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.”

What hypnotherapy isn't

Now that I've covered what hypnotherapy is, you're probably thinking about all the things I didn't touch on: how hypnosis is portrayed in movies and books and things you've heard or seen about hypnosis in general, or how your aunt Helen stopped smoking forever after 2 hours with some hypnotist in Brooklyn.

I'm going to cover some major myths about hypnosis.

Frankly, hypnosis has always had suffered from a problem of public image. Maybe this goes back to the origins of these sorts of techniques. I could guess why, but I'm not totally sure. Anyhow, without further ado:

Myth 1: the dominance/mind control myth

Many people think that hypnosis is somehow about a person (a hypnotist), gaining control over someone else's mind. For example, Incredibles 2 basically uses the term hypnosis as a synonym for mind control. And the recent movie, Get Out! (2017) is another good example of a portrayal of this myth in a more nuanced way. I've saved the spoilers/more full discussion for further below, but, long and short of it, in the movie, hypnosis is used basically as a restraint technique, keeping the main character from acting to save his own life. I've also seen portrayals of hypnosis being used to commit crimes: as if I could hypnotize a bank teller into willingly hand over the contents of their cash drawer without tripping the secret alarm.

In actuality, hypnosis is more complicated. Though based on some truth, and though hypnosis techniques are useful for many things, mental restraint and robbing banks are not among its uses, and it's definitely not mind control.

The truth here is that nobody can make you do what you truly don't want to do, even in a hypnotic trance state. The grain of truth to the myth, though, is that many of us are estranged from the wants of our unconscious minds. Sometimes, our unconscious wants to do things that surprise us.

This is how stage hypnosis functions: a stage hypnotist will attempt to hypnotize a whole audience of people. And it doesn't work on most of them. But, out of a group of 100, say 5 end of going into a trance and become the subject for a humorous set of suggestions and ridiculous antics. Why? Because on some level they wanted to. Maybe their unconscious minds wanted to know what it would be like? Or were bored with just sitting in the audience? or maybe they wanted attention or felt exhibitionist? Or because of their history with authority figures? Or doing so made them feel more in control than being a bystander? It depends on the person, who probably weren't aware what they unconsciously wanted themselves. But the result is that they might think that this hypnosis stuff is mind control.

Personally, I also think much of mind control reputation comes from authoritarian medical professionals and their use of hypnosis, especially in the last century. Back before ideas like collaborative treatment and before the internet, which encourages people think for themselves about their symptoms, the family doctor was seen as a major authority figure and source of wisdom. If he said you had chicken pox, you took that as a fact. If he said you needed to take this medicine every day for 3 weeks, you did it. If he said you needed an operation, you'd get it. The doctor's orders were—well—orders. And hypnotherapists (who were mostly doctors at the time) used this social power, usually rightly, but sometimes wrongly. So if the doctor said, "you're now going to go into a trance" your unconscious would have very little precedent to disagree. If the doctor told you then that your left hand would go completely numb, your unconscious would produce the numbness, or if he said you could enter a state of sleep so deep that a surgery could be done on you and you wouldn't wake, your unconscious would find a way to do it. (I use these examples because they're real: glove anesthesia and hypnosis-assisted surgery do actually happen).

So it’s not that hypnosis is mind control, it’s that for a long time, the doctors who practiced hypnosis were exploiting their authority to get people to do stuff—usually good stuff, though with a few noteable exceptions. Even today, most of us want to make authority figures happy, and our unconscious minds, wanting the same, comply with what authority wants.

On the other hand, it's unlikely that I (or any hypnotherapist I know) could get someone to do something that would cause obvious harm to themselves. Why? Because the unconscious (just like the conscious mind) wants safety, comfort and happiness, among other things. Even when it does stupid things, it wants these. Milton Erickson did a series of experiments with his students and patients about this. The results are amusing and quite telling. You can read about what he discovered here.

So could I create a posthypnotic suggestion that every time someone hears me stir a spoon in a teacup, they could consciousness, allowing me to lock them up and cut out their brain? Well, I haven't tried... but I’m confident that no, I couldn’t.

You’ll be happy to know, though, that authority has lost its prominence in clinical hypnosis. More about this in my next post.

Myth 2: the hypnosis = sleep myth

This is a complicated myth. I think sometimes this is evoked also to suggest mind control in the sense that when someone's asleep, they're vulnerable and it's as if someone else (again, the powerful/wicked hypnotist) can do all sorts of things to them they wouldn't normally allow.

On the other hand, hypnotherapists themselves perpetuate this myth in various ways. James Baird, an early pioneer in hypnosis sometimes called it “nervous sleep.” The term hypnosis itself is derived from Hypnos, the Greek god of sleep (Latin, Morpheus). Some inductions (techniques to put people into hypnotic trance) also involve the injuction to sleep.

If you're thinking about someone swinging a pocket watch saying, "you're getting very very sleepy..." then you've got the right idea: though I'd never use a pocket watch, the suggestion to sleep to someone who is definitely awake can produce a trance state. That said, I think this myth is more a culture/language issue than anything else:

We don't have a lot of good words for mind states in everyday English. We all know what it means to be awake, right? And we all know what it means to be asleep. But what about other states? Our language gets pretty vague…

"Lost in a day dream," "zoned out," "dissociated," "in a fugue state," "lost in thought"... All these are attempts to describe trance states--states that are out of the realm of "normal waking state." So are expressions like, "totally absorbed," "in the zone," “on a roll,” and “entranced”—the second set are descriptions of trance states that are useful or helpful in some way.

All the same, while you could easily tell me the difference between being awake and asleep, could you tell me the difference between being “zoned out” and “entranced”? Or how about “zoned out” and “entranced”?

The variety of trance states is immense--from ecstatic spiritual rapture to repetitious self-berating fantasy--and trance states are neither "normal waking state" nor sleep, but it's easy to see how, when we’re at a loss for words, people can make the logical jump from “well, I wasn’t awake” to “I was asleep” because we don’t have clear words for anything in between.

Myth 3: hypnosis is magical, effortless, and/or guaranteed to work

Sometimes people come to see me and they lie back and say declare something like, "okay! I'm ready! fix me!" as if I'm going to wave my magic wand, yell "Hazzah!" and their problems will fade away.

The other myths about hypnosis encourages this fantasy: the idea of a hypnotist controlling your mind can be relieving if you've been struggling to control your own mind. Likewise, the idea of going to sleep and waking up with your problem gone can feel very enticing if all you're exhausted from fighting things.

The marketing of hypnotists sometimes plays into this, as if the writer of the blog you're reading has all the keys to unlock your life. (Sorry to disappoint you: you have the keys—don’t let anyone tell you different. I promise to help you find them, though.)

There is truth the idea that a lot of amazing stuff can be done with hypnosis--stuff that can't be done using other methods. But that doesn't mean hypnosis is magical--it just means it's another approach that can do some stuff that other approaches can't do. Like all good techniques and tools, it can do some pretty amazing things, especially in the hands of the right person and in the right situation. But this isn't what makes it special--it's what makes it ordinary.

I've seen some astounding results from both pharmaceuticals and therapeutic massage, for instance. But they aren't magic and nobody would claim they were. They’re just each different approaches that can do things other appoaches can’t. Hypnotherapy is the same. These different approaches can also sometimes not work, or can even do harm. Like any ethical professional, I do my best to avoid doing harm, but there are no guarantees in any of these fields.

Despite hypnosis seeming otherworldly or "magical," I encourage people to be skeptical, thoughtful consumers of any kind of therapy, including hypnotherapy. If somebody is making incredible claims or seems untrustworthy, then don't take them at their word: do your research and ask more questions, or go find someone else. Avoid undergoing any treatment, including hypnosis, with someone you feel uncomfortable about. At best, it won't work. At worst, it could do more harm than good.

If you’re still reading this, you probably would like to know more about how I do clinical hypnosis. I will cover that in my next entry, “Types of hypnotherapy and my approach.


More about Get Out!

Above, I note that it's unlikely that hypnosis could actually do in real life what it does in the movie. I think hypnosis is a symbol in the movie to evoke authority and white people’s oppression/dominance over black people more broadly. What's represented should really give us more pause than hypnosis, which is just a symbol.

However, as I note above, there is an authoritarian bent to hypnosis that comes from the old school approach, which is what gives the symbolic representation force, and this is the grain of correctness in the incorrect portrayal in the firm. Race adds an interesting complication to hypnosis and the authoritarian model.

If we just look at the portrayal of hypnosis in the movie, essentially the question becomes: could the power of racial authority be strong enough to induce black people to let themselves be destroyed by an authoritative white person? I say it’s really really unlikely. If it were the case, though, hypnosis then would simply be a tool/weapon used in a bigger cultural problem of internalized racism or internalized racial authority. Though I'm an expert in hypnosis, that greater cultural problem is not something I can speak to with expertise. Likewise, my expertise in hypnosis itself is to help people do the opposite with the tool than what was done in the movie.

That said, what I know about real life mind control research is this: the hardest part of controlling anybody is the problem of getting them to do something they really on the whole don't want to do. The attempts I've read about to do this have required torture, obscuring reality with drugs, subverting people's beliefs with propaganda, and other work-arounds simply to get enough of a person in line with the desired action. Much of this is quite ugly (think Reek in Game of Thrones) or (in the “best” cases) very time consuming.

If anybody developed a clean, easy mind control strategy to do what Missy Armitage does in the movie, it would be a momentous (and catastrophic) development, which would be infinitely more profitable in the military world than any surgical technique to replace people's brains. In other words, a more realistic portrayal of this in the movie would have the whole family supporting Dr Missy Armitage (Catherine Keener’s character) as she sells her services to clandestine military operations everywhere to create secret agents that can be activated at the stir of a spoon.

What is hypnotherapy?

Have you wondered about hypnosis but didn't know how to ask about it?

Been afraid or curious about hypnosis but don't really understand it?

Aren't sure if hypnotherapy is for you?

Well, I've decided to do a blog series about my hypnotherapy work. This is the first blog entry, a basic answer to the question:

What is hypnotherapy?

Hypnotherapy is the therapeutic use of hypnosis. Basically, I use hypnosis to help people with psychological problems. Hypnosis itself has been around for hundreds of years, and much longer if you could all the stuff that existed before the name hypnosis came onto the scene.

Basically, as a therapist, I help people enter, exit, and utilize trance states for psychotherapeutic purposes.

A trance state is an altered state of consciousness where you're focused in a particular way, often at the exclusion of other things. This may sound unusual, but it’s something we all do every day:

Maybe you've been watching a show, playing a game, or reading a book at some point, and been so absorbed that you've lost track of time, or things were happening around you and you didn't notice.

Or maybe you've had the experience of driving or walking somewhere and realize you've arrived and have no recollection of the journey because you've been so involved in your thoughts.

Or maybe you've meditated and it felt like you entered a different world in some way--that things were suddenly different... In all these situations (and in hypnosis), your mind is engaged in a way that it isn't in normal life--this is what an altered state means--and it's focused in a particular way.

Though these experiences are all quite different in nature and in purpose, they're all trance states.

In clinical hypnosis, the purpose, just like in psychotherapy in general, is psychological benefit.

What we are able to do with trance states is pretty impressive: people go into "the zone" and they write books, play music, create beautiful works of art, and come up with life changing solutions to problems.

What can happen in hypnosis can be impressive too. I regularly help people learn how to give their unconscious the message that it's time to relax or go into a different mode. And I regularly work with people to let go of past traumatic experiences or fears. I also help people learn how to connect to their unconscious abilities or knowledge in fascinating ways. Sometimes, the results of these ways utilizing trance states come quite quickly--much more quickly than in talk therapy.

You may have the idea that in hypnosis, someone puts ideas in your head, like, “from now on, when you see a cigarette, you’ll feel nauseous.” This is what’s called a direct suggestion. I’ll talk more about this later in my blog series. For now, you should know, this is only a small part of what hypnosis actually is.

On the other hand, if you've seen hypnosis in movies--for instance, the recent movie Get Out!--you may have an impression that hypnosis is something like mind control. This is a misconception.

Likewise, if you've seen stage hypnosis performances--it's also not like that at all. (stage hypnosis is definitely not therapeutic).

I'll cover more about hypnosis myths in this blog series’ next installment: "What hypnotherapy Isn't."