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Hypnosis in the Desensitization of Fears of Dying ABSTRACT 1. CASE CONTEXT and METHOD Hypnosis in the Desensitization of Fears of Dying 1 S.R. Hamburg Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 2, Module 2, Article 1, pp. 1-30, 05-11-06 [copyright by author] Hypnosis in the Desensitization of Fears of Dying SAM R. HAMBURG a,b a Independent Practice, University of Chicago’s Pritzer School of Medicine, Family Institute of Northwestern University b Correspondence concerning this article should be addressed to Sam R. Hamburg, Ph.D., P.C., 79 W. Monroe Street, Suite 1311, Chicago, IL 60603 Email: [email protected] _________________________________________________________________________ ABSTRACT This paper describes two cases in which hypnosis was successfully used, in the context of an integrative approach to therapy, to treat pathologically obsessive fears of death. The hypnotic interventions employed in each case are described in detail. The cases illustrate how hypnotherapy can be adapted to clients with widely differing clinical contexts and demographics, with one involving a 40-year-old African-American man (Lawrence), and the other, a 36-year- old white woman (Betty). The latter case illustrates how clinical knowledge, transmitted via a published case of Milton Erickson’s, provided the author the idea for developing a novel solution to the client’s pressing clinical problem. Key words: obsessive fear of death; hypnosis; hypnotherapy; multimodal therapy ________________________________________________________________________ 1. CASE CONTEXT AND METHOD The Cases The two cases presented here have in common their presenting problem: pathological fear of dying. (Note that the names and other identifying characteristics of the clients have been disguised to preserve their anonymity; and both clients gave their permission to have their case written up for publication.) In both cases, hypnosis, within the broader framework of an integrative behavioral/experiential approach to therapy, is the treatment technique that seems to have helped. Both cases have been written up many years after they were conducted, employing the author’s memory and written clinical records. This presents substantial methodological limitations to cases, since working from session transcripts, employing quantitative and standardized self-report measures, bringing in peer supervision reports, and related strategies are clearly ways to enhance the quality of information about therapy cases that were not available in the present cases. On the other hand, I believe that these two cases show the dramatic, positive effect of hypnosis for a very disturbing symptom (persistent and at times intense fear of dying) when other techniques were not working. Moreover, the second case has very positive, 7-year follow-up data. And so I would offer that these two cases have important lessons to offer, in spite of their methodological limitations. Hypnosis in the Desensitization of Fears of Dying 2 S.R. Hamburg Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 2, Module 2, Article 1, pp. 1-30, 05-11-06 [copyright by author] Hypnosis and Behavior Therapy Long before the advent of cognitive-behavior therapy, hypnosis was in use as a rapid, direct, operationally specific, symptom-focused method of psychological healing. Not surprisingly, therefore, hypnotic techniques were part of the armamentarium of early behavior therapy. Wolpe and Lazarus (1966) recommended hypnotic induction as an effective way to produce the state of deep relaxation required for systematic desensitization. And Wolpe (1984) reported a case in which a flight phobia was cured by hypnotic suggestion. There have been a few reports of hypnosis as an adjunct in cognitive-behavior therapy, and a meta-analysis of these found that they enhanced treatment outcome (Kirsch, Montgomery, & Sapirstein, 1995). That hypnosis can profoundly alter experience in laboratory situations, e.g., raising pain thresholds, has been amply documented; and there is reasonably good evidence for its effectiveness in a variety of clinical applications (Rhue, Lynn, & Kirsch, 1993). Nevertheless, hypnosis has not found a firm footing in behavior therapy. I suspect this is due to its avowed mentalism -- all the talk of the "unconscious mind." (Of course, systematic desensitization, despite its behavioral rationale, is utterly mentalistic in its employment of visual imagery.) Also, the ongoing disputes among researchers about the nature of hypnotic phenomena probably impeded its acceptance. In the early post-war decades the debate was cast in terms of the question, is hypnotic behavior due to a truly altered state of consciousness or is it simply an artifact of the social psychology of the hypnotic situation? The questions have since become more subtle but the controversy over the nature of hypnosis persists (Kirsch & Lynn, 1995). Another bar to hypnosis in behavior therapy has been the overwhelmingly rationalist bias of the prevailing therapeutic ideology in behavior therapy: cognitive-behavior therapy. A theory of psychopathology and psychotherapy that posits dysfunctional, irrational thoughts as the origin of complex psychophysiological problems such as depression leaves little room for a technique that capitalizes on imagery and other extra-logical mental processes. Multimodal behavior therapy (Lazarus, 1989), by contrast, is congenial to hypnosis. First of all, in according equal ontological validity to all the factors constituting psychological life -- affect, sensation, and imagery as well as cognition and behavior --multi-modal therapy provides a theoretical framework consistent with the mentalistic emphasis of hypnosis. Second, in its advocacy of technical eclecticism, and implicit acknowledgement that the mechanisms of action of all psychotherapeutic techniques are obscure, multi-modal therapy does not consign hypnosis to illegitimacy simply because its effects have been explained in contradictory, and sometimes implausible (i.e., "animal magnetism") ways. For clients who request it, Lazarus will use hypnosis within a multi-modal approach (Lazarus, 1999). Although the therapeutic approach described in this article is not, strictly speaking, multi-modal therapy, it is multi-modal in spirit. Hypnosis in the Desensitization of Fears of Dying 3 S.R. Hamburg Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 2, Module 2, Article 1, pp. 1-30, 05-11-06 [copyright by author] 2. THE CLIENTS Case A: Lawrence Both clients were seen in my private office. Lawrence, who was referred by a employee assistance program (EAP) counselor at his work. He was a tall, healthy-looking, 40-year-old, African-American man. His chief complaint was, "I have a fear of my own mortality." His only other complaint was that he suffered from middle insomnia -- awake and watching TV for 30-45 minutes several nights a week -- which he couldn't explain, but denied all other symptoms of major depression. He had a good, non-dangerous job, responding to emergencies resulting from equipment malfunctions in a high-tech environment; he lived in a nice neighborhood and denied any fear of being the victim of criminal or random violence; and he said that his marriage and family were fine. This was his second marriage. His 20-year-old son and 14-year-old daughter from his first marriage lived with him and his second wife, along with a daughter and 6-year-old son from the current marriage. Case B: Betty Betty was 36 when I met her. She had been married, happily overall, for 16 years and had a nine year-old son who was doing well. She worked in a responsible management job in a large corporation and had been referred by its medical department. Betty's presenting problem was a continuing and daily obsessive fear that she or her husband or son would be struck by fatal cancer. This obsession interfered in her life every day and manifested itself in a variety of ways. This manifested itself anytime she, her husband, or her son had any physical symptom, leading her to jump to the conclusion that this was a sign they had cancer and would surely die from it. She would seek out television, newspaper, and magazine stories about cancer, and newspaper obituaries. On the days before her yearly gynecology exam, her fears of cancer would exacerbate. 3. GUIDING CONCEPTION WITH RESEARCH AND CLINICAL EXPERIENCE SUPPORT: HYPNOSIS IN MY PRACTICE My own adoption of hypnosis is closely connected with my movement away from a strictly cognitive-behavioral approach. When I was first hypnotized, during my internship at a VA hospital in 1975-1976, I still identified strongly as cognitive-behavioral, and so I didn't think much of it. A psychologist from another VA hospital visited and gave a presentation on hypnosis. I remember him identifying himself as a cognitive-behavior therapist and wondering what a nice cognitive-behaviorist like him was doing messing with hypnosis. At the end of the presentation he announced that he would do a brief induction. I don't remember what happened in the 15 minutes following that; I was in a hypnotic state. Indeed I had experienced an amnesic trance, which I later learned is characteristic of some highly hypnotizable subjects. Despite this Hypnosis in the Desensitization of Fears of Dying 4 S.R. Hamburg Pragmatic Case Studies in Psychotherapy, http://pcsp.libraries.rutgers.edu Volume 2, Module 2, Article 1, pp. 1-30, 05-11-06 [copyright by author] striking demonstration of the reality of hypnosis, I did not follow up on it simply because my strict cognitive-behavioral,
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