Academic journal article American Journal of Psychotherapy

Out-of-Illness Experience: Hypnotically Induced Dissociation as a Therapeutic Resource in Treating People with Obstinate Mental Disorders

Academic journal article American Journal of Psychotherapy

Out-of-Illness Experience: Hypnotically Induced Dissociation as a Therapeutic Resource in Treating People with Obstinate Mental Disorders

Article excerpt

Psychological dissociation is commonly perceived by mental health professionals as the pathological splitting of consciences or as an impairment in adaptive integration. In hypnotherapy dissociation is considered one of the most significant features of hypnosis, constituting a major therapeutic resource. In the present article, we use hypnotically induced dissociation (HID) to treat patients with obstinate mental disorders (OMD). These disorders are characterized by persistent, problematic behaviors, thoughts, and feelings that become organizing principals of identity and form enduring psychopathologies. To promote psychological change in patients with OMD, we use HID to enhance dissociative processes that enable the differentiation of health from pathology and allow the emergence of experiences previously overshadowed by pathological personality patterns. Three clinical cases of OMD (chronic depression, obsessive-compulsive disorder, and a personality disorder) illustrate the effects of HID as an effective therapeutic tool that facilitates emotional processing, consolidates therapeutic achievements, and secures therapeutic results.

KEYWORDS: dissociation; hypnosis; hypnotherapy; obsessive-compulsive disorder (OCD); mental disorders

. . . the opportunity hypnosis gives the patient to dissociate himself form his problems, to take an objective view of himself, to make an inventory of his assets and abilities, and then, one by one to deal with his problems instead of being overwhelmed with all of them without being able to think clearly in any direction

(Erickson, 1945/1980, p 34.)


From time to time, most clinicians confront patients who are difficult to manage and appear as untreatable or chronically ill. Their psychopathologies are rooted deeply in their personalities, derived from constitutional traits, and reinforced by environmental and developmental factors. In this paper, we refer to this group of patients, who sometimes fail to meet distinct diagnostic criteria but are well known by professionals in clinical practice, as having obstinate mental disorders (OMD).

A fundamental problem in the psychotherapy of people with obstinate mental disorders is the identity-like feature of their psychopathology. In patients with OMD, persistent and problematic behaviors, thoughts, and feelings become central traits that evolve into the organizing principals of their personalities (McWilliams, 1994). Patients with OMD often find it difficult to remember premorbid functioning, and thus lack faith that life can be different. This point of view impedes them from engaging in new, nonpathological and unfamiliar ways of living (Hollander, Kwon, Stein, Broatch, Rowland, & Himelein, 1996). Some of these patients develop psychopathology before or during identity formation (around adolescence) or in the course of one of the developmentally sensitive periods of life (Kroger, 2004). In these cases, the obstinacy and persistence of the psychopathology is even more protruding (Burke, Burke, Rae, & Regier, 1991). This problematic feature has to be addressed in order to enhance the efficiency of therapy with patients who have OMD, while taking into consideration aspiration for steady and long-term outcomes.

An association with the functioning parts of the patient's personality enables the therapist to establish a therapeutic alliance that serves as a foundation to the treatment process. At the beginning of the therapeutic process, the procedure of dissociating the pathological aspects of identity from the healthy ones is essential for allowing patients to align their psychological resources, gather hope, and set appropriate goals for therapy. In the middle phases of therapy, dissociation promotes both insights and changes in deep psychological structures (Lemke, 2005; Meyerson & Gelkopf, 2004; Edgette & Edgette, 1995). Finally, towards the conclusion of therapy it can help secure therapeutic results (Meyerson & Gelkopf, 2004). …

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