Stages of Hypnotherapy
In the first session, the client and the hypnotherapist determine an achievable goal and establish a rapport. The first session has a thorough preparation and each session thereafter includes an evaluation of the problem and the desired outcome.
During the preparation, the hypnotherapist assesses the client's receptivity, suggestibility, and the possibility of achieving the desired outcome. The hypnotherapist must screen the client for factors that might make the client ineligible for hypnotherapy. Here are some questions the hypnotherapist may ask the client:
- Why did you seek a hypnotherapist at this time?
- What do you hope to accomplish?
- Is your condition medical or psychological? Has a physician or psychotherapist been consulted?
- What other treatments have you had for the condition?
At this time, the hypnotherapist assesses the client's capacity to receive and act on posthypnotic suggestions. The hypnotherapist must understand what words, imagery, and symbols affect the client. It is important for the client to understand his or her own suggestibility, so that he or she can participate effectively with the hypnotherapist.
During the preparation, the hypnotherapist corrects any misconceptions or unrealistic expectations the client may have about hypnosis and clearly communicates what hypnosis can and cannot do. Once the hypnotherapist is satisfied that the client is ready for hypnosis, he or she reviews the stages of hypnosis and begins the induction.
During induction, the hypnotherapist guides the client to narrowly focus his or her attention to the point that sensory impressions are blocked out. The client can then reach the state of complete relaxation necessary for hypnosis to occur. The hypnotherapist's office usually is quiet and dimly lit to create a relaxing atmosphere. The hypnotherapist chooses a particular method or combination of methods for induction based on the assessment of the client. An induction script may use different types of verbal and visual cues, including the following:
- Use of authorityThe hypnotherapist gives instructions in simple declarative sentences (e.g., "As I speak, you will relax.").
- Guided visualization or imageryThe hypnotherapist suggests images or describes a scene for the patient (e.g., "Let your mind drift to a calm and peaceful place. See the wind blowing through the trees, the flowers in the meadow.").
- Quiet music or rhythmThe hypnotherapist speaks in a steady, evenly paced rhythm without varying voice tone. Sometimes the therapist plays music in the background.
- Repetition of words or soundsThe therapist repeats key words or sounds (e.g., "Breathe in deeply . . . ", "As you breathe in . . . ").
- Emotional cues or probesA hypnotherapy session may be used to gather more information about painful experiences or to help patients cope with difficult emotions. The therapist integrates the inquiries or instructions into the induction script (e.g., "You are in control and will choose to experience or ignore any suggestions during the session.").
- Analogies, metaphors, and associative statementsThe hypnotherapist uses comparisons to familiar experiences or images to help clients achieve physical relaxation (e.g., "Your legs are sinking into the couch, heavy as logs." "Feel your body, heavy and relaxed, being supported by the tree behind you, the ground beneath you.").
Clients do not always readily accept suggestions. The hypnotherapist is alert to any sign of negative reactions or abreactions that may occur during the induction. The hypnotherapist guides the client through these feelings or, if necessary, rewords the suggestion during a later session. An abreaction can present itself as a yawn, a frown, a scratch, or movement in the hand or foot.
On occasion, clients might feel somewhat disoriented, or in rare instances, nauseous. Stopping the induction can usually relieve these effects, or they may disappear as the hypnotic state deepens. After the induction, some people report feeling different physical sensations (e.g. tingly, heavy, floating); others feel nothing unusual at all.
Next, the hypnotherapist uses deepening techniques to enhance the hypnotic stage. These can include simply continuing the chosen induction, changing to another type, or talking directly to the client.
There are three levels of hypnotic states:
- Hypnoidala light stage of hypnosis, characterized by fluttering eye movements
- Cataleptica deeper state, characterized by side-to-side eye movements
- Somnambulisticthe deepest state, characterized by the eyes rolling up
The somnambulistic level has three levels. The first two involve a kind of amnesia, that is, the client receives posthypnotic suggestions on a subconscious level and may not remember hearing them. The third level of somnambulism is so deep that a person in this state can undergo major surgery without anesthesia.
For sessions focused on self-improvement or changing unwanted habits, the hypnoidal and cataleptic states are adequate; however, better results can be achieved if the client enters into the cataleptic state.
Before moving on to the utilization stage, the hypnotherapist must be sure that the client is in a hypnotic state and ready to receive posthypnotic suggestions. There are several observable indicators of the hypnotic state:
- Lack of body movement, stillness
- Pallid, waxen complexion
- Rapid eye movements, eyelid fluttering
- Redness around the eyes
- Relaxed posture, slumping
- Slowed breathing
- Swallowing, gulping
- Water or tears in the eyes
A posthypnotic suggestion is made during the utilization stage. The posthypnotic suggestion is a verbalized statement of the desired outcome. If taken in and acted upon, the suggestion affects behavior after the client has emerged from hypnosis and returned to regular daily activities. The posthypnotic suggestion is the key to achieving the client's goal.
As long as they are clear and specific in describing the goal, posthypnotic suggestions can be visual or auditory. Only positive suggestions based on the client's suggestibility effectively change behavior. For example, the hypnotherapist might suggest that when a client finds him- or herself in a usually stressful situation, they will not desire a cigarette.
An abreaction, such as a frown or shift in posture, may occur when the suggestion is made. Repeating the suggestion, rewording it, or choosing a different type of suggestion may help the client become more receptive.
By repeating the suggestion to the client in each session, a new conditioned response may be achieved. The repeated chosen key words in the suggestion become associated with the desired outcome. If the client successfully receives the suggestion, he or she begins to formulate internal processes (emotions, visualizations, or dialogues), which help achieve the desired outcome.
After the posthypnotic suggestion has been introduced and developed, the hypnotherapist leads the client into the termination stage.
Termination is the slow, gradual return to consciousness. Just prior to ending the hypnotic state, the hypnotherapist often repeats that the client is in control of his or her body and mind, and has been in control throughout the session. Several termination techniques may be used; the best known is counting backwards followed by the authoritative command "Wake up." The client opens their eyes and adjusts to the relaxed but aware state that follows hypnosis.