Beautiful this article I wish to share with you, you see, sometimes , little is known of the dynamics that govern our being, in an otherwise useful rlazionale primary. Good reading.
Michele Giannantonio, Anna Laura Boldorini
Website: psychotraumatology Communication published in the Proceedings of the XI National Congress of AMIS, "Forty years of hypnosis in Italy: Present and Future", 1998
1. Introduction It is a common practice in hypnotic psychotherapy used to build mental representations of real places or imaginary to induce trance, deepened or for specific therapeutic objectives. This approach, however, may not be immediately fit for use or satisfactory. Some patients, in fact, show the obstacles from the beginning of the hypnotic work, though, apparently, it was only a stage of preparation and introduction. In reality, these patients are already in psychotherapy, as to overcome these difficulties produce important effects on their personalities and transformative work on the alliance.
In this communication, we intend to highlight some of the most common problems that we encounter in our clinical practice at the beginning of hypnotic work. We intend to show how the types of obstacles may contain crucial diagnostic information and guidance to the next therapeutic intervention. Employ some clinical cases to illustrate how the manifestation of the difficulties in question and their treatment by the writers.
Part of what we will discuss is commonly understood as "strengthening the ego", a concept so vast that, therefore, is likely to seem empty of meaning. Within it, in fact, are often enclosed processes between them is very different for the necessary management arrangements for the results they generate. In any case, however, a correction on the emerging difficulties should lead the patient to receive a "retreat inward" more and more solid that allows him to build the self within a relatively conflict-free, a safe base intrapsychic, the starting point for further exploration and experiential therapy.
2. The consolidation of the inner refuge inside a shelter (henceforth "RI") is access to a place like that experienced by the patient. Commonly chosen are classic places like a beach, a meadow, forest, etc., But the patient may need different places, such as the attic of a house located in the imaginary "nowhere." In any case, the parameter to assess the adequacy finding is a sense of safety, security and freedom of expression that gives, and therefore the attitude the therapist is required to operate with maximum flexibility to use any demand, resource and need to be used individually in an environmentally friendly manner by the patient.
When a person requires our intervention often has the impression of being in trouble globally, as if "everything" went wrong and it was not possible to find any point of leverage to make changes intact. Under these conditions the initial finding or building (the difference is fundamental and will be specified later) of an RI is presented as a useful intervention for many reasons, as it can make:
1) Access to a condition psychophysiological "Conflict-free" according to a terminology of ego psychology (12), lived as a restaurateur and self-care, in implementing this, we are often well aware of how they would feel the person and therefore, more correctly, may indicate the final state obtained by the resolution of conflicts.
2) to learn or improve their capacity for repression aware of the conflict and suffering, often lacking in those patients who feel invaded by past or present problems.
3) The re-accessible to forgotten inner resources, contaminated or impossible to use, belonging to a more peaceful past, in this will allow the patient to use tools essential to your change, which are often unattainable by purely verbal procedures (7, 12).
4) to make an implicit progression of age, consists not so much restricted by terms of fantasies and wishes (5, 12) or a generic "Strengthening the Ego", but actively to direct the expression of needs, desires and resources of the patient towards goals cenesthetically founded.
5) As of 3), to obtain important diagnostic and prognostic information on patient conditions.
6) to return a sense of cohesion and continuity of the self, often flooded or
fragmented by mental illness (8, 12).
7) If you need to begin to live it as a landmark in itself
themselves, constructing or reconstructing an interior living space as a secure base
introjected, often absent or deficient in the more severe pathologies (2, 8, 11, 12 14).
3. Barriers to discover that he had "inside himself" a beautiful place, safe, friendly, allowing for "feel good" to rest, to express themselves freely, as appropriate to reconsider an appropriate emotional involvement with your past and future, is itself a discovery that for many people is indelibly positive and transformative. The path leading to the discovery or construction of such a place can be hampered by many factors, which do not however have to be totally negative in itself, but rather opportunities for diagnosis and prognosis that require intrinsically different therapeutic interventions. In general, one can say that the specific problems they encounter contributes to the formulation of diagnosis, while often the rigidity with which the obstacle is a prognostic indicator.
3.1 False or irrelevance of experience, some patients report that the positive experience of living is, in fact, materially false, worthless, too far from the "real" world.
Such a kind of argument, often expressed indirectly, may be placed by individuals who find it hard to recognize some degree of kindness and beauty in themselves and in their inner world. The fury with which this belief is defense is indicative of the degree of embeddedness of the negative image of self and flexibility with which this image can be modified and updated by integrating new experiences. You can respond to this claim, explaining that the substance of what they imagined as this has emerged spontaneously in a nutshell, is calibrated to their actual needs, can not have been inoculated by the therapist, but only elicited maieutically mainly from parts of the unconscious mind of the patient.
These explanations, together with repeated re-accessible to RI are sufficient to achieve a gradual acceptance of experience, producing changes not only self-esteem (construct rich and complex components of cognitive awareness) as the perception of their somatic pleasantness and kindness. It 'also provides a first glimpse on the recognition of unexpected resources involved in resolving individual problems and needs of nell'appagamento deep.
3.2 Abandonment Access to a RI absolutely requires the sale of part of control to the therapist but also to the imaginative and emotional inner world. This step is not always easy, and most of the intensity of fear often has a reliable prognostic value of the difficulty with which it is passed. We can meet this obstacle, for example in people with panic disorder, with or without agoraphobia (1), used to feel with a lot of fear responses independent of the body and certainly do not perceive it as a safe place. In these patients therapy is an integral part of learning the abandonment and discovery that it is often too self-control and emotional coercion to produce the feared problems (6, 10).
Otherwise, it may happen that the difficulties of neglect are linked to the report, more generally, to transference issues present since the beginning of treatment related to the transfer of power, confidence and control. In these cases, the hypnotic work can certainly be helpful, but a substantial part should be done in time is often long, in more traditional settings (13).
3.3 The security may be impossible that a place is reached, but that is not perceived as "safe." In addition to being an indirect indication of the degree of patient involvement in their problems and the difficulty in separating from them albeit temporarily as a safe place to live it, puts the therapist in the need to operate directly therapeutic for a welcoming and safe place chosen by the patient. But there may be many reasons that make it impossible to feel safe:
3.3.1.La apparent safety. The patient is apparently safe, but in reality can not explore its RI. Often it is just an initial problem that will be passed spontaneously familiarization. Other times, the patient is unable to make an exploratory movement. You can then assist the patient with a "helper" to serve as a secure base. The ideal treatment for his intrinsic ecological, is represented dall'elicitazione of the patient to fulfill this protective role,
already or will be later in life when solved certain problems (12).
not always being possible, then it must fall back on people's current life or past, or as a last chance, the same therapist. The choice of the person testifies to their degree of impairment or intrapsychic and relational resources at his disposal. We find similar situations, in general, in people who are struggling to stay hooked to a safe state, and low-self as the Anxiety Disorders or Mood Disorders, but also in those personality disorders that prevent the expression of autonomous and serenely independent person (for example, Employee Disorder, Avoidant and Borderline Personality, 1).
as the ultimate therapy must always consider that, where possible, as is always desirable, has the goal of self-exploration relying primarily on intrapsychic or relational resources, and then, to that effect should be in Subsequent long-term oriented interventions. Erica, for example, has already reached its RI sometimes, but really does not seem to play a protective and reassuring. I do not feel like " RI's (as happens often positively), feels watched, the beach there is a lot of people but, more importantly, there is always a fisherman on a rock, still, even in this self-hypnosis exercises prescrittile.
coupling the appropriate moment, she is told that one must know what is there, the fisherman, and for this reason, select a person that provide security and protection to go talk to him (the therapist chooses) . She went to the fisherman, "discovered" (but actually if you "feel") that it is actually the father, deceased, with whom the patient has had an incestuous relationship more years of which he started to talk only with the onset of therapy, then 28 years after his term. Recognized as the father in the fisherman yells at him to leave, leave it alone for now is great.
As soon as the father goes away, the patient called him back, could not bear to have him hurt and saddened. Despite the abuse continued, in fact, this father was to the patient an important point of reference, being the mother completely absent and unreliable. Being an adult and free is an achievement to be built.
3.3.2 The security threat. In some cases the safety of the RI is threatened by "something" more or less accurate. General indication of the difficulty in suppressing the problems, it is always good to try to find objective source of fear and manage to create a space of safety. For example, Paul, at his second experience with RI, report that they were observed by someone, as if it were filmed. On the third access an enormous serpent coils around her, something which was "something I had done wrong." Next time, when the snake comes back, I rise to help her, digging a deep hole, throw in something to eat (in a manner systematically applied by Leuner: 9), and at this point the snake, harmless and satisfied, is ready to talk with Paul, says he does not want to hurt her, but just make sure that does not commit the suicide attempts to attract the attention of her husband and other family members. At that point, the snake disappears and Paula feels that becomes his ally. This example also shows how it is possible through the use of a RI to enforce the integration of material that is not integrated, that is repressed, dissociated or removed.
3.3.3.La Security empty. Sometimes the place can be experienced as safe, but nevertheless rewarding and not a condition for the free expression of self. Paul, for example, after the inclusion of the snake, he finds himself sitting on the beach crying because of a deep sense of loneliness and unmanageable: the patient, in fact, depressed in drug treatment, partly because of the construction of a "false self" linked in part to his obesity, it is absolutely devoid of any genuine human relationship, real or introjected. Equally, after some familiarization with grass desert where you can not invite anyone except the therapist feels the urge to feel more protected and less alone. He was chosen a forest inhabited only by animals, including a hawk that perches on his shoulder to protect it. The safety experience is still extremely limited, as Sara can enter into a relationship with animals, because the only human being who has access to the forest, the therapist has only the role of ensuring the safety of that patient.
Paola has a borderline personality disorder, characterized by a marcatissimo ambivalent-insecure attachment (8, 11).
In other cases, the RI is not really as rewarding emotions and feelings of emptiness or even palpable: they are often deeply depressed patients who, if already in drug treatment, leaving a poor prospect for improvement, often partial, only through a long and difficult rehabilitation to enjoy life. For Leonardo, 55, with Dysthymia and Major Depression Recurrent, probably already depressed after aa 10, although slightly improved with medication, any place and imagined experience with hypnosis are little more than indifferent, although they have sufficient skills hypnotic.
3.3.4.L 'inability to be there. If only we ask the patient who was in RI, it is not uncommon to find that there was not really in that place or in full our patient. Sometimes the patient is present as it once was, before developing certain problems, or the mode of being of the patient is too tied to mechanisms
wish fulfillment without any real transformative power and guidance of resources.
In other cases, the RI is not really as rewarding emotions and feelings of emptiness or even palpable: they are often deeply depressed patients who, if already in drug treatment, leaving a poor prospect for improvement, often partial, only through a long and difficult rehabilitation to enjoy life. For Leonardo, 55, with Dysthymia and Major Depression Recurrent, probably already depressed after aa 10, although slightly improved with medication, any place and imagined experience with hypnosis are little more than indifferent, although they have sufficient skills hypnotic.
3.3.4.L 'inability to be there. If only we ask the patient who was in RI, it is not uncommon to find that there was not really in that place or in full our patient. Sometimes the patient is present as it once was, before developing certain problems, or the mode of being of the patient is too tied to mechanisms
wish fulfillment without any real transformative power and guidance of resources.
Other times the patient is there, but with a body not his own, a fantasized or a worsening of the previous body image. The latter situation arises frequently in dismorphophobias and psychogenic eating disorders where it is easily detectable alteration in body image (3, 4). It 'important to realize that working on these "patients, in reality we do actions that tend to stay with little or no results, they were not directed to the integrity of the patient, however, because it does not come into play too important aspects of his personalities involved in its suffering. For example, in a patient with an eating disorder with a psychogenic or dismorphophobias, needing to work with the main aspects of the person, we have to produce gradual acceptance of the body, but in reality this preparatory work is essential to therapeutic importance.
Other situations instead reflect broader issues: Antonia, severely depressed for many years and provided with low interpersonal skills, in the first period of familiarization with the RI can not see. She is then suggested to be there, but to be invisible to all, through this loophole, the patient is able to explore its RI, a beach, standing far away from people, until, with the proper precautions, it becomes visible and you know the show from a character that intrigues and entertains.
Summary
The authors described the therapeutic significance of the building and the discovery of an inner refuge for the patient at the beginning of a hypnotic psychotherapy. They also highlighted the main difficulties encountered in this process some types of patients, with particular attention to their diagnostic and prognostic value. It follows that such practice, far from being just a "familiarization hypnosis" or "ego strengthening" not otherwise directed, is in itself a therapeutic tool aimed preliminary and subsequent interventions, without neglecting the aesthetic and creative change.
