Unusual cases in psychotherapy: Birth under hypnosis
AUTHOR: Assistant Professor, principal psychologist, specialized in integrative psychotherapy and hypnosis, president of the Association of Psychotherapy INTEGRATIVE – Camelia Alina Stavarache
Hypnosis analgesia is used successfully in other countries over a hundred years, Romania made the first birth under hypnosis in 1996 at University Hospital in Bucharest. This paper presents modern information about hypnosis, myths and truths, goals of psychotherapy program for birth under hypnosis, hypnotic analgesia characteristics.
Hypnosis has been defined in many ways, from an altered state of consciousness (hypnotic state) to build psychological state (non-hypnotic state). Chertok (1981) believes that altered states of consciousness “may differ in some of their mechanisms, but they share more or less loss of identity during trance”. For the authors describing hypnosis as a constructed psychological state, the role of the subject is to present himself as “hypnotized”, according to previous expectations. The subject can become very involved in role and may use several strategies to achieve the desired behaviors (eg.: imagination and focus attention).
Most experts define induced hypnosis as a state resembling to sleep, but different from this one from the physiological point of view. Hypnotic trance is characterized by increased suggestibility and a number of sensory, mnemonic, perceptual and motor changes (Wetzenhoffer, 1963).
Practical applications of hypnosis can be used to the field of clinical psychotherapy, and in other areas where human performance optimization is required (athletes, astronauts, exams preparations).
In psychotherapy and for clinic purposes hypnosis is used successfully to combat pain. Thus, operations were conducted without anesthesia or with a small amount of anesthetic. Besides analgesia, hypnosis balances the emotional state by reducing preoperative anxiety and speeding healing. When we speak of pain, we mean both the pain of chronic disease or dental disease, and the pains of childbirth.
Recent research has highlighted the positive influence of hypnosis in the treatment of cancer and AIDS.
There are also some not too serious psychosomatic disorders that can be solved only by few simple interventions that involve several sessions and self-hypnosis or relaxation. Thus, Alladin (1988) reported good results in patients with migraine who practiced relaxation together with the therapist and obtained positive results in patients with tinnitus (ringing in the ears). In these cases the basic element consists of practicing relaxation and not hypnotic induction.
Hypnosis, speaking only in terms of induction and trance deepening, is not essentially different from other therapeutic techniques such as autogenic training, progressive relaxation, meditation, guided imagery or biofeedback-based procedures (Edmondston, 1981, Humphreys, 1984; Wadden and Anderton, 1982; Wegstaff, 1981). In all these techniques, the subject is deeply relaxed, his/her attention is focused to some sensations, feelings and inner images, he/she is given suggestions of relaxation and deep relaxation and the person is encouraged to adopt a passive, non-analytical attitude etc. What distinguishes these therapeutic methods from hypnosis is the particular emphasis on verbal suggestions and images designed to provoke altered state of consciousness. These means not only the induction and trance deepening, but what the therapist does after these phases have been overcome.
Hypnosis can increase the effectiveness of psychotherapy, because it increases the patient’s suggestibility, unlock imaginative skills, improve patient-therapist relationship and reduces the subject’s focus over the close reality (Holroyd, 1987). Moreover, hypnosis facilitates access to those areas of the unconscious psyche, where informations on current problems and symptoms are stored, allowing the patient the awareness of unacceptable or traumatic memories, of impulses and conflicts and leads to their satisfactory resolvation.
Truths About Hypnosis
– Most people have an average capacity to live a hypnotic trance if guided by an experienced hypnotherapist;
– Hypnotizability is a stable personality trait, so a person is not more hypnotizable one day and less in another, or do not react better to a therapist and less or no to another;
– Hypnosis is a harmless and even pleasant phenomenon;
– The degree of hypnotizability (deep trance) can not be trained in various ways (different techniques of hypnotic induction, talks to change attitudes towards hypnosis subjects). What changes is the speed with which we enter the trance;
– Children can be hypnotized “as soon as they are able to understand” (Bernheim, 1986) and are more susceptible to hypnosis than adults;
– There are not significant differences of hypnotizability between men and the women.
Myths about hypnosis
– Hypnosis weaken the will of the subject – False. During an experiment, the therapist raises the skirt of simulated patient and she recovered immediately.
– Hypnosis produces side effects of psychogenic nature .- False. These cases are extremely rare and occur only in those patients that alerady have psychotic latent potential. A trained specialist can determine the psychopathological risk situation and therefore, if the risk exists, will not induce a hypnotic trance. A danger also exists with those therapies targeted to treat only the symptom. Thus, Prenman (1954) cite the occurrence of severe symptoms in the treatment of “painful tics” by rising alcohol analgesic effect. Another author, Meninger (1941) described a patient where gasterectomia (partial resection of the stomach) that successed for a peptic ulcer but was followed by suicide because of stomach pain could no longer hide the depression patient. The pacient used poor condition caused by stomach pains to justify the depressive malaise.
– The patient can not get out of the trance – False. Even if the therapist gets hurt, the hypnotic trance is continued to a natural sleep for 30-60 minutes.
– The possibility of committing antisocial acts during hypnotic trance-False. A famous experiment showed that subjects in trance hit a dummy with a knife when told to do, but refused and went out of trance when suddenly asked to do the same with a real man. Instead, Hilgard, citing the Barber and Orne, said it is unlikely that the subject to commit antisocial acts in a state of hypnosis that they could not commit when awake.
– The patient can be hypnotized against his will. If a subject consciously wants not to be hypnotized, but at a subconscious level he wants, he can be hypnotized. Instead, if both the conscious level, and unconscious-does not want to enter a hypnotic trance, then this will not be possible, no matter how talented is the hypnotist. So if there is an unconscious motivation to be hypnotized, even if the subject says otherwise, then we can say that it can be hypnotized “against his will” (Marcuse, 1959).
– Hypnosis is a Satan tool – False. It is one of the prejudices hard to fight because of its emotional implications for the subject. But we can certainly say that hypnosis is scientifically validated and successfully used in various medical cases.
Hypnotic analgesia
The pain stimulus is not a simple one or uncomplicated, but on the contrary, it is multidimensional: somatic, psychological, emotional, temporal.
Pain is a complex, it is a construction – comprised of past and remembered pain, the pain of present and anticipated future pain (M. Erickson, 1983). This means that the immediate pain is amplified if there were similar pains in the past. Anticipation of future pain also has a negative role.
The authentic, real pain is only one third of all experience, while the remaining two thirds is psychological boost. The “easyest” would be that pain that had never experienced in the past and who one thinks that will not happen again. These temporal aspects of pain enhances the effects of hypnosis in producing analgesia.
Most people live the pain in an anguishing way and for those it is accompanied by negative emotions therefore it is deemed as uncontrollable. The focus of intense attention on external stimuli, having a potential risk, reduces pain, while the anticipation and anxiety amplifies it in a negative way.
In reducing pain, hypnosis plays a royal. Hypnosis can be used to relieve pain only after a medical examination was conducted and determined that it is not possible to mask any pathological process whose signal is pain (Gibson, 1989). In order to apply successfully hypnosis in pain control, the hypnotizability of the subject should be above average.
Birth under hypnosis
Waxman (1989) based on numerous clinical studies, made a list of the benefits arising from the use of hypnosis in obstetrics:
– a physical and mental relaxation;
– does not produce a breath or blood circulation lock between mother and fetus;
– Shortenes the first stage of labor;
– Increases the obstetrical shock resistance;
– does not interfere with normal mechanisms of labor;
– in preliminary phases reduces pain by decreasing anxiety and tension;
– In more advanced stages, produces partial or total analgesia and anesthesia, through direct suggestions
– Amplifies the control of the expulsion of the baby’s head and shoulders
– It ensures painless episiotomii;
– Provides easy and uneventful post-operative recovery;
– Stimulates lactation and facilitatebaby breast feeding through direct suggestions.
In 2006, at the University Hospital of Bucharest I made the first delivery under hypnosis in Romania. Meanwhile the number of births under hypnosis I made grew. In all deliveries I made with patients in a state of hypnotic trance, the labor time was greatly reduced (2-7 hours), cervical dilation was accelerated (at a rate of 1 cm per hour at 3 cm / hour), analgesia (the a pain scale of 1 to 10 subjective assessment of patient pain was 1-2); faster recovery after birth, keeping the pregnancy to term (in one case, a primiparous patient was 38 years old and had lost seven pregnancies during their first trimester.
In this case psychotherapy began in the same time with the detection of pregnancy and has proposed the use of hypnosis in order to eliminate the repeated abortion trauma and mental imagery techniques for viewing baby’s healthy development and its stages of intrauterine).
The therapeutic plan I elaborate for this case of birth under hypnosis (C. Stavarache 2006) was divided into 15 sessions (14 prenatal sessions and the birth session itself).
Prenatal psychotherapy objectives were:
– Patient’s psychological profiling in order to identify any psycho-pathological changes, type of hypnotic susceptibility and resistance to the pain threshold.
– Induction of hypnosis and learning pain management techniques;
– Learning self-hypnosis and setting passwords for emergency situations when the therapist can assist the patient;
– Visual imagery for designing a positive future;
Psychotherapy objectives in order to assist pregnant women in the birth process were:
– anxiety decrease – analgesia – increased neck dilation – facilitating the baby expulsion – elimination pf the placenta;
In my book “Unusual cases in psychotherapy. Integrative psychotherapy programs” published by Ceconii , 2007, and prefaced by Mrs. Univ. Dr. Irina HOLDEVICI you will find detailed presentations of the 14 sessions of psychotherapy. The book also contains a comprehensive program of psychotherapy with stress tests, psychotherapeutic techniques and exercises for action at the thoughts level (cognitive restructuring techniques), the unconscious level (relaxation techniques, hypnotic induction, anchoring in resource states, therapeutic metaphor), body level for accumulated emotions (Alexandre techniques Wilheim Lowen and Reich) and also at the behavioral level (assertive training).
The book “Unusual cases in psychotherapy. Integrative psychotherapy programs “also offers interesting revelations in the form of case studies: Narcis no longer loves itself (case study and plan of therapy for migraine), Crina and obsession of flatulence, Mugurel’s fear of buttons, Oak and fear of strife (case studies, diagnostic criteria for anxiety disorders and psychotherapy plan for panic attacks), the Depression that protects the couple, Gerbera fear of the devil, Bradutza and trauma at five years (symptoms, diagnostic criteria and plan of psychotherapy for depression).
References:
– “Unusual cases in psychotherapy. Integrative psychotherapy programs “by Camelia Stavarache, publisher Ceconii, 2007;
– “Clinical Hypnosis” by Ion Dafinoiu, Iasi, 2005,
– “Positive Thinking” by Irina Holdevici, Science and Technology Publishing House, 2005
