International Handbook of Clinical Hypnosis - E-Lib FK UWKS

INTRODUCTION 11
problem. The authors of Chapter 9 present a series of arguments in favour of a trial
of hypnotherapy augmenting cognitive-behavioural management of depression.
To complete the anxiety±depression spectrum, Spiegel's lucid and comprehensive
presentation of PTSD symptoms and treatment approaches in Chapter 10
begins with an account of the vicissitudes undergone in developing the concept of
post-traumatic stress disorder. It provides a cautionary tale that however con®dent
we feel in the accuracy of our knowledge we can never know all the answers, and
therefore should retain an open mind for opposing views.
Dr Spiegel notes the growing interest in the overlap between hypnotic and
dissociative states and post-traumatic stress disorder, in particular a clear analogy
between the three main components of hypnosis: absorption, dissociation, and
suggestibility Spiegel, 1994), and the categories of PTSD symptoms.
Like PTSD, conversion disorders are particularly suited for treatment using
hypnosis. In 1986 Trillat made the hasty conclusion that hysteria was an illness that
would no longer be seen, but conversion disorders still present neurologists,
psychiatrists and psychotherapists with a considerable problem. Chapter 11 by Dr
Hoogduin and Dr Roelofs views the relationship between conversion disorders and
dissociative disorders from a modern cognitive psychological standpoint. Hypnotherapeutic
strategies are described and illustrated by case histories. Finally, it is
emphasized that in an appreciable percentage of patients misdiagnosed as having a
psychological) conversion disorder, there may be an organic cause for the
complaint.
A further note for caution is sounded. Is hypnosis an essential element in all the
cases where treatment involving it leads to a favourable result? There is great need
for controlled research in this area. On the other hand, there has been no controlled
research relating to other treatment strategies, although some well-documented
case descriptions indicate that behaviour therapy and physiotherapy achieve very
positive results with conversion disorders.
As Dr Murray-Jobsis notes in Chapter 12, it is over a century and a half since
hypnotic methods have been applied to the treatment of the extremely dif®cult
conditions of psychosis and personality disorder. Most experimental work supports
the conclusion that psychotic and personality disordered patients possess hypnotic
capacity which can be used productively and safely.
The clinician dealing with the severely disturbed patient must have experience
with this type of population, and also requires sensitivity. Moreover empathy in
pacing is an essential in hypnotherapy of these psychologically fragile patients.
The conceptual framework of hypnotherapy in dealing with psychotic patients
and personality disorder has a psychoanalytic framework. The aim is to redo life
experiences and allow the disturbed patient to redevelop potential for healthy
growth and development. Virtually all traditional psychotherapy techniques can be
adapted for use with hypnosis in the treatment of these patients.
The use of hypnosis for dissociative trance disorder is also presented from a
strongly psychoanalytical viewpoint. Treatment involves interrupting pathological