Working with dissociative fugue in a general psychotherapy practice: A cautionary tale

American Journal of Clinical Hypnosis, Apr 2003 by Jasper, Frank J

Since I had never dealt with complete amnesia before, I decided to follow Crasilneck and Hall's (1985) advice to proceed cautiously and not force the patient to examine the traumatic event or to have his memory return too quickly. I adopted a permissive and non-directive approach. I decided to use ideomotor signaling as the safest way to proceed. It was my hope that this would help avoid any direct contamination of Joe's memory experiences in case something illegal was involved. Since recovery of memory material is fraught with legal implications, an informed consent is imperative (Hammond et al. 1995; Brown, Scheflin & Hammond, 1997; Scheflin & Shapiro, 1989).

Joe went into a deep trance (Spiegel grade 4, possibly grade 5) very rapidly (Spiegel & Spiegel, 1976). He responded with clear ideomotor signals, and I rapidly established a positive response set (as follows):

Therapist: It's quite distressing for you to have lost your memory, isn't it?

Patient: Yes.

Therapist: Would you like to remember things about your wife and family?

Patient: Yes.

Therapist: Would you be willing to answer some questions about your memory?

Patient: Yes.

Therapist: Would it be helpful for you to regain your memory?

Patient: Yes.

Therapist: Would you be willing to return to the events of Monday in the safety of this trace?

Patient: No.

Therapist: Would you be willing to allow your memory to return gradually at a rate that is just right for you?

Patient: Yes.

Joe indicated (through ideomotor signaling responses) a desire to regain his memory, especially for his family, his work and his earlier life. He also responded that he had little memory before his adolescent years, as his wife indicated. So, I concluded that he used dissociation as a way to cope with early life experiences. He indicated that the fugue began Monday after a meeting with his boss. It was also clear that he did not want to return to the events that happened that day, no matter how safe or distant I made it. Finally, he grabbed his yes finger with his other hand and I knew that the use of ideomotor signaling was over for that session. This gesture could indicate the presence of a Dissociative Identity Disorder (inasmuch as it could represent one alter interfering with the ideomotor responses of another alter), and it clearly indicated intense internal conflict regarding the questioning (Steinberg, 1994a; Kluft, personal communication, March 23, 2001). It is likely that this reaction during the session could also have reflected the intense internal conflict Joe experienced with his boss.

At the conclusion of the session, I gave Joe the suggestion that you will be able to remember all that you need to know and all that you want to know at a time that is just right for you. People, places and things will remind you of events and your memory will return gradually when the time is ready, but not before then. You will be able to remember only those things that you are capable of coping with at the time. " I attempted to provide a sense of safety and security so he could gradually allow his memory to return (Loewenstein, 1995).