This author has modified the technique by allowing the affect to change. One thereby learns about the connection of affects, ideas, and memories. For example, one may start out with anger and trace it back in time to an event where fear was involved as well. At this point, fear could be traced in a similar fashion and might yield information about an incident of child abuse. Such discoveries help to unify the affect and the historical information.

If the information about an event was so overwhelming as to force sequential memory encoding across personalities, then the best way to retrieve it is to start with the facts of the event and discover who knows about it (not necessarily gathering the details). Next, locate the personality who has the last piece in the sequence. Obtain what information it has and from whom it took over. Follow this chain backwards using hypnosis to call forth the personalities and to calm them, allowing them to relate the needed information. While this discovery process is going on, each personality can be desensitized by multiple abreaction techniques, learn coping skills via rehearsal in fantasy, and gain mastery through hypnotic manipulation of the contingencies.

Age regression and age progression techniques are useful for gathering information about specific life events. A patient known to have two lines of personalities can be given a set of ideomotor signals: movement of index finger would be understood to mean yes, thumb--no, and little finger--stop. Stop is used to give the patient some control and avoid a forced choice situation.

This author uses the term "cue words" (or phrases) to describe the word(s) established as hypnotic induction cues or signals. Caul first described their usefulness in MPD especially for the protection and the therapist. Cues cannot be relied upon exclusively for this. However, they do reduce the time spent on induction, especially if one is going to do multi-level work (for example, using hypnosis of one personality to contact a second which will be treated hypnotically).

Cue words are valuable in negotiating matters such as who will be in control of the body and when. In this way certain goals can be accomplished and internal disputes can be settled before an incapacitating escalation of conflicts takes place. For example, a personality dedicated to hedonism and another trying to complete graduate school might be helped to an accommodation.

After needed information is gathered, the psychodynamic issues of each personality must be worked through so that integration will yield a functional whole, not one paralyzed by conflict. This phase of therapy is done with or without hypnosis, as circumstances suggest. For an excellent discussion of the fate of integrations based on insufficient working through, see the outcome data reported by Kluft, who also discusses other pitfalls.

The next step toward integration, or fusion, is the establishment of co-consciousness: the ability to communicate with, and be aware of what other personalities are thinking and doing. This can be established initially using the therapist as the "switchboard." with each personality telling the therapist and the therapist telling whomever. Later it may be done via an Internal Self Helper (ISH), internal group therapy with the ISH or therapist as group leader, or without any intermediary. At this point, integration may occur spontaneously, but often needs a push and the aid of a ritual, usually hypnotic.

Integration ceremonies have been described by Allison, Braun, and Kluft. They use various fantasy techniques such as going into a library, reading about, and absorbing others: various forms of flowing together as streams into a river or the mixing of red and white paint to get pink, etc. Some fragments may use the image of being dissolved like an antibiotic capsule whose energies/medicines get absorbed and circulated throughout the system/body.

Successful and lasting integrations have psycho-physiological components. Some patients report that stimuli are greater, things and colors seem sharper, color blindness is lost, allergies are lost or found, eyeglass prescriptions need changes, insulin requirements change drastically, etc. At first reading, there also appear to be neurophysical changes that go along with the psychophysiological ones.

The final integration which meets Kluft's criteria still represents only about the 70% mark of therapy. If the patient has not learned self-hypnosis before teaching it is valuable at this time. It can be used to learn new coping skills such as relaxation, assertiveness training, rehearsal in fantasy, etc. For protection from overstimulation, an adaptation of Allison's "egg shell" technique is very useful. One imagines a healing white light or energy entering the body (via the top of the head, unbilicus, etc.), filling it up, coming out through the pores and laying on the skin as a semipermeable membrane. This membrane is as moveable as the skin, but protects the patient from the "slings and arrows" of life like an armor.

It serves to damp down stimuli so they can be observed and registered without inundating the patient and causing blocking, denial, and additional dissociation. The patient needs to be assured and reminded that stimuli will be moderated so that they may be responded to appropriately, but nothing important will be missed.

Deep hypnotic trance can be used (like meditation) as a coping skill and healing process. This is equally true both before and after final integration. I first learned of this from M. Bowers, in October 1978. The patient is placed into, or goes into, a deep trance and continues to deepen it over an extended period of time. Usually, it is suggested that the mind will be blank until a prearranged signal is heard. This may be an alarm clock, a danger stimulus, or a cue from the therapist.Occasionally it is useful to suggest that the patient will work unconsciously on "X," or have a dream about "X."

SUMMARY

Patients with multiple personality disorder are, as a group, highly hypnotizable. No significant evidence has been published which causally links judicious heterohypnosis to either the creation of multiple personality disorder or the creation of new personalities, though the demand characteristics of the situation in which hypnosis is used may aid in the creation of a fragment. Hypnosis is a useful tool when used with multiple personality disorder, for diagnosis and both for pre- and post-integration therapy. The major limitations to its use are the skill and experience of the hypnotherapist.

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