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Metaphor, Verstehen or Neither: A Reflection on Hypnotic Analgesia and Active Ingredients in Psychotherapy

Robert A. Karlin


Hamburg, an experienced and expert therapist, presents two successful psychotherapy cases. In both cases he viewed success as being the product of his use of metaphor, the patients' successful surmounting of a high difficulty task, hypnosis, and nonspecific factors. One of the cases involves a medically unexplained chronic and disabling pain. With a couple of brief vignettes of my own, I suggest careful screening, as using hypnosis to control medically unexplained, chronic pain may cause problems for some patients with major psychopathology (e.g., paranoid schizophrenia). Next, I note that clinical data will reflect back to us the a priori assumptions and interests we bring to it. As an example of how often and misleadingly this can happen, I discuss the autobiographical nature of clinical personality theories. Finally, I agree with Hamburg about the importance of ubiquitous nonspecific effects and note my difficulty accepting that they may be more important than the specific things we do deliberately in psychotherapy.

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