Hypnosis, dissociation and survivors of child abuse

Hypnosis, dissociation and survivors of child abuse

Gold, Steven N

Degun-Mather, M. (2006). Hypnosis, dissociation and survivors of child abuse. Hoboken, NJ: Wiley & Sons.

Marcia Degun-Mather is a psychologist in the United Kingdom who, according to the biographical sketch in the front matter of this book, has extensive experience in the hypnotherapeutic treatment of trauma-related disorders. Among her listed credentials is a long history of training others in the clinical applications of hypnosis. In addition to the treatment of trauma-related disorders, eating disorders and sexual disorders are listed as her special areas of expertise.

In this volume, Degun-Mather addresses an important and relatively neglected topic, the application of hypnosis to the treatment of clients with a history of child abuse and dissociative difficulties. Recognition of the relevance of hypnosis to this population dates back to the origins of modem psychotherapy in the work of Janet (1973), Freud (1959a, 1959b), and others in the late 19th Century (Cotsell, 2005). However, as the author notes, this subject has received little attention in recent years probably due in large part to the lingering aftermath of the so-called “memory wars.” Beginning in the early 1990s, claims by therapists began to emerge that survivors could, and commonly did, completely block out recollection of abuse and later recover those memories in the course of treatment. This contention was countered by the accusations of others that many therapists were naively facilitating the formation of false memories of abuse in their clients through various questionable interventions, notably the suggestive use of leading questions and hypnosis. The author states these accusations came primarily from researchers without direct clinical experience.

Degun-Mather, therefore, has taken on a considerable challenge in writing this book, since she is addressing a topic that is a “hot button” issue. Delayed recall of past abuse is a subject that has generated a very large body of contentious literature during the 15 years. The application of hypnosis to the treatment of abuse survivors is a difficult matter to address in a way that balances clinical practicality with the cautions raised by some academics and researchers. While it would probably be difficult to satisfy extremists on either side of the controversy, Degun-Mather does an admirable job of weighing these two considerations.

There is a second reason, however, why this subject matter is difficult to convey. Degun-Mather’s objective is to help clinicians integrate the use of hypnosis into the treatment of abuse survivors with dissociative difficulties. Working in this manner with that population requires practitioners to master a number of advanced skills. These skills rarely receive more than minimal coverage in graduate training programs in mental health and this includes even the most basic material on trauma (Courtois, 2002). The necessary skills include the ability to induce hypnosis, elicit various hypnotic phenomena, apply hypnotic skills to facilitate therapeutic goals. And these skills include the ability to assess, identify, and treat dissociative difficulties, PTSD, and conduct psychotherapy with survivors of childhood abuse. Furthermore, it is unrealistic to master these intricate areas and their application purely through reading one work.

As I read through the book I kept wondering what was its target audience. For clinicians who have no previous familiarity with hypnosis or who have not received previous training in working with abuse survivors or with dissociative clients, the material would be extremely advanced and seem overwhelming. For those who already routinely treat abuse survivors and employ hypnosis in their practice, much of what is covered here would already be known. Degun-Mather, nonetheless, has obviously given much thought to the implications of integrating hypnotherapy with the treatment of survivors in a way that would be beneficial to these therapists. For the large group of practitioners whose knowledge and skills fall somewhere between novice and expert, the book would serve as a useful introduction; it would be crucial to alert clinicians of the importance in obtaining supervision to learn how to competently apply what is covered here.

The sheer volume and complexity of material can render making one’s way through this book in its entirety a daunting experience. It may be best for most readers to tackle it one chapter at a time, giving extended interim periods to digest each segment before proceeding to the next After one completes this book, it will serve the function as a useful resource reference. Practitioners will want to refer back to specific topics and intervention techniques as needs arise.

The first three chapters of the book are detailed literature reviews that synthesize research and theory. Chapter 1 provides a nearly comprehensive introduction to the topics of hypnosis, memory, and the impact of hypnosis on recall. The second chapter is devoted to the complexities of memory for traumatic experiences in general and for child abuse trauma in particular. Chapter 3 is an introduction to the topic of dissociation with special emphasis on its manifestations in adult survivors of child abuse.

The second three chapters represent a considerable change in tone. Chapter 4 consists of very detailed discussion of specific hypnotherapeutic techniques for working with abuse survivors. The transition from chapter 3 and 4 are somewhat jarring due to the marked shift from a relatively academic discussion of research and theory in chapters 1 through 3 to an extremely detailed description of practical clinical applications in chapter 4.

Chapter 4 presents an array of specific hypnotherapeutic techniques, each suitable for use with child abuse survivors at a particular point in the progression of treatment. Chapter 5 then shifts back to a more broad-based perspective, providing an overview of the typical structure and course of hypnotherapy for abuse survivors. The order of these 2 chapters is puzzling: it seemed to me that the detailed interventions discussed in chapter four would have been more understandable after having been introduced to the wider context presented in chapter 5. Chapter 6 concludes the volume with a very useful set of three case presentations that demonstrate how the approaches surveyed in the previous two chapters were applied in particular instances. An especially useful aspect of this chapter is the variety of the cases selected. Each one has markedly different features that nicely illustrate the range of symptom pictures, abuse histories, and complexity and length of treatment that can be encountered in working with abuse survivors.

Given the enormity of the task Degun-Mathers has taken on, this book represents an impressive achievement. The work is a useful survey of a large body of knowledge. For those who are conversant in this area, Degun-Mathers has performed the valuable service of reintroducing a long-avoided topic in a sober and thoughtful manner.

References

Cotsell, M. (2005). The theater of trauma: American modernist drama and the psychological struggle for the American mind, 1900-1930. New York: Peter Lang

Courtois, C. A. (2002). Traumatic stress studies: The need for curricula inclusion. Journal of Trauma Practice, 7(1), 33-57.

Freud, S. (1959a/1893). On the psychical mechanisms of hysterical phenomena. In J. Riviere (Trans.), Sigmund Freud: Collected papers. Vol. 1. New York: Basic Books.

Freud, S. (1959b/1896). The aetiology of hysteria. In J. Riviere (Trans.), Sigmund Freud: Collected papers. Vol. 1. New York: Basic Books.

Janet, P. (1973/1889). L’automatismepsychologique: Eessai depsychologie experimentale sur lesformes inferieures de l’activite humaine. [Psychological automatisms: An experimental psychological essay on the lower forms of human activity.] Paris: Societe Pierre Janet/Payot.

Reviewed by Steven N. Gold, Ph.D., Trauma Resolution & Integration Program, Nova Southeastern University, Fort Lauderdale, FL.

Copyright American Society of Clinical Hypnosis Jan 2008

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