HYPNOTERAPl - Dansk Selskab for Klinisk Hypnose

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6 The Psychodynamics and Initiation of Effective Abreactive Experiences John G. Watkins og Helen H. Watkins JOHN G. WATKINS, Ph. D., and HELEN H. WATKINS, M.A., have been practising and refining egostate therapy for over 30 years. John Watkins is a professor emeritus, University of Montana, and Helen is a retired clinical psychologist from the Counselling Center of the University of Montana. Both authors have published numerous papers and chapters and have presented workshops und lectures worldwide. ABSTRACT Abreaction is a very powerful therapeutic technique when properly conducted, but like any effective procedure, if misapplied it can initiate a re-traumatization or induce temporary psychotic reaction. It is especially suited to the treatment of trauma-based conditions, such as PTSD, but the essential ingredient is the committment and personal involvement of the clinician´s own self. Correspondence Address: John and Helen Watkins 413 Evans St. 59801 Missoula, MT USA Phone: + 1-406-5499202 Fax: + 1-406-5436232 In a prior paper, "The Psychodynamic Treatment of PTSD (Combat Neuroses) with Hypnosis During World War II" (in press, International Journal of Clinical and Experimental Hypnosis) the first author described his experience in treating a large number of these cases in the Welch Convalescent Hospital at Daytona Beach, Florida, primarily by hypnotherapy. The technique of "abreaction" was used quite frequently with very positive resuits and without apparent retraumatization or precipitation of psychotic reactions. Following the War from 1946 to 1972 he (JGW) continued to treat this type of casualty within Veterans Administration installations and university settings. Moreover, the abreactive technique was applied to a number of dissociative reactions, termed then "Multiple Personalities" and now called "Dissociative Identity Disorders" (American Psychiatric Association, 1994). We did learn a great deal concerning the approach, and today would apply it (hopefully) with more finesse and attention to detail. Our theoretical understanding of this process has also changed substantially as we came to realize that much more than emotional release is involved. From 1972 until the present (1999) we have continued working psychotherapeutically within a hypnoanalytic and ego-state therapy framework. Both of us have employed the abreactive technique frequently with a wide variety of trauma cases, not necessarily war veterans.
The following summarizes our experience and discusses both the theory and our rationale as to the results achieved, since they seem to differ from teachings and admonitions of a number of very respected colleagues (Brende & Benedict, 1980; Brown, 1990; Brown & Fromm, 1986; Chu, 1998; Fromm & Nash, 1997; Horowitz, 1986; Phillips & Frederick, 1995; Ross, 1989; Spiegel, 1981; van der Hart and Brown, 1992; van der Kolk and van der Hart, 1989; Wolberg, 1948). These contributors apparently feel it is a much more dangerous procedure than we have found it to be, and they advise a more cautious approach to it. We fully recognize that any therapeutic procedure which is strong enough to help can harm if mishandled, and this principle certainly applies to abreactions. During the many abreactions conducted by us with the dissociative and child abuse cases, which characterized much of Helen's ego state therapy practice for the past 25 years, we did not find one of these patients breaking into a psychotic reaction, nor was there any evidence in which the abreaction itself re-traumatized the patient (Watkins and Watkins, 1997). We have been repeatededly asked why such results - often with skepticism. We also wanted to know why. We cannot ascribe the favorable results simply to good luck, nor do we make any claim to being miraculous therapists. There must be some other reasons that are the determining factors, perhaps in how we envision the term "abreactions," and specifically how we conduct them. Although Freud (1958) initially found abreactions therapeutic, he eventually abandoned them for the slower psychoanalytic methods which emphasized the initiation and workingthrough of transference reactions. We wonder whether the forebodings presented in so much of the literature stem from Freud's theories, or from actual disastrous abreactions, experienced by patients of the writers themselves. THE NATURE AND PSYCHODYNAMICS OF ABREACTIONS The "abreaction" is a re-living, a re-experiencing, of an emotionally traumatic event which appears to have become fixated in an intra-psychic conflict resulting in painful and incapacitating symptoms. The patient is bound up in this event, unconsciously if not conscious-ly, and is not able to extricate himself from it and gain closure. The traumatic event, even though it may have occurred some time in the past (perhaps many years ago), continues to exist within the patient's psyche. To be resolved it must be re-experienced and mastered. That word "mastered" is the key concept. A mere re-living of a horrible event does not mean that it has been mastered, and in fact it may have simply been reinforced. If we conceptualize an abreaction as merely an emotional re-living or a draining of the affect, and stop at that point, then indeed a negative effect may result. There is a kind of continuing war between the pathology and the ego strength of the patient, and the victory may go to whichever has the greater "power." It is like a final confrontation, an internal battle of Waterloo. If the therapist merely prods, stimulates or initiates such a confrontation and waits to see how the battle comes out, the patient (and the therapist) may indeed lose the war. But that is not the way we conduct an abreaction. Emotional release is only one of the steps needed to bring mastery over the pathology. In any batlle with one's enemy it is important that there is more power on one's own side than in the opposition. Furthermore, this confrontation must be in the reality of a true "reexperiencing" in the here-and-now, not merely with a cognitive, verbal "remembering". The psychological setting must be comparable (and as near as possible identical) with that in which the trauma was experienced in the first place. Accordingly, we consider the following essential. STEPS IN THE ACCOMPLISHING OF AN ABREACTION 1. An estimation of the "ego strength" of the patient to judge whether he "can take it," i.e., 7
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HYPNOTERAPl - Dansk Selskab for Klinisk Hypnose

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