In working with patients who are suffering from PTSD-like symptoms, I
generally have only one guideline: the way in which the symptom
demonstrates a separation from the self. By taking whatever presenting
symptom appears seriously, I find I can find a path to the self back
through the symptom to the pain and then to triggering event of the
symptom. My goal is to bring the individual back to a sense of an
integrated self. I have found the best way to do that is to follow a few
basic steps:

* Induction
* Creating a safe place
* Letting defenses speak
* Entering into time/place where trauma occurred
* Allowing abreaction to the extent the person feels safe
* Re-patterning/transforming relationship to trauma
* Reintegration of experience with larger self

Induction

I use words to relax the patient and to bring him into harmonious contact
with his body and mind. This allows him to "turn down the volume" on the
defenses to experience contained in the conscious mind and allows him to
"turn up the volume" on his ability to focus on his actual experience. All
later steps take place in the hypnotic state the induction provides. The
hypnotic state as used here is best described as a state of calm alertness
to all aspects of a patient's inner reality: emotional, physical, mental
and spiritual.

Creating a safe place

In the first hypnosis session, I invite the patient, through guided
meditation to connect with a safe place within himself and to define parts
of himself which contain resources to help with the process of
transformation. Suggestions are given to return to this place if anything
becomes too scary or overwhelming. Also, in each session, the patient is
reminded that he has full control over the entire process and that the
hypnotist can "count him out" at any time.

Letting defenses speak

I generally ask the patient to identify where in his body he is feeling the
presenting symptom, whatever its nature. By asking him to describe and
vivify the sensations in his body in this way, the conscious mind's
defenses to feeling are dismantled. I then ask him to go to a time and
place where he was feeling the same sensations in his body for the first
time. At this point, we may find ourselves in some sort of "side loop" or
"blank place." If this is the case, we simply explore the defenses until
they resolve themselves. We can then continue with the work of returning to
the original situation where he was first feeling the sensations in the
body identified at the beginning of the session. If we find ourselves in
another defense, we will simply explore it until it is understood and the
patient feels it is safe to let it rest while we continue the work. We may
spend a whole session, or several sessions on this process, allowing the
patient to get comfortable with the process and reinforcing the control he
can have if he needs it. Defenses are recognized as having been valuable at
the time of trauma, but that they are less useful now and even perhaps
standing in the way of further self-understanding. However, suggestions are
constantly given that he can "go deeper" or "further" into this matter each
time.

Entering into time/place where trauma occurred

As we enter into the situation where the trauma occurred, I establish
place/time by asking the patient to describe details which may or may not
be related to the trauma to bring him closer to the event. I ask questions
related to sight, smell, touch, feel, hearing and taste. I don't ask "what
are you thinking" or other cognitive questions. I gently ease him into
contact with the trauma through breathing and focusing.

Allowing abreaction to the extent the person feels safe

In this phase, strong emotions or physical movements may occur. I allow
this to continue for a brief period of time until the "charge" is reduced.
I create a "container" of safety with my words and intentions so the
patient feels supported in going as deeply as possible into the emotions.
He is reminded that it is safe to re-experience what he may have thought
was not safe to experience the first time as he has developed resources and
understandings since that event which will help him re-experience the
trauma in a safe way.

Re-patterning/transforming relationship to trauma

Here I will often use inner child work (bringing the current self's
resources to the past self's situation) or call forth the resources
connected with safety to transfer the "containing" aspect of the experience
to the patient. I will ask him to re-enter the situation, with the
perspective that he has in current day life or with the perspectives gained
in the dismantling of defenses as above. Many health care professionals do
not believe people who are suffering from PTSD can bring this type of
strength to the situation, but I have found that even so-called psychotic
individuals have strengths which can be activated for this process. I ask
him to see the situation/ his reaction to it from this perspective.
Generally, forgiveness of self (for things not done which should have been
done or things done which should not have been done: i.e.: running for
cover when fellow soldiers stayed to fight or killing someone in battle) or
forgiveness other is order here. Forgiveness is never forced. Discharge of
responsibility for events he cannot be logically responsible for is
addressed as this is often a mitigating factor in recovering an integrated
sense of self.

Reintegration of experience with larger self

As the shift in understanding of the experience at the situational level
occurs, the patient is ready to reintegrate this newly-understood
experience into the larger framework of the self. Some questions to be
asked here: What did you learn from this experience that you could not have
learned any other way? Can you bring this learning to past situations where
you reacted off of the fear/shock/trauma and now insert this learning into
that situation? Feel how it shifts your experience/understanding of that
situation. How can you visualize acting on this learning in future
situations?

I have heard some health care professionals say that they think hypnosis is
dangerous. I can see how allowing abreaction to occur in hypnosis with none
of the re-patterning or reintegration to occur can be counter-productive.
But I never go into a panic state with a patient in hypnosis without
integration to the larger self as my main intention. I sometimes wonder if
people who think hypnosis might be dangerous think it might be dangerous
for them, not the patients, because of their inability to deal with the
full emotional and energetic patterns associated with panic/shock/trauma.
It may true this work would be dangerous for them. But I am sufficiently
comfortable with extreme fear and panic states that I have never been drawn
into the patient's panic in such a way that would hamper my ability to draw
forth new perspectives on the panic from the client's psyche.

This is a very brief resume of my work with PTSD-like symptoms. There are
many nuances and choices to be made during the hypnosis session which must
be navigated by remaining fully present and open to the patient's
experience. These cannot be easily outlined but they play a significant
role in the process. This process has helped many, many individuals in my
practice regain normal functioning without the disruption of panic attacks
or trigger events in their everyday lives. It has even taken them beyond
simply functioning normally to a much fuller understanding of themselves
and the nature of reality.

Dr. Isa Gucciardi's Email: isag@popd.ix.netcom.com