Hypnotherapy

Hypnotherapy
Lewis R. Wolberg
e-Book 2015 International Psychotherapy Institute
From American Handbook of Psychiatry: Volume 5 edited by Silvano Arieti, Daniel X. Freedman, Jarl E.
Dyrud
Copyright © 1975 by Basic Books
All Rights Reserved
Created in the United States of America

Table of Contents
Hypnotherapy
Hypnosis and Research
The Nature of Hypnosis
Characteristics of the Trance
Induction of Hypnosis
Dangers of Hypnosis
Hypnosis in a Comprehensive Psychotherapy
Bibliography
Hypnotherapy
In recent years, hypnosis has gained an increasing acceptance among
the psychiatric profession, both as a therapeutic implement and as a research
vehicle for the investigation of many complex aspects of human behavior.
Instrumental in lending some scientific credibility to hypnosis have been the

two leading organizations in the field: the Society for Clinical and
Experimental Hypnosis, and the American Society for Clinical Hypnosis. The
former publishes The Journal of Clinical and Experimental Hypnosis, the latter
The American Journal of Clinical Hypnosis. Both magazines contain informative
articles on hypnosis of contemporary interest. Moreover, a number of serious
researchers and clinicians have made contributions that have given an
atmosphere of respectability to the practice of hypnotherapy.
Nevertheless, hypnosis continues to be blighted with misconceptions

promulgated mostly by uninformed persons or those whose personal needs
lead them to link hypnosis with magic and the paranormal. It has been
difficult to dislodge this association with the occult not only from the minds of
the public but also from some professional groups. Levitt and Chapman
(1972), discussing the problems of research in hypnosis, have pointed out the
reasons why hypnosis is not employed more frequently in research: it
requires much time and effort; it involves an unusually high probability of

sampling bias; and, most importantly, it currently lacks "respectability" in the
American Handbook of Psychiatry Vol 5 5

community of scientists. They state: "Until the mystical aura of the centuries
has finally been dispelled, hypnosis will not be afforded a full, fair opportunity
to demonstrate its value as a hypnosis and research method."
Hypnosis and Research
In spite of these deterrents, hypnosis has been employed as a research

tool in the study of emotions, psychopathological phenomena, dreams,
defense mechanisms, physiological processes, and test validation. The
available evidence is that it is at least as powerful as other laboratory

techniques.
One problem in hypnotic research is that, in an effort to maintain

impartial experimental objectivity, the researcher may eliminate or distort
the hypnotic phenomena being studied (Shor, 1972). That is, a hypnotist must
approach his subject confidently and optimistically in order to produce the

proper expectancies on which much of the trance is based. An attitude of
neutral un-involvement—the preferred stance of the researcher—will tend to
act against the hypnotic process itself. It is difficult or impossible for a
researcher who fully commits himself to the role of hypnotist not to attempt
to validate his personal expectations and thus defeat his desire, as a
researcher, to maintain objectivity.
Another problem is how to differentiate the phenomena under
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investigation that are due to hypnosis from those due to the subject’s
expectations. Individuals under hypnosis may attempt to please the operator
by divining what is required of them and then living up to anticipated
demands. Or on the other hand, subjects may try to frustrate or defy the
hypnotist because of hostile feelings toward him, or fear of being controlled,

or transferential projections. Moreover, the residual prejudices of subjects
will tend to contaminate their reports.
An ongoing difficulty in research on the trance state is that of distilling
reliable and conceptually meaningful data out of the multiple phenomena
encountered. Similar ambiguities, of course, are met in research in

psychotherapy and other interpersonal processes. An experimental design
often employed in hypnosis to meet this problem is the "subject-as-own-
control." For example, physiological measurements are first made during the
waking state. After the induction of hypnosis, the same tests are repeated
without any direct or indirect suggestions being made. Differences between
the two sets of measurements are then attributed to interposition of the
trance state. Another design is that of "independent groups," in which two

classes of subjects are designated. One receives hypnotic induction, the other
gets simple instructions to use their imaginations strongly. The problem of
adequate controls continues to plague the experimenter here, but some

progress has been made; Orne (1959; 1969) and London and Fuhrer (1961)
have indicated ways in which control techniques may be employed in

hypnosis.
The Nature of Hypnosis
Speculation about the nature of hypnosis dates back to the earliest
writings on the subject in French, German, Italian, and Spanish, which have
recently been translated by Tinterow (1970). An appreciation of how
hypnosis may help in psychotherapy would seem to presuppose an
understanding of its structure, but at the outset we must admit that although
hypnosis was identified as a phenomenon two centuries ago, we still know

little about its nature. This is not altogether surprising, since consciousness
and sleep, the states between which hypnosis is suspended, also remain a
mystery. Many of the blind spots in our knowledge of the trance are
compounded by our present limited understanding of neuro-physiological
and psychodynamic processes in general. Future research will undoubtedly
shed light on the true nature of the hypnotic state, but until that time arrives
we are limited to theoretical assumptions.
Unfortunately, no theory to date is sufficiently comprehensive to explain
all of the complex manifestations of hypnosis. This judgment includes the

physiological theories that postulate changes within areas of the cerebral
cortex such as those of inhibition and excitation; analogical linkages to animal
hypnosis; and considerations of dissociation, conditioning, role-playing,
regression, or anachronistic revival of the child-parent relationship as the
prime process present in hypnosis. What we are probably dealing with in
many of these theories is a delineation of phenomena liberated by the trance,
rather than a description of the hypnotic state itself.
Attempts have been made in recent years to identify physiological
parameters that are distinctive for hypnosis. To date, however,

measurements have failed to reveal any specific differences in biochemical
and neurophysiological areas. A few features observed thus far may be
mentioned. Electroencephalographic patterns during hypnosis differ from
those of sleep stages 2, 3, and 4. There seem to be some similarities between
hypnosis and the descending stage-1 transitional sleep (Chertok, 1959; Tart,
1965), but the findings are not conclusive. A number of studies are currently
taking place, employing sophisticated computer techniques, that may
establish a differentiation of brain wave patterns (particularly alpha activity)
in waking and in hypnosis (London, 1961; Ulett, 1972; Ulett, 1972). Evans
(1972) however, reviewing the available data, concludes that alpha activity
does not appear to change during hypnosis and that we cannot predict
hypnotizability from alpha activity. At this stage of our knowledge, all that we
know is that the trance state lacks the electrophysiological characteristics of

sleep; indeed, it subserves a different function.
Barber (1972) insists that recent research has produced data

incongruous with the prevalent trance paradigm. Among the anomalous
findings are the following: (1) unselected subjects given suggestions in the
waking state (such as that they experience body immobility, analgesia,
hallucinations, age regression, amnesia, and so forth) are just as responsive as

are unselected subjects exposed to "trance induction;" and (2) no special
physiological changes distinctive for the "trance" state have ever been
discovered that would establish that state as a unique entity. Barber offers an
alternative paradigm: in order to produce the phenomena considered

characteristic of hypnosis, it is essential to give instructions, in any state of
subject awareness, that will elicit positive attitudes, motivations, and
expectancies toward the test situation. A capacity for vividly imagining things
suggested to him increases the subject’s responsiveness, as does a covert
verbalizing of suggestions to himself, along with an inhibition of contrary
thoughts. Thus, according to Barber, the subject’s positive reaction in
hypnosis is not due to the "trance" but instead is related to psychological and
social influence processes such as conformity, attitude change, and
persuasion. Abilities believed by some to be characteristic of hypnosis are

actually within the normal human repertoire—such as analgesia,
hallucinations, age regression, age progression, amnesia, and so forth. In

disagreement, authorities convinced of the existence of an identifiable entity
in the trance say that what Barber seems to be doing is equating the
phenomena produced during hypnosis with the hypnotic state itself. The fact
that one can produce practically any phenomenon in the waking state that
one can in the trance, in a subject who possesses the proper attitude,
motivations, and expectancies, does not nullify the existence of a special
condition that we call hypnosis.
For example, by means of sensory deprivation or the use of

psychotomimetic drugs like LSD and psilocybin, we can produce some of the
same symptoms in a nonschizophrenic person that we find in schizophrenics.
These phenomena may therefore be presumed to fall within the normal
human repertoire. Moreover, no special physiological findings of a consistent
nature have been found in schizophrenia to establish it as a separate state.
These facts do not prove that schizophrenia does not exist as an entity. We
may employ a second example: the techniques of psychotherapy. The fact that
psychotherapeutic effects may be secured spontaneously without benefit of
any professional services does not mean that psychotherapy does not exist as
a body of procedures that can score significant gains.
From a clinical point of view, arguments as to how genuine a state
hypnosis is are more or less arbitrary. What we are interested in discerning is

whether the maneuvers we implement in producing what is called a "trance"
in a subject will also increase his suggestibility, since this will serve us during
treatment. That such is the case has experimentally been demonstrated by

Hilgard and Tart (1966). Therapists who employ hypnosis are almost

universally convinced of the fact. Whether it is because of the special routines
of induction or because the therapist, persuaded by the powers of hypnosis,
communicates suggestions more convincingly—hence increasing expectation,
motivation, and positive attitudes—does not truly matter from a pragmatic

standpoint.
In speculating on the dynamics of hypnosis, it is essential to remember

that the experience of being hypnotized is filtered by each patient through a
gauze of his own special emotional demands and needs. What we may be
seeing in phenomena mobilized by the trance are aspects of the subject’s
unique psychological problems rather than manifestations of the hypnotic
state per se.
Characteristics of the Trance
The fact that practically all of the features of hypnosis may also be
observed in other states of awareness has tended to obscure the issue of
specificity. In addition, we may be confused by the fact that the responses we
encounter merge into normal behavioral manifestations on the one hand, and
into neurotic and even psychotic symptomatology on the other.
In every trance we may witness a dynamic configuration of many
different kinds of phenomena, constantly fluctuating in response to

psychophysiological changes within the individual and changes in the
meaning of the hypnotic relationship to him. Some of the elements elicited in
the trance may lend themselves to therapeutic use. First, largely because the
subject equates hypnosis with sleep and because of the therapist’s
instructions, there is a remarkable easing of tension as muscles relax
progressively. Second, the individual becomes extraordinarily suggestible to

pronouncements from the operator that are not too anxiety-provoking. Third,
he experiences a shift in attention from the outside world to the inner self;
there is greater self-awareness, a deeper contact with his emotional life, a

lifting of repressions, and an exposure of repudiated aspects of his psyche.
Fourth, a relationship develops with the operator that assuages the subject’s
sense of helplessness and satisfies some of his inner wishes and demands.
Any of these effects may be diminished by anxiety in the subject or be

neutralized by suggestions from the hypnotist.
Relaxing Effects
Continued stress may have a damaging effect on bodily functions, both
physiological and psychological. It can create somatic imbalance, interfere
with the healing process in physical disorders, exaggerate the symptoms of

psychological ailments, and bring into play various defensive
instrumentalities, some of which may be maladaptive in nature. Any device
that eases tension may neutralize these ravages and create the most fertile
conditions for spontaneous and applied curative forces to work effectively.

Even chronic and progressive organic ailments may be benefited greatly
thereby.
How hypnosis aids relaxation is illustrated by the studies of Moody
(1953), Mason (1956), and Kirkner (1956). Moody divided twenty patients,
each of whom had an uncomplicated peptic ulcer of at least six years’

duration, into two groups. Medication was discontinued for the experimental
group; instead, thirteen one-hour hypnotic sessions were given, oriented
around simple suggestions to relax and to concern oneself less and less with
stomach pains. Medication was continued for the control group, but no
hypnosis was employed. After a period of several months, X-ray and clinical
examinations showed a significantly greater number of patients improved in
the experimental than in the control group. Mason (1956) reported

hypnotherapy of 135 cases of chronic skin diseases. The cases, with an
average duration of ten years, had not yielded to regular dermatological
treatments. Of these, a remarkable total of sixty-six were cured with no return

of symptoms, even after a three-year period of observation. Kirkner described
sixty individuals with assorted physical disorders who were treated in a
general-hospital setting by hypno-relaxation; forty-three cases markedly
benefited from this regimen.
A wide variety of medical, orthopedic, and neurological ailments in

which stress plays a part have been successfully treated by hypnosis.
Describing these is beyond the scope of this paper, but brief mention will be
made of the syndromes that have responded. These include hypertension,
Raynaud’s disease, coronary disorders, paroxysmal tachycardia, cerebral
accidents, asthma, speech disorders, enuresis, impotence, chronic gastritis,

dyspepsia, spastic colitis, ulcerative colitis, dysmenorrhea, amenorrhea, and
menorrhagia. In such diseases of the central nervous system as tabes,
Parkinson’s disease, syringomyelia, muscular dystrophy, multiple sclerosis,
and the post-traumatic syndrome, residual incoordination, muscle weakness,

and paresthesias are reduced by decreasing tension through hypnosis. Since
peripheral chronaxy may be heightened and lowered by suggestion, nerve
function may be improved in conditions where reversible neuropathological

changes exist, as in Sydenham’s chorea. Thus hypnosis may be effective in
both organic and psychogenic somatic disorders, because of its ameliorative
influence on provocative and coincident stress factors.
Where the patient is suffering from disabling tension and anxiety, the
mere institution of a trance may exert a tranquilizing influence on his
symptoms and increase his ability to cope with his immediate difficulties.
Once tension is reduced and a sense of mastery restored, it is remarkable how
the patient’s latent strengths come to the surface and facilitate adaptation.
Where the goal in therapy is to restore the individual to the level prior to his
immediate upset, no further psychotherapeutic measures may be required.
Obviously there will be no great changes wrought in the patient’s personality,

and under overwhelming stress he may again break down. But if stress
contingencies can be reduced or eliminated, a proper adjustment may be
indefinitely maintained.
Some therapists, pleased with the outcome of hypnotic relaxation, do
nothing more than buttress these effects by teaching the patient self-
hypnosis. The results of such techniques are little different from those that
the patient may achieve for himself through yoga exercises and
transcendental meditation—purely palliative, and only rarely satisfactory in
themselves.
Enhanced Trance Suggestibility
In Shakespeare’s great drama, Hamlet approaches Polonius and points
out ". . . yonder cloud that’s almost in shape of a camel." Polonius agrees that
it is like a camel indeed. But, says Hamlet, "methinks it is like a weasel." To
which Polonius replies, "It is backed like a weasel." Hamlet counters: "Or like
a whale?" Says Polonius: "Very like a whale." This kind of interchange,

pointing to the power of suggestion, may be repeated in many contexts and
especially in the context of hypnosis. Hypnosis wields its effects largely
through the influence of suggestion. The degree of suggestibility in a
particular subject is of greater importance than is the depth of trance. In

extremely suggestible subjects one may obtain phenomena in waking life that
are produced in most persons only in hypnosis, such as analgesia and even
hallucinations. The virtue of hypnosis is that it reinforces suggestibility,
rendering susceptible many of those who would not be responsive to
suggestions in the waking state.
How powerful suggestion can be is illustrated by the phenomenon of
the voodoo curse among primitive or semi-primitive groups. A member of

such a group may suffer illness and even death upon being convinced of a
sorcerer’s evil magic. Valid cases have been documented of voodoo deaths
that were produced solely by the breaking of a taboo, the penalty for which is
traditionally accepted as death. The accursed native becomes listless, refuses
to eat, and then wastes away. Medical intervention is futile. However, if a
friendly witch doctor exorcises the offended spirits and presumedly restores
the sinner to their good graces, the latter often recovers immediately—to the
consternation of the sorcerer who originally cast the spell.
Suggestion, which influences the individual profoundly in a positive

way, is the rationale behind most uses of the trance. Hammer (1954) has
shown (at statistically significant levels of confidence) that hypnotic and
posthypnotic suggestions may produce the following effects: (1) an increase

in psychomotor speed and endurance, and a decrease in physical fatigue; (2)
an increase in the span and duration of attention; (3) an increase in the speed
of learning; (4) an increase in the speed of association, mental alertness,

concentration, and general mental efficiency; (5) an improvement in the
application of abstract abilities in relation to number content; (6) an
improvement in the speed of reading comprehension; and (7) a heightened
sense of enjoyment in performance. The influence on learning is especially

interesting, since hypnosis may potentially be able to modify learning
processes, breaking long-established modes of action and even conditioned
reflexes and thereby altering set habits (Dorcus, 1956). In an interesting
experiment, Barrios (1973) has shown that hypnosis can greatly augment
higher-order conditioning.
The patient’s exaggerated suggestibility will vitalize the placebo effect of
hypnosis, since a great deal of the benefit that an individual derives from
therapy is due to his expectancies (Goldstein, 1966). Persons who evince

sufficient faith in hypnosis to ask for it, are apt to endow hypnosis with
healing powers that can have a constructive effect. For example, twenty
clients treated by Lazarus were divided into two groups: those whose request
for hypnosis was granted, and those in whom it was refused. The relaxation
techniques employed with both were identical, except for the avoidance of
the word "hypnosis" in the latter group and the inclusion of the words
"hypnotic relaxation" instead of "relaxation" in the former group. This

resulted in a significantly greater response to behavior modification methods
in the former group. On the other hand, we might expect that where
expectations are unreasonable, the patient will respond with great
disappointment and even hostility when he discovers that his complaints are
not immediately dispersed by the magic of hypnosis. This constitutes a
problem in starting therapy with a person whose expectations in relation to
hypnosis are obviously unreasonable. Should the therapist let the patient ride
on his wagon of hope, or should he deflate this exaggerated confidence? Most
hypnotherapists do not interfere with their patients’ optimistic fantasies until
the first signs of lack of progress develop, at which time a correct picture of
the therapeutic situation is firmly drawn, [p. 594]
Hypnotic suggestion facilitates many behavioral techniques, such as

systematic desensitization, role-playing, behavior rehearsal, time projection,
emotive imagery, anxiety relief, Ellis’ Rational Therapy, Lazarus’ Emotive
Therapy, Salter’s Assertion Training, modeling, logical problem solving,

labeling and expressing the affect, and so forth. I have found in my own work
that some patients who have not responded to behavior therapy techniques
as I practice them in the waking state, respond easily to the same techniques
when hypnosis is employed as a catalyst.
During hypnosis one may take advantage of the patient’s enhanced
impressionability by proffering persuasive suggestions, or suggestions

toward the yielding of noxious symptoms. These exhortations are usually
absorbed with greater facility than in the waking state. If accepted, they may
be helpful in neutralizing anxiety, promoting a more optimistic outlook,

reducing symptomatic suffering, and enhancing adjustment. Whether they
can alter the intrapsychic structure and produce any reconstructive character
change is dubious. However, they may divert the individual from tormenting
himself with his hopelessness and nudge him into more constructive attitudes
toward himself and more healthy modes of relating to people. One may, for
example, employ John Hartland’s "ego-strengthening technique" of altering
the suggestions in accordance with the specific problems of the patient.
Hartland (1965) believes that irrespective of the kind of psychotherapy one

employs, preliminary administration of hypnotic "ego-strengthening"
suggestions will enhance the effects of therapy, whether these are aimed at
supportive or reconstructive goals. The patient becomes more confident and

self-reliant, and he finds it easier to adjust to his environment. Hartland
points out that the manner in which suggestions are given is as important as
the content; such elements as rhythm, repetition, interpolation of appropriate
"pauses" and the stressing of certain words and phrases are all vital. In my
own experience, I have found ego-strengthening suggestions (coupled with
the making of a hypnotic tape) valuable in short-term therapy where my

goals were not too extensive. They have not added a great deal to working
with patients in depth over a longterm period, during which I use traditional
analytic methods; but I would not hesitate to employ ego-building where the
patient’s defenses were shattered, as a preliminary to more elaborate
procedures.
Symptom Removal or Alleviation
Patients whose lives are being tormented by symptoms often possess
no further motivation for therapy than to eliminate their complaints. The

average psychiatrist, however, would like to pursue more extensive goals
than pure symptom relief: namely, betterment of the patient’s general
adjustment and possibly, where serious characterologic problems exist, a

reconstruction of the personality structure. Realism, however, dictates that
we may have to abbreviate our goals and simply do as much for our patients
as time, finances, and other practical factors allow. It is here that hypnosis can
play a significant role, catalyzing the impact of practically any short-term

method.
Direct symptom control is often practiced in emergency situations, as
when hysterical symptoms cripple adjustment. In such a case, hypnotherapy

may be the treatment of choice (1951). The symptoms that respond best to
suggestive hypnosis are hysterical amnesia, stupor, coma, twilight and dream
states, dramatic posturing and acting, panic reactions, clouding of

consciousness, hallucinations, delirium, and dissociated reactions such as
somnambulism and fugues. In conditions of exhaustion due to persistent and
uncontrollable hiccupping, and in severe undernutrition caused by functional
vomiting and anorexia nervosa, hypnosis may be a life-saving measure.
The possibility that another symptom will be substituted upon

elimination of the symptomatic complaint factor is not a great one, but it
should be kept in mind. According to a controlled study by Browning and
Houseworth (1953), of thirty ulcer patients postoperatively examined
following a vagotomy, a significant number developed new symptoms after
losing their ulcer complaints. These findings were similar to those reported in
an independent study by Szasz (1949) of other vagotomized patients. Seitz
(1946) described the case of a man in whom symptom removal by hypnotic
suggestion produced symptom substitution. And Crisp (1966) published a

paper detailing the treatment, by behavior therapy, of nine patients in whom
elimination of symptoms resulted in the development of other complaints.
Wolpe (1969) has suggested that where "neurotic anxiety" is associated with
a symptom, failure to eliminate the anxiety may result in symptom

substitution.
Against these claims there is a host of evidence that the removal of
symptoms is rarely followed by the development of new problems. Indeed,
there is evidence that the resulting improvement spreads into other aspects
of the individual’s adaptation. If the therapist utilizes a permissive suggestive

approach, offering the patient an opportunity to overcome his symptoms if he
so desires, there is little to fear. On the other hand, if the therapist comes at
the patient like a bull in a china shop, his blunt behavior may have a traumatic
effect. But this can occur with any therapy, and not only hypnosis. In fact, in
cases where symptoms do serve an important purpose in maintaining the
patient’s psychological equilibrium, some therapists deliberately employ
symptom substitution in order to avoid the possibility of reactions. The
theory behind this is that the patient’s subversive needs for a symptom may
be propitiated with a less noxious token. Erickson (1954) believes that

suggestions are best limited to symptom substitution, transformation, and
amelioration. For instance, in two patients with disabling arm paralysis,
Erickson substituted, with satisfactory results, wrist stiffness and fatigue in

one case, and stiffness of the little finger in the other.
A number of observers have challenged the traditional caution in the

hypnotic removal of symptoms. If the therapist is dynamically oriented,
watches the reactions of the patient, and restores symptoms by hypnotic
command in instances of ego collapse, there is little or no danger in symptom

removal by authoritative suggestion. The way in which a suggestion is
phrased is also extremely important. When the patient understands that he
may retain those symptoms that are important to him, in their entirety or in
part, and when his cooperation is obtained for the procedures utilized, there
is little hazard involved.
In some patients, a "chain reaction" may be started as the result of the

successful hypnotic handling of one aspect of the total problem, with benefit
to the individual’s general adjustment. For example, a patient applied for

therapy with the request that he be taught self-hypnosis to help him retain

and recall material for an important examination that was to be held six
weeks in the future. As a civil service employee, it was urgent that he pass the
examination to fill the vacancy at the head of his department for which he was
eligible by virtue of seniority. His fear of failure was compounded by the

specter of losing face with his fellow employees in the event he was unable to
achieve a passing grade. It was apparent that his faulty concentration and
memory were by-products of an extensive personality disorder associated
with fear of and resentment toward authority, as well as a greatly devaluated

self-esteem. During his childhood he had been repeatedly reminded by a
successful and authoritarian father that he was expected to bring credit to the
family through his career accomplishments. One of the important operative

dynamics in the case was a fear of success coupled with a terror of competing,
achieving parity with, and perhaps even vanquishing his father. There was
also a hostile defiance of his male parent, since success also symbolized
submitting to and being destroyed by the latter. Since the patient lived in the
South, refused referral to local psychiatric sources, and saw no need for
working on any problem other than his faulty concentration, short-term

therapy was considered expedient. In hypnosis he was given suggestions to
the effect that his mind would gradually clear, his attention sharpen, and his
desire to study improve. Furthermore, he would understand more and more
clearly why he was blocked in his memory and recall. A tentative explanation
of the dynamics was offered him, and he was asked to consider, think about,
and decide for himself which aspects were false or true. He was instructed to
explore his reactions and to try to discover reasons for them. In the waking
state he was encouraged to talk about his relationship with his parents and to
make connections with patterns that were operating in his present life
situation. He was additionally taught the process of self-hypno-relaxation for
the purpose of reinforcing suggestions. Therapy consisted of a total of five
sessions. Not only was the patient able to pass his examination successfully,
but a follow-up visit one year later showed conclusively that his behavior
patterns had been beneficially influenced. He had become capable of standing
up to authority when necessary, and he felt degrees of independence and
assertiveness in himself that he had never believed were within his potential.
Habit Correction and Rehabilitation
Hypnosis has been employed for the correction of certain habit

disturbances. It is generally satisfactory for this purpose unless the disorder
is linked intimately with deep-seated personality problems and needs. Thus
obesity that dates back to childhood rarely responds to hypnotherapy. On the
other hand, where excessive food intake does not serve an important
psychological function such as gratifying frustrated early oral demands or
deprivations, dietary control may be materially helped through hypnotic
suggestions. Insomnia similarly may respond better to hypnosis and self-

hypnosis than to almost any other measure. However, where the patient has

become seriously habituated to hypnotic drugs, there may be little reaction to
suggestions other than frustration. A gratifying number of patients who wish
to give up smoking tobacco, but who cannot do so, find that hypnosis relaxes
their tensions sufficiently to keep their suffering from being extreme when
they abstain. Some sexual difficulties such as impotence or mild frigidities
yield rapidly to reassuring suggestions, made during hypnosis, that are
geared toward helping the patients regard sexuality as a pleasure function
rather than as a performance. Satisfactory results also have been reported

when employing hypnosis in enuresis. I have used hypnosis (coupled with
aversive stimulation) in intractable hair-pulling and nail-biting cases and
have found it a tactic to which some of these patients will respond. Alcoholic
abuse and drug addiction are difficult to treat, but certain dedicated
therapists seem to be able to effectuate some constructive impact on these
severe habit disorders when motivation is present.
Indeed, through appropriate suggestions, hypnosis may serve as a

powerful motivational determinant. For example, it may be possible to
motivate a patient to cease resisting medical dietary orders, in obesity; to

restore appetite, in anorexia and undernutrition; to avoid excessive stress
and overactivity, in cardiac conditions; to facilitate speech retraining, in

aphasic disorders; to exercise a limb that has been immobilized by a cast or
by arthritis; to obtain essential rest and sleep, in insomnia; and to give up
smoking, where nicotine and coal tar exert a dangerous influence. Hypnosis
may help divert the patient’s mind from unhealthy and self-destructive
fantasies, encouraging him toward more productive thoughts and actions. In
chronic ailments where the patient has lost the will to live, hypnotic
suggestion may inspire him to keep up the fight; it may promote a shift in his
attitude that spells the difference between survival and death.
We have only begun to investigate the rehabilitative uses of hypnotic
suggestion. It may play a most important role, particularly in individuals who
are more disabled by their fears and attitudes than by their physical
disorders. In emotional ailments where there is a lack of incentive for

psychotherapy, hypnosis may promote an acceptance of the treatment
situation by offering active and immediate help, by developing constructive
rapport with the therapist, and by demonstrating that the patient’s problems
are not visited on him by an evil providence but are instead related to
conflicts within himself that need treatment (1957).
Alleviation of Pain
Proper hypnotic suggestion may lower or eliminate overt and subjective
responses to painful stimuli. This is accomplished by the reduction of tension

and anxiety, promotion of muscle relaxation, and diversion of attention from
the pain stimulus. The resultant is an analgesia that may be advantageously
employed in minor surgical procedures, in diagnostic exploration such as

sigmoidoscopy, in dental operations, and in obstetrics. Relaxing and analgesic
suggestions are particularly valuable as an aid to chemical anesthesia, helping
to reduce the amount of anesthetic required. Indeed, hypnosis may eliminate
the need for preoperative analgesics, which, as Beecher (1951) has indicated,
depress respiration and lower the blood-oxygen level. Smaller quantities of

chemical anesthetic may be lifesaving in toxic conditions, as well as in serious
operations such as lung and heart surgery. Hypnosis minimizes neurogenic
shock and reduces postoperative pain and discomfort. Excellent accounts of

the adjunctive uses of hypnosis in anesthesia may be found in papers by
Mason (1956), Marmer (1956), Raginsky (1951), Owen-Flood (1953), and
Crasilneck et al (1959).
The induction of hypnotic anesthesia sufficiently deep to permit major
surgical operations has been reported. Its use here is limited to the 5 to 10
percent of patients who are able to achieve the profound somnambulistic
trance required for such employment. As an anesthetic by itself, hypnosis has
a limited utility, chemical anesthesia being more universally applicable. The
chief advantage of hypnosis is an adjunctive one. It is sometimes employed in

dentistry (hypnodontics) (see Marcus [1957], Moss [1953; 1954], and West et
al [1952].). It is used to (1) quiet a terrified and tense patient so that he will
permit exploratory and corrective dental measures; (2) reinforce local

anesthesia by lowering the required dosage and helping to overcome gagging,
coughing, and excessive salivation; (3) foster better cooperation in using
dental appliances; and (4) correct habits that interfere with mental health,
such as nail-biting and bruxism.
One of the most effective areas for the use of hypnoanalgesia is
childbirth (Delee, 1955; Heron, 1952; Kline, 1955; Kroger, 1953; Newbold,
1949). A chief problem in obstetrics is the prolonged period during which

pain-relieving measures are necessary. Since difficult labor may go on for
hours and even days, chemical anesthetics have a toxic potential for both
mother and fetus. They are hazardous in toxemia of pregnancy and in cardiac
failure. They may also, when administered during the second stage of labor,
tend to depress uterine contractions as well as impair the respirations of the
infant. Hypnosis may serve as a competent analgesic in itself; the so-called
"natural childbirth" method, which consists of conditioning the patient in

proper breathing and relaxation during childbirth, is probably a form of
hypnosis. Or as said, as an adjunct to chemical anesthesia it may greatly
reduce the amount of anesthetic required. Moreover, by improving morale

and lessening apprehension, it tends to shorten labor. Patients prepared by
hypnosis have had a shorter and less variable labor period, have complained
less about pain and discomfort, and have needed fewer analgesic drugs
(Abramson, 1951). Owing to the time factor in training preparturient

patients, the handling of prospective mothers in groups in prenatal clinics has
been advocated (Abramson, 1950).

Hypnoanalgesia may also be valuable in controlling both functional and
organic pain (Rosen, 1951). Dolorous hysterical conditions may yield readily
to properly phrased suggestions. Organic pain may be relieved by helping the
patient to detach from his suffering. The pain stimulus is not eliminated here,
as it may be in functional disorders, but by focusing the patient’s interest
away from himself, hypnosis may ameliorate some of his distress. This is,
perhaps, akin to what happens when attention is diverted during pain in the
waking state. Beecher (1951), for instance, cites observations of soldiers with
severe wounds who, in the heat of battle, have felt no pain; of athletes who
were so bent on winning that they were oblivious to extensive physical
injuries; and of religious martyrs who have endured unbelievable tortures

during ecstatic reveries. Hypnosis, reinforced by self-hypnosis, may be
employed for pain associated with such conditions as causalgia, post-
therapeutic neuralgia, trigeminal neuralgia, cervical discogenic disease, and

spinal-cord injuries (Dorcus, 1948; Livingston, 1944). In advanced cancer,
where pain cannot be controlled by other means, hypnosis may reduce
suffering and help the patient face the present and the future with greater
courage. If the patient is capable of entering a very deep trance state, he may
be able to experience almost total relief from pain.
Certain surgical conditions may be helped by hypno-suggestion.
Crasilneck et al (1955). have reported excellent results in the hypnotic

treatment of patients with very severe burns. Loss of fluids, toxemia, and pain
encourage shock reactions, with curtailed appetite, mobilization of tension,
and shattering of morale. Hypnosis may be used to advantage as an analgesic
for the changing of dressings, debridement, and skin grafting. Because of the
toxemia, hypno-anesthesia is better for the burned patient than chemical

anesthesia. Direct hypnotic suggestions may also help the intake of food and
fluids. Often the effect of hypnosis is dramatic—a listless, depressed,
nauseated patient who has resisted feeding and drinking suddenly showing
an interest in his meals. Posthypnotic suggestions reduce post-dressing pain
and enable the patient to get out of bed and to move about, thereby avoiding
becoming bedridden.
Diagnostic Uses
The diagnostic uses of hypnosis are founded on heightened
suggestibility. Occasionally it is necessary to distinguish certain functional
disorders from organic disorders—for instance, where disposition is
dependent upon diagnosis. Thus certain cases of abdominal pain severe

enough to simulate surgical emergencies may be hysterically determined;
although the patient may clamor for surgical interference, he will need to be
treated by psychiatric means. Inconsistencies in signs and symptoms will

encourage the cautious surgeon to seek psychiatric consultation, and
hypnosis may aid in determining the functional nature of the complaint by

temporarily removing it through suggestion. Other symptoms that may call

for diagnostic differentiation where signs of organic involvement are not clear
are anesthesia, paresthesia, hyperesthesia, headaches, paralysis, spasms, ties,
choreiform movements, gait disturbances, convulsive seizures, vomiting,
hiccupping, urinary retention, and disorders of vision and hearing. In post-

traumatic cases, residual pain may require diagnosis to determine if the pain
is related to the original accident or whether it has been elaborated as a
psychoneurotic symptom. Hypnosis has been used to differentiate anorexia
nervosa from hypo-physical cachexia, to distinguish an articulation disorder

from stuttering (Madison, 1954) and to detect malingering in cases of feigned
color blindness and paraplegia (Dorcus, 1956). Hypnosis is also sometimes of
diagnostic value in determining the dynamic meaning of symptoms. For

instance, Rosen and Erickson (1954) have used suggestion to precipitate
attacks in patients with convulsive and asthmatic symptoms. They then
blocked the attacks; the effect was to mobilize anxiety, which in turn was
repressed by direct verbal suggestion in order to allow the underlying

fantasies to erupt into awareness.
During the early stages of psychotherapy, hypnosis may help to

demonstrate to a non-motivated patient (or to one who is unable or unwilling
to accept dynamic formulations) the workings of his unconscious. For

example, a patient suffering from severe and crippling back pains of psychic
origin—the basis of which he credited to an undetected arthritic spinal
condition—was inducted into a trance, and the pain was transferred from his
back to his right shoulder. He was conditioned to experience this transfer of
pain to his shoulder whenever I tapped three times on the side of my desk;
upon emerging from the trance he expressed surprise that his back pain had
vanished, but he complained bitterly of discomfort in his shoulder. After

fifteen minutes had passed he again experienced his habitual back agony,
with relief in his shoulder, but my tapping reversed his complaint once more.
From this he realized that his mind was so susceptible to suggest that it could
create and shift pain. He was then able to accept the fact that his mind could
also be responding to self-imposed painful suggestions. This helped to
remove his resistance to the acceptance of psychotherapeutic help. For
patients who stubbornly deny having conflicts, the process of repression may
be demonstrated by suggesting that a hypnotically-inspired dream disappear
in the waking state and then reappear at a given signal. This may suggest to
the patient that he is keeping certain thoughts and feelings from his own
awareness. The creation of experimental conflicts is also a most dramatic

means of demonstrating psychopathological mental operations to the patient
(Wolberg, 1964).
Lifting of Repressive Controls
As the trance deepens, there is a relative withdrawal of attention from
the outside world and a refocusing on the inner self and its processes. The
individual becomes aware of certain aspects of his unconscious life that had

eluded him in the waking state. There follows an easing of repressive
controls, with release of charged emotional components, a flourishing of
fantasy, and an activation of primitive mental operations with more vivid
symbolization. These tendencies potentially lend themselves for use in

psychoanalytic therapy by encouraging emotional catharsis, by bringing the
individual into closer contact with repressed needs and conflicts, and by
facilitating a search for significant memories with the aim of exploration of

genetic determinants. It does not follow from this that hypnosis is necessary
or useful in all patients. If there is no extraordinary resistance, the analytic
process proceeds quite satisfactorily without recourse to hypnosis. However,
in cases where resistance blocks exploration of unconscious elements,
hypnosis may prove to be of help. For example, where the patient is unable to
verbalize freely because of overwhelming anxiety, hypnosis may encourage a

discharge of obstructive emotions or may relax speech operations sufficiently
so that articulation is possible.
A patient was referred for therapy with a severe speech disorder that
had defied every physical, rehabilitative, and psychiatric measure that could
be applied. When he married at the age of thirty-five, his speech problem
(periodic up to this time and appearing only under extraordinary stress

circumstances) rapidly became so exaggerated that he could hardly make
himself understood. He was able to retain his job because of the influence of
his family and because he was considered a gentle and lovable member of his
organization. His wife confided that he never displayed anger, being the most
reserved and reasonable person she had ever met. This observation
conflicted sharply with his productions in the Rorschach test, which were
replete with figures moving against each other, tearing things apart, and
creating explosions in impact. The patient insisted that his past
psychotherapeutic efforts were a rank failure because he was unable to talk.
He was willing to expose himself to hypnosis, but he could not guarantee that
he would respond. During trance induction, the patient could be observed
fighting off succumbing to a trance. He confided that for some reason he was
unable to concentrate. He was promised that no "secrets" would be extracted
from him; indeed, it was not even essential that he talk. With this reassurance
the patient entered into a trance, whereupon he suddenly began to wail and
beat the sides of the chair with his fists. A series of bloodcurdling shrieks
preceded a torrent of invective directed against his wife and boss. It is
difficult to describe graphically the verbal violence that was released. As the
patient recounted instances of abuse and exploitation with great passion, his
utterances became progressively clearer. In successive sessions we were able

to explore the many resentments that he harbored within himself, the
fantasies associated with rage, and the origins of the defensive mechanisms,
such as his stammering, that he had developed to conceal hostility from
himself and others.
In this case the mere induction of a trance lowered repression

sufficiently to bring painful thoughts, emotions, and memories to the surface.
In most patients, however, probing operations are necessary before a release
is possible. With pointed questions the patient may be helped to engage in
more productive free associations, to activate fantasies, and to liberate some

important memories. Where the patient continues to be resistive, the
techniques of regression and revivification may sometimes prove successful
(Wolberg, 1964).
A patient with strong anxieties and depressions was referred for
therapy following hospitalization for an attempt at wrist slashing. Her two

years of analytic therapy previous to her referral had helped her greatly, but
they had not prevented periodic acting-out tendencies. These took the form of
seeking hospitalization compulsively, faking various ailments to ensure her

admission, or threatening suicide by cutting the skin of her wrists. The latter
act was always arranged so that she could be apprehended and hospitalized
before she had seriously injured herself. A bright, sociable, and intelligent
woman, she professed dismay at activities that had brought great
embarrassment to her and to her friends. She claimed being possessed by an
impulse so powerful that it forced her to execute these bizarre actions, even
though she realized that they were against her best interests. Free association
in the waking and hypnotic states revealed no clues as to the meaning of her
behavior, but whenever she spoke of retreating to a hospital she did so with a
none-too-well-concealed excitement that left no doubt that her destructive
acts yielded deep and significant gratifications. In a trance she was given the
suggestion to return in time to that period of her life when she had first had
an impulse similar to the one that now repeatedly forced her to seek
hospitalization. Responding to this suggestion, the patient saw herself as a

child of nine escaping from her house after a quarrel with her mother, filled
with rage after unsuccessfully seeking solace and support from a detached
and passive father. In her turmoil she slipped and fell against a barbed-wire
fence. She then slowly and deliberately cut her wrists with the barbs of the
fence until she drew blood. In part her purpose was to convince herself she
could stand pain, which was a way of living up to her mother’s ideal of acting
like a Spartan; in part it was to bring to her side the family physician who had
comforted her far beyond the call of duty in her times of need, acting like a
substitute father. As a result of recall of this memory, she was able to realize
that her wrist slashing and insistence on hospitalization were revived
impulses for seeking help from a doctor who represented to her a giving
father figure. She recognized that her episodes developed whenever she
experienced severe rejection. This insight enabled her to work through her
acting-out and eventually to eliminate from her life her destructive behavioral
tendencies.
The bringing to awareness of important past events and experiences
may be helpful in a variety of emotional disorders, particularly where there
has been a sealing off of powerful emotions associated with a significant past

event. Some symptoms are protective defensive devices, elaborated to shield
the patient from the return of painful repressed feelings and fantasies.
Hypnosis offers the patient a milieu of relaxed relatedness with a trusted
person, the hypnotist—an atmosphere that helps the patient to tolerate the
implications of the repressed material. Perhaps this accounts for the success
of hypnosis in hysterical amnesias, since once the patient feels capable of
facing the dangers within, he may be able to drop protective symptoms that
have been disorganizing to his total adjustment. It goes without saying that
the working-through process, which must be carried on in the waking state,
will require many months of laborious effort. Often the release of significant
material in the trance may be seemingly forgotten. However, a chain reaction
will have been started that reverberates through the individual, eating away
at his resistances to waking recall. In this reference, one may witness a

change in the character of the dreams as they reflect increasingly less
distorted symbols of the repressed material. Finally a breakthrough of

important memories may occur in full consciousness. This indicates that the
ego has strengthened to a point of tolerating inner conflicts and fears.
It is essential not to take memories and experiences recounted in the
trance at face value. The productions elaborated by a person during hypnosis

generally are a fusion of real experiences and fantasies. However, the
fantasies are significant in themselves, perhaps even more significant than
the actual happenings with which they are blended. Asking a patient to recall
only real events, or to verify aspects of the material as true or false, reduces
but docs not remove the clement of fantasy.
Hypnosis is a valuable aid in the stimulation of dreams in patients who
are unable to remember them or who have "dried up" productively, operating
on a plateau in their analysis from which they cannot seem to progress. Often
a simple posthypnotic suggestion to remember dreams stimulates the
analytic process. For example, a woman in analysis had achieved
improvement but continued to detach herself from men, complaining that her
contacts were limited by her reality situation. She claimed it was impossible
for her to meet the right male companion, because of the restrictions imposed
on her by a maiden aunt with whom she lived and by the inroads of her work
on her leisure time. Although these excuses were obvious rationalizations, the
patient refused to accept them as such, and she obstinately denied that any
anxiety promoted her refusal to accept dates. She had no dreams to report,
and her free associations assumed a controlled, repetitive quality. Hypnosis

was finally employed, and the patient was given a posthypnotic suggestion
that she would have dreams that would help her understand better her
relationship with men. At the next session she reported a dream that
apparently had been provoked by my suggestion. In the dream the patient

saw herself inside a house looking out of a window. "I was situated at an
enormous distance from an event that was going on that fascinated me. I was
afraid to look, but I had to. I needed a telescope to see what was going on. I

saw two people in a fight. One man was hitting another man. Blood was
drooling from his mouth. I knew if he keeled over and played dead, the man
would drop him and leave. I tried to tell him to play dead and not gurgle, so
that he would not be killed." In the trance the patient was asked to redream
the same dream she had had, but to add any parts she had forgotten. She
recalled one element in the dream that she had overlooked, which was that
the victim was wearing high heels. Her associations were that the high heels
were similar to those on the shoes worn by the men in the third card of the
Rorschach test. At the time of her test, she had wondered why men were
wearing women’s shoes. She then related experiencing a feeling of
inconsistency to the effect that she too wore high heels, even though she
considered herself to be as efficient as a man. She confided with bitterness
that the sexual role she had to play as a woman had bloody connotations for
her. To sleep with a man signified being victimized, humiliated, virtually
killed. The meaning of the dream became apparent to her after this revelation.
Her looking through a telescope was a viewing of her relationships with men
from a distance, since she did not want to expose herself to the hurt of a close
contact. What she saw in the dream frightened her. A man, an aspect of
herself, was being attacked. She could easily be the victim of a bloody assault
in a sexual embrace with a man. In the waking state she continued her
associations, and soon she confessed having had sexual feelings toward me,
which had frightened her so that she could not divulge them. She had
responded with defensive detachment and with resistance, which had
obstructed her progress. The recounting of this dream enabled us to proceed
satisfactorily with her analysis.
Mobilization of Transference
Hypnosis may have a remarkable influence by virtue of the unique
relationship that develops between the participants during the trance. For
instance, some patients may feel singularly protected, as if they are under the
aegis of a powerful and supporting .agency who can minister to their needs
and defend them from hurt. They may experience warmth in closeness to
another human being, which vitalizes them. These attitudes can be extremely
meaningful, particularly to persons who are consumed by anxiety and
paralyzed with a sense of helplessness, to individuals who are
characterologically detached and fearful of human contacts, and to those who

lack motivation for therapy. The fact that the patient derives something
important from the trance experience often helps him to relate in a more
constructive way to the therapeutic situation. Schizoid persons may be

enabled to develop a relationship with the therapist in a few sessions that
would require many weeks or months of tedious working-through of
resistance in the process of ordinary psychotherapy. Fisher (1954) has shown
that the effect of even a single hypnotic induction may carry over long after
the trance has ended. Therapeutically beneficial influences may be stimulated

that persist after hypnosis is no longer employed as a technique.
Some patients neurotically interpret the hypnotic relationship as one in

which they must yield to every utterance and command of the hypnotist. This
makes them peculiarly responsive to suggestions that (if not too anxiety-
provoking or too depleting of important defenses) will remove, modify, or

control the patient’s symptoms. The personality dynamics of such individuals
usually require the constant operation of dependency as a security maneuver,
and they often compulsively seek to put themselves under the protective
custody of some idealized parental agency. The hypnotist easily is identified

as such a force and is credited with great power and intelligence. The higher
the amount of tension and anxiety, the more the patient will be motivated to
establish this kind of relationship. It must not be assumed from this that
hypnosis precipitates dependency; the dependent patient will eventually play
the same role with a therapist who does not employ hypnosis. The person
with no excessive dependency problem will become no more dependent on

hypnosis than on any other kind of therapy.
Hypnosis may rapidly mobilize other transference manifestations. Thus
patients who are unable to develop strong transferences may be stimulated to

do so by the induction of hypnosis. In the trance, the patient may misidentify
the hypnotist as a parental or sibling figure, or he may respond post-

hypnotically with transference dreams. A man with severe gastrointestinal
symptoms was referred by an internist for psychotherapy, which he
vehemently resisted. Hypno-relaxation produced an abatement of symptoms,
fostered a feeling of trust and closeness, and helped motivate him to accept
therapy on a level deeper than a supportive one. His resistance, however, was
strong, and his progress lagged. Hypnosis was resumed with the goal of
helping the patient break through his block. Free associations were
accelerated in the trance, and it was possible to stimulate dreams and
fantasies that were related to some of his basic conflicts. During one of our
sessions, I suggested that the patient think about his feelings toward me. After
a silence of five minutes, he opened his eyes with a start. He had a fantasy, he
revealed, of me moving toward him with an erect, exposed penis with the
intent of forcing it into his mouth. He complained of tension and discomfort,
which continued the remainder of the hour. At the next session he reported
this dream: "I see my wife downstairs in her panties and bra. I am repelled
and furious with her. Then I am outside looking at my car. It isn’t as powerful
as my brother Jack’s car. Then I am at a funeral. A young woman of twenty is
crying. I put my arms around her to console her and she responds. But as I
look at her she turns older and older and is around fifty. Then I am in a
basement, a prisoner of the Communists, and they are sticking rods in my

mouth. I am repelled and nauseated and feel that they are out to kill me. I
awoke and found that I had had a wet dream." His associations appeared to
indicate impulses toward his wife that would have her as a mother figure who

attracted, infuriated, and revolted him; and a fear of his older brother and
father, toward whom he felt inferior and who, he believed, could render him
helpless. On a more unconscious level, the patient apparently sought
castration and homosexual affiliation. His relationship with me reflected his
fear of homosexual attack. The content of later sessions concerned
themselves with working with oedipal and homosexual material that had
been stimulated by his hypnotic transference reactions.
Induction of Hypnosis
Concerning the tremendous diversity of techniques used for the
induction of hypnosis, there is no evidence of the superiority of any one
method of induction over any other. Actually, all methods are efficacious if the
hypnotist adapts them to his personality, applies them confidently, persists in
making suggestions in the face of the patient’s seeming inability to respond,
and avoids haste by allowing enough time to elapse for the patient to adjust
himself to the demands that are being made on him in the trance. Successes
are most common where the therapist is able to perceive, to recognize, and to
deal with the immediate emotional needs of the patient as well as his
resistances to trance suggestions. This necessitates flexibility in the

employment of techniques, in accordance with the developing reactions of the
patient.
Factors in the patient that correlate positively with hypnotizability are a
desire for hypnosis, faith in the hypnotist, and confidence in the specific
method of hypnosis that is currently being applied. An inner sense of
helplessness, intense anxiety, and a loss of feelings of mastery may facilitate
entry into a trance state. Thus, as a rule, soldiers in battle fatigue are more
easily hypnotizable and enter into deeper trances than after their recovery
from the shock of combat. Factors that correlate negatively with hypnosis are
distrust of, fear of, and resentment toward the hypnotist; absent motivation;
doubts regarding the efficacy of hypnosis as a treatment process; resistance
toward the method of induction that is being employed; fear of revealing
frightening or shameful secrets in the trance; terror over yielding one’s

independence or of losing one’s will in hypnosis; fear of failure; and the need
to dominate and vanquish the hypnotist. The skill of the hypnotist in
recognizing and circumventing these resistances will determine whether his

results are good or bad.
The actual induction of hypnosis may readily be learned. Involved in

practically all induction methods is a gradual narrowing of consciousness by
limiting sensory impressions. This is accomplished by fixing attention on a
"fixation object" such as a pencil, coin, finger, or spot on the ceiling, or by

focusing on a limited group of ideas presented by the hypnotist, such as a
restful scene or one’s inner sensations. Sensory restriction is reinforced by a

rhythmic, monotonous repetition of suggestions to the effect that the subject

will feel sensations of tiredness and drowsiness until his lids close and he
approaches a state that approximates sleep. Once the eyes are shut, further
graduated suggestions are given the subject until he responds satisfactorily to
verbal commands. Detailed elsewhere are the various induction methods and
induction procedures (Weitzenhoffer, 1957; Wolberg, 1948). Experience will
best teach the therapist which conditions the trance is most useful for, as well
as which specific kinds of techniques are valuable to achieve set goals.
Dangers of Hypnosis
The dangers residual in hypnotherapy are minimal or absent if it is
employed by a responsible and well-trained therapist who knows how to
handle the patient’s general reactions and resistances to psychotherapy. An

unskilled and unsophisticated hypnotist, however, may sometimes provoke
inimical reactions. Instances have been reported of individuals plunged into
anxiety as a result of unwise suggestions given them by stage and amateur
hypnotists. Spontaneous hysterical phenomena may be precipitated in some
patients during a trance, perhaps as a defense against conflicts mobilized by a
return of the repressed material. These will usually disappear after hypnosis
is terminated. Sometimes a patient may not be awakened properly, and for
some hours he may walk around in a daze. Occasionally, a hysterical patient
may develop spontaneous trance states between sessions. These may be

eliminated by proper suggestions during hypnosis. The forceful ordering
away of symptoms may, in somnambulistic subjects, occasionally release a
very intense anxiety that had been bound by the symptoms. The authoritarian
use of hypnosis should therefore be avoided except in certain emergencies.
Hypnosis-inspired instances of uncontrolled sexual acting-out and of

dependency and infantilization were rarely or never encountered in a survey
covering a sizable number of psychiatrists who employed hypnosis regularly
in their practices (Wolberg, 1956).
It is theoretically possible to release criminal tendencies in persons who
have latent impulses in this direction that are repressed and controlled in
ordinary life. How this may happen is suggested by what occurs in fugue
states and in dissociated personality disorders, in which an aspect of the
patient’s personality takes over and displays unusual or antisocial behavior

for which there is amnesia later on. By carefully worded suggestions, one may
(in certain individuals) activate parts of the self that have been dissociated
from the personality mainstream and that respond to criminal incitement.

However, attempts to implant criminal impulses in people who are not
latently psychopathic are fruitless, no matter how deep the trance may be,
and whether or not antisocial behavior is possible in the trance, one assumes
that the therapist who employs hypnosis is not himself criminally inclined
and would no more attempt to influence a hypnotized patient toward
criminal or self-destructive behavior than he would prescribe a lethal dose of
a toxic substance under the guise of its being a medicament, or cut a patient’s

heart out during surgery after rendering the patient helpless with anesthesia.
Hypnosis in a Comprehensive Psychotherapy
A great deal of the disillusionment in psychotherapy stems from the fact
that patients are reluctant to give up their distorted values and maladaptive
drives even when they see clearly that these bring unhappy "rewards." The
peculiar tenacity of human nature in clinging to self-defeating behavior has
confronted philosophers and healers from time immemorial. The fact that we
have not yet devised universally successful modes of rectifying this blemish in
the human condition need not deter us from working toward this end.
Success and failure in therapy will ultimately depend on whether or not we
can reeducate our patients toward behaving in life with a new logic. The
crucial question is how best can we do this.
Perhaps one of the reasons we are either blessed or burdened with so

many different kinds of therapeutic stratagems is that people come to have
unique patterns through the processes of learning and change. What works
for one patient may have no effect whatsoever for another. One group of
individuals will respond rapidly, almost miraculously, to simple suggestions

preferred by a respected authority figure, or to philosophical formulations,
persuasive injunctions, or recipes for correct behavior. Others, balking at
these expediencies, will react gratifyingly to various modes of behavior
modification, to systematic desensitization, aversive conditioning, assertive
training, role playing, and the like. Still others find challenge and change in a
cognitive approach, in searching out sources of conflicts, in tracing behaviors
to genetic origins, in employing the resulting insights toward corrective

adaptations.
The variables in psychotherapy are great and still beyond our complete
understanding. It is fortunate indeed if a therapist happens to employ a
method and to have a personality that coordinates with a special patient’s
needs. The fact that a patient does not happen to respond or responds
negatively to our stratagems, does not necessarily mean that the technique is
worthless. It may merely signify that the patient is not a suitable subject for
the technique, or that a temporarily existing combination of factors does not

enable the patient to utilize that technique at the time.
In the light of these circumstances, one can understand why a
comprehensive psychotherapy employing flexible procedures offers the

therapist the best opportunity to fashion his approach to the realities of the
moment. Within the past two decades a host of methodologies have invaded
psychotherapy. Some of these use accepted scientific precepts. Others

proceed pragmatically. If the therapist is able to experiment with a number of
methods, he will eventually evolve modes of operations for himself that are
singularly suited to his personality and skills. It is in this manner that

hypnosis offers itself as an approach that can potentially enhance the effects
of a broad spectrum of treatment approaches ranging from simple relaxation,
to symptom-relieving suggestions, to behavior modification, to
psychoanalytically oriented psychotherapy.
Hypnosis serves as a unique interpersonal process that can catalyze
therapeutic effects and rapidly bring out latent needs and defenses. [pp. 182-
200 (Wolberg, 1972)]. It is helpful in creating incentives when the patient
lacks motivation for treatment. It is particularly useful for the patient who
refuses to begin therapy unless he is assured of immediate relief of his
symptoms. It is valuable as an expedient in helping to develop a warm
working relationship between patient and therapist. It may restore
communication when the patient is unable to verbalize freely, and by lifting

repressions it can expose pathological zones of conflict. It may enable a
patient to remember dreams and fantasies in psychoanalytic therapy. By
facilitating transference it can expose the harmful imprints of past

relationships. It is sometimes useful in bringing repressed and repudiated
memories to the surface, when these are deemed essential to the therapeutic
process. It may permit more rapid progress in behavior modification than the
many different behavioral techniques.
These are only brief indications of how hypnosis can be effective in

psychotherapy, whether the therapist fashions his methods around the
theory that unconscious memories or conflicts are the basis for emotional
ailments, or whether he adheres to the hypothesis that neuroses are exclusive
products of faulty learning and conditioning. Not all therapists are able to
employ hypnosis, either for personality reasons or because of unresolvable

prejudices. But the therapist capable of transcending his fears and prejudices
will find that the practice of hypnosis adds an important dimension to his
technical skills.
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Hypnosis and Research

The Nature of Hypnosis

Characteristics of the Trance

Hypnosis in a Comprehensive Psychotherapy

the psychiatric profession, both as a therapeutic implement and as a research

vehicle for the investigation of many complex aspects of human behavior.

Instrumental in lending some scientific credibility to hypnosis have been the

articles on hypnosis of contemporary interest. Moreover, a number of serious

researchers and clinicians have made contributions that have given an

atmosphere of respectability to the practice of hypnotherapy.

Nevertheless, hypnosis continues to be blighted with misconceptions

reasons why hypnosis is not employed more frequently in research: it

requires much time and effort; it involves an unusually high probability of

American Handbook of Psychiatry Vol 5 5

to demonstrate its value as a hypnosis and research method."

Hypnosis and Research

In spite of these deterrents, hypnosis has been employed as a research

defense mechanisms, physiological processes, and test validation. The

available evidence is that it is at least as powerful as other laboratory

One problem in hypnotic research is that, in an effort to maintain

approach his subject confidently and optimistically in order to produce the

neutral un-involvement—the preferred stance of the researcher—will tend to

act against the hypnotic process itself. It is difficult or impossible for a

researcher, to maintain objectivity.

Another problem is how to differentiate the phenomena under

by divining what is required of them and then living up to anticipated

hypnotist because of hostile feelings toward him, or fear of being controlled,

will tend to contaminate their reports.

An ongoing difficulty in research on the trance state is that of distilling

reliable and conceptually meaningful data out of the multiple phenomena

encountered. Similar ambiguities, of course, are met in research in

often employed in hypnosis to meet this problem is the "subject-as-own-

without any direct or indirect suggestions being made. Differences between

the two sets of measurements are then attributed to interposition of the

trance state. Another design is that of "independent groups," in which two

gets simple instructions to use their imaginations strongly. The problem of

adequate controls continues to plague the experimenter here, but some

American Handbook of Psychiatry Vol 5 7

The Nature of Hypnosis

Speculation about the nature of hypnosis dates back to the earliest

hypnosis may help in psychotherapy would seem to presuppose an

hypnosis was identified as a phenomenon two centuries ago, we still know

we are limited to theoretical assumptions.

Unfortunately, no theory to date is sufficiently comprehensive to explain

all of the complex manifestations of hypnosis. This judgment includes the

cortex such as those of inhibition and excitation; analogical linkages to animal

hypnosis; and considerations of dissociation, conditioning, role-playing,

many of these theories is a delineation of phenomena liberated by the trance,

rather than a description of the hypnotic state itself.

Attempts have been made in recent years to identify physiological

parameters that are distinctive for hypnosis. To date, however,

and neurophysiological areas. A few features observed thus far may be

mentioned. Electroencephalographic patterns during hypnosis differ from

those of sleep stages 2, 3, and 4. There seem to be some similarities between

establish a differentiation of brain wave patterns (particularly alpha activity)

know is that the trance state lacks the electrophysiological characteristics of

Barber (1972) insists that recent research has produced data

American Handbook of Psychiatry Vol 5 9

waking state (such as that they experience body immobility, analgesia,

hallucinations, age regression, amnesia, and so forth) are just as responsive as

alternative paradigm: in order to produce the phenomena considered

subject awareness, that will elicit positive attitudes, motivations, and

verbalizing of suggestions to himself, along with an inhibition of contrary

thoughts. Thus, according to Barber, the subject’s positive reaction in

persuasion. Abilities believed by some to be characteristic of hypnosis are

hallucinations, age regression, age progression, amnesia, and so forth. In

motivations, and expectancies, does not nullify the existence of a special

condition that we call hypnosis.

For example, by means of sensory deprivation or the use of

same symptoms in a nonschizophrenic person that we find in schizophrenics.

These phenomena may therefore be presumed to fall within the normal

human repertoire. Moreover, no special physiological findings of a consistent