This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.

Hypnotizability is defined as “an individual’s ability to experience suggested alterations in physiology, sensations, emotions, thoughts, or behavior during hypnosis“. It is most useful to consider hypnotizability as a trait that may affect how quickly clients progress and/or may contribute to the depth of their experience of the hypnotic (mindful) state. It may also determine how much practice a client needs with mindful self-hypnosis in order to achieve their therapeutic goals. This chapter explains the concept of hypnotic abilities and how it can relate to mindful hypnotherapy (MH). It reviews scales to measure hypnotizability, and provides the clinical form of the Elkins Hypnotizability Scale (EHS-C) at the end of the book for clinical use. Research has shown that most people have hypnotic abilities and most individuals can benefit from hypnotherapy just as most people can benefit from mindfulness.

Mindfulness is a contemplative practice involving focused attention, attentiveness to the present moment, and nonjudgmental awareness. It is a way of experiencing the world that can facilitate powerful life changes and open the door to greater well-being. Clinical interventions that use mindfulness offer a unique perspective that can help people improve clients’ lives. Mindful hypnotherapy (MH) is an intervention that intentionally uses hypnosis (hypnotic induction and suggestion) to integrate mindfulness for personal or therapeutic benefit. This chapter begins with a quote from Dr. Milton Erickson, one of the most important figures in contemporary psychotherapy and hypnosis: “Until you are willing to be confused about what you already know, what you know will never grow bigger, better, or more useful“. There is great potential for the integration of hypnosis and mindfulness; however, to achieve this, clinicians and individuals must be open and flexible in their understanding of both concepts.

Mindfulness and meditation were embedded within their religious and cultural roots, and as such they were rarely used by psychologists as interventions in a secular therapy context. In recent years there has been an emerging body of empirical research supporting both mindfulness and hypnosis interventions. Mindfulness and hypnosis have been shown to be of benefit for similar problems (i.e., stress, anxiety, pain, depression, irritable bowel syndrome), and in other research hypnosis may offer some advantages of brevity and effect on symptoms (i.e., acute and procedural pain, hot flashes, dermatological symptoms, sleep quality, habits). However, the mechanisms by which they achieve benefit may be similar in some regards (i.e., relaxation, focus of attention, awareness) and different in other aspects (i.e., hypnotizability, hypnotic state, expectancy, goal-directed suggestions). Also, studies provide substantive evidence that when hypnotherapy is integrated into standard cognitive behavioral treatment (CBT), therapeutic gains tend to be superior to CBT alone.

Hypnotic induction techniques are methods that are used to achieve a state of consciousness involving focused attention and reduced peripheral awareness. Achieving a hypnotic state has positive benefits as it involves absorption and focused attention and may (or may not) involve relaxation. Furthermore, within a hypnotic state the individual may be more receptive to positive ideas and may be able to experience suggested alterations in physiology, sensations, emotions, thoughts, or behaviors. These changes can be of great clinical utility, since they enable the client and clinician to collaborate in making direct changes to symptoms and experiences in the service of overcoming their presenting concerns. Hypnotic inductions are simply procedures that are designed to induce hypnosis. They involve a focus of attention and generally include suggestions to deepen the hypnotic state. This chapter presents an overview of the structure and processes of hypnotic inductions.

Unwanted sequelae of therapeutic trance states were observed in the healing temples of ancient Greece. Hypnosis, like other beneficial therapeutic modalities, is inevitably associated with instances of unintended, unwanted, and undesirable consequences. These range from transient and trivial discomforts to more lasting mild through severe uncomfortable forms of physical, psychophysiological, and psychological distress. While unwanted responses to hypnosis are more common and covert than has been generally understood, the risk of their occurrence can be markedly reduced by the more thorough evaluation of the patient, the regular use of rather basic and straightforward clinical interventions, and the individualization of the techniques and imagery brought to bear in the treatment setting. Further, initially unrecognized incipient problems often can be identified and nipped in the bud by monitoring alertness with the clinician- and patient-friendly Howard Alertness Scale (HAS) and the more assertive use of directive approaches to dehypnosis.

Hypnosis relates to when a person’s behavior shows he or she is in a trance like frame of mind, dissociated from his or her usual conscious awareness. Hypnosis challenges the polarization between the different aims of behavioral and analytical therapy. The reports of many of the patient shows the real source of their distress, and sometimes seem to make the problem worse. This has been eloquently expressed by a young doctor, a survivor of childhood anorexia. “When you live with anorexia, you fight your own thoughts and fears, your own self, every second of every minute of the day. Recognizing this spontaneous hypnosis or trance state as a clinical sign involves a different level of listening skills, a modified approach to history taking and to all the advice given. The focus of therapy is turned from the past to the future from regression to progression.

This chapter deals with the subject of hypnosis in rehabilitation, as it pertains to the amelioration of suffering from untoward medical events that alter a person’s physical, intellectual, or emotional capacities. The genesis of suffering from a lasting medical event includes the wounding of self and the narcissistic injury or threat that incurred. The chapter focuses on one particular approach to restoring a sense of self that is not identified necessarily with the self as a physical being alone or as an agent or narrator of one’s life. Suffering from injury or disability is increased when the cognitive self cannot create a meaningful narrative that integrates the loss of function and ability. Ego-state therapy can be used to target “the narrative self” or any aspect of the psyche that is suffering from the medical condition and disability arising from such.

Children and teens with anxiety disorders share some common patterns in their thinking and response. They share core difficulties in accurately appraising specific situations, experiences, and other stimuli. Enhancing self-regulation, that is, shifting one’s attention in order to control and modulate one’s psychophysiological reactivity, emotions, thoughts, and behavior leads to various, individualized goals for treating anxious youth with hypnosis, cognitive behavioral therapy (CBT), and other mind-body approaches. Chronic childhood anxiety, the earliest and most frequent mental disorder among youth, has a potentially lifelong negative impact on self-regulation, learning, memory, and social behavior. Despite the dearth and variable quality of research, hypnosis offers a valuable adjunct to psychological interventions in the treatment of childhood anxiety, presenting as anxiety disorders, anticipatory and medical procedural anxiety, primary care presentations, or “normal nervous” responses to developmentally based situational stressors.