Susan

SUSAN

During my last year of residency I was asked to see Susan for a consultation on the neurosurgical ward.  She had been admitted there with the suspicion that she might have a brain tumor.  Extensive testing, however, had failed to reveal any treatable pathology.  Following a myelogram she had developed a headache that had been prolonged and incapacitating in its severity.  When I saw her and also talked with the staff providing her care it appeared that a situation had developed in which they viewed her symptoms to be more faked or at least more psychogenic than real. She, on the other hand, was experiencing her symptoms as very real and blamed staff for their inability to provide her with a proper diagnosis and treatment that would give her relief.  As I saw it, it was a situation in which both factions blamed the other for her lack of progress.  I speculated that things had developed to the point that she could not give up her symptom without the loss of self- esteem that might accompany a spontaneous recovery without further physical treatments.  It also seemed clear that further testing would be contraindicated and would only make things worse.

Susan was bright, young, attractive and suggestible.  She was not psychologically sophisticated and I did not think she would respond to interpretations related to what I had observed.  I decided that a better approach might be to utilize hypnosis as a way to give her permission to get well. 

The first problem was that I had never hypnotized anyone.  An additional problem was that most of the psychiatrists and psychologists who were my mentors did not view hypnosis as a legitimate type of treatment

I made an appointment for Susan to see me the following day in my office.  In the interim I read the most authoritative volume on hypnosis I could find in the library.  Upon her arrival I explained that I had concluded that her headaches had initially been caused by her myelogram but were now being perpetuated by tension.  I further thought that if we could replace this tension with relaxation, a vicious cycle (pain creating tension and tension prolonging pain) could be interrupted and this was likely to result in her headaches going away for good.  I explained that hypnosis, in the way I was suggesting we use it, was a way to facilitate her ability to make this happen. I emphasized that I would not be doing something to her that would take away her pain.  I would simply be helping her to do so. I explained that she would remember everything that transpired and that if at any time she felt confused or uncomfortable she would be able to wake up and terminate the procedure. 

After she agreed to give it a try, I had her lie down on the couch in my office and began to repeat the lines I had rehearsed from the book.  Somewhat to my surprise she rapidly responded to suggestions involving things like hand levitation and eye closure.  I was momentarily distracted by the thought that my training supervisor might not approve of what I was doing when I would present Susan’s case to him later.  Putting these thoughts aside I proceeded. When she appeared to be in a hypnotic state I essentially repeated what I had told her before we had begun.  I suggested that her state of tension was being replaced by a state of relaxation and that as this was occurring she would notice that her pain was going away.  I also suggested that now that she had broken the tension cycle her pain was unlikely to return.  I suggested that she would have full recall of what had happened and upon awaking should feel free to discuss or ask questions about anything that had occurred.  When awakened and asked how she felt she said that for the first time in over a week her headache was gone.

Susan was discharged from the hospital later that day.  I asked her to make an appointment to see me for follow up two weeks hence.  Upon her return she indicated that she had remained free of headaches.  She, however, had decided that her real problem had been with her glasses and had obtained a slight change in her prescription.  I supported her conclusion and asked if there was anything else she wanted to ask or talk about before ending what would be our last meeting.  She said the only thing that she had noted was the occurrence of vivid dreams with sexual themes on the night after the hypnosis and wondered if I thought this was significant.  Rather than delve further I responded that I didn’t think dreams like these were likely to be interpreted in ways that would be helpful to her.

When I discussed the case of Susan with my supervisor I was greatly relieved. Rather than admonishing me, he complimented me for utilizing an approach much different from the slow moving, psychoanalytic, dynamic approaches taught in our program at that time that had placed very little emphasis upon treatment of specific symptoms.

Over my years in practice I utilized hypnosis on several occasions, usually with good results.  I never used it as a means to get someone to disclose information that he or she might not feel comfortable in sharing in a face to face session.  Based upon my experience with Susan, I always had a nurse, family member or female office staff present during the procedure with my women patients.  I found this technique useful in speeding the treatment of phobias.  I found that some patients were able to generate a strong analgesic response and could then be taught how to induce the hypnotic state themselves in order to bring about this effect.  Often it succeeded because it gave someone like Susan permission to get better without the loss of dignity.