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Hypnotherapy for Traumatic Grief: Janetian and Modern Approaches Integrated

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Abstract

Traumatic grief occurs when psychological trauma obstructs mourning. Nosologically, it is related to pathological grief and posttraumatic stress disorder (PTSD). Therapeutic advances from both fields make it clear that the trauma per se must be accessed before mourning can proceed. The gamut of psychotherapies has been employed, but hypnosis appears to be the most specific. Pierre Janet provided a remarkably modern conceptual basis for diagnosis and treatment based on a dissociation model. His approach is combined with contemporary innovations to present a systematic and integrated account of hypnotherapy for traumatic grief.
Onno van der Hart, Paul Brown, Ronald N. Turco 1
Hypnotherapy for Traumatic Grief:
Janetian and Modern Approaches Integrated
Onno van der Hart
Utrecht, Netherlands
Paul Brown
Melbourne, Victoria, Australia
Ronald N. Turco
Portland, Oregon
Received November 11, 1988; revised September 12, 1989; accepted for publication October 18, 1989.
Traumatic grief occurs when psychological trauma obstructs mourning. Nosologically, it is
related to pathological grief and posttraumatic stress disorder (PTSD). Therapeutic advances
from both fields make it clear that the trauma per se must be accessed before mourning can
proceed. The gamut of psychotherapies has been employed, but hypnosis appears to be the
most specific. Pierre Janet provided a remarkably modern conceptual basis for diagnosis and
treatment based on a dissociation model. His approach is combined with contemporary
innovations to present a systematic and integrated account of hypnotherapy for traumatic
grief.
Hypnosis is widely used in the treatment of
pathological grief but is much underreported. It
speeds and facilitates mourning and makes
possible a personal reorientation to the future
(Fromm & Eisen, 1982; Yager, 1988). Hypnosis is
specifically indicated in the resolution of
traumatic grief. Grief is traumatic when it follows
objective and severe subjective trauma and when
posttraumatic reactions inhibit mourning.
In recent years, reports of traumatic grief in
both children and adults have begun to appear,
describing the reactions of survivors of those lost
as a result of lethal accidents (Lundin, 1984;
Lehman, Wortman, & Williams, 1987); disasters
(Raphael, 1986); homicide (Rynearson, 1984;
Amick-McMullan, Kilpatrick, Veronen, & Smith,
1989); and battle combat (Spiegel, 1981).
Traumatic grief reactions do not occur only when
the event is witnessed directly. Death of loved
ones can also be seen on television, read in news
reports, reconstructed in fantasy from court
proceedings, or even experienced in cells adjacent to
torture chambers (0. Brozky, personal
communication).
As yet, there have been few reports on
treatment of traumatic grief. Singh and Raphael
(1981) describe marked neglect of psychological
trauma in bereavement counseling. The earliest
reports of successful use of hypnosis for traumatic
grief were from the early and middle nineteenth
century (Bakker, Wolthers, & Hendriksz, 1814;
Hoek, 1868). At the end of the nineteenth and
beginning of the current century Pierre Janet
systematized the hypnotic treatment of posttraumatic
stress disorder (PTSD), including traumatic grief
(Janet, 1889, 1898a, 1898b, 1904, 1911, 1919/25).
Recently, the hypnotic treatment of traumatic grief
has been taken up again, especially within the con-
text of advances in hypnotherapy of PTSD.
However, further development has been hampered
by the absence of an adequate conceptual basis for
diagnosis and treatment.
Pathological Grief and PTSD
Traumatic grief straddles two diagnostic fields:
pathological grief and PTSD. Neither one describes
the symptomatology completely, and because neglect
to accommodate both aspects may lead to therapeutic
failure, the clinical focus must include both (cf.
Amick et al., 1989; Burgess, 1974; Eth & Pynoos,
1985; Furman, 1974; Lehman et al., 1987; Lindy,
Green, Grace, & Tichener, 1983).
According to Horowitz, Wilner, Marmar, and
Krupnick (1980), pathological grief involves
intensification of mourning without progression to
completion. Parkes and Weiss (1983) subdivided
pathological grief into three distinct syndromes:
chronic grief occurring from the onset in dependent
relationships, ambivalent grief where relationships
are conflicted, and unexpected grief. Parkes (1985)
recognized that sudden and untimely grief was also
often horrifying, painful, and mismanaged. 1n fact,
the symptoms of traumatic loss center on recurrent
terrifying images of the victim's death (Eth &
American Journal of Clinical Hypnosis, Volume 32, Number 4, April 1998
Onno van der Hart, Paul Brown, Ronald N. Turco 2
Pynoos, 1985; Rivers, 1918; Rynearson, 1981,
1987). These "traumatic memories" intrude into
waking life as flashbacks and disturb sleep with
nightmares. They are accompanied by fears of death
and dying and by feelings of helplessness and shame
(Lindy et al., 1983). Survivors generally avoid re-
minders of the loss and of death in general (Terr,
1984). They become withdrawn, hypervigilant, and
given to startle reactions. Survivors of the victims of
homicide also report feelings of rage and
vengefulness (Amick-McMullan et al., 1989;
Rynearson, 1984).
These posttraumatic reactions, which can be
subsumed under the diagnostic category of PTSD
(American Psychiatric Association, 1987), prevent
grief work; they mask, inhibit, and delay the mourn-
ing process (Burgess, 1974; Eth & Pynoos, 1985;
Furman, 1974; Rivers, 1918; Rynearson, 1986;
Wolfenstein, 1969).
Thus, traumatic grief is not only a subset of
pathological grief but also of PTSD and exhibits the
same biphasic symptom-swings from symptoms of
arousal, intrusive traumatic imagery, and anxiety to
defensive numbing and avoidance (cf. Horowitz,
1986; Brom, Kleber, & Defares, 1989). As with
PTSD, there are many formes frustes (cf. Brown &
Fromm, 1986). Not all cases of traumatic grief
overtly present with posttraumatic symptomatology.
Survivors are frequently silent about their traumatic
loss. In some this is a conscious suppression, but in
others it reflects psychogenic amnesia. Diagnosis is
further complicated by disorders which overlap,
mimic, or mask the posttraumatic grief response.
Cases sometimes present with antisocial
behavior and substance abuse, as has particularly
been noted in Vietnam veterans (Jellinek &
Williams, 1987). Traumatic imagery presenting
in the form of pseudo-hallucinations may even
be managed as functional psychoses. Kardiner
and Spiegel (1947) recognized that the adaptive
failure in posttraumatic states, including
traumatic grief, can actually give rise to the
symptom picture of any known mental illness.
It was Pierre Janet who first presented many
cases of traumatic grief and emphasized its
dissociative nature (Janet, 1889, 1898, 1904,
1911). Janet observed that many persons exposed
to the sudden or violent death of a loved one
were completely unable to adjust to it. Instead,
they were overwhelmed by vehement emotions,
which exerted a disintegrative effect on the
mind. The traumatic experience became
dissociated from ordinary consciousness and
continued as "traumatic memories," described by
Janet as subconscious fixed ideas (cf. van der
Hart & Friedman, 1989). Ordinary consciousness
became restricted, and affect and interest also
became restricted. Traumatic memories, evoked
by associations and reminders, manifested as
vivid and terrifying flashbacks, nightmares, and
behavioral reenactments in the form of
"somnambulistic crises." The vehement emotions
which accompanied these traumatic man-
ifestations, and the related sleeping disorders in
many of these patients, caused fatigue and
emotional exhaustion (cf. van der Kolk, Brown,
& van der Hart, 1989). Thus the capacity to
assimilate the traumatic memories was further
reduced; patients became even less able to
transform their traumatic imagery into narrative
memory and to perform their grief work, that is,
to accomplish the necessary adaptation to the
loss of their beloved one (cf. van der Hart,
1988a).
Hypnotic Approaches to Traumatic Grief
Hypnosis played a key role in Janet's
treatment of traumatic grief and related
posttraumatic syndromes (Janet, 1889, 1898a &
b, 1904, 1911, 1919/25). His view of the
relationship between hypnosis and posttraumatic
stress is remarkably similar to modern thinking
as exemplified by Kingsbury (1988): ". . .
hypnosis may be an isomorphic intervention for
PTSD because both involve related dissociative
shifts in the state of consciousness" (p. 84).
Hypnosis was incorporated into a three-stage
treatment model (van der Hart, Brown, & van der
Kolk, 1989). Initially hypnosis was employed to
induce relaxation, relieve life-threatening
symptoms such as anorexia, mobilize energy,
and focus attention on the therapeutic task. In
stage two, it was required to access and modify
dissociated mental states. Janet called this
process "liquidation" and employed three
hypnotic approaches: uncovering, neutralization,
and substitution. The former was often
incorporated in the latter two. Neutralization
consisted of progressive uncovering and
dissolution of traumatic memories. It enabled the
patient to move from experiential (symptomatic)
recall to neutral, verbal recollection. Substitution
was a method of therapeutic revision in which
traumatic memories were substituted by positive
or emotionally inert images. Liquidation of
traumatic memories enabled mourning to
proceed, often with the aid of hypnosis in stage
three. In general, this stage consisted of
prevention of the tendency to dissociate and
relapse, consolidation of therapeutic gains, and
rehabilitation.
Uncovering and liquidation of traumatic
memories also form the basis of modern
hypnotherapy for traumatic grief. Methods are
drawn from contemporary treatment approaches
to PTSD. They are usually not grounded in
theoretical models of psychological dissociation.
We have tried to restore this conceptual basis,
and below we attempt to systematically describe
the hypnotic techniques of both Janet and
modern authors.
Hypnotic Approach 1: Uncovering Traumatic
Memories in Traumatic Grief
Patients with complicated traumatic grief
are amnestic for the traumatic memories of the
death of their loved ones. Instead, traumatic
imagery emerges in dissociative symptomatology
or is disguised and replaced by conversion
symptoms, antisocial behavior, or psychotic
phenomena. Traumatic memories can be
uncovered by a variety of direct and indirect
methods. Janet employed hypnosis, automatic
writing, and guided fantasy. Janet's case of Zy
(Janet, 1898a) is complemented by a
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Onno van der Hart, Paul Brown, Ronald N. Turco 3
contemporary example of hypnotic uncovering
from Turco (1981).
Case 1. At the age of 39, the female patient
Zy was admitted to the Salpêtrière with a 2-year
history of insomnia. She had lost her son 3 years
earlier. Her mourning process, which was
originally within the normal range, was
interrupted after 3 months by a prolonged
typhoid fever. She became obsessed with her
son's demise and developed visual hallucinations
of his traumatic death and burial. These
symptoms disappeared 2 months later and were
replaced by insomnia and psychogenic amnesia.
Janet first induced hypnotic sleep and then
uncovered the dissociated traumatic memories in
the form of hypnotic dreams. Subsequently he
modified these dreams and made them disappear
altogether.
Case 2. Turco reported a case of path-
ological grief which presented following a
sequence of serious road traffic accidents. The
patient's daughter had been a motor fatality
victim 2 years earlier. Using hypnotic age
regression Turco uncovered traumatic factors
which blocked mourning of her daughter and
also factors impeding mourning of her father
many years earlier.
Hypnotic Approach 2: The Neutralization
Technique
In this approach Janet used hypnosis to
elicit experiential recall and then facilitate more
"neutral" description of the trauma in words, i.e.,
without the vehement emotions which
accompany reexperiencing of unassimilated
traumatic memories. He achieved neutralization
first under hypnosis and later in the waking
state. Assimilation of the traumatic memories
subsequently enabled mourning to proceed.
Janet's complex hypnotic treatment of Irène took
over 2 years to complete (Janet, 1904/11).
Follow-up was for a further 14 years.
MacHovec's current example demonstrates how
hypnosis can enable more rapid and spontaneous
neutralization (MacHovec, 1985). It is an
important case, because it is one of the few that
draw attention to the need to deal with trauma
before mourning can proceed.
Case 3. Irène, a girl of 20, had been a timid,
sickly, and dependent child. She nursed her
tubercular mother through 60 consecutive
sleepless nights. When her mother died, Irène
dragged her body back onto the bed. Irène
wandered in a fugue state and subsequently
showed no awareness of the death and burial.
She alternated between somnambulistic crises in
which she reenacted her mother's demise and her
states of indifference. Irène twice attempted
suicide and was hospitalized in the Salpêtrière.
Janet first uncovered Irène's dissociated
traumatic memories and facilitated
reexperiencing within the therapeutic arena. As
their emotional tone diminished, Irène was
eventually able to reconstruct a verbal memory
of her mother's death without suffering
dissociative symptoms. Irène proceeded with her
mourning, set her life in order, and became
independent.
Case 4. MacHovec's patient, a 42-year old
divorcee, celebrated her forthcoming wedding
with her new fiancé at a gourmet restaurant.
They both immediately became ill with food
poisoning, from which the man died. She
survived but experienced posttraumatic
anxieties, anorexia, and insomnia. Medication
gave a troubled sleep from which she awoke in
terror. She denied her fiancé’s death and was
offered hypnotherapy. Prolonged induction and
suggestion for relaxation facilitated spontaneous
recall of the entire restaurant episode. Once the
dissociated traumatic memories had been elicited
and put into words, the patient was able to start
grieving. Five more hypnotic sessions were re-
quired, and at one-year follow-up the positive
outcome was maintained.
Hypnotic Approach 3: Therapeutic
Revision
Janet based his hypnotic revision on his
substitution technique. It was addressed to
severely disturbed patients who were unable to
neutralize their traumatic memories and
transform them into a personal narrative. Instead
Janet assisted them in substituting alternative
emotional, inert, or even positive imagery. In the
case of Cam, Janet hypnotically substituted pos-
itive images for scenes of death (Raymond &
Janet, 1898). Spiegel (1981) reported the case of
a Vietnam veteran in which positive imagery was
combined with traumatic memories rather than
substituted for them. The content of the trauma
remained unchanged but its impact was lessened
so that mourning could proceed.
Case 5 Cam lost her two infants and mother
in close succession. She was in constant despair
and suffered gastrointestinal cramps and
vomiting. Cam was admitted to the Salpêtrière,
emaciated, preoccupied with reminders of her
children, and regularly hallucinating realistic
scenes of their deaths. Janet initiated treatment
by having her give up the reminders for
safekeeping. Using hypnotic suggestion, he
substituted her traumatic death images with those
of flowers. Then he made them fade away
altogether. Subsequently Janet focused Cam's
attention on the future and in particular on her
training in midwifery. At one-year follow-up she
was working again and considered to be cured.
Case 6. Spiegel's patient, G.R., was a career
officer whose psychiatric history of psychopathy,
psychosis, and depression commenced after a 3-
year tour of duty in Vietnam (Spiegel, 1981).
There he witnessed a rocket attack on an
orphanage in which his adopted son was burnt to
death. Spiegel had the patient hypnotically re-
gress to the time of death and burial. Traumatic
images were combined with happy memories of
the child's birthday party. He instructed the
patient in selfhypnosis so that he could visualize
a mental split-screen image of the grave along-
side memories of a birthday cake. He was also
instructed to relinquish the experience if it
became too painful. The patient was able to
remember without retraumatization and was
discharged from treatment.
American Journal of Clinical Hypnosis, Volume 32, Number 4, April 1998
Onno van der Hart, Paul Brown, Ronald N. Turco 4
Modern hypnotic revision goes beyond
substitution or addition of neutral or positive
images. Therapists explore and revise a broad
range of traumatic factors impeding grief. Thus,
failure to assimilate traumatic memories is
frequently associated with the haunting idea that
something more could have been done. It is often
retrospective and loaded with feelings of guilt.
The tendency to act may have arisen during the
traumatic episode itself, when its implementation
was impossible to achieve. This tendency was
dissociated and persisted at a subconscious level
beyond the subject's control. In the following
two contemporary cases, hypnotic revision was
used to have the patients perform the desired
action in imagination. It facilitated assimilation
of the psychological trauma and enabled grieving
of the loss to occur.
Case 7. Scott Jennings (1979) described a
woman who lost her 18-yearold daughter in a
jeep accident 3 years earlier. She had been
forbidden by a nurse to hold her dead daughter in
her arms. The patient suffered severe arm pains,
nightmares, and guilt feelings. Hypnotic age
regression to the scene of the trauma allowed her
to bug her deceased daughter in fantasy. The
patient experienced immediate relief, laying the
way open to completion of the grief.
Case 8. Lamb (1982) reported a case in
which posttraumatic grief followed courtroom
revelations concerning the murder of the
patient's niece. He was obsessed with the
question of whether he could have prevented the
death. Hypnosis facilitated exploration of this
issue and expression of unspoken positive
feelings towards the deceased.
Mourning can he impeded by subconscious
fixed ideas or traumatic memories in which
promises or disturbing thoughts towards the
deceased predominate. These occult, pathogenic
ideas provoke a range of neurotic and psychotic
posttraumatic reactions. Hypnosis provides an
opportunity for their revision and for sympto-
matic resolution (cf. Mutter, 1986). Sexton and
Maddock (1979) reported a case of traumatic
grief in which pathogenic promises were
corrected.
Case 9. The patient was a 52-year-old
woman who presented catatonic after a suicide
attempt. There was no obvious precipitant or past
history of mental illness. Hypnosis uncovered
the unexpected and traumatic losses of her
brother (when she was 12), father (at 16), and
mother (at 24). When hypnotically regressed to -
age 16, she remembered promising beside her
father's coffin, "I will be with you sometime." A
combination of deep hypnotic relaxation and
concentration enabled her to "reunite" with her
loving father in heaven and return to her husband
on earth who also loved her. She recovered
completely, experiencing no further death wish.
Grief may be hindered by recurring dreams and
fantasies whose symbolic content reflects a
traumatic loss. Hypnosis can be aimed to revise
their traumatic contents and allow them to
grieve.
Case 10. Van der Hart (1988a) described
the case of a 32-year-old woman in which
traumatic imagery was revised when the patient
returned for hypnosis a second time. Initially,
treatment had focused on the patient's fears and
traumatic memories of her violent father.
Following his sudden and unexpected death she
returned for resolution of pathological grief. This
time she was able to overcome the threatening
images of her father and bury him symbolically
in fantasy. At 6 months the patient had made a
good recovery.
Conclusions
Janet and a number of contemporary authors
recognized that the experience of psychological
trauma may complicate and inhibit mourning and
must first be resolved before grief can be
completed. Using a model of dissociation, Janet
showed how traumatic memories remain
unassimilated and prevent grief work. Based on
this dissociation model, he developed hypnotic
techniques for retrieving, neutralizing, and
revising them. Modern approaches are akin to
these. Neutralization involves decatlhexis of
traumatic memories, in which vivid traumatic
imagery is transformed into neutral, personal
narrative. Resulting verbal recall both stimulates
and reflects acceptance of the loss and adaptation
to life without the deceased. MacHovec's patient
(case 4) achieved this rapidly and spontaneously,
but Janet's case of Irene (case 3) was much more
arduous. However, for severely traumatized and
complex cases and in states of chronic emotional
exhaustion, neutralization often proves
impossible. Here, Janet recommended substitution
with neutral or positive images (case 1, 5), and
Spiegel used linkage of traumatic memories with
positive imagery (case 6). Janet's substitution
technique is complementary with modern
approaches of hypnotic revision, which encourage
patients to develop and pursue their own
modifications. Scott Jennings reported hugging
the deceased in hypnotic fantasy (case 7), Sexton
and Maddock correcting pathogenic promises
(case 9), and van der Hart completing fantasies
related to traumatic grief (case 10).
Almost all reports of hypnotherapy with
traumatic grief also mentioned working with the
loss itself. In various forms the patients took
symbolic leave from the deceased, for example,
by saying an imaginary goodbye, covering the
dead body, and burying the body with mementos
alongside it. Mourning also involves a total
personal reorientation towards the future. Janet,
for instance, realized this when he focused Cam's
attention on her training in midwifery (case 5).
Hypnosis can also complement other
treatment techniques which are part of more
global strategies of mourning therapy. This is
especially the case in dealing with material
reminders of the deceased. Both Janet (cf. case 5)
and modern clinicians have recognized the
pathogenicity of fostering these so-called "linking
objects" (Volkan, 1981) or "key symbols" (van
der Hart, 1983, 1988b). The therapist may keep
them for the duration of the therapy or the patient
may "depart" from them in a therapeutic leave-
taking ritual.
American Journal of Clinical Hypnosis, Volume 32, Number 4, April 1998
Onno van der Hart, Paul Brown, Ronald N. Turco 5
Trauma complicating grief has thus been
recognized and treated specifically with hypnosis
for nearly 200 years. Janet based his diagnosis and
treatment on a dissociation model which
integrates well with modern treatment approaches.
All of these methods aim to assimilate traumatic
memories, reduce traumatic effects, and enable
mourning to proceed.
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American Journal of Clinical Hypnosis, Volume 32, Number 4, April 1998
... Grief triggered by a traumatic event is conceptualised in the literature as traumatic grief (Van der Hart et al, 1990). Trauma makes the grief process more complex and challenging, increasing the risks for adulthood. ...
... Yasın travmatik bir olayla başlaması, literatürde travmatik yas olarak kavramsallaştırılır ve ayrı bir durum olarak tarif edilmektedir (Van der Hart et al, 1990). Travma yas sürecini çok daha zor ve çetrefilli bir hale getirmekte, yetişkinlik hayatında ortaya çıkabilecek riskleri arttırmaktadır. ...
... This event in the imagery domain coupled with the actual visit to his father's grave constituted the resolution of his chronic, traumatic grief (cf. Van der Hart et al., 1990). ...
Chapter
The concept of hysterical psychosis (HP) suffered a curious fate in the history of psychiatry. Important observations were made about the phenomenology of HP and its curability through psychotherapy, particularly with the use of hypnosis. Pierre Janet described HP as a kind of 'waking dream' in which the subject could not differentiate between the dream elements and normal perceptions. The concept of reactive (psychogenic) psychosis was introduced into psychiatric nosology at the beginning of the twentieth century. Like reactive psychoses, the immediate cause of HP is usually a traumatizing or stressful life event. Theoretical notions about the symbolic and psychopathological nature of trauma‐induced psychosis coalesced a century ago in the concept of hysterical psychosis. Since then, the extant clinical case studies and empirical examinations have not been sufficient to validate the existence of HP as an independent epidemiological and clinical entity.
... The first approach is called the substitution technique, and was originally developed by Janet (1889Janet ( , 1898cf. Van der Hart, Brown, & Van der Kolk, 1989;Van der Hart, Brown, & Turco, 1990). In it he suggested a completely different course to the original traumatic event. ...
Article
To overcome their traumatic memories, survivors need to integrate them into their personality. In patients with complex dissociative disorders who generally have experienced severe and chronic relational traumatization, this integration requires a paced and regulated approach within a relational context. Management and resolution of traumatic memories require, above all, an understanding and treatment of dissociation. The dissociative organization of these individuals’ personality includes at least one part of the personality primarily engaged in daily living, while trying to avoid traumatic memories, and at least one other part primarily fixated in traumatic memories, i.e., sensorimotor and in many cases highly affectively charged re-enactments of traumatic experiences, including innate defensive action tendencies in the face of perceived or actual threat. The treatment of traumatic memories should generally be embedded in a phase-oriented treatment – the current standard of care – in order to ensure that it will not exceed the patient's capacity as a whole person to integrate these re-enactments.
... Van der Hart (1988a) discussed one form of mourning therapy that involved a "therapeutic leave-taking ritual" and a parting with symbols associated with the deceased . Also Van der Hart, Brown and Turco (1990) discussed the integration of hypnosis and Janetian theory (Janet, 1889) in treatment of traumatic grief . Spiegel (1981) reported on the use of hypnosis to facilitate grief work amongst Vietnam veterans who were experiencing grief and posttraumatic stress symptoms . ...
Article
Full-text available
Hypnosis was used with a client facing a difficult vocational decision. The client was a young woman who had made a series of vocational decisions in the past without fully understanding her own interests and needs. A variety of hypnotic techniques were used, including time projection, going to a special place, and listening to an older and wiser version of herself. Hypnosis was effective in developing self-confidence and relaxation, as well as enhancing self-awareness, enabling the client to make an appropriate vocational decision. Hypnosis is not often reported in the vocational counselling literature, but this case study demonstrates its efficacy.
Chapter
Full-text available
Apart from the Netherlands and Belgium, clinical interest and research in Europe in the field of dissociation and the dissociative disorders are lagging far behind North American developments. In most European countries, strong professional ignorance and skepticism still exist. After a brief description of the clinical field in Europe, in particular in the Netherlands and Belgium, the main focus of this chapter is on European studies on dissociation and dissociative disorders. Special attention is given to studies on the development of a scale for the assessment of dissociative experiences and symptoms and on the prevalence of these phenomena in both general populations and psychiatric patient samples.
Article
Grief and mourning are assodated with emotional distress and a process of psychological adjustment. Current models of grieving and mourning provide some understanding of effective psychotherapy work but largely neglect the integration of hypnotherapeutic interventions. In this paper, a theoretical model for hypnotherapeutic intervention is presented and illustrated via a case study. The clinical case study is of a woman whose husband had died, which led her to enter hypnotically oriented psychotherapy. Clinical hypnosis may provide a powerful adjunct therapy for the treatment of grieving and facilitate resolution of mourning.
Article
IntroductionHelping the Terminally Ill PatientFear and LossBereavementImportance of RapportThe Boat Metaphor for LifeThe Honey Pot MetaphorThe Bomb Blast MetaphorThe Forest Fire MetaphorPost ScriptReferences
Book
Advanced Hypnotherapy focuses on tested hypnoanalytic techniques, with step-by-step procedures for integrating hypnosis into psychoanalytic processes. In its examination of the latest thinking, research, and techniques, the book discusses historical origins of hypnosis as well as how to apply it to current events, such as using hypnosis in the treatment of trauma with soldiers coming out of the war in Iraq. The text shows how hypnosis can be combined with pscyhoanalysis to make it possible to understand the subjective world of clients. Its accessible nature, rich detail, and significant updates make the book an invaluable resource for the professional who wishes to incorporate hypnosis into his or her practice. With the authors' extensive and impressive knowledge, careful updates, and comprehensive coverage of the proper and appropriate techniques to use, this volume is an indispensable addition to the field.
Article
Full-text available
A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group. (C) 1989 by the American Psychological Association
Chapter
The Chowchilla school-bus kidnapping commanded international attention. All 26 children (age range, 5–14 years) who enrolled in the Alview Dairyland summer school disappeared for 27 hours, and they eventually escaped from their captors. After their return the children disclosed that their school bus had been stopped by a van blocking the road, three masked men had taken over the bus at gunpoint, and they had been transferred to two blackened, boarded-over vans in which they were driven about for 11 hours. They were then transferred into a “hole” (actually a buried truck trailer), and the kidnappers covered the truck trailer with earth. The children were buried in the hole for 16 hours until 2 of the oldest and strongest boys (ages 10 and 14 years) dug them out. By then the kidnappers had left the vicinity.
Article
Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.
Article
Clinicians have gained considerable knowledge about psychopathology and treatment but this knowledge is poorly systematized and hard to transmit. One way to organize clinical knowledge is to circumscribe a limited area and describe within it the interactions between personality dispositions, states of disorder, and treatment techniques. This report models such an approach by limiting disorder to stress response syndromes, personality to obsessional and hysterical neurotic styles, and treatment to focal dynamic psychotherapy. Within this domain, an information processing approach to working through conflicted ideas and feeling is developed. The result is a series of assertions about observable behavior and nuances of technique. Since these assertions are localized conceptually, they can be checked, revised, refuted, compared, or extended into other disorders, dispositions, and treatments.