Advanced Hypnotherapy: Hypnodynamic Techniques (Book Review)

Author:  Watkins, John and Barabasz, Arreed
Publisher:  Routledge
Reviewed By:  Anthony F. Tasso, PhD, Fall 2008, XXVIII, No. 4, pp. 52-55

Hypnosis and psychoanalysis are inextricably linked. Freud’s early contact with Charcot and Bernheim proved highly influential. While Freud acknowledged the curative properties of hypnotic techniques, he also believed that if hypnosis remained a part of his newly created theory and practice, psychoanalysis would forever labor in the shadow of hypnosis. Eventually Freud jettisoned hypnosis as a technique, noting that he wished to keep the ‘pure gold” of analysis unsullied by the “copper of suggestion.” Freud extracted hypnosis from psychoanalytic technique not because it he thought it was ineffective, but because he worried that its use clouded the distinction between spontaneous patient associations (i.e., free association) and patient utterances influenced by the therapist. Even though Freud explicitly forbade the use of hypnosis in psychoanalysis, he never pronounced it anathema. He remained curious about it for his entire life, puzzling over it in his writings. Some of Freud’s more ardent followers, however, shunned hypnosis, refusing to speak its name lest they be branded unorthodox. Thankfully, the hypnosis-psychoanalysis relationship was strained, but not severed.

Advanced Hypnotherapy: Hypnodynamic Techniques (Routledge) demonstrates the continuing strength of the relationship between hypnosis and psychoanalysis. The successful follow-up and extension to their earlier Hypnotherapeutic techniques (Barabasz & Watkins, 2005), Advanced Hypnotherapy is authored by two prominent clinical researchers, John Watkins and Arreed Barabasz. Dr. Watkins is professor emeritus at the University of Montana and is past president of the Society for Psychological Hypnosis, Division 30 (Hypnosis) of the APA, the Society for Clinical and Experiment Hypnosis, and the American Board of Psychological Hypnosis. In this book, John Watkins reflects often on his illustrious career, which spans more than sixty years. His work consists of direct practice (much of which consisted of working with military veterans), clinical training, and experimental and clinical research. Much of his therapeutic techniques and case examples in this book reflect his life-long collaboration with his wife, the late Dr. Helen Watkins. He is among our most senior, seasoned clinicians and eminent scholars. He can rightly claim credit as the man who taught Erika Fromm about hypnosis.

Dr. Arreed Barabasz is a professor and director of the Hypnosis Laboratory at Washington State University. He is past president of the Society of Psychological Hypnosis, Society for Clinical and Experimental Hypnosis, and Division 30 of APA. He is the current editor of the International Journal of Clinical and Experimental Hypnosis. In this book, Dr. Barabasz incorporates experiences from his research, training, and practice. Of particular significance is his integration of the neuroscientific literature, much of which stems from his own extensive programmatic research. Like Watkins, much of Barabasz’s body of scientific work done in collaboration with his wife, Dr. Marianne Barabasz.

Advanced Hypnotherapy consists of twelve well-organized chapters. The Introduction highlights contemporary psychoanalytic thinking. Specifically, the authors explain how, unlike boilerplate manualized intervention techniques, classical and contemporary psychodynamic approaches adhere to the individualized assessment and treatment method. The authors emphasize how psychoanalytic treatment perspectives that use hypnosis are able to comprehensively access the subjective world of their patients. In other words, Watkins and Barabasz underscore how hypnodynamic/ hypnoanalytic treatments enable a psychologist to treat people, not merely their symptoms.

The first few chapters provide an overview of hypnoanalytic themes and how hypnosis is aligned with the goals of psychoanalytic treatment. Chapter 1, “Introduction to Hypnoanalytic Techniques,” demonstrates the mutually enhancing relationship between psychoanalysis and hypnosis, and how hypnotic procedures fit within a psychodynamic framework. Chapter 2, “Hypnoanalytic Insight Therapy,” begins with an explanation of one of the cornerstones of psychoanalytic treatment: that lasting change comes from emotional, rather than intellectual, insight. The ability of hypnoanalytic treatments to go beyond the superficial in a time-limited fashion is discussed and demonstrated with numerous case examples. Watkins and Barabasz provide cogent details on the numerous ways in which hypnosis facilitates lasting insight and changes, and argue how it does so without the need of more traditional multiple sessions each week and the many years typical of psychoanalysis proper. Chapter 2 also discusses the phenomenological process of hypnosis and its relation to treatment outcome. There are great individual differences in the extent to which people experience the hypnotic process. This process, called hypnotic depth or trance depth, lies on a continuum with individual differences ranging from light depth (i.e., total alertness), intermediate depth (i.e., a deeply relaxed state), to a deeply regressed trance depth. Although the extent to which one experiences hypnosis varies from individual to individual, such individual differences are rather stable. The authors report on how theory and research suggest that traditional psychoanalytic techniques such as free association, dream interpretation, and analysis of transference are effectively conducted in the hypnotic state. Furthermore, intermediate hypnotic depth is often the optimal state in which the greatest level of therapeutic change occurs.

Chapter 3, “The Psychodynamics of Hypnotic Induction,” carefully explains the ways in which the actual hypnotic induction impact a patient. Watkins and Barabasz discuss how hypnosis allows a patient to adaptively regress, a process commonly referred to as “regression in the service of the ego”. This positive therapeutic regression facilitates a loosening of defenses, which increases the accessibility of information-rich primary process material. The authors explain how hypnoanalytic treatments are perhaps the most efficient and expeditious methods by which adaptive therapeutic regressions occur. Hypnoanalytic psychotherapies proactively uncover and work with unconscious material, even in a shorter-term approach. The fact that the adaptive regressive abilities of the patient are enhanced by hypnoanalysis is a key reason why hypnotic techniques within a psychoanalytically informed therapy allows for quick yet thorough changes. Chapter 3 also discusses how erotic and death-like experiences of the hypnotic state allow for related fantasies to quickly come into sharp focus. Watkins and Barabasz also provide information on how a patient’s willingness (or lack thereof) to engage in the hypnotic process offers insight into patient resistances. Thus, the hypnoanalytic process brings resistances into immediate awareness, which allow for an analysis of resistance earlier in the treatment process than in other forms of psychotherapy. By breaking down the psychodynamics of the hypnotic process, Watkins and Barabasz clearly describe ways in which adjunctive hypnotic techniques allow for quick access to crucial patient dynamics, and in doing so creates a more comprehensive treatment experience.

In Chapter 4, “Hypnodiagnosis and Evaluation,” details the wealth of information that can be gathered when at least part of the diagnostic interview is conducted while the patient is hypnotized. Specifically, they discuss how hypnotic interviews often allow for greater recall of memories of which the patient is unaware. Though newer material is reported, Watkins and Barabasz appropriately call into question the veracity of such newly “remembered” material. They lean on the vast empirical data supporting the hypersusceptibility of patients to provide iatrogenic memories born out of many hypnotic and non-hypnotic clinical interviewing techniques. Such material—accurate or not—has substantial emotional valence and therefore warrants therapeutic attention. Chapter 5, “Advanced Abreactive Techniques,” highlights the indispensability of abreaction for successful treatment outcomes. They explain the many ways in which abreactive experiences occur, both within and independent of hypnosis, and provide criteria for a patient’s goodness-of-fit for successful abreactions. The authors compellingly reason how hypnoanalytically created releases of deeply repressed affect lead to corrective emotional experiences, and, in turn, facilitate genuine therapeutic changes.

Chapters 6 through 9 discuss non-traditional therapeutic techniques. Chapter 6, “Sensory Hypnoplasty and Hypnography,” taps into unique and creative treatment possibilities. Specifically, this chapter demonstrates the therapeutic use of art. Hypnography is when a hypnotized patient draws or paints whatever comes to mind, while hypnoplasty is the hypnotic free associations to the patient’s self-directed clay moldings. The authors offer numerous case examples and pictorial demonstrations of these two ways in which unconscious processes are accessed and addressed.

Chapter 7, “Realities, Dreams, and Fantasies,” begins with a succinct review of the clinical, empirical, and neurophysiological literature on dreams. This is followed by step-by-step procedures for dream interpretation, both within and outside of hypnosis. Chapter 8, “Projective Hypnoanalysis,” consists of an in-depth case study of a patient of Dr. Watkins’ in which he demonstrates the clinical utility of incorporating traditional (e.g. TAT cards) and nontraditional (e.g. dissociated hand writing) projective techniques during the hypnotic state. Chapter 9, “Dissociative Hypnoanalysis,” addresses the various ways in which patients with dissociative proclivities and disorders (including PTSD) present in their daily lives as well in the clinical consulting room. The authors offer theory and research supporting their clinical approaches with a wide range of patients treated by the hypnoanalytic method. Perhaps the most interesting aspect collectively highlighted during these three chapters is the various ways hypnosis is yet another viable royal road to the unconscious.

Advanced hypnotherapy is rooted in both classical and contemporary analytic thought. One of the key components of this book is the authors’ demonstration of the flexibility of hypnodynamic therapies. Furthermore, they explain how hypnodynamic treatments are particularly suitable to be conducted in a time-limited fashion that does not compromise the deep-rooted therapeutic changes that we have come to appreciate as germane to traditional psychoanalysis. Chapter 10, “Ego-State Therapy,” is a treatment approach that is an integration of different analytic and non-analytic theories and techniques. Ego-state theory rests on the assumption that the recognition of separate aspects of one’s personality allows for a more directive hypnoanalytic intervention. This specifically tailors the therapy to address pathological part(s) of one’s personality. Such a short-term treatment modality was precisely developed for the use of hypnotic techniques. Although the underpinnings of ego-state therapy may be considered a stray from traditional psychoanalytic or hypnoanalytic practice, the authors make a compelling argument for the clinical utility of this approach.

Psychoanalytically informed clinicians share an appreciation for the power and importance of the therapeutic relationship. In Chapter 11, “Hypnotic Transference, Counter-Transference, and the Therapeutic Alliance,” Watkins and Barabasz provide a concise overview of the nature of transference. They explain the ways in which transference phenomena present in the consulting room and how they can be utilized therapeutically. This chapter demonstrates how hypnosis expedites the manifestation of transference phenomena, which in turn aids in shorter-term treatment with longer-lasting results. The authors also report on clinical and empirical evidence in which hypnoanalytic approaches allow for comprehensive transference-work with borderline and psychotically organized patients: two groups historically thought to be unanalyzable due to the putative difficulties in establishing transferences. Watkins and Barabasz elucidate how hypnosis often helps the patient experience a more stable internal representation of the therapist, which increases the range of candidates treatable by psychoanalytically informed (and hypnoanalytically informed) psychotherapies.

Chapter 12 adds a unique theoretical perspective to the psychodynamic practitioner: existentialism. “Existential Hypnoanalysis and the Therapeutic Self” brings frequently occurring (but seldom discussed) themes into the center of attention. In this chapter Watkins and Barbasz address clinical conditions and presentations that do not fit into our standard DSM taxonomy. Common patient conditions such as boredom, experience of (and wish to prevent) the passage time, and the meaning of life, are focal points of existential psychotherapies. The authors outline how the integration of existential approaches within a psychodynamic framework allows for successful treatment of these (and other) existential themes. Specifically, Watkins and Barabasz explain how a clinician’s ability to “be-there” and coexperience the here-and-now of a patient sustains the treatment process. They further expound on how hypnosis can effectively enhance the togetherness of the therapeutic process and how hypnotic interventions facilitate the treatment of existential concerns.

Advanced Hypnotherapy will be of great use for several different groups of psychologists. One group for whom this book is geared are those clinicians looking to widen the scope of their clinical practice. This book carefully demonstrates how the addition of hypnosis to preexisting therapeutic techniques enhances a therapist’s range of practice, skillfulness in patient treatment, and overall treatment effectiveness. Furthermore, Watkins and Barabasz explain how hypnosis allows for a more expeditious therapeutic process, and how such abridged treatment does nothing to compromise (but rather buttresses) the thoroughness of dynamically oriented psychotherapies.

Psychologists already familiar with hypnosis are another group for whom this book is of use. Advanced hypnotherapy is just that: an advanced text that elevates the clinical thinking and innovative ways hypnotic procedures can be used. The heavily referenced research is a must for researchers and practitioners alike. The authors demonstrate how easily hypnosis fits with psychoanalytic practice. The advanced therapist will find the detailed hypnoanalytic cases material enlightening. Furthermore, the experienced hypnotherapist will appreciate the applicability of hypnoanalysis to clinical populations ranging from the higher functioning college student to the psychotically organized individual.

Watkins and Barabasz’s book is also of value for those clinicians looking to further hone their case conceptualization, even if not necessarily intending to add hypnosis to their practice. The authors use ample clinical case examples, each of which is accompanied with a thorough case formulation. These case conceptualizations of these two highly skilled psychologists carefully delineate various psychodynamic phenomena and how they present in the real-word of the consulting room.

There is another important component of this book: science. Advanced Hypnotherapy is anchored in empirical data. Throughout the book the authors link empirical findings with clinical theory and practice. The scientific element of this book should be appreciated, especially amongst psychoanalytically oriented clinicians. Watkins and Barabasz should be lauded for their efforts to provide a scientific foundation to psychoanalytic practice at a time when empirical support for psychoanalysis is not a luxury but rather a necessity for our field to remain viable in academic psychology and in a managed care environment. Throughout the book the reader will appreciate the authors’ ability to coalesce the natural science model with clinical practice.

There is one group of psychologists for whom this book is not likely a good fit: those practitioners new to hypnosis. Although the text offers much information on applied hypnosis, it is not a “primer.” This current edition rests on the assumption that readers possess an understanding of basic hypnosis principles. This is not a beginner’s “how-to” manual but rather an advanced reading for the clinician already abreast of the fundamentals of hypnosis. Neophyte hypnosis practitioners may understandably struggle grasping the core concepts on which this text builds. Those looking to develop basic hypnosis skills should see the authors’ first edition (Barabasz & Watkins, 2005) or seek training through a professional affiliation (e.g. Society for Clinical & Experimental Hypnosis, Division 30 of the American Psychological Association).

Advanced Hypnotherapy: Hypnodynamic Techniques is a book I picture residing in many psychologists’ library. For some, it remarries psychoanalysis with hypnosis. For others, it advances their psychoanalytic case conceptualization abilities. For more, it is a useful tool to expand their scope of clinical practice. Watkins and Barabasz offer lucid instructions on the integration of hypnosis into psychodynamic treatment. They provide clear information on the psychogenic and biological underpinnings of hypnosis, as well as procedural instructions for the practice of hypnosis. The procedural information is clearly written and supported with numerous clinical case examples. The aggregate of this well-written book provides a wealth of useful practice information. Though this text has a virtual simultaneous release as Nash and Barnier’s 2008 The Oxford Handbook of Hypnosis (in which Arreed Barabasz coauthors a chapter), each book has its respective place on a psychologist’s bookshelf.

No doubt there are well-informed psychodynamically-oriented clinicians who fear that hypnosis is in direct conflict with the goals of classical or contemporary psychoanalysis. In many ways, this belief speaks to long-reaching power of Freud’s influence, or at least that of his over-scrupulous acolytes. The authors rightly point-out this is especially ironic, given that Freud used hypnosis to manage the pain from his mouth cancer. Hypnosis does not contradict psychoanalysis. The two are, in fact, mutually facilitative. As the authors eloquently state:

“Hypnoanalytic techniques should not be regarded as competing with traditional practices of psychoanalysts or those employing psychoanalytically oriented therapy, but rather a means of complementing their work. Hypnoanalysts can be viewed as merely an extension and elaboration of the methods by which Freud and his colleagues undertook to explore the fascinating world of the human mind, one that continually influences our behavior and well-being, but of which we are often so little aware” (p. 3).

In sum, Advanced Hypnotherapy: Hypnodynamic Techniques is for the learner, seasoned psychologist, and clinical-researcher, as it will readily stimulate and inform practitioners’ clinical thinking regardless of experience or theoretical preferences.

References

Barabasz, A. & Watkins, J.G. (2005). Hypnotherapeutic techniques. New York: Brunner-Routledge.
Nash, M.R. & Barnier, A. J. (2008). The Oxford handbook of hypnosis: Theory, research, and practice. Oxford University Press: Oxford, UK.

Reviewer Note

Anthony F. Tasso

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