International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DISSOCIATIVE DISORDERS 193
affect regulation often must be addressed. Hypnosis should be used to create a
supportive environment and to reduce anxiety. Often this is suf®cient to promote
the spontaneous recovery of the amnestic material. Frequently the use of hypnosis
for anxiety relief provides an excellent medium for the patient's developing a
rapport and positive transference that will sustain the necessary therapeutic work.
A frequent complication on the use of hypnosis for other applications with such
patients is the occurrence of either a precipitous return of the repressed material or
the experiencing of panic as relaxation or some aspect of the induction leads the
patient close enough to the as yet unrecovered material to become terri®ed by the
affect and/or pain associated with it. The patient should be instructed to inform
the clinician at once should either of these begin to occur. Usually, with calming
suggestions and suggestions that the material stay back until it is timely for it to
emerge, such episodes can be interrupted.
Hypnosis has a venerable history in the resolution of dissociative amnesia. There
is currently much concern about confabulations of traumatic materials. Although it
is possible to retrieve confabulations with this use of hypnosis, it is also possible
for patients to recover well-being by working through a confabulated trauma. Since
the recovery of the patient is the goal rather than the recovery of historical truth,
this should not be a major concern in most instances, especially if one bears in
mind that any other interpersonal in¯uence that addresses the recovery of memory
also may have had a distorting impact.
Traditionally, clinicians made efforts to help the patient have a full and often
exhausting reexperiencing of what is recovered. However, contemporary clinicians
are often reluctant to both explore and abreact at the same time. Usually they want
to discover what they will have to help the patient come to grips with before
moving right in to abreactive work Kluft, 1991). It is often useful to use screen
techniques when ®rst exploring such areas, to allow the patient to have some
distance from a potentially overwhelming reexperiencing of traumata. Within the
conventions of screen techniques, it is often possible to make the images less large
and less frightening, and to titrate the discomfort that is felt. Many therapists now
begin with screen techniques, and , after some processing of dif®cult material, then
move for the more traditional reexperiencing if it seems advisable.
Age regression to the missing period of time is a traditional usage. However, in
dissociative identity disorder patients, it may have unexpected results because the
particular personality with which the clinician is working may not have access to
the material in question, and switch to the relevant alter cannot be assumed Kluft,
1986b). Watkins' 1971) `Affect Bridge Technique' can be very useful, even if one
has no idea what one is searching for. One can try a number of dysphoric affects
and see which one takes the patient to the missing material. In my own practice,
before using these techniques I invariably use ideomotor signalling to get permission
to carry out the exploration. Often I am given permission to make limited
inquiries. When I remain within those boundaries, I am usually allowed to go
further at a later date. I also have found it very useful to use a screen technique to