1. Tahir Özakkaş, M.D. – Psychotherapy Institute TURKEY ESH 2017
HYPNOTIC CONTRAINDICATIONS:
Suicide Attempt In Hypnotic Trance
Tahir Özakkaş, M.D. – Psychotherapy Institute TURKEY ESH 2017

2. Introductıon
Hypnotic trance is one of the hypnotherapeutic techniques that radically help to suppress, modify and eliminate symptoms in many cases.
When applied with suitable patients, hypnosis can be a valuable tool in the course of psychotherapy.
However, there have been reports of hypnotic side-effects in the literature. We have encountered one such rare case in our clinic.
The patient first received an intensive treatment in the form of a 40- session structured program over two weeks, called attack therapy.
Then she proceeded to long-term psychodynamic psychotherapy that was eclectic and integrative in nature.

3. PatIent HIstory
The patient was 42 years old, married with two children, homemaker.
She had a high school degree.
She presented a complicated and complex clinical picture with a long history of chronic depression, occasional suicidal ideation, and occasional fugue states.
She had a highly traumatic life story, with repeated experiences of abuse and suicides of close relatives.
These experiences led to a depressive and sometimes suicidal state, along with intense feelings of guilt, helplessness and hopelessness.

4. Hypnosis was used to reveal these states, and sometimes for exposure work, together with the metaphoric materials integrated into the treatment.
The patient was sometimes put into hypnotic trance to help her regress to past traumatic memories and resolve the trauma.
She accessed her traumas several times in hypnotic trance, slowly processing them to make them tolerable.
The goal was to strengthen the ego and re-integrate the dissociated traumatized parts of the self.
Psychotherapeutic techniques were used together with hypnosis in order to help the patient face her traumas and strengthen her helpless inner little child.
Hypnotic trance was combined with ego-state therapy and trauma treatment where, in the absence of helping objects in the patient’s inner world, her current self could help her, and the therapist could support her.

5. In such works with the patient, it was found that she had been sexually abused since childhood, which went on to adolescence and later years.
Due to the impairment caused by these traumas, she has always had dissociative reactions of freezing in response to stressful situations.
These dissociative experiences in the form of derealization and freezing served as invitations to future abusers, causing the patient to be sexually abused and traumatized by others.
These traumas continued throughout her professional career, leading to further identity diffusion and dissociations, which caused new traumas.
She had a very complicated clinical picture, involving loss of place and time orientation, and occasional suicidality

6. At the SessIon
During an instance of trauma work in hypnotic trance, the patient was suddenly detached from time and place, and was imprisoned within the trauma.
Having lost the part of the ego to keep in contact with the therapist during trance, she fell deep into the hole of the traumatic memory.
She was confused and began to experience the therapist as the abuser.
She went into frenetic attempts to get out of the room that was perceived as the place of the trauma.
The therapist’s efforts to help her were useless.
She was banging on the walls, damaging the furniture around, and crying in despair.
The patient could not be brought back to reality or calmed down despite all soothing attempts of the therapist.

7. She was crawling on the ground, crying like an 8-year old, although she was 42 years old.
Therapist tried to manage the situation by calmly waiting on his chair.
Therapist’s every attempt at soothing the patient was experienced as an abuser’s movement, thus eliciting great reaction from the patient.
Therefore, the therapist left the patient be, trying to create a safe space as much as possible.
The patient was seeking a way out of her dissociated state, randomly touching the walls, as if she was looking for the exit in her mental experience.
It was evident that she was not conscious of being in the therapy room, but rather felt like she was with the abuser, and she did not have visual perception of her surroundings.

8. The patient seemed to be incapable of experiencing where she was.
She was only trying to get rid of a moment and memory where she was imprisoned within herself.
She was trying to figure out her surroundings by touching the furniture one by one.
Then she began to touch the window, slowly got up, and opened the window.
Therapist interpreted the patient’s attempt at opening the window in a different way, thinking that she wanted to get some air, so he wanted to leave the patient some room to feel comfortable, and did not intervene.
But the patient suddenly made an attempt to jump out of the window. Immediately understanding it as a suicide attempt, the therapist quickly took hold of the patient and could draw her back.

9. The patient was likely experiencing herself in a new trauma with the feelings of helplessness and hopelessness triggered by being trapped in the traumatic state.
The patient must have had a sense of hope when she discovered the window and could open it.
Her hope was to end her suffering.
The suicide attempt was an idea of salvation, an alternative that would eliminate her helplessness and despair.

10. Conclusion
This experience indicates the need for great caution by us therapists.
The patient’s trauma was activated in hypnotic trance, which triggered the sense of helplessness and hopelessness, eliciting suicidal thoughts.
It did happen within one session, during a hypnotic session.

11. It also shows the importance of video recording the sessions for the safety of both the patient and the therapist.
The objective of this presentation was to raise awareness about containing the environment and objects that might be potentially harmful to the patient and might allow suicide attempts during hypnotic trance, especially when working with trauma.

12. Hypnosis is a technique full of wonders that facilitates therapy and sometimes allows direct ways of treatment.
However, it may also open the gates to hell, and the patient, stuck in the heart of fire, may impulsively turn to suicide attempts for self-protection.
The awareness that patients may harm themselves or others in hypnotic trance highlights the importance of therapists’ alertness and designing the conditions of therapy accordingly.
There is need for further work and literature on this subject.

13. Thank You…