International Handbook of Clinical Hypnosis - E-Lib FK UWKS

CONVERSION DISORDERS 163
imitates the behaviour of a bird with a broken wing to distract a bird of prey away
from the nest. Similar violent, almost uncoordinated motor reactions are also seen
in various other animals exposed to extreme threat. When captured, a bee will buzz
around as though demented; a bird caught in a room will ¯utter desperately, ¯ying
against walls and windows in its panic.
In animals these phenomena are survival mechanisms triggered by danger cf.
Hoogduin, 1988). In people, too, the dissociative reaction seems to be a way of
coping with extreme circumstances.
The following points can be made in summary of the foregoing:
· Patients with conversion symptoms develop the disorder when they have been,
either long term or momentarily, in severely threatening situations.
· There are indications that a similar mechanism lies at the root of both
conversion disorder and dissociation
· Conversion symptoms resemble states or conditions that can be induced
through hypnosis.
· Conversion symptoms resemble behaviours sometimes observed in animals at
moments of extreme threat.
THE HYPNOTHERAPEUTIC STRATEGY Hoogduin & van Dyck,
1990, 1992)
Van Dyck and Hoogduin 1989) divided hypnotic intervention into two broad
categories: symptom directed and exploratory. The former is the older of the two
and consists of the creation of a state of heightened suggestibility in order to
in¯uence symptoms in a favourable way. In the exploratory approach, techniques
such as revivi®cation or age regression are used in order to discover the possible
cause of the symptoms. This may be followed by symptom-directed suggestions.
The procedures described here are a combinationÐwhere possibleÐof both
these strategies. Firstly, investigations were carried out to discover whether the
onset of the conversion symptoms had been preceded by some traumatic experience.
If so, revivi®cation was used, followed by an attempt to in¯uence the
symptoms both directly and indirectly. Where no psychological trauma was
discovered, the approach was limited to direct and indirect in¯uence of the
symptoms.
The treatment strategy suggested here is therefore the following:
· A rationale, explaining that the symptoms are the result of strong emotions
which the patient has been unable to deal with and that, by reliving the event
which gave rise to the emotions, these will be re-experienced and dealt with,
causing a reduction of the symptoms.
· Formal trance-induction with revivi®cation during which the patient is encouraged
to give free rein to any emotions.