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Analytical Hypnotherapy: Principles and Practice
BOOK REVIEWS Clinical Psychology and Medicine: A Behavioral Perspective Edited by Chris J. Main, New York, Plenum Press, 1982,372 pp, $39.50.
• The era of behavioral medicine was ushered in during the early 1970s. For most professionals in psychology, psychiatry, and related disciplines, the term "behavioral medicine" was initially introduced by Birk's Biofeedback: Behavioral Medicine (1973). Unfortunately, health professionals perceived behavioral medicine to be synonymous with biofeedback. That biofeedback has made important contributions to clinical practice is indisputable, but it constitutes only a part of the field of behavioral medicine. The editor and the contributors to this volume avoided the mistake of narrowly defining the scope of behavioral medicine. Indeed, one of the strengths of the book-which had its origins in the 1980 fall conference of the Scottish Association for Behavioral Modification-is the diversity of behavioral-change procedures and clinical problem areas addressed. Because of that diversity, reflecting the heterogeneous nature of the papers presented at the conference, the book is divided into four sections. The initial section focuses on theoretical viewpoints in an attempt to integrate physical and psychological factors. Of particular importance here is the questioning of the foundations of cognitive behavior modification. The application of behavioral psychology to problems of the community-based medical practice
is the focal point of the second section. This reviewer was impressed with the treatise on climacterium and behavioral bibliotherapy, especially the latter. In recent years, there have been numerous claims for the effectiveness of the "self-help" treatment packages based on self-administered procedures or at least involving minimal professional consultation. These claims are predominantly unsubstantiated, lacking supportive empirical evidence. Notwithstanding this paucity of supportive research, the burgeoning interest in and application of bibliotherapy in the treatment of clinical problems (eg, sexual dysfunction, obesity, and phobias) is reviewed and recommendations for future research are delineated. Section three reviews specific clinical procedures applied to the treatment of physical illnesses such as cardiovascular disease, primary dysmenorrhea, and headache. A review of recent advances regarding behavioral intervention in cancer treatment is conspicuously absent. The fourth and final section of the book is devoted to the treatment of chronically ill hospitalized patients, who represent the core of those who manifest the most intractable symptoms. A variety of effective behavioral strategies, as evidenced by research, are reviewed (eg, verbal reinforcement, token economy, modeling). Although the chapters span a variety of clinical problems in adults (the editor acknowledges that problems in children and adolescents are beyond the scope of this book) that are of interest to the
health practitioner, the work is not comprehensive. As mentioned, a discussion regarding cancer is notably absent, and of further consequence is the omission of research and clinical approaches to the treatment of depression, especially Beck and associates' cognitive behavioral assessment and treatment strategies in their Cognitive Therapy of Depression. The material in the present book has value for the health clinician who seeks an enhanced understanding of the contributions of, cautions against, indications for, and contraindications to behavioral interventions in the treatment of acute or chronic clinical problems. It is not a handbook of clinical procedures. Rather, it reviews the research and assists the clinician in making decisions on the appropriate intervention for specific clinical problems. The authors cite a number of references for the reader who is interested in pursuing in more detail a particular clinical behavioral procedure. In sum, this volume should be a useful reference source for both the researcher and the clinician interested in behavioral psychology and its relationship to the clinical problems of medicine-indeed, behavioral medicine. Norman H. Rasmussen, Ed. D. Mayo Clinic
Analytical Hypnotherapy: Principles and Practice By E. A. Barnett, Kingston, Ontario, JUNI· CA Publishing, 1981,497 pp, $35.00.
• Many books on hypnosis devote a great deal of space to reviewing the nature of hypnosis, the com(continued)
MARCH 1983 • VOL 24 • NO 3
299
RestfuI~ alert awakening 8
"5mg
~
JOmg
capsules
(temazepam)
A more appropriate half-life One3
RES-183-2
A
Phannaceullcal Olvlllon
SANDOZ, INC. East Hanover. NJ 07936
BOOK REVIEWS mon misconceptions related to hypnosis, the various induction techniques, and how to use posthypnotic suggestions. Every novice in the area of hypnosis is eager to learn how to hypnotize, not realizing that all hypnosis is in fact selfhypnosis and that it is more important to learn what to do while the patient is in a trance than to learn how to induce the hypnotic state. In that sense most hypnotherapists use direct suggestion as their main therapeutic tool. However, it is well known that although direct suggestion may be very effective in some cases, there are many more cases in which individuals do not respond to suggestive communication, even though it is given during the hypnotic trance. It was this puzzling phenomenon about direct suggestion and hypnosis that motivated Dr. Barnett to seek a better understanding and consequently to come across hypnoanalysis. It provided him with clues not only to the origin of symptoms, but also to the subjective changes that account for the variable response to direct suggestion. Dr. Barnett emphasizes the difference between hypnosis and analytical hypnotherapy. In hypnosis with direct suggestion there is one-way communication from therapist to patient; the immediate response of the patient is not a necessary part of the therapy. On the other hand, sensitive and detailed two-way communication is an essential part of analytical hypnotherapy. The book is composed of two parts. In part I, Dr. Barnett delineates some basic material relating to hypnosis in general, briefly reviewing the history of hypnosis, the 302
nature of hypnosis, hypnotic phenomena and hypnotizability, and rapid-induction procedures. The essence of this section lies in the last five (of nine) chapters, where the reader will find a clear, detailed account of analytical hypnotherapy a la Barnett. This includes theory, principles, indications, uncovering techniques, and the special use of ideomotor questioning. Dr. Barnett's theory of analytical hypnotherapy, which is based on Eric Berne's thoery of ego states, may be succinctly summarized: Mental illness and emotional disorders are assumed to be due to the ongoing and outmoded conflict between the "I want" (the Child) part of the personality and the "I ought" (the Parent) part. This conflict can be resolved only by the application of the "I will" or "I can" (the Adult) arbitrator in that conflict. The conflict is terminated when both the Parent part and the Child part accept the arbitration, and we can reach the happy state in which the Adult, the Child, and the Parent coexist in harmony. Chapter 6 is devoted to the principles of analytical hypnotherapy: (I) identification of the critical experience; (2) understanding the repressed emotion and the associated guilt; (3) recognition of current irrelevance of repressed emotions; (4) relinquishing the repressed emotions and the repressed guilt; (5) confirmation of resolution of Parent/Child conflict; (6) rehabilitation, the objectives here being ego strengthening and, when applicable, assertiveness training; and (7) review, with the objective of prevention of symptom relapse or of unwanted behavior patterns. The indications for analytical PSYCHOSOMATICS
hypnotherapy are presumed to be present in any clinical condition created as a result of a Child/ Parent conflict. However, an adult effective and active ego state, must be present: the absence of such an adult ego state as in schizophrenic and borderline disorders, is a contraindication to analytical hypnotherapy. The author summarizes a broad array of uncovering techniques that may be used in analytical hypnotherapy.
The second part of the book shows how to apply, in practice, the methods and techniques of analytical hypnotherapy. In each chapter a theoretical review is followed by a word-for-word account of the communication between the a u thor and the patient, offering an excellent demonstration of the practical aspects of analytical hypnotherapy. Concluding the book is an appendix written by Alan R. Bull, Ph.D., analyzing the results of an-
alytic hypnotherapy of 1,247 patients. The book contains a wealth of clinical material, with many helpful illustrations. All in all, I found it very interesting-filled with "how to" instructions, logically organized, and easy to comprehend for the experienced clinician as well as the beginner.
Emergency Psychiatry for the House Officer
of violent and/or suicidal patients. The book also contains extensive listings of specific differential diagnoses, and medication known to produce psychiatric symptoms. Although emphasis is placed on making accurate diagnoses, this volume does not provide the definitive differential diagnosis and treatment for every clinical situation. As a consequence, caution should be advised for the true beginner in medical practice, because the temptation to make a rapid or premature diagnosis can be dangerous. Despite the book's success in pointing the reader in the right direction, it is far from infallible. From a practical standpoint, the chapters organized around presenting symptoms or complaints work best. It should be noted that those chapters discussing psychiatric diagnoses per se (syndromes) assume that the reader has prior knowledge of the correct workup, evaluation, and treatment. Nevertheless, despite the useful and practical approach to the evaluation and treatment of delirious and suicidal patients in particular, the absence of a discussion of de-
pression and its treatment was striking. In view of a rising incidence of drug overdose by tricyclic antidepressants, it would also have been useful to provide further information on the treatment of anticholinergic toxicity. The quality of the writing is uneven. Generic and brand names of medications are frequently interchanged. Numerous annoying typographic errors are present. These errors might even lead to the inappropriate administration of medication. Recommended dosages of antipsychotic medications are supplied without adequate consideration of potency, efficacy, and onset of action. In summation, it is clear that this brief volume is not the ultimate reference on emergency psychiatry, and that was not its intent. As long as the serious limitations in its use are recognized, it can focus one's attention on the importance of a working differential diagnosis, and can serve a practical function as a guide for house officers in the emergency room.
By William R. Dubin and Robert Stolberg, New York, SP Medical & Scientific Books, 1981,166 pp, $15 (paperback).
• This book was designed to facilitate clinical decision-making for house officers who work in emergency rooms. Initial discussion centers on the frequent need to distinguish between the symptoms of functional and organic illness. This is followed by a presentation of the diagnostic criteria for delirium and dementia, two of the more common organic conditions encountered in emergency medicine. Throughout, emphasis is placed on the importance of a working differential diagnosis. Many topics are covered in a brief and practical manner. Chapters are provided on the mental status examination, delirium and dementia, psychotic illness (including schizophrenia and affective disorders), nonpsychotic disturbances (anxiety, grief, personality disorders), and on alcohol and drug abuse. Other chapters are devoted to the recognition and management MARCH 1983 • VOL 24 • NO 3
Moshe Torem, M.D. Wright State University School of Medicine
Theodore A. Stern, M.D. Harvard Medical School 303
• The era of behavioral medicine was ushered in during the early 1970s. For most professionals in psychology, psychiatry, and related disciplines, the term "behavioral medicine" was initially introduced by Birk's Biofeedback: Behavioral Medicine (1973). Unfortunately, health professionals perceived behavioral medicine to be synonymous with biofeedback. That biofeedback has made important contributions to clinical practice is indisputable, but it constitutes only a part of the field of behavioral medicine. The editor and the contributors to this volume avoided the mistake of narrowly defining the scope of behavioral medicine. Indeed, one of the strengths of the book-which had its origins in the 1980 fall conference of the Scottish Association for Behavioral Modification-is the diversity of behavioral-change procedures and clinical problem areas addressed. Because of that diversity, reflecting the heterogeneous nature of the papers presented at the conference, the book is divided into four sections. The initial section focuses on theoretical viewpoints in an attempt to integrate physical and psychological factors. Of particular importance here is the questioning of the foundations of cognitive behavior modification. The application of behavioral psychology to problems of the community-based medical practice
is the focal point of the second section. This reviewer was impressed with the treatise on climacterium and behavioral bibliotherapy, especially the latter. In recent years, there have been numerous claims for the effectiveness of the "self-help" treatment packages based on self-administered procedures or at least involving minimal professional consultation. These claims are predominantly unsubstantiated, lacking supportive empirical evidence. Notwithstanding this paucity of supportive research, the burgeoning interest in and application of bibliotherapy in the treatment of clinical problems (eg, sexual dysfunction, obesity, and phobias) is reviewed and recommendations for future research are delineated. Section three reviews specific clinical procedures applied to the treatment of physical illnesses such as cardiovascular disease, primary dysmenorrhea, and headache. A review of recent advances regarding behavioral intervention in cancer treatment is conspicuously absent. The fourth and final section of the book is devoted to the treatment of chronically ill hospitalized patients, who represent the core of those who manifest the most intractable symptoms. A variety of effective behavioral strategies, as evidenced by research, are reviewed (eg, verbal reinforcement, token economy, modeling). Although the chapters span a variety of clinical problems in adults (the editor acknowledges that problems in children and adolescents are beyond the scope of this book) that are of interest to the
health practitioner, the work is not comprehensive. As mentioned, a discussion regarding cancer is notably absent, and of further consequence is the omission of research and clinical approaches to the treatment of depression, especially Beck and associates' cognitive behavioral assessment and treatment strategies in their Cognitive Therapy of Depression. The material in the present book has value for the health clinician who seeks an enhanced understanding of the contributions of, cautions against, indications for, and contraindications to behavioral interventions in the treatment of acute or chronic clinical problems. It is not a handbook of clinical procedures. Rather, it reviews the research and assists the clinician in making decisions on the appropriate intervention for specific clinical problems. The authors cite a number of references for the reader who is interested in pursuing in more detail a particular clinical behavioral procedure. In sum, this volume should be a useful reference source for both the researcher and the clinician interested in behavioral psychology and its relationship to the clinical problems of medicine-indeed, behavioral medicine. Norman H. Rasmussen, Ed. D. Mayo Clinic
Analytical Hypnotherapy: Principles and Practice By E. A. Barnett, Kingston, Ontario, JUNI· CA Publishing, 1981,497 pp, $35.00.
• Many books on hypnosis devote a great deal of space to reviewing the nature of hypnosis, the com(continued)
MARCH 1983 • VOL 24 • NO 3
299
RestfuI~ alert awakening 8
"5mg
~
JOmg
capsules
(temazepam)
A more appropriate half-life One3
RES-183-2
A
Phannaceullcal Olvlllon
SANDOZ, INC. East Hanover. NJ 07936
BOOK REVIEWS mon misconceptions related to hypnosis, the various induction techniques, and how to use posthypnotic suggestions. Every novice in the area of hypnosis is eager to learn how to hypnotize, not realizing that all hypnosis is in fact selfhypnosis and that it is more important to learn what to do while the patient is in a trance than to learn how to induce the hypnotic state. In that sense most hypnotherapists use direct suggestion as their main therapeutic tool. However, it is well known that although direct suggestion may be very effective in some cases, there are many more cases in which individuals do not respond to suggestive communication, even though it is given during the hypnotic trance. It was this puzzling phenomenon about direct suggestion and hypnosis that motivated Dr. Barnett to seek a better understanding and consequently to come across hypnoanalysis. It provided him with clues not only to the origin of symptoms, but also to the subjective changes that account for the variable response to direct suggestion. Dr. Barnett emphasizes the difference between hypnosis and analytical hypnotherapy. In hypnosis with direct suggestion there is one-way communication from therapist to patient; the immediate response of the patient is not a necessary part of the therapy. On the other hand, sensitive and detailed two-way communication is an essential part of analytical hypnotherapy. The book is composed of two parts. In part I, Dr. Barnett delineates some basic material relating to hypnosis in general, briefly reviewing the history of hypnosis, the 302
nature of hypnosis, hypnotic phenomena and hypnotizability, and rapid-induction procedures. The essence of this section lies in the last five (of nine) chapters, where the reader will find a clear, detailed account of analytical hypnotherapy a la Barnett. This includes theory, principles, indications, uncovering techniques, and the special use of ideomotor questioning. Dr. Barnett's theory of analytical hypnotherapy, which is based on Eric Berne's thoery of ego states, may be succinctly summarized: Mental illness and emotional disorders are assumed to be due to the ongoing and outmoded conflict between the "I want" (the Child) part of the personality and the "I ought" (the Parent) part. This conflict can be resolved only by the application of the "I will" or "I can" (the Adult) arbitrator in that conflict. The conflict is terminated when both the Parent part and the Child part accept the arbitration, and we can reach the happy state in which the Adult, the Child, and the Parent coexist in harmony. Chapter 6 is devoted to the principles of analytical hypnotherapy: (I) identification of the critical experience; (2) understanding the repressed emotion and the associated guilt; (3) recognition of current irrelevance of repressed emotions; (4) relinquishing the repressed emotions and the repressed guilt; (5) confirmation of resolution of Parent/Child conflict; (6) rehabilitation, the objectives here being ego strengthening and, when applicable, assertiveness training; and (7) review, with the objective of prevention of symptom relapse or of unwanted behavior patterns. The indications for analytical PSYCHOSOMATICS
hypnotherapy are presumed to be present in any clinical condition created as a result of a Child/ Parent conflict. However, an adult effective and active ego state, must be present: the absence of such an adult ego state as in schizophrenic and borderline disorders, is a contraindication to analytical hypnotherapy. The author summarizes a broad array of uncovering techniques that may be used in analytical hypnotherapy.
The second part of the book shows how to apply, in practice, the methods and techniques of analytical hypnotherapy. In each chapter a theoretical review is followed by a word-for-word account of the communication between the a u thor and the patient, offering an excellent demonstration of the practical aspects of analytical hypnotherapy. Concluding the book is an appendix written by Alan R. Bull, Ph.D., analyzing the results of an-
alytic hypnotherapy of 1,247 patients. The book contains a wealth of clinical material, with many helpful illustrations. All in all, I found it very interesting-filled with "how to" instructions, logically organized, and easy to comprehend for the experienced clinician as well as the beginner.
Emergency Psychiatry for the House Officer
of violent and/or suicidal patients. The book also contains extensive listings of specific differential diagnoses, and medication known to produce psychiatric symptoms. Although emphasis is placed on making accurate diagnoses, this volume does not provide the definitive differential diagnosis and treatment for every clinical situation. As a consequence, caution should be advised for the true beginner in medical practice, because the temptation to make a rapid or premature diagnosis can be dangerous. Despite the book's success in pointing the reader in the right direction, it is far from infallible. From a practical standpoint, the chapters organized around presenting symptoms or complaints work best. It should be noted that those chapters discussing psychiatric diagnoses per se (syndromes) assume that the reader has prior knowledge of the correct workup, evaluation, and treatment. Nevertheless, despite the useful and practical approach to the evaluation and treatment of delirious and suicidal patients in particular, the absence of a discussion of de-
pression and its treatment was striking. In view of a rising incidence of drug overdose by tricyclic antidepressants, it would also have been useful to provide further information on the treatment of anticholinergic toxicity. The quality of the writing is uneven. Generic and brand names of medications are frequently interchanged. Numerous annoying typographic errors are present. These errors might even lead to the inappropriate administration of medication. Recommended dosages of antipsychotic medications are supplied without adequate consideration of potency, efficacy, and onset of action. In summation, it is clear that this brief volume is not the ultimate reference on emergency psychiatry, and that was not its intent. As long as the serious limitations in its use are recognized, it can focus one's attention on the importance of a working differential diagnosis, and can serve a practical function as a guide for house officers in the emergency room.
By William R. Dubin and Robert Stolberg, New York, SP Medical & Scientific Books, 1981,166 pp, $15 (paperback).
• This book was designed to facilitate clinical decision-making for house officers who work in emergency rooms. Initial discussion centers on the frequent need to distinguish between the symptoms of functional and organic illness. This is followed by a presentation of the diagnostic criteria for delirium and dementia, two of the more common organic conditions encountered in emergency medicine. Throughout, emphasis is placed on the importance of a working differential diagnosis. Many topics are covered in a brief and practical manner. Chapters are provided on the mental status examination, delirium and dementia, psychotic illness (including schizophrenia and affective disorders), nonpsychotic disturbances (anxiety, grief, personality disorders), and on alcohol and drug abuse. Other chapters are devoted to the recognition and management MARCH 1983 • VOL 24 • NO 3
Moshe Torem, M.D. Wright State University School of Medicine
Theodore A. Stern, M.D. Harvard Medical School 303