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American Journal of Clinical Hypnosis
Volume 35, Number 4, April 1993
Pages 277 - 284


Accessing the Relevant Areas of Maladaptive Personality Functioning

John G. Watkins and Helen H. Watkins

University of Montana

Personality functions in different dimensions: perceptual, cognitive, and affective (emotional). It can be manifested in different areas -- overt (conscious), covert (unconscious), or in some relative degree of each. Personality segments can operate independently of one another, as in multiple personalities or with varying degrees of mutual dependence and intercommunication, as in normal "ego states." Therapeutic interventions will be more efficient if focused within the problem dimension, area, or segment. The essence of Alexander and French's "corrective emotional experience" was a restructuring of the patient through release and interpretation within the "emotional" sphere. When their concept is extended to other dimensions of personality functions, such as behavioral, perceptual, and cognitive, it allows interventions to be more specifically focused in the regions that are most relevant. In this paper we present specific techniques using this extended concept. Rapid and significant change followed in the patient so treated.

This paper represents no momentous breakthrough in psychotherapy, brilliant innovative techniques, or revolutionary new theory. It does attempt to match treatment procedures with different aspects of personality functioning to improve the efficiency of therapy, hypnotic and other.

Personality functions in different dimensions: behavioral, perceptual, cognitive, and affective. It may be manifested in different areas -- for example, overt (conscious), covert (unconscious), or some relative degree of each. Also, personality segments can operate independently of one another, as in multiple personality alters, or with varying degrees of mutual dependence and intercommunication, as in "normal" ego states (see Chap. 9 in Watkins, 1992).

While recognizing that most problems are multifactorial, therapy can be more efficiently accomplished if the clinician first determines in which dimensions, areas, or personality segments the maladaptiveness appears to be centered and just where within these lies the greatest promise of therapeutic intervention.

The search for less time-consuming techniques of therapy through focusing on specific aspects of a problem has engaged

p. 277

p. 278

the attention of many different contributors, which includes Alexander and French (1946), Beahrs (1986), Bellak and Small (1965), Erickson (see Zeig, 1982), and Strupp, (1984). No attempt will be made to review their different strategies, but we will describe here an approach that we have found of value.

There are many procedures that help patients if applied in a general way regardless of one's theoretical orientation -- such as positive reinforcement, ventilation, desensitization, ego strengthening, and committed relationship. Patients often get well through these alone. A well-focused intervention may accomplish more change in a given period of time than a shotgun approach, however well intentioned; even as a specific antibiotic in a well-diagnosed physical disease is usually preferred medically to a broad-spectrum prescription.

Therapeutic progress does not generally advance at a steady rate but rather with periods of little change interspersed by sudden spurts -- especially when the right buttons are pushed. It is our impression that much time in therapy is spent groping for the right buttons to push, and that genuine change, although requiring time, occurs during intensive periods of "experiential" time rather than the extended inactivities of chronological time that therapist and patient often spend together. This is our criticism of classical psychoanalysis. It may be effective, but it is inefficient.

The approach suggested here does not eliminate the therapist's intuition in seeking for "right buttons," but it delimits the personality area so that the search has greater possibility of success. Hypnosis is a flexible modality in which suggestive and other direct interventions can be potentiated, time lines crossed, transferences more quickly mobilized, therapist-patient relationship intensified, experiential time increased, and treatment procedures more specifically focused.

Alexander and French (1946) described a psychoanalytic approach involving the emotional release and affective restructuring of a patient. They termed this approach an "emotional corrective experience," a therapeutic tactic that they found very powerful. This concept should be expanded to delineate corrective restructuring likewise in the behavioral, perceptual, and cognitive dimensions of personality functioning. Let us consider some examples where the procedures and points of application were each primarily in one of these four personality dimensions: behavioral, perceptual, cognitive, or affective.


Corrective Behavioral Experience
(JGW)

When I first counseled as a young psychologist, I would initially remark to my client, "You have feelings of inferiority, don't you?" With considerable surprise each would respond, "How did you know?" Of course, one is almost never wrong. College students frequently complain of such feelings. They report anxiety when attempting to reach out to others because of a fear of rejection. Because they expected rejection, they behaved as if rejected. Consequently they were rejected. A cycle of maladaptive behavior was established and reinforced.

I found a simple suggestive, behavioral approach often effective. Under hypnosis the student was given the following suggestion: "When you walk across the campus, I want you to look at everybody who approaches you directly in the eye, smile, and say, 'Hi.' " The suggestion was instilled with firmness and reinforced through repetition if needed in subsequent sessions.

p. 279

The efficacy of this simple procedure lies in the fact that almost everybody so contacted responds likewise, hence, with a smile and "hi" back, and each time, the self-image of the client is reinforced. People now pay attention to this person, and because they smile, the individual thinks they must like him/her. If we consider the effect of this simple maneuver several times a day, 5 days a week for an entire school year, it is not surprising to find the student's feelings of inferiority significantly diminishing. Of course, not all such feelings respond to a simple behavioral device, and in some clients much longer and deeper therapy is required. But I was surprised how often this technique succeeded.

Several years ago I (JGW) taught a summer session at UCLA. During the 6-week period, I stayed in a nearby apartment complex where the residents would congregate around the pool in the late afternoons. In one such group we each happened to mention our occupation, when a young woman approached me with the usual, "What would you think of a person who ___ ?" Many of you have been so approached when you were identified as a psychologist or psychiatrist. 1

1 I once wrote an article on this point: Watkins, J. G. (1965). What would you think of a guy who ___? The Rocky Mountain Psychologist. 2, 3031; 35.

In a short time this woman informed me that she had been a medical technician at the UCLA Medical School, but she had resigned her job and had been out of work for almost 2 years. Something prevented her from returning. She had no complaint toward the job, her boss, or her associates. There was no traumatic experience, but 2 years ago she had developed a cold and had stayed home for over a week. When it was time to go back to work, she decided to rest up for one more day. The next day she awakened tired and decided to wait still another day. The third day she decided to go in the afternoon, but as she approached the campus her anxiety mounted, and she returned home without entering the Medical School building. She was afraid to try to explain to her superior why she had stayed out so long. Gradually a full-blown phobia developed. Now she was an occupational invalid, existing only on welfare, plus some savings. Because she was afraid to go to the campus she could not go to work, and because she was afraid to go to work she could not go on the campus.

She had no money for therapy. I was leaving in 2 weeks. I had no treatment office and had not considered taking patients. Moreover, the office granted to me by the University was a temporarily vacant one on the campus (to which she could not go). I had no intention of assuming a therapeutic responsibility under the circumstances but was intrigued by her dilemma.

I mentioned that the next day after my morning classes I had an errand to do (returning some papers), but that if she wished to accompany me, we could talk more about her problem while I was driving. I did not tell her that the "errand" was to take the papers back to my campus office. We drove to the office. While I went into the Psychology Building she waited patiently in the car, and when I came out she showed no apparent anxiety. I drove back through the campus, purposely passing the Medical Building and stopping at a nearby parking space. I then suggested that because I had never been in the building, I would like to see it.

When we were inside, I asked her on which floor she used to work. We took the elevator and proceeded there. She seemed

p. 280

to be pleasantly surprised that the receptionist recognized her and welcomed her heartily. I asked who her boss was. She named him and mentioned that his office was at the end of the hall. I suggested she might just want to say "hello" to him and that I would read some magazines in the waiting room. To my surprise she was gone for a half hour, and on her return she was wreathed in smiles. "You won't believe it. He was very glad to see me. He offered me my job back, and I am going to work in the morning."

She went to work the next day and the next. Two weeks later I saw her again in the lobby of the apartment building as I was leaving to return home. She approached me and said, "Thanks so much for taking me back to the University. I'm enjoying my job, and all the old fears are gone."

What has happened here? I don't know, except that the right button seems to have been pushed at the right time. Maybe she only needed a supporting figure and a behavioral intervention to tip the balance back between her desire to return to work and her fears.


Corrective Perceptual Experience

Correcting perception is the heart of the psychoanalytic technique called "analyzing the transference." The patient behaves as if the analyst were his father, mother, or some earlier significant person. The interpretation of this misperception is considered by psychoanalysts as their most powerful technique. The distorted perception is usually unconscious until pointed out by the analyst's interpretation, and then it is understood, if not actually perceived consciously.

One of the most demonstrable phenomena of hypnosis is its ability to alter perception and even create hallucinations. Subjects can be induced to sniff ammonia and report smelling a beautiful perfume, fail to perceive an individual who has been hypnotically rendered invisible, or claim to see a nonexistent person. In highly hypnotizable subjects, the distorted perception is reported as very real.

This ability of hypnosis to alter perception can be constructively used in therapy. Through hypnotic suggestion we can change a perception of the world from a hostile one to an accepting and friendly one, thus resulting in a patient's more cooperative behavior with associates.

A young embittered veteran who had become a paraplegic following a dive into shallow water was told repeatedly under hypnosis: "Bill, all the nurses and the doctors are amazed at your courage. They highly respect you, and, in fact, you are their favorite patient on the ward. Everybody is pulling for you." A smile began to grow on his face. He brightened, signed up for a college course, which he completed, writing with a pencil between his teeth, and at last contact was well on his way to a college degree. Simple? Yes, but the right button was apparently pushed at the right place in his perceptual world. Another patient treated similarly recovered from porphyria (a condition considered untreatable at that time).

Interpretations of transference become more powerful when words are accompanied by hypnotically suggested images. Instead of saying, "You are perceiving your wife as if she were your mother and acting toward her accordingly," the hypnotized patient is told: "Bring up a clear picture of your wife. Can you see her face distinctly? Yes? Now notice that the features blur and become fuzzy. Signal me with your index finger when that happens. I won't say anything for a while, but you

p. 281

will notice the blurring beginning to clear. See if another face fuses with that of your wife's and takes her place."

In astonishment the patient shouts, "It's my mother's." He is now asked to move the faces back from one to the other and shown how unconsciously he has been doing this often in his behavior toward his wife. The transference, that is, the perceptual distortion, can also be made clear to the patient in traditional psychoanalysis but usually only after the lapse of a much longer period of treatment than required by this "fuzzy-faces" hypnotic technique. Notice that the therapist did not suggest whose face would appear, only that a different one might. The "fuzzy-faces" technique may not work if the patient is not yet ready to confront his mother transference.


Corrective Cognitive Experience

Reasoning and persuasion have been used from time immemorial to alter an individual's understanding; Dubois (1909), Levine (1942), and many practitioners, Thorne (1950), plus present-day "cognitive" therapists, such as Ellis (1971), Beck (1976/1974), Mahoney (1977), and Meichenbaum (1977), have employed similar techniques to help patients understand their illness in new ways and thus bring more constructive motivations to bear.

Unfortunately, reasoning and persuasion often have little effect on inner convictions of which the patient is not aware. You cannot dispatch (or change) an enemy in its absence. Hypnosis permits us to use these cognitive procedures at deeper levels of personality functioning. We can "teach" under trance, that is, explain in hypnosis psychodynamic processes that are impairing a patient's functioning. It is also possible to direct the reasoning to a single, hypnotically activated ego state.

In a recent case (HHW) the dissociated patient, bordering on true multiple personality, needed badly to abreact and release a great quantity of stored-up rage. However, she had so completely dissociated all feeling because of fear that at the slightest signs of affect she would slash herself and become actively suicidal. The therapist's problem: how to induce feeling and secure an emotional release without creating a danger of suicide. A strategy aimed primarily at the release of emotion could well precipitate this very hazard.

Under hypnosis an underlying state, "The Protector," emerged claiming, "If she is permitted to have feelings it will destroy her. So my job is to shut off all emotion. " My (HHW) customary approach in such cases is to recognize "The Protector's" survival needs, to credit it for them, and to induce it to try another way of "protecting," failed at first.

I suggested to the patient that an automatic device was needed to withdraw anger slowly. The patient, an artist, was asked to draw something that might break this impasse. She brought in a diagram of a fuse box with wires leading from inner emotions to outer expressions, explaining that if there could be an automatic device like this in place, then feelings that she could not handle would never be permitted to become overwhelming. In case of overload the circuit breaker would shut the process down. However, it was obvious that the "device" would not work unless "The Protector" would agree to give it a chance.

"The Protector" was hypnotically activated and proved to be most resistant to anything that would release emotion. I spent much time in persuasive diplomacy, reasoning with it and inducing it to accept the initial release of small bits of feeling by

p. 282

pointing out that the "fuse box" was prepared at all times to shut the operation down if the amount of affect being submitted for experiencing became too great. It reluctantly agreed to give it a try, and the necessary release of bound anger could then begin.

Here we see the essential tactic as cognitive restructuring, but not aimed at the entire individual or the primary personality. Rather, it was specifically focused on the point of resistance, "The Protector" ego state. It had to be convinced to cooperate, because it had the power to sabotage the entire therapeutic maneuver. No amount of argument or persuasion would have been successful if it had been directed toward the whole person or any of the other ego states. The affective release required a prior cognitive restructuring for this one of the patient's personality segments. Treatment progressed only after "The Protector" had experienced a "corrective cognitive experience," which was accomplished under hypnosis.


Corrective Emotional Experience

In hypnoanalysis the well-conducted abreaction involving revivification, release of affect, interpretation, and often repetition, constitutes the prototype for resolving emotional blockage. Numerous writings regarding this technique are available (Comstock, 1986; Freud & Breuer, 1953; Kluft, 1988; Nichols & Zax, 1977; Spiegel, 1981; H. Watkins, 1980; J. Watkins, 1949, 1992; J. & H. Watkins, 1978) and will not be further described here. However, one case illustrating the directing of this emotional restructuring as focused on a single personality segment in a special way would be appropriate.

Rhonda was a friendly, cooperative, executive state in a true multiple personality plagued by an angry, vindictive alter, called "Mary" (Watkins & Johnson, 1982). Attempts to initiate abreactions in Rhonda, even under hypnosis, were not effective, because Rhonda was not the repository of this rage. Abreactions focused on Mary did evince expressions of anger, but these did not result in significant permanent improvement until a specific modification was put into place.

We reasoned as follows: The dissociation had been caused by harsh treatment from the outer world in the form of child abuse, thus generating anger, which could not be expressed. The rage was then repressed and dissociated into the Mary alter. Accordingly, the treatment must reverse that process. This meant that the anger must be transferred by Mary back into Rhonda, who must then accept it and release it into the outer world.

Two key tactics would be required. First, we must secure Mary's willingness to transfer it back to Rhonda. Her agreement might be very difficult to secure, because Mary perceived this anger as her "life blood." She felt that without it she might die. As Mary put it: "Rhonda, I've got to hurt you. That's the way I live. If I didn't hurt you, shoot you, or cut you up, then I wouldn't exist." Because Mary was originally created to store the hate when Rhonda was a child, this statement had much validity. Accordingly, Mary was very resistant at first. Finally she agreed to cooperate after it was suggested to her that: "Why should you have to suffer from all this hate garbage? Rhonda sloughed it off on you, and it is time now that she takes responsibility for it."

The second and accompanying tactic was that we must induce Rhonda to accept back the fury, which as a child she could not tolerate and from which she relieved herself by dissociating it into "Mary."

p. 283

With much resistance she, too, agreed.

Under hypnosis Mary released into Rhonda increasing quantities of anger through a series of abreactions that were then screamed out to the external world by Rhonda, with much relief. On completion of these, Mary continued to exist but was no longer angry. She ceased to emerge spontaneously as an overt alter and became a benevolent, covert ego state, protective of Rhonda while insisting to her that, "From now on you have to accept responsibility for your own anger, because I won't take it any more." The essence of therapeutic integration in dealing with multiples was approached, that is, the assumption of responsibility for all feelings and memories by the primary state, in this case, Rhonda. The abreactive procedure did not show much permanent success until we focused it specifically on the acceptance by each state to undertake a specific task: Mary to release the rage, Rhonda to accept it back, and then through catharsis release it outward.

Emotional release through abreactions is a valuable therapeutic procedure, as is a constructively altered cognitive understanding, the correction of a false perception, and the hypnotically suggested emplacement of more adaptive behaviors. However, we will be more successful if, through careful evaluation of the relevant personality dimensions, we focus specifically at the proper place or process within the personality rather than at the patient in general. Perhaps then we may push more therapeutic "buttons" in a shorter period of time.

References

Alexander, F. & French, T. M. (1946). Psychoanalytic therapy. New York: Ronald Press.

Beahrs. J. (1986). Limits in psychiatry: Role of uncertainty in mental health. New York: Brunner/Mazel.

Beck, A. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

Bellak, L. & Small, L. (1965). Emergency psychotherapy and brief psychotherapy. New York: Grune & Stratton.

Comstock, C. (1986). The therapeutic utilization of abreactive experiences in the treatment of multiple personality disorder. Presented at the 3rd International Conference on Multiple Personalities and Dissociative States, Chicago, IL.

Dubois, P. (1909). The psychic treatment of nervous disorders. New York: Funk and Wagnals.

Ellis, A. (1971). Growth through reason. Palo Alto, CA: Wilshire Books.

Freud S. & Breuer J. (1953). Studies on hysteria. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud. (Vol. 12). London: Hogarth Press. (Original work published in 1825)

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.

Levine, M. (1942). Psychotherapy in medical practice. New York: Macmillan.

Mahoney, M. J. (1977). Personal science: A cognitive learning therapy. In A. Ellis & R. Grieger (Eds.). Handbook of rational emotive therapy. New York: Springer.

Meichenbaum, D. (1977). Cognitive behavior modification: An integrative approach. New York: Plenum.

Nichols, M. P. & Zax M. (1977). Catharsis in psychotherapy. New York: Gardner Press.

Spiegel, D. (1981). Vietnam grief work using hypnosis. American Journal of Clinical Hypnosis, 14, 33-40.

Strupp, H. (1984). Psychotherapy in a new key: A guide to dynamic psychotherapy, New York: Basic Books.

Thorne, F. C. (1950). Principles of personality counseling. Brandon, VT: Journal of Clinical Psychology.

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Watkins, H. H. (1980). The silent abreaction. International Journal of Clinical and Experimental Hypnosis. 28, 101-113.

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

Watkins, J. G. (1992). Hypnoanalytic techniques: Clinical hypnosis (Vol. 2). New York: Irvington Publishers.

Watkins, J. G. & Johnson, R. J. (1982). We, the divided self. NY: Irvington Publishers.

Watkins, J. G. & Watkins, H. H. (1978). Abreactive technique. (audio tape). New York: Psychotherapy Tape Library.

Zeig, J. (Ed.) (1982). Ericksonian approaches to hypnosis and psychotherapy. New York: Brunner/Mazel.

John G. Watkins, Ph.D., and Helen H. Watkins, M.A., 413 Evans Street, Missoula, MT 59801.
Received March 4, 1990; revised December 4, 1992; accepted for publication January 12, 1993.

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