Trance and treatment: Clinical uses of hypnosis

Mott, Thurman Jr

Spiegel, Herbert & Spiegel, David (2004). Trance and treatment: Clinical uses of hypnosis (2nd Edition). Washington, DC: American Psychiatric Publishing, xxvii + 545 pages, $52.00. Reviewed by Thurman Mott, Jr., MD, Ijamsville, MD.

This is the second edition of an outstanding book; it has been revised and updated thoroughly. Almost all of the content has been modified somewhat, but the chapters on the neurophysiology of hypnosis and on the treatment of posttraumatic stress disorder have been completely rewritten. Although the book is centered around the assessment of hypnotizability with the Hypnotic Induction Profile (HIP), they present a total picture of a sound approach to hypnosis and its use in treatment.

The first chapter discusses naturally occurring trance phenomena and myths about hypnosis. Most of the myths described are ones that are commonly described or taught in workshops. However, the myth that "Hypnosis is therapy" is less widely described and taught. "That hypnosis is therapy is also a troublesome myth. We avoid the term hypnotherapist because by itself hypnosis is not therapy.. . . It may enhance therapeutic leverage, but by itself is not a treatment" (p. 16). I emphasize this point because for many years I have been trying to get authors to avoid the use of the term hypnotherapy and substitute, for example, suggestive therapy facilitated with hypnosis or restructuring therapy facilitated with hypnosis, etc. Doing this would help dispel the myth that hypnosis is the therapy.

In the chapter on induced trance phenomena, the authors point out that ". . . the authentic hypnotic experience can be defined as formal hypnosis only when it is knowingly induced by the operator; responded to by the subject in a sensitive, disciplined way; and terminated by the operator's signal" (page 35).

The next chapters of Part I describe the rationale for the HIP and the administration and scoring of the procedure. Although there are other clinical scales for assessing hypnotizability such as the Morgan and Hilgard's Stanford Clinical Scale for Adults(1978/79) and Pekala's PCI-HAP (1995), the Hypnotic Induction Profile requires less time and provides somewhat different useful clinical information. The instructions for administration and scoring are very detailed and specific, making it possible for the clinician to do the assessment in a standard way so that the results are useful as a way of reporting hypnotizability in clinical cases. They have updated the induction score on the HIP to a 16-point scale instead of the old 10-point scale. The 16-point scale does not change the administration of the test, just the scoring, so it can be applied to results done prior to the change in scoring.

Part II, The Hypnotic Profile as a Diagnostic Probe, is unique in the way personality style is approached. The personality style is determined with a personality inventory plus the HIP. "Three major personality types that emerge from the data are Dionysian, Apollonian, and Odyssean. Dionysians are intuitive, feeling, and trusting of others; they tend to be highly hypnotizable. Apollonians are logical, organized, and prefer to lead rather than follow. They tend to be at the low range of hypnotizability. Odysseans fluctuate between action and despair but are more balanced in the dialectic between feeling and thinking" (page 96). They go on to describe in detail these three personality types and how they are characterized with regard to space awareness, time perception, and their myth/belief constellation. In the chapter on "Hypnotizability and Severe Psychopathology" they correlate the findings from the HlP with the type of psychopathology, both Axis I and Axis II disorders.

As mentioned above, the chapter on neurophysiology is completely rewritten and updated. It is a brief but comprehensive review of the recent advances in understanding the neural substrate of hypnosis. It will be of particular interest to those who have not had the opportunity to read all of the literature in this field and want an overview of this important information.

The first chapter of Part III, Using Hypnosis in Treatment, is devoted to the important topic of formulating the problem. This chapter introduces their approach to the brief, symptom-oriented treatment called restructuring. However, most of the chapter is devoted to a useful discussion of various aspects of understanding the problem. Although occasionally mentioning the HIP it is comprehensive enough to be of value to clinicians whether or not they use the HIP.

The treatment method called restructuring is described in detail and is basic to understanding the next seven chapters on the treatment of specific disorders. Restructuring is recommended for the patient who is comparatively well integrated, scores in the intact range of the HIP, and who has a clearly defined and reasonable symptomatic complaint for which brief treatment is appropriate. In restructuring therapy the ". . . patient is invited to view the relationship between himself and his body as dialectical. That is, the patient is not his body nor entirely separate from it. ... The individual is invited to restructure the relationship between the self and the body . . ." (p. 225). The discussion of restructuring includes a philosophical background as well as how it is facilitated by hypnosis. The seven chapters on specific disorders include specific restructuring suggestions along with case examples for smoking control, eating disorders, anxiety, insomnia, phobias, pain control, psychosomatic disorders, conversion symptoms, and miscellaneous behavior disorders.

Although they "prefer to abide by the principle of parsimony" and use shortterm treatment whenever possible, in the chapter, "Spectrum of Therapies," they discuss long-term therapy in the light of the HIP and the personality types associated with it. Therapies are presented as a continuum: exploration, confrontation, consolation, guidance, and persuasion. For example, Apollonians (low-hypnotizable) are suited best for exploration, whereas Dionysians (high-hypnotizable) are more appropriately treated with guidance and persuasion. For the very highly hypnotizable patient: "There is a growing accumulation of clinical data that suggests that introspective psychoanalytic therapy is contraindicated for the grade 5 patient. . .". The special considerations they suggest in the chapter on the Grade 5 syndrome are important for all clinicians, whether or not they use hypnosis.

The last chapter on treatment, "Hypnosis in the Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder, and Dissociation," will be useful to all clinicians who use hypnosis, whether or not they use the HIP. Because "hypnotic-like phenomena occur spontaneously in individuals with posttraumatic and dissociative disorders" hypnosis is "a means for learning to control such symptoms."

This book is clearly written and extremely well referenced (29 pages of references). Although it will be of special interest to those who want to use the HIP, many sections of the book will be valuable to all clinicians using hypnosis in treatment. It is essential reading for anyone who is teaching a comprehensive course on hypnosis. Assessing hypnotizability should be a part of every basic hypnosis course for clinicians.

References

Morgan, A.H. & Hilgard, J.R. (1978/79). The Stanford Clinical Scale for Adults. American Journal of Clinical Hypnosis, 21, 134-147.

Pekala, R.J. (1995). A short unobtrusive hypnotic induction for assessing hypnotizability level: I. Development and research. American Journal of Clinical Hypnosis, 37,271-283.

Reviewed by Thurman Mott, Jr., MD, Ijamsville, MD.

Copyright American Society of Clinical Hypnosis Oct 2004
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