Hypnotherapy: A Reappraisal -- Part I

by Alfred A Barrios, PhD

Introduction

Throughout the years there have been periodic surges of great interest in hypnosis. Many extraordinary phenomena have been attributed to its effects and great claims made as to its effectiveness in therapy. Yet, in spite of such claims, there still appear to be relatively few therapists using hypnosis as a major tool. Why? Is it because the criticisms usually leveled at hypnosis are true? That it is overrated, actually limited to a small range of problems, unable to produce lasting changes? Will removal of symptoms by hypnosis lead to new symptoms? Is it dangerous? No, there is far too much clinical evidence contradicting these statements. Such evidence can no longer be ignored. It is felt that the major reason behind the rejection of hypnosis has been that for most people it is still virtually an unknown. It seems to be human nature to stay clear of or reject anything that doesn't seem to fit in or be explained rationally, especially when it seems to be something potentially powerful. It is mainly its unknown nature that has led to the many misconceptions surrounding hypnosis and has kept us from making the best use of it.

The purpose of the present paper is to present some of the recent clinical evidence contradicting the common criticisms and misconceptions surrounding hypnotherapy, to provide a good indication of how to make the best use of this tool, and to provide a rational explanation for its hard-to-believe therapeutic effects.

Overview of Recent Literature

There have been 1,018 articles2 dealing with hypnosis in the past three years (1966 through 1968), approximately forty per cent of which dealt with its use in therapy.

In the same period we find 899 articles on psychoanalytic therapy and 355 on behavior therapy.

Formerly at University of California, Los Angeles.
According to the National Library of Medicine's Medical Literature Analysis and Retrieval System (MEDLARS) storage of information, based on some 2,400 journals. The number given above does not include the articles on hypnosis in dentistry (64) and anesthesia (59) or those on suggestion (391) or the hypnosis studies done in the European socialist countries (532 in two recently released bibliographies covering the years 1945-1965 – Hoskovec and Svorad, 1966).

Contrary to popular opinion that hypnosis is only effective in certain specific symptom-removal cases, a wide range of diagnostic categories have been successfully treated by hypnotherapy. This includes anxiety reaction, obsessive-compulsive neurosis, hysterical reactions and sociopathic disorders (Hussain, 1964), as well as epilepsy (Stein, 1963), alcoholism (Chong Tong Mun, 1966), frigidity (Richardson, 1963), stammering and homosexuality (Alexander, 1965), various psychosomatic disorders including asthma, spontaneous abortions, dysmenorrhea, allergic rhinitis, ulcers, dermatitis, infertility and essential hypertension (Chong Tong Mun, 1964, 1966). Also in the past few years an increasing number of reports indicate that the psychoses are quite amenable to hypnotherapy (Abrams, 1963, 1964; Biddle, 1967).

Three Large Scale Studies

Three large scale studies in the past five years contain basic findings.

Richardson's (1963) study dealt with seventy-six cases of frigidity. He reports 94.7% of the patients improved. The average number of sessions needed was 1.53. The criterion for judging improvement was increase in percentage of orgasms. The percentage of orgasms rose from a pre-treatment average of 24% to a post-treatment average of 84%. Follow-ups (exact length not given) showed that only two patients were unable to continue realizing climaxes at the same percentages as when treatment terminated. Richardson's method of treatment was a combination of direct symptom removal, uncovering, and removal of underlying causes, since he had found that direct symptom removal alone was not always sufficient. He reports no hypnotic induction failures.

Chong Tong Mun's (1964, 1966) study covered 108 patients suffering from asthma, insomnia, alcoholism, dysmenorrhea, dermatitis, anxiety state, and impotence. The percentage of patients reported improved was 90%. The average number of sessions was five. The criteria for judging improvement were removal or improvement of symptoms. The average follow-up period was nine months. Chong Tong Mun's method of treatment was a three-fold approach. With some patients he would work on reeducating the patient with regard to the behavior patterns immediately underlying the symptoms. With others he would first regress the patient back to the original onset of the symptom. Once regressed, he would reeducate the patient to the fact that the original cause was no longer operative. In addition, he usually used supplementary suggestions of direct symptom removal.

Hussain's (1964) study reports on 105 patients suffering from alcoholism, sexual promiscuity, impotence and frigidity, sociopathic personality disturbance, hysterical reactions, behavior disorders of school children, speech disorders, and a number of different psychosomatic illnesses. The percentage of patients reported improved was 95.2%. The number of sessions needed ranged from four to sixteen. The criteria for judging improvement were complete or almost complete removal of symptoms. In follow-ups ranging from six months to two years no instance of relapse or symptom substitution was noted.

Hussain's approach is illustrated by the case of a 35 year old woman exhibiting the following symptoms: anxiety, alcoholism, depression with suicidal tendencies, sexual promiscuity, insomnia, and inability to make decisions and future plans.

Prior to treatment, Hussain pinpointed the various fears and negative attitudes which he felt were underlying the symptoms – e.g., the patient feeling unloved and unwanted in regards to her marriage, feelings of inadequacy at being a mother, fear of her own mother, fear of responsibility and making decisions, and guilt over her sexual promiscuity.

Hussain then used a therapeutic technique somewhat similar to Wolpe's (1958) desensitization technique to eliminate these fears and negative attitudes. For example, he would have the patient think of a particular fear-producing situation and recondition her by suggesting she would find herself calm and relaxed in the situation. This particular approach is very often used now in one form or another. Abrams (1963) refers to it as an "artificial situation" technique. Through hypnosis the patient is able to experience his new attitudes in an "artificial situation," an imagined situation. It differs from Wolpe's approach in two respects. First of all, Wolpe does not often use hypnosis. Secondly, Wolpe has the patient go through a hierarchy of "imagined situations," going from easiest to deal with to most difficult. (There is no reason, however, why this hierarchy approach cannot be incorporated into hypnotherapy.)

With the above patient Hussain also used direct symptom-removal suggestions. For example, "aversion to the thought and sight of alcohol was also built up by direct suggestion." This patient was discharged from the hospital after twelve sessions. "No relevant symptoms were left behind and there was no relapse during the six-month follow-up period."

Current Method of Using Hypnosis

As one can see in the above studies, and this probably comes as a surprise to most therapists, the main use of hypnosis is not as a means of direct symptom removal. Nor is its main use as an uncovering device. The current trend is to use hypnosis to remove the negative attitudes, fears, maladaptive behavior patterns, and negative self-images underlying the symptoms. Uncovering and direct symptom removal are still used to a certain extent, but usually in conjunction with this new main function.

In the past, so much emphasis was directed towards symptoms and disease processes that some of us were guilty of forgetting the person in the body. It is incumbent upon us [hypnotherapists] to concentrate on treating the particular patient who presents the symptom rather than the symptom presented by the patient (Mann, 1963).

Psychiatric hypnotherapy, as practiced today by the leading practitioners in the field, has in common with all other forms of modern psychiatric treatment that it concerns itself not only with the presenting symptoms but chiefly with the dynamic impasse in which the patient finds himself and with his character structure (Alexander, 1965).

The objection that the results of symptom removal will seldom be permanent is certainly not valid. This may have been so in the past, when direct symptom removal alone was practiced and nothing was done to strengthen the patients ability to cope with his difficulty or to encourage him to stand on his own two feet (Hartland, 1965).

This change is being stressed in the present paper because it is part of its purpose to fit hypnotherapy into "the scheme of things." Many therapists have rejected hypnosis because its direct symptom approach of the past clashed violently with their dynamic approach. Now we see that such a clash need no longer exist.

The Ahistorical vs. the Historical Approach in Therapy

Some hypnotherapists use, in part, a historical approach, going back into the patient's childhood and changing his attitudes regarding the causes of these patterns (Fromm, 1965; Abrams, 1963; Chong Tong Mun, 1964,1966). However, most hypnotherapy is ahistorical and, it would seem, faster. If we wanted to change the direction of a river it might be much easier to work on the main current directly (once it had been located) rather than going back upstream, locating all the tributaries, and pointing each one in a new direction.

A comment on the Dangers Ascribed to Hypnosis

In the past there have been certain dangers ascribed to the use of hypnosis – for example, the danger of a psychotic break, or the substitution of more damaging symptoms. According to a number of investigators (Kroger, 1963; Abrams, 1964) these dangers have been grossly exaggerated. However, whatever dangers there were have been virtually eliminated by this new approach. The few mishaps that have occurred in the past resulted either from (1) the misuse of hypnosis as an uncovering agent, or (2) its misuse as a direct symptom remover. The first type of mishap was produced by a therapist who would allow, or force, the patient to become aware of repressed information which he was not strong enough to face. The second type of mishap occurred when the therapist wrested away a symptom which the patient was using as a crutch before he was strong enough to stand on his own.

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