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Главная Hypnotherapeutic Techniques
Hypnotherapeutic TechniquesArreed Barabasz, John G. Watkins
Two premier hypnotherapists collaborate on a new edition of this award-winning text, considered to be the complete hypnotherapy manual for the professional practitioner.
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RT5814_half title page 11/3/04 11:50 AM Page 1 HYPNOTHERAPEUTIC T E C H N I Q U E S 2E RT5814_book.fm Page ii Friday, November 19, 2004 8:46 AM RT5814_title page 11/3/04 11:46 AM Page 1 HYPNOTHERAPEUTIC T E C H N I Q U E S 2E ARREED BARABASZ AND JOHN G. WATKINS NEW YORK AND HOVE RT5814_book.fm Page iv Friday, November 19, 2004 8:46 AM Published in 2005 by Brunner-Routledge 29 West 35th Street New York, NY 10001 www.brunner-routledge.com Published in Great Britain by Brunner-Routledge 27 Church Road Hove, East Sussex BN3 2FA www.brunner-routledge.co.uk Copyright © 2005 by Taylor & Francis Books, Inc. Brunner-Routledge is an imprint of the Taylor & Francis Group. Printed in the United States of America on acid-free paper. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Barabasz, Arreed F. Hypnotherapeutic techniques / Arreed Barabasz, John G. Watkins.-- 2nd ed. p. cm. Includes bibliographical references and index. ISBN 0-415-93581-4 (hardback) 1. Hypnotism--Therapeutic use--Handbooks, manuals, etc. I. Watkins, John G. (John Goodrich), 1913- II. Title. RC495.B337 2004 615.8'512--dc22 2004019944 RT5814_book.fm Page v Friday, November 19, 2004 8:46 AM To Helen Hunt Watkins Who, like a concert artist, knew how to wield the science of clinical practice for the betterment of human beings. And to her colleagues, students, and patients, who will completely understand the message she wrote: "All that we have been in life will live on in the quality of other lives that we have touched significantly, and in that way, we are reborn again, and again, and again." v RT5814_book.fm Page vi Friday, November 19, 2004 8:46 AM RT5814_book.fm Page vii Friday, November 19, 2004 8:46 AM Preface Unlike the majority of other treatment modalities and adjuncts to therapy, hypnosis has been around for a very long time. Now, more than half a century of science has demonstrated that hypnosis is one of the most versatile and useful of health care tools for physical and mental health. Clinical hypnosis is securely grounded in an enormous foundation of careful empirical work that substantiates its efficacy under a variety of circumstances (for a recent review, see Lynn, Kirsch, Barabasz, Cardena, & Patterson, 2000; Patterson & Jensen, 2003). Franklin and Lavoisier described science as "disciplined wonderment" in their royal commission report to the king of France on mesmerism (Franklin et al., 1784). This notion is as relevant now as it was 220 years ago. The efficacy of hypnosis is recognized by the National Institutes of Health (Journal of the American Medical Association, 1996). The American Medical Association officially approved the clinical use of hypnosis in 1958, and the American Psychological Association approved it in 1960. The two major hypnosis societies, the Society for Clinical and Experimental Hypnosis and the American Society of Clinical Hypnosis, hold memberships in both the American Association for the Advancement of Science and the World Federation for Mental Health. An increasing number of rigorously controlled studies are showing hypnosis is not just effective but also superior to a number of standard treatment procedures. For example, Lang and her colleagues (Lang et al., 2000; see also A. Barabasz & M. Barabasz, 2000) found hypnosis to have significantly more pronounced effects on pain and anxiety reduction for invasive medical procedures in contrast to structured attention or even intravenous analgesia. The effects are not limited to adult populations. In a comparison of hypnosis and distraction in severely ill children undergoing painful medical procedures, J. Smith, Barabasz, and Barabasz (1996) vii RT5814_book.fm Page viii Friday, November 19, 2004 8:46 AM viii studied an ethnically diverse sample of children suffering from cancer or blood disorders. Measures of pain and anxiety were obtained from the children and their parents, as well as independent raters. Hypnotizable children (the majority) showed significantly lowered pain, anxiety, and distress scores in response to hypnosis in contrast to low hypnotizable children, and hypnosis was superior to standard pain amelioration interventions. Perhaps of greater interest to the majority of practicing psychologists is the effectiveness of hypnosis as an adjunct to psychotherapy. J. Watkins and Watkins (1997, pp. 162–194) summarized the effectiveness of ego-state therapy and hypnoanalysis. Both procedures were found to be superior to psychodynamic therapies in general. Those using cognitivebehavioral therapies will no doubt be impressed by the comprehensive meta-analysis of hypnosis as an adjunct (Kirsch, Montgomery, & Sapirstein, 1995). The analysis was performed on 18 studies in which cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of the clients receiving nonhypnotic treatment. They are particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments. Hypnosis is cost effective. As medical costs continue to soar, new opportunities for those trained in hypnosis are on the horizon. Until recently, the authors of numerous reports have merely alluded to the costeffectiveness of hypnotic interventions. Recently, a major Harvard Medical School study (Lang & Rosen, 2002) showed findings that are astonishing to those untrained in hypnosis. The average cost associated with standard sedation for a range of outpatient procedures was $638, compared with $300 for sedation with adjunctive hypnosis. The addition of hypnosis resulted in a savings of $338 per case. Hypnosis was shown to reduce outpatient room time, but hypnosis remained more cost effective even if it added as much as an additional 58 minutes to room time. One can only speculate about the cost-effectiveness produced by the greater improvement, an average of 70%, shown with hypnosis by the Kirsch et al. (1995) meta-analysis based on cognitive-behavioral therapies but, similar to the Lang and Rosen (2002) findings, A. Barabasz and Barabasz (2000) demonstrated significantly increased clinical effectiveness and a reduction in treatment time by nearly 50% when hypnosis was added to specific biofeedback treatment interventions. Therapists who practice approaches (such as psychoanalysis) that require several sessions per week over many months or even years are RT5814_book.fm Page ix Friday, November 19, 2004 8:46 AM ix faced with a severe economic crisis (Goldberg, 1996). Insurance companies, and other third-party payers, will simply not fund such lengthy treatments. Hypnoanalysis, based on psychodynamic theories (Brown & Fromm, 1987; Lavoie, 1990; J. Watkins, 1992, substantially reduces treatment time to as little as 60 to 150 hours. Similar magnitudes of efficiency are achieved with hypnosis in structural and developmental hypnoanalytic treatment of severely disturbed patients (Baker, 1990; Brown & Fromm, 1987; Copeland, 1986). More recently, J. Watkins and Watkins (1997, pp. 162–194) demonstrated that intensive ego-state therapy (an extension of hypnoanalysis) might offer an effective and even briefer approach. On the basis of 15 years of case data, they concluded that therapy of as little as 12 hours often achieves permanent, structural personality changes, including resolution of lifelong disorders. Although treatment efficacy and cost-efficiency are primary considerations, there is yet another important overlay that makes the study of hypnosis all the more critical at this time. The United States is currently undergoing demographic changes that are entirely without precedent in its history. In 1960, only 16 million Americans did not trace their ancestors to Europe. Today, the number is in excess of 80 million. No nation has ever undergone as rapid and radical a transformation. Immigration to the United States is the largest population transfer in history. People are coming from Asia, Africa, and Latin America. Embracement of cultural diversity in the United States has put an end to the "melting pot," a concept made famous by Israel Zangwill, the Russian-Jewish playwright, in his famous 1908 play of the same name. Diversity in the United States now is a salad rather than an acculturating melting pot. Virtually all psychotherapeutic modalities currently practiced today in the United States, Canada, Europe, Australia, and New Zealand are Western-culture bound. In contrast, hypnosis is multicultural in nature, with experimental and clinical research published in more than a dozen scientific journals worldwide. Hypnosis is the only therapeutic modality that is yet scientifically supported on the basis of Western science that makes it possible, for example, for a psychologist skilled in hypnosis to be accepted simultaneously by Native American healers and those from Eastern cultures. As employment opportunities for both clinical and counseling psychologists continue to shift toward hospital or outpatient medical settings, multicultural adaptability is already becoming increasingly important. The time has come to look seriously at the integration of hypnosis in Ph.D. training. In recognition of this need, the APA Committee on Divisions of APA Relations has provided a grant specifically for "the integration of hypnosis training in Ph.D. programs" led by APA's Division 30 (Society for Psychological Hyp- RT5814_book.fm Page x Friday, November 19, 2004 8:46 AM x nosis), Division 45 (Multi-Cultural), and Division 17 (Counseling Psychology, 2002–2003). The present book, developed from J. Watkins's (1987) classic text, updates and expands the earlier work. It is specifically intended to meet the current and emerging needs of a university graduate program to train psychologists and medical practitioners in the use of hypnosis. Unlike many other therapeutic modalities, it is still often difficult to get training in hypnotherapy. The majority of top medical schools offer training in hypnosis, but lagging behind are graduate schools of psychology and counseling psychology, where just a minority regularly offers courses in hypnosis. The major scientific societies in the field, the Society for Clinical and Experimental Hypnosis, the American Society of Clinical Hypnosis, and the Society of Psychological Hypnosis (Division 30 of the APA), do offer workshops, up to about three days in length, at their annual meetings and during the year at various centers about the country. These are usually "cram courses" where the beginner is immersed for a very short time in a strange and baffling field that is frequently foreign to his or her previous experience. Fascinating to be sure, but with demands upon his or her own personality and its defenses, that immersion may provoke anxiety. The skilled surgeon, calm and collected in the face of observable physical pathology, may practice his or her skills with high concentration and equanimity. Yet the same person confronted with apparently magical happenings for which he or she has no apparently tangible objective rationale, quails and avoids as if asked to stay in a haunted house. On the other hand, the objective scientific researcher who has dealt with concrete, observable behaviors as variables, and who can trace intricacies of behaviors with the aid of complex designs and mathematical analyses, often wishes to avoid a modality that lends itself to objective formulations only with the greatest of difficulty and complexity. Of the cognitive, sociocognitive, or behavioral theories available today, none can adequately account for the esoteric phenomena induced by hypnotic trance. There are few competent instructors in this field. Many university graduate schools, as well as many medical schools, still do not have even a single faculty member who is properly prepared to offer regular courses in this discipline. Furthermore, there is a tremendous ignorance on the part of many physicians and psychologists concerning hypnotic phenomena, which is manifested by suspicion and distrust of workers in the field. Despite substantial scientific evidence to the contrary, a number of psychologists confuse the effects of hypnosis with those that can be wrought with suggestion and misconstrue its effects on pain relief as nothing more than the effects of relaxation-suggestion. Some psychoanalysts RT5814_book.fm Page xi Friday, November 19, 2004 8:46 AM xi continue to parrot objections to hypnotherapy based on unverified theoretical positions voiced by Freud and his associates nearly a century ago. Accordingly, it is no wonder that so few professionals are skilled in the use of hypnosis as a treatment modality. The bottleneck seems to be that skill in hypnotherapy is limited to a few psychotherapists as compared with many practitioners who have mastered other approaches for dealing with mental and physical disorders. In light of the previously mentioned information, and the recognition of hypnosis as a legitimate scientific and treatment modality by the American Association for the Advancement of Science and the World Federation of Mental Health, as well as the American Medical Association and APA, it is clear that hypnosis should be taught along with other accepted methods of treatment in medical schools and graduate programs in psychology. Even for those psychology graduate programs that limit their emphasis to only cognitive-behavioral treatments, dramatic enhancement of outcomes by the addition of hypnosis (Kirsch et al., 1995) clearly indicates that training in hypnosis should be included routinely as part of these emphases. Despite the plethora of articles and reference works on hypnosis currently available today, not one of these seems to have been specifically designed as a teaching textbook. The topics, although often well discussed, are not arranged in the same systematic way that one would expect a general textbook in physiology or zoology would be arranged. Units of instruction should be outlined with consideration of the typical three- to five-credit-hour course for an academic semester or quarter. Lecture and discussion need be interspersed with practicum experiences that gradually initiate the new student into the various hypnotic phenomena and the techniques for eliciting them. Presentations must range hierarchically from simple to more complex. Theories of hypnosis, often thrown at the reader in great profusion, should be simplified and directly related to hypnotic experiences. The history of hypnosis needs to be presented in a way that allows the newcomer to identify with the struggles and difficulties pioneers had when investigating these phenomena, developing their treatment techniques, and dealing with hostile opposition from colleagues. For indeed the history of hypnosis is one of repetition. One worker after another has gone through the same sequence of skepticism, observation, conviction, overzealousness, effort to maintain scientific respectability, and problems of explaining his or her approaches to associates and the public. The history of any field, and especially of hypnosis, ought to be presented in such a way that the newcomer can identify with the stream of its development, its heroes, and its innovators. In such training, the newcomer can experience the same changes of perception and understanding RT5814_book.fm Page xii Friday, November 19, 2004 8:46 AM xii that characterize the professional careers of our predecessors. Students will pass through the initial amazement the same way their instructor did. Whether this turns them on to the field or scares them off will depend on whether the initiation is systematic and stepwise, permitting them to cognitively master new experiences, integrate them into their previous professional background, and develop confidence in the skills of hypnotic induction and therapy. Such skills are essential yet are too frequently superficially learned by those involved only in university-based research in hypnosis. For decades, we have taught hypnosis to hundreds of psychologists, physicians, dentists, and psychiatrists, as well as to other psychotherapists. Several of them became quite proficient in the modality. Dozens are now distinguished clinical and experimental contributors to the field. But sadly, many left the courses, the workshops, or the institutes in which the instruction was given, interested and fascinated, promising themselves they would really learn to use these techniques but finding themselves many years later using only nonhypnotic procedures. Somehow, their early anxieties, personal blocks, and difficulty in obtaining supervision and mentorship in the field were never overcome. Many of us who have served as teachers of hypnosis have met former students who report that they enjoyed the course, gained a great deal in understanding their client's personalities, improved their doctor-patient relationships, and developed a greater comprehension of the role of psychogenic factors in causing mental and physical dysfunction. But they then state, "I always intended to practice hypnosis, but I never felt entirely at ease with it." If a student has not started using hypnosis within a month or two after completing a course, he or she often never employs it. Much is lost in the teaching of this modality, because only a minority of those who take workshops have become active users of hypnosis in therapy or researchers of the phenomenon. Here at Washington State University at Pullman, a four-credit-hour course in clinical and experimental hypnosis has been a regular yearly part of graduate training for counseling psychologists for the past 20 years. In the year 2000, an advanced course in hypnosis and psychotherapy was added and is offered biannually. Students enrolled in the Washington State University APA-accredited PhD program in counseling psychology may begin their use of hypnosis at the university counseling center in practicum experiences in their second practicum year, where nearly all of supervising faculty are experienced and trained in hypnosis. At the University of Montana at Missoula, a course in hypnotherapy has been a regular part of doctoral training in the APA-accredited clinical psychology program for RT5814_book.fm Page xiii Friday, November 19, 2004 8:46 AM xiii more than 30 years. Teaching in both programs involves demonstrations in class that are continually integrated with lectures and discussion. Audiovisual media also are used. In spite of all this, we found that only about a third of our students were actively using hypnosis in their practices 2 or 3 years later. Students begged for additional supervised training with actual patients, and accordingly an advanced hypnotherapy team was established in the Clinical Psychology Center at the University of Montana for those who had completed the course. At the Washington State University counseling center, a workshop is offered every few years for licensed psychologists. Findings show that initial courses, however well organized, can whet the professional appetite of practitioners and generate research interests for many students. But if these students are to profit from advanced seminars, they need much more actual experience in using hypnosis. In our training, students serve as subjects and as therapists. They work with screened volunteer subjects of known hypnotizability, and they study the literature and relate it first to their experiences in hypnotizing subjects and later to their understanding of clinical cases. Only in this way do they seem to acquire the confidence that permits them to employ hypnosis regularly as a continuous technique in their therapeutic armamentarium. It is from considering this background that we determined that a teaching text in hypnotherapy was needed that would address specifically the problems of teaching and learning and the personal needs of students wrestling with this as a new modality. This book is, accordingly, designed with a focus on the professor and his or her students. It aims to include that which can be learned, and no more, within a typical academic semester. Given reasonable mastery of this text, a broader background, familiarization with a wider variety of techniques, acquaintance with the many nuances of theoretical controversy, and polished finesse in the practice of hypnotic skills will come later with greater ease. After having acquired certain basic procedures, having thoroughly convinced themselves of the potential effectiveness that hypnosis can demonstrate in the treatment situation, knowing at least a number of clinical problems within their practices that are amenable to hypnotic approaches, and having mastered the initial awe to the point where they feel some confidence in their hypnotic abilities, clinicians can then develop further through individualized reading of the literature plus attendance at scientific meetings and legitimate workshops. This book, therefore, is dedicated to getting students over the initial hurdles and furnishing the starting impetus necessary to make them into functioning practitioners in the field of hypnosis. One must subsequently develop skills if one is to be an artist, a master of the discipline, and more than a journeyman practitioner. RT5814_book.fm Page xiv Friday, November 19, 2004 8:46 AM xiv Many of the books written in this field are written from the standpoint of the writer's attempt to pour his or her experience, and wisdom, into the student—the "big jug and little mugs" theory of education. We also have written earlier books, book chapters, and articles in this field that were presented from that point of view—that of the instructor. In this book, we are attempting to handle the task before us a bit differently. A theory of the therapeutic relationship presented in an earlier work (J. Watkins, 1978) posited two viewpoints from which we may view another person: the objective and the resonant. When we are objective we observe the actions of a patient from an outside vantage point, much as one might look at a specimen under a microscope. The other is an "it," not ourselves, and our responsibility for "its" actions are minimal. But if we temporarily identify with the other, perceive the world as if through his or her eyes—even view our own self as he or she might—then we are resonating. This might be viewed as a large step beyond, but certainly in the same direction as, empathy. Resonance is that process by which the individual (therapist) attempts to replicate within himself or herself a close facsimile of another's experiential world. It is approaching a problem from the inner perspective of the other rather than from that of our own. The practice of resonance can be as valuable in the field of education as in therapy. The teacher whose presentations are developed from the viewpoint of the student struggling to master the material should be more effective than the professor who simply "doles it out" and places on the student the burden of mastery. Insofar as it is possible, we shall try to incorporate the resonant point of view in writing this book. This means that when designing each unit we shall try to think not "What is it we wish to tell the students? What should they learn?"; rather, we will endeavor to continually ask ourselves the question, "If I were a new student what would I want to know, what help would I need to master both my own insecurities in this new modality and the techniques necessary to use it skillfully?" Whenever possible, we will assume the student's frame of reference and write the material accordingly. To help ensure a student's perspective, Ciara Clear Christensen, a student naive with respect to hypnosis at the beginning of the preparation of this volume, read and discussed each chapter with the first author as the text was written. Questions such as "Sounds great but what does this mean?" or "Why say it that way?" were addressed. We also owe her a great debt of gratitude for her dedication and weekends of work in typing endless hours of dictation, proofreading, and serving as the subject for photographs in this volume. The chapter on Hypnosis and Sport Performance was contributed by Erik Dunlap, a Ph.D. student of Arreed Barabasz, who brings his back- RT5814_book.fm Page xv Friday, November 19, 2004 8:46 AM xv ground as a former offensive lineman on the Duke University football team to the subject. The second author's theories of psychotherapy (J. Watkins, 1963, 1967, 1978; J. Watkins & Watkins, 1982, 1997) emphasize a balance between objectivity and resonance. Therapy is only a kind of education or reeducation, often at unconscious levels. But a good therapist is a good teacher. Here we are not trying to treat problems of a student but trying to inculcate techniques, manners, and approaches effective in the treatment situation. If this approach can be effectively used in teaching hypnotherapy, then perhaps a beneficial spin-off will also occur. We learn by modeling. Those of us who are psychotherapists often copied manners and skills from the master, the professor or the analyst with whom we studied. In the same way the clinical instructor relates to his or her students, the students will relate to their students—their patients. Manners are contagious, so perhaps the manner of presenting our material may prove of benefit, first, objectively, as the student learns, practices, and masters the necessary skills, and, second, through resonance, as he or she incorporates some of the indirect manners of bringing about the phenomena of hypnosis both with and without a formal induction, use of hypnotic suggestions, and interpretation that might be transmitted by the written and the spoken word. We believe that although the use of hypnosis in therapy may be learned as a science, it is practiced as an art. Every science-based discipline has its own unique language. Psychoanalysts talk in "psychoanalese." Behavior modifiers write in "behaviorese" terms, and cognitive therapists are forever reframing. Without wishing to offend the psychologist, the psychiatrist, or other professionals, the terminology in the present book is intended to be as clear and simple as possible. When we use technical or professional terms, we do not assume that the student understands them. Because the physician, psychiatrist, psychologist, psychoanalyst, and dentist each have a unique vocabulary, we try to couch the language here in terms that are easily understandable to the broadest range of graduate students. We explain and illustrate specialized terms. Repetition will not harm the sophisticated reader; failure to explain may leave the professional from another discipline confused. Explanations should be concrete, illustrations and case examples frequent, and specific wordings presented. For example, how often have you read a good psychoanalytic case presentation where the following statement was made: "At this point I interpreted his negative transference"? And how often have you wondered, "Yes, you did. But just what did you say? Exactly what were the words you used, and why did you choose those specifically? Why did you decide to interpret the negative transference at RT5814_book.fm Page xvi Friday, November 19, 2004 8:46 AM xvi this time? What specific reactions did your patient show to your interpretation—in his or her next remark, his or her behavior during the rest of the session, in the hours and days that followed?" The statement "At this point I interpreted his or her negative transference" may have satisfied the writer. It was objective, but it was not resonant because it did not meet the needs of the student to understand. It did not answer the questions that were on the reader's mind, and it did not develop learning so that the reader would know just how to interpret the negative transference of a patient when required. This is why the present book is made as concrete and specific as possible. We use pictures and diagrams, and we note audiovisual examples that have been made available, because these may be a further aid in the learning process. Study questions and practicum exercises are designed to develop the stages of learning and to maximize retention of factual knowledge and acquisition of technical skill. As much as possible, we present verbatim induction techniques and case materials, together with explanatory notes. Hypnotherapy must be learned and practiced as a meaningful discipline, not as a collection of scientific facts or as a cookbook of recipes for handling various clinical problems. Elements must not be learned in isolation from one another but be integrated as the whole of understanding that should emerge within the student. As in other professional treatment disciplines, the hypnotherapist should become a clinician, not a technician. The study of hypnosis usually makes a clinician a better psychologist or physician (or other) and makes him or her a more understanding student of human nature. Perhaps nowhere in the behavioral sciences does the interplay of psychological cause and effect show more clearly than in the psychodynamic movements revealed by hypnosis. Whatever has been one's skepticism about the reality of unconscious processes, no other experience, unless it is that of intensive psychoanalysis, is so convincing as to the reality of covert interactions within the human psyche. The orientation is psychodynamic and eclectic in this treatise. That is, it is psychoanalytic to the extent that it accepts the existence of unconscious behavior, considers that it is mediated within psychodynamic mechanisms (such as projection, identification, displacement, rationalization, etc.), and takes the point of view that these interactions play significant roles in the etiology of pathological symptoms and maladaptive behavior. However, because many contributions to the treatment of clinical problems have stemmed from the recent investigations of the cognitive behaviorists and have been incorporated in the technology of cognitive-behavior therapy, this work also is eclectic. It is our opinion that some clinical problems are RT5814_book.fm Page xvii Friday, November 19, 2004 8:46 AM xvii most adequately and efficiently approached from a psychoanalytic point of view whereas others are best approached from the perspective of either behavioral or cognitive-behavioral therapy. Furthermore, the significant, broad and long-range goals targeted by the humanistic-existential therapists, such as the development of meaningfulness, authenticity, and spontaneity in the self, often are required if other than temporary relief is to be granted to many of our patients. Obviously, this book is not meant to be "purist." Instead, it draws from several alternative theoretical conceptualizations and skills that, practiced within the hypnotic modality, promise maximal therapeutic effectiveness. We include information relating to the major scientific societies and how to affiliate with them. They are key to an individual's continued growth as a clinician who uses hypnosis in his or her practice or research. They furnish continuing education for the initiate and for the expert in the field. There are legitimate national and international societies concerned with research and practice in hypnosis and with ethical codes governing its use. Unfortunately, certain other organizations with lowered professional and ethical standards attract those whose power and exhibitionistic needs exceed their professional sense of responsibility for the amelioration of mankind's ills. The content of this volume is sufficient for a semester course in graduate school or medical school, or for an intensive introductory workshop. It provides a background history of hypnosis, the phenomena of hypnosis, theories of hypnosis, hypnotizability testing, and, most important, details of hypnotic inductions and deepening techniques. Throughout, the intention of our emphases is to make it possible for students to learn how to induce actual hypnosis in the subjects that they work with to make possible responses that can go well beyond the comparatively weak effects that can be obtained by role playing, expectancy, context, or suggestion without inducing a true state of hypnosis. Students will learn powerful techniques that make it possible to use hypnosis to go beyond the effects that might be wrought by social influence. Recent and rigorously controlled experimental studies show us that hypnosis is clearly much more than social influence or a simple response to suggestion. However, this text recognizes that the use of hypnosis in the treatment of our patients will probably always involve a complex interplay of actual trance induced states and sociocognitive factors. We draw on both domains to maximize the participants' ability to achieve a true hypnotic state that can be substantiated by neural substrates. Worldwide, the number of clinical and experimental studies being currently published on hypnosis has become exponential. Accordingly, RT5814_book.fm Page xviii Friday, November 19, 2004 8:46 AM xviii the bibliography of references included can in no way be exhaustive. It is not intended to be. Many excellent books and articles must, of necessity, be excluded. However, we have tried to refer to many of the most significant works, and the serious student will wish to read further in this vast literature. For those readers who are just starting their acquaintance with clinical hypnosis, welcome aboard and bon voyage. We guarantee an exciting and challenging experience. For those of you who are already working in the field, you know what we mean by the fascination of probing deeper into the mysteries of human psychological and physical experience. We, the authors of this treatise, are a generation apart. However, it came as no surprise to either of us that as little boys we were both thrilled by tales of exploration. In our very early teens we were both contributing to science. The first author's observations of the aurora borealis were accepted as part of the extension of the International Geophysical Year Studies, while the second author's observations of variable stars were accepted by the Society for the Study of Variable Stars. Alas, we have both mused with sadness that we will probably not be privileged to walk on the surface of the moon or gaze through a porthole window as the terrain of an unknown planet unfolds beneath us. But as this book teaches you how to use hypnosis, perhaps you too, like many of us who began its study earlier, will experience the same intriguing sense of wonder as you see the amazing phenomena that it continually reveals within "inner space," the universe of behavior and experience that constitutes the "self " of every person. Enjoy the adventure and resources that true hypnosis, like no other modality, affords your patients and research participants. —A.F.B. and J.G.W. RT5814_book.fm Page xix Friday, November 19, 2004 8:46 AM Table of Contents 1. The History of Hypnosis and Its Relevance to Present-Day Psychotherapy 1 2. Hypnotic Phenomena 27 3. Theorizing About Hypnosis: Recent Breakthroughs Shed New Light 53 4. Hypnotizability 89 5. Introductory Techniques of Hypnotic Induction 121 6. Advanced Techniques of Hypnotic Induction 147 7. Deepening Hypnotic Trance 185 8. Placebo, Hypnotic Suggestion, and the Hypnotherapist 203 9. Relieving Pain With Hypnosis 219 10. Hypnosis in Anesthesia and Surgery 241 11. Hypnosis for Childbirth Pain and Trauma 257 12. Mind–Body Interaction I: Hypnosis in Internal Medicine 289 13. Mind–Body Interaction II: Hypnosis in the Treatment of Dermatological Disorders 309 xix RT5814_book.fm Page xx Friday, November 19, 2004 8:46 AM xx ∑ Hypnotherapeutic Techniques: Second Edition 14. Meditation and Hypnosis for Health 323 15. Dental Hypnosis (Hypnodontia) 335 16. Hypnosis for Specialized Problems 357 17. Hypnosis With Children 387 18. Hypnosis and Sports Performance 411 Appendix: Societies and Journals 441 References 451 Index 477 RT5814_book.fm Page 1 Wednesday, November 17, 2004 1:56 PM Chapter 1 The History of Hypnosis and Its Relevance to Present-Day Psychotherapy Perhaps the earliest recorded description of hypnoanesthesia comes from Genesis 2:21–22: "And the Lord caused a deep sleep to fall upon Adam, and he slept; and He took one of his ribs, and closed up the flesh instead thereof. And the rib, which the Lord God had taken from man, made He a woman." Now, just imagine that you, as a doctor who has devoted your life to the study of human illness, have discovered a totally awesome new healing principle. You have happened, by good luck, on a new approach that seems to have miraculous results in relieving pain and curing many conditions that have defied the best efforts of your country's most distinguished practitioners. You have watched hundreds of sufferers lose their pains, throw away their crutches, and resume normal living after being invalids for years. As to the effects of your new technique, there can be no doubt. Furthermore, to account for this therapeutic power, you have developed a theory that is related to what is known scientifically about the operations of natural law. Your waiting room is besieged by patients from near and far. Your reputation as a great healer is established throughout the land. Only one cloud shadows your satisfaction: Your colleagues refuse to listen to you, learn your procedures, and verify them on their own patients. How would you feel? What would you do? 1 RT5814_book.fm Page 2 Wednesday, November 17, 2004 1:56 PM 2 ∑ Hypnotherapeutic Techniques Perhaps in your eagerness to share this great discovery with the rest of the world and to be scientifically recognized for your contribution, you would welcome an official hearing. Let some highly respected members of the medical and scientific societies investigate your practice and see your therapeutic achievements firsthand. Their skepticism will be erased. They can announce to your colleagues and to the rest of the world the truth about your great discovery. Suppose that finally the government appoints such a commission, consisting of several of the most respected names in science. This group visits your treatment office. They study your charts, observe your therapeutic procedures, and interview your patients. Now you surely will be vindicated. Their long-awaited report is finally published. You are devastated. They ignored the concrete examples of your healing. They paid little attention to the reports of your many patients who attest to their cures. They only criticized the theory by which you attempted to explain your therapeutic achievements, and then said that any reported results must be due to "imagination." How would you feel now? Could you carry on being scorned by colleagues and patients alike? Or would you, like Franz Anton Mesmer, leave the country in disgrace, filled with shame and bitterness? The Discoveries of Mesmer Mesmer, born in 1734, secured a degree in medicine in 1766. In tune with the times, his doctoral thesis, De Planetarum Influsu, attempted to relate changes in human functioning to gravitational and other forces in the surrounding universe. After all, if the position of the moon could so move the oceans of the world, would not such powerful forces also have significant impact on the operations of living organisms, especially humans? Mesmer was a brilliant man of great imagination. His interests were indeed broad. A musician himself, he was a friend of Mozart, Gluck, and Haydn. Vienna of that day was a city in which the arts blossomed as much as the sciences. But Mesmer was equally a scientist and physician, and as such had been made a member of the Bavarian Academy of Science. The mid-eighteenth century was a time of great ferment. The impetus for new advances, which two centuries before in the Renaissance had broken the frozen grip of medievalism and stimulated a new flowering in all the arts, especially in Italy, that now swept on into the realms of natural science. Newton, Galileo, Copernicus, Kepler, and others had made significant breakthroughs in understanding the universe and its laws. Gravity, chemical reactions, electricity, and magnetism were being discovered as great natural forces, energies that were soon to be harnessed and enormously increase man's standard of living. The Western world was on the RT5814_book.fm Page 3 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 3 verge of an industrial revolution. And speaking of revolutions, explosive social forces were at work that would soon sweep through the United States and Europe. Monarchies tottered before the increasing clamor of the many common people demanding their rights for liberty, equality, and fraternity. It was in such a world that Mesmer learned from the Royal Astronomer in Vienna, a priest named Maxmilian Hell, the principle of the magnet. If one would hold a bit of magnetized metal before the eyes of an individual, he or she would become transfixed. Moving and acting as if in another realm, the subject was especially susceptible to healing suggestions that could be administered at that time. His or her pains could be made to leave. Many other complaints could also be banished under the spell of the magnet. However, Mesmer soon made a most puzzling discovery. A priest named Gassner had been practicing a form of healing much like magnetism, which involved passes of the hands without the use of metal magnets. Mesmer observed Father Gassner's work and found that he himself could also accomplish the same results merely by placing his hand near his patients even without holding a piece of magnetized metal. How could this be? It had been established that a magnet has about it a field that influences other pieces of metal, and when held close to patients it obviously influenced them too, because pain and other symptoms were relinquished. There must be something of the same energy in the hand of the doctor. Therefore, this great healing power apparently was not limited to metals; it could also be found in bodily tissues. So Mesmer coined the term "animal magnetism" to represent a universal force that might account for the healing achieved by "the laying on of hands." How normal, how natural it was that a brilliant thinker with the searching mind of Mesmer could arrive at such an explanation. Yet here we see an example of what has often occurred in science where, through faulty reasoning, an invalid theory is formulated even though based on apparently sound observational data. Accordingly, Mesmer established his clinical practice on a concept that several years later was invalidated by scientists who were more careful and rigorous in their experimental controls. Mesmer was not the last to advocate the theory of a fluid, magnetic energy to account for healing effects. A century and a half later, a brilliant, creative psychoanalyst, Wilhelm Reich (1945), formulated theories about the concept of the "orgone," a life energy that could be concentrated in a box and focused back on the human body with healing results. He also treated patients according to his theory and was jailed for refusing to obey a desist ruling of the Federal Food and Drug Administration in the United RT5814_book.fm Page 4 Wednesday, November 17, 2004 1:56 PM 4 ∑ Hypnotherapeutic Techniques States. He died in jail, but perhaps his idea, even now, has not been put finally to rest. Recent "Kirlian" photographs (Krippner & Rubin, 1973) have shown that there is an "aura" of radiation about plant and animal tissue and alterations in it are correlated with healing effects. Maybe, just maybe, Mesmer and Reich were not entirely wrong. Mesmer's Controversial Case of "Restored" Sight Maria Theresa Paradis, a young singer and pianist, had been blind since the age of 3 years. The best physicians had not been able to restore her sight. She was brought to Mesmer, who developed a strong interest in her case. With her parents' consent, he took her into his home and treated her. Although a number of prominent physicians had diagnosed her condition as due to destruction of the optic nerve, there was considerable evidence that the blindness might be hysterical. Maria had performed before Empress Maria Theresa who, being favorably impressed with the girl, had provided for her education and granted her parents a pension. At first, the treatment seemed to be successful, and the girl apparently was able to see again. However, the case created consternation within the conservative medical profession of Vienna. If Mesmer really had such powers, the other doctors might lose their patients to him. Several influential physicians were able to convince Marie's parents that her cure was not genuine, and they suggested that if she was no longer thought to be blind, the parents might lose the pension. As a result, she was removed by her parents from Mesmer's care and returned to her home, after which her blindness returned. Here we see an experience from history that is so frequently repeated today, one that society prefers to ignore but that complicates enormously the task of the healing arts practitioner; namely, attempting to treat a patient who has more to gain by remaining ill. Huge malpractice suits are won; workman's compensation, disability payments, and the pensions of neurotically ill veterans are awarded to those who can successfully establish and retain symptoms in the face of treatment, psychological or physiological. To his great chagrin, Mesmer learned about secondary gains and reinforcements in the maintenance of illness long before the investigations of such factors by scientist-practitioner psychologists. This case example also serves to warn us that the first therapeutic question is not how we should treat the patient but whether the patient should be treated at all. Mesmer's Fascinating Theory of Disease Mesmer held that because the human body was composed of the same elements as those that made up the universe, it should be subject to the same RT5814_book.fm Page 5 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 5 laws that govern other bits of matter, including the planets. The body, too, should be influenced by light, heat, electricity, and changes in gravitation and even by influences from celestial space. He believed that the two halves of the human body acted in relation to each other like two poles of a magnet and that physiological processes were disrupted when there was a lack of harmony because of the improper distribution of magnetism. Animal magnetism was viewed as a kind of fluid that could penetrate all matter, that could be concentrated and reflected, and that could be invested by the human will into various parts of the body. Mesmer believed that he could direct this magnetic fluid through his presence, the passes of his hands, the waving of a metallic rod, and contact with the baquet. The baquet was a large wooden tub about a foot high, which he had constructed within his clinic. It was filled with bits of metal, bottles systematically arranged in concentric rings, broken pieces of glass, and water. It was large enough to allow a number of patients to sit around it. From its upper lid there projected several iron rods. This baquet was supposed to concentrate the magnetism (like a kind of eighteenth-century cyclotron) that could then be transferred by patients to their afflicted members through rubbing against the rods. Being a musician (and undoubtedly somewhat of a showman) Mesmer felt that the experience would be enhanced if the clinic room was darkened and music was playing while he, in a long flowing purple robe, passed among his patients, rubbing their bodies from time to time with his metal rod. Because patients were expected to go into crises (hysterical seizures) when the concentration of "magnetism" became sufficiently great, it is not surprising that every so often one would writhe and fall into a "fit," thus further impressing the others as to the potency of the treatment. When the number of patients seeking Mesmer's help exceeded the capacity of his clinic, he would magnetize a tree in a nearby park by stroking it. People could then stand around it, basking in its "magnetism" and occasionally going into crises. Despite all of this apparent foolishness, Gravitz (2004), as a remarkable historian of hypnosis, brought to our attention that Mesmer also recognized that his own belief in animal magnetism was a crucial element and that it "must in the first place be transmitted through feeling" (Mesmer, 1781, p. 25). At some level then, Mesmer understood the criticality of what we speak of when we emphasize the importance of resonance as a key element in helping to bring about the state of hypnosis as an instrument of therapeutic change. Indeed, it would seem that Mesmer had an awareness of key aspects of transference. Although he had no concept of issues of libidinal regression, he was a century ahead of Freud's recognition that the RT5814_book.fm Page 6 Wednesday, November 17, 2004 1:56 PM 6 ∑ Hypnotherapeutic Techniques hypnotic state was created from transferential phenomena: "the key to an understanding of hypnotic suggestion" (S. Freud, 1910, p. 51). A complete discussion is cogently presented by Gravitz (2004). Mesmer's Reception by Colleagues The same suspicion and criticism by medical colleagues that plagued him in Vienna continued in Paris, and the greater his successes, the greater became the hostility of the other doctors. In 1784, because of the conflicting claims, King Louis XVI appointed a distinguished commission, whose members were suggested by the French Academy of Science, to investigate Mesmer's practice. It is most interesting to note who was included among its members. There was doughty old Benjamin Franklin, who had discovered the relation of lightning to electricity with his kite. At that time, he was the American ambassador to France. There was Lavoisier, the first to isolate the element of oxygen. There was Jussieu, an eminent botanist, and finally (not without symbolic significance for the future of Mesmer's practice) there was the inventor of that device for amputating the head — Dr. Antoine Guillotine (we might also blame him for starting the whole mind–body separation notion that persisted until just a decade ago). Mesmer's therapeutic zeal was exceeded only by his tendency for exaggeration, his lack of caution in theoretical generalization, and his arrogance, a trait not uncommon in many good therapists today. The commission was soon able, through simple but well controlled experiments, to conclude that the changes in the symptoms of Mesmer's patients could not have occurred through the action of a hypothesized magnetic field. Their report stated flatly that there was no such thing as animal magnetism and that, because it did not exist, reported cures could be only the result of fraud or imagination. Rejected by colleagues and patients alike, Mesmer left Paris, and, after some wandering, settled in Switzerland near Lake Constance, on whose shores he had been born 50 years before. There he spent the rest of his days, unnoticed and unheralded. How often do individuals who are beaten by the forces of life return to the scenes of their childhood? How often do they simplify their existence, relinquish challenges to competitors, and cease efforts to make further advances? We see it every day in many of our patients. We call it regression. Mesmer's star burst forth like a brilliant nova in the development of psychological treatment, but within a few short years it had returned almost to oblivion. Although personally discredited, broken, and embittered, he left a legacy of findings and questions that have ever since fruitfully stimulated humans' quest for more knowledge about themselves. Mesmer RT5814_book.fm Page 7 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 7 reached to become God; he ended up very much human. Such strivings for power have often been the nemesis of practitioners of hypnosis, who, dazzled by the apparently unbelievable effects they achieve through the hypnotic modality, reactivate their own infantile yearnings for omnipotence. They sometimes lose their raison d'être as practitioners of the healing arts, as servants to men, and seek to use their newfound skills to become masters of humankind. The history of hypnosis has many lessons to teach the would-be hypnotist, and history tends to repeat itself. The development of modern hypnosis is considered to have started with Mesmer. However, the use of hypnosis in treating human ills is probably as old as the history of medicine. There is evidence that most hypnotic phenomena were known to ancient man. Eighteen hundred years before Christ, hypnosis was apparently practiced in China. The Old Testament Hebrews employed the trance state in the making of prophecies. And the Druids would put suspects into a "sleep" to induce them to tell the truth. In the fourth-century B.C., temple cults developed in Greece (during which an induced sleep was combined with other forms of suggestion for the treatment of illness). Through the dances of whirling dervishes, the ancient Egyptians induced states of trance and ecstasy, during which hypnotic analgesia could be achieved. It would appear that many of these early inductions were successful in establishing true hypnotic trance effects, well beyond what is labeled "hypnosis" by some today. As we reveal in the theories and techniques foci of this text, a number of practitioners and even researchers today seem content to settle for nothing more than the social influence or suggestion and relaxation effects that accompany some insufficient hypnotic inductions. Although these effects can be used to the benefit of our patients, far more can be accomplished with true hypnotic trance, which can now be identified by reliable and rather robust physiological markers of hypnosis (see chapter 3, "Theorizing About Hypnosis"). Mass hypnosis may largely account for the rage of tarantella dancing that swept through Europe during the late Middle Ages. Hundreds of people were seized by the fury, and they gyrated in wild abandon until they collapsed in a state of exhaustion. In India and Tibet, more passive forms of hypnotic meditation were developed that have continued today in the exercises of the Yogis and various forms of Buddhism. Many Indian tribes in the United States used the trance for purposes of medical treatment, making it possible today for psychologists and medical practitioners who are skilled in hypnosis to be accepted by tribal healers. G. Williams (1968) presented a more detailed and documented account of the various hypnotic practices among early peoples. It is sufficient here to note that hypnosis (although called many different names) has been known for many RT5814_book.fm Page 8 Wednesday, November 17, 2004 1:56 PM 8 ∑ Hypnotherapeutic Techniques centuries by both primitive and civilized humankind and was employed to treat ills in every part of the world long before it became a serious object of scientific inquiry. The Development of Hypnosis After Mesmer Let us now return to trace the history of this interesting phenomenon during more recent years. One of Mesmer's students, the Count Maxime de Puysegur, is credited with being the first to discover the phenomenon of somnambulism, wherein the hypnotized individual can walk, talk, and engage in many activities, yet still remain in a trance state. After Mesmer, a number of people continued to practice in the field, calling themselves magnetists or mesmerists. Some of these, such as de Puysegur, while employing Mesmer's therapeutic techniques, were not convinced that the phenomena were due to an invisible magnetic fluid. They approached close to the more psychological etiologies that are now held. (In 1821, in France, Récamier reported a painless surgery accomplished on a "magnetized" patient.) Although practice of animal magnetism became almost extinct in France following the discrediting of Mesmer, workers in Germany, especially during the 1840s, continued to employ it. Their efforts were apparently aimed at gaining respectable medical and scientific acceptance, and, in fact, in 1818 the Berlin Academy of Science offered a prize for the best thesis on the phenomena. However, little more was done to bring new discoveries to the field, and none of these men left enduring marks on its development. Sporadic attempts were also made by disciples of Mesmer in France to reactivate interest. They were able to induce the French Academy of Medicine on several occasions during the early 1800s to appoint a commission to examine the therapeutic claims of magnetism. The results were usually inconclusive, and it was not until many years after Mesmer's death in 1815 that renewed study of the phenomenon awakened attention. Perhaps this illustrates the repetitive nature of the history of hypnosis that has occurred again and again up until the present. Each episode started as a reputable physician or scientist observed hypnotic demonstrations by another worker. The physician's incredulity changed to belief and enthusiasm. These techniques were adopted in their practice and valiant efforts were made to convince professional colleagues. Students and disciples flocked around, and his or her center became a beehive of practice and investigation. The physician would frequently become overly arrogant and pretentious in his or her therapeutic claims, thus antagonizing more conservative scientific colleagues who then tried to discredit the RT5814_book.fm Page 9 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 9 findings. Overenthusiastic followers attempted to treat all conditions, both organic and functional, with hypnotic techniques. Similar to a borderline patient, they made their leader a god. Inevitably they became disillusioned, and interest in the field died down, only to be revived again similarly by a new messiah. A critical psychiatrist once remarked, "Hypnosis has been tried and abandoned by the human race many times. Why should we study it now?" To which the only appropriate reply is, "No matter how many times hypnosis has been abandoned, people keep coming back to it." Apparently, its efficacy kept rising to the surface well before present-day research and the National Institutes of Health found hypnosis to be officially efficacious. Not only has the cycle of skepticism, discovery, application, and overenthusiasm leading to abandonment characterized different times and the physicians of different countries; it is a typical experience today by the newcomer who is taking his or her first course or workshop in the field. In fact, you who are now reading this may go through these same stages. You undertake a course in hypnosis because of curiosity or the recommendation of a colleague. Initially you have many doubts and reservations about its reality or potency. You observe the induction of a number of individuals taken into a trance state and learn how to do it yourself. You watch demonstrations of deep trance phenomena, such as pain control, regression, perceptual distortions, and hallucinations. You are astounded. Why had you not been taught these marvelous powers before? Here you have the "magic bullet" that medicine has always sought to cure human ills. You enthusiastically apply the procedures to your own practice with varying degrees of success. If you now seek perfection and omnipotence, sooner or later you will be disappointed. Many of you will forsake the field, as did most of Mesmer's followers. First stage is skepticism. Second stage is overenthusiasm. But if you can persevere through to the third stage, you may reach the point where you recognize that hypnosis is not the magic wand, that it cannot cure all conditions, that it has limits, and that it does not always work. You will then perceive it as simply another useful technique in your therapeutic armamentarium that can often help in the successful treatment of many sufferers. You will find that with this tool you can at times do some things you could not otherwise accomplish, or at least not without a much greater expenditure of time and effort. You are then no longer merely a hypnotist. You are a mature member, along with many others, of the healing arts professions who knows how to use this modality as an adjunct to other aspects of your training for the benefit of your patients. These are a few of the lessons that the study of scientific hypnosis teaches us. RT5814_book.fm Page 10 Wednesday, November 17, 2004 1:56 PM 10 ∑ Hypnotherapeutic Techniques It is 1837 in England, and history is about to be repeated. John Elliotson (1843), a very attractive and brilliant physician, has just observed demonstrations by Monsieur Depotet, a visiting French mesmerist. Elliotson was known for his tremendous energy, his willingness to experiment with new concepts, and his unorthodoxy. He had been the first physician in England to use a stethoscope (curiously, the motivation for the invention of the stethoscope came from the physicians' restraint in placing their ears on the chest of a more than frequently filthy patient). He had translated Blumenbach's Physiology, a major text of the day. He had many other original contributions to his credit. He had discovered the value of such drugs as potassium iodide and prussic acid in the treatment of various conditions. Moreover, he was first professor of the Practice of Medicine in London University and president of the Royal Medical and Chirurigical Society. Obviously, such an inventive and innovative man would be fascinated with the phenomenon of hypnosis. He began practicing and writing about it. He and his students published a journal, the Zoist, devoted to the reporting of cases treated by mesmerism. He immediately incurred the anger and scorn of his medical colleagues and was singled out especially for attack by the editor of Lancet, the medical journal. Elliotson believed in the magnetic theories of Mesmer and was inveigled into an experiment where he intended to demonstrate that a silver coin (because it contained magnetism) would induce the trance state, whereas a lead coin would fail. Unfortunately, one of his opponents switched coins. The subject was hypnotized by the lead coin, hence responding to Elliotson's words and not to the "magnetized" coin. Elliotson was bitterly attacked. He continued his work against all opposition, but he was denied the pages of the medical journals and forced to resign his post on the staff of the University Hospital. He was especially noted for his treatment of children, with whose sufferings he could so well identify. Ridiculed, despised, and abused, he died in 1868, vainly attempting to interest his medical colleagues in the practice of mesmerism and to regain his scientific respectability. Times are better now for clinicians and researchers interested in hypnosis. Courses in the modality are offered in many medical schools and in graduate departments of psychology and counseling psychology. One can specialize in this area and retain professional acceptance. But even yet, the shades of reactionary ignorance linger on. If you return to your hospital or clinic and practice what is taught in this book, do not expect to be automatically received by your more conservative colleagues with open arms. And if you are an academic professor of psychology, your department might indicate it would prefer that you study such respectable areas as RT5814_book.fm Page 11 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 11 learning theory, motivation, or perception. Yet my (A.F.B.) own appointment at Harvard Medical School and early promotion to associate professor was made possible only because of my work in hypnosis. The similar acceptance and career rewards have come to many of my former PhD students who rapidly became chiefs of their psychological services units or repeated winners of major National Institutes of Health grants for research. The second author's (J.G.W.) stellar lifelong career features appearances on national TV (60 Minutes, etc.), and his international reputation of fame as the "Father of Ego-State Therapy" is unquestionably due to his work in hypnosis. Now, the time is 1845 and the place is Calcutta, India. A skilled surgeon by the name of James Esdaile (1957) has been conducting dozens of operations using mesmerism as his anesthesia. He induces profound trance states in his patients and during a period of 7 years has performed more than 2,000 painless operations. Some 300 of these would be classed as major surgery. They involved amputations, removal of scrotal tumors, cataracts, and so on. At first, Esdaile attracted favorable attention, especially from the deputy governor of the State of Bengal. Through his auspices, Esdaile was given a hospital devoted to mesmeric practice. He even succeeded in convincing a number of prominent physicians of the validity of his work. However, when he returned to Scotland in 1852, he too was the recipient of the rejection that had been hurled at Elliotson. In Calcutta, hypnoanesthesia was for the first time practiced on a grand scale. True, scattered operations had been reported earlier in the United States, England, France, and Germany, but no one had before employed mesmerism for the wholesale relief of pain in hundreds of surgical cases, and no one has employed it so extensively since that time. Ether and chloroform were discovered. The more general applicability of chemoanesthesias, coupled with the unreliability of the mesmeric trance and the greater skill required for its use, soon settled the matter. However, at least one finding of Esdaile's has not been challenged to this day and is deserving of much further research. Although a high proportion of surgical cases died in surgery (or shortly afterward) of shock, almost none of those whose operations were conducted under mesmerism did so. This favorable ratio held even when compared with the ratio of successful surgeries conducted under chemical anesthesias. One other great contributor of the day came from the English-speaking world. James Braid (1843) was a Scottish ophthalmologist. In November 1841, he visited the demonstration of La Fontaine, a French magnetist. Initially skeptical, he denounced the first séance. But he stayed, continued his observations, and changed his mind. Within a year, he presented a RT5814_book.fm Page 12 Wednesday, November 17, 2004 1:56 PM 12 ∑ Hypnotherapeutic Techniques paper, which was rejected, to the Medical Section of the British Association in Manchester. Braid received attacks, not only from the medical profession but also from the clergy with whom he got into a controversy as to whether the effects of mesmerism were due to the influence of "Satanic agency." Braid could not accept the magnetic theories of Mesmer. He was the first to insist that the phenomenon was psychological in nature and due to suggestion administered while the patient was in a unique state. Extrapolating on the work of Faria (1819) who coined the term sommeil lucide (lucid sleep) as an alternative to the animal magnetism explanation of the behaviors elicited by Mesmer, Braid saw a neurological basis and termed it "neuro-hypnotism," or nervous sleep. Soon he referred to it as simply "hypnotism" and the one who practiced it as a "hypnotist." Braid derived the word from the Greek term that means sleep. However, hypnosis is not sleep at all. As Herbert Spiegel (1998) pointed out, both sleep and hypnosis involve a contraction of outside awareness. But it goes in opposite directions: in sleep it dissolves, in hypnosis it intensifies. Braid did not suffer as much from the darts of jealous colleagues as did Mesmer and Elliotson. But then he was not a man who was driven to seek prestige as much as the others were, nor was he as argumentative in his claims. His career leaves us with a constructive thought. He who returns from his first acquaintance with hypnosis to trumpet enthusiastic claims for its superiority as a therapeutic modality can expect the mobilized opposition of his colleagues. Resistance is not engendered nearly as much when assertions of its value are tempered. Interest in magnetism reached the United States during the 1830s and 1840s and a number of operations under trance were reported, facilitating an active society of mesmerists in New Orleans in 1845. Phineas Quimby practiced hypnosis in the United States, but he is not as well known as his most celebrated pupil, Mary Baker Eddy, who founded Christian Science. Although the latter method of healing greatly resembles hypnotic interventions, its founder and followers, contrary to controlled research showing that hypnotic phenomena are present in eye movement desensitization and reprocessing therapy (R. Alexander, 1997), insist that it has nothing to do with hypnosis (see Janet, 1919/1925). Almost a half-century after the death of Mesmer, the focus of hypnotic practice returned to France. In 1864, Ambroise-August Liebeault, a poor man's doctor, settled in Nancy after finishing his medical degree in 1850 at the University of Strasbourg. After reading a book on mesmerism during his medical studies, he had been successful in hypnotizing several subjects. However, it was not until 1860 that he began to practice the modality seriously. RT5814_book.fm Page 13 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 13 Liebeault was a simple and modest man. To induce his French peasant patients to submit to hypnotic treatment (because they were accustomed to drugs and physical manipulations), he offered to treat them free with hypnosis while charging for the more traditional therapies. By offering such free treatment he, unknowingly, was testing the effects of hypnosis versus those of expectancy. During the late 1900s, expectancy was thought by those of the sociocognitive perspective (Kirsch, 1990; Kirsch & Council, 1989) to account for much if not all of what could be wrought by hypnosis. Such notions, originally refuted by the therapeutic results produced by Liebeault more than 100 years ago, are only now being brought to requestioning (A. Barabasz, 2001b; Russell & Barabasz, 2001). Liebeault acquired much respect among the poor people of the area and is pictured as a great humanitarian, interested in the welfare of others regardless of recompense to himself. Bramwell (1956, p. 57) described a typical incident that he observed in Liebeault's clinic: Two little girls, about six or seven years of age, no doubt brought in the first instance by friends, walked in and sat down on a sofa behind the doctor. He, stopping for a moment in his work, made a pass in the direction of one of them, and said; "Sleep, my little kitten," repeated the same for the other, and in an instant they were both asleep. He rapidly gave them their dose of hypnotic suggestions and then evidently forgot all about them. In about twenty minutes one awoke and, wishing to go, essayed by shaking and pulling to awaken her companion, her amused expression of face when she failed to do so being very comic. In about five minutes more the second one awoke, and, hand in hand, they trotted laughingly away. Liebeault believed that the phenomena were psychological in nature, and he completely discarded the magnetic theories. After 2 years of hard work he published a book titled Du Sommeil et des Etats Analogues, Considères Surtout au Point du Veu de l'Action de la Morale sur le Physique (On Sleep and Related States, Considered Especially from the Point of View of the Action of the Mind on the Body). Perhaps initially the most unsuccessful book ever published, only one copy of the book (Liebeault, 1866) was sold then. He continued treating as the poor man's doctor, unknown, for some 20 more years, when great recognition belatedly came his way. Liebeault practiced actually and figuratively on "the wrong side of the tracks." On the other side lay the great University of Nancy, and at its medical school resided an eminent doctor, Hippolyte Bernheim, professor of neurology. Liebeault was successful in treating a patient who for many RT5814_book.fm Page 14 Wednesday, November 17, 2004 1:56 PM 14 ∑ Hypnotherapeutic Techniques years had resisted Bernheim's therapeutic efforts, and the eminent professor decided to pay a visit to Liebeault. Highly skeptical at first, Bernheim might have felt that he was carrying out this investigation for the purpose of exposing a quack. However, if he came to jeer, he stayed to cheer. Liebeault's work interested him greatly, and he became one of the country doctor's best friends. In 1886, he published his own textbook, Suggestive Therapeutics (see Bernheim, 1964), describing the techniques and giving due credit to Liebeault. After that, visitors from far and near flocked to Nancy to observe and study with Liebeault and Bernheim. Even though now famous and although many purchased his book, Liebeault preferred to treat the poor for little or no fees, and he apparently never profited financially from his newfound status. He and Bernheim developed what came to be known as the Nancy School, a center for hypnotic practice and instruction that emphasized the concept of suggestion and taught that hypnosis was a psychological phenomenon, not a magnetic one. Another school developed to the north in Paris under the leadership of the distinguished neurologist Jean Martin Charcot (1889). Charcot, who practiced at the Salpetrière Hospital, opposed the views of the Nancy group. He mistakenly believed that hypnotic phenomena were pathological and found only in hysterical people. Although he was aware of the factor of hypnotic suggestion and of psychological influence, he still tried to revive interest in the old magnetic theories (see Figure 1.1). Liebeault and Bernheim were soon drawn into a controversy with Charcot and a number of joint experiments were set up to test the relative claims of each. The views of the Nancy group prevailed, and magnetic theories of hypnotism were no longer seriously voiced after that time. Pierre Janet (1919/1925) studied with both Bernheim and Charcot and was a prolific practitioner of the hypnotic art. He considered it a form of dissociation and likened hypnosis to hysteria. He reported an interesting case of a young woman who suffered from anorexia and a glove anesthesia (see p. 246 of this volume) over most of her body. She would eat only while under a state of hypnosis. Once, while Janet was absent from the clinic, he left her under hypnosis so she could be fed. In the hypnotic state, she appeared so normal that when her family came to visit that day they concluded she was cured and took her home. After a week or two, the hypnosis wore off, and her symptoms returned. She was hypnotized by Janet again and sent home once more. During the next 8 years, she was placed back in hypnosis and sent home every few weeks. She died of tuberculosis, apparently having spent 8 years without any further problems caused by anorexia. Janet was aware of unconscious processes and wrote about them. RT5814_book.fm Page 15 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 15 Fig. 1.1 A demonstration of hypnosis by Jean Martin Charcot. A Clinical Lecture at the Salpetrière. A. Brouillet's painting shows Charcot at the height of his fame, demonstrating a case of grande hysterie to an elite audience of physicians and writers; behind him is his favorite disciple, Babinski. The painter has involuntarily shown Charcot's fatal error: his verbal explanations and the picture on the wall suggest to the patient the crisis that she is beginning to enact; two nurses are ready to sustain her when she falls on the stretcher, where she will display her full-fledged crisis. (Le Salon de 1887, Paris, facing page 62). However, because it was Freud who described these processes in more detail, Janet was not given the credit for discovering them. Up to this time, hypnosis had been used as a general therapeutic method for attacking all types of symptoms, whether organic or psychogenic in nature. Hypnoanesthesia and the relief of pain were its most common uses. Also, until this time, most practitioners considered psychiatric illness to be, if not simply malingering, organically caused. Even Charcot subscribed largely to this point of view. But now the time was ripe for the discovery that many disorders were psychologically, not physiologically, caused, and hypnosis was to play an important role in the vanguard of these advances. Josef Breuer was a general-practice physician in Vienna, highly respected and also a teacher of medicine, although not a professor. He was conservative in nature and given to much equivocation and doubt in pursuing a remarkable discovery he had made. Hypnosis had been used primarily to suppress or eliminate symptoms. Thus, Bernheim and Liebeault RT5814_book.fm Page 16 Wednesday, November 17, 2004 1:56 PM 16 ∑ Hypnotherapeutic Techniques would hypnotize their patients and instruct them to relinquish their illnesses. Often this was effective; often it was not. Breuer used "suggestive hypnosis" to treat a young woman known as Anna O., who suffered from a hysterical disorder. He was not successful in relieving her symptoms at first. However, when he induced her to "abreact" or relive early traumatic situations in her life in which she remembered (reconstructed memory may or may not be accurate; see A. Barabasz, 2001a) and expressed feelings, the symptoms left. Breuer and Freud were close friends. In fact, Breuer helped Freud financially during his early medical studies, which enabled Freud to get married. Both men had studied with Dr. Ernst Bruecke, a psychiatrist who espoused a strong physical–chemical approach to the understanding of mental disorders. Freud was most intrigued with Breuer's abreactive method, but he received no encouragement from Charcot when he described it to this teacher, and Bruecke was most violently opposed to hypnosis, which he regarded as rank charlatanism. Accordingly, although Freud had observed Breuer's work as early as 1882, he did not take up the practice of hypnotism until 1887. Freud's experience with hypnosis brought him to the discovery of unconscious processes and provided the great breakthrough in psychiatric thinking that was to dominate this discipline for the next half century (Breuer & Freud, 1957). However, for a number of reasons he relinquished his use of this technique. In the first place, he was not a very good hypnotist. He was unable to induce a deep state in many of his cases. This might have been due to the fact that Freud, a brilliant, impatient young genius, was not sensitive in interpersonal relationships. Not unlike some noted hypnosis researchers today, he was not sufficiently patient to involve himself in the induction process long enough to secure a profound hypnotic state. Furthermore, Breuer, the modest old conservative, was quite embarrassed when Anna O. developed strong love feelings for him because of the treatment. This caused him to break off his therapeutic relationship with her. Freud was similarly embarrassed when a female patient threw her arms about him. He had not at that time discovered the meaning of transference and did not know how to deal with such manifestations. Also, many patients who relinquished their symptoms under hypnotic abreaction would reinstate them again, and Freud despaired of achieving permanent results by this modality (see J. Watkins, 2001, and J. Watkins & H. Watkins, 1997, for new hypnotic abreactive techniques that minimize this problem). At any rate, Freud developed a much slower and less effective method of cathartic release by pressing his hand on the patient's forehead and asking the patient to freely associate, that is, tell everything that came to mind. As RT5814_book.fm Page 17 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 17 we see later, this might have actually constituted the induction of a light hypnotic state, but the material that emerged was less emotionally laden. As Freud was better able to handle and understand this, he was able to study the process more logically and with less emotional distraction. Perhaps this was best for the development of psychoanalysis because it brought to therapy a slower and more rational approach. Unfortunately, Freud masked his own inadequacies at working within the hypnotic relationship by maintaining that psychoanalysis began only with his discarding the hypnotic method and introducing that of free association. The daughter (psychoanalysis) rejected its mother (hypnosis), and it was the parent that was regarded as illegitimate during the next few decades. Most of the objections that Freud raised about hypnosis, such as that its results were temporary and that it "bypassed the ego," have since been disproved by investigators in the field. It should be noted also (see Kline, 1958) that when Freud practiced psychoanalysis, he was content to listen passively to the associations of his patients, but when he used hypnosis, his own manner of treatment changed. He became the authoritarian and commanded the symptoms to disappear. In fact, he said that he became bored with the monotonous arbitrary prohibitions used in treatment by hypnosis. Whether Freud's different therapeutic manner when he used hypnosis compared with when he was psychoanalyzing was because of his having been taught that hypnosis was an authoritative approach involving command and entreaty or whether something within his own counter-transference needs was stimulated by the hypnotic relationship, we will probably never know. Hypnosis gives the hypnotist the illusion of great power, and many a modest man has been seduced by power into becoming a tyrant. At least it does teach us that therapeutic hypnosis is much more than an altered state of consciousness achieved by manipulations of the operator. In the treatment situation, it is a sensitive mode of communication, and its effective use is subject to the quality of the interpersonal relationship between hypnotherapist and patient. There is little doubt now that Freud's failure with hypnosis was largely due to his personality rather than to an inherent weakness in the modality. It is a pity that this point seems unknown by the majority of analytic psychotherapists. But the aura of Freud, the great master of psychoanalysis, remains and still keeps many of his disciples from learning to recognize that his prejudices withheld from the psychoanalytic field a most fruitful technique that can uncover repressed material, assist in its ego integration, and frequently produce permanent results in a much shorter time than can free association. RT5814_book.fm Page 18 Wednesday, November 17, 2004 1:56 PM 18 ∑ Hypnotherapeutic Techniques In spite of his rejection of hypnosis, Freud could never quite abandon it completely. Time and again, he would toy with the idea, although he personally could not bring himself to reexamine his position and use it again on his patients. In 1919, he wrote, "Hypnotic influence might find a place in it [psychoanalysis] again." He also stated that practical psychoanalysis might constitute an alloy of "the pure gold of analysis" with the "copper of direct suggestion" meaning hypnosis (S. Freud, 1900–1953, p. 402). The days of the 1890s were a boom time for hypnotic practitioners. Everybody hypnotized everybody for every known disorder. Carcinomas, brain tumors, viral diseases, and so forth were subjected to hypnotic suggestion, of course with a high number of failures. Doctors who wished for omnipotence and thought that they had arrived there became disillusioned. Then, with the rising interest in psychoanalysis among physicians, hypnosis fell once more into disuse. Only a few isolated practitioners and lay entertainers continued to employ the modality. A Harvard psychiatrist, Morton Prince (1906), investigated multiple or dissociated personalities by hypnosis and, in World War I, Simmel in Germany and Hadfield in England employed it to treat war neuroses. Simmel (1944) developed a modified abreactive technique in which his German soldier-patients were induced to release their angers by tearing to pieces under hypnosis a dummy wearing a French uniform. Hadfield integrated hypnosis with psychoanalytic techniques and was probably the first to coin the term hypnoanalysis. Modern Hypnosis In 1933, Clark Hull, a distinguished experimental psychologist, published the first book that presented controlled research investigations on hypnotic phenomena. He and his associates looked into such matters as the relation of postural sway to hypnotizability, age differences in hypnotizability, the relation of hypnotizability to general intelligence, the ability of individuals under hypnosis to transcend normal motor and sensory abilities, and so forth. These were the first carefully controlled investigations. Up to that time, nearly all data about hypnosis had been secured from clinical observations on patients. Such reports had inherent in them the subjectivity and biases that are characteristic of case studies. Hull was the first to map out hypnosis as a legitimate field of study by modern experimental science. The world of academia proved to be just as conservative as the province of medicine, and Hull was the recipient of much criticism by other psychologists, who regarded hypnosis as within the field of magic and not sci- RT5814_book.fm Page 19 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 19 ence. Hull's pioneering studies did much to break down academic prejudice against investigators in this area, because his own scientific credentials were impeccable. He was widely renowned as a researcher and theorist in the field of learning, and in 1936 served as president of the American Psychological Association (APA). Hull and his students were a powerful influence in making hypnosis respectable among experimental scientists, just as Bernheim and Charcot had been in relation to the medical profession. During the 1930s, another boost to physicians and psychotherapists came in the form of a flood of innovative papers emerging from the pen of Milton H. Erickson (see Haley, 1967). This psychiatrist experimented with a wide variety of ingenious techniques for inducing hypnosis and eliminating symptoms. He became a master in the art of using language to communicate with his patients at unconscious levels. Erickson did not subscribe to the psychoanalytic goals of achieving insight into the causes of neurotic disorders. Rather, he would bypass resistances and make his patient's defenses untenable, thereby forcing a relinquishment of symptoms. As first president of the American Society for Clinical Hypnosis, and as the first editor of the American Journal of Clinical Hypnosis, he achieved worldwide recognition. He was also a controversial figure during the societal quarrels that broke out among hypnotic specialists during the late 1950s and early 1960s. That is another story, which we describe later. During World War II, the second author of the present text (J. Watkins, 1949), while at the Welch Convalescent Hospital in Daytona Beach, Florida, was given the unusual opportunity of developing a hypnotherapy program for returning soldiers. The abreacting of war experiences had been found valuable by Grinker and Spiegel (1945), but in their work they, as well as most other military psychiatrists, relied on the use of such drugs as sodium amytal and sodium pentothal to induce the altered state of consciousness that would permit emotional release. At that time, only a few military practitioners were employing hypnotic techniques in the treatment of war neuroses. In 1945, the Welch Hospital included some 2,500 soldiers who were psychiatric casualties, and an entire company of patients was allocated to treatment either by hypnotherapy or by "narcosynthesis," the term Grinker and Spiegel (1945) applied to their approach. Much latitude was given in this "Special Treatment Company" to develop and experiment with a wide variety of hypnoanalytic procedures. During the years immediately after the war, there was a great upsurge of interest in the applications of hypnosis to dental practice. The anxieties and dental phobias shown by many patients have always been a source of difficulty to these practitioners. Hypnosis offered an approach for dealing RT5814_book.fm Page 20 Wednesday, November 17, 2004 1:56 PM 20 ∑ Hypnotherapeutic Techniques with them. In addition, hypnotic anesthesia might prove of value in either replacing or supplementing chemoanesthesias for the relief of dental pain. Burgess (1952) and Heron (1953), two psychologists in Minnesota, taught hypnotic techniques to many dental practitioners. "Hypnodontia" societies were organized, and there were more than 300 dentists within that state using hypnotic procedures almost before dentists in other parts of the country had heard of such procedures. A pioneering group of some 25 psychologists and psychiatrists organized the Society for Clinical and Experimental Hypnosis (SCEH) in 1949. The leaders in this group were Jerome M. Schneck, a psychiatrist and psychoanalyst, who served as its first president, and Milton H. Kline, who became the editor of the Journal for Clinical and Experimental Hypnosis, published by the society. To counter the criticism focused on hypnosis by psychoanalysts, conservative physicians, and academic psychologists, membership in this organization was purposely restricted by the extremely high membership requirements. To become a member one was required to have had many years of experience and have published significant contributions. Accordingly, the organization grew very slowly, and during the following 8 years, it did not number more than 100. In 1955, a report by a lay hypnotist was published that described a participant who, under hypnotic regression, purported to be the reincarnation of a young Irish woman called Bridey Murphy. Bridey gave many details of her supposed "life" of 150 years earlier. Although reputable scientific study could find no realistic basis for this claim, the case attracted much public attention. Time, Life, Look, and many other magazines devoted space to it. Both lay people and professionals were intrigued. The publicity given to Bridey Murphy tended to emphasize the unscientific and spectacular claims that had so often in the past brought repudiation of hypnosis by reputable physicians and scientists. It smacked of Mesmer's showmanship. Interest in hypnotic "reincarnation" died down, but a number of scientists and mental health practitioners were induced to commence serious study of the therapeutic potentialities in hypnosis. Milton Erickson organized a teaching team that gave 3-day seminars throughout the United States to physicians, psychologists, and dentists. Many new recruits to the field received their initial training at these courses. However, these newcomers found that they did not have the extremely high requirements for membership in the SCEH. They were considerably dissatisfied at their inability to affiliate with the only hypnosis society existing at that time. After a battle over efforts to lower the entrance requirements for the SCEH, Erickson and his associates organized, overnight, a new society RT5814_book.fm Page 21 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 21 called the American Society of Clinical Hypnosis (ASCH). Filled from the ranks of the students in seminars, this organization grew rapidly and became much larger in size than the SCEH. A bitter conflict ensued between the parent group, centered in New York, which insisted on the extremely high standards of membership, and the new vigorous young ASCH, centered in Chicago, which argued that hypnosis was too valuable a modality to be so restricted. This split occurred in 1957 and was followed by more than 5 years of bitterness, name-calling, and raiding of each other's memberships. Competition for new members, especially of those who had achieved status in the field, was keen. The SCEH prided itself on its quality and had at that time, as it does today, the better-established journal. The ASCH, with its large and increasing membership, was much stronger financially, had a built-in recruitment system for new members in the seminars, and held out its shingle as "the most representative" organization in the field. The SCEH, threatened by the large membership and financial solvency enjoyed by the ASCH, countered in 1958 by developing two new organizations that were to make significant impact. Specialty boards existed in the field of medicine, dentistry, and psychology that certified practitioners who could demonstrate certain high-level qualifications. Thus, medicine had the American Board of Obstetrics and Gynecology, the American Board of Psychiatry and Neurology, the American Board of Surgery, and so forth. Specialty certification existed in such dental fields as periodontia and orthodontia, and in psychology the American Board of Examiners in Professional Psychology certified highly qualified practitioners in the fields of clinical, industrial, and counseling psychology. These usually involved 5 years of specialized experience plus examinations. Accordingly, the SCEH undertook to organize and launch the American Board of Clinical Hypnosis with three subboards: the American Board of Medical Hypnosis, the American Board of Hypnosis in Dentistry, and the American Board of Examiners in Psychological Hypnosis; the latter issued separate certificates in clinical and in experimental hypnosis. Reception of these boards was mixed. The psychology board was approved by the APA, and its "diplomats" were officially listed in the association's directory. The medical board did not receive official recognition by the American Medical Association (AMA), although the association had approved hypnosis as a legitimate medical discipline. The dental board did not receive the approval of the American Dental Association, nor would the association even recognize hypnosis as a legitimate study for dentists at the time. RT5814_book.fm Page 22 Wednesday, November 17, 2004 1:56 PM 22 ∑ Hypnotherapeutic Techniques To complicate the picture of conflict further, the AMA, stimulated by its psychiatric members, tried to restrict the use of hypnosis only to medical practitioners and to exclude psychologists from the field, especially clinical psychologists who were employing it psychotherapeutically. In general, this effort was not successful, except for a few states where medical practice laws were amended to limit the use of hypnosis to physicians. Within the two societies, the SCEH and ASCH, physicians, psychiatrists, psychologists, and dentists enjoyed a close congenial relationship, and quarrels between disciplines were largely avoided. The second move by the SCEH at that time was in organizing the International Society for Clinical and Experimental Hypnosis (ISCEH). The ASCH had been more successful in developing the field within the United States, but its very name limited its member-getting ability in other countries. Accordingly, the ISCEH, with the SCEH as its U.S. division, soon initiated divisions in some 30 different countries. Bernard B. Raginsky, a Canadian psychiatrist who was president of the SCEH at the time, requested John G. Watkins to form and chair the International Organizing Committee. The committee contacted leading workers all over the world to become the international directors of the new society and to organize the various national divisions. Raginsky (1963), who was also a president of the Academy for Psychosomatic Medicine, was a distinguished contributor to the field and had published numerous papers, especially on the applications of clinical hypnosis to the treatment of psychosomatic disorders. Widely known and respected, his leadership as the first president of the ISCEH was strongly instrumental in getting it accepted on a worldwide basis. The second author (J.G.W.) served as its executive secretary during the first 4 years, and later served as its president. The ASCH initially perceived the boards and the ISCEH as inimical to its interests, and it boycotted both organizations. However, as time passed and as the bitterness of competition between the SCEH and ASCH declined, it became rather inevitable that these two groups were complementary to each other and that each had something constructive to offer the field. The ASCH had many more members and a continuous educational program. The SCEH had the boards, the ISCEH, and a widely accepted journal, the International Journal of Clinical and Experimental Hypnosis. Many people who were members of both societies pressed for unification. As of 2005, such a uniting had not taken place, but the old quarrels, the bitterness, and the competition have disappeared. The two societies now cooperate in many matters, and joint national conference meetings are planned. Reports of each other's conventions and papers are RT5814_book.fm Page 23 Wednesday, November 17, 2004 1:56 PM The History of Hypnosis and Its Relevance to Present-Day Psychotherapy ∑ 23 published in both the American Journal of Clinical Hypnosis and the International Journal of Clinical and Experimental Hypnosis. The ISCEH held meetings about every 2 to 3 years (Chicago, 1958; São Paulo, 1960; Portland, Oregon, 1962; Kyoto, 1967; Mainz, West Germany, 1970; Uppsala, Sweden, 1973; Philadelphia, 1976; Melbourne, Australia, 1980; Glasgow, Scotland, 1982; Toronto, Canada, 1985; The Hague, 1988; Jerusalem, 1992; Melbourne, Australia, 1994; San Diego, 1997; Munich, 2000; Singapore, 2004). In 1973, it was reorganized and its name changed to the International Society of Hypnosis. Both the ASCH and SCEH are now affiliated with it. The Institute for Research in Hypnosis was also originally organized by the SCEH as a training and research unit. It was chartered by the Board of Regents of the State University of New York as a nonprofit educational foundation and served as the medium through which a number of courses, workshops, and international congresses were presented. The institute developed a treatment facility in New York City called the Morton Prince Center for Hypnotherapy. In the APA, Division 30 (formerly known as "Psychological Hypnosis" and recently renamed "Society of Psychological Hypnosis" [SPH]) also was organized to promote research and practice in the field of hypnosis. The SCEH, the ASCH, and to a much lesser extent the Society of Psychological Hypnosis sponsor workshops in hypnosis, as do various local hypnosis societies. APA's Division 17 (Counseling Psychology) started a Special Interest Group in Hypnosis in 1997. An increasing number of medical schools and graduate departments of psychology and counseling psychology from the larger universities now offer training in hypnosis. The year 2002 is another milestone. APA's Committee on APA Divisions Relations awarded a grant to the first author of this text (as president of the Society of Psychological Hypnosis 2002-2003) to develop a basis for the Integration of Hypnosis Training in PhD Programs (in clinical psychology and counseling psychology). The grant was developed in cooperation with APA's Multicultural and Counseling Psychology Divisions. At long last, hypnosis has largely overcome the prejudices in the medical profession and academia. Hypnosis is accepted as a legitimate scientific and treatment modality. The substantive National Institute of Mental Health supported research from the 1960s to 1980s at laboratories, such as those headed by Ernest Hilgard at Stanford, Martin Orne at the University of Pennsylvania, and Theodore X. Barber at the Medfield Foundation. More research and clinical application is focused in medical settings led by Harvard University Medical School, where hypnosis is the standard nonpharmacologic analgesia for interventional radiological procedures (see RT5814_book.fm Page 24 Wednesday, November 17, 2004 1:56 PM 24 ∑ Hypnotherapeutic Techniques Lang et al., 2000; Lang & Rosen, 2002), and by Stanford University Medical School, where hypnosis is routinely used to prolong life and provide cancer pain relief (see Spiegel, 1997.) At the University of California (Davis)

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