“Practising Safe Hypnosis – A Risk Management Guide” by Roger Hambleton, Crown House Publishing Ltd, pp209. Review by Anthony Jacquin.
Here is the blurb from the book jacket. “This unique book comprehensively explores the damage that can be caused by the misapplication of hypnotic techniques in therapy, laboratory and stage performance settings. The laws of assault and negligence are used to assess the hypnotist's criminal and personal injury liability in the English, American and Australian courts. Topics include civil and criminal assault; induction; informed consent; hypnotic coercion; pre-existing conditions; termination. The reader will find commentary on the history of hypnosis, induction scripts for use in conjunction with best practice, theoretical comparisons on the nature of hypnosis including the surrounding hypnosis as an altered state of consciousness”.
Introduction – the intro makes plain the problem facing many hypnotists – there is no single, book or other document that comprehensively covers the risks associated with hypnosis. I have found this to be true on many training courses too. Many do spend some time on how to deal with abreactions and how to avoid obvious professional compromises. However they do little to go beyond the basic code of ethics and best practice. The first part of the book helps by collating journal articles and book extracts concerned with hypnosis and the risks associated with it. Five distinct categories of risk are identified. The second part of the book addresses the laws of civil and criminal assault and the law of negligence, as they apply to both transient and serious psychological effects – injuries – caused by or arising from hypnotic procedures.
The author is an experienced lawyer. He also holds a degree in psychology and an advanced practitioner of clinical hypnotherapy diploma.
Chapter 1 – History and Theories of Hypnosis.
This chapter is a race through the history of hypnosis from the usual nod to the 'sleep temples' of ancient Greece and Egypt, through Mesmer and Braid, right up to an outline of the present key theories. The author leans toward what he calls 'The Suggestion Theory', which translates as a hypnotic state theory requiring an acceptance of particular ideas about the nature of the unconscious mind, depth and suggestibility. This is very much based on the ideas of Gibson and Heap. Between half and a whole page is then dedicated to each of the other theories; Pavlovian Theory; Psychoanalytical Theory; Dissociation Theory and the Social Psychological Theory.
He concludes with a quote from Waxman in Hartland's medical and Dental Hypnosis which in itself is testament to the bias toward trance based state theory.
'It would seem that our present knowledge of human behaviour is not yet sufficiently developed to produce a complete and satisfactory theory of hypnosis. In trying to define it accurately we are only describing an end result...In most trance states, suggestion, dissociation and conditioning all play a part to some extent'.
Chapter 2 – Induction of Hypnotic Trance
This chapter explains some methods of the induction of a hypnotic trance, how to deepen a trance and how a trance can be terminated. Susceptibility of the individual to hypnosis is examined as well as the symptoms of hypnosis at various levels of trance. Just a couple of health and safety tips are included here. The author suggests that if the subject has been recently drinking or taking drugs such as tranquillisers then they can in combination with hypnosis increase the potential for abreaction (a sudden and strong release of emotion). He also suggests avoiding any procedures that require the subjects natural rate of breathing to be altered if they have an adverse heart condition.
Chapter 3 – The Nature of Hypnosis
The author points out that in any criminal prosecution for assault and civil claim for damages on the grounds of assault and battery it must be stated with what the injuries were inflicted e.g. a knife. As hypnosis is an intangible instrument the nature of hypnosis has to be either authoritatively and consensually defined or its characteristics clearly described. When considering consent to hypnosis it is if course important to be able to explain the nature of hypnosis and this includes defining the risks. How else could the subject make a clear assessment before participation? Equally in a prosecution or claim alleging psychological injury, psychiatric evidence must be adduced as to the nature of the injury. Therefore the so-called expert witness must be able to define the characteristics of hypnosis as the instrument causing the injury. At the time of publishing in 2002 there was no reported criminal or civil case of assault where hypnosis is the alleged instrument occasioning injury. The author then looks at a variety of definitions and the conclusion is clear – there is no satisfactory definition. He quotes Scheflin and Shapiro from their book 'Trance on Trial' who set out a forensically based definition of hypnosis that begins with 'Hypnosis is an altered state of consciousness'. Given that there is no conclusive evidence for this 'state' and many experts who reject any state definition, defining hypnosis satisfactorily is at this time impossible. The next best thing is to define the nature of hypnosis in terms of its characteristics and the author asserts these are likely to be admissible as evidence of the presence of hypnosis in a court of law. The most common characteristics cited are; increased suggestibility; reality testing reduced; enhanced role play; ideosensory activities and post hypnotic behaviour. It can of course be argued that each of these characteristics can be elicited without any special state or hypnotic process too.
Chapter 4 – Risks – an overview.
This chapter enlightens the reader to what constitutes a psychological injury in terms of a charge of assault. Evidence of such an injury must be given by a properly qualified psychologist or psychiatrist. The injury must be sufficient to qualify as a constituent part of an assault. The simple answer regarding how to define what injury would be considered assault is to use the Diagnostic and Statistical Manual of Mental Disorders (4th Revision 1994) known as DSM – IV. In short the 'injury' in an 'illegal assault' can be described as an injury of psychological origin which is caused by hypnosis, contained within DSM-IV and is of neither a minor or temporary nature (e.g. headaches, dizziness, nausea). Risks relating to pre-existing conditions are given attention here too. The various categories of risks of hypnosis are listed these are; hypnosis per se; therapeutic use; failure to terminate; coercion and on stage.
Chapter 5 – Six case studies
This chapter is also revealing. It outlines a variety of cases and how the 'injury' would be qualified in light of the DSM-IV.
Chapter 6 - 9 – Dangers of Hypnosis – these four chapters dig deeper into the five categories of risk identified. They draw upon a wide variety of studies and complaints and make clear that there is a larger risk of complaint when hypnosis is used for therapy. This seems to be because the temporary 'episodic' nature of any effects is clearly communicated in research and on stage but not in therapy. The major danger is identified as the failure to 'de-hypnotise'.
Chapter 10 and 11 – Criminal and Civil Assault
This chapter clarifies what conditions must be present for something to be considered criminal or civil assault. There are three 1) a harmful act (actus rea), 2) an accompanying mental element (mens rea) and the absence of a valid defence. The author focuses on the first two of these, the third element speaking for itself. The definitions of terms like 'intention', 'recklessness' and 'negligence' with regard to mens rea are enlightening. Failure to terminate hypnosis for example could qualify both as a harmful act with a mental element – recklessness.
Chapter 12 and 13 – Consent and Negligence
These chapters make clear what qualifies as consent and what could qualify as negligence.
Chapter 14 and 15 – Australian and American Law
Special considerations with regard to Australian and US law are outlined here.
Chapter 16 – Key conclusions for good practice
The key findings of the authors research are outlined succinctly in two pages. Terminate hypnosis being the key recommendation.
This book does a unique and excellent job of describing the risks associated with hypnosis. It clarifies what the potential problems are, as well as the relevant sections of law that many people will not be familiar with. The author achieves this in such a way that this book remains an interesting read that is easy to understand. It makes clear that agreement on a definition of hypnosis is not necessary for legal action to proceed, as it can do so on the basis of the characteristics of hypnosis. From a cognitive behavioural perspective I believe these characteristics could also be questioned as to whether they are core to hypnosis, they are certainly not unique to hypnosis. Overall for hypnotists this book should set their mind at rest to some degree. The potential risks can mostly be taken care of with good practice. I would have liked the book to be more balanced with the arguments set out reflected upon from a Cognitive Behavioural perspective as well as the state model, especially the requirement for trance termination. I think there is also room within the book to cover some of the potential for negligence with reference to stage management but understand that may fall outside of the scope of the book and authors knowledge. This should be on the reading list of all hypnotists whether hobbyist, performer, therapist or researcher.