The types of hypnotherapy and my approach

Curious to learn more about hypnosis? Or about my approach to it? You’re in the right place. Read on…

Generally speaking, there are two schools of thought about how to do hypnotherapy. The approaches are sometimes called by different names, and really, it’s more of a spectrum between two extremes.

Directive approach

On one end of the spectrum is directive hypnotherapy, or sometimes called classic hypnotherapy or authoritarian hypnosis. In this school, a hypnotherapist gets a person into a trance state and gives the person's unconscious directions to make things better. Typically, this comes in the form of direct suggestions, a hypnosis term that refers to specific instructions that the unconscious will either accept or reject. Examples of direct suggestions are things like:

  • And now your legs will feel very heavy and you'll hardly be able to move them.

  • Now your body is more and more relaxed, as relaxed as you've ever been in your life.

  • When I count to three, you'll imagine yourself in the middle of Central Park.

Direct suggestions can also be post-hypnotic, meaning they can affect things after the hypnosis session is over. For example:

  • Whenever you see a pack of cigarettes, you'll become nauseous and filled with disgust.

  • When you notice yourself clenching your teeth, you will stop and it will feel like your mouth is full of soothing jello.

Most of the recordings and scripts you can find on the internet are primarily directive in nature, as are most of the books of scripts or manualized protocols you can find. What this approach tends to rely on is the authority of the person conducting the hypnosis to ensure that the person receiving the suggestions follows them. That is to say, when someone we respect or attribute authority toward (like, say, a doctor) tells us do something, we usually try to do it. And this is (mostly) even more true on an unconscious level.

In this directive approach, the suggestions themselves tend to be pretty straightforward and standardized: it's assumed that one method of weight loss or smoking cessation will work for everybody. While there are many other things that one can do in hypnosis besides make suggestions, it's much harder to standardize the other stuff.

Typically, if the hypnotherapist has significant enough authority or charisma and the problem isn't too complicated, this approach works really well.

I do this kind of hypnosis sometimes, but not very often. Why? Because while this works, people are individuals and giving the same suggestions to everybody isn’t as effective as tailoring something to each person individually.

Which brings us to the other approach:

The utilization approach

On the other end of the spectrum is the utilization approach. This approach originates from the work of Milton Erickson, one of the most important characters in they history of modern hypnosis, as well as of psychotherapy as a whole. Erickson felt that the utilization principle was his most important contribution to hypnosis, and it has deeply affected most of the field of clinical hypnosis, especially in the mental health world.

The utilization principle is the idea that the hypnotherapist uses the skills, material, and issues that the client comes with. In contrast to the directive approach, it's much more about crafting the right intervention for the particular person based on the person's strengths.

While the directive approach might be epitomized by the direct suggestion, the utilization approach is better epitomized by imagery or evocative techniques. What are those? Let’s imagine for a moment…

Imagine you have a good friend who is always watching out for you. In fact, your good friend is always with you and watches out for you all the time, often catching things that you miss, and thinking of the solutions you haven’t had the time or energy to think of.

Sounds great, right? Well, the good news is that this friend is your unconscious mind. Your unconscious mind is taking in all the sensory information that you aren’t consciously taking in, and is responsible for all the thoughts you’re not consciously aware of. For example:

The reason you woke up thinking about your 3rd grade teacher? Your unconscious was revisiting your those memories.

How you came up with a solution to a problem plaguing you at work while you were in the shower yesterday? Your unconscious was working on the problem while you were doing other stuff.

The reason you can’t help thinking of a elephant when I say don’t think about an elephant!? — your unconscious is helpfully responding to a suggestion (and the unconscious mind doesn’t typically recognize negator words, like don’t).

Typically, people don’t have strong relationship with their unconscious minds, or even have negative relationships with them. Nevertheless, the unconscious mind is there observing and thinking about things, gathering ideas and points of view. Evocative techniques or imagery techniques are ways to connect to the unconscious' vast pool of creative ideas andknowledge. Erickson is famous for saying things like, "Trust your unconscious: it knows more than you" and "You know more than you think you know." He’s speaking about that storehouse of knowledge we all have.

But, because this seems like it's getting abstract, I'm going to make up an example. Let's say someone contacts me—let’s call her Lynn, and she's dealing with anxiety regarding public speaking.

If I were to use a directive approach, maybe I'd see her for 1-2 sessions and give her a series of direct suggestions telling you that she will relax before she goes on stage or presents.

Again, this could work in many cases, especially if I present it authoritively and give Lynn the expectation that it'll work. The major pros of this approach is that it's fast and easy for me as a clinician. Two sessions is also not too expensive for Lynn and I would just do the same thing I do with everybody with a public speaking phobia. On the other hand, it might not work, or it could work for a bit and then wear off.

On the other hand, let's say I use this utilization approach. I meet with Lynn for a first session and I talk to her about her problem in depth. I know she has a problem with public speaking but I ask lots of questions about it and about her life in general. Here's a blurb of what I find:

Lynn, 39, works as a job rep at a temp agency. She enjoys her job interviewing people and trying to match them to prospective jobs. For reasons she doesn't understand, her boss has picked her to start doing group trainings and presentations to large companies who want to contract with her agency--which is great--except that whenever she gets in front of more than 3-4 people, she sweats heavily and has trouble modulating the loudness of her voice, sometimes speaking super loud, and sometimes very quietly, and it feels like everyone's giving her weird looks. She's motivated to get over this problem, though, because she likes her job and needs the money to support herself and her 1-year-old daughter. (She smiles a lot and looks blissful as she talks about her daughter, Becca)

In her off time, she reads a lot, mostly fiction, and makes references to books by Diane Wynne Jones. She also talks about cooking and baking, the fun of seeing how experimental recipes turn out.

When asked when the problem started, at first she says she's always had fear around group presentations, but notes that when she was in middle school, she did a presentation about nuclear power plants and, though she was nervous, it wasn't nearly as bad and she found she could speak fluidly and at length about the subject. She feels it was easy because she was knowledgeable about the topic at the time.

When asked about trauma and any difficult experiences, she indicates no abuse history or problems of that nature, but when talking about books she likes, she mentions her ex-boyfriend was just like Howl (from Howl's Moving Castle, a book by Diane Wynne Jones) and she once had a loud verbal fight with him in the middle of a pizza place when she was 16 because he felt he couldn't be seen in public eating bread sticks and was mortified that she was eating them without fear. While it's clear now that he needed a good bit of therapy himself, at the time, he demanded they leave and blamed her when the manager came to the table because they were "making a scene."

Now, I just made this case up. But you can see a lot in here that I can work with. In the utilization approach, it's my job to take this and craft a set of things to do to help from it. This process is collaborative and I’ll bring up any ideas before we do them. Some ideas that come to mind at the moment are: Maybe help Lynn connect to her love to her daughter before she presents--those chubby cheeks could go a long way to relaxing anyone. Or maybe could tell her a Diane Wynne Jones-esque story to indirectly suggest change, or evoke another character from her stories, like Sophie (a strong female character from Howl’s Moving Castle) who can help her get through those presentations. Likewise, she shows a sense of adventure and curiosity around cooking and such that could be helpful: What if we helped her unconscious draw a metaphorical connection between presenting and making an experimental recipe?: could that excitement and curiosity she feels while cooking replace anxiety. Or, Lynn and I could go back to when she was 12 and she was having a pretty normal reaction to public speaking and help her bring that feeling to the present. This is called an age regression and is a particular and special kind of evocative technique… or we could work with inner resourcing and self-appreciation in general, helping Lynn's unconscious learn the reasons her boss might think she's the right person for the job, and help her feel more like that right person. Or we could do another kind of age regression: go back to her 16 year old pizza restaurant incident and help her get free of any lasting effect that might have had on her unconscious--which, though not clinically traumatic, could be getting triggered, causing embarrassment to erupt from any situation people seem to be watching.

It's also possible to simply ask or evoke ways her unconscious might know to solve the problem, and work with those. Whatever we do, however I might prompt things, the solution actually comes from Lynn and what she brings.

In the end, this may take longer than a directive approach because I need to spend at least some time getting to know who the client is and what she brings. At least 3 sessions at minimum, usually 5 for a situation where I'm only seeing someone with a specific issue, like a phobia or a habit change. More sessions are needed, obviously, with issues where there is a need for both talk therapy and clinical hypnosis.

But the result of this kind of approach is much more nuanced than the directive method. Because it's so tailored to an individual client, and more palatable to an individual mind, it’s much more likely to be useful over the long term. Likewise, rather than coming from the authority of the hypnotherapist, the effectiveness of the utilization approach comes from what the client brings and how we (the client and myself) collaboratively and creatively work with it.

Actually, I apply this utilization approach to almost all my clinical work, not just in hypnosis but in therapy in general. Sometimes, I get the uncanny sense that I'm not actually the one doing much at all--that it's the unconscious of the person I'm working with that's responsible for healing and change, not me. When that happens, it's awe inspiring for both me and client. This is why I'm serious when I say that I enjoy helping people discover their strengths.

So, maybe you’re thinking at this point that this all sounds amazing. But maybe you’re wondering what the downsides to hypnotherapy are. In my next entry in this series, I’ll be talking about “the hypnosis warning labels and informed consent.”