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Uses Of Hypnosis with Multiple Personality

by Bennett G. Braun, M.D.

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General Issues Concerning Hypnosis

Allison, Caul, Braun, Bliss, and Kluft have reported that multiple personalities are good hypnotic subjects. One can take advantage of this to expedite both diagnosis and treatment. Access to the several personalities can be facilitated. After inducing trance, one can teach the patient to respond to cue words (called "key words" by Caul) so that future inductions can be achieved more rapidly.

In determining whether or not to use hypnosis, it is recommended that it not be undertaken unless the clinician has specific therapeutic objectives in mind and can anticipate the possible outcomes of the intervention. If the results are as expected, one is likely to be on the right track. If not, one must clarify one's understanding before proceeding. Poorly planned hypnosis can cloud issues.

When hypnosis is employed, the therapist must formally "remove" the trance before the session ends, and reserve enough time to process the sessions and help reorient the patient to the current time and place. In emerging from trance, a sense of disorientation is common. This is accentuated in MPD, because the trance experience is akin to their switching process. Patients may complain of a "hangover" effect if a trance has not been removed properly.

Uses Of Hypnosis For Diagnosis Of Multiple Personality

Our discussion begins with a renewed word of caution. As noted above, one cannot "create" multiple personality, but the injudicious use of hypnosis (via pressure, shaping responses, and insensitivity to demand characteristics) may create a fragment or elicit an ego state which can be misinterpreted as a personality.

I withhold the use of hypnosis until I have exhausted other means. One consideration is to avoid difficulties and criticism (inducing artifacts). A more substantial reason is that since these patients have often been abused, I do not want to do something abruptly or early on that might be perceived as another assault. Spending extra time in observation and building rapport is generally worthwhile.

Once the decision is made to use hypnosis, I proceed by doing an induction, and at times, teach self-hypnoses. Merely inducing hypnosis and observing often suffices to yield the material needed to make the diagnosis. The serendipitous discovery of MPD during hypnosis for other problems has been reported by this author and others. A major part of the session is conducted with the patient in a hypnotic trance. If the necessary information is not forthcoming, use is made of material that the patient has disclosed, including inconsistencies, to probe further. "Talking through" has also proven useful. In this technique, one talks through the current host personality using statements aimed at underlying personalities, who are presumed to be facial expressions, posture changes, movements, and response patterns to observe subtle shifts. One notes the topics under discussion when these occur. When the host appears confused by the words spoken by the therapist and there are data to indicate the existence of another ego-state, one might say, "I'm not talking to you," or ask if there is anyone else inside. Finally, an attempt can be made to call out another personality by inquiry about a troublesome event: for example, "Will whoever picked up the man and let Mary find herself in bed with him, please be here and talk with me?"

Hypnosis can be used to confirm a suspected diagnosis. One may move faster when doing a consultation than when working with an ongoing case. When working with limited time, a consultant may miss the diagnosis due to insufficient rapport and trust. On the other hand, he may get some information more easily because it was withheld from the primary therapist for fear its revelation would prompt rejection. There also may be an empathic connection between an experienced consultant and an alter personality which allows it to come out when it was previously reluctant or unable to.

When other personalities have been out, the host may notice that he or she cannot recall what happened during parts of the session. When confronted with the existence of "others," the denial shown by some personalities can be astonishing. A confrontation using tapes (especially videotapes) of previous sessions can be invaluable, but denial can override this evidence also.

Timing is critical. If the patient is confronted with the diagnosis too early, before a good therapeutic alliance has been established, he or she may avoid future therapy. Multiple personality patients test the doctor and the therapeutic relationship almost continuously and rather excessively. If a therapist waits too long, the patient may believe that the therapist waits too long, the patient may believe that the therapist is unable to help him or her because early "obvious" cues had been missed.

With the therapist's and the patient's mutual acceptance of the diagnosis, specific treatment for MPD can begin. Prior to this point, many non-specific benefits of therapy may be realized, but the core pathology remains largely untouched.

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