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60
ERIC
P.
SIMON AND MONIQUE M. CANONICO
CASE
XAMPLE
Medical History
"Mary" was a 61-year-oldAsian American being treated for hypo-
thyroidism and hypertension.Over a
2-
to4-month period, sheexhibited
a marked decline in cognitive functioning and energy level. Magnetic
resonance studies indicated focal anomalies and the presence of small-
vessel white-matter ischemic changes in both hemispheres and
in
the
pons. Results fromher neuropsychological examinationwere consistent
with a dementing process. Her
attention/concentration,
immediateand
delayed memory, and visuospatial functioning were all severely
impaired. Her intellectual functioning was determined to be signifi-
cantly lower than her premorbid estimate. Therewere no noted difficul-
ties, however, with motor functioning and comprehension of speech.
Because of her rapid and severe cognitive decline, Mary's neurologist
elected to conduct an
LP
to rule out tertiary syphilis and
to
assess for
alleles of Alzheimer's dementia.
Preprocedure Assessment, Hypnotic Rehearsal, and Preparation for
LP
Mary was referred for hypnosis to help her with this procedure,
because she suffered from a needle phobia. A few days prior to the
LP,
she
met with the first author for an appointment, duringwhich time she
was given a hypnotic assessment.As expected, given Mary's severely
impaired attention/concentration abilities, extensive time and effort
were required forher to experiencehypnosis. An eye-closureinduction,
which typically takes approximately
5
minutes to achieve, tooknearly 15
minutes. Because we anticipated her difficulties with sustaining atten-
tion, we speculated that it might be best to restrict all of the suggestions
during this part of the procedure to one sensorymodality.Given this, all
of the suggestionswere targeted to her spot of focusand the changes she
was experiencing
in
her visual field. Because of her attentional difficul-
ties, however,Mary repeatedly turned her attention away fromher spot
of focus on the ceiling and directed her focus to lookingat the therapist.
The therapist found it helpful to continuallyredirect her attention to the
spot on the ceiling,both with verbal directions(e.g.,
"
...
and you canjust
focus right back on that spot on the ceiling.
..
that spot that you've cho-
sen..
.
for your very own.
..
to draw all
of
your attention and concentra-
tion on .
.
,
and you can continue..
.
to just watch that spot very care-
fully") and, most important,
nonverbal head movements
in the directionof
the ceiling.
Once in hypnosis, however, Mary did very well with the help of
con-
tinual direction and redirection
and
minimal extended pauses.
Following
Eliseo's (1974) recommendation that it is best not to be
too
concerned
about depth of hypnosis with confused patients, a formal measure of
hypnotic susceptibility was not employed. However, it was observed
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