Through a Glass Darkly: The Psychoanalytic use of Hypnosis with Post-Traumatic Stress Disorder

Abstract

A severe case of post-traumatic stress disorder stemming from consciousness (with auditory and pain perception) during surgery was treated with 8 sessions of hypnosis. Abreaction and revivification used alone initially retraumatized the patient, and her symptoms worsened. Ego-mastery techniques were then added; emphasis was placed on the role of the therapist as a new object presence to be internalized in restructuring the traumatic memory; memory consolidation and working-through techniques were instituted. The patient's symptoms abated and her condition remitted. The similarities between hypnotic and analytic work are highlighted. In addition, the case material provides a clinical example of the existence and potential traumatic effects of conscious awareness during surgery. It is like through glass, and you see movement and color and stuff--like you see thick glass--and now the glass is real thick and I can see a mass of colors that are not moving or nothing, like a wall. I can't remember anything past that [The Patient]. In the great majority of cases it is not possible to establish the point of origin by a simple interrogation of the patient, however thoroughly it may be carried out. This is in part because what is in question is often some experience which the patient dislikes discussing; but principally because he is genuinely unable to recollect it and often has no suspicion of the causal connection between the precipitating event and the pathological phenomenon. As a rule it is necessary to hypnotize the patient and to arouse his memories under hypnosis of the time at which the symptom made its first appearance; when this has been done, it becomes possible to demonstrate the connection in the clearest and most convincing fashion [Breuer & Freud, 1893/1955, p. 3].

PSYCHOSOCIAL TREATMENTS FOR POSTTRAUMATIC STRESS DISORDER: A Critical Review

“…A number of case reports (e.g. Jiranek 1993;Kingsbury 1988;Leung 1994;MacHovec 1983;Peebles 1989;Spiegel 1988Spiegel , 1989, involving a wide range of traumas from the common to the idiosyncratic, have testified to the usefulness of hypnosis in treating PTSD. Most, however, lack methodological rigor and thus cannot provide a basis for assessing the efficacy of hypnosis for PTSD and related pathology.…”

“…None specifies the symptoms targeted for treatment, other than noting that the patient underwent some type of trauma. In several of the reports (Jiranek 1993, Leung 1994, Peebles 1989), patients were said to have PTSD, but no information was provided about how the diagnosis was ascertained. Only two of the above reports (Leung 1994, MacHovec 1983 detailed how hypnotherapy was conducted, and none employed the controls suggested in our gold standard criteria.…”

Not all roads lead to rome: A response to michel boyer's paper entitled “matching hypnotic interventions to pathology types”

“…Numerous authors have elaborated structural and developmental perspectives for framing and attuning such hypnotherapeutic interventions, especially with preneurotic patients (Baker, 1981;Copeland, 1986;Frederick & McNeal, 1999;Peebles, 1989). When hypnotherapeutic work is not informed by such conceptualization, techniques are often not helpful and occasionally harmful as they provoke m o d u l a t e d dissociation and regression or metabolized affective intensity, As the clich6s of our cultural experience remind us, one size does not fit all, and all that glitters isn't gold.…”

Oorlogstrauma bij vluchtelingen uit de frontlinies

“…De erkenning van de zinloosheid bevordert echter wel de werkrelatie. Hypnose blijft aangewezen bij amnesie voor tenminste een deel van de traumatische herinneringen, wanneer directe bewustwording te bedreigend is (Brende & Benedict, 1980;Brown & Fromm, 1986;Erickson & Rossi, 1983;Mutter, 1986;Peebles, 1989).…”