Cases of the
New England Society...
Number 2.3
March 2000
Comments by Dr. Max Shapiro on
The Case of Anna: Headache and Heartache
by Daniel P.
Kohen, M.D.
Max P. Shapiro, PhD is the Director of Education & Research for the New England Society
of Clinical Hypnosis. Dr. Shapiro practices and teaches in
Newton, MA. A Past-President of NESCH, he was formerly the Chief
Psychologist at Newton-Wellesley Hospital, where he maintained a practice in
behavioral medicine. He has practiced and taught psychotherapy, clinical hypnosis, and
hypnotherapy on the Faculty of the Harvard Medical School and The Tufts
University School of Medicine. Dr. Shapiro has a special interest in the use of
hypnosis in enhancing outcomes in healthcare, academics, athletics, and the
performing arts.
The Case of Anna: Headache and Heartache by
Dr. Daniel Kohen presents the significant gains achievable when hypnosis is an integrated part of a comprehensive
healthcare intervention. Several aspects of the case are noteworthy:
First, Dr. Kohen saw his patient only after a full
diagnostic evaluation by her pediatrician and a consulting neurologist, both of
whom found no underlying pathophysiology (neurological disease, tumor, etc.) This sequence of evaluations is important because attempts to
modify physiological symptoms through hypnosis are generally fruitless unless
the patient can be assured that the
symptom is not serving a valid physiological
function. No individual will
give up a “useful signal”: eg.,
pain sensations that protect the individual, or that serve to alert her to an unrecognized
problem.
Second, Dr. Kohen assessed the possible
psychological/developmental functions of the
headache symptom. It is believed that some symptoms are “empty symptoms”:
phenomena that originally served a purpose for the person, but are no longer
useful. However, learning is powerful and symptoms can easily become habits.
Obsolete “empty habits” can often be ameliorated with hypnosis, but such
was not the case here. Rather, the history suggested a link between this
patient’s difficulty managing important family losses and her symptom course.
Third, Dr.
Kohen’s focus was teaching Anna how to achieve active mastery. While
important for all hypnotic work, it is essential for work with
adolescents for whom mastery is a key developmental issue. By presenting
hypnosis as a way for Anna to “be the boss of herself”, Dr. Kohen was able
to build a therapeutic alliance of considerable power. As he continued to help
Anna develop her hypnotic skills in managing the symptom, she could feel
her increased strength and the symptom loosened its grip. As this strengthened
her self-control, the protection afforded by the therapeutic alliance with Dr.
Kohen could then encourage Anna to bear the vulnerability and pain of
the grief work. It is quite common to find that hypnosis alters a symptom which
has been blocking normal development. The symptom amelioration then allows
growth to resume, often paving the way for gains in other areas.
Finally, Dr. Kohen’s technical use of hypnosis is
exemplary:
=>Quite sensitive to his patient’s subtle alterations in state of
consciousness, he utilized the occurrence of spontaneous trance states to offer
therapeutic suggestions:
“you can send me all your past, present, and future headaches...”
The use of "trance-logic" here is elegant: Anna was invited to
dissociate the headache pain in the future and also to develop
amnesia for previous pain. Highly useful since the memory of previous pain
serves as a trigger for stress and anxiety which inevitably increases the
patient's suffering.
=>He taught Anna how to symbolize the headache pain ( i.e.,
color, circle, numeral), and then manipulate the symptom by strengthening
the mind-body connection. This is, of course, one of the most intriguing applications
of hypnotic process.
=>In addition, he
helped her control her symptoms by skillfully using appropriate therapeutic
tools in addition to hypnosis ( self-monitoring, biofeedback, etc.)
=>Later in
the treatment, Dr. Kohen reinforced and suggested continued gains in the healing
process, increased proficiency in self-hypnosis, and Anna's ongoing creativity in
further developing her skills after the formal office visits ceased.
=>To her request for additional suggestions, he responded that she “might
want to do her self-hypnosis as a “stress
immunization…” Empowering
the patient to continue to strengthen her coping skills is another hallmark of
an excellent course of treatment. He also normalized her continued use of
trance, making it more of a "life skill".
In summary, this case report is an excellent
presentation of technical proficiency in hypnosis. It presents an outstanding clinician who
demonstrated great skill and compassion in helping his patient.
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