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From the "mesmeric rapport"
to the therapeutic alliance
(Du Rapport Magnétique à l'Alliance Thérapeutique)

PARIS, November, 28 & 29, 2008, Colloque International Francophone

[French Version]

"Rapport magnétique" was the expression used by Franz Anton Mesmer (1734-1815) to describe the relationship of dependence which takes place and develops in the therapeutic process between a magnetizer and his or her patient. The idea was further developed by Amand-Marie-Jacques de Chastenet, Marquis de Puységur (1751-1825), as he explained the possibility of placing two somnambulists in such a rapport by an intermediary willingly involved (Process of electivity). Puységur described the manner of producing the "rapport magnetic": magnetizer and patient had to connect their magnetic fluid in order to establish a "circulation", which was then managed actively through the will of the operator. The operator can then move the patient's body pretty well as he can move his own, simply by willing the result he desires. The patient was now in a state of somnambulism, even in a profound trance: this meant that it was then possible to set up the rapport. The therapist had to express by his intentional involvement an intense display of his command while he placed one or two hands over the patient's head or epigastria. The rapport could at that time be continued even without contact, and also be transferred to another operator. "Croyez et veuillez" (Believe and want) were the two key words emphasized by Puységur. He also noted that the magnetized person was only susceptible to his voice, or to another voice to whom his command had been transferred.

After 1850 in France, there was a passing from "animal magnetism" to hypnosis, mostly under the influence of the famous Abbé José-Custodio de Faria (1756 - 1819) and one of his very close friends, the physicist Alexandre Bertrand (1789 - 1831). Faria created the term lucid sleep to replace magnetic somnambulism. Bertrand documented how Faria proceeded: he placed the person who wished to be influenced in an armchair, and urged him to close his eyes and meditate; then, suddenly, he uttered in a strong and commanding voice the word "sleep". It produced a slight jolt of the whole body, warmth, perspiration, and sometimes somnambulism. If the first attempt did not succeed, Faria submitted the patient to a second, and then a third and even a fourth, after which if the desired results were not met, he declared him incapable of entering into lucid sleep.
In England, James Braid (1795-1860), in the United States, La Roy Sunderland (1804 - 1885), W.B. Fahnestock and J.K. Mitchell (1798 -1858), were all interested in magnetism but finally rejected it for other explanations.

But it was not until Pierre Janet (1859-1947) established the concept of "psychological deconstruction" (désagrégation psychologique) that the hypnotic relation acquired its true theoretical status. The emergence of a "secondary personality" very precisely calls to mind the state of somnambulism and the elective exchange which followed, which was specific to the well known "rapport". The two personalities, first and second coexisted, while for some researchers they succeeded one another in a somnambulist state.

Today it is known by our clinical experience that dissociation is a progressive phenomenon: from a slight dissociation, as for instance when we are distracted, to an extremely profound dissociation, seen in cults of possession of the soul or mystic states for example. These dissociative processes should be studied because they approach, even blend into certain forms of psychotic cleavage, which we know are accompanied by intense transference and opening onto the fantastic.

The hypnotic rapport is thus clearly the establishing of an elective rapport between the being of the dissociated person and another, who is either dissociated or not, while the primary state of the protagonists is ever ready to surface… It's only placed into a secondary position.

The parallel between the hypnotic rapport with the Freudian transference has led some researchers to think that "hypnosis is just a transference", simply because of the Freudian hypothesis of the submissiveness from the patient who finds himself in a childlike attitude.
The relationship of the hypnotic rapport to transference according to Freud has made it possible to say that "hypnosis is nothing more than a transference", by the simple fact that the Freudian hypothesis of passage by submission, when analysis leads to a finding of the infant state . However, the hypnotic rapport, as well as a trance, can not be accommodated to the theory of an unconscious limited to submission, as was Freud's belief. Theories of dissociation (The hypnotic state of Breuer, the work of Hilgard, the clinical studies of Milton Erickson, including recent studies in neurophysiology…) stifle and render limited the Freudian unconscious to a very small part of an unconscious which is infinitely greater than the Freudian view of the unconscious. It cautions against critics who, according to Morton Prince , formulate in a Freudian sense: a theory of dissociation that has to explain every case of dissociation, including those not only due to repression.
Erickson and Jung have in common the idea of an unconscious which is much greater: a reservoir of resources, a source of restructuring for some, opening for others to the collective unconscious. The common dissociation in all its form of trance allows a mode of specific communication which characterizes the therapeutic work of these great masters: the art of putting into relation… a magnetic rapport to a therapeutic alliance.
The therapeutic alliance is defined as therapist/patient links which is created in a spirit of collaboration where the protagonists well understand their respective tasks, and consider these tasks as both important and pertinent. The objectives of the therapy are clear, well understood and agreed upon by the two parties. An affective link is based on truth, involvement, acceptation, as well as a great empathy on the part of the therapist linking the two of them. , ,
Much research has been done since the work of such precursors as Luborsky and Co., from Pennsylvania University (Pennsylvania helping alliance) or Marziali, Marmar and Krupnick, from Menninger Foundation. They defined in this framework a research project for psychotherapies, based on the therapeutic alliance not only as a prerequisite for the therapeutic work, but also as a principal direction of a general change of outline . According to a vast synthesis of research published in 2003 , the role of the patient would be determinant in so far as what constitutes a good therapeutic alliance. In effect, involvement and determination would play for about 40% in the chances of the therapy's success. It seems that the most important aspect of involvement of patient (a notion which includes both commitment and action) is a sincere intention to collaborate in the therapeutic process. Good will, agreed upon efforts, and the initial openness of the spirit of the patient would be determinant. Studies have in fact shown a strong correlation between initial agreement of the patient and the short and long term success of the therapy. It has also been noted that trust and esprit of collaboration shown by the therapist can have a positive influence on the involvement of the patient. Finally of note is a study published by Harvard Medical School which states that the patient should be motivated and should actively participate in the treatment, and also be ready to face intense emotions. Another important role is that played by the utilisation of metaphors in the establishment of an alliance, in particular with children.

Themes of the colloquium


Affective link, empathy, willingness and determination… These are strongly evocative and often mentioned by hypnotherapists.


1. Is hypnosis a tool to study the therapeutic alliance?
2. Is hypnosis a facilitating tool?
3. Is the hypnotherapeutic alliance very specific?
4. What about the specificity of the hypnotherapeutic alliance?
5. Concerning the alliance and the medical hypnosis approach: Is the alliance specific?
6. Is there a correlation between the intensity of the dissociation and the quality of therapeutic alliance?
7. What is the place and role of language?
8. What is the place and role of symbolism?
9. What would be the effect of the use of metaphor on the alliance process?
10. What is the affective impact on protagonists in this construction?
11. What is the subtle interplay between the second personality of the therapist and patient set?
12. What are the specificities of the therapeutic alliance with children or even with several members of the same family?
13. What are the links between the therapeutic alliance and ritual?
14. What is the role and impact of theories and frameworks of the setting up of theatre as a place of expression in the therapeutic alliance?
15. The therapeutic alliance and shamanism: does the concept of alliance extend to traditional therapy?
16. What are the contributions of anthropological studies?

 

Bibliography

1. Sédat Jacques, Le déclin du transfert, une invention freudienne, in Les Carnets de la psychanalyse, N° 18, 2006, P25.
2. Prince Morton, The mechanism and interpretation of dreams, The Journal of Abnormal Psychology, October- November, 1910
3. Summers RF, Barber JP. Therapeutic alliance as a measurable psychotherapy skill. Acad Psychiatry. 2003 - Fall; 27 (3):160-5. Synthèse d'études.. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin
4. Hubble Mark, Duncan Barry, Miller Scott. The Heart & Soul of Change - What Works in Therapy, American Psychological Association, États-Unis, 2003.
5. Gaston L. The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. Psychotherapy, 27, 1990, p. 143-153
6. Luborsky L, Luborsky E, 1992, Evaluation des phénomènes transférentiels par différentes méthodes dont celle du " thème relationnel conflictuel central ", in Guerin P, Dazord A, Recherches cliniques " planifiées " sur les psychothérapies, méthodologie. Paris Inserm, pp. 35-54
7. Castonguay LG, Goldfried MR, Wiser S, Raue PJ, Hayes AM. Predicting the effect of cognitive therapy for depression: a study of unique and common factors. J Consult Clin Psychol. 1996 Jun; 64(3):497-504.
Roth Anthony, Fonagy Peter. What works for whom? - A critical review of psychotherapy research, Guilford Press, États-Unis, 2005, p. 463.
8. Ackerman SJ, Hilsenroth MJ. A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clin Psychol Rev. 2003 Feb;23(1):1-33. Synthèse d'études.
9. Ambuhl H, Grawe K. The effects of psychotherapy as a result of the relation of therapeutic availability and acceptance by the client. Z Klin Psychol Psychopathol Psychother. 1988; 36 (4):308-27.
Ackerman SJ, Hilsenroth MJ. A review of thrapist characteristics and techniques positively impacting the therapeutic alliance. Clin Psychol Rev.
10. Craig Miller Dr Michael. How important is the therapeutic alliance, Harvard Mental Health Letter, Harvard Medical School, September 2004. www.health.harvard.edu
11. Sommers-Flanagan J, Sommers-Flanagan R, The Wizard of Oz metaphor in hypnosis with treatment-resistant children, . Am. J Clin Hypn. 1996 Oct;39(2):105-14.

 

Colloque organisé par le Groupement pour l'Etude et les Applications Médicales de l'Hypnose

avec le soutien de

l'Institut de Psychiatrie Paul Sivadon

 

 

 

 


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