International Handbook of Clinical Hypnosis - E-Lib FK UWKS

168 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
`spontaneously' slide her foot forward a little. She managed this, albeit rather
sluggishly and woodenly. Finally, the patient was given a programme of exercises
that she could do with her husband's help, so that she could progress from these
stiff, robot-like ®rst steps to once again being able to carry out normal movements.
Six treatment sessions later, Mrs C was able to walk for 15 minutes without
ataxia. She still complained of tiredness, but the wheelchair was once and for all
relegated to the attic. On follow-up 3 years later, she was still without complaints
Hoogduin & van de Kraan, 1987).
CONCLUSION
Although clinical treatment involving hypnosis appears to offer the possibility of a
favourable result for patients with a motor conversion disorder, it is as well here to
®nish on a note of caution. It is important to remember that there is a very real
chance that a patient who appears to have conversion symptoms could actually be
suffering from a severe physical condition. The diagnosis `conversion disorder'
should only be considered when thorough somatic and neurological investigation
has produced no explanation for the complaints and, even when this is the case, the
therapist must remain alert to adverse changes. If there is any doubt, one should
always seek further neurological examination. The patient will only appreciate such
caution.
No less than 26±60% of patients diagnosed as having a conversion disorder later
turn out to have a severe neurological) disorder Weintraub, 1983). Two patients
provide sad illustration of this. The ®rst was a 40-year-old woman who declared in
a very theatrical manner that she had a bloated feeling in her abdomen. She also
said she was experiencing some pain in her back and rather unpleasant sensations
in her legs. Repeated and also clinical) neurological investigations offered no
explanation for the complaints. A few months later, after having been discharged
from the neurological clinic, the patient was readmitted to hospital with a tumour
on the spinal cord membrane.
A second patient who, also in a very theatrical manner, said that she could not
talk properly and clearly tried to demonstrate this, was convinced that her
symptoms were physical and refused to follow the directions given her by the
psychotherapist. Indeed, she wanted nothing to do with him. She died a year later
as a result of a tumour of the cerebellum.
A further note for caution is that it is not known for certain that hypnosis is an
essential element in all the cases where treatment involving it leads to a favourable
result. There is a great need for controlled research in this area. It is possible to be
equally brief, however, in one's conclusions relating to other treatment strategies:
there has been no controlled research. There are, however, some well-documented
case descriptions from which it can reasonably be supposed that behaviour therapy