On Hypnosis (Part 23/26)

 Hypnotherapy: Painwashing, Brainwashing?

The therapist-client relationship is generally not, perhaps never is, one of equals...The client is in a position of revealing his problems, inadequacies, and fears to a person who seems to be going through life successfully and carefree...The relationship is characterized by the therapist being the expert, the authority, and a client's uncertainty or inability to detect personal choices can easily induce obedience to authority...The need for acceptance and the need to belong are also factors present in the hypnotic relationship. 

Avoiding confrontations with the authority, doing things to please her (ranging from generating therapeutic results to knitting her a sweater), conforming to her language style, values, and theoretical ideas are all ways this need can be discovered...

In order to be truly influential, discovering where (not whether) a person is open to suggestion (and everybody is at some level) is the task of the clinician.

Yapko, Trancework[1]

Long-range effectiveness in hypnotherapy depends upon the success of posthypnotic suggestion. Suggestions implanted in the mind of the patient during the session must continue to exert an influence long after the session has ended. The suggestion that an obese woman will eat less during the next week as she learns to dislike fattening foods must stick in her mind if it is to work. In order for suggestions to accomplish this they must somehow alter the patient's ideas and attitudes about the problem being treated. Recall that Erickson repeatedly described hypnosis as a process of presenting new ideas. Indeed, the phenomenon of suggestion makes it possible to replace a negative state of mind with a more beneficial one suggested by the therapist. What must be understood, however, is that a new state of mind is at once the achievement and the limitation of suggestion. For it is at best ephemeral -- never able to eradicate years of childhood experiences that summated into a feeling of worthlessness, for example. Only the belief in magic could imagine otherwise.
If one understands that early traumatic experience is imprinted, impressed into the neurophysiologic system permanently then one quickly sees that a suggestion in the present, no matter how powerful, is at best palliative; the business of repressing Pain and distorting reality goes on as usual throughout the body. In short, suggestion is never a match for an imprint.
Let's review what characterizes the hypnotic trance experience. As described in the previous chapter, someone who is in a trance:

• waits passively for information as to how to behave

(suspension of the "planning function");

• pays attention only to the hypnotist and follows hypnotist's directions ("selective attention" and "redistribution of attention");
• accepts distortions as reality (reduction of "reality testing");
• is highly susceptible to the hypnotist's suggestions (heightened "suggestibility");
• will readily adopt a role of being someone else ("role enactment"), and
• may forget and recall the hypnotic experience ("post-hypnotic amnesia")

In other words, the hypnosis subject, guided by the hypnotist's cues, tunes out some external and internal stimuli while tuning in on others. While in a trance, his experience is narrow, with a separation ("dissociation") existing between his conscious and unconscious minds. In such a condition he is highly susceptible to the hypnotist's suggestions, such as new ideas ostensibly designed to change his state of mind: to dissociate from pain, replace depressive thoughts with positive ideation, see one's body in more attractive light, learn better self-esteem, and so on.

The attraction of suggestion therapy is that it offers an apparently speedy and effective means of bringing about change without having to deal with the troublesome contents of the unconscious in their own terms. But precisely because this approach keeps aloof from the generating experiences behind the problematic mental states, suggestion therapy can never be resolving. It can only paper over the cracks, rearrange defenses and symptoms, further dissociation and disconnection and, in effect, streamline the neurosis. 

Because neurosis is the post-hypnotic state in which we carry out the "suggestions" of childhood, we may see hypnotherapy as offering counter-suggestions. This might be well and good were not the original suggestions of neurosis bound to physiological imprints laid down in the course of development. Suggestion therapy is really only the offer of a better looking and more hopeful defense. How different is all this from a psychoanalyst who "suggests" that his patient is suffering from this or that, and perhaps she ought to leave her husband, go back to school, try harder to be nice? Are these not suggestions? That is why the best therapy involves no suggestions whatsoever.

Once the patient is the center of all therapeutic power, suggestions are superfluous. It is then she who suggests to the therapist what is the possible motivation behind certain behavior; it is the patient who thinks perhaps she ought to try this or that. Her feelings will dictate, not the words, however reassuring and mellifluous, of a therapist. Power to the patient! 

Within the experience of each Pain is a unique and complex spectrum of responses -- responses which, as I have said, are mediated by ongoing neurophysiological processes. An early trauma may diminish the effectiveness of part of the immune system, such as the natural killer cells. The trauma may change the thyroid output (our hypothyroids often are able to normalize with reliving of Pain). The entire body and brain is thus involved in each Pain response, and it is the entire body and brain which must be involved in each undoing. Otherwise we are fighting against the Primal tide, and that tide is not easily overcome.
Look at it another way. Suppose someone steals and is caught. He is beaten every day for a year. Chances are this will encourage him not to steal. But the tendencies are not beaten away. You can't beat a childhood away, nor can you encourage it away, any more than you can encourage the physiology to change permanently. To think otherwise is again to believe in magic. Never forget the "why" in therapy. If you do forget it, then the therapy is bound to fail. Why does she do this? Why does she have migraines? Why does he steal? Can suggestion erase twenty years of ghetto life? Not likely.


Hypnotherapy: Reality or Delusion?

Most hypnotherapists today contend that hypnosis does not involve control and manipulation, as was originally believed. They contend that the patient is not merely a passive recipient; he is instead an active participant, accepting suggestions that suit him and rejecting those that do not. To me this oversimplifies and makes the situation a matter of semantic. It ignores two important factors: the vulnerability inherent in being a patient, and the passivity inherent in the act of receiving suggestions.

Being vulnerable means "capable of being wounded; assailable; open to attack or damage." A patient is vulnerable because he is in the hands of someone else. Vulnerability detracts from one's judgment and common sense, which is why accepting or rejecting suggestions as a patient is no simple matter. If a patient were so clearly able to determine what did or did not suit him, he wouldn't be a patient in the first place. He would be a healthy, feeling person. How can a patient even know what kind of suggestions will help her problems if she doesn't really know what her problems are? Disconnection characterizes neurosis.

Vulnerability is precisely what makes hypnotherapy so appealing. A beneficial reality can be superimposed over Pain and problems by a kindly father figure. Beneficial suggestions are seen as the perfect antidote to the vulnerability of tension and anxiety. But how truly beneficial are these suggestions? How beneficial is it to be told you are feeling comfortable and relaxed when you are really feeling otherwise? Doesn't this also replay the parent-child paradigm where the child is admonished into smiling when she doesn't want to, into acting happy when he really feels sad.

Hypnotic suggestions for comfort, relaxation, stress-reduction, and the like really require the same compromise the neurotic has made all his life. This is what can and does happen not only in hypnotic past-life regression; vulnerable to the hypnotist's suggestions and expectations, the patient produces a fantasy disguised as a traumatic memory, and believes that re-experiencing it makes the current symptoms that it supposedly generate disappear. Such is also the case in hypnotic age regression in which the patient does not fully relive and integrate the early trauma but instead shoves it back down.
To say that the patient has control over the hypnotic situation, as modern hypnotherapists contend, is a double contradiction in terms. First of all, the neurotic is never in control; that is part of the problem. The neurotic's history controls him; it is the unconscious reference point around which his life revolves. Perhaps he overeats, for example, and why? Because he has no control over the arcane forces at work. The neurotic who has reached the point of seeking therapy does so because he has at least a dim realization that his Pain is controlling him. 

We can have no control over our Pain as long as it remains unconscious; and that is the most that hypnotherapy can do -- make us unconscious. This brings us to the second part of the contradiction: the patient cannot be in control of something of which he is unconscious. As long as Pain remains unconscious, as it must in the hypnotic situation, it wields the force. To say that the neurotic has control in the hypnotic situation is to contradict the meaning of both hypnosis and neurosis.
I believe that passivity is inherent in the hypnotic relationship. No matter how much the patient supposedly "participates," it is still in response to the hypnotherapist. The hypnotherapist is really the active agent, the one who defines the situation, however broadly. 

Erickson believes that hypnosis is an active process for the patient because hypnotherapists base their suggestions on the patient's "repertory of life experiences and learnings." Carefully worded suggestions, "utilizing the patient's own frame of reference," can then stimulate the patient to reassociate and reorganize his associative processes." But basing suggestions on the patient's life experience does not make them any more valid therapeutically. For one thing, fitting suggestions to the patient is not a clear matter of incorporating life experiences. The hypnotherapist can only incorporate the patient's life experiences as he (the hypnotherapist) understands them; as he relates to them. The suggestions can never be a pure product of the patient's past but only a subjective interpretation and rephrasing of that past by the hypnotherapist. Compounding this problem is the interesting fact that neurotic patients do not really know their past in the first place because it is so repressed. Until they relive it their reports of past experiences can only be fractionally accurate.


[1]_pp. 91-102.