USE OF CLINICAL HYPNOSIS AND EMDR IN KIDNAPPING AND RAPE: A CASE REPORT

Abstract

This case study describes the use of clinical hypnosis and EMDR (eye movement desensitization and reprocessing) in a woman with post-traumatic stress disorder (PTSD) due to her kidnapping and rape, before and after which she also experienced emotional violence from her husband. The patient suffered from panic attacks, crying, and sadness, in a climate of constant social isolation. Treatment goals were to eliminate anxiety attacks and stress, and to strengthen self-esteem and resilience while encouraging an optimistic attitude. To measure these variables, five psychosocial scales and ratings of three emotional states (wellbeing, anxiety and tranquillity) were used throughout the treatment to assess the progress of therapy. EMDR was used in the first four sessions to treat PTSD symptoms, and hypnosis was employed to facilitate emotional abreaction and strengthen self-esteem during sessions 2 to 9. Findings showed a significant decrease in anxiety attacks and stress levels, along with improvements in general wellbeing, tranquillity, optimism, self-esteem and resilience. The combined use of hypnosis and EMDR was shown to be an effective therapeutic strategy to reduce PTSD related symptoms.

Full text

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Correspondence regarding this paper should be sent to Génesis M. Rocha at genesis.r@
tecmilenio.mx or Arnoldo Téllez at atellez50@hotmail.com.
AustrAliAn JournAl of CliniCAl And ExpErimEntAl Hypnosis
Vol. 41, No. 1, 2016, 115–133
USE OF CLINICAL HYPNOSIS AND EMDR IN
KIDNAPPING AND RAPE: A CASE REPORT
Génesis M. Rocha and Arnoldo Téllez
Universidad Autónoma de Nuevo León, Psychology School, Mexico
This case study describes the use of clinical hypnosis and EMDR (eye movement
desensitization and reprocessing) in a woman with post-traumatic stress disorder
(PTSD) due to her kidnapping and rape, before and after which she also
experienced emotional violence from her husband. The patient suffered from
panic attacks, crying, and sadness, in a climate of constant social isolation.
Treatment goals were to eliminate anxiety attacks and stress, and to strengthen self-
esteem and resilience while encouraging an optimistic attitude. To measure these variables,
five psychosocial scales and ratings of three emotional states (wellbeing, anxiety and
tranquillity) were used throughout the treatment to assess the progress of therapy. EMDR
was used in the first four sessions to treat PTSD symptoms, and hypnosis was employed
to facilitate emotional abreaction and strengthen self-esteem during sessions 2 to 9.
Findings showed a significant decrease in anxiety attacks and stress levels, along with
improvements in general wellbeing, tranquillity, optimism, self-esteem and resilience. The
combined use of hypnosis and EMDR was shown to be an effective therapeutic strategy
to reduce PTSD related symptoms.
Keywords: clinical hypnosis, EMDR, post-traumatic stress disorder, rape,
kidnapping.
INTRODUCTION
Among high-impact crimes in Mexico the most frequent is kidnapping,
which refers to the illegal deprivation of a person’s liberty in order to extort
a payment (Reyes, 2013). Officially, there were 1307 kidnappings reported in
the year 2012 (National Observatory Citizen [ONC], 2013); however, the real
number is higher because many cases go unreported to the police. According
to a government study, Mexico suffered an estimated 102,000 kidnappings
in 2014 alone. Express kidnappings, where a smaller, affordable ransom is

116 Rocha and Téllez
demanded rapidly, are the most frequent, comprising 59% of all kidnappings
(National Institute of Statistics and Geography, 2015).
Jiménez (2002) states that: “Kidnapping is one of the illegal activities that
affects our society presently the most, not only by the amount that are being
perpetrated, but because how they are accomplished is increasingly violent.”
Referring to the fact that concurrently kidnapping victims are beaten,
mutilated and sexually abused.
After being raped and kidnapped some victims exhibit PTSD. The intensity
or severity of this condition depends on various factors, which Williams and
Poijula (2002) describe:
1. Factors prior to the event: The number and intensity of stressful events
preceding the traumatic experience influence how the person will react
to it. Examples of those events could be emotional or sexual child abuse
or ineffective coping skills, amongst others.
2. Factors during the event: age and the event’s meaning to victim.
3. Factors after the event: this is whether social support was or was not
received and/or being unable to find a meaning for the traumatic event.
Chacón (2006) describes the symptoms of PTSD as:
1. Re-experiencing:
Flashbacks, feelings and sensations associated by the subject to the
traumatic situation.
Nightmares; the event or other images associated with it often recur in
dreams.
Disproportionate physical and emotional reactions to events associated
with the traumatic situation.
2. Increased arousal:
Difficulty sleeping.
Hypervigilance.
Trouble concentrating.
Irritability, impulsivity and aggressiveness.
3. Avoidance behaviour and emotional blockage:
Strong rejection of situations, places, thoughts, feelings or conversations
about the traumatic event.
Loss of interest.
Emotional blocks.
Social isolation.
These symptoms are widespread in the population affected by PTSD, but
associated problems are commonly observed in clinical practice (Crowson,

Clinical Hypnosis and EMDR in Kidnapping and Rape 117
Frueh, Beidel, & Turner, 1998; Frueh, Turner, Beidel, & Cahill, 2001).
PTSD involves multiple concurrent disorders, the most common are
(Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Zatzick et al., 1997):
• Panic attacks: present when exposed to situations related to the traumatic
event. These include intense feelings of fear and anxiety accompanied by
physical symptoms such as palpitations, sweating, nausea, and tremors.
• Depression: manifested as loss of interest, decreased self-esteem, and in the
most serious cases as recurrent suicidal ideation.
• Anger and aggression: They are very common reactions amongst victims
of trauma.
• Extreme behaviours of fear: avoiding everything related to the trauma.
PTSD was included in the chapter “Trauma and Stressor-Related Disorders”
in The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5;
American Psychiatric Association, 2013), and its diagnostic criteria include a
history of exposure to a traumatic event followed by symptoms from each of
four symptom clusters: intrusion (traumatic nightmares, dissociative reactions,
flashbacks, and intense or prolonged distress); avoidance (avoiding thoughts,
feelings, places or people related the traumatic event); negative alterations in
cognitions and mood (dissociative amnesia, fear, anger, or guilt); and alterations
in arousal and reactivity (hypervigilance, startle response, irritable behaviour,
angry outbursts and sleep disturbance).
Treatment of Post-traumatic Stress:
There are multiple psychological interventions for therapeutic work in
kidnapping and rape, such as: psychoanalysis, pharmacotherapy, cognitive–
behavioural therapy, Gestalt therapy, humanist techniques, eye movement
desensitization and reprocessing (EMDR), and Er icksonian hypnosis techniques
(De Shazer, 1995; Friedman, 2000; Harvey, Bryant, & Dang, 1998; Solomon
& Shapiro, 2008).
Brief therapy focuses on potentiating the positive attitudes of the patient,
expanding the ability to solve their problems by reviewing the changes,
and attributing control to the patient. This prevents them from becoming
dependent on therapy, since the interval between sessions is lengthened as the
patient improves. Milton Erickson was a pioneer in brief and tailored therapy
using hypnotic language for beneficial results, leading to a combination of
hypnosis with other areas of psychology which is called clinical hypnosis or
hypnotherapy (O’Hanlon & Martin, 1992; Téllez, 2007; Watkins & Watkins,
1997).

118 Rocha and Téllez
Hypnosis is widely considered to be a special state of consciousness,
produced by a state of highly focused attention (Téllez, 2007). Some studies
have demonstrated that hypnotherapy treatment is highly effective for the
patient who has experienced a traumatic event (Cardeña, Maldonado, Van der
Hart, & Spiegel, 2009). Hypnotherapy has effective techniques to eliminate
the after-effects of kidnapping and rape, providing a safe environment for the
treatment (Gil, 2007).
With this method it is possible to improve the quality of life for people who
have suffered rape and kidnapping. De Shazer (1995) stated that the change
is achieved most effectively and permanently when the therapist focuses on
changing the unconscious patterns of the patient, which often include their
values and frames of reference.
Another technique widely used for traumatic events is eye movement
desensitization and reprocessing (EMDR; Edmond, Rubin, & Wambach,
1999). It is one of the psychotherapeutic approaches that emphasizes the
importance of the brain’s intrinsic system of processing information which
activates symptoms considered a result of disturbing experiences (Solomon &
Shapiro, 2008; Wilson, Silver, Covi, & Foster, 1996).
Shapiro (1995) proposes that the clinician “use hypnosis or guided
imagery” to make the client feel more comfortable during the session of
EMDR. There are several studies on the combination of EMDR and clinical
hypnosis indicating that often the clinical effects of both are similar, besides
being beneficial in a short term (Beere, Simon, & Welch, 2001; Bjick, 2001).
Therefore it was decided to implement these techniques together in the
following case to enhance the effectiveness that either clinical hypnosis or
EMDR alone may provide.
METHOD
The patient, a 39-year-old married mother of two children aged 16 and 17,
with a certification as an executive assistant, reported frequent anxiety attacks
after the kidnapping and rape by a group of criminals two years before the
therapy. The patient met the DSM-5 diagnostic criteria of PTSD.
The therapeutic intervention was carried out across nine sessions, the first
eight were weekly with the final, ninth, session two weeks later. The therapist
who performed the intervention specializes in this approach.
The methodology unfolded across the sessions as follows (see Table 1).
In the first four sessions a modified version of eye movement desensitization
and reprocessing (EMDR) technique developed by Shapiro was applied:

Clinical Hypnosis and EMDR in Kidnapping and Rape 119
1. An oral narrative of the critical incident or traumatic event was obtained
along with the patient’s self-rating of emotional distress, which was scored
from 1 to 10, where 10 is the maximum intensity.
2. Subsequently, the patient was asked to write the narrative of the traumatic
event, which was again scored from 1 to 10 on an emotional distress scale.
3. The patient narrated or read the traumatic event while moving eyes back
and forth following an object which can be the therapist’s finger or while
being tapped on both sides of the head. This step was repeated several
times until the patient reported no distress related to the targeted memory.
4. The negative thoughts that the patient had while the traumatic event
occurred were identified and written down. These were then rated from
1 to 10 on an emotional distress scale.
5. The patient repeated or read their negative thoughts over and over again
while they continued recollecting the event and moved their eyes back
and forth following an object such as the therapist’s finger, or while being
tapped on both sides of the head.
6. The patient was asked to write a list of positive thoughts, which could
make the patient feel very calm and self-confident.
7. The patient repeated or read over and over again the positive thoughts
while recalling the event and while continuing to move their eyes rapidly
from side to side following an object such as the therapist’s finger or while
being tapped on both sides of her head.
Table 1: Techniques used in each session
Session Hypnosis techniques
1 EMDR —a
2 EMDR Ego-strengthening (Torem, 1990)
3 EMDR The prominent tree metaphor (Pelletier, 1979)
4 EMDR —
5 — Strengthening the Ego – Pekala (Pekala & Kumar, 1999).
6 — Silent abreaction (Watkins, 1980)
7 — “The empty chair technique” under hypnosis
8 — An abstract technique for ego-strengthening (Gorman,
1974)
9 — “The empty chair technique” under hypnosis
a Not applied

120 Rocha and Téllez
Before starting the first session the patient was asked to fill out the following
psychosocial scales:
The Duke-UNC-11 Functional Social Support Questionnaire (Broadhead,
Gehlbach, De Gruy, & Kaplan, 1988). The responses on this 11-item
questionnaire are chosen from a 5-point Likert scale where 1 represents “as
much as I would like” and 5 represents “much less than I would like.” The
higher the total score is, the higher the level of social support. In this case, we
used the Spanish version of Duke UNC-11; Cronbach’s alpha = 0.92 (Bellón,
Delgado, Luna, & Lardelli, 1996).
The Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). The
original version of the PSS is a 14-item scale that measures the degree to
which respondents appraise situations over the last month as stressful. We use
the Spanish version of the PSS by Remor and Carrobles (2001), which was
culturally adapted for Mexico by González and Landero (2007); Cronbach´s
alpha = 0.83.
The Rosenberg Self-Esteem Scale (Rosenberg, 1965). This scale contains 10 items
on self-respect and self-acceptance that are measured on a 4-point Likert scale,
where 1 represents “totally disagree” and 4 represents “totally agree”. We use
the valid RSES Spanish translation; Cronbach’s alpha = 0.85 (Martin-Albo,
Núñez, Navarro, & Grijalvo, 2007).
The Life Orientation Test – Revised version (LOT–R). This instrument is the
most frequently used measure of dispositional optimism (Scheier, Carver, &
Bridges, 1994). In this case report, we used the Spanish version of the LOT-R
(Otero, Luengo, Romero, Gómez, & Castro, 1988). The LOT-R consists of
10 items with a 5-point Likert scale; 6 of these items measure dispositional
optimism, and the other 4 are neutral. Cronbach’s Alpha = 0.79.
Wagnild and Young’s Resilience Scale (RS) measures the capacity to withstand life
stressors, and be able to thrive by taking meaning from challenges; it consists
of a 17-item “Personal Competence” subscale and an 8-item “Acceptance
of Self and Life” subscale. Cronbach’s alpha range from .72 – .94 (Abiola &
Udofia, 2011).
Session 1
When the session started an initial interview was conducted, from which the
following information was collected:
In August 2010 three gunmen with high-powered rifles tried to kidnap
her eldest son while he played street soccer with his friends. The boy ran

Clinical Hypnosis and EMDR in Kidnapping and Rape 121
when he heard several gun shots, managed not to get injured and went into a
neighbour’s house, climbed to the roof and ran across several houses. Then he
climbed down a tree and managed to escape. After that event the family moved
home and went to live with the patient’s mother in another town because they
suspected people wanted to kidnap the boy, because his father was at that time
a successful merchant.
She reported the event as follows: “I came back from shopping, headed
home with my children and went to the kitchen to cook dinner. Then I heard
somebody call out to my son to invite him to play soccer. A few minutes later,
I heard screeching tires and a scream from my son, ‘Dad! We just saw three
boys that look like gang members.’ But I didn’t see my son and I thought that
he must have run along with the other boys and hidden with the neighbours.
Next I saw the gang members get in the car and leave. A few minutes later my
son came and told me that they wanted him to get in the car. After that, we
packed some stuff and immediately went to my mom’s house. We didn’t return
to the house after that and I transferred him to another school.”
In February 2012 at 10 pm when parking on the street outside her sister’s
home, a man appeared and prompted her to open the door. He asked for
her purse and told her to move into the passenger seat. She responded by
telling him to take the car and the purse but to let her get out of the car,
but he refused. Another man climbed into the back seat, and she realized
that another car was following them. Then they put her in the back seat and
blindfolded her while the car was still moving. They stopped the car. One of
the criminals raped her and she was locked in the boot so the vehicle could
also be used to rob other people. This lasted eight hours, during which time
the patient thought they would kill her, and she thought of her children. The
car was stopped again. The criminals left, but not before telling her not to
say anything because they knew where she lived. When she could not hear
anything anymore, she kicked in the rear seat to be able to leave the vehicle
and took a taxi back home.
She said that after this she had no one to vent to. Eventually the abductors
were captured and she was present at a trial to identify one of the criminals,
who was a minor, but her husband could not accompany her. She was unable
to testify because she had her first anxiety attack. Following this, the patient
had frequent panic attacks, the intensity of one being so great she had to be
hospitalized. She took Tafil (alprazolam) to go to sleep because she was afraid
to sleep, fearing she might suffer a heart attack while sleeping. The patient

122 Rocha and Téllez
cried almost every day and rarely left home. Her goal was to “stop thinking
about all of that” and to “erase bad memories of her marriage.”
After describing the abduction the patient assessed her anxiety on a scale of
1 to 10, where 1 is the lowest and 10 the highest, placing it at 10. She was then
asked to write the story of what happened and read it out loud, after which
the intensity of her anxiety dropped to 6.
Session 2
Although the patient said she still felt as she had in the first session, she realized
that she had stopped crying and the feeling of losing her breath had been less
frequent.
She was asked to read what happened out loud, and after reading it reported
being at level 3 on the anxiety scale of 1 to 10.
The technique of EMDR was applied. We asked the patient to tell her
traumatic story while experiencing lateral and upward eye movements,
following the movement of a pen. After one trial the patient reported her
anxiety at level 1. Immediately afterwards we asked her to describe the
traumatic event again while we gave her alternating lateral taps in the temporal
region of the head. She reported an anxiety level of 1 and also mentioned that
the lump in her throat had disappeared. Finally, we wanted to strengthen the
therapeutic accomplishment and she described the traumatic event again as
she was given slaps on her thighs. She remained at level 1 on the scale of 1 to
10, and said she was feeling very calm.
Then we utilized a hypnotic technique for strengthening self-esteem
developed by Torem (1990), and she reported feeling very calm. Using ratings
of tranquillity on a 0 – 10 interval scale, with 0 representing “not at all
tranquil” and 10 representing “most tranquil,” she reported 5.
Session 3
The patient felt she had undergone a “mood improvement” as she previously
was always moody and would respond rudely to any requests from family
members. Her husband and children now felt they received a better response.
She says it was because previously she had a lot of anger inside. She said, “I
tried to endure it and I exploded, I don’t anymore.” The patient reported that
that she had not had panic attacks that week, only small anxiety attacks which
were present every day.

Clinical Hypnosis and EMDR in Kidnapping and Rape 123
EMDR phase two began. This involved asking the patient to remember the
negative thoughts that went through her mind during the different moments
of the traumatic event. The thoughts reported were:
“Where are they taking me?”
“Maybe the gun will go off.”
“They’re going to torture me.”
“They’re going to rape me.”
“They are going to transmit a disease to me.”
“I’m not going to see my kids again.”
“How am I going to die?”
“I felt panic whenever the car stopped.”
“If they ask for ransom and my husband cannot pay the full amount they will
kill me.”
The patient was asked to remember the traumatic event while repeating
aloud the negative statements described above without any intervention, and
the anxiety intensity went back to 5. When the therapist applied taps bilaterally
on the patient’s head during the entire story retelling and the repetition of
negative thoughts, the anxiety was maintained at level 5. The procedure was
repeated and the anxiety intensity went down to level 3. The same procedure
was repeated but with one more element added: The patient was asked to tap
her thighs with her hands alternately and her anxiety decreased to level 2. In
the fourth repeat it was held at level 2 and in the fifth it dropped to level 1.
After that we use the “prominent tree metaphor” hypnotic technique for
strengthening self-esteem (Pelletier, 1979) and the patient said that she had felt
sad because she had identified with the tree in the part that says: “See how tall
the trunk is with a few twists and turns, the scars and rough edges that are the
result of the tree’s struggle to survive against the wind, the hail, and the storms
of life. The struggle to survive made it stronger.” The patient reported a 7 on
a scale of 1 to 10 of tranquillity.
Session 4
The patient said, “I have not had panic attacks during the past week, only a
very small one. Emotionally I felt very happy; I do not feel so angry. Since
then, I don’t feel so pressured to do the house chores anymore. Also I sleep
much better and I do not take the sleeping pills. I previously thought that if I
fell asleep, my heart would stop. Before therapy I used to sleep for five hours,
now I sleep for eight.” The patient said that she had reached 60% of general

124 Rocha and Téllez
wellbeing. Her husband who attended the session said, “I see her as being very
different, very calm, and very quiet. I calculate an improvement of 50%.”
In this session we had the third and final phase of EMDR. We asked
the patient to make a list of thoughts that made her feel strong, confident,
optimistic, and invulnerable. The patient constructed the following phrases:
“God is with me all the time.”
“I’m going to see my children grow up.”
“My husband is by my side.”
“I’m going to see my children become professionals.”
“I have my brothers with me.”
“I have my parents.”
“I’m going to do the projects that I have planned.”
“I have good health.”
“I will travel with my children.”
“I will be happy with my family.”
Then we asked the patient to recall the traumatic event while repeating
aloud these positive and “empowering” sentences four times. The first trial was
with eye movement and on a scale of 1 to 10 where 10 was the maximum
level of tranquillity she reported 7.
During the second trial instead of eye movements we applied taps on the
temporal region on each side of the head. The patient again rated tranquillity
as 7. In the third trial the same procedure was repeated and she reported an 8
for tranquillity and on the fourth trial she reported a 10. Upon completion,
the patient said she felt she was fine. When she was asked how long she had
felt this way she said, “For the past several months I had a sense of a lack of
purpose and meaning in my life, but now I feel so good”.
Session 5
The patient reported that “This week I have not had any panic attacks, only
a negative thought [that she was going to get a heart attack]. That used to
happen every day and would not let me sleep, but I slept just fine this time.
In my daily life I am now more tolerant, I have not gone to the hospital for
anxiety attacks, and I do not take tranquilizers [Xanax] because I no longer
need them. What I cannot do yet is to watch the news on television because
of everything that is happening lately. I begin to imagine what the victim felt,
maybe it was not like that, but it’s how I imagine it. It frustrates me and makes
me feel bad.” The patient reported that the relationship with her children and

Clinical Hypnosis and EMDR in Kidnapping and Rape 125
husband was much better. She revealed that ten years ago her husband had an
affair and that their eldest son was aware of this. The affair lasted four years.
She accepted it meekly and never confronted her husband until she finally
asked him to leave the house. Her husband eventually ended that extramarital
relationship permanently.
In this session we applied Pekala and Kumar’s (1999) technique of hypnotic
ego-strengthening. Before we started she reported a 7 on a scale of tranquillity,
with 10 being the maximum. After the technique she scored a 10 and said, “I
felt completely happy. Yeah, I’ve visualized all the happy times doing what I
love, I see myself on the beach with my kids and my husband, and at home
with my family and my brothers. I am at peace, no insecurities, no fear, and
no terror. I feel calm with a tranquillity level of 10. With the first tree session
[hypnosis session] I felt sensitive. In the last session I felt good.” The patient
reported her level of general wellbeing as 75%.
After the session her eldest son, who initiated therapy in the aftermath of
the attempted kidnapping, was asked how he perceived his mother, he replied:
“My mom has changed and improved a lot. She’s not angry or explosive
anymore, now she smiles and is very happy.”
Session 6
The patient came to the meeting smiling and reported feeling more
encouraged and very happy. She reported sleeping without waking up during
the night. That week she had not a single panic attack. She said, “This week I
felt better and I laughed more. Before therapy nothing made me laugh.” The
patient reported a 90% level of wellbeing, commenting: “Maybe I will never
reach 100% and maybe there are things that I will never forget, but now I can
have a good quality of life.” On a scale of tranquillity from 1 to 10, where 10
is the maximum, she reported a 9.
In this session the silent abreaction technique (Watkins & Watkins, 1997)
was used. She was asked to imagine if all the negative emotions were
symbolized on a stone, what would that stone be like, and she said it would be
a stone of more than one metre, rough, and dark. At end the session she again
reported her relaxation level as 9. She had imagined that she broke the stone
in half and she felt good doing that. After splitting the stone, she went into a
waterfall of pure crystalline water and was cleansed inside and out. “The water
was very comforting; I felt the water washed everything away, it felt great.”

126 Rocha and Téllez
Session 7
The patient reported feeling very well, she felt a big change. She said that she
felt a 90% improvement. However, she reported that her husband had caused
her much psychological damage. She said that he puts his parents, his brothers,
and his side of the family before her and their children. “During most of my
pregnancy, he did not allow any housework breaks, the house had to be in
perfect order. Before coming home, he would go first to his parents’ house. He
also spoke to me so aggressively that I just remained quiet. In the past I often
asked him for forgiveness without knowing why, because I thought that if I
didn’t he would not speak to me or would leave me.”
At that moment she reported a level 8 on the emotional pain scale from 1 to
10, where 10 was the highest pain. After that we applied the “hypnotic empty
chair,” which consists of the empty chair technique of Gestalt theory followed
by a hypnotic induction. The hypnotic empty chair technique is a powerful
method for helping patients become more aware and to express thoughts and
feelings toward others which have been suppressed. In this technique we did
not suggest the patient “see” a particular person on the chair. Instead of this
we asked her unconscious mind to visualize a person to whom she needs to
tell something important.
T: Who’s sitting in the chair?
P: My husband, who seems angry.
T: Say hello. Tell him, “How are you?”
P: I cannot confront him.
T: You’re not going to confront him, just say hello.
P: “How are you? I want to tell you that you caused a lot of damage to me
and the boys. You would leave us alone for days. You didn’t know if we ate or
not. I had to go and sell used clothing to be able to feed the kids. We went
without breakfast, you didn’t know that. You spent your money on her, that’s
why the business you had went bankrupt. You had me working while I was
nine months pregnant with both children and then abandoned us. Before
coming to our house you had to go to your parents first and you arrived
late at night after I had worked all day. It hurt me to have to stop tending to
my children to tend to you. You know that my child is how he is because of
what he saw and the many things that you showed him, and he feels the same
way I feel. Much of what my child is affected by is because of everything he
witnessed. You placed your family first, then your brothers and then us. That’s
why my children will not approach your family and they don’t even go into
their houses. My children have the right to have two families, not just one.”

Clinical Hypnosis and EMDR in Kidnapping and Rape 127
Then we asked her to imagine that he left his body (the dissociation),
and during that moment she should imagine that she was her husband
(introjection). But when we encourage “the husband” to speak, he (she) said,
“I already told her what I had to say.”
Session 8
The patient stated that she felt perfectly well without any anxiety attacks.
During the week she went to a casino alone which was not the norm, as
she used to go with her sister. She reported a score of 95% on the subjective
wellbeing scale. Interviewed separately, her son reported that he perceived that
his mother had improved very much because she doesn’t get scared as she used
to. She used to take fright every time she saw a car with men inside, thinking
they were after her. Now she fears this to a lesser degree.
In this session we used the “magic carpet” technique, which suggests the
patient, during hypnosis, imagine a magic carpet that can fly. We asked the
patient to use the rug to take her up to the clouds and from the top she
saw herself as a child. She was asked to come down to greet and talk to that
girl; to strengthen the self-esteem of the girl by telling her how important
she is, how much she is loved, how much she is worth; to make the girl feel
protected and loved. After this she reported feeling very well and said she had
a childhood full of love, freedom and happiness. She associated those emotions
with the present, reporting feeling 10 on the tranquillity scale of 1 to 10. Later
we applied the abstract technique for ego-strengthening (Gorman, 1974), and
she reported feeling more relaxed, saying “I felt very calm, nothing crossed my
mind and I stopped listening to your voice. There was a period where there
was nothing. I am not sure what happened.” She again reported a tranquillity
level of 10 on a scale of 1 to 10.
Session 9
The patient reported that during the week she had two panic attacks which
she saw as a result of a serious problem with her husband, but she was still
sleeping well. She also reported that she was feeling a 4 on a scale of 1 to 10
of relaxation. The patient reported having a panic attack after going to the
casino and another at home doing household chores. She assumed that it all
began a week before when she was on vacation with her husband and kids. In
the evening she went with her husband to a dance club, but she started to feel
dizzy. So she went to the bathroom to vomit and after that her husband took
her to the hotel. He told her he would go back to look for the kids, but later

128 Rocha and Téllez
she found out that he had returned to the club and he was talking to other
women. That night she didn’t allow him to sleep with her. She supressed her
anger and was miserable the rest of the time. She said she felt a very intense
sensation of a lump in her throat; when asked how intense it was on a scale of
1 to 10, she responded 9.
We applied the hypnotic empty chair technique and she visualized her
husband and begun to express feelings of hostility and resentment toward him.
After that the lump in the throat sensation disappeared. She was subsequently
dissociated and we asked her to imagine herself being her husband, the
husband was an important introject in the emotional life of the patient
(Emerson, 2008). This helped her to express emotions and understand her
husband’s point of view. With this technique she felt that her husband felt
lonely because she usually did not accompany him to social events and when
she did she felt physically ill. She, acting as her “husband,” apologized for what
happened. At the end of the technique she reported a level 9 of tranquillity.
Later a hypnotic technique for strengthening self-esteem was used. This
involves a regression in age through various stages of her life until the time
of birth and then a return to the present through the same stages adding a
positive restructuring of each stage (Watkins & Watkins, 1997). The patient
reported feeling 10 on the relaxation scale and mentioned at first she had to go
through several negative moments of her life, but in the return to the present
most of it became positive.
EVALUATION OF THE EFFECTIVENESS OF TREATMENT
Throughout the treatment a series of changes were observed in the scales
shown in Table 2.
Table 2: Percentage of change Pre- Treatment to Post-Treatment
Measure
Pre-
treatment
score
Post-
treatment
score
Percentage
change
LOT-R. Dispositional Optimism Scale:
Life Orientation 28 38 25%
Resilience 104 154 33%
Functional Social Support Questionnaire.
Duke-UNC 36 44 18%
Perceived Stress Scale 37 28 -23%
Self-Esteem Scale 24 31 23%

Clinical Hypnosis and EMDR in Kidnapping and Rape 129
Finally the progress achieved in each session is shown, evaluating treatment
as represented by overall wellness (Figure 1).
Figure 1: Responses to the Question “Rate Your Overall Sense of Well-Being Using
0–100 Point Scales (0 = No sense of Well-Being and 100= Maximum of Wellbeing)”
The concept of wellbeing refers to optimal psychological functioning and
experience (Ryan & Deci, 2001).
Over the course of treatment her panic attacks disappeared. Besides being
able to sleep and rest without the need for medication, she stopped crying over
the traumatic event and was more loving and understanding with her children.
She also became more understanding with her husband. This was measured
each session through a series of self-report scales.
DISCUSSION AND CONCLUSION
Kidnapping and rape are amongst the most common crimes in Mexico
(INEGI, 2015) and they can lead to PTSD that can have long-term negative
health and social consequences for survivors if they do not receive appropriate
psychological treatment. Therefore it is necessary to continue developing
therapeutic strategies that can be useful to treat this anxiety disorder. This
case study shows that the combined use of EMDR with clinical hypnosis
was an effective strategy to reduce the symptoms of post-traumatic stress
resulting from kidnapping and rape. EMDR was used in the first four sessions
to reduce and eliminate the painful emotions of recalling the traumatic event

130 Rocha and Téllez
and facilitate cognitive restructuring. Clinical hypnosis was used to implement
suggestions for strengthening self-esteem, optimism, and resilience to reduce
perceived stress.
The combined use of clinical hypnosis and EMDR can be useful as a
relatively fast and effective strategy to reduce the suffering of PTSD victims
and help them reintegrate into a socially and economically productive life.
The most important advantages of the combined use of these two
techniques is that in EMDR one formulates a target from an explicit memory
in order to activate neural systems and the brain’s innate capacity for healing
to perform a restructuring of traumatic explicit memories at a conscious level,
while hypnosis can work with implicit memory and catalyse the unconscious
resources of the patient (Shapiro, 2001).
An important limitation of this case report was the lack of follow-up
to determine the long-term effects of this therapeutic strategy. Although
the clinical case report has a longstanding tradition in psychotherapy, some
researchers have pointed out the lack of ability to generalize and difficulties
to establish cause–effect relationship amongst its major limitations (Nissen
& Wynn, 2014). Therefore we are planning to carry out in the future
a randomized clinical trial to determine with greater certainty the real
therapeutic power of the combination of these two techniques.
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