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CLINICAL
FORUM
59
characteristics of the situation and the heightened motivation and
expectancy” (p. 268).
THE
LITERATURE
ON
HYPNOSIS
AND
THE
COGNITIVELY
IMPAIRED
Although there is no extant research on hypnosis with dementia
patients, a few studies document the use of hypnosis with patients who
are otherwise cognitively compromised. Schizophrenics, for instance,
tend to yield hypnotizability scores similar to that of “normals” (Kramer
&
Brennan, 1964).BothBiddle (1967)and Bowers (1961)have shown that
hypnosis can be successfully used with psychotic/schizophrenic
patients to control specific behaviors. Furthermore, Rosen (1960)
sug-
gested that hypnosis could be used with psychotic individuals, pro-
vided that the clinicianwas very experienced with such a population.
Perhaps closer to the topic of our case, Crasilneck and Hall (1970)
have used hypnosis in the rehabilitation of neurologically impaired
patients who had difficulty communicating. These authors proposed
that it was necessary to speak very slowly, give very simple instructions,
and repeat the instructions authoritatively. Finally, Eliseo (1974)offered
three case examples of hypnosis in the treatment of organic brain syn-
drome with psychosis. Although none of these cases were of dementia,
the patients nonetheless exhibited disorientation and general confusion.
From these cases, Eliseo distilled what he believes were the three most
important factors for success: (a) a positive interpersonal relationship
with the therapist,
(b)
therapist attitude, and (c) modest therapeutic
goals.Once a positive relationship was established, these authors, along
with Crasilneck and Hall (1970),found that the patient responded best to
a high degree of direction when confused. In terms of therapist attitude,
Eliseo (1974) advised that the therapist be comfortable and convey an
attitude of confidence.
In
this regard, Eliseofurther advised the therapist
to show a lack of concern with the depth of hypnosis, conveying the
notion that if the patient could experiencehypnosis even in a mild form,
it would be beneficial to the patient. Finally, Eliseo suggested that thera-
peutic goals should be limited, for instance, targeting better orientation,
less confusion, and modest pain relief for the confused organic psychotic
patients, rather than attempting personality restructuring.
Extrapoiatingfrom thepediatric,needle-phobia, and cognitive impair-
ment literatures,
it
seems possible that hypnosis might be helpful in alle-
viating the common experience of pain
and
anxiety associated with
LPs.
This might be best accomplished generally by reducing sympathetic
arousal and, more specifically,by giving patients suggestions to reinter-
pret their sensory experience and encouraging a process of dis-
sociation. Drawing upon the limited research base outlined above, we
describe
an
attempt to use hypnosis to alleviate
LP
procedural distress in
the following needle-phobic dementia patient.
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