A Cross Sectional Survey Of Client Experiences Following a Course Of Pure Hypnoanalysis (PHA)

Clients who had completed a course of pure hypnoanalysis (PHA) were invited to participate in an online survey indicating the degree to which their original presenting 'complaint' had been affected following the course of therapy. The initial feedback indicated that all participating clients (n=63) had reported a reduction in, or resolution of their original symptoms. Respondents also produced detailed additional comments regarding their experiences of therapy. A follow up is planned at twelve months.

Introduction
PHA is a unique approach therapy that has been developed by practitioners belonging to the International Association of Pure Hypnoanalysts (IAPH). Its origins date back to 1974 since when the practice has been developed and modified. The terms hypnotherapy and hypnoanalysis occur frequently in the literature, but cannot be drawn upon as evidence for the effectiveness of PHA as their interpretations and definitions vary. The practice of PHA involves working with a client for a maximum of twelve sessions at weekly intervals. Its underlying premise being that repressed material has a significant role in the development and maintenance of both physical and psychological pathology. Practitioners do not however interpret or analyse client's recollections in the traditional sense, but rather allow the opportunity for material to surface using a modified version of free association (FA) whilst the client is in a light trance. The assertion being that repressed material which is of significance is not deeply buried, but likely to be seeking an outlet. Clients are encouraged to link associations and 'here and now' experiences rather than to recall a chronological history. Practitioners are extremely aware of the risks associated with 'leading' a client, especially when in hypnosis, and for this reason interventions made by them should only be for prompts or clarification. For example clients who maintain long periods of silence are likely to be intellectualising and editing their thoughts rather than free associating, and it would be understood by both parties that this would not be complying with the ground rules for a successful therapy.

Practitioners experiences to date have indicated that using this method, clients can reach a point of abreaction at between six to twelve sessions, and that having done so, this leads to a reduction or disappearance of the presenting problem, e.g. emetophobia. Evidence from clients suggests that the majority of repressed experiences are linked with strong feelings of guilt and shame irrespective of any underlying 'incident'. It is not therefore the recollection of a client's history which is significant, but the processing and releasing of experiences (i.e. as they are occurring in the clients mind at the time of therapy) which has the therapeutic effect.

A number of terms have been used to describe how a client feels after the completion of therapy. The words 'enlightened' and 'librated' have been in common use for some years. Clients are offered the opportunity for a follow up appointment after the course of therapy before being discharged. There is usually a strong transferential relationship which has developed, and the meeting allows the opportunity for this to begin its resolution.

Prior to the survey, no systematic collation of client's responses had been coordinated, although several validated anecdotal accounts, including testimonials were in existence.

Methodology
The survey was administered nationally (in the UK) and all practising IAPH members were able to bring it to the awareness of discharged clients. On completion of therapy clients were given a card offering them the opportunity to log on to the IAPH website if they wished to participate. This process included gaining their consent. Participants were then directed to an online questionnaire which asked a number of 'direct' and 'choice' questions. Most questions contained additional comment boxes. The inclusion criteria meant that only clients who had completed the course of therapy were included. For this study no provision was made to follow up drop outs. The study design was subject to ethical approval by the IAPH Council.

Results
The majority of respondents were female. The largest age group category for both groups being 26-35 yrs followed by 36-45 yrs. No respondents were aged over 65 yrs. The majority of clients completed therapy within 10-12 sessions, with the next largest group completing in7-9 sessions.

The majority of clients presented with problems under the heading of 'general anxiety' although several also indicated other presenting difficulties, the second highest category being 'social phobia' and 'Depression'.

Clients were offered a rating scale to indicate the 'intensity' of their problem for a pre and post therapy rating. This ranged from 'No interruption to everyday thinking, feeling and behaviour'' to 'Very significant interruption to everyday thinking, feeling and behaviour' on a five point scale. All clients reported a reduction from their original rating on completion of the course. A number of comments were received, for example;

'Before therapy I felt my life had come to an end. I was unable to do normal everyday things like eating out, going on public transport, hairdressers etc. The normal things that people take for granted'
(This client rated from significant to no interruption on pre and post therapy scales).

Clients were asked about their understanding of a repression and abreaction. Approximately 50% stated that the abreaction they experienced was a complete surprise, with the remainder having 'some idea' (albeit vaguely) of the contributing cause of their problem.

All clients reported a reduction in their original presenting problems. A number stated that it had now been completely resolved, (often following a number of years during which other treatments had been tried).

Summary This cross sectional survey indicates very positive results for clients who have undertaken a course of PHA. It is an ongoing study (June 2009) and follow up data will be collated at twelve months. There are a number of limitations to the study. It is not a controlled trial, and has used a self selected sample. There are potential confounders such as co-existing medication. It is however a condition of treatment that the client is not receiving any other form of psychotherapy or counselling at the same time as PHA. It is not possible to generalise from these early results with any level of statistical significance. The responses and detailed comments from this sample group do however indicate that PHA has been effective at symptom removal, and allowed clients the opportunity to lead improved lives as a result.

For more information visit www.iaph.org.