An important approach to treating post-traumatic stress disorder (PTSD) involves the narrative processing of traumatic memory. This is designed to undo the ongoing distressing effect of the traumatic experience that intrudes on the patient’s current life such as symptoms of PTSD, depression, and dissociation. Narrative processing collects and organizes fragmented images and perceptions of trauma into a coherent verbal structure with beginning, middle, and end. Now the person can assimilate the collected fragments in verbal memory as personal history. The impact of trauma is no longer staggering in the present and no longer feels like an unfinished threat. The experience can finally be examined in light of present awareness as a remembered past event.

It is extremely difficult to simply recite a traumatic experience. Outside of verbal awareness, memory fragments rot like “memory shrapnel” and prevent narrative closure. Getting the help of the “mind’s eye” and right brain images can make it easier to assimilate these non-verbal images into verbal memory. It is not just about what the mind’s eye sees, but how it sees and reports. When the mind’s eye serves narration, it is observing and describing through the perspective of a hidden observer. Helps protect the person from reliving the experience.

The methods of drawing the mind’s attention to the work of narrative processing rely on visual images, although many of the memory fragments may not be visual. They can consist of bodily sensations such as pain or pressure or feelings of terror. Whatever the content, its presence can be detected by the mind’s eye and reported by the hidden observer. It is the duty of the hidden observer to give an objective narrative while resisting the subjective pull of the unfinished experience and avoiding reliving the experience. Once narrative closure is achieved, there is no further attraction to the traumatic experience.

The hidden observer

In the 1970s, research psychologist Ernest Hilgard experimented with hypnotic induction of analgesia and found that a hidden bystander could be elicited in subjects who claimed to be pain free. He asked for a report from a part of the subject that felt the pain and could rate the severity. Some subjects responded from a part of themselves that was aware of pain and could rate it on a scale of ten for as long as the subject had claimed analgesia. These parts obtained were very similar from one subject to another. The part was normally hidden from the subject’s consciousness, although the part claimed to have always been there. The party was aware of experimentally induced pain (produced by ischemia of the arm deprived of circulation by the tourniquet effect of a blood pressure cuff inflated to a pressure above systolic pressure) but the party denied suffering. Dr. Hilgard designated these parts as “Hidden Observers”. Hidden Observers claimed to be bystanders of the person’s experiences at all times, whether the subject was hypnotized or not. They did not play any role in the execution of the action and did not participate in the emotional experience of the subject.

More than 90% of patients undergoing hypnosis in an intensive trauma therapy clinic were able to release a Hidden Observer. After hypnotic induction by progressive relaxation, the patient visualizes an imaginary scene and performs the imaginary action of leaving the body and observing the body from outside. The therapist refers to the viewer as the hidden observer and points out the patient’s capacity for emotional detachment. The hidden observer temporarily leaves the patient in the imagined scene and goes to the moment of trauma to observe the traumatic event as it unfolds. The Hidden Observer narrates the event impassively, referring to the self in the trauma in the third person – as “he” or “she” – and telling the story from beginning to end. The narration is videotaped for later review by the patient in a normal waking state. The hypnotic session ends after the Hidden Observer returns to the self left in the imagined scene.

Review of the videotaped narrative in the waking state completes the hypnotic narrative processing. The patient and the therapist look at the played videotape together. Now the patient no longer has the emotional distance of the Hidden Observer. The patient may vaguely remember much of the narrative and there is a risk that he will re-experience the trauma. If this happens, the therapist will stop the tape and help the patient ground himself.

Usually there is little or no activation or abreaction with the tape review. This is positive because abreaction interferes with verbal narrative assimilation. There may be an element of desensitization in the review. Emotional desensitization can also decrease assimilation because the patient may escape full confession or possession of the experience and instead feel as if it had happened to someone else. If this flaw is not corrected, all narrative processing must be repeated.

Typically, when narrative processing is repeated, the second narrative is more detailed and complete, filling in the gaps that were not detected during the first. When this still does not alleviate the intrusive symptoms of PTSD, the cause may be that the symptoms arise from previous trauma. The patient may have to look for unremembered trauma, such as preverbal trauma or overlooked trauma due to medical or surgical procedures, for example.

Processing traumatic memories with the mind’s eye and the Hidden Observer makes it possible to perform trauma therapy quickly and safely without re-traumatizing the patient.