There are many conceptual models within traditional psychotherapeutic models which seek to understand the nature of Post Traumatic Stress Disorder (PTSD). These models are helpful in describing and categorizing the way in which the disorder presents itself in panic, dissociation, hallucinations and other phenomena, but they are not so helpful in providing resolution to deeply-held shock and terror which is usually at the root of the presenting symptoms.

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.

Copyright © 1998 to the author. Reprinted with kind permission