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Trance and Treatment: Clinical Uses of Hypnosis, Second Edition

Joan S. Zofnass, D.S.W.

This is the second edition of Trance and Treatment, written by the father and son leaders of the field and serving as a virtual bible of hypnosis. Together in 545 pages they cover the ins and outs of hypnosis, presenting theories, concepts, and procedures in a cogent fashion while backing up their ideas with research findings, both their own and that of others. For the Spiegels, the "book is an effort to synthesize laboratory discipline and an appropriate respect for the observations and intuitive judgments of the clinician." In marked contrast to my 2-hour crash course in "how to hypnotize" immediately before meeting with my first subject, the Spiegels proceed from the premise that the more knowledge one has, the more competent one will be in using hypnosis effectively.

Trance and Treatment is divided into three parts, paralleling the sequence of evaluation and treatment. In Part I entitled "Trance: The Phenomenon and Its Measurement," hypnosis is defined and discussed, followed by a thorough exploration of the Hypnosis Induction Profile. The Hypnosis Induction Profile is a clinical assessment that includes the upgaze, roll, squint, eye roll sign, arm levitation instruction, tingle, dissociation, signal arm levitation, control differential, cutoff, amnesia, and float. Although there is much discussion of how to score each of these factors, someone not familiar with the process will find the chapter on administration and scoring a challenge at best (I spent 15 minutes just trying to differentiate the pictures of the upgaze from the roll and was hard pressed to distinguish the subtle differences). While there is extensive detail on each step of evaluation and induction, the reader should not expect that reading this tome alone will suffice in teaching one the necessary skills of hypnosis.

In Part II, the use of the Hypnosis Induction Profile as a diagnostic probe is explored in depth, and the literature on hypnotizability and personality is explored. They postulate that three questions need to be answered in order to formulate the best treatment approach: 1) What is the problem? 2) Who is the person with the problem? 3) What is the best strategy to help that kind of person deal with that type of problem? Part II addresses the "who" part of the puzzle. The Spiegels present their clinical observation that, in general, patients can be clustered into one of three groups: Dionysian, the most hypnotizable, who are marked by feeling, trusting, and intuition; the Apollonian, who are the least hypnotizable and tend to be logical, organized leaders; and Odysseans who are moderately hypnotizable and more balanced between feeling and thinking. The authors prefer the use of these terms rather than the more usual descriptors of personality style/disorder to preserve a more neutral stance, noting that "people differ in many ways that are healthy." A questionnaire is provided to differentiate among the three personality types described, with discussion of its application and case examples. The Spiegels then look at more serious psychopathology that may interfere with hypnotizability, discussing some of the more common axis I and axis II diagnoses and where individuals with these diagnoses fall on a scale of hypnotizability. While DSM diagnosis may help the clinician decide on the possible utility of hypnosis, the Spiegels also look at the problem from the other end: performance on the Hypnosis Induction Profile and hypnotizability can help in diagnosis, and they suggest that the Hypnosis Induction Profile be incorporated as part of a full mental status assessment. This section includes a review of the possibilities of hypnosis as a treatment in a wide range of disorders, ranging from psychosis to personality disorders. Finally, the neurophysiology of hypnosis is addressed, describing results from a variety of studies using imaging or measuring of the brain’s activity and interpreting these studies as they apply to theory of how hypnosis may achieve its effect.

Part III addresses the use of hypnosis in treatment. The Spiegels start with the premise that two questions need to be answered: "What caused the symptom?" and "Why does it persist?" With several clear examples they lay out a road map for determining how to use hypnosis. Taking into account such factors as support systems, secondary gain and loss, self-esteem, motivation, distancing, and the capacity for change, the therapist can have a fairly reliable estimate of the most important problems and how to enhance the patient’s own resources in coping with them. The process of formulating the problem lends itself to the development of a restructuring strategy that allows that patient to see the problem from a new perspective that facilitates its potential resolution. "The restructuring approach emphasizes making a disciplined effort at rapid symptom mastery, first by assessing those who are presumably capable of it with the HIP, and then by teaching them how to better mobilize their own resources." Anyone in the treatment field will find the possibility of hypnosis thought provoking, regardless of professional background or personal training style. The possibilities of intervening with a technique that can, within a very short period of time, diminish if not completely resolve incapacitating symptoms is hard to resist. The Spiegels review a variety of symptoms and problems that can be treated with hypnosis. Beginning with a discussion of smoking control, they then cover eating disorders, anxiety, concentration, phobias, pain control, psychosomatic disorders and conversion, and miscellaneous disorders such as trichotillomania and stuttering. Within each problem area, case examples are presented that always begin with a clear assessment of how the patient’s Hypnosis Induction Profile and personality cluster determination guided the use of hypnosis for the resolution of the particular symptoms.

While most of the 500 pages address what can be accomplished with hypnosis, the reader is cautioned that there are those patients who will not be able to benefit, and that a complete evaluation, often including psychological testing, is crucial to identifying the most appropriate therapeutic approach. The authors caution that hypnosis is not a therapy but a facilitator and not to be seen as a substitute for a thorough understanding of the patient and his or her problem and therapeutic needs.

Trance and Treatment is no leisurely discussion of hypnosis to be skimmed through before your next patient session. The book serves as a complete and complex introduction to the process and potential of hypnosis. While there is ample description of how to assess and intervene, this book might best be used with the Professors Spiegel at your side, rather than as a self-instructional manual. The cases they present and the results they achieve are compelling, but the reader is left to wonder whether his or her hesitant or puny efforts at hypnosis would have the same effects that patients would experience at the masters’ hands. It is hard to complete this book and not wonder if we are just at the beginning of our understanding and utilization of hypnosis. If some patients’ physical and psychological symptoms can be rapidly reduced or eliminated by hypnosis, as demonstrated by the cases presented, it behooves us to make better use of this modality in our quest to minimize patients’ suffering.

I was left wanting to spend clinical time with the Spiegels in order to master these techniques, since despite its length, Trance and Treatment gives only a taste of the potential that hypnosis might offer for therapists of all clinical orientations.

FOOTNOTES

Dr. Zofnass is in private practice in New York City.

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Zofnass, J. S. Search for Related Content Articles by Zofnass, J. S. General Topics in Psychiatry

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