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American Journal of Clinical

Hypnosis
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Emotional Relationships during

Dental Hypnosis
Melvin Land A.M., D.D.S.
Published online: 20 Sep 2011.

To cite this article: Melvin Land A.M., D.D.S. (1962) Emotional Relationships
during Dental Hypnosis, American Journal of Clinical Hypnosis, 4:4, 256-258, DOI:
10.1080/00029157.1962.10401910

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 EMOTIONAL RELATIONSHIPS DURING DENTAL HYPNOSIS’
Melvin Land,, .A.M., D.D.S.z
INTRODUCTION tient in any branch of medicine; the
Freud has stated: “All physicians, bedside manner of the general prac-
yourselves included, are practicing titioner, the rapport of the psycho-
psychotherapy, even when you have therapist, the transference of the psy-
no intention of doing so and are not choanalyst, the hypnotic rapport of the
aware of it; it is disadvantageous, how- hypnotherapist, and the psychothera-
ever, to leave entirely in the hands of peutic rapport of the dentist. Each of
the patient what the mental factor in these represents an emotional rela-
your treatment of him shall be. Is it tionship with the patient, and in each
not then a justifiable endeavor on the situation the skillful dentist or physi-
part of the physician to seek to control cian purposefully alters the quality of
this factor, to use it with a purpose, the relationship according to the spe-
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and to direct and strengthen it. This, cial needs of the patient at the partic-
and nothing else is what scientific ular moment.
psychotherapy proposes.” Since we as To establish effectively the hypno-
dentists must deal with patients at an therapeutic relation for use in dental
interpersonal level, and since proper- treatment it is necessary to have a
ly we do use hypnosis, there is a need clear understanding of the different
to be consciously aware of the psycho- phases of the emotional encounter.
therapeutic implications in the total PHASE I
situation. The coming together of two person-
Thomas H. Huxley, in a letter to alities in an interpersonal relationship
Kingsley, said: “Sit down before the will constitute the first phase of the
fact as a little child; be prepared to therapeutic frame of reference.
give up every preconceived notion,
follow humbly wherever and to what- The purpose of this relationship is
ever abysses nature leads, or you shall two-fold: (1) to provide for the pa-
learn nothing. I have only begun to tient as much as possible in the form
learn content and peace of mind since of pleasure in the treatment situation,
I have resolved at all risks to do this.” i.e., physical and emotional comfort
with reference to the operative pro-
Regardless of the use to be made of cedures, the restoration of missing or
the hypnosis, there is in the dental sit- diseased anatomical parts, and the in-
uation certain emotional relationships tegration of responses incidental to
which precedes any introduction of these procedures thus restoring the
hypnosis. It is my purpose to review psyche and soma to as near a state of
these emotional relationships in the normality as is possible under the ex-
light of personal experiences in a isting circumstances; (2) to perform
clinical setting. the services in such a manner that the
Dr. Ainslie Meares in his recent patient is pleased, comfortable, and
book has called our attention to the willing to accept responsibility for the
emotional relationship with the pa- cost of his betterment. This monetary
relationship is not to be taken lightly
1 Presented at the Fourth Annual Scien-
tific Assembly of the American Society of
in the therapeutic situation for the
Clinical Hypnosis at St. Louis, Missouri, adage, “that which is received free is
October, 1961. without value,” has a large element of
2 2623 Abrams Road, Dallas, Texas. truth.
256
 EMOTIONAL RELATIONSHIPS
In the establishment of the doctor-
patient relationship, both doctor and
patient accept definite roles. It has
been observed that as soon as either
fails to accept or to abide by his role,
that is, if the patient involves the doc-
tor in too close a social relationship, or
if the doctor involves the patient in
such a social relationship, the doctor-
patient relationship becomes changed,
and the cultural taboos can no longer
be set aside professionally without
erotic involvement or physiological
disquiet. The successful establishment
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of a good doctor-patient relationship
works to save both patient and doctor
from psychological distress or distur-
bance. The success with which this
doctor-patient relationship is formed
is more closely dependent upon the
way in which the dentist or physician
indirectly communicates his personal
integrity than upon his academic qual-
ifications or his technical professional
skills.
It is to be remembered that just as
it is desirable to establish a workable
doctor-patient relationship it is some-
times desirable in the patient’s bost in-
terest to recognize when it would be
impossible to establish or to maintain
such relationships. When the doctor
thinks and feels the objectives which
he hopes to realize for the patient are
not obtainable, then the relationship
should be willingly terminated.
The first relationship (doctorlpa:
tient) is a simple, easy, comfortable,
uncomplicated emotional relationship
upon which the subsequent hypnotic
relationship is based.
Phase I may be accomplished in the
first hour or visit or it may require
several such periods, depending upon
the anxiety, manifest or latent, along
with the resistances and defenses of
the patient to dental, medical or sur-
gical treatment. The doctor must be
willing to give his time to hear the
patient out and thus to establish com-
257
munication with him, which, in turn,
will bring the relationship to Phase 11.
This is accomplished without effort on
our part. The patient simply comes to
realize our genuine interest and con-
cern for him as another human being.
We accomplish this by allowing him to
say, think or feel anything which
comes to mind. We do not necessarily
concur with his feeling, thinking or
behavior, but we nevertheless permit
the patient this freedom and we strive
in every way possible to communicate
our feeling without verbalizing it. It
has been our experience that a per-
missive approach makes for this quick,
comfortable interpersonal relationship
we have described as Phase I which is
so necessary for the subsequent induc-
tion and use of hypnosis.
PHASE I1
The second phase of the interpersonal
emotional relationship is rapport. The
rapport of the doctor-patient relation-
ship is an emotional adjustment be-
tween doctor and patient which makes
the therapy with hypnosis possible and
effective. Rapport is much deeper and
more significant than the usual profes-
sional relationships. The patient has
a need to trust the doctor, to have
faith in him, and to feel free to talk
to him about himself in ways not pos-
sible with other people. The patient
needs to feel that his particular doctor
not only understands his illness, dental
or otherwise, but also understands him
as an individual. He comes to feel the
doctor of his choice can help him.
This emotional aspect of rapport is
not entirely one-sided. There is an in-
teraction between two persons respon-
sive to each other in a specific situa-
tion. Rapport is not to be regarded as
a love relationship. We can develop
rapport equally well with male or fe-
male patients. It is not an erotic rela-
tionship, although it very likely has
primitive erotic elements. It is our
use of these primitive unformulated
 258 LAND
erotic elements that make the hyp-
nosis more easily possible. The fact that
the doctor himself is involved in the
emotional relationship of rapport is
clear evidence that he must be on
guard and keep examining and re-
stricting the relationship critically and
objectively. It has been observed many
times that hypnosis is partially rooted
in the basic human attitude of subor-
dination to an authority. But it has
also been our observation that hyp-
nosis may also be rooted in some as-
pects of sexuality.
It was Schilder’s observation that
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rapport is an absolute prerequisite for
the passive induction of hypnosis. He
observed that factors which help to in-
duce hypnosis represent erotic values:
gentle stroking, soothing reassurance,
the “fascinating gaze,” and, on occa-
sion, the harsh brutality of raising the
voice in shouts.
In establishing rapport, any purely
logical intellectual approach is of lit-
tle value. We must communicate our
feelings of respect and sincerity, our
feelings of oneness in being fellow
members of the human race. If we
seek patients’ trust we must permit
them to see us as we are, and without
false pretense. The type of relation-
ship which we desire with the patient
cannot be obtained by presenting a
facade to him. Rapport is not easily
established with every patient, nor is
it always absolutely necessary, but if
hypnosis is to be used effectively for
the betterment of most treatment situ-
ations, rapport is an essential consid-
eration.
PHASE I11
The third phase of the emotional re-
lationship is that of transference. Ac-
cording to Meares in his recent book,
“Transference is distinct from rap-
port.” In a transference situation the
patient reacts with feelings for the
doctor which h e really feels or has felt
for some other person. Rapport, on
the other hand, arises out of a situa-
tional setting. However, rapport is
never seen in completely pure form.
The patient’s emotional reaction in
rapport is necessarily colored by past
experiences.
The capacity to be hypnotized, ac-
cording to various psychoanalysts de-
pends upon the extent of the trans-
ference. Although the feeling of awe
for the parents and the compulsive
need to obey them implicitly disap-
pears as the individual matures, some
analysts postulate that there persists
within each person a need to revere
someone. This need is reactivated in
the hypnotic state and the subject ac-
tually regards the hypnotist as if he
were a revived image of his parents.
Various other early students of hyp-
nosis stress the concept that both hyp-
nosis and suggestibility are essentially
of an erotic nature, that the trance is,
in essence, an erotic state with inhib-
ited goals. Similarly, in attempting to
elaborate these .ideas, some students
offer the speculation that hypnotizabil-
ity is correlated with masochistic
yielding.
Wolberg, in his work with hypnosis,
is satisfied that there exists an emo-
tional interpersonal relationship, and
that the trance state cannot be ex-
plained exclusively on either a physi-
ologic or a psychologic basis. Rather
it is a complex psychosomatic reaction
which embraces both physiologic and
psychologic forces. Hence, it is ap-
parent that the last and final defini-
tive word has not yet been said. The
specially induced state of human be-
havior which we have chosen to call
hypnosis needs much experimentation
for final definition. The explanations
we have in many instances seem satis-
factory but equally, often prove un-
satisfactory. We are still collecting
information, refining it, and hoping
we may arrive nearer to a scientific
understanding of this phenomenon we
find so helpful in many ways in the
healing arts.