International Handbook of Clinical Hypnosis - E-Lib FK UWKS

44 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
client viewing hypnosis as a failure, should the headache not be relieved. In
addition, because hypnosis is considered a skill, it is subject to improvement with
practice. Clients can be instructed to practice self-hypnosis, thereby increasing their
skills while simultaneously validating their altered state, thus increasing positive
expectancies.
CONTRAINDICATIONS
There are only a few instances in which hypnosis should not be used, and these
mostly have to do with the skill of the therapist. Hypnosis should not be used with
any presenting problem that the clinician is unprepared to treat without hypnosis.
When a client's presenting problem is outside the clinician's ®eld of expertise the
client should be referred elsewhere. Every clinician has had the experience of
meeting a client they would rather not treat. It is advisable to refer them elsewhere,
as well. While the literature contains case reports of successful hypnotic applications
with almost every DSM category, most clinicians have delineated a narrower
®eld of practice and will ®nd they can easily apply hypnosis within their de®ned
domain.
Some clinical presentations are poorly suited to hypnotic intervention. Organic
brain syndromes is one such category. Clients who present as suicidally depressed
or as paranoid schizophrenics are generally not good candidates for hypnosis, at
least in the beginning of treatment. The rapidity with which hypnosis may bring
forth repressed material, or unravel the already fragile psychic structure, are unwanted
repercussions with such clients.
Similarly, in uncovering work, caution must be taken when working with clients
with fragile ego structure, thought disorders, or borderline psychotics where there
may be further decompensation with hypnosis. Paranoid clients may also feel an
intensi®cation of hostile feelings related to feeling controlled following hypnosis
Frauman, Lynn & Brentar, 1993).
Forensic subjects can pose a particular challenge to clinicians. Recent recommendations
Hammond, Garver, Mutter et al., 1994) clarify the state and federal
models for forensic hypnosis. Training in forensic applications of hypnosis and
nonsuggestive or nonleading interviewing techniques are recommended for professionals
working with forensic subjects. It is the clinician's responsibility `to reject
the use of hypnosis in any case in which' the client the witness) is not competent
to give or refuses to give written informed consent, or where the mental, emotional
or physical health of the person will be at risk of harm with the use of hypnosis, or
when `the witness was not in a position to realistically perceive the events in
question' ibid, p. 39). In the aggregate, when forensic guidelines have not been
properly followed by a forensic subject, the use of hypnosis is ill-advised.
As noted earlier, indiscriminate removal of organic pain may lead to complications.
This is a particular problem with highly hypnotizable clients whose talents in