International Handbook of Clinical Hypnosis - E-Lib FK UWKS

134 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
and affect of the client were elicited and processed, enabling him to put these
impulses aside to consider more adaptive life alternatives.
THE PROCESS OF HYPNOSIS
The process of hypnosis, in practice, is extremely variable. With a few exceptions
e.g. Yapko, 1992; Alladin, 1994) therapists rarely specify in any detail what they
do in practice. It is clear that the comparison of treatment techniques and outcomes
is extremely dif®cult when clinicians who describe their work broadly in terms of
similar models are in practice doing very different things.
POTENTIAL PROBLEMS IN THE USE OF HYPNOSIS
The reluctance to utilize hypnotic techniques in the management of depression is
associated with a range of concerns or factors which are seen as contraindications.
These include the following.
SUICIDE RISK
It has been argued that the risk of suicide makes the use of hypnosis dangerous in
the management of depression. Crasilneck & Hall 1985) argue that hypnosis is
inappropriately used in an outpatient setting for this reason. The potential for
increased suicide risk has been explained in a number of ways. Burrows 1980)
argues that hypnosis may inappropriately relieve anxiety before depressive affect
has signi®cantly lifted, allowing the depressed individual suf®cient energy and
anxiety reduction to act on suicidal impulses. Crasilneck & Hall 1985) observe
that this phenomenon is not con®ned to hypnosis but has also been described for
the range of treatment methods including psychotherapy, antidepressant medication
and electroconvulsive therapy p. 323). The evidence to support this proposal is
primarily in the form of clinical case material, making it dif®cult to counter the
criticism that, given the signi®cant rate of suicide in patients with major depression,
such case material represents a chance correlation.
Spiegel & Spiegel 1978) suggest that the potential for suicide lies in the
possibility that the depressed individual will place unrealistic hopes in the trance
experience as a way of ending their depression. These unmet expectations may
result in a suicide attempt. Meares 1979) argues a similar viewpoint when he
expresses his concern that: `A trial of hypnotherapy usually leads to disappointment
and may involve the patient in an unnecessary risk of suicide' p. 293) Yapko
1992) is critical of the Spiegels and other workers in the ®eld who emphasize the
formal assessment of suggestibility, arguing that this promotes a sense of success
or failure which may enhance suicide potential. He argues that negative expecta-