Psychotherapy
HYPNOTIC TREATMENT OF MULTIPLE PERSONALITY:
A CASE STUDY
WILLIAM N. CONFER
Wiregrass Comprehensive Mental Health Center
A 27-year-old female with five
personality alternates was successfully
treated for personality integration with
a comprehensive treatment plan.
Hypnosis proved valuable in
understanding personality dynamics
maintaining dissociation, in recovering
dissociated experience, and in merging
of personality fragments. MMPI data,
client report, and success with other
clients support the efficacy of the
intervention strategy.
Although hypnosis has been considered the
treatment of choice for hysterical dissociative re-
actions (Ellenberger, 1971), others (Bowers et
al., 1971; Gruenewald, 1971) have cautioned
against the use of hypnosis with multiple personality
because of concern that indiscriminate use would
work against the goal of personality integration.
Specifically, contacting alternate personalities
hypnotically may be understood by the client as
the therapist's sanctioning of the dissociative pro-
cess. Consequently, the therapist may unwittingly
shape or reward further splitting and the client
may unconsciously react to perceived demand
characteristics of the situation by sustained frag-
mentation.
Iatrogenesis of multiple personality during
treatment has been reviewed elsewhere (e.g.,
Greaves, 1980: Sutcliffe & Jones, 1962) with the
conclusion that the possibility of artifactual creation
of secondary personalities in no way invalidates
the naturally occurring phenomena. While indis-
criminate use of hypnosis may contribute to further
Requests for reprints should be addressed to William N.
Confer, Clinical Director, Wiregrass Comprehensive Mental
Health Center, P.O. Drawer 1245, Dothan, AL 36302.
408
Volume 21/Fall 1984/Number 3
pathology, more judicious application can capitalize
on the tendency of multiple personalities to be
excellent hypnotic subjects (C. Wilbur, personal
communication, 1978; Allison, 1974). This latter
possibility is illustrated below in a case of multiple
personality in which hypnosis played an integral
role in understanding personality dynamics main-
taining fragmentation, in the integration of once
unacceptable experience, and in the merging of
the fragmented portions of the personality into a
unified whole.
Case History
Rene (pseudonym), a 27-year-old white female,
presented in March 1978 as a neat, timid, guilt-
prone, and self-effacing woman who sat with her
legs welded together, scarcely speaking above a
whisper. She complained of severe recurrent
depression that worsened during the Easter season
each year accompanied by headaches, bruxism,
nightmares, stiffening of the hands and arms, and
"people seeming far away like an echo." With
considerable hesitation she reported a long history
of memory lapses and fugue episodes, the con-
sequences of which were embarassing or repulsive
to her. Her family history was replete with al-
coholism, state institutionalization, and suicide.
Her individual history, uncovered during the course
of therapy, was punctuated by inconsistent and
cruel treatment by both parents who evidenced
much pathology. Beatings, guilt-inducing state-
ments, insults, and rejections were commonplace.
She married an alcohol abuser who was 17 years
her senior. Although domineering, he appeared
to care greatly for Rene and provided for the
material needs of the client and their three children.
He was perplexed by her behavior changes.
Jeane, an alternate personality fragment, ap-
peared spontaneously during an early session when
Rene experienced strong angry feelings beyond
her tolerance, and Jeane was easily accessed under
hypnosis at other times. She portrayed herself as
 Hypnotic Treatment of Multiple Personality
a spunky, audacious, provocative, and rebellious
teenager who was easily angered and unafraid of
others. Jeane described herself as a friend from
"down the street" who would take up for Rene
since Rene was age four and fight back against
mistreatment. Her initial appearance was associated
with Rene being blamed by her parents for their
disharmony. She felt Rene needed to "buck up"
and that another alternate, Stella, was a "shallow
bitch." While embodying the strength and asser-
tiveness of the client, Jeane remained asexual.
In contrast to Rene and Jeane, the other major
alternate, Stella, was sultry and seductive. She
attuned herself to sensory experiences of all types
and held Rene's sexual responsivity. Her impul-
siveness often left Rene in predicaments difficult
to explain to herself and others. Stella's initial
emergence was associated with a painful rape by
Rene's father that occurred on Easter when Rene
was eleven.
Three other alternates appeared to play more
minor roles in the psychological economy of Rene.
Sissy Gail functioned as a frightened four-year-
old whose development was associated with the
sudden death of a supportive grandfather who was
attempting to remove four-year-old Rene from her
abusive home situation. As he had asked Rene to
wait for his return, this part of her responded
faithfully for over 20 years. A male fragment,
Bobby, held what Jeane described as "black rage"
that frightened even her. Although Rene could
vaguely recall putting black shoe polish on her
hair as a youngster and saying she was "Bobby,"
this alternate's espoused purpose in life was to
kill Rene's parents for the hardship they had caused
her brothers. Mary, a religious fundamentalist,
appeared at the same time as Bobby and functioned
as his counterpart. While holding a simplistic for-
mula for inner peace, she did appear to embody
the capacity to forgive. Sissy Gail and Bobby
were spontaneously incorporated once the two
major alternates were integrated. Rene chose to
accept integration of Mary's capacity to forgive
and eschewed her other religious beliefs. Only
major alternates possessed individualized clothing
styles, cigarette brand preferences, and other tan-
gible indications of individuality.
Overview of Therapy
The therapeutic ritual for the merging of alter-
nates culminated 29 sessions of psychotherapy
across four months of treatment. Rene was helped
to achieve a conceptual understanding of her dis-
order that accented the importance, even the ne-
cessity, of dissociating portions of her experience
at one point in her life and the untenability of that
strategy to cope with intolerable stress currently.
Interventions geared toward helping the client ac-
quire skills to deal with portions of her life formerly
managed by alternates reduced her need to rely
upon dissociation to cope with similar experiences
in the future. In addition, cooperation from sources
of support in her environment were marshalled to
provide encouragement and reduce unnecessary
stress.
While the client developed coping resources,
alternates were encouraged to cooperate in the
effort of Rene to recover repressed experiences.
A more compassionate reframing of unacceptable
experiences reported by alternates was thought to
help each component become more acceptable to
the others and bridge the gap between dissociated
experience and total awareness. Alternates were
helped to understand advantages of fusing with
the main personality as well. For example, alter-
nates were assured their values would be repre-
sented within the whole person while at the same
time their behavioral repertoire expanded and any
shortcomings compensated for by other components
of the personality. Nonetheless, considerable effort
was required to help alternates understand that
they were components of one personality rather
than separate entities.
The therapist hypothesized that if an unac-
ceptable experience was associated with the for-
mation of an alternate, then recall of the traumatic
episode would obviate the need for continued dis-
sociation represented by the alternate, and con-
ditions would be met for integration of the alternate
itself. An understanding of client dynamics that
maintained the separation of experience from
Rene's consciousness was readily available from
the alternate that represented the dissociated ex-
perience. Willful access to each alternate was
achieved by asking the client, under hypnosis, to
close her eyes and the desired alternate to respond
upon eye opening. The alternates provided in-
valuable data concerning misconceptions on the
part of the primary personality requiring reframing
and offered suggestions to make the experience
more palatable for her as well. Integration of the
unacceptable experience by the primary personality
was contingent upon her not dissociating during
the attempted recovery of the experience. The
possibility was minimized by enlisting the aid of
alternates in comprising a hierarchy of traumatic
409
William N. Confer
situations according to degree of threat and by
allowing alternates to ventilate stored affect as-
sociated with the experience initially to reduce
the intensity of the emotion for the primary per-
sonality. During the actual integration attempt the
client was provided a hypnotically-induced "re-
laxation button" to press if the emotional intensity
became too great for assimilation. The therapist
provided encouragement and helped her focus upon
expression of feeling during this task. As she
recalled her troublesome experience she was helped
to challenge misconceptions that maintained re-
pression of experience. Details of the therapy pro-
cedures described above as well as those for the
merging ritual below are provided elsewhere
(Confer & Abies, 1983).
The Integration Ritual
As the alternates and the primary personality
acquired an appreciation of one another during
the course of therapy and the client successfully
recovered the once unacceptable experience as-
sociated with the onset of an alternate, Rene ap-
peared ready to integrate her fragmented person-
ality. The mechanics of the meeting were handled
through hypnosis.
Rene learned to establish hypnosis quickly by
counting from five to one and to reinstate ordinary
awareness by counting from one to five. She was
instructed that counting from one to four would
bring her to the necessary degree of awareness
for her and an alternate to co-exist simultaneously.l
She was further instructed that when she wished
to speak she could do so from her chair and when
the alternate wished to speak it could do so by
occupying the chair across from Rene. While the
two parts of the client coexisted they were helped
to state needs, express dissatisfactions, negotiate
compromises, and express appreciation of one
another along the lines of couple therapy (Abies
& Brandsma, 1977).
When the two components agreed to become
closer, the client was asked to hug herself loosely
and relate how she experienced increments of
closeness. Gradually, the alternate was incorporated
in this manner. Once internalized, therapeutic em-
phasis shifted to cementing the bond. Suggestions
were offered to heighten awareness of newly in-
tegrated behaviors, affect, sensation, and cogni-
tions.
Suggestion of Jeffery Brandsma.
410
The process proved to be a dramatic one as the
verbatim transcript of the integration of Stella
demonstrates. Once Rene recovered the rape ex-
perience satisfactorily, she placed her father in a
more realistic perspective as a troubled alcoholic
who achieved revenge against his philandering
wife by raping her daughter. She appeared ready
to cautiously reacquaint herself with Stella. The
following excerpt from the 24th session takes place
approximately two weeks after successfully in-
corporating Jeane and one week after integrating
her rape experience (T = therapist, R = Rene,
S = Stella):
T: I think, perhaps, if you, Stella, can get closer to Rene and
you two can get to know one another better you'll be
feeling less depressed. She has some things she can offer
you just as you have some things you can offer her. And
in that sense you both need one another.
S: Okay, I'll try it. If it'll help.
T: I think it will. If you will, then, would you close your
eyes and, Stella, I'd like you then to drift off to sleep right
now, drift to sleep and relax comfortably. And in a moment
I'm going to bring you two, both you, Rene and you,
Stella, to that point of awareness where you two can become
aware of one another and talk to one another. And the
way this can be done is by my counting from one to four
and when I reach four you'll both be here and both be
present and can talk to one another. And the way this can
be done is, Rene, you'll be speaking from this chair where
you're at now and, Stella, when you'd like to speak, you
speak from the chair that will be right across from Rene.
And I'll be counting now: 1, 2, 3, 4. [Pause] Would you
put into words what you are experiencing now?
R: Yes. I can see her, sense her, her fear.
T: Would you kind of introduce yourself to Stella?
R: Stella, I'm Rene. And it's nice meeting you and there's
some things I'd like to talk to you about. I'd like to talk
to you about the way you go out and spend money, and
write those enormous checks and use the credit cards and
so on to the limit.
T: What effect does that have on you?
R: That has a very bad effect. Martin [husband] gets angry
and upset and he is always under pressure and, as a matter
of fact, he has high blood pressure. I think that is a lot
of it—is worry. And it just, it has a terrible effect all
around. Every—you see, when you go out and when you
spent a great deal of money like that, then we suffer for
it for maybe two or three months. The children do without
and we all do without things.
T: Stella, being impulsive like that then can have some pretty
negative consequences—
R: Sure.
T: For you.
R: Right. It does, Stella. It has a bad effect because, you
see, well just like now, we don't have the credit cards or
the checkbook or the credit cards.
T: Perhaps, if Stella could respond to you, so she can kind
of help you understand what's going on inside of her.
R: Okay. Would you explain to me what is going on? [Rene
moves to the other chair. She continues to exchange seats
as appropriate.]
 Hypnotic Treatment of Multiple Personality
S: The only reason I spent too much—I know I spent too
much money sometimes; but there's just, there's not really
anything else to do. I get bored and, you know, or if I
get kind of mad at Martin then I go out and spent some
money and buy some things. And it seems like once I get
started I can't hardly stop. But, I buy things I don't really
want anyway.
T: Would you explain to Rene how you are feeling kind of
mad with Martin.
S: Well, I get mad at him because he doesn't ever want to
do anything. He never wants to do anything that's fun.
He never wants to go out and eat. He never wants to go
out to a nightclub. Or he never wants, seldom ever wants
to make love. When he does want to make love it's just
for his, for him. And you, I know you wouldn't understand
that.
T: I'm hoping you can help her with that.
S: Well—
T: For now could we let Rene respond to you about how,
perhaps, you could express your feeling angry with Martin
in a way that it won't bring these bad effects on you where
you lose things rather than get what you want?
S: Okay. [To Rene] Do you want to tell me that?
R: Well, now the way I see it is, if we can work together on
this and I could help you, you know to kind of, we could
come to like a happy medium.
T: Um-hum.
R: Like a happy medium and after a, I don't know, maybe
a month or maybe two months then we'll probably get
the credit cards back and we'll kind of be on a budget.
We'll sit down. We'll talk to Martin and he'll tell us. I
mean, he's generous. He'll put us, he'll allow so much
money for clothing or whatever and then, you know, you
can buy things.
T: Seems like you're willing to help Stella get some of her
needs met.
R: Yeah, yeah. Sure, Sure. There's things every woman wants
but then, then, too, I mean I think you would be a lot
happier like that because then you could, when you want
to buy something, then you could buy something that you
really liked and really wanted, without just grabbing up
everything, you see, and on impulse—
T: Um-hum
R: Like that. And then when you got home then you would
be happy with what you had.
T: What about Stella's buying things because she's angry
with Martin? Is there a way you could help her express
her anger with him in a way that will help get more of
her needs met rather than indirectly?
R: Right. The best way to express your anger with Martin is
to talk with him about it. You see, he doesn't understand
when you go out and you buy and you, you know, you
spend a lot of money or you take off on a trip or something.
He doesn't understand that this is because you're upset or
angry with him. He thinks that this is just something that
you want to do, that you're just trying to break him, you
see.
T: Um-hum.
R: And he gets angry and it gets to be a circle.
T: Yeah.
R: Stella, it gets to be a circle. It just goes around and around
and then when he gets angry, then you go out and you
spend some more money. All right, when the bills come
in then he's angry, right? Do you see what I'm trying to
tell you? Do you understand?
T: So how can you two work together to break that circle?
R: Well, if we can just all get together and I can help her
understand, you know, and show her how to deal with it
and how to talk with him about it and discuss it and say,
"Look, this is the reason that I do this. It's an expression
of anger—"
T: Um-hum.
R: "and we can find another way to work this out." I don't
know, he's a reasonable guy. He's reasonable. He'll, you
know, I'm sure he will work with us.
T: It does seem like you're willing to meet Stella to get some
of her needs met and to help her with some things she
has trouble with.
R: Yes, and—
T: What do you want back from Stella? What do you need
from her?
R: I need to know, I would like to know something, something
about the birds and the bees. No, I would really like to
know something about sexual experiences.
T: Perhaps Stella could respond.
R: If it's painful.
T: Okay, perhaps Stella could respond to that.
S: Okay, if you help me on the, you know, spending part
and help talk to Martin about, you know, getting my credit
cards back and maybe if you can show me how to slow
down, that does make a lot more sense to buy something
that you really like. It does make more sense. Then I'll
help you on the sex part.
T: And help you express your anger, too, in a way that can—
S: Yeah.
T: reduce the anger rather than increase it.
S: Right.
T: Would you respond, then, to her request about the birds
and the bees and whether it's painful?
S: Okay. No, sex isn't painful. I know why you have that
in your mind. I know what's there. I know about your
father, and I know that was a terrible, terrible, it was a
very painful experience; but then you were 11 years old.
You were a child and that would be a painful experience
for any child, but you're not a child anymore. You're a
grown up lady. And it's not like that. It's a very natural
and beautiful experience. And, no, it's not painful. It's
just, well, it's just wonderful. It really is.
T: Perhaps you could tell Rene something about what it's
like to feel sensuality in general and not specifically sexual—
sensuality.
S: Okay. All right. There's an awareness, there's an awareness
about you as a woman. You feel stimulated. . . .
T: As I recall, Stella, at one time you had told me that you
can feel sexual feelings, but that you don't feel love.
Perhaps you could ask Rene what that's like.
S: Yeah, did you hear that? I have the sex part but I don't
have, you know, like all the guys that I've known, you
know, well I wanted, you know, I like them and I liked
the sex part but I didn't, I like them but I didn't love
them, but I wanted to keep them. I didn't want nobody
else to have them; but I didn't want them too much, either.
Do you understand? You don't understand, so maybe you
could tell me something about loving someone. Really
and truly loving. Would you do that?
R: Loving. Well, that is—you commit yourself to one person.
Love, I'm talking about love with a man. There is all
kinds of love. There is the love that, you know, for the
children or love for your friends or—but love for a man
is you commit yourself to that person and you think, you
411
William N. Confer

see faults in him, but they're not, they don't seem nearly R: Because I want her. I need this, I need this here; I need
as bad. . . . We have standing up for him and believing her here.
him, having faith—you know, love, trust, faith. Well, T: Then say, "I'm sensual."
helping him and, you know, encouraging them to talk R: I'm sensual. I'm not afraid of sex. And it doesn't hurt. I
through their problems, and there is so much involved in really don't hurt.
loving someone. How do I tell? T: How does it feel?
T: It seems like you're trying to get across to her that it's a R: Well, I feel different. My body feels different. More alive.
very caring, willingness — More alive. I feel more alive.
R: Right. T: Can you put some of that different feeling into words?
T: to understand them. R: Yeah. I feel like I have more confidence. My body looks
R: Right. And if you love someone you don't, you're not different to me and—
interested in other people. Loving someone wouldn't be T: How does your body look to you now?
like not wanting them but not wanting anyone else to have R: [Laughs with elation.] Better! It looks better. I just, I feel
them either. [Short laugh.] If you love someone you want like I'm ready to, to experience some things that I haven't.
them and you don't want anybody else to have them; but T: I'm going to wake you up than in a moment and then you
you want them, too, you know. Yeah. can go on telling me what you experience.
T: It seems like you two have really worked here this morning R: Okay.
to get closer to one another, to understand one another, T: If you will then, close your eyes for a moment and I'm
and have found some real common grounds where you going to count one more number, five, and when I say
need one another. that you'll be wide awake, refreshed, and be able to retain
R: I think so. all of you that you've experienced today. And five, Rene.
T: With that in mind, perhaps you two would be willing to Awaken refreshed. How are you feeling?
hug one another right now, to get closer. [Rene hugs R: I feel fine.
herself loosely] Would you put in words what you ex- T: Can you recall what you've been through?
perience? R: Yeah, I can. [Sigh of satisfaction.]
R: [In a soft voice] I feel more [moans softly]—this is a new T: And will you put into words how you experience yourself
feeling! differently now?
T: What do you feel like? Would you put words with that? R: I just feel, this is such a new feeling. This is, I feel more
R: Yeah, it's a, I don't know, more confident. She's, I don't confident.
know, maybe sensual. Come a littler closer and let me T: Um-hum
see. [Hugs herself more tightly.] R: More feminine. Yes, more feminine. Yeah, I feel softer—
T: Would you put it in words what you're experiencing? T: Um-hum.
R: Um-hum. Yeah, I feel so feminine, very feminine. And R: You know, it's a good mixture.
such sensuality. [Hugs self more tightly.]
T: Now that you're closer still, how does it feel? Conclusions
R: Good. Feels good.
T: Perhaps you would hold her closer then. [She does.] Tighter. Validity for this intervention strategy with Rene
R: I need this! is derived from objective personality assessment
T: You need this. and client report. MMPIs for Rene soon after
R: I need this.
T: Say it again, "I need you."
initiating treatment, Stella, and Rene after incor-
R: I need you. I need you with me; I see that now. porating Stella and Jeane are presented in Figure
T: Would you pull her in.
R: Yes. Yes, let's do. I do need, I do need this. I'm not 00 • • Rene
afraid anymore of this. That must be the reason. 0 C Stella

T: Embrace then. [Pause, as she does.] K • M Rene Integrated

\
90
R: She's here.

A /V
T: Say that again.
R: She's here! She's here! 80

A / /v \l
T: Would you put into words what you're experiencing, Rene? \ \ \ \

/ / v\ K M
R: Un-huh. A lot of, more awareness. More confidence. I 70

T^V- ^ / V^ /
* \ * 1A
feel more feminine. Sensual. There is a definite sensuality.
T: Would you say— "? 60
R: More aware of being a woman.
T: Would you say, "I'm more aware of" and finish that? 50 • / ..._i \1
R: I'm more aware of being a woman. Of being a whole 1 \
woman. I feel whole. I feel even more complete.
40
T: Um-hum.
R: Yeah, she's here. She's here.
T: Would you say, "I have her in me?" 30
L F K Hs D Hy Pd Mf Pa Pt Sc Ma Si
R: I have her here with me, in me. She's here. If I turn loose
she's not going to go.
Scales
T: Say that again.
R: If I let, if I turn loose she's not going to leave. Figure 1. MMPIs for two major alternates of a multiple
T: Because? personality before and after integration of alternates.

412
 Hypnotic Treatment of Multiple Personality
1. The profile of each personality fragment is
consistent with client report and therapist obser-
vation, and markedly different from the other per-
sonality fragment. The profile after merging is
suggestive of a merging of qualities of the two
fragments and appears to be healthier in general.
The last contact with Rene occurred approximately
six months after treatment. At that time she reported
she had never been happier and was looking for-
ward to spring for the first time in her life.
Two other cases have been treated using the
strategy suggested above, one by the author and
another independently by a colleague. The degree
of success achieved with each case has been most
encouraging.
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