Can hypnotherapy make a patient unstable

Possibilities and Limits of Hypnosis. Forms, areas of application and methods

Author: Nikolai Zantke

The hypnosis

application areas

Hypnosis has always had an important place in medicine. Even today, the medical / therapeutic area is still one of the most important. This is discussed in more detail below and the broad range of indications is presented. Hypnosis is used in an almost endless list in medicine / dentistry: e.g. in the treatment of pain, hiccups, intestinal diseases, allergies, warts, diabetes ... But also the anesthesia and rehabilitation after e.g. paralysis often takes place under hypnosis. There are even treatments for cancer and AIDS.

This important area of ​​application is to be taken into account in a special chapter1 In the field of clinical psychology, hypnosis can be used both with the indication of symptom control, but also in the context of revealing dynamic-analytical procedures. The graphomotor information therapy according to Lazarus and Ambramovitz from 1962 should be mentioned here: The therapist has the patient make drawings of the problem to be worked on before and during the hypnosis. Then the drawings are compared (possibly together with the patient) and the differences are interpreted.

When it comes to symptom control, the focus is primarily on the therapy of painful conditions. Various techniques can provide the patient with some relief. A light trance is sufficient for this. Similar methods are increasingly used in medical psychology (e.g. in dentistry or obstetrics), but also in psychiatry (depression, hysteria, sleep disorders, schizophrenic disorders, impotence ...) and in psychotherapy (for problematic memory difficulties, Decision-making problems, confrontations ...) Hypnosis is also used in the therapy of neurotic and psychosomatic diseases. However, the classic suggestive method is used here more in current crisis interventions in order to favorably influence symptoms, e.g. in the case of an acute psychogenic asthma attack.

As part of a supportive therapy, hypnosis should contribute to inner relaxation, alleviate symptoms and support the general stabilization of the state of health. In behavior therapy, hypnotic suggestion is used as a supportive procedure (e.g. for smoking cessation).

In the context of revealing procedures, hypnosis is used to gain access to the unconscious and to repressed memories. Hypnoanalysis is the combination of a hypnoid state and an analytical-therapeutic approach. The acceleration of the process is an advantage here, because resistance can be more easily reduced in trance and a systematic desensitization can take place. For example, in the case of compulsive eating, post-hypnotic orders and aversion therapies are used.2

Contributions to the literature on the use of hypnosis in sports are extremely rare. Probably every trainer is careful to keep his form of training method and technique a secret. The first official publications come from the 1960 Olympic Games in Rome (Naruse, 1974).

Some examples of documented applications are given below:

Fear of competition can be combated, for example, by relaxing, creating a distance to disruptive stimuli, mentally reliving competition situations. The training and development of different physical and mental competition skills is increasingly taking place under hypnosis. This is done, for example, by carrying out a conscious analysis of the most efficient movement sequences. But also the ability to reduce pain (during the competition or after injury) and the possibility of mentally fading out the spectators can be trained under hypnosis as well as strengthened in the competition in light stages of hypnosis. Some studies confirm that motor skills can be optimized, for example through hypnotic concentration, other studies either do not confirm this or confirm the opposite. The establishment and maintenance of optimal competitive fitness in hypnosis-assisted training is also rated positively by some studies and not by others. Hypnosis has also often come under fire in the field of sport, as some athletes have used up ALL performance reserves under (self-) hypnosis. Not all accidents due to exhaustion or even deaths are due to doping.

Laypeople and scientists have always dealt with the question of the extent to which hypnosis can be used to commit criminal acts.

There are documented and certified cases of criminal acts under hypnosis in which either the victim was hypnotized (e.g. in the case of sexual harassment / rape) or the perpetrator. There were some high-profile hypnotic murders in the 1970s. However, many well-known specialists advise being very skeptical about such reports. A person cannot do things under hypnosis that are repugnant to him. Either the statement to have committed something under hypnosis is therefore an excuse or the perpetrators and the victims are partially responsible. Regarding hypnosis in the forensic area (ie serving in the decision-making of legal cases, serving the clarification of legal cases) it must be said: Hypnosis does not increase memory! Hypnosis makes sense here because the respondents are more relaxed and feel more stable, as the survey is carried out very carefully and carefully. The respondents often see the crime from a different perspective. Witnesses / victims with trauma amnesia can still testify. In the clinical area of ​​forensics, the sanity can be assessed, or a psychotherapeutic care of crime victims can be provided. However, a questioning under hypnosis is hardly more meaningful in court, as it may be possible that hypnosis can be faked.

One of the best-known areas of hypnosis is probably show and stage hypnosis. Actually, this is not really hypnosis at all: The show hypnotist looks for a test person and quickly determines readiness. If the person is unsuitable, he can have them sit down in the background ("sleep now"). The people are mostly unsettled and obey or simulate. The test subjects are not hypnotized in the clinical sense (no relaxation parameters can be proven) - they just WANT with the Star of the stage cooperate. In addition, they do not see the full course of the show because of their closed eyes. They think, for example, that the applause is for them. This in turn leads to a further increase in readiness. After the show, the circumstance applies, hypnotized Show hypnosis is more suitable than any other area for cheating. It is not uncommon for hypnosis to be carried out by initiated, paid "volunteers". Likewise, the show is based only on an (optical) trick. A few examples: lay unprotected on a nail board (with a nail spacing of 1.5 cm and a weight of 200 kg, there is only a pressure of 100 g per nail!) Or walk barefoot over glowing coals (the soles of the feet hold temperatures of 50 ° C to 200 ° C for a short time out!).

The legislation here is very sketchy. In some countries, show hypnosis is forbidden, but "hypnosis" by laypeople is not!

Animal hypnosis is by no means real hypnosis. Usually there is immobilization (after suddenly turning on the back) or pressure stimulation in certain places (eg the "turning" of a cobra into a stick - works by applying slight pressure to the neck area).

Self-hypnosis (autohypnosis) is in contrast to third-party hypnosis (heterohypnosis). It emerged when authoritarian hypnosis declined after the Second World War and the patient was more and more involved in the hypnosis process, so that he sometimes performed self-hypnosis. Usually self-hypnosis is only used by patients with previous experience and can be planned and supervised by the therapist or carried out using cassette instructions. Examples we all know are autogenic training, meditation and the "flow experience".

The problem is often that there are no evaluation criteria, feedback and reinforcement by second.

Forms & Methods

As diverse as the possible uses of hypnosis may be, a simple division into three forms / characteristics has proven to be the most common:

1. Experimental hypnosis

It is characteristic that the "patients" are usually not emotionally unstable - they are usually students. The relationship with the "therapist" is very short and emotional reactions are seldom achieved and / or broken down. The course of a hypnosis session is usually short, structured and standardized.

2. applied hypnosis

This form is in stark contrast to research. The hypnoses are always individually tailored to the patient. They require a long preparation and have a (mostly therapeutic or clinical) goal. see item "Model hour of a hypnosis session"

3. Stage and show hypnosis


Hypnotist / subject ratio

In the following, some criteria are listed that determine and influence the relationship between the therapist and the patient:

Dangers for the therapist are the feeling of omnipotence over the psyche, but should not see the patient as a partner as a reacting object. It has also happened quite often that the therapist himself falls into a trance or he takes up the instructions himself (e.g. that the beer no longer tastes so good to him either).

The basic rules for him are: calm and objective-friendly demeanor, confident demeanor, no negative formulations, positively influencing the patient's expectations, creating transparency, providing the required factual information, providing clarification; always control and stop all phenomena.

The patient's situation is determined by many criteria:

Fears, blockages (caused by lack of information, prejudices, fear of loss of control, rejection of the therapist, fear of confrontation with a certain topic ...), expectations, passivity (i.e. he expects manipulation to be effective quickly without much personal effort. The patient should, however, actively deal with The therapist should friend of the patient. This may lead to a certain addiction; the patient may be afraid of healing because he will then be his friend can't see again. At the start of therapy, the relationship between therapist and patient must be downright amicable. The patient must not be unsettled (e.g. because of the information the therapist requests). It must be clear to the patient:

Nobody can be hypnotized against their will or against their knowledge! The more sympathetic the hypnotist is experienced, the greater his influence on the hypnotized person will be.

Model of a hypnosis session

Although there are several approaches in the therapeutic / clinical application of hypnosis, a basic scheme can be created that is based on the common features of different sessions. The following example is taken from the textbook Hypnosis by Kossak (´93; Psychologie Verlags Union Weinheim; 2nd edition). First of all, a structured overview is offered, which is then discussed in detail later.

1. Educational talks / breaking down prejudices (preliminary exercises and tests)
2. Indication (selection of the suitable hypnosis method) Therapist determines via which sensory channels the patient is particularly responsive
3rd intervention phase (practical-specific clinical implementation)
4. Completion of therapy (return)
5. Debriefing

At the beginning of the therapy, the therapist must prepare a concrete plan for the basic therapy. In therapy discussions, he has to formulate the objective. Important aspects in the preparation phase are the clarification of the therapeutically relevant ones hypnotic suggestibility (ie the ability of a person to accept certain instructions given to them and to react appropriately), the assessment of the expected depth of hypnosis (depends on the duration of the induction, expectations, motivation ...) and the examination of the patient's ability to imagine. In the latter case, a reduction in the ability to remember, e.g. through repression or flattened experience (e.g. depressive influences prevent plastic memory). The ability to verbalize must also be determined so that the therapist can adapt to the patient's level of treatment. And the therapist should cover the spectrum in advance irrelevant imagination (Every person stores, codes and calls up experiences in different ways, it should be queried via different perception channels (via smell, hearing ...).

Hypnosis and suggestibility scales:

Here, too, only examples are given. There are:

1. Hypnosis scales for adults
2. Suggestibility scales (willingness to react to suggestions)
3. Clinical application scales (patient behaviors relevant to therapy)
4. Hypnosis scales for children
5. Subjective scales (self-reports)

The question arises as to how hypnotic suggestibility can be determined and, if possible, even quantitatively measured precisely. Hypnosis is particularly difficult to grasp here, since it is important to operationalize what is relevant from the patient's numerous experiences. Basically, it is about a meaningful test construction that must meet all quality criteria, and at the same time it must be selective, increasing in difficulty and clearly identifiable or evaluable.3

SHSS test items: C 4

1. Raises of hands 7. Age regression
2. Bring hands apart. 8. Arm immobility
3. Mosquito hallucination 9. Insensitivity to smell
4. Taste hallucination 10. Hallucinated voice
5. Arm stiffness 11. Negative visual hallucination
6. Dream 12. Post-hypnotic amnesia

The indication (initiation of hypnosis) is usually verbal, ie the patient is introduced to the hypnosis in a story. During the therapy discussion, an introductory story is passed without any transition, unnoticed by the patient. It leads to a calm scene in which the patient now relaxes completely. The therapy intensifies through this individual rest phase (agreed before the therapy).

Example of a quiet scene:5

“You are here on the beach on the Costa del Sol in Spain; this is your beach with the wonderfully wide curved bay in front of you and the wide sandy beach. It's so bright that it almost blinds in the sun. You lie on your bath towel and enjoy the time you have. The sun shines warm on your skin, you can clearly feel the warmth of the skin

The rays of the sun on your face, how they slightly tense the skin there. You will also notice this warmth on your shoulders very clearly. .. "

The intervention phase now follows; the actual therapy: the therapist recognizes the state of hypnosis and the depth of hypnosis from various signals (physiological reactions, voice messages, willingness to carry out tasks ...). There are many different depth scales:

- behavior-based scales (certain hypnosis tasks)
- undefined depth scales (one-dimensional scales from "not hypnotized at all" to "hypnotized as deeply as you think it is at all possible" - no comparability)
- Self-estimated hypnosis reactions (problem: Patients orientate themselves very differently when assessing depth)
- Diagnostic assessment of behavior and experience (on the part of the therapist)

Classification of hypnosis according to the North Carolina Scale6

0 = awake

1-10 = relaxed, ideomotor movement

20 = analgesia

25 = dreams

30 = amnesia, very high suggestibility

40 = all effects are experienced as real. 50+ = mental indolence

The therapy consists of verbal reports, role plays, conversations or acting out the problem - depending on the indication, the ability of the therapist and the patient. This part should also go unnoticed by the patient, as if by chance in that the therapist makes incidental comments on the topic to be worked on. The end of therapy includes regression. The resolution usually works in the classic way (was counted at the beginning so it is counted now). ALL intended effects / phenomena must be traced back!

The debriefing is part of rounding off and consolidating the therapy. The therapeutic event is discussed and further processed. Additional diagnostic conclusions are drawn alongside the therapy. Here too: as little suggestive as possible, but rather incidental questioning. Further therapies or therapeutic homework (diary entries ...) may follow. In this way, the treatment can be intensified.

Dangers / criticism / limits / fears

Side effects after hypnosis treatment are not uncommon: Weitzenhofer documented in 1959: “Patients complained of after-effects (sometimes lasting for hours) such as drowsiness and headaches (7.7%) and other side effects (not described in detail, author's note) (35%), long-lasting impairments (15%), gaps in memory, latent pathology (isolated) ". In exceptional cases, epileptic seizures even occurred during hypnosis.

It can also reveal latent tendencies (homosexuality) or intensify phobias. In a study by Coe and Ryken in 19837 with several control groups (verbal learning group (test subjects learn words from a learning drum), class group (test subjects describe experiences from their class), exam group (test subjects should remember experiences from the last exam), college group (test subjects should remember events from college life) ) the hypnotized had far less unpleasant experiences (most of the exam group). Hypnosis is widely regarded as "low-risk". Now one must ask oneself whether "low-risk" adequately meets the safety requirements. Hypnosis is at least not without its problems! Such "side effects" can be countered with more detailed preliminary investigations regarding suggestibility ... or better selection of the test subjects and hypnotists. Above all, however, the training of the hypnotist must be sufficient. There is no training standard, but well-known hypnotists appeal for a voluntary one Basic training, which includes a basic knowledge of clinical psychology. The wide range of training courses must be viewed critically and carefully selected from these. Above all, no ability to perform miracles should be expected. The training by the DGH is a guaranteed serious training over several years, to which only psychologists, doctors and dentists will be admitted.

The danger often lies not in the hypnosis but in the users. Important: A patient is not at the mercy of the therapist without will!


[1] see chap. . . "Model hour of a hypnosis session"

[2] See Revenstorf, D. (Ed.): Klinische Hypnose. Heidelberg: Springer, 1990. and Heigl-Evers, Heigl, Ott: textbook of psychotherapy. Stuttgart; Jena: G. Fischer, 1993,

[3] see Lienert, 1967

[4] Stanford Hypnotic Susceptability Scale, Form C; Weitzenhofer & Hilgard, 1962

[5] From: Kossak, H.-C .: Textbook Hypnosis, p. 78

[6]Classification of hypnosis according to the North Carolina Scale; Tart, 1963, 1979

[7] Kossak, H.-C .: Textbook Hypnosis, p. 382