For over a century, researchers have debated the efficacy of hypnosis and whether "hypnotic states" truly exist.
Hypnotherapy CPD state or non-state theory - knowing the difference influences how you work with clients
State theorists believe that hypnosis is an altered state of consciousness which is distinct from other states of mind.
Non-state theorists suggest that people take on the role of someone who is hypnotised and that hypnosis is similar to other states of mind.
Clients who are not highly hypnotisable may still be able to achieve positive therapeutic outcomes if they believe in hypnosis and are motivated.
If you’ve ever been hypnotised, or met someone who has been, you may be aware of some of the symptoms that people might experience during hypnosis—including sound and time distortion; feelings of floating, heaviness, and moving; or an inability to remember what was said during the session. From a therapeutic perspective, it's theorized that when people reach a state where they experience these or other symptoms, they are more susceptible to believing positive suggestions that would normally be bypassed by their logical, critical minds.
But is a “state of hypnosis” actually real? And can hypnotherapy be effective if it’s not—or if people don’t reach that state at all?
For over a hundred years, this question has been hotly debated. “State” theorists believe that there is a unique state of hypnosis and that achieving this state is integral to a positive therapeutic outcome.1 “Non-state” theorists, on the other hand, believe that people “take on” the role of someone who is hypnotised, in much the same way as someone takes on a variety of other roles in their lives.2
This “taking on” is far more than play-acting; the person believes they are hypnotised and will act as if they are hypnotised, to the extent that they may experience those hypnotic phenomena, such as floating and time distortion. Non-state theorists also question whether there’s anything unique about people’s hypnotic experience, or whether it is similar to states such as daydreaming and meditation.
Many researchers take the middle ground between these two views, speculating that people’s experience is being shaped both by role-taking and by some kind of neurological changes which lead to the experiencing of a particular “state.”
What Are the Implications for Practitioners and Clients?
We know that some people experience a far greater range of hypnotic phenomena than others. Thus, it’s important for academic researchers to know whether their subjects are highly hypnotisable in order to measure their response to particular interventions.
However, practitioners aim to work with everyone who comes through our doors, regardless of whether they would be considered highly hypnotisable or not. In general, hypnotherapists start from the perspective that someone is seeking help for a particular issue and that hypnotherapy is their chosen approach.
From the perspective of both a practitioner and someone who has undergone hypnotherapy, I can report that both myself and my clients have experienced a range of hypnotic phenomena, from a sense of release and relaxation to more intense symptoms. Personally, I’ve experienced very similar symptoms during yoga nidra and meditation, leading me to suspect that the hypnotic state is similar to these other altered states of mind. I’ve also witnessed people who don’t experience any particularly intense symptoms and instead only describe feeling a sense of relaxation.
With this huge diversity in experience, then, can hypnotherapy be successful for people who aren’t highly hypnotisable? Or can it work for people even if you don’t believe that hypnotic states exist?
Having worked with a large number of clients, I've come to believe that if people believe that hypnotherapy can help them, if they have a good rapport with the hypnotherapist, and if they have a genuine desire to enact change, then they will experience a good therapeutic outcome. Conversely, someone may have a deep hypnotic experience, but if they’re not committed to the process, they may not experience a positive therapeutic outcome.
I recently heard from a client that they had visited a hypnotherapist a few years previously. This client was extremely anxious and had problems engaging with their session, after which the hypnotherapist informed them that they couldn’t be hypnotised and there was no point in coming back for future sessions.
I argue that the therapist should have realised that, due to the client's anxiety and the lack of a therapeutic relationship between them at that point, they may not have been in the best space to achieve whatever their own personal state of hypnosis might be. If I was the therapist, I would have focused on establishing a supportive therapeutic relationship and working with that client’s motivation, desire to change, and belief that hypnotherapy could help them. It turned out that this client was highly motivated and had a deep belief in the power of hypnosis, which eventually drove them toward positive change.
Does this mean I’m a “non-state” theorist or believe that hypnosis isn’t real? Absolutely not. But I do believe that hypnotherapy is far more complex than it appears and that it’s important for practitioners to be open to that complexity.
When I'm teaching, it can be very hard for students to let go of the idea that there is a distinct and discrete state that people have to enter in order to benefit from hypnotherapy. And yet I argue that it's crucial to retain an open mind and realise that, as long as a client believes in hypnosis, it may very well work for them, regardless of any neurological changes which are (or are not) taking place.
Clients should be assured that any hypnotherapist who has received full training should be well aware of the complexities of their clients’ experiences. A practitioner who has studied a fully accredited hypnotherapy course, which typically requires around 450 study hours and includes working with case studies, will not only have learned about hypnosis; they should also have a sound therapeutic skill base within which they can work with you, whether or not you are highly hypnotisable.
So: Is hypnosis real? I believe the answer is yes. But it’s probably far more complicated than you might have thought.
1. Barber, TX (1969) Hypnosis: a scientific approach. New York: Van Nostrand Reinhold Company
2. Sarbin, TR and Coe, WC (1972) Hypnosis: a social psychological analysis of influence communication. New York: Holt, Rinehart and Winston