28.10 Interpersonal Therapy
887
Therapeutically, hypnosis’s effectiveness in facilitating accep-
tance of new thoughts and feelings makes it useful in treating
habitual problems and also with symptommanagement. Smoking,
overeating, phobias, anxiety, conversion symptoms, and chronic
pain are all indications for hypnosis. They can often be treated in a
single session, in which a patient is taught to perform self-hypno-
sis. Hypnosis can also aid in psychotherapy, notably for posttrau-
matic stress disorder, and it has been used for memory retrieval.
Contraindications
No intrinsic dangers to the hypnotic process exist. Because
of the increased dependence that the hypnotized patient has
toward the therapist, a strong transference may occur, however,
in which the patient exhibits feelings for the therapist that are
inappropriate in regards to their relationship. Strong attach-
ments may occur, and it is important that these are respected and
properly interpreted. Negative emotions may also be brought
out in the patient, especially those who are emotionally fragile
or who have poor reality testing. To minimize the likelihood of
this negative transference, caution should be taken when choos-
ing patients who have problems with basic trust, such as those
who are paranoid or who require high levels of control. The hyp-
notized patient also has a reduced ability to critically evaluate
hypnotic suggestions and, thus, the hypnotist must have a strong
ethical value system. Controversy exists about whether patients
can perform acts during a trance state that they would otherwise
find repugnant or that run contrary to their moral system.
R
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eds.
Kaplan & Sadock’s Comprehensive Textbook of Psychiatry.
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Philadelphia: Lippincott Williams & Wilkins; 2009:2804.
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ate post-surgical wound healing? Results of a clinical trial.
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▲▲
28.10 Interpersonal
Therapy
Interpersonal psychotherapy (ITP), a time-limited treatment for
major depressive disorder, was developed in the 1970s, defined
in a manual, and tested in randomized clinical trials by Gerald L.
Klerman and Myrna Weissman. ITP was initially formulated as
an attempt to represent the current practice of psychotherapy for
depression. It assumes that the development and maintenance
of some psychiatric illnesses occur in a social and interpersonal
context and that the onset, response to treatment, and outcomes
A 29-year-old woman was referred for evaluation and treatment
of ongoing facial pain that was not responding to traditional meth-
ods of intervention. Neurological evaluation showed no objective
physical correlations. Her high midrange performance on the HIP
added support to the potential of a psychological mechanism for the
pain. Initially the pain was controlled by a hypnotic intervention,
but it returned 24 hours later. Her self-hypnotic technique ceased to
be effective. A decision was made to explore more completely the
meaning of the pain. Age regression under hypnosis was used, and
the patient was regressed to a time prior to the pain. She related that
her brother had been injured by a car while he was running in the
street. The patient was babysitting at the time, and her father was
so angered that he hit her. Recently her friend’s dog ran away, and
she felt responsible. As she began to recognize her need to punish
herself because of her guilt over what had occurred, she was able to
understand her feelings and reframe her thoughts in a more produc-
tive manner. An “affect bridge” was also used, and the patient was
asked to go to back to a previous time when she felt guilty and was
punished. She then was able to describe her feelings of being hit
by her alcoholic, abusive father. She continued to gain insight and
mastery over the past and was able to ablate her pain. (Courtesy of
A. D. Axelrad, M.D., D. Brown, Ph.D., and H. J. Wain, Ph.D.)
A 42-year-old married mother of three children had been kid-
napped and locked in a large packing trunk. After she had freed her-
self and broken out, her abductors had stabbed her multiple times,
tied her up, put her back in the trunk, and thrown her down a cliff.
She had eventually managed to break out and crawl to safety. Even-
tually she had been picked up by a passerby. She reported that others
had seen her lying on the road and appeared frightened to approach
her. Eventually 911 had been called and she had been transported to
a hospital. Following medical stabilization she had been discharged
and found herself developing nightmares, reexperiencing avoidance,
and having hyperarousal symptoms. She was referred by her internist
for treatment and was initially started on 25 mg of sertraline (Zoloft),
which was increased to 50 mg 4 days later. She was evaluated on the
HIP and determined to be a mid- to high-range hypnotic subject. She
was taught to go to a safe place and to use a split-screen technique.
She was also given permission to describe her nightmares, reexperi-
ences, and overwhelming anxieties and fears that she faced while
being captive, as well as her feelings of abandonment while lying on
the road. She was reinforced for her ingenuity in breaking out of the
trunk. Her feeling of blame for her capture was reframed while she
was under hypnosis. She was taught to calm herself and to reframe
her negative feelings about her helplessness. Hypnotic age regres-
sion was used to help her master her experiences and facilitate their
becoming like a bad movie. Initially her startle response was used as
a signal for her to go to her comfort zone. Age progression was used
to help her to rehearse the future. The treatment used the milieu of
hypnosis along with exposure, cognitive reframing, psychodynamic
approaches, and pharmacology. (Courtesy of A. D. Axelrad, M.D., D.
Brown, Ph.D., and H. J. Wain, Ph.D.)
