International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DISSOCIATIVE DISORDERS 191
Under no non-emergency) circumstances should hypnosis be employed prior to
obtaning the patient's informed consent for its use. Although speci®c informed
consent forms have been developed e.g., Hammond et al., 1995; Brown, Sche¯in
& Hammond, 1997), there is much to be said for the concept of informed consent
as a process, advocated by Appelbaum and Gutheil 1992). In this approach, it is
assumed that matters that bear on the issue of informed consent emerge recurrently
throughout the course of a therapy, and must be revisited and reexplained. This is
especially valuable in work with dissociative identity disorder patients, whose
treatment is prolonged, and whose identity and memory are fragmented, and who
undergo an ongoing process of recon®guration throughout their psychotherapy. A
particularly crucial area of informed consent is making clear to the patient that any
material recovered with hypnosis or any other intervention may be quite useful for
the therapy, but cannot be assumed to be historically accurate without external
con®rmation. This caveat may require frequent reiteration over the course of the
therapy. Often it is useful to apply a type of verbalization drawn from Appelbaum
and Gutheil's ideas, and often taught by Gutheil in workshop settings for teaching
patients about medication side effects, but modi®ed for hypnosis by the author
e.g., Kluft, 1997b):
When we use hypnosis to explore this block in your memory, we will be looking for
hypotheses for further exploration. If we ®nd something, whatever we ®nd will be the
starting point for more ongoing workÐnot the end of a quest or search. The nature of
your hypnotic experience may give whatever we come up with the personal experience
that it is very real. That and the fact you may visualize it can make it seem like what
you have actually experienced and seen it, but that can be real deceptive. We tend to
think that if we see it it has to have occurred. But that is not the way it is. We can
deceive ourselves. Remember, we're looking for hypotheses. Moses didn't come down
the mountain with what you may ®nd in hypnosis engraved on a slab of stone, but it
can feel that way.
All in all, then, the clinician must make a circumspect assessment of the patient's
needs and circumstances, and arrive at a veritable cost-bene®t analysis vis-aÁ-vis the
use of hypnosis. At different moments in a given therapy, it may be that the
clinician comes to different conclusions as to how to proceed.
HYPNOSIS AND THE TRIPHASIC TREATMENT OF TRAUMA
Dissociation is a commonplace reaction to trauma in psychiatric patients and in
non-patient populations Putnam, 1985; Spiegel, 1986, 1991). Without entering the
complex domain of the relationship of dissociativity to hypnotizability, I will
simply acknowledge that authorities disagree about their relationship, but most
concur that they are dif®cult to distinguish when both are present to a high extent,
and their copresence is commonplace in dissociative disorder patients. Conse-