Fortunately, psychoanalysts and eclectic psychiatrists are now changing their views toward hypnosis. However, there are valid criticisms and limitations of hypnosis and psychoanalysis. The author hopes that the best features of these therapeutic methods will be synthesized and absorbed into the mainstream of American psychiatry.
DO WE KNOW HOW HYPNOSIS WORKS?
Critics of hypnotism often remark, “No one knows why it works.” By the same token, no one knows the exact modus operandi of aspirin, yet we use it. Hypnotherapy in the presence of a strong interpersonal relationship between therapist and patient provides a meaningful intrapersonal experience for the patient which is particularly conducive to the establishment of expectations leading to convictions. In the presence of an expectant attitude, the imaginative processes unleash the inherent recovery forces.
Freud did not consider hypnosis as a subjective phenomenologic experience.9,15 Therefore, he did not think of it as even partial validation of his concepts. However, he correctly considered suggestion “as a nucleus of hypnosis and the key to its understanding.…”14
HYPNOTHERAPY IS NOT A PANACEA
Hypnosis must divorce itself from the unwarranted claims made by some of its ardent proponents. These persons often have done more harm than have its uninformed opponents. The latter, however, while they deny its therapeutic efficacy, impute great harm to even a single posthypnotic suggestion. Even though hypnotherapy is no more curative than other psychotherapies, it is a relatively rapid method when compared with the more orthodox psychotherapies, and can reach certain disorders ordinarily refractory to conventional psychotherapy, such as chronic conversion reactions, phobias, compulsive disorders, addiction, and pain problems. It is unfortunate that many laymen and some uninformed therapists look upon hypnotherapy as a “magical gesture.” It should not be oversold; otherwise it will soon be another nostrum.
DOES STRONG DEPENDENCY ON THE THERAPIST EXIST?
One criticism repeatedly stressed is that extreme dependency on the therapist is fostered because the hypnotic interpersonal relationship is “like that of parent and child.”7 Where dependency occurs, it may be due to the manner in which the hypnotic interpersonal relationship was utilized! One must consider the emotional needs of the therapist and the degree of neurotic involvement of the patient. Therefore, dependency is not produced because of the hypnotic situation, but rather is due to the nature of the interactional processes between therapist and patient. In psychoanalysis, undue dependency is analyzed, and this also can be done when it becomes a problem during hypnotherapy. Kubie states there is no dependency.20 Not a single patient has become “addicted” to hypnotherapy.39 Thus hypnotic dependency is a myth.
DOES HYPNOTHERAPY SEXUALIZE THE DOCTOR-PATIENT RELATIONSHIP?
One continually hears that in hypnotherapy the relationship has an erotic root. Sexual attraction between patient and therapist occurs in other therapeutic relationships and is not limited to hypnotherapy. It is highly unlikely that a subject in deep hypnosis will act out his sexual fantasies in a properly conducted hypnotic session. Sexual submission is a highly selective process, and, where it occurs, it is definitely the result of factors other than hypnosis.5
IS ANALYSIS OF THE TRANSFERENCE NECESSARY IN HYPNOTHERAPY?
The old concept of transference is no longer considered a blind repetition of childhood relationships. Freud took hypnotic rapport and called it transference. His remark that there was “something positively seductive in working with hypnosis,”27 indicated that it is possible that his overemphasis on erotic elements in the therapeutic relationship was due to his own repressed sexual feelings (counter-transference).18
Watkins observes that the patient during analytic sessions is often in hypnosis without the analyst's awareness of it, and that during hypnosis the hypnotherapist's own attitudes are to a degree displaced to the patient without the former's recognition of it.37 Transference is understood better in this sense than it is by assuming it to be a manifestation of child-parent relationships.
Freud denied the use of suggestion in his therapeutic approach. Despite this denial or lack of awareness, he stated:15
In psychoanalysis we work upon the transference itself, dissipate whatever stands in the way of it and manipulate the instrument which is to do the work. Thus, it becomes possible for us to derive entirely new benefits from the power of suggestion; we are able to control it; the patient alone no longer manages his suggestibility according to his own liking, but insofar as he is amenable to its influence at all, we guide his suggestibility.*
“Transference” for Freud became a wider concept than faith, and psychoanalysis made full use of reparation to obviate pain, anxiety, shame, and guilt.18
ARE FREE ASSOCIATIONS NECESSARY?
Freud used the technic taught to him by Liébeault and Bernheim. Later he discarded the “pressure method” and utilized what he called the “free association” method to recapture significant experiences and overcome resistances. It has been pointed out that free association often results in spontaneous hypnosis.35
Schmideberg asks:
Are free associations sufficiently standardized to permit comparable observations on different days and with different patients?31
If free associations and their interpretations resulted in a higher recovery rate than that of standard psychotherapy, it would have been a significant contribution. However, deliberate and faulty interpretations of free associations often lead to betterment.
DOES HYPNOTHERAPY OVERCOME RESISTANCES?
Freud thought hypnosis concealed the resistances.13 Haley points out that there is often no need even to allow the resistances to develop during hypnotherapy: “A resistant maneuver is dissipated by having it accepted and redefined as cooperation.”17 He believes that “this type of interaction is central to winning control of a relationship; maneuvers to define the relationship are not opposed but ‘taken over.’”
Freud referred to hypnosis as the “tyranny of suggestion.”10 Being a dedicated scientist, however, he was puzzled about hypnosis, and repeatedly tried to fit “the riddle of suggestion” into his theoretic formulations. Kline points out that Freud avoided rather than rejected hypnosis.18 In the light of the historical development of Freudian theory, perhaps “we need a psychoanalysis of current psychoanalytical resistance to the use of hypnosis.”22
WHAT IS THE ROLE OF PSYCHODYNAMICS IN PSYCHOTHERAPY?
Psychodynamics has been defined as the motivational basis for human behavior. There have been numerous critics of psychodynamic psychiatry.1,4,29 Bailey states:
The psychodynamicists must cease to teach their neophytes in terms of mythological pseudoscientific entities—that the system of explanation used by psychodynamics is really too simple to satisfy other than immature minds. It amounts to no more than a set of elaborate fictions.1
Conn adds:
It was becoming apparent that we had accepted a pseudoscientific system of metaphors and verbal traps that were primarily descriptive and could not serve as explanatory concepts.4
Eysenck, an outspoken critic of psychoanalysis, emphatically stated that it has no effect whatsoever.6 Frank and his co-workers argued that it was difficult to demonstrate specific results from psychoanalysis.8 Other authorities still believe that long-term therapy is an effective procedure.2,3,21,34
Shortly before his death, Freud spoke very resignedly about the poor results of psychoanalysis in an article seldom mentioned by his loyal followers.9 As Rado observed, “Digging into the past yields diminishing returns.”28 Others question the value of recapturing early fantasies and memories. This is not to imply that many of Freud's observations in human behavior will not be of enduring value. Contemporary technics in hypnoanalysis could not have developed had it not been for his penetrating insights.
Physical scientists currently are attempting to explain the many facets of behavior in terms of systems that can be evaluated statistically. This may provide a better understanding of behavior, particularly higher central nervous activities. In this regard, the open systems theory of von Bertalanffy,36 the information-communication theory of Shannon and Weaver,32 and the cybernetics of Wiener38 should prove helpful (see Chap. 32).
ARE INTERPRETATIONS VALID?
When the therapist offers interpretations, is it not largely what he thinks is going on, and is not the patient being controlled without realizing it?31 There is no reliably controlled evidence that interpretations are responsible for results. Before such contentions can be validated, there must be a control group in which the postulated cause produces similar symptoms. It is not the validity of the interpretations, but the faith in the therapist's methods, which leads to cure. Furthermore, any system using its own data to prove itself can only encounter a paradox (Gödel's theorem).
IS SYMPTOM REMOVAL DANGEROUS?
To Freud's everlasting credit, he noted that hypnosis had no deleterious effects, and that it was not a dangerous tool.13 According to behavior therapists, the removal of psychological symptoms by hypnotherapy is more lasting.40 Symptom removal by hypnosis “prevents the reinforcement of the inappropriate responses and new appropriate ways of handling the conflicts. As a result the appropriate responses are reinforced.”
IS INSIGHT REALLY NECESSARY?
Hypnotherapy without insight is as effective in dealing with symptomatic behavior as those therapies which provide insight. If insight is necessary, then how do the various schools of psychotherapy explain the success of those groups that do not require insight?
Freud obtained recoveries in short analyses.12 Brief psychotherapy, consisting of a few visits, has yielded good results. Most deep-seated conflicts are forgotten with the passing of time, and insight is never achieved.
Often “insight” is not the patient's insight, but the therapist's preconceived notion of what “insight” the patient should have. Usually the patient merely takes over the value systems, the faith, and the confidence of the therapist—this is actually what makes emotionally disturbed individuals better!
IS AUTOHYPNOSIS DANGEROUS?
Autohypnosis is employed in many spiritualistic religious-healing modalities. Therefore, it is difficult to see how autohypnosis can be dangerous when the very essence of prayer is based on the fundamental principles of autohypnosis.
CONCLUSIONS
It may safely be asserted that nearly all of the criticisms applied to contemporary hypnotherapy are untenable. Many justifiably are directed toward a type of hypnotherapy that was practiced in the last century. There is no proof of the superiority of any psychotherapeutic approach, as it is virtually impossible to eliminate the importance of the interpersonal relationship.16 Well-trained psychotherapists, with considerable experience, cannot show a higher recovery rate than gifted neophytes with lesser training. However, there are limitations to hypnotherapy, and these are the same as those found in any other type of psychotherapy.
Current research in hypnosis does not substantiate a single reason for Freud's avoidance of hypnosis. The reader is referred to an excellent monograph on the subject, Freud and Hypnosis, for a detailed description of Freud's reasons for avoiding hypnosis.18 Since scientific hypnosis was in its infancy in Freud's time, one can hardly blame him for adopting a negative attitude. However, there is no valid reason why Freud's successors should continue to use this embryonic period in the historical development of hypnosis to criticize contemporary hypnotherapy. Masserman recognized that hypnosis was the core that underlies all forms of psychotherapy when he recently spoke on “Hypnosis, the Misnamed Source of All Interpersonal Therapies.”23 Freud must have anticipated this when he prophetically wrote:
It is very probable too, that the application of our therapy to numbers will compel us to alloy the pure gold of analysis with the copper of direct suggestion; and even hypnotic influence might find a place in it again as it has in the treatment of war neuroses.14
All psychotherapists should at least become conversant with recently developed hypnotic technics, much as progressive physicians do with new drugs.
Orne has brilliantly traced the development and concepts of psychotherapy in contemporary America.26 He describes how psychodynamic ideas were accepted because they were promulgated under medical and scientific auspices. He points out that the theory and practice of psychoanalysis (and no doubt behavior therapy as well) have met with an increasing lack of acceptance not only from the scientific community, but also from the public. Orne is a leader in hypnosis research and psychodynamic therapy. He sounds a clarion call for hard clinical and scientific data to prove that the insights derived from the dynamic view have, as he believes, a sound basis. He notes the difficulties in evaluating the effectiveness of any type of psychotherapy because of self-fulfilling prophecies,24 experimenter-expectancy effects,30 and demand characteristics.25 More importantly, he warns against the plethora of irresponsible therapies that are springing up.
It is becoming increasingly obvious that American psychiatry is in the throes of an identity crisis. It is splintered by many movements, all of which seem to help to some degree. It is riding off madly in all directions. Powerful voices are now asking the psychotherapist to provide corroborative data of the efficacy of his particular school of therapy. This means that the recovery rate, as judged by empirical observations, can be meaningful only if it exceeds the 65 per cent cure rate—the placebo effect.
The author believes that hypnosis and behavior therapy (which is covert hypnosis) and some of the tenets so well enunciated by Freud, and which created a new discipline, will emerge as a practical therapeutic approach. Today, we are witnessing the impact of meditative states, the relaxation response, and other methodologies which grew out of opposition to traditional psychotherapies. That hypnosis and the Eastern methodologies, mentioned in Chapter 24, have existed for several thousand years and now are being increasingly accepted indicates that they will play a meaningful role in psychotherapeutic processes. They are here to stay, and they are modalities that American psychotherapy must eventually incorporate.
No therapeutic modality is applicable to all problems. The skillful psychotherapist must be flexible and use a therapy that is adapted to the needs of the patient, rather than the patient to the method. However, much psychotherapy in the Western world has been applied as dogma. No therapist has any special curative remedies, yet each approach may serve a genuine purpose if used wisely and judiciously.
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