with conscious learnings. This should be foremost in your mind whenever you use hypnosis on psychiatric patients. You can recognize that you can resolve a conflict, a phobia, or an anxiety in the trance state. But unless you do something about it in the waking state, the patient is still likely to have that anxiety or phobia. You can remove a phobia for a certain color in the trance state so that the patient behaves normally. Nevertheless, when he awakens from the trance state, he will still have conscious habit patterns of response to that particular color. And therefore it is essential to integrate the unconscious learnings with the conscious learnings.

While a patient of mine was recovering a traumatic experience, she developed a fear of the color blue. She had seen her sister nearly drown, and her sister had looked decidedly blue in appearance. The patient didn't really recover from her fear of blue, although she could handle anything blue and look at anything blue in the trance state, until she had a feeling of conscious comfort while dealing with blue cloth and blue colors of all sorts in the waking state. She did not necessarily need to have a complete knowledge of her sister's near drowning, but she did need to have an awareness that blue used to be associated with very uncomfortable things. Therefore, in dealing with patients it is always necessary to decide how rapidly and how thoroughly they will need to integrate what they learn unconsciously with what they learn consciously.

Dissociating Intellect and Emotion in Dealing with Anxiety, Phobia, and Trauma

Hypnosis can also allow you to divide up your patient's problems. For example, a patient comes to you with some traumatic experience in the past which has resulted in a phobic reaction or an anxiety state. One can put him in a deep trance and suggest that he recover only the emotional aspects of that experience. I have demonstrated this phenomenon in the past by having one of my demonstration subjects recover all the merriment of a joke without knowing what the joke was. And yet that subject laughed and laughed in the merriest fashion over the joke, wondering at the time what the joke was! Later, I let my subject remember the actual joke. In other words, one can split off the intellectual aspects of a problem for a patient and leave only the emotional aspects to be dealt with. One can have a patient cry out very thoroughly over the emotional aspects of a traumatic experience and then later let him recover the actual intellectual content of the traumatic experience. Or, one can do it in a jigsaw fashion—that is, let him recover a little bit of the intellectual content of the traumatic experience of the past, then a little bit of the emotional content—and these different aspects need not necessarily be connected. Thus, you let the young medical student see the pitchfork, then you let him feel the pain he experienced in the gluteal regions, then you let him see the color green, then you let him feel himself stiff and rigid, and then you let him feel the full horror of his stiffness and rigidity. Various bits of the incident recovered in this jigsaw fashion allow you to eventually recover an entire, forgotten traumatic experience of childhood [a gangrenous wound from an accidental stabbing by a pitchfork] that had been governing this person's behavior in medical school and handicapping his life very seriously. [See Erickson & Rossi, 1979, for detailed examples of these approaches.]

Facilitating Recovery and Amnesia of Traumatic Events

This brings us to the possibility of inducing a complete memory of traumatic experience, and then inducing an amnesia for it. Often patients come to you not knowing why they are unhappy or distressed or disturbed in any way. All they know is that they are unhappy, and they give you a wealth of rationalizations to explain it: Things aren't going right, the mortgage is too much of a burden, their job is too difficult, when actually it may be the lingering, unconscious effects of the father relationship, the mother relationship, of their childhood. One can actually regress the Patient, return him to his childhood, and get him to remember forgotten incidents with remarkable clarity and detail. One can secure all of that information from the patient which gives you complete understanding of many aspects about your patient, and then awaken the patient with a total amnesia of what he has told you. The patient doesn't know what he is talking about, but you know what he is talking about. And therefore, you can guide the patient's thinking and speaking closer and closer to the actual problem. You can detect the significant words that refer to the traumatic experience of which he is consciously unaware and thus understand the deeper implications of what he is talking about. [Eventually, the patient will probably be able to deal consciously with the traumatic experience. But while conscious awareness of it is still too painful, you can help him deal indirectly or metaphorically with the problem.]

Learning the Indirect Approach

In this regard, you need the practice of repeatedly attempting to get a patient to talk about something in ordinary, everyday life. You need the practice of trying to get normal hypnotic subjects to talk about the lighting, for example, in the corner of the room. Of course, the lighting is not important, but how you guide them to talking about it is important. How can you do this? You merely need to observe their ordinary utterances and casual conversation. Then, emphasize the fact that all of a sudden they said the word corner, and you wonder why. Soon, they will say something is light, and very shortly you can have them talking about the lighting in the corner of the room. It is a matter of directing them. In a similar way, as long as you know some of the traumatic past of the subject, you can guide every one of your remarks in that direction.

Psychological Reorientation for Discharging and Displacing Resistance: Facilitating a Yes Set

What are some of the obstacles that you will encounter in using hypnosis? Your patients in the psychiatric field are often exceedingly difficult. They are fearful to begin with, they are distressed—they do not know how to handle themselves or they would not be your patient. You can employ all of the various hypnotic phenomena. I can recall one of my patients who came to me and spent the time explaining that he just could not talk to me. There was nothing he had to say, and he felt too miserable to be able to have any thoughts at all. My response was simply this: That he could go into a light trance and experience some interesting and rather helpful phenomena. He agreed that he needed some help, but he didn't know how to get it. And so, in an apparently random fashion, I stated that I could place a chair right there, that it would be just about so far from the bookcase, about so far from the door, about so far from my desk, and it would be really very nice to sit in that chair and be able to talk when sitting in that chair. My patient tended to agree with me that if there were a chair over there, it would be so far from the bookcase, it would be so far from my desk, it would be so far from the door.

At this point I had elicited three excellent agreements from my patient which brought us to the statement that if he were sitting in the chair in such-and-such a relationship, he might find it helpful to him in talking about himself. Of course he risked nothing in saying that he might find it helpful if he sat there in that chair—since there was no chair! I had not had him hallucinate one. I simply had him imagine it just as all of you can. But what is the subject really doing? He is agreeing with me without knowing it that he would find it easier to speak more freely if he were sitting in a different position in the office. Then I suggested that it was impossible, really, to talk in this chair—the one that he was actually sitting in—but all that would be necessary for him to do would be to take the chair, put it over there, sit down, and begin talking. I've had a patient more than once pick up his chair, move it to another side of the room, and immediately begin discussing his problems and giving me the information he needed to give. In effect, he has left all of his resistances in the room orientation that he had when sitting in this chair. But by sitting in that chair, which had just been moved over there, he saw the room in a different way entirely.

I have found that whatever you can do to alter the orientation of your patients in the office aids them tremendously in communicating with you and examining their problems. [Reorienting a patient physically and spatially often helps to reorient him psychologically. The chair in its old position represents the patient's old patterns of thinking and behaving. Moving the chair to a new position represents the patient's willingness to look at himself in a different way and gives him, literally and psychologically, a different perspective.] Hypnotically, of course, it is very easy to induce a deep trance and reorient patients completely, even to depersonalize them. That is why I emphasize the importance to all of you, no matter what field of medicine you are in, to work with normal subjects. Spending a little time with normal subjects will enable you to discover all the various hypnotic phenomena.