International Handbook of Clinical Hypnosis - E-Lib FK UWKS

192 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
quently, most traumatized persons with major dissociative manifestations are
excellent candidates for the use of therapeutic hypnosis in the absence of contraindications.
In recent years Herman 1992) has advocated a triphasic approach to the
treatment of the traumatized, building on similar observations made ®rst by Janet,
and subsequently by numerous others. Therapy begins with a phase of safety, in
which the patient is made to feel secure, and can be both comforted and
strengthened. Thus forti®ed and prepared, it proceeds to a phase of remembrance
and mourning, in which the trauma is addressed and its impact and consequences
are appreciated and grieved. Finally, in a phase of reconnection, issues of the
reintegrations of one's identity, redressing interpersonal concerns, reentering one's
social roles and obligations, and reestablishing normal coping are addressed.
In the phase of safety, hypnosis may play a role in relaxation, anxiety relief,
symptom relief, ego-building, the creation of a safe place, affect regulation, accessing
dissociated ego states, and the control of ¯ashbacks and sleep disruption, among
many other applications. Even suggestions of permissive amnesia have a role in
some cases, in which the patient is totally devastated by what has befallen him or her,
and is falling into a major regression, or becoming suicidal. In the phase of
recollection and mourning, hypnosis may play an important role in relieving
amnesia; the management of abreactions; the recon®guring of ego states to ensure
that work with one state's trauma does not mobilize others, leading to decompensation
or alloplastic responses to painful material; and the containment and relief of the
anguish associated with dealing with traumatic material. In the phase of reconnection,
hypnosis can facilitate the blending of ego states, the integrations of egodystonic
material, mastery of more adaptive coping, anxiety reduction, dealing with
residual character and other issues, and has many other applications as well.
HYPNOSIS IN THE TREATMENT OF SPECIFIC CONDITIONS
DISSOCIATIVE AMNESIA
That most but not all) dissociative amnesia patients have troubled childhood
backgrounds is a relatively recent ®nding Coons, 1992a,b). 72% have endured
childhood trauma Coons, 1992a,b). This may explain why although some dissociative
amnesia resolve rapidly, others will require prolonged treatment because work
with one area of dif®culty rapidly spreads into other areas. Often a defensiveness
with regard to childhood issues results in massive resistance to the exploration of a
contemporary amnestic episode. In any case, profound intrapsychic stress and
con¯ict with or without exogenous trauma has played an etiologic role.
Therapy is never simply a matter of getting back what has been forgotten. In any
case one may assume that overwhelming affects and the personal meanings of the
trauma reinforce the amnesia. Threats to one's former identity and disruption of