This site is intended for health professionals only

Understanding hypnotherapy

Tricia Woolfrey
Harley Street

Hypnotherapy has been around for thousands of years –  there is evidence in Sanskrit writings and ancient Egyptian papyrus scrolls of healing trances being used.2

However, it was not until the late 1700s that the technique was popularised. Franz Anton Mesmer, a Viennese doctor, wrote an article about the use of magnets in healing.2,3 He used magnets to heal a variety of conditions such as retention of urine, toothache, earache, depression and temporary blindness, which had previously been considered incurable.3 One day, he was working with someone who was bleeding and couldn't use his magnets, so he picked up a stick and passed it over the patient's cut and the bleeding stopped. This was essentially a nonverbal hypnotic suggestion for the bleeding to stop.

In 1841 the technique was observed by a London surgeon named James Braid who, thinking it to be a trick, volunteered himself as a subject and found it to be genuine. He progressed the technique and found that he could create a similar state by utilising eye fixation (focusing on one point) and used this state for medical and surgical purposes.3 He was responsible for writing the first book on hypnotherapy in 1843 entitled Neurypnology. By the 19th century, hypnosis was widely practised by physicians.1

The Wall Street Journal published an article by Michael Waldholz on 12 October 2003 which discussed the use of hypnosis to help relieve pain and speed recovery in a variety of illnesses, such as to help alleviate excruciating pain for burns patients, to speed up postsurgical recovery time, and to help women give birth without drugs.

What is hypnosis?
Hypnosis is a completely natural state that most people fall into almost every day. For example, when you drive a regular journey you may sometimes arrive at your destination largely unaware of your trip. That is because your conscious mind has been thinking about other things – perhaps the day ahead, or a problem you are facing, or wondering what you are going to have for dinner. In the meantime, you have negotiated flawlessly all the traffic lights, roundabouts and junctions without incident. This is because, while your conscious mind has been otherwise engaged, your subconscious mind has taken over the driving. Your subconscious knows everything, including your journey and how to navigate you safely to your destination.

Hypnosis is an altered state of awareness where you are awake and aware. It is not sleep, nor is it relaxation, and it isn't a third dimension that you are transported to. It can be experienced as a tingling, numbness, heaviness or light sensation, or indeed none of these things. Everybody is different. Some people simply feel as though they have their eyes closed, nothing more and nothing less. It is a completely natural state where you stay in control. Because of this, you have to want it to happen. No-one can be hypnotised without their consent and they certainly cannot be forced to do anything they are not comfortable with. This is because a part of the mind, called the "critical factor", protects the self.

The mind has three areas all of which have a protective function. This is explained in Table 1.

[[Tab 1 hyp]]

You will see that there is the conscious, subconscious and unconscious mind. With hypnosis, all communication is directed at the subconscious mind, although the conscious mind might listen, it might drift off or it might have random thoughts flow in and out. The subconscious mind is the storehouse of the self. It is the part that is more capable of change and more flexible to change. However, sometimes, it needs a little help and that is where hypnotherapy comes in. This is because someone may consciously want to change, such as to stop smoking, or lose weight, or overcome a phobia, but the problem is serving another purpose. For example, smoking may be a way of managing stress, or a crutch in social situations; excessive eating may be a way of suppressing emotions or providing comfort; a phobia may be a way of avoiding social situations or gaining sympathy or attention or even a sense of identity (who would I be without my phobia?).

This, together with the fact that the conscious mind has limited capacity for storage of information, is why many change efforts are unsuccessful. The conscious mind would have to be fully conscious of the need to make change all the time, but as we are only able to process seven to nine pieces of information at once, this is difficult to achieve without the help of the subconscious.

In order to be successful with hypnotherapy, it is important to overcome any secondary gains (the benefits to the problem) to deal with the problem effectively and for the long term.
In hypnosis it is perfectly OK to interrupt proceedings. This has only happened to me once in my entire career as a hypnotherapist and the story is worth sharing as a way of understanding hypnosis more clearly. After a lengthy consultation with a new client, I proceeded with the hypnotherapy, but in the middle the client sat up and asked if she could have a chat, which we duly did. It wasn't about anything in particular and certainly not about the process. After a minute or two, she said she was ready to continue. At the end of the session she reported that she had felt much more relaxed in the second part of the hypnosis. This was because she had proved to herself that she was, indeed, in control, that she wasn't under the spell of someone else and that if she wanted to stop the proceedings, she could. This is a wonderful illustration of how hypnosis is entirely voluntary and cannot be imposed on an unwilling subject. It is as though the client is the driver of the bus, while the therapist is the tour guide, offering suggestions which the driver can choose to follow or not, as they wish.

Most people will feel a sense of calm and relaxation, although these are not required for hypnosis to occur. I am reminded of my own first hypnotic experience when I was but 18 years old. I was quite anxious and self-conscious, although the therapist was very kind. At no time did I feel hypnotised. I remember thinking that I only had my eyes closed because I had been asked to and, being very polite, I duly complied. I heard every word that was said and I know I could have opened my eyes or spoken at any time. I was astonished to find that the hypnosis had worked.

Implications for healthcare professionals
The medical profession are able to use a state called "waking hypnosis" where suggestions are given to patients without creating a formal hypnotic state. It is important to know that whatever is said, whether the patient is conscious or unconscious, can be heard by the subconscious mind and, if there is sufficient trust, for that "suggestion" to be acted upon. It is also important to know that the brain does not process negatives very well. For example, when a nurse says "Nothing to be scared of", not only is the subconscious mind likely to ignore the word "nothing", thus hearing "be scared of", but that acts as a suggestion to the patient to be scared. It is very important to be aware of what is said in the patient's earshot. "Are you safe and comfortable?" will be a suggestion to the patient to be safe and comfortable. Equally, when a patient is informed "You have six months to live", this is a hypnotic suggestion.

There have been reports of late about hypnosis being used in place of anaesthetic in dental procedures (Dr Mike Gow has been widely reported as using hypnosis in his dental practice in Glasgow4). Dr Martin Wall, President of the Royal Society of Medicine's Hypnosis and Psychosomatic medicine division says: "Hypnosis is a powerful technique with a great many benefits for the patient. It's a great way of relieving anxiety and boosting confidence."

According to Dr William S Kroger, in his book Clinical and Experimental Hypnosis,5 "There is no reason why hypnotic conditioning cannot be combined with drugs when the latter are indicated as part of a comprehensive treatment program. For example, hypnotic conditioning can reduce the fears and anxieties which exacerbate attacks in cardiacs to instill optimism and feelings of well being."

He explains the use of hypnosis in the treatment of a number of conditions including psychosomatic cardiovascular disorders, coronary disease, postmyocardial infarction syndrome, peptic ulcers, colitis, emotional diarrhoea, postgastrectomy syndrome, constipation, arthritis and rheumatism, although not osteoarthritis, obesity, anorexia nervosa, hyperthyroidism and Raynaud's disease.

In addition, Vickers and Zollman indicate that there is "strong evidence from randomized trials of the effectiveness of hypnosis and relaxation for cancer related anxiety, pain, nausea and vomiting."6

Furthermore, the National Institute for Health and Clinical Excellence recommends the use of hypnotherapy in management of IBS symptoms.7 My own experience with clients is that anything that is made worse by stress and anxiety can be improved with hypnotherapy.

Types of hypnotherapy
There are three main types of hypnotherapy:

Hypnosis, an altered state of consciousness, allows the subconscious mind to accept suggestions which are helpful to a person's problem by bypassing the critical factor (see Table 1). For example, someone suffering from IBS would have a suggestion that their stomach was calm and relaxed and that their digestion was strong and healthy. This is a generalisation of course, and a good hypnotherapist will tailor suggestions very specifically to the person's problem.

In the right hands, this is an extremely effective technique which works on the root cause of a problem, such as anxiety. The hypnotherapist will take the person back to the initial sensitising event to neutralise its effects and to gain insight and wisdom from the event, which is then applied to subsequent sensitising events. The client becomes stronger and wiser from this experience. It is interesting to note that sometimes the initial sensitising event is quite insignificant but can have a profound effect when experienced by a young child and when compounded with other sensitising events.

Parts mediation therapy11
This technique, also known as ego state therapy, deals with internal conflict, where a "part" wants something that another "part" of the self resists. The therapy is like doing mediation between couples – find a way for them to move forward so that they both have their needs met. A common example is with weight loss. A part of the self may want to lose weight but a part of the self does not.

The most interesting case I personally dealt with in this way was of a woman who seemed to be doing all the right things to lose weight but it wasn't happening for her. In speaking with the part that was resisting I discovered that its purpose was to keep her from being promiscuous. When she was slimmer, she was very promiscuous, entering into meaningless encounters with men, and this part of her wasn't happy about it so piled on the pounds which gave her a "reason" not to do this any more. The promiscuity was for validation of the self, so the therapy was then about helping her to feel more secure inside herself, and to help her build longer term relationships. Then the weight could fall.

Sometimes weight loss can be about being brought up in an environment where it is "bad" to lose something. Usually parents are talking about losing a toy or something important, but the small child generalises this information to losing anything, including weight. Weight loss is one of the most complex conditions to treat since the underlying emotional causes can be so varied.

This method was devised by Milton Erickson and is nondirective and very creative. Erickson would use metaphors in his therapy that would allow the person to absorb the indirect suggestions more easily, bypassing the critical factor. He was a master hypnotherapist and utilised whatever the client gave him.
An example of this was when a young girl had experienced a bad cut and complained of the pain. He told her "It hurts right there," and she agreed. He continued "It hurts right there. It doesn't hurt right here, half an inch to one side. It doesn't hurt here, half an inch to the other side. Just right there." He recognised the girl's pain and got her confidence that he had understood. What he had in effect been doing is narrowing the girl's reality of the pain down to a small, inch-long scratch.

Can everyone be hypnotised?
Apart from an ability to comprehend the hypnotherapist, a high degree of motivation for change is essential for hypnotherapy to be effective. Sending a patient to a hypnotherapist to stop smoking or overcome alcoholism, for example, when they are reluctant to do so will not yield the desired result. Other than motivation, it is essential that the patient be confident with the therapist and that the therapist is professional and experienced, otherwise the critical factor will create a warning signal that would preclude hypnosis.

Finding a good therapist
There are thousands of hypnotherapists in the UK all with varying degrees of ability. In finding a good hypnotherapist, it is important to go to a reputable professional body (see Resources). While most organisations will request evidence of training and appropriate insurance, it is still worthwhile meeting and interviewing potential hypnotherapists to assess their professionalism, confidence to work with your patients and whether they participate in continuous professional development and supervision.

Hypnotherapy is a powerful technique which, in the right hands, can help a wide variety of people, if they want to be helped. It can complement the work of the medical profession though it is important to note that it is difficult for a client on antidepressants to benefit from treatment because of the effect on their emotional responses.

1. BMA. Medical use of hypnotism: Report of a subcommittee appointed by the Psychological Medicine Group Committee of the BMA. BMJ 23 April 1955;Suppl:190-3
2. James T, Flores L, Schober J. Hypnosis – a comprehensive guide. Carmethen, Wales: Crown House Publishing; 2000.
3. Waxman D. Hartland's medical and dental hypnosis. Oxford: Baillière Tindall; 1989.
4. Available in Daily Mail 27 June 2008.
5. Kroger WS. Clinical and experimental hypnosis. New York: JB Lippincott; 1977.
6. Vickers A, Zollman C. ABC of complementary medicine. Hypnosis and relaxation therapies. BMJ 2000;319: 1346-9.
7. NICE. Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. NICE Clinical Guideline 61 (4.2). London: NICE; 2008
8. British Psychological Society. The nature of hypnosis. London: BPS; 2001.
9. Davison GC, Neale JM. Abnormal psychology. 8th ed. New York: John Wiey and Sons; 2001.
10. Banyan CD, Klein GF. Hypnosis and hypnotherapy. California: Abbott Publishing House; 2001.
11. Emmerson G. Ego state therapy. Carmethen: Crown House Publishing Ltd; 2003.
12. Rossi EL, Ryan MO, Sharp FA. The Seminars: workshops and lectures of Milton H Erickson. London: Free Association Books; 1998.

Clinical evidence
Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome

Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia

Long-term improvement in functional dyspepsia using hypnotherapy

Hypnotherapy as a treatment for atopic dermatitis in adults and children

Hypnotherapy for warts

Hypnotherapy as a treatment for enuresis

British Institute of Hypnotherapy

General Hypnotherapy Register
W: www.general-hypno

Association for Professional Hypnosis and Psychotherapy

Further reading
O'Hanlon WH, Martin M. Solution oriented hypnosis. New York: WW Norton; 1992.

Bromberg W. Man above humanity. New York: JB Lippincott; 1954.

Cutten GB. Three thousand years of mental healing. Scribner; 1911.

Rosen G. History of medical hypnosis. In: Thomas CC, edtior. Hypnosis in modern medicine. Springfield; 1959.

Wolberg L. Medical hypnosis. New York: Grune and Stratton; 1951.