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3 1293 00800 3083

 

 

 

 

Llama?!
Michigan State
University

 

 

 

This is to certify that the

dissertation entitled

Regressive Transference, Hypnosis,
and the Placebo Effect

presented by

Diane Margaret Denman

has been accepted towards fulfillment
of the requirements for

 

 

Ph.D. degreein Psychology
ajor ofessor
Joseph Reyher, Ph.D.
Date .Jun.EL_S_,__J_9_B_L

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REGRESSIVE TRANSFERENCE, HYPNOSIS,
AND THE PLACEBO EFFECT

By

Diane Margaret Denman

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCFOR OF PHILOSOPHY

Department of Psychology

1987

ABSTRACT

REGRESSIVE TRANSFERENCE, HYPNOSIS, AND THE PLACEBO EFFECT
By

Diane Margaret Denman

The experiment was designed to investigate the relationship
between the factors of subject impasse, experimenter role, and
regressive transference (Freud). Eighty—eight subjects were assigned
to high (HI) or low (LI) impasse conditions based on manner of
recruitment and instructional set. High Impasse subjects were
required to be at impasse in the course of working on an academic,
vocational, or personal problem or project while participating in the
study. No financial rewards or academic credits were offered. Low
Impasse subjects were drawn from Introductory Psychology classes at
MSU, and they received academic credits in exchange for participation
in research. TWO experimenters played both low protective—competence
(LPG) and high protective-competence (HPC) roles with both subject
groups. Subjects were offered an experience in imagery and problem-
solving and were asked to produce a series of hypnotic dreams. The
dependent variables indexing regressive transference included self-
report measures and the Holt (1970) system for scoring primary

processes in imagistic material.

HI subjects in the HPC condition showed significantly greater
formal regression in hypnotic dreams than all other treatment groups
on three of the five Holt indices. Dream content on the Dependence
Subscale of the Holt gave direct evidence of regressive transference
for HI subjects in the HPC condition. The HI group also showed
significantly greater regression in hypnotic dreams than did the LI
group on three of the five Holt indices. 0n self-report measures two
weeks following hypnosis, however, HI groups reported significantly
mgrg criticism of the experimenter and mggg anxiety about their
problem than did LI subjects, an unexpected finding.

Results suggested that self—report and behavioral measures of
transference may be highly discrepant. An interpretation based on
demand characteristics and transference was offered. The relation of
findings to the "placebo effect" in medicine and psychotherapy was

discussed.

ACKNOWLEDGEMENTS

This final product depended upon the contributions and support of
many people whom I wish to thank.

First, I want to acknowledge the contribution of Dr. Joseph
Reyher, my chairperson. His clarity of thought brought my incipient
ideas to completion, and his enthusiasm sustained my efforts. Second,
I want to acknowledge the varying contributions of my committee
members at different times. Thanks go to Dr. Abeles for his timely
advice and use of the MSU Psychological Clinic premises. I appreciate
Dr. Levine’s statistical expertise, his availability at short notice,
and his basic sanity. Thanks also go to Dr. Kaufman for his
understanding of the student’s dilemma.

Especially I want to acknowledge the major contribution of my
hypnotists, Katherine (K.J.) Miller and Lora Vellmer, who actually
believed they could do the impossible and did it. I appreciate, also,
Terry Compeau and Mark wein, my raters, who brought a lively interest
and sense of fun to the scoring effort and who never let me down.

I also want to thank the large number of students and.members of
the community at large who donated their time and trust in
volunteering to participate in the study.

Finally, I wish to acknowledge my father, whose unwavering faith
in me made possible the whole educational endeavor. He has gone home
now, but he would be here if he could.

iv

TABLE OF CONTENTS

Page
LIST OF TABLES. ........... ........................................ vii
LIST OF FIGURES ..... ............. ........ ......................... ix
INTRODUCTION...................................................... 1

Clinical and Experimental Hypnosis.......... ....... ...........
Regressive Transference and the Placebo Effect. ........... ....

~10)

MEI'I-IOD OOOOOOOOOOOOOOO .00.... ..... O 00000000000000 00.0.00... 00000000 17

Subjects...................................................... 17
Experimenters................................................. 22
Procedure..... ...... . ........ ............... ....... ........... 27
Materials....... ............. ................. ............. ... 40

Evaluation of Hypotheses.... ...... ......... ........... . ...... . 49
Scale Reliabilities.................. ....................... .. 50
Manipulation Checks..................................... ..... . 51
Preliminary Analyses: Age Differences........................ 56
Hypothesis 1: Regressive Transference Scales 1 and 2......... 59
Hypothesis 2: Problem-Solving Scale.......................... 62
Hypothesis 3: The State—Trait Anxiety Index. ............. ... 63
Hypothesis 4a: High versus Low Impasse Groups on the Total

Libidinal Scale.......................................... 71
Hypothesis 5a: High Impasse Subjects in the HPC Condition

on the Total Libidinal Scale............................. 71
Hypothesis 4b: High versus Low Impasse Groups on the Total

Defense Scale............................................ 75
Hypothesis 5b: High Impasse subjects in the HPC Condition

on the Total Defense Scale............................... 75
Hypothesis 40: High versus Low Impasse Groups on the

Anxiety Scale............................................ 76
Hypothesis So: High Impasse subjects in the HPC Condition

on the Anxiety Scale..................................... 76
Hypothesis 4d: High versus Low Impasse Groups on the Object

Aggression Scale......................................... 77
Hypothesis 5d: High Impasse subjects in the HPC Condition

On the Object Aggression Scale........................... 78

V

vi
Page
Hypothesis 4e: High versus Low Impasse subjects on the
Total kgreSSion scale 0 O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 0 O O O 79
Hypothesis 5e: High Impasse subjects in the HPC Condition
on the Total Regress ion &ale 0 O O O I O O O 0 O O O O O O 0 0 O O O O O O O O O O O 7 9
Hypothesis 6: High Impasse subjects in the LPC Condition
and Aggression toward.0thers in Hypnotic Dreams.......... 81
Hypothesis 7: High Impasse subjects in the HPC Condition
and Aggression toward.0thers in Hypnotic Dreams.......... 81
Additional Analyses: Age, Impasse, and the Regressive
TraIleerenCe scale 2 O O O O O O O O O O O O O O O O O O O O O O O O O O O O C 0 O O O 0 O O O 82
DISClJSSION. O O O O ....... O O 0 O O O O O O C O O O O O O O 0 O O O O O O 0 0 0 O O O O O 0 O O 0 0 O O O O O O O 87
smry Of Findirlgs O O O O O O O O O O O O C O O O O O O O O O O O I O O O I O O O O O O O O O 00000 87
Regressive Transference Immediately.After Hypnosis and
at FOIIOW-‘Jpo O O O O C O O O O O 0 O O O O O I O O 0 O C O O O O O O O O O O O O O O O O O O O O O O 91
PI‘Oblem-SOlvj-rlg O O 0 0 I O O O O O O O O O O O O O O O O O O O O O O O O I O O O O O O O O O O O O O O O O O 93
Regressive Transference: Age, Impasse, and Ambivalence....... 94
State Wiety. O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O I O O O O O O O O O 97
Regression in Hypnotic Dreams........................... ..... . 102
Regressive Transference, Hypnosis, and the Placebo Effect..... 111
APPENDIX A... ........................ .... ....... ...... ............ 117
APPENDIX B 00000000000000000 O 0 O O OOOOOOOOOOOOOOO O O O O O O O O 000000000000 1 18
APPENIDIX COOOOOOOOOOOOO ....... .0000000.00.00.00....OOOOOOOOOOOO... 119
APPENDIX D. O O O ......... O 00000000000000 O O O O O O O 0 0 O O 00000 O ......... 0 O 121
APPme E OOOOOOOOOOOOOOOOOOOOOOOOOOOOO O O 0 O O O O O ..... O ...... O O O O O O O 1 27
APPENDB F ...... 0 O O O O O O O O O O O O ..... O ........... O O O O ..... O 0000000000 128
APPENDIX G OOOOOOOOOOOOOO 0 O O O O O O 00000000000000000 O O O O 0 O O O O O O 0 O O O O O O 130
APPENDIX H 00000 O I 0 O O O O O O O 0 O 0 O O O O O 0 O O 0 O O O O O O O O O 0 O 0 O O O O O 9 O 0 O O O O O O O 0 0 132
WIX I OOOOOOOOOOOOOOOOOOOO O O O O O 0 O O O O O O O ...... 0 ......... O O O 0 O O O 134
APPENDIX J OOOOOOOOOOOOOOOOOOOOOOOO O O O O 0 O O O O 0 O O O O O O 0 O O O O O O O 00000 O 0 O 136
APPWDIX K. O O O O O O 0 O 0 O O O 0 O O O O O O O O O O O O O O O 0 O 0 O O O O O O O O O 0 O O O O O 0 O O O O O O O O 144
APMDH L 0000000000 O 000000000 O 000000000 O 0 O O O O 0 O O O O I 0 O O 0 O O 0 0 0 O O O O O 145
APPENDIX M 00000000000 O O O O O O 0 O O 000000 0 O O O O O O O O O O O O O O O O 0 O O O O O O O O 0 O 0 O 148
APPENDIX N. O O O O O 0000000 O 0 O O O O O O I O O 0 O O O O O O O O 0 O 0 O 0 O O 0 0 O O O O O ......... 163

LIST OF REFERENCES ..... ......... ......... ......... ............. ... 206

LIST OF TABLES

Table Page
1 Reliability Scores for Holt Content Categories................ 52
2 Ratings of Experimenter Role Performance...................... 55

3 Two-way Analysis of variance for Time Spent Talking with
MrimenterOOOo ..... ......OOOOOOOOOOOOOOOOOOOOOOOOOOOO ...... .148

4 Correlations and Partial Correlations with Age................ 57
5 Subjects per Cell in Three-way Factorial Design............... 59

6 Two—way Analysis of Variance for the Regressive Transference
scale 1.0.00....O0..00......00.0.0000.........OOOOOOOOOOOOOOOO 149

7 Three-way Analysis of Variance for the Regressive Transference
scale 2.0.0.00000000000.0....0.0.0.000.......OOOOOOOOQOOOOOOOO 149

8 Two—way Analysis of Variance for the Regressive Transference
808182 ....... O 00000 0.00.0. ...... OOOOOOOOOOOOOOOOOOOO. ...... O. 150

9 Two—way Analysis of Variance for the PrOblem—Solving Scale.... 150
10 Two-way Analysis of Variance for the Trait Anxiety Index...... 151
11 Two—way Analysis of Variance for STAII... .......... ...... ..... 151
12 Mean STAI Scores Across Time Intervals........................ 66

13 Two-way Analysis of Covariance for Difference Scores,
STAI1—STAIZOO00....0.0.0.......OOOOOOOOOOOOOOOOO0.000.000... 152

14 Two-way Analysis of Covariance for Difference Scores,
STAI].—STAI300.00.0IOOOOOOOOOOOOOOOOOOOO....OOOOOOOOOOO00.000 153

15 Correlation of Libidinal Subscales with Total Libidinal

seal—€00OO0.000000.0.0.0IOOOOOOOOOOOOOOOO......OOOOOIOOOIO0.00. 71

16 Two-way Analysis of variance for Holt Oral subscale........... 153 _
17 Two-way Analysis of variance for Holt Anal subscale..... ..... . 154

vii

*2:

viii
Table Page
18 Two-way Analysis of variance for Holt Sexual Subscale......... 154

19 Two-way Analysis of variance for HOlt Exhibitionistic/
voyeuI'iStiCsubscale000000000000000000000000000000000000000000 155

20 Two-way Analysis of variance for Holt Homosexual Subscale..... 155
21 Two—way Analysis of variance for Holt Dependency Subscale..... 156
22 Two-way Analysis of variance for Holt Total Libidinal Scale... 156
23 Three—way Analysis of variance for Holt Total Defense Scale... 157
24 Two-way Analysis of variance for HOlt Total Defense Scale ..... 158
25 TWO-way Analysis of variance for Holt Anxiety Score........... 158

26 Two-way Analysis of variance for Holt Object Aggression
scoreOOOOOO ...... ....00............OOOOOOOOOOOOOOOO0.0.0.0.... 159

27 Two-way Analysis of variance for Holt Total Regression
scaleOOO0.000.000.0.0000...00....0.000.009.00.000.0.0.0.000... 159

28 TWO—way Analysis of variance for Holt SUbject Aggression
30819000000 ....... 0.00.......OOOOOOOOOOOOOOOOO...... ..... .0009 160

29 Within-Cell Correlation of Age with the Regressive
TranSferencescale 2.00.0.0...OOOOOOOOIOOOOOOOOOOO... ..... .000 83

3O TWO-way Analysis of variance for Age and Condition Within
Low ImmsseOOI..000............OOOOOOOOOOO00.000-00.0000000000. 160

31 Two-way Analysis of variance for Age and Condition Within
High ImmsseOOOOOOOOOOOOOOOOOO......OOOOIOOOOIOOOOOOO ......... 161

32 Three—way Analysis of variance for Age, Impasse, and
Regressive Transference............................... ...... .. 162

33 Mean Regressive Transference Scale 2 Scores Collapsed
Across conditiOHOOOOOO....OOOOOOOOOOOOOOO00.000.00.000. ....... 86

34 Correlation Matrix of Self4Report Indices and Hypnotic
DreamRegreSSionOOOOOOOOO00.00.000.000.0.00.00.00.00... ....... 90

35 State Anxiety Mean Scores and.variances....................... 100

36 Problem—Solving Rationales among High Scoring Subjects on
thePr0blem-SOlVir1g80816000000000000000000 oooooo 0000000000000108

 

LIST OF FIGURES

FIGURE Page

1 STAI at Different Times of Administration..................... 66

2 Cumulative Frequency Distribution for State Anxiety........... 100

ix

 

INTRODUCTION

Although the psychoanalytic literature is rich in clinical
observations, its constructs have been difficult to demonstrate
experimentally. In particular, the construct of regressive
transference, stemming from early studies of hypnosis, appears to be
relevant both to hypnotic phenomena and to the recently defined
"placebo effect" in medicine and psychotherapy. Since few researchers
have focused directly on the concept of transference, however,
evidence generally tends to be indirect, and criteria of proof must be
generated.

Freud (1953, 1959) originally conceptualized hypnosis as a
transference manifestation, akin to love, and later psychoanalytic
theorists have elaborated on his ideas (see Gruenewald, 1982).

Despite differences in emphasis among varying authors, the
psychoanalytic tradition has maintained that hypnosis is, above all, a
special type of relationship. Features of this relationship include
enhanced suggestibility and a regressive transference where the
subject experiences the self as relatively dependent and helpless in
relation to a caring, powerful other. Additionally, regression in the
type of relationship formed by the subject is accompanied by

regression in ego-function, including diminution in reflective

2
awareness and an increase in primary process modes of thinking
(Fenichel, 1945, p. 47).

Reyher (1977, 1980) has formulated.a two—step theory of hypnosis
which allows operational definition of the concept of regressive
transference. According to Reyher, there are two levels of heightened
suggestibility, each brought about by differing mechanisms. All that
is necessary for Level 1 hyper-suggestibility to occur is that the
subject adopt a receptive, open-minded attitude of waiting silently
for instructions. A further increase in suggestibility, termed hyper—
suggestibility Level II, occurs when subjects capable of assuming a
passive-receptive attitude undergo a regressive transference in
relation to a suitable facilitator. The occurrence of hyper-
suggestibility Level II depends primarily on two variables. First,
the individual must be experiencing acute anxiety regarding his or her
personal, social, or physical welfare, in circumstances where the
individual does not know how to relieve the distress. Second, the
available caretaker must assume a demeanor of unquestionable self-
assurance, competence, and kindness in his or her approach to the
suffering individual. Reyher (1980) hypothesizes that the above
conditions reconstitute the circumstances of early childhood or
infancy, which cue in a state—dependent manner reminiscences of being
cared for by loving, omniscient parents. These reactivated
remembrances constitute, in psychoanalytic terms, the regressive
transference, which serves as a defense against anxiety and which
mediates further suggestibility. These remembrances, however, are not

discrete memories of specific persons or events. Rather, they are

 

3
more aptly characterized as longings or affectively toned strivings to
find sanctuary in relationship with an accepting, strong,
authoritative figure. The reactivation of childhood remembrances is
accompanied by other indices of regression, including an increase in
primary process thinking. Reyher (1977) has reformulated the concept
of primary process functioning as a mode of representation integrated
by lower cortical levels than those governing waking thought and
behavior.

The advantage of Reyher’s formulation is that, in specifying
antecedent conditions necessary for a regressive transference to
occur, the construct is available for experimental manipulation, and
the nature of the evidence relevant to the construct becomes more
clear. Subjects experiencing a regressive transference should be
characterized by intense dependency strivings, conceptualized either
as an enduring disposition or as the consequence of a stressful
situation beyond the individual’s resolution. The designated
facilitator of such a transference, whether doctor, psychotherapist,
or researcher, must be perceived as possessing sufficient protective
competence to allow the individual to depend. In the process of
establishing such a relationship, the individual is likely to
overestimate the positive attributes of the facilitator and to show
exquisite sensitivity (enhanced suggestibility) to his or her wishes.
Similarly, fantasies produced by the subject should indicate
reciprocal child—parent roles or other derivatives of a sheltering

relationship. The organization of these fantasies should be

4
characterized by more primitive features than is typical of nonmal
waking consciousness.

Experimental evidence regarding features of the hypnotist-subject
relationship are not inconsistent with the concept of regressive
transference. Studies in experimental hypnosis indicate that the good
hypnotic subject is characterized by acquiescent and affiliative
tendencies (Fourie, 1980; Levitt, Brady, & Lubin, 1963; Roberts &
Tellegen, 1973), rather than the opposite, and responds best in a
trusting relationship (Kramer, 1969; McDermott & Sheehan, 1976) with
an operator perceived as warm (Greenberg & Land, 1971; Hartman, 1961),
confident (Barber & Calberly, 1964), experienced (Balaschak, Blocker,
Rossiter, & Perin, 1972), and prestigious (Small & Kramer, 1969).

More suggestive evidence of transference, however, comes from a group
of studies examining subjects’ attributions of personality qualities
to the hypnotist, exquisite sensitivity to the wishes of the
hypnotist, and fantasy productions about the hypnotic experience.

Regarding attributions to the hypnotist, Land and Greenberg
(1971) found that, independent of subjects’ perceptions of an actual
experimenter present in the room, the tape-recorded hypnotist was
always viewed as highly competent, warm, and experienced. Crosswell
and Smith (1974) compared responses of subjects in hypnotic,
simulating, and control groups to a tape-recorded "hypnotist—
storyteller." Results of the study suggested that the hypnotist was
viewed by the hypnotic subject as a wise, powerful, knowledgeable, and

parent—like figure, in marked contrast to the other groups.

5

Sheehan (1980) has used the term counterigg to express the
tendency of some highly susceptible subjects to follow the intent of
the hypnotist despite competing demands. This subset of subjects
scores high on dependency and is extremely sensitive to the implicit
wishes of the hypnotist in a way which differentiates them from
subjects simulating hypnosis, low susceptibles, and unhypnotized
controls (Dolby & Sheehan, 1977; Duncan & Perry, 1977; Sheehan, 1971;
Sheehan & Dolby, 1975). The performance of these subjects
deteriorated when the hypnotist acted to reduce rapport (Sheehan,
1980).

A third index of transference stems from subjects’ fantasy
productions during or after hypnosis. Sheehan and Dolby (1979) asked
three groups of subjects given differing instructions to produce a
dream under hypnosis. Dream imagery produced by hypnotic subjects
portrayed the hypnotist as protective and guiding. This pattern was
especially evidenced by the most highly motivated subjects in the
hypnotic group, as previously indexed by countering behaviors. The
authors commented that the results did suggest a "transference—like
involvement" of some hypnotic subjects with the operator. Davé (1979)
invited students at impasse with a self—defined prdblem to participate
in a study of hypnotic dreams and creativity. In analyzing the
dreams, Reyher (1980) found the material to be characterized by more
references to powerful or fantastic adult figures, babies, and phallic
symbols than a control group of dreams, while aggression was

underrepresented.

:3 1':

6

Studies of attribution, enhanced suggestibility, and fantasy in
hypnosis, then, do indicate that some hypnotic subjects become
intensely involved with the hypnotist. The dreams of some hypnotic
subjects do show archaic features and demonstrate reciprocal childe
parent roles. The extent of regression taking place in the
relationship, however, may depend on the motivational intensity of the
subject as well as the nature of the setting in which hypnosis takes
place.
Clinical and Experimental Hypnosis

Results from experimental studies in hypnosis may not always bear
directly on the construct of regressive transference, due to the
motivation of subjects participating in an experiment and the nature
of the setting (August, 1967; Erickson, 1967; Reyher, 1977). First,
regressive transference is a motivational construct in which an
individual ready to experience a dependent state encounters a
facilitator who meets the conditions necessary for that individual to
relinquish autonomous self-control. College students who volunteer to
participate in hypnosis research may be motivated by a number of
factors, including curiosity or the desire to pass a class, which have
little to do with specific dependency strivings activated by a
particular situation. Second, there is considerable evidence that
hypnosis is a multi—faceted event in which cognitive as well as
motivational variables play a role. Cognitive variables have been
alternately construed as receptive attention (Bowers, 1977; Reyher,
1977), capacity for absorption (Monteiro, MacDonald, & Hilgard, 1980),

imaginative involvement (Spanos & MCPeake, 1975), tolerance for

7

unusual experience (As, O’Hara, & Munger, 1962), and the like. It is
possible that, in the experimental situation, cognitive factors may
become more important in determining hypnotic response, while
motivational strivings are less intense. Third, the laboratory
setting is not one which invites subjects to regress. The subject
knows the relationship with the examiner is temporary and that the
experiment is not directly designed to benefit him or her. These
contextual differences suggest that clinical and experimental hypnosis
may, in fact, constitute relatively separate events. Perry and
Sheehan (1978), for example, found that, in the laboratory, high
susceptible subjects performed identically across videotaped and live
induction presentations, whereas medium to low susceptible subjects
were influenced adversely in performance by the videotaped induction.
In a study of hypnotic responsiveness in hospitalized pain patients,
however, Johnson and Weise (1979) found that medium and high
susceptible subjects were most responsive when the operator was
present than when given a videotaped induction, whereas low
susceptible subjects showed no differences across conditions. The
hypnotic subject, then, may respond in opposite ways to identical
conditions of induction, depending on whether or not that subject is
vulnerable and in pain.
Regressive Transference and thegglgcebo Effect

A body of research relevant to regressive transference which has
largely taken place in a clinical setting with highly motivated
subjects is that concerning the placebo effect. The placebo was

defined by Shapiro and Morris (1978) as "any therapy or component of

8
therapy that is deliberately used for its nonspecific, psychological,
or psychophysiological effect...but is without specific activity for
the condition being treated" (p. 371). As reviewed by Shapiro and
Mbrris (1978), placebo reactions have been demonstrated in every
aspect of modern medicine. In the process of defining the
psychosocial factors involved in this powerful effect, researchers
(Kazdin, 1979; Strupp & Bergin, 1969) recognized the relevance of the
paradigm to psychotherapy, redefining the placebo effect as a
"nonspecific factor" common to all therapies. Currently,
psychologists have argued for the elimination of the negative
connotations associated with the concept of the placebo and have
called for research illuminating its mechanism of action (Critelli &
Neuman, 1984; Ross & Buckalew, 1979; Wilkins, 1984).

The antecedents of hyper-suggestibility Level II, as postulated
by Reyher (1977, 1980), are very similar to the psychosocial factors
associated with the placebo effect, suggesting that a regressive
transference may be the mechanism underlying both the placebo effect
and intense hypnotic experience. The placebo effect is most likely to
occur among patients who are anxious and vulnerable (Beecher, 1968;
Frank, 1974; Shapiro & Morris, 1978) and who expect to receive help
from socially sanctioned authority figures (Frank, 1973; Goldstein &
Shipman, 1961; Kazdin & Wilcoxon, 1976). In a manner analogous to
hypnosis, the individual most likely to facilitate the placebo effect
is the warm (Atoynatan, Goldstone, Goldsmith, & Cohen, 1954; Rickels
et al., 1971), confident (Wheatley, 1968; Gryll & Katahn, 1978), and

prestigious (Rosenthal, 1964; Shapiro, 1964) practitioner. It is the

9
client who is anxious, vulnerable, and at impasse, then, who is most
likely to benefit from the relationship with a caretaker who offers
hope, concern, and certainty.

The critical importance of a state of impasse and expectancy is L,
also illustrated by the differences in results between placebo studies
done in experimental versus clinical settings (Beecher, 1960; Shapiro
& Morris, 1978). Beecher (1965), for example, found that pathological
pain displayed by hospital patients yields ten times more to placebo
than does experimental pain produced in the laboratory. These
findings are complemented by research emphasizing the importance of
the setting in facilitating placebo reactions (Rashkis & Smarr, 1957;
Nash et al., 1964; Uhlenhuth et al., 1966) and suggest that a clinical

environment may serve as an inherent "therapeutic stimulus,’ arousing
expectancies of help. Reyher, Wilson, and Hughes (1979) have proposed
that the shared expectancies of all participants function as a strong
suggestion to the patient who is in a state of readiness to receive
such suggestion.

Although evidence from placebo research is consistent with a
transference interpretation, few studies of the placebo effect have
focused directly on the concept of transference. Park and Covi
(1965), however, in a "nonblin " placebo trial, were able to
investigate patients’ attributions to their doctors in conjunction
with treatment outcome. Doctors participating in the study told
patients seeking drug treatment for anxiety symptoms that they were
being given a sugar pill with no active ingredient. This message was
accompanied by the kindly statement, "I think this pill will help you,

as it has helped so many others" (p. 337). Following one week, 13 out

10
of 14 patients showed marked improvement, with an overall 41% decrease
in symptoms of anxiety. A subgroup of patients who fantasized the
doctor as a beneficent protector standing in special relation to their
particular needs, however, showed the most symptom relief. Rationales
provided by patients for their improvement were ingenious and at times
approached magical beliefs in the doctor’s omniscience and
beneficence. For example, a male patient, convinced he was given an
active drug, thought the doctor told him he was receiving a placebo so
that he would think he was helping himself.

LeBaron, Reyher, and Stack (1985) operationally defined
transference by means of a Regressive Transference Scale designed to
assess both the quality and intensity of positive and negative
feelings toward the doctor and nurses responsible for the care of 57
females undergoing abortion. Patients were divided into paternalistic
and egalitarian treatment groups based on the doctor’s interpersonal
style, and patient suggestibility was measured pre- and post-surgery.
Results indicated that both suggestibility and transference scores
were higher in the paternalistic than in the egalitarian treatment
condition. Additionally, fewer objective signs of surgical shock were
found in the paternalistic as opposed to the egalitarian condition.
Results support the notion that a regressive transference heightens
suggestibility and ameliorates physical symptoms following surgery.

In the arena of creative prOblem-solving, Davé (1979) found that
subjects at impasse in solving a personally relevant prOblem reported
the most success following participation in a hypnotic dream group, as
opposed to a rational-cognitive group and a personality-interview

control group. Similarly, Barrios & Singer (1981) reported that,

 

11

among 48 volunteers with creative blocks in artistic, literary,
scientific, and professional projects, waking imagery and hypnotic
dream conditions were most effective in promoting resolution of
creative blocks. Reyher (1980), in a review of Davé’s work, found
that hypnotic dreams produced by subjects showed primary process
distortions characteristic of regressive transference. In a study
conducted by Reyher reported in the same article, the author
additionally found that subjects reporting successful prOblem-solving
were significantly more anxious, suggestible, and placating—submissive
in personal style than were subjects who reported less improvement.

The present study was designed to investigate the relationship
between the factors of subject impasse, experimenter role, and
regressive transference. The study consists of a 3—way factorial
design with one control and two experimental factors. The design is
an adaptation and expansion of a study conducted by Davé (1979) on
creative problem solving. Experimental factors included subjects and
experimenter role. subjects were divided into High and Low Impasse
groups. Two experimenters played both low protective-competence (LPC)
and high protective-competence (HPC) roles with both subject groups.
The control factor, experimenters, was included to rule out the
possible influence of personal qualities belonging to experimenters as
a source of subject response. All factors were between-groups
factors. It was anticipated that the experimenter factor would
produce no significant interactions, so that the data could be
collapsed and analyzed as a 2 X 2 factorial design. Hypotheses and

conditions were framed upon this assumption.

 

12

No attempt was made in this study to determine which aspects of
experimenter role were most important in producing regressive
transference. Rather, role variables known from previous research to
potentiate a "placebo" effect were combined in a package to study the
mechanism involved.

Subjects were offered an experience in imagery and problem
solving and were asked to produce a series of hypnotic dreams. The
dependent variables indexing regressive transference included
attributions made about the hypnotist, sensitivity to the wishes of
the hypnotist, and extent of regression in the hypnotic relationship,
as operationally defined. Attributions about the hypnotist were
measured by process and interview data scored according to the
Regressive Transference Scale (LeBaron, Reyher, & Stack, 1985).
Sensitivity to the wishes of the hypnotist was indexed by reports of
successful problem—solving, measured by the Problem-Solving Scale
(adapted from Davé, 1979). Extent of regression in the hypnotic
relationship, signified by the subject’s perceived relief from anxiety
following treatment and by features of the hypnotic dream, was
measured, respectively, by the State—Trait Anxiety Inventory
(Spielberger, Gorsuch, Lushene, vagg, & Jacobs, 1983) and by the Holt
(Holt & Havel, 1960) system for scoring primary processes. Hypotheses
regarding attributions about and sensitivity to the wishes of the
hypnotist, along with regression as signified by anxiety reduction,
were the following:

H1 : High Impasse subjects paired with a hypnotist demonstrating
high protective competence view the hypnotist as being more
powerful and more reassuring than all other experimental
groups.

13

H2 : High Impasse subjects paired with a hypnotist demonstrating
high protective competence report greater success in
prOblem-solving than all other experimental groups.

H3 : High Impasse subjects paired with a hypnotist demonstrating
high protective competence report greater relief from
anxiety following experimental treatment than all other
experimental groups.

The concept of regression in the hypnotic relationship includes
that of formal regression, where primitive methods of representation
replace the modes of daily waking thought (Freud, 1965, p. 587).
Wiseman and Reyher (1973) have previously shown that the manifest
content of hypnotic dreams induced by Rorschach cards show increased
primary process characteristics relative to waking and simulating
control groups. Reyher (1980) has noted that the hypnotic dreams of
subjects at impasse and under pressure to become dependent show an
atypical directness in the depiction of repressed strivings.
Accordingly, the Holt (Holt, 1970; Holt & Havel, 1960) system for
scoring primary processes in imagistic material was used to measure
regressive features of the hypnotic dream. From this system, five
variables were selected. These included libidinal expression,
defensive manifestations, anxiety, and aggression, directed either
toward the self or others. It was reasoned that subjects in both High
Impasse groups, due to pre-existing intrapsychic conflict, would show
greater libidinal expression and heightened defensive efforts in
hypnotic dreams relative to Low Impasse groups. Similarly, it was
also anticipated that, with the emergence of forbidden impulses, High
Impasse subjects would form more anxiety-laden and self—punitive

images in dreams than Low Impasse subjects. High Impasse subjects

paired with a LPC hypnotist, however, given less opportunity to

14
regress in their relationship with the experimenter, should
demonstrate fewer indices of libidinal expression in dreams along with
reduced defensive efforts, anxiety, and aggression turned inward
relative to High Impasse subjects paired with a HPC hypnotist. The
comparison of High and Low Impasse groups under varying conditions of
interpersonal interaction, then, should allow differentiation of
intrapsychic and interpersonal sources of influence on dream content. L”"

It should be noted that the anxiety scale, as originally defined
by Holt and Havel (1960), has relevance to the interpersonal aspects
of regressive transference. The above authors defined the anxiety
category as the depiction of a situation of helplessness in the face
of impersonal danger. The portrayal of helplessness and jeopardy in
hypnotic dreams implies both trust in the hypnotist and implicit
strivings for protection on the subject’s part. The anxiety category,
then, was conceptualized as having relevance to both intrapsychic and
interpersonal aspects of regressive transference.

It was also expected, given the satisfaction of dependency
strivings, that High Impasse subjects in the HPC condition should show
the least aggression directed toward others in hypnotic dream
protocols than any other group (Reyher, 1980). In contrast, High
Impasse subjects paired with a LPC hypnotist should experience
frustration of dependency strivings, leading to enhanced aggression
expressed toward others in hypnotic dream protocols. The formal
statement of hypotheses regarding regression in hypnotic dreams is as

follows:

 

 

H6:

15

: High Impasse subjects show more regression in hypnotic

dreams than do Low Impasse subjects.

(a)

(b)

(C)

(d)

(6)

High Impasse subjects demonstrate more libidinal
expression in hypnotic dreams than do Low Impasse
subjects.

High Impasse subjects show more defensive
manifestations in hypnotic dreams than do Low Impasse
subjects.

High Impasse subjects express more anxiety in hypnotic
dreams than do Low Impasse subjects.

High Impasse subjects show more aggression toward the
self in hypnotic dreams than do Low Impasse subjects.

High Impasse subjects show more total regression in
hypnotic dreams than do Low Impasse subjects.

: High Impasse subjects paired with a HPC hypnotist show

higher indices of regression in hypnotic dreams than do all
other treatment groups.

(a)

(d)

(e)

High Impasse subjects in the HPC condition show more
libidinal expression in hypnotic dreams than do all
other treatment groups.

High Impasse subjects in the HPC condition show more
defensive manifestations in hypnotic dreams than do all
other treatment groups.

High Impasse subjects in the HPC condition express more
anxiety in hypnotic dreams than do all other treatment
groups.

High Impasse subjects in the HPC condition show more
aggression toward the self in hypnotic dreams than do
all other treatment groups.

High Impasse subjects in the HPC condition show more
total regression in hypnotic dreams than do all other
treatment groups.

High Impasse subjects in the LPC condition show the most
aggression toward others in hypnotic dream protocols.

High Impasse subjects in the HPC condition show the least
aggression toward others in hypnotic dream protocols.

 

 

16

In summary, the present study attempts to manipulate the factors
of subject impasse, experimenter role, and regressive transference.
Regressive transference as a construct encompasses the notion of a
reactivation of early parent-child images, experienced in the context
of an appropriate relationship, along with an increase in the
prevalence of more primitive, drive-dominated.modes of thought.
Subjects’ attributions about the hypnotist, sensitivity to the wishes
of the hypnotist, felt relief following treatment, and features of
regression in hypnotic dream protocols were considered to index
regression. It was hypothesized that the subject group experiencing
high distress paired with a protective, competent hypnotist would show
the highest scores on all indices of regressive transference. It was
also predicted that subjects experiencing high distress would show
greater regression in hypnotic dreams than Low Impasse subjects and
that hypnotic dream content would demonstrate a relationship between
the frustration of dependency needs and the portrayal of aggression in
hypnotic dreams. The implications of the findings will also be
considered with respect to creative problem-solving and treatment

outcome.

 

METHOD

Subjects

Subjects included 88 male and female members of the Michigan
State University community at large. Most participants were either
undergraduate or graduate students attending the university. Subjects
were divided into two experimental groups based on method of
recruitment and instructional set.

Low Impasse Group. subjects included 44 university

 

undergraduates drawn from introductory psychology classes at MSU.
Among these subjects, 21 were female and 23 were male. The mean age
of the group was 19.32 years, with a range from 18 to 30 years of age.
Low Impasse subjects volunteered to participate in research and
received academic credit in exchange. The study was described as an
experiment on imagery, hypnosis, and creativity, headed by the
caption, "Adventures in Imagery." The phrasing of the notice was
designed to attract intellectually interested and adventurous
students, rather than those with help-seeking motivation. (See
Appendix A for specific notices posted in classes).

High Impasse Group. The remaining 44 subjects were solicited by

 

advertisements placed in the Michigan State university student
newspaper, the State News; by letters sent to residents of university
graduate housing; and by announcements in classes where credit was not

given for research participation. subjects included 22 females and 22

17

 

18
males. Because High Impasse subjects were not drawn from
undergraduate classes alone, the mean age of this group, 23.23 years,
was slightly higher than the Low Impasse group. Ages ranged from 18
to 40 years.

The High Impasse subjects were required to be at impasse in the
course of working on an academic, vocational, or personal prOblem or
project while participating in the study. No financial rewards or
academic credits were offered. The study was described as an
experiment on imagery, hypnosis and problem-solving, headed.by the
caption, ”Creative Problem-Solving." It was assumed that the emphasis
of the advertisement and the lack of tangible reward would draw
subjects highly motivated to seek and expecting to receive help in
resolving personal impasse. Samples of the advertisements and letter
are included in Appendices B and C.

Initial contact. Initial contact was made between the subject

 

and the author (E1) by phone, either by subjects’ phoning in or El
calling them in response to expressed interest. At this time, initial
information was gathered from subjects according to the following
brief interview schedule:

Name Address Phone:

 

Sex Age Occupation

 

How did you hear about this project?

 

What about the study interested you?

 

The latter question in the interview was designed as a manipulation

check to determine whether or not subjects recruited in differing ways

 

 

 

19
did, in fact, express different reasons for participating in the
study. Responses to the question were not-used for group assignment.

Following these questions, subjects at impasse who responded to
advertisements were given a description of the study identical to that
contained in the letter to graduate students. The task was defined as
resolving an impasse in problem-solving, as follows:

I am a graduate student at MSU in clinical psychology, and I am

conducting research on imagery, hypnosis, and prOblem solving.

Specifically, I am interested in the effectiveness of imagery in

facilitating the ability to overcome an impasse or mental block

encountered in the course of working on a problem or project.

This could encompass a wide range of academic, professional,

aesthetic, or personal concerns, from difficulty writing a paper

to problems resolving a marital difficulty. The only
requirements are (1) that you are currently working on a problem
or project, and (2) that you are 'stuck' in some way which
prevents you from reaching a satisfactory solution to that
problem or from completing the project. Do you think your
situation meets these criteria?

Subjects recruited from the classroom who were participating to
gain academic credit were contacted after they had signed a list
indicating interest in participating in the research. Upon phone
contact, El gave the following information:

I am a graduate student at MSU in clinical psychology, and I am

conducting research on imagery, hypnosis, and creativity.

Specifically, I am interested in the effectiveness of imagery in

 

20

enhancing creativity. Creativity is not something that belongs

exclusively to artists or great scientists. Rather, creativity

is something that each of us uses in solving the prdblems of
daily living. The first task of the experiment, then, is for you
to select a project or prOblem on which you are currently
working. This could encompass a wide range of academic,

professional, aesthetic, or personal concerns, from writing a

paper to solving a problem in a relationship. The main

requirements are that (1) you are currently working on a problem
or project, and (2) that you are 'stuck’ in some way so that you
have not yet reached a solution to that problem or have not yet
completed the project.

I would like you to think back over the last two weeks to
the problems you have confronted or the projects on which you are
working. Then select one on which you would most like to work
during the experiment. Do you think you can do that?

Appointment times for the experimental sessions were scheduled on a
random basis during the initial phone contact. Subjects were assigned
either to the Low or High Impasse group based on manner of recruitment
and instructional set.

Problems and project presented. subjects from both High and Low
Impasse groups brought in a wide range of problems and projects
covering academic, vocational, and personal concerns. Academic and
vocational problems included career direction, procrastination, study
habits, performance anxiety, and the completion of special projects

such as a term paper, work of art, or job assignment requiring

 

21

creative effort. Personal problems included, among others, conflict
in relationships, loss, shyness, insomnia, and.habit disorders such as
weight control, smoking, and nail biting. Although it was not
possible to counterbalance precisely the nature of prdblems presented
across experimental groups, habit disorder and academic, vocational,
and relationship problems were represented in each experimental group.

subject attrition. It was assumed that any subjects who declined
participation in the experiment when given additional information were
insufficiently motivated to continue. All subjects initially
contacted by E1 in response to their interest agreed to participate.
Eighteen subjects, however, cancelled or failed to appear for their
scheduled appointment and were dropped from the study. Participating
subjects, then, were considered to be roughly matched in motivational
intensity, independent of type of motivation involved.

There is considerable evidence that capacity to dream during
hypnosis involves both cognitive and motivational variables (Hilgard,
1965). Only subjects who were able to produce a dream series were
included in the data analysis. A dream series was defined as the
production of imagery on at least two out of the three hypnosis
trials, with imagery consisting of at least one visual episode. A
visual episode was defined as pictorialization of a person, object, or
setting, with a change in persons, objects, setting or activity
demarcating each episode. Twenty subjects were unable to have a
hypnotic dream or dream-like experience which met the criteria for a
dream series. These subjects were given post-hypnotic suggestions to

dream and continued the latter phases of the experiment although their

 

22
data was not included in the analysis. The remaining subjects were
thus considered to be roughly matched in hypnotic susceptibility. The
inclusion of only susceptible subjects, operationalized as the
capacity to have a dream series while hypnotized, however, limits the
generalizability of the results of the study.
Experimenters

Two experimenters were trained by the principal investigator to
administer the questionnaires, rationale, and hypnotic induction. The
experimenters were advanced undergraduate students, both females.

They were selected on the basis of interest in hypnosis and
psychological research. Both intended to Obtain advanced degrees in
psychology.

Each experimenter was trained in performing both low protective-
competence (LPC) and high protective-competence (HPC) roles. The
experimenters varied roles across subject groups so that each
conducted an equal number of sessions with High and Low Impasse
subjects while playing LPG and HPC roles.

Experimental roles. HPC and LPG roles were designed to

 

operationalize five variables found in previous research to have
potent non-specific therapeutic effects. These include the status
(Shapiro & MOrris, 1978), warmth (Atoynatan, Goldstone, Goldsmith, &
Cohen, 1954), and perceived competence (Shapiro, 1971) of the
practitioner, in addition to the nature of the message given about the
treatment (Gryll & Katahn, 1978) and the nature of the setting

(Uhlenhuth et al., 1966).

 

 

23

The HPC role required that the experimenter dress in a
professional manner, e.g., a tailored skirt and.blazer with an
expensive appearance, designed to give the impression of status and
savoir faire (Gavrilides, 1980). In the LPC role, experimenters were
instructed to dress casually, wearing bluejeans, as a student might.
Regarding warmth, the HPC role emphasized empathic verbal interaction
with the subject, whereas in the LPC role verbal dialogue was kept to
a minimum. In the HPC role, experimenters were rehearsed toward
smooth and error-free performance, giving an impression of competence
and ease. In contrast, in the LPC role, experimenters were instructed
to make a minor error in conducting the procedure, corrected in the
presence of the subject, in order to give an hmpression of uncertainty
and lack of familiarity with the method. The message given about the
procedure by the HPC experimenter to the subject was positive and
affirmative in wording, giving a strong suggestion that the treatment
would be effective. In contrast, the LPC experimenter conveyed a
balanced, neutral message about the procedure, allowing few
conclusions to be drawn.

The nature of the setting also varied systematically with the
role played by the experimenter. subjects assigned to the HPC
condition met with the experimenter in a clinical room in the building
on campus which housed the Michigan State Psychological Clinic. The
room contained a reclining chair as well as rug, pictures, and other
signs of comfort. The clinical setting was anticipated to arouse
expectations of care. In contrast, subjects assigned to the LPC

condition met with the experimenter in a laboratory room in a

24
psychology research building on campus. The room was equipped with a
comfortable reclining chair, a frame chair for the experimenter, and
research equipment. The research setting was expected to arouse
prospects of intellectual adventure. The major differences between

HPC and LPG roles are summarized below:

Treatment Condition

 

 

Experimenter Behavior Construct HPC LPC

attire status professional casual

time spent talking warmth much little

with subject

personal manner competence smooth and hesitancy in
fluent speech; speech; error
error-free made in
procedure procedure

message about suggestion positive neutral

the procedure
context expectancies clinical care intellectual
adventure

Rationale given to the experimenters. The experimenters were
kept blind regarding the hypotheses of the study. Since belief in the
effectiveness of the method is an important nonspecific factor in
therapeutic outcome (Shapiro & Morris, 1978), this variable was held
constant. Both experimenters were told that there was considerable
evidence demonstrating that the hypnotic method to be employed in the
study was effective in enhancing creative prdblem-solving. The
present study was described as an attempt to examine right and left-
hemispheric contributions to creativity following a hypnotic dream

series obtained under varying conditions of interpersonal interaction.

25
The differing roles were described to the experimenters as a contrast
in egalitarian versus authoritative interpersonal styles. Both roles
were described in equally positive, plausible ways, and the
experimenters’ enthusiasm was directed toward the importance of
playing convincing roles. Specific information given to the
experimenters was as follows:

we do not know under what conditions varying personality types

will respond to imagery as a means of creative problem—solving.

Some individuals are autonomous in personal style. No matter how

pressured they may feel or appear to others, they prefer to rely

on themselves to solve prdblems. When working with another
person, they respond best in a low-key, egalitarian atmosphere
where their autonomy is not threatened. Other people are more
dependent in attitude. They look to others for direction and
work best in a structured setting with an enthusiastic and
authoritative leader. In this study, each of you will be trained
to play both roles.

A detailed transcript of the rationale given to the experimenters is

included in Appendix D.

Trainigg. Detailed scripts following along with the procedure
were written for the experimenters to define their performance
throughout the experiment. Additional training in empathic listening
(Gordon, 1975) and in the non-verbal accompaniments of a confident,
competent attitude were given for the HPC role. Training in
competence was based on the Personal Power Functions Profile developed

by Reyher (1979). Both experimenters also received instruction in

 

26
experimental ethics and in responding to typical fears and
misconceptions regarding hypnosis.

All sessions were audiotaped following subject consent. Tape
recordings of the experimental sessions were monitored on a weekly
basis by the principal investigator to ensure conformdty to the
script. Experimenters were supervised weekly by El and errors in
procedure corrected. Following data collection, both experimenters
were completely debriefed and the reasons for deception thoroughly
explained.

Manipulation check. Naive observers unaware of the hypotheses of
the study were asked to participate in the research as simulating
subjects at two points during the experiment. During the sixth week
of the experiment, two Observers completed rating scales on each of
the experimenters. The first Observer acted as a subject for 32 in
the HPC role and E3 in the LPC role, whereas the second observer acted
as a subject for E2 in the LPC role and E3 in the HPC role. During
the fourteenth week of the experiment, two additional observers
repeated this procedure. The experimenters were unaware that these
subjects were simulators instructed to rate their role behavior.

Rating scales were devised which asked the observers to estimate
each experimenter’s status, warmth, competence, and the nature of the
message conveyed regarding the procedure. Inter-rater reliabilities
were calculated for each pair of Observers. The rating scale is
included in Appendix L.

The manipulation check was designed to determine (1) if role

behavior was significantly different across conditions for each

27
experimenter, and (2) if both experimenters were playing significantly
similar roles within each condition. If the above conditions were
fulfilled, it seemed reasonable to assume that the data generated by
both experimenters could be combined.
Procedure
Introductory interview. Subjects in all conditions were greeted
and given the following initial information about the research:
Let me tell you about the study. we are primarily interested in
imagery, creativity, and problem-solving. This study also
involves the use of hypnosis, which is an effective method for
stimulating the imagination. we will use music and relaxation to
help you get into hypnosis. Then, while your suggestibility is
enhanced, you will have a series of dreams or dreamelike
experiences which may relate to your problem/project. Are you
interested in continuing with the study?
Subjects were then asked to sign the Human Subject Consent Form and a
waiver permitting audiotaping during the session. Both forms include
the provision that consent to participate may be withdrawn at any time
without penalty. Copies of the forms are included in Appendices E and
F.
All subjects were then interviewed regarding the problem or
project they had selected for the experiment according to the
following format:

Can you briefly describe your project/problem.to me?

 

Approximately when did you begin to work on/become aware of this

project/problem?

 

 

28
Is there a deadline or time-pressure for completing/do you feel a

time-pressure for solving your project/prOblem?

 

Can you describe what remains to be done on/what needs to happen to

solve your project/problem as clearly as possible?

 

 

At this point, if subjects had difficulty defining a diffuse or
multi-faceted dilemma, they were encouraged to select a focal point or
one aspect of the problem to work on. All subjects were able to
define their prOblem with sufficient focus to allow hypnosis to
proceed.

The State—Trait Anxiety Inventory (STAI) (Spielberger et al.,
1983) was then administered to subjects according to the following
instructions:

We would like to know how anxious or disturbed you are by this

problem/project on which you are working. I have here a form

which describes how people feel when facing a difficulty. I

would like you to fill out this side with regard to how you are

feeling now about the problem/project you have described. Then
fill out the other side according to how you generally or usually
feel.
The STAI was administered to determine whether or not subjects self—
selected as "at impasse" did characterize themselves as more anxious
than student volunteers and to provide a basis for before and after
treatment comparisons. Subjects were instructed not to put their

names on the form which was given to them with only their experimental

29
number at the top. The experimenter left the room while the subject
completed the form to ensure both confidentiality and privacy.

The procedure hereafter varied according to whether or not
subjects were assigned to the high or low protective-competence
condition.

Eigh protective-competence condition. Upon re-entering the room,
the HPC experimenter asked the subjects to discuss the prOblem or
project in more detail, stating, "Before we begin the hypnotic
procedure, I would like to ask you a few more questions about the
problem you are presenting. OK?" Questions consisted of the
following structured interview:

What methods have you tried using in order to solve your

problem/complete your project?

 

Have these been at all successful?

 

What factors in the environment do you think might be contributing to
any difficulties you are having in solving your prOblem/completing

your project?

 

Do you sense or feel that there is anything about yourself that might
be contributing to the difficulties you are having solving the

problem/completing the project?

 

Questions were devised to increase rapport and were not scored in any
way. Subjects in this group were allowed to talk for as long as 25
minutes about their project or problem. Length of the interview was
discretely timed by E2 as a check on whether or not subjects actually

used the time made available to them.

 

30

At the end of 25 minutes, if the subject continued to talk, the
HPC experimenter commented, "I think I understand now something about
what this problem/project means to you. I hesitate to interrupt, but
we must keep an eye on the clock. Do you feel ready to go on with the
experiment now?"

If the subject had finished the interview before the end of 15
minutes, the HPC experimenter simply said, "I think I understand now
something about what this problem/project means to you. Do you feel
ready to go on with the experiment now?"

The HPC experimenter then proceeded to describe the problem—
solving rationale in highly positive terms, suggesting that others had
found the technique helpful:

Let me tell you more about the rationale of the study. We know

that hypnosis, imagery, and most creative functions are mediated

by the right hemisphere of the brain. Most of us, however, rely
on the left hemisphere when we try to solve problems. That is,
we try to think, reason, and use words to find a solution.

Often, however, solutions come not from the left hemisphere but

from the right, in the form of dreams or images which provide new

and unexpected perspectives. In previous investigations, we have
been successful in providing the conditions necessary for
creative prOblem solving to take place. Since music, imagery,
and hypnosis are all mediated by the right hemisphere, we will
use music to get you into hypnosis, or, into your right
hemisphere. Then, you will have a series of dreams or dream—like

experiences which should help you eventually to come to

31

satisfactory solution/completion of the prOblem/project facing

you. Do you have any questions?

Any fears or misconceptions which the subject raised about hypnosis
were addressed at this time.

Lowgprotective-competence condition. Following administration of
the STAI and upon re-entering the room, the LPC experimenter stated in
a kind but matter—of—fact and businesslike manner:

I am sure there is more you could tell me about your

problem/project. I am sorry that time does not permit my

listening to each individual in detail. I would like to describe
the rationale of the study in more detail to you now.
The LPC experimenter then proceeded to describe the problem-solving
rationale in neutral terms, indicating that whether or not the method
was helpful was a matter for scientific inquiry, as follows:

we think that hypnosis and imagery may be mediated by the right

hemisphere of the brain. Creativity, however, may involve both

left and right hemispheres. That is, some investigators propose
that the left hemisphere thinks, reasons, and used words, while
the right hemisphere imagines and dreams. Although we are not
sure which hemisphere is most important in prOblem solving, there
is some evidence to suggest that most of us rely on the left
hemisphere when we try to solve problems. That is, we try to
think, reason, and use words to find a solution. Our experiment
is designed to determine if stimulation of right—hemisphere
functions, that is, the experience of imagery, can facilitate

creative problem solving. Since music, imagery, and hypnosis all

32
may be mediated by the right hemisphere, we will use music and
relaxation to help you get into hypnosis, or, into your right
hemisphere. Then you will have a series of dreams or dream-like
experiences. we hope to learn whether or not these dream—like
experiences will have relevance to satisfactory solution/
completion of the problem/project facing you. Do you have any
questions?
Any fears or misconceptions about hypnosis that the subject raised
were addressed at this time.

Hypnotic induction. Following this period, subjects in both

 

groups were asked to recline in the overstuffed chair in which he or
she was already sitting, to close his or her eyes, to relax, and to
listen to the music and to E’s voice. Music was selected as a means
of induction because the procedure tends to arouse relatively little
anxiety in subjects (Reyher, 1980) and has been demonstrated to induce
hypnosis in previous research (Talone, Diamond, & Steadman, 1975).
The music used to mediate the hypnotic induction was Oldfield’s
"Tubular Bells," played by cassette on a tape-recorder. This music
was selected because its highly repetitive melody and driving rhythms
make it suitable for capturing attention fully. The hypnotic induction
and dream visualization procedure is based on a technique devised by
Reyher (1980) for studying creativity.

The only difference between high and low protective-competence
conditions at this point was the ease of transition into the hypnotic
induction. Before inviting subjects to relax in the recliner, the LPC

hypnotist appeared to fumble with her notes, looked down, and said,

 

33
"Let’s see, where do we go next? Oh, yes. Would you like to make
yourself comfortable now, and I will begin the music."

The music was accompanied by suggestions to relax and notice the
quiet regularity of breathing along with suggestions of deepening
relaxation as E counted from 1 to 10. Fifteen minutes into the
hypnotic induction, the music was gradually phased out. At this
point, E was operationally defined to be under hypnosis. In all
conditions, E then gave the following suggestion to E:

very soon I will turn down the music. As the music softens, you

will find that an image of yourself in a pleasant and peaceful

setting will come to mind. It may be a beach, a meadow, or any

other place you like to be. When you see yourself in such a

setting, please raise your hand about six inches.

Once the hand was raised, E was asked to describe what he or she saw,
"You can lower your hand now. I would like you to describe to me what
you saw." Following the subject’s report, E then went on to suggest
the following:

Soon a person, animal, or object, such as a car or boat, will

enter the scene. When you see the person, animal, or Object,

please raise your right hand about six inches.
Again, once the hand was raised, E was asked to describe what he or
she saw. Following the report, E continued:

Soon you will experience some kind of action, event, or happening

which takes place (in the pleasant setting). When you see this

action or event take place, please raise your right hand about

six inches, as you did before, and then describe the event to me.

 

 

34
Once § had described the event, action, or happening, E then
recapitulated the session in positive terms and provided the following
instructions:
Good. You can lower your hand now [if the hand was still
raised]. YOu have had a successful experience of imagery. You
can rest for a moment now, simply enjoying the experience of
relaxation.
If E failed to visualize two out of the three suggested scenes, he or
she was given a post-hypnotic suggestion for nocturnal dreams and then
was formally awakened. The post-hypnotic suggestion consisted of the
following:
Every night, including tonight, for the next seven nights, the
elements of your project/problem will become very lively and
represent themselves in your dreams in one way or another. YOu
will be able to remember everything about these dreams once they
are over. If you understand what I have just said, please nod
your head. [If E failed to nod, the instructions were repeated.]
I will now count backward from five to one. When I reach the
count of one, you will be fully awake.
Once awakened, E was informed that the experimenter would telephone
one week from the date of the session for a brief followeup interview.
The E was also told that, following the call, an additional
appointment with the principal investigator would be scheduled.
If E completed two out of three imagery tasks, however, E then

provided the following instructions:

35
Now I would like you to picture in your mind’s eye all the
elements of [project/problem was referred to by name,
for example, "your M.A. thesis" or "the poem you are trying to
write"]. When you see all of these in your mind’s eye, raise
your right hand about six inches to let me know.
Once the hand was raised, g was asked to describe what he or she saw.
E then stated, "Now drop your hand [or "nod your head", if E had
already dropped the hand] when these things disappear from your mind’s
eye." Following E’s indication, E stated the following instructions:
Even though you cannot see these elements any longer, they are
still very alive in the back of your mind, out of sight. In
fact, they have a life of their own where you can’t see them, and
when I count to three, they will cause a dream or dream-like
experience to come into your mind’s eye. Please raise your right
hand when this dream or dream—like experience ends. If you
understand what I have just said, please not your head. [If E
failed to nod, the instructions were repeated.] OK, I will now
begin to count. One...two...three...
If E did not raise his or her hand within two minutes, E stated, "I am
going to count, and.by the count of ten your dream will come to some
conclusion. One...two...three...four...five...six...seven...eight...
nine...ten."
E was then asked to describe his or her dream. Following the
dream report, one minute was taken to rest. E then repeated the
instructions asking E to dream, beginning in the following way: "Soon

you will have another dream. Even though you cannot see the elements

 

36
of your problem any longer, they are still very alive in the back of

your mind, out of sight.... The remainder of the paragraph was
repeated verbatim. The instructions were repeated twice, giving E a
total of three problem-solving dreams or dreamrlike experiences.

Once the final dream was recorded, E was given the identical
post-hypnotic suggestion described previously and.was then formally
awakened. Once awakened, E was given time to become oriented to his
or her surroundings. E inquired, "How do you feel?" in order to give
E the opportunity to make any spontaneous comments about E or about
the procedure. E was then asked to complete the STAI again, regarding
how anxious or disturbed the subject felt at present regarding the
problem or project brought to the experiment. As before, the form was
given to E with only an experimental number at the top, and E left the
room while E completed the form. Upon completion of the STAI, E was
informed that E would telephone precisely one week from the date of
the session for a brief follow-up interview. As before, E was also
told that, following the call, an additional appointment with the
principal investigator would be scheduled.

Follow—up inquiry. Es in all conditions were telephoned one week
following the experimental session by the experimenter who had
conducted the session. At that time, an inquiry was made along the
following lines:

What is the current status of your project/problem?

 

 

[If E was still at an impasse, he or she was thanked for

participating, and the experimenter scheduled an appointment for E

37
with the principal investigator during the following week. If E
reported a change in status, the interview proceeded.]

What solution did you implement to overcome the problem?

 

 

How did you arrive at this solution?

 

 

Are you satisfied with your solution as it now stands?

 

 

Have you had any outside assessment of your solution (grade, critique,

etc.)? If so, please elaborate

 

 

 

Regarding scheduling the final interview with the principal
investigator, subjects were told that the interview would involve the
completion of some additional questionnaires along with gathering E’s
impressions of the experiment and answering any questions E might
have. All interviews were scheduled to take place within seven days
following phone contact.

Verbatim notes of the phone interview were taken by the
experimenter who had tested the subject. Transcripts were later
scored by independent raters according to a set of criteria entitled
the "Problem—Solving Scale," adapted from Davé (1979) (see Appendix
G). Scores on this scale ranged from -1 to +3. A -1 was scored if
the subject indicated that the prOblem was worse. A zero score was
given if no change in the status of the project or problem was
reported. A +1 was scored if the subject reported change in the

status of the project/problem toward solution, if the subject was able

 

 

38
to relate the solution to the experiment, and if the subject felt
fully satisfied with the solution as it stood. Points were added when
each criteria was met to Obtain the final score. Any Objective
information available about prOblem-solving was recorded if available.
Although the efficacy of the treatment was not at issue here, groups
were expected to differ in their report of success or failure and
their ability to generate a solution related to the experiment
depending on the nature of their relationship with the experimenter.

Final interview. Upon greeting the subject, E1 expressed thanks

 

for the time E had spent on the experiment. The STAI form and a

questionnaire asking for subjects’ reactions to the experiment were

then introduced:
I would like you to fill out the Self-Evaluation
Questionnaire again with regard to how you are feeling Q93
about the problem or project you described during the
experiment. YOu only need to fill out side Y-l. In
addition, I have a questionnaire which asks about your
reactions to and feelings about the experiment. What I
would like you to do is fill out this questionnaire as
frankly and completely as possible. Do not put your name on
the questionnaire. When you have finished, put the
materials into this envelope with your experimental number
at the top, seal it, and return it to this collection box.
You can be sure that your responses will remain

confidential. Following completion of the questionnaires,

 

 

 

39

we can discuss the experiment in more detail, and I will

answer any questions you might have.

Ensuring confidentiality was considered important in order to
give Es the freedom to express any feelings about the experiment which
otherwise might be suppressed in order to please a prestigious
"principal investigator." The collection box was a large cardboard
box with a lid containing a slot into which envelopes could be
dropped. The subject completed the questionnaires in a room separate
from El’s office to mitigate further any interpersonal pressure.

The semi—structured questionnaire, titled "subject’s Post-
experimental Questionnaire," was adapted from LeBaron, Reyher, and
Stack (1980) and included the following questions:

In general, what were your impressions of the experiment?

 

 

Did you have any specific responses to or feelings about the hypnotic

procedure?

 

How did you feel about or respond to the experimenter?

 

 

In your opinion, did the experimenter do a good job? Please explain.

 

Was there anything the experimenter said or did that might have made
you feel worried or uncomfortable during the procedure? If "yes",

please explain.

 

was there anything the experimenter did or said that was especially
helpful or gratifying to you during the procedure? If "yes", please

explain.

 

 

 

'.-.

 

40
Were there any times during the procedure when you worried about your

welfare or safety? If "yes", please explain.

 

 

Were there any times during the procedure when you especially felt a

sense of hope, reassurance, or enjoyment? If "yes", please explain.

 

If you have any additional comments, please feel free to make them

here.

 

Subject’s responses to this questionnaire became the basis for scores
on the Regressive Transference Scale, described below.

E1 then explained the objectives of the study. subjects were in
all cases reassured that their behavior and feelings about and during
the experiment were completely appropriate whatever they had been.

The necessity of deception in order to ensure that the research was
fully relevant to actual therapeutic situations was explained, and the
value of the Es’ participation emphasized. Subjects who continued to
express considerable distress over any unresolved impasse in their
problem/project were referred to the appropriate counseling service
for further help, if requested. (See Appendix H and I for debriefing
procedures). Subjects were not allowed to leave until E1 was
satisfied that E had accepted his or her participation in the research
with equanimity.

Materials

State—Trait Anxiety Inventory. The STAI (Spielberger et al.,
1983) is a well-known instrument for measuring state and trait anxiety

with demonstrated construct and concurrent validity and high

 

41
reliability. The STAI was used to measure anticipated differences in
state anxiety between High and Low Impasse subject groups upon first
entering the experimental situation and at two points upon completion
of the treatment. Difference scores between pre- and post-treatment
measures of anxiety for all groups were measured, under the assunption
that the High Impasse/HPC group would show the greatest reduction in
anxiety. Although difference scores between any two occasions contain
the error components of both initial and final scores, making
difference scores less reliable, the use of an initially highly
reliable test provides a credible rationale for the use of difference
scores.

The STAI A-state scale assesses qualities of tension, worry, and
apprehension. In developing the A-state scale, it was found that
feelings of anxiety were highly correlated with the absence of
feelings of calmness, content, and the like (Spielberger, Lushene, &
McAdoo, 1977). The most recently developed form of the test
(Spielberger et al., 1983), then, consists of ten anxiety-present and
ten anxiety—absent items. Anxiety-present items include statements
such as "I am tense" or "I feel strained," which are rated by the
subject on a continuum from 1 to 4. Anxiety-absent items include
statements such as "I feel content" and "I feel comfortable," also
rated on a continuum of 1 to 4. Scoring weights for anxiety-absent
items are reversed, giving a range of a minimum of 20 and a maximum of
80 in state—anxiety scores. Low scores indicate states of serenity
and satisfaction, intermediate scores reflect moderate levels of

tension, and high scores indicate states of fearfulness verging on

42
panic (Spielberger, Lushene, & McAdoo, 1977). Recent factor analyses
of the A-state scale (Spielberger et al., 1983, p. 31) indicate that
anxiety-present and anxiety-absent items constitute two separate
factors.

Ceiling and baseline limitations on scores as an artifact of test
construction do not appear to be a prOblem under usual experimental
conditions, because the A—state scale allows a wide range of scores
and measures two factors -— contentment and anxiety. A minimum score
of 20 reflects not simply the absence of anxiety but a state of serene
contentment, whereas a maximum score of 80 measures not only the
existence of severe anxiety but the absence of any experience of
security and satisfaction. Neither extreme is likely to be
encountered in waking daily experience except under highly unusual
conditions.

In line with this perspective, Spielberger et al. (1983) report
means and standard deviations on the Arstate scale for a variety of
populations. Extremely high or low scores are very infrequently
attained. The mean A—state score attained in a normative sample of
855 college students tested under resting conditions was 36.47 for
males and 38.76 for females, with standard deviations, respectively,
at 10.02 and 11.95. Mean A—state scores earned in another normative
sample of 900 college students tested under resting and exam
conditions were 40.02 and 54.99 for males and 39.36 and 60.51 for
females, respectively. In a comparison of A—state scores in a
population of 197 undergraduate students tested in situations ranging

from relaxation-training to severe stress, mean scores varied,

43
respectively, from 32.7 to 50.03, with standard deviations ranging
from 9.02 to 12.48. The A—state scale has similarly shown sensitivity
in differentiating between varying diagnostic groups. In summary,
then, the A-state scale has proved to be an effective method for
detecting differences in reported anxiety across a range of scale
values. The majority of subjects can demonstrate either increase or
decrease in scores depending on experimental manipulations.

The Regressive Transference Scale. The Regressive Transference
Scale (Appendix J) was originally developed by LeBaron, Reyher, and
Hayes (LeBaron, Reyher, & Stack, 1985) at Michigan State University.
The scale was designed as an operational definition of regressive
transference and assesses the quality and intensity of positive and
negative feelings toward the practitioner involved with a client or
subject.

Since the scale was developed in order to infer the existence of
dependency strivings among subjects under particular conditions, the
validity of the scale can be established only by its ability to
differentiate subjects systematically according to their group
membership. Similarly, its reliability can be established only by
repeated replication of such differentiation in similar studies. In
two experiments, the scale has shown significant differences between
subject groups hypothesized to vary in dependency strivings toward the
experimenter according to experimental group membership (Hayes, 1982;
LeBaron, Reyher, & Stack, 1985).

In this study, the Regressive Transference Scale was expanded to

include three dimensions: (a) nurturance, (b) competence, and

 

 

44
(c) hypnotic regression. High scores were assigned to comnents which
suggested dependency and attributions of competence to the hypnotist.
Low scores were assigned to overtly critical comments about the
hypnotist or the experiment, such as questioning the hypnotist’s
concern or credentials.

The attitude of the subject toward the hypnotist was measured at
two points during the experiment. Following hypnosis, the
experimenter asked the subject upon awakening, "How do you feel?" The
subject’s spontaneous comments were transcribed from audiotapes of the
session and were scored according to the Regressive Transference
Scale. This index was designed to serve as a manipulation check
regarding the role impact of the experimenters as well as a measure of
ongoing relatedness during the session. As Ericsson and.Simon (1980)
have shown, concurrent verbalizations can be a.more valid index of
subject response than verbal reports requested following a time delay.

The Regressive Transference Scale was also scored from written
responses to the "subjects’ Post-experimental Questionnaire"
administered during the final interview. The questionnaire inquired
regarding subjects’ feelings of safety or distress during the
experiment and subjects’ opinions regarding the competence of the
hypnotist.

Transference scores for both measures were computed for each
subject by assigning a rating to all statements made about the
experiment or the experimenter. Phrases that appeared to be
explanatory and unrelated to the experiment or experimenter were not

scored. A statement was defined simply as a complete sentence,

45
including autonomous declarative phrases (ellipsesl) beginning with a
capital letter and ending with a period. The ratings were summed and
divided by the total number of statements, giving a mean transference
score for each subject.

Dream.scales: Holt content gnd.defense scores. The Holt system
for scoring primary and secondary processes in imagistic material was
originally designed for use with the Rorschach. In this context,
Aronow and Reznikoff (1976) report that scores have adequate
reliability and validity, with content scales showing the most
reliability from the standpoint of statistical rObustness and
psychological meaningfulness. Holt (Holt & Havel, 1960) has argued 1 ,
that his scoring categories can be applied to any sample of visual “
imagery (p. 267). Reyher and his associates (Reyher & Smeltzer, 1968;
Wiseman & Reyher, 1973) have used aspects of the Holt system in
scoring visual imagery. They report inter—rater reliabilities ranging
from .94 to .99 with experienced scorers across a number of different
studies.

The content and defense variables of the Holt system are designed
to measure drive activation as indicated by the pictorial content of
response. Content variables include libidinal, aggressive, and
anxiety/guilt categories (Holt & Havel, 1960). Libidinal categories
include oral, anal, sexual, exhibitionistic-voyeuristic, homosexual,

and miscellaneous content. Aggressive content includes aggression

 

1ellipsis (noun): (1) the omission of a word or words necessary
to complete a sentence or expression; (2) a sudden jump from one
thought or subject to another without inclusion of logical
connectives. Doubleday Dictionary, Doubleday & 00., Garden City, NY:
1975.

46
toward the self and aggression toward others as distinct categories.
Aggression is further scored as happening in the past, present, or
future. The anxiety category is defined as the depiction of feelings
of utter helplessness in the face of impersonal or unspecified
dangers.

Defense variables are conceptualized as attempts on the subject’s
part to disguise expressed content which has come too close to
awareness. The defense scores which appeared most relevant to
hypnotic dream protocols gathered from an earlier study (Davé, 1979)
included remoteness and miscellaneous (mostly pathological) defenses.
The remote category was scored if imagery was distanced from the here
and now in time, place, person, or level of reality. The pathological
defense category comprised a multiplicity of defenses involving
cognitive and/or emotional reversal, such as denial, minimization,
evasion, undoing, and isolation.

In the 1970 revision of the scoring of primary process
manifestations, Holt (1970) discarded the anxiety category, placing
depictions of "nightmarish helplessness" in the category of aggression
directed toward the self. While there is certainly theoretical
justification for this revision, in the present study the anxiety
category was retained because of its special relevance to regressive
transference. The portrayal of a situation of helplessness and
jeopardy in hypnotic dreams, along with the corresponding inhibition
of aggression, imply both trust in the hypnotist and implicit
strivings for protection on the subject’s part, which index regressive

transference. Holt’s definition of the anxiety category as placing

 

 

47
special emphasis on helplessness in a situation of impersonal danger
was also retained, and additional examples were generated for
inclusion in the scoring. These additional examples are included in
Appendix K.
Holt (1970) defined the "miscellaneous" libidinal category as a
collection of infrequent responses which were libidinally tinged,

H H

including, for example, "eggs, embryos," and "urination." For
purposes of the study, the miscellaneous category was confined to
content having to do with birth and youth, including embryos, infants
or baby animals, eggs, young things organically growing, the self as a
child, rebirth, or resurrection. Previous research (Reyher, 1980) has
suggested that the portrayal of youth in hypnotic dreams may index
regression, providing an indirect statement of the subject’s feeling
in relation to the hypnotist. Accordingly, the miscellaneous category
was renamed the dependency category for use in the study.

In all other respects, Holt’s (1970) revised manual was followed
in scoring hypnotic dream material. The six libidinal categories were
scored separately and were then combined into one "libidinal score"
for purposes of analysis. Holt’s three types of aggressive content
(subject, object, and time of activity) were collapsed into two scores
reflecting either aggression expressed by the subject (subject
category) or aggression expressed toward the sUbject (Object
category). Scores in the Anxiety Category were tallied separately.

Remote and pathological scales were scored separately and were then

combined to form one overall "defense score."

48

Drive scores were assigned to each visual episode in the dream
narrative when appropriate. A visual episode was defined as a change
in persons, objects, setting, and/or activity. Each drive-laden
content item was weighted depending on whether it fell in Level 1 (two
points) or Level 2 (one point) categories. Each defensive content
item was scored as either present (one point) or absent (zero points).
Length of dreams was recorded in terms of total number of visual
episodes in the dream. Scores in libidinal, aggression, anxiety, and
defense categories were divided by the total number of visual episodes
portrayed in order to obtain mean scores on each scale for each
subject. A summary score for total regression in hypnotic dreams was
obtained by adding the mean scores in libidinal, Object aggression,
anxiety, and defense categories. The subject aggression category was
not included in the total regression score because predictions for the
subject aggression category ran counter to hypotheses made for the

other content categories.

 

RESULTS

Evaluation of Hypotheses

Hypotheses regarding one treatment cell were tested by a weighted
means analysis comparing the mean of that cell with all other
treatment means. Differences between the mean scores were evaluated
by calculating the mean square of the difference divided by the error
mean square for the whole group, giving an F-ratio (Keppel, 1982, pp.
112-114, 209). Hypotheses regarding High and Low Impasse groups were
tested by a weighted-means analysis comparing the means of each
treatment group, equivalent to the F-ratio for subgroups of the 2 x 2
analysis of variance. All tests were two—tailed, and a prObability
level of p (.05 was adopted for determining significance of results.
Additionally, an over—all 2 x 2 analysis of variance was conducted for
each variable. Any significant findings not predicted by hypothesis
are reported following the description of results for the hypothesis
in question. Tables for all analyses of variance conducted are
located in Appendix M.

With the exception of the State-Trait Anxiety Index, dependent
variables were based on ratings of interview and projective material.
For varying reasons, distribution of scores on these variables were
often mildly to markedly skewed, violating the normality assumption
underlying the F—test. However, Norton’s (cited in Keppel, 1982, p.
86, and Lindquist, 1953, pp. 79-91) Monte Carlo experiments have

49

I ‘l
f, L,

50
demonstrated that the F-ratio is insensitive to non-normality if
within-group distributions are homogeneous in form and within-group
variances are homogeneous. Consequently, frequency distributions for
all of the treatment groups on each dependent variable were graphed
and examined for homogeneity of form. Within-group variances across
treatment groups were compared by means of Hartley’s test (Winer,
1971, p. 206). If distributions were homogeneous in form and
variance, the data was analyzed within the analysis of variance format
without adjustments. For heterogeneity in form or variance, Norton
(cited in Lindquist, 1953, pp. 83-87) has provided tables estimating
the probable percentage of error in the F-ratio. Under these
conditions, the probability level required for significance was
adjusted to accommodate percentage of error.
Scale Reliabilities

All scale ratings were made independently by two advanced
undergraduate students trained.by E1. The raters were blind to the
hypotheses of the study and the group membership of subjects. Inter-
rater reliability scores were calculated by a Pearson correlation
coefficient.

Ratings for the Problem-solving Scale were based on subjects’
responses to a structured telephone interview made one week following
the experimental session by the experimenter who had conducted the
session. The inter—rater reliability was .94 (p (.001.)

Scores for the Regressive Transference Scale were based on two
sets of data. Inter-rater reliability for Regressive Transference

Scale 1, based on subjects’ spontaneous comments upon awakening from

.
5?

I"

51
hypnosis, was .98 (p (.001). Inter-rater reliability for Regressive
Transference Scale 2, based on written responses to the subject’s
Post—experimental Questionnaire, was also .98 (p (.001).

Reliability coefficients were calculated for 15 content and
defense scales on the Holt, including summary scores in libidinal and
defense categories. Inter—rater reliabilities are given in Table 1.
Scoring of the visual episodes in dream protocols was done by El. In
order to estimate the reliability of visual episode units, 36
protocols, including nine from each treatment group, were randomly
selected and scored by a second rater. The inter—rater reliability
for visual episodes was .95 (p (.001).

All inter-rater reliability scores were above .86. The research
scales used in the study appear to allow reliable differentiation
among subjects. For purposes of analysis, rater scores were averaged,
giving one score per subject.

Manipulation Checks

Three preliminary tests were made to verify assumptions of the
experimental design. These assumptions relate to subject motivation
and experimenter role behavior.

Subject motivation. It was assumed that Low Impasse subjects
recruited from introductory psychology classes would choose to
participate in the study primarily out of interest in hypnosis. High
Impasse subjects, on the contrary, were expected to be motivated by
their need for help in solving a problem. When initial contact was
made between subjects and E1, E was asked, "What about the study

interested you?” Answers were classified into three groups:

52
Table 1

Reliability Scores for Holt Content Categories

 

 

 

Scale categogy Inter-scorer reliability
Libidinal
Oral .97‘
Anal .953
Sexual °90*
Exhibitionism .97*
Homosexuality .94‘
Dependency .90*
Total .95*
Anxiety .86‘
Aggression
Against others .95*
Against the self .93‘
Defense
Remoteness .97‘
Pathological .94*
Total .973
Total Regression .97‘
*p (.001

 

53
(1) interest in hypnosis, (2) desire to solve a pressing problem, or

(3) both. Among High Impasse subjects, 27 mentioned only the need to

solve a personal prOblem, and 17 mentioned both interest in hypnosis
and desire to solve a problem. Among Low Impasse subjects, all 44
indicated only an interest in hypnosis. Data were arranged in a 2 x 3
contingency table. A chi-square test indicated that High and Low
Impasse groups differed significantly in their response to the
interview question, with X2(2,88) = 88, p (.001.

Experimenter role behavior. Results of analyses from
ratings of experimenter role behavior and from time spent talking with
subjects indicated that data from both experimenters could be combined
and the experimental hypotheses tested within a 2 x 2 factorial
format.

Two pairs of simulating subjects blind to the hypotheses of the
study originally provided ratings of the role behavior of the
experimenters in both LPC and HPC conditions. Raters 1 and 3 observed
E2 in the HPC condition and E3 in the LPC condition. Raters 2 and 4
observed E2 in the LPC condition and E3 in the HPC condition.

However, Rater 3 became hypnotized and had to be dropped fromrthe
study. Comments made by this rater indicated an enthusiasm for
hypnosis and an involvement in the simulated problem brought to the
experiment which made objective observation impossible. Since
obtaining inter-rater reliability scores requires pairs of observers,
data provided by Rater 4 also could not be used. Inter-rater
reliability scores, then, were based on ratings made by Raters 1 and 2

during the sixth week of the experiment.

 

54

Ratings were based on four scales which asked the observer to
estimate the degree of status, warmth, competence, and credibility
demonstrated by the experhmenter in role. Each scale ranged from
0 - 15 points, giving a maximum total of 60 points for the four scales
combined. Each rater produced eight scale scores across experimental
conditions. The scores of Rater 1 and Rater 2 were compared by means
of a Pearson correlation coefficient. Overall inter-rater reliability
was .78 (p (.05). Ratings of experimenter role performance are shown
in Table 2.

In order to determine if the experimenters were demonstrating
significantly different role behaviors across conditions, the eight
scale scores given by raters within each condition were averaged and
their means compared. The mean score for experimenters in the LPC
condition was 9.38 (maximum scale score = 15), with standard deviation
at 1.83. The mean score for experimenters in the HPC condition was
12.75, and the standard deviation was 1.39. A one-tailed test
resulted in a 3(6) score of 5.46, p (.005, indicating that the
experimenters were performing according to their assigned roles.

Experimenter role behavior was also monitored by comparing the
time subjects spent talking with the experimenter in each condition.
The length of each interview in minutes was Obtained from audiotape
recordings of sessions. The means for Low and High Impasse groups in
the LPC condition were 5.41 and 6.14 minutes, respectively. The means
for Low and High Impasse groups in the HPC condition were 13.09 and
13.55 minutes respectively. A 2 x 2 fixed factor analysis of variance

showed a large condition effect with F(1,84) = 59.40, p (.001.

B 12:

Table 2

55

Ratiegs of Experimenter Role Performance

 

 

 

 

Experipegters
Condition _Eeele EE EE
Rater 1 Rater 2 Averege
HPC Status 11 13
warmth 13 13
Competence 15 14
Credibility 11 12
Sum 50 52
Mean 12.5 13 12.75
Rater 2 Rater 1
LPC Status 9 9
Warmth 10 11
Competence 8 10
Credibility 10 8
Sum 37 38
Mean 9.25 9.5 9.38

 

56
Contribution of subgroup membership (High or Low Impasse) to the
overall variance was minimal, with F (1,84) = .36, p = NS (See Table
3, Appendix M). Results show that the experimenters were encouraging
High Impasse subjects in conversation while effectively limiting the
interview with Low Impasse subjects.
Preliminery Analyses: Age Differences

Age differences between High and Low Impasse groups could not be
controlled during the experiment and presented a challenge in
analyzing the data. Age differences between Low (M = 19.32 years) and
High (M = 23.23 years) Impasse subjects were highly significant, with
3(86) 2 5.40, p (.005. The Pearson correlation coefficient of age
with impasse as a factor was .44, p (.001 (biserial r = .63, p (.005).
Results indicated that age was potentially confounded with impasse,
obscuring interpretation of 2 x 2 factorial tests.

Generation of a correlation matrix for all variables indicated
that age was significantly (p (.03) correlated with four dependent
variables, including the Regressive Transference Scale 2 and three of
the Holt indices. These four variables were subjected to a partial
correlation procedure. Results are displayed in Table 4. With
factors of both subgroup and condition controlled, age was still
correlated with the Regressive Transference Scale 2, r = -.30 (p
(.003) and with the Total Defense Scale on the Holt, r = .19 (p
(.036). Results suggested that age might constitute a third factor
affecting these two dependent variables.

As a precaution, data from the Regressive Transference Scale 2

and Total Defense Scale on the Holt was first analyzed by means of a

 

Table 4

57

Correlations and Partial Correlations with Age

 

e with
Regressive Transference Scale 2
Holt Anxiety Scale
Holt Total Defense Scale

Holt Total Regression Scale

Age with

Regressive Transference Scale 2
Holt Anxiety Scale
Holt Total Defense Scale

Holt Total Regression Scale

Age with

Regressive Transference Scale 2
Holt Anxiety Scale
Holt Total Defense Scale

Holt Total Regression Scale

e with

Regressive Transference Scale 2
Holt Anxiety Scale
Holt Total Defense Scale

Holt Total Regression Scale

Zero-order Partial

 

 

E
—.3746 .001
.1997 .031
.3218 .001
.2249 .018
—.2887 .003
.1443 .091
.2043 .029
.0701 .259
Controllingifor Condition
-.3822 .001
.1984 .033
.3153 .001
.2143 .023
Controlling for Both
—.2970 .003
.1427 .095
.1943 .036
.0509 .321

 

in:

58

three-way analysis of variance to determine whether or not age was
a significant factor influencing results. Factors included
subgroup, condition, and age. Subjects were divided into High and
Low age groups. The High age group was defined as those subjects
with age above the total group mode (20 years) plus one-half the
mode. The Low age group was defined as subjects with age below
the mode plus one-half the mode. Scores in the modal category
were randomly assigned in pairs to High and Low age groups.

Before random assignment, modal scores were paired, highest with
lowest, to avoid chance build-up of high or low modal scores in
any one treatment group. This manner of assignment of subjects to
groups appeared to be the only way of insuring a sufficient number
of subjects in each cell. Division at the total group mean
(21.27), mode (20.00), or median (19.88) left either empty cells
or cells containing only two subjects. With the modal category
divided, cells contained unequal numbers, but there were enough
subjects per cell to provide an estimate of within-group variance.
Number of subjects per cell based on age assignment for these

variables is displayed in Table 5.

 

59
Table 5

Subjects per Cell in Three—way Factorial Desigp

 

 

Condition (Factor A)

 

 

Subgroup (Factor B) LPC HPC
Age Age
Low High Egg High
Low Impasse 17 5 18 4
High Impasse 6 16 5 17

 

Self-report Indices

Hypothesis 1: Regressive Transference Scales lgepd 2
Results failed to provide support for the hypothesis that High Impasse
subjects paired with a hypnotist demonstrating high protective
competence view the hypnotist as more powerful and reassuring than
other experimental groups. Instead, the data show marked differences
between face-to-face and written evaluations of the experimenter and
an unexpected partial reversal of the hypothesis.

Face-to-face interaction: Regressive Transference Scale 1.
Scores on the Regressive Transference Scale 1 were moderately skewed
to the left. Frequency distributions for all groups were homologous,

however, and within—group variances were homogeneous. Total E on the

 

60
Regressive Transference Scale 1 was 80, with 20 subjects per cell.2
Negative numbers on the scale were eliminated by adding +4 to each
score, giving the scale a range of 0-8 points.

Data failed to confirm the hypothesis that High Impasse subjects
in the HPC condition view the hypnotist as being more powerful and
more reassuring than all other experimental groups. A weightedrmeans
comparison of the mean for High Impasse subjects in the HPC condition
with the combined means of all other treatment groups resulted in
F(1,84) = .09, p = NS. The mean score for High Impasse subjects in
the HPC condition was 5.43. The mean score for all other treatment
groups combined was 5.35. The mean square for the comparison was .10,
with the error mean square at 1.13.

Written evaluation: Regressive Transference Scale 2. Data from
the Regressive Transference Scale 2 was analyzed by a three-factor
least squares regression analysis of variance. Negative numbers on
the scale were eliminated by adding +4 to each score, with scale range
from 0 - 8 points. None of the F-tests for main effects or
interaction were significant (see Table 7, Appendix M). Since age did
not appear to be of consequence in the analysis, the three-way design
was collapsed to a 2 x 2 factorial table with equal numbers of

subjects in each cell.

 

2Data for seven subjects was lost due to the theft of audiotapes
from a storage locker before transcription was complete. Fortunately,
the loss was distributed equally among experimental groups, with two
subjects missing from three cells and one subject from the fourth. An
additional subject was dropped at random from the fourth cell to
provide equal numbers of subjects in each experimental group.

61

Results of the analysis did not support the hypothesis that High
Impasse subjects in the HPC condition view the hypnotist as being more
powerful and reassuring than do other experimental groups. A
weighted-means comparison between scores of High Impasse subjects in
the HPC condition and the combined scores of all other treatment
groups gave an F(1,84) ratio of .47, p = NS. The mean of the High
Impasse group in the HPC condition was 4.69. The mean for all other
treatment groups combined was 4.82. The mean square for the
comparison was .35, and the error mean square was .76.

Additional findinge. A 2 x 2 analysis of variance of scores on
the Regressive Transference Scale 1 showed no significant F-ratios for
condition, subgroup, or interaction effects (see Table 6, Appendix M).
Mean scores for all four groups fell between 5.22 and 5.62 points,
with standard deviations ranging from .94 to 1.19. In face—to-face
interaction, then, there were no significant differences among
treatment groups in their verbal response to the hypnotist immediately
following hypnosis.

In contrast, a 2 x 2 analysis of variance of scores on the
Regressive Transference Scale 2 revealed a highly significant main
effect for subgroup, with F(1,84) = 7.58, p (.007, in a direction
which partially reversed the hypothesis. Means for Low Impasse
subjects in LPC and HPC conditions, respectively, were 5.06 and 5.02,
with standard deviations at .89 and .59. Means for High Impasse
subjects in LPC and HPC conditions were, respectively, 4.37 and 4.69,
with standard deviations at .92 and 1.02 (see Table 8, Appendix M).

High Impasse subjects across conditions, then, were significantly more

62
critical of the experimenter in written evaluations following hypnosis
than were Low Impasse subjects.

An inspection of the mean scores indicates that the High Impasse
group in the LPC condition produced the lowest average score. A
weighted means comparison of scores of High Impasse subjects in the
LPC condition with the combined scores of all other treatment groups
gave an F—ratio of 6.65, significant at the .025 prObability level.
High Impasse subjects in the LPC condition, then, were the pee;
critical of the experimenter among all treatment groups in written
evaluations following hypnosis.

The discrepancy between findings on the Regressive Transference
Scales 1 and 2 suggests that in face-to-face interaction with the
experimenter, the desire to please and conform takes precedence. Out
of sight of the experimenter, suppressed negative feelings may emerge.
That the High Impasse group was most subject to such reversal in
feeling, however, was a striking and unexpected finding. The behavior
of High and Low Impasse groups in varying conditions on other
experimental measures may provide a context for interpretation.
Hypothesis 2: Problem-Solving Scale

Results did not support the hypothesis that High Impasse subjects
in the HPC condition report greater success in problem-solving than
all other groups. Rather, a weighted-means analysis showed no
significant differences between comparison groups in reports of
successful prOblem-solving.

Frequency distributions for each treatment population on the

Problem-Solving Scale were skewed to the left, but distributions were

 

63
homologous, and within-group variances were homogeneous. In order to
eliminate negative numbers, +1 was added to each score, giving the
scale a range of 0 - 4 points. The mean for the High Impasse group in
the HPC condition was 2.89, and the mean for all other treatment
groups combined was 2.55. The mean—square for the comparison was
1.87, and the error term was 1.33. The resulting F(1,84) ratio was
1.40, p = NS.
Hypothesis 3: The State—Trait Anxiety Index

The hypothesis that High Impasse subjects in the HPC condition
report greater relief from anxiety following experimental treatment
than all other experimental groups was not supported by the data.
Instead, treatment groups expressed equal relief immediately following
hypnosis. After a two-week interval, High Impasse subjects across
conditions showed significantly leee reduction in anxiety relative to
initial anxiety scores than did Low Impasse subjects, an unexpected
finding.

The State Anxiety Index was administered immediately following
the first four questions of the initial interview (STAII), immediately
following hypnosis (STAIZ), and two weeks later before the debriefing
session (STAIB). Subjects were asked to complete the Trait Anxiety
Index only during the first administration. On the State Anxiety
indices, subjects were asked to rate each time how they felt now about
the problem brought to the experiment.

Trait and state anxiety as measured by the STAI are highly
correlated (Spielberger, Lushene, & McAdoo, 1977), and persons who are

characterologically disposed to experience anxiety report greater

64
changes in state anxiety when in ego-threatening situations than do
others (Endler,1981). Initial differences in trait anxiety, then,
could constitute a subject factor necessitating a within-subjects
design. However, a 2 x 2 analysis of variance of Trait Anxiety scores
with F(1,84) showed no significant differences between treatment
groups and no significant interaction terms (see Table 10, Appendix
M). There did not appear to be any loading of unusually anxious
subjects in one treatment cell, and there was no appreciable effect of
treatments on scores. The absence of significant differences between
treatment groups indicates that subjects were reasonably equated in
Trait Anxiety, so that state anxiety and difference scores could be
analyzed by means of a two-factorial between—groups analysis of
variance.

The initial State Anxiety Index was given to allow before and
after treatment comparisons and to determine whether subjects self-
selected as at impasse did in fact characterize themselves as
initially more anxious regarding their problem than did student
volunteers. Means for all groups on the STAIl ranged between 45.27
and 46.93, with standard deviations between 11.59 and 14.55. An
F(1,84) test showed no significant differences between treatment
populations and no significant interaction terms (see Table 11,
Appendix M). There was no relationship, then, between self-defined
impasse and level of anxiety on the STAII. Self-report indices of
anxiety may not measure adequately the notion of being "at impasse,"
defined operationally in this study by active help-seeking behavior in

the absence of external reward.

J

65

Because there were no significant effects of experimental
treatments on initial State Anxiety scores, the STAI1 was included as
a covariate in the analysis of difference scores. The covariate
adjustment provides a way of correcting final means for initial
differences (McNemar, 1979, p. 428) and is a defensible procedure when
it is known that the experimental treatments have not influenced the
covariate (Keppel, 1982, p. 492). For planned comparisons, treatment
means were adjusted for differences among the means on the covariate.
The adjusted mean-square for the comparison was tested over the
adjusted mean-square for error (Keppel, 1982, p. 500-502; Winer,
1971, p. 779).

Difference scores between initial and later administrations of
the State Anxiety Index were computed as a measure of net change
(McNemar, 1979, pp. 96—98). STAIZ scores were subtracted from STAll
scores, giving a measure of relief from distress immediately following
hypnosis. STAI3 scores were subtracted from STAIl scores as an
indication of longer lasting relief. Since STAll scores fell in the
moderate range, ceiling and baseline effects were not expected to
influence results.

Mean scores on STAIl, STAIZ, and STAI3 for each treatment
population are presented in Table 12. Results are shown graphically
in Figure 1. As demonstrated by Figure 1, all groups showed a pattern
of immediate relief from distress after contact with the hypnotist,
followed by increase in anxiety over time. The pattern is very

similar to results Obtained by Frank (1974) in a study of the reported

66

 

 

 

 

 

 

 

Sfi- CK
45- \
l
7‘. \
\ \ H/HPC
4¢- H LPC
\ \ ' /
\ \
m L/LPC
m 35— \ \ / ,0
8 \ z
‘” \
\ ’ /,x L/HPC
3¢- \ ‘ //
V’/
25-
STAI1 STAIE STAI3
TEST
Figure 1
STAI at Different Times of Administration
Table 12
Mean STAI Scores Across Time Intervals
Group
H/LPC L/LPC H/HPC L/HPC
Test
STAI1 44.55 49.32 46.59 43.95
STAI2 32.28 31.18 31.36 27.41
STAI3 38.41 35.77 39.64 32.96

 

 

“JV.

67
relief of anxiety over time following administration of a drug placebo
to psychiatric outpatients.

Level of anxiety immediately followipg hypnosis. Contrary to

 

hypothesis, High Impasse subjects in the HPC condition did not
demonstrate more relief from anxiety following hypnosis than did all
other groups. A weighted-means comparison of the adjusted mean score
for the High Impasse group in the HPC condition versus the adjusted
mean of all other groups combined resulted in F(1,83) = .05, p = NS.
The adjusted mean difference score for High Impasse subjects in the
HPC condition was 14.83, and the adjusted mean difference score for
all other groups combined was 14.42. The mean—square for the
comparison was 2.72, and the adjusted mean-square for error was
57.21.

Level of anxiepy two-weeks following hypngeie. Similarly,
results did not support the hypothesis that High Impasse subjects in
the HPC condition demonstrate more relief from anxiety two-weeks
following hypnosis than do all other groups. The F—test for a
weighted-means comparison of adjusted.mean difference scores for High
Impasse subjects in the HPC condition versus all other treatment
groups combined gave F(1,83) = .89, p = NS. The adjusted mean for
High Impasse subjects in the HPC condition was 6.59. The adjusted
mean for all other groups combined was 9.20. The mean-square for the
comparison was 112.43, and the adjusted.mean—square for error was
125.87.

Additional findinge. A 2 x 2 analysis of covariance of

 

difference scores between first and second administration of the State

 

68
Anxiety Index showed no significant differences between treatment
populations and no significant interaction term (see Table 13,
Appendix M). After a two-week interval, however, there was a
significant main effect for subgroup, with F(1,84) = 6.18, p (.02, in
a direction which partially reversed the hypothesis (see Table 14,
Appendix M). Mean difference scores for Low Impasse subjects in LPC
and HPC conditions, respectively, were 13.55 and 13.00 points. Mean
difference scores for High Impasse subjects in LPC and HPC conditions,
respectively, were 6.14 and 6.95 points. High Impasse subjects across
conditions, then, showed.lee§ reduction in anxiety following treatment
relative to initial anxiety scores than did Low Impasse subjects.

The latter finding parallels results for the High Impasse group
on the Regressive Transference Scale 2. On self-report measures two
weeks following the experiment, High Impasse groups reported
significantly more criticism of the experimenter and more anxiety
about their problem than did Low Impasse subjects.

Regression in Hypnotic Dreams

A cursory inspection of the hypnotic dreams of Low and High
Impasse subjects demonstrates clear differences between the samples in
amount of primary process activity in dreams. A few characteristic
examples from each group will illustrate these differences. The
following dreams are from Low Impasse subjects:

1. Female, age 20, Dream 2

I’m showing at a fashion show. It has all my clothes in it

that I just designed. I’m really proud. All the models

are showing my outfits. People are looking up to me.
They think I am successful, beautiful, intelligent.

m}

69
2. Male, age 20, Dream 2

I can see myself struggling hard with my schoolwork. I feel
very frustrated about it. I almost quit and give up. It
just seems that if I did, it would be the answer to what I
feel so frustrated about. But I don’t want to quit. Then

I finally work through it. I have a career or some type of
job that doesn’t need math skills. I can do very well at
it, but I think that this is not really true, it is just

my imagination. I think that no matter what I want to do,
that I won’t be able to do it because I’m.having a hard

time doing well in school and on tests.

In contrast, the following dreams are from High Impasse subjects:
1. Male, age 23, Dream 2

I saw a tower growing very fast like clay, playdough. It just
went zoom through space... climbing at phenomenal speed...I cut
it, but it still kept growing. Then it arc-ed around, came back
down to the earth, hit the earth, and took off another way,
straight out. I rode it like a snake or a horse, and I just kept
zooming. I hit a planet very hard, and...I went into the heart of
the planet. I wanted to become a sun...

2. Female, age 35, Dream 3
It was a jet plane flying in the sky. I was outside of the jet
plane watching it objectively. The plane was completely filled
with people, all different people...each with their own life. I
was outside of the plane, but I was also part of all those
people. The plane was flying along, and it exploded. Everything
in it exploded into tiny little pieces. And I was outside the
plane and I was all the people. There was nothing left, just
little bits. I felt it both from the outside and from the inside.
I wondered as I watched it, if I still exist. And I did.
Of course, there were also individual differences within each
sample. Some Low Impasse subjects brought in prOblems which were
anxiety—provoking for them and produced complex dreams. Some High
Impasse subjects struggled with the dream process and remained on the
surface.
The Holt scales were devised as measures of regression in

hypnotic dreams which might capture differences between and allow

comparisons among treatment groups. Scores in content and.defense

r-v'
I0

70
categories on the Holt were tallied and divided by the total number of
visual episodes in the hypnotic dream, giving an average score for
each content category per visual episode for each subject. Since all
scores were adjusted for length of the hypnotic dream and were
expressed as a function of the same unit (the visual episode), scores
on the Holt are comparable across categories. Category and scale
scores have been multiplied by ten to facilitate interpretation during
statistical analyses. Results for hypotheses related to each scale on
the Holt are presented in order, following a brief description of the
scale.

The Total Libidinal Scale

 

Libidinal scores in each of the six content categories were
tallied and divided by the number of visual episodes in the hypnotic
dream, giving an average score for each libidinal category per visual
episode. A given content could not be scored twice, for example, as
both sexual and exhibitionistic, but had to fall into one or the other
libidinal category. The Total Libidinal Scale score was the sum of
the average scores in each of the six categories, otherwise referred
to as subscales. The range of obtained scores on the Total Libidinal
Scale was 0 — 7.35 points. Scores on the Total Libidinal Scale were
mildly skewed to the right. However, distributions for all groups
were homogeneous in form and variance. Pearson correlations of each
of the subscales with the Total Libidinal Scale are presented in Table
15. Very few responses were obtained in anal and homosexual

categories.

71

Table 15

Correlation of Libidinal Subscales with Total Libidinal Scale

 

Subscale E P
Oral .5361 .001*
Anal .0864 .212
Sexual .4535 .001‘
Exhibitionistic/Voyeuristic .6699 .001*
Homosexual .1679 .059
Dependency .3580 .001‘

 

*significant p

Hypothesis 4a: High versus Low Impasse Groups on the Total Libidinal
$9.112

Scores on the Total Libidinal Scale of the Holt did not support
the hypothesis that High Impasse subjects demonstrate more libidinal
expression in hypnotic dreams than do Low Impasse subjects. A
weighted-means comparison between High and Low Impasse groups on the
Total Libidinal Scale resulted in an F(1,84) ratio of .02, p = NS.
Means for the Low and High Impasse subgroups, respectively, were 2.29
and 2.35. The mean-square for the comparison was .08, and the mean-
square for error was 4.00 (see Table 22, Appendix M).
Hypothesis 5a: High Impasse subjects in the HPC Condition on the
Total Libidinal Scale

Contrary to hypothesis, there was no evidence on the Total

Libidinal Scale that High Impasse subjects in the HPC condition show

72

more libidinal expression in hypnotic dreams than do all other
treatment groups. The F(1,84) ratio resulting from.a weighted-means
comparison between the High Impassse group in the HPC condition and
all other treatment groups combined was 2.47, p = NS. The means for
the High Impasse group in the HPC condition and for all other groups
combined were, respectively, 2.90 and 2.13. The mean-square for the
comparison was 9.87, with the error term at 4.00.

Other findinge. To determine whether there were differences
among treatment groups in type of libidinal content expressed in
dreams, a 2 x 2 analysis of variance was conducted for each subscale.
Libidinal subscales included oral, anal, sexual, exhibitionistic-
voyeuristic, homosexual, and dependency categories. The range of
obtained scores on subscales was from 0 - 5.82 points. Frequency
distributions for all subscales were skewed to the right. Oral,
sexual, and exhibitionistic—voyeuristic subscales were homogeneous in
form and within-group variances. Anal, homosexual, and dependency
subscales demonstrated heterogeneity in form and.within-group
variances. Following Norton (cited in Lindquist, 1953, p. 83-87),
where forms and variances were heterogeneous, the prObability level
required for significance at p (.05 was set at .03 to allow for a two—
percent error in estimation.

Results showed no significant differences among groups for five
of the six libidinal subscales (see Tables 16 - 21, Appendix M). For
the Dependency Subscale, however, the analysis of variance found a
significant subgroup and condition interaction, with F(1,84) = 6.84,

p (.001. The main effect for condition was also significant, with

73
F(1,84) : 5.73, p (.019 (see Table 21, Appendix M). An examination of
the means revealed that the condition effect was due primarily to the
high mean score produced by High Impasse subjects in the HPC
condition.

A.weighted—means comparison between scores of High Impasse
subjects in the HPC condition and the combined scores of all other
treatment groups was conducted. The prObability level of .05 was
reduced to .03 to compensate for heterogeneity of within-group
variance. The resulting F(1,84) ratio was 15.22, p (.001, exceeding
the required significance level. The mean for High Impasse subjects
in the HPC condition was .57, and the mean for all other groups
combined was .09. The mean-square for the comparison was 4.30, with
the mean—square for error at .28. High Impasse subjects in the HPC
condition produced significantly more imagery related to youth than
did all other groups.

Only fourteen subjects (16%) out of the total sample produced
imagery scorable in the dependency category. Eleven of these subjects
were in the HPC condition, and nine of these were High Impasse
subjects in the HPC condition. Given the infrequency of youth imagery
in the sample as a whole, results are rather striking and warrant
examples. Among High Impasse subjects, imagery scored as related to
youth included, among others, the following excerpts:

I saw a large brown eagle, fierce—looking, strong...It

landed in a nest. Lifted its wings up, as if it was

feeding its young.

I’m in (a friend’s) office, playing with a little baby...

I started to play with the baby with the crayons. The baby
is drawing on the paper, seated on the floor...

74

A big strong wind, like a hurricane...It’s a southern,

tropic scene, like southern Alabama or the Florida coast.

I was in a hurricane there once when I was small.

A deer walked in, a little fawn with spots. The mother

deer came, and she took him away, because my dog was

barking.

Hypnotic dream images suggest a reactivation of affectively-toned
remembrances of childhood which constitute regressive transference.
The Total Defense Scale

Remote and pathological defense scores were tallied separately
and divided by the total number of visual episodes in the hypnotic
dream, giving an average score per defense category per visual
episode. The Total Defense Scale score was the sum of the average
scores in each defense category. The Remote Subscale (r = .89,

p (.001) and the Pathological Defense Subscale (r = .84, p (.001) were
correlated almost equally with Total Defense Scale scores. The range
of obtained scores on the Total Defense Scale was 0 - 15.23.
Distributions of scores on the Total Defense Score were moderately
skewed to the right. Form of the distributions was homologous, but
variances were heterogeneous. Therefore, the probability level
required for significance at p (.05 was set at .03 to allow for a two-
percent error in estimation.

Data from the Total Defense Scale was first analyzed by a three—
factor least squares regression analysis of variance in order to
determine the effect of agegroup on scores. The resulting F(1,80)
tests showed a significant main effect for subgroup but no significant

effects for agegroup, condition, or interaction terms (see Table 23,

Appendix M). Since age did not appear to be a factor in the analysis,

75

the three-way design was collapsed to a 2 x 2 factorial table with
equal numbers of subjects in each cell.
Hypothesis 4b: High versus Low Impasse Groups on the Total Defense
Seals

Scores on the Total Defense Scale confirmed the hypothesis that
High Impasse subjects show more defensive manifestations in hypnotic
dreams than do Low Impasse subjects. A weighted-means comparison
between High and Low Impasse subgroups resulted in a highly
significant F-ratio, with F(1,84) = 11.10, p (.001 (see Table 24,
Appendix M). Means for Low and High Impasse groups, respectively,
were 1.81 and 3.80. The mean—square for the comparison was 87.12, and
the error term was 7.85.

Hypothesis 5b: High Impasse subjects in the HPC Condition on the

 

Total Defense Scale

Data also supported the hypothesis that High Impasse subjects in
the HPC condition show more defensive manifestations in hypnotic
dreams than do all other treatment groups. A weighted—means analysis
comparing the scores of High Impasse subjects in the HPC condition
with the combined scores of all other treatment groups was performed.
The probability level of .05 was reduced to .03 to compensate for
heterogeneity of within-group variance. The resulting F(1,84) ratio
was 5.77, p (.025. The mean for Uhe High Impasse group in the HPC
condition was 4.04 points, and the mean for all other groups combined
was 2.39. The mean-square for the comparison was 45.32, with the

mean—square for error at 7.85. The hypothesis that High Impasse

76
subjects in the HPC condition show more defensive manifestations in
hypnotic dreams than all other groups was accepted.
The Anxiety Scale

The Anxiety Scale score was the sum of anxiety scores within a
protocol divided by the total number of visual episodes. The range of
obtained scores was 0 — 4.44. Scores were skewed to the right.
Although distributions were homologous, within-group variances were
heterogeneous. Accordingly, the prObability level required for
significance was adjusted to p (.03.
Hypothesis 40: High versus Low Impasse Groups on the Anxiety Scale

Results failed to confirm the hypotheses that High Impasse
subjects express more anxiety in hypnotic dreams than do Low Impasse
subjects. The F(1,84) ratio resulting from a weightedrmeans
comparison between High and Low Impasse subgroups was 2.30, p = NS
(see Table 25, Appendix M). Means for Low and.High Impasse groups,
respectively, were .34 and .60. The mean-square for the comparison
was 1.42, and the mean-square for error was .62.
Hypothesis 50: High Impasse subjects in the HPC Condition on the

Anxiety'Scale

 

Data did not support the hypothesis that High Impasse subjects in
the HPC condition express more anxiety in hypnotic dreams than do all
other treatment groups. A weightedrmeans comparison of High Impasse
subjects in the HPC condition with all other groups combined resulted
in F(1,84) = .002, p = NS. The mean for High Impasse subjects in the

HPC condition was .05. The mean for all other groups combined was

77
.04. The comparison mean—square was .001, and the error term was .62.
The Object Aggression Scale

Object aggression was scored if the subject portrayed victims of
active aggression in hypnotic dreams. These could include hurt,
unhappy, frightened, or dead persons and animals or damaged objects.
The scene is pictured from the standpoint of or emphasizing the
victim, indicating the subject’s identification with the injured one.
The Object Aggression Scale score was the sum of object aggression
scores within a protocol divided by the total number of visual
episodes. The range of obtained scores was 0 - 5.00. Scores on the
Object Aggression Scale were moderately skewed to the right. Within—
group variances were homogeneous, but frequency distributions for
treatment groups varied in form. The prObability level was adjusted
to p (.03 to compensate for heterogenity of form.
Hypothesis 4d: High versus Low Impasse Groups on the Object

Eggression Scale

 

Results provided support for the hypothesis that High Impasse
subjects express more aggression toward the self in hypnotic dreams
than do Low Impasse subjects. The F-test for a weighted-means
comparison between Low and High Impasse groups resulted in F(1,84) =
7.77, p (.007 (see Table 26, Appendix M). Means for Low and High
Impasse groups, respectively, were .70 and 1.43. The comparison mean-

square was 11.62, with the error mean-square at 1.50.

78

Hypothesis 5d: High Impasse Subjects in the HPC Condition on the
Objectiéggression Scale

Data also confirmed the hypothesis that High Impasse subjects in
the HPC condition express more aggression toward the self in hypnotic
dreams than do all other treatment groups. A weighted-means
comparison between High Impasse subjects in the HPC condition and all
other treatment groups combined was conducted. As before, a
probability level of .03 was adopted for evaluation of results. The
resulting F(1,84) ratio of 8.61, p (.01, exceeded the probability
level required for significance. The mean for the High Impasse group
in the HPC condition was 1.73. The mean for all other treatment
groups combined was .84. The mean-square for the comparison was
12.96, and the mean-square for error was 1.50. The hypothesis that
High Impasse subjects in the HPC condition show more aggression
directed toward the self in hypnotic dreams than do all other
treatment groups was accepted.

The Total Regression Scale

The Total Regression Scale score was the sum of Total Libidinal,
Total Defense, Anxiety, and Object Aggression Scale scores. Since
each scale score consisted of the average for that content category
per visual episode, the Total Regression scale score represented the
average overall regression index per visual episode. Correlations of
each scale with the Total Regression Scale were the following:
(1) Total Libidinal Scale, r : .48, p (.001; (2) Total Defense Scale,
r = .79, p (.001; (3) Anxiety Scale, r = .26, p (.007; and (4) Object

Aggression Scale, r = .42, p (.001. The range of obtained

79

scores on the Total Regression Scale was 0 - 18.2. Distributions for
treatment populations were mildly skewed to the right and were
homologous. Within-group variances fell below Hartley’s critical
region.
Hypothesis 4e: High versus Low Impasse Subjects on the Total
Eegression Scale

Results on the Total Regression Scale confirmed the hypothesis
that High Impasse subjects show more overall regression in hypnotic
dreams than do Low Impasse subjects. A weighted-means comparison
between High and Low Impasse groups gave a highly significant F-ratio,
with F(1,84) : 14.80, p (.001 (see Table 27, Appendix M). Means for
Low and High Impasse groups, respectively, were 5.14 and 8.17. The
mean-square for the comparison was 202.10, and the error mean-square
was 13.66.
Hypothesis 5e: High Impasse Subjects in the HPC Condition on the Total

Eegression Scale

 

Data also confirmed the hypothesis that High Impasse subjects in
the HPC condition show more overall regression than do all other
treatment groups. A.weighted—means contrast between the scores of
High Impasse subjects in the HPC condition and the combined scores of
subjects in all other groups gave an F(1,84) ratio of 13.97, p (.001.
The mean for High Impasse subjects in the HPC condition was 9.20. The
mean for all other groups combined was 5.80. The comparison mean-

square was 190.79, with the error mean-square at 13.66.

80

Additional findipge. Although a condition effect across
subgroups was not predicted, subjects in the HPC condition showed
significantly more overall regression than did subjects in the LPC
condition. A 2 x 2 analysis of variance revealed a significant main
effect for condition, with F(1,84) = 6.18, p (.015. Means for Low
Impasse subjects in LPC and HPC conditions, respectively, were 4.21
and 6.06, with standard deviations at 2.35 and 4.50. High Impasse
subjects in LPC and HPC conditions, respectively, attained mean scores
of 7.13 and 9.20, with standard deviations at 3.51 and 4.07. subjects
in the HPC condition, then, independent of initial motivation,
responded with deeper regression in hypnotic dreams to the hypnotist
in a clinical setting who played a protective and competent role.

Results demonstrate the effect of both crisis and condition on
extent of regression in hypnotic dreams among subjects. High Impasse
subjects self-defined as in crisis showed greater regression than Low
Impasse subjects across conditions. Within the High Impasse group,
subjects in the clinical (HPC) condition attained higher overall
regression scores than did all other treatment groups combined.
Student volunteers in the Low Impasse group who were not in crisis
nonetheless regressed more deeply in hypnotic dreams when presented
with a clinical rather than an experimental situation.

The Subject Aggpession Scale

 

Subject aggression, or aggression toward others, was scored if
the individual portrayed persons, animals, or things initiating or

completing an aggressive act in hypnotic dreams. The scene is

81
pictured from the standpoint of or emphasizing the aggressor,
indicating the subject’s identification with the aggressive one.

The subject Aggression Scale score was the sum of subject
aggression scores within a protocol divided by the total number of
visual episodes. The range of Obtained scores was 0 - 3.21. Scores
on the subject Aggression Scale were skewed to the right. Frequency
distributions for treatment groups were homologous, however, and
within—group variances were homogeneous.

Hypothesis 6: High Impasse Subjects in the LPC Condition and

Aggression toward Others in Hypnotic Dreams

 

Data did not support the hypothesis that High Impasse subjects in
the LPC condition show more aggression toward others in hypnotic
dreams than do all other groups. A weighted-means comparison of High
Impasse subjects in the LPC condition with all other groups combined
resulted in F(1,84) = .01, p = NS. The mean for High Impasse sUbjects
in the LPC condition was .04, and the mean for all other groups
combined was .06. The mean—square for the comparison was .007, with
the error mean—square at .68.

Hypothesis 7: High Impasse Subjects in the HPC Condition and
Aggression toward Others in Hypnotic Dreams

Results did not provide support for the hypothesis that High
Impasse subjects in the HPC condition show the least aggression toward
others in hypnotic dreams. The F-ratio for a weighted—means
comparison between High Impasse subjects and all other treatment
groups combined was .005, p = NS. The mean for the High Impasse group

in the HPC condition was .07, and the mean for all other treatment

82
groups combined was .05. The comparison mean square was .003, with
the error mean-square at .68.

Overall, there was no apparent relationship between the
frustration of dependency needs and the expression of aggression
toward others in hypnotic dreams. There were no significant
differences between comparison groups in the absolute amount of
aggression expressed toward others in hypnotic dreams.

Additional Analyses: eAge, Impasse, and the Regressive Transference

 

Scale 2

Because within-cell correlations of age with the Regressive
Transference Scale 2 were high and negative in three out of four
experimental cells, additional analyses probing the relationships
among age, impasse, and written evaluation of the experimenter were
performed. A two-way least squares regression analysis of variance
contrasting the factors of age and condition was conducted for Low and
High Impasse groups separately. Age groups were redefined by dividing
subjects into low and high samples at the mean age represented in each
Impasse subgroup. Among Low Impasse subjects, there were no
significant differences between treatment groups in scores on the
Regressive Transference Scale 2. Within the High Impasse group,
however, subjects older than 23 years were significantly'more critical
of the experimenter than were subjects younger than 23 years of age.
High Impasse subjects above 23 years of age in the LPC condition were
more critical than all other groups. A three-way least squares
regression analysis of variance comparing the factors of agegroup,

subgroup, and condition indicated that both subgroup membership and

83
age were significant determinants of scores on the Regressive
Transference Scale 2.

Despite the fact that agegroup did not appear to be a significant
factor influencing results in the entire sample, within-cell
correlations of age with the Regressive Transference Scale 2 were high
and negative in three out of the four experimental cells. The within-
cell correlations of age with the Regressive Transference Scale 2 are
presented in Table 29. From inspection of the table, age accounts for
between 12% to 25% of the within—cell variance of scores in all cells

except the Low Impasse group in the LPC condition.

Table 29

Within-cell Correlation of Age with the Regressive Transference

 

 

 

Scale 2
CONDITION
LPC HPC
I- r__ = .041 —_ E r -;---.474 E
R2 = .002 R2 = .225
10W p < .427 p < .013
E N = 22 g N = 22 E
IMPASSE :- .. i '
u u u
g r = -.497 g r = -.349 1
HIGH g R2 = .247 E R2 = .122 g
g p ( .009 g p = .056 E
E N = 22 E N = 22 E

 

84

It appeared that the need to divide age groups at the mode (age
20) in the whole sample reduced the probability of detecting the
effect of age on Regressive Transference Scale 2 scores within each
Impasse subgroup. High and Low Impasse groups differed.in both
variance and range of ages represented in each sample. Among Low
Impasse subjects, age range was between 18 - 21 years, with two
outliers at 23 and 30 years of age. Among High Impasse subjects, age
range was between 18 - 35 years, with one outlier at age 40.
Therefore, High and Low Impasse subgroups were analyzed separately,
and age groups were defined by dividing subjects into low and high
groups at the mean age represented in each sample.

Among Low Impasse subjects, the mean age for the subgroup was
19.32. Subjects aged 19 and below constituted level 1 and subjects
aged 20 and older constituted level 2 of the age factor. A least
squares regression analysis of variance found no significant effects
of either age or condition on Regressive Transference Scale 2 scores
(see Table 30, Appendix M). Means for younger subjects in LPC and HPC
conditions, respectively, were 4.94 and 5.13, with standard deviations
at .90 and .59. Means for subjects over 20 years of age in LPC and
HPC conditions, respectively, were 5.33 and 4.72, and standard
deviations were .88 and .53. The interaction of age with condition
also was not significant.

Among High Impasse subjects, the mean age for the subgroup was
23.23. Subjects aged 23 and below constituted level 1 and subjects
older than 23 years constituted level 2 of the age factor. A least

squares regression analysis of variance showed a significant main

85
effect for age, with F(1,40) = 7.49, p (.009 (see Table 31, Appendix
M). Means for subjects 23 years of age or below in LPC and HPC
conditions, respectively, were 4.55 and 4.98 points. Means for
subjects older than 23 years in LPC and HPC conditions, respectively,
were 3.76 and 4.06. An analytical contrast between the mean score of
the High Impasse group in the LPC condition and the combined means of
all other groups resulted in an F(1,40) of 4.49, p (.05. Older
subjects in the High Impasse group were significantly more critical of
the experimenter two weeks following hypnosis than were younger
subjects, and the tendency was particularly pronounced among High
Impasse subjects in the LPC condition.

Results of the two-way analyses indicated that age was a
significant factor influencing scores on the Regressive Transference
Scale 2 among High Impasse subjects. In order to compare the relative
strength of the factors of age and impasse in determining outcome, a
three—way least squares regression analysis of variance was conducted.
Low Impasse subjects aged 19 and below and High Impasse subjects aged
23 and below constituted level 1 of the age factor. Low Impasse
subjects aged 20 and above and High Impasse subjects older than 23
years of age constituted level 2 of the age factor.

Results of the three-way analysis showed significant main
effects for subgroup, with F(1,80) = 12.07, p (.001, and for age
group, with F(1,80) : 4.71, p (.033. The interaction between subgroup
and agegroup was also significant, with F(1,80) = 4.51,

p (.037 (see Table 32, Appendix M). Mean scores for the interaction

are displayed in Table 33. An inspection of the means indicates that

1‘7

Fe:

7!

 

86

the main effect for age was produced primarily by the very low mean
score of High Impasse subjects in the high age group (above 23 years).

Outcome of the three-way analysis indicated that both subgroup
and age were important in.determining scores on the Regressive
Transference Scale 2. High Impasse subjects across age groups were
significantly more critical of the experimenter than.were Low Impasse
subjects. In addition, High Impasse subjects above 23 years of age

were significantly more critical than all other groups.

Table 33
Mean Regressive Transference Scale 2 Scores Collapsed Across Condition

IMPASSE

 

 

M : 5.03

HIGH M = 5.02 M = 3.91

E?

 

 

DISCUSSION

Summary of Findipge

The central hypothesis of the experiment, comprising Hypotheses
1, 2, 3, and 5, was that subjects experiencing high distress paired
with a protective, competent hypnotist show the highest scores on all
measures of regressive transference. Results for Hypotheses 1, 2, 3,
and 5, however, showed a marked discrepancy between self-report and
behavioral measures of regressive transference. NOne of the self-
report indices designed to measure transference, including the
Regressive Transference Scales 1 and 2, the PrOblem-Solving Scale, and
the State-Trait Anxiety Index, supported the hypothesis. In fact,
additional findings revealed that on self-report measures two weeks
following hypnosis, including the Regressive Transference Scale 2 and
the State Anxiety Index, High Impasse groups were significantly pepe
critical of the experimenter and.pepe anxious about their problem than
were Low Impasse subjects. On the Regressive Transference Scale 2,
both age of subjects and level of distress contributed to scores.
High Impasse subjects across age groups were significantly more
critical of the experimenter than were Low Impasse subjects. High
Impasse subjects above 23 years of age were more critical of the
experimenter than all other groups.

Measures of regression in hypnotic dreams, however, confirmed
Hypothesis 5 on three out of five scales. Subjects in crisis paired

87

88
with a hypnotist demonstrating high protective-competence showed more
formal regression in hypnotic dreams than did all other subjects on
Total Defense, Object Aggression, and Total Regression Scales. In
addition, High Impasse subjects in the HPC condition produced
significantly higher scores on the Dependency Subscale than did all
other groups. The nature of the hypnotic dream images reported on the
Dependency subscale gave direct evidence for regressive transference
among High Impasse subjects in the HPC condition.

A subsidiary hypothesis of the study (Hypothesis 4) was that
subjects in distress, due to pre—existing intrapsychic conflict, would
show greater regression in hypnotic dreams than would Low Impasse
subjects. The hypothesis was confirmed on three out of five hypnotic
dream scales, including the Total Defense, Object Aggression, and
Total Regression Scales.

On the SUbject Aggression Scale (Hypotheses 6 and 7), there was
no evidence for a relationship between the frustration of dependency
needs and the expression of aggression toward others in hypnotic
dreams among High Impasse subjects.

In general, findings suggest the operation of demand
characteristics that attenuate differences among treatment groups on
self—report measures and of special conditions (age) that may
influence the relationship between independent and dependent
variables.

Self—Report versus Behavioral Measures of Transference
One of the most intriguing features of the experimental results

is the discrepancy between self-report and hypnotic dream indices of

89
transference. In Table 34, Pearson correlations and significance
levels are presented for the State Anxiety Index over three
administrations, the PrOblemeSolving Scale, Regressive Transference
Scales 1 and 2, and the Total Regression Scale on the Holt.

As indicated by Table 34, self-report measures are highly
intercorrelated, but there are no significant correlations of any of
the self-report measures with the Total Regression Scale of the Ho1t.
Furthermore, with the exception of some rather unexpected findings on
the Regressive Transference Scale 2 and the State Anxiety Index, none
of the self-report indices have any relation to the independent
variables manipulated in the study. In contrast, the independent
variables of subject impasse and experimenter role had a major impact
on most, but not all, of the behavioral-imagistic measures of
regression in hypnotic dreams. These findings suggest that self-
report and behavioral-imagistic indices are measuring different
domains (Rockstroh, Elbert, Birbaumer, & Luzenberger, 1982; Zeldow,
Clark, & Daugherty, 1985, p. 490).

Scrutiny of the correlation matrix in Table 34 reveals a number
of interesting features. Those who report the highest initial level
of anxiety tend to report more liking for the hypnotist in written
evaluations (Regressive Transference Scale 2). Those who experience
considerable relief from anxiety immediately following hypnosis
(STAIZ) also tend to report successful prOblem-solving, enthusiasm for
hypnosis (Regressive Transference Scale 1), and liking for the
hypnotist. Similarly, those who report more successful problem—

solving also report more liking for the experimenter in written

90

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91
evaluations and reduced anxiety levels two weeks following the
experiment (STAI3) .

The correlation matrix appears to be describing a powerful
disposition to please, conform, and elicit help and reassurance from
others which enters into the pattern of results on all self-report
measures as a confounding factor. Reyher (1977) has described these
security operations (Sullivan, 1953), or maneuvers designed to
maintain self—esteem in the face of interpersonal anxiety, in detail.
In a study of problem-solving, Reyher (1980) found that subjects
reporting successful problem-resolution were significantly more
anxious, more suggestible, and more likely to utilize placating—
submissive security operations than were subjects who reported less
improvement.

Attempting to differentiate the effects of security operations
from regressive transference is the focus of the discussion of self-
report indices.

Eegressive Transference Immediately After Hypnosis and at Follow—up

The Regressive Transference Scale 1 was based on subjects’
spontaneous comments upon awakening from hypnosis in the immediate
presence of the hypnotist. Under these conditions, the obtained
frequency distribution was skewed to the left. The mean for the whole
group was 5.37, skewed toward the upper end of the scale. The range
of the scale was restricted on the negative end. Sixty-four percent
of the subjects earned scores between four and six points on the
scale. Only five percent of subjects scored below four points,

whereas 31% scored above six points.

92

In contrast, the Regressive Transference Scale 2 was based on
subjects’ written evaluations of the experimenter two weeks following
hypnosis. Subjects answered the questionnaire alone in a classroom
and placed the completed questionnaire in a collection box. Under
these conditions, the Obtained frequency distribution was moderately
skewed to the right. The mean for the whole group was 4.78. Scores
were restricted at the positive rather than the negative end of the
scale. Sixty-seven percent of the subjects earned scores between four
and six points on the scale. Twenty-four percent of subjects scored
below four points, whereas nine percent scored above six points.

The shape of the frequency distribution of scores on the
Regressive Transference Scale 1 as compared to the frequency
distribution of scores on the Regressive Transference Scale 2 suggests
that the interpersonal nuances of face-to—face interaction with the
hypnotist were more powerful factors than treatment conditions in
determining results. Specifically, both subject and experimenter are
implicitly aware of the role (Orne, 1970; Rosenthal, 1964, 1969) and
interpersonal (Reyher, 1977) demands of the situation. The subject
does not wish to look like a failure and would like to please the
experimenter, who has just spent an hour attempting to hypnotize him
or her. In the same way, the experimenter wishes to be a successful
hypnotist, does not want to receive feedback to the contrary, and does
not want to embarass the subject. Both parties subtly collude to
avoid interpersonal distress, suppressing negative percepts and

limiting the range of communication.

93

Hamernik (1985), in a study of figure drawings and stories
produced by subjects, found that subjects reporting their wish—
fulfilling stories orally demonstrated more anxiety on polygraph
ratings than did subjects who wrote their stories. Masling (1960), in
a review of situational and interpersonal variables influencing
projective test results, reported that with the examiner absent,
subjects tended to show more involvement in stories and produced.more
sad.themes and outcomes in stories on the TAT than when the examiner
was present. The latter studies appear to present complementary
findings which support the interpretation given above. Face-to-face
interaction with the experimenter can be accompanied.by interpersonal
anxiety which arouses security operations and limits the range of
interaction. When alone, subjects show'more immersion in their
affect-laden subjective processes and allow themselves to express more
negative feelings than when they are in the presence of the
experimenter.

Although security operations may accompany a regressive
transference, they are present in all interpersonal encounters and do
not necessarily index transference.

PrOblem—Solving_

Phone interviews requesting information about problem-solving
were conducted one week following hypnosis by the experimenter who had
hypnotized the subject. Similar to the distribution of scores on the
Regressive Transference Scale 1, the frequency distribution of scores
for the Problem-Solving Scale was markedly skewed to the left. The

majority of subjects reported that they had made some progress toward

94
solution of their problem. Twenty-five percent of subjects reported
full satisfaction with the solution achieved and attributed positive
outcome to the experiment. Thirty-two percent reported substantial
progress toward solution but either were not fully satisfied with the
results or did not attribute results to the experiment. Twenty-four
percent indicated that there had been some change in the status of the
prOblem toward solution, but no results had.been achieved. Fourteen
percent reported no change, and five percent indicated the prOblem had
intensified.

The highly skewed nature of the frequency distribution of scores
for the whole group again suggests that the desire to please the
experimenter and conform to expectations was more influential in
determining results on the PrOblem-Solving Scale than were subgroup or
condition factors. It appears that in direct interaction with the
hypnotist, most subjects are hesitant to express negative feelings.
Regressive Transference: Agei Impasse, and Ambivalence

Another initially puzzling finding of the study was the fact
that, although the Holt indices supported the hypothesis that High
Impasse subjects show greater regression in hypnotic dreams than do
Low Impasse subjects on the majority of dream scales, High Impasse
subjects were less positive in evaluating the hypnotist than were Low
Impasse subjects two weeks following hypnosis. In short, those
subjects who allowed themselves to depend the most on the experimenter
during hypnosis were also the most critical of the hypnotist following
the experiment. This tendency was particularly pronounced among High

Impasse subjects over the age of 23 years and among older High Impasse

95
subjects in the LPC condition. What do age, condition, impasse, and
regression in hypnotic dreams have to do with the evaluation of the
hypnotist?

The relationship between enhanced dependency during hypnosis,
indicated by regression in hypnotic dreams, and criticism of the
experimenter following hypnosis suggests that High Impasse subjects
were deeply invested in the hypnotic relationship and may have
experienced frustration of regressive longings aroused.during the
hypnotic dream phase of the experiment. Two studies in the literature
support this interpretation.

Newman, Katz, and Rubenstein (1960), in an early clinical study
of implanted conflict and the hypnotic dream, found that the dreams of
subjects expressed intense ambivalence about the hypnotist and the
experimental situation. The authors concluded that their subjects
were motivated, often without awareness, by a need for help.
Ambivalence was produced by a conflict between their unverbalized
expectations and what was explicitly offered by the experimenters.
Shevrin (1979) compared 13 female hypnosis subjects with 13 female
non—hypnotic controls on stories told to Card 12M (the "hypnosis
card") on the TAT. In interview, hypnotic subjects described the
hypnotic experience as pleasant and relaxing. On the TAT, however,
only one hypnotic subject described a clearly positive interaction
between the figures on the cards The remaining 12 told stories
emphasizing hostile interactions. The one subject who told a positive
story was the only one who had.a continuing relationship with the

hypnotist. In contrast, the non-hypnotic control group produced five

96
positive, seven neutral, and one negative story to the same card on
the TAT. The author suggests that the hypnotic induction arouses in
subjects the regressive longing to be unconditionally loved and cared
for and to have all of their troubles "washed away." When the
experiment was over and the fantasied gratifications were not
forthcoming, frustration and anger were produced, reflected by
negative stories on the TAT.

The conditions of the present experiment parallel those reported
in the studies by Newman et al. (1960) and Shevrin (1979). High
Impasse subjects were at impasse with a personally relevant problem
and were actively seeking care, conditions hypothesized as necessary
for the instigation of regressive transference. If the hypnotic
induction intensified the regressive aspect of subjects’ dependency
strivings among High Impasse subjects, arousing longings for parental
care, those longings would inevitably be frustrated by the limits of
the experimental situation. Frustration would be greatest, however,
among those unable to transfer the image of a parental surrogate on to
the hypnotist, thereby Obtaining some gratification of needs in
fantasy. Both age and the presence of an experimenter playing an
egalitarian role could complicate the development of a transference
relationship, arousing frustration and anger, reflected in written
evaluations of the hypnotist following the experiment. Some
supporting evidence for the impact of age differences comes from a
study by Simon (1973), who found that among a sample of 169 subjects
ranging in mean age from 25 to 40 years, older therapists were

preferred to younger therapists.

97
Although conclusions must remain tentative, the diffidence and at
times frank hostility displayed by High Impasse subjects on the
Regressive Transference Scale 2 suggest the presence of unverbalized
longings for parental care, aroused by the inception of a regressive
transference during hypnosis and frustrated by the realistic aspects
of the experimental situation.

State Anxiety

 

Initial State Anxiety. The State Anxiety Index was initially

 

administered following the first four questions of the interview
during the experimental session. Scores on the State Anxiety Index at
first administration failed to differentiate between subjects self—
defined as at impasse and subjects who volunteered to participate in
research for credit. The State Anxiety Index is a glObal measure that
does not differentiate between interpersonal and intrapsychic sources
of anxiety. It is possible that different sources of anxiety
characteristic of Low and High Impasse groups in the experimental
setting served to attenuate any actual differences between groups.
Allen (1970) has demonstrated that State Anxiety scores are influenced
by demand characteristics. Students receiving credits for research
knew they were supposed to bring in a "prOblem" and may have
unintentionally inflated scores out of concerns regarding their
ability to be "good subjects" (interpersonal anxiety). In contrast,
Frank (1973) has shown that the anxiety scores of psychiatric
outpatients seeking treatment dropped over 20 points within one-half
hour simply as a function of being attended to by a professional.

Subjects participating in research under pressure from an unresolved

98
problem may have felt reassured in the presence of a helper, lowering
scores (intrapsychic anxiety).

State anxiety immediately following hypnosis. The State Anxiety
Index was administered a second time by the hypnotist immediately
following the subject’s awakening from hypnosis. Although responses
were written and the subject was not in the immediate presence of the
hypnotist while taking the test, subjects returned the form to the
examiner. subjects could easily interpret the scale as a form of
feedback to the experimenter regarding how well she had performed as a
hypnotist.

The cumulative frequency distributions for the State Anxiety
Index over three administrations of the test are shown in Figure 2.
The corresponding means and variances are given in Table 35. As
demonstrated by Figure 2, the frequency distribution of scores on the
STAIZ was markedly skewed to the right for the whole group, and the
range of scores was restricted. On the STAI1, the 25th percentile
occurred at the score of 37 points, the 50th percentile at 44 points,
and the 75th percentile at 57 points, with scale range encompassing 53
points total. On the STAIZ, the 25th percentile occcurred at 25
points, the 50th percentile at 29 points, and the 75th percentile at
32 points, with scale range covering 37 points. A comparison of the
variances of STAIl scores with STAIZ scores resulted in F = 2.73,
p_(.11. The most obvious factor in the situation powerful enough to
affect the whole group appears to be the subject’s desire to please

and protect the hypnotist.

99

State anxiety at follow-up. The State Anxiety Index was
administered along with the Regressive Transference Scale 2 by E3 two
weeks following hypnosis and immediately before the debriefing
session. The subject completed the questionnaires in a classroom
separate from E3’s office and was instructed to place the completed
forms in a cardboard box in the classroom.

Results on the STAI3 paralleled findings for the Regressive
Transference Scale 2. For the whole group, the mean anxiety score on
the STAI3 was higher, the variance was greater, and a larger
percentage of subjects attained scores on the negative (heightened
anxiety) end of the scale relative to scores on the STAIZ (see Table
35 and Figure 2). Whereas the Holt scales indicated that High Impasse
subjects allowed themselves to depend more deeply on the hypnotist
during the hypnotic dream.phase of the experiment, State Anxiety
scores two weeks following hypnosis found that High Impasse subjects
showed less reduction in anxiety about their problem following
treatment relative to initial anxiety scores than did Low Impasse
subjects.

A number of interpretations, not mutually exclusive, spring to
mind. First, the heightened anxiety scores of High Impasse subjects
relative to the Low Impasse group may simply reflect the gradual
return to baseline in feelings of anxiety and depression
characteristic of subjects who have received a placebo. Frank (1973),

for example, found that mean discomfort scores of psychiatric

100

 

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6%-

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Frequency

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Figure 2

Scores

 

Cumulative Frequency Distribution For State Anxiety Scores

Table 35

State Anxiety Mean Scores

and Variances

 

Test

 

STAI1

STAIE

STAI3

Mean

45-1¢

36.26

35.19

Variance

158.42

51.55

142.32

ettqueoued

 

101
outpatients given a medical placebo, following an immediate drop,
gradually rose over a period of two weeks to approximately half of the
original difference between baseline discomfort and initial relief
scores. An examination of the mean scores of High Impasse subjects on
the STAIl, STAIZ, and STAI3 (Table 12) indicates that the mean score
for STAI3 is almost precisely half the difference between STAIl and
STAIZ. A second possibility, following the transference
interpretation given for scores on the Regressive Transference Scale
2, is that the State Anxiety scores for High Impasse subjects were
inflated by feelings of frustration or abandonment by the
experimenter. These interpretations are not mutually exclusive, in
that the gradual rise in discomfort scores among psychiatric
outpatients reported by Frank (1973) may similarly be due to these
patients’ need for ongoing relationship with a parental surrogate.
Third, the scores of Low Impasse subjects may reflect the effect of
interpersonal anxiety, rather than intrapsychic anxiety created by
personal impasse. If so, initial State Anxiety scores for Low Impasse
subjects would be elevated due to concerns regarding one’s ability to
be a good hypnotic subject in a problemrsolving experiment, and scores
on the third administration would be lowered for the same reason. The
curve (see Figure 1) for Low Impasse subjects may be reflecting the
influence of security operations, whereas the curve for High Impasse
subjects may be reflecting the effects of both security operations and

regressive transference.

102
Regression in Hypnotic Dreams

The independent variables were effective in predicting regression
in hypnotic dreams. subjects at impasse paired with a hypnotist
demonstrating high protective-competence showed.more regression in
hypnotic dreams than all other groups combined. SUbjects at impasse
and seeking help showed.more regression in hypnotic dreams than did
students volunteering to participate in hypnosis research for academic
credit. On the Total Regression Scale, student volunteers showed
greater regression in hypnotic dreams when paired with a HPC hypnotist
than when paired with an LPC hypnotist.

Total Libidinal Scale. The failure to find differences among
treatment groups on the Total Libidinal Scale was initially
perplexing. Wiseman & Reyher (1973) found significant differences on
the Holt libidinal indices in favor of a hypnotic dream group versus
waking controls upon administration of the Rorschach.

Upon examination of hypnotic dream protocols, however, there
appeared to be qualitative differences in libidinal imagery produced
by subjects. In the first type of image, the subject described a
pleasant experience of gratification in prosaic terms, similar to
reminiscing or daydreaming. In the second type of image, libidinal
impulses are expressed but they are distanced, disguised, or negated,
sometimes taking on a nightmarish quality. The following examples
demonstrate the two types of libidinal imagery with content expressing
sexual impulses:

It was over the summer when my boyfriend and I went to the beach

for the day. I could see us playing with a ball in the sand.
We went swimming in the water. we were playing frisbee together,

103

and he would swim under and grab my legs and dump me...I can
remember what a good time we had, just all by ourselves.

I was at the foot of a flight of stairs, and somebody threw a
red carpet down the stairs that unrolled as it pulled down the
stairs. As I climbed up the stairs, there was a king’s throne at
the top of the flight of stairs. It looked like maybe one of the
church fathers carved in stone...Then it seemed like I was about
to enter into a dance, a kind of formal 18th century dance. But

I never really accepted the dance, so it ended.

Both types of imagery receive libidinal scores. In the second dream,
however, defensive operations, including the remote setting and the
subject’s negation of any desire to join the dance, overwhelm the
libidinal content, "dance." The second type of dream, where allusions
to libidinal events were accompanied by massive defensive efforts, was
more common among High Impasse than Low Impasse subjects. High
Impasse subjects may have earned lower scores on the Total Libidinal
Scale relative to other Holt indices, then, because a larger
proportion of the dream was characterized by primary process
distortion.

As a rough check on this interpretation, the Total Libidinal
Scale score was subtracted from the Total Defense Scale score for Low
and High Impasse subjects, giving a mean difference score for each
group. Negative scores indicated the relative predominance of
libidinal content over defensive content, whereas positive scores
indicated the opposite. The mean difference score for Low Impasse
subjects was -.49, and the mean difference score for High Impasse
subjects was 1.45. A t(1,86) test of the difference between the mean
difference scores (McNemar, 1969, p.98) resulted in t = 2.69, p (.01.
The pooled error term was .72. Results of the comparison supported

the interpretation given above.

104

Anxiety. The Anxiety Scale was originally seen as having special
relevance to regressive transference, because the portrayal of a
situation of helplessness in hypnotic dreams implies strivings for
protection on the subject’s part. However, the portrayal of the self
as humiliated, unwanted, or injured by others in hypnotic dreams,
scored in the Object Aggression category, was difficult to distinguish
conceptually from images scored in the Anxiety category. The
following examples are characteristic of image sequences scored,
first, in the object aggression category and, second, in the anxiety
category:

I was riding my bike...down the hill. I came around the corner

and the postman came out of the post office. He waved at me,

and all I could think about was how he always told me there

wasn’t any mail. I get not very far past the post office, and

I fall off my bike into the street. There’s kids in the park...

so I was pretty embarrassed.

It was nighttime, and I was walking through the woods along a

lane leading me nowhere. It was really dark. I couldn’t find

my way, and I realized I was lost. I was really scared.
Both images present the self as vulnerable and make an implicit appeal
for the hypnotist’s protection and support. Despite original
conceptualization, for the purposes of the present study, there seemed
to be little rationale for maintaining the Anxiety Scale as a separate
category.

Dependency. Contrary to expectations, the Dependency Scale,
rather than the Anxiety Scale, proved to be of special relevance to
regressive transference. Findings corroborate those of Reyher (1980),
who found that the hypnotic dreams of subjects at impasse contained
more references to infants and powerful adult figures than did control

subjects. Sheehan & Dolby (1979) also found that the dreams of

105

hypnotized subjects portrayed the hypnotist as an authority providing
protective care and guidance more than did the imaginative products of
task-motivated or waking-imagination control subjects. This was
especially true for a subset of 11 subjects who were highly motivated,
as indicated by their expectancy behaviors in previous tests of
hypnotic susceptibility.

Sheehan & Dolby (1979) conclude that their data demonstrate more
"the positive transferencelike aspects of subjects’ motivated
cognitive commitment to the task of dreaming than an infantile wish
fulfillment reflecting obedience to an authority, as the
psychoanalytic account of dreaming would suggest" (p. 582). The
construct of regressive transference, however, does not refer to
themes of obedience in the interpersonal relationship between
hypnotist and subject but rather to the reactivation of early memories
of being cared for by loving, omniscient parents. These reactivated
remembrances constitute the regressive transference, which serves as a
defense against anxiety elicited by a situation which the individual
feels is beyond his or her coping capacity. Some of the hypnotic
dream transcripts presented by Sheehan and Dolby (1979), like some of
the excerpts from hypnotic dreams presented earlier in this study,
illustrate the dynamic of the hypnotist’s protection of the subject
from anxiety explicitly.

Imagery and problem-solving; An alternative hypothesis regarding

 

findings from the Problem— Solving Scale is that the hypnotic
procedure was a highly effective means of prOblem-solving for all

subjects, overriding differences in subject motivation and

106
experimenter role. Davé (1979), who developed the procedure adapted
for the current study in conjunction with Reyher (1980), compared 24
subjects in three prOblemesolving conditions, including a hypnotic
dream group, a rational-cognitive group, and a personality-interview
control group. Results indicated that participants in the hypnotic—
dream group showed a significantly higher level of creative problem-
resolution than did subjects in other conditions. Davé concluded that
the success of the treatment was due to the mediating role of imagery.
Similarly, Barrios and Singer (1981) compared 48 volunteers reporting
creative blocks in artistic, literary, scientific, and professional
projects in four different prOblem—solving treatments. waking Imagery
and Hypnotic Dream conditions were most effective in promoting
resolution of creative blocks. The authors conclude that the
imagination may have greater adaptive potential than has been
acknowledged by most behavioral scientists. Reyher (1980), however,
in reviewing Davé’s work, found that obvious imagery-mediated
solutions did not occur among hypnotic dream subjects and that
hypnotic dreams produced by subjects showed formal and content
features of regressive transference. Reyher suggested that subjects
were so highly motivated to earn the approval of the hypnotist that
they lowered their criteria for defining resolution of impasse. He
concluded that favorable treatment outcome in prOblem-solving through
imagery can best be explained by non-specific effects, including
strivings for approval, transference, and shared expectations of

SUCCESS .

107

At issue here is the question of whether or not the high rate of
report of successful problem-solving in this experiment was brought
about by the mediation of imagery produced during hypnotic dreams.
Although the present experiment was not designed to focus on prOblem
solving r se, an attempt was made to approach the question by
categorizing the problem-solving rationales provided.by subjects who
earned a score of four points on the PrOblem-Solving Scale. In order
to achieve a four-point score, the subject had to indicate full
satisfaction with the solution achieved, whether that solution was a
concrete achievement or a change in attitude, and had to attribute
positive results to the experiment or experimenter in some way.

Table 36 lists the group membership, sex, type of problem
presented, rationale given, and type of solution achieved (concrete
versus attitude change) among high—scoring subjects. The twenty—two
subjects (25%) from the total sample who attained a four—point score
were evenly distributed among treatment groups. Six were Low Impasse
subjects in the LPC condition, and four were Low Impasse subjects in
the HPC condition. Five were High Impasse subjects in the LPC
condition, and seven were High Impasse subjects in the HPC condition.

Rationales provided fell into four categories. Two subjects
attributed change to a specific image experienced during hypnosis. An
18-year old female student volunteer struggling with procrastination
felt that her dream of a ladder during hypnosis made her think of
putting her priorities in order. She then bought a datebook and
organized her schedule. A 20—year old female who responded to an ad

in the newspaper indicated that dreaming of herself in an impermeable

Table 36

108

Problem-SolvinggRationales amogg High Scoring subjects on the Problem;

Solving Scale

 

Group Sex PrOblem Presgpted Type of Solution Rationale
HLPC M Career choice Attitude State
HLPC M POOr concentration Concrete None
HLPC F Relationship Attitude Image
HLPC F Career goal Concrete State
HLPC F weight control Attitude Fbcus
LLPC F Procrastination Concrete Image
LLPC F Bulimia Concrete None
LLPC M Procrastination Concrete None
LLPC F Smoking Concrete Focus
LLPC M Choice of residence Concrete Focus
LLPC M Relationship Concrete Focus
HHPC M Ideas for advertising Concrete None
HHPC F Procrastination Concrete None
HHPC F Relationship Concrete None
HHPC M Insomnia Concrete None
HHPC M Religious preference Attitude Focus
HHPC F Bulimia Concrete None
HHPC F weight control Concrete NOne
LHPC F weight control Concrete None
LHPC M Poor concentration Concrete None
LHPC M Performance anxiety Attitude State
LHPC M Procrastination Attitude Focus

 

109
bubble helped her tolerate the time she had to spend.apart from her
boyfriend. As described, from.the two subjects providing an imagery
rationale, one achieved concrete change and one experienced a change
of attitude.

Three subjects referred to aspects of the state of hypnosis as
responsible for change. Of these, one mentioned that the state of
relaxation had helped him to feel less anxious and more confident so
that he could approach the prOblem with a new attitude. The second
provided a behavioral rationale, stating that visualizing himself
performing successfully on stage with his guitar while in a state of
deep relaxation made him feel confident that he would give a
successful performance the next time he was on stage. The third said
that the sense of freedom she experienced during hypnosis made her
realize she was trying to conform too much to the expectations of
other people. The realization allowed her to make a career choice she
felt was right for her. Among these three subjects, one achieved a
concrete change, and two indicated a change of attitude.

Six subjects stated that simply focusigg on the prOblem had
forced them to take action. Among these six subjects, three found
concrete solutions to their prOblems, including quitting smoking,
finding a better place to live, and resolving a conflict in a
relationship. The remaining three stated they had found a new
attitude which they felt certain would bring positive results.

Eleven subjects (50%) out of the twenty—two high scorers provided
no rationale at all beyond the fact that they experienced.major change

following hypnosis. These subjects implicitly attributed change to

110
magical cure and frequently communicated an attitude of awe and
incredulity along with their statements. A few examples will suffice
to communicate the qualitative aspect of these subjects’ experiences.
A 20-year old male High Impasse volunteer suffering from insomnia told
the experimenter the following:

I just seem to be falling asleep easier now. I haven’t done

anything new. Basically, I’m just freaked out because it’s

been so easy to fall asleep.

A 21-year old female subject who had responded to an ad in the student
newspaper and who wanted to lose weight stated the following:

I’m just not eating as much...I noticed it a couple of days

after I was at the session with you...I’m losing weight. I

really don’t know why this is happening. I’ve only had to

eat once a day.

All eleven of these subjects reported having achieved a concrete
solution to their problem. In ten out of the eleven, this solution
represented a complete "remission of symptoms" associated with poor
concentration, procrastination, overeating, or ambivalence in a
relationship.

Out of 22 subjects reporting problemeresolution and relating
change to the experiment, then, two attributed results to specific
imagery, nine attributed results to other aspects of the experiment,
and 11 provided no rationale beyond noting sudden and major changes in
their behavior following the experiment. From the 22 subjects
reporting success, six lowered their criteria for defining resolution
of impasse (change of attitude). Regarding treatment group
membership, 33% of Low Impasse subjects in the LPC condition, 50% of
Low Impasse subjects in the HPC condition, 20% of High Impasse

subjects in the LPC condition, and 86% of High Impasse subjects in the

111

HPC condition implicitly attributed problem-resolution to the "magical
cure" rationale. The resulting X2(3) was 6.05, p (.12, a provocative
finding.

From these results, it is apparent that the majority of subjects
did not attribute prOblem-solving to the presence of specific imagery
in dreams. Furthermore, the high number of subjects in general and
the large proportion of High Impasse subjects in the HPC condition
willing to report change without a rationale and describing the sudden
cessation of problematical behaviors within one week of the experiment
suggest that these subjects were experiencing a regressive
transference, or hypersuggestibility Level II (Reyher, 1977). When
considered in the light of the markedly skewed frequency distribution
of scores on the Problem-Solving Scale, the informal survey of
problem-solving rationales strongly suggests that results on the
PrOblem-Solving Scale were determined primarily by subject’s
motivation to please the experimenter, intensified in at least some
cases by the presence of regressive transference.
Regressive Transference, Hypnosis, and the Placebo Effect

The main premise of the study was that a regressive transference
may be the mechanism underlying both intense hypnotic experience and
the "placebo effect" or non-specific effects in psychotherapy.
Factors seen as necessary for the establishment of a regressive
transference included an individual at impasse in resolving a
personally significant problem and the presence of a warm, competent
caretaker giving a positive message. Dependent variables thought to

index regressive transference included attributions made about the

112
hypnotist, sensitivity to the wishes of the hypnotist, and extent of
formal regression in hypnotic dreams.

The independent variables manipulated in the study were effective
in bringing about intense hypnotic experience as indicated by
regression in hypnotic dreams. A subgroup of High Impasse subjects in
the HPC condition reported imagery directly depicting a parent-child
interaction or the reactivation of memories of youth. High Impasse
subjects in general reported greater anxiety and less liking for the
therapist two weeks following treatment than did Low measse subjects,
perhaps reflecting frustration of dependency strivings aroused by the
inception of a regressive transference during hypnosis. The evidence
suggests that intense hypnotic experience is accompanied by a
regressive transference.

The relation of regressive transference to the "placebo effect"
in medicine and to non-specific factors in psychotherapy, however, is
unclear. Self-report and behavioral measures of transference were not
significantly correlated and appear to index different domains.
Subjects who reported complete satisfaction with problemesolving and,
in some cases, who presented all the features of a "transference cure"
did not necessarily show greater regression in hypnotic dreams than
did others, nor were these subjects necessarily at impasse in prOblem-
solving. Likewise, subjects who demonstrated features of regressive
transference during the hypnotic dream did not report greater problem—
solving or liking for the hypnotist than did others. The most Obvious
conclusion is that the establishment of a regressive transference does

not depend on the capacity to regress in hypnotic dreams.

113

Data from the present study does indicate, however, that before
any conclusions can be drawn regarding the relationship of regressive
transference to non—specific effects in medicine and psychotherapy,
demand characteristics of the setting (social domain) and security
operations active among both subjects and experimenters (interpersonal
domain) must be defined and controlled. Shapiro & Morris (1978) have
suggested that there may be multiple "placebo effects" depending on
different conditions and resulting in different outcomes. It is
possible that under some conditions the desire to please and meet the
expectations of a significant other are sufficient conditions for
motivating change without an accompanying reactivation of childhood
reminiscences. Unless demand characteristics, security operations and
transference are conceptually differentiated and criteria for their
operational definition established, however, the question of multiple
pathways cannot be addressed.

Security operations in this study were most apparent in the
influence of the conditions of report on the content of subjects’
reports. One important factor influencing the content of report was
whether or not subjects gave direct feedback to the experimenter who
had hypnotized them. When subjects were in face-to-face interaction
with the experimenter (Regressive Transference Scale 1, Problem—
Solving Scale) or knew that the experimenter had immediate access to
their written report (STAIZ), responses were either negatively skewed
or were restricted in range. When evaluations were written and
presented to E3, who did not work directly with subjects, responses

(Regressive Transference Scale 2, STAIB) were either positively skewed

114
or a much greater range of response was obtained (see Figure 2, Table
35).

A second factor influencing content of report, which may be
unique to research within the treatment outcome paradigm, is the
timing and context of report. If the interpretation of scores for
High Impasse subjects on the Regressive Transference Scale 2 in this
experiment is correct, the report of outcome (STAI3) and liking for
the experimenter (Regressive Transference Scale 2) may be powerfully
influenced by the nature of the termination of the relationship.

Those subjects who feel prematurely abandoned or frustrated by the
loss of the therapist will report less satisfaction and less
successful outcome than will subjects who are either less dependent on
the therapist or who have an ongoing relationship with the therapist.

A third factor which may have a major influence on report, again
within the treatment outcome paradigm, concerns whether or not the
hypnotist, therapist, or physician supplies a concrete solution to the
problem presented by the subject, client, or patient. A comparison of
the results of this study with the findings of LeBaron et al. (1985)
provides an illustration. LeBaron and his associates in a study of
regressive transference in a medical setting found positive results on
all three indices of transference operationalized in this study.
Patients in the paternalistic treatment group had higher
suggestibility scores (sensitivity to the wishes of the experimenter)
and regressive transference scores (attributions) than did patients in
the egalitarian condition. Additionally, patients showed fewer

Objective signs of surgical shock (behavioral) in the paternalistic as

115
opposed to the egalitarian condition. In this setting, patients were
at impasse because they were unable to supply for themselves the
medical treatment needed to relieve their distress. Like medical
studies of the placebo effect in general, the required treatment,
whether surgery or medication, was concretely offered them by the
physician. In contrast, what was offered subjects in the present
study was not a concrete solution to the prOblem presented but an
experience related by rationale to a possible outcome. It was still
up to the individual subject to follow through on his or her
experiences during hypnosis. The lack of a concrete solution,
requiring more activity on the subject’s part, may frustrate the aim
of the regressive transference, which is to have something done :9;
one, affecting reports of satisfaction and positive outcome. Support
for this interpretation is provided by Strupp (1977), who presents an
excellent discussion of the prOblematic aspects of the dependency
strivings of some patients, which cannot be met in the context of the
psychotherapeutic relationship.

For future research, the prevalent role of security operations in
this study emphasizes the importance of including in experimentation
an operational measure of transference that is behavioral and
relatively less under the individual’s conscious control (Barrett,
1979; Kazdin, 1979) than self-report indices. A simulating control
group not seeking therapy, like that suggested.by Orne (1959) for
studies in hypnosis, might index the social demand characteristics of
therapy outcome research. An alternative, suggested by Nisbitt &

Wilson (1977), is simply to ask subjects not participating in the

116
actual research what they think will happen. Security operations
might be controlled by varying the conditions of report. This study
appears to have made a contribution by documenting the differences
between behavioral-imagistic and self-report measures as indices of

transference in hypnosis and prOblem-solving.

APPENDIX A

NOTICE POSTED IN UNDERGRADUATE CLASSRGN

 

 

APPENDIX A

NOTICE POSTED IN UNDERGRADUATE CLASSROOM

ADVENTURES IN IMAGERY!!
Participate in an experiment on imagery, hypnosis, and
creativity. Time required is a maximum of four hours spread
over two to three weeks. If interested, please sign up,
leave your phone number, and you will be contacted by phone.
You may also call D. Denman at 351-1611. If I am not
available, please leave a message and I will return your

call as soon as possible.

117

APPENDIX B

DISPLAY ADVERTISEMENTS IN THE STATE NEWS

APPENDIX B

DISPLAY ADVERTISEMENTS IN THE STATE NEWS

 

Advertisement in the State News Classified.Section
CREATIVE PROBLEM-SOLVING2!

ARE YOU STUCK?? Participate in an experiment on
imagery, hypnosis, and problem-solving.
Participants need to be at impasse in some problem
or project. Time required is a maximum of four
hours spread over two to three weeks. If
interested, call D. Denman at 351-1611. If I am
not available, please leave a message, and I will
return your call as soon as possible.

"It’s What’s Happenigg" Column, State News
ARE YOU STUCK?? Participate in research on
imagery, hypnosis, and problemrsolving.
Participants need to be at impasse on some problem
or project. Time required is a maximum of four
hours spread over two to three weeks. If
interested, call D. Denman at 351—1611. If I am
not available, please leave a message, and I will

return your call as soon as possible.

118

APPENDIX C

LETTER TO MSU STUDENTS IN GRADUATE HOUSING

APPENDIX C

LETTER TO MSU STUDENTS IN GRADUATE HOUSING

Dear MSU Student,

I apologize for the impersonal nature of this letter. I am
a graduate student at MSU in clinical psychology, and I am
conducting research on imagery, hypnosis, and problemrsolving.
Specifically, I am interested in the effectiveness of imagery in
facilitating the ability to overcome an impasse or mental block
encountered in the course of working on a prOblem or project.
This could encompass a wide range of academic, professional,
aesthetic, or personal concerns, from difficulty writing a paper
to problems resolving a marital difficulty. It is not necessary
that you be an MSU student. The only requirements are (1) that
you are currently working on a problem or project, and (2) that
you are "stuck" in some way which prevents you from reaching a
satisfactory solution to that prOblem or from completing the
project.

My purpose in writing this letter is to invite interested
persons to participate in the research. The amount of time
requested of participants is a maximum of four hours spread over
the duration of two to three weeks. If you would like to
participate, or simply have questions, please call me at

119

120
351-1611. If I am unavailable, please leave a message on the
answering machine, and I will return your call promptly.
Thank you for your time and attention. Sincerely,

Diane Denman

 

APPENDIX D

RATIONALE GIVEN TO THE EXPERIMENTERS

  

APPENDIX D

RATIONALE GIVEN TO THE EXPERIMENTERS

Purpoee of the Experiment

Let me tell you something about the study I am conducting before
going on to describe more specifically your tasks and
responsibilities. The study concerns the effectiveness of imagery in
enhancing creativity. Creativity is not something that belongs
exclusively to great artists or scientists. Rather, creativity is
something that each of us uses in solving the problems of daily
living. Creativity is also related to current research on the right
and left hemispheres of the brain. There is a large body of research
demonstrating that the left hemisphere thinks, reasons, and uses
words, while the right hemisphere imagines and dreams. we know, for
example, that hypnosis and imagery are mediated by the right
hemisphere of the brain, and hypnosis is an effective method for
stimulating imagery. Our experiment is designed to determine under
what conditions stimulation of right hemisphere functions, that is,
the experience of imagery, can facilitate creative prOblem-solving.

I have operationalized or defined creativity for experimental
purposes as the ability to solve a prOblem which the individual in

some way finds perplexing. The criteria for including subjects in the

121

 

122
study, then, are two: (1) that the subject is currently working on a
problem or project that can be defined in a focal way, and (2) that
the subject is "stuck" in some way so that he or she has not yet
reached a solution to the prOblem or has not yet completed the
project. After subjects have been selected, the procedure will
include inviting subjects while hypnotized to have a series of dreams
or dream-like experiences. Since music, imagery, and hypnosis are all
mediated by the right hemisphere, we use music and relaxation as the
method of hypnotic induction.

Your job will be to schedule appointments, to administer pre- and
post—treatment questionnaires, to conduct the hypnotic induction, and
to collect the dream reports by audiotape. The procedure is straight—
forward but rather detailed. YOu don’t have to worry about the
detail, however, because I will write out the procedure for you, and
we will rehearse it sufficiently until it seems second-nature to you.

There is considerable evidence that the method we are using in
this experiment is effective in enhancing creative problem—solving.
However, we do not know HEX the method is effective. One variable
that we are attempting to measure in the study is the extent and type
of right and left hemisphere contributions to problem-solving. The
second variable that we are manipulating is that of the experimenter’s
role. we do not know under what conditions varying personality types
will respond to imagery as a means of creative prOblem-solving. Some
individuals are autonomous in personal style. No matter how pressured
they may feel or appear to others, they prefer to rely on themselves

to solve problems. When working with another person, they respond

123
best in a low-key, egalitarian atmosphere where their autonomy is not
threatened. Other people are more dependent in attitude. They look
to others for direction and work best in a structured setting with an
enthusiastic and authoritative leader. In this study, each of you
will be trained to play both roles. Let me describe each role more
fully.
Egalitarian Experimenter Role

The role I would like you to adopt as an EGALITARIAN experimenter
is a very simple and natural extension of interest in what happens
during the experiment. It is as though you and the subject are both
co-experimenters interested in learning about imagery, creativity, and
prOblem-solving. This attitude will not be hard for you to assume
because it is simply an extension of your own scientific interest.

Sharing responsibility versus taking responsibility. In the
egalitarian role, you implicitly share responsibility for the results
of the experiment with the subject. That is, you help the subject
into hypnosis, but how far the sUbject is able to go in problem-
solving is up to him or her. Your attitude is friendly but neutral
and disengaged. You are simply curious about what will happen during
the experiment, and you assume that the subject is an autonomous agent
well able to look after him or herself.

Eliminating status barriers versus emphasizing status barriers.
Also, artificial barriers between yourself and the subject should be
avoided. Artificial barriers could include wearing clothing
designating special status or adopting a superior attitude, pretending

to have special knowledge that subjects do not have. Instead, you can

124
wear casual clothing that you would normally wear on campus. You
behave in a friendly, natural, but not over involved way, as you might
with an.acquaintance. In fact, aspects of the procedure you will
follow in the egalitarian role have been especially designed to break
down artificial barriers which prevent the establishment of an open,
permissive atmosphere.

Givigg balanced information which lets the subject decide verege
giving only the information needed to reassure subjects. In the
egalitarian role, you share information freely with subjects about the
nature of research, letting them know the issues are not fully
resolved. YOu implicitly challenge subjects in this way to find out
for themselves whether or not hypnosis and imagery can contribute to
problem-solving.

Context. In keeping with the egalitarian role, you will meet
with the subject in one of the experimental rooms in the Psychology
Research Building.

Authoritative Experimenter Role

 

The AUTHORITATIVE role, in contrast, requires you to adopt an
active, empathic, and caretaking attitude toward subjects during the
experiment. It is as though you are a concerned and competent helper
accustomed to listening to the problems of others. This role will not
be difficult for you to learn, because it is a natural extension of
concern and caring for other people.

Taking responsibility versus sharing responsibility. As an
expert and a responsible caretaker, you do not assume that the subject

can fully help him or herself apart from you. Your attitude is one of

125
attentive, empathic listening paired with concern for the subject.
YOu want to know as much as possible about the subject’s prOblem, as
though you were in a position to advise him or her. YOur dialogue
with subjects is designed to guide them toward a positive experience
during the experiment.

Emphasizing status barriers versus eliminating status barriers.
When people seek help with a difficulty, they expect to meet with an
individual who fits the socially defined role of helper. This role is
defined in many ways, including the clothing we wear, our physical
surroundings, and our sense of ease and confidence when listening to
the problems of others. In the authoritative role, then, status
barriers are deliberately emphasized. You demonstrate an attitude of
"professionalism", or, manifesting the qualities of your office. I
would like you to dress somewhat formally and to emphasize competence
in your manner.

Givingeonly the information needed to reassure subjects versus
giving balanced information which lets the subject decide. In the
authoritative role, you do not make subjects aware of the diversity of
results in research. Instead, you summarize results and emphasize the
positive. Like a doctor, you give only the information that is needed
to reassure patients and help them get well.

Context. In keeping with the authoritative role, you will meet
with your subjects in one of the clinical rooms at Olds Hall.

Keeping the Experimenter "Blin "
There are other features of the study, as well as some aspects of

measurement, which I cannot reveal to you. This is called keeping the

126

H

experimenter "blin to aspects of the experiment in order to prevent
bias in results. Of course, I will give you all the information you
need to do your job with competence and ease.
Confidentiality

I also want to alert you to the importance of confidentiality in
research. It is important that you do not talk with friends about the
details of your job until the experiment is over. Names of
participating subjects must be kept confidential under all

circumstances. After the experiment is over, I will brief you on the

overall design and trends in the results of the study.

APPENDIX E

DEPARTMENTAL RESEARCH (DNSENT FORM

APPENDIX E

MICHIGAN STATE UNIVERSITY

Department of Psychology

DEPARTMENTAL RESEARCH CONSENT FORM

I have freely consented to take part in a scientific study being

 

 

conducted by DIANE DENMAN
under the supervision of: DR. JOSEPH REYHER
Academic Title: PROFESSOR, DEPT. OF PSYCHOLOGY

 

The study has been explained to me and I understand the
explanation that has been given and what my participation will
involve.

I understand that I am free to discontinue my participation in
the study at any time without penalty.

I understand that the results of the study will be treated in
strict confidence and that I will remain anonymous. Within these
restrictions, results of the study will be made available to me
at my request.

I understand that my participation in the study does not
guarantee any beneficial results to me.

I understand that, at my request, I can receive additional
explanation of the study after my participation is completed.

Signed:

 

Title of Exper. Hypnosis, Imagery,
and Creative PrOblem—Solving

Date:

 

127

APPENDIX F

AUDIOTAPE RELEASE FORM

APPENDIX F

AUDIOTAPE RELEASE FORM

CIG Misc . 74-32

Audio and/or video playback of clients or research:eubjects

 

Whenever audio and/or video tape of clients may be viewed by persons
other than those directly involved in the taping and service delivery
to the client, a release form of the type shown below is to be used.
If the material is to be used in research and/or teaching, the client
must be so informed and his/her written consent obtained using the
Departmental Consent Form egg a release form of the type shown below.
In addition, the parental consent form is to be used when children are
involved.

RELEASE

I, , hereby agree to permit films,

 

kinescopes, videotape recordings, photographs or audiotape recordings
portraying and depicting psychological interviews in which I appear to
be used for demonstration and instructional purposes and for
duplication for up to 20 years from the date noted below. I
understand that I may withdraw my permission for use of these
materials in general, and for any specific purpose or situation, at
any time, by making a written request to Michigan State University or
the Department of Psychology. I understand that the confidentiality
of the material presented will be protected. I likewise authorize
Michigan State University to use such materials so prepared for
exhibition purposes with professional psychology groups and to permit

128

129
the right of use to other parties for such purpose so long as they
also agree to protecting the confidentiality of the material. The
materials recorded by the processes noted above will be stored and
protected as confidential material by the researcher or therapist.
The specific method for maintaining confidentiality and storage are
determined by the professional supervisor and the student. When the
materials are no longer useful for demonstration, instructional, or
research purposes, or at my written request, they will be withdrawn

from use, mechanically erased, or destroyed.

Signed:

 

Date:

 

Witness:

 

 

 

APPENDIX G

PROBLEM-SOLVING SCALE

 

 

SCORE

+1

+1

APPENDIX C

PROBLEM-SOLVING SCALE

STATEMENTS BY SUBJECT

The subject indicates that the prOblem is worse than
before hypnosis. No change has taken place in a
positive direction. Instead, the prOblem has
intensified, and the subject may complain of symptoms,
e.g., the inhibition of dreaming.

The subject indicates that he/she is still at impasse
on the prOblem or project brought to the experiment.
No progress toward solution is indicated.

The subject indicates that there has been a change in
the status of the project or problem brought to the
experiment or a change in attitude which moves the
subject in the direction of resolving the impasse.

The subject attributes positive results to the
experiment or the experimenter in some way:

(a) The subject may describe a solution used to
overcome the impasse which is specifically
related to the experimenter or experimental
procedure, e.g., hypnotic dreams, nocturnal
dreams, visual representation of elements of
the problem, experimenter’s interest, or any
aspect of the experimental situation.

(b) The subject experiences change following
hypnosis which seems beyond understanding:
"Since the experiment, I simply have not felt

like eating." "I’ve been freaked out because
I’ve been able to sleep every night since the
experiment."

130

 

+1

131

The subject indicates full satisfaction with the
solution achieved:

(a) The subject indicates full satisfaction with
changes in attitude experienced following the
experiment, but he/she has not yet achieved a
concrete solution.

(b) The subject indicates full satisfaction with a
concrete solution as it stands, e.g., the
solution is not a temporary or partial step
which requires revision or is without
practical merit.

 

APPENDIX H

DE-BRIEFING PROCEDURE

 

 

APPENDIX H

DE-BRIEFING PROCEDURE

The de-briefing procedure was structured around providing
information to subjects along with detecting and remediating any
mistrust or disappointment among subjects stemming from disguise of
the hypotheses of the study or unfulfilled.expectations. Based on
previous research (Barrios & Singer, 1981; Davé, 1979), no adverse
effects related to the hypnotic procedure itself were anticipated.

The de—briefing began as follows. After completion of the
Subject’s Post-experimental Questionnaire, all subjects were given a
typewritten de—briefing sheet entitled Imagery, Hypnosis, and Creative

Problem—Solving: Feedback to Subjects. The de—briefing sheet gave

 

information regarding the actual objectives of the study. After § had
finished reading the handout, E1 simply asked, "Do you have any
questions for me about the experiment?" If S did not initiate
conversation, E then shifted to the interview modality, stating,
I am wondering how you are reacting to the information I have
given you. Do you have any responses, feelings, thoughts, or
questions that you would like to discuss?
Issues of deception, disappointment, or any other questions raised by

the subject were then addressed. If any subjects expressed feelings

of resentment or embarrassment over having been deceived, E1 made

132

 

133
whatever efforts were necessary to restore S’s self-esteem. It was
conveyed to S that his or her experience had allowed the collection of
information bearing on important theoretical and practical matters.
Practical implications of the research, such as making those in the
helping professions aware of the importance of the relationship formed
with people at impasse were also described. If any subjects expressed
continuing distress regarding inability to resolve an impasse in the
prOblem brought to the experiment, E1 allowed the individual to talk
more about the problem, adopting an attitude of empathic listening.
Information regarding available counseling services was given if
requested. The de-briefing interview continued until E1 was satisfied
that the subject had accepted his or her participation in the research

with equanimity.

 

APPENDIX I

DE—BRIEFING SHEET

 

 

APPENDIX I

IMAGERY, HYPNOSIS, AND CREATIVE PROBLEM-SOLVING:
FEEDBACK TO SUBJECTS

The imagery technique you experienced during the experiment has
proven helpful to people in previous research. Our actual focus in
the experiment, however, was not on the imagery technique itself, but
on the relationship formed between yourself and the experimenter. The
experhment was designed to explore the nature of the relationship
formed when a person feels at impasse with a prOblem or project.

There is currently a debate going on in psychotherapy research
between what are called "common factors" and "specific factors" in the
helping relationship. "Common factors" are those factors which occur
in all helpful relationships. This type of relationship could include
that formed between a student and a teacher, a patient and a doctor, a
churchgoer and a church official, or a client and a psychotherapist.
Common factors include the beneficial effects of simply having a
supportive individual listen to you, take you seriously, and help you
elaborate upon your prOblem or impasse. This supportive, attentive
attitude occurs in all helping relationships.

"Specific factors" refer to those specific features in any
helping technique which contribute to prOblem-solving. For example,
behavioral therapies try to teach actively a new approach;
psychoanalysis hopes to give a client insight. In this case, the
"specific factor" refers to the effect of the experience of imagery on
prOblem—solving.

To test our hypotheses, we needed four groups consisting of two
groups of subjects and two experimenter types. The first group of
subjects were students who signed up for an experiment and were
assigned the task of defining a problem which they wanted to work on
during the experiment. The second group of subjects responded to ads
or letters looking for people who felt at impasse with a problem or
project. On this basis, we reasoned that the second group was likely
to be experiencing greater impasse than the classroom participants and
might be more highly motivated to form a strong relationship with a
warm and interested person.

134

 

135

Our experimenters were characterized as medium and high in
rapport. The "medium" experimenter was instructed to spend about five
minutes with subjects talking about their problem or project. The
experimenter high in rapport was instructed to spend about 20 minutes
with subjects talking about their prOblem or project. We wanted to
see if the differences in experimenter attitude would make a
difference in the amount of anxiety-reduction and.problemesolving
subjects experienced. we also wanted to know which factor, the
imagery technique or the experimenter’s attitude, was most important
in creative problem-solving. The results of the study have not been
completely analyzed, so we do not know whether or not our hypotheses
have been confirmed.

we would appreciate your keeping the hypotheses of the study
confidential, as the experiment is still in process. As you can
imagine, if individuals have full awareness of the hypotheses of the
study, this knowledge adds a new, uncontrolled factor to the
experiment and can invalidate results.

Thank you for your participation in helping us gather information
which has both theoretical and practical significance.

Diane Denman - Department of Psychology
135 Snyder Hall, MSU
Phone: 351-1611

APPENDIX J

REGRESSIVE TRANSFERENCE SCALE

 

APPENDIX J

REGRESSIVE TRANSFERENCE SCALE

 

SCORE STATEMENTS BY SUBJECT
+4 (A) Statements implying a parent-child relationship

1. WOrds such as "father", "mother", or Godlike are
used.

2. References to oneself as childlike: "I felt like a
little kid."

(B) Attribution of magical knowledge or power to the
hypnotist
1. Statements that the hypnotist can do anything
2. Problem resolution is described in a magical way,

without attempts to rationalize: "When we began
talking, I just knew something was going to happen
on my problem."

3. Statements that the subject felt the hypnotist had
magical understanding of him/her: "I don’t know
why, but I felt we had known each other all of our
lives."

(C) Descriptions of hypnosis transcend the range of normal
experience: "It was ecstatic." "I lost all contact
with my body." "It was just like an LSD trip."

+3 (A) Indications of special gratification in the relationship

1.

Statements worded in superlatives or hyperbole:
"She’s the greatest." "She’s fantastic, terrific."
"I have never felt safer." "I was extremely
reassured." "I felt thoroughly understood."

136

+3

+2

(B)

(C)

(A)

137

Reluctance to break off relationship with the
hypnotist or with hypnosis: "I wish she would come
home with me every night and hypnotize me." "I want
a copy of the tape." "Can she teach me hypnosis?"
"I didn’t want to wake up."

Attributions of special knowledge or power to the
hypnotist; an experienced transfer of ego functions

1.

Statements that the hypnotist’s presence was
decisive, essential, or led to renewed hope in
problem resolution: "I couldn’t have done it
without her." "After talking with her, I felt I
could come to terms with my prOblem."

Assumptions that the hypnotist knows the meaning of
the subject’s hypnotic dreams: "Now will you tell
me the meaning of all this?" "Why did I dream about
a rabbit?"

Indications of regression during hypnosis

1.

Statements referring to the power of the hypnotic
experience: "WOw!" "It blew me away." "I didn’t
realize how affected I was by it."

Statements referring to relative ego—loss during
hypnosis: "I felt like I was floating." "I had no
awareness of the passage of time."

Statements describing hypnosis are worded in
superlatives or hyperbole: "I felt just terrific
afterwards!"

Indications of security and trust in the relationship

1.

Statements indicating the subject felt safe, cared
for, or reassured: "I felt safe at all times." "I
felt she cared about what happened to me." "I felt
accepted."

Expressions of trust and confidence in the
hypnotist: "She put me at ease." "I felt
comfortable around her." "I was surprised I was
able to relax without any difficulty in her
presence."

Statements indicating that the subject felt free to
self-disclose in the relationship with the hypnotist

+2

(B)

(C)

138

(a) Discussion of the prOblem with ease: "I talked
about my boyfriend, and she helped.me to get it
all out."

(b) Sharing of life experiences not directly
related to the problem at hand: "I told her
about my trips to Lake Michigan after the
experiment, and she seemed interested."

Statements indicating a desire to please the
hypnotist

(a) Protecting the experimenter from criticism;
turning blame upon oneself: "I had trouble
talking about my prOblem, but it was not her
fault."

(b) Asking for evaluation: "How did I do?" "Does
everyone have dreams like this?"

Statements expressing confidence in the experiment or in
the hypnotist’s knowledge and abilities

1.

Acknowledging the hypnotist’s effectiveness in
performing her role: "She knew what she was doing."
"I trusted her to manage the session." "I was
impressed by the questions she asked."

Acknowledging the effectiveness of the experimental
procedure: "I was impressed by the experiment."
"The whole procedure was gratifying."

Statements that the subject was able to use the
experiment in some way to work toward problem
resolution: "After it was over, I felt more
optimistic about my prOblem." "The visual images
gave me insight."

Statements describing an experience of pleasurable
relaxation during hypnosis

1.

Comments indicating relaxation during hypnosis: "I
felt relaxed." "I feel drowsy, sleepy." "I feel
heavy." "I can’t get up out of the chair."

Expressions of pleasure following hypnosis,
indicated by long, drawn-out tones. If asked, "Are
you relaxed?", the subject replies: "Ummmhmmm.
Ohhh. Mmmm."

 

 

+1

139

(A) Statements indicating a mildly positive relationship
with the experimenter

1. Mildly positive statements: "She was nice." "She
was pleasant and friendly." "She was professional."
"I enjoyed participating."

2. Descriptions of a positive incident: "She smiled."
"She had a nice voice." "I liked the part about

N

 

(B) Statements complimenting the hypnotist’s competence or
the design of the study

1. Mildly positive statements: "She seemed competent."
"She did a good jo ." "She performed well." "The
experimental design was soun ."

2. Descriptions of a positive incident of competence:
"She did the hypnosis well." "She explained the
procedure adequately."

3. Statements indicating that the experiment had

aroused interest in hypnosis or psychology: "It was
a very interesting new experience." "It was kind of
exciting."

4. Mildly positive statements regarding problem
resolution: "The experiment might help in the long
run." "I’ve felt some change, although I don’t know
if it was entirely due to the experiment."

(C) Statements describing an experience of mild relaxation
or interest during hypnosis. When asked "How do you
feel?", the subject replies, "Rested." "It was neat."

In response to questions regarding the subject’s experience,
or questions regarding the subject’s level of anxiety during
the procedure, the subject appears to be responding to demand
characteristics but does not reveal any affect. For example,
the subject responds simply "yes" or "no" without further
elaboration. In response to 2’8 asking "How do you feel?", a
comment such as "fine," "OK," "alright", or "I don’t know,"
without further elaboration, is given. Other noncommittal
comments, such as "It was interesting" or "The lights are
bright," are also scored zero.

(A) Statements indicating mild discomfort in relationship to
the experiment or the experimenter.

 

(B)

140

Mildly negative global statements: "Things didn’t
go very well." "I was hoping for more of an
experience." "It was strange, sort of unpleasant."

Statements that the subject felt apprehensive or
uneasy regarding the experiment or the experimenter:
"I wasn’t totally at ease." "I found it difficult
to relax." "I was trying to impress her too muc ."

Descriptions of negative events: "Whenever she told
me I was enjoying hypnosis, I became somewhat
anxious." "Being taped made me uncomfortable."
"Some of the dreams were unpleasant."

Descriptions of failure to produce requested images
or dreams: "I didn’t have the follow-up dreams."
"I kept drawing blanks."

Statements indicating feelings of inadequacy on the
subject’s part: "I felt stupid when I answered the
questions too fast." "I worried if my images were
'right'."

Statements mildly criticizing the hypnotist’s
performance or the design of the study

1.

Descriptions of incidents of disappointment in the
hypnotist: "I couldn’t hear her voice over the
music." "She coughed."

Statements suggesting improvements in the
experimental procedure: "A discussion of general
relaxation techniques would’ve been helpful."

Statements suggesting changes in the setting:
"Perhaps a more comfortable chair." "I didn’t like
the music."

Expressions of doubt or uncertainty regarding the
effectiveness of the experiment: "I don’t know if
it really helped with the prOblem." "I am unsure
regarding the purpose of the experiment."

Expressions of doubt or disappointment regarding the
experience of hypnosis

10

Statements questioning the depth of the hypnosis:
"I was unsure if I was really hypnotized." "I kept
wondering, 'When will it happen'."

 

(A)

(B)

(C)

141

Disappointment in the hypnotic dream experience:
"The pictures were drifting and unclear." "I didn’t
really have images, more like thoughts."

Statements that hypnosis was not what the subject
expected: "I thought I would be unaware while
responding." "I didn’t expect to remember any of my
dreams."

Indications of lack of trust and rapport with the
experimenter

1.

Statements that the subject was uncertain about the
experimenter’s involvement and care: "She seemed to
be in a rush." "She seemed.detached." "She didn’t
seem to care what happened to me."

Statements that the subject felt strong anxiety or
fear: "I felt tense, like I couldn’t get enough
air." "I was concerned with the thought of losing
consciousness." "I started crying."

Indications of lack of confidence in the experimenter’s
abilities or in the experimental procedure

1.

Statements that the subject was dissatisfied with
the hypnotist’s role performance: "She needed to be
a bit more forceful." "She could’ve been more
relaxed and natural."

Statements that the subject was uncertain about the
experimenter’s competence in handling problems:
"She was a bit unprepared for my reaction to
hypnosis." "I wasn’t completely confident that she
understood my problem."

Statements that the subject was unable to use the
procedure toward prOblem-solving: "It was
frustrating to feel that I did.not get anywhere with
it."

Descriptions of insecurity or fear during hypnosis

1.

Statements that the subject felt rushed during
induction: "I needed.more time to relax." "One
time was not enough for hypnosis to occur."

Statements indicating superficial compliance during
hypnosis: "She thought I was more deeply hypnotized
than I was."

 

(A)

(A)

(B)

142

Descriptions of feelings of alienation from the
experimenter or the experiment

1. Statements that the subject experienced the
hypnotist as cold, rejecting, or grossly
insensitive: "Her whole character was kind of
cold." "I don’t remember one word coming from her
about my prOblem."

2. Statements worded.in superlatives or in hyperbole:
"I felt she was extremely unsure of herself." "Her
manner was mechanical." "The room.was oppressive,
the music jarring."

Statements that the experiment was ineffective or the
hypnotist unqualified or incompetent; an experienced
inability to transfer ego functions

1. Questioning the hypnotist’s competence or
credentials: "I don’t think she was properly
trained." "She wasn’t very good at it." "She was
too young and inexperienced to do hypnosis."
"Someone more qualified would have had a stronger
impact on me."

2. Rejection of any positive influence stemming from
the hypnotist or the experiment: "She didn’t leave

me with any sense of hope." "I thought it was
supposed to help me solve my prOblem." "It didn’t
work."

Rejection of the experience of hypnosis

1. Statements that the hypnotist was unable to
hypnotize the subject: "She wasn’t able to
hypnotize me." "I was never able to relax and go
with the experience."

2. Statements that the subject experienced no change in
awareness: "I didn’t feel in a trance." "There was
no difference between this and relaxing on my own."

Statements indicating the subject experiences the
hypnotic relationship in a coercive, sado-masochistic,
or nightmarish way: "I felt she was forcing me to
dream."

Flat rejection or hostile derogation of the experiment
or the experimenter: "I’ll never do anything like this
again." "Certainly nobody in the experiment was moved
toward a solution." "The experiment did no good at
all."

 

 

 

 

+4

+3

+2

+1

143
(C) Ridicule of the experience of hypnosis: "I thought it
was fake." "I was never even close to hypnosis."
ABSTRACTED DIMENSIONS OF THE SCALE
An experienced relationship to an omnipotent other

Special gratification; an experienced transfer of ego
functions

The experience of safety, security, trust

The experience of mild attachment; courtesy, compliments
No affect; evasion of comment

An experience of mild discomfort

The experience of insecurity and lack of trust

The sense of rejection; an experienced inability to transfer
ego functions

An experience of malevolence; open criticism or hostility

 

 

APPENDIX K

HOLT CONTENT SCORING SYSTEM

 

 

 

 

 

 

APPENDIX K

HOLT ANXIETY/GUILT CONTENT SCORING: ADDITIONAL EXAMPLES

Insecure:

Frustration:

Entrapment:

Out of control:

Confusion:

Abandoned:

a man tied, helpless, falling into space; someone
falling, crashing, stumbling; pile of rocks about
to topple over; precarious setting

inability to obtain a desired goal or complete a
desired act; reaching for object which retreats;
impeded by glass barrier, mountain, impersonal
object or situation

a person enslaved by circumstances; feeling
trapped, struggling to get out but cannot;
helplessly burdened; snowed in; in a cocoon; in
smothering clothing; buried alive

subjected to an uncontrollable storm, tornado,
flood; being helplessly carried away by something,
train, boat, with negative affect; subjected to
pressures beyond one’s control, being pulled in
opposite directions, being pulled apart, feeling
ready to explode

lacking direction; lost in a maze; in fog or dark;
in a haze, lost in a cloud

abandoned and alone or deprived but with no

specific person noted; a child crying alone, lost
in woods, forest

144

 

APPENDIX L

RATING SCALES: ROLE MANIPULATION CHECK

 

APPENDIX L

RATING SCALES: ROLE MANIPULATION CHECK

For each question, please put a checkmark on the category or unit of
the scale that best represents your impressions of the experimenter.

Status

1.

Based on the experimenter’s appearance, what do you think the
experimenter’s educational level might be?

High school student
Community college student
University undergraduate
Graduate student
Professional status (Ph.D.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. How old do you think the experimenter is?
17-18
19-20
21-22
23-24
25-above
13. How would you rate the experimenter’s attire?
High fashion shop (luxurious)
Specialty store
Department store
Discount store
Street person
1Adapted from the Personal Power Functions Inventory Profile,
Reyher, 1979.

145

 

146

Warmth

1.

Did the experimenter spend time talking with you about your
problem in detail?

Definitely Somewhat Slightly Not at all

 

 

 

 

 

 

 

 

YES : : : NO
22. How would you rate the examiner in the personal quality of
warmth?
very Somewhat Neither Somewhat Very
FRIENDLY : : : : HOSTILE
COLD : : : : WARM
SENSITIVE : : : : INSENSITIVE
Competence
1. Did the experimenter seem.clumsy or make any errors in
administering the procedure?
Definitely Somewhat Slightly Not at all
YES : : : NO
2. How would you rate the experimenter in the personal quality of
competence?
Very Somewhat Neither Somewhat Very
INOOMPETENT : : : : OOMPEI‘ENT
INTELLIGENT : : : : UNINTELLIGENT
CONFIDENT : : : : LACKS CONFIDENCE

 

Positive Message

 

1.

Did the experimenter leave you with the impression that the
imagery technique was a sound one likely to bring positive
results?

Definitely Somewhat Slightly Not at all
YES : : : NO

 

2Semantic differential items were adapted from Assor, 1978.

147

2. How would you rate the experimenter regarding the certainty of
the message conveyed about the experimental procedure?

very Somewhat Neither Somewhat very

UNTRUSTWORTHY : : : : TRUSTWORTHY

 

CONVINCING : : : : - UNCONVINCING

INDECISIVE : : : : DECISIVE

 

APPENDIX M

ANALYSIS OF VARIANCE SUMMARY TABLES

 

 

APPENDIX M

ANALYSIS OF VARIANCE SUMMARY TABLES

Table 3

Two-way Analysis of Variance for Time Spent Talkingewith Experimenter

 

 

Source SS MS F p
Condition 1252.545 1252.545 59.403 .0011‘
subgroup 7.682 7.682 .364 .548
Interaction .409 .409 .019 .890
Residual 1771.182 21.085

Total 3031.818 34.848

 

*significant p

148

 

 

149

Table 6

Two-way Analysis of Variance for the Regressive Transference Scale 1

 

 

 

Source SS MS F p
Condition .175 .175 .155 .695
subgroup .183 .183 .163 .688
Interaction 1.935 1.935 1.720 .194
Residual 85.518 1.125

Total 87.811 1.112

Table 7

Three—way Analysis of Variance for the Regressive Transference Scale

 

 

Source SS MS F p
Condition .000 .000 .000 .983
Subgroup 1.675 1.675 2.266 .136
Age group 1.624 1.624 2.196 .142
C/S 1.930 1.930 2.610 .110
C/A 1.090 1.090 1.475 .228
S/A .901 .901 1.218 .273
C/S/A .992 .992 1.341 .250
Residual 59.155 .739

Total 70.677 .812

 

 

150

Table 8

Two-wayiAnalysis of Variance for the Regressive Transference Scale 2

 

 

Source SS MS F 9
Condition .406 .406 .534 .467
subgroup 5.752 5.752 7.576 .007‘
Interaction .743 .743 .978 .325
Residual 63.776 .759

Total 70.677 .812

 

*significant p

Table 9

Two-way Analysis of Variance for the Problem-Solving Scale

 

 

Source SS MS F 9
Condition .182 .182 .137 .712
Subgroup .011 .011 .009 .927
Interaction 4.102 4.102 3.089 .082
Residual 111.568 1.328

Total 115.864 1.332

 

Table 10

151

Two-way Analysis of Variance for the Trait Apxiety Index

 

 

 

 

 

 

Source SS MS F p
Condition 294.557 294.557 3.025 .086
Subgroup 82.102 82.102 .843 .361
Interaction 294.557 294.557 3.025 .086
Residual 8178.500 97.363

Total 8849.716 101.721

Table 11

Two—way Analysis of Variance for STAIl

Source SS MS F 9
Condition 60.557 60.557 .357 .552
Subgroup 25.102 25.102 .148 .702
Interaction 301.92 301.92 1.778 .186
Residual 14264.50 169.815

Total 14652.08 168.415

 

 

152

Table 13

Two-way Analysis of Covariance for Difference Scores, STAIl — STAIZ

 

 

Source SS MS F p
Covariate
STAI 1 9924.162 9924.162 173.549 .001

Main effects

Condition 24.017 24.017 . .420 .519

subgroup 64.366 64.366 1.126 .292
Interaction 70.828 70.828 1.239 .269
Residual 4746.235 57.184

Total 14829.818 170.458

\

 

 

 

153

Table 14

Two-way Analysis of Covariance for Difference Scores, STAIl - STAI3

 

 

Source SS MS F p
Covariate
STAI 1 7910.334 7910.334 62.879 .001

Main effects

Condition 39.642 39.642 .315 .576
Subgroup 777.260 777.260 6.178 .015*
Interaction 91.416 91.416 .727 .396
Residual 10441.678 125.803
Total 19261.273 221.394

 

*significant p

Table 16

Two-way Analysis of Variance for Holt Oral Subscale

 

 

Source SS MS F 9
Condition .715 .715 .615 .435
subgroup 1.596 1.596 1.374 .244
Interaction .006 .006 .005 .944
Residual 97.552 1.161

Total 99.868 1.148

 

154

Table 17

Two-way Analysis of Variance for Holt Anal Subscale

 

Source SS MS F

 

 

 

 

 

P
Condition .085 .085 3.041 .085
Subgroup .001 .001 .053 .819
Interaction .001 .001 .053 .819
Residual 2.356 .028
Total 2.444 .028
Table 18
Two-way Analysis of Variance for Holt Sexual Subscale
Source SS MS F p
Condition .077 .077 .100 .752
Subgroup .081 .081 .105 .747
Interaction .229 .229 .296 .588
Residual 64.944 .773

Total 65.331 .751

 

155
Table 19

Two-way Analysis of Variance for Holt Exhibitionistic/VOyeuristic

 

 

 

Subscale

Source SS MS F 9
Condition 3.698 3.698 2.627 .109
Subgroup .228 .228 .162 .688
Interaction 1.798 1.798 1.277 .262
Residual 118.264 1.408

Total 123.989 1.425

Table 20

Two-way Analysis of Variance for Holt Homosexual Subscale

 

 

 

Source SS MS F 9
Condition .002 .002 .162 .688
Subgroup .010 .010 .741 .392
Interaction .003 .003 .193 .661
Residual 1.138 .014

Total 1.152 .013

 

 

 

156
Table 21

Two—way Analysis of Variance for Holt Dependency Subscale

 

 

Source SS MS F 9
Condition 1.615 1.615 5.733 .019*
Subgroup .837 .837 2.970 .088
Interaction 1.926 1.926 6.840 .011‘
Residual 23.658 .282

Total 28.035 .322

 

*significant 9

Table 22

Two—way Analysis of Variance for Holt Total Libidinal Scale

 

 

 

Source SS MS F p
Condition 8.763 8.763 2.193 .142
subgroup .080 .080 .020 .888
Interaction 4.752 4.752 1.189 .279
Residual 335.631 3.996

Total 349.226 4.014

 

157
Table 23

Three-way Analysis of Variance for Holt Total Defense Scale

 

 

Source SS MS F 9
Condition 5.717 5.717 .710 .420
subgroup 47.642 47.642 5.915 .017*
Agegroup 3.055 3.055 .379 .540
C/S 3.956 3.956 .491 .485
C/A .436 .436 .054 .817
S/A 7.728 7.728 .959 .330
C/S/A 5.806 5.806 .713 .401
Residual 644.398 8.055

Total 768.721 8.836

 

‘significant p

158
Table 24

TWO—way Analysis of Variance for Holt Total Defense Scale

 

 

Source SS MS F p
Condition 18.182 18.182 2.316 .132
Subgroup 87.122 87.122 11.096 .001‘
Interaction 3.881 3.881 .494 .484
Residual 659.536 7.852

Total 768.721 8.836

 

1"significant p

Table 25

Two-way Analysis of Variance for Holt Anxiety Score

 

 

Source SS MS F 9
Condition .037 .037 .060 .806
subgroup 1.418 1.418 2.303 .133
Interaction .536 .536 .871 .353
Residual 51.704 .616

Total 53.695 .617

 

 

 

159
Table 26

Two-way Analysis of Variance for Holt Object Aggression Score

 

 

 

Source SS MS F _p_
Condition 3.131 3.131 2.082 .153
Subgroup 11.622 11.622 7.727 .007*
Interaction 1.078 1.078 .717 .400
Residual 126.336 1.504
Total 142.167 1.634

 

1‘significant p

Table 27

Two-way Analysis of Variance for Holt Total Regression Scale

 

 

Source SS MS F _p
Condition 84.398 84.398 6.181 .015‘
Subgroup 202.101 202.101 14.801 .001’
Interaction .266 .266 .019 .889
Residual 1146.989 13.655

Total 1433.753 16.480

 

*significant p

 

 

 

 

 

160
Table 28

Two-way Analysis of Variance for Holt Subjecteeggression Scale

 

 

 

Source SS MS F _p
Condition .037 .037 .055 .815
subgroup .050 .050 .073 .787
Interaction .943 .943 1.390 .242
Residual 57.012 .679

Total 58.042 .677

Table 30

Two-way Analysis of Variance for Age and Condition Within Low Impasse

 

 

Source SS MS F p
Condition .415 .415 .737 .396
Subgroup .001 .001 .001 .971
Interaction 1.484 1.484 2.634 .112
Residual 22.532 .563

Total 24.042 .559

 

 

 

161
Table 31

Two—way Analysis of Variance for Agegand Condition Within High Impasse

 

 

Source SS MS F p
Condition 1.133 1.133 1.361 .250
Subgroup 6.232 6.232 7.486 .009*
Interaction .045 .045 .054 .818
Residual 33.299 .832

Total 40.882 .951

 

*significant p

 

 

Table 32

Three-way Analysis of Variance for Age,iImpasse, and Regressive

 

 

 

Transference

Source SS MS F 9
Condition .100 .100 .144 .706
Subgroup 8.426 8.426 12.073 .001*
Agegroup 3.288 3.288 4.711 .033‘
C/s 1.471 1.471 2.108 .150
C/A .999 .999 1.431 .235
S/A 3.149 3.149 4.512 .037‘
C/S/A .483 .483 .692 .408
Residual 55.831 .698

Total 70.677 .812

 

‘significant p

APPENDIX N

LITERATURE REVIEW: REGRESSIVE TRANSFERENCE, HYPNOSIS
AND THE PLACEBO EFFECT

 

 

APPENDIX N

REGRESSIVE TRANSFERENCE, HYPNOSIS, AND THE PLACEBO EFFECT

Despite the explosion of experimental interest in hypnosis during
the 1960’s, the nature of the relationship between hypnotist and
client has remained a relatively neglected topic in research. This
relative neglect may be due to the fact that constructs which describe
hypnosis as a relationship stem primarily from psychoanalytic theory.
The typical psychoanalytic formulation of hypnotic phenomena in the
clinical situation involves the notion of transference as a central
construct.

For example, Ferenczi (1950), following Freud (1953, p. 150)
defined hypnosis as a regressive transference involving both libidinal
and submissive strivings in relation to a maternal or paternal figure.
Rado (1925) introduced the notion that the patient identified with the
hypnotist as a defense against submissive strivings, allowing the
hypnotist to function as a "parasitic super-ego" during the course of
hypnosis (p. 21). Kubie and Margolin (1944) construed.hypnosis as a
state where the subject temporarily incorporated the image of the
hypnotist as an experimentally-induced superego, similar to the early
parent—child relationship. Wolberg (1945), emphasizing the active

participation of the subject, saw hypnosis as a dependency relation

163

 

 

164
where the subject sought gratification of various needs through the
agency of a parental or other external authority figure. Gill and
Brenman (1967), emphasizing the demand.characteristics of the
situation, defined the transference underlying hypnosis as the
constellation of dependency strivings within the ego subsystem evoked
by environmental press. Recent theoreticians who utilize transference
as a central construct in hypnosis include Fromm (1975, 1977), Shor
(1959, 1962), and Reyher (1964, 1977, 1980). Despite differences in
emphasis among these authors, the psychoanalytic tradition on the
whole has maintained that hypnosis is, above all, a special type of
relationship. The features of this special relationship include
enhanced suggestibility and a regressive transference where the
subject experiences the self as relatively dependent and helpless in
relation to a caring, powerful other.

Although the psychoanalytic literature contains an abundance of
clinical evidence, however, its constructs have been difficult to
operationalize, and laboratory methods have not been systematically
developed for their proper evaluation. In contrast, more recent
approaches developed in an experimental context, including behavioral,
social psychological, and cognitive perspectives, have shown less
interest in hypnosis as a relationship. While these perspectives have
made valuable contributions to the understanding of hypnosis as a
learned event, as a social role, and as a cognitive state,
relationship variables tend to be construed and operationalized in

ways which are only indirectly related to the notion of transference.

 

165

For example, Cautela (1975), in an article discussing covert
conditioning and hypnotherapy, mentions that hypnotic induction may
facilitate rapport so that the therapist becomes a stronger reinforcer
for the client. The components and antecedents of rapport as an
affective and motivational state, however, have been left unspecified
by the author. Hilgard (1965), from the context of developmental-
interactive theory, does not see the initial rapport upon which
hypnosis is based as a transference. Rather, hypnotic susceptibility
is conceptualized as the ability to become deeply involved in fantasy.
The important factors mediating hypnotic induction include simply a
setting which inspires confidence and a subject capable of tolerating
a dependency relationship. These antecedent conditions release the
subject’s potential for immersion in experience, construed as a quasi-
cognitive, quasi-motivational variable. Sarbin and his associates
(Coe & Sarbin, 1977; Sarbin, 1950; Sarbin & Anderson, 1967) emphasize
the importance of the social context in hypnosis. Their role-
enactment model characterizes the hypnotic relationship as one in
which the hypnotist shapes and socially reinforces the behavior of a
subject who is eager to perceive cues regarding acceptable role—
behavior in the situation. The hypnotist is seen as a social
reinforcer whose warmth and prestige strongly influence the subject’s
performance. Cognitive theorists such as London (1967) and Bowers
(1976, 1977) have tended to focus on attentional processes and the
cognitive characteristics of subjects as the primary factors
responsible for hypnosis. The relationship between subject and

hypnotist is then seen as facilitating or inhibiting the trust

 

 

 

166

necessary for individuals to assume an attitude of receptive
attention. Sheehan and McConkey’s (1982) concept of rapport, for
example, includes interpersonal trust, with the operator seen as a
protective guide. Barber and.his associates (Barber & DeMOor, 1972;
Barber, Spanos, & Chaves, 1979) give motivation equal weight with
cognitive factors in inducing hypnosis, but they define such
motivation as simply valuing hypnosis, wanting to be hypnotized, and
expecting to succeed. From the psychoanalytic perspective, however,
the important factors which make up hypnosis as an event differing
from other social events include the nature of the dependency
strivings of the subject and the meaning of the hypnotist to the
client in terms of his or her capacity to gratify those needs in
fantasy. These factors are not emphasized in any of the above models.

Reyher (1977, 1980), however, has formulated a two-step theory of
hypnosis which allows operational definition of the concept of
regressive transference. According to Reyher, hypnosis involves both
cognitive and motivational factors. The cognitive factor refers to
the restriction of sensory input and the suspension of active mental
processing which takes place during induction as the subject focuses
on the operator’s voice. All that is necessary for suggestibility to
increase, termed hyper-suggestibility, level I, is that the subject
adopt a passive—receptive, open-minded attitude of waiting silently
for instructions. If the subject can give up to the hypnotist his
role of actively processing sensory input and can adopt a passive-
dependent attitude in relation to the hypnotist, the induction will

succeed (Reyher, Wilson, & Hughes, 1979). If the character structure

 

 

167
of the subject will not allow the adoption of a dependent attitude
without the arousal of anxiety, however, defenses are activated and
hypnosis will not occur.

A further increase in suggestibility, termed hyper-suggestibility
level 11, occurs when subjects capable of assuming a passive-receptive
attitude undergo a regressive transference in relation to a suitable
facilitator. The occurrence of hyper-suggestibility level II depends
primarily on two variables. First, the individual must be
experiencing acute anxiety regarding his or her personal, social, or
physical welfare, in circumstances where the individual does not know
how to relieve the distress. Second, the available caretaker must
assume a demeanor of unquestionable self-assurance, competence, and
kindness in his or her approach to the suffering individual. Reyher
(1980) hypothesizes that the above conditions reconstitute the
circumstances of early childhood or infancy, which cue in a state-
dependent manner reminiscences of being cared for by loving,
omniscient parents. These reactivated remembrances constitute, in
psychoanalytic terms, the regressive transference which mediates
further suggestibility. These remembrances, however, are not discrete
memories of specific persons or events. Rather, they are more aptly
characterized as longings or affectively-toned strivings to find
sanctuary in relationship with an accepting, strong, authoritative
figure. Any variables which increase the helplessness and anxiety of
the client and which enhance the caretaker’s appeal will contribute to
the formation of a regressive transference. These factors might

include, among other things, character traits of the subject and the

 

168
perceived status and interpersonal power of the hypnotist. The
advantage of Reyher’s formulation is that, in specifying antecedent
conditions necessary for a regressive transference to occur, the
construct is available for experimental manipulation.

Additionally, in providing a cohesive definition for the concept
of regressive transference, the nature of the evidence relevant to the
construct becomes more clear. subjects experiencing a regressive
transference should be characterized by intense dependency strivings,
conceptualized either as an enduring disposition or as the consequence
of a stressful situation beyond the individual’s coping capacity. The
designated facilitator of such a transference, whether researcher or
therapist, must be perceived as possessing sufficient protective
competence to allow the individual to regress. In the process of
establishing such a relationship, the subject is likely to
overestimate the positive attributes of the facilitator and to show
exquisite sensitivity (enhanced suggestibility) to his or her wishes.
Similarly, fantasies produced by the subject should indicate
reciprocal child—parent roles or other derivatives of a sheltering
relationship. Experimental evidence regarding features of the
hypnotist—client relationship are not inconsistent with the concept of
regressive transference. Despite contradictions in the literature,
personality features which correlate with hypnotic susceptibility
across a wide variety of personality inventories include docility
(Bentler, 1963), deference (Lang & Lazovik, 1962), dependence (Levitt,
Brady, & Lubin, 1963; Roberts & Tellegen, 1973), affiliation (Bentler,

1963; Lang & Lazovik, 1962), and acquiescence (Hilgard, 1965; Schulman

 

 

 

169
& London, 1965). Correspondingly, Levitt, Brady, and Lubin (1965) and
Roberts and Tellegen (1973) found refractory hypnotic subjects to be
more aggressive, dominant, independent, and critical than good
hypnotic subjects. Correlations between personality traits measured
by paper-and—pencil tests and hypnotic susceptibility, however,
generally have been low, and replications with any one instrument have
been inconsistent (see Barber, 1964; Deckert & west, 1963; Derman &
London, 1965; Kihlstrom et al., 1980).

In the face of conflicting evidence, Dana and Cooper (1964),
following an extensive review of the literature, suggested a two—
factor hypothesis of susceptibility consisting of a cognitive or
hypnotic skill factor and a personality factor. Following the lead of
Dana and Cooper (1964), Reis, Wheeler, and.wolff (1975) examined the
role of multiple factors in predicting trance depth. Two factors,
cognitive and interpersonal, were defined. The cognitive factor was
derived from a test measuring imaginative-perceptual versus analytical
intellectual style. The interpersonal factor consisted of a measure
of salience of needs for affiliation, deference, and succorance versus
needs for autonomy and rejection of others. The authors predicted
that highly susceptible hypnotic subjects would be characterized by an
imaginative-perceptual cognitive style along with salient needs for
affiliation, deference, and succorance, whereas low-susceptible
subjects would show the opposite pattern. They also hypothesized that
both factors would jointly predict trance depth among subjects,
whereas neither factor alone would successfully allow prediction.

Results confirmed each hypothesis. Based on one factor alone, no

 

170
pattern of results was found from which trance depth scores could be
adequately predicted. The multiple classification scheme, however,
correctly predicted hypnotic susceptibility for 24 of the 28 subjects
who were categorizable into high and low groups on both cognitive and
interpersonal dimensions. When skill and interpersonal factors are
isolated, then, the personality correlates of the good hypnotic
subject tend to be in the direction of the affiliative and acquiescent
tendencies found by previous research.

Barber (1964), on the other hand, emphasized the greater value of
an interactional rather than a trait model of hypnotizability and
called for research examining the hypnotist-subject relationship.
Fourie (1980), using an interactional model, attempted to predict
hypnotizability from aspects of the relationship existing between the
subject and operator immediately prior to hypnosis. Based on pre-
induction interview ratings, he found that the degree to which
subjects put themselves in a dependent position vis-a-vis the
hypnotist was positively correlated with susceptibility, whereas the
amount of direct aggression expressed to the hypnotist was negatively
correlated with susceptibility. Results are in accordance with the
earlier findings of Roberts and Tellegen (1973) and Levitt et al.
(1965).

Additionally, experimental evidence does suggest that depth of
interpersonal rapport is related to hypnotic responsivity. Factors in
the interaction associated with increased suggestibility include trust
(Roberts & Tellegen, 1973; Shapiro & Diamond, 1972; Shor, 1962), an

attitude of collaboration (MCDermott & Sheehan, 1976), and the

171
existence of a previous relationship with the hypnotist (Kramer, 1969;
Tart, 1970). Reyher and Wilson (1973) have also shown that anxiety
present during induction can interfere with hypnosis.

Similarly, features of the hypnotist which facilitate trust and
encourage the adoption of a passive—receptive attitude on the
subject’s part have been found to influence hypnotizability. These
factors include warmth and friendliness (Greenberg & Land, 1971;
Hartman, 1967), the perceived experience of the hypnotist (Balaschak,
Blocker, Rossiter, & Perin, 1972; Coe et al., 1970), the operator’s
prestige (Coe et al., 1970; Small & Kramer, 1969), and the forceful,
confident manner in which suggestion is given (Barber & Calverly,
1964). This body of evidence would suggest that the good hypnotic
subject tends to be characterized by acquiescent and affiliative
needs, is capable of forming a trusting relationship and responds best
to an operator perceived as warm, capable, and experienced.

More direct evidence of transference, however, comes from a group
of studies examining subjects’ attributions of personality qualities
to the hypnotist, subjects’ exquisite sensitivity to the wishes of the
hypnotist, and subjects’ fantasy productions about the hypnotic
experience. Regarding attributions to the hypnotist, in an early
clinical study of hypnotherapy, Schneck (1955) pointed out that
patients, in part, create their own hypnotherapist and utilize the
fantasied therapist as a projection of their unconscious. Later
experimental studies have substantiated this Observation.

Land and Greenberg (1971), for example, varied the attitude of an

experimenter present in the room with the subject along warmth and

 

172
prestige dimensions in a 3X2 factorial design. The actual hypnotic
induction was presented by a different hypnotist on videotape.
Regardless of how subjects perceived the experimenter, there were no
differences in subjects’ perception of the tape-recorded hypnotist:
he was always viewed as highly competent, warm, and experienced.
Crosswell and Smith (1974) asked subjects to evaluate the personal
qualities of a videotaped "hypnotist storyteller" in three different
conditions. The first group received a standardized hypnotic
induction. The second group was asked to simulate hypnosis and
listened to a tape-recorded story, while the third group simply
listened to the story. The hypnotic induction group differed
significantly from both simulating and control groups on 7 of the 10
items of the evaluation scale. Results of the study suggested that
the hypnotist was viewed by the hypnotic subject as a wise, powerful,
knowledgeable, and parent-like figure, in marked contrast to the other
groups. These studies suggest that subjects actively strive to create
the conditions under which they can safely regress, which include the
presence of a fantasied warm and competent caretaker.

Sheehan (1980) has used the term counterigg to express the
tendency of some highly susceptible subjects to follow the intent of
the hypnotist when other social influences would dictate competing
responses. This subset of subjects score high on dependency, are
extremely sensitive to the implicit wishes of the hypnotist, and are
motivated to acquiesce to those wishes in a way which differentiates
them from subjects simulating hypnosis, low susceptibles, and

unhypnotized controls (Dolby & Sheehan, 1977; Sheehan, 1971). The

 

 

173
phenomenon has been replicated across varying conditions including
perceptual illusions (Sheehan & Dolby, 1975) and post-hypnotic
suggestion (Duncan & Perry, 1977; Sheehan, 1971). In addition, the
performance of these subjects deteriorated.when the hypnotist acted to
reduce rapport (Sheehan, 1980). The data are in accordance with
transference theorizing, in that the hypnotist appears to be given a
special degree of importance by a subset of highly dependent hypnotic
subjects who show markedly enhanced suggestibility.

A third index of transference—like involvement stems from
subjects’ fantasy productions during or after hypnosis. Sheehan and
Dolby (1979) asked.three groups of subjects given differing
instructions to produce a dream.under hypnosis. Results indicated
that hypnotic subjects perceived the operator in a more authoritative
manner than waking or imagination-instructed subjects. Rapport among
hypnotic subjects expressed protection-care or guidance dimensions.
This pattern was especially evidenced by the most highly motivated
subjects in the hypnotic group, as previously indexed by countering
behaviors. The authors commented that the results did suggest a
transference—like involvement of some hypnotic subjects with the
operator but could not be construed as a regressive display of wish—
fulfillment, as implied by psychoanalytic constructs. The authors,
however, did not further define what they meant by the term
"regressive wish-fulfillment." Results would seem to conform to the
definition of regressive transference as formulated.by Reyher (1977,

1980).

 

 

174

In contrast, Davé (1979) invited students at impasse with a self—
defined problem to participate in a study of hypnotic dreams and
creativity. In re-analyzing the dreams, Reyher (1980) found the
material to be characterized by more references to powerful or
fantastic adult figures, babies, and phallic symbols than a control
group of dreams, while aggression was underrepresented (p. 88). This
study suggests a motivated involvement with the hypnotist in which the
self is experienced as child-like and in the care of a powerful
parent. Similarly, Newman, Katz, and.Rubenstein (1960), in an early
clinical study of implanted conflict and the hypnotic dream, commented
that subjects in their experiment appeared to be unconsciously
motivated by a need for help. In later sessions, when the same
subjects were allowed to dream freely, the researchers found the
dreams expressed intense ambivalence about the hypnotist and the
experimental situation. The authors attributed this ambivalence to
the frustration of their subjects’ unconscious hopes for parental
care. Later, in a quasi-experimental study reported by Shevrin
(1979), 13 women, following hypnotic experience, were asked to tell a
story to Card 12M (the "hypnosis card") on the TAT. Of the 13
subjects in the experiment, only 1 described a clearly positive
interaction between the figures on the card, while the remaining 12
told stories emphasizing hostile interactions. The one subject who
told a positive story was the only one who had a continuing
relationship with the hypnotist. In contrast, a non—hypnotic control
group of 133 female subjects produced 5 positive, 7 neutral, and 1

negative story to the same card on the TAT. The author suggests that

 

 

 

175
hypnotic subjects are motivated by longings to be nurtured and to have
their troubles resolved. When the experiment was over and the
fantasied expectations were not forthcoming, frustration and anger
were experienced, reflected by negative stories on the TAT. Studies
of fantasy involvement, then, do indicate that some hypnotic subjects
become intensely involved with the hypnotist, who may arouse both
powerful strivings and frustration among subjects. The extent of
regression taking place in the relationship, as reflected by fantasy
indices, may depend on the motivational intensity of the subject as
well as the nature of the setting in which hypnosis takes place.

Clinical and Experimental Hypnosis

 

Results from experimental studies in hypnosis may not always bear
directly on the construct of regressive transference, due to the
motivation of subjects participating in an experiment and the nature
of the setting (Reyher, 1977). First, regressive transference is a
motivational construct in which an individual wishing to experience a
dependent state encounters a facilitator who meets the conditions
necessary for that individual to relinquish autonomous self-control.
College students who volunteer to participate in hypnosis research may
be motivated by a number of factors, including curiosity or the desire
to pass a class, which have little to do with specific dependency
strivings activated by a particular situation. Second, there is
considerable evidence that hypnosis is a multi-faceted event in which
cognitive as well as motivational variables play a role. Cognitive
variables have been alternately construed as receptive attention

(Bowers, 1977; Reyher, 1977), capacity for absorption (Monteiro,

 

 

176

MacDonald, & Hilgard, 1980), imaginative involvement (Spanos &
McPeake, 1975), tolerance for unusual experience (As, O’Hara, &
Munger, 1962), and the like. It is possible that, in the experimental
situation, cognitive factors may become more important in determining
hypnotic response, while motivational strivings are less intense.
Third, it is difficult to determine the nature and intensity of the
strivings brought to the hypnosis experiment by the subject because,
with a few exceptions (Our, 1974; Hayes, 1981; Sanders & Reyher,
1969), motivational factors have not been systematically manipulated
in the experimental setting. Fourth, the laboratory setting is not
one which invites subjects to regress. The subject knows the
relationship with the examiner is temporary and that the experiment is
not directly designed to benefit him or her. These considerations
bear on the issue of the differences between clinical and experimental
hypnosis.

Clinical and experimental hypnosis have often been conceived as
qualitatively different procedures. In 1967, the American Journal of

Clinical Hypnosis devoted a special issue to the discussion of these

 

differences. In that issue, Erickson (1967) noted that some subjects
respond differentially to the two situations, becoming hypnotized
either under experimental conditions or clinical conditions but not
both. August (1967) described several dimensions which distinguish
clinical and experimental hypnosis. These include differences related
to the credentials and training of the operator; the goals sought by
therapist and researcher; the setting in which hypnosis takes place;

the selection of patients or subjects; and the difference between

 

177
patients and subjects in motivation, emotional involvement, and
potential gains. Similarly, Bowers (1976, pp. 22-23) pointed out
that, although hypnosis has been of immense value for pain control in
clinical situations, including Obstetrics, dentistry, and terminal
illness, compelling experimental evidence of the analgesic effect of
hypnosis has been hard to Obtain. As reasons for this discrepancy,
Bowers mentions the important fact that, in the laboratory, pain is
induced by the experimenter in a pain-free subject, while in the
clinic suffering individuals seek a helper who can bring relief.
These contextual differences imply important motivational differences
between subjects and operators and patients and practitioners,
suggesting that clinical and experimental hypnosis may, in fact,
constitute relatively separate events.

Experimental support for this point of view comes from research
contrasting the effect of videotaped versus live induction procedures
in hypnosis. In the laboratory, conflicting results regarding the
importance of having the operator present appear to be the rule rather
than the exception (Cabibi, Hughes, & Butler, 1965; Hoskovec, Svorad,
& Lane, 1963; Reyher & Pottinger, 1976; Throne & Beier, 1968).
However, there do appear to be marked differences in results when
experimental and clinical conditions are compared. Perry and Sheehan
(1978), for example, found that, in the laboratory, high susceptible
subjects performed identically across videotaped and live induction
presentations, whereas medium to low susceptible subjects were
influenced adversely in performance by the videotaped induction. In a

study of hypnotic responsiveness in hospitalized pain patients,

178
however, Johnson and Wiese (1979) found that medium and high
susceptible subjects were most responsive when the operator was
present than when given a videotaped induction, whereas low—
susceptible subjects showed no differences across conditions. The
highly susceptible subject, then, may respond in opposite ways to
identical conditions of induction depending on whether or not that
subject is vulnerable and in pain.
Regressive Transference and the Placebo Effect

A body of research relevant to regressive transference which has

largely taken place in a clinical setting with highly motivated

subjects is that concerning the placebo effect. The placebo was

 

defined by Shapiro and.MOrris (1978) as "any therapy or component of
therapy that is deliberately used for its nonspecific, psychological,
or psychophysiological effect, or that is used for its presumed
specific effect, but is without specific activity for the condition
being treated" (p. 371). With the advent of antibiotic drugs during
the late 1940’s, physicians in internal medicine began to test the
efficacy of these drugs, using an inert placebo or "sugar pill" as a
control. Following the introduction of tranquilizers in 1953,
psychiatrists followed suit. To the amazement and chagrin of
researchers, placebos proved to be as effective as drugs in many
trials (Shapiro, 1960). Whereas the placebo reaction was initially
seen as a nuisance factor Obscuring test results (Adler & Hammett,
1973), physicians soon learned that the placebo effect was a potent
therapeutic factor in its own right. As reviewed by Shapiro and

Morris (1978), placebo reactions were demonstrated in dentistry,

 

179
podiatry, optometry, and every aspect of modern medicine including
biofeedback, cancer treatment, surgery, and electroconvulsive therapy.
The inert lactose capsule proved capable of reversing the action or
duplicating the effect of potent active drugs. Placebos could be
addictive, could produce side effects, and had demonstrable direct
effects on bodily organs and organic illness (Shapiro & Morris, 1978,
p. 372). Interest then shifted to an attempt to determine the
psychosocial factors involved in this powerful effect. In the process
of defining these factors, psychologists (Kazdin, 1979; Strupp &
Bergin, 1969) recognized the relevance of the pardigm to psychotherapy
research, redefining the placebo effect as a "nonspecific factor"
common to all therapies. Currently, researchers have argued for the
elimination of the negative connotations associated with the concept
of the placebo and have called for research illuminating its mechanism
of action (Berg, 1983; Bootzin & Lick, 1979; Critelli & Neumann, 1984;
Ross & Buckalew, 1979; Wilkins, 1984).

The antecedents of regressive transference, or
hypersuggestibility level II, as postulated by Reyher, are very
similar to the psychosocial factors associated.with the placebo
effect, suggesting that a regressive transference may be the mechanism
underlying both the placebo effect and the dramatic effects of
clinical hypnosis. Evidence for this point of view depends on a
number of factors.

There do not appear to be enduring personality tendencies which
characterize the placebo reactor (Buckalew, Ross, & Starr, 1981;

Honigfeld, 1964a). Reactions to placebos vary among individuals

180
across time and.differing conditions. Frank (1974), for example,
administered a placebo pill to the same group of individuals at
initial intake and three years later. Although the same percentage of
individuals responded on each occasion, they were not the same
individuals. Liberman (1964) found inconsistent placebo reactions
among the same group of subjects across three different situations of
pain. Similarly, questionnaires designed to measure personality
traits in relation to placebo response have found conflicting results,
although acquiescence and suggestibility could be considered weak
correlates (Shapiro & Morris, 1978). In general, researchers have
concluded that the most powerful factors influencing the phenomenon
reside in the setting and in the doctor-patient relationship.

However, there are two subject variables, conceptualized as
states rather than traits, that have been consistently associated with
a positive placebo response in both medical and psychotherapy
research. The first of these is a state of anxiety, depression,
and/or heightened emotionality (Rickels & Downing, 1967; Shapiro,
Mike, Barton, & Shapiro, 1973; Shapiro & Morris, 1978; Shipman,
Greene, & Laskin, 1974). For example, Beecher (1968), in a study of
post-operative pain, demonstrated that the analgesic effect of a
placebo is greatest when pain and anxiety are most intense. Uhlenhuth
and Park (1964) in a study of anti—depressant drugs found that the
patients’ initial distress was the most consistent single factor
predicting their improvement. Frank (1974) indicated that, following
an intake interview for psychotherapy, drop in discomfort among

patients was greater the higher the initial anxiety score. Zisook,

 

 

181
Rogers, McClelland, Faschingbauer, and Lloyd (1978), in a study of
tranquilizing drugs, found that state anxiety was more responsive to
placebo treatment than was trait anxiety as measured by the Hamilton
Anxiety Scale. These studies highlight the importance of motivational
state in mediating the placebo effect. It is the client who is
anxious, vulnerable, and at impasse who is most likely to benefit from
the relationship with a caretaker who offers hope and concern.

The second subject variable consistently associated with a
positive placebo reaction is that of favorable expectancy of results,
which Frank (1973) has termed "hope." During'the 1960’s,
investigators at the Johns Hopkins School of Medicine (Frank, 1974;
Friedman, 1963; Nash, Frank, Imber, & Stone, 1964; Uhlenhuth & Duncan,
1968) and at the University of Pittsburgh School of Medicine
(Goldstein, 1960; Goldstein & Shipman, 1961) consistently demonstrated
that favorable patient expectancies were correlated.with the reduction
of symptomatology following placebo administration. Mere recent
studies which have controlled for expectancies in the laboratory by
manipulating the subjects’ set have similarly found that positive
attitudes toward treatment in general enhance reports of symptom
relief (Kazdin & Wilcoxon, 1976; Miller, 1972; Rosen, 1974).

The antecedents of favorable expectancies toward treatment,
however, are unclear. In contrast, the positive expectation of help
among patients who are anxious and vulnerable could be seen as a
"transference readiness" (Shapiro, 1971, p. 444) for relationship to
the caretaker, based on satisfactory early experiences with parents or

parental surrogates. Support for this interpretation is provided by

 

   

182

Frank (1974) who commented that,in general, placebo responders allow
themselves to depend on others for help and readily accept authority
figures in their socially defined roles. Similarly, in an early study
of hospitalized surgery patients, Lasagna, Mosteller, VonFelsinger,
and Beecher (1954) found that placebo reactors were more anxious,
dependent, and extroverted than non-responders. In comparison, non-
reactors appeared withdrawn, rigid, reliant on intellectual defenses,
and they were less comforted in general by the care received. A
transference interpretation is also suggested by those patients
characterized as "negative placebo reactors." These individuals
experience unpleasant side effects or worsening of symptoms following
placebo administration. A position of vulnerability may be very
threatening to some patients, arousing resentment and.memories of
helplessness in the face of indifferent or punitive parental figures.
Rickels, Boren, and Stuart (1964) found that placebo side-effects are
more frequently reported by patients in the relatively impersonal
atmosphere of a clinic as compared to private practice patients.
Downing and Rickels (1967) reported that high scores on a scale
measuring indirect hostility correlated positively with placebo side—
effects. Although it is clear, then, that the enduring traits of
placebo reactors are highly varied, nevertheless the most important
personality disposition relevant to the placebo effect may be the
individual’s ability to seek help from others when in a state of
heightened vulnerability.

The critical importance of a state of impasse and expectation of

help is also illustrated by the differences in results between placebo

 

 

183
studies done in experimental versus clinical settings. Beecher (1965)
found that pathological pain displayed by hospital patients yields ten
times more to placebo than does experimental pain produced in the
laboratory. Additionally, morphine is more effective in relieving
post-operative pathological pain than laboratory—induced pain. He
concluded that both placebos and some drugs are more effective when
individuals are stressed and that the placebo acted primarily to
reduce anxiety, or the "reaction component" of pain. Evans (cited in
Shapiro & Morris, 1978, p. 378), in a review of 14 experimental
studies, calculated average placebo relief at 16% of the population,
below the 35% figure reported by Beecher (1960) for clinical
populations. These studies are complemented by research emphasizing
the importance of the setting in facilitating placebo reactions
(Rashkis & Smarr, 1957; Nash et al., 1964; Shapiro & Morris, 1978;
Uhlenhuth et al., 1966) and suggest that a clinical environment may

serve as an inherent "therapeutic stimulus,‘ arousing expectancies of
help. Differing results found between laboratory and clinical
settings in placebo research parallel differences found in
experimental and clinical hypnosis. It would appear that the doctor-
patient and researcher—subject relationships differ in highly
important ways, depending on the motivation and expectancies of the
subject, the connotations of the setting, and the role assumed by the
authority figure in charge.

Additionally, characteristics of the physician which enhance the

placebo effect are consistent with those features necessary to

potentiate a regressive transference. Shapiro (1971) has emphasized

 

 

184
the importance of the physician’s attitude toward the patient in
treatment, which he terms countertransference:

The patient’s transference relationship with the doctor, and the

doctor’s countertransference relationship with the patient, are

important elements in placebo reactions and their direction

(positive, negative, or absent), and they influence the outcome

of all treatment. Although the concept of transference is

difficult to demonstrate experimentally, it is frequently
referred to as being important in the placebo effect. It may be
referred to as the doctor-patient relationship, rapport, warmth,

trust, faith, empathy, and so on (p. 444).

Shapiro and Morris (1978) have found three aspects of the doctor-
patient relationship to be especially important in the placebo effect.
These include (a) the doctor’s interest in and liking for the patient,
(b) the doctor’s investment in or enthusiasm for the treatment, and
(c) the prestige which is associated with both the doctor and the
treatment. As non—specific effects in all treatments, these variables
have had a demonstrated impact in both chemotherapy and psychotherapy
research.

Regarding physician warmth and.interest in the patient,
Atoynatan, Goldstone, Goldsmith, and Cohen (1954), for example,
compared the effectiveness of inhalation therapy for reducing anxiety
under two conditions of therapist orientation. In the permissive
condition, patients were allowed to talk freely about themselves to
the doctor for as long as 15 minutes before and after the inhalation

treatment. In the nonpermissive condition, the physician pointed out

185

in a sympathetic way that time did not permit listening to each
patient, and interaction was kept to a minimum. Symptom reduction as
measured by independent ratings was significantly greater under
permissive conditions. Similarly, Kast and Loesch (1959, 1961)
demonstrated that the effects of chemotherapy were greatly enhanced
under favorable doctor-patient relationship conditions, and.Rickels et
al. (1971) showed that patient reduction of anxiety following drug
treatment was significantly greater for patients who rated their
physicians as "warm" during the first visit than for patients who gave
a "non—warm" rating. In the field of psychotherapy, the therapists’
interest in the patient has been associated.with the likelihood of
acceptance of treatment, fewer drop—outs, and successful outcome of
treatment (Shapiro & Morris, 1978). Frank (1974), in a study
examining the effect of three therapists on patient improvement in
short—term therapy, notes that the most successful therapist was the
most experienced, the most optimistic, and the most empathic. The
many studies of Truax and his associates (Truax & Carkhuff, 1967)
which demonstrate that therapists who offer accurate empathy, non-
possessive warmth, and genuine response to patients obtain the best
results with a variety of patients also offer convincing evidence.

Secondly, the importance of the physician or therapists’ positive
investment in the treatment provided has been repeatedly demonstrated.
In chemotherapy studies, the attitude of the doctor toward the
particular drug or placebo prescribed is correlated with its effects
on patients (Feldman, 1956; Honigfeld, 1964b; Sheard, 1963; Uhlenhuth,

Canter, Neustadt, & Payson, 1959; Uhlenhuth et al., 1966). For

 

 

186
example, Wheatly (1968) found that, among a group of 200 practitioners
prescribing the same drugs, the best results were obtained with
optimistic doctors, less good results with indifferent doctors, and
the worst results with pessimistic doctors. In psychotherapy studies,
therapists’ interest in their profession and in the particular
treatment offered are related to symptom reduction among patients
(Goldstein & Shipman, 1961; Luborsky, Chandler, Auerbach, & Cohen,
1971; McNair & Lorr, 1964). Frank (1974) has suggested that the
duration of treatment in psychotherapy depends on the particular
treatment rationale endorsed by the therapist. Those therapists who
believe they can produce results in a few sessions tend to get these
results, while practitioners of long—term therapy may find that
patients take years to respond.

Shapiro and Morris (1978) have termed the physician’s investment
in the treatment "indirect iatroplacebogenics" (p. 385). They suggest
that the physician’s enthusiastic commitment to the treatment offered
may facilitate placebo effects because the patient experiences the
physician’s interest as a personal one. A recent study of Gryll and
Katahn (1978) regarding the placebo effect in dentistry, however,
would suggest other interpretations. The authors manipulated four
independent variables in a complex factorial design. The independent
variables included the status of the communicator of drug effects, the
amount of dentist-patient verbal interaction, and the nature of the
information given about the pain-reducing drug (a placebo). The
placebo was presented either in a positive manner designed to

communicate certainty as to its effects, in a neutral and non-

 

 

187
committal manner, or as a saliva pill irrelevant to patients’
concerns. The dependent variables were patients’ ratings of pain from
injection, pre-post placebo state anxiety, and pre-post placebo fear
of injection. Each of the variables investigated affected patients’
responses to placebo administration. However, the most salient of
the four variables was the type of information provided about the
placebo. Patients given an enthusiastic, positive message about the
drug’s supposed effectiveness reported the least pain during injection
and the greatest reduction in state anxiety and fear of future
injections. The authors concluded that, althOugh attitudes on the
physician’s part which demonstrate interest in the client can
facilitate placebo effects, the nature of the message given is a
potent independent variable in its own right. Physician investment in
the treatment provided, therefore, may have an impact on the patient
(1) by increasing the patient’s confidence in both the doctor and the
method, allowing the patient to regress safely, and (2) by providing a
strong suggestion that the treatment is effective.

Indirect support for the former interpretation is provided by
Kazdin (1979) who cites several studies demonstrating that the
credibility of rationale given in psychotherapy analogue studies
enhances subjects’ expectancies for successful outcome. The
credibility of rationale may allow subjects to rely on the
experimenter for guidance without anxiety. Regarding the latter
interpretation, there is substantial research support for the
importance of suggestion, or the specific message given to the

patient, in producing placebo effects. For example, the power of

188
suggestion given in the medical setting can be illustrated by studies
which have attempted to differentiate the effect of the placebo
itself, placebo instructions, and an actual drug on patients’
response. A number of experiments have demonstrated that "placebo

0

instructions,’ or the physician’s remarks to the patient when
administering a drug or placebo, can counteract or enhance the effects
of actual drugs given (Byerly, 1976; Lyerly, Ross, Krugman, & Clyde,
1964; Wolf, 1959). For example, Luparello, Leist, Lourie, and Sweet
(1970) presented two drugs, a bronchoconstrictor and a bronchodilator,
to asthmatic subjects under varying conditions of instruction. When
the subject received instructions which were in accordance with the
actual drug action, the drug effects were significantly greater than
when the subject was given discordant instructions. In a related
study, Luparello, Lyons, Bleecker, and McFadden (1968), using
suggestion alone, were able to precipitate and reverse bronchospasms
in a group of asthmatics by means of the same saline solution,
presented either as an irritant or a bronchodilator. Dinnerstein and
Halm (1970) administered aspirin to patients under varying conditions.
Although aspirin by itself had no significant effect on mood, it did
appear to enhance moods when accompanied by placebo instructions.

When subjects were led to believe that the aspirin was a tranquilizer,
it produced a mood described as "friendly intoxication" by the
authors. When energizing instructions were given with the aspirin,
subjects demonstrated "asocial sObriety."

In the field of psychotherapy, Frank (1974) found that patients

aroused by adrenalin were more suggestible than normal controls,

 

 

189
giving some confirmation for the link between heightened emotionality
and susceptibility to persuasive communications. Buckalew (1972)
assessed the impact of three independent variables on reaction times
in an experimental setting. the three variables were a lactose
capsule (placebo), the capsule plus suggestions that it would increase
reaction time, and reinforcement to the effect that reaction time had
increased. As might be expected, the administration of the lactose
capsule, leaving subjects free to form their own ideas as to its
nature and influence, had no effect on reaction times. Suggestion
emerged as a main effect in the results, however, with the interaction
between suggestion and reinforcement also attaining statistical
significance. The practitioner’s investment in his or her treatment,
then, can be seen as an aspect of the message given to the patient
regarding the effectiveness of the treatment sought. The message may
impact the client by enhancing trust in the doctor and by giving a
strong suggestion that outcome will be successful.

The third factor, influencing phenomena as diverse as laboratory
research, the placebo effect in medicine, and psychotherapy outcome,
is the prestige of therapist or researcher. Rosenthal (1964, 1969)
has shown that the prestige of the investigator is an important
determinant in biasing research results in the direction of the
researcher’s original hypothesis. Liberman (1961) and Shapiro (1959,
1964) have illustrated the importance of physician prestige in
bringing about dramatic cures. Gryll and Katahn (1978), in the study
cited above, found that the status of the communicator was a

significant factor in three major interactions, although it did not

 

190
attain significance as a main effect. Regarding psychotherapy,
Shapiro and Mbrris (1978) cite eight studies demonstrating the impact
of the prestige of the therapist on therapy outcome. Simon (1973), in
a determination of patients’ preferences, found that, in general,
psychologists and psychiatrists were preferred to "emotional
counselors" or social workers, male therapists were preferred to
female therapists, and middle—aged therapists were chosen over aging
or youthful therapists, all traditional indices of status. Bloom
(1977) found that female therapists in a traditional professional
office and male therapists in a warm "humanistic" office were
perceived as more credible than the opposite arrangements, an
interesting interaction of sex with warmth and prestige dimensions.
The individual most likely to facilitate the placebo effect, then, is
the warm, interested personality, vested with social authority, who is
sure that his or her treatment will work.

Although evidence from placebo research is consistent with a
transference interpretation, few studies of the placebo effect have
focused directly on the concept of transference. Two studies,
however, provide more direct information. Park and Covi (1965), in a
"nonblind" placebo trial, were able to investigate patients’
attributions to their doctors in conjunction with treatment outcome.
Doctors participating in the study told patients seeking drug
treatment for anxiety symptoms that they were being given a sugar pill
with no active ingredient. This message was accompanied by the kindly
statement, "I think this pill will help you, as it has helped so many

others" (p. 337). Following one week, 13 of 14 patients showed marked

 

 

191
improvement, with an overall 41% decrease in symptoms of anxiety. Six
patients believed the pills were a placebo. From this group, the five
patients who expressed certainty in their belief reported
significantly more relief of distress than those who harbored some
doubt. Those who were certain either way felt strongly that the
doctor had selected the treatment to help them. Rationales provided
by patients were ingenious and at times approached magical beliefs in
the doctor’s omniscience and beneficence. One female patient who felt
certain the pill was inactive feared becoming addicted to drugs and
thought the doctor had given her an inactive pill to protect her.
Another female patient similarly construed the prescription of a
placebo as the doctor’s effort to prevent her from making a suicide
attempt. A male patient, convinced he was given an active drug,
thought the doctor told him he was receiving a placebo so that he
would think he was helping himself. A subgroup of patients who
fantasied the doctor as a beneficent protector standing in special
relation to their particular needs, then, showed the most symptom
relief. Results show the extent to which patients actively strive to
create the conditions necessary for their recovery, similar to earlier
cited studies in hypnosis, and are strongly supportive of a regressive
transference interpretation.

LeBaron, Reyher, and Stack (1985) operationally defined
transference by means of a Regressive Transference Scale designed to
assess both the quality and intensity of positive and negative
feelings toward the doctor and nurses responsible for the care of 57

females undergoing abortion. Patients were divided into paternalistic

 

 

192

and egalitarian treatment groups based on the doctor’s interpersonal
style, and patient suggestibility was measured pre— and post—surgery.
Results indicated that both suggestibility and transference scores
were higher in the paternalistic than in the egalitarian treatment
condition. Additionally, fewer objective signs of surgical shock were
found in the paternalistic as opposed to the egalitarian condition.
Results support the notion that a regressive transference heightens
suggestibility and ameliorates physical symptoms following surgery.

Summarv

 

In summary, although the psychoanalytic literature is rich in
clinical observation, criteria for experimental verification of its
constructs have often been lacking. In particular, the construct of
regressive transference, stemming from early studies of hypnosis,
appears to be relevant both to hypnotic phenomena and to the recently
defined placebo effect in medicine and psychotherapy.

Reyher (1964, 1977, 1980) has formulated a two—step theory of
hypnosis which allows for an operational definition of regressive
transference. According to Reyher, an individual experiencing an
impasse in life which arouses feelings of helplessness and anxiety
seeks out a caretaker to relieve his or her distress. The caretaker
must be perceived as trustworthy and as capable of relieving that
distress. Given the intensity of the individual’s dependency
strivings and the receptive attitude adopted in the presence of a
suitable facilitator, a special relationship is formed. The
individual experiences the self as childlike and trusting in relation

to an omnipotent, parental other. Suggestibility is enhanced, and

193
anxiety is reduced. The formation of the relationship may constitute
in itself an "altered state" in which rapid and dramatic physical and
emotional change can occur.

The advantage of Reyher’s formulation is that, in specifying
antecedent conditions necessary for a regressive transference to
occur, the construct is available for experimental manipulation, and
the nature of the evidence relevant to the construct becomes more
clear. Subjects experiencing a regressive transference should be
characterized by intense dependency strivings, conceptualized either
as an enduring disposition or as the consequence of a stressful
situation beyond the individual’s resolution. The designated
facilitator of such a transference, whether doctor, psychotherapist,
or researcher, must be perceived as possessing sufficient protective
competence to allow the individual to depend. In the process of
establishing such a relationship, the individual is likely to
overestimate the positive attributes of the facilitator and to show
exquisite sensitivity to his or her wishes (enhanced suggestibility).
Similarly, fantasies produced by the subject should indicate
reciprocal child-parent roles or other derivatives of a sheltering
relationship.

Experimental evidence from research in both hypnosis and the
placebo effect is not inconsistent with the concept of regressive
transference. Studies in experimental hypnosis indicate that the good
hypnotic subject is characterized by acquiescent and affiliative
tendencies, rather than the opposite, and responds best in a trusting

relationship with an operator perceived as warm, capable, and

V

 

194
influential. In an analogous fashion, the placebo effect is most
likely to occur among patients who are anxious, vulnerable, and
capable of accepting help from others, in the presence of a warm,
interested, confident, and prestigious practitioner.

The results of a subset of studies from both fields are
suggestive that a regressive transference may be the mechanism
underlying both the placebo response and intense hypnotic experience.
In the process of forming the requisite relationship, some individuals
attribute parental qualities to the practitioner, show exquisite
sensitivity to the wishes of the practitioner (enhanced
suggestibility), and produce fantasy material indicative of the desire
for sheltering care. Evidence in general, however, tends to be
indirect, and few studies have focused directly on the construct of
transference. Given the promise of the construct, research designed
to operationalize regressive transference and specify criteria of

proof is recommended.

195

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