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Page 3 of 6
A number of workers have described the facilitation of treatment with amobarbital and/or videotaped interviews. Hall, Le Cann, and Schoolar describe treating a patient by retrieving material in amytal in treatment. Caul has described taping hypnotically- facilitated sessions, and offered cautions about the timing of playing back such sessions to the patient. While there are some patients whose personalities tolerate videotaped confrontation with evidence and alters from which they were profoundly dissociated, many are overwhelmed by such data or re-repress it. Such approaches are best considered on a case-by-case basis, and cannot be regarded as uniformly advisable or effective. Caul recognizes this and seems to advocate a version of what hypnotherapists refer to as "permissive amnesia," i.e., the patient can see the tape when he is ready to see it (an analogy to the suggestion the patient will remember a traumatic even when he or she is ready to do so).
Hypnotherapeutic interventions have an established role in the contemporary treatment of MPD despite the controversy which surrounds their use. On the one hand, a large number of clinicians have helped a good many MPD patients using such interventions. On the other hand, many prominent and eloquent individuals have raised concerns that hypnosis can concretize, exacerbate, or even create MPD (as noted in the first part of this lesson). Often the debate becomes arcane to those unfamiliar with the literature of hypnosis, and the specialized concerns of forensic hypnosis, in which workers struggle to guard against the induction of confabulated or false memories which are perceived as concrete reality, and, if so reported, can impede the judicial process. The thrust of the clinical literature is that judicious hypnotherapeutic interventions thoughtfully integrated into a well-planned psychotherapy, individualized to a particular patient and oriented toward integration, can be extremely productive and helpful, and that ill-advised hypnotic work, like any other inappropriate steps, may well miscarry. The use of hypnosis in exploration, in accessing personalities for therapeutic barriers, in encouraging alters communication, and in encouraging alters communication, and documented by Allison, Bowers et al., Braun, Caul, Erickson and Kubie, Gruenewald, Horevitz, Howland, Kluft, Ludwig and Brandsma, and Spiegel, among others.
A number of clinicians advocate the provision of a very tangible corrective emotional experience, under rubric of reparenting. They undertake to create experiences within the treatment which offer to nurture the patient through a more positive recapitulation of various developmental issues and to provide more positive interjects. No published article addresses this approach. It is the author's experience that successful treatment does not necessitate such measures.
Also not available in the literature are papers on the successful approaches involving the coordinated efforts of a team of therapists employing several modalities in conjunction. This approach was pioneered by B. G. Braun and R. G. Sachs of Chicago.
Useful Principles and Caveats
According to an empirically-derived model, the patient who develops MPD had (1) the capacity to dissociate, which becomes enlisted as a defense in the face of (2) life experiences (usually of severe abuse) which traumatically overwhelm the nondissociative adaptive capacities of a child's ego. A number of (3) shaping influences, substrates, and developmental factors determine the form taken by the dissociative defenses (i.e., personality formation). Those who remain dissociated are given (4) inadequate stimulus barriers, soothing, and restorative experiences, and are exposed to pressures and further traumatization which reinforce the need for and shape of the dissociative defenses. The elements of the Four-Factor Theory of Etiology have certain implications for treatment. Whether or not a clinician elects to use hypnosis, he ought to be aware of its phenomena, and of how dissociative manifestations may express themselves in clinical settings, especially as psychosomatic and quasi-psychotic presentations. The patient brings his dissociative defenses into the therapy. One must "be gentle, gradual, and avoid imposing upon the patient any overwhelming experience that is not an inevitable concomitant of dealing with painful material. The material to be recovered brings with it the certainty of reliving anguish, and explains these patients' frequent evasiveness, protracted resistance's, and mistrust of the therapist's motives. The patient needs to be empathetically understood across and within all personalities; the therapist must deal with all with an "evenhanded gentle respectfulness, but help the patient protect himself from himself. A mutuality of working together and recognition of the difficult nature of the job to be done is essential. These treatments "sink or swim on the quality of the therapeutic alliance established with the personalities."
Certain principles advocated by Bowers et al. have stood the test of time. In summary, the therapist must remain within the limits of his competence and not rush to apply incompletely-understood and partially-mastered principles and techniques. The therapist must give integration priority over exploring fascinating phenomena and differences. He should help all alters understand themselves as more or less dissociated sides of a total person. The personalities names are accepted as labels, not as guarantees or individual rights to irresponsible autonomy. All alters must be heard with equal empathy and concern. Often one or more will be especially helpful in advising the therapist about readiness to proceed into painful areas. "Encourage each personality to accept, understand, and feel for each other personality, to realize each is incomplete so long as it is separated from the rest of the individual, and to unite with the others in common interests." Respect the patient's distress over facing painful material and the alters' misgivings over integration. Therapy must be gentle. ECT is contraindicated. Psychodynamic psychotherapy is the treatment of choice. Within its context, hypnosis may be valuable for dealing with serious conflicts among alters and, when used synthetically, to help the individual "recognize, consider, and utilize his various past and present experiences, impulses, and purposes for better self-understanding and increased self-direction." Intervene therapeutically with concerned others when necessary. Do not dramatize amnesia; assure the patient he will recover his past when he is able. Bowers et al. cautioned against irresponsible misuse of hypnosis, lest splitting be worsened, yet their classic article did not list "acceptable techniques" as there was a lack of space. Bowers and two co-authors, Newton and Watkins, in personal communications in a recent source within the rubric of the constructive use of hypnosis.
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