Improving hypnotherapy Outcomes
Hypnotherapy is one of the talking therapies. It is interesting to consider how it is similar and how it is different from other talking therapies. Examining the structure of other talk therapies might give insights into improving hypnotherapy outcomes.
Some of the most used talking therapies and what they do, include:
cognitive behavioral therapies: change how you think about the world, stop using dysfunctional schemas
interpersonal psychotherapy and some dynamic therapies: improve into personal relationship skills
self compassion therapies, acceptance and commitment therapy: be more accepting of yourself
emotion focused and dynamic therapies: be able to express difficult emotions
mentalization therapies: accepting the perspective of others.
All of these therapies have a number of factors in common. First is the relationship between the therapist and the client. Second is building an expectation in the client that they will be helped. Third is the actual form of therapy.
Many decades of research suggest that the relationships and expectations are much more important than the actual therapy itself.
The therapeutic relationship
The relationship between the client and therapist actually begins before they get to know each other. Research suggests that a level of trust of some sort is worked out in the few microseconds before either person says anything. This level of trust is influenced by how the therapist is dressed, the layout and furnishing of the office, and interpretation of the therapist's facial expression. It may also be influenced by recommendations from others and beliefs about that type of therapy in general. The relationship is also strongly influenced by whether the client wants to be there, or has been forced to go there.
The psychodynamic relationship
This is basically about how the client and therapist perceive each other. This relationship is different from normal social relationships because there is an implied confidentiality, and it focuses entirely on the emotional problems of the client. Whatever the client says, the therapist has to accept it uncritically.
Expectations and goals
Expectations have a strong role in outcomes. This is basically the placebo effect at work. If you believe something will work, then it very often does. People who believe a bottle of wine is expensive, will reliably report that it tastes better.
If the therapist sets out to create positive expectations in the client, this can be enough to lift the client out of the cycle of hopelessness. They may have tried and failed many times. If someone tells them, with evidence, that they can get better, this will have an immediate effect.
Similarly, giving people a reason for their distress or illness, may reverse faulty thinking. Many clients come to therapy with 'folk' explanations for why they feel the way they do. Replacing these with scientific or pseudo-scientific explanations changes their mindset.
Giving the client a goal, and a way to reach that goal, gives them a way out of their problem. It focuses on the problem, and not on their personal failures.
Specific therapies
Every type of therapy is based on some sort of theory, and some sort of protocol for creating change. However, in most talking therapies, there is no clear scientific explanation for how they work. Each therapy has a theory that they insist is right, and every other theory is wrong. Each therapeutic model insists that there must be certain elements present before change can happen.
However, more than a century of research suggests that the effect of the specified elements of the therapy is actually very small. In other words, it really doesn't matter what therapy you use. They are all about equally effective.
Why does the therapy not matter?
This rather unexpected result can be explained by any number of things.
In some therapies, the client and therapist will meet for hundreds of sessions. It has been suggested that much of the benefit of therapy is actually because it is in the nature of a professional friendship. The client feels validated, accepted, understood, and avoids loneliness. This in itself can be very therapeutic.
Many clients come to therapy because they are living in unbearable situations. It is the situation that is causing the problem. Most therapies do not deal with clients' lifestyle at all. So giving them a goal and a way to reach it may be enough to help them change the external causes of their problems.
Therapeutic alliance
Research finds that the most important element in therapy is what is called the Therapeutic Alliance. This consist of the therapist-client bond, the goals of the therapy, and agreement about the tasks of the therapy. It includes elements of empathy, positive regard and collaboration.
Laboratory experiments have shown the personal relationship between the caregiver on their client has a major effect on the success of the treatment. Just having a warm and friendly manner goes a very long way. Personal relationships also involve recognizing and valuing your client's cultural background.
Expectations also play a major role. No matter what type of therapy is offered, giving your client a solid expectation of success affects that success.
Research also shows that the warmth and friendliness of the therapist is much more important than how good the therapist is at delivering the therapy. This reinforces the findings that the therapy itself is not all that important.
Improving hypnotherapy outcomes
You might think doing hypnosis has little in common with say psychoanalysis, or CBT. But in fact, the same elements are there. There are lessons to be learned from this research.
You, as a hypnotherapist, can work on each of the three elements. Start by building trust. You can improve your website, or your sales literature, to include testimonials and other proof of how good you are. Make sure that your office gives the impression of professionalism and competence. You can make sure that you dress appropriately. You can decorate your office with your awards and qualifications. All of these will go a long way to convincing your client that you are reliable and competent, before even opening your mouth.
You can spend time building rapport with your client, before starting the therapy. Showing an interest in the client's lifestyle, situation, relationships will all help to build a deeper level of trust.
You can spend time explaining how and why you work the way you do. Make sure that the client has no unanswered questions or reluctance. Fill your client with confidence in you, that you care about them personally. Don't treat all smokers the same, or give all phobias exactly the same treatment.
Make sure that you spend time telling the client exactly what to expect from you, and during the hypnosis, and what they will feel after the hypnosis.
Very importantly, don't just tell them at the end it's all finished and they don't have to do anything. Give them some sort of homework to do. Even if it's a placebo, it will constantly remind them that they have changed and focus them on making that change permanent.
Improving hypnotherapy outcomes is not about better hypnosis
Most hypnotists spend a lot of time and effort on trying to improve their hypnosis. They try to become better hypnotherapists, to become better at delivering the therapy.
Perhaps some of that time would be better spent developing skills in managing the therapist-client relationship?
Source: Bruce Wampold. (2015) How important are the common factors in psychotherapy? An update. Psychiatric World. https://doi.org/10.1002/wps.20238
The easiest way to do this is to test for eye catalepsy after the induction. This lets both you and the client know that the client really is in trance. I have trained myself to always do this. When I started out as a hypnotist I was often afraid to do this test, just in case the client wasn't in trance. I have since learned that if the client opens their eyes then you both have learned something valuable. The other simple convincer is to do a finger lift at some point in the session.
