International Handbook of Clinical Hypnosis - E-Lib FK UWKS

198 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
problems Fine, 1991). When alters have done their work and dealt with their
issues, they may integrate with hypnotic suggestion if they have not done so
spontaneously integration rituals). Suggestions of merger and joining with imagery
appropriate to the particular patient are often effective, and follow-up of hypnotically-facilitated
integrations demonstrates good stability Kluft, 1986a).
Often it is useful to touch bases with the alters not involved in day to day
treatment in order to anticipate and preempt crises and to see whether alters
represented as integrated have in fact become separate again recheck protocols).
Using ideomotor signals, a large number of alters can be asked if they have issues
that need to be addressed in a very brief period of time. Cooperative patients can
use autohypnotic techniques effectively, but some patients may subvert what they
learn in the interests of resistance Kluft, 1982). One use of autohypnosis is relapse
prevention. Integrating patients can be taught techniques to stabilize themselves
when intercurrent crises prove a threat to their hard-won integrations Kluft,
1988b). Suppressive techniques were recommended by Allison 1974) in early
papers. They are now a historical footnote, but retain relevance because they are
often spontaneously used by patients to contain or con®ne alters that are deemed
disruptive, and must be understood. Often complex negotiations with many alters
prove necessary to deal with such internal `solutions,' which may encourage
ongoing hostility among the alters, with disastrous consequences in terms of selfharm
or suicide attempts, often magically misunderstood by the alters as the attack
of one separate individual upon another.
It is dif®cult to discuss the usefulness of hypnosis in the treatment of dissociative
identity disorder patients simply in terms of the hypnotically-facilitated interventions
that are undertaken. An awareness of hypnotic phenomena and a sensitivity to
the fact that every interaction with such patients occurs in an ambience of hypnotic
phenomena is a tremendous asset for the therapist to bring to his or her work with
this patient population.
DEPERSONALIZATION DISORDER
Because depersonalization is an extremely common psychiatric symptom, it is
essential to evaluate the patient thoroughly to be con®dent that depersonalization
disorder, rather than depersonalization as a symptom of some other psychological
or medical disorder, is present. The literature on the treatment of depersonalization
disorder is anecdotal, with no one approach having achieved wide success. Kluft
1987) proposed that two categories of depersonalization disorder be appreciatedÐ
one a dissociatively-driven condition in patients with high hypnotizability, and
another with obsessive and other defensive processes that estrange the patient from
his or her sense of him or herself, and from a connection with one's feelings and
body. The latter group consists of patients with a wide range of hypnotizability;
many are not good hypnotic subjects. The former are quite amenable to direct