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International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Hypnosis as a Tool for Termination of Therapy William Kir-stimon
a
a
Flossmoor, Illinois Published online: 31 Jan 2008.
To cite this article: William Kir-stimon (1978) Hypnosis as a Tool for Termination of Therapy, International Journal of Clinical and Experimental Hypnosis, 26:3, 134-142, DOI: 10.1080/00207147808409314 To link to this article: http://dx.doi.org/10.1080/00207147808409314
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/termsand-conditions
The Internatwnal Jourml of Clrnrral and Expermental Hrpnorcr 1978, Vol. XXVI. No. 3. 134-142
HYPNOSIS AS A TOOL FOR TERMINATION OF THERAPY WILLIAM KIR-STIMON’
Downloaded by [ECU Libraries] at 02:09 23 April 2015
Flossmoor, Illinois
Abstract: Cases are presented with varied induction methods to illustrate the use of hypnosis as a final step in psychotherapy. In each situation, therapy had been clinically active without hypnosis. Problems in termination revolved around patients’ fear of taking the ultimate step in controlling their own lives. Hypnosis helped to provide a bridge between previous and current self-concept and an acceptance of individual creativity. Discussion focuses on the use of hypnosis as an adjunct in overcoming anxiety in the ego’s relation to the umwelt rather than for initiating rapport or working through transference. Hypnosis then becomes a positive factor in enhancing self-mastery and autonomy as well as in handling resistance to the full utilization of ego strength.
In reviewing a number of therapeutic situations involving hypnosis in the last few years, I have begun to see a pattern emerge that has just now become clear. I refer to the use of hypnosis as a tool, not in the development of initial rapport or in the middle portion of therapy as such but in overcoming serious blocks to progress late in the therapeutic process. This observation is noted not because hypnosis has not been of value earlier in therapy but rather because my personal style tends to utilize a variety of techniques and modalities. The specific value of hypnosis as a tool to be used later in therapy in certain cases has only now come to my awareness in these situations and the reason for waiting with regard to employing hypnosis is not yet clear to me-possibly, because the cases involved have all been rather intricate, with delicate emotional balances to maintain. In each instance, the patient seemed to have reached a “dead end” rather than the typical plateau so often evident in a series of therapeutic steps. The major problem in each case had been the fear of going off into a void without regaining one’s personal identity, of reaching a kind of emotional abyss, and the fright of never being able to come back to one’s former life style-as disturbing as this had been. Gardner (1976)recently wrote of patient versus therapist locus of control and the sense of personal mastery as a factor in hypnotherapy. Manuscript submitted July 26, 1976; final revision received December 20, 1976. ’ Reprint requests should be addressed to William Kir-Stimon, 3235 Vollmer Road, Flossmoor, Illiiois 60422. 134
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Stolar and Fromm (1974) have discussed active and passive control of the ego over its own functioning, the question of “masterful” or “protective” (defensive) coping behavior, and the ego’s striving to maintain the ideal self via ego ideals. It is somewhat in this framework that I speak, but with emphasis on using the resistance phenomenon itself to idduce hypnosis and on the values of the ensuing hypnotic experience in developing further insights for the individual to use in handling ego stresses. This becomes a matter, then, not only of losing or gaining control, but also of permitting oneself to trust one’s own organism and the mysteries of one’s own unconscious, of taking the final step, as it were, to terminate therapy and become a fully responsible-for-oneself adult. In all of these situations, patients had been in treatment for a considerable time, approximately 1.5 to 2 years, and numerous other methods had been used to elicit unconscious material-among these art therapy, dream analysis, group interaction, experiential-existential therapy on an individual basis, vacant chair fantasy, psychodrama, and imagery with different sense modalities. Psychotherapy had progressed well in each case and the final “breakthrough” was imminent but never quite emerged. In this context, two to four hypnotic sessions were utilized to conclude rather than open therapy, taking place a few interviews before termination became feasible. A few typical cases will serve as illustrations. The first is somewhat different from the others in that there was an earlier transference resolution and a subsequent regression that needed working through. Resistance was evident in all of these situations, not so much, however, to the relationship with the therapist as a resistance to seeing their still unacceptable ego strengths. ,
CASE REPORTS
Case 1
Paradoxically, V. at 34 presented an instance where, in order to fully accept his own substance as a living individual, he had finally to accept the pain of his own death. Therapy had proceeded well until the discovery of a malignant growth with terminal metastases. This appeared to undo much of our previous progress and for a while resulted in anger, distrust, and a renewed panic. It was the need to deal with the cessation of his life at the moment of greatest personal growth that offered the last obstacle to his self-acceptance. During the course of therapy, he had dealt with his obligations toward a psychotic mother and alcoholic father, the loss of a child, an earlier unsuccessful marriage, and he was staving off the breakdown of his second marriage.
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He began to gain respect for his own opinions and feelings, worked through some tendencies toward hypochondriasis, and was on his way toward a new career as a fashion designer, when he learned of his terminal illness. Then, the impasse. Hypnosis was initiated to relieve pain, with induction readily achieved through visual focus, followed later by a simple tap on the shoulder. Although pain became increasingly difficult to ease as the disease progressed, this patient was no longer panicked by his attacks and continued to amaze his physicians by acceptance of his ensuing death. Hypnosis was continued for a few sessions, each interview, however, concluded with a nonhypnotic review of his life and emphasis on his increasing joy in the time left to him. Finally, hypnosis was rejected and therapy terminated soon afterwards as unnecessary. The patient wanted to use the remaining time to experience himself and his family more fully and therapy could be seen as an intrusion on his privacy. At the patient’s request, however, the therapist and patient continued their contacts, and he was seen at the hospital in a jovial but not euphoric mood the day before his death. Case 2
Mrs. W. was a talented artist who, at the start of therapy, had difficulty in releasing her abilities and in communicating with others. At 26 she was unhappily married, had two children, and was subject to periods of severe depression and brooding silences-even in therapy. The marriage, however, was now relatively intact; she had returned to school for further training, was handling her children well, and had resolved her problems with siblings, parents, and some extra-marital relations that had given her deep concern. She was no longer suicidal and had evened out her rage episodes when anger was outer-directed, Therapy was at a standstill with, I felt, some fear of losing her dependency on the therapist and I was questioning whether transference could indeed be resolved within the time limitsof our relationship. The depth of her deprivations and feelings of aloneness became more evident and it was felt she needed some additional support, which was provided via group therapy. In this way too, the transference became more diffused and was less threatening, and my own counter-transference contained. However, her work had suddenly come to a halt. She was having problems with her studies, was quite restless, and was again suicidal. Induction was achieved using the reverse hand levitation method. The first session resulted in long, silent periods during which she went deeper into hypnosis of her own choice, cried, and then, upon awakening, was considerably relaxed. She preferred not to talk about her
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crying and was reluctant to discuss the images that evoked her distress.
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As therapist, I respected this silence. The second hypnotic interview proceeded more easily and she enjoyed an experience with hypnoplasty. Both the induction method and hypnoplasty were utilized with this patient because she felt at ease working with her hands and the hypnoplasty gave her an opportunity to reinforce her own artistic skills. She worked at the “clay sculpture” until she was finished, smiling with pleasure as she worked, and awoke satisfied with herself. No time limits were set and she chose her own material-a terra cotta clay. She was simply advised to let me know when she was through by stopping and then wiggling a finger. She was quite at ease with this nonverbal expression and we spent much time in the ensuing nonhypnotic sessions exploring the sense of mastery she felt in her hands. Surprisingly, she now found herself able to communicate much more readily with both positive and negative affect. Her artistic productivity increased, even with other media, she made great strides academically, and individual treatment was terminated except for an occasional “check up” interview and some supportive group work. It is not expected that she will evolve into a highly verbal individual (she still retains her periodic silences),but her affect and speech are now more free and her self-worth more evident. Case 3
In his early 50’9, H. had been through a series of traumatic episodes which resulted in severe hyperventilation, dizziness, numerous somatic complaints, a phobic reaction to driving and entering stores, and an inability to stay at work. Therapy uncovered a bright alcoholic who had lived in an overprotective, matriarchal environment during his childhood and youth and who was having difficulty adjusting to the deaths of the males in his family. Physiological symptoms abated, he was able to drive and return to work. He also resolved much of his problem with women; he remained sober and was working at his marriage. On the other hand, he was still uncertain of himself in his relationships with his wife and children and on the job he was still subject to dizzy spells, using these to avoid facing the opportunity for advancement. Hypnosis was held off for some time until he became angry and demanded this modality. Initially, induction was somewhat in doubt because of H.’s fear of losing control, despite his verbal intentions. However, visual focus, finger lock, and hand levitation were achieved and patient went into trance state. Nothing of particular note contentwise was developed in two hypnotic sessions-which he pulled out of quickly-but he had learned something of considerable importance to
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him.He recognized that hypnosis was not a magical tool and that the therapist was not a magician who could or would give him answers. I saw him as a highly suggestible individual and avoided giving him posthypnotic suggestions 80 as not to increase his dependency on treatment. His sense of mastery of a hitherto unknown level of consciousness gave him an additional feeling of security and control over himself. It allowed further release of the ego strength he had held in check and freed his imagination. He subsequently took and passed an examination for job advancement, shopped in stores, drove, and began to assert himself at home and to enjoy the skills and knowledge he had until now repressed. There was discussion before and after these two hypnotic sessions of his fear of losing control and his ability to retain this control for himself (e.g., the strength in his own hands kept them from unlocking until he relinquished them as well as the strength he exhibited in deciding when and how long he wished to be in a trance-or even a panic-state). Case 4
Among other things, S., a college teacher, had been troubled by an inability to deal with her rampant children and could not begin to write up her doctoral dissertation in mathematics. She came into therapy to deal with a depression centering around her father’s serious illness, questions of her own sexuality, and episodes of intense fright around what she felt were symptoms of dissociation, which manifested themselves during an encounter group session elsewhere. Therapy resolved most of these problems, but she was unable to move beyond the first chapter of her thesis and was still in a panic over being “unable to come back” after deep emotional experiences. Her need for narcissistic control was explored further and it was decided to attempt hypnosis. This was achieved initially via relaxation techniques (because of her evident physical tenseness) and in two sessions, though we had already worked through her fear of homosexuality, she could accept the fact that she was controlling not only her children but her husband as well. Acknowledgment of this devious use of her energies permitted her to face the ways in which she had repressed her more creative abilities. The last two sessions, however, were an induced fantasy focused on an ideal self (off in the distance) which she was later able to merge with her “normal” ego-and in doing so,get in touch with a deepened feeling of personal identity. This gave her a sense of stability and “centeredness” that she could then use as a bridge outside the therapeutic session. The hollowness and void she had feared vanished. Therapy was terminated after an additional few interviews in which
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she described her burgeoning selthood and increasing sense of youthfulness and vitality. She soon had her dissertation well in hand and decided to stay in the marriage and “work it out” with her husband.
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Case 5
He had functioned as a borderline personality for years and came into treatment because of a sudden surge of blackouts and suicidal thoughts. Treatment was lengthy and was carried on with several month-long hiatuses in between. A possible schizophrenic process was arrested and he was able to handle effectively a change of job (from school librarian to art supervisor), resolved the loss of both parents, and, for the first time at 38 had taken part in several heterosexual relationships. However, he was unable to leave therapy entirely and panicked at even the thought of termination. After five interviews, during which there were several hypnotic sessions, he was able to break for a “vacation” and did not return, although he did have occasional telephone contact with the therapist. Because of this patient’s previous difficulty with visual and auditory hallucinations, focus on his own hand was used in effecting trance. In one of these sessions, age regression elicited an episode in which he recalled his mother’s trimming his nails and his fear of having his toes cut off. Although we had dealt with castration fears earlier, this return to a primitive apprehension presaged a brief regression that led to the final step out of therapy. In another session, devoted to body awareness, he was able to sense various parts of his anatomy and then integrate them into a single self-image so that he could accept himself as having a spatial identity. Being in control of his own body and space gave him the final fillip into what he now considered a normal life. He became artistically productive and was even considering a commitment to marriage. DISCUSSION In each of these cases, one can see how the patient was able to overcome his or her feeling of helplessness and the fear of impending inundation by the unknown. Although this still concerned to some extent the instinctual id impulses and superego doubts, which had been worked through in therapy previously, what emerged as significant was the feeling of mastery over the bimodal creative/destructive urges at the very root of ego autonomy. During these ensuing sessions, the patients became less fearful of expressing negative affect and they were able to explore a more positive approach to living. The significance of resolving for oneself the choice between selfhood and dependence, between personal growth/productivity and ego-dystonic
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fear/immobilization has been fully amplified by Maslow (1968), Erich Fromm (1964),and others. That the persons involved in the treatment process here described were all finally able to react creatively in the spirit of their own lives is indicative of the value of hypnosis as a creativity-releasing-mechanism. Its greatest benefit, however, derives from the additional sense of mastery over both conscious and unconscious wishes and strengths it was able to provide-a tool for total rather than subtotal acceptance of self. Another aspect of the therapies involved here was the use of hypnosis to ease the bridge between two time periods and to enable a cross-over from present to future. In each situation, the experiences of the past had been explored and yet the patient was held back from participating in activities where ego control could mold his own life further. Hypnosis helped to provide the patient with a new awareness of heretofore unrecognized or a t least unacceptable potentials, a way of leaping across the abyss between the “now” and “to be.” Except for an emphasis on relaxation and relief of tension, in none of these situations did it seem appropriate to make posthypnotic suggestions. It seemed more in keeping with the needs of the patient to let him proceed at his own pace, what has elsewhere been referred to as his personal tempo (Kir-Stimon, 1977). Hypnosis facilitated termination in each instance by permitting the patient to finally accept his autonomy as well as his normal interdependency as a human being. In each case too he was able to see himself with some kind of temporal perspective, as it were, in a present related to a past and future. He was also more attuned to his own life style and in touch with a deepened awareness of himself as a multidimensioned being, occupying space and time. Although the transference per se had seemingly been resolved, there was now a broader and more general loosening of object ties, an increasing feeling of self-determination, an ability to make decisions, and a sense of personal mastery and control. The final resistance overcome was the fear of losing oneself in the void between the existential self and the nonself (the “other” who had the presumed magical control over the patient’s life). As one patient said, “I am now trusting parts of me I have not been aware of. It was not trusting myself that I couldn’t see. I can now look at me in the mirror and I’m
OK.” REFERENCES FROMM, ERICH.The heart of man: Its genius for good and evil. New York: Harper & Row, 1964.
GARDNER, G . G . Hypnosis and mastery: Clinical contributions and directions for research. Int. J. din. exp. Hypnosis, 1976,24, 202-214.
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KIR-STIMON, W. Tempo-stasis as a factor in psychotherapy. Psychotherapy: Theov, Research, & Practice, 1977,14, 245-248. MASLOW,A. H. Toward a psychology of being. (2nd ed.) New York Van Nostrand Reinhold, 1968. STOIAAH, D., & FROMM,ERIKA.Activity and passivity of the ego in relation to the superego. In&.Rev. Psycho-Anai., 1974, I , 297-31 1.
Hypnose als Werkzeug fur Therapietermination
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William Kir-Stimon Abstrakt: Es werden hier Fiille mit verschiedenen Induktionsmethoden dargeboten, um den Gebrauch von Hypnose als einen letzten Schritt in Psychotherapie zu illustrieren. In jeder Situation handelte es sich um klinisch aktive Therapie ohne Hypnose. Die Probleme der Termination drehten sich um die Angst der Patienten, den ultimativen Schritt zum Kontrollieren ihres eignen Lebens zu machen. Hypnose verhalf dazu, eine Briicke zwischen dem friiheren und jetzigen Ich-Konzept und dem Akzeptieren der individuellen Schopfungskraft zu bilden. Im Brennpunkt der Diskuseion steht vielmehr der H y p nosegebrauch als Hilsmittel im ijberkommen der Angst des Ichs in seiner Beziehung zu der Umwelt als die Bildung eines Rapports oder eines Arbeitens durch nertragung. Hypnose wird dadurch zu einem positiven Faktor erhoben, der das Meistern und die Autonomie des Selbsts verstiirkt wie auch die Handhabung der Resistenz gegen die volle Ausniitzung der Starke des Selbsts.
L’hypnose, une technique facilitant la fin de la therapie William Kir-Stimon Resume: L’auteur presente quelques cas, avec differentes methodes d’induction, pour illustrer l’usage de I’hypnose comme derniere etape d’une psychotherapie. Dans chaque situation, la therapie a ete cliniquement active sans hypnose. Les problemes de fin de therapie se cristallisent autour de la peur que ressentent lee patients face au dernier pas qu’ils doivent faire pour reprendre le plein controle de leur vie. L’hypnose aide a faire le lien entre I’ancien et le nouveau concept de soi et favorise l’acceptation de la creativite individuelle. La discussion porte sur I’hypnose comme methode d’appoint pour surmonter l’anxiete du moi dans sa relation avec le umwelt, plutot que pour I’etablissement du rapport ou la resolution du transfert. L’hypnose devient alors un facteur positif permettant d’augmenter la maitrise personnelle et l’autonomie, et de r6soudre les resistances a la pleine utilisation des forces du moi.
Hipnosis: Una tecnica para facilitar el fin de la terapeutica William Kir-Stimon Resumen: El autor presenta algunos casos, con diferentes metodos de inducion, para explicar el us0 de la hipnosis como ultima etapa de la psicoterapia.
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En cada situacion, la teraphtica ha estado ya clinicamente activa sin hipnosis. El miedo de terminar la terap&utica, de este dtimo paso que el paciente tiene que hacer, de establecer un controlo sobre su vida, es el problema mas importante que se encuentra. La hipnosis ayuda a c n u a r el viejo y nuevo concept0 de si mismo, y facilita tambien a aceptar la creacion individual. La discusion pone en enfasis el metodo hipnotico que ayuda a dorninar la ansiedad del *‘ego” en su relacion con el umwelt, en vez de comenzar esta relacion o la resolucion de la transferencia. La hipnosis se hace asi un factor positivo permitiendo de aumentar el controlo de si mismo y la autonomia, y tambien permitiendo de resolver las resistencias a la llena utilizacion de las fuerzas del “ego.”
International Journal of Clinical and Experimental Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/nhyp20
Hypnosis as a Tool for Termination of Therapy William Kir-stimon
a
a
Flossmoor, Illinois Published online: 31 Jan 2008.
To cite this article: William Kir-stimon (1978) Hypnosis as a Tool for Termination of Therapy, International Journal of Clinical and Experimental Hypnosis, 26:3, 134-142, DOI: 10.1080/00207147808409314 To link to this article: http://dx.doi.org/10.1080/00207147808409314
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/termsand-conditions
The Internatwnal Jourml of Clrnrral and Expermental Hrpnorcr 1978, Vol. XXVI. No. 3. 134-142
HYPNOSIS AS A TOOL FOR TERMINATION OF THERAPY WILLIAM KIR-STIMON’
Downloaded by [ECU Libraries] at 02:09 23 April 2015
Flossmoor, Illinois
Abstract: Cases are presented with varied induction methods to illustrate the use of hypnosis as a final step in psychotherapy. In each situation, therapy had been clinically active without hypnosis. Problems in termination revolved around patients’ fear of taking the ultimate step in controlling their own lives. Hypnosis helped to provide a bridge between previous and current self-concept and an acceptance of individual creativity. Discussion focuses on the use of hypnosis as an adjunct in overcoming anxiety in the ego’s relation to the umwelt rather than for initiating rapport or working through transference. Hypnosis then becomes a positive factor in enhancing self-mastery and autonomy as well as in handling resistance to the full utilization of ego strength.
In reviewing a number of therapeutic situations involving hypnosis in the last few years, I have begun to see a pattern emerge that has just now become clear. I refer to the use of hypnosis as a tool, not in the development of initial rapport or in the middle portion of therapy as such but in overcoming serious blocks to progress late in the therapeutic process. This observation is noted not because hypnosis has not been of value earlier in therapy but rather because my personal style tends to utilize a variety of techniques and modalities. The specific value of hypnosis as a tool to be used later in therapy in certain cases has only now come to my awareness in these situations and the reason for waiting with regard to employing hypnosis is not yet clear to me-possibly, because the cases involved have all been rather intricate, with delicate emotional balances to maintain. In each instance, the patient seemed to have reached a “dead end” rather than the typical plateau so often evident in a series of therapeutic steps. The major problem in each case had been the fear of going off into a void without regaining one’s personal identity, of reaching a kind of emotional abyss, and the fright of never being able to come back to one’s former life style-as disturbing as this had been. Gardner (1976)recently wrote of patient versus therapist locus of control and the sense of personal mastery as a factor in hypnotherapy. Manuscript submitted July 26, 1976; final revision received December 20, 1976. ’ Reprint requests should be addressed to William Kir-Stimon, 3235 Vollmer Road, Flossmoor, Illiiois 60422. 134
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Stolar and Fromm (1974) have discussed active and passive control of the ego over its own functioning, the question of “masterful” or “protective” (defensive) coping behavior, and the ego’s striving to maintain the ideal self via ego ideals. It is somewhat in this framework that I speak, but with emphasis on using the resistance phenomenon itself to idduce hypnosis and on the values of the ensuing hypnotic experience in developing further insights for the individual to use in handling ego stresses. This becomes a matter, then, not only of losing or gaining control, but also of permitting oneself to trust one’s own organism and the mysteries of one’s own unconscious, of taking the final step, as it were, to terminate therapy and become a fully responsible-for-oneself adult. In all of these situations, patients had been in treatment for a considerable time, approximately 1.5 to 2 years, and numerous other methods had been used to elicit unconscious material-among these art therapy, dream analysis, group interaction, experiential-existential therapy on an individual basis, vacant chair fantasy, psychodrama, and imagery with different sense modalities. Psychotherapy had progressed well in each case and the final “breakthrough” was imminent but never quite emerged. In this context, two to four hypnotic sessions were utilized to conclude rather than open therapy, taking place a few interviews before termination became feasible. A few typical cases will serve as illustrations. The first is somewhat different from the others in that there was an earlier transference resolution and a subsequent regression that needed working through. Resistance was evident in all of these situations, not so much, however, to the relationship with the therapist as a resistance to seeing their still unacceptable ego strengths. ,
CASE REPORTS
Case 1
Paradoxically, V. at 34 presented an instance where, in order to fully accept his own substance as a living individual, he had finally to accept the pain of his own death. Therapy had proceeded well until the discovery of a malignant growth with terminal metastases. This appeared to undo much of our previous progress and for a while resulted in anger, distrust, and a renewed panic. It was the need to deal with the cessation of his life at the moment of greatest personal growth that offered the last obstacle to his self-acceptance. During the course of therapy, he had dealt with his obligations toward a psychotic mother and alcoholic father, the loss of a child, an earlier unsuccessful marriage, and he was staving off the breakdown of his second marriage.
Downloaded by [ECU Libraries] at 02:09 23 April 2015
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He began to gain respect for his own opinions and feelings, worked through some tendencies toward hypochondriasis, and was on his way toward a new career as a fashion designer, when he learned of his terminal illness. Then, the impasse. Hypnosis was initiated to relieve pain, with induction readily achieved through visual focus, followed later by a simple tap on the shoulder. Although pain became increasingly difficult to ease as the disease progressed, this patient was no longer panicked by his attacks and continued to amaze his physicians by acceptance of his ensuing death. Hypnosis was continued for a few sessions, each interview, however, concluded with a nonhypnotic review of his life and emphasis on his increasing joy in the time left to him. Finally, hypnosis was rejected and therapy terminated soon afterwards as unnecessary. The patient wanted to use the remaining time to experience himself and his family more fully and therapy could be seen as an intrusion on his privacy. At the patient’s request, however, the therapist and patient continued their contacts, and he was seen at the hospital in a jovial but not euphoric mood the day before his death. Case 2
Mrs. W. was a talented artist who, at the start of therapy, had difficulty in releasing her abilities and in communicating with others. At 26 she was unhappily married, had two children, and was subject to periods of severe depression and brooding silences-even in therapy. The marriage, however, was now relatively intact; she had returned to school for further training, was handling her children well, and had resolved her problems with siblings, parents, and some extra-marital relations that had given her deep concern. She was no longer suicidal and had evened out her rage episodes when anger was outer-directed, Therapy was at a standstill with, I felt, some fear of losing her dependency on the therapist and I was questioning whether transference could indeed be resolved within the time limitsof our relationship. The depth of her deprivations and feelings of aloneness became more evident and it was felt she needed some additional support, which was provided via group therapy. In this way too, the transference became more diffused and was less threatening, and my own counter-transference contained. However, her work had suddenly come to a halt. She was having problems with her studies, was quite restless, and was again suicidal. Induction was achieved using the reverse hand levitation method. The first session resulted in long, silent periods during which she went deeper into hypnosis of her own choice, cried, and then, upon awakening, was considerably relaxed. She preferred not to talk about her
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crying and was reluctant to discuss the images that evoked her distress.
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As therapist, I respected this silence. The second hypnotic interview proceeded more easily and she enjoyed an experience with hypnoplasty. Both the induction method and hypnoplasty were utilized with this patient because she felt at ease working with her hands and the hypnoplasty gave her an opportunity to reinforce her own artistic skills. She worked at the “clay sculpture” until she was finished, smiling with pleasure as she worked, and awoke satisfied with herself. No time limits were set and she chose her own material-a terra cotta clay. She was simply advised to let me know when she was through by stopping and then wiggling a finger. She was quite at ease with this nonverbal expression and we spent much time in the ensuing nonhypnotic sessions exploring the sense of mastery she felt in her hands. Surprisingly, she now found herself able to communicate much more readily with both positive and negative affect. Her artistic productivity increased, even with other media, she made great strides academically, and individual treatment was terminated except for an occasional “check up” interview and some supportive group work. It is not expected that she will evolve into a highly verbal individual (she still retains her periodic silences),but her affect and speech are now more free and her self-worth more evident. Case 3
In his early 50’9, H. had been through a series of traumatic episodes which resulted in severe hyperventilation, dizziness, numerous somatic complaints, a phobic reaction to driving and entering stores, and an inability to stay at work. Therapy uncovered a bright alcoholic who had lived in an overprotective, matriarchal environment during his childhood and youth and who was having difficulty adjusting to the deaths of the males in his family. Physiological symptoms abated, he was able to drive and return to work. He also resolved much of his problem with women; he remained sober and was working at his marriage. On the other hand, he was still uncertain of himself in his relationships with his wife and children and on the job he was still subject to dizzy spells, using these to avoid facing the opportunity for advancement. Hypnosis was held off for some time until he became angry and demanded this modality. Initially, induction was somewhat in doubt because of H.’s fear of losing control, despite his verbal intentions. However, visual focus, finger lock, and hand levitation were achieved and patient went into trance state. Nothing of particular note contentwise was developed in two hypnotic sessions-which he pulled out of quickly-but he had learned something of considerable importance to
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him.He recognized that hypnosis was not a magical tool and that the therapist was not a magician who could or would give him answers. I saw him as a highly suggestible individual and avoided giving him posthypnotic suggestions 80 as not to increase his dependency on treatment. His sense of mastery of a hitherto unknown level of consciousness gave him an additional feeling of security and control over himself. It allowed further release of the ego strength he had held in check and freed his imagination. He subsequently took and passed an examination for job advancement, shopped in stores, drove, and began to assert himself at home and to enjoy the skills and knowledge he had until now repressed. There was discussion before and after these two hypnotic sessions of his fear of losing control and his ability to retain this control for himself (e.g., the strength in his own hands kept them from unlocking until he relinquished them as well as the strength he exhibited in deciding when and how long he wished to be in a trance-or even a panic-state). Case 4
Among other things, S., a college teacher, had been troubled by an inability to deal with her rampant children and could not begin to write up her doctoral dissertation in mathematics. She came into therapy to deal with a depression centering around her father’s serious illness, questions of her own sexuality, and episodes of intense fright around what she felt were symptoms of dissociation, which manifested themselves during an encounter group session elsewhere. Therapy resolved most of these problems, but she was unable to move beyond the first chapter of her thesis and was still in a panic over being “unable to come back” after deep emotional experiences. Her need for narcissistic control was explored further and it was decided to attempt hypnosis. This was achieved initially via relaxation techniques (because of her evident physical tenseness) and in two sessions, though we had already worked through her fear of homosexuality, she could accept the fact that she was controlling not only her children but her husband as well. Acknowledgment of this devious use of her energies permitted her to face the ways in which she had repressed her more creative abilities. The last two sessions, however, were an induced fantasy focused on an ideal self (off in the distance) which she was later able to merge with her “normal” ego-and in doing so,get in touch with a deepened feeling of personal identity. This gave her a sense of stability and “centeredness” that she could then use as a bridge outside the therapeutic session. The hollowness and void she had feared vanished. Therapy was terminated after an additional few interviews in which
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she described her burgeoning selthood and increasing sense of youthfulness and vitality. She soon had her dissertation well in hand and decided to stay in the marriage and “work it out” with her husband.
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Case 5
He had functioned as a borderline personality for years and came into treatment because of a sudden surge of blackouts and suicidal thoughts. Treatment was lengthy and was carried on with several month-long hiatuses in between. A possible schizophrenic process was arrested and he was able to handle effectively a change of job (from school librarian to art supervisor), resolved the loss of both parents, and, for the first time at 38 had taken part in several heterosexual relationships. However, he was unable to leave therapy entirely and panicked at even the thought of termination. After five interviews, during which there were several hypnotic sessions, he was able to break for a “vacation” and did not return, although he did have occasional telephone contact with the therapist. Because of this patient’s previous difficulty with visual and auditory hallucinations, focus on his own hand was used in effecting trance. In one of these sessions, age regression elicited an episode in which he recalled his mother’s trimming his nails and his fear of having his toes cut off. Although we had dealt with castration fears earlier, this return to a primitive apprehension presaged a brief regression that led to the final step out of therapy. In another session, devoted to body awareness, he was able to sense various parts of his anatomy and then integrate them into a single self-image so that he could accept himself as having a spatial identity. Being in control of his own body and space gave him the final fillip into what he now considered a normal life. He became artistically productive and was even considering a commitment to marriage. DISCUSSION In each of these cases, one can see how the patient was able to overcome his or her feeling of helplessness and the fear of impending inundation by the unknown. Although this still concerned to some extent the instinctual id impulses and superego doubts, which had been worked through in therapy previously, what emerged as significant was the feeling of mastery over the bimodal creative/destructive urges at the very root of ego autonomy. During these ensuing sessions, the patients became less fearful of expressing negative affect and they were able to explore a more positive approach to living. The significance of resolving for oneself the choice between selfhood and dependence, between personal growth/productivity and ego-dystonic
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fear/immobilization has been fully amplified by Maslow (1968), Erich Fromm (1964),and others. That the persons involved in the treatment process here described were all finally able to react creatively in the spirit of their own lives is indicative of the value of hypnosis as a creativity-releasing-mechanism. Its greatest benefit, however, derives from the additional sense of mastery over both conscious and unconscious wishes and strengths it was able to provide-a tool for total rather than subtotal acceptance of self. Another aspect of the therapies involved here was the use of hypnosis to ease the bridge between two time periods and to enable a cross-over from present to future. In each situation, the experiences of the past had been explored and yet the patient was held back from participating in activities where ego control could mold his own life further. Hypnosis helped to provide the patient with a new awareness of heretofore unrecognized or a t least unacceptable potentials, a way of leaping across the abyss between the “now” and “to be.” Except for an emphasis on relaxation and relief of tension, in none of these situations did it seem appropriate to make posthypnotic suggestions. It seemed more in keeping with the needs of the patient to let him proceed at his own pace, what has elsewhere been referred to as his personal tempo (Kir-Stimon, 1977). Hypnosis facilitated termination in each instance by permitting the patient to finally accept his autonomy as well as his normal interdependency as a human being. In each case too he was able to see himself with some kind of temporal perspective, as it were, in a present related to a past and future. He was also more attuned to his own life style and in touch with a deepened awareness of himself as a multidimensioned being, occupying space and time. Although the transference per se had seemingly been resolved, there was now a broader and more general loosening of object ties, an increasing feeling of self-determination, an ability to make decisions, and a sense of personal mastery and control. The final resistance overcome was the fear of losing oneself in the void between the existential self and the nonself (the “other” who had the presumed magical control over the patient’s life). As one patient said, “I am now trusting parts of me I have not been aware of. It was not trusting myself that I couldn’t see. I can now look at me in the mirror and I’m
OK.” REFERENCES FROMM, ERICH.The heart of man: Its genius for good and evil. New York: Harper & Row, 1964.
GARDNER, G . G . Hypnosis and mastery: Clinical contributions and directions for research. Int. J. din. exp. Hypnosis, 1976,24, 202-214.
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KIR-STIMON, W. Tempo-stasis as a factor in psychotherapy. Psychotherapy: Theov, Research, & Practice, 1977,14, 245-248. MASLOW,A. H. Toward a psychology of being. (2nd ed.) New York Van Nostrand Reinhold, 1968. STOIAAH, D., & FROMM,ERIKA.Activity and passivity of the ego in relation to the superego. In&.Rev. Psycho-Anai., 1974, I , 297-31 1.
Hypnose als Werkzeug fur Therapietermination
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William Kir-Stimon Abstrakt: Es werden hier Fiille mit verschiedenen Induktionsmethoden dargeboten, um den Gebrauch von Hypnose als einen letzten Schritt in Psychotherapie zu illustrieren. In jeder Situation handelte es sich um klinisch aktive Therapie ohne Hypnose. Die Probleme der Termination drehten sich um die Angst der Patienten, den ultimativen Schritt zum Kontrollieren ihres eignen Lebens zu machen. Hypnose verhalf dazu, eine Briicke zwischen dem friiheren und jetzigen Ich-Konzept und dem Akzeptieren der individuellen Schopfungskraft zu bilden. Im Brennpunkt der Diskuseion steht vielmehr der H y p nosegebrauch als Hilsmittel im ijberkommen der Angst des Ichs in seiner Beziehung zu der Umwelt als die Bildung eines Rapports oder eines Arbeitens durch nertragung. Hypnose wird dadurch zu einem positiven Faktor erhoben, der das Meistern und die Autonomie des Selbsts verstiirkt wie auch die Handhabung der Resistenz gegen die volle Ausniitzung der Starke des Selbsts.
L’hypnose, une technique facilitant la fin de la therapie William Kir-Stimon Resume: L’auteur presente quelques cas, avec differentes methodes d’induction, pour illustrer l’usage de I’hypnose comme derniere etape d’une psychotherapie. Dans chaque situation, la therapie a ete cliniquement active sans hypnose. Les problemes de fin de therapie se cristallisent autour de la peur que ressentent lee patients face au dernier pas qu’ils doivent faire pour reprendre le plein controle de leur vie. L’hypnose aide a faire le lien entre I’ancien et le nouveau concept de soi et favorise l’acceptation de la creativite individuelle. La discussion porte sur I’hypnose comme methode d’appoint pour surmonter l’anxiete du moi dans sa relation avec le umwelt, plutot que pour I’etablissement du rapport ou la resolution du transfert. L’hypnose devient alors un facteur positif permettant d’augmenter la maitrise personnelle et l’autonomie, et de r6soudre les resistances a la pleine utilisation des forces du moi.
Hipnosis: Una tecnica para facilitar el fin de la terapeutica William Kir-Stimon Resumen: El autor presenta algunos casos, con diferentes metodos de inducion, para explicar el us0 de la hipnosis como ultima etapa de la psicoterapia.
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En cada situacion, la teraphtica ha estado ya clinicamente activa sin hipnosis. El miedo de terminar la terap&utica, de este dtimo paso que el paciente tiene que hacer, de establecer un controlo sobre su vida, es el problema mas importante que se encuentra. La hipnosis ayuda a c n u a r el viejo y nuevo concept0 de si mismo, y facilita tambien a aceptar la creacion individual. La discusion pone en enfasis el metodo hipnotico que ayuda a dorninar la ansiedad del *‘ego” en su relacion con el umwelt, en vez de comenzar esta relacion o la resolucion de la transferencia. La hipnosis se hace asi un factor positivo permitiendo de aumentar el controlo de si mismo y la autonomia, y tambien permitiendo de resolver las resistencias a la llena utilizacion de las fuerzas del “ego.”
