Arnoldo Téllez: Profesor de la Facultad de Psicología UANL. Presidente de la Asociación Mexicana de Hipnosis Clínica.
We have to start from the premise that childhood is the most vulnerable stage of life and therefore requires a social system (family) that accompanies and protects it as it evolves towards independence and self-sufficiency in adult life.
Adverse Childhood Experiences (ACEs)
It is now recognized that traumatic experiences suffered in childhood are the main triggering or maintaining factors for anxiety, depression, somatoform and dissociative disorders, as well as chronic health problems in adulthood.
What are ACEs?
Adverse Childhood Experiences represent a child’s exposure to negative situations such as:
- Physical abuse: Fist blows, spanking, slapping, kicking and blows with instruments such as belts, shoes, sticks, whips, etc.
- Emotional abuse: Public or private humiliation, discrimination with respect to other children or siblings, among others. Exclamations such as: «You are useless», «You are a fool», «I should not have brought you into the world», among others.
- Sexual abuse: Includes touching, kissing with sensual intent, digital penetration, and/or rape. The prevalence of sexual abuse in the world is high, for example, in Mexico alone the rate of rape of girls and boys is 1,764 per 100,000, and the rate of unwanted touching is 5,000 per 100,000 inhabitants. One out of every four girls and one out of every six boys is raped before reaching the age of majority (Unicef, n.d.). Thus, Mexico ranks first in child sexual abuse among the OECD countries, with 5.4 million cases per year. Child sexual abuse is a serious and complex problem in Mexico. According to the National System for the Integral Development of the Family (DIF), in 2021, 12,541 cases of child sexual abuse were registered in the country. Other data on child sexual abuse in Mexico show that 75% of child sexual abuse cases occur within the victim’s home and 40% of the aggressors are relatives of the victim, according to a survey conducted by Save the Children in 2019.
- Neglect: Neglect refers to the lack of attention and care of the parents or caregivers towards the child. Neglect can be of several types:
- Physical Neglect, which refers to failure to provide basic necessities such as adequate food, adequate clothing and apparel, safe and healthy shelter, personal hygiene, lack of supervision and protection from physical hazards.
- Emotional Neglect, which refers to failure to provide emotional care and support, failure to provide a stable and safe environment, ignoring or rejecting the child’s emotional needs, failure to offer guidance and support in times of crisis.
- Medical Neglect, consists of failure to provide adequate medical care when the child is sick or injured, failure to administer medication as medically indicated, and failure to perform regular medical check-ups.
- Educational Neglect, includes failure to provide access to appropriate education, to support the child’s cognitive and academic development, and to foster curiosity and interest in learning.
- Domestic violence refers to when a child witnesses any act of violence, force or threat that is exerted on a family or household member. This includes not only physical abuse, but also emotional, psychological and sexual abuse. This violence can be manifested in couple relationships, between family members or in any context where there is cohabitation and can be classified into several types: a) Physical violence which refers to the use of physical force that causes bodily harm to the victim; b) Psychological violence: Refers to any act that causes emotional or psychological harm, such as control, manipulation, threats or isolation; c)Economic Violence refers to the control of the victim’s economic resources, depriving her of her financial independence; and d) Verbal Violence, which includes insults, humiliation and any type of verbal aggression that undermines the dignity of the person.
- Absence of a parent due to divorce or separation.
- That a family member suffers from a mental disorder, incarceration and/or addictions.
Trauma
The root of the word «trauma» comes from the Greek language meaning «wound». Psychological trauma is the response to a profoundly distressing, overwhelming or disturbing event that overwhelms a person’s ability to cope, resulting in feelings of helplessness, diminished self-esteem and the ability to feel the full range of emotions and experiences unique to being human. Trauma can lead to a variety of lasting emotional, physical and behavioral problems. These difficulties are magnified when the trauma occurs during infancy, as the child has not developed any coping skills yet and his or her small brain is just in the process of developing, which would allow him or her to protect and process it in a more or less adaptive way, and buffer the negative effects of the traumatic event.
Types of trauma
One of the first attempts to define the concept of complex trauma was by Terr (2011), who differentiated between Type I and Type II trauma.
- Type I traumas are usually single events that produce symptoms more similar to post-traumatic stress disorder (PTSD).
- Type II traumas, also called «Complex Trauma» (CT) are usually repeated and prolonged events that can present with a variety of symptoms, such as denial, dissociation, anger, self-destructive behavior and persistent sadness.
Complex trauma has been further defined as a traumatic event that is repetitive and occurs over a prolonged period of time, undermines primary caregiving relationships, and occurs at sensitive times with respect to brain development. But what is the impact of CT compared to more acute trauma? Problems in emotional relationships and attachment, emotional and behavioral dysregulation, cognitive/attentional deficits, dissociative disorders, dissociation and changes in self-perception, and changes in self-perception all tend to occur.
Prevalence of CT
The prevalence of complex trauma can be considered in two ways. First, it can refer to the frequency of exposure to complex traumatic experiences. Exposure to repetitive or multiple forms of victimization is common in childhood. Finkelhor and colleagues (2005) found that 22% of a nationally representative sample of 2030 children aged 2-17 years had experienced four or more different forms of victimization in the past year.
Second, it can refer to the frequency of complex trauma outcomes in response to such exposure. Research supports a dose-response relationship with exposure to more types of trauma resulting in greater breadth and complexity of symptoms in children and adults.
Developmental traumatic disorder
For their part Van Der Kolk and a team of experts (Spinazzola et al., 2021) have referred to CT as developmental trauma disorder (DTD), a proposed syndrome designed to describe the outcomes associated with exposure to complex trauma in children with repetitive traumatic events.
As we know, the brain develops from the bottom up. The lower parts of the brain are responsible for functions dedicated to ensuring survival and responding to stress. The upper parts are responsible for executive functions, such as understanding what is being experienced or exercising moral judgment, which is why many children who suffer traumatic events have significant learning difficulties, because their brain is in instinctive survival mode, which blocks the activation of the cortical structures in charge of learning, which, in survival situations are not necessary.
The chronicity and severity of the consequences of CT are greater when: a) the trauma exposure has an earlier onset, b) the duration of the traumatic event(s) is longer, c) multiple types of traumatic events are present (e.g., emotional, sexual and/or physical abuse, neglect) and d) when the trauma is of an interpersonal nature (e.g., physical abuse) than of a non-personal nature (accidents, natural disasters, or medical interventions).
Neurobiological findings have shown that neuroendocrine dysregulation, structural changes in the developing brain, such as a reduction in the volume of the hippocampus, amygdala and prefrontal cortex, as well as a decrease in the size of the corpus callosum, occur after trauma exposure. In addition, biological systems shift from a focus on learning to a focus on survival. It is also very important to note that brain organization and activation focus on structures that promote rapid, autonomic responses to avoid harm and regulate arousal (e.g., brainstem, midbrain, amygdala), rather than on structures of complex learning and long-term adaptation (e.g., medial and dorsolateral prefrontal cortex) (Campbell, 2022).
The consequences on physical and emotional health
Traumatic events in childhood can have significant and lasting effects on an individual’s behavior and physical health. Some of the most common effects include:
- Psychological effects:
Learning and behavioral problems: Children who experience traumatic events often have learning and behavioral difficulties, which can affect their academic performance and social relationships.
Anxiety and depression: Traumatic events can lead to anxiety and depression in childhood and adulthood.
Risky behaviors: Children who experience traumatic events may be more likely to engage in risky behaviors, such as substance abuse or aggressive behavior.
Difficulties in emotional regulation: Traumatic events can affect a child’s ability to regulate emotions in a healthy way.
- Effects on Physical Health:
Headaches and stomachaches: Traumatic events can lead to recurrent headaches and stomachaches with no apparent cause.
Sleep problems: Children who experience traumatic events may have difficulty sleeping or may experience recurring nightmares.
Extreme fatigue: Traumatic events can lead to extreme fatigue with no apparent cause.
Mental health problems: Traumatic events can increase the risk of developing mental health problems, such as post-traumatic stress disorder (PTSD).
Long-term consequences
Relationship difficulties: Traumatic events in childhood can affect an individual’s ability to establish healthy relationships in adulthood.
Low self-esteem: Traumatic events can lead to low self-esteem and a negative self-image.
Physical and mental health problems: Traumatic events can increase the risk of developing physical and mental health problems in adulthood.
Psychological health problems: Depression, suicidal attempts, anxiety, low self-esteem and sexual risk behaviors and consequent transmission of sexually transmitted infections (STIs) are the most frequent psychological and behavioral problems in adult patients who suffered ACEs.
The most common physical health problems are the following: Drug dependence, cardiovascular disease, diabetes, cancer.
– Diabetes: Physical and sexual abuse in childhood and adolescence has been associated with an increased risk of type II diabetes. For example, moderate and severe physical abuse was associated with a 26% to 54% risk of developing diabetes in adulthood, forced sexual touching was associated with a 16% risk, forced sexual activity was associated with a 34% risk if it occurred only once, and the risk increased to 69% when the abuse occurred repeatedly.
– Cancer: A group of Chinese researchers led by Hu (2021) through a meta-analysis found that adults who reported childhood sexual abuse were 26% more likely to suffer cancer in adulthood than those who did not suffer such abuse. However, other adverse childhood events such as physical abuse (26%), as well as emotional abuse and neglect (23%) are also associated with an increased likelihood of cancer in adulthood (Hughes et al., 2017).
ACEs and «wounded children».
Pathological egos (or wounded children) develop in the face of traumatic events during childhood when the individual is disempowered and dependent on caregivers (Bowlby, 1985) and their neuroplasticity is at its peak. These wounded children remain inactive until an event in the social environment relevant or congruent to the aforementioned Ego activates it again producing symptoms of depression, anxiety and/or psychosomatic discomfort.
How can we use hypnosis to help the adult with ACEs seizures?
Hypnosis has been defined as a state of consciousness involving a concentrated focus of attention and reduced peripheral awareness characterized by an increased ability to respond to suggestions and hypnotherapy as «the use of hypnosis in the treatment of medical or psychological issues or disorders» (Elkins et al., 2015). This state of consciousness is well suited for cognitive and imaginative processes to bridge the mind-body gap so that emotional and physical healing processes can be facilitated.
Therapeutic and hypnotherapeutic strategies for healing the wounded child
The first thing to establish is a lot of rapport with the patient who has suffered ACEs. It is very important to keep in mind that he/she is a child who has been a victim of some kind of abuse or traumatic event, therefore, the patient needs to feel the support and empathy of the therapist, so that he/she can feel safe in the therapeutic accompaniment. In my particular case, I do not initiate any hypnotherapeutic intervention until I feel that the patient already trusts me and my professional skills. Once a good rapport is established, the intervention can begin. Ideomotor techniques are optimal for initiating the exploration of traumatic memories that have been encoded in the sensorimotor system. It should be remembered that the first intelligence according to Piaget is sensorimotor, that is, the child encodes and processes information and knowledge with sensations and movements, so many memories of this age are encoded in this way. I recommend using the implied directive technique with hand movement developed by Dr. Ernest Rossi (1993), which is a structured way of accessing unconscious information and helping to restructure and heal them. A detailed description of the technique follows:
The implied directive is composed of 3 segments: 1) an introduction with time link or with a conditional (e.g., «yes,» «when,» «now,» «as soon as,» «at the time that»), 2) an implied suggestion for an unconscious response (e.g., «go into a trance.» «retrieve a memory,» among others), and 3) a behavioral response indicating the moment when the implied directive is being carried out (e.g., «your hands will come together,» «your eyes will close,» among others) (Rossi and Cheek, 1988).
The patient is asked to place the palms of her hands at a distance of 10 centimeters from each other, to fix her gaze on a point of her choice on either her right or left hand. She is asked not to move her hands or her gaze from the point of her choice. Next, she is told: «Now do not move your hands or your gaze from that point, now I am not going to talk to you, but to your subconscious mind. Subsequently, she is offered a series of implied directives:
| 1 | When you are ready to begin the exercise, you can take a deep breath. |
| 2 | First directive involved:
«Yes. Your unconscious mind wants you to enter into a trance your hands will come together on their own as if they were two great magnets». (When the hands are already joined, then move on to the second directive). |
| 3 | Second directive involved:
«If your unconscious mind wants you to thoroughly review that problem you want to review Then one of your hands will go down on its own towards your legs, while the other remains in place.» (After one hand is completely down, move on to the next directive.) |
| 4 | Now, yes
«Your unconscious mind wants to help you solve what you want to solve in a first phase or in a definitive way using all its internal resources. Then the other hand will start to come down on its own». |
| 5 | Ratification of therapeutic achievement
«If your unconscious mind thinks that you have already managed to resolve in a first phase or in a definitive way that which it wants to resolve. Then You will take a deep breath to let me know». |
| 6 | Consolidation of achievements
«Now your unconscious mind…» You can take a long minute to consolidate and reinforce those achievements gained (wait a minute). |
| 7 | «When your unconscious mind has already successfully completed
This process then you can open your eyes and be completely alert and relaxed.» |
Recently, in a course-workshop I gave on «Traumatic events in childhood», one of the participants mentioned that she did not remember anything from the age of 0 to 9 years old, which is possible evidence of dissociative amnesia caused by traumatic events in childhood. After the application of the above-mentioned exercise, she commented to me: “Doctor, I remembered something in my childhood and the possible cause of my forgetfulness, the abandonment of my father when I was a child».
Ego state therapy
Ego state therapy is a polypsychic theory developed by the married couple John and Helen Watkins (1997), which is very effective in locating and healing ego states (inner children). It is recommended to start with the «Three Card» technique by asking the person to close his or her eyes and then saying: “We are going to write a letter to someone, to a little child, a little child yourself from the past, maybe four, six, or eight years old, I don’t know, let your subconscious mind choose it, you will not do anything, a little child who needs you to talk to him, to tell him something he needs from you as an adult, ok, when the image of that child appears, observe what expression he has and the approximate age, and you will open your eyes». When the patient opens his eyes, he is asked to write the first letter, saying the following: «Take these sheets of paper and this pen, and write to that child. It will be a letter with your heart in your hand. Write what you feel and believe that child needs to hear from you. Write to that child whatever comes spontaneously to you or intuitively you know you need to say, connect your hand to your heart and not to your conscious mind; you can begin».
When the patient finishes writing the letter, he/she is asked: «How did you feel when writing the letter, any emotions, any sensations in your body?
We will start from the assumption that the emotions and sensations reported by the patient are what that inner child feels.
The patient is then asked to read the letter aloud. He/she is again asked to describe the sensations and emotions he/she felt during or after the reading of the letter. It is common for the patient to experience different emotions in reading aloud.
Then, the patient is told, «Let’s do an imagination exercise, how good are you at imagining things?» (it doesn’t really matter the answer, it’s just a preparation to activate the brain’s imagination mechanisms. If the patient says he/she is not good at imagining, he/she is told «I believe or intuit that you have a good hidden ability to imagine, but in a moment more we will be able to check»). «I want you to imagine, just for a moment, that this inner child has already read the letter and heard you. Just imagine it. Now, I want you to mentally step aside and allow that inner child to answer that letter. Let that inner child writes to the present you, the you of this moment. Go ahead. Let that child write».
When the patient has finished writing the letter, the patient is asked, «How did you feel, what sensations and emotions did you feel with that letter?»
«Now, can you read it aloud to me?»
When finish reading, ask: «How did you feel, what sensations and emotions did you feel when you read that letter?
Then say: «Now, I am going to ask you to answer the letter that your inner child wrote. And with that we are going to conclude. Answer that letter, explain yourself to your inner child. Go ahead”.
The patient is also asked about the sensations and emotions when writing it and when reading it aloud.
Once finished, the patient is asked to read the three letters consecutively, aloud. The patient is asked to report his or her emotions and sensations.
Finally, the patient is asked to take the three cards with him/her and to choose a trusted person to whom the cards can be read. It is important to ask for the name of the trusted person to whom the cards will be read, in order to strengthen the therapeutic commitment.
At the end of this exercise, in the same session or in the following one, a hypnotic empty chair exercise is performed, to express everything that was written, and that the inner child has the opportunity to express out loud to the adult self what he/she wrote.
Let’s see an example:
Hello, I’d like to know your name, I’m intrigued to know what you look like, what you’re doing here, why are you so sad? I’m not upset with you, if that’s what you think, I’m hardly upset.
With love
Deborah
Then I asked her to imagine, just for a moment, as if she were that little girl, to just imagine that that little girl had already read that letter and now let her answer that letter to the adult me. She wrote the following, but in a very different handwriting:
Hello, my name is Sofia, I am a girl and my hair is short. I have very small hands and I am skinny. I am sad because my dad left, and he left us alone. I want to go out and cry and be listened to. I’m sick and tired of not being loved.
Sofia
It is unusual for a patient to identify an ego state that is not herself, i.e. not a «little Deborah», but another child called «Sofia». Sofia is an ego state that was formed from the traumatic event of her father’s event, an eight-year-old Sofia who feels unloved and abandoned. Which emerged or became executive when an event occurred that made her perceive herself unloved or abandoned by a male figure. Finally, we asked her to read the letter aloud, and to write back to that eight-year-old Sophia that letter.
Sofia:
There are many people who love you, among these people I am. My dad also left and I suffered a lot. But then I realized that I had my mom, my sister and myself. Don’t torment yourself because just one person doesn’t love you and see how much I worry about you.
Deborah
At the end of the session she mentioned «I feel like a blindfold has been removed from my eyes and somehow I saw myself naked for the first time. I am or was this girl and it’s okay to feel what I feel, I just have to channel it differently.» She was asked to draw her experience, and she drew herself with the inner child.
Although this is one of the ways to initiate, we can also use the strategy of «body bridging», especially in cases where the symptomatology is manifested somatically. Likewise, both as an exploration and as a means of cathartic exploration and communication with formed introjects, we can use the «hypnotic empty chair» to re-signify important figures and find some other more «nourishing» ones.
It is important to mention that healing strategies for «wounded inner children» can help, if the therapist guides a resignification of the growth of the person we work with, to strengthen the current ego of the patient, strategies such as the «magic carpet» and ego strengthening techniques become paramount at the end of each session working with ego states. All the aforementioned strategies and other complementary ones are described for their application in the book “Terapia de los Estados del Ego” (Téllez and Valdez, 2024), in which both hypnotic and non-hypnotic strategies are addressed, as well as the theory that frames this type of intervention.
Conclusion
The hypothesis of this work is that depression, anxiety and different psychosomatic disorders, in many cases, are a consequence of «wounded children». In adults, wounded children represent a cluster of perceptions and memories of a certain age, which were formed because of experiencing severe traumatic events. These inner wounded children become executive at the moment when the adult experiences situations like traumatic events. Therefore, hypnosis and ego state therapy are an excellent, effective and brief alternative for healing wounded children.
Ego state therapy can be combined very well with other types of therapies such as EMDR, suggestive hypnosis to strengthen self-esteem and active-alert hypnosis, as a way to potentiate the therapeutic effect.
References
- DIF. (2021). Estadísticas sobre abuso sexual infantil. Recuperado de https://www.gob.mx/dif
- Elkins G. R., Barabasz A. F., Council J. R. y Spiegel D. (2015). The Revised APA Division 30 Definition of Hypnosis. Intl. Journal of Clinical and Experimental Hypnosis, 63(1): 1–9.
- INEGI.
- Save the Children. (2019). La infancia en peligro: abuso sexual infantil en México. Recuperado de https://www.savethechildren.org.mx
- (S/f). Unicef.org. Recuperado el 9 de junio de 2025, de https://www.unicef.org/mexico/comunicados-prensa/informe-anual-de-unicef-m%C3%A9xico-garantizar-oportunidades-educativas-inclusivas
- Terr, L. C. (2011). Working with children to heal interpersonal trauma: The power of play.
- Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment, 10(1), 5–25. https://doi.org/10.1177/1077559504271287
- Spinazzola, J., van der Kolk, B., & Ford, J. D. (2021). Developmental trauma disorder: A legacy of attachment trauma in victimized children. Journal of Traumatic Stress, 34(4), 711–720. https://doi.org/10.1002/jts.22697
- Campbell, K. A. (2022). The neurobiology of childhood trauma, from early physical pain onwards: as relevant as ever in today’s fractured world. European Journal of Psychotraumatology, 13(2), 2131969. https://doi.org/10.1080/20008066.2022.2131969