The investigators hypnotized people and asked that they recall their earliest memories. Gorham & Hafner tested highs and lows in 2 sessions, one with a hypnotic induction. Ss in hypnosis reported more themes, whether high hypnotizables or not. Ss might have held back in non hypnosis condition however.
Hypothesized that early memories would have affect-laden materials.
20 Ss in hypnosis group, 20 Ss in relaxation condition, all highs (scored minimum of 9 of 12 on the Harvard Scale). Ss were told they were randomly selected from a pool and that it was a study of personality. Ss were administered a number of questionnaires and tests.
The two groups received either a Stanford Form C Scale induction or a relaxation procedure.
We used the procedure of Bloom [spelling?] for recall of two memories, and to probe the earliest memory. Also to recall two recent memories. Counterbalanced for order of presentation.
Positive affect, negative affect, affect intensity, and primary process were rated; 12 themes were rated. ANOVA was used.
Earliest memory at 3.8 yrs. Next earliest is 7.5 for hypnosis and 5.2 for relaxation groups. 4.3 is earliest for hypnosis group; there may be a basement effect. Negative affect varied by condition and by order of administration and recency of memory assessed. When early memories were elicited first, no differences were found in groups; when elicited second, negative affect was greater for [missed words]. Affect was more abundant and intense in the hypnosis group, but only when recent memories were elicited before early memories and only in the [missed words].
Early recollections were slightly more primary process (bizarre) than later, which should alert clinicians.
Themes didn’t differ between groups. Early memories involved more trauma than later memories. Negative affect correlated with psychopathology measures for earliest memory but not later memory.
Used posthypnotic experiences scales. There is a decrease in unpleasant experiences, suggesting the benefit of catharsis when recalling early memories.

Watkins, Helen H. (1993). Ego-State therapy: An overview. American Journal of Clinical Hypnosis, 35, 232-240.

Ego-state therapy is a psychodynamic approach in which techniques of group and family therapy are employed to resolve conflicts between the various “ego states” that constitute a “family of self” within a single individual. Although covert ego states do not normally become overt except in true multiple personality, they are hypnotically activated and made accessible for contact and communication with the therapist. Any of the behavioral, cognitive, analytic, or humanistic techniques may then be employed in a kind of internal diplomacy. Some 20 years experience with this approach has demonstrated that complex psychodynamic problems can often be resolved in a relatively short time compared to more traditional analytic therapies.
Claridge, Karen (1992). Reconstructing memories of abuse: A theory-based approach. Psychotherapy, 29, 243-252.

The recovery of traumatic memories is an important part of therapy with survivors of abuse. This article describes a conceptual framework for memory reconstruction based on Horowitz’ (1986) theory of stress response syndromes. The client’s history of intrusive symptoms provides a way to anticipate the nature of the trauma, even when no memory of it exists. Ongoing intrusive symptoms are used to retrieve memory fragments, and their emotional impact is used to build the client’s emotional tolerance. Emphasis is placed on preparing for memories by identifying what the client will need when the memories return, building coping skills, and beginning to restructure cognitions at the “what if” stage of remembering. Case material is used to illustrate.
Darken, Rachel (1992). Hypnosis in the treatment of survivors of sexual abuse. Australian Journal of Clinical and Experimental Hypnosis, 20, 105-110.

This paper outlines the problems of child sexual abuse and its long-term sequelae, often reaching down generations. In psychotherapy with survivors of childhood sexual abuse, hypnosis offers a flexible treatment modality and the paper focuses particularly on the use of hypnosis and self-hypnosis for the “reparenting” element of psychotherapy.
Faller, Kathleen Couborn (1992, Summer). Can therapy induce false allegations of sexual abuse?. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 3-6.

NOTES: “Concern about the impact of therapy on children’s accounts of sexual abuse should be understood in the context of two phenomena: (1) the adult need to deny that children are sexually abused, and (2) adult identification with the alleged abuser. These phenomena operate at both individual and societal levels” (p. 3).
“Research related to impact of stressful situations on children’s ability to recall provides mixed results, some studies finding children are less accurate if the event is traumatic (Peters, 1991) and others finding they are not (Goodman, Reed, & Hepps, 1985).
“Research reveals that it is rare for children to falsely allege that they have been touched in their private parts. In one study, a substantial proportion of children who experienced genital and anal touch during a physical examination by a doctor did not volunteer this information when asked general questions about the examination. The majority of children in the study revealed genital and anal touch only when they were asked specific questions like, “Did the doctor touch you there?” (Saywitz, Goodman, Nicholas, & Moan, 1991)” (pp. 3-4).
“Clarke-Stewart and her colleagues (1989) have demonstrated that children’s interpretation of ambiguous events can be manipulated and altered by an authority figure who insists upon a particular interpretation (see also Lindberg, 1991)” (p.4).
“In sum, the research suggests that older children are likely to provide more complete unassisted disclosure than younger children. Younger children may need more memory cues in the form of specific questions than older children. Therapists are much more likely to find false negatives than false positives. Finally, therapists should be aware of the possibility the child may identify the wrong person. … Generally, however, the research indicates that concern about the contaminating effects of therapy on children’s recollections of sexual abuse is exaggerated” (pp. 4-5).
“Research indicates that the proportion of fabricated reports may be higher in the divorce scenario than in other contexts (Faller, 1990; Jones & Seig, 1988). Studies suggest most false reports are made by adults, not children (Jones & McGraw, 1987; Jones & Seig, 1988)” (p. 5).
“Clinical research (Sorenson & Snow, 1991) and experience (Faller, 1988) indicate that for most children, revealing sexual abuse is a process which occurs over time. A typical pattern is one in which children begin with the least overwhelming experience and gradually disclose more and more as their accounts are accepted and believed” (p. 5).
“[In conclusion]… therapists should be aware of the findings from research on children’s memory and suggestibility. This research indicates that there are vulnerabilities which should be taken into account during therapy” (p. 6).
Herbert, James D.; Mueser, Kim T. (1992). Eye movement desensitization: A critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry.

The scientific evidence supporting the efficacy of eye movement desensitization (EMD), a novel intervention for traumatic memories and related conditions, is reviewed. The sparse research conducted in this area has serious methodological flaws, precluding definite conclusions regarding the effectiveness of the procedure. Clinicians are cautioned against uncritically accepting the clinical efficacy of EMD.
Lohr, Jeffrey M.; Kleinknecht, Ronald A.; Conley, Althea T.; Dal Cerro, Steven; Schmidt, Joel; Sonntag, Michael E. (1992). A methodological critique of the current status of eye movement desensitization (EMD). Journal of Behavior Therapy and Experimental Psychiatry.

Eye Movement Desensitization (EMD) has been recently advocated as a rapid treatment for the elimination of traumatic memories responsible for the maintenance of a number of anxiety disorders and their clinical correlates. Despite a limited conceptual framework, EMD has attracted considerable interest among clinicians and researchers. The popularity and interest generated by EMD will likely result in wide usage. We present a methodological critique of it with reference to assessment, treatment outcome, and treatment process. We also provide guidelines for judging the methodological adequacy of research on EMD and suggest intensive research to assess effectiveness, treatment components, and comparisons with other procedures.
Lynn, Steven Jay; Rhue, Judith W. (1992, October). Memory. [Paper] Presented at the annual meeting of the Society for Clinical and Experimental Hypnosis, Arlington, VA.

NOTES: [Author presented a dramatic case report of patient who recalled specific events that subsequently he and the patient investigated and disproved. What the patient thought they saw could not possibly have been seen.]
The experimental literature on memory gives us some things to think about. Therapy relies highly on memory, and the therapist shapes the contours of the memory by validating the memories, which are rarely doubted. Tacit acceptance of memories as historical facts is part of the contract of therapy.
Memory studies challenge the idea of accurate storage. Some people are unduly confident of their memory. Bartlett’s research demonstrated distortion according to schema, interpretations, embellishments, etc. Jacobi et al indicate people’s theories about what happened shape memory.
One theory is that trauma leads to amnesia, repression, dissociation. But research does not show inability to recall early life events indicates presence of a traumatic history. Repression is not prima facia evidence of abuse. The Courage to Heal book states that merely thinking you were abused is evidence that you probably were.
How do vague ideas crystallize? Loftus finds if inability to remember isn’t attributed to ordinary forgetting, the person may look for memories, thereby creating them.
Studies of persons who confess to crimes, unsure whether they did or didn’t do them, indicate that these people are easily coerced. Doubt in a memory’s accuracy can be reframed by a therapist.
Hypothesis: Therapists who confidently state a view risk implanting pseudomemories. Therapists must be cautious.
Clients can confuse sources of information that they receive. Different sources of information can be integrated into a single memory (e.g. what occurred to them and what occurred to siblings can be integrated into a pseudomemory). Some limited evidence that early life experience memories could be implanted has been presented by Loftus.
Certain client characteristics contribute to false memories: 1. Present mood state (mood congruent memory). This effect is reliable when people are clinically depressed. Though clinicians may say it indicates early childhood abuse, the memory might be selective or biased. 2. History of fantasy-proneness. In childhood this type of person might have had problems distinguishing fantasy from reality. LaBelle et al found absorption made it difficult to distinguish sounds in hypnosis from what really occurred, creating pseudo- memories. With this population it is essential to avoid suggesting abuse.
Lynn was successful in implanting an idea of abuse in an alter called Person. He used the Orne technique (from the BBC film “Hypnosis on Trial”) to ask a patient what she had told him about her dog during the hypnosis; he did this to convince her of the importance of exploring her amnestic episodes.
Does hypnosis foster a literal re-experiencing of childhood events? NO. Nash, in an exhaustive review, failed to find correspondence between information from hypnotic age regression and childhood events. He notes that literal reliving is not possible. It is possibly an expression of primary process thinking. Hypnosis doesn’t ameliorate memory problems; and it may exacerbate memory problems.
Lynn views primary process thinking observed in hypnosis as due to the demand of hypnosis to fantasize and relinquish critical thinking or objectivity. This plus Therapist and Patient expectancies may foster tenacious beliefs that events occurred.
Many hypnotic suggestions may interfere with memory. The AMA 1985 report suggests that hypnosis can influence confidence in a ‘memory’ with no actual improvement in accuracy.
The effects aren’t limited to hypnosis however. Simulators and controls also generate pseudomemories. Repeated questioning of Ss who are led to believe that questioning helps distinguish memories from fantasies, actually diminishes the accuracy of memories.
Hypnotizability is correlated with pseudomemory occurrence. We should evaluate a client’s hypnotizability when evaluating for pseudomemories.
Perceived verifiability rate is important, as pseudomemories are higher where you can’t verify the reported memory, it is thought. Therefore, approach with caution. Make every effort to corroborate memories.
Subjective reports may tell narrative truths even though inconsistent with the historical record, and could be useful independent of historical accuracy. I agree that those ‘memories’ could be important, just as age progression or past life regression material could be useful in therapy. But should we base our interpretations or conclusions on events that are not confirmed? A patient’s belief in abuse by their parent has enormous implications for a family.
Therapists should understand the dynamics of a request for using hypnosis to recall forgotten memories before using uncovering techniques. Ask yourself, “Why is this being requested?” Also ask other questions: 1. Is the person fantasy prone, dissociative, suggestible, a high hypnotizable? 2. Is the person stabilized enough to focus on an abreaction? 3. Is there conscious or unconscious motivation to avoid responsibility for one’s own behavior? 4. Is there a wish to arrive at a facile solution, a magic cure, the royal road to the unconscious; or is there an attempt to control the treatment hour, to avoid issues, to test the therapist? 5. Is therapy stalled, not moving forward? 6. Am I angry with the client because they expect to uncover more?
Instead of using hypnosis to retrieve memories, I may focus on the issues to which I answer ‘Yes’ in the forgoing list.
I do not believe current research is sufficiently persuasive to throw out hypnosis for retrieving memories. The dangers of pseudomemory are endemic to therapy. Incorporating hypnosis into a broader frame of therapy depends on the skill of the clinician. However, we must use hypnosis with great caution
COMMENTS FROM AUDIENCE. Joseph Dane: In 75% of cases that could be verified, they found corroborating evidence: what should you look for as an index that the memory recalled in hypnosis is more likely to be accurate?
Lynn: Many instances of abuse are corroborated. No one questions the veracity of all memories. To my knowledge there are no ways of corroborating genuine from false memories. We know subjective conviction is not sufficient, and clients’ affective experience can be very misleading. Since my experience [in the case study reported at the beginning of this presentation] I have talked with many therapists who have had similar experiences.
David Spiegel – the problem is not the hypnosis: patients go in and out of hypnosis all the time, momentarily. The problem is, how do I explore the material in psychotherapy? There is no substitute for corroboration if you can get it. But you have to be sensitive to the vulnerability of those people.
Howard Hall: What is a genuine memory? No memory is undistorted. More importantly, can we verify significant events that might have had long term consequences, like abuse? We should try to verify memories when we base treatment programs on them. The only memories in the literature that have a reputation of being accurate are highly traumatic events that stand out, and these reports are anecdotal in nature.

Murrey, Gregory J.; Cross, Herb J.; Whipple, Jim (1992). Hypnotically created pseudomemories: Further investigation into the ‘memory distortion or response bias’ question. Journal of Abnormal Psychology, 101 (1), 75-77.

In order to study whether pseudomemories represent actual memory distortions or are a result of response bias, 60 highly hypnotizable subjects and subjects from the general population were divided into 4 experimental groups and were tested for pseudomemory manifestation after receiving a false suggestion. Of the 4 groups of subjects, 3 were offered a monetary reward as a motivation to distinguish false suggestion from the actual occurrence. Pseudomemory manifestation was found to be significantly higher among subjects not offered a reward than among subjects who were offered such a reward. The implications of these findings are discussed.

The article contains a review of the literature through 1989. The study tested the hypothesis that when it is important to distinguish fantasy from reality in a hypnosis experiment, subjects can do so–a position presented by Spanos and McLean (1986). They used a verifiable event to test for pseudomemory production, as in research published by McCann and Sheehan (1988). Subjects were 30 high hypnotizable and 30 unselected students.
Subjects were shown a videotape of a mock robbery scene. The next week, Groups A, B, and C heard audiotapes “to enhance memory,” but in addition to motivating statements about “trying to remember” certain details, the tapes included misleading information (e.g. “Remember the color of the hat the robber was wearing” when in fact there was no hat on the robber). Subjects in these groups were ‘influenced.’
“Both highly hypnotizable subject groups (Groups A and B) listened to the audiotape after being administered a 10-min hypnotic induction procedure (modified from that of Barber, 1969). Subject Group C listened to the audiotape without hypnosis. The control group, Group D, did not listen to the audiotape and was, therefore, classified as ‘uninfluenced.'”
A week later subjects responded to multiple-choice and yes-no or true-false questions about the robbery scene. The yes-no question about whether the robber was wearing a hat served as the dependent variable, a measure of pseudomemory. “To motivate subjects to report the truth rather than to follow any perceived expectations of the experimental of social context, we offered subjects in Groups B, C, and D a monetary reward if they achieved the most correct answers on the quiz (according to the videotape). The reward was offered just before administration of the quiz to ensure that no collusion between the subjects could occur. Group A was not offered any such reward” (p. 76).
“The number of subjects in Group A (hypnotized, influenced, no reward) who reported the false information at posttest (12) was significantly greater then that of Group B (hypnotized, influenced, offered reward…. However, the difference in incidence of pseudomemory between Group B and the control group, Group D (not hypnotized, uninfluenced, offered reward), was nonsignificant” (p. 76).
Table 1 Incidence of Pseudomemory Per Group ——————————————————————————————- False suggestion Group A Group B Group C Group D
result (n=15) (n=15) (n=15) (n=15) ——————————————————————————————-
Accepted 12 6 7 3
Rejected 3 9 8 12 —————————————————————————————— Note. Group A = hypnotized, influenced, not offered reward.
Group B = hypnotized, influenced, offered reward.
Group C = not hypnotized, influenced, offered reward.
Group D = not hypnotized, not influenced, offered reward.
In the Discussion, the authors wrote, “Because the only variable among these groups was the reward, a reasonable conclusion from the findings is that pseudomemories manifested by the subjects were (for the most part) not actual memory distortions. Presumably, the reward provided the subjects in Group B an incentive to ‘report the truth’ and a disincentive to give biased reports on the basis of the perceived expectations of the social or experimental context. Thus these data suggest that pseudomemory effects or the occurrence of the pseudomemory phenomenon among highly hypnotizable subjects can be minimized by providing a motivation to subjects to give unbiased reports.
“A major implication of these findings is that researchers should control for response bias resulting from perceived social demands or from leading test designs when they conduct pseudomemory research. Of further concern is the fact that a number of researchers contend that hypnotic interrogation of eye-witnesses can greatly facilitate the creation of pseudomemories (Levitt, 1990; Loftus, 1979; Orne, 1979; Putnam, 1979), and therefore hypnosis either should not be allowed in the courtroom or should be strictly controlled. Yet in light of our findings, response bias may be a confound in pseudomemory research, and thus researchers need to be cautious when making inferences to specific situations from data obtained in an experimental setting.
“Despite the existence of a confound of (unmeasured) differences in hypnotizability between the two groups, there was no significant difference between Group B and the control group (Group D). This suggests that if response bias is controlled for, there may not be significant differences in manifestation of pseudomemories between highly hypnotizable subjects and subjects representative of the general population. However, further research is needed in order to address this question” (pp. 76-77).

Ofshe, Richard J. (1992). Inadvertent hypnosis during interrogation: False confession due to dissociative state; mis-identified multiple personality and the satanic cult hypothesis. International Journal of Clinical and Experimental Hypnosis, 40, 125-156.

Induction of a dissociative state followed by suggestion during interrogation caused a suspect to develop pseudo-memories of raping his daughters and of participation in a baby-murdering Satanic cult. The pseudo-memories coupled with influence from authority figures convinced him of his guilt for 6 months. During this time, the suspect, the witnesses, and all the evidence in the case were studied. No evidence supported an inference of guilt and substantial evidence supported the conclusion that no crime had been committed. An experiment demonstrated the suspect’s extreme suggestibility. The conclusion reached was that the cult did not exist and the suspect’s confessions were coerced- internalized confessions. During the investigation, 2 psychologists diagnosed the suspect as suffering from a dissociative disorder similar to multiple personality. Both psychologists were predisposed to find Satanic cult activity. Each concluded that the disorder was due to “programming” by the non-existent Satanic cult.
Perry, Nancy W. (1992, Summer). How children remember and why they forget. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 1-2; 13-16.

NOTES: “‘My memory is the thing I forget with.’ (a child’s definition, cited in Grossberg, 1985, p. 60)” (p. 1).
“Unlike the simpler forms of memory retrieval, free recall is strongly age-related… the recall skills of preschool children develop gradually” (p. 2). “…in some cases, younger children can provide _more_ accurate information than adults (Lindberg, 1991). For example, if an event is particularly salient (as sometimes happens in cases of trauma), recall may be exceptionally good (Brainerd & Ornstein, 1991; Lindberg, 1991)” (p. 13).
“Children have limited ability to use memory strategies. For this reason, children often know more than they can freely recall” (p. 13).
“The use of _rehearsal_ as a memory strategy is almost automatic for adults. … Ten-year-olds also commonly use rehearsal to aid memory. Young children, however, have not mastered rehearsal (Harris & Liebert, 1991).
“Another memory strategy is imagery, which involves (1) mentally picturing a person, place, or object, or (2) visually associating two or more things that are to be remembered. Children develop imagery much later than other memory strategies. Indeed, some people never learn this memory strategy (Flavell, 1977)” (p. 13).
“… stress alone may not impair memory processes. Indeed, stress can lead to arousal, heightened attention, and improved encoding (Deffenbacher, 1983). However, stress that results from intimidation may lead to either impairment in encoding or problems in recalling or reporting memories” (p. 14).
“Because the effect of suggestion on material that has been well encoded tends not to be significantly different across age groups (Cohen & Harnick, 1980), it may be that younger children’s inferior performance on suggestive tasks results from inferior encoding” (p. 15).
Putnam, Frank W. (1992). Using hypnosis for therapeutic abreactions. Psychiatric Medicine, 10, 51-65.

The dramatic reliving of traumatic events under hypnosis, is a powerful therapeutic intervention useful in the treatment of victims of trauma. First systematically applied in World War I, abreaction coupled with psychotherapeutic processing of the recovered material is increasingly being used with victims of child abuse and chronic PTSD. Abreactions are helpful in recovering dissociated or repressed traumatic material, reconnecting missing affect with recalled material and for transforming traumatic memories. Although abreactions can be induced with medications, hypnosis is the method of choice except in acute situations where it is not possible to establish rapport. A variety of hypnotic techniques for the induction and management of abreaction are discussed, together with the indications and contraindications for their use.
Summit, Roland C. (1992, Summer). Opinion: Misplaced attention to delayed memory. The Advisor (Published by American Professional Society on the Abuse of Children), 5 (3), 21-25.
NOTES: “I believe this is the time to cap a century of progress with a monumental achievement in awareness. We must cherish and develop the concept that what we don’t know can hurt us. We can establish, for the first time, that our lives and even the nature of our society can be shaped by experiences so terrible that they are, in the words of Josef Breuer a century ago, ‘forbidden to consciousness’ (1895, p. 225). We may learn that huge chunks of oppositional thought, cruelty, perversity, helplessness, self-destruction and mental illness are derived from this hidden reservoir of suffering, and we could inspire unprecedented achievements in healing, prevention and enlightened peacemaking” (p. 21).
“We have been slow to consider the implications of dissociation for protective awareness of child sexual abuse” (p. 22).
“And we should respect the painful threat that enlightenment poses for our comforting faith in a just and fair society. We would have to consider that we may be capable as a people of hiding our most grotesque activities under the cover of dissociation, so that we don’t know we’re doing it, our victims can’t say it’s happening, and as an outer society we will insist that no such thing could possibly exist” (p. 22).
“While it is urgently important to know that dissociation is real, it is doubly important not to endorse as accurate, in fact, details or encounters that may be part of a still unknown process of distortion” (p. 22).
“The most distinguished clinicians, the people who occupy the platform of authority as scientists and educators, are joining with those who, until now, have been recognized mainly for their adversarial positions. Now those two poles are coming together in aroused opposition to the phenomenon of delayed memory, especially when acquired in therapy with young women in their 30’s, especially when those therapists lack an M.D. or a Ph.D. diploma. We face, once again, an ageist, sexist, elitist professional standoff around an issue that deserves to be explored in harmony” (p. 24).
“In California and several other states the statute of limitations has been suspended for individuals who can demonstrate delayed discovery of childhood trauma” (p. 24).
“The rush to judgment is not confined to civil litigation. There is no statute of limitations on murder” (p. 24).
“How many kids have hidden the memory of unspeakable assaults which can be unearthed years later to plunge them into courtroom testimony? How many free citizens could be sued or imprisoned by such remote discoveries? What should we do as scientists in support of or in opposition to those delayed memories?” (P. 24).
“We know that skepticism can quash the emergence of dissociated memories. Can we prove that therapeutic zeal cannot enhance such memories? Survivors who gain a clear picture of sexual assault in the climactic period of discovery tend to fade out the sharp edges as they achieve resolution and healing. The most seasoned survivors may discount the intermediate memories which once provided the impetus for their recovery” (p. 25).
Yapko, Michael D. (1992). Editor’s Viewpoint. Milton H. Erickson Foundation Newsletter, 12 (3), 2.

“A controversial issue is heating up, and therapists are beginning to feel the heat. The issue involves the common practice of helping clients recover apparently repressed memories of early childhood sexual trauma.
“In the second edition of my hypnosis textbook, _Trancework_ (1990, Brunner/Mazel), I included a special section on the possibility of hypnotically implanting false memories—vivid memories of things that never actually happened that the client comes to believe as true recollections. I pointed out the risks of suggestive procedures and urged caution in suggesting memories of any sort, whether a formal hypnotic induction took place or not.
“Early this year a non-profit foundation was formed in Philadelphia called the _False Memory Syndrome Foundation_ which serves as a clearing house for relevant information, and even publishes a newsletter. It also provides support to families broken apart by these problems. If you are interested in the complex issues regarding suggestion and memory, you can contact the FMS Foundation at _3508 Market Street, Suite 128, Philadelphia, PA 19104,_ telephone _(215) 387-1865. David Calof’s_ group also _publishes Treating Abuse Today_. They, too, are cognizant of the relevant issues. Their address is _2722 Eastlake Avenue East, Seattle, WA 98012,_ telephone _(206) 329- 9101_” (p. 2).

Chu, James A.; Dill, Diana L. (1991). Dissociation, borderline personality disorder, and childhood trauma. American Journal of Psychiatry, 148 (6), 812.

Comments on the article by S. N. Ogata et al (see PA, vol 78:4681) on the high prevalence of childhood physical and sexual abuse in inpatients with borderline personality disorder. It is suggested that dissociative symptoms in borderline patients may simply be a less severe form of intrapsychic fragmentation than multiple personalities.
Cornell, William F.; Olio, Karen A. (1991). Integrating affect in treatment with adult survivors of physical and sexual abuse. American Journal of Orthopsychiatry, 61 (1), 59-69.

Presents a theoretical and technical model for affectively centered treatment of adults abused as children, focusing on the function of denial and dissociation as central defense mechanisms. The concept is introduced of working at an “affective edge.” At this experiential point, a client can maintain both cognitive understanding and emotional and bodily awareness without triggering denial and dissociation. This approach fosters careful monitoring of the client’s functioning both during and between therapeutic sessions. The proposed therapeutic approach uses noninvasive touch and body-centered techniques. Focus is on integrating affect and on the importance of the therapeutic relationship.
Friedrich, William N. (1991). Hypnotherapy with traumatized children. International Journal of Clinical and Experimental Hypnosis, 39 (2), 67-81.

The psychological impact of trauma can include cognitive, affective, and behavioral components. The degree to which a child is either overwhelmed by or unable to access the traumatic event can make the working through of the event in therapy difficult. Hypnotherapy is a useful modality not only for alleviating symptoms but also for uncovering the traumatic event(s) with associated affects, integrating and making sense of the experience. 4 case studies are reported to illustrate the utility of hypnotherapy with young, traumatized children.
Rhue, Judith W.; Lynn, Steven Jay (1991). Storytelling, hypnosis and the treatment of sexually abused children. International Journal of Clinical and Experimental Hypnosis, 39 (4), 198-214.
The present article describes an assessment and therapy program for sexually abused children using hypnotherapeutic techniques which center on storytelling. Storytelling presents the therapist with an opportunity to use comforting suggestions, symbolism, and metaphor to provide the emotional distance necessary to deal with the trauma of abuse. Hypnotherapy proceeds in a stepwise fashion from the building of a sense of safety and security; to imaginativge sharing; to the introduction of reality events; to the final step of addressing complex emotional issues of loss, trust, love, and guilt brought about by the abuse.
Sanders, Barbara; Giolas, Marina H. (1991). Dissociation and childhood trauma in psychologically disturbed adolescents. American Journal of Psychiatry, 148, 50-54.
Tested the hypothesis that dissociation in adolescence is positively correlated with stress or abuse experienced earlier by assessing the relationship between degree of dissociation and degree of reported childhood stress, abuse, or trauma in 47 13- 17 year old disturbed adolescents. Subjects had been institutionalized for periods of 1-13 weeks. Subjects completed a Dissociative Experiences Scale (DES) and a child abuse and trauma questionnaire. Scores on the DES correlated significantly with self-reported physical abuse or punishment, sexual abuse, psychological abuse, neglect, and negative home atmosphere but not with abuse ratings made from hospital records. Findings support the view that dissociation represents a reaction to early negative experience and places multiple personality disorder at the extreme end of a continuum of dissociative sequelae of childhood trauma.
Smith, William H. (1991). Antecedents of posttraumatic stress disorder: Wasn’t being raped enough? A brief communication. International Journal of Clinical and Experimental Hypnosis, 39, 129-133.
Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients’ symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.
Terr, Lenore C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20.

Suggests 4 characteristics common to most cases of childhood trauma: visualized or otherwise repeatedly perceived memories of the traumatic event; repetitive behaviors; trauma-specific fears; and changed attitudes about people, life, and the future. Childhood trauma is divided into 2 basic types. Type I trauma includes full, detailed memories, “omens,” and misperceptions while Type II trauma includes denial and numbing, self-hypnosis and dissociation, and rage. Characteristics of both types of childhood trauma can exist side by side. Such crossover Type I – Type II traumatic conditions of childhood are characterized by perceptual mourning and depression and childhood disfigurement, disability, and pain. Case examples are provided.

Wielawski, Irene (1991, October 3). Unlocking the secrets of memory. Los Angeles NOTES 1:
NOTES: This is a newspaper article about Eileen Franklin-Lipsker of Palo Alto, who testified that her father, George T. Franklin, killed an 8-yr-old girl in 1979 and that she repressed the memory for nearly two decades.

Hoencamp, Erik (1990). Sexual abuse and the abuse of hypnosis in the therapeutic relationship. International Journal of Clinical and Experimental Hypnosis, 38, 283-297.
In the Netherlands, individuals charged with rape may be prosecuted only in instances in which the suspect could have known that the victim was unconscious or in a state of powerlessness. Hypnosis might be looked upon as a method by which an unscrupulous person could sustain such a state of powerlessness in a victim. As an expert witness, the present author participated in a court case against a lay hypnotist who was accused of abusing 9 women. The methods and strategy used by the lay hypnotist are presented as well as are the diverse reactions of the women involved in the case. Feelings of nonvolition appear to have been a relevant factor in the coercion, especially in women who demonstrated hypnotic phenomena such as arm levitation, catalepsy, etc. The basis for sexual coercion was established only after the interpersonal relationship had been redefined as a therapeutic relationship. Introduction within the pseudotherapeutic relationship of a sexual rationale for the presented complaints helped to provide a framework for actual sexual acts to occur. With certain individual patients, the introduction of hypnosis enhanced the subjective experience of nonvolition and with it the vulnerability for abuse. It may be hypothesized that patients with a tendency for external attribution and high hypnotizability are specifically at risk for this kind of abuse when hypnosis is used in the context of a therapeutic relationship.

Perry, Campbell (1990). Coercion by hypnosis? Invited discussion of Levitt, Baker, and Fish: Some conditions of compliance and resistance among hypnotic subjects. American Journal of Clinical Hypnosis, 32 (4), 242-243.

NOTES: “A postexperimental inquiry (following Orne, 1959) might have informed the reader of the degree to which operationalization of the coercion in terms of disobedience was successful. Without this additional step, it is difficult to determine whether what was found in the laboratory by these investigators applies to what has been reported in clinical and field settings for almost 200 years” (p. 242).
“In particular, elsewhere, the authors equate coercion with involuntariness and appear to view involition as a euphemism for coercion. While I agree that perceiving involition of one’s own behavior may contribute to the commission of unconsenting acts in hypnosis, the two are easily distinguished at the conceptual level. Laboratory subjects ordinarily report much behavior in hypnosis that is experienced involuntarily, without the issue of it being coerced ever being broached” (p. 242).
Author describes cases in which patients claimed they participated in sex with hypnotist against their wills because they were hypnotized. “What may be happening in both of these reports is that the hypnotized subjects found themselves responding involuntarily; from this, they appear to have adduced that they could not resist the hypnotist’s suggestion. That is, they were coerced not by hypnosis but by their belief, which was a direct function of the experience of involuntariness, that they could not resist” (p. 243). “In short, if a hypnotized person equates involuntary behavior with powerlessness, “coercion” may occur in this limited sense. Conceptually, this appears

Rhue, Judith W.; Lynn, Steven Jay; Henry, Stephanie; Buhk, Kerry; Boyd, Patti (1990-91). Child abuse, imagination and hypnotizability. Imagination, Cognition and Personality, 10, 53-63. to be a far cry from equating involition with coercion” (p. 243).
Research was designed to provide a rigorous test of J. R. Hilgard’s hypothesis that hypnotizability is related to a history of physical punishment and to imaginative involvements. College students who reported a history of physical abuse (N = 21) and sexual abuse (N = 23) were compared with control subjects who either lost a parent by way of death or divorce (N = 20) or who were from intact homes (N = 35), under test conditions that minimized the possibility that context effects would prejudice the findings. No support was found for the hypothesis that increased hypnotizability was associated with a history of physical or sexual abuse: All of the groups ere indistinguishable on measures of objective and subjective response to hypnosis. However, consistent with Hilgard’s hypothesis, physically and sexually abused subjects were found to be more fantasy-prone than subjects in both nonabused control conditions.
Ross, Colin A.; Miller, Scott D.; Reagor, Pamela; Bjornson, Lynda; et al. (1990). Structured interview data on 102 cases of multiple personality disorder from four centers. American Journal of Psychiatry, 147, 596-601.
Data from 102 patients with multiple personality disorder at 4 different centers were collected using the Dissociative Disorders Interview Schedule (C. A. Ross et al, 1989; C. A. Ross, 1989) and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders – III — Revised (DSM-III–R) Dissociative Disorders (M. Steinberg et al; ) The presenting characteristics of Subjects at all 4 centers were very similar. The clinical profile that emerged included a history of childhood physical and/or sexual abuse in 97 (95.1%) of the cases. Subjects reported an average of 15.2 somatic symptoms, 6.4 Schneiderian symptoms, 10.2 secondary features of the disorder, 5.2 borderline personality disorder criteria, and 5.6 extrasensory experiences; their average score on a dissociative experiences scale was also meaningful. Multiple personality disorder appears to have a stable, consistent set of features.

Ganaway, George K. (1989). Historical versus narrative truth: Clarifying the role of exogenous trauma in the etiology of MPD and its variants. Dissociation, 2, 205-220.

The author notes a current trend toward viewing multiple personality disorder (MPD) and its variants as a form of chronic post-traumatic stress disorder based solely on exogenous childhood trauma, and cautions against prematurely reductionistic hypotheses. He focuses on Kluft’s Third Etiological Factor, which includes the various developmental, biological, interpersonal, sociocultural, and psychodynamic shaping influences and substrates that determine the form taken by the dissociative defense. He hypothesizes a credibility continuum of childhood and contemporary memories arising primarily from exogenous trauma at one end, and endogenous trauma (stemming from intrapsychic adaptational needs) at the other. The author offers alternative multidetermined explanations for certain unverified trauma memories that currently are being accepted and validated as factual experiences by many therapists. He describes some potentially deleterious effects of validating unverified trauma memories during psychotherapy, and recommends that the MPD patients’ need for unconditional credibility be responded to in the same manner as other transference-generated productions.
Pillemer, D. B.; White, S. H. (1989). Childhood events recalled by children and adults. In Reese, H. W. (Ed.), Advances in child development and behavior. New York: Academic Press.
NOTES: Authors discuss a dual memory theory. The first memory system is prominent in early childhood, and is a system in which are organized and evoked by persons, locations, and emotions. Such memories are not easily “transportable” outside the original experience. These memories are accessed through images of face and place, actions, or feelings. The second memory system begins to develop in early childhood, is verbally mediated, and stores experiences in narrative form. Such memories are accessible through verbal interaction, and can be reviewed and shared with others verbally. For a small child, to access all of a memory one would need to tap into both memory systems. The authors suggest that the first memory system continues to be available throughout one’s life, especially when strong emotion was associated so that verbal cues are not attached. [This has implications for retrieval of “lost” memories using imagery-based approaches like hypnosis.]
Sanders, B.; McRoberts, G.; Tollefson, C. (1989). Childhood stress and dissociation in a college population. Dissociation, 2, 17-23.
ABSTRACT: Two studies are reported demonstrating that individual differences in dissociation in college students are positively related to differences in self-reported stressful or traumatic experiences in youth. In Study 1, differences in the degree of stress or unpredictable physical violence experienced in childhood or early adolescence were shown to be related to scores on the Dissociative Experiences Scale (DES). Study 2 replicated these relationships and extended them to another dissociation measure, the Bliss scale. Study 2 also demonstrated that both dissociation measures correlate positively with reported physical and psychological abuse. These findings for a nonclinical population are discussed in relation to the etiology of dissociation in clinical groups.

Chu, James A. (1988). Ten traps for therapists in the treatment of trauma survivors. Dissociation, 1, 24-32.
Patients who have survived trauma, particularly those who have experienced early childhood abuse, stand out in the clinical experience of many therapists as being among the most difficult patients to treat. These patients have particular patterns of relatedness, along with intense neediness and dependency which make them superb testers of the abilities of their therapists. They often push therapists to examine the rationales and limits of their therapeutic abilities, and frequently force therapists to examine their own personal issues and ethical beliefs. A conceptual framework for understanding treatment traps is presented, along with 10 traps which these patients present, consciously and unconsciously, in the course of treatment. Included are traps around trust, distance, boundaries, limits, responsibility, control, denial, projection, idealization, and motivation.
Lynn, Steven Jay; Rhue, Judith W. (1988). Fantasy proneness: Hypnosis, developmental antecedents, and psychopathology. American Psychologist, 43 (1), 35-44.
This article presents a summary of the findings of our ongoing research program on the fantasy-prone person. In seven studies, nearly 6,000 college students were screened in order to obtain five samples of 156 fantasy-prone subjects. Fantasy- prone subjects (fantasizers) were selected from the upper 2%-4% of the college population on a measure of imaginative involvement and contrasted with nonfantasizers (lower 2%-4%), and medium fantasy-prone subjects (middle range). General support was secured for Wilson and Barber’s construct of fantasy proneness: Fantasizers were found to differ from nonfantasizers, and in many cases also from medium-range subjects, on measures of hypnotizability, imagination, waking suggestibility, hallucinatory ability, creativity, psychopathology, and childhood experiences. Differences in hypnotizability were most reliable when subjects participated in a multisession study and were screened not only with the screening inventory, but also with an interview that substantiated their fantasy-prone status. However, our findings indicated that less correspondence between fantasy proneness and hypnotizability exists than Wilson and Barber suggested. Hypnotic responsiveness is possible even in the absence of well-developed imaginative abilities, and not all fantasizers were highly hypnotizable. Fantasizers recollected being physically abused and punished to a greater degree than other subjects did and reported experiencing greater loneliness and isolation as children. Many fantasizers appeared to be relatively well-adjusted; however, a subset of fantasizers were clearly maladjusted based on self- report, Minnesota Multiphasic Personality Inventory (MMPI), and Rorschach test data. Because of the diversity inherent in the fantasy-prone population, it is misleading to think of individuals at the extreme end of the fantasy-proneness continuum as conforming to a unitary personality type.
Terr, Lenore C. (1988). What happens to early memories of trauma? A study of twenty children under age five at the time of documented traumatic events. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 96-104.
The verbal and behavioral remembrances of 20 children who suffered psychic trauma before age 5 were compared with documentations of the same events. Ages 28 to 36 months, at the time of the trauma, serves as an approximate cutoff point separating those children who can fully verbalize their past experiences from those who can do so in part or not at all. Girls appear better able than boys to verbalize parts of traumas from before ages 28 to 36 months. Short, single traumas are more likely to be remembered in words. At any age, however, behavioral memories of trauma remain quite accurate and true to the events that stimulated them.

Miller, Arnold (1986). Hypnotherapy in a case of dissociated incest. International Journal of Clinical and Experimental Hypnosis, 34 (1), 13-28.
This case study describes hypnotherapy with a young woman who, in the course of treatment, began to remember her incestuous relationship with her alcoholic father. Her presenting symptoms included self-assaultive masturbation, suicidal fantasies, depression, impaired sexual functioning, and inability to resume her education. Different phases of treatment entailed uncovering work, mastering the incest experience with the help of emotionally corrective experiences, the use of part-selves to assist coping, and the integration of several part-selves into a more effective personality. After 4 years of treatment she has successfully resumed her education, has normal sexual functioning, and is no longer incapacitated by depression.

Nash, Michael R.; Lynn, Steven Jay; Givens, Deborah L. (1984). Adult hypnotic susceptibility, childhood punishment, and child abuse: A brief communication. International Journal of Clinical and Experimental Hypnosis, 32, 6-11.

Earlier empirical and theoretical work has suggested that there is a relationship between higher hypnotic susceptibility and severity of childhood punishment. Experiment 1 surveyed the parents of 14 extremely high and 11 extremely low susceptible Ss concerning punishment. Low susceptible Ss were found to be more frequently punished than highs; no significant differences were found on the severity measure. Experiment 2 assessed the hypnotizability of 16 adult Ss who reported being physically abused before the age of 10 and compared these scores to those of 300 adult Ss who had not reported being abused. The mean hypnotizability of abused Ss was greater than that of controls, and the distribution of their scores appeared bimodal. Limitations of both experiments are discussed and suggestions are made for future investigations.
Stava, L. (1984). The use of hypnotic uncovering techniques in the treatment of pedophilia: A brief communication. International Journal of Clinical and Experimental Hypnosis, 32 (4), 350-355.
This case study describes the use of the hypnotic uncovering techniques of induced dreams (Sacerdote, 1967) and the affect bridge (Watkins, 1971) in reducing inappropriate sexual arousal in a male pedophile. Treatment effects were examined through the use of both psychophysiological measures of penile tumescence and psychological tests. The hypnotherapeutic treatment regime consisted of 25 sessions over approximately 9 months. At the end of treatment, psychophysiological measures revealed a definite reduction of sexual excitation to slides of prepubescent children. Psychological testing indicated reduced defensiveness as well as reduced sexual anxiety to adult women. Various hypnotherapeutic experiences which may have contributed to the treatment effects are discussed.

Active Alert Hypnosis

Fredericks, Lillian E. (2001). The use of hypnosis in surgery and anesthesiology. Springfield IL USA: Charles C Thomas.

The authors suggest that any induction procedure legitimizes acceptance of primary-type suggestions that are at variance with everyday experience. Such primary (i.e. “waking”) suggestions are actually accepted at a higher rate than most people think (Barber & Calverley, 1962), and passing those suggestions convinces the subject he must be “hypnotized.” However, inductions with the word “sleep” tend to retard subject”s response to suggestions. An inudction that is more oriented to alert states would be very useful for many people and situations. “Hyperempiria” in Greek means hyper-experience or enhanced quality of experience. The hyperempiric induction contains suggestions of increased alertness, mind expansion, enhanced awareness, and enhanced sensitivity.

Fredericks, Lillian E. (2001). The use of hypnosis in surgery and anesthesiology. Springfield IL USA: Charles C Thomas.

Preface: Definition of Hypnosis
History of Hypnosis in Surgery