HYPNOTERAPl - Dansk Selskab for Klinisk Hypnose

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.,
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