SIS-I was administered to three patients who were not responding with medical treatment. The SIS was able to identify deep-seated conflicts which patients were unable to uncover through conventional therapy. The usefulness of therapeutic tool of reframing along with hypnotic relaxation is also demonstrated with the help of three case studies.
‘What is learned and remembered is dependent on one’s psychological state at the time of the experience’ (Rossi 1986). Accessing the state-bound memory or experience creates an opportunity for growth through reframing or reorganizing it to facilitate some resolution. This is achieved through the recreation of the emotions, sounds and thoughts related to the repressed event or experience. Accepting the concept of state-bound memory, the therapist strives to create for the patient an opportunity to access the state-bound sources of the problem. Hypnosis is one way of helping patients to access state-bound memories. All patients, however, can access these memories. This chapter illustrates the use of the SIS as a PT and an adjunct to hypnosis to help patients access the state-bound memory, when conventional therapy is unable to achieve the same result.
A three-stage administration technique is used. The first step is to administer the SIS cards and for the patient to identify the three cards they found least disturbing and the three cards they found most disturbing. The second step is to induce a light trance. Depending on the severity of the condition, the author would either induce a light trance or a deep one. The patient is given suggestions of relaxation and the state of relax is then anchored in the fingers. The third step is to ask the patient to open their eyes, look and concentrate on the card and close their eyes again. The patient is asked to report what emotional responses the card evoked or what images came to mind.
Three vignettes describe the use of the SIS to access state-bound memory. The cases described are of a woman with marital problems, an anorectic child and a woman with chronic anxiety. Once the memory was accessed and reframed, the patients showed a dramatic improvement in their condition.
<Level B>Case 1
Mrs E. D. is a 38-year-old married woman who was referred by a colleague because she was not responding to conventional treatment and hypnotherapy for the complaint of marital and sexual problems. She dated the onset of her problem to nine years prior to being seen by the author after having had a Pap smear. She reports that she was embarrassed by the examination and had difficulty opening her legs. The examining doctor made derogatory remarks about her being sexually active as a single woman. She is married for two years to her boyfriend of 12 years and has a 2-year-old son. Her husband had visual problems. After extensive therapy by a colleague, which included hypnotherapy, the patient showed no signs of improvement. She was referred for hypnotherapy (Savage, 2001).
At the initial interview, the SIS-II Booklet was administered after taking a partial history. The following is what the author considered were some of the more significant responses.
A3 I don’t know.
A4 Left-hand side looks like a rose bud starting to open.
A5 Looks like a small body, length and arms. This is the mouth. Like this person is confused like me.
A6 Looks like a teddy bear sitting here could either be legs. Also reminds me almost like sperm going somewhere. Could also be me keeping myself closed?
A7 Someone drawing could also look like the fruit being hanged, looks like me moving my body away.
A8 [After a long silence] looks like a figure as well, like a pregnant tummy. Looks like sperm. Pinocchio’s nose growing.
A12 An ear could be someone always wants to listen.
A13 A hand and it looks like some hand of a plant or something. Saying stop right there. Like its telling you if you go any further it might be dangerous. Could also be a flame or something that is in the sea, something like that?
A22 Looks like a head cut apart, some object, two heads that were put together but separate.
A26 Looks like a deformed face, I see the eyes, or it could be a scan, a baby, development taking place.
B1 Head of a baby, flames, picture depicting the moon from space, whirlwind.
B10 Scan of womb showing developing foetus, pregnant stomach.
B15 Confusion, a child’s scribble, danger, dangerous pointing.
B30 Ears, there will always be someone who will listen to you.
By looking at the responses, the author formed the hypothesis that the patient was feeling confused and was asking for someone to listen to her story. The frequent references to babies were difficult to interpret. Because hypnosis was the treatment of choice, the following two sessions were spent clarifying any misconceptions the patient might have about hypnosis and to let her experience what it feels like to be in a state of relaxation and to provide her with an anchor for relaxation. This was done with the full knowledge that the referring colleague had used hypnosis and that the patient was familiar with the technique. The primary objective was to establish a rapport and to introduce her to my way of working.
Session 4
Two options were considered; one was to explore the responses to the booklet in greater detail or to administer the SIS cards. The second option was decided on as a further diagnostic tool. The following are her responses to the cards.
Card 1.
Patient: Could be a young girl with ponytails. Could be two birds. Young girl’s eyes look a bit sad.
Therapist: What is she sad about?
Patient: I do not know. Maybe she wanted something she was not allowed to get.
Therapist: What do you think it could have been?
Patient: My mind goes back to when I was 10 years old. Mother had cancer; I knew she was sick when I was nine. I knew she had pain. I did not realize that she had died. I knew she had to go to a hospital. I knew she was in pain, I insisted that she plait my hair. When I left for school she wanted me to kiss her, I refused to kiss her.
Comment: At this point, the patient became very quiet and tears rolled down her face.
Patient: At school, the principal called me, I thought it was my uncle who had open heart surgery and I thought uncle Bobby had passed away. When I got home, my grandfather told me, my mother was gone. My grandfather was crying. At the funeral, I refused to look at my mother in the coffin. I feel sad. I often think about her. I am sad; I did not kiss her goodbye. My greatest fear is that I lost my mother; I hope my son does not lose me before he is 18. I think of her quite often. My grandfather had two daughters.
Comment: On a further questioning, patient told the therapist she had two photos of her mother displayed in her house and that she was sexually active before the marriage.
Card 2.
Patient: Little boy with a big face, there is a smile on his face. There is a smile but no eyes. I cannot read the expression. I do not know if it is a smile or not or they are just stretching their lips.
Therapist: What does that make you think of?
Patient: A person not saying her true feelings, just smiling, a smile on her face. I am always smiling don’t let anyone know.
Therapist: Why did you get married?
Patient: He insisted. After a year I proposed, maybe it was the sexual thing, after a few years he wanted to get married. I made up my mind; no, I did not want a big wedding. I never had my parents. I got pregnant; he said we had to get married, as his uncle did not want another child out of wedlock. I was 35, I was single for a long time, I felt free. At the age of 18, my husband started having problems with his eyes. I accepted his condition, I am proud of what he had achieved. I feel it is too much, I feel if I do not help him he will leave me. I went into this relationship knowing his eyes were bad. He had a drinking problem. He wants another child.
Card 3.
Patient: Another face, long hair. Person is contented, could be a little bit (could not make out what the patient said) I don’t know why I said that. It dawned on me she is asking me a question, do you think she did the right thing I want to say yes, maybe I did not forgive XX (she mentioned her own name) for what she did.
At this point, the hour was over, and the patient was distressed. The session ended with the patient being relaxed.
Session 5
Conclusions drawn from session 4 were that the patient had some separation anxiety. There was guilt about her mother’s death and her refusal to kiss her goodbye on the day she died, and she had some unresolved conflicts about her premarital sexual activities. The author decided to use hypnosis to help her to work through these conflicts. Routine induction was done with systematic relaxation. Using age regression and visualization, the patient was able to ‘talk’ to the 10-year-old girl and reassure her that young girls react on impulse sometimes and that she could forgive the 10-year-old girl for what she did.
Session 6 and 7
During these sessions, hypnosis was used to complete the grief work and help her to resolve conflicts related to her mother’s death. Some ego strengthening was also done.
Session 8
Patient reported that she was feeling relaxed and had visited her mother’s grave and was able to complete her ritual of separation and felt proud of her achievement. She reported that she had applied for a promotion post and requested some assertiveness training to prepare her for the interview. She still had the fear of dying. Basic stress management techniques were discussed.
Session 9
She reported that she was able to make decisions with confidence and only spoke very briefly about her marital problems. She was concerned that her husband was very friendly with a colleague at his work. She promised to phone to confirm the next appointment. The patient defaulted and did not return to therapy.
The case demonstrates the usefulness of the SIS in identifying deep-seated conflicts which patient was unable to uncover through conventional therapy. The usefulness of the therapeutic tool of reframing is also demonstrated. The patient presented with marital problems but did not respond to conventional therapy aimed at the ‘problem’. The SIS helped to identify the underlying unresolved grief. Once this was dealt with and reframed, the patient was able to continue with her normal duties. Because the patient terminated therapy, no follow-up appointment was given. It is interesting to note that only three cards were used in this case. An unknown factor is that the author does not know whether any of the other cards would have uncovered some other conflicts. Because of the patient’s improvement, the matter was not pursued.
<Level B>Case 2
- P. was an 11-year-old boy who was referred to the author by his mother because he was not responding to previous treatment for an 11-year history of primary enuresis. He was extensively investigated medically and was exposed to various recognized treatments for enuresis. He did not respond to medication which he was on for six months. The parents had a discordant relationship when J. P. was about five years old, but they have a good relationship now. Mother was concerned because J. P. was wetting the bed every night.
Session 1
During the session, a routine history was taken and basic information about hypnosis,
the treatment of choice by the author, was explained to the parents.
Session 2
By means of a diagram, the author explained the basic working of the brain with reference to the controlling function it has. Hypnotic induction by means of systematic relaxation was done. While in trance suggestions of control by the brain were given with a post-hypnotic suggestion that whenever he is asleep, and his bladder is full he will wake up to go to the toilet. A two-week follow-up appointment was given. Mother phoned the author to report that J. P. had only wet the bed once during the week but had wet the bed over the weekend.
Session 3
This session was used to reinforce the suggestions given during the first session and a two-week follow-up appointment was given. Mother phoned after a week and a half to report that J. P. was back to wetting the bed daily. A fourth session was arranged.
Session 4
Because of J. P’s resistance to treatment, it was decided to administer the SIS-I cards to see if there was any underlying dynamics that was missed. The following are the responses to the cards:
Card 1: A sheep, a goat.
Card 2: Looks like a person who is smiling.
Card 3: Two people who are dancing or something.
Card 4: Looks like a person who is doing something.
Card 5: Looks like a star.
Card 6: Looks like birds.
Card 7: Heart.
Card 8: Looks like a skeleton of a person.
Card 9: Kidneys.
Card 10: Looks like a snail.
Card 11: Looks like a heart.
Card 12: Looks like a body or something.
Card 13: I don’t know, looks like a heart turned upside down.
Card 14: Looks like an eye.
Card 15: Spine.
Card 16: Eyes and nose.
Card 17: Looks like a fish swimming in the sea.
Card 18: Looks like a monster’s face.
Card 19: Looks like a cockroach’s head.
Card 20: Looks like a face.
He liked cards 20, 4 and 19 and did not like cards 5, 13 and 3.
The technique used by the author is to induce a light trance and to ask the patient to look at the cards and while in a relaxed state to say what it reminds them of. The following are the responses while the patient was in a trance. The responses to the cards he liked were as follows:
Card 4: A body moving, that is all.
Card 19: No response, the patient just looked at the card and did not respond to any probing question by the author.
Card 20: Looks like a monster.
The responses to the cards he did not like were as follows:
Card 3: He just looked at the card with no response.
Card 5: He just looked at the card with no response.
Card 13: He looked at the card and said nothing.
Therapist: Does it make you think of anything?
Patient: Someone playing around in the park. Person is happy.
Therapist: Why is the person happy?
Patient: Because he is with his friends.
Therapist: Is there anything else?
Patient: A person’s face, makes me frightened [silence].
Therapist: Why are you frightened?
Patient: Because I get scared … silence.
Therapist: Are you afraid of someone?
Patient: Yes.
Therapist: Who made you frightened?
Patient: I’m scared of the dark.
The patient could not recall any incident that could have precipitated his fear of the dark nor could he remember how old he was when he first became aware of this fear.
With the patient still in hypnosis, he was regressed to an earlier age. He identified the age as two years, he was alone and afraid. He did not know why he was afraid and there was no one who made him afraid. Using the reframing technique, the 11-year-old boy reassured the 2-year-old boy that it was normal for a young child to be afraid of the dark. The therapist had the 11-year-old boy ‘talk’ to the 2-year-old until he was sure that the 2-year-old boy was no longer afraid of the dark. The patient was relaxed and reassured. He was asked to open his eye and look at Card 13 a second time. The following is his response:
Patient: People are dancing.
Therapist: Why are they dancing?
Patient: They are feeling happy.
Therapist: What happened to make them so happy?
Patient: Someone got married.
Therapist: Is everyone happy?
Patient: Yes, no one is sad.
Therapist: Does the card make you feel unpleasant.
Patient: No.
Therapist: Does the card remind you of anything you are afraid of?
Patient: No.
The patient was given the suggestion of deep relaxation and a post-hypnotic suggestion that he was not afraid of the dark any longer. The patient’s fear of the dark was discussed with the parents and they agreed to place a night light in the room. Two weeks later, the mother phoned the therapist to report that J. P. had been dry up to then. One month after the termination, the patient was still dry.
<Level B>Case 3
Mrs. J. P. is a 52-year-old married woman with an 18 years history of anxiety and depression. Different general practitioners with various medicines with no symptomatic relief treated her. She has one daughter prior to her marriage and four children born within the marriage. Her husband and daughters have formed an alliance against the patient and she reports, ‘I feel very alone’. The symptoms she complained of were suggestive of a diagnosis of chronic free-floating anxiety.
At the age of 10, she started sleepwalking and from the age of 15 she was afraid of going to sleep at night. She married at the age of 25 and reports that she is still afraid to go to sleep at night and suffers from agoraphobia. She has a recurring nightmare of seeing her mother in a coffin and of her asking her mother to open her eyes, as she is not dead. Her mother died when patient was 42 years old. Patient has a pronounced stutter whenever she must speak in public. Because of the severity of the symptoms, the author decided to concentrate on symptomatic relief. The first three sessions were devoted to taking the history and to teaching the patient the technique of self-hypnosis, anxiety management and stress management. At the end of the third session, the patient reported no relief in the severity of the symptoms. The author decided to administer the SIS cards to identify any underlying conflict that the patient was unable to access.
Session 4
The following are her responses to the cards she identified as the most liked and those she did not like: she found Cards 2, 4 and 6 least disturbing and Cards 18, 19 and 20 most disturbing.
Card 2: This looks like someone very happy, a smiling person.
Card 4: This seems to be another kind of dancing, laughing figure to me.
Card 6: Looks like someone kissing, two shapes, there is a feeling one wants to get close to the other one.
Card 17: This is a spooky something, scary something with pinches.
Card 18: This is another scary thing, looks like a nasty animal ready to fight.
Card 19: Oh, mmmm looks like a bad face with a mask on, an evil face.
Card 20: Another … like a vicious dog wanting to pounce.
The exploration of the cards was done at the following session.
Session 5
The method used to explore the cards is to induce a light trance and to get the patient to open her eyes, focus on the cards and report what the card reminded her of. The author decided to start with the cards least liked by the patient.
Card 18
Patient: I see a coffin; my uncle is in the coffin.
Therapist: What else do you see?
Patient: I am 12 years old. They want me to touch him. I am afraid.
Comment: At this point, tears started to roll down her face. The reframing took the form of helping the patient to let the 52-year-old person comfort the 12-year-old girl, in her mind, by telling her that it was normal for a young child to be afraid to touch a dead body. The 52-year-old had to continue comforting the 12-year-old until she was sure that the 12-year-old was no longer afraid. When the patient indicated that the 12-year-old was no longer afraid the following card was shown.
Card 19
Patient: A man’s face, cruel [a long pause].
Therapist: Whose face, is it?
Patient: Vicky, my child’s father. I loved him so much and he left me. I could not say goodbye.
Therapist: Why could you not say goodbye to him?
Patient: He hurt us so much; the two of us [long pause].
Therapist: Why did he leave you?
Patient: I was too poor, he wanted lots of things. When I told him I was pregnant, he told me he could not marry me. He said he was going to marry (X) and that hurt me. He just left.
Comment: The patient was very distressed at this point and there was a long pause. The therapist has made the patient compose a letter in her mind to her ex-boyfriend. In the letter, she had to tell him how she felt when he left her to marry another person, she also had to say goodbye to him in her own way. When she had ‘written’ the letter, she had to visualize giving the letter to him and watch while he read it. When he had read the letter, she could if she wished say a verbal goodbye or she could just walk away. She did not share with the therapist what she did.
Card 20
Patient: (She started to cry loudly and uncontrollably) I am scared, a scary face, someone wants to bite me, I don’t know, someone wants to hit me. He looks black, big white eyes.
Therapist: How old are you now?
Patient: I am 4, I see a man [pause].
Therapist: What is the man doing?
Patient: He is taking me by the hand, going into the house, on the bed … taking off my panty … he is going to cut me. Not going to cut. He is patting me, on my private. He is saying it is all right. I am not afraid anymore. I get up, walking out of the door; I’m going home (patient is crying aloud freely now). I’m scared to go home. My mommy’s going to hit me. I’m outside; I’m not scared anymore. It’s OK. its ‘Mal Willie’ (Mad Willy). He’s putting me on the swing. I’m so scared of the swing, I am scared, and why is he pushing me so high. I jump off; I’m falling on the tar. My leg is bleeding. I’m scared. I’m so scared of the man he is so big. I’m going home. I’m at home. It’s OK. I’m not scared anymore. My mommy is there in the kitchen. I’m in the park, I see him again, Mal Willie (Mad Willie). I’m not alone; I’m not scared of him anymore.
Comment: The patient had settled down by now and became very quiet. The therapist reinforced the suggestion of deep relaxation and reframed the incident by helping the patient to visualize the 52-year-old adult comfort the 4-year-old child. She had to continue to talk to the young child in her mind and to reassure the child that it was normal for a 4-year-old child to be afraid of an adult who does things they are uncomfortable with. She had to further reassure the 4-year-old that there was nothing she could have done and that she was not to feel ashamed of what had happened. The patient had to continue talking to the young child in her mind until she was satisfied that the young child felt comforted. After a period of silence, the patient settled down. The session ended with the patient being relaxed and being given a post-hypnotic suggestion that she would remember only those things that were comfortable for her to remember.
Session 5 was held three months after session 4 because it was over the Christmas period. At this session, the patient no longer had free-floating anxiety. She did, however, complain of situational anxiety with relation to her husband. The patient terminated the therapy. She contacted the author again 18 months after terminating for a completely different problem.
These cases demonstrate the usefulness of the SIS in identifying deep-seated conflicts which patients are unable to uncover through conventional therapy. The usefulness of the therapeutic tool of reframing is also demonstrated. In Case 1, the patient presented with marital problems but did not respond to conventional therapy aimed at the ‘problem’. The SIS helped to identify the underlying unresolved grief. Once this was dealt with and reframed, the patient was able to continue with her normal duties. Because the patient terminated therapy, no follow-up appointment was given. It is interesting to note that only three cards were used in this case. An unknown factor is that the author does not know whether any of the other cards would have uncovered some other conflicts. Because of the patient’s improvement, the matter was not pursued.
In Case 2, the young man did not respond to both therapeutic and medical intervention. The SIS cards helped to identify the very basic problem of a fear of the dark. Once identified, it became obvious that this was a very logical question to ask. Everyone, including the author, was so concerned to treat the enuresis that no one thought of asking the patient if he was afraid of the dark. Once a night light was placed in his room and his fear of the dark was reframed, the enuresis stopped.
Case 3 is an example of the effects of childhood sexual abuse. Eighteen years of treatment did not bring symptomatic relief. With the use of the SIS, the underlying problem was identified, treated and reframed, with the desired symptomatic relief.
It could be argued that the problems would have eventually been identified but at considerable emotional cost to the patients. These case histories have demonstrated the usefulness of the SIS cards to identifying deep-seated conflicts.