Harm in Hypnosis: Three Understandings From Psychoanalysis That Can Help.

Over 50 years of empirical data demonstrate unequivocally that psychotherapy can cause harm as well as good. Two therapist factors increasing harm risk are inadequate assessment of patients' vulnerabilities and certain attitudes/affects. Adding hypnosis as a technique within psychotherapy heightens risk for harm because: (a) trance can unexpectedly expose patient vulnerabilities (through loosening reality orientation, lessening structure, generating unfamiliar sensations and perceptions, and intensifying access to interior information such as emotions and imagery); and (b) trance can unexpectedly increase porousness to therapist's attitudes/affects (through heightening mental receptivity to the internal states of others). A century of clinical data from psychoanalysis offers guidance for protecting against such risks. Concepts of structure, interiority, and countertransference are explicated and translated into practical clinical suggestions for harm prevention.