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There is no definite dividing line between a normal waking state and a hypnotic
or trance state. Examples of alterations in consciousness occur frequently and
most people experience some of them. Both children and adults can become so
absorbed in daydreaming that they lose track of what is going on around them.
Some people consciously use daydreams to divert themselves from certain aspects
of their existence. When someone is concentrating intently on a work project,
the hyperfocusing that aids the work may also shut out noises and other
distractions. Someone who is absorbed in an activity may, when the activity
ends, need to take a moment to reorient to the external world
What hypnosis is not: Sleep. Adults who are hypnotized often prefer to have
their eyes closed. This is not necessary in order to have a deep trance state.
In fact, many children prefer to have their eyes open and even to walk around
during hypnosis. While in hypnosis, one’s attention and concentration is more
focused. During sleep, this is not usually the case. EEG patterns during
hypnosis and during sleep differ. Hypnosis is intense focused concentration,
with the partial or complete exclusion of awareness of peripheral phenomenon.
Some feel that individuals who are able to become intensely absorbed in an
activity or daydreaming make the best hypnotic subjects. Hypnotic or trance
states can occur spontaneously both inside the therapy room and in every day
Individuals may feel disappointed and say, “I didn’t feel like I was under
hypnosis.” They expect their eyes to close automatically and expect to feel a
floating or tired state. Despite this, within a few days, their target symptoms
seem to get better. This may actually be good hypnotic treatment. Individuals
experience trance in their own way. Many, particularly children, do not close
their eyes or even remain seated, during the hypnosis. Some people may continue
their work consciously or unconsciously after they leave the session. Other
individuals consider medical hypnosis a failure because they have unrealistic
expectations or goals. While hypnosis may be the primary treatment of choice for
certain symptoms and disorders, it is often appropriate as an adjunct to other
biological or psychotherapeutic techniques
When I explain hypnosis to a new patient, I often have to explain how my
procedures differ clinically and ethically from amateur stage hypnosis. Stage
hypnosis depends on a certain amount of peer pressure and a given individual’s
conscious or unconscious wishes to perform. Frequently it is not done with
consideration for the subject’s needs or vulnerabilities. I see hypnosis as a
specific medical or psychological procedure that should be done within the
context of a therapeutic relationship.
Recently a clinician from another state asked for advice about branching out
from clinical hypnosis to hypnosis for public entertainment. I advised her to
avoid this completely. It is important for licensed mental health practitioners
to use care in determining the appropriate venue for hypnosis.
Some patients worry that if hypnosis helps their pain that it means that the
pain in “all in my head.” Actually, that is true because ALL pain is mediated
through the brain. Pain related to surgery or medical conditions such as
shingles can respond well to hypnosis. I usually work with the patient to build
in safeguards so that he or she will be alerted to any change or increase in the
Hypnosis has been shown to be effective bruxism (repetitive teeth grinding) I
have used it successfully to help individuals stop smoking. For individuals with
alcoholism or other chemical dependency, I strongly suggest that if they are
seeing me for hypnosis, they also attend 12 step meetings.
I have had good results using hypnosis to attenuate nausea associated with
cancer chemotherapy. An added benefit in one individual was the ability to learn
to dilate small veins prior to a needle stick. “Morning sickness,” the nausea
associated with pregnancy, can range from mildly annoying to medically
dangerous. Pregnant women often wish to avoid medication unless absolutely
necessary. I do not see hypnosis, in isolation, as a substitute for childbirth
preparation classes such as Lamaze or Bradley. However, it can work in
combination with these approaches. Women with anxiety disorders, who wish to
avoid medication during early pregnancy, can often use these techniques to
decrease anxiety and minimize panic attacks.
Almost by definition, hypnosis induces a state of relaxation. This can be short
term, as when used to interrupt panic. When used with self-hypnosis, a motivated
individual can often achieve longer-term results.
Hypnosis can help anxiety disorders in more than one way. It can directly
decrease anxiety and panic by inducing a state of relaxation. The therapist can
also use the hypnotic state to help the patient focus more clearly on issues
that might be causing the anxiety. Often the use of fictional stories, used as
metaphors, can give the patient a new way of looking at his or her problems.
Story telling is more permissive than direct suggestions. It gives the patient a
chance to accept or reject the suggestion without feeling that he is being
of strong emotional state:
Individuals in crisis are often more susceptible to suggestion.. Susceptible
individuals may actually dissociate spontaneously during a trauma or crisis.
This tendency may be used therapeutically in emergency situations.
do not use hypnosis as the primary treatment of schizophrenia or bipolar
disorder. However, I occasionally will use hypnosis to interrupt an intense
emotional state while waiting for other medical treatments to take effect. One
must use caution when using hypnosis with these individuals, but hypnosis is not
Hypnosis can be a useful part of exploratory psychotherapy. The therapist often
makes use of metaphorical stories to help the patient develop another way of
looking at certain situations.
Some, such as the Speigels, feel that each individual has an innate capacity for
achieving trance state. They see this capacity as relatively stable over time.
They suggest that there may be inheritability of this capacity. Thus, they do
not use deepening techniques as much as other clinicians. They do note that
expectations and rapport with the therapist can influence the success of the
Milton Erickson emphasized less a biologically determined capacity for hypnosis.
He attempted to find metaphors suitable for each individual. He also would use
deepening techniques. He felt that individuals who seemed to have a limited
capacity for trance could still achieve trance states with proper technique.
Many clinicians approach their hypnotic work from a middle ground. It is useful
to get a sense of the patient’s capacity to easily achieve trance. However, much
can be done to deepen and enhance the trance state. Additionally, a great deal
of productive work can be done while an individual is in a light trance state.
The induction is essentially a ritual that helps formalize a transition to a
more focused state of consciousness. Deep or light trance states can occur
spontaneously. The formal induction process serves to organize and structure the
process so that the trance state can be more efficiently used in therapy. There
are a wide variety of types of hypnotic inductions. Some therapists tend to use
a particular type of induction most of the time. Others vary the type of
induction depending on the personality type and preferences of the patient.
Brief induction techniques can be more practical because the patient can often
learn to use it himself in “real world” situations.
I will often teach patients how to use self-hypnosis so that they can gain more
control over the process. They can use it between sessions as boosters. Often I
teach them a long induction for when they have time and a shorter induction for
quick use in crisis situations. Individuals who have difficulty doing the self
hypnosis may benefit from hypnosis tapes. I will often make up custom tapes for
Children are actually more easily hypnotized than adults. They may become bored
with a slow adult-type progressive relaxation induction. If one expects to see a
hypnotized child lie still with his eyes closed, one may conclude that the child
is incapable of trance.
When children experience pain, they may not understand what is going on. Thus,
the pain may be complicated by anxiety. Hypnosis along with sensitive, age
appropriate explanations, can result in good pain relief. In severe or chronic
pain, the psychiatrist may want to coordinate treatment with other medical
In separation anxiety, hypnosis can compliment a comprehensive approach which
may also include specific family guidance, psychotherapy and sometimes
medication. The hypnosis may help decrease the child’s anxiety during separation
by helping him or her to carry an internalized representation of a parent with
them. In reactive anxiety, (anxiety directly related to stress) hypnosis may be
the treatment of choice and further treatment may not be necessary.
Cognitive psychotherapy can help a child or adolescent with OCD as it can an
adult. Hypnosis can be an adjunctive treatment.
I do not use hypnosis as a primary treatment for AD//HD or learning disorders.
Primary treatments for this condition include parent training, medication,
educational intervention, psychotherapy, and the use of support groups. Hypnosis
can sometimes augment these treatments by improving self-esteem, anxiety, and
When one is treating a child or adolescent, the goals of the parent and school
may be different from those of the child. In such situations, control issues may
be prominent. When I use hypnosis in such situations, I emphasize the permissive
nature of the trance state. I do not try to use the hypnosis to make a child do
things he does not want to do. I try to use the hypnosis to help the individual
focus on the positive things he or she wants to achieve. The trance state may
help the child or adolescent break out of an oppositional stance by encouraging
him or her to think of creative solutions.
This is a controversial subject. Different clinicians have varying opinions
about the appropriate uses of hypnosis. I tend to be more conservative than some
other experienced clinicians. Most licensed clinicians agree that they should
not use hypnosis for public entertainment. It is not a good idea to try to
induce hypnosis in a patient who does not want it. One should not use hypnosis
to try to achieve goals other than the patient’s wishes. Generally, it would be
difficult to use hypnosis in this way. However, there have been reports of
manipulation of ambivalent patients in hypnotherapy and other forms of therapy.
There are a number of specific patients who I might feel would benefit more from
another type of psychiatric intervention. In such cases, I will discuss a range
of treatments and their potential risks and benefits. Hypnosis is one of a
number of psychiatric treatment techniques. The person doing the hypnosis should
first be a well-rounded clinician with knowledge of psychiatric diagnosis and