10 April 2018
Do you know how hypnotherapy works? To a lot of people, what a hypnotherapist does is a bit of a mystery, so we’ve written this blog in order to cast a little light onto what is involved in a successful hypnotherapy session/treatment plan.
To begin with, a fundamental element of an effective hypnotherapy session is the consultation process. The information that a hypnotherapist gets from (and gives to) a client will significantly influence the resulting work. Beyond simply getting basic identifying information (name, address, medical history, lifestyle), taking a detailed ‘case history’ enables a full exploration of not just the problem, but also what the goals are for therapy. If you only focus on ‘getting rid of the problem’, you have no tangible direction. Hence, goals (desired direction), are really important to the hypnotherapy process. The hypnotherapist will also help the client to ensure that their therapy goals are realistic. Perhaps a client wants to lose enough weight to run a marathon. However, if they are 10 stone overweight, a more realistic goal (initially) may be to be able to walk around the block. It is also common practice, during the consultation/client intake process, for the hypnotherapist to educate the client about their issue, about hypnosis (a ‘pre-talk’) and to determine their hypnotic suggestibility. This initial consultation process can set the resulting therapy on a more accurate path and will help the therapist choose the correct treatment approaches to meet the client’s own individual needs.
Obviously, a hypnotherapy session needs to include hypnosis (generally)…
The hypnosis tends to happen before the ‘therapy’ part, and there are a vast number of methods that hypnotherapists use to create the hypnotic state. These methods are known as ‘inductions’. Hypnotic inductions can range from slow to fast, they can be indirect and conversational, or direct and commanding. Some involve elements of relaxation, others utilise movement, confusion or cognitive overload. Once the client has entered into the state of hypnosis, the hypnotherapist then uses a ‘deepener’, which helps to intensify the state of hypnosis, allowing the client to settle and become accustomed to the hypnosis process.
Many professional hypnotherapists will work to a three-phase treatment plan throughout their session(s), working to ‘stabilise’ the client, building resources and resilience to optimise their engagement and to ensure they’re ready for therapy. Once the client is stabilised, the next stage is ‘treatment’ where the majority of the therapy is conducted, prior to the final stage of ‘maintenance’ where the aim is to maintain and develop the new ways of responding and prevent relapsing to previous behaviours and responses.
One of the very first approaches a hypnotherapist may employ, once hypnosis has been established, can be to enhance relaxation in the client. This is often achieved by either ‘directly suggesting’ that the client relaxes, or creating an imagined ‘safe place’ or a ‘favourite place of relaxation’. Whilst relaxation is not essential for hypnotherapy (indeed it isn’t used commonly in some applications, such as sport), when used as an initial approach, it can help the client engage with the process, and promotes a sense of positivity and wellbeing. Therefore, relaxation provides a favourable starting point for the client to then participate further within the hypnotherapy process.
Throughout the hypnotherapy process as a whole, and certainly within the ‘treatment’ phase, the hypnotherapist will often use ‘direct’ and ‘indirect’ suggestions to create change. Direct suggestions are more commanding and explicit, such as “let go of that tension… now…”, and are good for a person that appreciates a firmer approach. In contrast, indirect language is softer, often giving an illusion of choice, such as “I wonder whether your right shoulder is relaxing now… more deeply than your left… or whether your left shoulder is relaxing now… more deeply than your right…”. Indirect hypnotherapy suggestions tend to work well with those clients who prefer more ‘permissive’ instructions, those who don’t like being ‘told what to do’, and also those who want to be an active, part of the collaborative therapy process and have their therapy done with them rather than to them. Many hypnotherapists will use both direct and indirect suggestions within a session.
Talking of clients who want therapy ‘done to them’, an influencing factor that hypnotherapists look for when choosing to take a direct or indirect approach, is the client’s ‘locus of control’…
This is a personality trait scale that identifies the extent to which a person believes they have control over their life. The scale goes from ‘internal’ through to ‘balanced’ and to ‘external’. Someone who is very external may believe they are ‘at the whim of fate’, taking little responsibility for their own health. Whereas, someone very internal, believes they are responsible for events that, in reality, are outside of their control. For successful therapeutic engagement, it helps if the client’s locus of control is more ‘balanced’, so that they will accept appropriate responsibility for their therapy process. Locus of control can be addressed using ‘ego-strengthening’.
Ego-strengthening within the hypnotherapy process not only can enhance and balance the client’s locus of control, but also positively benefits their self-esteem, self-confidence, and sense of self, empowering them, together with working on developing resources and building resilience. This helps facilitate the therapeutic process and can result in more effective and lasting change. Ego-strengthening approaches can either be direct, or, popularly, metaphorical.
‘Metaphorical’ work (one aspect of the ‘Ericksonian Hypnotherapy’ approach) is very effective within hypnosis. We use metaphors in everyday language, such as ‘he was boiling mad’, and ‘her memory of the event was foggy’. Beyond simple phrases, we also are familiar with metaphorical stories. As children, we are told stories (such as at bedtime) and these stories generally have meanings that we absorb without even having to make an effort. As adults, when we are told a story, we tend to relax and even forget we are engaged in a therapeutic process. Thus, there is less likelihood of ‘unpicking’ or resisting therapy. Therapeutic metaphors indirectly identify the issue (drawing parallels within the metaphor itself) and tend to explore what has been tried previously, then suggests an alternative way of responding to the issue, and what the benefits this approach might have. For example, with a client who would benefit from looking at their work or lifestyle for the source of their issue, a metaphor could be:
“One of my clients had sore shoulders recently… [issue] He had regular massages, did more exercise, and even changed his mattress… but nothing seemed to help him… [attempt to resolve] …and then he was sitting at work one day and noticed his posture when using his new laptop was rather hunched… so, he changed his posture, sitting better whilst working… [possible solution] …and from then onwards, he has been so much more comfortable, and in a better mood all round… [benefits]”
These ‘therapeutic metaphors’ can be dropped into everyday conversation and each person will draw their own meaning from them. For some, they will take it literally, and think about their posture, for others it will be about considering things from a different perspective, such as that by considering different perspectives they can influence their own circumstances.
Other therapy approaches
Although suggestion work is a fundamental aspect of hypnotherapy (closely followed by use of metaphors), most professional, effective hypnotherapists tend to have a good working knowledge of a broader range of hypno-psychotherapeutic approaches. ‘Behavioural hypnotherapy’ approaches aim to identify and change repeated unhelpful behaviours, considering ‘what, where and how’ the client does what they do. These behaviours are often in the form of established habits and responses, both where the individual is consciously aware (such as sitting in a poor posture working on a laptop whilst on the sofa), and where they are not consciously aware (such as thumb sucking or nail biting). Together with direct and indirect suggestions, a behavioural approach is often a therapists first line of response to many issues, working to establish or change a clients’ automatic or ‘conditioned’ response (this is where the client has learned to respond a certain way to a stimulus or trigger). For example, if a client is stressed at work, as soon as they sit down at their desk, they may start to tense their muscles. With hypnotherapy, this can be identified and a different response developed (cognitively) and reinforced (using hypnotic suggestion) to create a new behaviour or ‘habitual response’.
Behavioural hypnotherapy approaches can often be supported by ‘cognitive hypnotherapy’ work, considering, challenging and changing unhelpful and limiting beliefs, thus ‘what, how and why’ they believe the things they do. Here, unhelpful beliefs are explored, considering the emotional and physical consequences of those beliefs, together with identifying and developing new, desired beliefs and becoming aware of the positive consequences that accompany them. For example, a client may hold the belief or attitude that they should always be able to relax as soon as they get into bed. So, when at times, they are tense in bed, this can lead to disturbance, with unwanted physical tension at bedtime as well as psychological stress. The cognitive hypnotherapy approach might be to help the client develop a healthier (more realistic) belief or attitude that whilst they would prefer to relax instantly, they accept that at times, they may need to focus on relaxing each part of themselves until they are fully relaxed. This transition from an ‘absolute’ belief to a ‘preference’ promotes psychological flexibility and reduces stress. A blend of approaches, such as ‘cognitive-behavioural’ work, can also help, particularly with intrusive thoughts, where you are able to address both the habit of the thinking pattern, as well as resolve the underlying unhelpful thoughts/beliefs.
Moving on from behavioural and cognitive hypnotherapy approaches, ‘analytical hypnotherapy’ approaches help clients consider ‘why’ they do what they do, working to gain insight, and to discover and adjust unconscious drivers and patterns.
Together with exploring why they do what they do, it can help to identify a particular purpose (a ‘positive intention’) for the original behaviour and they can then negotiate change to something more desirable or relevant. For example, a client may always be tense when travelling as a passenger in any car (even with perceived ‘safe’ drivers), and they find this distracting and unsettling, as they don’t ‘consciously’ understand why they are tense. An analytical approach may discover a reason, such as a long-forgotten car accident (potentially ‘repressed’ where the mind was trying to protect the client). However, this ‘protective response’ is no longer helpful, indeed it is now unhelpful, and thus the client would benefit from understanding the reasons and being able to change their response.
Most hypnotherapists select their therapeutic approaches from a least intrusive to most intrusive perspective, often working in the present, with current behaviours and beliefs. If the behavioural and cognitive approaches are insufficient to fully address the issue, then a therapist may engage in analytical work, in order for the client to gain beneficial change. Finally, and often thought of as a last resort, is ‘regression hypnotherapy’. This approach helps identify ‘when’ initial events/responses occurred. By engaging the imagination and memory processes, to ‘go back’ to that time, there are opportunities to change how the memory is presented or engaged with by the client. For example, ‘going back’ to the first time a client had an anxious response on a fairground ride as a child, and gaining a new adult perspective (with their adult knowledge and understanding), the client can then more easily change how they respond to similar situations in the future.
Hypnotherapy tends to be considered a ‘brief, strategic, solution and goal-focused’ approach to change work. Unlike some other ‘talking therapies’, it isn’t something that is done to a client, rather, it is a collaborative approach. The benefits and gains of the hypnotherapy work is enhanced by clients engaging in activities and tasks (‘homework’), beyond the therapy session. Therapeutic homework tasks reinforce the new thoughts and behaviours and can help a client move from ‘knowing’ into ‘doing’. In addition to real-world activities, such as going to an airport (for someone who had a phobia of flying) or keeping a food diary (for a weight management client), many hypnotherapists will also teach their clients ‘self-hypnosis’. This can help a client become more settled in the hypnosis process and provides opportunities for reinforcing relaxation, ego strengthening, or engaging in other therapeutic techniques for specific purposes.
Homework is a key part of the ‘maintenance’ phase and helps empower the client to keep the therapeutic gains and changes, whilst developing the skills and attitude to be self-managing and self-supporting in not just keeping these positive changes, but fully integrating them into their everyday life, thus developing lasting effectiveness.
Concluding the hypnotherapy session
When the work in hypnosis has been completed, the hypnotherapist will re-alert or ‘wake up’ the client (although, they weren’t actually asleep), Whilst the hypnotherapist (usually) won’t quiz the client about their experience during hypnosis (nor ask for performance feedback!), they will usually check in with how the client is feeling about the presenting issue and may book them in for another session, if appropriate. Alternatively, they may schedule a telephone catch up to check in with the client at a later time. This enables the hypnotherapist to ensure that the client is on track to achieve their therapy goal.
Concluding the therapy process
Different clients (and issues) respond to hypnotherapy at different speeds. So, a hypnotherapy approach might involve just one session, or a number of sessions in order to reach a satisfactory conclusion. Furthermore, as therapy progresses, further issues (or ‘deeper’ issues) may arise, which the client may not have been consciously aware of initially. This is why professional, effective hypnotherapists will check at the start of each session, what the client’s overall goals are, and establish the goals for that session.
Auditing practice and keeping in contact
Many hypnotherapists will keep records regarding the effectiveness of their approaches and the impact therapy has had on their clients. This may be at the end of the therapy process, or can even include a follow-up, weeks or months after therapy has concluded.
It might seem that the work of a hypnotherapist is limited to the time spent working with clients. However, there is much more to it than that. It starts with getting high quality initial training in hypnotherapy, including how to build and manage a successful therapy practice. This naturally includes all the admin’ and other tasks of a self-employed person, such as marketing, networking and business development. In addition, a professional hypnotherapist will engage in ongoing learning and development (‘continuing professional development’ or CPD) and clinical supervision. They might get involved in research, present at conferences, or write (whether blogs, articles or even books). All of this knowledge, experience, and more, comes together in the therapy room, to ensure the hypnotherapy client gets the best possible experience and outcome.
We hope that this blog on how hypnotherapy works has been helpful to you. If you have any more questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks
& Rory Z Fulcher