The Integrative Period The Acceptance Of Hypnosis And The Integration Of Technique And Theory

In the 1980s, the literature of clinical case reports of successful hypnotic work with both psychotic and personality disorder patients continued to grow. However, in addition to these clinical case reports, the literature began to present new hypnotic techniques for working with psychotic and personality disorder patients and the integration of these techniques into established psychological theory and conceptual models of hypnosis (Baker, 1981, 1983a, b; Brown, 1985; Brown & Fromm, 1986; Copeland, 1986; Fromm, 1984; Murray-Jobsis, 1984, 1985, 1986, 1988, 1989, 1991b, 1992, 1993, 1995, l996; Scagnelli, 1980; Scagnelli-Jobsis, 1982; Vas, 1990; Zindel, 1992, 1996).

In l980, Scagnelli reported on the use of trance by both the patient and therapist. Brief vignettes were presented of work with both psychotic and personality disorder patients. It was noted that patients with this severity of disorder frequently utilized hypnosis for ego strengthening and integration of their emotional and cognitive resources. However, it was also noted that some insight and uncovering work could be done by these patients. Both formal induction techniques and informal hypnotic techniques were found to be useful. In addition to the use of trance by the patient, Scagnelli stressed the particular usefulness of trance by the therapist as a valuable technique in working with the severely disturbed patient population. The author proposed that the use of an autohypnotic trance by the therapist (along with the patient's trance) heightened the therapist's empathy. This heightened empathy could facilitate the therapist in utilizing his own body, mind and feeling state to enhance his receptivity and understanding of the patient's feelings and experience. This heightened empathy could then help the therapist identify, verbalize and reframe feelings and experience for and with the patient. Several vignettes of case work with patients were presented, illustrating how such empathic contact and interpretation of feelings with the patient could be crucial to the progress of therapy.

In 1981, Baker presented a rationale for the use of hypnosis with psychotic patients, based on object relations theory. Baker developed a protocol of seven steps designed for the hypnoanalytic treatment of psychotic patients. He based this protocol on the deficits in object relatedness and in other ego functions associated with psychotic conditions. The seven-step protocol was designed to enhance the positive aspects of the emerging transference and to support the patient's capacity to maintain real connections with the external environment. A case example of a 23-year-old paranoid schizophrenic was presented illustrating these techniques. Baker's work was later elaborated on and extended by Fromm (1984) and Copeland (1986).

Baker also expanded on his own work in hypnotherapy with severely disturbed patients in two additional papers published in 1983. In his first paper, Baker (1983a) reported on work he had done with narcissistic, borderline, and psychotic patients, utilizing hypnotic dreaming as a transitional object to facilitate a connection with the therapist for the patient as he left the therapy session with his dream.

In addition, the hypnotic dream process could also be utilized by the patient outside of therapy to foster autonomy and independence. A case example of a personality disorder patient utilizing such hypnotic dream work as a transitional process was presented.

In a second paper, Baker (1983b) examined various aspects of resistance that became manifest in hypnotherapy with borderline, narcissistic and psychotic patients and gave specific suggestions for the management of this resistance. A brief vignette of a schizophrenic patient was presented to illustrate resistance due to a need for distance and the therapist's utilization of boundaries and separation to reduce patient anxiety.

Contemporaneous with the ongoing accumulation of clinical case reports and the development of specialized techniques for hypnotic work with the severely disturbed patient, consensus also was building concerning the capacity and usefulness of hypnosis for this patient population. In the early 1980s, three literature review articles were published supporting the conclusion that psychotic and personality disorder patients were susceptible to hypnosis and were capable of utilizing hypnosis productively and safely. In 1982, Scagnelli-Jobsis published a review of the experimental and clinical literature concerning the use of hypnosis with severely disturbed patients, concluding that the literature supported the view that psychotic and personality disorder patients were susceptible to hypnosis and were capable of utilizing hypnosis productively and safely.2 In that same year a literature review by Pettinati (1982, Pettinati, Evans, Staats & Home) came to very similar conclusions, stating that, 'It can be concluded that a number of severely disturbed psychotic (typically schizophrenic) patients can be successfully hypnotized...'. In 1985, Lavoie & Elie published a review (building on work begun in 1978 and 1980) concurring with the conclusions of Scagnelli-Jobsis and of Pettinati concerning the hypnotic capacity of psychotic patients. Specifically, Lavoie and Elie found that 'schizophrenic patients do present mean susceptibility scores essentially similar to ones obtained by normal Ss of comparable age.' Thus, the early 1980s marked a watershed period when it became generally accepted that psychotic and personality disorder patients were potentially capable of safe and productive utilization of hypnosis.

In 1984, Murray-Jobsis published a chapter (in Wester & Smith) summarizing the consensus concerning the applicability of hypnosis with severely disturbed patients and describing the necessary treatment techniques and adjustments required by this population. Induction techniques, specific treatment techniques and special considerations for this patient population were presented and discussed. The chapter outlined and described in detail the integration of hypnosis into traditional treatment techniques and then clarified any necessary adjustment to these techniques for use with the severely disturbed patient. In addition, new hypnotic techniques developed especially for the severely disturbed patient were introduced and explained. A case example utilizing and demonstrating some of the techniques was presented.

Brown & Fromm (1986) also presented specific hypnotic techniques for treating psychotic and borderline patients. Their techniques were based on developmental theory and were intended to promote the formation of boundaries and body image, the development of object and self-representations, and the development of affect (Brown, 1985; Brown & Fromm, 1986).

Then, beginning in the late 1980s and extending into the 1990s, Murray-Jobsis further developed and expanded specialized techniques for working with the severely disturbed patient, based on a developmental/psychoanalytic framework and designed to supply missing developmental experiences. Building on therapy techniques and clinical work begun in 1976, Murray-Jobsis developed and elaborated techniques of nurturance in hypnotic imagery for the development of bonding and a positive relational capacity and for the formation of a positive self-image. In addition, imagery techniques utilizing hypnosis to foster separation-individuation based on mastery and competence rather than abandonment were also developed. These techniques were based on a developmental framework and emphasized the creation of 'healing scripts'. With these 'healing scripts' patients were encouraged to create positive imaginary past experiences as a restitution for missing or developmentally damaging past real-life experiences. (Murray-Jobsis, 1984, 1986, 1989, 1991b, 1992, 1993, 1995, 1996; Scagnelli, 1976).

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