Hypnotherapy warning labels and informed consent

In this post, I’m going to talk about the warnings or bad stuff that can happen during or as a result hypnosis. Frankly, there aren’t a lot. But, when I’m going to do hypnosis with someone, I always talk about these because it’s my duty as a clinician to give this information so my clients can give informed consent to treatment.

Do you know about informed consent?

I don’t mean to be pushy, but I’m often struck how few of my clients know about it until I bring it up. The gist is this: Whether you’re getting psychotherapy or a medical procedure or taking a medication, your provider is supposed to give you enough information about what could happen so you can reasonably consent to it, understanding the risks, side effects and pros and cons of proceeding. This is informed consent. If you aren’t given enough information by your provider to make informed consent, then they aren’t doing their jobs.

This blog entry is basically a blog version of my informed consent talk about hypnosis.

Ready?

Falling asleep: the drifting off warning label

Sometimes hypnosis doesn’t work because the person I’m working with falls asleep. This isn’t always a bad thing: Sometimes people are sleep deprived or their unconscious mind is serving some purpose by knocking them out.

Generally, I just wake the person up again. Do I get upset when people fall asleep? I promise I don’t. As a side effect goes, this is pretty mild for both me and my client. The worst thing that happens is that we have to do the hypnosis session again, or we pick up again at the point where the person drifted off.

While there is some thought that the unconscious is listening and taking in information while asleep, it doesn’t work well for the evocative kinds of hypnosis work I do. So we just go back and maybe I ask the person to sit up instead of lying down on the couch, or I find ways to keep them more engaged.

Okay. You got it? Hypnosis is relaxing… Sometimes so relaxing that…

Emotional release: a psychological warning label

Strong feelings can come up in hypnosis. Sometimes these can be quite surprising to people. Typically, what happens is that something is right below the surface and so, when a person goes into trance state, a strong emotion of some kind erupts because the person’s “guard is down” when their conscious mind becomes relaxed. I have seen this happen, for instance, with grief, with anger, and with trauma material.

Clinically, this is called an abreaction, and is a kind of like a catharsis, if you know your Greek tragedy or psychoanalytic vocabulary. While it’s not always a bad thing, it can sometimes be quite intense and unpleasant for people when it occurs. I talked already about abreactive therapies in my traumawork post.

If you’ve been in psychotherapy before, you’re probably aware, however, that this kind of thing can also happen in regular talk therapy: Imagine, for instance, you’re talking pleasantly about your dear friend or pet who died last year, and you find yourself suddenly start crying, experiencing grief from losing your companion. This is the same phenomenon I’m talking about. In keeping with the seemingly faster/deeper nature of hypnotherapy, the difference is that, in hypnosis, you might start crying and not know why, or the material that comes up might be quite strongly.

To help prevent this upwelling from happening uncontrollably, I talk people through what we’re going to do beforehand so the unconscious is primed for what we intend to do (and is less likely to stumble into something unexpected) and I watch out for the unconscious material that could be close at hand.

Then, if something still does come up, I try to make sure that someone is ready for it. And then I encourage the use of it for therapeutic purposes.

For now, you should know that this can happen. It’s a reasonably rare side effect—I would say strong emotions unexpectedly come up in 1 out of 30-40 hypnosis sessions I do, and they’re most likely in unstructured sessions.

“False memories”: a legal warning label

If you’re over 30 or so, you might remember when America was going through an obsession with Satanic ritual abuse in the 80s. Or maybe you remember the false memory court cases themselves.

The story is like this: a psychiatrist, therapist or coach would be working with a client. Maybe they’d be doing hypnosis or deep breathing, gestalt therapy or some other technique. And the client would suddenly remember something he didn’t remember before. Maybe he’d remember his dog Jojo getting hit by a car when he was 4. When someone remembers something they were not at all aware of previously, it’s referred to as a repressed memory (or previously repressed memory, since now it’s no longer repressed). Repressed memories are relatively rare but they do exist—I see them in maybe 1 out of 100 age regressions.

But let’s suppose in our example, the client remembers Jojo being hit by a car, but the client previously never remembered having a dog, and his parents confirm that there was never a dog that fits that description. In other words, there was no way (if the parents are to be believed) that Jojo (who was imaginary) was hit by a car. Then this is what we might call fabricated memory material or a “false memory”—a memory of something that never actually occurred. This is pretty rare. If repressed memories are 1 out of a 100, false memories are 1 out of a 1,000 or 10,000.

How do these happen? Nobody exactly knows, but we know recalling memories is similar in the brain to imagining. Our explicit memory—the memory of normal events—is stored in shorthand, you might say. So each time we recall something, we’re kind of making up the details. This is a major problem with eye-witness testimony: usually we don’t know the difference between what we actually saw and the details we filled in. The result is that three different witnesses of one event can come up with wildly different versions of what happened depending on what else has happened in their day, their own preoccupations and preferences.

And it’s possible—especially with repetition or trance—to get people to remember things that they could not have an actual memory of. Maybe it starts with a seed of some kind, but then a whole memory forms around it. For instance, when I was a kid, my parents talked about their old house a lot. They talked about it so much that I was convinced I’d been there as a child. I even remembered a picture of me as a baby there. But I wasn’t born until after my family had moved out of that house and my parents were clear I’d never been there.

You may be thinking at this point that this is the warning label: that hypnosis can create false memories. And there’s a wee bit of truth to it: hypnosis can do this — however — so can storytelling, late night TV, news/propaganda, psychedelic substances, other trauma modalities, and dreaming — the problem isn’t hypnosis, the problem is the way memory works. That said, say I’m working with someone and they recall a potential repressed memory, i do treat it with caution. If you were a fly on the wall, you’d hear me liken what comes up in hypnosis as like what comes up in dreams: sometimes it’s literal, sometimes it’s symbolic.

Frankly, I think hypnotherapy with hypnotherapists is the least likely place to develop a problematic false memory: clinicians who are well trained in hypnosis avoid doing the kinds of things that create false memories: we know how to ask questions in a non-leading away and we know how to avoid accidental suggestions of remembering a certain thing. We also know how to regard new memory material when it does arise… But, this is all kind of an aside…

The warning label here is actually legal.

Here is the meat of it: Because of the history of false memories in court, the false memory debates, and the effects of various advocacy organizations, if you’ve had hypnosis, it’s possible that your testimony in court could be thrown out or discredited because of the chance that your testimony could be tainted with unconsciously fabricated memory material. In Massachusetts, for instance, if you recall something in hypnosis and there’s no corroboration by other witnesses, the precedent is that if you tried to press a case, it probably won’t go very far. Likewise, if you’ve got a legal case pending or intend to press one, or any situation where you’re a witness, you should give statements or written testimony before doing any kind of hypnosis with me or anybody else.

This is the warning label.

I’d like to stop here. So if you're satisfied at this point, you can stop reading.

There are three warnings: sleep, emotional material, and legal issues having to do with false memories.

But you may also be aware of more context to #3 here, and I want to acknowledge that too.

Because usually repressed memory stories don’t typically involve cis-male clients remembering little dogs named Jojo… What typically happened was that an adult woman would discover memory material of being sexually abused by a family member, often her father, grandfather or an uncle.

This gets very political very fast, but, basically, the idea of false memories — even the term “false memory” — was developed as a legal defense for those fathers or family members. Hypnosis took a lot of the blame, whatwith its already dicey myths of mind control and sleep-like vulnerability: Power/fame hungry therapists warping the minds of vulnerable women and all that. Is hypnosis blameless in all this? No. Perhaps there were power-hungry therapists, and there were definitely naive and incompetent ones doing age-regression work in ways that could create problems. But the political undertones of this are striking. It’s also not lost on me that all this derailed the most helpful trauma treatment modality to exist until EMDR hit the scene in the 1990s.

Luckily, today there are many traumawork modalities. But remember: before you engage in any of them (or any other therapeutic or medical process), get the information you need to make informed consent.

Next, before circling back to some other clinical issues, I’m going to talk a bit about the global view of my work, including meditation, hypnosis, and other stuff.