AJCEH Vol25 No1 MAY97

AUSTRALIAN
AUSTRALIAN JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS

JOURNAL OF
CLINICAL AND
EXPERIMENTAL
HYPNOSIS
MAY 1997 VOLUME 25 NUMBER 1

May 1997 25 : 1
Published by the
ISSN 0156-0417 AUSTRALIAN SOCIETY OF HYPNOSIS

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AUSTRALIAN JOURNAL OF
CLINICAL AND
EXPERIMENTAL HYPNOSIS
May 1997 Volume 25 Number 1
EDITORIAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
INVITED PAPER FROM STEVEN JAY LYNN — KEYNOTE SPEAKER
AT THE ASH ANNUAL CONGRESS, PERTH, 7–12 SEPTEMBER 1997
A SOCIAL NARRATIVE MODEL OF

DISSOCIATIVE IDENTITY DISORDER
Steven Jay Lynn and Judith Pintar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FINAL CONCLUSIONS OF THE APA WORKING GROUP ON
INVESTIGATION OF MEMORIES OF CHILDHOOD ABUSE
Working Party of the American Psychological Association . . . . . . . . . . . . . . . 8
RECOVERED MEMORIES: SOME CLINICAL AND EXPERIMENTAL
CHALLENGES
Peter Sheehan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
HYPNOSIS IN THE TREATMENT OF CANCER PAIN
Burkhard Peter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
HYPNOSIS IN THE TREATMENT OF HEADACHES
Patricia Burgess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
POST-TRAUMATIC STRESS DISORDER
Malcolm Desland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
OBSTETRIC HYPNOSIS: TWO CASE STUDIES
Carol Sauer and Marc I. Oster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
CONCEPTUAL THEORY OF SELF-HYPNOSIS
Brian Alman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
CASE NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
BOOK REVIEWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
BOOKS AVAILABLE FOR REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
AUSTRALIAN JOURNAL OF
CLINICAL AND EXPERIMENTAL HYPNOSIS
Copyright © The Australian Society of Hypnosis Limited 1997
EDITORIAL BOARD
Editor
Barry J. Evans, PhD, Monash University, Victoria
Associate Editors
Greg J. Coman, MSc, Addiction Research Institute, Melbourne
Kevin McConkey, PhD, University of New South Wales
Graham Scott, BDSc, BBehSc, Melbourne
Robb O. Stanley, DClinPsych, University of Melbourne
Wendy-Louise Walker, PhD, Sydney
Editorial Consultants
Peter B. Bloom, MD, Institute of Pennsylvania Hospital and University of Pennsylvania
Graham D. Burrows, AO, KSJ, MD, ChB, BSc, DPM, FRANZCP, FRCPsych, MRACMA
University of Melbourne
Harold B. Crasilneck, PhD, PC, University of Texas Health Science Center,
Southwestern Medical School, Dallas, Texas
Frederick J. Evans, PhD, Carrier Foundation and UMDNJ
Rutgers Medical School
Fred H. Frankel, MD, ChB, DPM, Beth Israel Hospital and Harvard Medical School
Ernest R. Hilgard, PhD, Stanford University
Martin T. Orne, PhD,
Institute of Pennsylvania Hospital and University of Pennsylvania
Campbell Perry, PhD, Concordia University, Montreal
Peter W. Sheehan, PhD, University of Queensland
Editorial Assistant
June Simmons
FEDERAL EXECUTIVE OF
THE AUSTRALIAN SOCIETY OF HYPNOSIS LIMITED
President: Dr Wendy-Louise Walker (New South Wales)
President-Elect: Dr Len Rose (Victoria)
Past President: Mr Robb Stanley (Victoria)
Federal Secretary: Dr Mark Earl (South Australia)
Federal Treasurer: Mr Greg Coman (Victoria)
Chairman — Publications: Dr Barry Evans (Victoria)
Chairman — Board of Education: Mr Robb Stanley (Victoria)
ISH Representatives: Dr Barry Evans (Victoria)
Dr Graham Wicks (South Australia)
ASH Federal Secretariat, Clinical School Suites, NEMPS Campus,
Austin & Repatriation Medical Centre, Private Bag 1, Rosanna, Victoria 3084
Fax: (03) 9243 1158 Tel: (03) 9243 1159
Manuscripts and editorial matter should be addressed to the Editor, Dr Barry J. Evans, at
the above address. All journal business communications and subscriptions should be
addressed to the Editor.
EDITORIAL
Editions of the journal in recent years have published a range of theoretical,

research, and clinical articles, reflecting my intention to broaden the scope and
appeal of the journal, to meet the needs and interests of members of ASH and
subscribers. I hope this first edition for 1997 reflects my editorial policy.
The first manuscript is an invited paper from Steven Jay Lynn, PhD, from the
Psychology Department of Binghamton University, New York, U.S.A., and his
associate, Judith Pintar. Dr Lynn will be a Keynote Speaker at the forthcoming
ASH Annual Congress, being held in Perth, 7–12 September 1997. His invited
paper presents a framework for understanding the nature of dissociative
disorders, and the apparent epidemic in their occurrence in recent years, based
upon a narrative model from social psychology. I am sure you will find his paper
interesting. I also urge you to attend the Annual Congress, being held in Perth
and take the opportunity to hear Dr Lynn in person. His curriculum vitae can be
found in the first ASH Federal Newsletter published in 1997.
This edition of the journal contains the final conclusions of the Working
Party established by the American Psychological Association to investigate
theoretical and clinical issues related to memories of childhood abuse. The
report addresses implications for clinical training and practice that are of
relevance to all practitioners.
Continuing the theme of recovered memories, Peter Sheehan from the
University of Queensland examines trends in research themes in the major
hypnosis journals, then addresses experimental, conceptual, and clinical issues
in the area of recovered memories.
The first article with a clinical theme is that reported by Burkhard Peter. He
discusses the use of hypnosis in the treatment of cancer pain and relates his
specific techniques in a series of case vignettes. This article is republished from
Hypnos: Swedish Journal of Hypnosis in Psychotherapy and Psychosomatic
Medicine, with permission of the Editor.
Two Australian authors have case studies included in this edition. Patricia
Burgess reports the use of hypnosis in the treatment of headaches. Malcolm
Desland describes the use of hypnosis in her treatment of a case of post-
traumatic stress disorder following sexual abuse. The final clinical report in this
edition is an article describing the use of hypnosis in obstetrics, published by
Carolyn Sauer and Marc Oster from California, U.S.A.
iii
iv Editorial
In Case Notes, Kathryn Gow describes how indirect techniques can be

integrated with NLP scripts, to maximise their effectiveness. The edition
concludes with book reviews undertaken by members of the Society. I
recommend the journal to you and hope it is of interest and clinical use to each
reader.
Barry J. Evans
Monash University
May 1997
Australian Journal of Clinical
and Experimental Hypnosis
Vol. 25, No. 1, 1997, pp. 1–7
A SOCIAL NARRATIVE MODEL OF DISSOCIATIVE

IDENTITY DISORDER
Steven Jay Lynn
Binghamton University
Judith Pintar
University of Illinois
This paper is based on a commentary on a talk that was delivered by Sherrill Mulhern at
the Nato Symposium on Recollections of Childhood Trauma, Port de Bourgenay, France,
1996. Her talk presented a sociological and anthropological perspective on the history of
multiple personality disorder (MPD, now dissociative identity disorder) and its treatment.
In this paper, which touches on a number of themes introduced by Dr Mulhern, we
advance a narrative model or framework for understanding certain aspects of serious
dissociative disorders. An expanded version of this paper will be published in the
forthcoming book, Recollections of Childhood Trauma: Scientific, Research, and Clinical
Practice, Don Read and D. Stephen Lindsay (Eds.).
Our model owes a debt to a body of psychological literature (e.g., Meichenbaum

& Fong, 1993; Sarbin, 1986; Spence, 1984) that can be loosely identified as
narrative social psychology, which considers personal identity, not just as an
attribute of an individual, but as a dynamic process constructed within social
relationships through the mechanism of shared narratives. These narratives give
personal identity continuity in the past and the future. When a woman becomes
a mother, for instance, what determines the extent of her identification with
motherhood will include her memories of her own mother, as well as cultural
images and discourse about motherhood. Most importantly, others will treat her
as a mother, and will expect her to act in a “motherlike” way, defined by shared
narratives. In this way, identity is constructed and maintained through
relationships. Motherhood is performed.
Requests for reprints should be sent to Steven Jay Lynn, 45 West End Avenue, Binghamton,
New York 13905, U.S.A.
1
2 Lynn and Pintar
An interesting aspect of our social identities is that we can have many such
roles, which can exist together without discontinuity. A woman can be a mother,
a daughter, a doctor, and a wife, a complex set of roles which may wear her out,
but will probably not confuse her sense of herself. A child who is sexually
abused, on the other hand, finds herself in the position of having experiences
which not only exist outside of shared social narratives, but which blatantly
contradict them. Elsewhere (Lynn, Pintar, & Rhue, in press; Rhue, Lynn, &
Pintar, 1996) we have suggested that the phenomenon of dissociated identity
may be a straightforward reflection of traumatic and contradictory social
conditions; in other words, if personal identity is constructed through social
relations, and if those social relations are ruptured in traumatic fashion, then the
construction of identity is accordingly disrupted. In this view, the dissociation
itself is not a pathology, but the particular manifestation of a normal cognitive
capacity under abnormal circumstances.
A narrative view of dissociation — in contrast to mechanistic concep
tualisations which locate the phenomenon within an individual as a symptom of
a disorder, or as a defence mechanism outliving its usefulness — locates the
phenomenon in the social relations of the victim, both at the moment of the
trauma, and as a continuing or recurring process. We might ask the question, if
identity is constructed within social relations, what type of social relations
would lead to the subjective experience of multiple or partial selves? In
attempting to answer this question, it is necessary to distinguish in greater detail
between dissociated multiple identities, and the multiple identities we all
experience that are merely complex.
A child who lives in separate households may develop a complex sense of
self that encompasses two distinct narratives: “I am a responsible big sister” in
one household and “I am just a little kid” in the other. This is a multiple personal
narrative, but it is occurring within a larger social narrative which may be
stressful, but is not traumatic. The child has toys and clothes at Mum’s and
different toys and clothes at Dad’s, and she can bring the toys from Dad’s house
to Mum’s house if she wants to. But what if she is being abused at Dad’s house?
There are still two personal narratives, but something is different: what Dad is
doing is no longer reflected in a shared social narrative. What does the child do
now? Who is she when she’s with her Dad? Not the same person she is when
she is with her Mum where personal and social narratives match. She cannot
bring Dad’s toys with her to Mum’s house. She may say that she “split” at that
point, but the crucial thing to note is that the world split first.
The social narrative upon and through which she constructed her identity
ruptured. It lost coherence and consistency. We would suggest that rather than
being a way to separate from reality, dissociation may well be, under some
circumstances, a way to bring identity in line with those circumstances. Trapped
between a broad social narrative that says, “fathers care for their daughters and
don’t hurt them” and a personal narrative based on the experience of being
repeatedly raped by her father, the child’s construction of a multiple identity is
Dissociative Identity Disorder 3
a realistic reflection of her actual social condition, and her subjective experience
of having many selves which appears to be a distortion of reality, may be an
accurate reflection of lived experience.
Multiplicity is perhaps the only way that both narratives can be true at the
same time. She can be both a nine-year-old school girl and her father’s lover. It
may be true, as many have postulated, that pathology arises because she cannot
“integrate” the two identities within one coherent self. But the reason the
identities cannot co-exist is that the social world does not acknowledge that they
might both be true. It may be accurate to suggest that the world and she are
mutually dissociated from one another.
The important point to note is that what the experience of trauma disrupts is
not identity itself but the social process through which identity is constructed.
Correspondingly, in this view, the phenomenon of multiplicity is not so much a
disorder of identity, but a disorder of identity construction. The suggestion that
multiplicity is in part, or whole, iatrogenic becomes less surprising (though no
less problematic) in this light. Multiple identity, like unitary identity, is
performed, that is to say it is dynamically constructed through social
relationships.
Therapists treating multiples share with their clients a narrative about identity
that includes a belief in the existence of MPD/DID (dissociative identity disorder,
the current nomenclature for what was once multiple personality disorder). They
engage in discussions with alters, developing relationships with them within
which the alters come alive. The therapist–client relationship may not be the only
one in which the alters perform, but is often the most important one.
The meaning of whether therapists convince their clients that they are
multiples varies as a function of what the client believes in advance. If the client
believes “Oh, I’m not a multiple; that’s just a mood that I’m in sometimes,”
that’s one thing. It’s another if the client’s belief is “Oh, I’m not a multiple; Jane
is a physically distinct other person, rather than another personality.” In the first
case, the therapist’s effort can legitimately be construed as iatrogenic creation
of MPD. In the second, it can be construed as countering a delusion and not at
all iatrogenic, but a reflection of the subjective conviction of multiplicity.
The process in which multiple identities are constructed or maintained within
the discourse of a therapeutic relationship will be even more powerful in a
relationship between therapists and their highly suggestible and fantasy-prone
clients. Research in our laboratory (Lynn, Rhue, & Green, 1988) has shown
there are many parallels between persons with a profound history of fantasy
involvements that date to early childhood. Indeed, when we look at what
measures of dissociation index, one prominent component is fantasy and
imaginative proclivities. Fantasy-prone persons report that they play with
imaginary companions during childhood, often pretend to be other people
during times of stress, report out-of-body experiences to deal with traumatic and
non-traumatic experiences, and create absorbing imaginative narratives during
which time stands in abeyance. In short, we might say they dissociate.
4 Lynn and Pintar
These individuals are also more suggestible, even in non-hypnotic situations,

than their less fantasy-prone counterparts. To say that a client is suggestible is
also to say he or she is particularly sensitive to the immediate social relationship,
so that the influence of a hypnotherapist can override other pre-existing social
beliefs; for instance, if the therapist suggests that a woman’s arm is getting
lighter and will rise on its own, that narrative suggestion replaces, at least for
the moment, the shared social belief that arms do not ordinarily do that.
In ordinary conversations, many of us talk about ourselves as having different
parts or as feeling as if one part of ourselves is in conflict with another part. So
suggestions for one part to “come out” in the context of psychotherapy or
hypnosis may, in fact, conform more closely to one’s ordinary experience of
oneself than the feeling of nonvolition and involuntariness that often accompanies
responses to hypnotic suggestions for one’s arm to rise, for example.
The majority of hypnotisable participants can easily get in touch with
so-called hidden parts of the mind, or “hidden observers” that can comment on
imaginative and hypnotic dreams and age regression suggestions and afterward
report complete or partial amnesia for what the “hidden part” revealed during
hypnosis, awake imagining, and relaxed non-hypnotic conditions (Mare, Lynn,
Kvaal, Segal, & Sivec, 1994). It is not likely, however, that suggestibility or
imaginative tendencies alone can explain why an individual would take on and
participate in the ongoing construction of multiple identities. It may be
necessary for the therapist and the relationship to provide incentives (e.g.,
feeling of being special, meeting important needs of the client and therapist, and
so forth) for construing the self in terms of having multiple, discrete identities,
a conceptualisation reinforced and legitimised by therapeutic procedures (e.g.,
repeated suggestions for alters to emerge during hypnosis) that give fibre and
body to nascent aspects of the self.
However, another, yet by no means mutually exclusive possibility, is that the
narrative of multiple identity that underlies DID may be comfortable to many
survivors of traumatic abuse because it fits their subjective experience of their
disrupted identities more closely than the dominant cultural narrative of ordinary
unitary identity which assumes non-traumatic social conditions and relations. A
woman who accepts the diagnosis of DID and engages in complex interactions
through a group of altered personalities cannot be said simply to be “faking it,”
unless we are willing to consider our more mundane construction of unitary
identity to be fake as well. The bottom line is that identity is a malleable
narrative construct, exquisitely sensitive to social conditions.
In attempting to outline the ways in which social and cultural forces acted
together to “create” multiple personality disorder as a category of psychological
distress, Mulhern (in press) persuasively argues that the medicalisation of child
abuse shifted the locus of control over the meaning of traumatic experience from
the survivors of the trauma to a “corps of experts;” with the resulting shift in
interest from remembered stories of abuse to repressed memories, accessed only
with the help of these experts. Memories of abuse became, in short, a “mediated
discourse.” An intrinsic part of that discourse is the process of diagnosis. There

is a self-recursive irony in the diagnosis of DID as an “identity disorder” since
the dynamic process of diagnosis itself confers identity.
In diagnosing physical illnesses, Western medicine traditionally has
maintained a distinction between sickness and wounding. There is a big
difference between having arthritis in the knuckles, and having a sore thumb
because you hit yourself with a hammer. The pain may be comparable, but the
sickness confers identity (you have become an arthritis sufferer) in a way that
the wounding does not. A patient who learns that she has cancer, for instance,
becomes at that moment a “cancer patient,” a label that comes with a lot of
baggage. Relationships will be negotiated, and she will have to decide to what
extent she wishes to take on or reject this label as an aspect of personal identity,
to identify with other cancer patients as a group. Identity after remission
involves a similar process of negotiation, both internal and external, as she
decides whether she wants to think about herself as a “recovered cancer patient”
or just as an ordinary person again, the person she was before the cancer.
The distinction between sickness and wounding exists in the treatment of
mental health problems, but it is a slippery one. In coming to speak about the
consequences of psychological trauma in medical terms, the symptoms of
psychological wounding become a sickness, so that a woman diagnosed as DID
is not only suffering from having been abused, but from the fact that she is now
“a multiple.” A psychiatric diagnosis actually confers identity in a much more
powerful way than a medical diagnosis. A psychiatric patient, especially one
who is diagnosed as having an identity disorder, is under an exceptionally strong
compulsion to identify with the category of diagnosis since multiplicity is not
something you have, like cancer; it is something you are. The existence of an
authoritative diagnosis for DID creates a contested category of identity
increasingly contingent on the criteria of spontaneity and non-volition, so that
we now must distinguish between real multiples, those who are faking it, and
those whose personalities are iatrogenic concoctions.
A patient’s identification with the diagnosis is made more likely when it is a
contested status. MPD and now DID are trendy diagnoses which may, in some
instances, bring more or better attention from mental health workers and
insurance companies. A diagnosis of DID also provides a boost of self-esteem
since multiples are supposed to be creative individuals with high IQs. Examined
through the lens of multiplicity, behaviours such as self-mutilation, promiscuity
and infantile regressions which in other contexts may have been viewed as
repugnant or deviant, can come to be seen as understandable, and even heroic.
Another factor that may have encouraged identification with the disorder was
the political climate of “identity politics” during the 1980s, when it became
fashionable and politically expedient to identify with membership of a group
with a grievance. As survivors of sexual abuse organised, so did the subgroups
who identified themselves as multiples or as survivors of satanic abuse. When
one is born into a racial minority and membership is uncontested, membership
6 Lynn and Pintar
in these psychological communities requires evidence of shared suffering and

identification with the community involves conscious choice.
As we implied earlier, identification with a diagnosis also results from the
therapeutic relationship, a culturally constructed relationship that has both
medical and what we might call ritual components. The ritual aspect of therapy
is particularly explicit when hypnosis is involved. And the rhetoric of “belief”
in debates about multiplicity lends the whole discussion a mythical tone: “Do
we believe in false memories?”, “Do we believe in multiplicity?”, “Do we
believe in the existence of satanic cults?” Diagnosis acts on these beliefs and
confers a status change in identity. To be pronounced a multiple by a medical
authority invokes a sanction of the spoken word, in much the same way that a
priest can pronounce a couple to be married. With that kind of authoritative
power a psychiatrist can “create” a multiple, at the moment of diagnosis, in the
same way that the leader of a possession cult can decide whether a possession
is authentic by identifying and authenticating the appearance of a particular
spirit. The “diagnosis” confers upon the possessed individual a change in status
within the cult. The combination of medical and religious structure and authority
makes the therapeutic relationship into a powerful mechanism of socialisation.
Mulhern’s analysis of the historical, cultural and sociological mechanisms
that facilitated the construction of the MPD model is a clarion call for self-
reflection. For researchers, this means greater awareness of the historical biases
and cultural influences that may affect the way that theoretical models are
developed; for clinicians it means coming to terms with the fact that in spite of
our best intentions our methods can hurt as well as heal. We think it is fair to
say that the diagnosis of multiplicity — with its narrative of separation and
integration, can be a useful therapeutic tool for a few patients, but that for most
patients it opens a veritable Pandora’s box, and can lead to an exacerbation of
symptoms, a breakdown of relationships and social networks and a tangled
conflation of fantasy images with actual memories.
To believe unconditionally in clients’ recovered memories, of satanic ritual
abuse, for example, can be as damaging to them as it is to write off their
authentic memories as oedipal-based fantasies. It is simply bad therapy to fail
to recognise the highly suggestible nature of the subsample of abuse survivors
who can be identified as fantasy-prone. It is also a mistake to suggest to
dissociative clients that multiplicity is a category of identity that one can be,
rather than a narrative of identity that one can use. There is a world of difference
between saying to a client, “The experience of trauma made you feel as if you
were three people, let’s imagine what they would say to one another,” and
saying “The experience of trauma made you into three people, let me talk to
them.”
Multiplicity is a narrative of identity that is compelling for certain trauma
survivors because it comes closer to reflecting their subjective experience of self
than other shared social narratives. It becomes problematic when it ceases to be
just a useful metaphor, and becomes (through the process of evaluation/
suggestion/iatrogenic procedures leading to a medical diagnosis) a category of

identification. This is especially dangerous for those whose presenting symptoms
have to do with disruptions in identity to begin with. It appears, in this light, that
the “epidemic” of DID during the last twenty years is not the deliberate product
of a conspiratorial movement of therapists to construct a chronic disorder in a
highly suggestible and fantasy-prone subpopulation, but the byproduct of a
compelling metaphor run wild.
REFERENCES
Lynn, S. J., Pintar, J., & Rhue, J. W. (in press). Fantasy proneness, dissociation, and
narrative construction. In S. Powers & S. Krippner (Eds.). Broken selves:
Dissociative narratives and phenomena. New York: Brunner/Mazel.
Lynn, S. J., Rhue, J., & Green, J. (1988). Multiple personality and fantasy proneness:
Is there an association or dissociation? British Journal of Experimental and Clinical
Hypnosis, 5, 138–142.
Mare, C., Lynn, S. J., Kvaal, S., Segal, D., & Sivec, H. (1994). Hypnosis and the dream
hidden observer: Primary process and demand characteristics. Journal of Abnormal
Psychology, 103, 316–327.
Meichenbaum, D., & Fong, G. T. (1993). How individuals control their own minds: A
constructive narrative perspective. In D. M. Wegner & J. W. Pennebaker (Eds.),
Handbook of mental control (pp. 473–490). Englewood Cliffs, NJ: Prentice-Hall.,
Mulhern, S. (in press). Commentary on a paper by Willem Waagenar, D. Read, &
D. S. Lindsay (Eds.). Recollections of childhood trauma: Scientific, research, and
clinical practice. New York: Plenum Press.
Rhue, J., Lynn, S., & Pintar, J. (1996). Narrative and imaginative storytelling:
Treatment of a sexually abused child. In S. J. Lynn, I. Kirsch, & J. W. Rhue (Eds.),
Casebook of clinical hypnosis (pp. 251–270). Washington, DC: American
Psychological Association.
Sarbin, T. (1986). Narrative psychology: The storied nature of human contact. New
York: Praeger.
Spence, D. (1984). Narrative truth and historical truth: Meaning and interpretation in
psychoanalysis. New York: W. W. Norton.
Vol. 25, No. 1, 1997, pp. 8–17
FINAL CONCLUSIONS OF THE APA WORKING GROUP

ON INVESTIGATION OF MEMORIES OF CHILDHOOD
ABUSE
Working Party of the American Psychological Association
The following document is the Final Report of the Working Party established by the
American Psychological Association [APA] to investigate memories of childhood abuse
and how these, if they exist, can be validly accessed in therapy.
The APA Working Party commenced its deliberations in 1993, to review the current
scientific literature and identify future research and training needs regarding the evaluation
of memories of childhood abuse. Members of the Working Party were Drs Judith Alpert,
Laura Brown, Stephen Ceci, Christine Courtois, Elizabeth Loftus, and Peter Ornstein.
The Final Report of the Working Party, reproduced below, was presented to the APA
Board of Directors on 14 February 1996. The preface to the report notes that the report
does not offer any “solution” to the problem of adult memories of childhood abuse. It
does, however, offer a clear and concrete delineation of the issues, what research we need,
and the differences that must be reconciled for the science and profession of psychology
to attend responsibly to the dilemmas posed by adult memories of childhood abuse.
It is clear from the Working Party’s Final Report that consensus on many issues could
not be reached. At the same time, it provides a pragmatic and immediately applicable
document that the Working Party hopes will contribute to a widespread questioning of the
divisive discourse around this issue, to the ultimate benefit of the public the APA is
committed to serve.
The Final Report is reproduced, with permission of the APA, to facilitate a similar
debate among members of the Australian Society of Hypnosis.
Published with permission of the American Psychological Association. Requests for reprints
should be sent to Barry J. Evans, Editor, AJCEH, Edward Wilson Building, Austin Campus,
Austin and Repatriation Medical Centre, Heidelberg, Victoria 3084.
For a copy of the Final Report, contact Paul J. Donnelly Jr, Director, Public Interest
Administration, Board Operations & Governance Communication, American Psychological
Association, 750 First Street, NE, Washington DC 20002-4242 USA. Fax: 202 336 5723;
Email: pzd:apa@email.apa.org
8
Memories of Abuse 9
In this section (of the Final Report), we seek to set a context for the following
documents by summarising our points of agreement and disagreement. We also
articulate some of the implications of our deliberations for clinical practice,
forensic practice, research, and training. Finally, we conclude with a plea for
unity within our discipline.
WHERE DO WE STAND?
Inspection of the reviews and commentaries in the Final Report will indicate
that we are in agreement concerning a number of key points. Indeed, as indicated
in the Working Group’s Interim Report, we agree on the following:
1. Controversies regarding adult recollections should not be allowed to obscure
the fact that child sexual abuse is a complex and pervasive problem in
America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of
what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time
to be remembered.
4. It is also possible to construct convincing pseudomemories for events that
never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and
inaccurate recollections of childhood abuse.
As important as these areas of agreement are, it is equally, if not more important,
to acknowledge frankly that we differ markedly on a wide range of issues. At
the core, the clinical and research subgroups have fundamentally differing views
of the nature of memory. These contrasting conceptions of memory have led to
debate concerning: (a) the constructive nature of memory and the accuracy with
which any events can be remembered over extended delays; (b) the tentative
mechanisms that may underlie delayed remembering; (c) the presumed “special”
status of memories of traumatic events; (d) the relevance of the basic memory
and developmental literatures for understanding the recall of stressful events; (e)
the rules of evidence by which we can test hypotheses about the consequences
of trauma and the nature of remembering, (f) the frequency with which
pseudomemories may be created by suggestion, both within and outside of
therapy; and (g) the ease with which, in the absence of external corroborative
evidence, “real” and pseudomemories may be distinguished.
WHERE DO WE GO?
Given this characterisation of our understanding of the critical issues, how do

we proceed from here? And what are the implications of these documents for
research, practice, training, and forensic psychology? As suggested above, one
of the most consistent observations emerging from our deliberations has to do
10 APA Working Group
with the very divergent epistemologies and definitions utilised by psychologists

who study memory and those who study and treat the effects of trauma.
Although there are exceptions, we frequently do not speak the same professional
language or define phenomena in the same manner; we read different journals
and books, and attend different specialty meetings; and each group finds useful
and compelling studies that the other group sees as problematic and
questionable.
Many of the difficulties that we have encountered in attempting to achieve
consensus reflect these profound epistemological differences, a phenomenon
which has been previously documented in studies comparing psychological
scientists and psychological practitioners (Caddy, 1981; Dawes, 1994;
Kalinkowitz, 1978). If we are to go forward toward the development of
productive research that will be found to be credible by both scientists and
practitioners, and toward the promotion of clinical practice that is psychological
science, some steps must be taken to resolve these epistemological differences
and develop consensual definitions about what is being studied and discussed.
To begin, it is essential to address fundamental differences between the two
subgroups in terms of basic definitions of the issues under investigation. Thus,
for example, it is necessary to consider the two groups’ contrasting views of the
nature of early trauma and the young child’s representation of various types of
sexual abuse. Accordingly, one important implication of our deliberations is that
psychologists who work in the field of trauma and those who study memory
would benefit from working collaboratively to (a) develop paradigms for
research, (b) search for consensual definitions of constructs that speak to the
issue of how trauma affects memory, and (c) develop models that will be
scientifically sound while being well-grounded in the realities of clinical
practice. No matter how well designed, a study that equates stressful experiences
that are socially sanctioned with those involving pain, betrayal, and loss of
safety will be found less credible by those who treat the survivors of the latter,
just as texts on treatment, no matter how therapeutically useful they may seem
based on the author’s anecdotal observations, will lack credibility to scientists
when what is clinically suggested violates the data available through research.
Some studies of therapists (Poole, Lindsay, Memon, & Bull, 1995; Yapko,
1994) have criticised practitioners for their lack of knowledge of the workings
of memory and their willingness to endorse techniques that might implant
suggestions. An alternative view of this state of affairs might be that, based on
their experience, which is a powerful source of data for practising clinicians,
many therapists have developed beliefs about techniques that they feel are
clinically effective in reducing the distress of trauma survivors. Future research
is needed to evaluate the validity of these beliefs and to better inform both
practitioners and researchers as to the characterisation of “useful” as opposed to
“risky” approaches to interventions.
The epistemological foundation from which one evaluates clinical outcomes
or research findings affects the meaning given to those outcomes/findings.
Memories of Abuse 11
Because the entire Working Group converges on the belief that a science-
informed practice will be the most effective strategy for treatment, we believe
that practice-informed research will enhance the integration of knowledge about
memory into the overall field of trauma treatment. This direction in research
may also help us to answer the still unclear questions about the nature of various
observed human behaviours in response to trauma.
IMPLICATIONS FOR PRACTICE
The deliberations of the Working Group strongly underscore the importance of

a careful and science-based preparation for professional practice in psychology.
Many possible errors in working with adult survivors, or with clients who
present as recovering memories of childhood abuse, could be avoided if the
therapist were well-grounded in developmental psychology (particularly
developmental psychopathology and cognitive development), cognitive
psychology (especially the study of memory), and research on trauma (with an
emphasis on the range of responses to interpersonal violence). Both the
scientist–practitioner (PhD) and scholar–practitioner (PsyD) models of training
embrace this necessity. Given the very high rates of histories of some kinds of
interpersonal violence among the patient population (Jacobson & Richardson,
1987), all doctoral level training programmes in professional psychology,
including those whose primary focus is the training of clinical researchers,
should ensure that students are exposed to formal coursework and supervised
practica in which the role of interpersonal violence as a risk factor for
psychopathology is central. Currently practising psychologists, if lacking in
these knowledge bases, should be encouraged to pursue formal continuing
professional education on these topics. Care should be taken to ensure that
instructors (and course curricula) reflect a science knowledge base as well as
high-quality clinical practice.
A second important implication of our findings for clinical practice is that
care, caution, and consistency should be utilised in working with any client, and
particularly one who experiences what is believed (by either client or therapist)
to be a recovered memory of trauma. Moreover, clients in all circumstances
must be given information about possible treatment strategies and should in turn
provide informed consent for treatment. As with any intervention, clients have
the right to know both risks and benefits of procedures used by a therapist.
Careful histories should be taken from all clients, and questions about the entire
range of risk factors, including but not limited to a history of sexual abuse, must
be asked of all new clients, not only those whose symptoms arouse suspicions
of abuse in a clinician. This is because such suspicion may be unfounded, while
genuine experiences of interpersonal violence may never be volunteered by
clients with such histories whose symptoms do not conform to a clinician’s
beliefs about the sequelae of abuse. Questions should be phrased in a non-
leading manner, and in the most open-ended way possible, in order to promote
a more behaviourally descriptive and less affectively laden introduction of this
difficult topic into the history-taking process.
When clients report what they phenomenologically experience as memories
of previously unrecollected trauma, therapists should take a number of steps to
avoid imposing a particular version of reality on these experiences and to reduce
risks of the creation of pseudomemories. If these materials are intrusive and
create problems for the client’s functioning, the first goal of treatment should be
stabilisation and containment following the recommendations of many experts
in the field of trauma treatment. It is important to remember that the goal of
therapy is not archaeology; recollection of trauma is only helpful insofar as it is
integrated into a therapy emphasising improvement of functioning. Therapists
should avoid endorsing such retrievals as either clearly truthful or clearly
confabulated. Instead, the focus should be on aiding the client in developing his
or her own sense of what is real and truthful. Clients can be encouraged to
search for information that would add to their ability to find themselves credible
(e.g., contemporaneous writings, reports of third parties), and to carefully weigh
the evidence. Therapists should carefully consider all alternative hypotheses,
including: (a) that the retrieved material is a reasonably accurate memory of real
events; (b) that it is a distorted memory of real events, with distortions due to
developmental factors or source contaminations; (c) that it is a confabulation
emerging from underlying psychopathology or difficulties with reality testing;
(d) that it is a pseudomemory emerging from exposure to suggestions; or (e) that
it is a form of self-suggestion emerging from the client’s internal suggestive
mechanisms.
Clients who seek hypnosis as a means of retrieving or confirming their
recollections should be advised that it is not an appropriate procedure for this
goal because of the serious risk that pseudomemories may be created in trance
states and of the related risk due to increased confidence in those memories.
Clients should also be informed that the use of hypnosis could jeopardise any
future legal actions they might wish to take. Moreover, in those situations in
which hypnosis is employed, it is necessary to interpret the client’s responses in
light of parallel measures of suggestibility and proneness to fantasy.
As indicated above, it can be helpful to seek corroborative evidence for
claims of sexual abuse. Nonetheless, denials by alleged perpetrators should also
not be taken as evidence that the client is experiencing other than an accurate
recollection. Indeed, known perpetrators of child sexual abuse can also deny and
lie about their behaviours, even in the presence of physical evidence that
incontrovertibly links them to the abuse, and sometimes tell their victims that
the abuse “never happened” or should be forgotten. Finally, while there are no
statistics available on its prevalence, it is known that on occasion, adults who
report recovering memories will lie, particularly when the constellation of
motives (fear, embarrassment, desire to protect loved ones, desire for revenge)
outweighs the incentives to tell the truth.
In some states, persons who have recovered memories of childhood sexual

abuse are eligible for crime victims’ compensation if they report the alleged
abuse to the police in a timely fashion. They are then treated as any other
victims/witnesses of a crime. When resources for treatment are in short supply,
this course may be attractive to both client and therapist as a means of ensuring
payment for therapy. However, both parties need to be especially cautious in
making assertions to legal authorities as to the factual basis of recent
recollections. Such actions may prematurely commit both therapist and client to
a particular interpretation of the information reported by the client, and may
commit a client in some instances to testifying in a resulting criminal case,
should the report fall within statutory limits. Thus, therapists should explore a
variety of other alternatives with the client before embarking on this particular
course.
In short, a responsible path for therapists to pursue is one in which clients are
empowered to be the authority about their own lives and reality, where the
emphasis is on recovery and function, and where memories of trauma are
viewed within the context of what one might tentatively assume to be a post-
traumatic response. This approach, however, may mean that clients occasionally
reach conclusions about what may have happened to them that we find difficult
to accept. Nonetheless, respect for the dignity of adults who seek treatment must
inevitably temper therapists’ efforts at reality testing. Therapists need to eschew
the roles of advocate, detective, or ultimate arbiter of reality, unless the veracity
of the material being constructed/retrieved becomes important for either
therapeutic or legal reasons.
IMPLICATIONS FOR FORENSIC PRACTITIONERS
The role of the forensic psychologist is that of an educator to the triers of fact,
the judge and jury. In that capacity, forensic psychologists, in general, should
avoid attempting to speak to the ultimate issue (i.e., guilt or innocence) in a
case, because they usually are not in a position to know the truth. Forensic
psychologists should always exercise caution, temper the degree of certainty
with which they offer their testimony, and be aware of both the problems and
the strengths of their methodologies. How, then can forensic experts practise
responsibly in cases where questions of recovered memories of childhood abuse
are involved?
First, whenever possible, therapists should avoid serving as expert forensic
witnesses in the cases involving clients whom they are treating. This is consistent
with APA ethical standards and with guidelines published by the Division 41 of
APA (Psychology and Law — AP/LS) for forensic practice. Experts, moreover,
should confine their testimony to their specific areas of expertise and knowledge.
For example, questions of the appropriate standard of care would ordinarily be
the purview of those trained in the fields of professional psychology; this might
be distinguished from expert testimony about risks of a specific therapeutic
technique when the technique or practice being considered is one in which

scientists’ findings could be applicable (e.g., the risks of using hypnosis to
bolster a memory). When evaluating a person who alleges having recalled
memories of childhood abuse, forensic experts should utilise all possible
sources of information, and not rely solely upon the self-report of either plaintiff
or defendant. Possible sources of suggestion and contamination should be
explored rigorously. Because there is no one syndrome or symptom pattern
associated with a history of childhood sexual abuse, care should be utilised in
making inferences from the symptoms to the credibility of a plaintiff’s report.
In cases involving complaints against therapists who are alleged to have
created pseudomemories of sexual abuse, similar care should be taken by
forensic psychologists to rely on a variety of sources of information and to
search for the convergent validity of data. Reports by clients of what has
occurred in therapy may or may not be accurate; reports by therapists about
what transpired in therapy may or may not be accurate; and reports by third
parties who were not present at the treatment may or may not be accurate. When
feasible, expert clinical opinions should be based upon direct or videotaped
observation, and not simply reviews of written or audiotaped materials.
IMPLICATIONS FOR RESEARCH AND TRAINING
Just as the Working Group has endorsed the value of a scientifically informed
approach to practice, its members also endorse the value of a practice-informed
approach to research. There is much to be gained by both researchers and
practitioners when their respective insights cross-fertilise each other’s professional
activities.
For researchers, this means incorporating into their designs as many of the
ingredients of real-world trauma as is ethically and practically permissible, and
learning from clinicians about those phenomena that require further study. In this
regard, in recent years there has developed a large body of naturalistic empirical
research that stands at the interface between the domains of memory and trauma.
Examples include Wagenaar and Groeneweg’s (1990) study of Dutch concentration
camp survivors’ memories of victimisation; Parker, Bahrick, Lundy, Fivush, and
Levitt’s (1995) study of child survivors of Hurricane Andrew; both Merritt,
Ornstein, and Spicker’s (1994) and Goodman, Quas, Batterman-Faunce,
Riddlesberger, and Kuhn’s (1994) explorations of children’s bladder
catheterisation; and Eisen, Goodman, and Qin’s (1995) study of the susceptibility
of sexually abused children to sexual suggestions. More recently there have also
been studies of the neurobiological substrates of memory for traumatic events
(Bremer, Randall, Scott, Bronen, Seibyl, et al., 1995; Yehuda, Kahana, Binder-
Byrnes, Southwick, Mason, et al., 1995). Nonetheless, there is a clear need for
more of this sort of research, particularly as it applies to the phenomenon of
repetitive boundary violations within the family setting, in which a number of
complex person–situation variables are at play.
For practice-oriented students, cross-fertilisation means that training faculty

needs to ensure that they are well grounded not only in the substance of
scientific psychology but also in its core values (e.g., the pursuit of “proof by
disproof” as the strongest means of knowing). For research-oriented students,
this means some degree of orientation to the limitations of generalisability of
research findings to clinical applications, and a familiarity with clinically
observed phenomena that require further study. In an ideal world, all graduate
trainees, whether in practice or scientific research, would be exposed to each
other’s ideas, readings, and experiences, and would thus acquire a common
vocabulary and shared knowledge base.
Too often, members of each group develop in what amounts to a culture of
isolation from the other group’s knowledge and experiences. To some extent,
this is the unhappy consequence of increased specialisation and the need for
increasingly prolonged and focused apprenticeships to acquire the tools of each
of these psychological trades. Presently, the sheer amount of domain-specific
knowledge that must be learned to be considered competent in science or
practice is enormous, and enjoiners to learn even more may seem unrealistic in
view of the real limits of time and resources. Fortunately, there are ways of
solving this dilemma that can expose each group to phenomena without
requiring additional curricula, but merely a reorganisation of what is already in
place in many programmes. What we have in mind is the use of critical case
studies in training that bridge both groups’ interests.
As an example, the issue before us — the recovered-memory debate — is a
window through which the generic chasm can bridged. Both clinical and
research trainees can be exposed to the type of argument and data contained in
this Working Group Report as a means of not only acquainting them with the
specifics of this particular debate, but far more importantly of inculcating a
sense that the world is full of phenomena that require a consideration of both
groups’ perspectives. Clinical students, as well as those studying both cognitive
and developmental psychology, would benefit from a consideration of the issues
that have animated this debate, and it could be couched in the context of existing
coursework.
This case study approach, moreover, can also serve to teach valuable lessons
about professional behaviours that are and are not consistent with standards of
good practice or good science. From our perspective, there are signs everywhere
of psychologists making public pronouncements on matters of importance,
based on anecdotes and impressions rather than on systematic empirical
evidence, challenged by alternative explanations. When researchers and
clinicians espouse views in public, including courtrooms, they have the highest
responsibility to make clear to their audiences the limits to generalisation of
their conclusions, all known threats to the external validity of their information-
gathering procedures and/or clinical interpretations, and the results of attempts
to test alternative explanations. These professional behaviours can be illustrated
readily in the context of this and other important debates.
A FINAL STATEMENT
We wish to end on a note with which we can all agree. The members of the
Working Group, individually and collectively, bemoan the increasing
“Balkanisation” of psychology, a development that has surely made our tasks
more difficult as we have attempted to bridge across powerful gaps of
understanding. Our discipline has spawned many psychologies, often
disconnected from each other, and both the cortical and ethical glues that ought
to have connected them seem to have been neglected. We are fast becoming a
collection of psychologies, each uninformed by the data and epistemologies of
the others; in short, we are pluribus, but not unum. And, most critically, we need
to change dramatically if psychology as a discipline seeks to lead the way in
avoiding harm to all those who are affected by the consequences of both
accurate and false recollections of abuse.
REFERENCES
Bremer, J. D., Randall, P., Scott, T. M., Bronen, R. A., Seibyl, J. P., Southwick, S. M.,
Delaney, R. C., McCarthy, G., Charney, D. S., & Innis, R. B. (1995). MRI-based
measurement of hippocampal volume in patients with combat-related posttraumatic
stress disorder. American Journal of Psychiatry, 152, 973–981.
Caddy, G. R. (1981). The development and current status of professional psychology.
Professional Psychology, 12, 377–384.
Dawes, R. M. (1994). House of cards: Psychology and psychotherapy built on myth.
New York: Free Press.
Eisen, M. L., Goodman, G. S., & Qin, J. (1995, May). The impact of dissociation and
stress arousal on the suggestibility and memory of abused or neglected children. In
P. J. Morrison (Moderator). Children’s memory: Implications for testimony. Invited
symposium at the meeting of the Midwestern Psychological Association, Chicago.
Goodman, G. S., Quas, J. A., Batterman-Faunce, J. M., Riddlesberger, M. M., & Kuhn,
J. (1994). Predictors of accurate and inaccurate memories of traumatic events
experienced in childhood. Consciousness and Cognition, 3, 269–294.
Jacobson, A., & Richardson, B. C. (1987). Assault experiences of 100 psychiatric
inpatients: Evidence of the need for routine inquiry. American Journal of Psychiatry,
144, 434–440.
Kalinkowitz, B. (1978). Scientist–practitioner: The widening schism. Clinical
Psychologist, 32, 4–5.
Merritt, K. A., Ornstein, P. A., & Spicker, B. (1994). Children’s memory of a salient
medical procedure: Implications for testimony. Pediatrics, 94, 17–23.
Parker, J. F., Bahrick, L. E., Lundy, B., Fivush, R., & Levitt, M. J. (1995). Children’s
memory for a natural disaster: Effects of stress. In J. Parker (Moderator). Eyewitness
memory: Effects of stress and arousal on children’s memories. Symposium at the
meetings of the Society for Applied Research in Memory and Cognition, Vancouver,
BC.
Poole, D. A., Lindsay, D. S., Memon, A., & Bull, R. (1995). Psychotherapy and the
recovery of memories of childhood sexual abuse: U.S. and British practitioners’
opinions, practices, and experiences. Journal of Consulting and Clinical Psychology,
63, 426–437.
Wagenaar, V. A., & Groeneweg, J. (1990). The memory of concentration camp
survivors. Applied Cognitive Psychology, 4, 77–87.
Yapko, M. D. (1994). Suggestibility and repressed memories of abuse: A survey of
psychotherapists’ beliefs. American Journal of Clinical Hypnosis, 36, 163–171.
Yehuda, R., Kahana, B., Binder-Byrnes, K., Southwick, S., Mason, J. W., & Giller,
E. L. (1995). Low urinary cortisol excretion in Holocaust survivors with posttraumatic
stress disorder. American Journal of Psychiatry, 152, 982–986.
Vol. 25, No. 1, 1997, pp. 18–39
RECOVERED MEMORIES: SOME CLINICAL AND

EXPERIMENTAL CHALLENGES
Peter Sheehan
University of Queensland
This article examines memory distortion in hypnosis and imbeds its significance and that
of the relevant field (forensic hypnosis) into the context of international comparative data
that have been collected from an analysis of the hypnotic literature in the last decade. One
issue, in particular, stands out from this analysis — recovered memories. This finding
emphasises the growing importance of the need to reconcile clinical concerns and
experimental findings from the laboratory setting. The recovered memory debate has
profound theoretical, empirical and professional importance and shows up the tensions in
the clinical–laboratory interface. Preliminary data are discussed which attempt an analysis
of the phenomenon in a relatively neutral fashion so to provide limited base-rate data to
facilitate that interface.
This article attempts first to place its concerns within a brief review of
contemporary trends in hypnosis research. I choose to define the term
“contemporary” in terms of major themes in research occurring since the 1985
review of the field of hypnosis by John Kihlstrom in the Annual Review of
Psychology. Then I shall move to the issue of recovered memories, pointing out
some of the major experimental, conceptual, and clinical challenges.
In introducing my topic in this way, I want to comment comparatively on
research in hypnosis viewed internationally over the last decade. I will talk to
the nature of hypnosis and memory, then focus on recovered memories in
particular, to present some suggestive and controversial data.
COMPARATIVE ANALYSIS OF THE FIELD SINCE 19851

From Kihlstrom’s review (which covers publications up to 1983), one acquires
a significant understanding of some of the shifts which occur in fields of interest
Paper presented at Workshop, Memories of Abuse: True Memories and the False Memory
Syndrome, The Australian Society of Hypnosis, Melbourne, 12 October 1996.
Requests for reprints should be sent to Peter Sheehan, Deputy-Vice-Chancellor
(Research and Postgraduate Studies), University of Queensland, Cumbrae-Stewart Building,
Research Road, Brisbane, Queensland 4072.
18
Recovered Memories 19
and controversy over time. The original review (Kihlstrom, 1985) was divided
into many sections.
Table 1 gives the major content areas in hypnosis journals for the period
1986–1995. The journals analysed are: the American Journal of Clinical
Hypnosis, the Australian Journal of Clinical and Experimental Hypnosis, the
International Journal of Clinical and Experimental Hypnosis (IJCEH), and
Contemporary Hypnosis (previously known as the British Journal of Experimental
and Clinical Hypnosis). An overwhelming number of publications classified
under health and mental health treatment have been excluded. The classification
shown in Table 1 is quite similar to the content area covered in Kihlstrom’s
review; only 11 of the categories are actually distinct. Figure 1 shows the
distribution of content areas in the IJCEH (the most international of the
journals). The modal themes illustrated in this figure are physiological linkages
Table 1 Content Categories Drawn From the Literature in the Last Decade
1 Absorption
2 Amnesia
3 Analgesia
4 Brain mechanisms*
5 Development of hypnotisability
6 Ethical/professional issues*
7 Expectancy effects*
8 Forensic issues*
9 Historical aspects
10 Hypnotic communications*
11 Hypnotic relationship*
12 Hypnotic types
13 Hypermnesia
14 Imagery
15 Immune functioning*
16 MPD
17 Memory
18 Modifying hypnotisability*
19 Other hypnotic phenomena
20 Personality correlates
21 Phenomenology/EAT*
22 Physiological links*
23 PTSD
24 Scales of hypnotisability
25 Self-hypnosis
26 Sports hypnosis*
27 Statistics/psychometrics
* Rapidly expanding/new categories in the decade since Kihlstrom’s review article,
20 Sheehan
Figure 1: Analysis of Contents of International Journal of Clinical & Experimental

Hypnosis 1986–1995
THEORY
SELF HYP.
SCALES OF HYP.
R.E.S.T.
PTSD
PHYSIOLOGICAL LINKAGES
PHYSIOLOGY
PHENOMENOLOGY
PERS. CORREL.
OTHER HYPNOTIC PHENOMENA
OTHER HYP. PH.
MODIFYING HYP.
MEMORY
MEMORY
MPD
LEARNING
IMAGERY
HYPERMNESIA
HYP. TYPES
HYP. RELTSHP
HYPNOTIC COMMUNICATIONS
HYP. COMMS
HISTORICAL
HISTORICAL
FORENSIC FORENSIC
EXPECTANCY
ETHICAL-PRO.
EAT
DEVELOPMENT
DENTISTRY
BRAIN MECHS
ANALGESIA
AMNESIA
ABSORPTION
0 2 4 6 8 10 12 14 16 18
Numbers of publications (papers)
(17 articles); historical aspects and memory (15 in each category); and hypnotic
communications, other hypnotic phenomena and forensic issues (12 in each
category).
Table 2 takes the Psych LIT Classification Scheme and applies it to the field
of hypnosis. Immediately it is obvious how much research in hypnosis really
interrelates with major domains in the study of psychology as a whole. Figure 2
shows the content of our own journal and Figure 3 contrasts the number of
articles in IJCEH and AJCEH. Finally, Figure 4 shows the numbers of
publications for Australia as a percentage of the world.
I have analysed the literature in three of our major journals. There are
differences in the reporting patterns of journals and some obvious arbitrariness
Table 2 The Psych LIT Classification Scheme* as Applied to the Major Areas of
Hypnosis Literature
21 General Psychology
Historical aspects and debate on underlying nature of hypnosis
22 Psychometrics, Statistics, Methodology
Scales of hypnotisability, absorption, imagery; experimental methods
23 Human Experimental Psychology
Experimental work on hypnotic phenomena: analgesia, memory effects,
perceptual distortions
25 Physiological Psychology, Neuroscience
Brain processes — EEG rhythms and diurnal rhythms
26 Communication Systems
Hypnotic communications; induction types
28 Developmental Psychology
Development of “high” hypnotisability; ageing and hypnotisability
29 Social Processes, Social Issues
The hypnotic relationship
30 Social Psychology
Beliefs, attitudes and expectancy effects; experimental demand effects
31 Personality Psychology
Individual differences in hypnotisability; hypnotisability correlates
32 Psychological/Physical Disorders
Mental/physical disorders and hypnosis
33 Health/Mental Health Treatment and Prevention
Medical, dental hypnosis; hypnotherapy; hypnotic interventions
34 Professional Psychology/Health Personnel Issues
Professional and ethical issues in use of hypnosis by professionals
35 Educational Psychology
Modifications of hypnotisability; learning enhancement
37 Sport Psychology and Leisure
Hypnosis in sport
42 Forensic Psychology and Legal Issues
Forensic hypnosis, hypnosis and the law
* Numbered and in bold

NUMBER OF ARTICLES
0
5
10
15
22 Sheehan
GEN.-HISTORICAL
PSYCHOMETRICS
EXPERIMENTAL PSYCH.
PHYSIOLOGICAL
COMMUNICATION
DEVELOPMENTAL
Figure 2: Contents of AJCEH 1986–1995
SOCIAL CONTEXT
INDIVIDUAL DIFFS
DISORDERS
PROFESSIONAL
EDUCATION
SPORTS
Categories based on Psych LIT classification scheme

FORENSIC-LEGAL
Other
Figure 3: Comparison of Contents of AJCEH and IJCEH 1986–1995
FORENSIC-LEGAL
SPORTS
EDUCATION
PROFESSIONAL
Categories based on Psych LIT classification scheme
DISORDERS
INDIVIDUAL DIFFS
SOCIAL CONTEXT
DEVELOPMENTAL
COMMUNICATION
PHYSIOLOGICAL
EXPERIMENTAL PSYCH.
PSYCHOMETRICS
GEN.-HISTORICAL
0
10
20
30
40
Numbers of articles
International Journal of Clinical
24 Sheehan
Figure 4: Numbers of Publications: Australia as a Percentage of World
Number of Australian articles, 1994

4.5
1974–76
4 1983–85
1992–94
3.5
3
Percentage
2.5
1.5
0.5
198 203 95 168 219 130 41 80 661 580 201 35 41
0
22: Psychometrics
23: Human Exp.
24: Animal Exp.
25: Physiological
28: Developmental
29: Social Processes
30: Social
31: Personality
32: Disorders
33: Health & Mental Health
35: Educational
37: Sports
42: Forensic
Classification Code
on my part in the choice of classification categories, but certain major themes

nevertheless emerge from the data which present an overview to my later
observations.
The major trends in research hypnosis from this analysis are: the history and
nature of hypnosis, individual differences in responsivity, experiments on
hypnotic phenomena, social influences on hypnosis, and forensic issues and
legal concerns (which are related to the theme I will elaborate). Table 3 lists in
summary form those emerging issues as important in the comparison of the
1985 review with the content analysis conducted of the three main hypnosis
journals. Issues 2, 4 and 5 are the most relevant ones to recovered memories.
Comparison of the data on hypnosis with trends reflected in the number of
psychology publications in the world (see Figure 4) show that hypnosis is
idiosyncratic with its continuing emphasis on its history and debate about the
underlying nature of the construct of hypnosis, issues concerning individual
differences in susceptibility, and forensic hypnosis. It is largely the field of
forensic hypnosis that incorporates the significance of recovered memories.
Given the importance, comparatively speaking, of these forensic issues and
the practical implications of memory data, I want to focus first on memory as a
contemporary issue of major significance.
MEMORY AS A CONTEMPORARY ISSUE
In the past, work in hypnosis has highlighted errors in memory that clearly
depend upon a combination of social psychological variables, such as beliefs,
attitudes, sets/expectations, and person-attributes (like imagery, imagination,
Table 3 Issues Arising From the Comparison of Kihlstrom’s 1985 Review with the
Content of 3 Main Hypnosis Journals (1986-1995)
1 The rise in the use of phenomenological data

2 The increased acceptance of the importance of social and contextual
influences in the production of hypnotic responses
3 The inclusion of consciousness and self-consciousness as legitimate topics
for study amongst “mainstream” experimental psychologists
4 The rise in the use of hypnosis and corresponding professional and ethical
dilemmas in all applied (legal, medical and clinical) areas
5 The increase in numbers of professional and legal guidelines for the use of
hypnosis
6 New areas of application of hypnosis in the sports and health fields
7 The emergence of cross-disciplinary studies on topics in hypnosis — in
particular, attention, memory, and analgesia
8 The increasing numbers of experimental studies linking physiological
systems functioning and hypnosis
9 Continuing controversy over the validity of the concept of susceptibility, and
the nature of the hypnotic response.
26 Sheehan
absorption, automaticity, and dissociative ability). Posthypnotic amnesia, for

example, appears to be not just a matter of subjects’ abilities (Perry, 1992, p.
247). Amnesia has been referred to as “highly responsive to suggestions,
enhancement and cancellation” (Hilgard, 1987, pp. 252–253). The specific
thrust of recent research has, however, clearly focused upon particular
hypnotically influenced memories, and their status in the legal setting.
Hypnotically Influenced Memories
The phenomenon of hypnotic hypermnesia, or enhanced memory accessibility

under hypnosis, is of special interest both clinically and forensically. It has been
investigated in the laboratory setting with inconsistent results. Research has
attempted to unravel the effects of different variables, such as the type of
material remembered and the process of recall. Using methodologies which
eliminated reported hypermnesic effects of repeated recall, and “response bias”
of highly susceptible subjects (Whitehouse, Dinges, E. Orne, & M. Orne, 1988),
investigators such as Dinges, Whitehouse, Orne, Powell, Orne, et al. (1992), and
Erdelyi (1994) have concluded that hypnosis per se does not improve memory
for recent events.
It has been demonstrated, however, that whole memories (pseudomemories)
can be implanted into a person’s real-life autobiographically and even non-
experienced events can occupy the minds of the young (Loftus, 1993). It is
intriguing that one important feature of successful “implantations” is the type of
relationship between the subject in the experiment and the source of the
pseudomemory. One might conjecture that these special relationships of trust
between person and source of the pseudomemory are also significantly involved
in cases of false criminal confessions (Ofshe, 1992), the so-called “false-
memory syndrome” and some cases of Multiple Personality Disorder. Belief in
the authenticity of the information received may be a critical factor in the
creation of the pseudomemory, supplementary to the suggestibility of the
recipient of the information, or it may be inextricably involved in the
phenomenon of suggestibility itself.
The repeated recall of inaccurate memories or pseudomemories does appear
to increase a person’s confidence in the accuracy of the memory. This fact has
been borne out in the literature repeatedly, and has been shown to be the case
even in subjects of low hypnotisability (Dinges et al., 1992; Pettinati, 1988).
Research evidence tends to suggest, therefore, that not only false, but actual
memories can be distorted under hypnosis. It also implicates the major influence
of social-contextual factors in the shaping of pseudomemories. However,
hypnotisability, rather than other factors, seems to be the most probable
indicator of whether a pseudomemory will be accepted (Labelle, Laurence,
Nadon, & Perry, 1990; McConkey, 1992; Weekes, Lynn, Green, & Brentar,
1992).
Some combination of the greater hypnotisability of some people with other
factors appears responsible for facilitating the production of pseudomemories.
Table 4 Major Inferences from Experimental Data Drawn on the Association between
Memory and Hypnosis
1 No reliable memory enhancement effects occur either within single

paradigms or across them.
2 Memory distortion effects are not unique to hypnosis.
3 A number of variables exist (adhering to context) that are influential in
determining effects.
4 Patterns of effects depend on the means by which false information is
communicated in the test situation.
5 Hypnotic skill is especially influential across different methodologies.
6 Confidence, in particular, is influential across paradigms with distorted
memories frequently being reported confidently.
Note: Adapted from Sheehan (1994).
The literature warns that the variables involved in pseudomemory creation are
complex, involving some combination of what is measured by inventories
assessing “absorption,” those assessing some preference for imagining, and
some interaction between the two (Labelle et al., 1990) as well as other
contextual factors in relation to pseudomemory suggestion itself (Sheehan,
Statham, & Jamieson, 1991). Table 4 sets out what I consider are the major
inferences from the experimental data.
Let me turn now to explain my view of the nature of memory, and of
hypnosis, before commenting more specifically on recovered memories.
THE NATURE OF HYPNOSIS AND MEMORY
The Nature of Hypnosis
The nature of hypnosis has been much debated in the literature (Kihlstrom,
1985; Lynn & Rhue, 1991; Orne, 1959). Nevertheless, there seems reasonable
consensus about some of its defining properties. Although distortions typically
occur, hypnosis can be said to occur when one person (the subject) experiences
alterations in perception, memory, or mood in response to suggestions given by
another person (the hypnotist). Although distortions can and do occur, hypnosis
is essentially an experiential phenomenon wherein the hypnotist typically
guides the subject to create a favourable situation for the display of his or her
special capacities and skills. Substantial reliance has to be placed therefore on
the subject’s self-report as to the nature of the experience.
Typically, however, susceptible subjects use their own capacities to respond
appropriately (though at times constructively) to what the hypnotist is suggesting
even though the content of these suggestions is false. This is not a view that is
compatible with hypnosis recovering traces of original perception, and sits most
comfortably with the perspective that memories retrieved in hypnosis are
28 Sheehan
products of hypnotised subjects’ imaginative capacities at work. It does not say,

however, that hypnosis is inherently distorting.
The Nature of Memory
Memory is equally a complex process. Suffice to say that it is a labile

phenomenon with inherent plasticity that is clearly acknowledged in the
literature (e.g., Annonn, 1988). It is influenced strongly by pre-existing
representations (Echabe & Rovira, 1989), but post-event misinformation is also
effective and known to lead to distortion of memory in both adults and children
(e.g., Ceci, Ross & Toglia, 1987). The fact that memory is far from being
reproductive is captured most aptly by Kihlstrom (1994) in his quote, “memory
is not so much like reading a book as it is like writing one from fragmentary
notes” (p. 341).
Recovered Memories
One of the key contemporary questions or issues in relation to memory and

hypnosis is that of recovered memories. It is especially relevant in that it
illustrates the complexity of the many factors affecting the association between
memory and hypnosis.
It is a special category of hypnotically influenced memories and represents
memories of events that may or may not have occurred and that are typically
distant in time. McConkey (1995) and others (e.g., Ofshe, 1992) have
commented on the explosion in literature on this controversial matter which has
become a minefield of emotional issues. Let me attempt to summarily review
that minefield. Table 5 sets out what we know in relation to recovered
memories.
Table 5 Recovered Memory: What do we Know?
1 We know that child abuse and sexual trauma happen too frequently no matter
what the frequency is.
2 We know that traumatic memories are formed in some ways that are different
from normal memories.
3 We know that dissociation is a capacity that can be used defensively, giving
rise to amnesia which may lift at a later time.
4 We know that memory can be highly reliable, we know that memory can be
highly unreliable, and we know that memory can be influenced by a variety
of factors, including suggestion and misinformation.
5 We know that people can be influenced by others even to the extreme. We
know that misinformation provided by credible authorities with no apparent
motive to deceive can be absorbed and responded to as though it were true.
Note: Adapted from Yapko (in press).

Evidence on recovered memories The concept of memory as a constructive and

reconstructive process has important theoretical implications for the phenomenon
of recovered memory which are canvassed well by Bowers and Farvolden
(1996). What is remembered about an event is shaped by what was observed of
that event, by conditions prevailing during attempts to remember, and by events
occurring between the observation and the attempted remembering. It is
essential therefore to recognise that memories can be altered, deleted, and
created by events that occur during and after the time of encoding, during the
period of storage, and during attempts at retrieval.
Repression and dissociation are key processes for some theories about the
phenomenon. Importantly, however, they are also relevant to particular
approaches to therapy. According to these processes, memories of traumatic
events may be blocked out unconsciously and this leads to a person having no
memory of those events. However, memories of traumatic events may become
accessible at some later time. It is important to recognise that the scientific
evidence does not allow precise statements to be made about a definite
relationship between trauma and memory (McConkey & Sheehan, 1995), and
the link between incidence of trauma and whether repression or dissociation is
the key concept to use is not at all clear (see Bowers & Farvolden, 1996).
Furthermore, the evidence tells us that memories reported spontaneously or
following the use of special procedures in therapy may be accurate, inaccurate,
fabricated, or a mixture of these. Belief can often be strong but it is not the
yardstick of veracity; and the level of detail is not diagnostic of the truth of the
recollections.
We know that sexual and/or physical abuse against children and adults is
destructive of mental health, self-esteem, and personal relationships. It is also a
fact that reports of abuse long after the events have occurred are difficult to
prove or disprove in the majority of cases. Independent corroboration is for the
most part impossible.
Looking summarily at the evidence, it is increasingly the case that individuals
are entering therapy with no specific recollection of incest or molestation who,
during the course of therapy, uncover detailed recollections of repeated sexual
abuse by family members. Many of these people believe their recovered
memories are veridical, and have taken legal action on the basis of these
memories which have sometimes been recovered through hypnosis. There is
now full-scale debate about these issues in the scientific, professional, and
mass-market literature.
Serious questions remain in the literature about the validity of recovered
memories (see research by Loftus and her associates; Loftus & Ketcham, 1994,
for example). Major issues at stake include the validity of repression as a
psychological mechanism, where there is substantial evidence that people can
be very confident about the accuracy of their memories of past events even when
those memories are wrong. Neisser’s work with Nicole Harsch (Neisser &
Harsch, 1992; see also Neisser, 1993) on the Challenger space shuttle disaster
30 Sheehan
illustrates compellingly that memory for emotionally charged events is widely

inaccurate, despite the convictions people hold about them. That work
convincingly demonstrates that personally memorable events occurring in the
past are often not what they seem and can be entirely misleading in the manner
in which they are reported. Memories of distant events and particularly
memories of early childhood appear to be very susceptible to distortion and
error. Further, it is the case that many victims of traumatic events do not repress
events, but remember them and often report uncontrollable, intrusive memories
about them. What distinguishes then for traumatised people, memories that can
be retrieved (if sufficient effort is made), from memories that are seemingly
permanently blocked (despite efforts at retrieval)? Evidence reported by Lindsay
and Read (1994), implies that complete forgetting of childhood sexual abuse,
whether through repression, dissociation, or normal forgetting, never actually
occurs; rather, necessary caution is advocated in assuming any particular
incidence rate for amnesia and in accepting or rejecting the recovered memories
of an individual. As Loftus and her associates claim, although sexual abuse may
be tragically common, the emerging culture of unearthing traumatic repressed
memories may be creating as many problems as it is claimed to be solving.
The question of hypnotising a person who is involved in an actual memory
event (to be later retrieved) has many potential difficulties. The laboratory
evidence tells us that aptitude for trance is clearly a highly relevant variable,
state instruction may be relevant, and lying is a possibility. Emotional
involvement is clearly implicated in analysing the association of memory and
hypnosis, and one major issue is how emotion can be handled in real-life
settings when recovered memories are reported. Memories that are recovered
are often given spontaneously and when they are associated with hypnosis they
occur in a context where therapeutic questions may also be suggestive. These
memories can be accurate, in error, or show a combination of both; and
confidence in the memories, and the level of affect associated with them, offer
no proof of literal accuracy.
Recovered Memory Therapy
The term “Recovered Memory Therapy” profiles a form of therapy that in

formal terms does not exist. As a term it really refers to the recovery for
therapeutic purposes of repressed memories of sexual abuse, such memories
often being associated with reported satanic rituals and manifestations of
Multiple Personality Disorder. It is a label that essentially has come to denote
poor practice across a range of therapies, forgotten memories being the natural
target of many different modes of treatment.
A forgotten instance of abuse in a history of abuse is not necessarily evidence
of repression at work, and a number of issues are implicated: memories may be
avoided, not just remain temporarily inaccessible, and some people may be
more successful than others in that process of avoidance. Equally, there are
reports in therapy that can be trusted and reports which cannot. The problem is
to know which is which and we have no precise way of making that
discrimination — a problem that is exaggerated in its significance when many
of us accept routinely that the important issue for therapy is the client’s personal
account of what has happened and what he or she is feeling about that now.
Therapy certainly can facilitate access to memories and produces memory
reports, but it is also a mode of influence that inevitably transmits specific cues
and suggestions about what is fitting, wanted, or appropriate to report. Therapy
(like other influence techniques) can produce significant memory distortion
while at the same time fresh memories can be retrieved that are true and
reported. The essential problem is that we have no easy guarantee of the veracity
of verbal reports offered in therapy, and past emotional events can rarely be
corroborated independently to establish their truth value.
Because of the risks of suggestion and the many possibilities of distortion,
special professional obligations exist when the memories being explored in
therapy are associated with possible past abuse. This leads one to a major matter
for consideration — the need for guidelines for practice.
Summary Comment
Let me provide a summary comment of the complex issues addressed so far.

Consider, for a moment, a man who remembers in therapy that he was abused
sexually and recovers that recollection in therapy. His memory may be genuinely
very difficult to retrieve. The events themselves, however, may have taken place
in a state of normal or dissociated consciousness. Events that were encoded in
an altered state of consciousness may be especially difficult to retrieve. If they
are not, there are enormously strong motivations that exist for that person not to
want to recall them.
Intervening between the original trauma and therapy is often a life span of
experiences and other recollections. The person has been exposed to a myriad
of events, suggestions, and experiences which have the potential to reshape and
later correct recollections of what has, in fact, previously occurred. In therapy,
there may be a grain of truth, as it were, in what is eventually remembered, but
the facts could well be distorted, reshaped, embellished, or confabulated. What
occurs makes eventual reporting far from the absolute truth.
Into the act of retrieval comes a professional, years later, who, in the task of
interrogating (albeit supportively), is unwittingly influential in altering further
recollections of those past events. Those events are then explored in a context
where there are implicit or explicit cues about what should be remembered. That
suggestion will occur is incontrovertible; and it is largely for this reason that
guidelines for proper professional practice must be adopted, understood and
practised.
32 Sheehan
CLINICALLY RELEVANT EXPERIMENTAL DATA

The data that I consider new and clinically relevant to the issues I’ve outlined
come from a study in my own laboratory that used phenomenologically oriented
techniques to explore subjects’ base-rate responses to leading questions that
suggested incorrect answers. The methodology employed was based on Susan
Whitehead’s adaptation of the Experiential Analysis Technique (EAT; Sheehan
& McConkey, 1982) and the procedural extensions of Eva Bányai and her
associates (Bányai, 1991; Bányai, Gosi-Gerguss, Vágó, Varga, & Horváth,
1990). The thrust of the work was geared to isolate the parameters and processes
associated with subjects’ personal responses to misleading questions.
The questions themselves were embedded into the hypnotic setting as part of
the hypnotic session. High- and low-susceptible subjects were asked (with no
other cue to suggest a confirmatory reply was wanted) whether they noticed “the
person coming into the room a while back.” They were then asked whether it
was true that they seemed a little upset at the time, and then whether they knew
“who came in.” A fourth, post-hypnotic question, asked subjects “Did anyone
come into the room a while back?” Analysis of subjects’ responses to these four
questions focused on memory accuracy and confidence in the proposition that a
person had come into the room. The latter measure endorsed subjects’ confusion
level at the time, confusion in recall being an accepted symptom in the hypnotic
literature of developing delusory thinking. The questions themselves were
designed to elicit an increasing commitment to a state of affairs that didn’t
happen, but also repeated events so as to place increasing pressure on both high-
and low-susceptible subjects to shift whatever was their previous response.
The core rationale of the study was to explore the extent to which clinically
relevant answers could be elicited in an entirely neutral laboratory context
where “personal” response was not only inappropriate to the context, but not at
all expected by the hypnotist who administered the questions. In all of these
senses, the design was intended to supply a base-rate measure for clinically
relevant responses occurring in a non-therapeutic context. It used leading
questions in a hypnotic setting which would have different significance if the
context were clinical (not experimental). In so far as the research examines the
incidence of the acceptance of ambiguously phrased leading questions, the
results bear meaningfully on the current theoretical debate about the construction
of false memories and possibly on the clinical phenomenon of recovered
memory, in particular.
The overall hypothesis of the work is a subtle one. It was predicted that
questions in the experimental setting, which might be expected to produce a
high incidence of acceptance in the clinical setting, will not produce a high rate
of acceptance because of the social constraints of the experimental setting itself.
However, where distortion is evidenced — and it is a moot question really as to
what that rate will be — it was hypothesised that it will occur most strongly for
high-susceptible subjects, and subjects in hypnosis. Although some parallel can
be expected between the results for accuracy and confidence, the experimental
literature indicates the value of separately examining the pattern of differences
among subjects with respect to both these measures.
Tables 6 and 7 set out the experimental data for the accuracy and confidence
measures.
Data in Table 6 show that the first of the questions produced no confirmatory
response whatsoever but by the fourth (repeated) question, four out of 25
subjects acquiesced — all of them highly susceptible to hypnosis. By the third
question, one of these subjects had already shifted response to acquiesce (in
hypnosis). The conflicting nature of subjects’ responses, however, is heavily
evidenced in the data. To the third question (“Do you know who came in?”),
four subjects said they were perfectly confident that a person entered the room,
but at least three-quarters of this same group denied this. And the same variable
pattern of response is evident for the confidence data. My point is that what
simply looks inconsistent in an experimental context could be interpreted as
dynamically meaningful in a therapeutic one.
The overall pattern of the data tells us clinically relevant responses in a
neutral context are possible (for susceptible subjects particularly) when
suggestive cues are present and the repetition of the questions reinforces the
subject’s acquiescence. It is not too hazardous to conclude that in a clinical —
more relevant — context where that same repetition exists, the rate of acquisition
and confusion would be much higher — enough, one might say, to highlight a
genuine forensic problem.
Table 6 Frequency of Distorted (Yes) Responses for Four Misleading Questions
Yes No D/K or Total

Response unclear
Question 1: (Did you notice?)
High 0 25 0 25
Low 0 24 0 24
Total 0 49 0 49
Question 2: (Were you upset?)
High 7 16 2 25
Low 0 22 2 24
Total 7 38 4 49
Question 3: (Do you know who came in?)
High 1 24 0 24
Low 0 24 0 25
Total 1 48 0 49
Question 4 (Post-hypnotic): (Did anyone come into the room a while back?)
High 4 20 1 25
Low 0 24 0 24
Total 4 44 1 49
34 Sheehan
Table 7 Frequency of Confidence Judgments
Question 1: (Did you notice?)

1 2 3 4 5+ Split rating/ Total
confused rescore?
High 8 10 2 3 0 2 25
Low 22 0 0 0 0 2 24
Total 30 10 2 3 0 4 49
Question 2: (Were you upset?)
1 2 3 4 5+ None of the Total
numbers
High 10 6 5 3 1 0 25
Low 23 0 0 0 0 1 24
Total 33 6 5 3 1 1 49
Question 3: (Do you know who came in?)
1 2 3 4 5+ - Total
High 8 7 4 2 4 - 25
Low 23 1 0 0 0 - 24
Total 31 8 4 2 4 - 49
Question 4 (Post-hypnotic): (Did anyone come into the room a while back?)
1 2 3 4 5+ Split rating/ Total
confused rescore?
High 12 6 1 3 0 3 25
Low 24 0 0 0 0 0 24
Total 36 6 1 3 0 3 49
Note: For each of these four questions, a 5-point confidence scale was used where “1”
meant no confidence that a person had entered the room, and “5” meant perfectly
confident that a person had entered the room.
There are some important practical implications from the data presented
here. The development of tools which can differentiate between real and
constructed memory may not be possible if it is proven that original memories
are overlaid by recent imaginings and remembering. If, however, original
memory is still intact after being recalled as suggested in some research
(McCann & Sheehan, 1987), there may be a way in some cases (e.g., Johnson,
Foley, Suengas, & Raye, 1988; Spence, 1994; Steller & Koehnken, 1989) of
making the important distinction between fact and fantasy or differentiating “the
signal of true repressed memories from the noise of false ones” (Loftus, 1993,
p. 534). Research into memory systems and how they function is of crucial
importance in establishing how best to investigate the extremely controversial
and emotive area of truth in recovered memory.
Clinical researchers emphasise that the historical truth is not always the issue
in therapy. Information may be clinically useful though not necessarily accurate
(Bowers & Farvolden, 1996; Spence, 1982). However, in the legal setting it has
been said there is another reality (Loftus, 1993) echoing also others’ claims that
the nature of recovered memories has profoundly different meanings for legal as
opposed to therapeutic settings (Pennebaker & Memon, 1996).
The limitations imposed by the reported content of memories mean that the
conclusions of pseudomemory studies can only be extrapolated with difficulty
into the clinic or courtroom setting (Greene, Wilson, & Loftus, 1989).
Laboratory experiments do not relate well to situations such as cases of
suspected child abuse, or criminal events where the memories may have strongly
emotional overtones. As Yuille and Cutshall (1986) comment in relation to
eyewitness reports of real-life traumatic events, subjects can behave and
remember very differently when they are true participants, and not passive
observers. The issues are complex and both the clinical and experimental
settings can help unravel the dilemmas.
CONCLUSION
The data just presented returns me to the relevance of what I signalled earlier.
Experimental and Applied Hypnosis: A Symbiotic Relationship
Drawing on my earlier comparative analysis and my discussion of recovered

memories, in the last decade there is emerging something of what I would call
a symbiotic relationship between experimental and applied concerns. The fusion
is fuelled not only by the applied concerns of “forensic and clinical hypnosis,”
but by the special stimulation of the particular controversies currently captured
by the ongoing debate on recovered memories.
It is clear that the applied issue which is most likely to occupy our attention
in the future is that of recovered memories. Are such memories real and/or
fabricated? What is the therapeutic meaning of memories retrieved in hypnosis?
There are also questions, in particular, of what injustices can be caused to
individuals, what law courts are able to do with uncorroborated information, and
whether research can, for instance, isolate when hypnosis is being faked. The
implications that this whole issue has for the legal status of hypnotically
produced testimony are major. The relevance of the issue is already emerging in
the recent experimental literature of Kinnunen, Zamansky, and Block’s work
(1994) on “is the hypnotised subject lying?” Analyses of recovered memories I
predict will be the test case for the rapprochement of clinical and laboratory
hypnosis. Much is needed to bring laboratory and clinical concerns together and
I suspect that this single issue will provide us with some unexpected solutions.
In the common search to differentiate actual abuse from its reporting, theory and
practice will immeasurably advance from knowing whether repression or
dissociation is at issue or subjects/clients are simply failing to report.
In final comment, I want to return to views I expressed in my article entitled
36 Sheehan
“Clinical and Research Hypnosis: Toward Rapprochement” (Sheehan, 1979).

They are views I would wish to re-echo now.
The association between clinical and research hypnosis may be viewed in a
number of ways, but one of the most useful modes of conceptualisation is to
regard the two activities as analogous endeavours involving a stepwise sequence
of operations anchored to solving a particular problem or issue. Difficulties
exist, however, for assessment procedures to really detect the cognitive resources
at work among hypnotised persons, procedures being needed which are attuned
to the isolation of clinical events that will reflect the true interaction between
motives, cognitions, and expectancies.
Let me conclude by pointing to the plethora of clinical, experimental, and
conceptual issues requiring the interaction I am advocating. In the listing I am
borrowing from Yapko (in press). There are major unknowns about trauma and
childhood repression.
The associated assumption is that traumatic memories can be preserved at a
higher level of integrity than normal memories for later recall. However,
some basic questions about this phenomenon remain unanswered: how many
buried traumatic memories remain intact, and how many deteriorate? If
buried memories of trauma decay over time, is it because of natural
deterioration of some sort, or is it due to a defensive self-protection?
Why do some memories of known trauma never return in some people
while other people do recover such memories? . . . This raises several key
questions yet to be satisfactorily answered: do children repress memories
after each specific incident of abuse, or as a whole set of experiences at some
later point in time? If children forget each traumatic episode instantly, as it
happens, how exactly do they do this? How does the child lose continuity
such that the event loses both its antecedents and immediate aftermath? If
children store many memories of abuse and then later develop amnesia for
them all, then what generates the amnesia if not the abusive episodes
themselves? And, finally, why do some people repress a particular type of
trauma and others do not? (Yapko, in press, pp. 28–29)
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38 Sheehan
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1 Material in Tables 1, 2, and 3 is drawn from the historical introduction used in

the author's state-of-the-art address (Sheehan, 1996).
Vol. 25, No. 1, 1997, pp. 40–52
HYPNOSIS IN THE TREATMENT OF CANCER PAIN
Burkhard Peter
Founding President of the MEG; Editor, ISH Newsletter,

Hypnos and Cognition; Teacher and Administrator — MEG
This article reviews a number of issues relating to the pain of cancer and its treatment, and
the role of hypnosis in pain management. The author concludes with a number of case
vignettes which illustrate the efficacy of hypnotic techniques for these patients.
Cancer still remains one of the most feared diseases, despite significant advances
in diagnosis and treatment in recent years. One of the reasons is the associated
pain. That this fear is not unwarranted has been demonstrated by epidemiological
studies which have shown that 60% to 90% of adult tumour patients develop
pain during the later stages of cancer (Bonica, 1980; Cleeland, 1984).
Cancer pain is defined here as acute and chronic pain which occurs directly
or indirectly from tumour lesions and/or the accompanying medical treatment.
For example, skeletal and neuropathic pain is caused by tumour infiltration.
Classical medical treatment (surgery, radiotherapy, and chemotherapy) can
curtail pain symptomatology in many cases by reducing the malignant tissues,
but quite often patients experience painful side effects (secondary pain) like
phantom pain after amputation, polyneuropathies after chemotherapy, or
myelopathies after radiotherapy. Moreover, some medical interventions are
quite painful themselves, such as bone marrow aspirations or lumbar punctures.
These again can lead to conditioned pain, fears, and other unpleasant and
anticipatory reactions, for example, conditioned vomiting (Noeker & Petermann,
1990; Rosen, 1984).
Studies have shown that the variance of the experience of cancer pain is only
explained in part by such organic factors as type of cancer, illness stage, number
and location of metastasis, or terminal phase. Therefore, part of the pain
experience of cancer patients should also be attributed to psychological factors
(Bond & Pilowsky, 1966; Bond & Pearson, 1969; Spiegel & Bloom, 1983a,
Reprinted with permission from Hypnos: Swedish Journal of Hypnosis in Psychotherapy
and Psychosomatic Medicine (1996, XXIII, 99–108)
Requests for reprints should be sent to Burkhard Peter, MEG, Konradstr. 16, D-80801
Munich, Germany.
40
Hypnosis in the Treatment of Cancer Pain 41
1983b; Turk & Fernandez, 1990). Today it is no longer necessary to emphasise

that pain experience always comprises the interaction of sensory, affective,
cognitive, and behavioural components, with these considerations incorporated
in Melzack and Wall’s (1965) Gate-Control Theory.
The problem with each and every pain therapy is its controllability and
efficacy. Many patients report they are completely helpless and anxious if they
depend on physicians and their staff for pain control and/or if their treatment
does not offer the desired pain relief. Any assistance that helps the patient regain
and control pain facilitates an essential improvement in the quality of life of
cancer patients. Hypnosis is one, but not the only psychological method, by
which a patient can gain control over his/her cancer pain.
Hypnosis and Pain Control
Hypnosis was one of the few effective analgesics until the introduction of ether
in 1846 and chloroform in 1847. According to Gravitz (1988), the first
documented anaesthesia with hypnosis was performed 1829 by a Parisian
surgeon during a mastectomy. The British surgeon John Elliotson (1843)
reported several pain-free operations with hypnosis (mesmerism). The Scottish
surgeon James Esdaile (1846) performed several hundred minor operations as
well as over 300 major surgeries in India with hypnosis (mesmerism) during
which 80% of the patients felt no pain. Numerous experimental and clinical
studies have since demonstrated that hypnosis is a very effective method in pain
control (Crasilneck & Hall, 1973; Elton, Stanley, & Burrows, 1983; Evans,
1987; Hilgard & Hilgard, 1975; Peter, 1986, 1990).
Theoretical controversies concerning hypnosis traditionally revolved around
two competing paradigms, the so-called special process and the sociocognitive
perspective. Special process theorists (cf. Hilgard, 1989, 1991) hypothesise
non-ordinary states of consciousness (e.g., trance), and special psychological or
psychophysiological mechanisms (e.g., dissociation), and maintain that hypnotic
behaviour, like hypnotic pain control, differs fundamentally from ordinary
behaviour. Sociocognitive proponents, such as Spanos (1991), on the contrary,
insist there is nothing special about the hypnotic situation because it simply
represents a salient example of social interaction variables which social and
cognitive psychologists regularly employ to explain other forms of social
behaviour (like demand characteristics of the situation, attitudes, expectation,
role enactment, etc.). According to sociocognitive theorists, the subjects in pain
studies simply follow instructions and show the desired behaviour (Spanos,
Carmanico & Ellis, 1994).
In a recent study, Kiernan, Dane, Phillips, and Price (1995) have shown,
however, that hypnosis significantly attenuates even a physiological variable,
the R-III, a nociceptive spinal reflex. This demonstrates that hypnotic pain
control can be beyond the mere reduction of unpleasantness. The reports of
reduced pain may truly represent not only the attenuation of sensory pain but
42 Peter
also that of a spinally mediated, that is, peripheral, process. Even though this
kind of research was pioneered by Hagbarth and Finer, who already showed an
altered spinal nociceptive withdrawal reflex by hypnotic analgesia, it calls for
replication for it seems to show a truly descendent (“top down”) inhibition. This
would add a third component to the already known two factors of pain reduction,
the sensory and the affective.
Hypnosis and Pain Management in Adult Cancer Patients
Erickson (1959, 1966, 1967) and Sacerdote (1970, 1982) provided some of the
best known clinical contributions to hypnosis in the control of cancer pain. Less
well known are the early reports by Butler (1954), Lea, Ware, and Monroe
(1960), and Cangello (1961). Butler’s hypnotic analgesia was successful in 5 out
of 12 cancer patients. However, successful hypnotic analgesia correlated with
the ability of the patient to be hypnotised, that is, suggestibility. Spiegel and
Bloom (1983a, 1983b) reported significant differences in control of cancer pain
(and other symptoms like depression and anxiety) with hypnotic analgesia in 34
patients with metastasised breast cancer in comparison to a control group which
only received medication. Reeves, Redd, Storm, and Minagawa (1983) compared
a group of cancer patients receiving two sessions of hypnotic training for the
reduction of pain induced by hyperthermia with an untreated control group. The
treated patients reported significantly less pain than the patients in the control
group. More recent studies have also demonstrated the efficacy of hypnotic
analgesia. For example, Kaye (1987) was successful with 8 out of 12, Kraft
(1992) with 5, and Campanella (1993) with 8 cancer patients. In a controlled
clinical trial, Syriala, Cummings and Donaldson (1992) were able to show that
hypnosis was effective in reducing reported oral pain in 45 haematological
cancer patients undergoing bone marrow transplantations. These studies, as well
as my own clinical experiences (Peter & Gerl, 1985), demonstrate the efficacy
of hypnosis in pain control in adult patients.
Hypnosis and Pain Management in Children and Juveniles
Hilgard and LeBaron (1982, 1984) treated leukaemic children and juveniles
who had to continuously undergo bone marrow aspirations. The pain baseline
was assessed on 63 patients and they were then offered an hypnotic analgesia
pain management programme. Of the 24 patients who participated, 19 were
highly suggestible and 10 out of 19 were able to reduce their pain during the
bone marrow aspiration after only one hypnotic session and 5 after two sessions.
The five patients who were less suggestible were unable to reduce their pain
with hypnosis, but were able to reduce their anxiety before and during the bone
marrow aspiration. Zeltzer and LeBaron (1982) compared the efficacy of
hypnotic (guided imagery) and non-hypnotic behavioural intervention (deep
breathing exercises and distraction procedures) in children and juveniles during
bone marrow aspirations and lumbar punctures. The pain and anxiety baseline
was obtained from the patients themselves as well as independent observers
during one to three medical diagnostic treatments without any psychological
interventions. The baseline data showed that experienced pain during the bone
marrow aspiration was greater than during the lumbar puncture. Results
indicated that the two psychological interventions reduced the experienced pain
during bone marrow aspiration significantly, with hypnosis being more effective
than the behavioural intervention.
Hypnosis was also effective during lumbar puncture. Anxiety was reduced by
the behavioural intervention, but significantly less so than with the hypnotic
intervention. Kuttner, Bowman, and Teasdale (1988) compared imaginative
involvement, behavioural distraction, and standard medical procedures on a
sample of 59 children with leukaemia. After two intervention sessions the
authors were able to show that the hypnotic method had an all-or-none effect
during bone marrow aspiration, while distraction appeared to require coping
skills which had to be learned over more than one session.
Does Outcome Correlate with Suggestibility?
In most of the aforementioned studies, the suggestibility of patients correlated

with the success of the hypnotic measures. Spiegel (1986) clearly recommends
that “There is no point in trying to use hypnosis with the one-third of patients
who are not hypnotisable” (p. 87). This kind of statement requires that the
patients take a suggestibility test (e.g., the Stanford Hypnotic Clinical Scale
[Hilgard & Hilgard, 1975]) before intervention and the therapist is convinced
that suggestibility is a valid stable trait (Hilgard, 1965). However, a number of
sociopsychological studies have demonstrated that low-hypnotisable subjects
can increase their hypnotisability if they practise enough (Gorassini & Spanos,
1986; Spanos, 1991; Spanos & Coe, 1992).
As does Bányai (1991), I believe that suggestibility/hypnotisability is both a
stable trait within certain limits but also a teachable, and therefore modifiable,
skill. Furthermore, the discussion on the superiority of indirect versus direct
induction and utilisation of hypnosis (Lynn, Neufeld, & Mare, 1993) cannot be
settled with an either/or argument. Especially with cancer patients, it is
paramount to establish rapport (Peter, 1994c, 1996), in which case the question
of suggestibility or the use of direct or indirect hypnotic approaches seems less
important. Katz, Kellermann, and Ellenberg (1987), for example, found that
therapist–patient rapport predicted the treatment outcome in children with
cancer, but not their hypnotisability.
44 Peter
CANCER PATIENTS AND RAPPORT
I would like to discuss rapport with cancer patients in more detail, since I am
frequently painfully aware of the problem of therapeutic relationship and
successful outcome. With some of my patients I have been unable to establish a
good therapeutic relationship. In such cases hypnotisability is relatively
unimportant, since I cannot use it. Therefore it would be helpful for me if I
could assume that suggestibility is considered a stable trait and that I could
attribute my failure to the low or missing suggestibility of the patient. On the
other hand I also know AIDS and cancer patients whose established low
suggestibility could be improved due to our good rapport (Peter, 1994a).
Sometimes I reach my limits with cancer patients, in comparison to neurotic and
psychosomatic patients, because I tend to get too involved; that is, I lose the
balance of distance and closeness. Too much closeness and empathy results in
my suffering along with the patient and I become helpless. Maintaining too
much distance, based on the need to protect myself from this kind of suffering,
also inhibits rapport and prevents effective hypnotherapeutic therapy. Sometimes
supervision is helpful, but not always.
Unrealistic and very high expectations on the part of the patient can also
prevent therapeutic cooperation because any correction of these expectations
might be taken as a rejection by the patient. Such expectations might be the
convictions that even hopeless cases can be cured and that pain is completely
eliminated with hypnosis. Such expectations and similar ones suggested by
some dubious publications make it impossible to offer some patients that
measure of hypnotic analgesia which might still be possible under the given
circumstances, or even to talk to them about death or dying (Peter, 1994b).
Limitations of Hypnotic Pain Control for Cancer Patients
A number of additional problems can aggravate or even prevent the effective

pain management of cancer patients. Hypnotic pain management needs the
cooperation and concentration of the patient and some patients are not able to
provide this because of their illness. Some pain states are so overwhelming that
patients are unable to cooperate mentally; some brain tumours or extreme
fatigue make psychological interventions impossible. However, the adequate
provision of opioid analgesia has made it possible to control even severe pain.
In some cases, even the pain cancer patients experience can result in
secondary gain. For example, the pain can be used as a vehicle to communicate
with other people, family members, physicians, and hospital staff, or the patient
receives financial compensation from health insurance or other organisations.
As long as these problems have not been worked through with the patient,
hypnotic pain control will be impossible or only of short-term efficacy. However,
I don’t want to give the impression that hypnotic pain control for cancer patients
is any more difficult than, for example, that for other pain populations. On the
contrary, during 15 years of therapeutic practice with these patients I have

learned that the suggestibility and compliance of these patients is better than
that of other pain patients (Peter & Gerl, 1984, 1985). For this reason cancer
patients can profit considerably from hypnotic pain control.
Techniques of Hypnotic Pain Control
We need to differentiate between dissociative, associative, and symbolic

techniques used in hypnotic pain control, although some overlap generally does
occur in practice.
The objective of the dissociative techniques is to separate the pain, that is, to
isolate it from the rest of the healthy body; or to separate that part of
consciousness which suffers and is aware of the pain. The simplest way is
diversion of awareness, for example, by involving the patient in conversation,
that is, focused listening; by concentrating on parts of the body not experiencing
any pain; or by suggesting feelings of warmth or coolness. Sometimes some
simple relaxation techniques are sufficient to reinforce such pleasant feelings as
warmth or heaviness in those parts of the body not experiencing pain and this
forces the pain awareness into the background.
Symptom substitution also belongs to the category of dissociative techniques.
Instead of pleasant sensations, disturbing sensations should be produced in
other parts of the body until the patient is able to completely focus her/his
attention on that spot. Such substitute paraesthesias can be an intensive itching,
severe tingling, or numbness. For example, the patient can recall numbness felt
after receiving analgesia from the dentist, or the falling asleep of an arm, and
can then place these pain-antagonistic sensations to the painful area.
Real hypnotic dissociation begins when the pain sensation becomes reduced
or changed hallucinatorily in such a manner that the pain is separated and
completely isolated from the body schema. This works best for pain in the
extremities. For example, each arm levitation, and each catatonic state of parts
of the body represents almost automatically a clearly perceivable dissociation of
the arm or the respective catatonic part from the rest of the body. Depending on
hypnotic ability and existing rapport, larger parts of the body can be dissociated.
Thus, some patients can, for example, leave their bodies from the abdomen or
from the neck downward and concentrate on the other painless body parts. This
can continue until the patient imagines they completely leave their painful body
in the bed and moves with an imagined healthy body to another room where
they watch TV or do other pleasant things (Erickson, 1959). The temporal
variation of complete body dissociation, that is, out-of-body experience, is age
regression to a time when there was no pain and the patient remembers pleasant
experiences. This temporal orientation can be based on vacation experiences
which are generally associated with pain antagonistic sensations (warmth and
coolness, relaxation, or other pleasant sensations) and/or significant life
occurrences, like engagement, marriage, or birth of a child (Campanella,
46 Peter
1993).
Associative techniques require that the patient pay attention to the pain,
which at first most probably will have a pain reinforcing effect and, for this
reason, should not be used with all patients, since it requires high motivation
and a great deal of trust in the therapist. It is especially helpful in cases of
radiating pain to determine the exact pain boundaries, that is, to find out where
the pain-free areas start. Just the determination of pain boundaries can facilitate
pain relief, in that the patient is told indirectly they can control pain. Once the
boundaries have been established they can be traced with an imaginary pencil
or pen suggesting to the patient that these boundaries can be changed, meaning
they can be shifted more to one side or the other. It is better, however, to ask the
patient to first perform such a shift by enlarging the pain area since this is easier
than reducing the boundaries right from the beginning, or to simply ask her/him
to change the location in terms of symptom shifting. Both instructions contain
the message that pain is not something permanent or unmovable, but changeable
and therefore reducible and relievable.
As soon as the pain boundaries have become variable, other pain modalities
can be changed too. At this point it is important to know how the patient
represents her/his pain in order to get to the so-called submodalities of
perception. For example, if the pain sensation is experienced as sharp and
stabbing, then the attempt is to dull it; if the pain is rather a pulling sensation,
reduce the muscle tension or, for a burning pain, suggest a cooling sensation.
Most important, however, is to determine which submodality is responsible
for most of the suffering. If it becomes possible to completely separate the
suffering from the total pain experience then the rest pain, maybe in form of a
so-called “white pain,” may become much easier to bear. The most extreme
form of such pain awareness would be to imagine the pain process as a purely
physical process occurring within nerve cells and certain areas of the brain.
The step towards symbolic information processing is no longer difficult, once
certain pain aspects have been changed. By symbolic processing I mean that the
patient changes the total pain or certain aspects of it into symbolic or synesthetic
representation, that is, into an adequate acoustic and/or visual hallucination.
Within this new synaesthetic frame, changes can be executed much more easily
than at the originally kinaesthetically experienced pain site, by imaging, for
example, extinguishing a glowing fire, letting a storm die down, or calming
down a stormy ocean.
The utilisation of associative or symbolic techniques by the therapist,
however, should not imply to the patient they should view pain as a partner with
whom one can converse or argue. Most cancer patients with unbearable pain
would consider this an impertinence, if not a ridicule of their suffering (whereas
pain as a partner would be appropriate for patients who are suffering from
psychosomatic pain). Cancer pain is one of the most unnecessary pain
experiences which really does not make any sense and which should be relieved
with anything that has proved to be effective.
Which kind of hypnotic strategy or combination thereof should be used can

only be determined by the kind and severity of pain, the hypnotisability of the
individual, the patient’s and therapist’s attributes, and other factors. One of
these is the issue as to what the pain signifies to the patient (does she/he
interpret pain as a sign of being alive or as a sign of decay and impending
death?). In the latter case, one should probably use dissociative strategies,
whereas associative and symbolic strategies would be indicated for the former.
In any case the therapist should select that approach which most easily brings
about the desired objective.
CASE VIGNETTES
The following case illustrates the use of dissociative techniques. This patient
had cancer of the mouth and came to me about one year after being diagnosed.
The first pain episodes could easily be controlled with relaxation, based on
progressive muscle relaxation. At that stage it was difficult to determine whether
pain control was achieved by the relaxed body state, or because of the patient’s
mental concentration while doing these exercises, or because of the mind–body
interaction.
His pain became a lot worse when he had to have all his teeth pulled, two or
three at a time, because the medical analgesia no longer seemed to work. At the
beginning I taught him to remember how it used to be when he visited his dentist
and when the injections brought about feelings of numbness. During this age
regression, I suggested that the patient could leave the treatment room in his
mind and travel to his favourite vacation place. This was a picturesque island
located in the middle of the Mediterranean Sea, warm, sunny, and surrounded
by cool waters. When the patient arrived there, he told me exactly what he saw,
heard, felt, smelt, and did. By asking detailed questions about all the different
sensory experiences, I tried to create experiential hallucinations in order to
divert his attention from the actual experience in the dentist’s office. At the next
tooth extractions the patient was able to apply these dissociative techniques and
he hardly felt any pain, except for some itching and pressure.
After this incident he did not discuss pain control for a long time, although
tumour progression was evident. When I asked him he said that his “vacation
technique” was still working very well.
Only a few months before his death, when the skin of the upper and lower
jaw had already become necrotic, did he begin to complain once again about
pain which no longer could be controlled by hypnosis alone, but only in
conjunction with time-contingent opioid analgesia. At this stage he was only
able to communicate by moving his head since he was unable to talk. Every time
I visited him I told him stories about his special vacation place and kept
reiterating that in one’s mind one could leave the body behind and go to a place
where one could think and feel differently. From his breathing and from the
expression in his eyes it seemed as if my stories helped him, although it was
48 Peter
impossible to ascertain this from his facial gestures as his face was almost
entirely destroyed by the cancer. Shortly thereafter, the patient went into a coma
and died.
The next case illustrates the use of associative techniques. The patient had
breast cancer and the cancer had already metastasised throughout her body, with
the metastasis in the spine, in particular, being extremely painful. My idea was
to increase the muscle tonus of her back muscles in order that those muscles
would form a so-called corset around her spine. At first I used arm levitation
with the right, then with the left arm, and then with both arms simultaneously.
Then I instructed her “unconscious mind” to transfer the exact feeling of “light
tension,” that is the “tight lightness” of the arms, across her shoulders down to
her back and to continue doing this until this tightness formed a complete
enclosure around the painful areas in her back, so that the pain would be locked
in. At first the radiating pain was reduced considerably and with more and more
practice the patient was able to change her pain experience. The hot and stabbing
pain changed into a dull and cool sensation which felt uncomfortable but not
painful. She was able to go without pain medication for about two months. After
that she was admitted to the hospital because of pathological fractures of the
spinal vertebrae and had to wear a real corset. During the last two weeks of her
life, only very high doses of opioid analgesia were able to keep the pain under
some control.
Symbolic change of pain experience can be illustrated with the following
case. A patient with small-cell lung cancer came to me with extreme pain in the
chest area following radiotherapy. I asked this patient if she would like to learn
something about imagery. For example, she could imagine that she was standing
in the middle of a meadow and in addition to seeing and feeling the different
grasses and flowers she could also taste and smell them if she only got close
enough. Furthermore, she would be able to hear the singing of the birds and the
humming of the insects and their music filled the air. Just before she had seen
and heard enough, and just before she would become bored, she could remember
her chest pains out there in the normal world. She could then put this pain into
the container which was lying at her feet but at the same time she could take
great care that each and every corner of the pain would be in the box so that
none would be sticking out when she closed it and picked it up.
After she had done this she was to take a walk into the nearby forest carrying
her box under her arm or on her shoulders until she found a bubbling spring. At
that spring she should take a rest, have a drink of water, and continue to go
deeper and deeper into the forest until she came to a cave. She enters the cave
still carrying her pain box. As she explores the cave it gets larger and larger until
she comes to a very big and light room. In this room she finds a very old and
wise woman. She goes to the woman, holds up her box, and asks her what she
is supposed to do with it. The old woman first looks at her and then at the box
for a long time and finally asks how much this box weighs. The patient is very
surprised when she realises that the box has become much lighter than before.
Actually it had become so light and small that she was able to carry it in her
hand, whereas before she had to frequently carry it on her back or change sides
because it had been so heavy. Now she was happy. She thanks the old woman,
leaves the cave and goes back to the meadow, with the box remaining small and
light.
When the patient came out of the trance, and after the discussion of various
unimportant matters, the patient said, after being asked, that her chest pains
were a lot less — about half as bad as before. I repeated this story every session
— the old woman in the cave kept changing important pain aspects — until the
patient no longer talked about chest pains. The pain-free period that followed
might, however, also be attributed to the fact that the lungs were healing. This
patient is really an unusual case. According to medical statistics she should be
dead, since small-cell lung cancer has a very poor prognosis. However, she is
still alive three years after diagnosis and doing well.
CONCLUSION
Hypnotic pain control can be learned and applied relatively easily. It provides
the patient with an additional measure of controlling the illness and pain. This
again gives the patient back their feeling of independence and leads to an
improvement in quality of life experience. The expectations of the patient about
its effectiveness should be realistic and should be realistically conveyed as such
by the therapist. Hypnotic pain control should not be considered a substitute for
effective opioid pain management. However, in many cases hypnotic analgesics
can reduce the amount of otherwise necessary analgesia and in some cases even
replace them for a longer period of time.
REFERENCES
Bányai, É. I. (1991). Toward a social-psychobiological model of hypnosis. In S. J.
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(pp. 564–600). New York: Guilford.
Bond, M. R., & Pearson, I. B. (1969). Psychological aspects of pain in women with
advanced cancer of the cervix. Journal of Psychosomatic Research, 13, 13–19.
Bond, M. R., & Pilowsky, I. (1966). Subjective assessment of pain and its relationship
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Vol. 25, No. 1, 1997, pp. 53–60
HYPNOSIS IN THE TREATMENT OF HEADACHES
Patricia Burgess
General Practitioner
This case illustrates the use of hypnosis to alleviate chronic headaches in an 8-year-old
girl. It underlines the importance of a child’s need for mastery and how hypnosis can help
a child regain that sense of mastery and so make the necessary responses for change. It
also demonstrates how much therapeutic work can be achieved at an unconscious level
without the therapist knowing the content.
HISTORY
Presenting Problem
Jane was referred by her general practitioner in March 1995 and came
accompanied by her mother. She complained of increasing frequency and
severity of frontal headaches over a four-month period.
The onset coincided with a febrile illness with accompanying headache and
fatigue and was thought to have been viral in nature. The illness lasted about
two weeks, the symptoms being relieved by the use of paracetamol.
However, the headaches continued to occur at a frequency of about three per
week, until the last two months when they began to occur daily. Jane would
often wake up in the morning with a headache or the headache could begin any
time of the day, at school or on weekends. There had been no nausea, vomiting
or aura, but Jane’s mother reported that Jane would often appear very pale. Jane
was experiencing difficulty going to sleep and would often lie awake for a
couple of hours because of the headache. The symptoms were interfering with
daily activities. She had begun to miss days of school and not infrequently
needed to lie down in the sick room. Jane had previously been very active in
basketball but there had been a reduction in performance and she often needed
to leave the court during the match, because of fatigue or headache.
Requests for reprints should be sent to Patricia Burgess, 27 Nunyah Drive, Banksia Park,
S.A. 5091.
53
54 Burgess
There had been changes in mood and behaviour and her mother reported that
she had become more “clingy” and seemed insecure. She appeared easily upset
and at times very teary.
Jane’s own assessment was that she did not know why she had headaches.
She told me sometimes she “felt sad” and even though she liked school, had lots
of friends, was happy in her family and loved her sport, she sometimes felt she
could not “cope.”
Management at the Time of Presentation

At the time of presentation Jane was needing regular four-hourly pain relief
during the day. Her mother was making every effort to “stretch out” the
medication (Paradex), but she was increasingly concerned about Jane’s
dependence. She was also taking Inderal 30 mg twice daily prescribed by a
paediatrician.
Jane had been assessed early in 1995 by a paediatrician, who had diagnosed
probable migraine and early puberty. Full medical and neurological examinations
were normal as were X-rays of the facial sinuses. Jane was commenced on
Sandomigran 0.5 mg to 1.0 mg twice daily. When this failed to provide relief,
she was commenced on Inderal 20 mg twice daily, this being later increased to
30 mg twice daily, in the hope of achieving control. Jane appeared to have failed
to respond to the two frequently used drugs for migraine prophylaxis and there
was concern that something more serious was present. A cerebral CT scan
showed no pathological lesion.
Jane and her family were naturally a little more than anxious about her lack
of response to the “normal” range of drugs. Coupled with this was increasing
concern about the development of dependence on Paradex.
Past Medical History

Apart from a bout of abdominal pain in 1994, history of sore throats and
tonsillectomy twelve months earlier, Jane’s physical health had been good.
There had been nothing in the history to indicate psychological ill health.
Family History
Jane is the youngest of five children in a close and supportive family
environment. She has two brothers and two sisters.
Jane’s mother suffered several migraine headaches when younger. There was
no history in the family of depressive illness. Jane liked school and was a good
achiever under her own efforts. She enjoyed reading, while her main sport was
basketball, in which other members of the family were involved. Jane was a
good player in a team which was achieving considerable success.
The family had a pool at home and Jane often spent time swimming, and just
enjoying being in the pool. She loved birds and she had many budgies of her
own, many different colours, but her favourites were the yellow ones.
Treatment of Headaches 55
SUITABILITY OF PATIENT FOR HYPNOTIC PROCEDURES

Since the days of Bernheim in the late nineteenth century, we have known that
children are more hypnotisable than adults, as long as they understand the
instructions and pay attention, the peak age being about 7 to 14 years (Gardner
& Hinton, 1980). Trance-like states and daydreams are very common to
everyday childhood experiences.
Other important factors contributing to suitability of this patient for hypnotic
procedures were as follows:
1. There were no contra-indications.
2. The problem that Jane had was amenable to hypnotherapy.
3. Jane and I had established good rapport and Jane had witnessed the positive
interaction between her mother and myself.
4. Jane wanted to get better.
5. Jane’s parents readily accepted the concept of hypnosis, and understood it to
be non-threatening to her.
RATIONALE FOR USE OF HYPNOSIS IN THIS PATIENT

Recurrent or chronic headaches are often psychogenic in origin, but it was
difficult to put this sole label to Jane’s headaches. By the time I saw her there
had been extensive investigation into the nature of her headaches and I was
satisfied that there was no pathology which would require other types of
management. Recent Epstein-Barr (glandular fever) studies had indicated that
Jane had been exposed to the virus sometime in the past. This was probably the
virus which, four months ago, had triggered the headaches. What began
originally as an organic headache, ultimately was composed of anxiety factors
and possibly iatrogenic as well.
The ability to manage pain by hypnotic techniques is known to be related to
hypnotisability and children are generally expected to do well. Jane did not
appear to have any underlying emotional need for her headache and in such
cases symptom-oriented methods can work very quickly.
Chronic pain is accompanied by anxiety (“I can’t cope”) and depression (“I
feel sad”) which in turn exacerbate the pain and so the cycle goes on.
Anticipation of pain and subsequent anxiety can add to the pain experience. The
use of hypnotic techniques can break this cycle and allow the child to move
towards personal well-being and security.
My experience has been that, often, children in chronic pain are “out of
control,” need mastery over themselves and their environment. Hypnotic
techniques can allow children to regain control and manage their own
problem.
GOALS OF MANAGEMENT
1. To explain the nature and cause of the problem to Jane and her mother.
2. To actively increase Jane’s motivation by my enthusiasm for success and so
56 Burgess
foster continuing sense of hope.

3. To teach Jane strategies for gaining control of her problem and thus curing
her headache.
4. To enable Jane to regain her former state of physical and psychological
health.
In using hypnosis I planned to:
1. Use the relaxation response to reduce anxiety and muscle tension, and thus
show Jane how she could “feel different.”
2. Increase response to suggestion for ego-strengthening and to use post-
hypnotic suggestions for symptom control.
3. Create alterations in perception of the pain.
4. Encourage Jane to privately communicate with deeper levels of awareness.
SPECIFIC TECHNIQUES
1. I planned to use a blend of permissive and direct suggestions for involvement

in visual and kinaesthetic imagery, utilising Jane’s particular areas of
interest.
2. Therapy techniques were to be mainly metaphors to arouse curiosity and to
encourage Jane to explore new frontiers.
3. Jane and her mother had begun monitoring the severity of the headache on a
scale of 1 to 10, so I planned to continue this as a guide to progress.
4. I planned to incorporate post-hypnotic suggestions which would offer a series
of challenges to allow Jane, in her own time, to move forward to success, and
which would build in protection for any future headache.
SESSION ONE
With the knowledge of the positive Epstein-Barr study, I was able to give a name
to the origin of Jane’s problem. I explained the nature of post-viral headaches
and time needed for their cure. I also explained how tension and worry can make
headaches worse. The use of medication was discussed, particularly possible
dependence and side-effects.
I believe that therapy actually commenced when Jane first began to explain
her problem to me, and together we were able to create favourable conditions
for a positive outcome. When Jane and her mother first presented, the situation
to me seemed rather urgent, as she had been in discomfort a long time, and she
had this feeling of “sadness.” Her headache was usually about level 5 on the
scale but with Paradex at times it was 3.
I told Jane that I could show her ways of curing her headache if she was
willing to learn. She could do it where no-one else had been able to. My
explanation of hypnosis was that it would involve imagining doing things that
she liked and going on imaginary trips to find interesting and lovely places and
perhaps to meet new friends. I elaborated on these ideas, linking in to a child’s

natural curiosity for new experiences.
Jane needed no encouragement and, with permission and support from her
mother, I proceeded with hypnosis at the first session. The induction was
“movement imagery” asking Jane to imagine playing basketball with the
suggestion to let her head nod when she felt tired or uncomfortable and needed
to rest. At this signal I asked her to rest quietly. I then offered ego-strengthening
suggestions, aiming to help Jane feel more self-worth. I explained once again
the cause of her headache and how no-one had been able to fix it. I reaffirmed
my belief in her ability to help herself because “you are a special person, part
of a special family who love you and want to see you as your old self again.”
I then asked Jane to imagine herself in her pool at home, floating, and with
whom she liked. I asked her to feel light and floaty, and to imagine her headache
becoming cool and floating into the water. This was followed by, “Now Jane I
want you to make your headache just a little bit stronger, just up to 5, and nod
your head when you have done that.”
Upon the signal, this was quickly reversed with the suggestion for, “Now you
can do that, so you can float the headache away in the cool water, and watch
your number scale as you do that. Feel how better the headache is now.” This
was followed by a post-hypnotic suggestion for daily practice: “Little by little
every day from now on you will find that you won’t be bothered so much by
your headache, and you will be pleased how much happier you feel. Soon you
will be able to enjoy your basketball and all the other things that you like.”
Jane had enjoyed the floating and had her budgies on her tummy. She had
begun the session with a number 3 headache and increased it to number 5 on
request. It was now less than 3. Jane told me she would practise every day and
we discussed the possibility of her school teacher allowing Jane to use her
hypnosis if the headache was a problem at school.
SESSION TWO
When I saw Jane one week later her headache was on number 2. She had been
without Paradex for three days. She was feeling better and was back playing
basketball although she had not played in a competition. Getting to sleep was no
longer a problem. Jane had practised floating her headache away twice a day
(always at bedtime) and at school when needed. She looked better, and was keen
to learn more.
I planned at this session to:
1. Reinforce Jane’s achievements so far.
2. Allow her to develop an increasing sense of control through imaginary
involvement, and enhance her ability to solve her problem when no-one else
could.
3. To build on previous post-hypnotic suggestion for achieving success.
58 Burgess
I used the basic framework of Marlene Hunter’s trip on a cloud through a

rainbow and “a child like you.” When we (Jane and her friends and myself)
reached the rainbow on our cloud, Jane was allowed to direct the cloud to fly
though any colour she wished. We then proceeded as follows:
and now that we are on the other side of the rainbow we see a beautiful land,
green grass, beautiful flowers, buildings and lots of happy people. Our cloud
settles down on a soft green lawn so we can all climb out. When you look
around, you can see all sorts of interesting things, Jane, but you begin to
notice that there is a little girl who seems to be standing on her own. There
are lots of happy people around but she does not seem to be happy. She has
had a headache just like yours, she has had a rotten old headache for a long
time and nobody seems to have known what to do to help her. She is very
miserable and her family is miserable too. But she knows that you have had
just the same problem and somehow she looks a little like you. She has
beautiful blond hair, she has a green T-shirt on and blue shorts and she does
look a little like you. So she understands that you know what your headache
was like, and she also knows that you have done something to help your
headache go away, something that other people could not do. She wants to
ask you to help her. Jane just nod your head if you would like to help this
little girl. That’s good, very good. Now you can talk together and I need not
know about this. She is relying on you to help her, so spend time talking to
her. And she wants to ask you some questions and you can answer them. I
need not know any of this . . . it is your own very special secret between the
two of you. She seems to live in such a happy place and it is not nice that she
has been so unhappy. When you think you have answered her questions and
told her what she needs to know, just nod your head. . . That’s good, well
done. And you will be able to visit this little girl any time you wish . . . in
fact she would probably look forward to seeing you again.
The return journey involved passing twinkling stars and a smiling moon, with
Jane checking that everyone was safely back home in our land.
Then followed ego-strengthening suggestions and reinforcement of previous
post-hypnotic suggestions:
I think that it won’t be long before your headache will be down to a number
1, and very soon after that I think it will be at a zero. But, in the future if you
do have a headache, then you will tell someone about it. But I think it won’t
be long before this headache is down to zero. And you can feel very pleased
with yourself. You’ll find that you will be so interested in what you are doing,
now that you can play basketball and enjoy all those things that you like, that
the old headache won’t bother you.
Jane had been part of the whole experience and had taken her birds and a
school friend with us. She told me that the land was very bright and pretty and
that she would like to go back to see her new friend.
SESSION THREE
One week later Jane’s headache was at a number 1 and there had been no need
for Paradex. She continued to practise every night, going through the rainbow
to speak to her new friend. Jane’s mother noticed that Jane rarely mentioned her
headache, she was enjoying life again, basketball was in full swing and Jane did
not need to practise at school any more. Jane’s mother commented that she “had
her child back again.”
The family had kept an appointment previously arranged by their general
practitioner with a second paediatrician. He had concurred with the diagnosis
and was supportive of hypnosis. Inderal was to be withdrawn on a sliding
scale.
Despite good progress, I felt that Jane still needed to experience one further
dimension important for childhood growth, that of rewards. At this session I
planned to extend the metaphor used previously. This time the “child like you”
was better and wanted to thank Jane for her help. She shared a special secret
with Jane, taking her to an old palace that she had discovered. The two girls
spent time dressing up in princesses’ clothes, with lots of jewellery and crowns,
all the while feeling how good it was to be happy and free.
OUTCOME
Just over a week later Jane was headache free. She continued to practise and had
been floating the headache away in cool sand at the beach, telling me that she
had made this up herself.
Later, Jane’s mother told me that Jane had helped her older brother deal with
an itchy rash, telling him how easy it was to “imagine it away.”
Up to this time Jane remains well. She chose to use her hypnotic talents,
instead of taking a Panadol recently, after she had had sutures to a chin
laceration.
DISCUSSION
The goals of management were achieved in three sessions of hypnosis. Once
Jane had a taste of success, her mastery increased. The final step was to use her
natural childhood tendency for sympathy and the innate impulse to help “a child
like you” who was really herself. She allowed nothing to be final or fixed about
what she had learnt, being able to use her skills with her family.
Very often hypnosis is thought of as a last resort, and I must say that I found
this to be a huge advantage. I had the benefit of information about failed
treatments: I had a child who felt oppressed and a failure because she had not
met medical expectations: I had supportive parents who needed answers and
help: but best of all I had a child who wanted to get better.
It makes sense to postulate that Jane’s headache had many facets to its
chronicity. Her lack of understanding and information about its cause created
anxiety, which probably decreased pain tolerance, and side-effects from one or
60 Burgess
more drugs or a combination of drugs.

Children are so much influenced positively or negatively by adults and so
often perceptions of symptoms can be temporarily or permanently affected. This
case has been a reminder to me to be ever-vigilant in my response to children in
pain. All who are involved in the care of children should be aware of the need
for sensitivity in responding to a child in pain.
Gardner (1976) points out in one of her surveys of health professionals’
attitudes to hypnosis that most felt comfortable with other treatment modalities
(pharmacological) and would continue with those before exploring anything
unfamiliar to them, even if the familiar approach was apparently inefficient.
Although this survey was done in America and in 1976, I suspect that in
Australia the situation may well be the same today.
REFERENCES
Gardner, G. G. (1976). Attitudes of health professionals towards hypnosis: Implications
for training. International Journal of Clinical and Experimental Hypnosis, 14,
63–73.
Gardner, C. G., & Hinton, R. M. (1980). Hypnosis with children. In G. D. Burrows &
L. Dennerstein (Eds.), Handbook of hypnosis and psychosomatic medicine (pp.
205–231). Amsterdam: Elsevier.
Vol. 25, No. 1, 1997, pp. 61–73
POST-TRAUMATIC STRESS DISORDER
Malcolm Desland
Psychologist
A 40-year-old woman presented with a complex chronic PTSD, including a rape (18
months before admission), a rape at age 15, and a childhood sexual abuse history. Coupled
with this was a previous negative therapy experience. At presentation she was severely
symptomatic, excessively anxious and avoidant. This case study discusses her history and
presentation information, assessment of hypnotisability, case formulation in light of a
previous negative therapy experience, counter-transferential issues, and initial interventions
utilising hypnosis and cognitive behaviour therapy. Therapy is still continuing, so follow-
up and outcome data are not available.
The available clinical and research literature indicates a relationship between

Post-Traumatic Stress Disorder (PTSD) (DSM-IV; American Psychiatric
Association [APA], 1994) and hypnotic phenomena (Evans, 1991, 1994;
Spiegel, 1994; Spiegel, Hunt, & Dondershine, 1988). PTSD symptoms fall into
three clusters: (a) intrusive symptoms such as nightmares and flashbacks; (b)
avoidant behaviours, such as emotional numbing/detachment and avoidance of
anxiety evoking stimuli; and (c) arousal symptoms, including hypervigilance,
exaggerated startle response and anger outbursts (APA, 1994; Turner, 1991).
Spiegel (1994) and Evans (1994) state symptom clusters parallel hypnotic
phenomena. Intrusive symptoms parallel absorption; avoidant symptoms parallel
dissociation; and arousal symptoms parallel the heightened suggestibility of
hypnosis.
PTSD sufferers demonstrate higher hypnotisability levels than other
psychiatric disorders and the general population (Spiegel et al., 1988). High
dissociation and absorption levels are also reported (Bernstein & Putnam, 1986;
Branscomb, 1991; Bremner, Southwick, Brett, Fontana, Rosenheck, et al., 1992;
Coons, Bowman, Pellow, & Schneider, 1989; Mackay, 1994).
Evans (1991, 1994) argued that hypnosis is the optimal choice in helping this
population. Hypnosis actively accesses dissociative and absorption phenomena,
increasing therapeutic effect and reducing therapy duration (Brown & Fromm,
Requests for reprints should be sent to Malcolm Desland, 8/19 Campbell Street, Parramatta,
N.S.W. 2150.
61
62 Desland
1987; Spiegel, 1994; Stanley, Burrows, & Judd, 1988).

This case study examines hypnosis and cognitive behaviour therapy (CBT) in
treating chronic complex PTSD in a 40-year-old woman named Ms V who was
admitted for in-patient treatment. The assessment spanned four interviews,
including psychometric tests during the first 10 days in hospital.
ASSESSMENT INFORMATION
Presenting Problem
Eighteen months previously, Ms V was raped by a masked intruder while

working night shift in a developmental disability home. She was attacked from
behind and forced to the ground. During the attack she sustained knife wounds
to her left shoulder. She managed to convince her assailant to stop and talk for
two hours as she attempted to dissuade him from raping her, but she was
ultimately unsuccessful. The police arrived shortly after she called them and the
next day was spent at the police station. She was then referred to the local sexual
assault centre where she attended weekly for six months. She was then referred
to a consultant psychiatrist whom she saw weekly for 12 months. The
psychiatrist then recommended in-patient treatment.
Four days prior to the rape she had returned to work after time off for a
hysterectomy operation. The rape caused internal bleeding, which necessitated
surgery in the week after the rape to cauterise the injuries.
Background Information
Ms V was the second youngest of six children (five boys, one girl). Her early
family childhood was described as “idyllic.” She was closest to her father, but,
at about age eight years, this changed when her father developed a drinking
problem. The closeness turned to sexual abuse. This lasted from age 8 to age 16,
when she left the family to marry her present husband. This still exerted effects
upon Ms V. In a flat detached manner she spoke of her anger and disappointment
at him “ruining” the relationship. The sexual abuse has remained a secret to
other family members. Her father died from cancer when Ms V was 21. She
reported nightmares of her father and stated her sexual relationship was
negatively affected by what had happened to her. At age 15, Ms V was raped by
a masked man while dating her present husband. The couple were parked at a
secluded spot when a torch light shone in their faces. A man claiming to be a
police officer told her husband to leave the car. He was tied up and Ms V was
raped.
In the late 1980s, she was contacted to give evidence in a legal case where a
police officer was charged with multiple rapes. Ms V gave evidence about her
own rape. This was disturbing, as the accused was the chief investigating officer
on her case. The investigation against the accused was inconclusive, he was
PTSD 63
acquitted and awarded compensation, which Ms V found very distressing. With

his compensation, the accused retired to live in Queensland, the state in which
Ms V lived. This resulted in relapse of PTSD symptoms in Ms V and alcoholism
in her husband, prompting a rapid sale of their home (at a substantial loss) and
a return to New South Wales.
Ms V is married with three children. Her early married years were troubled
by her husband’s drinking. He was not violent, though verbally abusive and
unreliable. He sought help through Alcoholics Anonymous and had remained
abstinent, apart from the lapse mentioned. Her family is supportive and tolerant.
She sees herself as not deserving this. Since the last rape, the family have
purchased two large dogs to help Ms V feel safe. She considered herself “a
burden to all.”
Ms V did not complete Year 10 and has had a range of jobs. In recent times
she had worked for the Department of Community Services in a developmental
disability home. She spoke highly of this job, believing she “was made for it.”
Since the rape, she has not returned to work. She fears being forced to return to
work as part of her occupational rehabilitation.
Ms V has a supportive social circle of friends, although most were unaware
of her PTSD. She reported no alcohol or social drug use, stating she did not
want to “lose any more control.”
Medical Status
Ms V had hypotension through a congenital kidney condition. This was managed

by Aprinox (bendrofluazide). At presentation she was taking Xanax (alprazolam)
and Prozac (fluoxetine).
Previous Treatment
Ms V’s first counselling was with the sexual assault centre. She viewed this
counselling as negative, “going around and around in circles. I couldn’t see the
point of going over and over it again.” She perceived the counselling as
bewildering and focused unnecessarily on her husband’s former drinking. She
was encouraged to attend AA, even though she did not feel alcohol was
relevant.
The “final straw” came when the therapist conducted an eye movement
desensitisation and reprocessing (EMDR) technique (Shapiro, 1989a, 1989b).
Prior to the EMDR usage, a progressive muscle relaxation was conducted which
resulted in a dissociative experience for Ms V. She visualised Freddie Kruegger
(the main character in the Nightmare on Elm Street films) at her feet. She
reported the session was conducted as the therapist read a journal article on
EMDR. The session ended with Ms V leaving extremely traumatised, and she
had a car accident while driving home. Contact with the therapist was
terminated.
64 Desland
The psychiatrist’s sessions were supportive but had not decreased her distress
greatly. Commenting she could “often see the point of the advice, but [I] can’t
do it.”
Current Symptomatology
Ms V presented in a very distressed state. She reported dissociative episodes,

including flashbacks, intrusive thoughts, and emotional lability. Her rape
memories were “fuzzy” and she commented that, for a long time after the event,
she was “only half there.” She reported her traumatic experiences without affect
or expression. Her sleep was erratic, punctuated by nightmares of both rapes and
the familial sexual abuse. Nightmares and flashbacks included movie characters
from Teenage Mutant Ninja Turtles and Freddie Kruegger. Ms V believed both
were expressive of previous traumata: the ninja turtles are masked and stocky in
build, similar to the recent rapist. Ms V’s psychiatrist interpreted dreams of
Freddie Kruegger, with his long claws and gnarled hands, to be expressive of
incestuous encounters with her father. During the assessment, Ms V was
cooperative, repeatedly saying she wanted to “get better.”
Psychometric Testing
To augment assessment information, the following tests were administered: the

Impact of Events Schedule (IES; Horowitz, Wilner, & Alvarez, 1979); the
Tellegen Absorption Scale (TAS; Tellegen & Atkinson, 1974); and the
Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986).
The IES, on which Ms V scored in the high range, measures PTSD symptom
severity. She was still highly symptomatic 18 months after the last trauma. Most
severity arose on arousal and intrusive symptoms. The TAS measures capacity
for absorption. Absorption phenomena occurs in hypnosis and PTSD. As
expected, she scored higher than the normal range on the TAS (Mackay, 1994),
indicating Ms V was absorbed in her internal processes (Walker, 1994). Given
the traumatic nature of her internal processes, this conveys the distress
experienced. The DES measures dissociative capacity. It was reasoned the
extent of Ms V’s dissociation was important in planning treatment. On the DES,
her scores were consistent with chronic PTSD sufferers (combat veterans and
childhood sexual abuse victims) (Branscomb, 1991; Coons et al., 1989). This
parallelled her reports and presentation.
DIAGNOSIS
Following hospital policy, DSM-IV (APA, 1994) criteria were used. The
following diagnosis and classifications were applied:
Axis 1: Post-traumatic Stress Disorder (Immediate Onset/Chronic type).
Axis 2: No evidence of personality disorder.
PTSD 65
Axis 3: Hypotension and a current congenital kidney condition.

Axis 4: There was evidence of economic problems and problems with the legal
system. Each was due to the rape and subsequent loss of employment.
Axis 5: Current Global Assessment of Functioning (GAF); 35. Highest GAF
level in last year; 50.
CASE FORMULATION
The following issues were considered:

1. Negative EMDR experience: EMDR is considered a dissociative treatment
(Evans, 1994) evoking abreaction. It was imperative for hypnosis procedures
not to fall into the same “abreactive trap.”
2. Dissociation and DES scores: it was hypothesised similar high levels of
abreaction could be induced in hypnosis. This should occur within the
contained context of a strong trusting and structured therapeutic
relationship.
3. Reactions to nursing staff: regular monitoring was required.
4. Therapy would focus on empowerment over symptoms and symptom
removal, using Ms V’s decision making and choice. Therapy including
hypnosis would be collaborative (Golden, 1989). Ms V would be active in
therapy, as opposed to a therapist ministering treatments to “get her better.”
5. Hypnosis as an intervention would be applied using caution and structure, to
minimise any noxious images or effects.
ASSESSMENT OF HYPNOTISABILITY
Hypnotisability was determined considering three factors:

1. Her attitude and perception of hypnosis.
2. Hypnotisability as measured by the Stanford Hypnotic Clinical Scale for
Adults (SHCS:A; Morgan & Hilgard, 1979).
3. Assessment of contraindications.
Ms V reported no prior hypnotic experience. It had been recommended by an
insurance medical officer. After an explanation was given, she was positive
about hypnosis. Though the literature documents higher hypnotisability in
PTSD victims (Spiegel et al., 1988), assessing an individual client’s
hypnotisability is required. Ms V scored in the high range on the SHCS:A (5/5).
No contraindications were evident.
THERAPY
This description begins with session 5, in which the hypnotic procedures were
commenced.
66 Desland
Session 5
I explained that hypnosis was an altered state of consciousness which parallelled

other normal spontaneous changes in consciousness (becoming lost in a
daydream, or becoming immersed in reading a good novel). We talked about
attentional shift occurring, enabling the person to suspend the usual functions of
consciousness, permitting a focus on internal processes. I also informed Ms V
of other changes to consciousness which might occur, promoting a relaxation
response, suspending critical self-awareness, and reducing vigilant monitoring.
She consented to hypnosis.
Ms V was educated about PTSD symptoms and their relationship with
hypnotic processes (Evans, 1991, 1994). Dissociation was used to help her
“reframe” her current way of coping with intense feelings. Intrusive symptoms
were explained as the central symptoms of PTSD. The inherent imagery was
“painful, distressing and very absorbing.” Absorption was explained as an
involuntary capacity to become lost in internal experiences (Mackay, 1994;
Walker, 1994). Ms V was relieved with this, as it removed part of the personal
blame and weakness she felt for having nightmares and other symptoms. Relief
was promoted further by the information that therapies utilising hypnosis could
change this. Hypnosis would be used to promote relaxation, alter intrusive
imagery, and promote helpful imagery aimed at change. Ms V was told that
therapy was collaborative (Golden, 1989), utilising her ideas as much as the
therapist’s.
Ms V’s arousal was caused by cognitive, dissociative, and physiological
factors. Cognitions identified were: “I will never be safe again,” “It [rape] will
happen again,” “I cannot stop it happening because I am stupid,” “I should have
died that night,” and “I deserved it.”
Dissociative symptoms included experience of, and attempts to avoid,
flashbacks. The Freddie Kruegger image occurred intermittently. Other
dissociative phenomena included seeing or feeling a “shadow” behind her or
someone watching her.
Physiological symptoms included heart palpitations, muscle tension, rapid
breathing, hypervigilance, and rigidity.
The initial intervention was to develop a “safe place.” Ms V said she felt
safest or relaxed when taking a bath in the late afternoons at home, but that she
experienced this feeling very infrequently. Reducing arousal symptoms would
not be merely remedied by “safe place” imagery. This was conveyed to Ms V to
orient her expectations.
Session 6
Ms V felt better since the last discussion and hypnosis was commenced with a
modified eye fixation induction with suggested eye-closure. Suggestions to
relax with each exhalation occurred. Deepening constituted a 1–20 count. The
PTSD 67
induction and deepening were selected for their straightforward simplicity. In

trance, Ms V was asked to “spend a few moments getting used to this,” and then
feedback was elicited. Slowly, she responded, saying she felt “fine.”
The session was devoted to safe-place images. Given her high hypnotisability,
regular feedback was gained. The intention was to monitor and, if necessary,
alter any noxious effects. Images were developed through imaginative
involvement, with each image coupled with soothing suggestions (knowing the
place, feeling OK, letting herself relax). Feedback was received before
proceeding to the next image. The initial images were her home, the yard,
surrounding bushland, seeing both dogs, husband and sons around the house.
Ms V was asked to visualise herself “floating” in the bath (Spiegel, 1994).
Positive suggestions were made of feeling warmed by the water, reassured when
seeing her bathroom nicknacks, burning incense, flickering candles, and the
sunset through the window. Ms V was urged to comfortably lose herself in this
reassurance. Her feedback: “I’m feeling wonderful.”
Suggestions were made to relax different parts of her body. This comfortably
flowed until her hands were reached. With this, the Freddie Kruegger image
appeared at the window. Ms V reacted with tension and fear. She was asked to
relate her experience, and she uttered “frightened.” Questioning and therapeutic
interventions assisted Ms V, identifying the intensity of the fear, tolerating this,
and investigating it. This exposure lasted briefly, with Ms V requesting it to end.
She was asked to visualise steam clouding the window and the image growing
smaller. Anxiety reduced and the body relaxation recommenced. De-hypnotising
used a 20–1 count, with suggestions of bringing the relaxed feelings into the
waking state. In debriefing, Ms V expressed ambivalence; feeling positive about
the relaxation and pleasant imagery, combined with anger and annoyance with
the intrusive stimuli. She experienced visual (flickering candle), kinaesthetic
(floating and warmth of bath), and olfactory (incense fragrance) stimuli during
trance. The same induction, deepening and de-hypnotising procedure was used
throughout therapy.
Session 7
Hypnosis was not conducted in this session. Ms V reported she had experienced
intrusive stimuli during the day and nightmares at night since her last session.
Despite this, she felt more relaxed, but “hassled” and intrigued by Freddie
Kruegger’s image, and expressed the desire to explore methods of alleviating
these images. Explanations regarding CBT interventions were given including
exposure, desensitisation, or modifying the image (Spiegel, 1994). Ms V
became eager to “get” Freddie Kruegger. This idea evoked embarrassment, glee
and anxiety in her, and she was cautioned to maintain realistic expectations. She
was encouraged to use her absorption capacity by attending to positive stimuli.
Absorption as a concept was elaborated, indicating it would work both positively
and negatively. Ms V was asked to experiment by focusing on flowers and a
68 Desland
fountain in the hospital grounds. She often found herself “looking at things and
not knowing where the time went.” This was exemplified as positive absorption
and she was encouraged to consciously use this to lift her moods, rather than
using it as an avoidance strategy. The next session was scheduled in two days.
Session 8
Ms V reported enjoying moments of positive absorption. Nursing staff had

reacted differently to this, with some viewing her as becoming more isolated.
An hypnotic trance was induced in this session and safe place imagery
evoked. The intention was to expose negative images, then alter these according
to Ms V’s input. Monitoring through feedback would continue. When asked if
she wanted to alter the image, that is, introduce noxious stimuli, she hesitated,
then visualised Freddie Kruegger behind the closed window. I suggested she
exhale tension by slow breathing and she indicated she was “going up and
down.” As Ms V became more anxious, suggestions to tolerate her emotions
were given and she was invited to change the image. Slowly, she indicated that
Freddie was “now chained to a tree, secure but struggling.” The final suggestion
was to feel her achievement. Debriefing included review and reinforcement of
her gains.
Session 9
This session took place three days later. No hypnosis was used. Ms V reported
feeling good about the last session. Since then, she supported herself by positive
visualisation. Although Ms V felt positive and motivated, her symptoms
remained unchanged. She introduced new therapeutic material in this session by
speaking of her relationship with her father, specifically his tacit coercion. The
striking difference was the increase in expressed affect. She shared with me her
use of dissociative coping strategies as a child. I highlighted the parallel process
with the previous hypnosis session, specifically how her strategies promoted
safety as a child, but, being safer now, she was able to express her emotions.
These different coping behaviours empowered her to face her perpetrators in
different ways as a child and as an adult. She became animated on awareness of
the connection. The next session was scheduled for three days later.
Session 10
Since the last session, Ms V had thought things over, perceived pressure from
nursing staff, and felt more uncomfortable with Freddie Kruegger. She said it
was new for her to feel sad about things in the way she now was. Her sleep was
less disturbed. We talked about feeling emotions and grieving losses and she
lamented the nurses felt she was doing nothing. The vague and derogatory
PTSD 69
weekend nursing notes validated this, indicating a lapse in clinical staff

communication. To remedy this, clinical meetings were arranged
Her increase in expressed emotion coincided with more discomfort about the
negative image and its recurrence. This was dealt with by two interventions: (a)
comments on her beliefs about how much she could emotionally handle and her
fear of losing control; (b) agreement to address this using hypnosis.
Session 11
Ms V initially expressed ambivalence regarding this session as she feared

recalling experiences, despite needing to come to terms with the issue. Her fears
were empathically supported and hypnosis indicated as a method of containing
and managing her fear. The session rationale, to enhance control and
understanding of the negative image, was explained to her. More information
would be accessed by an affect bridge (Gibson & Heap, 1991), enabling
abreaction, exploring aetiology, and identifying associated cognitions.
Safe-place imagery was used with a split-screen technique. The safe place
was visualised on one screen and the disturbing image on the other. Suggestions
of toleration and management of the image and associated affect were made.
Through feedback, Ms V guided alternations between the two screens for
further control and management. When comfortable control was gained, Ms V
was asked to focus on feelings and body sensations generated. She reported fear,
revulsion, disgust, and tightness in the neck. This was intensified slightly by
counting . . . 2, . . . 3, . . . 4. She was instructed to go to earlier experiences of
these feelings. She spoke of the occupational health and safety officer allocated
to her case management. She described him as “a sleazy bastard who couldn’t
be trusted,” detailing how he regularly asked her out for a date. This information
was not given during assessment. She conveyed guilt and anger when stating
that she “must have deserved being raped because” of his actions. Her own
actions in refusing, then telling her supportive supervisor, and reducing contact
were reframed from “defenceless” to self-protective. I tried to help her to
re-contextualise the experience, placing emphasis on the OH&S officer’s sexual
harassment as his own manipulative behaviour and his responsibility, altering
her self-blame to viewing the unfortunate randomness of his selection (Spiegel,
1994).
In trance, Ms V integrated this information and was able to re-attribute
responsibility to the other person. The session ended with suggestions of using
the new information to help herself. Once out of trance, Ms V elaborated on this
experience she had forgotten to tell me. The debriefing facilitated further
integration, altering beliefs about blame for the rape. It was agreed to explore
this in the next session, three days later.
70 Desland
Session 12
Since the last session, Ms V’s use of absorption was continuing well. Intrusive
stimuli during the day were fewer, and more manageable. Her sleep remained
erratic and only slightly improved. Ms V requested the same trance procedure
with the split screen, evoking the affect with improved management, then the
affect bridge. The experiences generated — in particular, the rapist’s actions
which were unpredictable, at times conversant and apologetic, silent, highly
agitated or impulsive — still distressed her.
Material from the earlier, more threatening rape also emerged. He had
threatened to kill her or her boyfriend if anything was said and stated she “had
it coming” to her. I explored the effects of this on her, at physiological,
emotional, and cognitive levels. I tried to subtly dispute her beliefs about blame
and responsibility. Her concern about the possibility of the rape happening again
were reframed as self-protective.
Ms V was asked to consider new thoughts about safety and the possibility of
another rape. This prompted silent vexation. Encouragement was given to
consider the belief that rape would not happen again as she was safe, but she felt
dissonant about this. This was resolved by helping her adopt the belief that she
was safe at this time. She repeated this to herself several times, paired with
concentration on breathing to promote comfort. The session ended with the safe
place screen to stabilise affect.
In debriefing, Ms V spoke about how clear her memories were now, compared
with the “fuzzy” ones she had before. She was exhausted but enthused by the
session. Next session was in two days.
Session 13
In the time since the last session Ms V felt less agitated. Daytime intrusive
symptoms had decreased, but her sleep pattern had worsened. She was aware of
nightmares, but had no memory of them. She requested the same hypnotic
procedure with the intention of getting in touch with the past and “getting on
with it.”
The same procedure swiftly moved from split screens to affect bridge. Ms V
detailed family experiences, with affect ventilated towards her father for his
behaviour. She expressed anger and sadness at the mixed messages from her
father: How she was labelled as “special” and how her father “couldn’t help
it.”
She then expressed anger and bewilderment to her mother for not knowing
the obvious. Ms V was asked to express her new awareness and views to each
parent, and she demonstrated tentative changes in her beliefs. The new beliefs
were coupled with breathing to reinforce the changes and empower her.
The safe-place screen diverted Ms V from this material and she was asked to
recall positive experiences with her parents. This was to promote a complete
PTSD 71
perspective (Spiegel, 1994). She initially struggled, but recalled pleasant

moments with each parent, which were then projected to the safe-place screen.
De-hypnotising and debriefing followed. She expressed mixed reactions to the
session, vacillating between feeling freer and more guilty. I empathically
supported her, by indicating her awareness of a broader perspective and time
restraints which prevented resolution at this session.
Session 14
In the two days since the last session, Ms V’s interrupted sleep continued.
Although accepting this, she sought support from the night nursing staff. She
was fatigued and confused, but okay about the last session. The split-screen
technique was again used. Suggestions were made to investigate and tolerate the
feelings evoked by the positive and negative images. When comfortable
toleration was gained, the images were modified to later events. Using feedback,
this shift occurred twice. Images alternated between each rape and the positive
images of support from others and herself were intensified by counting 1–5 and
coupling breathing.
Sessions 15–18
Ms V wanted to talk things over without hypnosis. Sessions since have

constituted typical therapy sessions devoted to further integration of material
accessed in hypnosis sessions. As such, therapy could be considered a
continuation of the debriefing phase in hypnosis.
Sleep disturbance continued, so her psychiatrist prescribed Tryptanol
(amiltryptiline), which helped achieve regular sleep. Although she continued to
have vivid dreams, the content was no long distressing or traumatic.
Ms V disclosed the abuse to her closest brother. She received another point
of view and felt there was understanding. Ms V and her husband have planned
a reaffirmation of wedding vows and a second honeymoon. Overall observations
and self-reports indicate improvement continuing.
This case study details six weeks of in-patient treatment using hypnosis.
In-patient treatment is still continuing and out-patient contact will be negotiated
to continue therapy. The IES was readministered at the end of session 18. Her
scores had reduced marginally to be in the moderate range. This appeared
inconsistent with her self-reports.
In conclusion, hypnosis and CBT were utilised in an in-patient treatment of
a chronic complex post-traumatic stress disorder. Treatment response thus far
has been positive. Clearly prolonged contact is indicated. The efficacy of this
intervention is still unclear as the resilience of change is yet to be determined in
a community context.
72 Desland
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Vol. 25, No. 1, 1997, pp. 74–79
OBSTETRIC HYPNOSIS: TWO CASE STUDIES
Carolyn Sauer
Psychologist
Marc I. Oster
Psychologist
This article examines the use of hypnosis in preparation for childbirth. Two cases are
described in which a model of obstetric hypnosis was used in psychological preparation
for labour, delivery, and postpartum issues. The techniques were utilised over a relatively
short period of time and offered significant benefits to the mothers. One benefit was
flexibility in terms of helping mothers achieve their individual goals. Other benefits
included an increased sense of self-confidence, ability to remain calm during labour, and
ease of transition into breast feeding. The role of practice on treatment outcome is also
addressed.
There is a substantial body of literature to suggest that the use of obstetric

hypnosis combined with childbirth education produces greater benefits to
mother and child than either treatment alone. Some of the benefits of hypnosis
include reduced medication, decreased perception of pain, higher Apgar scores,
and reduced bleeding (Craker, 1992; Harmon, Hynan, & Tyre, 1990; Oster,
1994). Despite the introduction of chemical agents, hypnosis is re-emerging as
a viable adjunct to current medical procedures in terms of the physiological and
psychological benefits afforded to mother and child.
THE APPROACH
Most models of obstetric hypnosis use a several-session approach over a

several-week period (individual or group) to prepare the expectant mother for
the labour and delivery process (Harmon et al., 1990; Hilgard & Hilgard, 1994;
Longacre, 1995; Oster, 1994). The two cases presented differed from the
aforementioned models in that the patients received two individual hypnosis
Requests for reprints should be sent to Carolyn Sauer, 4535 Missouri Flat Road, Suite 200-
C, Placerville, CA 95667, U.S.A
74
Obstetric Hypnosis 75
sessions on two consecutive days.

The amount of time between treatment and the onset of labour varied. In the
first case, the patient received hypnotic sessions two days prior to delivery. In
the second case, the patient received hypnosis five weeks prior to delivery.
During these sessions both patients were prepared for labour, delivery, and post-
delivery experiences. The patients were also given instruction on the use of
self-hypnosis (Preston, 1995).
SESSION 1
History was obtained regarding the expectant mothers’ previous birth experiences
and their attitudes to childbirth. In both cases this was a second pregnancy and
delivery. Information regarding their current expectations about labour, delivery,
and postpartum experience was also obtained. The patients were then introduced
to hypnosis.
Initially a technique was used to help relieve the patients of previous negative
experiences associated with childbirth and give them some positive expectations
and affirmations (Preston, 1995). This technique involved guided imagery, in
which the patients were asked to picture themselves at a blackboard in a
classroom writing the sentence, “I can manage my discomfort during labour and
delivery.” It was then suggested to the patients they picture themselves in a
library throwing out all books containing negative thoughts and experiences
related to pregnancies and deliveries. They were also given the suggestion to
unwrap three books titled: Success, Desires, and Health and Happiness. These
books were placed in a prominent spot on the shelf. The patients were then
asked to find a comfortable spot in the library and go there for the treatment
phase of the session. Hilgard and Hilgard (1994) have suggested testing for
depth in hypnosis research. These patients were tested for depth of hypnosis at
various times during the treatment using the heavy hand and hand levitation
tests. The results of the tests were consistently positive. Both patients appeared
to achieve a very deep state of hypnosis.
Once in a comfortable place in the library, the patients were given several
techniques for pain management (Longacre, 1995). A direct suggestion was
made that touching the forehead by either the patients or their husbands would
cause numbness in the midsection and total relaxation, and that a touch by a
gloved hand would cause numbing and relaxation to areas such as the vagina
(Preston, 1995). The patients were also asked to picture a pressure gauge on the
wall that measured discomfort related to pressure on the pelvic region. They
could control their level of discomfort by decreasing the numbers on the gauge.
Patients were then asked to picture themselves going through labour and
delivery in great detail, starting with the onset of labour, the trip to the hospital,
arriving on the hospital unit, stage I and II of labour, pushing, and finally ending
with breast-feeding. Each was given additional suggestions related to diminished
bleeding, numbness in the vagina, peritoneum and abdomen, and rapid
postpartum recovery.
76 Sauer and Oster
SESSION 2
The patients were instructed in the use of self-hypnosis which they practised in
the office. They were also taken through the same guided imagery exercise from
the previous session.
CASE PRESENTATIONS
Case One
The patient, aged 32 years, was self-referred for obstetric hypnosis. She reported
this was her second pregnancy in three years. She had attended Lamaze class
prior to her first childbirth. During our initial hypnosis session she recalled
several negative experiences associated with her previous pregnancy. Her labour
was long, approximately 20 hours, and she had complications during the final
phase of her labour, the transition. She received an injection of fentanyl in the
lumbar region of her spine (intrathecal) for pain when she was at approximately
5 cm dilation. She reported that the baby got stuck on her pelvic bone, causing
extreme pain, affecting her ability to push successfully. After being faced with
the possibility of a caesarean she was able to finally deliver vaginally. She
indicated that her difficulty was concern about modesty. Several friends were
present at this birth watching her cope with labour and transition. She was
worried about their impressions of her. The patient reported she had difficulty
recovering from this pregnancy and difficulty nursing. The baby would not latch
on to the breast, reportedly due to inadequate milk production. The patient’s
concerns regarding this pregnancy were: being able to push successfully during
transition, being able to breastfeed comfortably, and whether or not her 2-year-
old daughter would adjust to the new baby. She was also concerned about
embarrassing herself in front of her friends by appearing unable to control her
behaviour during labour and transition. She exhibited some apprehension which
she described as performance anxiety.
Result of Hypnotic Intervention
The patient reported her labour began at home the day following her second
hypnosis session. She reported she used the hypnosis successfully to control her
discomfort at home. She was unaware of using hypnosis after she arrived in the
hospital at 2 a.m., despite her report of being in a trance-like state for the next
two hours while her husband touched her forehead. She received her first
intrathecal when she was dilated to 4 cm. She described her contractions as very
intense compared to her previous labour. She received a second intrathecal at
6.30 a.m. when she was dilated to 8 cm. Subsequently the obstetrician told her
to push. Her initial response was to cry and request a caesarean. However, she
found a comfortable position and began to push effectively, despite the fact that
the baby became caught on her pelvic bone. In spite of the baby being caught,
the patient reported her efforts at pushing were more efficient compared to her
previous delivery experience.
The patient reported several experiences that gave her comfort. She said that,
while pushing, she felt an increased sense of comfort when the obstetrician put
his hand in her vagina and applied pressure posteriorly. She reported achieving
comfort when her husband, watching the foetal monitor, made the comment,
“The numbers are going down.” The patient also reported that the affirmation,
“I can manage my discomfort,” was helpful in coping with the difficulty of
transition.
The patient’s husband was present for the labour and delivery. He reported
this delivery was markedly smoother than the first and he indicated his wife was
calmer and more focused during labour and was more effective when required
to push. According to him, the patient seemed more confident throughout the
entire process and he was impressed with the results.
The patient reported she had heavy bleeding for one day following delivery
and then noticed the bleeding had greatly diminished. Her nipples were very
comfortable despite 24 hours of nursing. She received one dose of Tylenol with
codeine for the afterpains and used hypnosis to control subsequent cramping.
She was surprised to find that she was up and about sooner after this delivery,
compared to her previous experience. Her baby boy, she reported, was easy to
manage and seemed very calm. The Apgar scores were 7 and 9.
At two week follow-up, the patient reported her baby continued to be very
calm and easy to manage. Her milk supply was abundant and her nursing was
going exceptionally well. Her 2-year-old daughter was adjusting nicely to the
presence of a new sibling.
Case Two
The second patient, a 29-year-old, was also self-referred for obstetric hypnosis.
She reported this was her second pregnancy in four years. She attended
childbirth education classes and learned the Lamaze technique with her first
pregnancy, but reported limited success using this technique. She indicated that
once her water broke the contractions began slowly, with low intensity. After six
to seven hours of labour she felt intense discomfort and received an injection of
Nubain. She pushed for one and a half hours.
Her reason for using obstetric hypnosis with this pregnancy was to avoid the
use of medication during and after labour. Her other goal was to have the baby
one hour after she checked into the hospital. She used the Bradley method for
childbirth preparation (Eisenberg, Murkoff, & Hathaway, 1984). The patient had
one complicating factor, which was some abnormal cells on her pap smear. She
was given a suggestion to remove the abnormal cells from her cervix. Two
weeks later a coloscopy showed no abnormal cells.
78 Sauer and Oster
Results of Hypnotic Intervention
During hypnosis the patient accurately predicted the date her son would be born.
Labour began at home where her water broke. She checked into the hospital at
11.30 p.m. and the baby was born at 1 a.m. The patient reported she was very
comfortable until transition, when the pressure became more intense. She felt
calm and in control during the entire process and received no medication despite
the hospital staff suggesting she might want some. She was pleased that she felt
very alert and reported the birth was very easy. During the pregnancy, the patient
had expressed concerns that the baby might be resistive to coming out as she had
this sense with her first child during transition. This baby seemed to come out
on his own as the obstetrician told her to stop pushing toward the end of the
delivery. She indicated that two friends who were present during the delivery
commented on how she made the labour and delivery look easy. The patient’s
husband commented on how he had never seen anything like this. He said, “I
don’t know what you did, but it was incredible.”
According to the patient, the baby was calm and relaxed at birth. The Apgar
score was 9. She reported that she had very little discomfort postpartum. There
were no reported complications associated with breast-feeding. At one-week
follow-up, the baby was still calm and easy to manage. The mother’s bleeding
had stopped and she was feeling comfortable. She felt the hypnosis was useful
for both herself and the baby. She had practised self-hypnosis once a day for
four weeks prior to her delivery.
DISCUSSION
These cases illustrate the benefit of individualising or tailoring the intervention

(Flatt, 1984). In each case the patients used hypnosis in a slightly different
manner, according to their goals relative to the childbirth process. In the second
case, the goal was pain control without pain medication and a shorter labour. In
the first case, the goal was being able to push effectively, control of behaviour
during labour, to breastfeed comfortably, and to help her daughter successfully
adjust to a new sibling.
Another point raised by these two cases is the role of practice with regard to
self-hypnosis and outcome. In the first case, the patient was unable to practise the
self-hypnosis to any degree prior to her labour. Despite this, the patient appeared
to achieve benefit from the hypnosis on a subconscious level as opposed to a
conscious level. In the second case, the patient practised self-hypnosis on a
regular basis and appeared to achieve benefit on a conscious level.
The outcomes of both cases illustrate various types of possible benefits
afforded to mother and child. Both mothers reportedly had calmer infants. Both
experienced a smooth transition to breast-feeding and an increased ability to
manage afterpains. Both also reported a rapid and comfortable postpartum
recovery.
While medication appears to provide benefits in terms of pain management

during labour, it appears to offer little with regard to increasing the patients’
self-confidence and ability to focus. Hypnosis appears to offer benefits to the
mothers in terms of increasing their ability to remain calm during labour, and
increasing their ability to cope with postpartum issues such as breast-feeding,
blood loss, and afterpains.
REFERENCES
Craker, R., (1992). The use of hypnosis in psychological preparation for an elective
caesarean section. Paper presented at the Annual Scientific Meeting of the
American Society of Clinical Hypnosis, Las Vegas, NV.
Eisenberg, A., Murkoff, H. E., & Hathaway, S. E. (1984). What to expect when you’re
expecting (2nd ed.). New York: Workman Publishing.
Flatt, J. R. (1984). Hypnosis in the treatment of smoking: A single session success
story? Australian Journal of Clinical and Experimental Hypnosis, 12, 58–61.
Harmon, T. M., Hynan, M., & Tyre, T. E. (1990). Improved obstetric outcomes using
hypnotic analgesia and skill mastery combined with childbirth education. Journal
of Consulting and Clinical Psychology, 58, 525–530.
Hilgard, E. R., & Hilgard, J. R. (1994). Hypnosis in the relief of pain. New York:
Brunner/Mazel.
Longacre, R. D. (1995). Visualisation and guided imagery for pain management.
Dubuque, IA: Kendall/Hunt.
Oster, M. I. (1994). Psychological preparation for labor and delivery using hypnosis.
Preston, M. D. (1995). Seminar on medical hypnosis. Redding, CA.
Vol. 25, No. 1, 1997, pp. 80–84
CONCEPTUAL THEORY OF SELF-HYPNOSIS
Brian Alman
Psychologist
In 1976 I asked Dr Milton Erickson if he could give me some guidance with a

most important project — writing my book on self-hypnosis. He thought it was
an unusual request from me because we had just finished a day of learning that
focused on the value of face-to-face consultations. In order for a client to learn
self-hypnosis, which was individualised, the therapist and the client would have
to work together. I suggested there could be a book that helped people learn
self-hypnosis and individualise it to themselves. Plus, Dr Erickson and I agreed
that if a person were interested they could always have a meeting with a
professional afterwards or the professional could give them this book for further
training.
Since then, I have continued to try to explain how self-hypnosis works to
physicians, psychologists, dentists, counsellors, medical students, graduate
students, and many thousands of clients. It was during my recent trip to India
that I discovered the conceptual theory that I’m introducing to you now. I was
instructing meditation teachers about self-hypnosis. Few of them knew about
self-hypnosis or hypnosis. I had to describe and demonstrate something of
which they had no previous understanding. This was a first for me since most of
my teaching is with people who often come in with negative or magical
expectations about hypnosis. While I explained to this group that meditation and
self-hypnosis are very similar physically, psychologically and emotionally, they
differ significantly in their focus. Meditation intends to help a person develop a
state of joy, presence, peacefulness, openness, and awareness. Self-hypnosis
taps into the same state, but there is also a focusing on a specific goal, challenge,
or intention. It is a body–mind experience like meditation. Self-hypnosis is used
more as a tool to reorganise thoughts, feelings, patterns, expectations and
outcomes. Naturally, in meditation, self-hypnosis and all of life, each person is
responsible for their own evolution. We cannot make anybody else responsible
and to accept this gives us strength. Self-hypnosis can help create one’s own
Requests for reprints should be sent to Brian M. Alman PhD, PO Box 746, Del Mar, USA.
80
Theory of Self-Hypnosis 81
inner evolution.
The meditation teachers in India were open to learning self-hypnosis but
wanted a better definition. I told them what I knew, based on my years of
experience.
THEORETICAL IDEAS
The conscious mind wants to stay in control. It knows what it’s doing and wants
to keep things as they are, very familiar. The conscious mind wants to keep the
unconscious mind from taking over (which it thinks of as the unknown). The
conscious mind will frequently try to dominate the unconscious mind when it
thinks it is in danger of the unconscious mind manifesting itself in an
uncontrolled way. The conscious mind represents the known and is usually
under control. When we utilise self-hypnosis we are tapping into our unconscious
mind, too. Most people believe that they can manage the conscious mind, but
opening of the unconscious mind could lead to insecurity and this perpetuates
the fear of the unconscious.
This is the conflict: the conflict between the conscious and the unconscious;
between the energy that has become manifest and the energy that wants to
manifest.
Each individual is unique and has the choice whether or not to evolve. Self-
hypnosis is a risk, with the possibility of disappointments, and there are no
guarantees on this journey. One person’s understanding cannot be given to
another. Individuals need to find their own sense of understanding. There are
trials, errors, failures, frustrations, and real living that occurs. With self-hypnosis
there is growth. Clearly, an individual may simply continue their biological/
mechanistic existence and never pursue any kind of individual evolving process.
That is one’s choice.
Every person develops their own unique wall between their conscious mind
and their unconscious mind. As a child, this may have been protective, self-
sustaining, and intelligent at the time. But as the person becomes an adolescent
(medium-sized kid) or an adult (grown-up-sized kid), the protective wall
becomes a barrier and very likely keeps positive potential away more than it
keeps problems at bay. The conscious mind, in trying to protect itself and keep
itself in control, actually ends up keeping the creative potential of the
unconscious mind at a distance. Unfortunately, this means that people try to
resolve problems either with their conscious mind (most waking hours) or with
their unconscious mind (much of sleeping time in dreams which are often
forgotten or discounted). Perhaps, you’re beginning to see where I’m going with
this self-hypnosis theory: self-hypnosis helps remove the wall/barrier and builds
a bridge connecting the conscious mind with the unconscious mind. For the first
time in a long time, an individual can benefit from all of their inner resources
and their conscious and unconscious, simultaneously and together again.
A harmonious relationship between the conscious and the unconscious can
82 Alman
begin with self-hypnosis. For example, imagine a river that has a wall in the
middle of it that is intended to keep two communities apart (which represent the
conscious and unconscious). In order to build a bridge that connects these two
sides of the river, the wall is gradually removed. Once a longstanding wall is
removed, including the Berlin Wall, which surprised the whole world when it
came down, a bridge for new communication develops automatically.
As a demonstration of this, I had each of the meditation practitioners go
through a six step-process:
1. With eyes open, write down a challenge that you are facing in your life at the
present time
2. With your dominant hand, write down everything you can think about while
focusing on this problem . . . thoughts, ideas, doubts, etc.
3. With your eyes closed and with your non-dominant hand, communicate
everything you feel, and imagine while focusing on this challenge . . . and
this may be with shapes, designs, doodling or words.
4. Still with your eyes closed, imagine that you are up on a hill looking down
on a bridge that is connecting two sides of a river (like East and West) and
it’s replacing a wall that has blocked the two sides of the river for years. Now,
from this observer perspective without judgment or criticism, and with your
non-dominant hand (or with your dominant hand or both hands together),
allow your writing utensil to move across the paper as you allow for a
dialogue between the conscious mind and the unconscious mind . . . the East
side of the river and the West side of the river . . . and everything else that
you are able to observe about this transformation from this detached and yet
absorbing point of view. Be aware that at any time you need to feel safe,
secure, with just enough detachment and perspective, you can always feel
free in the observer perspective . . . during this experience and during any
experience, as need be. Simply, remember the bridge that you are creating
and allow your breathing to re-connect you with this any time. Naturally,
your breathing is a bridge between your outermost self, your body, and your
innermost self, your awareness. Perhaps, you can notice that your conscious
mind and your unconscious mind are thanking one another for their concern
and even saying, “I’m sorry for ignoring you in the past.” It’s possible now
for them to tell each other what they believe is important for the other to
know. Let them connect closer on the bridge and in your own worlds, saying
something like, “I want to come closer and be a friend . . . I never thought
about you working for me all those years and I have never thanked you and
is there anything that I can do better for you in our future?” Just allow the
writing utensil to move across the paper as they dialogue.
5. Next, with your eyes closed, imagine that you are up on what may be the
highest hill around and you’re looking down at the observer on the hill below
that has been observing the bridge that’s connecting the two sides of the river.
So, you’re observing the observer and you’re observing the bridge that’s
Theory of Self-Hypnosis 83
connecting your conscious side with your unconscious side. Now, with both
hands together or your non-dominant hand or dominant hand . . . it really
doesn’t matter . . . your choice . . . and without any judgment, criticism or
filtering . . . allow your writing utensil to move across the paper as you
describe what you’re observing about the observer who is observing the
bridge and both sides of the river. Allow the writing utensil to move across
the paper as you, from the highest hill point of view, observe what you can
about what’s going on down there on the bridge as the two sides of the river,
(the conscious mind’s ideas and the unconscious mind’s creativity), connect
with one another harmoniously.
6. Finally, as you are getting ready to finish with all this in the next few minutes
(and you know you can come back to this experience any time you choose
to), re-focus on the rise and fall of your breath. Also be aware that the bridge
that connects your conscious mind with your unconscious mind is the key
that opens up the wall, removes the barrier and develops the new internal
structure for your whole self. You may want to acknowledge that from any
observer perspective, this is the master key that can open up all the doors.
While you’re finishing up and relaxing inside about letting go and going with
the flow, keep in mind that the pilgrimage itself is the goal.
The unconscious mind has almost always been in conflict with the conscious
mind. The conscious mind has tried to dominate the unconscious mind because
it believed it was in danger of the unconscious manifesting itself. The conscious
mind is controlled and the unconscious is not. You can manage the conscious but
with a burst from the unconscious an insecurity may develop which is the fear
of the conscious mind. This is the conflict. The conflict between the conscious
and the unconscious; between the energy that has become manifest and the
energy that wants to.
Self-hypnosis and hetero-hypnosis open up the whole issue of vulnerability
and what is possible. As you approach the bridging the conscious mind and the
unconscious mind in a way that is respectful, maintains each individual’s
dignity and allows for a whole outcome, making friends with yourself like this
expands the communicating, caring and relaxation better than perhaps ever
before. The building of the bridge can take time and a commitment to the
construction.
As an example, on the first day of my five-day workshop in India, a doctor
asked me if self-hypnosis might be helpful in helping him manage his anger. He
went on to tell me that his younger brother had just died of leukemia and how
quickly it seemed that his brother, who was only 19, had gone from healthy to
dying. This doctor had always benefited from his meditations when he was
unhappy, going through a difficult time, or even been sick himself. This time he
was really troubled because he was getting angry with his wife and co-workers,
and felt like these feelings were underneath the surface at all times. When I
demonstrated the approach described above, he was the volunteer subject. As
84 Alman
one might expect, his meditation experience allowed him to get into a calm,
peaceful state very easily. Once he allowed his conscious mind to communicate
what it was thinking about his present life situation, he expressed a lot of self-
doubt, self-criticism regarding not being a good enough brother, and a variety
of negative expectations about his future. His unconscious communication
allowed for sadness, tears, anger, and longing for his brother. He also expressed
a comfort as if his brother were with him, telling him not to worry, that he was
okay now, and that he loved him for all that he had been. The bridge and
observer perspective opened up a whole new way of looking at the whole thing.
The doctor felt like his own inner therapist was reminding him that he could
choose to be afraid of living now or he could be free and evolve with all that was
happening to him and his family. He was able to realise that if he stayed stuck
in the fear of living he would be a slave. He would not have to be responsible
and this could even become comfortable. This could be less of a burden. Then,
he made the choice to be responsible and it was time now to deal with the
struggle. He could see that he alone was responsible and there was no escaping
this. He did not want to postpone the problem or deny the responsibility. In all
of this he felt courageous for the first time in a long time. He felt more
comfortable being expressive and it was described as a “positive force.” He
finished the process with a sentence about his choice as being totally his
responsibility.
Self-hypnosis can open up the doors of inner evolution including: listening to
your inner wisdom (both logical and poetic), learning to deal with all sides of
oneself (female, male, aggressive, receiving, open and waiting), reorganising
the way you experience yourself and situations (in friendship, work, love, or
problems . . . when in doubt, go deeper), living in the present and stopping the
past from controlling you now and in the future (with awareness and courage
dealing with the predetermined and the undetermined ways of life), and
accessing personal resources to overcome denial, boredom, imbalance, or any
vicious cycle (each of us must grow like a tree – in all directions – if we grow
in only one direction we are bound to be in deep difficulty). Naturally, there are
unlimited applications for self-hypnosis, especially as we learn to accept
ourselves as a whole human being. And we remember that the pilgrimage is the
goal.
Thank you for your openness in accepting your conscious mind’s ideas and
your unconscious mind’s creativity. Together, you are able to utilise all of your
resources with any issue, any time you choose.
Vol. 25, No. 1, 1997, pp. 85–88
CASE NOTES
The aim of Case Notes is to enable readers to contribute brief items and case material
drawn from their own experience. These may be case situations in which hypnosis has
been used in treatment or a description of specific hypnotherapeutic techniques used
within treatment contexts. The contributor is asked to supply as much information as is
needed to ensure the reader has an understanding of the situation, the therapeutic aims of
the hypnosis, and outcomes. It may also be appropriate for the contributor to research the
relevant research and clinical literature to justify and explain their use of hypnosis. While
the standard criteria for publication in the journal will not necessarily apply to Case Notes,
a clear exposition of the ethical professional practice of hypnosis will be required if the
material is to be published.
USING ERICKSONIAN HYPNOSIS AS A TRAINING TOOL
Kathryn Gow
Psychologist
The promotion of certain Ericksonian techniques through the NLP community

has led to hypnosis being utilised, for the most part very successfully, in NLP
training programmes. The following scripts are examples of unconscious
reviews that trainers can utilise to pull together the learning of the day, for
example, in an NLP trainers’ programme.
In the following scripts, NLP trainers’ terminology is embedded in the
language. The scripts are delivered by trainers at the end of a session, day or
programme, to summarise what has been learnt within a specified time frame.
NLP terminology is packed into the body of the script.
Trainees report that such scripts, delivered while in a light to medium trance
state, are powerful facilitators of their learning and increase their recall of the
content and integration of the course material.
Kathryn Gow, Queensland University of Technology, PO Box 268, Red Hill, Queensland
4059
85
86 Case Note
The underlined words indicate the main NLP techniques or messages that are
incorporated within the general theme of positive thinking and ego-strengthening.
These underlined words are commands to be emphasised. The names of the
techniques are listed at the beginning of the scripts for readers’ information.
Those of you who are familiar with NLP terminology will recognise the subtlety
of the suggestions.
You will note that two dots (..) are used to indicate the blurring of one
message into the other.
Script 1 contains references to NLP and Ericksonian concepts and is the
simpler of the scripts. The concepts, heavily embedded in Ericksonian language,
covered in Script 1 are: the swish technique, transformational search, the self-
edit, Bateson’s logical types and general Ericksonian language.
Script 2 contains more NLP concepts to be reviewed: parts integration,
Bateson’s logical types, Bateson’s distinctions, Rossi’s and others’ neurological
connections, Dilt’s belief changes, calibrations, physiological shifts,
submodalities, drill, the swish technique, Bateson’s ecology, the magic of
Erickson, Tad James’ time line therapy, secondary gains, Clare Graves values,
identity change, metaphors, principles and rules, the circle of excellence and the
Milton model.
USING THE MILTON LANGUAGE AS A FACILITATOR OF LEARNING
Script 1: Self-Esteem as a Trainer
Outcome: For trainees to review the day with insight and understanding as they
build their self-esteem.
As you prepare to review your learnings today with insight and understanding,
you may swish to close your eyes and relax or you may prefer to sit in your
chair very comfortably with your eyes open and fixed on one spot and go into
a trance whichever way you prefer to do it .. your way (that’s right) and if you
wish to transform your search, you can go in and out of trance during your
edit, then you can allow your conscious and unconscious mind to come
together to produce the most useful insights for you to feel good .. that you
have now come a different way along the path that you have chosen to follow
.. your inner voice which may have one special message about your learnings
which is highly significant for you..r integration is occurring now at a deeper
level than before you leave soon with the special gift that your unconscious
mind is now giving you, because you are special, as there is only one of you,
and if you are a logical type, then you know that it will depend on the quality
of accessing which distinctions you can now make about how brilliant you
really are.
And it’s a good thing to value the possibilities of making the changes
that you have, or have not, allowed to occur, at a neurological level, to a time
Case Notes 87
in the future when you are standing up in front of people who need to change
beliefs about learning, and you can calibrate the shifts in submodalities
because you have let go the blocks and refined your drill to such a special
tune that you can almost hear the swish of your hands as those powerful parts
of you come together to make changes so the ecology of your being is in time
with the cosmic play that you can not not prevent yourself from finding
joyful as you open your eyes now and anticipate with clarity new ways of
bringing more magic into your life.
Script 2: The Milton Model, Learning and NLP Training
Outcome: For participants to confirm that they are more confident and
comfortable in changing their identity to that of an NLP trainer.
As you now prepare to model Milton and conduct a self-edit on your
insightful strategies employed today, notice that you can not resist making
your chair feel comfortable by being totally entranced by what you have
learned .. a lot and changed your identity to that of an NLP trainer and you
already know what to do, didn’t you.
A part of me is wondering if you are completely comfortable now
because that means that you can make more and more new neurological
connect .. your mind and body in such a way from old patterns that resisted
you and violated your integrity is of value and I know that a part of you wants
to ensure you preserve the learnings from all of these experiences and let go
of the emotions, so that you block out the old picture and swish into your new
identity with distinction.
As you turn up the volume on the voice of your inner wisdom, you can
know just how logical it is to type the Clare Graves levels of value .. your
own progress because that means that you can calibrate towards success and
you may negotiate your gains with a secondary part of you that is critical to
finer distinctions, didn’t you.
As I spoke to Judy yesterday about this feeling of taking a flying leap,
she said that apart from experiencing how to fly, you can enjoy landing safely
on the other side and notice you have survived this metaphor of let .. ting go
your old identity, didn’t you. As you say “me too!!”, you can observe the
playful ecology of your principles as the creative design of the universe
empowers you to process the content and structure your play in alignment
with your circle of excellence and you can not not know your outcomes and
when you are ready, open your eyes to the models surround you.
RECOMMENDED READING
Bandler, R., & Grinder, J. (1979). Frogs into Princes: Neuro-linguistic programming.
Moab, UT: Real People Press.
88 Case Note
Bandler, R., & Grinder, J. (1982). Reframing: Neuro-linguistic programming and the
transformation of meaning. Moab, UT: Real People Press.
Dilts, R. (1983). Roots of neuro-linguistic programming. Cupertino, CA: Meta
Publications.
Dilts, R., Hallbom, T., & Smith, S. (1991). Beliefs: Pathways to health and well-being.
Portland, OR: Metamorphous Press.
Grinder, J., & Bandler, R. (1981). Trance-formations: Neuro-linguistic programming
and the structure of hypnosis. Moab, UT: Real People Press.
Grinder, J., DeLozier, J., & Bandler, R. (1977). Patterns of the hypnotic techniques of
Milton H. Erickson: Vol 2. Cupertino, CA: Meta Publications.
Laborder, G. Z. (1983). Influencing with integrity: Management skills for communication
and negotiation. Palo Alto: Syntony Publishing.
Lewis, B., & Pucelik, F. (1992). Magic of NLP demystified. Portland, OR: Metamorphous
Press.
Rosen, S. (1982). My voice will go with you: The teaching tales of Milton H. Erickson.
New York: W.W. Norton & Company.
Vol. 25, No. 1, 1997, pp. 89–90
BOOK REVIEWS
From Mesmer to Freud: Magnetic Sleep and the Roots of Psychological

Healing. Adam Crabtree. New Haven: Yale University Press. 1993. x + 413.
US$45.00 + postage and handling; hardcover.
The history of hypnosis, with its roots in the practice of Franz Anton Mesmer
and the French Mesmerists, is a source of deep fascination for me. So, given the
opportunity to review a book on the history of hypnosis has been a great
opportunity to indulge.
The main theme of From Mesmer to Freud is obviously not a new one.
Crabtree basically argues, along the lines of Ellenberger (1970), that psychiatry
and psychology owe an unacknowledged debt to hypnosis and mesmerism as the
fundamental sources of subsequent psychological theorising and research.
However, Crabtree goes on to introduce masses of original source material that
really seems to capture the concepts and questions that were current for the
historical periods he covers. In many ways it would appear that Crabtree is
trying to cover ground that has been left a bit bare by earlier historical
references. In doing so he has taken on a massive task.
From Mesmer to Freud is organised in four parts that appear to loosely follow
the historical development of hypnosis from magnetic healing to mesmerism to
magnetic sleep. Crabtree intends to trace the basis of many modern psychological
concepts in the earlier work of the magnetisers. Indeed, he seems to be deeply
enamoured of mesmeric history and it is easy to become overwhelmed by the
amount of detail he provides on the early mesmerists and their cases. Overall,
Crabtree spends considerably less time on the practitioners of hypnosis than the
mesmerists. This is not such a bad thing, insofar as the detailed history of
Mesmer and his followers seems to have become increasingly marginalised and
mythologised in the history of hypnosis. But some of the book becomes a
repetitious presentation of case material as Crabtree minutely traces the
contribution of mesmerism to psychological concepts, mind–body issues,
spiritualism, and several other topics.
Crabtree explains that his approach to historical research is to avoid the
“error” of presentism. Presentism is the practice of interpreting historical
documents and events within the sociopolitical context of the present day.
Crabtree sees this as an error in that it does not take into account the context
within which events occur. To my mind, however, this suggests that Crabtree
should endorse a position of analysing documentation within its historical
89
90 Book Reviews
sociopolitical context. But the major weakness of his book is its almost total
lack of analysis. There were very powerful societal and professional forces
arraigned against the practitioners of mesmerism and hypnosis, yet Crabtree
fails to analyse the factors and issues that led to the various twists and turns in
the fortunes of hypnotic practice. Rather, he presents the material that tells the
story without trying to set the scene. I found this very unsatisfying as I think
Crabtree has taken an erroneous position in trying to be objective by presenting
history as the source material by itself. I doubt that it is possible to be objective
in relation to anything. Further, I feel that unless we analyse historical records
from an understanding of the broader context of that period, it is not possible to
tease out the whys and wherefores of the production of information. This is very
important in the history of science, which is especially clouded by its mantle of
scientific “objectivity,” “rationalism,” and “truth.”
In relation to this Crabtree highlights an interesting question that nobody
appears to have properly explored. Whatever happened to the practice of
mesmerism? From Crabtree’s presentation it would appear that it was transformed
into spiritualism and largely disappeared in medical and psychological circles.
This is a fascinating example of the political avoidance of a therapeutic practice
due to its association with so-called “unscientific” superstition. Even today
there are only two references to using mesmeric “technology” and I could only
find one of these (Pulos, 1980). But Crabtree really fails to explore any of this
in detail.
In general, From Mesmer to Freud is a well-written book with a fascinating
tale to tell. There is probably too much detail and repetition to make it a really
great book but it is stimulating in its own right. Crabtree could certainly have
got away with producing several volumes of information. I would be inclined to
read any subsequent volumes he produces because he is an apparently meticulous
and careful historian, despite my disagreement about his philosophical approach
to his task.
REFERENCES
Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution
of dynamic psychiatry. New York: Basic Books.
Pulos, L. (1980). Mesmerism revisited: The effectiveness of Esdaile’s techniques in the
production of deep hypnosis and total body hypnoanaesthesia. American Journal of
Clinical Hypnosis, 22, pp. 206–211.
ALISTAIR CAMPBELL, Clinical Psychologist, Launceston General Hospital

Vol. 25, No. 1, 1997, p. 91
BOOKS AVAILABLE FOR REVIEW
Members of the Australian Society of Hypnosis interested in reviewing books

should apply to the Editor. Reviews are subject to editorial review prior to
publishing.
Robert G. Kunzendorf, Hypnosis and Imagination. Amityville, NY:

Nicholas P. Spanos, Baywood Publishing, 1996.
& Benjamin Wallace (Eds.)
Larry K. Michelson, & Handbook of Dissociation: Theoretical,
William J. Ray Empirical, and Clinical Perspectives. New York:
Plenum Press, 1996.
Karen Olness, & Hypnosis and Hypnotherapy with Children.
Daniel P. Kohen (3rd ed.). New York: Guilford Press.
91
The Australian Journal of Clinical and
Experimental Hypnosis
announces the publication of a clinical handbook
Hypnosis for Weight Management

and Eating Disorders
This clinical handbook contains reviews of current

research and clinical practice, providing the reader with
a comprehensive understanding of the classifications,
aetiology, and treatment of the disorders. There is, of
course, a detailed focus on the use of hypnosis in
treatment. Many chapters have been specially written
for the handbook by Australian and overseas experts,
with supplementary chapters reporting clinical
applications and case studies.
All anthologies and clinical handbooks published by

the Australian Journal of Clinical and Experimental Hypnosis
can be obtained from June Simmons, Editorial Assistant,
AJCEH, PO Box 592, Heidelberg, Victoria 3084,
Australia.
Hypnosis for weight management and eating disorders
Barry J. Evans, Greg J. Coman, and Graham D. Burrows AO KSJ (Eds)
304 pages, softcover, A$35.00 (ASH members), A $40.00 others, available immediately.
Contents
Introduction
Psychological issues in weight management. . . . . . . . . . . . . . . . Greg J. Coman and Barry J. Evans
Eating attitudes and behaviours in the normal population. . . . Nicole Lefkovitz and Barry J. Evans
Obesity and Weight Management Counselling
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barry J. Evans
Psychotherapy and hypnotherapy in the

treatment of obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fiona K. Judd and Graham D. Burrows
Treatment issues in weight management counselling . . . . . . . . . . . . . . . . . . . . . . . . . . Susan Hook
Psychotherapy and hypnotherapy for overweight and obesity counselling. . . . Diane J. McGreal
Weight management: A cognitive behavioural approach,

utilising hypnosis as a treatment strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Brian T. Jacka
Hypnotic treatment of obesity in a general practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . Scott Inglis
Hypnosis in a self-control behaviour modification programme

for weight reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lorna D. Channon-Little
Bulimia Nervosa
The nature and aetiology of bulimia nervosa. . . . . . . . . . . . . . . . . . . . . . . . . . . Rosalyn A. Griffiths
Hypnosis an an adjunct in the treatment of bulimia nervosa. . . . . . . . . . . . . . Rosalyn A. Griffiths
Hypnosis in the treatment of bulimia nervosa: A review of the literature . . . . . . . Greg J. Coman
Some similarities between disordered drinking and eating patterns:

Case illustrations and implications for treatment. . . . . . . . . . . . . . . Lorna D. Channon-Little
Hypnosis in the treatment of bulimia nervosa: A case study. . . . . . . . . . . . . . Rosalyn A. Griffiths
Hypnobehavioural treatment for bulimia nervosa: A treatment manual . . . . Rosalyn A. Griffiths
The use of hypnotherapy in the treatment of eating disorders. . . . . . . . . . . . . . . . . . . Delia Young
Group therapy and hypnosis for the treatment of bulimia nervosa. . . . . . . Marcia Degun-Mather
Anorexia Nervosa
The nature and aetiology of anorexia nervosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nola Rushford
Management of anorexia nervosa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nola Rushford
Hypnotic and strategic interventions in the treatment of anorexia nervosa. . . . Michael D. Yapko
Hypnotherapy in the treatment of anorexia tardive. . . . . . . . . . . . . . . . . . . . Elizabeth H. Georgiou

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AUSTRALIAN
AUSTRALIAN JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS

JOURNAL OF
CLINICAL AND
EXPERIMENTAL
HYPNOSIS
MAY 1997 VOLUME 25 NUMBER 1

May 1997 25 : 1
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ISSN 0156-0417 AUSTRALIAN SOCIETY OF HYPNOSIS

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AUSTRALIAN

AUSTRALIAN JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS

MAY 1997 VOLUME 25 NUMBER 1

ISSN 0156-­0417 AUSTRALIAN SOCIETY OF HYPNOSIS

May 1997 Volume 25 Number 1

A SOCIAL NARRATIVE MODEL OF

Editions of the journal in recent years have published a range of theoretical,

In Case Notes, Kathryn Gow describes how indirect techniques can be

A SOCIAL NARRATIVE MODEL OF DISSOCIATIVE

Steven Jay Lynn

Our model owes a debt to a body of psychological literature (e.g., Meichenbaum

These individuals are also more suggestible, even in non-hypnotic situations,

discourse.” An intrinsic part of that discourse is the process of diagnosis. There

in these psychological communities requires evidence of shared suffering and

suggestion/iatrogenic procedures leading to a medical diagnosis) a category of

FINAL CONCLUSIONS OF THE APA WORKING GROUP

Working Party of the American Psychological Association

Given this characterisation of our understanding of the critical issues, how do

with the very divergent epistemologies and definitions utilised by psychologists

IMPLICATIONS FOR PRACTICE

The deliberations of the Working Group strongly underscore the importance of

In some states, persons who have recovered memories of childhood sexual

IMPLICATIONS FOR FORENSIC PRACTITIONERS

technique when the technique or practice being considered is one in which

IMPLICATIONS FOR RESEARCH AND TRAINING

For practice-oriented students, cross-fertilisation means that training faculty

RECOVERED MEMORIES: SOME CLINICAL AND

COMPARATIVE ANALYSIS OF THE FIELD SINCE 19851

Figure 1: Analysis of Contents of International Journal of Clinical & Experimental

* Numbered and in bold

Categories based on Psych LIT classification scheme

Figure 3: Comparison of Contents of AJCEH and IJCEH 1986–1995

Figure 4: Numbers of Publications: Australia as a Percentage of World

Number of Australian articles, 1994

23: Human Exp.

24: Animal Exp.

29: Social Processes

33: Health & Mental Health

on my part in the choice of classification categories, but certain major themes

MEMORY AS A CONTEMPORARY ISSUE

1 The rise in the use of phenomenological data

absorption, automaticity, and dissociative ability). Posthypnotic amnesia, for

Hypnotically Influenced Memories

The phenomenon of hypnotic hypermnesia, or enhanced memory accessibility

1 No reliable memory enhancement effects occur either within single

Note: Adapted from Sheehan (1994).

THE NATURE OF HYPNOSIS AND MEMORY

The Nature of Hypnosis

products of hypnotised subjects’ imaginative capacities at work. It does not say,

The Nature of Memory

Memory is equally a complex process. Suffice to say that it is a labile

One of the key contemporary questions or issues in relation to memory and

Table 5 Recovered Memory: What do we Know?

Note: Adapted from Yapko (in press).

Evidence on recovered memories The concept of memory as a constructive and

illustrates compellingly that memory for emotionally charged events is widely

Recovered Memory Therapy

The term “Recovered Memory Therapy” profiles a form of therapy that in

Let me provide a summary comment of the complex issues addressed so far.

AUSTRALIAN JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS

ISSN 0156-0417 AUSTRALIAN SOCIETY OF HYPNOSIS

1 No reliable memory enhancement effects occur either within single