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"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?
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