PsycCRITIQUES - Contemporary Psychology: APA Review of Books
Clinical Hypnosis, Clinical Lore
A review of
Clinical Hypnosis: A Multidisciplinary Approach
William C. Wester, II and Alexander H. Smith, Jr.
Philadelphia, PA: Lippincott, 1984. 685 pp. $35.00

Reviewed by
John F. Kihlstrom

Hypnosis has been used by practitioners of medicine, dentistry, and psychotherapy for more than two centuries. The technique has appeared in various guises: the animal magnetism of Mesmer; the surgical anesthesia of Esdaile and Elliotson; the suggestive therapeutics of Bernheim (not to mention Breuer and Freud, who popularized his technique); the psychological healing of Janet; the hypnoanalysis of Brenman and Gill; the utilization techniques of Erickson and his disciples; and much, much more. Over the years, many claims have been made for the effectiveness of hypnosis in the treatment of everything from postoperative pain to cancer, from schizophrenia to sexual dysfunctioning. Unfortunately, these claims have rarely been accompanied by compelling empirical evidence in the form of controlled clinical studies or even by a series of representative cases. Instead, practitioners who want to add hypnosis to their battery of techniques are treated to a lot of clinical lore—inspirational and cautionary tales based on the successes and failures of other clinicians.

The present volume collects a great deal of this lore between hard covers. There are chapters on hypnoanalysis by Erika Fromm, on children by Donald O'Grady and Claudia Hoffman, on surgical anesthesia by Dabney Ewen, on general medical applications by Simon Chiasson, on dentistry by Selig Finkelstein, on sexual dysfunctions by Daniel Araoz, and on sports psychology by Beata Jencks and Eric Krenz. Another chapter is on educational uses by Raymond Klauber, and an essay on hypnosis and religion by Peter Carich reminds us that one of the roots of insight-oriented psychotherapy is the Christian practice of confession. There are two chapters on forensic hypnosis, one by Martin Orne and the other by Neil Hibler. Almost all of the material is original, and these chapters and their companions provide an abundance of clinically useful information.

At the same time, many of the contributions display some disquieting features. First, relatively little attention is given to empirical results of laboratory research studies. For example, several authors indicate that hypnosis is mediated by the right cerebral hemisphere, when in fact the available psychophysiological evidence is not nearly so definitive. A chapter on hypnotic phenomena virtually ignores the extensive and growing research literature on analgesia, amnesia, hallucinations, and age regression. The chapter on hypnotic susceptibility makes no reference to the extensive literature comparing the psychometric properties of the available standardized scales for measuring these individual differences. The chapters on analgesia make little substantive reference to laboratory studies of its mechanisms. These are only a few examples of a general trend, and there are certainly exceptions—notably in the chapters on forensic hypnosis and on hypnosis in children.

Equally disturbing, there are relatively few substantive references to clinical studies that would buttress the claims made in many of the chapters. When a new drug is introduced, it is accompanied by information from controlled outcome studies regarding its effectiveness, indications, and contraindications. Unfortunately, except in the case of analgesia and (to a lesser extent) psycho-physiological effects, this model has not generally been followed by clinicians who use hypnosis. Admittedly, such studies are hard to do properly. But hypnosis has been with us longer than systematic desensitization and implosion therapy, two cognitive—behavioral techniques whose efficacy for specific syndromes is well documented. If there is much in these chapters to intrigue the curious-and-enthusiastic, there is little to satisfy the curious-but-skeptical.

Finally, but more subtly, a great deal of emphasis is placed on clinical technique. The book's chapters provide, verbatim, numerous strategies for building rapport and for inducing and deepening hypnosis as well as many transcripts of illustrative clinical interactions. Reading this material, one gets the impression that responsibility for the success and failure of hypnotic interventions lies largely with the hypnotist—that if only the right induction were used, and the suggestions framed appropriately, hypnosis might be effective with almost any patient. If there is one thing we know about hypnosis, however, it is that most of the action comes from the subject: There are wide and stable individual differences in hypnotizability, differences that show interesting developmental trends across the life span but that are relatively resistant to situational manipulation. Moreover, even highly hypnotizable subjects show patterns of strengths and weaknesses within the domain of hypnosis, these patterns presumably depending on the degree to which the subjects possess component cognitive skills required by suggestions of various types. Just as psychological testing is used to help determine appropriate treatment, so individual differences in hypnotizability should be assessed before treatment begins, and intervention strategies should be designed in the light of the results.

The contributors to this book are cognizant of these ideas as well as of the other contributions of laboratory research. However, the reader is left with the impression that laboratory findings have not significantly influenced the practice of clinical hypnosis (a vivid counter example is Fred Frankel's Hypnosis: Trance as a Coping Mechanism, published by Plenum Press in 1979). Nevertheless, there is a great deal of interesting material in this book, contributed by some of the field's most prominent practitioners. Psychologists, physicians, clinical social workers, and dentists who already know something about hypnosis will find much here that may be clinically useful. How much more useful these suggestions could be, if only they were accompanied by the kind of empirical documentation that is rapidly becoming the norm elsewhere in scientific therapeutics.


William C. Wester II is president and senior psychologist at the Behavioral Science Center, Inc., in Cincinnati, Ohio. He is author of Questions and Answers About Clinical Hypnosis.

Alexander H. Smith, Jr., is in the private practice of psychotherapy in Cincinnati.

John F. Kihlstrom is professor in the Department of Psychology at the University of Wisconsin—Madison. He is a past recipient of APA's Distinguished Scientific Award for an Early Career Contribution to Psychology and coeditor of Functional Disorders of Memory with F. J. Evans.


PsycCRITIQUES
0010-7549
Previously published in Contemporary Psychology: A Journal of Reviews, August 1985, Vol. 30, No. 8, 617–618
© 1985, American Psychological Association