We can classify the different approaches to hypnotherapy using roughly three big categories: Cognitive-behavioural hypnotherapies, Ericksonian hypnotherapies and Psychodynamic hypnotherapies. In this brief discussion, I will describe the main characteristics of these approaches and the most prominent differences between them.
Cognitive-behavioural hypnotherapy (CBH) uses hypnosis partly as a facilitator, a therapeutically ideal context when applying CBT interventions. CBH also uses the psychotherapy/psychopathology model of CBT, but applies classical clinical hypnosis interventions as well. Behavioural interventions are based on the principles of conditioning. Teaching relaxation skills, linking relaxation with previously feared situations in hypnosis and in real life, acting deliberately in new ways are considered behavioural techniques. While behavioural approaches deal with emotions, subjective states influencing them (sort of) directly, cognitive strategies aim to reduce symptoms through changing how people see things, their attitudes, appraisals, negative self-suggestions, maladaptive beliefs. CBH applies a combination of cognitive and behavioural strategies using hypnosis to speed up the process and strengthen the changes.
Whereas cognitive and behavioural approaches emphasise conscious processes and effort in learning new responses, skills, Ericksonian and psychodynamic approaches often regard dealing with unconscious processes more fundamental.
Milton Erickson was one of the most influential therapists as regards modern hypnosis. He had a unique approach to hypnotherapy. Although he didn’t establish a school of hypnotherapy, he had great influence on contemporary and future therapists who advocated what they call ‘Ericksonian hypnosis’ and founded training centres. Ericksonians aim to mobilize unconscious resources mostly in indirect ways, using e.g. metaphors, stories, indirect suggestions. Some refer to this approach as ‘experiential’. Ericksonians often give assignments (or instruction to use self-hypnosis) to clients in an ambiguous/unexplicit way, aiming to facilitate spontaneously occuring insight and new behaviour. As a different approach, cognitive-behavioural hypnotherapy utilises self-hypnosis and homework/therapy assignments in a very structured, explicit and direct way with the same goal in mind: to provide clients with ‘experiential insight’, the insight of: ‘I really can see this differently and do it differently!’ which will lead to enhanced psychological and behavioural flexibility.
Erickson’s work was a big influence in the development of Neuro-linguistic programming (NLP), a personal development or therapeutic approach that is quite popular among many hypnotherapists. It makes use mainly of language patterns and visualisation techniques to help people achieve their goals. Although NLP is not an evidence-based method (often labeled as pseudoscientific), many therapists say that it is effective in helping people access their inner resources, once learned abilities to deal with upcoming difficulties (performances for instance).
Psychodynamic approaches to hypnotherapy are quite versatile. Analytical hypnotherapy will try to shed light on childhood (or ‘repressed’) memories, experiences and get insight, catharsis and a more refined self-awareness from them. This is called regression work, which can be done in sophisticated or crude ways, usually depending on the training level of the therapist. Trained psychotherapists may use hypnosis in conjunction with their psychodynamic approach, but often lay hypnotherapists (without formal psychotherapy training) also engage in some form of hypnoanalysis. Analytical hypnotherapy does not typically use self-hypnosis and ‘homework’.
Kathathym Imaginative Psychotherapy is a form of guided mental imagery that is often used by psychodynamically oriented hypnotherapists. The client, in a state of relaxation and inner focus, is guided through in each session a certain theme of images (of great symbolic value). Within the offered theme (by the therapist), the client can roam around freely in his inner world of images, impressions, sensations, and work with these experiences with the help of the attentive presence and guidance of the therapist. This approach is considered to be especially beneficial in dealing with psychosomatic and deep-seated psychological issues in general.
Ego-state therapy is also a psychodynamic approach that is often utilised by hypnotherapists. It works with the different parts or facets of the client’s personality. We have a natural tendency to verbalise our motivations, inner conflicts using expressions like: ‘Part of me feels like.., But an other part of me tells me that..’. Ego-state therapy aims to identify and acknowledge the motives, weaknesses and strengths of these different parts of ourselves and tries to resolve the conflicts between them. Ideally, at the end of the process, these different aspects of the personality will function in greater harmony and in a kind of enhanced ‘collaboration’ with each other. This type of work doesn’t necessarily involve hypnosis. It is interesting to note that ‘mode work’ in Schema therapy is almost identical to ego-state therapy, but it doesn’t use any hypnotic inductions, or references to hypnosis. Schema therapy is an integrative psychotherapy for the treatment of personality disorders, based on CBT and psychodynamic theories. The therapist may work with e.g. the client’s ‘vulnerable child mode’ and ‘healthy adult mode’ by initiating conversations between these sides or using mental imagery.
Suggestion therapy is often referred to as a distinct form of hypnotherapy (instead of a specific intervention) by therapy providers. However, I think giving helpful suggestions, ideas to a client in a state of concentrated and receptive attention, ideally is so fundamental in all forms of hypnotherapy, that it can hardly be considered a separate kind. As it is an essential intervention in all hypnotherapy, labelling a service ‘suggestion therapy’ really implicates the lack of a more complex, integrated therapeutic repertoire. Nevertheless, it is true that for some issues, delivering beneficial verbal suggestions in hypnosis alone can be a successful and sufficient intervention.
Today, many hypnotherapists have an integrative approach, meaning that they may use techniques of different schools of hypnotherapy (and psychotherapy in general) in an eclectic way. Ideally, an integrative approach uses those interventions of different traditions that research or decades of clinical experience proves effective. Plus, instead of applying them in an ad hoc way, it is desirable that they use them systematically, based on theoretical considerations, to meet the challenges of treating different types of problems most adequately.