One of the ironies that I encounter in our field of hypnotherapy and related fields, is that as we attempt to achieve more credibility, there is a need for more academic natured discussion of the field. With that, comes a lot of jargon and terminology that students new to the field of hypnosis and hypnotherapy find confusing.
They then end up feeling drowned by terminology rather than understanding some of the key concepts that are offered up.
My aim here then, is to offer up some of the main and major theories of clinical hypnosis and hypnotherapy in a manner that students and those simply curious of this field can understand if they do not have a hardcore academic background.
There is no doubt that differing schools of thought about hypnosis make radically different assumptions, adopt different methodologies, and accept different data as evidence of hypnosis being effective.I am not claiming that this is definitve or exhaustive, but attempting to make it easy to understand.
If you read this blog regularly, you may or may not be aware of a central debate to the field of hypnosis: State versus nonstate. You can read about it here on this blog. I am starting off describing theories of clinical hypnosis that tend to consider hypnosis a special state and then ending up with the more nonstate theories. That said, there is plenty of crossover here and there as well as strict disagreement.
The Theory of Psychoanalytic Schools:
Psychoanalytic schools of clinical hypnosis refer a great deal to ‘primary process thinking.’ By this, they mean the unconscious thinking of the Id and characteristic of unconscious mental activity, which uses symbols and metaphor, is focused on immediate gratification of instinctual demands and drives, disregards logic, and often manifests itself in dreaming.
Hmmm… What does all that mean? Well, it is really suggesting that there is a large part of us beneath or conscious awareness.
According to Freud, we are all born with an Id. According to psychoanlaytic theory, this is an important part of our personality because as newly born babies, the Id ensures that our basic needs met.
So when the baby (or toddler) is hungry, the id wants food, and therefore the baby cries… And when the child needs its nappy disposing of, the id cries to indicate that something unpleasant is lurking in the depths of its nappy. When the child is uncomfortable, in pain, too hot, too cold, or just wants attention, the id speaks up until those needs are met.
The id doesn’t consider reality, or the needs of anyone else, it is only concerned with satisfying itself. This theory accounts for why babies are so inconsiderate of the parents needs I guess… According to this notion, when the id wants something, nothing else is important.
This notion of the Id slots into what is known in psychoanalytic theory as a Topographical Model.
Freud believed that the majority of what we experience in our lives, the underlying emotions, beliefs, feelings, and impulses are not available to us at a conscious level. He believed that most of what drives us is buried in our unconscious. While buried there, however, they continue to impact us dramatically (according to Freud and this theory).
The topographical model then also comprises of the conscious and subconscious. This is the part of us that we can access if prompted, but is not in our active conscious. Its right below the surface, but still buried somewhat unless we search for it. Information such as our telephone number, some childhood memories, or the name of your best childhood friend is stored in the subconscious.
Because the unconscious is so large, and because we are only aware of the very small conscious at any given time, this theory has been likened to an iceberg, where the vast majority is buried beneath the water’s surface. The water, by the way, would represent everything that we are not aware of, have not experienced, and that has not been integrated into our personalities, referred to as the nonconscious.
Psychoanalytic schools of hypnosis tend to believe that hypnosis increases primary process thinking. That hypnosios is a way of better communicating with these levels of our mind.
Studies that document the role of unconscious influences on hypnotic responses often refer to the experience of ‘nonvolition’ during hypnosis; that is, behaviours not under a person’s control as oppossed to volitional behaviour (that under a person’s control). Basically, they believe that as a result of hypnosis being induced, the person has less conscious control over their behaviour.
Next up, we have Neodissociation Theories of Hypnosis.
The Neodissociation Theory is a theory of hypnosis that was developed by Ernest Hilgard. Hilgard asserted that, during hypnosis, the conscious mind dissociates from what happens during hypnosis. Hilgard also introduced the concept of a “hidden observer” in hypnosis, meaning that part of the mind is aware of what is happening during hypnosis even if the hypnotised individual is not consciously aware of this.
Again, with this theory, there tends to be a belief in us having levels of mind. What got people interested in Hilgards dissociative models that he wrote about in the 70s, 80s and 90s was that he suggested we have multiple cognitive systems or cognitive structures that exist in hierarchical arrangement under some measure of control by an executive ego.
This theory states that this ‘executive ego’ (or central control structure of some kind, our conscious control) is responsible for planning and monitoring functions of the personality. It is then thought that during hypnosis, certain aspects of control are temporarily dissociated from this conscious executive control and are instead directly activated by the hypnotist’s suggestions. In a nutshell, in hypnosis, the conscious control is taken over by the hypnotist.
This lessened level of conscious control, in turn, is the considered responsible for the subjective elements of nonvolition that often occur in hypnosis.
When presenting his neodissociative theories, Hilgard also introduced a metaphor of the ‘hidden observer’ to describe the phenomenon by which a person registers and stores information in memory, without being aware that the information had been processed.
This is incredibly popular still today… Whereby a hypnotherapist keeps suggesting that even though the conscious mind is unaware of what is going on during the hypnosis (i.e. they are totally zonked out!) the hypnotised individuals unconscious/deeper levels of mind are absorbing all the hypnotists suggestions and will then act upon them unconsciously (or at deeper levels of cognitive functioning).
Hilgard and his associates’ completed much research and published several hidden observer studies which have proven to be rather controversial. I could write a book on this subject alone and despite having a very particular opinion on this kind of theory, I want to explain them here today and not much more…
I will add though, the hidden observer does tend to be implicitly or explicitly suggested by the hypnotist. They refer to the unconscious mind, or the hidden observer of some kind, however subtly. It therefore can be thought of as no different from any other suggested hypnotic phenomenon that is guided by the participants’ expectancies and situational demand characteristics.
Regardless, the neodissociation perspective continues to be one of the dominant contemporary hypnosis perspectives and has inspired a great deal of research and provides a rationale for much clinical work.
I tend to recommend that hypnotherapy clients are informed that the hidden observer phenomenon is the result of suggestion, rather than something that actually exists, I explain that it is best used as a metaphor or imaginative creation that can be used to access valuable personal resources.
Now we start to look at the nonstate perspectives and we’ll start with the sociocognitive theory of clinical hypnosis.
This perspective rejects dissociation as a viable explanation and it challenges many widely held beliefs about hypnosis.
Sociocognitive hypnosis theorists contend that hypnotic behaviour is social behaviour that can be explained without any reference to ‘special processes’ or other mechanisms that are unique to hypnosis.
Instead, sociocognitive theories consider expectancies, attitudes, imaginings, and beliefs about hypnosis along with their interpretations of suggestions of those that are being hypnotised. These things are crucial to understanding hypnotic responses according to this theory. There are a number of contributors to this theory.
Theodore Sarbin’s Theory
The sociocognitive perspective can be traced to attacks on the concept of hypnosis as an altered state of consciousness. back in the 1950s, Theodore Sarbin challenged the traditional concept of hypnosis as a state.
Sarbin developed a role theory of hypnosis that relied heavily on the metaphor of role to capture parallels between the hypnotic interaction and a miniature drama in which both the hypnotist and the subject enact reciprocal roles to follow an unvoiced script
Latter theories with his colleague Coe suggested that hypnotic responsiveness was a result of the participants’ knowledge of what is required in the hypnotic situation; self- and role-related perceptions, expectations, and imaginative skills; and situational demand characteristics that guide the way the role is enacted.
Sarbin and Coe believed that the hypnotherapist can harness the patient’s imaginative abilities to achieve therapeutic ends. This is done by inducing the patient into the role of a hypnotic subject by way of education and dispelling misconceptions about hypnosis. This theory also expresses the need to ensure that the patient’s internal dialogue remained consistent with the requirements of the hypnotic role and treatment goals and consistently monitoring the patient’s role-related behaviors, experiences, and expectancies throughout the hypnotic proceedings.
Theodore X. Barber’s Model
Another Theodore, this one with a family name of Barber was influenced by Sarbin’s theorising and criticised the state concept because of its logical circularity (i.e., hypnotic responsiveness can both indicate the existence of a hypnotic state and be explained by it).
In an extensive series of studies in the 1960s, he showed that many of the things considered to be ‘hypnotic phenomena’ could be achieved equally well without hypnosis and that most people responded just as favourably to suggestions without hypnosis. Barber and his colleagues showed that attitudes, expectations, and motivations are more influential when determining hypnotic responsiveness.
In the 80s, Barber argued that hypnosis improves therapeutic outcomes by firstly, generating good levels of motivation and expectancies that serve as self-fulfilling prophecies within the therapy. Secondly, therapeutic outcomes are improved by a patient believing that therapists who use hypnosis are more highly trained, skilled, and knowledgeable (if only he knew – excuse the cheap shot!). Thirdly, he argued that therapeutic outcomes were enhanced with hypnosis because the therapist gets the chance to communicate with the patient in a very personal and meaningful way that is ordinarily not possible in a two-way conversation.
Next we have the Spanos Model
Spanos and his colleagues’ research programme focused on the importance of social psychological processes. So that includes expectancies, attributions, and interpretations of hypnotic communications. His work also focused greatly on the importance of goal-directed activities and strategic responding to suggestions.
In the 1970s Spanos hypothesised that participants experience their response to suggestions as involuntary when they become absorbed in a pattern of imaginings that he termed goal-directed fantasy (GDF). So basically, this notion suggests that when someone gets totally absorbed in imagining something, they start to believe it is happening involuntarily.
Response Expectancy Theory by Irving Kirsch
Pretty much every school of hypnotherapy though acknowledge the importance of creating a healthy level of expectancy as a way of enhancing gains made in therapy.
In the 1990s Kirsch maintained that like placebos, hypnosis produces therapeutic effects by changing the patient’s expectancies. But unlike placebos, hypnosis does not require deception to be effective. He referred to hypnosis as the non-deceptive mega-placebo. I love that.
Kirsch’s research has shown that a wide variety of hypnotic responses are related to people’s beliefs and expectancies about their occurrence.
The Notion Of Compliance
There are some schools of thought that suggest sociocognitive theories reduce responding to hypnotic suggestion to mere compliance with suggestions.
Although there is some evidence to suggest intentional compliance to please a hypnotherapist may play some role in hypnotic responding, most hypnotised people are neither faking nor merely complying with suggestions. Research has shown that unlike people who have been asked to pretend to be hypnotised (i.e., simulate being in hypnosis), highly responsive research participants remain responsive to suggestion when they think they are alone.
There are several other theories of clinical hypnosis, notably the modern theory of Kirsch and his response set developments, as well as the 1950s theory by Orne with his simulator control methods as well as phenomenological theories of Sheehans contextual model and McConkeys model… However, I think I have the classical and major theories explained in relatively simple terms here.
When examining the major theories, I tend to gather some important elements that I believe can aid us hypnotherapists in significantly enhancing hypnotic suggestibility and all hypnotherapists ought to be considering taking some of the fundamental notions from these theories to enhance their work. I am yet to encounter a hypnotherapist who does not value flexibility and understands the importance of developing good levels of rapport with the client.
All theories note the importance of being thorough in the individual assessment of the client and getting a deep understanding of their motives, expectancies, wishes and thoughts.
Creating the correct levels of expectation through educating the client. This should include dispelling myths and misconceptions about hypnosis and creating positive (yet remaining honest and realistic) expectancies about the hypnotherapy.
Allowing the client to interpret things their own way and not dogmatically prescribing that every single thing needs to be done according to the hypnotherapists wishes… And of course, keeping the client suitably motivated throughout.
Finally, ensure that the suggestions employed are tailored to the clients requirements which reduces resistance and increases their own sense of control during the hypnosis process.
For more in depth explanations and discussion of these theories of clinical hypnosis, read either chapter 4 of Hartlands Medical and Dental Hypnosis by Heap and Aravind, or chapter 2 of Essentials of Clinical Hypnosis by Kirsch and Lynn. Both offer up much more depth than I could ever do justice to here.
Tomorrows blog is going to be more lightweight…