How Hypnotherapy Works

The more I learn about hypnosis in therapy the more I have to abandon all the preconceptions I grew up with. Hypnotherapy is not about manipulating people or directing them to do things they wouldn’t normally do, act without the usual inhibitions of social behavior – as in all the theatrical stunts we’ve seen in stage acts and movies.

As Michael Yapko summarizes: it used to be hypnosis to, now it’s hypnosis with. I haven’t tried hypnotherapy, and I’m no expert in how it works. This post is mostly a summary of ideas I’ve been learning from his new book, Mindfulness and Hypnosis: The Power of Suggestion to Transform Experience.

He emphasizes a key similarity between hypnosis and guided mindfulness meditation. Both the therapist and the meditation teacher gently guide people into an enhanced awareness and acceptance. The difference is that the hypnotherapist works with a client to achieve a specific healing goal.

Mindfulness Has No Goal

As Jon Kabat-Zinn often says, in contrast, mindfulness is not something you do to achieve anything, even relaxation. The purpose is to be fully in the moment in a non-judgmental way.

You could say that there really is a goal but only a general one. It is learning the skill of separating your attention from all your wandering thoughts and feelings and directing it toward the immediacy of full awareness in the here and now.

That may be a goal but it is not aimed at healing a specific condition. You are not developing this heightened awareness of the present for any specific purpose.

A paradox that Yapko describes is that once you become fully aware and accepting of everything you experience, to appreciate who you are unchanged in the moment, the more you can change.

Hypnotherapy Is Goal-Driven

The way I think of it is that guided mindfulness meditation prepares you for healing in specific ways from within.

Hypnotherapy induces a similar state, then goes farther to help a client heal from within in a structured and purposeful way. It also differs from mindfulness by closely responding to each client’s needs and adapting the process to make it effective for that individual.

Without a specific goal in helping an individual change in some way, mindfulness meditation can be taught as a general method to a large group, as Pema Chodron does in her large workshops or Jon Kabat-Zinn in his training groups.

Everyday Trances

I think everyone gets into a trance-like mind space from time to time – and without any guidance from a teacher or therapist. These moments occur spontaneously, without conscious willing on your part.

Your attention suddenly focuses intensely on something you’re doing or thinking or feeling. All distracting sensations, even the ability to hear someone talking to you, disappear.

Those moments of heightened awareness can be soothing or even spiritual. You can fall into that state of mind while walking in a forest or staring at ocean waves or taking in the vastness of a great mountain. It could be triggered while viewing a painting or responding deeply to any form of art.

It could be as harmless and purposeless as daydreaming or as devastating as intense grief for a loved one.

If you’re depressed, you well know the torture of ruminating on failure, mistakes, irretrievable loss you believe you’ve caused. Nothing can shake you out of it.

A trance-like state might take over as you’re doing work you love, work that absorbs you so much that it no longer feels like a job but like part of you. You’re so involved that you’re aware of nothing else.

All these are self-induced, but when you have a specific inner pain or keep behaving in destructive ways you can’t control, you look for help in a guided and structured way.

An Example of Hypnotherapy

Yapko documents the similarities and differences between mindfulness, self-induced trances and hypnosis. One of the most helpful ways he presents this is by analyzing a series of meditation and hypnotherapy sessions. He uses his seven stage model for both types of experience.

Here is a brief overview of his example of a hypnotherapy session.

1. Stage 1: Preparing the Client

   From the first words, Yapko tries to draw the client into the process as an active participant in shaping its outcome. Using a conversational style, he moves from general ideas about life (… No one likes uncertainty, and we keep trying to explain our feelings …) to statements about what the client does. (… feelings you have are closely related to how you explain the things going on around you …).

   In this way, he offers ideas that the client can easily recognize and learn from. Woven into this discussion is the suggestion that the client can help herself change for the better. She won’t be waiting for the therapist to on his own to offer solutions.

2. Stage 2: Orienting the Client

   This is a brief step of introducing the idea of an absorbing experience like hypnosis or guided meditation. The therapist says it doesn’t matter if the client has never done it before. The first thing everybody can do is to let themselves sit comfortably. Indirectly Yapko is saying that he expects to do hypnosis with the client right now.

3. Stage 3: Focusing Attention

   In this stage, Yapko is drawing the client into a relaxed and focused state. He does this in a conversational way, trying to evoke memories of similar experiences, like the everyday trances.

   He emphasizes in his analysis of this stage that the particular method of helping someone into a special type of awareness doesn’t matter. It could be a body scan or a countdown or a less direct conversational method like his. The important thing is that the client feel comfortable with the approach and be willing to engage.

4. Stage 4: Building a Response Set

   The “response set” terminology is opaque to a layman like me, but the purpose in hypnotherapy is to help the client enter the process more deeply and form specific expectations about what therapist and client will be doing together.

   Yapko does this in his conversational style with comments like these: “I don’t know what will help you relax … and you don’t know exactly what I’m going to talk about that will be helpful to you … and you don’t know yet what I might say so that you’ll think better of yourself …”

   He’s saying in this suggestive way that he wants to adapt what he says and does to her needs, that she can help herself make positive changes and that the process will be successful. “… and you don’t really know at just what moment you’ll find yourself so wonderfully comfortable with the possibilities you’ll discover here . . .”

   This is where hypnotherapy most clearly sets itself apart from guided mindfulness meditation. In Jon Kabat-Zinn’s workshops, he’s helping a group relax to prepare for getting into a state of heightened awareness for its own sake. Yapko, on the other hand, is clearly suggesting that the relaxed and focused state will lead to specific changes in the client’s way of thinking about herself and the choices she makes in life.

5. Stage 5: Offering Therapeutic Suggestions

   While the client is in this state of relaxed awareness, the therapist uses a variety of suggestions and examples from everyday life to instill the basic skill of becoming aware of her thoughts, feelings and beliefs. He speaks slowly, with many pauses:

   “And as you start to become aware . . . much more fully aware . . . in moment-to-moment experience . . . you can start to see where the uncertainty is in everyday situations . . . and where the different possibilities are in life. . . .

   He uses an example of an unreturned phone call that can provoke a lot of uncertainty and worry to suggest the central idea of becoming aware that she is worrying – to observe herself feeling this way.

   “But it’s human nature to speculate about what things that happen mean . . . and the real skill is knowing when you’re speculating . . .
   and when you have evidence to affirm your interpretation. . . . After all . . . you want to react to something on an informed basis . . .”

   Building on this ordinary example and the awareness it helps instill, he weaves into his conversational style the idea of the second important skill – that of acceptance and being comfortable with not always having the answers. He then extends the example to much more general statements.

   “and when you really don’t know how to explain something precisely . . . with evidence . . . it’s perfectly alright to say you don’t know. . . .when you realize you really don’t know how things are . . . in some areas of your life . . . and that some questions we can ask . . . will never be answerable . . . allowing a calm acceptance . . . and a mindful awareness . . .”

   I wish I could hear Yapko doing this session. I wonder if his voice has the same calming yet quietly directing manner of Jon Kabat-Zinn’s guiding words. Judging from the words alone – and I’ve only quoted a few lines to give a sense of the delivery – this sounds like a masterful way of bringing someone to a sense of awareness and acceptance in a brief time.

6. Stage 6: Generalization

   Next Yapko continues in his conversational style to suggest other areas of life where this skill of awareness and calm acceptance can be useful. The ultimate suggestion is that the client will be able to use the new skills to make better decisions generally and so build a more positive sense of self.

   “So, in the future, when you face some important situation or event . . . and can mindfully hold the moment of not knowing in your awareness you can notice the quality of your explorations and conclusions getting better and better over time . . . just as your appreciation for your life experience grows ever greater.”

   Leading the client into confident use of these new skills in any situation is the end point that Yapko has been working toward. It’s only an example and doesn’t get to deeper issues that another client might need to work on. It’s a good illustration, though, of how hypnotherapy induces mindful awareness so that the client can make positive changes on her own.

7. Stage 7: Ending the Experiential Session

   He uses a fairly standard way of bringing the session to a close and easing the client back to normal awareness. It’s much like the closing Kabat-Zinn uses to encourage his students to continue the meditation process every day in other life settings. For hypnotherapy, though, the parting thoughts relate to the more specific purposes that have been developed during the hypnotic state.

As I read through Mindfulness and Hypnosis, I could see in bright lights how different hypnotherapy is from the theatrical myth we all know. The therapist is not trying to control the client and dictate future behavior. Instead, he suggests and evokes inner possibilities for change that the client has not used before.

Provided I could find a therapist with extensive training and experience in hypnotherapy, I can see working with this method. I never thought I could “submit” to hypnosis – in the sense of having it done to me. Michael Yapko’s description shows that it can be a helpful process because it’s done with me.

Does it seem like an approach that could be helpful to you?