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American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
“Back from the Future”: A Powerful Age-Progression Technique Moshe S. Torem M.D.
a
a
Northeastern Ohio Universities College of Medicine , USA Published online: 21 Sep 2011.
To cite this article: Moshe S. Torem M.D. (1992) “Back from the Future”: A Powerful Age-Progression Technique, American Journal of Clinical Hypnosis, 35:2, 81-88, DOI: 10.1080/00029157.1992.10402990 To link to this article: http://dx.doi.org/10.1080/00029157.1992.10402990
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS VOLUME
35. NUMBER 2.
OcTOBER
1992
"Back From the Future": A Powerful Age- Progression Technique
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Moshe S. Torem Northeastern Ohio Universities College of Medicine This paper briefly reviews the benefits of using age-progression techniques in hypnotherapy, followed by a detailed explanation and illustration of the "backfrom-the-future" technique with two case examples, including their outcome. The patients presented with feelings of helplessness, hopelessness, and a sense of futurelessness. Following the hypnotherapeutic intervention, patients were instructed to take time to reflect on the session and to write down the specific experiences they had on their voyage into the future focusing on their visual images, auditory sensations, experiences with other senses (touch, smell, and taste), as well as thoughts, emotions, and self-perceptions. Followup validated that the patients maintained their therapeutic accomplishments several months after the initial interventions.
We are what we imagine ourselves to be. Kurt Vonnegut, Jr.
One's life is dyed to the color of his imagination. Marcus Aurelius The greatest discovery of my generation is that human beings, by changing the inner attitude of their minds, can change the outer aspects of their lives. William James If you can dream it, you can do it.
Walt Disney
For reprints write to Moshe S. Torem, M.D., Akron General Medical Center, Department of Psychiatry & Behavioral Sciences, 400 Wabash Avenue, Akron, Ohio 44307. Received March 15, 1991; revised August 4, 1992; accepted for publication August 10, 1992.
The above statements show that the effectiveness of imagery has been known to mankind for many centuries. It is only recently that we have rediscovered the power of imagery and are relearning how to use its therapeutic effectiveness with a variety of human conditions, including the psychological and somatic effects of trauma. The use of imagery was recently reviewed by Achterberg (1985), Bry (1978), Fanning (1988), and Lazarus (1984). Patients with posttraumatic stress disorder have a range of symptoms including flashbacks, nightmares, anxiety, panic attacks, a variety of physical symptoms, sudden mood changes, outbursts of anger, and feelings of helplessness and hopelessness. In addition, some patients may feel a sense of powerlessness and futureless81
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ness associated with feelings of reliving traumas of the past and behavioral reenactment of the trauma. One way to understand the above list of symptoms is that this is the patients' unconscious attempt to regain a sense of mastery over their experiences in which they had a total loss of control. Another common symptom is their feeling regarding trauma where they felt victimized with a sense of total helplessness and powerlessness. One defense commonly used against such feelings is done through internalization of the blame communicated to them by the abusers and perpetrators. Survivors of trauma later experience the internalization and introjective identification with the abuser and perpetrator in the form of self-blame and guilt, believing that they may have caused the abuse and trauma. The sense of futurelessness associated with posttraumatic stress disorder was recently addressed by Lenore C. Terr (1991). Many patients with PTSD are experiencing a syndrome in which they are "prisoners" of their own past. They are reliving their past without consciously being aware of it and have no sense ofthe future. Many of these patients have stated that they live one day at a time, and their future is experienced as blank. The literature from Janet (1925) to Putnam (1992) has many publications focusing on the use of age regression and abreaction of traumatic memories in the treatment of PTSD. However, as pointed out by Spiegel (1981), abreactive therapy with PTSD patients has a high prevalence of negative responses. The first goal of treatment is to stabilize the symptom picture, as stated by Brown and Fromm (1986, p.276). This is extremely important since PTSD patients are vulnerable to reenactment of the traumatic experiences associated with flashbacks and depressed mood. This paper describes a specific technique
of age progression combined with ego strengthening in the hospital treatment of the PTSD patients. Age Progression Therapeutic techniques associated with age progression are designed to act as an antidote to the patient's sense of futurelessness. Milton Erickson (1954) described a technique of age progression facilitated by hypnosis, which he termed "... pseudoorientation in time as a hypnotherapeutic procedure." Erickson would guide the patient into a hypnotic trance and have the patient travel forward to the future into a time and space in which the patient has achieved a resolution of the problem. He would then suggest that the patient accept the future time as the present, and he would inquire what the patient leamed and did that helped to solve the problem. When Erickson obtained this information, he facilitated amnesia for having done so and used this information as a therapeutic strategy. Corydon Hammond (1990) mentions under the term "age progression" the following other terms that he found in reviewing the literature: "time projection," "mental rehearsal," "process imagery," "goal imagery," "success imagery," and "end result imagery." He stated, "... all of them refer to future-oriented therapeutic work." He conceptualizes mental rehearsal facilitated by hypnosis as a technique in which the patient is asked to replay mentally and covertly an anticipated future situation. Zilbergeld and Lazarus (1987) have referred to mental rehearsal as process imagery in which the patient imagines the process and means by which one eventually accomplishes the desired end result. Hammond (1990) believes that the difference between endresult imagery and age progression is like the difference between consciously remem-
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AGE-PROGRESSION TECHNIQUE
bering an event from your childhood versus undergoing a complete age regression and having are-vivification of a childhood experience while in a deep trance. Erickson compared this to the difference between conscious fantasies (mental rehearsal, success imagery) and unconscious fantasies (age progression). Hammond (1990) goes on to ask, "When we consider the research that documents how utterly real and convincing a confabulated (or therapist-suggested, but inaccurate) age regression may feel to a subject, why shouldn't age progressions have the potential to feel just as actual and real?" Hammond also points out that age progression is a form of goal-directed hypnotherapy and is compatible with Alfred Adler's future-oriented approach to treatment as described by Ansbacher (1990). This is based on Adler's belief that human beings are basically goal-oriented and see themselves as moving forward toward goals in the future. Many patients with PTSD, depression, and other conditions move towards irrational goals and use their imagery in self-defeating rather than constructive ways. "Back-From-the-Future" Technique Using this technique requires an understanding of and familiarity with the patient's condition and life circumstances. A discussion is held with the patient about a desired future image in which the patient would be comfortable as representing a better, healthier, desired, or, at least, acceptable setting in their life. Once that is identified, the patient is guided into a state of hypnotic trance and then age progression is hypnotically facilitated by "time travel" into a specific time in the future. The future reality is hypnotically enhanced by suggestions focused on visual, auditory, touch, smell, and taste senses. In addition,
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the experiences are enhanced by ego strengthening as described by Hartland (1965, 1971) and Torem (1990) for suggestions of positive thinking and pleasant feelings of joy and pride in reaching a solution to a specific problem. This is also accompanied by suggestions for a sense of health, strength, accomplishment, and a sense of innerresourcefulness and creativity in coping with life's stresses. The patient is then instructed to store the above positive feelings, images, and sense of accomplishment and to internalize them as the patient is hypnotically guided back from the future into the present. The patients are told that these positive images, sensations, and feelings are a special gift that they take with them on their trip "back from the future" into the present, and that these gifts will guide them on a conscious and subconscious level in their journey of healing and recovery. When the patient is out of the formal hypnotic trance, a brief discussion is conducted about the patient's experience. This is followed by a homework assignment in which the patient is asked to write about the experience and to tell what it was like to take such a voyage into the future. This written assignment may be requested while the patient is still in a state of hypnotic trance. The patient is asked to bring the written assignment to the following session and to read it. The symptoms of futurelessness, helplessness, and hopelessness are significantly reduced and are replaced by a sense of new hope, strength, inner resourcefulness, self-mastery, and belief in one's recovery. The suggestions for age progression (a verbatim example is given in the first case report) are used after the patient has learned self-hypnosis and is guided into a state of hypnotic trance. This can be followed by discussion ofthe patient's experience and
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an assignment to have the experience put in written form to be reviewed in the following session. Case Examples
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Case One Gigi was a 29-year-old, single mother of two children, ages 11 and 5. She was admitted to a psychiatry unit of a general hospital for the treatment of severe depression and suicidal thoughts precipitated by the loss of the relationship with an abusive boyfriend. She had a history of many previous hospitalizations and was diagnosed as suffering from a recurrent depressive disorder and posttraumatic stress disorder related to multiple traumas in her childhood. In the past, she was treated by several different antidepressants in combination with benzodiazepines. This time a reassessment of all drug therapy was done and she remained only on alprazolam (0.25 mg, four times a day). After several sessions I performed the Hypnotic Induction Profile (HIP), and she had a high hypnotic capacity (scored 4 intact on the HIP). The patient learned to use selfhypnosis for relaxation and was able to facilitate the induction of healthy and restful sleep at night. She identified a sense of futurelessness and helplessness and stated that she was "living just one day at a time." However, she was willing to engage in future-oriented guided imagery and identified the graduation of her ll-year-old son from high school as a future scene in which she would like to be present. With her consent, the following age-progression suggestions were given: Now that you have reached the state of self-hypnotic trance, I would like you to continue to breathe comfortably, in and out... With each breath that you continue to take, this calmness and total
state of peace, serenity, and inner harmony continue and become stronger and stronger. As this takes place, you may allow yourself, if you wish, to experience the very special state of extra-receptivity in which you pay attention to your commitment to full healing and recovery. Everyone committed to this state of full recovery has an image of the future. If you wish, you may follow me on this voyage in time to the future where we are moving forward, as you continue to mature and grow. I want you to see your older child growing in age, turning 9 (in this case the patient's older child is 8 years old) moving forward into 10, II ... that's right ... 12, 13, 14, 15 ... that's right · .. becoming an adolescent, 16, 17 ... that's right ... and 18 ... that's right · .. this is now the age that your child is reaching the point of being in the 12th grade of high school ... that's right .. · the time has come for the big ceremony of graduation ... that's right .... See yourself in that special place in the hall where the graduation ceremony from high school is taking place. See yourself sitting there dressed up in your favorite clothes. See your other child sitting there with you. Look at the place and see other graduating students dressed in their caps and gowns, see the band and listen to the music, look at the clothes that you are wearing and the clothes of your other child. You are all dressed in your best clothes. Listen to the sounds of people talking, the music playing...that's right...look at the face of your other child. Look at the joy and pleasurable anticipation. Now, if you wish, touch the hand of your younger child, and feel the special sensation of warmth and experience the sense of joy and anticipation for the special moment in the graduation of your older child. Take a deep breath through your nose and smell the special fragrance in the air. Now, look up at the stage and see
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the different dignitaries calling the names of the various students who are graduating. And, as this goes on, listen to the name of your son being called up and watch him walking up the aisle in cap and gown to receive the diploma. He steps up to the stage, shakes the hands of the various dignitaries, receives the diploma and you take pictures, if you wish, and then you watch him go back to his place. Experience the sense of joy and pride as you watch your first child receiving the diploma and graduating. Watch the joy in the face of your other child. At the end of the ceremony, everyone is meeting their children. See yourself meet your son, experience the hug from him, and hear his voice telling you, "thank you mom for being there for me all these years," and hear his voice telling you how much he loves you and how much he appreciates all you have done for him all these years. Experience the sense of warmth as your cheek touches his cheek. Hear his voice and experience the sense of joy and pride for this special day. Now, internalize all these feelings of strength, pride and joy, hope, and sense of inner resourcefulness, and come back with me from this voyage, back into 1992. Bring with you all these feelings of strength, hope, pride, and joy. All the way back into 1992, and these images shall guide you as you continue to grow and move forward every hour of the day and night, whether you are awake or asleep, whether you remember or whether you do not remember ... that's right ... are you ready? ... that's right · .. starting to count ... that's right .. · moving now all the way ... that's right · .. 18, 17, 16 ... that's right. .. the age of your child, 15, 14, 13 ... that's right · .. 12, 11, 10, 9 and 8, all the way into 1992 ... that's right . . . 1992, very good. These feelings of joy and pride, these images of health and strength, accomplishment, and resourcefulness
are now living in you . . . and will continue to guide you for the rest of your life. These are the special gifts you have brought with you from your voyage, that's right ... three, two and one, the eyes open, back to focus, fully alert, and awake ... that's right ... very good.
The patient was asked to read from her journal the report she had written after the session, in which the "back-from-the-future technique" was conducted: Today, around lunch time, Dr. Torem traveled with me in time. The year was 1999. The day was June 7. Sam is 18 years of age, and Sally is 12. We walked into the large auditorium at my son's high school where this great event was happening. I had my head held high with great joy and expectation. Sam, my first-born, was getting ready to take this great step. As Sally, Uncle Ed and I were taking our seats, I was thinking about how proud I was to be here. My hair was reddish blonde, and I had very little make-up on. I am wearing a beautiful, two-piece white and blue suit, size 16, with blue shoes and a purse to match. As I whispered to Sally, she smelled the aroma of my perfume, Chanel No.5. Sally said, "Gee, Mom, you look great, and you smell so good." Sally was dressed in her soft pink minidress with her shoes and purse to match. Her hair was pinned up and she had a touch of make-up. She, also, was proud of Sam. Uncle Ed was there with his hair still grey, and his feet hurting, but he was hanging in there with us in his three-piece blue suit. Of course, Lila came late with her fur and hat on, and high heels. I looked around the gymnasium and noticed it was filled to its capacity. Dr. E. R. Stone was the keynote speaker. As he spoke out, and everyone was listening he said, "There were some struggles in the past, but there will be more struggles in the future. You must remember to hold on to your goals. The road is going to get
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The woman was discharged after a 2week hospital stay and her mood was significantly improved. She continued in outpatient therapy for three more sessions, and in follow-up of several months later she continued to do well.
Case Two This was a 46-year-old mother of three children, ages 25, 21, and 18. She was hospitalized for the treatment of depression and suicidal thoughts. A thorough history and mental-status examination disclosed that she had been sexually mo-
lested by an alcoholic uncle and had partially dissociated the trauma and the abuse. Her diagnoses were depressive disorder NOS and posttraumatic stress disorder. She had been in outpatient psychotherapy focusing on recovering her memories of childhood trauma for over 3 years, and although she gained significant cognitive insight, her nightmares, insomnia, flashbacks, hopelessness, helplessness, and sense of futurelessness got worse, and the suicidal thoughts became intensified. She was highly hypnotizable (scored a 4 intact on the HIP). She learned quickly to use self-hypnosis for relaxation and facilitating better nocturnal sleep. After several sessions of hypnotically facilitated ego strengthening, the "back-from-the-future technique" was used. The patient endorsed a future image in which she would be walking in the park with two of her grandchildren on a sunny, springtime day, sitting on a bench along the lake, and teaching her grandchildren how to feed the ducks. In the following session the patient read from her written assignment as follows: Today, Dr. Torem took me on a trip into the future. I was experiencing a very lovely picture. In that scene I am a grandmother of two lovely grandchildren. My first is Jeremy, age 5, and my second is Jessica, age 3. The sun was shining; the trees were blooming; I could see the birds and hear them sing. I was walking with Jessica and Jeremy to the bench at the edge of the lake. I could feel the warm touch of their hands in mine. I could hear the lovely sound of their voices and the excitement as they said, "Grandma, Grandma, look, here are the ducks." We sat down on our favorite bench and we took out a loaf of white Wonder bread which we bought at a discount. I gave each of them one slice of bread and I showed them how to call the ducks. I could see the ducks
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AGE-PROGRESSION TECHNIQUE
swimming towards the edge of the water, followed by small ducklings in a straight line. As Jeremy and Jessica threw the bread into the water, robins and doves joined in the party, and they, too, were feeding on the bread. Jessica and Jeremy joined in the excitement and I could hear their lovely voices as they were laughing with joy. I felt so good being their grandmother. I could feel the joy and pride in watching my grandchildren playing and enjoying themselves.
Following 16 days of hospital treatment, which included individual psychotherapy, hypnotherapy, group therapy, and the use of antidepressant medication in the form of fluoxetine, 20 mg a day, she was discharged, free of suicidal ideations, with improved sleep, and with a sense of new hope in herself and her chances for recovery. On outpatient follow-up at 1,2, and 3 months later, she was still on fluoxetine, 20 mg a day, she had found full-time employment, and she continued to do well. Discussion Reports on the use of age progression as a hypnotherapeutic technique are meager. Fromm (1980) and Brown and Fromm (1986, p. 147) caution against the use of age progression. They said it should be employed rarely with even greater care than age regression since some self-destructive patients may act out their internal hostilities. However, Yapko (1986, 1988) is more liberal in using age progression as a hypnotherapeutic intervention. He points out that patients who experience depression with a sense of hopelessness and futurelessness benefit from age progression since it involves orienting the patient to a positive future experience and providing means for building positive expectation of therapy. Even Fromm (1980) agrees that when used, hypnotic age pro-
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gression should be used with ego-integrative suggestions for healthy growth and coping. Havens (1986) described a successful outcome in using age progression in the brief therapy of a young woman with mild depression. Frederick and Phillips (1992) described the successful use ofhypnotic age progression in the treatment of acute psychosomatic conditons. I have used hypnotic age progression with ego strengthening in patients with eating disorders (Torem, 1991a) with good results, as well as in patients with hyperemesis gravidarum (Torem, 1991b). The above cases illustrate the use of the "back-from-the-future technique," which is a modification in hypnotically facilitated age progression. The future is experienced as the present, and the patient's reality is augmented and enhanced with hypnotic suggestions focusing on all of the five senses coupled with suggestions for ego strengthening. The purpose is to internalize a future image of successful living in a scene associated with a sense of joy, pride, and self-mastery. The patient is then brought "back from the future" into the present with the experienced image internalized into their subconscious mind. A written homework assignment is followed. The tense that the patient uses in their written homework assignment may serve as a prognostic clue for successful outcome of this technique; that is, if the patient uses the past tense, it may be a clue that the image has been internalized. The favorable response in the two patients presented may simply represent a "flight into health," or a stabilization and symptom relief. However, if these responses shorten hospital morbidity and contribute to a restoration of adaptive functioning in PTSD or other patients, it certainly is a worthwhile technique. Additional work needs to be done, per-
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haps using a research study methodically designed to investigate the efficacy and long-term outcome of hypnotically induced age-progression techniques in the treatment of depression, posttraumatic stress disorder, and other conditions associated with a sense of hopelessness and futurelessness. References Achterberg, J. (1985). Imagery in healing. Boston: New Science Library. Ansbacher, H. L. & Ansbacher, R. R. (Eds.)(1990). The individual psychology of Alfred Adler. New York: Basic Books. Brown, D. P. & Fromm, E. (1986). Hypnotherapy and hypnoanalysis. Hillsdale, NJ: Laurence Erlbaum Associates, Inc. Bry, A. (1978). Visualization: Directing the movies of your mind. New York: Barnes and Noble. Erickson, M. (1954). Pseudo-orientation in time as a hypnotherapeutic procedure. International Journal of Clinical and Experimental Hypnosis, 2.261-283. Fanning, P. (1988). Visualization for change. Oakland, California: Harpinger Publications. Frederick, C. & Phillips, M. (1992). The use of age progressions as interventions with acute psychosomatic conditions. American Journal of Clinical Hypnosis, 35, 8998. Fromm, E. (1980). Values in hypnotherapy. Psychotherapy, theory, research and practice, 17,425-430. Hammond, D. C. (1990). Age-progression. In D. C. Hammond (Ed.), Handbook of hypnotic suggestions and metaphors, pp. 515516. New York: W. W. Norton. Hartland, J. (1971). Further observations of the use of ego-strengthening techniques. American Journal of Clinical Hypnosis, 14,1-8. Hartland, J. (1965). The value of ego-strengthening procedures prior to direct symptom removal under hypnosis. American Jour-
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nal of Clinical Hypnosis, 8, 89-93. Havens, R. A. (1986). Posthypnotic predetermination of therapeutic progress. American Journal ofClinical Hypnosis, 28,258262. Janet, P. (1925). Psychological healing: A historical and clinical study. New York: Macmillan. Lazarus, A. (1984). In the mind's eye: The power of imagery for personal enrichment. New York: Guilford Press. Putnam, F. W. (1992). Using hypnosis for therapeutic abreactions. Psychiatric Medicine, 10, 51-65. Spiegel, D. (1981). Vietnam grief work using hypnosis. American Journal of Clinical Hypnosis, 24, 33-40. Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20. Torern, M. S. (199Ia). Eating Disorders. In W. C. Wester & D. J. O'Grady (Eds.) Clinical hypnosis with children, pp. 230257. New York: Brunner/Mazel. Torem, M. S. (199Ib). Hypnotherapeutic techniques in the treatment ofhyperemesis gravidarum. Presented at the American Society of Clinical Hypnosis Annual meeting in St. Louis, Missouri. Torem, M. S. (1990). Ego strengthening. In D. C. Hammond, (Ed.), Handbook of hypnotic suggestions and metaphors, pp. 110112. New York: W. W. Norton. Yapko, M. D. (1986). Depression: Diagnostic frameworks and therapeutic strategies. In M. D. Yapko (Ed.), Hypnotic and strategic interventions: Principles & practice, pp. 241-242. New York: Irvington Publishers,
Inc. Yapko, M. D. (1988). When living hurts: Directive for treating depression, pp. 7281. New York: Brunner/Mazel. Zilbergeld, B. & Lazarus, A. A. (1987). Mind power: Getting what you want through mental training. Boston: Little, Brown & Co.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
“Back from the Future”: A Powerful Age-Progression Technique Moshe S. Torem M.D.
a
a
Northeastern Ohio Universities College of Medicine , USA Published online: 21 Sep 2011.
To cite this article: Moshe S. Torem M.D. (1992) “Back from the Future”: A Powerful Age-Progression Technique, American Journal of Clinical Hypnosis, 35:2, 81-88, DOI: 10.1080/00029157.1992.10402990 To link to this article: http://dx.doi.org/10.1080/00029157.1992.10402990
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS VOLUME
35. NUMBER 2.
OcTOBER
1992
"Back From the Future": A Powerful Age- Progression Technique
Downloaded by [Nanyang Technological University] at 19:15 25 April 2015
Moshe S. Torem Northeastern Ohio Universities College of Medicine This paper briefly reviews the benefits of using age-progression techniques in hypnotherapy, followed by a detailed explanation and illustration of the "backfrom-the-future" technique with two case examples, including their outcome. The patients presented with feelings of helplessness, hopelessness, and a sense of futurelessness. Following the hypnotherapeutic intervention, patients were instructed to take time to reflect on the session and to write down the specific experiences they had on their voyage into the future focusing on their visual images, auditory sensations, experiences with other senses (touch, smell, and taste), as well as thoughts, emotions, and self-perceptions. Followup validated that the patients maintained their therapeutic accomplishments several months after the initial interventions.
We are what we imagine ourselves to be. Kurt Vonnegut, Jr.
One's life is dyed to the color of his imagination. Marcus Aurelius The greatest discovery of my generation is that human beings, by changing the inner attitude of their minds, can change the outer aspects of their lives. William James If you can dream it, you can do it.
Walt Disney
For reprints write to Moshe S. Torem, M.D., Akron General Medical Center, Department of Psychiatry & Behavioral Sciences, 400 Wabash Avenue, Akron, Ohio 44307. Received March 15, 1991; revised August 4, 1992; accepted for publication August 10, 1992.
The above statements show that the effectiveness of imagery has been known to mankind for many centuries. It is only recently that we have rediscovered the power of imagery and are relearning how to use its therapeutic effectiveness with a variety of human conditions, including the psychological and somatic effects of trauma. The use of imagery was recently reviewed by Achterberg (1985), Bry (1978), Fanning (1988), and Lazarus (1984). Patients with posttraumatic stress disorder have a range of symptoms including flashbacks, nightmares, anxiety, panic attacks, a variety of physical symptoms, sudden mood changes, outbursts of anger, and feelings of helplessness and hopelessness. In addition, some patients may feel a sense of powerlessness and futureless81
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ness associated with feelings of reliving traumas of the past and behavioral reenactment of the trauma. One way to understand the above list of symptoms is that this is the patients' unconscious attempt to regain a sense of mastery over their experiences in which they had a total loss of control. Another common symptom is their feeling regarding trauma where they felt victimized with a sense of total helplessness and powerlessness. One defense commonly used against such feelings is done through internalization of the blame communicated to them by the abusers and perpetrators. Survivors of trauma later experience the internalization and introjective identification with the abuser and perpetrator in the form of self-blame and guilt, believing that they may have caused the abuse and trauma. The sense of futurelessness associated with posttraumatic stress disorder was recently addressed by Lenore C. Terr (1991). Many patients with PTSD are experiencing a syndrome in which they are "prisoners" of their own past. They are reliving their past without consciously being aware of it and have no sense ofthe future. Many of these patients have stated that they live one day at a time, and their future is experienced as blank. The literature from Janet (1925) to Putnam (1992) has many publications focusing on the use of age regression and abreaction of traumatic memories in the treatment of PTSD. However, as pointed out by Spiegel (1981), abreactive therapy with PTSD patients has a high prevalence of negative responses. The first goal of treatment is to stabilize the symptom picture, as stated by Brown and Fromm (1986, p.276). This is extremely important since PTSD patients are vulnerable to reenactment of the traumatic experiences associated with flashbacks and depressed mood. This paper describes a specific technique
of age progression combined with ego strengthening in the hospital treatment of the PTSD patients. Age Progression Therapeutic techniques associated with age progression are designed to act as an antidote to the patient's sense of futurelessness. Milton Erickson (1954) described a technique of age progression facilitated by hypnosis, which he termed "... pseudoorientation in time as a hypnotherapeutic procedure." Erickson would guide the patient into a hypnotic trance and have the patient travel forward to the future into a time and space in which the patient has achieved a resolution of the problem. He would then suggest that the patient accept the future time as the present, and he would inquire what the patient leamed and did that helped to solve the problem. When Erickson obtained this information, he facilitated amnesia for having done so and used this information as a therapeutic strategy. Corydon Hammond (1990) mentions under the term "age progression" the following other terms that he found in reviewing the literature: "time projection," "mental rehearsal," "process imagery," "goal imagery," "success imagery," and "end result imagery." He stated, "... all of them refer to future-oriented therapeutic work." He conceptualizes mental rehearsal facilitated by hypnosis as a technique in which the patient is asked to replay mentally and covertly an anticipated future situation. Zilbergeld and Lazarus (1987) have referred to mental rehearsal as process imagery in which the patient imagines the process and means by which one eventually accomplishes the desired end result. Hammond (1990) believes that the difference between endresult imagery and age progression is like the difference between consciously remem-
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bering an event from your childhood versus undergoing a complete age regression and having are-vivification of a childhood experience while in a deep trance. Erickson compared this to the difference between conscious fantasies (mental rehearsal, success imagery) and unconscious fantasies (age progression). Hammond (1990) goes on to ask, "When we consider the research that documents how utterly real and convincing a confabulated (or therapist-suggested, but inaccurate) age regression may feel to a subject, why shouldn't age progressions have the potential to feel just as actual and real?" Hammond also points out that age progression is a form of goal-directed hypnotherapy and is compatible with Alfred Adler's future-oriented approach to treatment as described by Ansbacher (1990). This is based on Adler's belief that human beings are basically goal-oriented and see themselves as moving forward toward goals in the future. Many patients with PTSD, depression, and other conditions move towards irrational goals and use their imagery in self-defeating rather than constructive ways. "Back-From-the-Future" Technique Using this technique requires an understanding of and familiarity with the patient's condition and life circumstances. A discussion is held with the patient about a desired future image in which the patient would be comfortable as representing a better, healthier, desired, or, at least, acceptable setting in their life. Once that is identified, the patient is guided into a state of hypnotic trance and then age progression is hypnotically facilitated by "time travel" into a specific time in the future. The future reality is hypnotically enhanced by suggestions focused on visual, auditory, touch, smell, and taste senses. In addition,
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the experiences are enhanced by ego strengthening as described by Hartland (1965, 1971) and Torem (1990) for suggestions of positive thinking and pleasant feelings of joy and pride in reaching a solution to a specific problem. This is also accompanied by suggestions for a sense of health, strength, accomplishment, and a sense of innerresourcefulness and creativity in coping with life's stresses. The patient is then instructed to store the above positive feelings, images, and sense of accomplishment and to internalize them as the patient is hypnotically guided back from the future into the present. The patients are told that these positive images, sensations, and feelings are a special gift that they take with them on their trip "back from the future" into the present, and that these gifts will guide them on a conscious and subconscious level in their journey of healing and recovery. When the patient is out of the formal hypnotic trance, a brief discussion is conducted about the patient's experience. This is followed by a homework assignment in which the patient is asked to write about the experience and to tell what it was like to take such a voyage into the future. This written assignment may be requested while the patient is still in a state of hypnotic trance. The patient is asked to bring the written assignment to the following session and to read it. The symptoms of futurelessness, helplessness, and hopelessness are significantly reduced and are replaced by a sense of new hope, strength, inner resourcefulness, self-mastery, and belief in one's recovery. The suggestions for age progression (a verbatim example is given in the first case report) are used after the patient has learned self-hypnosis and is guided into a state of hypnotic trance. This can be followed by discussion ofthe patient's experience and
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an assignment to have the experience put in written form to be reviewed in the following session. Case Examples
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Case One Gigi was a 29-year-old, single mother of two children, ages 11 and 5. She was admitted to a psychiatry unit of a general hospital for the treatment of severe depression and suicidal thoughts precipitated by the loss of the relationship with an abusive boyfriend. She had a history of many previous hospitalizations and was diagnosed as suffering from a recurrent depressive disorder and posttraumatic stress disorder related to multiple traumas in her childhood. In the past, she was treated by several different antidepressants in combination with benzodiazepines. This time a reassessment of all drug therapy was done and she remained only on alprazolam (0.25 mg, four times a day). After several sessions I performed the Hypnotic Induction Profile (HIP), and she had a high hypnotic capacity (scored 4 intact on the HIP). The patient learned to use selfhypnosis for relaxation and was able to facilitate the induction of healthy and restful sleep at night. She identified a sense of futurelessness and helplessness and stated that she was "living just one day at a time." However, she was willing to engage in future-oriented guided imagery and identified the graduation of her ll-year-old son from high school as a future scene in which she would like to be present. With her consent, the following age-progression suggestions were given: Now that you have reached the state of self-hypnotic trance, I would like you to continue to breathe comfortably, in and out... With each breath that you continue to take, this calmness and total
state of peace, serenity, and inner harmony continue and become stronger and stronger. As this takes place, you may allow yourself, if you wish, to experience the very special state of extra-receptivity in which you pay attention to your commitment to full healing and recovery. Everyone committed to this state of full recovery has an image of the future. If you wish, you may follow me on this voyage in time to the future where we are moving forward, as you continue to mature and grow. I want you to see your older child growing in age, turning 9 (in this case the patient's older child is 8 years old) moving forward into 10, II ... that's right ... 12, 13, 14, 15 ... that's right · .. becoming an adolescent, 16, 17 ... that's right ... and 18 ... that's right · .. this is now the age that your child is reaching the point of being in the 12th grade of high school ... that's right .. · the time has come for the big ceremony of graduation ... that's right .... See yourself in that special place in the hall where the graduation ceremony from high school is taking place. See yourself sitting there dressed up in your favorite clothes. See your other child sitting there with you. Look at the place and see other graduating students dressed in their caps and gowns, see the band and listen to the music, look at the clothes that you are wearing and the clothes of your other child. You are all dressed in your best clothes. Listen to the sounds of people talking, the music playing...that's right...look at the face of your other child. Look at the joy and pleasurable anticipation. Now, if you wish, touch the hand of your younger child, and feel the special sensation of warmth and experience the sense of joy and anticipation for the special moment in the graduation of your older child. Take a deep breath through your nose and smell the special fragrance in the air. Now, look up at the stage and see
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the different dignitaries calling the names of the various students who are graduating. And, as this goes on, listen to the name of your son being called up and watch him walking up the aisle in cap and gown to receive the diploma. He steps up to the stage, shakes the hands of the various dignitaries, receives the diploma and you take pictures, if you wish, and then you watch him go back to his place. Experience the sense of joy and pride as you watch your first child receiving the diploma and graduating. Watch the joy in the face of your other child. At the end of the ceremony, everyone is meeting their children. See yourself meet your son, experience the hug from him, and hear his voice telling you, "thank you mom for being there for me all these years," and hear his voice telling you how much he loves you and how much he appreciates all you have done for him all these years. Experience the sense of warmth as your cheek touches his cheek. Hear his voice and experience the sense of joy and pride for this special day. Now, internalize all these feelings of strength, pride and joy, hope, and sense of inner resourcefulness, and come back with me from this voyage, back into 1992. Bring with you all these feelings of strength, hope, pride, and joy. All the way back into 1992, and these images shall guide you as you continue to grow and move forward every hour of the day and night, whether you are awake or asleep, whether you remember or whether you do not remember ... that's right ... are you ready? ... that's right · .. starting to count ... that's right .. · moving now all the way ... that's right · .. 18, 17, 16 ... that's right. .. the age of your child, 15, 14, 13 ... that's right · .. 12, 11, 10, 9 and 8, all the way into 1992 ... that's right . . . 1992, very good. These feelings of joy and pride, these images of health and strength, accomplishment, and resourcefulness
are now living in you . . . and will continue to guide you for the rest of your life. These are the special gifts you have brought with you from your voyage, that's right ... three, two and one, the eyes open, back to focus, fully alert, and awake ... that's right ... very good.
The patient was asked to read from her journal the report she had written after the session, in which the "back-from-the-future technique" was conducted: Today, around lunch time, Dr. Torem traveled with me in time. The year was 1999. The day was June 7. Sam is 18 years of age, and Sally is 12. We walked into the large auditorium at my son's high school where this great event was happening. I had my head held high with great joy and expectation. Sam, my first-born, was getting ready to take this great step. As Sally, Uncle Ed and I were taking our seats, I was thinking about how proud I was to be here. My hair was reddish blonde, and I had very little make-up on. I am wearing a beautiful, two-piece white and blue suit, size 16, with blue shoes and a purse to match. As I whispered to Sally, she smelled the aroma of my perfume, Chanel No.5. Sally said, "Gee, Mom, you look great, and you smell so good." Sally was dressed in her soft pink minidress with her shoes and purse to match. Her hair was pinned up and she had a touch of make-up. She, also, was proud of Sam. Uncle Ed was there with his hair still grey, and his feet hurting, but he was hanging in there with us in his three-piece blue suit. Of course, Lila came late with her fur and hat on, and high heels. I looked around the gymnasium and noticed it was filled to its capacity. Dr. E. R. Stone was the keynote speaker. As he spoke out, and everyone was listening he said, "There were some struggles in the past, but there will be more struggles in the future. You must remember to hold on to your goals. The road is going to get
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The woman was discharged after a 2week hospital stay and her mood was significantly improved. She continued in outpatient therapy for three more sessions, and in follow-up of several months later she continued to do well.
Case Two This was a 46-year-old mother of three children, ages 25, 21, and 18. She was hospitalized for the treatment of depression and suicidal thoughts. A thorough history and mental-status examination disclosed that she had been sexually mo-
lested by an alcoholic uncle and had partially dissociated the trauma and the abuse. Her diagnoses were depressive disorder NOS and posttraumatic stress disorder. She had been in outpatient psychotherapy focusing on recovering her memories of childhood trauma for over 3 years, and although she gained significant cognitive insight, her nightmares, insomnia, flashbacks, hopelessness, helplessness, and sense of futurelessness got worse, and the suicidal thoughts became intensified. She was highly hypnotizable (scored a 4 intact on the HIP). She learned quickly to use self-hypnosis for relaxation and facilitating better nocturnal sleep. After several sessions of hypnotically facilitated ego strengthening, the "back-from-the-future technique" was used. The patient endorsed a future image in which she would be walking in the park with two of her grandchildren on a sunny, springtime day, sitting on a bench along the lake, and teaching her grandchildren how to feed the ducks. In the following session the patient read from her written assignment as follows: Today, Dr. Torem took me on a trip into the future. I was experiencing a very lovely picture. In that scene I am a grandmother of two lovely grandchildren. My first is Jeremy, age 5, and my second is Jessica, age 3. The sun was shining; the trees were blooming; I could see the birds and hear them sing. I was walking with Jessica and Jeremy to the bench at the edge of the lake. I could feel the warm touch of their hands in mine. I could hear the lovely sound of their voices and the excitement as they said, "Grandma, Grandma, look, here are the ducks." We sat down on our favorite bench and we took out a loaf of white Wonder bread which we bought at a discount. I gave each of them one slice of bread and I showed them how to call the ducks. I could see the ducks
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swimming towards the edge of the water, followed by small ducklings in a straight line. As Jeremy and Jessica threw the bread into the water, robins and doves joined in the party, and they, too, were feeding on the bread. Jessica and Jeremy joined in the excitement and I could hear their lovely voices as they were laughing with joy. I felt so good being their grandmother. I could feel the joy and pride in watching my grandchildren playing and enjoying themselves.
Following 16 days of hospital treatment, which included individual psychotherapy, hypnotherapy, group therapy, and the use of antidepressant medication in the form of fluoxetine, 20 mg a day, she was discharged, free of suicidal ideations, with improved sleep, and with a sense of new hope in herself and her chances for recovery. On outpatient follow-up at 1,2, and 3 months later, she was still on fluoxetine, 20 mg a day, she had found full-time employment, and she continued to do well. Discussion Reports on the use of age progression as a hypnotherapeutic technique are meager. Fromm (1980) and Brown and Fromm (1986, p. 147) caution against the use of age progression. They said it should be employed rarely with even greater care than age regression since some self-destructive patients may act out their internal hostilities. However, Yapko (1986, 1988) is more liberal in using age progression as a hypnotherapeutic intervention. He points out that patients who experience depression with a sense of hopelessness and futurelessness benefit from age progression since it involves orienting the patient to a positive future experience and providing means for building positive expectation of therapy. Even Fromm (1980) agrees that when used, hypnotic age pro-
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gression should be used with ego-integrative suggestions for healthy growth and coping. Havens (1986) described a successful outcome in using age progression in the brief therapy of a young woman with mild depression. Frederick and Phillips (1992) described the successful use ofhypnotic age progression in the treatment of acute psychosomatic conditons. I have used hypnotic age progression with ego strengthening in patients with eating disorders (Torem, 1991a) with good results, as well as in patients with hyperemesis gravidarum (Torem, 1991b). The above cases illustrate the use of the "back-from-the-future technique," which is a modification in hypnotically facilitated age progression. The future is experienced as the present, and the patient's reality is augmented and enhanced with hypnotic suggestions focusing on all of the five senses coupled with suggestions for ego strengthening. The purpose is to internalize a future image of successful living in a scene associated with a sense of joy, pride, and self-mastery. The patient is then brought "back from the future" into the present with the experienced image internalized into their subconscious mind. A written homework assignment is followed. The tense that the patient uses in their written homework assignment may serve as a prognostic clue for successful outcome of this technique; that is, if the patient uses the past tense, it may be a clue that the image has been internalized. The favorable response in the two patients presented may simply represent a "flight into health," or a stabilization and symptom relief. However, if these responses shorten hospital morbidity and contribute to a restoration of adaptive functioning in PTSD or other patients, it certainly is a worthwhile technique. Additional work needs to be done, per-
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haps using a research study methodically designed to investigate the efficacy and long-term outcome of hypnotically induced age-progression techniques in the treatment of depression, posttraumatic stress disorder, and other conditions associated with a sense of hopelessness and futurelessness. References Achterberg, J. (1985). Imagery in healing. Boston: New Science Library. Ansbacher, H. L. & Ansbacher, R. R. (Eds.)(1990). The individual psychology of Alfred Adler. New York: Basic Books. Brown, D. P. & Fromm, E. (1986). Hypnotherapy and hypnoanalysis. Hillsdale, NJ: Laurence Erlbaum Associates, Inc. Bry, A. (1978). Visualization: Directing the movies of your mind. New York: Barnes and Noble. Erickson, M. (1954). Pseudo-orientation in time as a hypnotherapeutic procedure. International Journal of Clinical and Experimental Hypnosis, 2.261-283. Fanning, P. (1988). Visualization for change. Oakland, California: Harpinger Publications. Frederick, C. & Phillips, M. (1992). The use of age progressions as interventions with acute psychosomatic conditions. American Journal of Clinical Hypnosis, 35, 8998. Fromm, E. (1980). Values in hypnotherapy. Psychotherapy, theory, research and practice, 17,425-430. Hammond, D. C. (1990). Age-progression. In D. C. Hammond (Ed.), Handbook of hypnotic suggestions and metaphors, pp. 515516. New York: W. W. Norton. Hartland, J. (1971). Further observations of the use of ego-strengthening techniques. American Journal of Clinical Hypnosis, 14,1-8. Hartland, J. (1965). The value of ego-strengthening procedures prior to direct symptom removal under hypnosis. American Jour-
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nal of Clinical Hypnosis, 8, 89-93. Havens, R. A. (1986). Posthypnotic predetermination of therapeutic progress. American Journal ofClinical Hypnosis, 28,258262. Janet, P. (1925). Psychological healing: A historical and clinical study. New York: Macmillan. Lazarus, A. (1984). In the mind's eye: The power of imagery for personal enrichment. New York: Guilford Press. Putnam, F. W. (1992). Using hypnosis for therapeutic abreactions. Psychiatric Medicine, 10, 51-65. Spiegel, D. (1981). Vietnam grief work using hypnosis. American Journal of Clinical Hypnosis, 24, 33-40. Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20. Torern, M. S. (199Ia). Eating Disorders. In W. C. Wester & D. J. O'Grady (Eds.) Clinical hypnosis with children, pp. 230257. New York: Brunner/Mazel. Torem, M. S. (199Ib). Hypnotherapeutic techniques in the treatment ofhyperemesis gravidarum. Presented at the American Society of Clinical Hypnosis Annual meeting in St. Louis, Missouri. Torem, M. S. (1990). Ego strengthening. In D. C. Hammond, (Ed.), Handbook of hypnotic suggestions and metaphors, pp. 110112. New York: W. W. Norton. Yapko, M. D. (1986). Depression: Diagnostic frameworks and therapeutic strategies. In M. D. Yapko (Ed.), Hypnotic and strategic interventions: Principles & practice, pp. 241-242. New York: Irvington Publishers,
Inc. Yapko, M. D. (1988). When living hurts: Directive for treating depression, pp. 7281. New York: Brunner/Mazel. Zilbergeld, B. & Lazarus, A. A. (1987). Mind power: Getting what you want through mental training. Boston: Little, Brown & Co.
