International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DISSOCIATIVE DISORDERS 197
Table 13.1. Varieties of hypnotically-facilitated interventions useful with dissociative
identity disorder
1 Accessing alters 12 Time sense alterations
2 Alter substitutions 13 Distancing maneuvers
3 Recon®gurations 14 Facilitating integrations
4 Ideomotor questioning 15 Temporary blendings of alters
5 Provision of sanctuary 16 Integration rituals
6 Bypassing or attenuating intense 17 Recheck protocols
affect 18 Symptom relief and symptom
7 Slow-leak techniques substitutions
8 Curtailing abreactions 19Teaching autohypnosis
9Fractionated abreactions 20 Suppressive measures
10 Facilitating abreactions 21 Trance rati®cation
11 Gathering historical data 22 Relapse prevention
enhancing techniques, or emerges spontaneously when previously available material
is processed. However, there remain many instances in which such explorations
are appropriate.
It is important to be able to access alters because the most common cause of
therapeutic stalemate is the presence of additional alters not known to the therapist.
It is often essential in order to map the system in the service of planning the
treatment. If one can access alters, one can request that a dysfunctional alter be
replaced by one able to handle the situation alter substitution). When the patient is
chaotic and many parts of the mind are imposing their feelings and ideas at once,
the patient may become overwhelmed. A more salubrious arrangement of the alters
recon®guration) combined with taking painful affect away bypassing or attenuating
intense affect) plus or minus suggesting that upset alters sleep between sessions
an example of time sense alterations) may prevent decompensation.
It is useful to use safe place imagery to create a place for alters to go when they
are overwhelmed or need rest, and/or a place to put child alters so they do not
interrupt the treatment or the patient's life provision of sanctuary). For example, a
patient whose days were dominated by childlike behavior was restabilized by
creating an imaginary playroom in the patient's `inner world' in which the child
personalities could play. Slow-leak techniques Kluft, 1988a) suggest that traumata
or painful affects come into awareness at a pace that the patient can tolerate.
Fractionated abreaction techniques, discussed above, are exceptionally useful for
the dissociative identity population, for which they were developed Kluft, in
press).
Bringing alters to be able to talk to one another, and to spend time in
coconsciousness or even in joint control of the body copresence), allows them
opportunities to break dissociative barriers and become less strange and ego-alien
to one another facilitating integration). This makes the process of integration less
threatening, and is a major component of Fine's 1991) cognitive approach. They
can be allowed to blend temporarily to share skill and assets to address particular