International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DISSOCIATIVE DISORDERS 195
identity is encountered, techniques relevant to dissociative identity disorder may be
applicable. Not infrequently there are considerable real world consequences
associated with the life a patient has led while in an alternate identity or a confused
state, or with the circumstances in the context of which the fugues occurred such
as leaving the scene of hazardous duty or important responsibilities). The recovery
of amnestic periods associated with fugues is far less certain than the reversal of
dissociative amnesia or amnesias in dissociative identity disorder.
In the unusual circumstance of working with a patient who is in the secondary
identity, there are often opportunities to explore the dynamics of the patient with
hypnoanalytic techniques. In my limited experience with such situations, I did not
elect to attempt to restore the primary identity promptly because I reasoned from
my work with dissociative identity disorder that to do so might prompt the
secondary identity to `®ght for its life,' unduly complicating treatment. Instead, I
worked to relieve the anxiety the patient felt as he began to appreciate his
circumstances, and a spontaneous remission occurred. In the two cases I saw, I was
unable to access the alternate identity on subsequent occasions. I am not sure
whether there was a spontaneous integration, whether the identity evaded my
efforts, or whether the alternate identity in these situations is so unlike those of
dissociative identity disorder that my efforts were misdirected.
When the patient is being treated after returning to the primary identity, hypnosis
often can recover aspects of the missing period, but the recovery is likely to be
partial at best. Since fugues are often associated with profound intrapsychic
con¯ict, hypnoanalytic exploration of the psychodynamics, and the use of techniques
suggested by what is learned of those dynamics, including ego-building, may
be productive.
The modern literature on fugue is small, and many older cases might have
received other diagnoses from contemporary clinicians. There is little systematic or
even anecdotal literature on the use of hypnosis with this disorder.
DISSOCIATIVE IDENTITY DISORDER
The treatment of dissociative identity disorder is the subject of a voluminous
literature, most of which addresses the role of hypnosis to some extent. Numerous
articles by the author, summarized in Kluft 1992a,b), and a more recent text by
Phillips and Frederick 1995) focus on hypnotic approaches. Dissociative identity
disorder involves lesions of identity, consciousness, and memory. Ideally, treatment
should help the patient achieve a subjective sense of a uni®ed identity by
integrating the personality states, and eliminate amnestic gaps by both achieving a
con¯uent identity in the here and now and by uncovering amnesia for the past so
that the patient develops a coherent and cohesive sense of personal identity and
personal history. it is understood that much of what emerges in such treatments
cannot be veri®ed, but nonetheless exercises a compelling degree of control over
the patient. It is not assumed that all that emerges is accurate Kluft, 1984, 1996),