International Handbook of Clinical Hypnosis - E-Lib FK UWKS

10 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
complete and lasting. Table 6.1 gives a very clear exposition of how Erickson
developed his strategy.
To obtain the best response, the therapist must understand that individuals may
be working together in any of the following positions: one-up, one-down or equal.
Zeig has given accounts of these different situations. These accounts are not only
clear but entertaining, especially the metacomplementary relationships leading to
secondary gain.
Erickson worked at modifying his technique where necessary to promote that
responsiveness. Similarly, during induction, the therapist may need to experiment
somewhat, before success is obtained in conveying covert messages to which the
patient will respond and initiate self-change.
The ®rst chapter of speci®c clinical applications of hypnosis is concerned with
the currently relevant and controversial one of recovered memory in trauma
victims. Clinicians must recognize that clients' remembrance of a previously
forgotten trauma has clinical relevance; but recovered memories of abuse cannot be
accepted as self-validating. Using hypnosis, it has been demonstrated that memory
can be reconstructed e.g. Barnier & McConkey, 1992).
Clinicians working with individuals who report recovered memories of childhood
abuse must display the sensitivity appropriate for dealing with any possibility
of childhood abuse McConkey, 1997). In doing so, however, they need to maintain
and use justi®able methods of diagnosis and treatment. Because of its long history
of misuse, clinicians when using hypnosis must be scrupulous in applying
scienti®cally based and clinically sound therapeutic intervention.
Hypnosis is particularly suited to use as an adjunct in treatment of anxiety
disorders; 95% of practitioners of hypnosis use it to assist in the treatment of
anxiety. Hypnosis can be a powerful adjunct to desensitization and to coping
rehearsal, since it attributes realism to imagined events. Arousal reduction and
relaxation may be enhanced using hypnotic procedures. Self-hypnosis techniques
or hypnotic interventions have proved useful in simple phobias, for panic patients
and in the treatment of agoraphobia. As Frankel and Orne 1976) have noted,
phobic patients tend to be more hypnotizable than other patients or the general
population. Apart from general anxiety reduction, hypnotic techniques may be
applied to re-establish a sense of self-worth and self-esteem.
Contrasted with the treatment of anxiety, there appears to be a widespread
assumption that hypnosis is inappropriate for the management of depression
because of the risk of suicide. Given our understanding that hopelessness is the best
predictor of suicide risk, the clinician needs to decide whether to avoid the use of
hypnosis with patients high on this variable, or to utilize hypnosis as a tool for its
reduction.
Major depression remains a challenge to all treatment modalities, including
pharmacotherapy, cognitive-behaviour therapy, and psychotherapy. The traditional
prejudice against its use in depression has prevented a serious assessment of
whether hypnosis has anything signi®cant to contribute to this widespread disabling