The following is a compilation of assignments for our Diploma in Clinical Hypnotherapy, which have been kindly provided by some of our ex-students.
Suppression, Repression and Abreaction
Provided by Sanje Pande
The concepts of Suppression, Repression and Abreaction are fundamental to the general therapy setting. However, they have a particular relevance to Hypnotherapy given that they are each relevant to conscious and/or unconscious processes. A good theoretical and practical understanding of them is highly important to a hypnotherapist’s professional integrity, level of competence and skill.
Suppression and Repression
Suppression is the process whereby challenging thoughts, emotions and impulses are pushed to periphery of the Conscious Mind. In Repression, they are excluded much deeper – into the Unconscious Mind. Hypnotherapy alters the state of consciousness of a patient, so enabling cooperation and/or distraction of their Conscious Mind to allow access to suppressed material at the peripheral level, where it is normally ‘guarded’ by the Conscious Mind.
In addition, removal of this normal ‘modus operandi’ of the Conscious Mind by trance induction enables the therapist to gain access to a patient’s Unconscious Mind. Consequently, through appropriate interventions, and facilitating changes to new positive frames of reference/beliefs, they can be helped so that their presenting problems are made better, resolved or even healed.
The difference between the two processes is very relevant clinically. As suppression is at the conscious level, it can be managed more proactively including via non-trance methods e.g. Counselling, CBT etc. On the other hand, as Repression is unconscious, it manifests to the conscious level through unexpected symptom(s), or via reliving of traumatic memories (Abreaction – please see later).
With suppressed experiences patients can still review earlier life experiences with conscious awareness of other time frames (age revivification). Hence, for example, the patient can experience an early life event but at the same time also maintains awareness of an adult existence as well as the therapy situation. Whereas with repressed events, patients are actually reliving earlier (negative) experiences.
without conscious awareness of future realities beyond the time frame being experienced (age regression). Therefore the patient whilst experiencing this state may not have awareness of any future life. It’s like they experience amnesia for the time following the age they are currently experiencing.
Given that the source of repressed material arises from the unconscious level, hypnotherapy can be very useful in helping patients to gain positive insights and learning’s from it. In addition, it can engineer the cooperation of the Unconscious Mind to positively reframe meaning of repressed experiences.
As highlighted earlier, Abreactions are the reliving of traumatic earlier life experiences. Repressed material originating from the unconscious comes to the ‘surface’ for resolution. They can often be dramatic as the emotion of trauma is so severe that it has previously been blocked out through amnesia as a survival or defence mechanism by the patient. This may be particularly true in cases of Multiple Personality. Multiple Personality, often caused by abuse, is the experiencing of many sub-personalities caused by continual abuse followed by dissociation from the traumatic experience, so that the person/child creates amnesia of the experience. Then when abused next time follows the same pattern until a number of personalities exist, each with their own unique experience and personality. These personalities usually have no knowledge of each other at a conscious level.
Abreactions can occur spontaneously but sometimes can be provoked deliberately or inadvertently by the therapist. A therapist should be sufficiently experienced and skilled in the field before attempting to utilise this technique deliberately. Patients known or identified to have serious psychopathology and/or severe trauma should not be considered for a facilitated Abreaction. Patients for whom a deliberately regressed Abreaction is appropriate may need to have the process repeated a few times until almost no emotion is evoked by this regression. When an Abreaction occurs unexpectedly, it can be very unsettling for both the patient and therapist. Hence, the therapist should remain calm and detached from the experience whilst maintaining control of the situation, and provide support for the patient as they abreact.
Once an Abreaction occurs patients usually remember the event, although sometimes spontaneous amnesia can also happen. When patients abreact they release energy that was previously used to repress the difficult event, and this can also result in generation of new insights or information on the problem. This new release of energy and related insights can then be applied and directed into achieving positive outcomes to help resolve their problem. So at the end of an Abreaction the therapist should begin to consider various therapeutic techniques or interventions to help the patient. At this stage more than any other the patient feels most vulnerable, hence, the patient should not be sent home until the therapist can utilise the experience and reframe or resolve it in some way, so that the patient leaves with new helpful beliefs and/or insights.
Interventions and Techniques to Handle Abreactions
Different techniques and interventions can be applied to help a patient who is abreacting and these will be discussed in more detail below. However, one procedure which should be a matter of consistent standard practice is establishing a ‘safe-secure place’ and/or safety anchor(s). This should be done with all patients before each main hypnotic induction. The importance of this becomes especially important with patients who abreact. These safety measures can give both patient and therapist confidence that they have tools at their disposal should the patient at any time feel uncomfortable. Care has to be taken in communicating this message gently to patients so that they do not misinterpret it as an embedded command.
Usually traumatic memories e.g. Abreactions have a cast of characters. In the case of abuse it may be a single person. In other cases it may be a number of people e.g. childhood memory of being laughed at in school. The patient will often have intense negative feelings towards these characters, such as anger, hate, revenge etc. These negative feelings should be ‘Reframed’ to help heal the memory. For example, converting the hatred to forgiveness, or if this is not possible then help to at least change it to a less negative emotion e.g. dislike.
Dissociation methods are designed to purposefully help patients manage feelings. Hence, they can be very useful in assisting patients cope with very strong negative feelings.
that are generated by an Abreaction. The further the patient can be led to dissociate from the traumatic memory the more remote the negative feelings will become.
A very good technique to achieve dissociation is V/K Dissociation Pattern (Cinema Screen/Projection Booth). Hand-in-hand with this approach is assisting patients to modulate the Submodalities of a negative memory, thereby increasing the Dissociation and lessening its intensity. For example, by changing the memory from colour to black and white, or varying the focus from clear to fuzzy, altering the distance from close up to far way, lowering the sounds from loud to quieter etc. Once the above interventions have helped to neutralise the negative emotion of an Abreaction then, if appropriate, the memory can be ‘replaced’ by positive feelings using techniques such as a Swish Pattern.
As a note of caution, one technique that should not be used with patients who have abreacted is teaching them Self-Hypnosis. Some patients may be very willing and keen to help themselves but the last thing any therapist wants is for these patients to go home with tools that enable them to regress themselves back to another Abreaction! A better approach would be to prescribe a suitable Task(s) that are Metaphorical in nature, that can help the patient build on the progress and positive learning’s generated during the session with the therapist. For example, a task requiring the patient to clear out or tidy up their garage, or cluttered room.
Sigmund Freud wrote ‘What is essential to remember from early childhood has been retained in screen memories. The analyst’s task is one of knowing how to extract it’. Clearly important memories, whether they arise from childhood or later on in life, can carry with them a lot of emotion. As emotion is the rawest material a therapist has to work with, then whether such memories arise unexpectedly or deliberately from suppressed or repressed events, (including Abreactions) they can provide an opportunity for new positive insights and so helpful positive change for the patient. Simultaneously, for the therapist, they can offer challenges that need to be met with confidence, calmness and objectivity.