International Handbook of Clinical Hypnosis - E-Lib FK UWKS

DISSOCIATIVE DISORDERS 199
hypnotic interventions, while the latter may be approached with hypnoanalytic
procedures and Ericksonian strategies, but may remain refractory to them.
With patients who have a high degree of hypnotizability, it often is possible to
demonstrate to the patient that their symptoms can be both instigated and terminated
by an hypnotic intervention. The patient can be taught autohypnotic strategies to
bring on and to conclude relevant depersonalization symptoms. Hypnosis can be
utilized to explore and to process the particular stressors that trigger depersonalization
episodes. For example, a woman who became depersonalized when criticized
was taught to counter this with autohypnotic relaxation. Often hypnotic suggestion
of both the removal of sensations and the experiencing of sensations can begin the
process of reconnecting the patient to his or her body. When the patient masters the
skill of making himself numb and disconnected, often with techniques useful for
pain relief, he or she may begin to achieve mastery of a symptom that had controlled
him or her. Split screen techniques in which the patient can see him/herself in a
distorted or disconnected manner and a normal and connected manner are often
useful. The patient can be taught to envision him or herself in a connected and
feeling manner to counter the distorted and disconnected self-perception. In a recent
case, the author serendipitously was using the image of a beach scene to relax a man
totally out of contact with his body, who always saw himself rather than experienced
himself. When the man began to react strongly to the scene, the author suggested
only that the sun was rising higher in the sky, and that noon was approaching. Within
minutes, the man was perspiring profusely. The author did not address the depersonalization
directly, but was able to build upon this experience to reconnect this man
to his body and identity in short order.
DISSOCIATIVE TRANCE DISORDER
This diagnostic category includes both temporary marked alterations in the state of
consciousness or loss of personal identity and instances in which another entity
replaces the customary sense of personal identity. The former are considered the
trance subtype, the latter the possession trance subtype. The former are world-wide.
The latter are often determined by the mores and beliefs of particular cultures, and
may constitute culture-bound syndromes.
Trance disorders often occur in the aftermath of trauma and extreme stress. The
triphasic model described above should be applied. In the absence of contraindications,
hypnosis may initially be used supportively. The patient, who is having
spontaneous and/or triggered trance states, can be taught mastery of his or her
autohypnotic talents and vulnerabilities by learning to enter and exit trance by
choice. While practicing autohypnotic exercises, the patient learns to use this skill
to reduce the tensions and pressures that precipitate trances, and to exit from and/or
preempt spontaneous trance phenomena. This restores a sense of an internal rather
than an external locus of control. As the patient feels increased control and
strength, and feels less at the mercy of spontaneous or triggered trances, hypnosis