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Should I Use Hypnosis With a Client Who Dissociates?

Mark responds to a question from one of our members on a Q&A call


Symptoms of pathological dissociation include feelings of depersonalization - of being outside of one's body, disembodied, and detached from life in general.

Recently I had a question on a members’ Q&A call about working hypnotically with a client who tends to dissociate :

“If dissociation is a fundamental part of hypnosis, is it something you would not use with someone who tends to dissociate?

Certainly it’s a great question. As you’ll see (or hear) in my reply, dissociation is a regular part of everyday life for all of us, but for some it becomes a dysregulated state and can properly be called a symptom.

Post-traumatic stress disorder, depression, and possibly right-hemispheric lesions1 and some medications,2 can all cause feelings of detachment, as can recreational drug use.3 Dissociation can also occur in those suffering psychotic illnesses such as schizophrenia.4

Symptoms of pathological dissociation include feelings of depersonalization, of being outside of one’s body, disembodied, and detached from life in general. People might also feel disconnected from their past or any sense of future.

We can all feel disconnected sometimes, not so much in a clinical sense but in a way that can make us feel empty, where life feels purposeless with little meaning. And perhaps a life spent in abstracted communication on phones rather than in embodied company can sometimes add to these feelings of derealization.

Now, the question we’re looking to answer here relates specifically to the use of clinical hypnosis with clients prone to feelings of dissociation. Should we use it?

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Circumstances alter cases

Of course, like so much in life, it depends.

We can use hypnosis to help people dissociate from anxiety or pain whilst associating with resourceful feelings of connection. So hypnosis isn’t just a state of dissociation, although we are always associated with something (even to feelings of dissociation) and disassociated from other things – like many of your memories, or the long ago heartbreak of a broken relationship.

We only associate with these particulars when something triggers their association and they come back to mind.

So there are three elements to this:

  • What do we mean by dissociation?
  • What is its purpose in life; why might it happen?
  • And where does hypnosis and its therapeutic use fit into this?

Anyway, you can read the transcript of my reply to the question or listen to it below. I hope I’ve managed to shed some light on this, but I’d love to hear what you think.

Listen to Mark’s answer or read below

Hear the answer by clicking the play button below:

or click here to download the mp3 and listen later (you may need to right-click and select ‘Save As…’)

Question

If dissociation is a fundamental part of hypnosis, is it something you would not use with someone who tends to dissociate?

Answer

That’s a good question. And firstly, if we think about dissociation, it’s a part of the human experience. When you are out at the store and are thinking about meeting friends later, you’re dissociating. If you’re imagining something else, if you’re thinking about where you are not at the present time, then you dissociate. When you are in bed sleeping in your bedroom but you’re in a deep dream, you can perhaps feel water as you swim through it, or you can have an imaginary conversation and so on. And that’s a profound level of disassociation in which you’ve even forgotten about the bed you’re lying in, and the bedroom you’re in, and even everyday life. Your very identity can be completely forgotten, because you’ve disassociated from it so profoundly through the REM state.

People who worry and ruminate disassociate, and you can see them doing this. They’re there, but they’re not there. They look distracted, as though they’re not really with us.

During hypnosis, which is a controlled, waking dream state in its deepest sense, the client is in your therapy room, but inwardly could be anywhere at all – in the past, in an imagined future, on holiday somewhere, anywhere else at all.

Dissociation is the foundation of creativity

When human beings began to disassociate creatively, about 40, 50, 60,000 years ago, with the genesis of art and cave paintings and so forth, it seemed that human beings learned to become abstracted from where they were in the present moment. Animals we know aren’t necessarily thinking about next week, they might instinctively be expecting a meal soon and so forth, but we developed the capacity to dissociate so that inventiveness could develop. We were able to stop just living in the present moment and begin to dream, plan, create, invent, and shape our lives.

We developed the capacity to dissociate so that inventiveness could develop. We were able to stop just living in the present moment and begin to dream, plan, create, invent, and shape our lives.Click To Tweet

Some people are prone to a kind of pathological disassociation, possibly as a protective mechanism brought about by trauma or maybe because of a right-hemispheric deficit in their brain. In schizophrenia or other psychotic conditions, we see a deactivation of the right hemisphere. And it’s the right hemisphere of the brain that provides us with a sense of connection, of wholeness, of place, of harmonious integration with a wider context. And if there’s a deficit there, then we start to feel disconnected. Hypnotherapy is a relaxed and calm way of using this natural human tendency to dissociate. So if someone is doing it anyway, such as when they dream, or worry, or use the imagination in other ways, then we might as well use it, but it needs to be controlled and we need to know why we’re using it. Certainly all hypnosis is dissociation, but it’s a controlled dissociation.

If someone is too prone to living in their heads, we might decide they need more embodied experience. For people prone to psychosis, a profound level of dissociation, working with the hands has been shown to be profoundly effective in managing the psychosis. It seems to be very therapeutic for some people to be acting in the world, not just being in their heads. When we’re just in our heads, we’re disassociated, abstracted from the environment we’re in. This is why, perhaps, spending time in nature – because it’s not a ‘townscape’ but the shapes are flowing – seems to have a greater impact on the right hemisphere of the brain, so people then start to feel more connected and less dissociated from reality, which is why spending time in nature seems to be so profoundly beneficial and palliative for people.

So we might use the abstracted state of hypnosis to help motivate people to go from a largely disembodied existence, in which they’re in their heads too much, to a more embodied existence, where they are acting in the world more, and with their bodies.

If someone is actively psychotic and disassociating to that extent, then I might try to focus and calm them, but I wouldn’t use deep hypnosis with them. But otherwise, as long as we use it constructively and calmly, it should be good for the vast majority of people.

Learn Hypnotherapy Online with Mark

For practitioners untrained in hypnosis, it might seem like some sort of dark art, something that only ‘hypnotherapists’ use. But hypnosis is a natural human ability and happens in all therapy sessions, whether you know it or not. Learn how to use this remarkable facet of human psychology to help your clients faster and more deeply on Mark’s course Uncommon Hypnotherapy.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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