23 - Medical Uses of Hypnosis
Editors: Shader, Richard I.
Title: Manual of Psychiatric Therapeutics, 3rd Edition
Copyright 2003 Lippincott Williams & Wilkins
> Table of Contents > 23 - Medical Uses of Hypnosis
23
Medical Uses of Hypnosis
Richard I. Shader
Claire M. Frederick
Stephen G. Pauker
The understanding of hypnosis has come a long way since 1794 when a special commission of the French Academy (including Benjamin Franklin, Lavoiser, and Guillotine) dismissed Anton Mesmer's work with the rather ironic charge that it was merely imagination. Some believe that the first description of hypnosis occurred in Genesis 2:21 22, which says that God caused a deep sleep to fall upon Adam, and while he slept God took one of his ribs . Hypnosis can be thought of as a state of intense focal concentration with diminished peripheral awareness that is usually coupled with a high degree of relaxation. It is part of the continuum of normal attention, and it is composed of heightened absorption in perceptions, the dissociation of mental states from one another, heightened suggestibility, and diminished critical judgment.
The use of hypnosis as a therapeutic tool has been sanctioned by the American Medical Association since 1958. Recognizing the value of hypnosis, the American Medical Association has recommended that medical students should be trained in hypnosis; only rarely is this recommendation implemented. When hypnosis is appropriately applied, it can facilitate diagnostic and therapeutic procedures in clinical medicine. Even though the field of hypnosis has been a focus of much research and many therapeutically helpful developments, a great deal of misinformation and prejudice about it still remains.
I. Suggestion
Clinicians cannot help but use suggestion; at issue is whether it is used knowingly for patient benefit or inadvertently in ways that may cause harm. When a clinician asks a patient, How is your pain today? , he or she is indirectly suggesting that the patient still has pain. A more helpful suggestion might be, I wonder whether you're more comfortable today. The kind of indirect suggestion illustrated here can be quite effective. Suggestions are even more effective when they are connected to strong emotions. Patients' expectations about the future clearly play a part in shaping the future and in how they perceive it. It is not simply mind over matter, but it is clear that mind matters (Spiegel, 1999).
II. The Trance State
The trance state is an altered, but natural, state of consciousness. Hypnotizable people can enter this state in a matter of seconds, and good hypnotic subjects (note: when hypnosis is used for medical purposes, the word subject is interchangeable with the word patient) often slip in and out of trance states without realizing it (see sections III and IV). One common kind of trance experience is being totally absorbed in reading a book or magazine or in watching a movie or television to the extent that one is unaware of peripheral distractions. This intense concentration on a focal issue permits subjects to ignore or modify their perception of unwanted stimuli, such as noise or pain. Moreover, suspending critical judgment or focusing selectively on alternative feelings or behaviors is possible. During a trance, many different subjective phenomena may be experienced, depending on variables such as the expectations of the patient, the suggestions of the therapist, and the depth of the trance (Table 23.1).
Typically, a person in a hypnotic trance wants to comply and cooperate with the suggestions offered by the therapist who induces the trance. When subjects profoundly object to suggestions, they are unlikely to comply. When obtaining consent for the medical use of hypnosis, reassuring patients that, while in the trance state, they will not involuntarily reveal any secrets, lose consciousness, or have weakened will power is important. On the other hand, during a trance
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patients may occasionally recall deeply repressed material about which they were consciously unaware and with which they may still be unable to deal or process. During the trance, these recollections are communicated to the therapist. In such situations, the therapist may sometimes suggest that, upon alerting, the patient will remember those things that are safe and useful but will remember to forget material that is not, until it is safe to do so.
Currently, contemporary research techniques are being applied to clarify the processes and changes in physiology underlying trance states. One recent study, for example, revealed increased cerebral blood flow occipitally and increased delta wave activity as measured by the electroencephalogram. In time, that the biology of trance states will be more fully understood seems probable.
III. The Trance Induction
All hypnosis is, in reality, self-hypnosis, whereby the subject allows himself or herself to slip into a mode of intense concentration. The therapist can systematically teach a patient how to use this capacity, while stressing from the beginning that nothing will be projected or forced onto the patient. An atmosphere of repose, free of coercion, that enables the therapist and patient to choose a focus of fixed concentration is extremely important. The particular ritual or technique of trance induction (Table 23.2) is less important than is the patient's conviction of its efficacy and of the need for therapeutic relief. In fact, some of the benefits of positive suggestion can be obtained without inducing formal trance. Clinicians can sometimes use suggestion en passant during other clinical activities, such as the physical examination or the performance of minor procedures. Rather than engaging in random conversation with the patient at these times, the clinician may choose to use waking suggestions to make the patient more comfortable, to improve adherence, to diminish anxiety, to facilitate healing, and to shape behavior. When a formal trance is used, providing the patient with the demonstration and recall of some manifestation of trance is useful for ratifying its existence (e.g., temporary glove anesthesia or some posthypnotic suggestion) (Table 23.3).
IV. Diagnostic Uses
Because people vary in their ability to go into a hypnotic trance, a growing body of experience now exists that recommends a systematic assessment of this trance capacity as a way of providing useful diagnostic information quickly. The trance experiences of comparatively healthy persons seem clearly distinguishable from those of persons with severe personality disorders, schizophrenia, or nonpsychogenic amnesic or pain syndromes (e.g., toxic states, head trauma). Patients with these more severe problems can enter the trance state only erratically,
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and they have difficulty maintaining the continuous concentration that is required. For example, hypnosis may assist in the difficult differential diagnosis of a dissociative disorder from other, possibly psychotic, conditions. The response to trance induction may be expected to differ strikingly in these two clinical situations. The hypnotizability of patients with dissociative disorders (see Chapter 4), posttraumatic stress disorders (see Chapters 14 and 27), and some eating disorders (e.g., bulimia nervosa) (see Chapter 8 and Esplen et al., 1998) is higher than normal, whereas that of patients with schizophrenia is quite low. Although hypnosis has yet to be studied adequately in toxic and other medical conditions, difficulties similar to those experienced with schizophrenic patients may reasonably be expected.
TABLE 23.1. SOME TRANCE (HYPNOTIC) PHENOMENA | |
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TABLE 23.2. A SAMPLE PROTOCOL FOR HYPNOSIS | |
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TABLE 23.3. DEPTH OF TRANCE POTENTIALLY OBSERVABLE PHENOMENA | |
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One brief (10-minute) assessment of trance capacity (Table 23.4) that may be incorporated as part of the clinical induction procedure is known as the hypnotic induction profile (Spiegel and Spiegel, 1978). It is usually carried out when evaluating patients for treatment with hypnosis or when hypnosis is used to assist in differential diagnosis. A series of behavioral instructions can be given after a brief hypnotic induction. The therapist suggests that a subject's hand will remain light and in an upright position. The patient shows hypnotizability by the degree to which he or she acts in accordance with this instruction and to which he or she experiences reversible alterations in sensation and motor control in the hand. Other good hypnotizability scales that have been adapted for clinical use are also available (e.g., Hilgard and Hilgard, 1975). However, many clinical
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reports suggest little difference in therapeutic outcomes from hypnosis based on the hypnotizability of the patient.
TABLE 23.4. SOME ILLUSTRATIVE ELEMENTS ADAPTED AND MODIFIED FROM THE HYPNOTIC INDUCTION PROFILE | |||||||||||||||||||||
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The therapist should be alert to at least two sources of artifact in this assessment. If the patient feels coerced or untrusting, the response may be below the individual's real capacity. In addition to this problem of motivation, when a patient is medicated, that sedative-hypnotics and antipsychotic agents, and possibly other classes of agents, would interfere with trance capacity is probable. Enough patients have sufficient trance capacity to make hypnosis a clinically useful tool, even if their hypnotic induction profile score is only modest. For this reason, many clinicians do not formally assess suggestibility or hypnotizability. Instead, they presume that the patient has an adequate capacity for trance and simply proceed. This is particularly important when hypnosis and suggestion are used as an adjunct to other medical therapies. For example, if the patient is about to undergo a procedure (e.g., catheterization, endoscopy, lumbar puncture, or even the suturing of a laceration), performing the hypnotic induction profile before deciding to use suggestion to mitigate the patient's discomfort would be inappropriate. Suggestion or even formal trance should be used in such circumstances as a matter of course.
Approximately 10% of the population are refractory to or uncooperative about hypnosis. Of the remaining 90%, about one-third are capable of light trance, one-third of moderate trance, and one-third are highly responsive (Hammond, 1998). Children tend to use trance more easily than do adults, with peak responsivity between the ages of 8 and 12 years. Experienced pediatricians skilled in hypnosis report the ability to induce trance in infants, even newborns, using nonverbal techniques (S. Pauker, personal communication, 2000).
V. Therapeutic Applications
Many psychiatric inpatients may be incapable of sustained trance experiences. In general medical settings and in outpatient treatment, however, hypnosis can augment a variety of therapeutic strategies; the higher that the patient's hypnotizability is, the more likely a positive outcome will be. The clinician must remember, however, that a patient's hypnotizability per se does not make hypnosis an effective treatment for that person. Other important factors include motivation to change, the presence of secondary gain, and the transference and/or alliance with the therapist (see Chapter 1).
A. Pain
Hypnosis can be remarkably effective in controlling pain, whether of psychogenic or nonpsychogenic origin. In the last century, Esdaile reported better than 80% surgical anesthesia with hypnosis. Esdaile's series of 3,000 patients also showed a 10-fold decline in operative mortality, from 50% to 5%, that presumably resulted from avoiding the effects of shock. Although hypnosis has been used successfully as the sole anesthesia in major surgery, very few medical indications are found for performing major surgery with hypnosis as the sole anesthesia. Rather, hypnosis should be considered an adjunct that permits comfort with lower doses of anesthetic agents and that may speed recovery and diminish intraoperative blood loss, especially if those expectations are established preoperatively. Highly hypnotizable subjects often can achieve full anesthesia; persons with a lower responsiveness can learn to transform their perceptions or to divert their attention from the pain. Hypnosis may be underrecognized as a helpful technique in natural childbirth; it is also potentially useful for the relief of preoperative anxiety that will usually augment the postoperative pain. Furthermore, patients with postsurgical or trauma-induced pain, as well as some with chronic distress, may be taught to hypnotize themselves to cope with pain better. Remembering that opiates and sedative-hypnotics, by clouding the sensorium, interfere with hypnotic capacity is important.
Before any treatment approach is chosen, establishing an accurate diagnosis is essential. Hypnosis can be used in a number of ways to control pain. One could produce a state of tingling numbness, warmth or coolness, and reduced sensitivity in an unaffected area (e.g., the left hand in a right-handed
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person) and could then recreate these feelings in the affected area. This is a substitution strategy. The patient can also be told to imagine that a local anesthetic has been applied to the painful area, although care should be taken to determine that the patient is not allergic to local anesthetics, lest the suggestion induce an allergic reaction, a rare complication of such suggestions. Another variation could shift or displace attention from the affected area to a neutral or unaffected area (e.g., from the lower back to the left hand). These strategies can be combined. In addition, use of repeated sessions to reduce the perceived magnitude of the pain decrementally at each successive session is often reasonable.
These examples illustrate one of the main elements in the control of pain by hypnosis, perceptual filtering. Another element is induced physical relaxation. The patient is taught to concentrate on a metaphor that connotes muscle relaxation, such as floating. This can often produce relaxation in the painful area and can thereby reduce pain signals. Among the strategies that can be useful in managing pain, suggestion can be used to alter the intensity of the sensation and its quality and duration, which refers to the ability of trance and posthypnotic suggestion to produce time distortion. When patients have difficulty decreasing the discomfort (a less jarring word than pain ), a useful approach can be to have the patient increase the severity of the pain. Once this has been accomplished, patients can be guided to the realization that they do have the ability to affect their own pain. At that point, the realization that they can, if they so desire, take the hurt out of their discomfort is a small step for them. Ewin (1983) noted that happiness and joy often override painful situations. In treating patients with acute thermal burns, he has found the suggestion that patients visit their laughing place to be useful.
Because chronic pain syndromes are so often accompanied by demoralization or depression, the treatment of pain must always be undertaken in a context that addresses the broader needs and problems of the patient (see Chapters 18 and 28). Even then, however, showing patients that they have some control over their discomfort can be liberating, and it can increase their coping capacity. To help patients manage chronic pain, therapists often use the trance to show the patient how to alter the severity or quality of the sensation and they use time distortion to modify its frequency or duration. A useful metaphor can be to ask the patient to scan their bodies and minds to locate the switch or rheostat that controls their sensation in that area and then to turn it to change its volume or tone.
B. Medical and Surgical Procedures
Hypnosis is a powerful adjunct for patients undergoing a variety of procedures. The relaxation and dissociation it provides decrease anxiety and discomfort. Its influence on the autonomic nervous system can produce selective vasoconstriction and can thereby diminish intraoperative bleeding. Hypnosis, even if it is introduced only in the preanesthetic induction setting, can establish positive expectations about surgical outcomes and can speed recovery. A recent controlled study demonstrated that formal hypnosis can diminish the procedure and recovery time (Lang et al., 2000). Pediatricians may find that providing their healthy young patients with a magic spot, which the patient controls and can apply as needed (e.g., for immunizations, for suturing lacerations), to be useful.
C. Medical Conditions
Hypnosis has been applied, with mixed success, to a broad variety of medical conditions. Unfortunately, the results remain mostly anecdotal, with few well-controlled trials in the literature. Nonetheless, because the risks of hypnosis are quite low (barring inadequate diagnostic evaluation and masking of important symptoms), clinicians may find the use of suggestion and hypnosis to be beneficial in many different settings (Pinnell and Covino, 2000). Among the conditions reported to respond to hypnosis are irritable bowel syndrome, asthma, migraine, warts, and psoriasis. (Note: Each of these is an episodic condition in which exacerbations can be produced by stress.)
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D. Psychosomatic Illnesses
Some medical conditions with large affective and stress-related components, such as asthma, can be susceptible to intervention with hypnosis. The technique is similar to that used for anxiety; it consists of teaching the patient to master his or her somatic responses in the face of an atopic or emotional stress to prevent further decompensation.
E. Anxiety
Patients with recurring anxiety can be helped to interrupt the snowballing effect of their somatic and psychologic tension. In such situations, hypnosis can be used to disconnect the somatic symptoms from the subjective psychologic distress. Patients are taught to use self-hypnosis. In one self-hypnosis exercise, for example, the patients imagine themselves relaxed and floating in a comfortable chair while picturing their concerns on an imaginary split movie screen. On one half of the screen are seen the anxieties and problems; on the other half are the patient's own internal resources stabilizing relationships, achievements, and abilities.
Patients with panic attacks can be helped with hypnosis in several ways. One is the use of relaxation and the split screen technique. Patients are instructed to picture a feared situation on one side of the screen and a means of coping with it, or other psychologic resources, on the other, all the while maintaining the feeling of floating. The screen may also be used to estimate the real risk and to diffuse the confusion between probability and possibility that affects many patients with panic attacks or phobias. The enhanced control over the physical response that is obtained through hypnosis can help anxious and phobic patients master their physical symptoms instead of feeling frightened by them. This technique enhances relaxation and promotes a sense of mastery. The initial stimuli remain, but the helplessness and immobilization are contained. The success of this particular technique is compromised when the anxious patient is unable to bind or contain the anxiety long enough to permit focused concentration. Self-hypnosis works best for minimal to mild anxiety (see Chapter 14). Hypnosis can also be used for the identification of triggers for panic attacks and for desensitization to both the triggers and the panic experience itself. Hypnoanalytic work has the potential for uncovering and repairing unresolved conflicts that may be expressing themselves in panic attacks.
F. Simple Phobias
These respond well to behavior therapy, but they may also respond to hypnosis, which, in some instances, is less time consuming. Phobic patients can be taught to bring on a sense of relaxation and well-being using the technique described in section E. For example, patients with flying phobias are taught to use a self-hypnotic feeling of floating with the plane, as if the plane were an extension of their own bodies. For all simple phobias, the patient and therapist work out a series of steps involving exposure to the feared object or situation coupled with a self-hypnotic state of relaxation. Again the goal is to contain the anxiety and to promote a sense of mastery (see Chapter 14).
Alternatively, some clinicians find that phobias, such as fear of flying, can be approached by asking patients to visualize a successful outcome in the future (e.g., walking off the plane at the planned destination) and slowly playing their mental tape or imagery backward until they can see the entire sequence (e.g., from leaving their home to arriving at their destination) as a series of successes. These same approaches can be helpful in patient who is extremely anxious about a procedure, such as surgery, or something they must accomplish, such as a performance or a sporting event.
G. Obsessions and Compulsions
A special case of anxiety control involves the alleviation of some of the distress and anxiety that either alters the threshold and produces an increased frequency of obsessive thoughts and compulsive actions (see Chapter 6) or results from attempts (or an inability) to resist them. The goal is to enhance
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the patient's sense of calmness and comfort, thereby raising the threshold for the emergence of these unwanted experiences; one approach involves using hypnosis to place time boundaries around them. Once the patient with a compulsion to clean has been hypnotized, for example, he or she is asked to imagine spending 1 hour a day thoroughly cleaning the bathroom. After several sessions, the patient would then be asked (while in the trance state) to describe the activities and feelings involved. Next, the therapist uses posthypnotic suggestion to give the patient the task of actually cleaning the bathroom in question within the 1-hour limit. If this goal is met, the patient is then helped to reduce the time (e.g., to 15 min per day).
Hypnosis can also be used to determine whether thoughts or contexts exist that lower the patient's threshold for the emergence of the obsessive thoughts and actions. For patients with more severe symptoms and distress (e.g., those meeting the criteria for obsessive-compulsive disorder) (see Chapter 6), hypnosis rarely works as a primary treatment. It can have value as an adjunctive therapy in further reducing an unwanted behavior (e.g., hair pulling) in a patient who has had a partial response to medication or behavior therapy.
Obsessive-compulsive symptoms can be thought of as existing on a spectrum ranging from the most biologically determined to the most psychologically determined. Many patients with obsessive-compulsive symptoms have dissociative difficulties as well (Frederick and McNeal, 1999). At times, hypnoanalytic work can help to resolve the psychopathologic underpinnings of obsessions and compulsions.
H. Dissociative Disorders and Conversion Symptoms
Although hypnosis is considered by many to be extremely helpful in working with patients who have dissociative disorders (see Chapter 4), the nature and treatment of these disorders has become a theoretical, forensic, and political battleground in recent times (Brown et al., 1997). Many patients with dissociative amnesia or fugue can be treated with simple hypnotic age regression. Highly hypnotizable people may be prone to conversion symptoms. They may be willing to give up or to eliminate these symptoms when the secondary loss has exceeded the gain. Hypnotic suggestion can be used to reduce, to exaggerate, or to transfer a symptom, thereby showing the patient how to enhance control over that symptom. This should be done in the context of a rehabilitation program that reinforces improvement and that does not interpret resistances. A nonhypnotizable patient is more likely to have hypochondriasis or a nonpsychogenic problem.
The diagnosis and treatment of trauma and dissociation is a rapidly developing field. The use of newer diagnostic tools has led many to believe that the incidence of serious dissociative disorders, such as dissociative identity disorder, is much higher than was previously believed. The diagnosis and treatment of dissociative identity disorder can be extremely complex. Although age regression and abreaction (recalling and reexperiencing or reliving suppressed or repressed events) of traumatic memory material can be used at times in the treatment of dissociative identity disorder and other serious dissociative conditions, emphasis has shifted to phase-oriented treatment models, in which the use of hypnosis for stabilization, ego strengthening, and mastery achieve prominence. Current standards of care require that hypnotically facilitated abreaction be conducted only in stabilized patients who have good ego strength and who have learned how to exercise mastery over trauma material. The therapist must always use extreme caution in avoiding any suggestion to patients that trauma or abuse has occurred.
When working with the patient, the therapist must be prepared to deal with emerging traumatic memory material, which may or may not be associated with accurate recall of actual traumatic events per se, and the traumatic transference and countertransference associated with childhood trauma or abuse. Training in trauma and dissociation is now considered to
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be necessary for those who treat posttraumatic and dissociative disorders, and additional advanced education in hypnosis is essential for those who wish to use it for treating these populations, especially for the victims of rape (see Chapter 27).
I. Habits
Hypnosis can facilitate a strategy of self-affirmation in dealing with difficult problems such as smoking. Self-hypnosis is a widely used aid to smoking cessation. It is used in the context of the cognitive restructuring of the urge to smoke, and it involves having the patient focus instead on a commitment to respect and protect his or her body. For example, the patient is instructed during the trance to repeat, For my body, smoking is a poison; I need my body to live; I owe my body the respect and protection of not smoking; I am responsible for my body; I am a nonsmoker. Patients learn to stop smoking not by fighting the urge to smoke but rather by connecting this urge to broader interests in health and protection of the body. Some clinicians present the patient with a model in which smoking is seen as a conditioned response to external stimuli, such as situation-specific stress. Patients are then shown how to use hypnosis to extinguish that conditioned response by playing out in their trance how the presentation of the stimulus (stress) does not need to be followed by the evoked response. Hypnosis is used to illustrate to patients the way that they relate to their bodies and how their bodies are dependent on them. Hypnosis is likely to be most successful when it is incorporated into a total treatment plan that includes group therapy and possibly the use of nicotine-containing preparations (e.g., patches, gum) or the prodopaminergic agent bupropion.
Similar approaches are used to help some patients who overeat, especially those who overeat when they are anxious (see Chapter 8). Little success has been found for the use of hypnosis in the treatment of addiction to alcohol or other abusable substances. Hypnosis has also been applied to bruxism, nail biting, gagging, tongue thrusting, enuresis, and other habit disorders.
J. Spontaneous Hypnosis
A subgroup of patients may require training in how not to enter the trance mode. These extremely hypnotizable people are constantly being entranced by others, are working to please them, and are suspending their own critical judgment. Here the trance induction is used as a demonstration of how susceptible they are, and they are taught how to control their own tendency to slip into trance states. Spontaneous hypnosis can also be observed to occur in houses of worship and in the emergency departments of hospitals.
VI. Cautions and Contraindications
Hypnosis should never be attempted under threat or coercion. The therapist should explain briefly the nature of hypnosis and should emphasize that trance is a natural state into which all enter on a daily basis, that all hypnosis is really self-hypnosis, that the patient will remain aware of what is happening, and that he or she is free to break the trance state at any time. The purpose of the hypnotic intervention should be explained clearly, and the nature of the induction procedure should be briefly reviewed. The clinician must remember that hypnosis is only a technique, and clinicians should never attempt to do anything with hypnosis that they are not trained to do without hypnosis. Even with some of the patients noted in the next three subsections, hypnosis can sometimes be used successfully to ease the discomfort associated with specific interventions, such as dental phobias, preoperative preparation, or obstetric and gynecologic procedures.
A. Severe Depression
Many hypnotic techniques can help with the mitigation and resolution of depression. Hypnosis can be used to augment both psychodynamic and/or object relations-oriented psychotherapy and cognitive-behavioral approaches (Yapko, 1996; Frederick and McNeal, 1999). Hypnotically facilitated ego strengthening can be of unparalleled value with suicidal patients
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when conducted by therapists well trained in therapeutic hypnosis (Brown and Fromm, 1986; Frederick and McNeal, 1999). However, the inexperienced should approach depressed patients with extreme caution. Persons who are severely depressed and suicidal may have their hopes for a magical cure raised and then dashed by an attempt at a hypnotic induction. A patient could view an unsuccessful induction as one more failure in life, and, if he or she is suicidal already, this experience could be used as an excuse for a suicide attempt. Careful assessment of level of depression, expectations, and suicidal tendencies is critical.
B. Paranoid Thinking of Psychotic Proportion
At one time, hypnosis was thought to be contraindicated with psychotic and borderline patients because it activates archaic preoedipal transferences, thus producing a state of regression. Later work (Baker, 1981 1994; Frederick and McNeal, 1999; Murray-Jobsis, 1985 1991) showed that hypnosis can be a premier tool for developmental repair with such patients when it is used by those who are highly trained in this area. The regression is actually a regression in the service of the ego, and hypnosis can be used with psychotic patients for relaxation and stabilization and as a significant medium for transitional experiences, boundary formation and strengthening, affect containment, impulse regulation, the correction of cognitive defects, and other aspects of developmental repair (Fromm and Nash, 1997; Frederick and McNeal, 1999). However, certain cautions must be exercised. A person who has developed a projective framework of thinking (see Chapter 4), for example, is not likely to appreciate the subtleties of hypnosis or self-hypnosis as distinct from mind control. He or she may attribute great powers to the therapist and may get quite angry at what seems to be a loss of control. This does not need to be the case, however, and paranoid persons may discover, to their surprise, that they achieve even greater control with hypnosis. But care must be taken, and hypnosis with paranoid patients should not be approached by the inexperienced. Most paranoid persons will make the therapist's decision to use hypnosis an unnecessary one by simply refusing to participate.
C. Patient With a History Suggestive of Abuse: Attempting to Use Hypnosis to Find Out What Really Happened
This issue often arises with patients who have a history suggestive of abuse. These patients are often problematic for the casual hypnotherapist, and the concerns noted in section V.H are important considerations, especially the realization that, although material accessed through hypnosis may bear some relationship to historical reality, it may also be untrue, distorted, or even symbolic of the patient's conflicts.
Recent clinical and legal cases have focused on the issue of patients coming to believe that certain events occurred when they in fact had not. The use of hypnosis when sexual abuse may be involved or suspected creates some legal exposure for the therapist. Many hypnotherapists require an informed consent from patients with whom they work.
D. Patients Who May Have to Testify in Court
In many jurisdictions, patients who have had hypnosis for the exploration of memory material or for any other reason whatsoever may be precluded from providing testimony in court. Hence, patients should be warned about those legal risks before any hypnotic encounter. Generally, using hypnosis with patients who may have to testify in court is most unwise.
VII. Comment
Many insurance companies will reimburse some portion of the charges for medical hypnosis when it is provided by a licensed clinician. However, referral to a well-trained clinician who uses hypnosis is not easily accomplished in some areas of the country. Because the practice of hypnosis is not regulated in many states, checking with a national organization may be advisable. The American Society of Clinical Hypnosis may be reached at 630-980-4740 (http://www.ASCH.net) and The Society for Clinical and Experimental Hypnosis can be contacted at 509-335-2097 (http://www.hypnosis-research.org).
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