International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS, DISSOCIATION AND TRAUMA 153
trauma, analysis of dreams and intrusive recollections, and exploration of transference
issues. The `traumatic transference' is important, since many trauma victims
displace onto the therapist feelings they have about the trauma or traumatizer. They
are also quite sensitive to apparent rejection by the therapist, feeling ashamed by
their traumatic experience. Clarifying transference distortions can help patients
accept and integrate traumatic experiences and repair damage to the self-concept.
Cognitive-behavioral approaches are based in part on the concept of systematic
desensitization Foa & Rothbaum, 1989; Foa, Davidson et al., 1995). Repeated
reaccessing of traumatic memories in a more benign therapeutic context gradually
deprives them of their affect-arousing qualities. Furthermore, distorting effects of
the traumatically induced self-assessment are challenged: the fact that it happened
does not imply that the victim deserved it, or that the victim deserves mistreatment
in other situations. The retelling is intended to diffuse emotion and provide an
opportunity for clarifying and correcting trauma-contaminated cognitions Keane,
Fairbank et al., 1989; Cooper & Clum, 1989).
Since the hypnotizability of Vietnam veterans with PTSD has been found to
be higher than that of other populations Stutman & Bliss, 1985; Spiegel, Hunt
et al., 1988), it makes sense that techniques employing hypnosis should be
useful. Especially if traumatized individuals with PTSD are in a spontaneous
dissociative state during and immediately after the trauma, hypnosis is likely to
be helpful in tapping traumatic memories by recreating a similar type of mental
state. The literature on state-dependent memory Bower, 1981) indicates that the
content of memory is better retrieved when the individual is in the same mental
state at the time of retrieval that he or she was in when the information was
acquired. Therefore the ability to tolerate congruent and painful) affect would
seem to be a prerequisite for retrieval of traumatic memories. Similar to
predominant affect, the structure of consciousness itself, such as being in a
dissociative or hypnotic state, constitutes another mental state which can
facilitate recollection.
Treatment employing hypnosis is now seen as involving not merely abreaction of
traumatic memories, but working through them by assisting with the management
of uncomfortable affect, enhancing the patient's control over them, and enabling
him to cognitively restructure their meaning Spiegel & Spiegel, 1978; Spiegel,
1981, 1992, 1997). Catharsis is a beginning, but it is not an end in itself, and can
lead to retraumatization if the catharsis is not accompanied by support in managing
affective response, control over the accessing of memories, and working them
through. A grief work model Lindemann 1944[94]) is useful. Observations of
normal grief after trauma have led to a recognition that a certain amount of
emotional discomfort and physical restlessness and hyperarousal is a natural, and
indeed necessary, part of acknowledging, bearing, and putting into perspective
traumatic memories Spiegel, 1986; Spiegel & Cardena, 1990). This is often
facilitated by using a hypnotic imaging technique, the `split screen', in which the
patient is asked to picture some aspect of the trauma on one side of the screen,