HYPNOSIS

According to Henri Ellenberger in his acclaimed book, The Discovery of the Unconscious, contemporary psychodynamic psychology and psychotherapy, with its sensitivity to unconscious process, began in the early eighteen hundreds in response to Franz Mesmer and his theories. These theories gave rise to the concept of hypnosis.

The early hypnotists were known as magnetizers or mesmerists. They were most active in the first half of the 19th century, and they developed the utilization of hypnosis as a psychotherapeutic tool to a rather high art. Their use of hypnosis involved three aspects: (a) the sedative effect of deep hypnotic sleep, (b) suggestion and (c) dialogue with intrapsychic parts.

Hypnosis fell into disfavor, but it was revived in the 1880’s by Bernheim and Charcot. In its resurrection, only the suggestive aspect of hypnosis was brought back into practice. This narrowing of perspective was so great that hypnosis and suggestion became inseparable in both the practitioners and the public mind.

Also, the attitude of the therapists who used hypnosis during its resurrection was different from many of the earlier magnetizers. By the 1880’s the practitioners were German and French psychiatrists. They were very high status people who had extraordinary authority. Their overall style, and their use of hypnosis, tended consequently to be very authoritarian. They achieved some significant results, but these seldom lasted.

Consequently, hypnosis again fell into disfavor. Recently, it has been revived as a therapeutic tool by three distinct schools of therapy. One branch of hypnotic psychotherapy follows the insights and research of Dr. Milton Erickson. Its focus is on a very sophisticated utilization of suggestive hypnosis within the context of brief psychotherapy. The second group uses trance induction and guided imagery as a means of accessing the client’s own intuitive gifts in the pursuit of personal growth and heightened awareness of internal conflict. The third group of practitioners includes the researchers and clinicians who work with individuals suffering from Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) and allied disorders. They use hypnosis as a vehicle for enhancing dialogue between the therapist and dissociated aspects of the psyche. These therapists also use hypnosis as a way to bring dissociated traumatic experiences into awareness so that they can be resolved -

These three forms of contemporary hypnotherapy are not mutually exclusive, although Eriksonian techniques have not been found to be very helpful with DID or borderline personality disorder (BPD) clients. The resolution of significant internal divisions and the healing of unresolved history are the two cornerstones of psychotherapeutically treatable psychopathology. It is extremely difficult to treat these successfully without the utilization of age regression and dialogue--oriented hypnotic techniques. Although some psychopathology is organically based, the vast majority of people seen in a clinical practice are dealing with history and internal splits, and the ramifications of these in their current life.

Despite the growing use of hypnosis, there is still considerable debate concerning the fundamental nature of the phenomenon. There are two major professional journals dedicated to the study of hypnosis. They represent the two basic, divergent points of view regarding the nature of hypnosis. One journal. the American Journal of Clinical Hypnosis, is used primarily by therapists. Its view of hypnosis is that hypnosis is a unique state of mind in which extraordinary things can be done. The other journal, The International Journal of Clinical and Experimental Hypnosis, is used primarily by researchers. Its view is that hypnosis is merely the expression of an ongoing human potential that individuals can enter and leave as a part of the normal course of their lives. Hypnosis is not seen as a significant altered state nor is it considered to be dependent upon any kind of special intervention to precipitate it. It is simply regarded as another, often spontaneous, part of normal psychological functioning.

There is some overlap between these two viewpoints, but the distinction--clinical versus experimental--does exist. This is a reflection of the confusion regarding the nature of hypnosis. Even though the experts cannot agree on a definition of hypnosis, there seem to be five qualities that are usually associated with trance or hypnosis. These are: (a) dissociation, (b) right brain dominance, (c) receptivity to suggestion, (d) focused awareness, and (e) a greater than usual openness to the experience and expression of emotions and internal processes. Some very recent research on hypnosis indicates that it is apparently both common and unique, and can occur spontaneously or be deliberately precipitated, in order to serve special purposes.

The first characteristic of hypnosis is dissociation, which is discussed in depth in chapters 1, 2, and 3. In dissociation, when attention is withdrawn from one context, it is usually focused on something else; however, some individuals dissociate into a disconnected daze. It appears that adults have a varying range of potential dissociative capacity. Some adults dissociate readily. A minority, about 20%, find it very difficult to dissociate.

A classic, almost archetypal example of dissociation under stress is the out-of-body sensation that is frequently reported by people who have had a near death experience. The focus of consciousness is withdrawn from the body and sensory experience, into a detached, observer point of view. There are also many other dissociations that people do all the time, such as getting lost in daydreams, ignoring unpleasant stimuli, detaching from feelings, etc.

People with a strong capacity for dissociation are able to let go of their focus on external frames of reference and external reality readily. Other people are so externally referenced that it is almost impossible for them to dissociate. Even when a therapist does everything she can to take their attention away from the External World, they cannot stop thinking about their bills, their car, their dog, the last fight they had with their boss, etc. One could say that they are more reality-oriented than the people who readily dissociate; however, it could also be argued that they are merely less flexible. Healing through Internal Work will usually be more difficult for them than for people who readily dissociate. Healing always means moving from the reality one is in to a reality that offers a greater capacity to be one’s True Self, a reality that allows the person to move beyond the limitations that his life has placed upon him. If an individual is determined to be in the reality he has always known, he is not going to be able to be open to the options for change in his life.

A related concept is cultural trance. People like to think that in ordinary consciousness they are in touch with reality. Trance and other altered states of consciousness are assumed to produce a distortion of reality. The point of the term cultural trance is that one’s perception of reality is always distorted. Humankind’s connection with reality is actually a social experience in which the individual’s perceptions interact with the assumptions of his culture, which, in turn, filter his capacity to experience reality. These cultural assumptions are built into language and custom. They are unavoidable. Humans are always in some kind of constructed reality that is not directly connected to what is.

The second aspect of hypnosis is that it is a more right brain oriented cognitive mode than ordinary consciousness usually is. Ordinary consciousness, in this culture, is primarily left brain dominant. American culture is highly rationalistic. Things are deemed to be real or significant only if they can be analyzed and defined. Much more attention is given to naming and controlling aspects of reality than to appreciating the flowing, dynamic nature of the whole. It is important to note that the distinction between right brain and left brain is not as great as it may seem from the distinctions I have made, and it certainly is not as great as the early literature proposed; however, some distinctions do exist. It is still agreed that the left brain is more oriented toward the analysis, fragmentation, and control of reality, whereas right brain function is more oriented toward feeling, experience, imagery, and holistic perception.

Hypnosis utilizes both a person’s dissociative capacity and right brain functioning. Therefore, it is most effective when the therapist guides the client into as dissociated a state as possible and adds feeling—toned imagery. This will move the client out of normal consciousness (i.e., left-brain oriented, external, verbal-dominated consciousness). Dissociated consciousness is more open, flexible, and in touch with basic human realities. Such realities include feelings, personal relationship issues, somatic processes, intuitive perceptions, and numinous spiritual awarenesses.

There are two basic means whereby a therapist can facilitate trance. In one, the therapist functions as an authority; in the other, as a catalyst.

Precipitating a trance in an authoritarian fashion can give clients the impression that the therapist has immense power over them. Most typical hypnotic induction techniques described in texts and workshops on this subject use suggestion and misdirection in ways that make the client feel as if he were under the therapist’s control. Although this perception is an illusion, it does heighten the client’s readiness to internalize the therapist’s suggestions.

It is also possible to induce trance by commands. The therapist can very firmly pull the client’s attention away from where he is ordinarily focused, by blocking the flow of normal conscious awareness, in which case the client will readily dissociate.

Another form of authoritarian trance induction is the use of confusion techniques. The therapist presents a dialogue that sounds as if it makes sense but it actually makes no sense at all. When this is done , the client will become confused and begin to lose his left brain focus. If the therapist then presents a coherent suggestion, or powerful imagery with a suggestion embedded in it, the subject will sometimes be deeply affected.

Whatever method is used, the goal is the same--to move the person from normal waking consciousness into the dissociated, often image oriented world of hypnotic trance. All of these methods affect the quality of relationship between the therapist and the client. Their implicit message is, “I (the hypnotist) am powerful. I am in charge. You (the client) will be affected by my extraordinary abilities and will change by the grace of what I do to you.” Because of this implicit -- and sometimes explicit -- message, a therapist who is genuinely interested in helping her clients achieve autonomy by learning to access their own internal wisdom and healing resources will avoid the authoritarian approach. Even though it might work in the sense of producing some immediate results, the implicit message is highly destructive and the results seldom last very long.

An excellent example of the authoritarian approach to hypnotic psychotherapy is neuro—linguistic programming (NLP). NLP is the best known of the contemporary forms of suggestive hypnosis derived from the work of Milton Erickson.

Milton Erickson observed that by embedding suggestions within a metaphor or story, he could have a significant impact. He also observed that people regularly move in and out of spontaneous dissociated states. If the therapist follows this natural flow, she does not need to use a formal induction to precipitate a dissociated state of mind in which the client will be much more receptive than usual to suggestion.

Additionally, Erickson discovered he could use methods other than overt induction to induce trance or dissociation, such as the confusion techniques previously described. Through the use of such techniques, a therapist could implant suggestions without the client being aware of what has happened.

Hypnotists usually assume that the Ego is the major impediment to the effectiveness of suggestion. If the Ego can be kept disconnected from the suggestive process, then the suggestions have a much better chance of taking hold. The consequence of doing therapy out of this model is a diminished sense of personal autonomy for the client, and an enhanced sense of power for the therapist. Therapy becomes an act of manipulation in which the therapist intentionally seeks covert control of the client in the most effective way possible. Even though these techniques are effective in some instances, they, like other forms of suggestive hypnosis, are of very little use in facilitating the profound healing of early life trauma and internal divisions that is essential for wholeness.

The unspoken message conveyed by this form of hypnosis is that status, authority, and locus of control are all invested in the therapist. This seems very detrimental to the development of the kind of interdependent, mutually respectful relationship I have found to be essential in helping deeply wounded people. In fact, it is the antithesis of the perspective outlined in this book.

Additionally, experts in the field of DID psychotherapy emphasize that therapists should not use NLP or Eriksonian techniques with multiples. The manipulative aspects of these techniques will erode the client’s trust, which is very fragile anyway. Moreover, it is impossible to manipulate any seriously disturbed client, especially a multiple, into healing. Real healing arises from the client’s own Center. The best therapists cooperate with the process and stay about a half step behind.

The positive alternative is for the therapist to function as a catalyst. This means that she is straightforward about what she wants to help the client accomplish. The induction of trance is clearly defined in terms of its purpose, how it works, and the process that will be used. The therapist leaves the manifestation of that process completely in the client’s hands. For example, I might say:

I think we need to do some Internal Work as a central part of your healing process. Today I’d like you to meet your Inner Wisdom (or your Hurt Child, etc.). In order to do that, you’re going to have to let go of the everyday concerns that are preoccupying you. You’re going to have to be able to focus your attention into your own Internal World, and that is done through a process of deep relaxation. The relaxation will.help you let go of worries and concerns so that you can be more attentive to your own Center and internal conflicts. So, if you would, please, lie down on the couch. I’ll take you through a relaxation procedure that will help you let go of all the things that are on your mind and will also help you drop your defenses some so you won’t be as guarded as you would ordinarily be. Through this, you can begin to be open to those things within yourself that are causing the problems that brought you here. Once I’ve helped you achieve deep relaxation, I’m going to paint a word picture for you as an additional help for focusing your attention within yourself. When you are well established in this internal frame of reference - which will be a beautiful mountain meadow - you will find that internal processes are surprisingly accessible. All we will have to do is invite them forward and begin working with them. Now, if you’re willing to do this, let’s go ahead and get started.

Then I take the client through the basic procedure presented in appendix A. It is a two—fold process; the relaxation disconnects him from external preoccupations and the use of imagery accentuates right brain function. Once the client is in the meadow, fully experiencing it with as many senses as possible, he is ready to begin encountering his personal, internal realities. This is relatively easy to do because in this state of mind he is much closer to his emotions, conflicts, instincts, and best resources than he is when in normal, left brain consciousness.

Unlike many other forms of hypnotic induction, induction by relaxation involves no dishonesty or misdirection and very little release of control to the therapist. It underscores the Ego’s centrality. It is a very straightforward and clear-cut process. The client fundamentally relaxes himself with the therapist’s guidance. He can even continue his Internal Work on his own, in between sessions. By using a relaxation induction, the therapist gives the client as much authority as she possibly can. Most other induction techniques are destructive because of their implicit messages regarding the therapist’s authority and the Ego’s lack of significance.

Although trance always involves some release of control, the Ego still needs to know that most of the time it retains some ability to be in charge of the process. (Deeply fragmented people are an exception to this rule. When they do Internal Work, the Ego may be completely supplanted by another part and have no control or awareness of the session.) If the therapist discounts the Ego by trying to work around it or undercutting it, she runs the risk of triggering all kinds of resistances. Some will be subtle and automatic, and some will be very obvious.

When an individual is in trance, his defenses are lowered. He is not totally devoid of his defenses, but most of his ordinary fears and concerns will seem distant. Therefore, he will not be as inclined to use his defenses as much as he normally would, and will be more open to truth. When the client’s pain starts hitting him, he may wish he had his defenses back up, but by then it is often too late. The recovery and reestablishment of defenses will have to be done after the day’s Internal Work is completed.

Regarding the suggestive use of hypnosis, there are several conditions that seem to be important in order for it to be effective. These are summarized in table 2. The first is rapport. Many people think that Freud was the first person to significantly analyze the client - therapist relationship itself as an important

Table 2

Conditions for Effective Suggestive Hypnosis.

1. Rapport.

2. Truth.

3. Use internally generated, rather than externally generated, suggestions and imagery.

4. Avoid direct confrontations with the Ego or other significant parts of the psyche.

5. Use imagery.

6. Acknowledge. and accept that there are clear limits to what suggestive hypnosis can achieve

aspect of psychotherapeutic healing. Actually, a great deal of very insightful work on this subject had been done before Freud. The first people to seriously analyze this relationship were the magnetizers. They studied the issue of rapport very carefully, and reached the same conclusion that I voiced earlier; namely, the quality of the therapeutic relationship is a major determinant of the effectiveness of the hypnotic work. They put considerable energy into maintaining rapport, which is the very term that they used. They were aware of the problem of resistance, which they believed was the reason why, after a period of time, their suggestions would not hold or the person’s response to the suggestions would be distorted. They tended to connect the issue of resistance with the issue of inappropriate or poorly worked out rapport. They were also very aware of the problems of idealization of the therapist and the sexual tension in the therapeutic relationship, and they explored all of these issues.

The second condition for effective suggestion is truth. If the therapist does not believe in her own suggestion, that dissonance will probably be sensed at some level by the client. The therapist may fool the Ego without too much trouble, but the non—verbal cues will usually reveal the therapist’s conflict about what she is saying. Therefore, the suggestion will not have very much impact.

Suggestion also needs to be Consistent with the client s perception of reality. For instance, suppose that a therapist wants to help a person stop smoking -- a typical use of straightforward, suggestive hypnosis. Under hypnosis, the therapist tells the client that it will be easy to stop because smoking is not physically addictive. It is merely a bad habit that he needs to face. If the person knows that nicotine is highly addictive and that for some people there will be problems with withdrawal, the effectiveness of the suggestion will be very limited because it contradicts the client’s knowledge of reality. On the other hand, if the person is firmly convinced that nicotine is not addictive and the therapist tells him that it is and gives him some suggestions that will help him deal with his withdrawal, he will ignore her. Again, this is because it contradicts the client’s perception of reality. For this reason, a therapist from one cultural milieu, with its own set of beliefs, values, and organizations of reality, cannot be an effective healer for someone who comes from a significantly different cultural milieu, unless she can adapt to the client’s culture.

Thirdly, the therapist should use themes emerging from the client rather than imposing her own “good” ideas. For example, it might seem obvious to the therapist that her client would have higher self-esteem and feel better in general if he ate fewer high sugar foods. This could be considered an excellent target for hypnotic suggestion; however, if the timing is off, the client will not yet be ready to give up his addiction. An attempt to implant a suggestion to that effect, even if it seems reasonable to both client and therapist, will, at best, result in a temporary suspension of the behavior. The client will often fall back into the behavior, or develop a different behavior that serves the same purpose. The long—term outcome might well be that the client will lose faith in the therapist. The therapist will have undercut the healing process, because she will be seen as ineffectual. Self-destructive behaviors usually have a purpose that must be addressed before they can be released. The client’s real need may be for help in resolving an internal conflict or changing the way he is dealing with his Hurt Child.

Perhaps the client is capable of making some changes in regard to physical appearance, but is not yet capable of changing his eating habits. The therapist will not know what degree of behavioral change is actually possible unless she has some insight from the client’s Center. For instance, a dream or Internal Journey might indicate that if the client would work on grooming skills, this would relieve some of the burden of his low self—esteem. The therapist could then use hypnosis to suggest that the client might dress and groom himself a little more nicely. That suggestion might well succeed, because it was presented to the therapist from within the client. By following an internally generated direction, the client can move at a pace that is possible. Both client and therapist will have succeeded, and some change will have occurred. One of the major reasons that suggestion fails is that the well-intentioned therapist is impatient, and wants to precipitate major changes too soon. To know what is best, the therapist must listen to what comes up from the client’s Center. The Wisdom within knows what is in the person’s best interest and what he is capable of.

Ideally, when the therapist reinforces a suggestion for the client that comes from within the client, she will also call upon one of the internal healing resources -- such as Inner Wisdom or the Great Mother -- to support the suggestion internally. In this way, the client is influenced by both the internal World and the external World. When a therapist can effectively call upon an internal resource to support the suggestive process, it is possible for the Ego to make long-term, powerful changes. An internal resource will usually not cooperate with the therapist unless what she is doing is in tune with the internal unfolding of the client’s potential.

The fourth condition for effective suggestion is to avoid direct confrontations with the Ego or with other significant parts of the psyche. For example, a man in a dating relationship knows it is going along the same destructive path as three previous relationships, but he loves the woman and does not want to let her go. The therapist, from her position as an external observer, can see that the client is caught in a repetition compulsion, reenacting with his girlfriend the relationship patterns he experienced in his family of origin. The emotional turmoil stimulated by these dysfunctional relationships keeps the client focused externally and unable to give proper attention to internal processes. Clearly, this client must eventually refrain from pathological relationships if he is going to be successful in his therapy.

Given this insight, the therapist might persuade the client to accept the use of suggestive hypnosis to help him release this destructive relationship. If the therapist is a competent hypnotist, the client may avoid calling his girlfriend for a day or two, and feel very odd when he is with her for awhile, but it will not last. The Hurt Child’s need to relive early life pain will overwhelm hypnotic suggestions, common sense, good intentions, or any other attempts to achieve balance in relationships that do not directly respond to the child’s pain and unmet needs.

In this example, if the part (or parts) that is driven to form unhealthy relationships is able through dialogue, Internal Work, and the healing of history, to lose this drive, and if the Ego has no strong investment in the behavior, the therapist will then be able to offer some suggestions that may be very effective.

The fifth condition for effective hypnotic suggestion is to use imagery. In stage hypnosis, the hypnotist chooses someone from the audience, uses some kind of induction, and then tells the subject, “At the count of three you’re going to become a chicken.” Sure enough, the hypnotist counts to three and the person begins to act like a chicken. The person chosen probably likes to be on stage and is inclined to be a bit dramatic anyway. It is very unlikely that there will be an established internal content that has anything against being a chicken. Additionally, if the person has a strong capacity for dissociation, the Ego would not be very involved with what is going on, and thus not be embarrassed by the process. However, in psychotherapy the issues are much more emotionally loaded and they tend to be deeply embedded. Even when a suggestion is fully supported by the Internal World, the therapist still needs to do all she can to make the suggestion as powerful as possible. This usually means that suggestions should be embedded in metaphor, experience, and imagery, not just in words. The best metaphors are those that use imagery already occurring within the client’s Internal World.

For instance, a client may be ready to give up compulsive overeating. The Internal Work has been done. All that remains is the habit. Instead of merely suggesting, “And now when you approach the table you won’t be as hungry, and your interest in sweets is going to fade,” the therapist might use an image of a very lithe deer that has previously appeared in the client’s Internal World in conjunction with her healing, and which is a metaphor for her True Self. The therapist might say, “Call forth your deer. Be in your deer. Feel her energy. Jump with her. Run with her. Notice how sinuously she moves.

The therapist should do everything she can to connect the Ego with the given image. An internally generated image will have more power and be better adapted to the client’s personality, than anything the therapist could devise. If, however, nothing arises from the Internal World, the therapist should still embed the suggestion in behavior, metaphor, and experience, but she will have to rely on her intuition to discern the most appropriate metaphor. For instance, I might say, “Notice yourself dressing in a smaller size. Notice what you’re thinking, how you’re feeling. Go for a walk. Notice there’s a bounce in your step.” The more a suggestion is embedded in imagery or metaphor, the more powerful it will be because these are deeper and more primitive levels of thinking. Stay away from “should’s”, “ought to’s,” and other shame—based messages. They are a waste of time and often make the Ego resistive.

Another issue is depth of trance. It is possible to get people so profoundly dissociated that they are thoroughly out of touch with the External World. This usually does not enhance healing. A light trance, in which there is sufficient dissociation to allow the person to be open to the internal flow, is all that is needed. If the client reports hearing cars go by outside and conversations or sounds in the building, I point out that this is normal and does not matter as long as the internal experience is vivid.

The final condition involves acknowledging that there are clear limits to what suggestion can achieve. A therapist cannot straightforwardly suggest that the client is going to get well. It simply will not work. It would give brief therapy a whole new meaning if that were possible. It does not matter whether or not the client is a hypnotic virtuoso. It is impossible to suggest healing. All the therapist can do is cooperate with the healing process, intensify it, and help the Ego connect with it more fully.

The reverse is also true. It is highly unlikely that a therapist will be able to suggest significant new pathology. It is no easier to suggest people into dysfunction than it is to suggest them into wholeness. The psyche has a natural, profound drive to be whole and authentic. If that drive is flowing in such a way that the Ego readily feels it, any suggestion contrary to wholeness will sooner or later fail regardless of how powerful the therapist’s connection to the Ego may be or how skilled a hypnotist she is.

Some researchers have been able, through hypnosis, to create pseudo MPD. That is, they have been able to cause a person to create two or three “alter personalities.” Although it may be fun for awhile, these “personalities” never last, because they contradict the psyche’s natural desire for wholeness. Fragmentation reduces the psyche’s ability to make best use of its options; therefore, it will not be permitted to continue.

Another major issue in hypnotic psychotherapy is resistance. Many people are less than enthusiastic about letting go of rational control. They are afraid of what might surface if they do. My best answer to them is:

I appreciate your hesitance. The only way you’ve been able to survive is by being in control of your life, but you’re coming to me because control isn’t working, or you wouldn’t be here. We’ve got to look at other alternatives. My experience has taught me that if you’re willing to move beyond control, you can trust that there’s a depth within you that will bring forth healing. It will be more powerful, more life-giving, and more real than anything you’ve ever been able to generate by trying to control your life.

Most people know that the controlled life they have been trying to live has not worked very well. If they can be persuaded to reflect on that, they will usually open up somewhat. There is also the phenomenon of people who are so invested in control that they appear to have developed several levels of ego control which function automatically and out of awareness. At the surface level they want to get well, and readily agree to do Internal Work, but as soon as they begin relaxing, they have a coughing spell, or become ticklish, or their muscles twitch. Any number of things may happen that make it impossible for them to go into trance. Sometimes what appears to be resistance is the physiological manifestation of an internal conflict or unmet need and should be explored by the therapist. Occasionally this may be due to interference by an internal part. Most often, it is merely another level of Ego. At one level the client may say okay, but he is so split even at the ego level that the aspect of the Ego that wants control overwhelms him and he cannot let go.

With some clients, the therapist has to earn the right to take them into trance. Some people are able to trust very easily, but many -- especially the more deeply wounded people -- are not about to let go with anyone until they feel secure. The best way to generate an atmosphere of security is by empathy, warmth, genuineness, and radical honesty on the part of the therapist. The client has to know that the therapist cares about her, is willing to make the effort to get to know her, respects her, and is committed to their relationship. If the therapist finds the person obnoxious and does not really care for her, the likelihood is that he will be unable to present a context in which the client will be able to do her work. If the therapist looks upon the client in a cynical or judgmental way, he will lack empathy and warmth. If he is contained in a role or a posture -- ”I am the therapist and I am here because I am an expert.” he is not going to be very genuine. Genuineness is important, because for the client to take the risk of letting down her barriers, and allowing the hell that she senses within break through, she has to know that she is with a real human being and not just somebody playing a role. The foundation for effective trance work, as for any therapy, lies in the client - therapist relationship. The relationship must be human, humble, and very real; not authoritarian or one-up in any sense. It must be profoundly empathic, radically non-judgmental, and free of cynicism and negativity.

If a client remains unwilling or unable to let go, the therapist should not insist on Internal Work despite its great potency. Instead, she should offer a more verbally oriented, conversational style of therapy. Compared to Internal Work, conversational therapy, although potentially very helpful cannot offer the impact and precision of Internal Work. It does, however, give the client and therapist time to build the level of trust and rapport necessary for the client to become less resistant to Internal Work.

Having outlined the conditions necessary for effective suggestion, I would like to explore the ways in which suggestion can be valuable. The principal use I make of suggestion is to reinforce internally generated messages I consider helpful. I do everything possible to encourage the Ego to accept and practice the guidance offered by wisdom figures, dreams, or other internal forms of revelatory insight. This is the most overt way I make use of the authority I have earned through the relationship I have built with the client. Much of what I do during a session is nothing more than quiet waiting while a client is doing Internal Work. When they have finished, or if they can talk about the process while they are experiencing it, I underscore the value of what they are experiencing, and may elaborate upon it if I sense that the Ego needs help in accepting and/or understanding the experience.

In the beginning of therapy, people usually trust the therapist more than they trust their own internal parts and processes. If the therapist uses her authority to validate and support the client’s internal authorities, the client benefits in two ways. First, he is much more likely to embrace valuable insights or lifestyle changes offered by his Internal World. Secondly, the therapist’s use of authority paradoxically enhances the client’s sense of personal autonomy and authority. Not only is this approach much more effective than covert teaching or suggestion that is not grounded in Internal Work, it also helps maintain a symmetrical relationship in which a sense of equality and intimacy can be maintained. The manipulative use of suggestion, or teaching as a display of the therapist’s wisdom and authority, creates an asymmetrical relationship with a hierarchical sense of status that invites contest and makes closeness very difficult (Tannen, 1990).

Another way of reinforcing an internally generated message is to strongly connect the Ego with the symbol involved in the message. If the internal metaphor is clear cut, the therapist should verbally affirm the symbol’s meaning. Clients usually remain somewhat dissociated after having done Internal Work, leaving them more open to suggestion than usual. This is a good time to reinforce internal messages. If time permits, the therapist can further accentuate the experience by asking the client to close his eyes and return to the internal experience. Then, by using the BASK model (Braun, 1988) as outlined in the chapter on Internal Work, he can greatly enhance the Ego’s connection to the experience, and, thus, the impact of the experience.

Many therapists who use suggestive hypnosis are aware of the power of externalizing internal symbols or metaphors, but they make the mistake of deciding what is the right metaphor for the client and what external instrument should carry it. For instance, one therapist gave a client as homework the task of wearing a rope with a huge cork on it around his neck, because this symbolized something for the therapist. The client did as instructed, but felt rather stupid. Basically, this was an act of submission to an all powerful therapist. In contrast, when the therapist suggests embracing some emblem of an inner symbol, she is telling the client to cooperate with his heart in every way he can. This has tremendous power, and the therapist is seen as being a servant of the client’s Internal World, rather than a master controlling the course of the therapy.

Another use of hypnotic suggestion is hypnotic cues. A hypnotic cue is an externally perceived signal that precipitates an internal process. Some clients have inner parts that are very strong, very stubborn, and extremely autonomous. Such parts are often unwilling to let go of the body once they get control. This can wreak havoc with a therapist’s schedule. Let me illustrate this with an example from my practice.

An angry inner child has come out and is in control of the body. I have people to see after her, but this angry child will not go back inside at the end of the session. To save myself time, I established a hypnotic cue that causes the adult Ego to reemerge. With this client, I first tried a sharp hand clap as the cue. I embedded the cue by telling the client while she was in trance exactly what would happen and then practicing it a couple of times. Later, when I needed it to help bring the Ego back, it worked just as anticipated, with one unfortunate side effect. We had been working on childhood physical abuse that day. From the client’s perspective, the cue sounded just like being beaten with a belt on bare skin. Not only did it cause the adult Ego to reemerge (as intended), it also threw both personalities into a panic and ruined the next two days.

In the next session, I put the client in trance, erased the hand clap cue, and established a new cue by taking her left hand, squeezing it gently, and using that to call back the Ego.

Cues can be erased by placing the client in trance and telling him that a particular cue will no longer be used as a signal. Table 3 outlines the procedure for establishing and erasing hypnotic cues.

Table 3

Hypnotic Cues

A. Establisbing a Hpynotic Cue

1. Explain to the Ego the reason for the cue.

2. Ask for the Ego’s permission to establish the cue.

3. Ask for permission and guidance iron the client’s Inner Wisdom.

4. Describe the cue.

5. Place the client in trance.

6. Rehearse the cue.

B. Erasing a Hypnotic Cue

1. Place the client in trance.

2. Describe the cue and clearly state that it will no longer be used as a signal.

Cues can also be used to precipitate trance very quickly. However, I do not do this because even if the client knows better, it feels like the therapist is controlling the client. I used to use this technique nearly every session because it saves time, but I stopped when I became sensitive to the implicit message it contains, which is not a message I want to give to my clients. Although using a relaxation procedure takes a little longer, doing so gives the client a greater sense of personal autonomy.

Cues are usually not necessary unless the client is deeply fragmented or is working through profoundly distressing material. In the latter case, cues allow the therapist to provide breaks, during which the client can rest and assimilate the material. As with all other forms of suggestive hypnosis, it is important to consult with the client’s Wisdom regarding the use of cues. Cues should be established before the work begins, but while the client is in trance. The therapist may want to practice the cues once or twice to be sure they are working. If adequately reinforced, cues generally work as intended.

If a therapist is dealing with a rageful part, it is important to have cues established so that she has some control over the process. Such personalities can be powerful and dangerous. The therapist needs to have some signal that can force a switch. Doing so provides valuable protection for both the therapist and the client.

Besides being a way to rapidly induce trance or to quickly return executive control to the Ego, cues can also elicit any internal part or process to which they have been effectively connected. For example, once a client has met the Hurt Child, all the therapist usually needs to do to return to that part is guide the client into trance and ask the Hurt Child to come forward. If the Hurt Child has a distinct name, using its name will make the process even more effective. A name is a powerful verbal cue that crystallizes or draws forward that aspect of the psyche the therapist wants to work with. If the client is deeply fragmented, many of his parts will already have names. Learning their names is a very important part of the therapeutic process. Not only will this facilitate the therapy, the therapist will also be showing respect to the parts.

Likewise, a word, a touch, or even a look will sometimes be sufficient to initiate experiences associated with a cue. Touch cues seem to have more power than the others, although all can be effective. If a cue is contrary to a strong internal part or process, or to a deeply felt ego-level need or attitude, it will lose potency over a relatively short period of time. Otherwise, the cue may be effective for months and, if periodically renewed, it can last indefinitely.

In practice, I avoid using any but the most self-evident cues (i.e., calling a part by name, referring back to the material we were working with in the previous session, etc.). Although I might use my notes to describe the experience of the previous session, I will not have established a formal cue during the previous session that would automatically and forcefully thrust the Ego back into the experience. As previously noted, such a display of control by the therapist casts the therapeutic relationship into an asymmetrical superior/inferior pattern and erodes the possibility of mutuality and bonding. Almost anything that can be accomplished through the use of cues can be accomplished merely by asking for it within Internal Work. If the Ego is hesitant to cooperate with the requested direction, it is a clear indication that some ego-level work needs to be done before the Internal Work can proceed. If hypnotic cues are used to bypass Ego resistance, the Ego will probably undo whatever is accomplished during the session.

Another facet of hypnosis, which might be considered a branch of suggestive hypnosis, is time manipulation. The psyche can be moved backward or forward in time, and it can have blocks of time removed. The therapist can manipulate the experience of time with the Ego, with a part, or sometimes with the whole System if it is not too deeply fragmented. The most typical manipulation of time through hypnotic work is age regression. There are basically two forms of age regression: (a) purposeful, directed age regression and (b) spontaneous age regression. I have not seen anything in the literature about the utilization of spontaneous age regression as a therapeutic modality. Almost all books on hypnosis discuss purposeful, directed age regression, in which the therapist has a particular age or experience in mind for the regression. The technique can be as simple as saying (with or without inducing trance), “Think about the house you lived in when you were nine years old. Really experience that house. Use all of your senses to be there as fully as possible. Look around. Listen to the sounds that are part of that house. Touch the things there. Notice their texture and temperature. Be aware of the variety of smells in the house. Notice also what emotions you are feeling in this place. Now, let yourself become the nine year old child in that house once again.” The therapist then takes the client through the BASK model in order to connect him to the sensory experiences evoked by the house as well as the emotions, behaviors, and awarenesses that go with being a nine year old child in that place.

A more cormnonplace form of directed age regression is to induce trance and then suggest to the client that he is going back through time. There are several techniques available, such as having the client watch a calendar flip pages or focus on progressively earlier memories until his attention is focused back at the selected age. The psyche is quite flexible, and a regressed client can be very much like a child of that age.

Intentional age regression is particularly useful when the therapist encounters a deeply wounded Hurt Child. If the child is too stubborn, angry, fearful, or withdrawn to work with, the therapist can ask the Internal World to take the client back to the beginning of the damage. If the source of the problem is not a specific traumatic event, but rather an extended process of inappropriate parenting, the psyche may present an infant of only a few weeks old. The Ego and the therapist can then begin to work much more effectively than with the more wounded aspect of the child.

Spontaneous age regression tends to be far more powerful therapeutically than directed regression. It also demands much less skill as a hypnotist on the part of the therapist. In spontaneous regression, the therapist helps the client find and connect positively with the Hurt Child. The age and agenda of the Hurt Child are determined by the Internal World. The therapist then asks the Hurt Child if it will take the Ego back to whatever material needs to be resolved. If the Hurt Child is willing, the therapist encourages the Ego to go with the child. Soon, both Ego and child will be back in the midst of unresolved childhood pain. If the Ego is open to the feelings, sensations, and thoughts of the Hurt Child, the therapist can simply allow the process to unfold as it will. If the Ego is aware but detached from the experience, then the therapist can temporarily integrate the Ego and the Hurt Child so that there is little distinction in consciousness. One way to accomplish this is to encourage the Ego to fix its attention on the Hurt Child, especially by looking into the Hurt Child’s eyes if possible. The therapist then says:

As I count backwards from five, you will move closer and closer until you are within and become one with the child. Five, you are moving toward the child; four, you’re getting close to the child; three, you’re getting very close; two, you are within the child; one, you are the child. Go now.

After the experience is over, the therapist separates them again and strongly encourage the Ego to support and nurture the Hurt Child. When the nurturing is completed, the event is largely resolved. Sometimes this can be done in one session; sometimes it is several months worth of work.

Richard Kluft (1993) strongly recommends that a rule of thirds be followed when potential dissociated trauma is invited back into awareness. The first third of the session is dedicated to reclaiming the trauma. The second is dedicated to helping the Ego, Hurt Child, etc. respond to the trauma. The last third is utilized to help the person reorient to ordinary life and begin to integrate whatever was experienced into his personal reality. If the regression work is initiated in the last part of the session without time for proper resolution, it may be extremely disorienting and trigger unnecessary crises between sessions. This will only serve to make the therapy longer and more disruptive than need be.

Another tactic Kluft (1991) suggests is the “timed safe.” If the uncovered trauma cannot be worked through within the session, whatever is left and the affect associated with it are placed in a bank vault with combination lock set by the client. The timer on the lock is set so that it will open only at the beginning of the next session in the presence of the therapist. I have used both of these suggestions to good effect.

Generally, I have found that the more deeply traumatized and fragmented a client is, the more aggressive I will have to be in using hypnotic manipulations to facilitate the healing process.

A central goal in this process is to remember what happened. If the client integrates his Hurt Child and becomes overwhelmed by the traumatic experience, but cannot remember what happened, the therapist needs to help the Ego and the Hurt Child separate somewhat. As a partly detached observer, the Ego can begin to bring back to consciousness at least the knowledge of what happened. In later sessions, the therapist will need to take the client back to the experience and gradually facilitate more and more connection until the complete experience with all its attendant sensations, emotions, and life decisions is reclaimed. Sometimes, wisdom figures or other parts can help control the flow of the experience so that the Ego can gradually bring it to awareness.

Spontaneous age regression provides many benefits. First of all, the therapist does not have to be an experienced hypnotist. Secondly, it will make available deeply repressed or dissociated material that would be inaccessible if the therapist were only using directed age regression. In directed age regression, the therapist can only help uncover what she already suspects or knows about. She cannot touch experiences of which the client is unaware, which are frequently the most potent experiences. In spontaneous age regression, the therapist trusts the client’s Center to select the scenarios. This allows access to what needs healing at approximately the pace it needs to be dealt with. It is much more powerful and also much easier.

Occasionally, part of the process involved in age regression is for the therapist to be available to the Hurt Child in a parental fashion. This is especially true if the Ego does not have that capacity or if it becomes overwhelmed by the experience and cannot separate out to nurture the Hurt Child. The therapist’s response to the child must be genuine and age appropriate. She will need to step in and offer the Hurt Child a nurturing, warm, protected environment. The child may be frightened and confused, and have no idea who the therapist is. The therapist must be flexible enough to deal with this.

Sometimes therapists will use age regression to get the psyche to a stage earlier than some particular dysfunction so that the client can re-experience what it was like to be functional and whole. It can give the client reason to be hopeful, but it is not the same as healing the abuse.

Two other manipulations of time are age progression and amnesia. Age progression can be helpful with those clients who are ambivalent about being in therapy. They do not want to work too hard, yet they enjoy having someone to talk to. Age progression amounts to an educated guess on the part of the psyche as to what the person will become if certain conditions remain unchanged. Such an experience can be very powerful for a person. If the client is not sure that he wants to do his work, or if he thinks he is just fine but his therapist is unconvinced, she might suggest using age progression to see what the client would probably be like five or ten years from now. This might include looking at relationships, work, and self image.

That can sometimes shake people loose because it will take their pathology, exaggerate it, and intensify it, which is usually what happens when people get older if they have not dealt with their material. The therapist can then ask the client if this is what he wants, reminding him that it must be his decision.

There are other applications of age progression as well. The therapist can take a Hurt Child or a Divine Child and have them become older so that the client can see how the two potentials diverge. However, if a therapist is going to manipulate psychological experiences, she should try to do so in tune with the client’s internal flow and with the permission of a wisdom figure.

The final manipulation of time is amnesia, whereby the therapist can take a block of time and move it out of awareness or at least block its impact. Amnesia may be helpful if the therapy dealt with very powerful and painful material which the therapist is convinced would render the Ego dysfunctional if it remained fully in awareness. The timed safe intervention developed by Kluft is my favorite for this purpose.

A final issue I want to address regarding the use of suggestion has to do with affirmations. Most books that discuss self hypnosis mention the value of programming oneself by giving oneself affirmations. These are usually nothing more than ego-determined suggestions to help the person become healthy, wealthy, wise, etc. People need to be very careful with the use of these “positive” affirmations. If the only thing the person is dealing with is Ego level negativity, then they can be helpful. If, however, the negativity or pain is being driven by unresolved internal issues, then the “positive” affirmations can easily feed into the Ego’s proclivity for denial and leave significant wounds festering.

However, affirmations do have a place in the psychotherapy wounded people. When the Internal World presents a message that affirms some aspect of the client, or some process of growth, the therapist should encourage the client to own it as fully as possible. I prefer that the client own it through a symbol that functions as a sensory cue, but it can also be owned through an affirmation. If the Divine Child has made its presence known, the person can use an affirmation like, “At my core, I am beautiful, life-giving, free, and innocent.” This is an act of owning what is presented. On the other hand, if all the client has experienced in his Internal World is his Hurt Child, a rageful part, and a highly distorted sexuality, the affirmation of the Divine Child will feel like a lie. Nor will the affirmation be realized. The client will finally wear himself out and decide that change is impossible so he might as well give up. This is a real danger in using affirmations, however positive and well meaning they may seem. Affirmations that are not in tune with the internal flow will not work. They must be a response to what is given from one’s Center. It is the same issue as with suggestion, except that affirmations are Ego directed instead of therapist directed.

An additional danger of affirmations is that they make the Ego the center of the psyche. No one, including the Ego, can ever fully know a person’s True Self. Affirmations are often an attempt to create a self. If an individual is using affirmations in order to be what he thinks he should be or wants to be, all he is doing is distracting himself from his givenness. The True Self is always unique and beyond description, and can only be known through embracing one’s darkness and pain. If an individual is successful in fostering an Ego-created self, it will almost certainly violate the core of his being. Constructive, life-giving affirmation, like constructive suggestion, is a nurturing of what emerges from the Center.

Earlier in this chapter I noted that the early magnetizers used both suggestive hypnosis and dialogic hypnosis. In suggestive hypnosis, they would present to their clients what they considered to be more constructive behaviors or reactions. If they did their job well, the person’s behavior would be altered along the line of the suggestion. These early hypnotists quickly learned that suggested changes were often short-lived and that suggestion seldom had a significant impact on serious pathology. They also realized that the psyche is not a unitary reality and that it was not possible to eliminate a demon or alter personality through suggestion alone.

In the annals of demonic possession which is actually an ancient way of perceiving fragmentation of the personality, the exorcist would spend hours and even days in dialogue with the demon, finding out about the demon’s wants, needs, demands, and expectations. He would try to discern what could be done to help all the parties involved, including the demon. At a somewhat more sophisticated level, the magnetizers would do that with the different parts of a person that they met while the subject was in trance. They would dialogue with the parts, working with them as best they could. Because these early hypnotists apparently did not understand the importance of resolving history, the results of their work were somewhat limited.

In dialogue oriented hypnosis, the therapist works with a part of the psyche other than the Ego. Dialogue with parts can be done directly or indirectly. When the dialogue is indirect, the therapist communicates with the part through the Ego. This is usually done with the client in a dissociated state. The therapist addresses the Ego, which is still in executive control of the body, and asks if the part can hear her. The Ego, which is now in the Internal World, checks to see if the part is able to hear the therapist. If the part cannot hear the therapist, the therapist can ask the Ego to speak for her. The part then responds to the Ego, who in turn tells the therapist.

A more subtle form of indirect dialogue is going on all the time. Whenever a therapist suspects that the client is fragmented, she needs to be careful about what she says, because she is probably being listened to not only by the Ego, but by a variety of other parts as well. If, while talking to the Ego, the therapist is saying nasty things about its errant sexuality or obnoxious anger, she will be simultaneously supporting the Ego’s rigidity and alienating a very important part of the psyche, which will become even more difficult to work with. The therapist must assume that she is in a dialogue position with other parts of the psyche whenever she is talking to a client that has the least likelihood of being fragmented, Because anyone who has been badly hurt as a child is likely to experience some fragmentation, this guideline will apply to most clients.

A direct dialogue is a little different. In a direct dialogue, the part is brought out into executive control of the body. The Ego is thoroughly dissociated so that it no longer has control over physical functioning or external awareness. The Ego may or may not be aware of the content of the dialogue between the therapist and the part. This phenomenon is not limited to MPD clients. However, for such an intervention to be effective and meaningful, the part needs to have had a significant autonomous existence. Otherwise, the therapist is merely engaging the Ego in a form of role playing, which may be of some value, but is limited by the Ego’s defects in awareness and need to control. Frequently, clients will have well-developed internal realities that precede the therapy and do need to be connected with the therapist for work that the Ego is unable or unwilling to do with them. These are what need to be called out into the body and encouraged to develop a therapeutic relationship with the therapist. The best way to determine if a part has a genuine, autonomous existence is to ask the part or Inner Wisdom. Sometimes the Ego is aware of the existence of the part, and may acknowledge it if asked. Frequently, however, the Ego will be in denial of internal fragmentation, and very hesitant to acknowledge such a possibility. The procedure for doing direct dialogues with split off parts is outlined in table 4.

Direct dialogues should address work that the Ego is unable or unwilling to do. It is preferable for the Ego to go inside and dialogue with and/or care for the

Table 4

Procedure for Direct Dialogue Hypnosis.

1. Place the client in trance.

2. Ask permission from the Ego and Inner Wisdom to call forward the part that needs to be

worked with..

3. Isolate and dissociate the Ego. Be sure to establish a cue that will call the Ego back if needed.

4. Call the part forward.

5. Dialogue with the part.

~6 After the, dialogue, ask the part to go back inside.

.7. Call the Ego back.

part, if it can do so without feeling too threatened or overwhelmed, or becoming negative toward that part. The therapist’s role should be that of mediator. Healing is always finally dependent upon the Ego’s active willingness. The more the Ego participates in the healing, the more it will own the process. However, sometimes there is a very wounded Hurt Child within, but the only feeling the Ego has toward the Hurt Child is disgust. If the Hurt Child’s needs are manifest and overwhelming and/or the symptoms that the Ego is experiencing in day to day life are out of the agony of the Hurt Child and are profoundly debilitating, it may be necessary for the therapist to intervene. In such an instance, the therapist should dissociate the Ego (with the Ego’s permission), call the Hurt Child into the body, and work with the Hurt Child directly.

Another part that is often difficult for the Ego to work with, and frequently needs to be worked with externally, is Anger. In an abused, fragmented person, Anger will be intense, usually rageful. Sometimes such an Anger is profoundly threatening to the Ego. The Ego does not dare go anywhere near it. Anger often would just as soon kill the Ego and may have tried on occasion. Such Anger cannot be ignored. In these cases, it is not only appropriate, but absolutely necessary that the therapist dialogue with Anger.

Whenever the therapist chooses to work directly with a part she should begin by getting permission from the Ego. Secondly, she should check to see if Wisdom supports this. Once the therapist has the Ego’s permission and the wisdom figure’s support, she suggests to the Ego that it go to a quiet, isolated internal place, where it can be very disconnected. Through the use of imagery, the therapist can be very helpful to the Ego in developing such a place. The therapist then invites the part in question to come into the body and talk with her. Usually the part will readily emerge. For someone who has never seen this happen before, it may be distressing. It is important for the therapist to perceive the part within its own frame of reference. If Anger’s self—perception is that it is a towering beast, the therapist must keep this in mind when addressing Anger, even if the body looks petite. Likewise, if the therapist is working with a Hurt Child, she must set aside whatever cognitive dissonance is created by the fact that the child is presenting in an adult body. If the part is a rageful Anger, the therapist needs to set some limits and have some cues established to help call the Ego back right away if needed. A raging part might try to attack her, tear up her office, or do other unpleasant things. That does not happen often, but it does happen and the therapist needs to be protected by having some cues available that can cause a rapid switch if needed.

In dialogue hypnosis, the therapist talks with the part. Just as with the Ego, the therapist may have to earn the part’s trust. This is done in the same way it is done with the Ego, through empathy, warmth, genuineness, and radical honesty. Another essential factor for developing trust is that the therapist accept that the part has a right to exist. A therapist who has established as her agenda the destruction of a part will never gain the part’s trust.

Inner parts always have a strong drive to be in the body. I cannot recall ever meeting a part that did not want at least some external expression. Therefore, it is not difficult to get them to emerge. What is difficult is getting them to cooperate or to work effectively toward healing. Often, inner parts, especially rage parts or a distorted sexuality, will be absolutely convinced that the therapist’s goal is to kill them. Therefore, they are not going to be very open to trusting the therapist even though they may come out to see what she is all about. The therapist must be clear in her own mind that she does not mean them any ill will, regardless of how they behave. They must know that she is genuinely concerned about their welfare. They will be very aware that the therapist is also supportive of the Ego and they may wonder how this is possible. It must be made very clear that the therapist’s job is not to choose sides. Nor should the therapist pick the personality she likes best, eliminate the others, and try to move her favorite into the body permanently. Such an attempt will probably fail, and in the process the therapist will alienate many aspects of the client’s psyche. If the attempt succeeds, the Ego that emerges will be depleted and unbalanced. Although it may be “nice,” it will be nothing like the True Self. Moreover, the destroyed or rejected energies will often recoalesce into a new form, and the client will be worse off than before therapy began. The therapist must realize that every facet of the psyche, except for introjects, is an expression albeit distorted of the client’s True Self. The therapist’s job is to bring everything back into balance. I continually assure the parts I dialogue with that they will not be forced to do anything. They know that in the long run, my hope is integration. Initially, such a prospect may seem absolutely insane to the part, and it will be certain there is no danger of that ever happening. However, as long as the part knows that this is the therapist’s agenda, it will know that it is not under any threat from her. Most importantly, the part now has someone to listen to it, which is usually felt as a great relief.

The next step in the dialogue is to begin negotiations, which might go like this:

Sally (the Ego) tells me that she hears you attacking and insulting her from within almost all of the time. This is really hard on her and it’s not helping you any either. I understand that you don’t like her, but you also have to realize that the more you attack her, the more rigid she will become. As she becomes more rigid and controlling, the less opportunity for expression you will have. Since she is finally allowing you a chance to freely be yourself with me, can’t we find some way in which you can get some of your needs met, without her having to endure so many attacks from you?

Usually some options will develop. Ideally, negotiation should be done between the Ego and the part directly. When this is not possible, then the therapist needs to be the facilitator. In the give and take of the negotiations, the part is always waiting to see if the therapist will keep her word. If she does not, then that part will withdraw and return to its old destructive patterns. It may even escalate the internal turmoil. Trust is very hard to establish with wounded or angry inner parts. Therefore, it is very important that the therapist be absolutely straightforward, honest, and deeply trustworthy with these parts.

When the therapist finishes her dialogue with the part, she should ask it to go back inside. I always ask for the part’s permission to tell the Ego everything that has happened. If the part insists that I not share the information, I will honor that request. I warn the Ego ahead of time that I must honor the part’s right to confidentiality, just as I honor the Ego’s right to confidentiality. I tape all my sessions. The tapes are for the Ego to take home and listen to. If a part does not want the Ego to hear the tape of that aspect of the therapy then I do not give the tape to the Ego. However, this is very unusual. Sometimes a part does this as a way of protecting the Ego from traumatic memories. Sometimes the part just does not like the Ego and knows that it will be distressing to the Ego to have lost a half hour. Nonetheless, the therapist must honor the request.

More people have authentic, well developed parts than is commonly believed. These people may not quite fit the criteria for DID/MPD because the Ego has always had a continuing flow of conscious awareness, but their parts do profoundly influence Ego function most of the time. Whether someone is a multiple or somewhat less fragmented is sometimes a very subtle distinction, and does not make much difference regarding the therapeutic approach. If the client has a part, the therapist must deal with it. Whether the part has ever been fully in charge or not is a moot point.

Dialogue hypnosis is more important for healing than suggestive hypnosis. It usually is not often done by contemporary therapists, but it is a central factor in Internal Work.