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The International Society for the Study of Dissociation, ISSD News
Volume 13, Number 6, December 1995
Pages 1 and 6


Hypnotic Abreactions in the Recovery of Traumatic Memories

John G. Watkins, Ph.D.

An article in the then-ISSMP&D News (Chu, 1992) presented three interesting commentaries regarding abreactions under amytal or hypnosis. The clinicians cited in the article (Hornstein, Putnam, and Ganaway) are very experienced practitioners and I agree with much of what they said, but I found a very important factor to be missing, namely, the self or personhood of the therapist, which determines success or failure in the conduct of abreactions.

The papers cited in the article by Chu stressed the hazards in premature recovery of traumatic memories, with the possibility that weak-egoed patients could not take the disclosure or could be "overwhelmed" and "suffer from frequent uncontrollable flashbacks." I agree with this possibility but believe that a great deal of the danger is not in the abreactive method per se but rather in the specific views, attitudes, and tactical approach of the therapist.

I have used abreactions (a type of "psychological surgery") for more than 45 years in my work with patients with dissociative and other disorders. My wife and colleague, Helen H. Watkins, has used them frequently during the last two decades in 10- to 12-hour weekend marathons with patients in hypnoanalytic ego-state therapy. We have yet to see a case in which the patient was overwhelmed and suffered a setback. Our experiences may be the result of how we perceive and use the technique.

Many clinicians view abreaction as a procedure that the therapist performs with a hypnotized patient, in which bound-up affect and traumatic memories are released. These clinicians also usually think of hypnosis as an altered state of consciousness in the patient that results from therapist-induced techniques. This stance of the objective clinician listening to the patient also is characteristic of classical psychoanalysis. Such insistence on objectivity (to avoid countertransference) may be one of the reasons why traditional analysis is inefficient as a therapy and why it takes months and years to do what hypnoanalysis can accomplish in a shorter time.

Emotions in the therapist are considered nonproductive and even harmful. But not all emotions are countertransference. Helen and I think of hypnosis as being an interpersonal relationship between therapist and patient in which "how we are with the patient" is more important than "what we do to the patient." This involves "resonance," in which one experiences, suffers, and celebrates with the patient. Resonance is a temporary identification (e.g., when we watch a movie, we resonate with the hero or heroine, experiencing emotions similar to theirs and visualizing ourselves in similar situations), an emotional "withness" rather than a countertransference, which is an "againstness," in which clinician and patient are "objects" to each another. It involves much more than merely inducing a trance in a patient and then probing for traumatic memories and dissociated pain. The therapeutic self of the clinician must be willing to endure the horror and pain of the traumatic memories, although at a lesser intensity. The situation then is so structured that if the quantity of trauma and pain being released is "overwhelming," the therapist could not endure it either, and the experience would be shut down or mitigated automatically within the close, interpersonal communication. This control is not a logical or cognitive decision by the therapist, but an affective one, and is accomplished almost unconsciously. Within such a therapeutic relationship, however, the patient is permitted to work at the maximum intensity that he or she and the therapist can together tolerate, thus potentially shortening the treatment.

Of course, the therapist's intense involvement in an emotional experience with a patient is temporary and is balanced by sufficient objectivity to prevent a folie à deux and to move the treatment toward realistic goals. This resonant "coexperience" of therapist and patient has been discussed in greater detail elsewhere (Watkins, 1978).

There is still another factor in such a therapeutic relationship that operates to permit the recovered traumas and painful affects so released to be processed and integrated rather than to overwhelm the patient. When the patient works with an therapist who is objective but not resonant, the patient works alone. The patient whose defenses have been reduced by the hypnotic induction is questioned or instructed by the therapist to go into "the darkened closet" of past memories and retrieve them alone. If the patient's

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ego is not strong enough to confront the task, then he or she indeed will be overwhelmed and perhaps relapse into a severe setback, sometimes even a psychotic reaction. But in an intense, highly resonant relationship in which the therapist is willing to coexperience the pain and horrors with the patient, the ego strength that is available to meet this challenge is not that of the patient alone but is rather the total of what they both possess.

As the therapist resonates with the patient's pain, the patient resonates with the therapist's ego strength; together, they can accomplish what the patient alone might not. For example, little Johnny can be induced to explore the dark closet for "monsters" if mother or father takes him by the hand and they enter together. When handled in this way, our experience has been that traumatic material can be processed and integrated in a much shorter time in patients with dissociative and other disorders.

In another work (Watkins, 1992), I detailed steps for a successful abreaction. These steps are outlined as follows:

1. Determine whether a specific experience or trauma is involved.

2. Determine whether the patient has sufficient ego strength to endure its release.

3. Decide whether the therapist can tolerate it.

4. Locate the time and place of the significant event by questioning or by use of an "affect" or "somatic" bridge (Watkins, 1971, 1992).

5. Induce a hypnotic state and help the patient regress to that point.

6. Revivify the event in all spheres: perceptually, cognitively, affectively, and behaviorally.

7. Experience the situation with the patient.

8. Follow up with interpretation and reintegration, in order to undo past destructive learning.

9. Have the patient, in cases of suspected abuse, "confront" the abuser -- not in actuality, but internally so as to help lessen the pain; the patient needs to get back his or her power.

10. Repeat the abreactive experience until the painful affect has been released and subsides.

11. Provide the patient with a large amount of support and positive reinforcement.

12. Keep in close contact with the patient in the postabreactive period.

It is our contention that, when a patient is overwhelmed by the material released, there often is inadequate attention to points 2, 3, 7, 8, 9, 11, and 12, because the therapist attempted only to initiate the experience rather than actually to share it with the patient. (By "coexperience" or "resonance" we mean that the therapist does not merely observe the patient's obvious pain but rather that the therapist truly experiences the pain, fear, or horror alongside the patient, albeit at a lesser level. When that "coexperience" is the essence of the abreactive experience, the patient does not feel alone and can generally handle a far greater load of confrontation.)

There will be times, however, when it may be advisable to attenuate and mitigate the abreaction. These are situations in which the clinician should employ the slow release (or "slow burn") approach described by Kluft (1988) or a "silent abreaction" (Watkins, 1980). These will occur when the therapeutic self of the clinician does not feel that "we" (the patient and therapist together) can tolerate the raw affect that is expected to be released.

The research studies on memory under hypnosis are controversial. In the laboratory, hypnosis does not seem to be very effective in recovering memories. However, hypnosis in the laboratory is very different from hypnosis in an actual treatment situation. In the laboratory, researchers make every effort to remain objective and to eliminate or minimize relationship effects. In therapy, clinicians make every effort to maximize the relationship, and the hypnotic relationship may be the really significant factor. Moreover, many of the laboratory studies have had defective design in control and population; these have been described elsewhere (Watkins, 1989,1993). The question of hypnotic hypermnesia in therapy is still open.

Research that attempts to test the efficacy of therapeutic techniques by themselves (without considering the therapist) have not been of much help. It is like trying to evaluate the quality of music played on a violin without considering who is playing it. One can read about abreactive techniques, just as one can read about how to hold a violin and bow and how to draw the bow across the strings. But there may be tremendous variability in the result, depending upon the skill of the violinist or therapist. We may study psychotherapy as a science, but we practice it as an art.

The case with amytal interviews is somewhat different. During World War II, I participated in amytal and pentothal interviews like those described by Grinker and Spiegel (1945). In my opinion, they constitute an aggressive invasion of the patient's defenses, which cannot be ameliorated or controlled by the relationship situation. Moreover, I found them often to be ineffective, or much less effective than hypnosis (Watkins, 1949).

Accordingly, I agree with the commentators cited in Chu (1992) that the use of amytal to induce abreaction is more likely contraindicative, especially in treating dissociative disorders.

References

Chu, J. A. (1992). The critical issues task force report: The role of hypnosis and amytal interviews in the recovery of traumatic memories. ISSMP&D News, 10, 6-9.

Grinker, R. R., & Spiegel, J. P. (1945). War neuroses. Philadelphia: Blakiston.

Kluft, R. P. (1988). On treating the older patient with multiple personality disorder: "Race against time" or "Make haste slowly." American Journal of Clinical Hypnosis, 30, 257-266.

Watkins, H. (1980). The silent abreaction. International Journal of Clinical & Experimental Hypnosis, 19, 101-112.

Watkins, J. G. (1949). Hypnotherapy of war neuroses. New York: Ronald Press.

Watkins, J. G.(1971). The affect bridge: A hypnoanalytic technique. International Journal of Clinical & Experimental Hypnosis, 19, 21-27.

Watkins, J. G. (1978). The therapeutic self. New York: Human Sciences Press.

Watkins, J. G. (1989). Hypnotic hypermnesia and forensic hypnosis: A cross-examination. American Journal of Clinical Hypnosis, 32, 71-81.

Watkins, J. G. (1992). Hypnoanalytic techniques: The practice of clinical hypnosis (Vol. 2). New York: Irvington.

Watkins, J. G. (1993, Fall). Dealing with the problem of "false memory" in clinic and court. Journal of Psychiatry and Law, 297-317.

Pat's note: hypermnesia - unusual ability to remember under hypnotic states or during free association.

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