International Handbook of Clinical Hypnosis - E-Lib FK UWKS

194 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
get a projective impression of the impact that the patient anticipates if the amnesia
were to be lifted. I ask the patient to visualize how he or she feels she will react
when he or she recovers what has been missing. If the fantasy involves decompensation
or self injury, I will desist, and do further preparatory work.
In such hypnotic explorations one attempts to use questions that are not leading.
My own favorite inquiry is `Whatever's there'. However, some patients become so
passive or distressed that it is dif®cult to remain in a format of open-ended inquiry.
It is my practice to write down my questions as I go when I cannot be open-ended,
so that I can review the process for potential errors at a later date.
When material is recovered, it is useful to document it in some manner, because
the patient may remain amnestic out of trance, or may be so overwhelmed by it that
permissive amnesia is the safest alternative. When dealing with situations that may
prove sensitive or to have major impacts, such as when I anticipate that intrafamilial
abuse may emerge, I often will tape the session. However, often one has no way
of anticipating that one is on the verge of such material. For example, I was
exploring an amnestic gap with a patient who had told me her father was overseas
at the time of the gap. However, we immediately encountered an incest scenario.
Ultimately, I learned that the conscious memory of the father's absence was a
defensive confabulation.
As material is recovered and emerges spontaneously, hypnosis may be used to
contain and titrate the distressing material, to facilitate the recovery of the material
in an orderly and well-paced manner, to offer ego-strengthening to the patient, and
to process and integrate the dissociated material. Not infrequently the memory will
be retained, but in a depersonalized and derealized manner, shorn of affect.
Hypnosis may be instrumental in recovering and processing the affect in an orderly
manner. In the 1970s I developed hypnotic techniques of fractionated abreaction to
employ when traditional complete abreactions were either potentially destabilizing
or when patients repeatedly redissociate distressing material. In recent years I have
described these techniques Kluft, 1988a, 1990, in press; see also Fine, 1991).
Hypnotic metaphors such as the rheostat metaphor) can be developed and used to
allow the patient to experience only, for example, 5% of the distress associated with
the ®rst 30 seconds of a misfortune. In fact, one can divide the trauma in the
temporal dimension, one can dissociate physical pain from dysphoric affect
sensation from affect in Braun's [1988] BASK model), and, with dissociative
identity disorder and allied forms of dissociative disorder not otherwise speci®ed,
one can isolate personalities from one another so it is possible to work with one
without unsettling the remainder Fine, 1991; Kluft, 1988a, 1990, in press). These
methods minimize the likelihood of regression or redissociation.
DISSOCIATIVE FUGUE
Hypnotic approaches to dissociative fugue patients have much in common with the
treatment of dissociative amnesia; in dissociative fugues in which an alternate