Creative mastery in hypnosis and hypnoanalysis : a festschrift for Erika Fromm 9781315827544, 1315827549, 9781317844174, 1317844173, 9781317844181, 1317844181, 9781317844198, 131784419X, 0805808329

Table of contents :
Content: Pt. 1. The work and influences of Erika Fromm --
pt. 2. The nature of hynosis --
pt. 3. The clinical relevance of hypnosis --
pt. 4. The mechanisms of change in therapy --
pt. 5. Clinical applications and new directions.

Citation preview

CREATIVE MASTERY IN HYPNOSIS AND HYPNOANALYSIS A Festschrift for Erika Fromm

Edited by

Margot L. Fass • Daniel Brown

CREATIVE MASTERY IN HYPNOSIS A N D HYPNOANALYSIS A Festschrift for Erika From m

CREATIVE MASTERY IN HYPNOSIS A N D HYPNOANALYSIS A Festschrift for Erika F rom m

Edited by

M arg o t L. Fass Clifton Springs Hospital, N Y

D an iel B ro w n The Cambridge Hospital

Routledge ¡¡¡^^ Taylori*FrardsGroup NEW YORK AND LONDON

Cover art is an original lithograph by Margot L. Pass, inspired by Erika Fromm

First Published by Lawrence E rlbaum A ssociates, In c., Publishers 365 Broadw ay H illsdale, New Jersey 07642 Transferred to Digital Printing 2009 by Routledge 270 M adison Ave. New York NY 10016 27 Church Road, Hove, East Sussex, BN3 2FA C opyright ® 1990 by Lawrence E rlbaum Associates, Inc. All rights reserved. N o p a rt o f the book may be reproduced in any form , by p h o to stat, m icroform , retrieval system, o r any other means, w ithout the p rio r w ritten perm ission o f the publisher.

Library o f Congress Cataloging-in-Publication Data C reative m astery in hypnosis and hypnoanalysis : festschrift fo r Erika From m / edited by M argot L. Pass, Daniel Brown, p. cm. Includes indexes. ISBN 0-8058-0832-9 (c) 1. H ypnotism —T herapeutic use. 2. Psychoanalysis. 3. From m , E rika. I. F rom m , E rika. II. Fass, M argot L. II. Brown, Daniel P ., 1948RC495.C74 1990 615.8'512 —dc20 90-3792 CIP

Publisher’s Note The publisher has gone to great lengths to ensure the quality o f this reprint but points out that some im perfections in the original may be apparent.

To the furtherance o f grow th, mastery, and creative interaction be­ tw een guide and follower, therapist and patient (or client), teacher and student, for all o f our m utual enhancement and enlightenm ent.

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CONTENTS

Preface Margo! L. Fass and Daniel Brown Forew ord Martin Orne

PA RTI T H E W O R K A N D IN F L U E N C E S O F ERIKA F R O M M 1

2

3

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E rika From m : An Intellectual H istory Daniel Brown

3

Erika From m as C o n trib u to r to H ypnosis, H y p n o th erap y , and H ypnoanalysis Ernest R. Hilgard

31

R eflections on H y pnosis and Related T opics Doris Gruenewald

35

A Personal Experience W ith Self-I Iypnosis and C reativity Andrew M. Greeley

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CONTENTS

PART II T H E N A T U R E O F H Y PN O SIS 5

6

7

C ognitive and Psychophysiological Correlates o f H ypnotic Responsiveness and H ypnosis Helen J. Crawford

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C ognitive Dissonance and the Responsiveness o f H ighly H ypnotizable Subjects Eugene Levitt, Elgan L. Baker, and Timothy L. Hulsey

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Phenomenological Explorations o f Self-H ypnosis Stephen Kahn

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PART III T H E C LIN IC A L RELEVANCE O F H Y PN O SIS 8

9

10

11

Clinical H ypnosis: A Psychodynam ic Approach Germain Lavoie

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The Clinical Relevance o f H ypnotic Susceptibility Philip Spinhoven

107

H ow H ypnosis May Potentiate Psychotherapy Jean Holroyd

125

Sequelae to Clinical and Experim ental Hypnosis Billie S. Strauss

131

PART IV T H E M E C H A N ISM S O F C H A N G E IN THERAPY 12

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14

From the Magical Wish to the Belief in the Self Marlene R. F.isen

147

The C reative Process in H ypnotherapy Peter B. Bloom

159

H ypnosis as a Tool for Facilitating Change in Short-T erm Psychoanalytic Psychotherapy: O n Alloying the Gold o f Analysis w ith the C opper o f Suggestion 169 Mark C. Sexton and Michael R. Nash

CONTENTS

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T he Problem -S olving N atu re o f H ypnosis: Its U se W ith C o rp o rate M anagers Daniel Araoz

PA R T V C L IN IC A L A P P L IC A T IO N S A N D N E W D IR E C T IO N S 16

T he Variable L o n g -T erm Effects o f Inccst: H ypnoanalytic and A djunctive H y p n o th erap eu tic T reatm ent Daniel Broum

17

W riting A ssignm ents and H ypnosis in the T reatm ent o fT rau m atic M em ories Onno van der Hart, Suzette Boon, and Ghisaitte B. van Everdingen

18

Ego- State Transferences in the H ypnoanalytic T reatm ent o f D issociative Reactions John G. i-Vatkins and Helen H. Watkins

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O n Silence and th e H olocaust: A C o n trib u tio n to Clinical T heory Arnold Wilson

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H ypnoanalysis for Structural Pathology: Im pairm ents o f Self-R epresentation and C apacity for O bject Involvem ent Elgan L. Baker References A uthor Index Subject Index

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PREFACE

T his book was w ritte n in response to a need w e recognized in ourselves, and after inquiries am ong E rika F ro m m ’s students, colleagues, and friends. O n the occasion o f her 80th b irthday, a Festschrift seem ed to be the m ost appropriate w ay to pay hom age to her personal and professional influence on all o f us. T he fact th at proceeds from the sale o f the b o o k w ill go to an Erika From m Scholarship F und to assist students w ith an interest in hypnosis, w ill ensure that her w id e-ran g in g effects on others w ill continue into posterity. Ideally, a Festschrift w o u ld be m ade up entirely o f original scientific and scholarly papers. H o w ev er, to adequately represent authors w h o have been close to and profo u n d ly influenced b y D r. F rom m , a few selections are revisions o r reprints o f already published papers. It should be clear from the b read th and d epth o f th e co n trib u tio n s to this volum e that she has had a seminal and pro fo u n d influence on th e clinical and research literature in hypnosis and related areas. T he b o o k 's contents are w ritten by persons w h o have w o rk ed closely w ith and/or have been signifi­ cantly influenced by her. T he authors have refined, expanded u p o n , revised, and conducted research in m any areas that D r. F rom m has explored in her m ore than 100 publications on the subjects o f hypnosis, self-hypnosis, hypn otherapy, and hypnoanalysis. Professional therapists w’ith an interest in personal g ro w th , self-aw areness, and creative m astery, w h eth er o r n o t they already have an interest in h y p n o ­ sis, should be well rew arded for reading this b o o k . I f the reader has p rev i­ xi

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ously eschewed hypnosis, the integrity o f the authors is so clear that the book m ight well stim ulate an initial interest that can only enrich clinical practice or research. The scope and treatm ent o f the subject m atter and organization o f the book are evident from the table o f contents. The subject m atter ranges from a detailed accounting o f Erika F rom m ’s professional biography and personal observations from friends and colleagues, to creative synthetic expandings o f awareness about process and w ell-controlled research analyses o fbiopsychosocial hypnotic phenom ena. Applications o f scientific theory and principles o f treatm ent to particularly difficult clinical situations are also explored. All are on the cutting edge o f advances in the field. The student m ight derive the most comprehensive sense o f the develop­ m ent o f D r. F rom m ’s career, which in turn has influenced the m aturation and fruition o f the w ork o f others, by reading the book from beginning to end. A lternatively, the reader m ight effectively brow se th rough it, focus on a particular area o f interest, and then allow him or herself to be led from one fascinating chapter to the next. T he collection is unique in that it represents the contributions o f those persons w ho w rite in the area, and were m ost touched by our request for papers. They responded quickly and cooperated w ith tight deadlines. We have found them all to have been dedicated, responsible, and m otivated to jo in in this labor o f love—a dem onstration o f their aftection for D r. Fromm and respect for her achievements. There are friends, colleagues, and students o f D r. From m w ho w ould have liked to have contributed to this Fcstschrift, bu t because o f the need to prepare the final product by the fall o f this year, we w ere unfortunately unable to include their offerings. We are nevertheless grateful to them for their w arm response. It is impossible to think o f one o f our ow n family members, therapists, patients, teachers, students, employers, employees, friends, or colleagues w ho has not helped in some w ay, large or small, to realize this project. The process o f w orking on it has enriched us personally in terms o f new positive relationships. O ne result has been a m utual expansion o f affection and respect that now includes a larger “ fam ily” for us all. It is intriguing to be a participant observer in the midst o f the pow erful effect D r. From m has in magnetically mobilizing healing energy that leads to self-actualization. This in turn results in an urge to contribute to the actualization o f others, and thus o f course, in further benefits to ourselves in the ever w idening netw orks in w hich w e develop.

ACKNOWLEDGMENTS This project grew out o f the enthusiasm , creative energy, and willingness to w ork hard that Erika From m inspired in her many students and colleagues.

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We w ould like to thank the m any individuals w ho supported the idea o f the Festschrift w ith constructive suggestions and original or reprinted contribu­ tions. Publishing this book in time for Erika F rom m ’s birthday required consid­ erable devotion. The editors w ould like to thank each author for subm itting their excellent chapters and responsibly responding to editorial queries, both often on very short notice, and being patient w ith and accepting the som e­ times significant changes needed to bring each chapter into a consistent volume. Each publisher w ho gave us perm ission to reprint, adapt, and/or translate material deserves not only recognition but an expression o f our appreciation as well. It was easiest to obtain perm ission to republish a modified version o f the “ Forew ord,” by Ernest H ilgard from Daniel B row n and Erika F rom m ’s book Hypnotherapy and Hypnoanalysis, one o f Lawrence Erlbaum Associates’ m ost successful technical publications. Given that Father Greeley has been a best selling author since his hypnotic experience w ith Erika From m , it also is not surprising that Simon & Schuster, publisher o f A ndrew G reeley’s Con­ fessions o f a Parish Priest, has given perm ission to use a portion o f the “ P ro ­ logue” o f that book. Guilford Press published Erika From m and Stephen K ahn’s book Self Hypnosis: The Chicago Paradigm in this year. D r. K ahn used parts o f this for his chapter, without telling D r. From m about it! Guilford Press was good enough to keep the secret from her, overlooking protocol for the sake o f the surprise. The translated and slightly modified chapter by G ermain Lavoie, first published in Psychiatrie Clinique: Approche BioPsycho-Social, Gaétan M orin Editeur, was w'ell received in its original version in French. Jean H o lro y d ’s chapter “ H ow H ypnosis M ay Potentiate Psycho­ therapy” was first published under the same title by the American Society o f Clinical H ypnosis in their ow n journal (Vol. 29, N o. 3) in January 1987. Dr. H olroyd selected this as being most representative o f the frequent correspon­ dence betw een hers and D r. F rom m ’s thinking. A considerably modified version o f Peter B loom ’s “ The Art o f Medical H ypnosis and T herapy” appears w ith the perm ission o f the Swedish Society o f Clinical and Experi­ mental H ypnosis, w ho originally published it in H Y P N O S (Vol. XVI, N o. 2, 1989). It is fitting that it should appear here, as this was D r. B loom ’s first published paper. H e tells us that D r. From m greatly encouraged him to present and w rite this material. The Analytic Press gave perm ission for reprinting the chapter entitled “ O n Silence and the Holocaust: A C o n trib u ­ tion to Clinical T h eo ry ” as it was w ritten by A rnold W ilson in Psychoanalytic Inquiry (Vol. 5, N o. 1, 1985). D rs. W ilson and From m collaborated in 1982 on a paper on this subject. O u r thanks go also to a num ber o f people w ho subm itted excellent material that w e w ere unable to include in the Festschrift. A m ong these individuals are some o f Erika F rom m ’s long-standing friends and colleagues: Sidney Blatt, Richard H orevitz, Cam pbell Perry, and Erika Wick. Some o f these individ­

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uals subm itted quite original w orks, w hich clearly w ould have been included under norm al circumstances, were it not for our tight publication date. We particularly thank our secretaries, M argaret N o rto n an d jo an M arconi, for their devoted hours spent m oving correspondence along, typing, m aking phone calls, checking references, gathering materials for the volum e, and entering substantial inform ation into the com puter. M ost im portantly they provided cheerful moral support and kept us organized. There were colleagues w ho relieved us o f other responsibilities, including William Swingly, Rashmikant Sangani, and D enish N anavati, w ithout w hose support w e w ould not have had the time to devote to meeting our stringent deadlines. Larry Erlbaum and R obin W eisberg o f LEA both personally orchestrated the production o f this book, and saw to its m aking a production schedule in order to be ready for Erika F rom m ’s 80th birthday party. Wc especially thank them for this. W ithout the considerable assistance o f everyone involved, it is hard to im agine that this book w ould have been in print less than a year and a half after its conception. With profound and fervent passion, w e w ould like to thank our families for their considerable patience and understanding as we developed this volum e. They probably knew better than w e did how m uch tim e and energy it w ould take to prepare and com plete it. A lthough the w o rk may have decreased the quantity o f tim e w e are used to and prefer spending w ith them , hopefully our involvem ent increased the quality o f that time. The privilege o f w o rk in g on the book w ith one another and w ith the fine ideas and persons that have become a part o f it has further enhanced our ow n sense o f Creative M astery, by w hich we hope o u r families, friends, and patients may benefit. Finally, we thank you, our readers. If you merely read this book, w e hope you, too, will further your sense o f Creative M astery, and the already wide ranging beneficial effects and influences o f Erika F rom m ’s lifetime to date w ill be felt even m ore profoundly. Y our purchase o f this book will further her w ork m ore, as all proceeds will be donated to the Erika From m Fund o f the Society for Clinical and Experim ental H ypnosis (SCEH), o f w hich she was a founding m em ber. This fund will be used to further scholarship and research in hypnosis. W ithout the psychological support o f the SCEH , particularly from M artin O rne, Kenneth Bowers, and M arion Kenn, this book w ould not have hap­ pened in quite this same way. Please feel free to join , participate in, and support this fine organization! Margot L. Fass Daniel Brown

FOREWORD

It is a rare h o n o r to be asked to w rite a F o rew o rd to the Festschrift for D r. Erika From m , on the occasion o f her 80th b irthday. Let me digress a b it and rem ind you o f the n o w classic film by Frank C apra entitled It’s a Wonderful Life, in w hich the view er is sh o w n w h at life m ight have been like for the people o f a sm all to w n had a decent m an (played b y Jim m y Stew art) never existed. As in this film, it often proves illum inating, w hen considering the contributions o f som eone’s life w o rk , to ask rhetorically w h at m ig h t be the present reality i f the person had n o t been involved. I posed this question as I pondered the celebration m arked b y this Festschrift for m y lo n g -tim e friend, colleague, and intellectual provocateur, Professor E rika From m . T he answ er is a testam ent to the extraordinary person she is and to the lasting co n trib u ­ tions she has m ade to the study o f the h um an m ind d u rin g the 57 years since she received her doctorate. B y any standard, E rika F rom m has charism a— th e charism a b o rn o f a stro n g sense o f self, o f a com m itm ent to honesty and standards, o f dedication to helping as m any people as possible. T h ro u g h o u t her life as a teacher, observer o f hum an behavior, and therapist, she has used her charisma to help em pow er students, colleagues, subjects, and m o st especially, patients. A bove all else, she has p rovided o v erw helm ing evidence for the im portance o f em pow erm ent in healing— em p o w erm en t th ro u g h an understanding o f psy­ chodynam ic ego-p sy ch olo g y , th ro u g h phenom enological self-know ledge, th ro u g h the application o f hypnoanalysis, and th ro u g h the teaching o f p er­ m issive h etero-h y p no sis and self-hypnosis. T he seminal ideas and practices she articulated in these areas have stood the test o f time. xv

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In perhaps no other area o f the m any contributions she has made is her insight and creative potential m ore evident than in her use o f hypnotic imagery. Possessing w hat can only be described as an extraordinary ability, Erika can quite literally and metaphorically lead a patient by the hand dow n a w inding spiral staircase covered in a soft, thick, deep purple carpet, to reach a point at w hich the patient can examine at his or her ow n pace the many treasures buried deep in the psyche. The point is that she is capable o f helping the patient gain m astery over an im agery that em pow ers the patient to explore deep-seated conflicts in a context that is enriching and forw ardlooking. Even for a patient w ho is not endow ed w ith the skill to be a hypnotic virtuoso, hypnosis becomes a very special experience as the patient follows Erika’s lead dow n a path o f rich imagery, w hich can uncover new avenues and approaches for the patient to try yet again in a m ore creative w ay to gain insight, and to solve problems. O ne has to witness her w o rk in this most personal o f domains to fully appreciate the im mediate and intim ate rapport she can establish by her skillful use o f imagery. Similar to the w ay in w hich the H ilgards resurrected the field o f hypnosis through the developm ent o f the behavioral, standardized scales o f heterohypnotizability and the ensuing systematic research program , Erika From m has pioneered a rich self-hypnosis paradigm for the laboratory and clinical contexts that points the w ay for future researchers and serious clinicians to revitalize the field and allow the im pact o f the therapeutic alliance to travel w ith the patient into his or her everyday life. H er innovative w ork on self-hypnosis and subjective experience has been a to u r-de-force in ad­ dressing fundam ental questions, including investigations o f the phenom eno­ logical differences betw een hetero- and self-hypnotic experiences, and the manner in w hich self-hypnosis is most effectively used in therapy. This volum e highlights the m any areas in w hich Erika From m ’s interests, ideas, and contributions have made a major difference. She has been a pioneer, not only in the clinical and empirical understanding o f hum an behavior through hypnoanalysis, bu t also in the establishment o f reasonable standards and practices w ith regard to the therapeutic use o f hypnosis and self­ hypnosis. As a leader am ong her peers, she has set im portant and lasting standards as Clinical E ditor o f the International Journal of Clinical and Experi­ mental Hypnosis and as a Past President o f the Society for Clinical and Experim ental H ypnosis. M ost im portantly, her life and her w ork have been an inspiration to her students and colleagues alike, and reminiscent o f the character played by Jim m y Stewart, she has made a lasting difference to those w ho have been fortunate to know her and her w ork. Martin T. Orne, MD, PhD Professor, University of Pennsylvania Director, Unit for Experimental Psychiatry The Institute of Pennsylvania Hospital

I THE WORK A ND INFLUENCES OF ERIKA FROMM

The first section o f this Festschrift provides an overview o f the w ork and influence ofE rika From m . Daniel B row n(chapter 1), one o f F rom m ’s students and colleagues for nearly 20 years, traces the developm ent o f From m ’s ideas and significant con­ tributions over nearly six decades. He places particular em ­ phasis on her evolving ego-psychoanalytic perspective and its relevance to her understanding o f dreams, hypnosis, self­ hypnosis, and other altered states o f consciousness and also to her hum anistic values orientation in treating patients in h y p ­ notherapy and hypnoanalysis. From m consistently emphasizes a few them es in her w ork: receptivity to preconscious and unconscious processes as manifested prim arily in imagery; creative coping and mastery; the active problem -solving ef­ forts o f the individual; and the h ere-an d -n o w reality-based relationship betw een patient and therapist, subject and exper­ im enter, and teacher and student. These them es all reflect her belief in the ability each individual has to discover and master life problem s w hen provided w ith the right kind o f supportive relationship. A modified version o f Ernest JR. H ilgard’s forew ord to Hypnotherapy and Hypnoanalysis (chapter 2), F rom m ’s main clin­ ical textbook (Brown & From m , 1986), w ritten by a leading

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PART I: WORK. INFLUENCES OF ERIKA FROMM

authority on hypnosis, stands as a testim ony to “ the substantive nature o f Erika F rom m ’s contributions to the field o f hypnosis, and to the quality o f clinical w ork done by a practitioner w ho has bccome one o f the leading hypnoanalysts in the w orld. We have also included a m ore personal reflection by another seasoned hypnoanalyst on h o w Erika From m influenced the developm ent o f her ow n ideas. In ’’Reflections on H ypnosis and Related T opics“ (chapter 3), D oris G ruenew ald discusses her ideas and personal observations about the dom ain o f hypnosis, w hich she secs as a multidim ensional continuum that includes such factors as suggestibility, im agery capacity, m em ory alteration, role playing, and dissociation. This personal account indicates how Erika From m influenced the developm ent o f another hypnoanalyst’s ow n thinking. The last section is an even m ore personal account o f Erika From m ’s influence. We have included (chapter 4) an excerpt from A ndrew M. Gree­ ley’s Confessions of a Parish Priest. H e opens this autobiography w ith an account o f his first experience w ith hypnosis. T hrough an hypnotic age regression facilitated by Erika From m , Greeley learned to appreciate the richness o f the mem ories, images, and feelings that hypnosis made available to him . A ccording to his ow n account, the personal experience was so com pelling that it opened an inner w orld o f creativity to him —a w orld that he has tapped productively ever since through the m any novels he has w ritten. H e is one o f many persons profoundly affected by the quality o f relationship Erika From m can establish w ith others and her ability to enable them , through hypnosis, to discover and explore their o w n rich w orlds o f inner resources.

Chapter 1 ERIKA FROMM: AN INTELLECTUAL HISTORY DANIEL BROWN The Cambridge Hospital /Harvard Medical School

EARLY INFLUENCES In a recent professional autobiography, Erika From m described tw o themes she considered m ost im portant in shaping the developm ent o f her professsional career (Fromm, 1987a). First, she always considered herself a “ rebel against orthodoxy ” (p. 207). Just as she rebelled as an adolescent to the very strict orthodox G erm an Jew ish household, th ro ughout her adult life she has always actively questioned and challenged the status quo o f society. W hether it be w ith respect to religion, science, psychoanalysis, o r politics, as a scientist and clinician, Erika From m has never adhered to an approach or established set o f ideas w ithou t first questioning its basic assum ptions. M uch in the spirit o f a pioneer she applied this attitude as a useful means o f forging new directions in many areas o f inquiry. Second, as a refugee from N azi G erm any, she had w atched the Nazis gain pow er during her adolescence. H er deep distrust o f the em pty rigidity o f the religious orthodoxy o f her childhood was com pounded by her h o rro r o f w atching the developm ent o f her fellow countrym en’s blind allegiance to the new and far m ore irrational and destructive orthodoxy o f Naziism. H er profound disillusionment in the follow ers o f this new and insidious m ove­ m ent left its lasting m ark. Erika From m fled from G erm any to H olland shortly after finishing her doctorate degree, and to this day she considers H olland, not G erm any, her hom e country. Since adolescence she has not spoken a w ord o f G erm an, w hile deligh ting in the chance to visit H olland and speak D utch again. 3

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Erika From m studied psychology at The U niversity o f Frankfurt under the Gestalt psychologist, M ax W ertheim er, and psychopathology w ith K urt Goldstein. Training in the Zeitgeist o f Gestalt psychology clearly affected F rom m ’s w ay o f thinking and approaching problem s. For example, W ert­ heim er (1945) was quite interested in “productive thinking.” Based on Gestalt principles, productive thinking w as a departure from traditional logic and also from associationism. Productive thinking is an attem pt to overcom e the in­ fluence o f habitual conceptions and routinized ways o f approaching a p ro b ­ lem. The productive thinker is aware o f the relationship betw een elements and strives to restructure the elements into some new organization or new way o f asking a question about the subject, until all the elements fit together into a new Gestalt. This approach m ust have had appeal for a young Erika Fromm. K urt G oldstein (1963) m ost influenced F rom m ’s approach to clinical psychology, especially to psychological testing. G oldstein emphasized the “ organism as a w ho le.” W hen a variety o f psychological tools are used to study individual traits, the individual is view ed in a piecemeal fashion as a collection o f various capacities and deficiencies. G oldstein emphasized the study o f the total personality o f the patient. G oldstein’s w o rk focused on patients w ith organic brain conditions. H e was particularly interested in the “ concreteness” o f brain damaged patients, (i.e., the loss o f abstract ability). H e also focused on the brain damaged patient’s disorganized perform ance on selected tasks caused by w hat he called the “ catastrophic anxiety” experi­ enced by such patients. While focusing on these particular attributes o f brain dam aged patients, G oldstein continued to emphasize the im portance o f keeping sight o f the total person. From m first became aware o f Freud’s w ork w hen she w as 15. She discov­ ered a num ber o f Freud’s w orks hidden behind a row o f other books in her father’s library. She secretly poured th rough the pages o f these seemingly forbidden w orks. From her early reading she developed an understanding o f unconscious m otivation and o f the operation o f impulses and defenses. H er interest in dynamic psychology continued throughout her graduate training, her clinical w o rk in H olland, her externship under Samuel Beck at Michael Reese H ospital in Chicago in the late 1930s, and her formal psychoanalytic training in the late 1940s and early 1950s.

THE INTEGRATION OF ORGANICITY AND PSYCHODYNAMICS From these disparate intellectual roots Erika From m faced the formidable task o f integrating the Gestalt psychology o f W ertheim er, G oldstein’s views o f psychopathology, and Freud’s classical psychoanalytic theory. M uch in the spirit o f Gestalt psychology From m strove to integrate biological and psychodynam ic perspectives on psychopathology into an understanding o f

I.

An Intellectual H istory

5

the total personality. D ynam ic and biological theories represented different perspectives on the organism as a w hole. H ow ever, G oldstein him self had rejected drive theory. A lthough he believed in unconscious processes—w hat he preferred to call “ nonconscious phenom ena” —he did not believe that these phenom ena were the result o f persistent childhood experience. In that sense, G oldstein’s theory was nondynam ic. From m could never accept this part o f G oldstein’s thinking.

THE INTERFACE OF ORGANICITY AND PSYCHODYNAMICS Some o f From m ’s earliest professional w riting reflects G oldstein’s interest in organic brain conditions. She attem pted to discrim inate betw een and to integrate psychodynam ic and biological perspectives on psychopathology. H er earliest w orks in H olland, for example, concern themselves w ith mental retardation (O ppenheim er, 1936), infection-induced dementia (O ppenheim er, 1937), and a case o f deaf-m uteness (Fromm, 1946). In this latter case study o f an invalid 10-year-old, she was able to elucidate the complex interaction betw een organic determ inants (complications from a m iddle car infection) and psychodynam ic determ inants (selective inattention to fearful sounds in the service o f self-preservation) Some o f her later papers in America reflect continued interest in this area. She devised a battery o f psychological tests to assess organic and psycholog­ ical sequelae to anoxia during labor and delivery (Benaron, et al.,1960). Follow ing the developm ent o f her interest in hypnosis in the early 1960s, she devised a series o f hypnotic experiments to distinguish betw een the effects o f organic and psychological factors contributing to brain damage (Fromm, Sawyer, & Rosenthal, 1964; G ruenewald & From m , 1967). She used the hypnotic state to “ suggest” brain injury to hypnotizable subjects. The re­ sponses o f the hypnotic subjects simulating the brain condition w ere com ­ pared to various control conditions and scored by criteria for assessing organicity. From m and her colleagues concluded that hypnosis could be used to produce all o f G oldstein’s classic signs o f organicity (catastrophic anxiety, concreteness, and fatigability) in the absence o f brain damage in hypnotizable subjects. The im plication o f these studies is consistent w ith w hat is relatively recently well know n (i.e., that seemingly organic signs sometimes can be produced by psychological means).

PSYCHOLOGICAL TESTING: INTELLECTUAL ABILITY AND PSYCHODYNAMICS AS AN EXPRESSION OF THE TOTAL PERSONALITY For the first tw o decades o f her professional life, From m w as one o f a num ber o f psychologists w h o pioneered the use o f psychological testing. Because o f

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her early interest in Gestalt theories o f perception, it is no accident that From m became particularly interested in the Rorschach as a psychological instrum ent. She learned the Klopfer m ethod o f scoring in Europe. Later she studied the Beck scoring system w ith D r. Beck in Chicago. In the 1940s and early 1950s she w orked prim arily as a child psychologist. She administered scores o f psychological test batteries to children and, to a lesser extent, to adults w ithin the greater Chicago area. At the time that From m first arrived in H olland (1934/1935), psychologists did not hold positions in hospitals, w hich w ere run by psychiatrists. She w orked as a research associate at The U niversity o f A m sterdam and was able to convince an influential psychiatrist at a large state hospital o f the valuable contribution that psychological testing could make to diagnosis. As a result, a num ber o f hospitals in H olland began to hire psychologists (Fromm, 1987a). In America, other Nazi refugee psychologists like D avid Rapaport w ere destined to make a similar im pact and to contribute to the grow ing appreciation o f psychological testing and the role o f the psychologist in the m ental health profession. From m ’s interest in psychological testing reached m aturity in her book, Intelligence—A Dynamic Approach, co-authored w ith Lenore H artm an (Fromm & H artm an, 1955) This volum e, and similar w orks, represent a continuation o f her ongoing attem pts to integrate organic and dynamic theory (Fromm, 1960; From m , H artm an, & M arschak, 1954, 1957). M any o f the psycholog­ ical tests she adm inistered to children in the 1940s consisted o f age-specific intelligence and aptitude tests. Since B inet’s introduction o f standardized intelligence tests in the early 1900s, intelligence was view ed in American psychology as a genetically determ ined ability. From m b ro ught to the A m er­ ican tradition o f intelligence testing no t only her background in Gestalt psychology, but also in dynamic psychology. H er perspective on psycholog­ ical testing again called for an integration o f the presum ed organically determ ined notion o f intelligence as a genctic trait and dynamic personality functioning, both aspects o f the total G estalt o f the person. In a m anner akin to Rapaport, Gill, and Schafer’s classic Diagnostic Psychological Testing (1945/1946), From m and H artm ann (1955) in their book, also argue for an appreciation o f the dynamic significance o f individual items on the various intelligence tests. T heir w ork suggests that the psychologist needs to look beyond the objective pass-fail response to a given test item to the possible dynamic variables involved, including the idiosyncratic nature and meaning the item may have to the respondent. In a systematic study, From m and her associates outlined about 50 vari­ ables that could affect responses to intelligence test items. A lthough Rapaport convincingly had show n the dynamic significance o f WAIS subtest scores and responses to individual item s in each subtest, From m and her colleagues applied this analysis to about 18 standardized intelligence tests com m only

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used by psychologists at the time. A ccording to her view , a variety o f im pulses, ego functions, and superego variables potentially influence re­ sponses to children’s intelligence tests at every age level, from infancy th rough adolescence. Any given item on an intelligence test can tap a wide variety o f personality dimensions. In this sense, F ro m m ’s w ork, m uch like R apaport’s, stands as an im portant contribution to the evolution o f psycho­ logical testing practice in America and especially to the value and credibility psychological testing has achieved w ithin the clinical disciplines.

PSYCHOANALYTIC INFLUENCES Short-Term Psychoanalytic Psychotherapy Erika From m received her formal psychoanalytic training at the Chicago Institute for Psychoanalysis during the days o f Franz Alexander and Thom as French. In those days, the C hicago Institute was unique am ong American psychoanalytic institutes in its departure from psychoanalytic orthodoxy. From m again thrived in the “ rebellious” atm osphere o f the C hicago Insti­ tute. The pioneering spirit o f Alexander and French is best captured in a ground breaking volum e entitled, Psychoanalytic Therapy: Principles and Appli­ cation (Alexander & French, 1946). This book was the result o f a clinical research study that focused on a search for a shorter and m ore efficient treatm ent than psychoanalysis had heretofore allowed, by attem pting to extract from analysis its basic therapeutic principles. The volum e, which marked the beginning o f the psychoanalytic psychotherapy m ovem ent, was not well received b y m any psychoanalysts, w ho did not believe that quick therapeutic results could yield lasting changes in the dynamics and character structure o f the patient, and w ere also likely to have been threatened by the book’s economic implications. M om entum developed w ithin the psychoan­ alytic profession to influence the Chicago Institute to curtail distribution o f the volum e if the Institute w ished to retain its association w ith the American Psychoanalytic Association. A lthough the b o o k ’s professional m arket was lost, its ideas were not. From m was deeply influenced by its socially responsible and ethical message, namely, to provide the quickest, least expensive, and yet m ost effective treatm ent possible, as an expression o f the clinician’s assertion o f the primacy o f the patient’s welfare. Later, she w ould take these ideas to a greater extreme that made some mem bers o f the C hicago Institute’s orthodoxy uncom fort­ able: H ypnoanalysis could provide a means o f treatm ent that is quicker and as effective than even psychoanalytic psychotherapy. She came to believe that

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w hat could be done in 3 years o f psychoanalysis could be done in 3 m onths, sometimes even 3 hours o f hypnoanalysis (B row n & From m , 1986).

Dream Interpretation A t the C hicago Institute, From m developed a fruitful collaboration w ith Thom as French, the outcom e o f w hich was a new approach to dream interpretation. In the 1950s, French (1952-1958) em barked on an ambitious three volum e treatise entitled The Integration o f Behavior. A lthough there is much w isdom in these volum es they never received widespread recognition, probably because they require the reader to sift through m any complicated analyses o f clinical examples to find the essential points. O ne o f these volum es, The Intrepretation o f Dreams (Vol.2, 1954), describes a genuinely innovative approach to dream analysis. Erika From m w orked closely w ith T om French to rew o rk the ideas contained in this volum e and to make them m ore accessible to a professional audience. From m again drew on her back­ ground in Gestalt psychology for the collaboration. She resonated w ith French’s ego-psychological view o f dream ing and dream organization, as well as w ith his search for a m ethod that accounted for the “pattern o f interrelated m eanings” o f any given dream. French was influenced by F rom m ’s emphasis on articulating a m ethod to approach dream interpreta­ tion. The product o f this collaboration, Dream Interpretation: A N ew Approach (French & From m , 1964), greatly simplifies French’s earlier w ork, elaborates his earlier basic ideas, and outlines the m ethod o f dream interpretation in greater detail. Like Freud (1900) in his Interpretation of Dreams, French and From m be­ lieved that dreams are expressions o f conflict. H ow ever, they also view ed them as reflecting current real-life problem s that may reactivate past con­ flicts. U nlike Freud, they believed that people do not dream directly about the past. The past is relevant to the dream only insofar as it is activated by a current em otional situation. D ream s are, as im portantly, manifestations o f ego functioning m ore than mere derivatives o f id impulses. D ream s repre­ sented the ego’s problem -solving activity to w hich defensive operations are subordinate. D raw ing on a botanical m etaphor they describe dream activity as representing the “ cambium layer o f the m ind . . . [a] . . . level w here active grow th, problem -solving, and learning all take place” (p.188). French and From m defined a “ focal conflict” as a specific conflict that is activated in the current context o f the dream er’s life and represents the dream er’s present attem pt to solve current life problem s. A lthough a dream may allude to a num ber o f subfocal conflicts associated w ith early childhood, it is not ovcrdcterm incd in that the central conflict in a particular dream represents the dream er’s com m itm ent to resolving one conflict, as it is played

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out in the current context o f the dream er’s life. E very dream thus has a precipitating stim ulus, or real-life event that activates the ego’s problem ­ solving activity. T w o sides o f the focal conflict are w hat French and From m called the "disturbing w ish” and the “reactive m otive.” The disturbing w ish arises from a current problem , and the reactive m otive represents the dream er’s reaction to this wish (i.e., w hy the w ish was perceived as disturbing to the dreamer). French and From m also conceptualized the dream ’s “ cognitive structure.” They viewed the dream from the Zeitgeist o f Gestalt psychology in contrast to Freud’s Zeitgeist o f associationism. From the Gestalt perspective, the cognitive structure o fa dream is a specific “ pattern ofinterrelated m eanings” (French, 1954, p.4). A given dream, although fleeting, is a total and particular solution to a current em otional situation so that each elem ent in the dream sequence, and every association to each element, makes perfect sense exactly as it is reported by the dreamer.

Scientific Intuition Dream Interpretation: A New Approach exemplified F rom m ’s longstanding interest in developing a scientific approach to intuitive interpretation in psychology. H er interest in w hat she called “ scientific in tuition” traces its roots to W ertheim er’s “ productive thinking” (1945). Scientific intuition also is a m ethod for overcom ing habitual w ays o f interpreting material, testing hypotheses, and discovering the structural organization underlying the m a­ terial. From m show ed her o w n skill in scientific intuition, w hich integrated principles o f scientific m ethod, dynamic, and G estalt psychology w ith the previously m entioned deaf-m ute boy (Fromm, 1946). She devised a series o f ingenious practical tests to determ ine under w hat conditions the boy m ight react to sounds. For example, she presented the boy w ith chirping noises com ing from a w ind-up toy bird that was out o f his sight. The boy did not react to the sound. After he played w ith the toy, it was taken away. Then, w hen the bird was kept ou t o f sight, the boy reacted to the chirping noises. In subsequent sessions she used sounds from a toy cap pistol, a tuning fork, and a piano. In a systematic m anner she was able to test h er hypothesis that the boy was not deaf, bu t reacted to sounds only under very specific conditions, then developed a dynamic explanation for the b o y ’s selective deafness to unpleasant sounds. Later, From m described and recom m ended a scientific/intuitive m ethod for interpreting projective test data, especially from the Rorschach (Fromm, 1958). She saw responses to projective material like dreams, as a manifesta­

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tion o f the patient’s ego activity in solving current reality situations. She suggested that the psychologist attempting to interpret projective material begin by developing intuitions about the projective responses. H e or she then should check and recheck these hypotheses by quantitative, qualitative, content, and sequence analyses o f each projective test, until finally arriving at the total Gestalt o f the patient’s focal conflict. From m ’s methodology o f scientific intuition reaches its maturity in Dream Interpretation: A New Approach and later in the application o f her m ethod o f interpreting art (Fromm, 1969). According to Fromm, interpretation in psychoanalysis is intuitive but needs to be balanced by an “objectively critical approach” (p.22). Interpreting dreams, the language o f the unconscious, is like reading the Rosetta stone. Dream interpretation is not simply a matter o f decoding symbols, but o f capturing the spirit or central meaning o f the message conveyed by the symbols. The disciplined clinician begins by al­ lowing his or her intuitive imagination to respond to the patient’s dream report. Through intuition the clinician tries to find the central problem expressed in the dream. He or she develops a w orking hypothesis. The second stage in dream interpretation entails “ critical analysis” o f these intuitions. In a deductive manner the interpreter sifts through the dream and its associations to look for clues and parallels that might allow some elabo­ ration o f the w orking hypothesis. He or she continuously checks and re­ checks the w orking hypothesis against the evidence. H e or she also pays special attention to gaps in the evidence and material that does not fit. The skilled interpreter is disciplined enough to drop the w orking hypothesis and begin again w hen elements do not fit. In From m ’s w ords, the process of beginning again, checking and rechecking, is “painstaking.” Yet, the persis­ tent and disciplined dream interpreter finally arrives at an accurate under­ standing o f the total gestalt o f the dream. Fromm believed there is only one correct interpretation for cach dream. The interpreter must account for all the evidence o f the elements in the dream, all the associations to each element, and all the process material from the clinical session in which the dream was reported. The skilled dream interpreter is able to reconstruct the cognitive structure o f the dream and explain each and every element in the exact sequence in the dream as an illustration o f a specific problem solving attempt by the patient. Although From m clearly wished to emphasize that something as seem­ ingly undisciplined as dream interpretation could be subject to disciplined scientific method, she also believed that valid interpretation sometimes, albeit rarely, occurred by a different mechanism, namely by w hat she called an “aesthetic experience” (Fromm & French, 1962). Much like the scientist who intuitively resolves a scientific puzzle (like Kukulc and the benzene ring) in a single vision, the dream interpreter sometimes correctly grasps the total gestalt o f a dream in a single instant. Fromm believed that an aesthetic

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experience w as a legitimate means to understand a dream , H ow ever, she w arned that such an approach can go astray w hen the interpreter gets carried away w ith the “ aha” cxpericnce and fails to critically test the intuition against the evidence.

Psychoanalytic Ego Psychology In her psychoanalytic training, Erika From m was especially influenced by psychoanalytic ego psychology. Psychoanalystic ego psychology began as a reaction against Freud’s narrow view that the ego’s main function was to tame drives. The first departure came w ith Anna Freud’s (1936/1946) classic volum e, The Ego and the Mechanisms o f Defense, in w hich defenses were seen as ego functions. A short tim e later, Heinz H artm an n ’s (1958) classic volum e, Ego Psychology and the Problem o f Adaptation, appeared. H artm ann’s central concepts w ere the “ relative autonom y o f the ego” and the ego’s “ adaptive function.” H e departed from Freud’s classical libido theory and emphasized the ego’s role o f adaption to and m astery o f reality and the ego’s role in the defenses against drives that associate ego w ith conflict. A lthough early ego developm ent may be associated w ith defense against conflict, the ego later achieves a position o f relative autonom y from the vicissitudes o f im pulse life. This conflict-free sphere o f the ego contains a num ber o f ego apparatuses such as perception, m em ory, m otor functioning, language, thinking, and decision making. From m was particularly im pressed by the them es o f coping and mastery in the ego-psychoanalytic w ritings. Ives H endrick (1942) first described an “instinct to m aster.” R obert W hite (1963) posited a third independent ego energy in addition to Freud’s notions o f libido and aggression that he called “effectance.” H e believed effectance could be readily observed in the child’s playful exploratory activity and developing social compctcnce. Lois M urphy (1962) elaborated on the child’s age-specific coping abilities. R apaport (1953b) first developed the concept o f ego orientation in his essay on ego activity and passivity. H e saw the form er as show ing relatively m ore ego autonom y, actively asserting control over drives, and the later a manifesta­ tion o f relatively less ego autonom y, and lacking control over drives. He also distinguished betw een ego and behavioral activity. From m accepted the basic tenets o f R apaport’s theory o f ego orientation, b u t R apaport’s m odel was limited to the ego’s orientation tow ard drives or impulses. From m expanded the concept to include the ego’s orientation tow ard the environm ent (Fromm, 1972a) and the superego (Stolar & From m , 1973, 1974). M oreover, From m blended R apaport’s concept o f ego activity/passivity w ith H art’s (1961) w ork on the “ feeling o f choicelessness” as the subjective experience o f ego passivity. In other w ords, From m was not ju st interested in

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the metapsychological functioning o f the ego but its implications for the subjective experience o f hypnotized subjects and patients. From m ’s theory o f ego orientation consists o f tw o essential ingredients. She emphasized first the decision-m aking function o f the ego, and its subjective counterpart, the feeling o f choice or choicelessness. The second ingredient, derived from M urphy (1962), is the creative coping function o f the ego. The ego is said to be active w hen it maintains relative autonom y from the demands o f the id, superego, and/or environm ent and w hen it manifests autonom ous decision-m aking and coping functioning. The subjective experiences associated w ith ego activity are the capacity for choice and the pride o f mastery. C onversely, the ego is said to be passive w hen it loses relative autonom y to demands from the id, superego, and/or the envi­ ronm ent, and also loses its decision-m aking and coping functions. Such an individual experiences being overw helm ed and helpless in the face o f such internal or external demands. T he concepts o f ego orientation and coping came to hold a central place in the decades o f From m ’s professional career. They are critical to any under­ standing o f her approach to patients. As her clinical ideas evolved, she came increasingly to appreciate the patient’s coping resources. She conceived o f tw o kinds o f coping: creative and defensive (Fromm, 1981). It is certainly true that patients manifest defensive operations. From m , like Anna Freud, saw defenses as a function o f the (active) ego. The sensitive clinician supports this ego activity. Pushing the patient w ould have the unfortunate effect o f shifting the patient from a position o f ego activity to ego passivity, and in turn, from a sense o f control to the sense o f being overw helm ed. O n the other hand, supporting creative over defensive ego function leads to mastery over the id, ego, superego, and/or environm ental demands. Such an approach potentially has profound implications for the patient. T hrough ego activity, the patient learns, discovers, develops confidence in, and strengthens his or her ow n inner coping resources. The therapist sets the context for the patient’s often creative discovery and exploration o f inner coping resources. The patient in turn directly experiences mastery o f the presenting problem , and along w ith it, feels a sense o f pride, competence and/or self-efficacy. C oping, in the form o f creative m astery, is at the very heart o f Erika F rom m ’s clinical practice and teaching.

THE NATURE OF HYPNOSIS The Hypnotic State Erika From m ’s interest in hypnosis began in the 1960s, shortly before she took a faculty position at The U niversity o f Chicago. Like m ost psychoana-

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lyrically trained clinicians, she was initially quite skeptical about hypnosis and hypnoanalysis. Since Freud, the master, had rejected hypnosis in favor o f free association, analysts after Freud had essentially dismissed hypnosis as a clinical tool. In 1960 From m was asked to participate in an APA program on hypnosis. She originally declined the offer. H ow ever, she was persuaded to participate as the voice o f healthy scientific reason in an area about which she knew little, except for negative stereotypes attributed to hypnosis. T o her credit, she participated w ith an open m ind and left the program convinced o f the merits o f hypnosis as a legitimate area o f scientific and clinical inquiry. T otally converted after participating in a w orkshop in w hich hypnotic phenom ena w ere dem onstrated w ith an hypnotic “ virtuoso,” her research and clinical interests in hypnosis and hypnoanalysis w ould span the next three decades o f her professional career at The U niversity o f Chicago up to the present. O ver these years, From m has em erged as one o f the leading figures in hypnoanalysis in the w orld. H er contributions in this field o f inquiry include a theory o f hypnosis and self-hypnosis as an altered state o f consciousness, and as clear a statem ent as can be found anyw here about the theory and practice o f hypnoanalysis from an ego-psychological perspective. From m b rought her background in psychoanalytic ego psychology to her understanding o f hypnosis. Gill and B renm an’s (1959) classic w o rk , Hypnosis and Related States, was the first major post-Freudian ego-psychoanalytic contribution to understanding hypnosis and hypnotherapy. From m ex­ tended the application o f these principles, further elaborating the nature o f the hypnotic state. She view ed hypnosis as a context for regression in the service o f the ego; the hypnotic state, or trance, as a manifestation o f altered ego functioning. O ver the years From m described a num ber o f im portant param eters o f the hypnotic state. These include: ego receptivity/activity, attention cathexis, fading o f the generalized reality orientation, deautom atization, shift from secondary to prim ary process, access to im agery and fantasy and adaptive regression (Fromm, 1979, 1981). In a series o f w orks beginning w ith “Ego Activity and Ego Passivity in H ypnosis,” From m (1972a) developed a theory o f ego orientation that served as the basis for her ego-psychoanalytic theory o f altered states o f conscious­ ness in general, and hypnosis in particular (Brow n & From m , 1986; Fromm 1976, 1977, 1979, 1981, 1984b, 1987b; From m & H urt, 1980; Stolar & From m , 1973, 1974). From m added a third orientation to her understanding o f a continuum o f ego activity/passivity in states o f consciousness. From D eikm an’s (1971) essay on “B im odal C onsciousness,” she came to describe subjects in an altered state o f consciousness as ego receptive. Ego receptivity is character­ ized by the relative suspension o f strict reality orientation, critical judgm ent, and goal-directed thinking. In such a state, individuals become m ore recep­

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tive to unconscious and preconscious material that floats into the awareness o f the relaxed alert subject. Just as the elements o f choice and coping are essential in understanding ego activity, the element o f attention is critical in understanding ego receptivity. Ego receptivity can be intentionally culti­ vated by an individual by adopting a particular attentional posture (Fromm, 1979; From m & H u rt, 1980). Theories o f ego orientation help us to understand the nature and experience o f hypnosis. From m came to see ego activity and ego receptivity as continuua along w hich the hypnotized subject’s experience varied. H ypnosis begins by focusing attention. O ncc the hypnotic state is induced, the subject may shift at times to a m ode o f unfocused free-flow ing attention. D uring this condition o f ego receptivity, the subject is m ore open to suggestions and also to the events occurring in the stream o f consciousness (i.e., to unconscious and preconscious material and to coping resources and solutions to problem s not readily available to w aking consciousness). At other times the hypnotized subject actively explores coping resources and attem pts solutions to p ro b ­ lems. D uring this condition o f ego activity, the hypnotized subject retains the capacity for choice and the ability to shape the unfolding experience. The skilled hypnotherapist supports the ego-receptive and ego-active orienta­ tion, and carefully avoids challenging the subject’s defenses and thereby overw helm ing the individual. In this approach to hypnosis, the hypnotized subject experiences mastery, discovers inner resources, and delights in func­ tioning at a new and m ore creative level.

Attention Cathexis F rom m ’s appreciation o f the pivotal role o f attention was derived partly from R apaport’s (1959) theory o f attention cathexis and B ro w n ’s (1977), cognitive/structural model o f altered states o f consciousness. A m ong the variety o f attentional skills that individuals draw on in altered states o f consciousness, From m focused on a continua o f focused, concentrated versus free-flow ing attention, and o f restricted versus an expanded range o f atten­ tion. H ypnosis requires facility in accessing the full range o f both (Fromm, 1979, 1981; From m & H urt, 1980). The form er pertains to relative selectivity or lack o f selectivity o f attention. It allows the hypnotized subject to shift voluntarily from an ego orientation o f receptivity to activity, respectively. T he latter refers to the span o f attention (i.e., how m uch o f the total stimulus range comes into awareness at any given mom ent). For example, the h y p n o ­ tized subject may be receptive to one event in the stream o f consciousness at a given m om ent (restricted range) or be receptive to a great variety o f events at any given m om ent (expanded range). F rom m ’s developm ent o f a theory o f attention brings her basic theory o f ego orientation even further into the

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arena o f the subject’s o w n capacity. T his theory again underscores the subject’s v o luntary co n tro l and free w ill in the exploration o f states o f consciousness and the discovery o f unconscious and preconscious coping resources.

The Fading o f the Generalized Reality Orientation F rom m and Shor (1972a, 1979) elaborated on the m echanism s by w h ich the hypno tized subject achieves adaptive regression. F ro m a cognitive perspec­ tive, S hor (1959) developed the concept o f th e generalized reality o rientation (G R O ), by w hich he m eant the stable fram e o f reference an individual in the w aking state uses to m aintain an orien tatio n to external reality. F rom m and Shor felt that the G R O fades in hypnosis. In F ro m m ’s ego-psychological term s, the active ego tem porarily suspends its concern w ith external reality and shifts its concern to th e events in the stream o f consciousness.

Deautomatization F rom m u nderstoo d the in duction o f hypnosis in term s o f deautom atization (From m , 1977b, 1979; From m & H u rt, 1980). T he concept o f d eautom ati­ zation w as first applied to hypnosis by Gill and B renm an (1959) and its application w as extended to o th e r altered states o f consciousness b y D eikm an (1971) and V an N u y s (1973). Deautomatization has been defined as “ an undoing o f the autom atizations . . . directed to w ard th e en v iro n m en t” (Gill & B renm an, 1959, p. 178). T h e individual in the norm al w ak in g state develops autom atized o r habitual m odes o f pcrcciving, thinking, o r acting w ith respect to the dem ands o f reality. These occur largely outside o f conscious aw areness. These habitual processes are deautom atized th ro u g h the redistribution o f atten tio n in hypnosis and are b ro u g h t into the arena o f conscious aw areness. This reinvestm ent o f such processes w ith atten tio n disrupts the pattern in g o f norm al w aking consciousness and results in quasistable new organization o f ego functions. T his new G estalt allow s access to an altered state o f consciousness like the h y p n o tic trance.

The Shift Along the Continuum o f Primary and Secondary Process F rom m developed F reu d ’s description o f prim ary and secondary process operations and their m anifestations in th in k in g and m ental functioning (Freud, 1900) as a w ay o f u n d erstanding the con ten t o ccurring in the stream o f consciousness in hypnosis (From m , 1981; F rom m , O berlander, & G ru e-

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newald, 1970). Primary process manifestations represent a form o f largely unconscious mental activity dom inated by impulses, wishes, or symbolic expressions that strive tow ard im mediate gratification. Secondary process manifestations represent largely conscious m ental activity dom inated by reality orientation, verbal expression, and the capacity for delay. From m believed that these tw o processes coexist and interact. Induction o f a hypnotic trance represents a shift along the continuum in the direction o f increased prim ary process m ental activity. H ypnosis is a means to recover a prim ary process m ode o f functioning and thereby gain greater access to unconscious and preconscious material. In an attem pt to test the concept o f prim ary/secondary process mental activity, From m and her colleagues (From m et al., 1970; O berlander, G ruenewald, & From m 1970) devised an experim ent in which Rorschach inkblots w ere adm inistered to highly hypnotizable subjects in the norm al waking and hypnotic condition in a counterbalanced design. Rorschach protocols were scored using the H o lt (1963) system for scoring levels o f prim ary process manifestations and defensive operations. As predicted, hypnotized subjects experienced significant prim ary process mental activity relative to the w aking state. H ow ever, an unexpected finding was that there was no signif­ icant increase in defensive operations in trance relative to the w aking state. An im plication o f these findings is that the greater access to unconscious and preconscious material in hypnosis occurs by a mechanism relatively autono­ m ous from w aking defensive operations. In other w ords, unconscious and preconscious material seems to ju st float into awareness during trance w ithout necessarily evoking significant defensive reactions.

The Role o f Imagery From m bccamc particularly interested in the role o f imagery’ in hypnosis and later in other states o f consciousness. H olt (1964) w rote a seminal paper on how im agery had returned from ostracism in the post-behavioral Zeitgeist. From m understood im agery in terms o f tw o central themes: voluntarism and dem and source. G o rd o n ’s (1949) distinction betw een bidden and unbidden im agery is based on voluntarism . B idden im agery is voluntarily produced; unbidden im agery arises b y itself. T w o kinds o f im agery also exist according to the dem and source. Reality-oriented im agery is directed tow ard the demands o f external reality and represents a kind o f cognitive problem ­ solving activity. It is usually unbidden and associated w ith ego activity. Symbolic im agery is associated w ith drive demands and is a form o f expres­ sion o f unconscious wishes. The symbolic fantasy is usually unbidden and associated w ith ego receptivity (allowing the im agery to arise) or ego pas­ sivity (becoming overw helm ed, as in a nightmare). This “ psychodynam ic structure o f im agery” illustrates its variation in hypnosis and other states o f

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consciousness (Fromm, 1979). In hypnosis, for example, im agery serves as a vehicle both for uncovering unconscious wishes and fantasies and for the active exploration o f coping ability th rough rehearsal in fantasy (B row n & From m , 1986; From m , 1977b). M oreover, im agery plays a vital role in creative acts and intuitive interpretation. The skilled patient and clinician alike find im agery to be a m edium for exercising healthy prim ary process m ental activity (Fromm, 1977b).

Regression Erika From m ’s earlier understanding o f the role o f regression in hypnosis was related to Gill and B renm an’s (1959) application o f K ris’ concept o f “ regression in the service o f the ego” to hypnosis. From m (1981) saw hypnosis as a tem porary return to earlier form s o f thinking. As m ore research and clinical studies on hypnotic age regression appeared, From m expanded her concepts. She came to see regression as a partial rein­ statem ent o f earlier m odes o f functioning. These w ould include a shift to earlier m odes o f physiological and cognitive/perceptual functioning, and ear­ lier developm ental levels o f self-and object representations and associated affective experiences (Brow n & From m , 1986). W ork that further influenced F rom m ’s reform ulation o f the concept o f adaptive regression in hypnosis included Rieff and Scheerer’s (1959) experimental studies o f cognitive and perceptual functioning o f hypnotized age-regressed subjects; W atkins’ (1971) clinical w ork studies w ith the affect bridge m ethod; and N ash, Johnson, and T ip to n ’s (1979) w ork on self-and object relations in hypnotic age regression. As usual, the interplay betw een theory, research, and clinical material pow erfully m otivated From m . H er interest in age regression was sparked by her treatm ent o f a highly hypnotizable Japanese-Am erican y oung man (1970). D o n was b o rn in the U nited States im mediately after the Japanese attack on Pearl H arbor. H e lived w ith his farmily for the first 4 years o fh is life in a relocation camp and spoke mainly Japanese. U pon release, D o n quickly became assimilated into American culture. H e completely repressed his Japanese heritage and w ith it the ability to speak Japanese. D uring hypnotic age regression he w as able to recover the ability to speak Japanese. Subse­ quent linguistic analysis o f the treatm ent transcripts dem onstrated that he had recovered a child’s version o f the Japanese language that could not have been confabulated. She found this case to be convincingly illustrative o f hypnotic age regression as a reinstatem ent o f earlier m odes o f functioning.

Hypnosis As an Altered State o f Consciousness These param eters o f hypnosis—ego orientation, attention cathexis, G R O fading, deautom atization, shift to prim ary process m ental activity, increased

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primacy ofim agery and adaptive regression—essentially justify From m ’s ego psychoanalytic view o f the hypnotic trance as an altered state o f conscious­ ness. Her perspective traces its roots to Rapaport’s (1951) essay on “ States o f C onsciousness.” Rapaport defined consciousness: (a) as an ego function, (b) w hich represents a complex organization o f various ego functions, and (c) exists in a variety o f states w ith (d) its variations associated w ith the distri­ bution or redistribution o f attention cathexis. From m integrated R apaport’s cgo-psychoanalytic theory w ith T a rt’s (1969, 1975) definition o f altered states o f consciousness. T art saw a discrete state o f consciousness as a “ unique, dynamic pattern or configuration o f psychological structures” (Tart, 1975, p .5). This concept o f a unique organization resonated w ith F rom m ’s emphasis on the total Gestalt o f ego functions. From m ’s state definition o f hypnosis also is situated w ithin a tradition o f other significant contem porary w orks on the nature o f the hypnotic state, notably O rn e’s description o f the “ essence” o f hypnosis as characterized by the ability to produce significant cognitive/perceptual distortions that are experienced by the hypnotized subject as convincing and real (1959), and H ilgard’s neodissociative theory (1977).

TOWARD A PSYCHOANALYTIC THEORY OF ALTERED STATES OF CONSCIOUSNESS Although some o f Erika F rom m ’s w o rk in the 1970s focused on developing an ego-psychological model for hypnosis, she then expanded this model to include a variety o f other states o f consciousness. This m ove tow ard a general ego-psychoanalytic theory o f altered states o f consciousness grew out o f her collaboration w ith Daniel B row n (1977) and also out o f her attendance at a series o f invited conferences in the early 1970s that w ere sponsored by the M enninger Foundation on the V oluntary C ontrol o f Internal States. She became increasingly familiar w ith research on other altered states o f con­ sciousness, such as drug-induced states and m editation. C onsistent w ith her earlier w o rk on hypnosis, From m continued to view a given altered state o f consciousness as a quasi-stable reorganization o f ego function or cognitive structures. M oreover, she emphasized focus o f and redistribution o f attention as defining the ego-active and/or ego-receptive orientation o f and shifts to given states o f consciousness. She saw the ego function o f decision making and the capacity for voluntary control over particular states, as param ount (Fromm, 1977, 1978/1979, 1981; From m & H urt, 1980). From m expanded the num ber o f axes or continuua along which states o f consciousness can vary incorporating her param eters o f hypnosis. Thus, she was able to develop a topology o f specific altered states o f consciousness according to variations along the continuua o f ego receptivity/activity; unfo­

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cused, free-flow ing versus focused, concentrated attention; autom atization/ deautom atization; shift in prim ary/secondary process mental activity; and fantasy/reality orientation. T hus, she came to describe and define altered states o f consciousness in very specific terms, for example, hypnosis as primarily an ego-receptive state o f focused attention w ith a relative shift tow ard prim ary process dominance. Imagery increases along w ith trance depth. N octurnal dream ing is a state alternating betw een ego activity and ego receptivity, characterized by a som ew hat expanded range o f attention and an extreme shift tow ard prim ary process m entation, and therefore greater access to the unconscious. Altered states o f consciousness induced by psychedelic drugs are prim arily ego-receptive states characterized by a greatly expanded range o f attention and a marked shift tow ard prim ary dominance. A ttention in meditative states can be either focused or expansive, depending on the type o f m editation practice, and a similar shift tow ard prim ary process dominance occurs in some m editative states (Fromm, 1979).

THE ORGANIZATION AND PHENOMENOLOGY OF HETEROHYPNOSIS AND SELF-HYPNOSIS From m and her students at The U niversity o f C hicago conducted extensive studies on the com parison o f heterohypnosis and self-hypnosis in the 1970s and 1980s. In these studies she maintained her interst in delineating the com parative structures o f these tw o similar altered states o f consciousness. In the first edition o f Hypnosis: Research Developments and Perspectives (1972a), From m and Shor first addressed the phenom enological investigation o f hypnosis as a cutting edge o f hypnosis research. Always integrating her new know ledge and form ulations w ith earlier foundations, From m emphasized a phenom enological approach to the inquiry on hetero-and self-hypnosis, which came to be know n as the C hicago Paradigm. H er extensive hypnoa­ nalytic w ork and her collaboration w ith Ron Shor w ere the basis o f this interest. This w ork began in 1972. T hirty-six subjects w ere given one experience each w ith heterohypnosis and self-hypnosis in a counterbalanced sequence. A taped version o f the H arvard G roup Scale o f H ypnotic Susceptibility (Shor & O rne, 1962) was used for the heterohypnosis experience and a taped version o f the Inventory o f Self-H ypnosis (Shor, 1970) was used for self-hypnosis. A com parison o f the similarities and differences betw een heterohypnosis and self-hypnosis was made using structured interviews. The least hypnotizable subjects (about one third o f the sample) w ere not able to distinguish hete­ rohypnotic and self-hypnotic experiences. The m ost hypnotizable subjects reported a greater quantity o f and richer quality o f im agery in self-hypnosis than in heterohypnosis. In self-hypnosis they also reported a greater num ber

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o f ego splits, betw een ego states such as speaker, listener, experiencer, and voice o f doubt (Fromm, 1975). In 1973 the From m group reform ulated their approach to the com parison o f heterohypnosis and self-hypnosis. Earlier research (Johnson & W eight, 1976; Ruch, 1975), including her ow n study (Fromm, 1975), was limited to self-directed responses to a taped version o f standard hypnotic inventories. A question arises as to w hether such experiences are genuinely self-hypnotic. In order to investigate a p urer form o f self-hypnosis in com parison to hete­ rohypnosis, the From m group devised a w ay to assess the experience o f relatively unstructured self-initiated self-hypnosis. T hirty highly hypnotiz­ able subjects w ere given heterohypnotic experiences w ith standard invento­ ries to use as guidelines to generate ideas for self-initiated self-hypnosis. Then, subjects w ere asked to practice self-hypnosis daily over a 4-w eek period in a standard setting. The instructions encouraged subjects to initiate their ow n self-hypnotic suggestions through creative discovery in trance. A series o f phenom enological questionnaires w ere given to subjects as a means to compare self-hypnosis w ith their experiences on the standard heterohyp­ notic inventories. In their analysis o f the questionnaire responses, the From m group found b o th similarities and differences betw een heterohypnosis and self-initiated self-hypnosis (From m et al., 1981). B oth heterohypnosis and self-hypnosis w ere characterized by increased absorption, fading o f the G R O , and skillful attention deploym ent. The reported differences betw een heterohypnosis and self-hypnosis w ere divided into three categories o f structure, content, and context. W ith regard to structure, or the overall organization o f ego func­ tions, self-hypnosis was characterized by greater ego receptivity, freeflow ing attention and significant fluctuation in trance depth. By contrast, heterohypnosis w as characterized by greater ego activity, focused, concen­ trated attention, and constancy o f trance depth. With regard to content, m ore vivid idiosyncratic im agery, spontaneously emerging personal memories and time distortions w ere reported in self-hypnosis. By comparison, there was a greater capacity to successfully experience age regression and positive hallu­ cinations in heterohypnosis. W ith regard to context, there was greater aware­ ness o f the presence o f and influence o f the hypnotist in heterohypnosis. The C hicago group also studied w hat the evolution o f self-hypnotic experiences over tim e were. A ccording to results from a longitudinal ques­ tionnaire, subjects in self-hypnosis reported increased skill in adapting to their inner w orld, greater trance depth and increased confidence in their ability to establish and m aintain the self-hypnotic trance as they gained experience during the weeks o f practice. A subsequent phenomenological investigation o f the self-hypnotic diaries kept by the subjects detailed the idiosyncratic and richly varied experiences o f these skilled self-hypnotic subjects (Fromm, Boxer, & B row n, 1985).

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In subsequent papers, the From m group devised coding systems to test the validity o f an ego-psychoanalytic theory o f self-hypnosis. From m , Skinner, Lom bard, and Kahn (1987/1988) scorcd the diary entries for the presence or absence o f a particular ego orientation such as ego receptivity, ego activity, or ego passivity. They found that self-hypnosis is both an ego-active and egoreceptive state. They emphasized that even w hen ego acitivity occurs, ego receptivity is at the very heart o f self-hypnosis. They also found a strong positive correlation betw een ego receptivity and the degree o f absorption, trance depth, and the quantity and quality o f both reality-oriented and symbolic im agery. A nother study by Lom bard, From m , and Kahn (in press) and Kahn, From m , Lom bard, and Sossi (in press) further elaborated on the central role o f im agery in self-hypnosis. M ore recent studies have focused on personality variables associated w ith self-hypnotic experience. Subjects w hose self-hypnosis was rated as significantly m ore ego receptive than others had a need for independence, w ere self-reliant, and tended to tru st in their ow n unconscious. Subjects w hose self-hypnosis was rated as significantly m ore ego active w ere characterized by a need for structure, certainty, and control. A recent book by Erika From m and Steve Kahn (1990) describes the From m gro u p ’s nearly tw o decades o f research on self-hypnosis, a synopsis o f w hich is included in this volum e. O th er recent studies have also em pha­ sized the clinical significance o f self-hypnosis (Eisen & From m , 1983; From m & Elsen, 1982).

THE THEORY AND PRACTICE OF HYPNOANALYSIS Theory Erika F rom m ’s (1965,1968a, 1984b) theoretical elaborations o f ego psy­ chology served as the basis for the developm ent o f a general theory o f hypnoanalysis. The hypnoanalyst facilitates an ego-active/ego-receptive ori­ entation in the patient during the treatm ent hour, and helps the patient learn to shift betw een these modes as indicated by the unfolding process. The patient’s skills are directed as necessary, either tow ard uncovering (an egoreceptive mode) or problem solving (an ego-active mode), b o th required in successful hypnoanalysis. The hypnoanalyst further helps the patient shift betw een utilization o f symbolic fantasy and practical reality-oriented im agery fostering the pa­ tient’s ability to creatively discover unconscious and preconscious inner coping resources and to learn mastery. H e or she provides reassurance that

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the patient can resort to a protective^ coping m ode w hen creative coping resources are unavailable. In addition to her theory o f the im portance o f ego activity and coping, From m clarified the nature o f the therapeutic relationship in hypnoanalysis. In her paper on transference and countertransference in hypnoanalysis (Fromm, 1968b), From m expands on earlier descriptions o f the hypnotic transference (Gill & Brenman, 1959; Ferenczi, 1909; Kubie & M argolin, 1944). The hypnotic state is characterized by the activation and reinstatem ent o f self-and object representations, m em ory impressions, and associated af­ fects from earlier points in the patient’s developm ental history. These are transferred to the hypnoanalyst. The perception o f the hypnoanalyst is thus distorted and the affects experienced tow ard the therapist are significantly intensified. A lthough similar to transference that occurs in psychoanalysis over time, the very induction o f the hypnotic state activates and intensifies transference reactions even in early stages o f the developing therapeutic relationship. In a later w ork (Brow n & From m , 1986), From m enumerates on three major types o f transferences occurring in hypnoanalysis according to the level o f psychopathology o f the patient. The three m ajor types o f transference are arranged along a continuum from m ore to less severe psychopathology. These are borderline and psychotic, self-object, and neurotic transferences. The latter are further subdivided into dependent, oedipal, and sibling trans­ ferences. From m also emphasized the patient’s here-and-now reality-based percep­ tion o f the therapist in the hypnotic relationship. She deeply believes that patients, irrespective o f transference reactions, have the capacity to accurately perceive qualities o f caring or insensitivity in the hypnoanalyst. The thera­ peutic alliance or misalliance is highly dependent on the w ay the therapist treats the patient. T he hypnoanalyst w ho offers a patient a series o f successful experiences and leaves the patient w ith the im pression that the patient’s gains are a function o f his or her ow n inner coping resources w ill significantly increase a healthy collaboration (Eisen & From m , 1983; From m & Eisen, 1982).

Clinical Practice From m has made num erous contributions to the practice o f hypnotherapy and hypnoanalysis. She applied the four classical psychoanalytic m ethods o f free association, dream interpretation, interpretation o f defenses, and the analysis o f transference to hypnoanalysis. From m felt that hypnotically suggested associations and dreams allowed the patient greater access to unconscious and preconscious material for uncovering w ork. H ypnosis thus becomes another “ royal road to the unconscious” (Fromm, 1987a, p. 209).

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Because the patient is less defended against spontaneously emerging u n ­ conscious and preconscious material, the hypnoanalyst respects m ore than circum vents defenses. This may m ean enhancing the patient’s need for p ro ­ tective coping, and/or facilitating a search for unconscious and preconscious coping resources. From m has contributed a variety o f fantasy-based hypnotic inductions such as the beach induction, the boat technique, induction while im agining strolling through a museum, and the deep sea induction (B row n & From m , 1986). She also has created several scene visualization techniques such as the cloud technique and the old picture visualization (Brown & From m , 1986). H er Ideal Self Technique is a particularly useful m ethod for m odifying the patient’s self-representation (Fromm, 1965). M oreover, she has articulated a num ber o f ways to w ork w ith affect during hypnotherapy and hypnoanalysis (Brow n & From m , 1986). H er clinical textbook, Hypnotherapy and Hypno­ analysis is devoted to a detailed discussion o f the w ording and rationale o f these methods.

Values Orientation Erika F rom m ’s ego-psychoanalytic w ork has served as the basis o f a values system w ith respect to the treatm ent o f patients in hypnoanalysis as well as to teaching hypnotherapy and hypnoanalysis to m ental health professionals. These values are im plicit in all o f From m ’s clinical papers, developed partic­ ularly in a paper entitled “ Values in H y p notherapy” (Fromm, 1980). The prim acy o f patient welfare and respect for the client as a person, and her image o f the “ perm issive hypnotherapist” stand at the heart o f her clinical values. H ypnosis is a relatively easy state to induce in a hypnotizable patient. Because hypnotherapy entails clinical practice while the patient is in an altered state o f consciousness, in w hich unconscious material is m ore readily accessible and less defended, the hypnoanalyst m ust always be w atchfully protective and guard against too rapidly uncovering material or otherw ise challenging the patient’s defenses. The permissive hypnoanalyst gives very open-ended sug­ gestions and refrains from introducing his or her o w n fantasy content into the patient’s unfolding process, mindful o f the patient’s increased suggestibility and tendency to accept suggestions uncritically (B row n & From m , 1986; Eisen & From m , 1983). Further, the hypnoanalyst m ust 1. draw on a sophisticated understanding o f the therapy process and the transference; 2. facilitate the patient’s creative coping efforts and active problem ­ solving attempts;

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3. leave the patient w ith the belief that his or her experiences in hypnosis and gains in hypnotherapy are a product o f his or her ow n resources; 4. help the patient discover and choose his or her ow n goals for treatm ent; 5. allow the patient the jo y o f discovery, the w onder o f the inner w orld, the trust in his or her ow n coping capacities, and the pride o f accom­ plishm ent; and 6. enhance the patient’s belief in the self over the magic o f the therapist.

New Clinical Directions In the last decade Erika From m has expanded the scope o fh e r original outline for the theory and practice o f hypnoanalysis to include approaches for a num ber o f new patient populations. She has pioneered the use o f hypnoa­ nalysis w ith at least three new groups: 1. hypnoanalysis w ith severely disturbed patients; 2. hypnoanalysis w ith patients suffering from post-traum atic stress dis­ order (PTSD); and 3. hypnobchavioral mcdicine, w ith patients suffering from psychophysiological and habit disorders. In each area she has made a major contribution by articulating a theoretical basis for her w ork w ith the patient population in question as well as by developing new m ethods for w orking w ith these special populations. The 1970s w ere characterized by a virtual renaissance in contem porary psychoanalytic thoery, that included the convergence of, in particular object relations theory (Jacobson, 1964; K ernberg, 1975, 1976; M odell, 1968), self-psychology (Bach, 1985; K ohut, 1971; Lichtenberg, 1975; Tolpin, 1971), and affect developm ent theory (Lewis & Rosenblum, 1978). D uring the same decade, outside o f psychoanalytic circles, researchers w ere carefully scrutinizing the stages o f child developm ent w ith m uch greater clarity than had been achieved previously. The synthesis o f contem porary psychoanalytic theory and the data from empirical child developm ent studies seemed inevi­ table. W orks integrating child developm ental observations w ith self­ psychology (Stern, 1985) and affect theory (Brown, 1985) began to appear. W ithin psychoanalysis a new paradigm was em erging for the study o f severely disturbed psychiatric patients heretofore neglected by psychoanal­ ysis. Exciting new theories and m ethods began appearing for the treatm ent o f the severely disturbed patient. Severe psychopathology was seen along a continuum from schizophrenia to borderline to narcissistic pathology. Severe disturbance w as being view ed as a manifestation o f earlier developmental failures along an ideal model o f the phase-specific tasks o f norm al hum an

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development tow ard “progressive structuralization” o f the psyche (Gedo & G oldberg, 1973). This new psychoanalytic theory came to be know n as developmental psychoanalysis (Stolorow & Lachmann, 1980) or structural psychoanalysis (Baker, Chapter 20, this volume). Erika From m became quite interested in this literature as it applied to understanding the patients she was treating. It was simply a m atter o f time before she was to develop a theory and method o f hypnoanalysis for severely disturbed patients. For several decades hypnoanalysts avoided using hypnosis with severely disturbed patients. O ne popular misconception was that patients with serious psychopathology were not hypnotizable. Studies began to appear in the 1970s and 1980s demonstrating that no significant differences existed be­ tween severely disturbed patients and normals w ith respect to hypnotizability. Another popular misconception was that hypnosis was dangerous and could precipitate psychotic episodes in severely disturbed patients (Abrams, 1964). Pioneers in the use o f hypnosis with severely disturbed patients in the 1970s had reported ju st the opposite. Hypnosis rarely precipitated fragmen­ tation w hen done sensitively. In some cases it actually helped contain and strengthen the patient against vulnerability to fragmentation. Fromm had become convinced o f the efficacy o f hypnosis with such patients from the w ork o f Baker (1981). Baker devised a series o f structured hypnotic visual­ izations to facilitate increased object constancy, primarily in borderline pa­ tients. From m applied these methods in her ow n w ork (Brown & Fromm, 1986). She modified and extended Baker’s approach (Fromm, 1984a), for example, adding some additional methods to help the borderline patient gain control over splitting. M oreover, she described in careful detail an exemplary case illustration o f the successful hypnoanalytic use o f these methods with Jessica, in Hypnotherapy and Hypnoanalysis (Brown & Fromm, 1986). The goal o f treatm ent o f the severely disturbed patient is “ restructuralization” (Fromm, 1984a, p. 73). The hypnoanalyst presents the patient w ith a systematic series o f visualizations designed to help the patient master the phase-appropriate tasks o f child development along the line o f development o f stable, integrated, and differentiated self-and object representations. H yp­ nosis serves as a useful tool because structured visualizations can be presented to the patient in a relaxed comfortable state wherein the patient has greater access to imagery and affects—the building blocks o f healthy internalization. The hypnoanalyst is able to actively structure the expericncc to foster the development and stabilization o f healthy internal representations more quickly than is possible in nonhypnotic psychotherapy (Fromm, 1984b). The protocol entails eight steps (Fromm, 1984a). The first five visualiza­ tions are designed to facilitate the internalization o f a representation o f the therapist as a “ good object.” The therapist first suggests that the hypnotized patient image him or herself in some pleasant activity in the presence o f the hypnotist. This exercise is designed to help the patient overcome the fear o f

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enguJfment. N ext, the patient is instructed to open his or her eyes, take in the hypnotist’s presence, close his o r her eyes, and attem pt to maintain the image o f him or herself. This visualization is designed to lay the groundw ork for the separation o f self-and object representations. The patient next visualizes the therapist alone, then the therapist and patient in the same scene, as separate but together, and finally, therapist and patient in interaction. The scenes often disappear or fragm ent early in the w ork. W ith persistence the patient de­ velops stable internal representations for the self and the therapist w ith o u t diffusion o f boundaries. The patient learns to differentiate and integrate these developing internal representations in the next three visualizations. The patient is instructed to visualize previously pathological introjects as external to the self, the self and therapist w ith both positive and negative qualities, and an actual m erger o f the good and bad self. T hrough these exercises the patient overcom es split­ ting and achieves a realistic representation o f self and other. The eight steps are designed to enable the patient symbolically to proceed along the norm al developm ental line o f self-object differentiation tow ard greater object constancy (Baker, 1981; From m , 1984a). This may speed up the therapeutic task o f developm ental repair, bu t From m is careful to rem ind us that hypnotic im agery alone, although helpful, is not in itself curative. She believes that a successful outcom e is m ore a function o f the quality o f the relationship betw een therapist and patient than o f the visualization per se. T he patient’s images are the result o f an active, engaging but not threatening therapeutic stance that provides the context for healthy internalization. Post-traum atic stress disorder (PTSD) was perhaps to the 1980s w hat borderline and narcissistic conditions were to the 1970s. T here was an enorm ous proliferation o f research and clinical studies on the assessment and treatm ent o f PTSD. W ithin this em erging trend during the last decade, Erika From m became quite interested in patients suffering from PTSD. This in­ terest and the developm ent o f m ost o f her ideas w ere sparked th rough her long-term hypnoanalytic treatm ent ofjessica, a 38-year-old w om an traum a­ tized early in her developm ent by sibling incest (Brow n & From m , 1986; From m & B row n, in press). C ontem porary clinical studies on the hypnoanalytic treatm ent o f PTSD, especially the treatm ent o f incest, are rare (Miller, 1986b). H istorically, the literature on the treatm ent o f traum a advocates abreaction. In such cases hypnosis is used to rapidly uncover and encourage the expression o f intense feelings associated w ith traum atization. C ontem porary clinicians have w arned that this use o f hypnosis is dangerous. T he patient may become overw helm ed, shift to ego passivity, and experience the therapeutic relation­ ship as retraum atizing instead o f as em otionally corrective (Brown & From m, 1986). M ost contem porary treatm ent o f traum a advocates some sort o f stage model for treatm ent in w hich the patient’s coping resources are enhanced

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prior to uncovering, and in w hich uncovcring proceeds in a slow indirect manner. From m ’s study ofjessica is exemplary o f this approach to treatm ent. In the study ofjessica, From m outlined 11 stages in the overall treatm ent o f Jessica. The first 6 pertained to the internalization o f a good object and the consolidation o f object constancy as described earlier. The rem aining 5 stages addressed symbolic and direct uncovering o f traum atic memories and feel­ ings associated w ith a forceful sibling incest incident. From m was careful to point out that internalization and consolidation o f the patient’s representa­ tional w orld m ust occur prior to uncovering to p rotect the patient from fragm entation. She also advocated a stage model to allow the patient to w ork through the traum a sym bolically and then literally. D ream s, guided fantasy, anagrams, and autom atic w riting also may be used for symbolic w orking through. Screen memories often provide early sym bolic material. Injessica’s case, a “soldier” visiting the family allegedly traum atized her. Later in the treatm ent, at a tim e she w hen she was able to accept direct uncovering o f these mem ories and feelings w ithout fragm entation, Jessica was able to recognize that her brother had been the perpetrator. The case ofjassica elegantly illustrates how to provide a holding environ­ m ent in w hich the patient can recover at a safe speed. Jessica required a treatm ent plan that addressed both her sym ptom s o f post-traum atic stress and her borderline/narcissistic psychopathology, a com m only seen dual di­ agnosis in severely traumatized patients.

CONCLUSION From m has distinguished herself as a scientist, clinician, and educator o f national and international reputation. H er career is m arked by continuous productivity. She serves as a role model for current and future generations o f young scientists and clinicians. From m has become one o f the forem ost authorities in the w orld on the theory, m ethods, and applications o f clinical hypnosis. She has contributed much to the current humanistic view that hypnosis is an ability o f the patient more than o f the hypnotist. The invaluable contribution o f the therapist is to provide a safe relationship w ithin w hich the patient can discover and explore coping resources tow ard mastery and grow th. From m has provided a con­ sistent theory o f the operations o f the patient’s experience, the manifestations o f associative processes, and the nature o f the hypnotic relationship during trance. Freud’s rejection o f hypnosis did m uch to limit its popularity as a clinical m ethod for the first h alf o f the century. F rom m ’s w o rk over the past three decades has done m uch to reestablish hypnosis w ithin the m odem repertoire o f clinical procedures, and perhaps is largely responsible for the

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rem arkable concurrent resurgence o f interest in its techniques even by some psychoanalytically oriented clinicians. From m was one o f the founders o f the Society o f Clinical and Experi­ mental H ypnosis and served as its president from 1975 to 1977. As clinical editor o f the International Journal o f Clinical and Experimental Hypnosis since 1969, she has p u t her stamp o f excellence on the clinical literature in this field. She has also contributed tw o m ajor texts on clinical hypnosis: Hypnotherapy and Hypnoanalysis and Hypnosis and Behavioral Medicine. The form er has been described in a recent review as “ a scholarly, clinically sophisticated reference that sets new standards for our field.” The latter is the only textbook currently available that integrates the fields o f clinical hypnosis and behav­ ioral medicine. From m has made progressive contributions to research on the nature o f hypnosis, the nature and phenom ena o f self-hypnosis and a theory o f altered states o f consciousness. In 1972 she co-authored w ith Ronald E. Shor a major text on experim ental hypnosis, Hypnosis: Research Developments and Perspectives (From m & Shor, 1972a). This book, since its second edition in 1979, has become established as a standard for the field o f experimental hypnosis. It received the “ best book on hypnosis” aw ard by the Society o f Clinical and E xperim ental H ypnosis. M oreover, Erika From m has played the role o f overseer for the evolving field o f experim ental and clinical hypnosis. O n three separate occasions she w rote reviews o f the state-o f-th e-art in the hypnosis field (From m 1987b; From m & Shor, 1972b, 1979). These reviews n o t only describe the current state o f hypnosis research but also predict future trends. A survey was sent to mem bers o f the Society o f Clinical and Experim ental H ypnosis in 1970 regarding the “ grow ing edges” o f research in the field. From the results, From m and Shor w ere able to assess and predict future trends for the field. In 1978 From m conducted a com puterized library search o f all hypnosis articles published from 1971 through 1978. T hro u g h a content analysis and by enum erating those areas in w hich research publications on hypnosis actually appeared betw een 1971 and 1978, From m was able to confirm their 1972 predictions. She has contributed close to 100 articles to the literature and to seven out o f nine grow ing edges identfied in 1970. A lthough Erika From m ’s contributions as a clinician and researcher have been impressive, her major and m ost im portant contribution, in her eyes, is as an educator. She has dedicated m ore hours to training graduate students and established professionals in hypnosis and hypnotherapy than any other indi­ vidual I know . I know her well in this sense, because I have taught w ith her for 18 years. She is well know n for the enthusiasm she brings to her w o rk and especially for her ability to inspire confidence in students and established clinicians to learn about hypnosis and then to apply it to their ow n clinical w ork w ith some sense o f mastery. She has taught countless courses and w orkshops for nearly three decades th roughout the U nited States and the

1. An Intellectual History

29

world. She is enormously popular as a teacher and her course evaluations are consistently positive. 1 recently read through the D irectory o f the Society o f Clinical and Experimental Hypnosis and recognized the names o f numerous individuals initially taught by Erika Fromm. She has trained over 4,000 beginning and established professionals in hypnotherapy or hypnoanalysis, probably far more individuals in hypnosis than any other contemporary. Those o f us that have had the privilege o f w orking closely w ith her know that she takes a Platonic view that genuine teaching has more to do w ith the development o f inspiration and character in students than it does with im parting information or technical skills. Many o f those inspired by her teaching have subsequently made significant contributions in their ow n right to the field. The range and depth o f contributions to this Festschrift are but a small representation o f the dedicated inquiry she has inspired.

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Chapter 2 ERIKA FROMM AS CONTRIBUTOR TO H YPNO SIS, H YPNO TH ERAPY, A N D HYPNOANALYSIS* ERNEST R. HILGARD Stanford University

I am pleased to jo in in th e celebration o f E rika F rom m for her m any contributions to psychology, hypnosis, h y p n o th erap y , and hypnoanalysis on the occasion o f her 80th b irthday. She has long been a go o d friend and colleaque. In recognition o f the substantive nature o f her contrib u tio n s, I am of­ fering here a slightly m odified verison o f th e F o rew o rd th at I w ro te to one o f her m ore recent b o o k s,Hypnotherapy and Hypnoanalysis (B row n & From m , 1986). A bout it, I said: [This] book by seasoned practitioners o f clinical hypnosis should be welcomed by all who are already using hypnosis in their clinical practice, as well as by graduate students. Their searches for and summarizations o f the variety of methods available have been thorough, and the voice o f experience shows in their recommendations for practice. For those not entirely familiar with the possibilities offered by hypnosis, the many detailed accounts of what actually is done will serve as an invitation to obtain training in the use o f hypnosis. Indeed, the expcricnccs reported here will provide a head start on accumulating the kinds o f hands on knowledge that otherwise would require years of practice with patients in all their variety. ♦R eprinted from H ilgard, E. (1986). Foreword. In D . B row n & E. From m . Hypnotherapy and hypnoanalysis (pp. xiii-xiv). Hillsdale. NJ: Lawrencc Erlbaum Associates.

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Scientfic hypnosis has made great advances particularly since World War II, both as part o f basic psychological science concerned with the understanding o f brain, mind, and personality, and as a professional skill in which knowledge o f hypnosis is used to serve human welfare by enhancing the quality o f life for those who have the good fortune to benefit from hypnotherapy and the related practice o f hypnoanalysis. The reader is brought abreast o f these developments, w ith the authors’ descrip­ tion o f hypnosis as an altered state o f consciousness interpreted theoretically from several points o f view, the therapeutic relationship, the depth o f hypnosis and the alterations within hypnosis as perceived by the hypnotized person, the art o f hypnotizing, and the most widely used induction and deepening tech­ niques. O ne w ithout wide acquaintance with hypnotic lore may well be sur­ prised by the variety o f approaches that are available to match the preferences, abilities, and needs o f the subject or patient. The authors have introduced the reader to the major aspects of hypnosis and how hypnotic procedures are carried out. The reader learns about selecting patients for hypnotic treatment (because it is not appropriate for all who come), how to plan the treatment, what techniques are available in therapeutic practice and finds a full-length case history o f hypnoanalysis. Because hypnosis per se is not psychotherapy, the authors wisely distinguish various ways in which hypnosis can be used in therapies based on different perspectives. The authors make important distinctions among three perspec­ tives on the use o f hypnosis in therapy. Briefer hypnotherapy includes tw o o f these: the first decribed as hypnobehavioral perspective, the second as dynamic hypnotherapy, or psychoanalytically oriented psychotherapy. The third is hyp­ noanalysis. The hypnobehavioral therapy is appropriate to some o f the simpler conditions in which symptom relief restores the patient’s ability to cope, w ithout the therapist’s delving into such issues as the emotionalized transference between patient and therapist. Therapy using the hypnobehavioral perspective is treated in detail in another volume by the authors (Brown & Fromm, 1987). Dynamic hypnotherapy uses hypnosis in the context o f brief psychotherapy as practiced by psychoanalytically oriented psychotherapists and requires that the therapist be sensitive to transference. Here, though, working through the transference may not be essential as it is in hypnoanalysis, the other perspective considered. Hypnoanalysis is the utilization o f hypnosis in connection with the long-term treatment that is usually associated with psychoanalysis. It may use hypnosis as an uncovering technique, taking advantage o f the hypnotic condition to sup­ plement the more typical free association technique o f psychoanalysis; or it may use hypnosis to advantage as it facilitates ego strengthening in cases o f character problems or maladaptive human relationships. Here working through the transference becomes essential to provide the corrective emotional experience upon which therapeutic success depends.

2.

C o n trib u to r to H y p n o sis, H y p n o th e ra p y , H ypnoanalysis

33

The orientations o f dynamic hypnotherapy and hypnoanalysis—central to this book—are avowedly based on contemporary psychoanalytic theory, and the practitioner must understand and be able to use approaches essential to these therapies, independent o f hypnosis. That is, hypnosis is an adjuvant, often a highly favorable one, but not always to be recommended. The theoretical background not only includes classical psychoanalysis but shows the influence o f many psychoanalytic thinkers since Freud, such as influences deriving from Franz Alexander and Thomas French, the later ego psychology within psycho­ analysis o f Heinz Hartmann, Anna Freud, and Erik Erikson, and the emphasis on narcissism by Heinz Kohut—to mention but a few o f the many cited. It comes as no surprise that the thorough documentation is shared between the references citing many workers in the field o f hypnosis whose w ork is directly relevant and those w ho arc w riting in the context o f psychoanalytic theory and practice w ith little or no mention o f hypnosis. The originality o f the authors rests in the manner by which they integrate psychoanalytic understanding with the advantages in treatment that hypnosis provides for those already committed to psychoanalytic psychology. The old taboo o f psychoanalysis against hyp­ notic therapy, a taboo initiated by Freud when he turned from hypnosis to free association, has o f course been broken from time to time by his followers. In this book we find an able case made for the advantages o f integrating hypnosis and psychoanalysis in clinical practice. Those already committed to therapies based on psychoanalytic assumptions will be prepared to assimilate the new teaching most readily, but at the same time there is much wisdom in this book to appeal to the practicing clinician who is uncommitted to psychoanalytic theory. I believe th at I h av e m ade it clear fro m m y sen tim en ts in this fo re w o rd th a t o v e r the years I still value h er c o n trib u tio n s as b o th p ro fo u n d and original.

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Chapter 3 REFLECTIONS ON HYPNOSIS AND RELATED TOPICS DORIS GRUENEWALD Laguna Hills, C A

Erika From m and I met in the A utum n o f 1 9 6 1 .1 had recently been adm itted to the U niversity o f C hicago’s doctoral program in psychology—reluctantly on the part o f the pow ers that be as they did not think very highly o f w om en, and older w om en at that, as students likely to do well o r to “ stick w ith it.” I did both. T hat I gained a dear friend in the process was a delightful extra dividend. Erika From m ’s hypnosis seminar, w hich I joined to learn w hat this thing called hypnosis was all about, proved to be very im portant to me. Several years earlier I had observed a dem onstration o f hypnosis at a meeting o f the Chicago D ental Association, to w hich I had been invited. W hat I saw there was intriguing, but I p u t it aside as “ one o f those things” one conies across here and there. When the opportunity presented itselflater, under the aegis o f the U niversity o f C hicago, to study the phenom enon o f hypnosis, I thought it w orthw hile to look into it some more. Little did I then think that theory, research, and clinical use o f hypnosis w ould come to occupy a good part o f my professional life. I ascribe it to Erika F rom m 's enthusiasm and involve­ m ent that I did engage seriously in w hat I had considered little m ore than a fringe phenom enon. Along w ith the pursuit o f some o f the questions inherent in the field o f hypnosis, a solid friendship developed betw een us that 1 treasure to this day. H ypnosis has come to represent for me a major facet o f the entire hum an m in d -b o d y entity. I think o f hypnosis as falling into a broad, m ultidim en­ 35

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sional continuum that includes phenom ena such as suggestibility, com pli­ ance, and m ultiple personality. The latter eventually became a topic o f special interest to me. Elsewhere (Gruenewald, 1984) I have presented a model o f hypnosis and m ultiple personality that was m ore or less limited to such issues as dissocia­ tion, m em ory, and role taking. N o t unlike the parable o f the elephant and the blind men, it is quite possible to delineate the bio-psychosocial phenom enon callcd hypnosis in m any different ways. Some o f these arc thoroughly dissim­ ilar, some o f them overlap w ith others, but none so far represent the totality o f the phenom enon itself. These rem arks are certainly not going to fill in w hat is still missing. M y main purpose is, rather, to reflect on some o f my thoughts that have evolved over the years to understand w hat I have personally observed. For the novice, and even for some seasoned practitioners, hypnosis can have a seductive influence. It is as though the hypnotist bro u g h t about w hat had been suggested. O n e ’s narcissism is inevitably an issue, and w ith it w hatever remains o f one’s latent grandiosity and sense o f om nipotence. I well rem em ber my early incredulous, elated reaction w hen a young volunteer subject responded positively to m y suggestion to paint a picture on the wall in front o f her and to describe it as she w ent along. This was one o f m y first tentative excursions into the realm o f the im agination. I venture to say that, had such attem pts failed, I m ight not have further become involved w ith hypnosis, as I as yet felt no serious com m itm ent. B ut the attem pts succeeded and I continued w ith m any practice inductions and, eventually, investigatory and therapeutic applications o f the techniques o f hypnosis. In these latter pursuits it became increasingly clear to me that I was using sensory im agery beyond the standard instructions printed in books and articles on techniques and procedures. I m ention this recognition, not at all startling in itself, bccausc I had always th o u g h t that I used w ords as symbols for imageless thou g h t (in the m ode o f the W uerzburg School). The ability to create by verbal means visual and other sensory im agery in empathic reso­ nance w ith the subject or patient therefore came as a surprise. It show ed me unequivocally that at a p re- or unconscious level m ore im agery was present than I had recognized, and that I was tapping into that reservoir. Erika From m had always been quite skeptical w hen 1 argued for my concept o f “imageless th o u g h t.” I take this opportunity to set the record straight; she was right. It took some years o f w orking w ith hypnosis as m ore or less a “ given” before I thought in greater depth about its nature. I had assumed from the beginning that the potential for hypnosis was inherent in the individual and was not created, b u t only elicited and facilitated, by the operator. Reports and com m unications regarding the experience itself, w hen available, gave valu­ able inform ation about the subjective aspects and revealed a great deal about

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Reflections on Hypnosis

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the personality dynamics o f the inform ant. B ut w ere the transferences, the regressions, the literalness o f some o r the retention o f logic by others, and so forth, an integral part o f the hypnotic state? C ould it be that the w hole thing was a hoax, in the m anner o f a folic a deux? A fter all, m ost if no t all o f the so-called hypnotic phenom ena w ere capable o f being produced w ithout anything like an induction! Puzzling questions these, especially in the absence o f any acceptable bio­ logical markers that w ould have differentiated hypnosis from ordinary con­ sciousness. The burgeoning research into the presence and function o f endo­ genous opiates in the brain did not lead to the breakthrough I had hoped for. And the developm ent o f positron emission tom ography (PET) was probably overrated in terms o f w hat was expected from it. A lthough very useful for delineating cerebral metabolism , PET did not lead to identifying a state o f hypnosis as such. Be that as it may. T here w ere other avenues open to deal w ith the phenom enon. Descriptions were not lacking, and many w orkers had system ­ atically explored the phenom ena o f hypnosis both in norm al and in patho­ logical conditions. It seemed that the concept o f hypnosis in some form or another could be applied to the w hole gam ut o f the m in d -b o d y unit. A ny and all organ systems were capable o f being influenced, and ofinfluencing in turn the functioning o f the organism . It is no w onder then that unw arranted claims and o utright quackery at times obscured the very real, solid findings and uses o f hypnosis. H ow far m utual b o d y -m in d influences could go was b ro u g ht hom e to me in the context o f a research project (Gruenew ald & From m , 1967). T w o young people in particular, one male and one female, were able in response to suggestions to become so im m ersed in the experience that a psychophysiological state was established that included functional alterations in the central and peripheral nervous system. This was explored by w ay o f an unfo rtu ­ nately, b u t necessarily, no t com pletely blind neurological examination. Al­ though the neurologist’s bias was in a negative direction, it was not possible to overlook or explain away certain changes in these intact subjects on grounds other than “hysterical sym ptom s, conversion type.” This raised yet other problem atic questions in my mind. W hat do hysteria and hypnosis have in com m on, and w hat is hysteria? Charcot, Janet, and Freud, to name only a few, had no problem w ith that term . It was only in the second h alf o f the 20th century that as a category hysteria fell into disrepute. It is now broken dow n into some o f its com ponents, one o f the latter being the dissociative disorders. Dissociative disorders are usually listed under the overall rubric o f hys­ teria—o r its successor names. H ow ever, as in the case o f hysteria itself, it seemed to me to be overly simplistic to reduce them to sexual-genital concerns, as hysteria had largely come to be understood in psychoanalytic

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parlance. The sym ptom atology ofhysteria tends to be protean, and the w ord itself allows for the inclusion o f traits, sym ptom s, and personality organiza­ tion currently assigned to other nosological categories. All o f this merely goes to show that neither nom enclature n or diagnostic processes can be pinned dow n w ith certainty and exactitude. Furtherm ore, they tend to change over time. As for hypnosis, the brilliant C harcot in his tim e th o u g h t it to be a form o f hysteria (i.e., a pathological condition). An air o f opprobrium clings to hypnosis in some quarters even today. T hat it has at the same tim e also been accepted as a m anifestation in norm al persons is ultim ately to be credited to the m any serious w orkers w ho have painstakingly tried to map out its quantitative and qualitative dim ensions and established that the norm al person is m ore likely to be responsive to hypnosis than one w ith mental or emotional problems. H ypnotic susceptibility cannot, in my opinion, be pinned d o w n to a cut and dried numerical value, although for statistical purpose it is useful to have a reliable standard measure available. Nevertheless, individuals m ay not fit into standard measurem ent as internal or external conditions m ay impose restrictions or cause facilitation o f response (Grucncwald, 1982a). W hen it comes to therapeutic uses o f hypnosis, such aspects as special motivations, transferences, and the like seem to be inextricably interw oven w ith hypnosis as a condition o f the person (Gruenewald, 1982b). It therefore is a most difficult task to tease apart w hat may or may not in fact be a direct effect o f hypnosis per se. A lthough many clinicians now administer one or another o f the extant hypnotic susceptibility scales—for valid enough reasons—and may be guided, at least in some cases, by the obtained values, I w ould question w hether process and outcom e o f hypnotherapy have m uch to do w ith that practice. I indicated earlier that I became interested in the multiple personality syndrom e (M PD). Like m y interest in hypnosis, this too was alm ost acci­ dental in its beginnings. A young w om an, previously diagnosed as “ border­ line psychotic” by com petent clinicians, was referred for yet another w orkup after being hospitalized because o f presum ptive suicidal tendencies. In the course o f meeting w ith me, she displayed unm istakable evidence o f dual personality, previously quite unsuspected (Gruenewald, 1971). Thus began w hat has over several years resulted in various contributions to the literature (e.g., G ruenewald, 1977, 1978, 1984) and a num ber o f consultations on suspected as w ell as established cases. H ere too, as w ith hypnosis, there is a significant element o f seduction in the often startling, always fascinating transform ations one sees w ith one’s ow n eyes. It is very tem pting to accept the overt evidence as hard fact, w ithout due regard to the potentially self-serving aspects o f that evidence and w ithout raising questions o f prim ary and secondary gain in the captivating display. I

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briefly summarize w hat I synthesized in my thinking on the basis o f such observations as I was able to make. The follow ing aspects and theoretical considerations regarding the etiology and structure o f M PD , although based on observation, are o f course inferential. O ne perhaps superficial but, I believe, im portant observation has been that M PD persons are highly intelligent people, even if their intelligence does not gain the usual expression. T hat is, they may show large gaps in know ledge, come across as quite ignorant and inconsistent in m any w ays, and, o f course, “ disappear” suddenly. The m anner in w hich the sudden change is carried out seems to depend o n w hat the person know s o f the condition. M oaning and groaning, pressing the hands to the temples, complaints o f headaches, or a rapid “ sw itch” to another personality are all fairly com m on mechanisms on display. I use the w o rd “ display” advisedly, for such it is. E ven if no one else is present, the inner w orld is peopled by an audience for w hose benefit the show can be enacted. This particular characteristic o f the M PD has, to my know ledge, not been sufficiently investigated. A ltogether it takes consider­ able mental ability to carry through consistently on the maneuvers that have been identified as belonging to M PD . B ut let me emphasize that subjectively the person is usually unaw are o f w hat is happening and thus is not lying in the proper sense o f that term. A nother im portant element involved in the genesis and maintenance o f M PD is that o f play and play-acting. It all starts ou t in a “ let’s pretend” situation, for very good reasons, to be sure. A history o f abuse in various form s and degrees is well enough docum ented to be accepted, although not necessarily present in each and every case. Thus, the com m on childhood practice o f inventing an im aginary com panion becomes solidified, is not relinquished w ith progressive developm ent, and is gradually expanded into greater and greater com plexity. The different “personalities” take on in­ creasing reality as they are fleshed out w ith the functions they m ust perform . The upshot is that to the outside observer there arc apparently disparate units in one body. In the realm o f m em ory too there are m ost interesting processes at w ork that allow continuty over time am ong the various apparently discrete ele­ m ents that make up the “ personalities.” I have elaborated on the issue o f m em ory elsewhere (Gruenewald, 1984). Suffice it to say that there seems to be no lack o f registration in the m em ory system. There is, how ever, a profound disturbance o f the usual retrieval mechanism, w ith resulting com partm entalization along unusual dividing lines o f the mem ories that become and rem ain available to the various segments. Briefly then, w e may assume a basic developm ental, or even possibly constitutional, vulnerability o f the person suffering from M PD . There is an early inability to coalesce and integrate into a cohesive self along the lines o f norm al developm ent. The histories o f M P D patients alm ost invariably point

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to adverse interpersonal experiences, w hether factual or subjectively per­ ceived. The young child, in order to survive, has an urgent need to create modes o f coping w ith otherw ise intolerable conditions—modes that may later result in the genesis o f m ultiple selves, w ith different tasks assigned to each. It seemed to me less likely that M PD w ould originate in a developm en­ ta l^ later, general constellation, as hysteria had been com m only defined in psychoanalytic theory. Rather, its actual roots w ere m ore likely to he in the narcissistic phase o f developm ent, even though hysterical mechanisms w ere significantly involved in its phenom enology and may well have triggered the overt emergence o f the disorder. In their manifestations M PD and hypnosis have much in com m on and tend to share similar and at times identical pathw ays for their expression. Elsewhere (Gruenewald, 1984), I have observed that specific forms o f pathology seem tied to prevailing fashions in the culture in w hich they occur. The same may be said for diagnostic and therapeutic practices. It is easier to make a diagnosis based on the num ber o f certain presenting sym ptom s than it w ould be if one took a m ore comprehensive look at the individual case. For instance, the presence o f delusions and/or hallucinations has all too often led to an alm ost autom atic diagnosis o f schizophrenia, disregarding the possi­ bility that such sym ptom s can appear in other conditions as well, including M PD . O pinions about M PD vary widely, from facile if not overenthusiastic acceptance o f the overt signs o f the disorder to extrem e skepticism regarding its existence. O ne o f the real difficulties in dealing w ith M PD is to find a balance betw een the necessary acceptance o f the patient’s self-presentation and an underlying theoretical orientation that goes beyond outw ard appear­ ances and seeks meanings. W ithout the acceptance o f w hat the patient brings to therapy no rapport or w orking relationship is possible. B ut to discard one’s skepticism altogether at times can lead to reinforcem ent o f the very condition for w hich one’s services were engaged. T he opinions expressed in these pages have evolved over m any years. They are a long w ay from the early days o f my w o rk w ith hypnosis. Erika From m always has been an interested listener, contributing ideas w henever she could. She was in many ways an im portant presence for me. For that I thank her.

Chapter 4 A PERSONAL EXPERIENCE WITH SELF-HYPNOSIS A N D CREATIVITY* ANDREW M. GREELEY The University o f Chicago

“Y ou are going deeper and deeper,” Erika F rom m ’s rich, M iddle European voice said reassuringly, “ you are climbing back dow n the ladder o f y our life and you are feeling very happy, oh, so very happy, deeper and deeper and deeper, you are filled w ith happiness. N ow mentally you open y our eyes and look around at this time o f y our life w hen you w ere so very, very happy. W here do you find yourself?” 1 was 3 years old and standing on a green, sun-drenched hill, looking at the law ns rolling dow n to the dull silver platter o f a lake. Behind me was a big stately Victorian m ansion w ith turrets and porches, a magic castle perhaps. O n either side were w ooden buildings painted w hite w ith green trim sur­ rounded by screened-in porches. In front o f me a bed o f thick red flowers surrounded a brilliant reflecting globe, a giant ball bearing; at the side o f the lake a dark stone platform covered w ith a peaked ro o f and on the lake itself speedboats (H unter D eluxe Specials!) and sailboats puttered about. C hildren and adults sat on a quaint w ooden pier that ju tte d into the lake and kids my age were frolicking on a great slide that sloped into the w arm , com forting w aters. I rushed quickly dow n the slope o f the hill and into the lake to jo in them . D r. From m ’s age regression had b ro u g h t me back to ecstatically happy experiences at the outer fringe o f m y conscious m em ory. Here was w here it ♦Reprinted from Greeley, A. (1986) Prologue In Confessions o f a parish priest (pp. 1-4) New York: Simon & Schuster.

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all started. C om m odore Barry Knights o f C olum bus C o untry C lub, a m ag­ ical place w ith a vast lake, tow ering jungle-covered hills, law ns and gravelcovered paths on w hich to run (and make shambles o f one’s knees), a dining hall w ith real mashed potatoes, gleaming corn on the cob, thick gravy, an endless supply o f roast beef, crow ds spread out on the law n on a Sunday m orning in front o f the pergola follow ing the progress o f the Mass, a distant drama marked by a tinkling o f a bell, barely to be heard over the summer sounds o f the lake. In the dining hall m en w ore ties although air conditioning was unknow n; and at Mass on Sundays, they put on coats and even carried their straw hats in their hands (many o f them , m y father included, w ere in “ plus four” knickers instead o f long trousers and carried caps instead o f hats). The priests w ho said the Mass lived in a secluded w ooden house at the fringe o f the country club, and enjoyed their quiet vacations, discreetly separated b u t no t completely isolated from the laity. M y reexperienced happiness in Erika F rom m ’s hypnotic trance was gen­ eralized and unspecific. Everything about T w in Lakes made me happy. The lake, thejungle-covered hill, the lawns, the boats, the clubhouse (as my magic castle was called) w ith its slot machines, my friends running dow n the hill and jum ping into the w ater, the lurking m ystery o f the pergola at night. The fat m an w ho was in charge o f the club and told jokes in the dining hall, the limitless supply o f food, chasing m y father on the g o lf course, dream ing about the possibility that we w ould have a house o f our ow n on the lake, looking through the thick overgrow th on the hill behind the club, excursions to Lake Geneva and the Fox Lake chain during w hich w e actually w ere perm itted to ride in H unter D eluxe speedboats instead o f gazing w istfully at them . There, at T w in Lakes, the early and middle 1930s was the m atrix o f my childhood and the m atrix o f my life. There w ere som e unpleasant memories: the smell o f the outd o o r toilets; the death during the w inter o f a dearly loved T w in Lakes friend (tonsil infection, poor radiant little girl); the day that my father, weary, w o rn and tired, came to T w in Lakes to tell my m other his business had been w iped out by the advancing Great D epression. Som ehow T w in Lakes was never quite the same after that. The images that had surfaced w hen Erika was teaching me the ageregression technique o f self-hypnosis exploded out o f my brain for weeks thereafter. First in m y ow n self-hypnotic exercises, then in ordinary w aking consciousness, the w hole w orld o f T w in Lakes in the 1930s recreated itself, benignly, vividly, overw helm ingly in my im agination. It was not that I was unaw are o f the C om m odore B arry C o untry C lu b ’s role in my life before Erika had taught me (I was helping her design a questionnaire for a study she was doing on techniques o f self-hypnosis in psychoanalytic therapy and she offered to teach me the technique). In the fragment o f a mem oir I w rote for G regory B aum ’s bookJourneys, published in the early 1970s, I m entioned the

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Personal Experience

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T w in Lakes phenom enon. Jo h n K otre in his “ intellectual b io g rap h y ” also cited the T w in Lakes experience in m y life. T he h y p n o tic interludes, h o w ­ ever, revealed to m e the critical influence T w in Lakes still is on m y im agina­ tion. T he sheer raw vividness and p o w er o f th e m em ories constrained m e to tu rn to fiction w riting. W hat until then had been a pipe dream becam e an obliga­ tion, a necessity. In m ost o f m y novels the experience o f sum m er and sum m er resorts w hile g ro w in g up is im p o rtan t n o t m erely as b ack g ro u n d against w hich the stories unfold, b u t as integral parts o f the n o v el’s structure. . . .

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II THE NATURE OF HYPNOSIS

For the last three decades Erika From m has been quite inter­ ested in the nature and phenom ena o f hypnosis. She views hypnosis as an altered state o f consciousness, as a stable reor­ ganization o f various ego functions. In this section several o f her colleagues address the issue o f the nature o f hypnosis. H elen J. C raw fo rd ’s chapter, “ C ognitive and psychophysiological Correlates o f H ypnotic Responsiveness,” seeks to iden­ tify psychophysiological correlates to the hypnotic state. Pre­ vious reviews on this topic, notably those appearing in From m ’s book on m odern hypnosis research (From m & Shor, 1972a, 1979), w ere largely inconclusive. Erika From m has always believed that there is a physiological basis to hypnosis. This belief traces its roots to From m ’s interest in the interaction o f physiological and psychological processes early in her career follow ing her training w ith K urt Goldstein. C raw ford gives some m ore definitive findings on the physiological basis o f hypnosis. Taking advantage o f sophisticated research tech­ nology now available, C raw ford is able to dem onstrate a variety o f physiological param eters to hypnosis. H igh b u t not low hypnotizable subjects manifest consistent changes in cere­ bral m etabolism , theta EEG, laterality, and integrated pow er am plitude during certain hypnotic tasks. C raw ford believes 45

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PART II: T H E N A TU R E O F H Y PN O SIS

that these studies lend physiological support for From m ’s ideas about the shift to prim ary process activity and the problem -solving nature o f hypnosis. Levitt, Baker, and H ulsey (chapter 6) study the extent to w hich the hypnotic trance is stable and therefore resistant to situational and relational influences. T heir cognitive dissonance experim ent is designed to ascertain the extent to w hich situational manipulations can influence both the stability o f the trance state and the transference perceptions o f the hypnotist. Their largely negative results suggest that hypnotizability and the relational aspects o f hypnosis are relatively stable and resistant to external influences. These results lend support to F rom m ’s belief that hypnosis is the subject’s, not the hypnotist’s ability. The permissive hypnotist does not try to direct or manip­ ulate the subject’s trance experience as m uch as to provide a supportive context for the subject’s ow n creative exploration o f his or her ability. The last chaptcr in the scction by Stephen Kahn (chapter 7) elaborates on F rom m ’s view o f hypnosis as an example o f creative mastery. K ahn sum m a­ rizes nearly tw o decades o f research conducted by From m and her associates on self-hypnosis. H e presents the so-called Chicago Paradigm for self­ hypnosis research in w hich highly hypnotizable subjects w ere asked to initiate their ow n self-hypnosis experiences daily over a duration o f 4 weeks. This research supports F rom m ’s evolving view o f the ego active/ego recep­ tive nature o f hypnosis.

Chapter 5 COGNITIVE AND PSYCHOPHYSIOLOGICAL CORRELATES OF HYPNOTIC RESPONSIVENESS AND HYPNOSIS H E L E N J. C R A W F O R D Virginia Polytechnic Institute and State University

As a sensitive and intuitive clinician, Erika Fromm, through her clinical practice, publications (e.g., Brown &■ Fromm, 1986, 1987; Fromm, 1987b), and many well attended workshops, has contributed immensely to the furthering o f hypnotherapy and hypnoanalysis in the U nited States, Europe, and Australia. She has had an impact on not only fellow clinicians but also experimental psychologists o f rather differing theoretical orientations. Al­ though Fromm emphasized clinical aspects o f hypnosis, she recognized equally the im portance o f validating clinical insights and has pursued labo­ ratory studies o f adaptive regression (Gruenewald, Fromm, & Oberlander, 1979) and self-hypnosis (e.g., Fromm et al., 1981). As she noted (Fromm, 1987b); In order to generalize our intuitive insights and m ake them valid insights that are w o rth transm itting to others, how ever, we need to test our hypotheses on statistically significant samples o f patients. Clinical intuition and scientific exploration m ust walk, and now do walk, hand in hand. (p.215)

This chapter highlights some o f the cognitive and psychophysiological re­ search findings, particularly from our laboratory, that support some o f From m ’s astute clinical observations about hypnosis. Fromm (1987b) has further hypothesized that hypnosis involves a dra­ matic shift in cognitive functioning such that a hypnotically responsive 47

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individual show s a significant decrease in sequential, analytical thinking and an increase in holistic, imaginal, and nonanalytical thinking. As From m (1987b) noted, during hypnosis this im agery constitutes a v ery pow erful uncovering technique because it is a sym bolic representation o f the activity o f the patient’s internal w o rld , o f unconscious feelings, th o u g h ts, and conflict (Reyher, 1963; S horr, 1972). Im agery reveals these u n d ercu rrents m ore clearly than logical, reality-oriented, rational th in k ­ ing . . . h y p n o tic im agery has often been found to represent problem -solving activity. . . . (pp.216-217)

A ccording to From m (1987b), the “ m ost im portant structural com ponents o f the hypnotic process are im agery and fantasy, absorption, dissociation, and various ego m odes and attention postures” (p. 216). H er clinical observations are borne out in num erous correlational studies that dem onstrate that hypnotically responsive individuals report m ore vivid im agery and absorptive involvem ent during their norm al activities as well as during their inner-directed, im aginative experiences (e.g., C raw ford, 1989; J. R. Hilgard, 1979; Sheehan, 1979; Tellegen & Atkinson, 1974). H ypnotic responsiveness loads positively on a happy, vivid, and positive daydream ing style in both adults (Craw ford, 1982) and children aged 8 to 12 (Allen, 1985). The absorptive involvem ent leads high hypnotizables to report much greater affect intensity than low hypnotizables to a given em otional experience (e.g., sad or happy emotions) in w aking states (C raw ford & B row n, 1989) and even m ore so in hypnosis (C raw ford, Clarke, K itner-T riolo, & O lesko, 1989). Em otional intensity is unrelated to frequency o f affective experiences (Diener, Larsen, Levine, & Em m ons, 1985). Interestingly, it is these very cognitive skills o f im agery, absorption, and intense, focused, and dissociative-like attention that seem to be magnified during hypnosis. Enhanced imaginal processing o f inform ation, particularly w hen the inform ation to be rem em bered is literal or untransform ed repre­ sentations, has been show n to be enhanced during hypnosis am ong hy p n o t­ ically responsive individuals in visual m em ory studies (C raw ford & Allen, 1983; C raw ford, N om ura, & Slater, 1983). In addition, a very small per­ centage o f high hypnotizables can produce eidetic-like visual m em ory for complex Julesz stereogram s during hypnosis (C raw ford, Wallace, N om ura, & Slater, 1986; Walker, G arrett, & Wallace, 1976; Wallace, 1978). These studies suggest that “ this enhanced processing may be accompanied by reports o f shifts in cognitive processing modes from a m ore verbal, detailoriented style during w aking to a m ore imaginal, holistic style during h y p ­ nosis” (C raw ford, 1989, p. 156). W ith the advent o f psychophysiological studies o f cognitive functioning that dem onstrated differential hemispheric laterality correlates accompa­

5.

Correlates o f H ypnotic Responsiveness

49

nying analytical and nonanalytical tasks (e.g., for review, see Springer & Deutsch, 1989), a commonly espoused hypothesis since the 1970s has been that hypnosis involves greater right-hem isphere involvement, as evidenced by the enhanced imagery and holistic processing just discussed. Many at­ tempts have been made to identify possible electrocortical correlates o f hypnosis (for reviews, see Crasilneck & Hall, 1959; Sabourin, 1982; Sabourin, Cutcom b, Craw ford, & Pribram, in press; Sarbin & Sable, 1979). It is only recently however, that there has been grow ing evidence that there are (a) EEG differences between low and highly hypnotizable individuals, and (b) EEG differences between waking and hypnosis conditions as moderated by hypnotic level. A robust finding o f interest here is differences in characteristic patterns o f hemispheric arousal associated w'ith hypnotic susceptibility. D uring waking, high hypnotizables show significantly greater EEG hemispheric specificity in the alpha band or overall total pow er at several bipolar recording sites. The EEGs o f high hypnotizables are more activated in the left hemisphere w hen doing analytic tasks and more activated in the right hemisphere when doing holistic, visuospatial tasks. Low hypnotizables are m ore equally activated in the two hemispheres and show less shifting (e.g., DcPascalis & Imperiali, 1984; DePascalis & Palumbo, 1986; DePascalis, Silveri, & Palumbo, 1988; Karlin, Goldstein, Cohen, & Morgan, 1980; M acLcod-M organ, 1979; M acLeod-M organ & Lack, 1982; Meszaros, Banyai, & Greguss, 1985). Differential bipolar fronto-central and parieto-occipital asymmetries in the low and high alpha bands during waking and hypnosis were found in low and high hypnotizables during rest, math, and imaginal tasks (Crawford, 1989; Meszaros, Craw ford, Szabo, Nagy-Kovacs, & Revesz, 1989). Sabourin et al. (in press) found that highly hypnotizable individuals demonstrated charac­ teristically higher left-hemisphere pow er in the beta band, across frontal, central, and occipital monopolar recording sites, during waking rest condi­ tions and hypnosis rest and suggestion conditions than low hypnotizables. There was no difference in right-hem isphere power. C raw ford et al. (1989) found consistent asymmetries in frontal and parietal m onopolar sites during suggested sad and happy emotional states during waking and hypnosis: Highs showed greater right-than left-hemisphere pow er in both low and high alpha bands, and low to high beta bands, whereas lows were fairly equal in power in both hemispheres and lower than liighs in the right hemisphere. A lthough much more research needs to be done in this area, w e believe these hemispheric specificity differences found between low and high hypnotiz­ ables support our hypothesis that highs demonstrate greater cognitive and physiological flexibility than do low hypnotizables (e.g., C raw ford, 1989; C raw ford & Allen, 1983). Using laterality ratios (left — right/left + right) o f integrated amplitude in different EEG frequency ranges, shifts tow ard greater right-hem isphere

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relative to left-hem isphere involvem ent during hypnosis have been reported for bipolar derivations o f occipital-parietal alpha (M acLeod-M organ, 1982), occipital-tem poral total pow er (Karlin, Cohen, & Goldstein, 1982; LaBriola, Karlin, & Goldstein, 1987), and frontal-occipital alpha and beta (Banyai, M eszaros, & C sokay, 1985; M eszaros et al., 1985). LaBriola et al. (1987) reported greater overall total am plitude in the right hem isphere at occipitalvertex bipolar derivations, w hereas tw o other studies (Meszaros & Banyai, 1978; M organ, M acdonald, & H ilgard, 1974) did not. H ow ever, laterality ratio studies can be criticized as the relative contribution o f left-and righthemisphere activity cannot be determ ined (e.g., Beaum ont, Y oung, & M c­ M anus, 1984). U sing spectral pow er measures rather than laterality ratios, C raw ford, M eszaros, and their associates (C raw ford, 1989; M eszaros et al., 1989) found enhancem ents in alpha and beta p ow er in the right parieto-occipital location during hypnosis in rest, m ath, and imaginal tasks, in high, bu t not low. hypnotizable subjects. C hen, D w orkin, and B loom quist (1981) examined EEG activity at frontal-parietal derivations w hile a patient w as going through dental surgery w ith hypnosis as the sole anesthetic. T hey found the total energy ou tp u t o f both left and right hemispheres to decrease, w ith a greater decrease in the left than right hemispheres in theta and alpha bands. Studies using m onopolar recordings during rest and hypnotic suggestions (Sabourin et al., in press) and during induced sad and happy emotional states (C raw ford ct al., 1989) found no shifts in pow er at anterior, central, and posterior (parietal or occipital) locations. The greater inhibition o f the left hem isphere during hypnosis has been reported in studies o f electrodermal shifts (e.g., Gruzelier, 1987; Gruzelier, B row n, Perry, Rhonder, & Thomas, 1984), b u t no hemispheric shifts w ere reported in regional cerebral blood flow studies o f hypnosis and w aking (C raw ford, 1989; C raw ford, Gur, Skolnick, G ur, & Benson, 1986). These divergent findings point out the difficulties we presently have in developing a cohesive evaluation o f the cognitive psychophysiological studies o f hypnosis as m oderated by hypnotic responsiveness level. Individ­ uals w ere often screened for hypnotic susceptibility level in different m an­ ners. W aking and hypnosis conditions are often not comparable across studies due to differences in tasks and rest instructions. Studies o f the rela­ tionships betw een electroencephalogram , electrodermal, and cerebral region blood flow arousal patterns are only now beginning. A lthough m ost o f the psychophysiological w o rk on hypnosis has examined electrocortical (EEG) activity, w e are even here limited in our com parisons because o f major differences across studies in their choices o f elcctrodc placements, recording m ethods (m onopolar vs. bipolar), EEG analysis m ethods, and EEG frequency bands chosen to be examined.

5.

Correlates o f H ypnotic Responsiveness

51

C ertain psychophysiological research does support F rom m ’s (1987b) o b ­ servation that “ hypnotic im agery has often been found to represent problem ­ solving activity” (p. 217). If there is an enhancem ent o f problem -solving activity during hypnosis, one m ight find accom panying psychophysiological changes supportive o f such activity. C raw ford et al. (1986; C raw ford, 1989) studied the effects o f rest, ischemic pain w ithout suggested analgesia, and ischemic pain w ith suggested analgesia in conditions o f w aking and hypnosis on regional cerebral blood flow as measured by the xenon inhalation method. Low hypnotizables had essentially the same regional cerebral blood flow metabolism patterns across frontal, tem poral, parietal, and parieto-tem poral regions in both w aking and hypnosis conditions, regardless o f the presence or absence o f pain. High hypnotizables show ed dram atic increases from 13% to 28% (highest being in the tem poral regions) in regional ccrebral blood flow, equally in both hemispheres, in hypnotic rest, pain, and suggested analgesia conditions. These unanticipated findings make sense if w e think that hyp­ nosis requires absorption and focused attention—it requires effort and w ork to be in hypnosis. The enhanced cerebral metabolism is reflective o f the enhanced cognitive effort and absorption that accompanies hypnosis. This enhanced cognitive effort is in contrast to the often observed external muscle relaxation during hypnosis. Increments in theta (approximately 3 to 7 Hz) EEG activity has been associated w ith many problem -solving, perceptual processing, and cognitive tasks as well as w ith the production o f im agery (for review, see Schacter, 1977; Vogel & B roverm an, 1964). Vogel, B roverm an, and Klaiber (1968) differentiated betw een tw o classes o f theta. “ Class I inhibition” is associated w ith general inactivity or drowsiness. “ Class II inhibition” is associated w ith m ore efficient and attentive perform ance and represents “ a selective inacti­ vation o f particular responses so that a continuing excitatory state becomes directed or patterned” (p. 172). If hypnosis involves greater attentional involvem ent in problem solving, w hen tasks or problem s are presented, then one m ight anticipate an enhancem ent o f theta during hypnosis (Sabourin, 1982). Increased theta during quiescent m editative states in experienced m editators has also been reported (Banquet, 1973; C orby, Roth, Zarcone, & Kopell, 1978; Elson, H auri, & Cunis, 1977; H ebert & Lehmann, 1979; Kasamatsu & Flirai, 1969; Saletu, 1987; Taneli & Krahne, 1987). Although not consistently found across studies for reasons yet unknow n, several early studies (Galbraith, London, Leibovitz, C ooper, & H art, 1970; Tebecis, P ro vins, Farnbach, & Pentony, 1975; U lett, A kpinar, & Itil, 1972) reported high hypnotizables generated m ore theta activity than low hypnotizables. In a study o f stringently screened high and low hypnotizables, Sabourin et al. (in press; also Sabourin, 1982) found that mean theta pow er was positively related to hypnotic responsiveness. In both w aking and hypnosis, highs generated substantially m ore theta than low s at occipital, central, and frontal

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locations. Interestingly, both low and high hypnotizables show ed a substan­ tial increase in mean theta pow er after the hypnotic induction and during hypnotic suggestions, although highs continued to have significantly more pow er than lows. These differences w ere m ost prom inent in the frontal and central locations. Further support for the relationship betw een theta and problem solving comes from a quite recent prelim inary study o f the EEG correlates o f cold pressor pain (C raw ford, 1990). Seven low hypnotizables and four high hypnotizables w ere stringently screened for hypnotizability level on several hypnosis measures and for strong right handedness. H ighs had to be able to eliminate completely all perception o f pain during a prelim inary cold pressor training session before being accepted into the main study. M onopolar recordings at frontal (F3, F4), tem poral (T3, T4), parietal (P3, P4), and occipital (01, 02) regions w ith references to balanced earlobes was done in counterbalanced conditions o f w aking and hypnosis on the same day. W ithin w aking and hypnosis there were the follow ing conditions: Prerest baseline, pain dip w ith no analgesia, suggested hypnotic analgesia w ith o u t pain, suggested hypnotic analgesia w ith pain dip, and postrest baseline. The left hand was dipped into cold w ater for 60 scconds; after 10 seconds the EEG recording was started. D uring prerest, from 13 to 19 Hz (low beta) and 37 to 42 H z (high beta) there was m ore integrated p ow er in hypnosis than waking. Given that hypnosis involves focused attention and the 40 Hz band is associated w ith focused attention (for review, see Sheer, 1984), this may be indicative o f the m ore overall focused state o f all subjects. As anticipated, during hypnosis, high hypnotizables dem onstrated signif­ icantly greater pow er than low hypnotizables w ithin the theta range: high theta (5.5 - 7.5 Hz) bu t no t low theta (3.5 - 5.5 Hz). A com parison o f hypnotic pain dips w ith and w ithout suggested analgesia revealed some fascinating interactions that support our previously stated hypotheses. As show n in Fig. 5.1, during pain and suggested analgesia dips, low s show no significant pow'er asymmetries betw een the left and right hemispheres at the frontal, tem poral, parietal, and occipital regions, whereas the highs show ed significant asymmetries in som e regions. In the tem poral and parietal regions, m ore so the tem poral, the highs w ere significantly m ore left hemisphere dom inant in the pain dip w hen they w ere experiencing pain, and then show ed a dram atic shift during the pain dip in w hich they experienced no pain at all: There w as a significant decrease in left-hem isphere theta pow er and a signif­ icant increase in right-hem isphere theta pow er. Tem poral theta may be reflective o f hippocam pal generated theta (Stumpf, 1965). Thus, the shifts in theta laterality may be indicative o f laterality shifit in the septal-hippocampal system. T he shift to greater right-hem isphere involvem ent during hypnotic analgesia w hen the subjects w ere vividly im agining themselves to be else­ w here and dissociated from the pain is quite supportive o f evidence that

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54

CRAWFORD

suggests that the maintenance o f vivid imagery is a right hemisphere dom i­ nant activity (e.g., Farah, 1988; Springer & Deutsch 1989). Thus, we have evidence for (a) differential hemispheric specificity patterns during painful stimuli in low and high hypnotizables, and (b) shifts in hemispheric domi­ nance during successful hypnotic analgesia in the high hypnotizables. In conclusion, it is increasingly evident that there are cognitive and phys­ iological differences between low and high hypnotizables, both in waking and hypnosis. In addition, there is grow ing evidence that some individuals, often high hypnotizables, show a greater propensity for shifting cognitive substructures or states o f consciousness than do others (e.g., Hilgard, 1977). Increased cooperation between clinical and experimental psychologists, as Erika From m advocated (1987b), should further our understanding o f the fascinating and complex psychological phenomena that occur during hypno­ sis, and why hypnotherapy can assist individuals to access memories, resolve conflicts, change behaviors, and reorganize the personality.

Chapter 6 COGNITIVE DISSONANCE AND THE RESPONSIVENESS OF HIGHLY HYPNOTIZABLE SUBJECTS EUGENE LEVITT Institute o f Psychiatric Research, Indiana University Medical Centre

ELGAN L. BAKER Indiana Centerfor Psychoanalysis and Indiana University School o f Medicine

TIMOTHY L. HULSEY University o f Tennessee T he essence o f hypnosis has been the focus o f a continuing controversy am ong investigators and theorists since the end o f the 19th century. This controversy has spaw ned a variety o f com peting constructs for describing and explaining the nature o f trance and o f hynotic responsiveness. T w o significant dim ensions along which these theories have varied are the issue o f the “involuntariness” o f hypnotic behavior and the role o f trait versus state variables in determ ining the specific param eters o f responsiveness and expe­ rience in trance. Experim ental investigation o f these core dimensions o f hypnosis have been ongoing for at least the past 50 years and have produced a variety o f inconclusive o r conflicting data, typically interpreted to confirm the pre-existing theoretical bias o f the investigators. T he current Zeitgeist o f the experim ental hypnosis literature has recapitulated these ongoing contro­ versies w ith the com peting view s o f the contextualists (including Coe, Chaves, Barber, and Spanos) w ho tend to emphasize situational, social role variables and the neo-dissociationists (including Evans, From m , H ilgard, N ash, and Orne) w ho emphasize the stable centrality o f “ hypnotizability” w ith its hypothesized antecedents and phenom enological correlates. O ver the last decade, o u r laboratory at Indiana U niversity School o f M edicine has undertaken a series o f empirical studies designed to simulta­ neously examine the comparative contributions o f trait (hypnotizability) versus state (social cues, expectations, m otivation, relationship factors) vari­ ables to determ ining hypnotic responsiveness, w ith a specific focus on the 55

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phenom enon o f involuntariness as it is perceived by the subject’s self­ reflection and measured by operationalized behavioral response. O u r re­ search has produced a series o f publications (Baker & Levitt, 1989; Levitt & Baker, 1983; Levitt, Baker, & Fish, 1990; Levitt et al., in press). The core design o f this research has essentially revolved around attem pts to induce hypnotized subjects to resist hypnotic suggestions by m anipulating a variety o f state variables that are “ pitted against” the subject’s measured level o f hypnotizability. O bserved responses to hypnotic suggestions have been clarified by exam ining interview , self-report, and phenom enological inven­ tory data in order to determ ine the nature o f the subject’s experience, w ith special attention to issues o f cognitive dissonance, conflict resolution, am ne­ sia, and efforts to give meaning or understanding to the hypnotic experience. O u r results, like those o f other researchers w ho have attem pted to examine variables central to the definition o f hypnosis, have been som ew hat incon­ sistent and complicated. A sum m ary o f our findings to date seems to point to several prelim inary conclusions. First, the experience o f hypnosis is heterogeneous. Individuals experience and respond to trance in a variety o f w ays and likely reflect in their hypnotic responsiveness differing configurations o f determ ining variables. For some subjects, social cues are m ore potent; for others, relationship factors that may involve transferential projections are m ore significant determ iners o f behav­ ioral response. For some subjects, hypnotic experience is prim arily m otivated by contem porary variables; for others, stable, trait factors appear to be more pow erful. Second, in general, individuals w ho evidence high levels o f hypnotizability seem to be less im pacted by contem porary state and contextual variables than subjects w ith m oderate or low hypnotic ability. H ow ever, our data suggest that it m ust be considered highly possible for at least some situational variables to alter or to override the influence o f at least some ordinarily critical trait variables. T hird, interpersonal-relationship factors appear to be pow erful variables that may often have a m oderating effect in determ ining hypnotic responsive­ ness. Further, these variables appear to be even m ore potent in shaping how individuals process and give m eaning to their trance experiences, regardless o f their role in producing that experience. These relationship factors often seem to operate in a nonconscious fashion that subjects may not be able to articulate or to rationally explain, suggesting at least some similarity to traditional notions o f “ transference.” In addition, positive perceptions o f the hypnotist appear to enhance trance involvem ent. H ow ever, negative percep­ tions o f the hypnotist or other figures attem pting to influence hypnotic responsiveness seem to be even m ore pow erful variables in decreasing the

6.

Cognitive Dissonance

57

subject’s behavioral response and post-hypnotic sense o f the trance experi­ ence. Finally, external incentives can im pact m otivational variables and serve to increase hypnotic responsiveness, involuntariness, and the experience o f trance, even am ong high hypnotizables. H ow ever, external incentives differ in their ability to im pact trait susceptibility. The nature o f the difference is probably idiosyncratic to the subjcct and reflective o f his or her dynamics, history, and personality style. Based on these em erging trends from our data, additional studies have been designed to attem pt to further explicate relationships suggested by our earlier w ork. In particular, efforts have been made to examine the experience o f high hypnotizable individuals w hose relatively stable capacity for trance involve­ m ent and involuntarincss has proven the m ost robust variable across the preceding projects. Further, our data have suggested that high hypnotizable subjects are those m ost often able to tolerate the inherent conflict or cognitive dissonance produced by the external m otivation w ith o u t alteration o f h y p ­ notic responsiveness. The current study was designed to m ore directly investigate the impact o f such dissonance on trance behavior am ong a group o f individuals w ith measured high hypnotizability.

SUBJECTS AND PROCEDURE T he subjects w ere 28 volunteers all o f w hom had scored 8 or higher on the Stanford H ypnotic Susceptibility Scale, Form A (W eitzenhoffer & H ilgard, 1959) and w ho w ere able to comply w ith the time requirem ents o f the project. All subjects w ere clerical or technical w orkers, except for three professional persons in the experim ental group and one in the control group. T hey were draw n from a pool o f nearly 100 subjects that had been developed for our hypnosis experiments. Subjects w ere assigned random ly to experi­ mental and control groups w ith the intent o f having 20 in the form er and 10 in the latter. D ue to failures to report for the experim ent, there w ere actually 19 experimental subjects and 9 control subjects. O f the subjects, 24 w ere w om en; there were 2 m en in each o f the groups. The mean ages for the tw o groups did not differ (experimental = 36.3; control = 41.0; i(26) = 1.06, ns). The experimental group had a mean score on the SHSS:A o f 10.05. The control group mean was 9.11. The difference is not significant [i(26) = 1.47, ns]. T he experim ental group was given the follow ing lecture by one o f the experim enters (ELB) in groups o f four or five subjects: Scientists have been interested in hypnosis for m ore than 100 years. D u rin g that period o f tim e, a great deal o f research has been done to try to understand m ore

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about what hypnosis is and what it can do. Perhaps your experience with being hypnotized has made you curious, too. I would like to tell you some things about hypnosis and some ways that it can be applied in psychology, psychiatry, and medicine. . . . Nearly everyone can be hypnotized. Researchers have deter­ mined that hypnosis is an ability that each individual possesses to some degree. Some people have a lot o f this ability. Some people don’t have very much. That ability, when combined with good motivation in the right situation, can help the individual enter a hypnotic trace. Some people believe that only people who aren’t very bright can be hypnotized. They think that the less intelligent you are, the more you will respond to the hypnotist’s suggestion. It is clear that feeling comfortable w ith the hypnotist is also an im portant variable in determining what the cxpcricnce of hypnosis will be like. . . . M ost o f the time, hypnosis produces some degree of relaxation. People who have been hypnotized often describe feeling very comfortable, calm, and quiet. M ost people like the experience and feel that it leaves them feeling relaxed and refreshed. Researchers have determined that different people experience trance in different ways. Some people feel like they are floating away; other people feel very, very heavy. Some people can develop very vivid images in trance, much more so than when they are awake. Some people believe that people will lose all self-control when they are hypnotized and that the hypnotist could make them do anything he wanted, even silly or embarrassing things. Most people can describe some changes in their experience when they have been hypnotized. Studying these experiences helps us to learn more about the nature o f the trance. . . . Hypnosis has been applied in many different clinical situa­ tions. It has been used to treat pain problems very effectively. Hypnosis has also been used to help people who have psychological problems like depression or anxiety. Researchers have found that hypnosis can work very well for some people in treating specific kinds o f physical problems like high blood pressure, warts, and asthma. Some people believe that only very dependent, weak-mlled, and needy people will respond to suggestions in trance. Perhaps the most frequent uses o f hypnosis in clinical work today are for treating obesity and smoking. Some people are very successful in using hypnosis to work on these problems . . . We hope that your experiences w ith hypnosis are positive and enjoyable. While I cannot answer any o f your questionsjust now, we would be happy to answer all o f your questions and discuss your experiences after this study is complete. . . . O ur researchers will now meet you to conduct you to a quiet, private office where you will again have the opportunity to experience hypnosis. T h e co n tro l g ro u p , in tw o su b g ro u p s, h eard the id en tical lectu re w ith the ex cep tio n o f th e italicized tex t. T h e in te n t o f this m isin fo rm a tio n w as to im p lan t th e n o tio n s th a t susceptible h y p n o tic subjects te n d to be less intelli­ g en t, ex trem ely d ep en d en t, and o u t o f c o n tro l u n d e r h y p n o sis com pared to less susceptible subjects. T h e S tan fo rd H y p n o tic S usceptibility Scale, F o rm B (W eitzcnhoffer & H ilg ard , 1959) w as th en ad m in istered to each subject in d iv id u ally . Subjects

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were awakened from the trance im mediately after adm inistration o f the scale had been completed and the follow ing instrum ents w ere employed in an effort to determine possible effects o f the pre-trance lecture: an adjective rating form (ARF; Baker & Levitt, 1989) to assess feelings tow ard the lecturer and the hypnotist; the Archaic Involvem ent M easure (AIM; N ash & Spinier, 1989) to assess the occurrence o f transference-like experience during the trance; and a structured interview in w hich subjects w ere asked to tell w hat they recalled o f the lecture. If the three topics were not m entioned spontane­ ously, experim ental group subjects were specifically asked w hether they rem em bered, and w hat they could recall, about references to intelligence, dependency, and loss o f control in the lecture. T hey were asked how the statem ents affected them and w hether or not they had tried to resist the hypnotist, successfully or unsuccessfully. They w ere also asked w hat they thought was the purpose o f the experiment.

RESULTS E xposure to the experim ental stimulus had no effect on susceptibility as measured by the SHSS:B [means = 10.16 for the experim ental and 8.78 for the control group - f(26)= 1.47, ns]; on the perception o f the lecturer as m easured by the ARF [means = 41.16 for the experim ental and 47.44 for the control group, i(2 6) = 1.01, ns]; on the perception o f the hypnotist Imeans = 38.33 for the experim ental and 43.78 for the control group, f(26) = 1.22, ns]; and on the AIM [means = 73.32 for the experim ental and 66.11 for the control group, ((26) = 0.70, ns]. Three experimental group subjects and one control group subject reported in the interview that they had attem pted to resist the hypnotic induction. This difference is n o t significant [corrected chi-square (1) = 0.00]. N one o f the four subjects believed that they had resisted successfully and none had according to SHSS:B scores that w ere the same as on the SHSS:A, except for one subject w ho attained a score 1 point higher. A lone control group subject attained a score o f 2 after having a pre-experim ental score o f 10. She did not claim to have resisted and was unable to explain the difference in scores. There were no differences in SHSS:B scores as a function o f hypnotists (F 4,23 = 0 .6 8 , ns). Recall o f the three statem ents in the experimental lecture was varied but tended to fall into three groups: accurate recall, usually accompanied by an expression o f disbelief; inaccurate recall, usually the opposite view or denial attributed to the lecturer; or no recall. Because o f the small num ber o f cases, we grouped recalling into accurate and inaccurate, including in the latter absence o f recall and the occasional distorted rccall (“H e said you d o n ’t have to be sm art to be hypnotized”). For the IQ statem ent, there w ere 12 accurate and 7 inaccurate reports; for

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the dependency statem ent, 13 accurate and 6 inaccurate; and for the control statem ent only 4 accurate and 15 inaccurate. N o significant differences w ere found betw een the accurate and inaccurate recall groups on any o f the dependent variables o f the experim ent. For example, the SHSS.B means for the accurate and inaccurate recall groups w ere 10.25 and 10.00 for intelligence, 10.50 and 10.00 for dependency and 10.25 and 10.13 for control. The respective i(17)s are 0.51, 1.00, and 0.20, none o f w hich are significant. Each experim ental subject was carefully debriefed by the interview er after the interview to be certain that the distorted statem ents were not believed. D espite this custom ary precaution, no subject in the experim ental group, or in the control group as well, correctly identified the purpose o f the experi­ ment.

DISCUSSION O n the whole, our results appear to be negative. The lecture failed to produce any behavioral trance effects in the experim ental subjects, either in their susceptibility or their perceptions o f the experim enters. Failure may be due in part to the simplistic nature o f the distortion interventions and to their lack o f definiteness. It is probably also partly due to the sophistication o f our subjects. For example, 10 o f the 12 subjects w ho correctly recalled the distorted statem ent linking intelligence and susceptibility indicated that they did not believe the statem ent. Because this was the first o f the three interven­ tions, it may have increased skepticism about the rem aining tw o distorted interventions. An interesting sidelight o f the results is the degree o f accurate recall in general. For the intelligence intervention, accurate recall w as 63% , about w hat m ight be expected w ith the narrative-interrogatory procedure used by the interview ers (Loftus, 1979). Accurate recall was only 26% for both the dependency and control interventions. The difference betw een the frequency o f accurate recall for the intelligence intervention, and the combined depen­ dency and control interventions is statistically significant [corrected chisquare (1) = 5.88, p .02]. M ost o f the inaccurate recall for the dependency intervention is due to the 12 subjects w ho did not recall the intervention at all. H ow ever, only one subject failed to recall the control intervention. T w o subjects did not recall the intelligence intervention. Some allusion to repression seems unavoidable. We m ight speculate that m ost o f our subjects easily brushed aside the distortion concerning suscepti­ bility and intelligence but were forced to adopt stronger measures to avoid the dissonance that w ould follow from accepting the distortions concerning dependency and control.

Chapter 7 PHENOMENOLOGICAL EXPLORATIONS OF SELF-HYPNOSIS* STEPHEN KAHN The University of Chicago

O ne o f the m ore significant contributions Erika From m has made to psy­ chology is in the area o f self-hypnosis. Beyond having pioneered the field, she has at the same time advanced the application o f phenom enological psychology. A lthough countless clinicians had utilized self-hypnotic tech­ niques for m any years, they have no t been systematically explored. Erika From m and her colleagues began their research in the early 1970s at the U niversity o f C hicago, exam ining self-hypnosis (SH) by taking an experi­ ential rather than a behavioral approach. By taking this tack, the Chicago group could m ore completely study aspects o f the self that could unfold and come to fruition in the practice o f self-hypnosis. A num ber o f questions were posed: W hat are the contours and boundaries o f the SH experience? H ow does SH compare to traditional, hypnotist-present hypnosis? Can SH be taught by establishing guidelines based on traditional hypnosis? Is there a learning curve involved in the assimilation o f SH techniques? W hat type o f individual is m ore susceptible or skilled in SH? Research based on these questions, conducted at the U niversity o f Chicago by D r. From m and her colleagues since the 1970s, came to be know n as the Chicago Paradigm 0ohnson, 1981). *Adapted from From m E., & Kahn, S. (1990). Summary and thoughts for future research In Self-hypnosis: The Chicago paradigm (pp. 219-233). N ew York: Guilford.

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THEORY AND DEFINITIONS Definitions o f hypnosis and self-hypnosis vary according to assumptions that are made about and the perspective that is taken tow ard them . Expectations o f w hat hypnosis is like define and delimit the parameters o f the hypnotic experience, ju st as expectations, attitudes, and beliefs in general affect and control our perceptions and behavior. A ttending to certain aspects o f reality enhances one kind o f experience, whereas attending to different aspects o f the same reality can create a completely different kind o f experience. The culture in w hich one lives provides the basic tem plate o f experience and a m ultitude o f options and possibilities w ith w hich to frame reality. An individual living w ithin a given culture can “ choose” any or all o f these possibilities. Usually it is through the consensual validation o f other individuals critical to one’s physical or emotional survival that specific beliefs are assimilated. Individual beliefs and attitudes thus emerge in the context o f the culture. W ith respect to hypnosis, a trance or trance-like experience emerges in the context both o f the culture and o f individual beliefs and attitudes. For instance, although our culture maintains a limited belief in such phenom ena as voodoo, a num ber o f T hird W orld cultures validate such activity, consid­ ering it to be a crucial part o f religious experience. H ypnosis per se, how ever, is m ore a W estern phenom enon, although it does share some o f the same elements, at least for certain individuals. W ithin our culture, som e individuals consider hypnosis to involve a total loss o f both control and consciousness, w ith complete pow er given to the hypnotist. At the opposite end o f the spectrum, hypnosis is conceived o f as an active rather than a passive state, w ith pow er and will located entirely w ithin the individual. H ypnotists and subjects alike vary in their views o f the hypnotic experi­ ence. H ypnotists for m any years m aintained an authoritarian stance vis-à-vis their subjects; the style, content, and the very w ording and intonation utilized reflected this attitude. The hypnotic subject likewise believed that rendering him or herself to hypnosis m eant surrendering or even eradicating his or her will. Since W orld War II, this view has evolved into a m ore permissive approach. The hypnotist views him or herself as a collaborator or a facilitator o f the experience. T he capabihty and the skill for creating and maintaining the trance is seen as residing in the subject. The m ore sophisticated subject whose contact w ith hypnosis has gone well beyond that o f stage hypnosis or depictions in movies realizes that he or she is the repository o f talent for the experience, and that the hypnotist merely provides direction and enhance­ m ent for this capability. T hus, as the culture modified general attitudes tow ard and beliefs about hypnosis, so too has individual experience changed and evolved accordingly. Rather than reify hypnosis as one specific phenom enon, it is m ore precise to speak o f different kinds o f hypnotic experiences. O ne w ay o f construing

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Phenom cnologica! Explorations o f Self-H ypnosis

hypnosis is to ascertain the relative levels o f self (subject) involvem ent and o th er (hypnotist) involvem ent in the experience. At one end o f the spectrum , hypnosis is controlled and directed by the hyp n o tist. A t the o th er end, the p henom enon is qualitatively different; the self initiates and directs the p ro ­ cess. (A heuristic representation o f this co n tin u u m is sh o w n in Fig. 7.1.) O v e r the last 17 years, the C h icago g ro u p has endeavored to isolate and describe the differences in the hyp n o tic experience at each end o f the spec­ trum . H ypnosis at P oint 5 (other-initiated) w as defined by the C h icago g ro u p as hetero-hypnosis (H H ) and the hypnosis at P oint 1 (self-initiated) w as term ed self hypnosis (SH). B oth ends o f the spectrum do share certain aspects o f the h ypnotic expe­ rience in com m on. F or exam ple, b o th can be conceived o f as an altered state o f consciousness in w hich p erception o f and in teraction w ith the external environm ent is changed and abso rp tio n in internal experience becom es m ore profound. W ithin o u r culture, certain characteristic changes com m on to b o th self-and h y p n o tist-d irected hypnosis are usually involved, including the selective focus o f different m odes o f attention, a m ore tranquil state o f m ind and body, perceived involuntarism , incongruous (trance) logic, tim e disto r­ tion, increased m em ory and im agery, and dissociation. It should be noted th at neither the self (subject) n o r the o th er (hypnotist) can entirely predom inate at either end o f this continuum . T he self cannot solely initiate the experience, because beliefs and expectations have been shaped and colored n ot only by the culture in w hich he o r she lives, b u t by exposure to various kinds o f hypnosis. Perhaps the purest exam ple o f an entirely self-initiated h ypnotic trance w o uld be one that spontaneously occurred to som eone w h o had no n o tio n o f trance and had never heard o f hypnosis before. H o w ev er, it w o u ld be difficult for this individual to co m ­ prehend w h at had occurred, let alone describe it to others. Sim ilarly, it w o u ld be im possible for the self to be entirely elim inated at the o pposite end o f the spectrum , w here the o th er o r h y p n o tist predom inates. N o m atter ho w forceful and authoritarian the h y p n o tist and no m atter h ow m uch an individual believes his o r her will and consciousness w ill no longer be Permissive Hypnosis U nstructured Hypnosis

Structured Hypnosis

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