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Hypnosis for Multiple Personality

Disorder: A Framework for
Beginning
a
Richard Horevitz Ph.D.
a
Associated Mental Health Services , Chicago, Illinois, USA
Published online: 22 Sep 2011.

To cite this article: Richard Horevitz Ph.D. (1983) Hypnosis for Multiple Personality Disorder:
A Framework for Beginning, American Journal of Clinical Hypnosis, 26:2, 138-145, DOI:
10.1080/00029157.1983.10404153

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 AMERICANJOURNAL OF C L I N I C A L HYPNOS~S
Volume 26, Number 2, October 1983

Hypnosis for Multiple Personality

Disorder: A Framework for Beginning

RICHARD HOREVITZ, Ph.D.

Associated Mental Health Services
Chicago, Illinois
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Increasing clinical attention, new research data, media and professional exposure
to multiple personality disorder (MPD) make it likely that an increasing number of
clinicians will make positive diagnoses. Controversy about the diagnosis persists,
and the relationship of hypnosis to the formation of the disorder and to its treat-
ment continues to be a major issue. All of this is likely to confound the otherwise
experienced clinician who is new to the treatment of MPD. This paper explores
the issues in the literature as they relate to beginning treatment and the uses of
hypnosis. It develops a framework for understanding the relationship between
hypnotic interventions and treatment as it is likely to occur for someone unfamil-
iar with the course of treatment in MPD. Special attention is paid to the range of
variation in individuals with MPD.

The diagnosis of multiple personality dis- demoralizing and defeating a t worst. In

order, once rare, is now being made with
increased frequency. In the last ten years,
Multiple Personality Disorder has had wide
e x p o s u r e in both print a n d electronic
media, as well as in clinical literature.
With this vast increase in clinical litera-
ture it is to be expected that an increasing
number of clinicians will begin to look for
and be able to detect the subtle signs in the
history and self-presentation of multiples
that lead to an accurate diagnosis.
The treatment of multiple personality is
difficult a t best. As other authors have
made clear (e.g., Kluft, this volume; Wat-
kins & Watkins, 1984), the course of treat-
ment can range from arduous to dangerous,
For reprints, write the author at Associated
Mental Health Services, 180 North Michigan
Avenue, Chicago, IL 60601.
I38
order to aid the “first-timer,’’ there is a
need to clarify several of the issues raised
in the literature, as well as a guide through
the difficulties likely to be encountered dur-
ing the early treatment stages.
Hypnosis is both a crucial tool and cen-
tral issue in the treatment of MPD. Its use,
non-use, timing, safeguards, range of ap-
plications, cautionary notes, special rules
and emergency procedures, are carefully
considered in this volume and elsewhere
(e.g., Braun, 1981; Kluft, 1982; Gruene-
wald, 1971, 1977). All of these considera-
tions and warnings are liable to leave the
beginner somewhat bewildered. In this pa-
per I will address this problem for the
“first-timer’’ who is also an experienced
clinician and hypnotherapist. No guide is as
valuable as an experienced supervisor, and
supervision is recommended for the begin-
ner whenever possible.
 HYPNOSIS FOR MULTIPLE PERSONALITY DISORDER
ISSUES
1 . Do multiple personalities really exist
or are we dealing with an exotic hysterical
phenomenon intensified by the role de-
mands of psychotherapy and especially
heightened by the use of hypnosis?
Under 100 cases of multiple personality
disorder were reported in the literature
from 1815 to 1972, with the vast bulk of
them occuring in the early 19th century
(Taylor & Martin, 1944; Ludwig, e t . al.,
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1972; Rosenbaum, 1980). The sparcity of
cases is somewhat misleading. By the time
Sybil was published, Wilbur had already
treated six multiple personalities (Schrei-
ber, 1973). Recent estimates of multiples in
treatment exceed 800, with Kluft and Bliss
each having treated over 100 (Kluft, 1982;
Bliss, 1983) and Braun (1983) having di-
agnosed 70.
The doubts about the validity of multiple
personality stem from its association with
hypnosis. Prince (1905) concluded that the
induced dissociation of hypnosis was suf-
ficient to account for a hysterical produc-
tion of an alter personality. The demand
characteristics of hypnosis under which
such productions could occur are well
documented (Orne, 1959, 1966; Shevrin,
1979). There is little doubt that while in
trance, responsive subjects can create sub-
jectively compelling, fictional persona with
biographies. They can be elicited by both
direct and indirect suggestion. However, in
the history of almost all multiple personali-
ties there is documented evidence of dis-
sociative states and the appearance of al-
ters prior to any encounters with hypnosis,
with many splits occurring before the age of
five (cf. Braun, 1983).
Harriman (1942, 1943), Leavitt (1947)
and Kampman (1976) claimed to have cre-
ated multiple personalities, or the phe-
nomenon of multiplicity, through the use of
hypnosis. Braun (1980 (b), 1983) and Kluft
(1982) have argued that these experimental
productions lack the characteristics of
I39
“true” alter personalities as they appear
clinically. While some suspicion remains
among experienced investigators, there is
no longer any doubt of the reality of MPD.
These studies indicate that the hypnotic
process can have a profound effect on indi-
viduals susceptible to “alter personality”
suggestions including genuine multiple per-
sonalities.
2. What is the relationship between hyp-
nosis and multiple personality disorder?
The belief that multiplicity is an artifact
of hypnosis in the highly suggestible, hys-
terical personality belongs within a long
tradition of theorizing about the rela-
tionship of hypnosis and psychopathology.
Despite changing fads and fancies of
theory, some strong link between multiplic-
ity and hypnosis appears to exist. Multiple
personalities are excellent hypnotic sub-
jects (Sutcliff & Jones, 1962; Brandsma &
Ludwig, 1974; Bowers & Brecher, 1955;
Braun, 1981, 1983; Bliss, 1983).
Braun (1980, 1982) and Bliss (1980, 1984)
have independently suggested that the
mechanisms of self-hypnosis a r e the
mechanisms by which the switching proc-
ess in multiple personality occurs. How
self-hypnotic processes or the self-hypnotic
state is related to the actual production of
alter personalities is a quite complex prob-
lem.
Such a connection poses practical clini-
cal problems. Gruenewald (1971, 1977) has
repeatedly expressed caution about the use
of hypnosis because it facilitates the de-
velopment of splitting (dissociative)
processes. If the cognitive processes in-
volved in switching and splitting are for-
mally related to those of (self)hypnosis,
potential dangers do lurk in the use of hyp-
nosis. Mistakes in the therapy that occur
during hypnosis can ( 1 ) activate the spfit-
ring processes leading to the formation of
new personalities, o r (2) activate the
switching processes leading to the emer-
gence of personalities who react to the
 140
“mistakes” of the therapist (and cooperat-
ing personalities) with negative, aggressive
or even violent acting-out to regain “con-
trol.” Even with the greatest of caution it is
not clear that such events can be avoided
altogether.
3. What is the relationship of hypnosis to
the treatment of multiple personality dis-
order?
The usefulness of hypnosis to the treat-
ment of multiple personality disorder has
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been a repeated theme in the literature. Re-
ports of its specific uses, successes and
limitations are frequent (Bowers, et al.,
1971; Allison, 1974; Howland, 1975; Mor-
ton & Toma, 1964; Bowers & Brecher,
1955; Braun, 1981; Kluft, 1982; Winer,
1978; Brende & Rinsley, 1981; Brende,
1983). Despite this, the actual utilization of
hypnosis in treatment can become an ex-
tremely difficult issue.
Experts, with the working knowledge de-
rived from a large number of cases, have
skills in approaching difficult and complex
subjects which are not available to begin-
ners. Thus when Kluft (1982) argues that
resistance to hypnosis can be handled by a
firm, repeated, but not overbearing insist-
ence, the beginner does well to recognize
that the “insistence” of someone who has
treated over 130 cases of multiple personal-
ity disorder is different than the beginners’.
For the beginner, it is a s important to
understand the range of variability among
multiple personalities as it is to understand
the commonalities. If only general expecta-
tions are considered, demoralization rapid-
ly sets in. To this end I will present two
cases of multiple personality to illustrate
the variance in relations to hypnosis.
CASEILLUSTRATIONS
The first case is that of a multiple person-
ality who readily involved herself in hypno-
sis, found it a useful tool and rarely was
threatened by t h e rapid switching it
HOREVITZ
allowed. She was a very fragmented per-
son, with several overtly suicidal and homi-
cidal personalities. She had frequent epi-
sodes of “blank” periods, where other per-
sonalities that were criminals or prostitutes
took over. She had little internal control
and already by the age of 19 was the mother
of a 3-year-old child who was exhibiting
early signs of splitting. She had frequent
emergencies with the ever-present possibil-
ity of acting out dangerously.
A number of personalities expressed a
great deal of curiosity in their multiplicity.
She had three “internal self helpers,” i.e.,
personalities that functioned as guardians
and therapeutic allies. The possibilities of
the use of hypnosis and self-hypnosis
appealed to them. Its introduction was in-
formal and early in treatment. I asked the
presenting personality if she had a way to
contact other personalities directly to enlist
their aid or to obtain their feelings and opin-
ions. She said she didn’t, but would like to
be able to do so. I explained that it was
quite simple and that she’d intuitively
understand the process. I asked her to let
her eyes roll up, let her lids close slowly,
then relax her eyes and let herself float in-
ward. When she did so, I suggested that she
could call inwardly to the personality she
wanted to contact. This worked easily and
was accepted readily. From that point on, a
working rapport with hypnosis was estab-
lished .
A second case was very different. This
woman, in her forties, did not readily
accept the use of hypnosis. “Firm but gen-
tle” insistence required over 20 months of
working through her resistance and objec-
tions to the use of hypnosis. In most other
regards she was an active and collaborative
patient. She readily engaged in a “non-
suicide” contract between all the personali-
ties and never presented an emergency
situation. Although she had crises of a fre-
quency common to treatment, they con-
sisted of anxiety surrounding work, social
 HYPNOSIS FOR MULTIPLE PERSONALITY DISORDER
or family situations or to the persistent feel-
ings of fatigue and depression that she ex-
perienced.
Her explicit reasons for refusing were
based on religious grounds and personal
history. However, with extensive analysis,
it appeared these were “cover” issues. The
roots of the resistance much deeper.
Many issues were involved in the resis-
tance. Interpersonal trust was perhaps the
most important. Trust is always a critical
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issue in multiple personality disorder. It is
present throughout treatment, appearing at
all times of crises, both in and out of ther-
apy. While trust from some personalities is
quite easily won, when the individual as a
whole is considered in terms of cumulative
behavior and response, trust is extremely
difJicult to earn. It remains fragile and
tentative until late in treatment. It may be
that it is never resolved until the final in-
tegrations have occurred and therapy is in
the “post-multiplicity” stage.
Sooner or later in treatment, the therapist
faces the unpleasant reality of the trust
issue. Multiples need to force the issue, fre-
quently employing destructive double-
binds, such as the one here: Permitting hyp-
nosis requires trust that nothing “bad” will
happen, but trust cannot exist if there’s no
prior experience; therefore, hypnosis is not
to be permitted.
Hypnosis was defined as important to
treatment and therefore had come to have
inter-personal importance. Eventually a
teenage personality agreed to try a test of
hypnosis by engaging in a guided fantasy. I
developed a benign fantasy of a walk
around a lake. On concluding, I was verbal-
ly attacked by this particular personality’s
“double.”* I was reviled for being incom-
* A complex problem in multiples with many
personalities is the existence of internal “double” per-
sonalities, personality composites and personality
fragments. This also suggests that individual personali-
ties can be in trance without the whole person being in
trance.
141
petent in the laborious detail of the fantasy
and for taking advantage of a compliant
person who would do just about anything to
please me. The personality who had been in
trance came to believe that something
“nasty” had occurred while she was in
trance.
Further use of hypnosis was refused for
months. Therapy proceeded without it.
One day, the “part” personality who
reacted so strongly to the guided fantasy,
suggested simply that she could go into
trance merely by my requesting her to do
so. Trance was requested and she re-
sponded immediately, revealing important
information leading to a working dialogue
between conflicting personalities.
UTILIZATION
OF HYPNOSIS
Interpersonal and Therapeutic Issues.
1. Hypnosis increases rapport. This is
important in the initial phase of treatment
when the therapeutic alliance building is
critical. Hypnosis can facilitate that
alliance when it is offered as a tool helpful
to the patient rather than as helpful to the
“treatment.” Case I demonstrated this use
of hypnosis. When offered as crucial to
treatment, it activates control issues as well
as trust issues. As in Case 11, because these
issues were heightened, the use of hypnosis
became a proof of the alliance, rather than
its facilitator.
2. Hypnosis can be offered initially as a
cognitive skill (Diamond, 1980) which the
patient can use for his own benefit. Hypno-
sis is presented as the outcome of the use of
the patient’s own talents and skills, not as
an interpersonal manipulation. Hypnosis is
practiced with the patient learning anxiety
management, relaxation, symptom relief,
self-control and mastery.
3. Other than for diagnostic clarification,
I recommend postponing investigative, re-
gressive and abreactive uses of hypnosis
until later in treatment. Hypnosis should be
 142 HOREVITZ

used sparingly for these purposes. If an 3. Ego strengthening of individual

objective can be achieved in these areas
without hypnosis it is, on the whole, better. treatment is integration of personalities. It
In general, hypnosis should be used in ways
that are implicity integrative and avoided
where possible when they are regressive,
abreactive and confrontational.
HYPNOSIS FOR INDIVIDUAL PERSONALITIES
1. A perplexing difficulty for the novice
is accepting that no personality truly speaks
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personalities is important while the goal in
takes a good deal of ego strength and hope-
fulness for a multiple to undergo integra-
tion. Many fears are attendant with this
process so that each personality involved in
an integration needs to be at its “best.”
Also since each personality has a function,
the better it functions, the better the whole
system functions. This is therapeutically

supportive. Failure in life and its pursuits

for all. It is crucial to remember that
reinforces the multiplicity and hopeless de-
hypnotic interventions described earlier are
spair that facilitates additional splitting.
generally directed to individual personali-
ties and their needs. From this perspective
HYPNOSIS FOR THE SYSTEM
the rules and use of hypnosis are the same
as in any individual therapy. A danger lurks 1. Multiple personalities are not a collec-
in mistaking the needs of a given personal- tion of personalities of varying characteris-
ity for those of the person. Because of the tics. They are persons whose conscious-
special nature of multiplicity, intense con- ness and experience are organized into a
flicts tend to be between personalities, not coherent system of individual personalities
in personalities, thus progress for one can that has regular rules and an organized
be a threat to another. There is no basis in hierarchy (Braun & Braun, 1978; Braun &
the beginning for assuming that progress Horevitz, in preparation).
will be generalized through the system. Therapeutic and hypnotherapeutic in-
2. It is important to remember that multi- terventions are best organized in a strategy
ples are “natural” at hypnosis. They in- that aims at caring for individual needs
tuitively understand the process of hypno- while recognizing the reality of the “sys-
sis even when they are unfamiliar with the tem,” its vital homeostatic and protective
techniques. More than the usual highly function as well as the underlying chaos,
hypnotizable subject, they have not only conflict and confusion that its apparently
the talent, but usually have considerable well ordered structure masks.
skill. That does not mean that sometimes Since multiplicity is a system, hypnosis
they are not terrified by trance states. They can be utilized in the same ways it is in
can be. In this case it is quite similar to group and family therapy. Braun (1980(a))
working with any highly hypnotizable, anx- outlines a number of functions ranging from
ious and readily dissociable individual. simple relaxation that improves the inter-
Hypnosis is taught slowly and continuous personal atmosphere, to shared experience,
feedback is sought in order to help them deepened capacity for listening, and work-
develop both the familiarity and skills ing through in fantasy. The natural rapport
necessary to cope with altered states of of hypnosis is utilized to establish increased
consciousness. Because they are “natu- feelings of closeness and empathy.
rals,” however, trance induction probably Internal communication is rather poor in
ought not be very complex or formal. multiples while conflict, distortion and de-
Twenty minute relaxation protocols are not ception are high. Hypnosis helps reduce the
necessary and often are more confusing latter while at the same time increasing the
than helpful. sense that the personalities are all in this
 HYPNOSIS FOR MULTIPLE PERSONALITY DISORDER I43

together, that they are inexorably linked. quire exploration. Resistance may indicate:
This is a major point because many person- (1) a need to protect the system as a whole;
alities will deny any connection with others (2) the fear of losing control either to other
or their concerns. They deny they share the personalities that are feared; (3) the fear of
same body. Indirect and unconscious sup- the switching itself, which may be loaded
port for their mutual connection and shared with anxiety; (4) a fear of exposure of the
“fate” has positive therapeutic effect. involvement with the therapist; ( 5 ) fear of
2. Hypnosis is used to help stabilize the violation of long held secrets; or (6) the fear
system by helping individual personalities of the immense loss that getting well repre-
regain control of the “body” from danger- sents. All of these need to be dealt with and
ous and destructive personalities. Hypnotic understood.
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and post-hypnotic cues are utilized along

with suggestions that the presenting COUNTERTRANSFERENCE
personality can and will resume control any
time these cues are utilized. These can and Countertransference in the treatment of
will resume control any time these cues are MPD also requires a full length treatment.
utilized. These can include trance induction Let me only remark here that since the
cues, what Caul (1979) refers to as “key heightened rapport of hypnosis is mutual;
words,” that immobilize the patient in unique, emotionally charged relationships
dangerous or emergency situations. These between therapist and individual personali-
tools are important to teach early on. They ties develop. Multiples are adept at inter-
require extensive practice until mastery is personal manipulation and deft at sensing
gained and the use of cues reliably elicits a and exploiting the heightened feelings hyp-
deep trance. nosis can provide.
3. Hypnotic techniques are indispen-
sable in the integration of personalities. This CONCLUSION
topic requires in-depth treatment in itself.
Hypnosis is utilized to provide both a In this paper I argued that hypnosis is
indeed an important and indispensable tool
cognitive/emotional analogue of the original
in the treatment of Multiple Personality
splitting state and to provide the
“rationale” and background for the par- Disorder. The therapist’s actual ability to
ticular integration being aimed for. In order utilize hypnosis with
a person suffering
from MPD may not be easy to come by. It
for an integration to represent therapeutic
may be that the fundamental cognitive
progress, it must be “natural,” the person-
mechanisms involved in the production of
alities involved must be prepared for the
event their individual crises worked out. multiplicity may be in common between all
multiplies; nonetheless, as individual pa-
Frequently, the hypnotic state is used to
tients they are more unalike than alike. This
resolve the grieving process that integra-
tions produce. includes their willingness to be involved in
the heightened processes at the core of
Integrations alter the structure of the sys-
hypnotic communication.
tem and can yield unpredictable results.
The refusal to engage in hypnosis may be
Hypnosis can be used for working through
a basic protective mechanism of the multi-
the changes brought about by the integra-
plicity, rather than the individual (resist-
tion.
ance).
RESISTANCE
How is the novice to know? There is no
Resistance to hypnosis is common and specific answer. There are some general
has several possible meanings. These re- rules. In the beginning, trust and rapport
 144
are critical; techniques less relevant. The
development of trust requires the thera-
pist’s respect of the individuality of each
personality as well as demonstrating an
understanding of what is occurring in multi-
plicity. It also requires the therapist to sur-
vive frequent manipulations and attempts
to distort reality by making it appear much
better than it is. Most importantly, because
the therapy is so intense, the patient’s his-
tory so egregious and need so extraordin-
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ary, the therapist must avoid the temptation
to “try anything” to cure his or her patient.
The lives of multiples have been filled with
people violating normative rules for uncer-
tain ends.
Hypnosis with multiple personalities can
be unpredictable. Another aspect of trust is
the patient’s developing belief that you can
be effective in dealing with whatever might
develop and provide the necessary protec-
tive safeguards. These include everything
from “inner” preparation to meet angry,
hostile and occasionally dangerous person-
alities, to the preparation of hypnotic cues
to get helpful personalities back in control.
The early steps involved in treatment in-
clude: (1) suspecting the diagnosis; (2) con-
firming the diagnosis; (3) gaining the pa-
tient’s acceptance of the diagnosis; (4) gain-
ing access to known personalities and dis-
covering others; (5) facilitating the switch-
ing process; (6) obtaining a description of
the system; (7) facilitating co-
consciousness, and (8) beginning to use
hypnosis for investigative purposes (cf.
Braun, 1980(b)). Hypnosis can be of use in
all of these stages.
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