by Tim Brunson, PhD
Those who practice any form of hypnotherapy – to include clinicians whose practice incorporates the rather trendy concept of mindfulness – absolutely must tread carefully if they learn or detect that their patient or client has experienced or continues to suffer from a past traumatic experience. As the power of the hypnosis process relies largely on bypassing some of a person's natural protective faculties (i.e. the innate resistance to pattern change) and very often involves mental reprogramming through association, its use may be contrary to their client's natural defense mechanisms. Careless use of hypnosis can intensify the use of these mechanisms and easily result in long-term suffering. Therefore, the use of hypnosis with trauma patients must be limited to only mental health clinicians, who are specifically trained in trauma care.
Caution with untreated trauma victims should not be limited to only appropriately trained mental health professionals. Others in the helping and healing professions will frequently come across people who have experienced severe trauma, which has never been addressed. During my decades of practice as a clinical hypnotherapist, I have frequently encountered people who willingly expressed past traumatic events in the form of accidents or abuse. This should not be surprising as the National Center for Mental Health Promotion and Youth Violence Prevention estimates that over 60% of adults in the United States have experienced some form of significant trauma during their childhood. Therefore, I am always on the lookout for those who have experienced trauma for which they have not been treated. In those cases I am quick to refer them to a more appropriate clinician. Furthermore, I am sensitive to any abreaction or other discomfort that can be caused by the hypnosis process. When detected, I immediately give suggestions of safety and appropriately terminate the session.
Why is hypnosis potentially dangerous to untreated trauma victims? This is largely due to the patient's use of dissociation as a protective reaction. It allows them to distort time and create distance from memories of an event – to the point of complete repression – in order for them to avoid suffering. Essentially, dissociation mitigates the stabilization role of the left frontal cortex. Hypnosis initially has the same effect. Therefore, when that stabilization is affected both by the trauma victim's defense mechanism and the hypnotic process, it will intensify the reaction and can possibly even cause them to go into a fugue state. Any exposure therapy used while the patient is hypnotized runs the risk of causing the patient to further dissociate. A trauma sufferer's avoidance of any association into memories of the initial sensitizing event completely breaks down their ability to attain any benefit from any associative process such as can be created during hypnosis. Trying to achieve that benefit while they still exhibit an associative "phobia" is extremely dangerous!
Nevertheless, hypnosis is a powerful tool for trauma treatment provided that the practitioner is competent and qualified. My review of trauma treatment by such clinicians revealed an effective three-step approach. The first step emphasizes self-efficacy and here-and-now mindfulness. Even though most practitioners avoid using the word "hypnosis," I have found that their techniques regarding this step to be extremely hypnotic. Specifically, it is this stage that is the most dangerous. The clinician's training must include a high level of sensitivity to any sign that their patient is adversely reacting to any efforts to get them to re-associate. Next the patient should be desensitized to the triggering event (if known) and any reinforcing incidents. Cognitive Behavioral Therapy (CBT) and Neuro-Linguistic Programming (NLP) have numerous elegant techniques that can be used for this purpose. And thirdly, the client or patient's ability to integrate life's experiences should be enhanced. Hypnosis is an excellent tool at this point. However, I again must remind the reader that this should only be done by a mental health practitioner who is specifically trained in trauma work.
Some could read this article as a justification for limiting hypnotherapy to only licensed mental health practitioners. That would be contrary to my intentions and very unwise. The hypnosis process is so ubiquitous in daily life that people in just about every profession and occupation will regularly use it whether they know it or not. Indeed, such folly would prevent police, school teachers, politicians, and the clergy from practicing their respective professions. Restricting hypnotherapy to only mental health practitioners would deny the public of many benefits that come from those non-licensed practitioners. Competent hypnotherapists are more aware of the implications of the process and can be easily trained to recognize when their efforts are getting into areas for which they are not suited. Likewise, very few licensed mental health practitioners are fully trained in the hypnotherapy skills although efforts can still often be helpful. They can benefit by partnering with a more highly trained hypnotherapist. Nevertheless, I am more worried when mental health licensees attempt to address trauma without adequate training specifically regarding trauma. Indeed, the treatment of unresolved trauma should never be done by any practitioner who has not been fully trained regarding the recognition of danger signs and how to address them safely.