Nancy-school suggestion therapy

1. Introduction

Version followed: Bernheim's suggestion method as set out in De la suggestion et de ses applications à la thérapeutique (1886; English translation Suggestive Therapeutics, Herter, 1889, from the 2nd French edition), with Liébeault's variant of the induction. Source status: the founders' own procedures are reported here through period secondary accounts, not from their books [uncertain]. Sidis (1898, ch. VII) lists Bernheim's nine degrees and Liébeault's six; Gerling (1909, Der praktische Hypnotiseur, chs. 6–7) sets out Bernheim's and Liébeault's inductions step by step; Sidis (ch. VI) quotes Bernheim's induction; Bramwell (1913) gives an eyewitness account of Liébeault's clinic; and the 1886 table of contents gives the book's structure. These support the induction sequence, the two degree scales, Liébeault's use of touch (hand on the forehead, thumbs closing the eyelids) and daily sessions. Unconfirmed: whether Bernheim himself touched patients during curative suggestion, and total course length [uncertain]. The method is restated here as modern, consent-based clinical hypnosis [synthesis].

What it is. The "Nancy school" is a historical school of medical hypnosis, not a manualised present-day therapy. Ambroise-Auguste Liébeault (1823–1904) opened a clinic in Nancy in 1860 and published Du sommeil et des états analogues in 1866. Hippolyte Bernheim (1840–1919), a Nancy professor of medicine, came to his clinic as a sceptic, became his pupil, and from 1882 hypnotised the hospital patients under his care. The physiologist Henri-Étienne Beaunis and the jurist Jules Liégeois joined the group. [source: Wikipedia, Nancy School; Bramwell 1913]

Core idea of change. The school held three things. Hypnosis is a normal, non-pathological state of heightened suggestibility. It is produced by suggestion itself, chiefly the idea of sleep, not by magnetism or a hysterical constitution (the Nancy position against Charcot's Salpêtrière school). An idea the patient accepts tends to realise itself. On this view sleep only makes the brain more receptive. Bernheim therefore held that suggestible patients can also be helped by persuasion while awake, and he later framed his work as "psychotherapy" (Hypnotisme, suggestion, psychothérapie, 1891). [source: Wikipedia, Nancy School; Sidis 1898; Bernheim 1886 table of contents]

What remains today. No body certifies "Nancy-school therapy" as such [uncertain]. Its legacy lives on in three places. The first is direct-suggestion clinical hypnosis taught within general clinical-hypnosis training [synthesis]. The second is Émile Coué's autosuggestion, sometimes called a "second" or "new" Nancy school. The third is Freud, who translated Bernheim and used hypnosis before developing psychoanalysis. [source: Wikipedia, Nancy School; uncertain: secondary, unverified] Use it only as a licensed health professional within your competence, and for medical symptoms only as an adjunct after medical assessment, never in place of medical treatment [synthesis].

2. Framework

The sources describe a session routine, not a phased programme. The phases below are my structuring of that routine for modern practice [synthesis].

Historical format [source: Bramwell 1913; Wikipedia, Nancy School (secondary)]

• Liébeault saw outpatients one after another in a shared consulting room in his garden, and others sat nearby while he worked. He offered hypnosis free, as an alternative to paid drug treatment. Induction was rapid and each session rarely went beyond about ten minutes. Sessions consisted of putting the patient to sleep and then giving curative suggestions, and no drugs were given.
• Bernheim worked on hospital wards. Bramwell reports about 5,000 cases in the first four years with hypnosis obtained in 75%, and later about 10,000 cases at 85%.
• Frequency: the report of the Nancy method given by Gerling (attributed to Liébeault) recommends daily sessions. If sleep had not come after about a minute, the attempt was put off to the next day, and after several days of practice patients fell asleep within seconds and reached deeper degrees [source: Gerling 1909, ch. 6]. Bramwell mentions a sciatica that Bernheim treated for six months without success and Liébeault then cured, which implies repeated sessions over weeks to months in resistant cases [source: Bramwell 1913]. Total course length is not stated [uncertain].

Modern phase structure [synthesis]

If there is no meaningful change after about 4 sessions, review the formulation and consider other treatments [synthesis].

Screening and contraindications. The period sources give almost none. Liébeault found "nervous and hysterical" patients the most resistant [source: Bramwell 1913], and in Gerling's report he found people used to obedience (labourers, peasants, children, former soldiers) the easiest to hypnotise [source: Gerling 1909, ch. 6]. Both points concern response, not safety. Braid, the pre-Nancy figure quoted by Bramwell, held that only a medical man should use hypnotism and that it was not a universal remedy [source: Bramwell 1913]. Gerling has a chapter on the dangers of hypnosis (ch. 11), whose content is not used here [uncertain]. The following exclusions and cautions are therefore all my own [synthesis]:

• Do not use, or refer on: active psychosis or mania; severe dissociative disorder; acute suicidality; intoxication; physical symptoms not yet medically assessed; a client who wants hypnosis to "recover" memories; current forensic or legal proceedings where the client's testimony may be affected.
• Use with caution: untreated PTSD (keep suggestions present-focused, with no regression); personality disorders with unstable alliance; fears about loss of control; epilepsy (consult the treating physician).

3. Guiding principles

[source for each, unless marked: as cited]

• Hypnosis is normal, not pathological [Wikipedia, Nancy School; uncertain: secondary, unverified]. Present it as an ordinary capacity of attention and expectation, not a sign of weakness or illness.
• Everyone is suggestible, only in differing degree [Wikipedia, Nancy School; uncertain: secondary, unverified]. Do not sort clients into "hypnotisable or not"; adapt the method and use whatever responsiveness is there.
• The decisive factors lie in the patient [Wikipedia, Nancy School; uncertain: secondary, unverified]. Credit change to the client's own acceptance of the idea, not to your power.
• No mystery: explain as you go [Bramwell 1913, on Liébeault]. Tell the client what you are doing and why, in plain scientific terms.
• Depth is not required [Bramwell 1913]. Suggestions can work in a merely drowsy state, so give therapeutic suggestion at whatever level is reached instead of chasing depth.
• Sleep only increases receptivity; waking suggestion also works [Wikipedia, Nancy School; Bernheim 1886 table of contents, ch. on suggestion in the waking state]. Use plain persuasion where trance is not needed or not wanted.
• Attention narrowed by monotony [Sidis 1898, quoting Bernheim]. Keep the voice even and repetitive, with one idea at a time.
• Brief, quiet, ordinary sessions [Bramwell 1913]. Avoid theatre: short sessions, no displays of phenomena.
• Target the symptom and support basic functions [Bramwell 1913]. Suggestions deny the morbid symptom and strengthen sleep, appetite and digestion, and similar foundations of health.
• Free choice of treatment [Bramwell 1913, Liébeault's offer of hypnosis as an alternative]. Today this means full informed consent, an offered alternative, and the right to stop [synthesis].
• The operator's expectations shape the phenomena [Wikipedia: Bernheim's critique of Charcot; uncertain: secondary, unverified]. Do not suggest dramatic phenomena you do not need, and check that the effects you see are not created by your own demands.
• Adjunct within competence [synthesis]. Treat only problems you are qualified to treat without hypnosis, and keep physical illness under medical care.
• Memories are experience, not evidence [synthesis]. Never use suggestion to uncover or confirm past events.

4. Intervention inventory

The inventory has three tiers. Items 4.3, 4.4 (historical form), 4.5 (the degree scales), 4.6, 4.7, 4.8, 4.9 (historical form), 4.10 and 4.11 are documented Nancy-school practice in the period sources. Items 4.1 and 4.12 have a historical root but take their modern form from me. Items 4.2, 4.13 and the modern steps of 4.4 and 4.5 are procedures I added for safe use [synthesis]. All example wording is my own and illustrative; none of it is Bernheim's or Liébeault's script. The induction steps, the degree scales and Liébeault's use of touch come from two period secondary accounts, Sidis (1898) and Gerling (1909), not from Bernheim's own chapter on induction (1886, Part One, ch. I) [source: Sidis 1898, ch. VII; Gerling 1909, chs. 6–7] [uncertain].

4.1 Offering the method and explaining it

• Purpose / when: before any induction. Liébeault offered hypnosis as a free alternative to standard treatment, and many patients declined at first. He explained that he had no mysterious power and that the effects could be explained scientifically [source: Bramwell 1913; Wikipedia, Nancy School].
• Steps:
  1. Describe suggestion in plain terms: an idea the person accepts tends to act on feelings, sensations and behaviour.
  2. Describe the procedure: a few minutes of focused attention on the idea of drowsiness and rest, then brief statements about the agreed goal, then alerting.
  3. Correct myths [synthesis]: the client stays aware, will not reveal secrets or act against their values, and can open their eyes and stop at any time.
  4. Offer an alternative treatment and record consent.
• Example language (illustrative): "Nothing magical happens here. I'll ask you to focus on one simple idea, feeling drowsy and resting, and while you're settled I'll repeat a few helpful statements we've agreed on. You stay in charge throughout, and if you want to stop, you just open your eyes."
• Watch for: fear of loss of control, expectations of a cure without effort, or a wish to retrieve memories. Address each before going on; the last is a stop signal (see section 2).

4.2 Screening and medical clearance [synthesis]

• Purpose / when: at assessment, and again whenever a new symptom is targeted.
• Steps:
  1. Take a psychiatric history with a focus on psychosis, dissociation, trauma, suicidality and substance use.
  2. For any bodily symptom (pain, digestive, sleep, skin), confirm a medical assessment and that medical treatment continues.
  3. Ask about earlier hypnosis experiences, both good and bad.
  4. Agree on one specific, observable target.
• Example language (illustrative): "Before we use this for your stomach pains, I need to know your doctor has examined them. This works alongside their care, not instead of it."
• Watch for: symptoms with no medical work-up, and pressure to stop medication. Neither is compatible with this method.

4.3 Sleep-suggestion induction with visual fixation (Bernheim)

• Purpose / when: the standard Nancy induction. Attention is narrowed onto a single idea, sleep, through visual fixation and a graded series of verbal suggestions in a monotonous voice [source: Sidis 1898, quoting Bernheim's Suggestive Therapeutics; Gerling 1909, ch. 6].
• Steps (historical sequence from Gerling's and Sidis's accounts of Bernheim; modern changes marked):
  1. Tell the client what the procedure is for, and seat or recline them in a position suited to sleep [source: Gerling 1909].
  2. Hold up one or two fingers a short distance in front of the eyes, a little above eye level (Gerling: over the bridge of the nose), and ask the client to keep looking at them [source: Sidis 1898; Gerling 1909].
  3. Ask them to hold their mind on the idea of sleep. Bernheim's instruction was "Look at me and think of nothing but sleep" [quoted in Sidis 1898; same wording in German in Gerling 1909].
  4. In an even, monotonous voice, give the suggestions one at a time in a graded order: eyelids growing heavy, eyes tiring, blinking more, vision blurring, then the instruction to close the eyes. Gerling lists eight graded steps from the sleep instruction to "you are falling asleep" [source: Gerling 1909; Sidis 1898].
  5. Historically, after eye closure Bernheim added a challenge that the eyes could no longer be opened, then stated that the patient was falling asleep [source: Gerling 1909]. In Gerling's account of Bernheim the eyes are closed by verbal suggestion alone, not by hand [source: Gerling 1909]. Modern use: leave out the challenge, or use it only with prior agreement as an optional check of response (see 4.5) [synthesis].
  6. When the eyes close, continue for a short while with suggestions of rest and drowsiness.
  7. If the eyes stay open, do not insist. The Nancy practice reported by Gerling was to stop after about a minute without result and try again the next day [source: Gerling 1909]. Today, invite the client to close their eyes comfortably or switch to waking suggestion (4.10); response is not required [synthesis].
• Example language (illustrative): "Just rest your eyes on my fingers … and let your mind settle on one idea, rest, drowsiness … the eyelids may begin to feel heavier … blinking a little more … whenever they want to close, let them close … and simply rest."
• Watch for: slower blinking, eyes watering, breathing slowing, the face relaxing, eyes closing. Bernheim attributed the effect to "the monotonous, wearying, and continuous impression" on one sense [quoted in Sidis 1898]. Rising tension, laughter or darting eyes call for a pause and a check-in (see 5).
• Modern adaptation: phrase steps as permissive invitations, not commands, and say in advance that eye closure is optional [synthesis].

4.4 Liébeault's induction and re-induction (hand on forehead, eye closure; adapted)

• Purpose / when: Liébeault's own variant of the Nancy induction. In Gerling's account he placed his hand on the patient's forehead and slowly closed the eyes, giving a shortened set of Bernheim's sleep suggestions in a voice that grew steadily quieter [source: Gerling 1909, ch. 6]. In a report of the revised Nancy method attributed to Liébeault, the patient gazes into the operator's eyes; the operator names the first signs of sleep (heavy lids, slackness, numbness) and says "Sleep!" when the lids flicker; if the lids stay open, the suggestions are repeated and the upper lids are pressed shut with the thumbs. With daily repetition, patients fell asleep within seconds [source: Gerling 1909, ch. 6]. Bramwell adds that Liébeault put experienced patients to sleep with a pass of the hand and a brief command [source: Bramwell 1913]. The defensible modern use is a short re-induction for a client already familiar with 4.3, with any touch agreed in advance [synthesis].
• Steps [synthesis, adapting the above]:
  1. Before any use of touch, say exactly where you would touch (a light hand on the forehead) and ask for explicit consent; record it. Offer the no-touch version as equally good.
  2. Do not close or press the eyelids yourself; ask the client to close their eyes.
  3. During an earlier session, agree a re-induction cue with the client, for example: "when I say 'rest now' and you're ready, you can return to this state".
  4. In later sessions, ask permission first, then give the cue (with the agreed light hand on the forehead, if consented).
  5. Name the expected signs of sleep in a progressively quieter voice, then deepen briefly as in 4.3.
• Example language (illustrative): "Ready to start? … Rest now … eyelids heavy … the body loose and slack … resting."
• Watch for: the cue must never be used outside a session or without consent. Any flinch or discomfort at touch: stop touching and continue verbally. Drop the hand pass, a mesmeric relic with no stated rationale in the Nancy theory [synthesis]. Liébeault found habitually obedient people the easiest subjects [source: Gerling 1909]; a modern client should never feel that compliance is expected [synthesis].

4.5 Gauging the degree of response (Nancy degree scales, adapted)

• Purpose / when: after induction, to decide whether to go on to suggestion. The Nancy group graded hypnosis by degrees. Bernheim's scale has nine degrees in two groups [source: Sidis 1898, ch. VII; Gerling 1909, ch. 7]:
  • Memory kept on waking (degrees 1–6): (1) drowsiness, and subjects often deny having slept; (2) drowsiness with inability to open the eyes; (3) suggested catalepsy that the subject can break at will; (4) catalepsy the subject cannot break without counter-suggestion; (5) suggested contractures; (6) automatic obedience, with no hallucinations.
  • Somnambulism, with amnesia on waking (degrees 7–9): (7) hallucinations not possible; (8) slight possibility of hallucinations during hypnosis but not after; (9) hypnotic and post-hypnotic hallucinations possible.
  • Liébeault's earlier scale has six degrees, running from drowsiness through catalepsy, automatic movements and rapport with the operator alone, to light somnambulism (hazy memory) and deep somnambulism (total amnesia) [source: Sidis 1898; Gerling 1909; the two accounts word his middle degrees slightly differently].
  • The Nancy view was that suggestion works at every degree, even mere drowsiness [source: Bramwell 1913; Wikipedia, Nancy School].
• Steps [synthesis]:
  1. Observe the signs listed under 4.3 (eye closure, relaxation, slowed breathing); this places most clients in the first two degrees, which is enough for treatment.
  2. Do not test the higher degrees (catalepsy, contracture, automatic obedience, amnesia, hallucination). They are not needed for curative suggestion, and testing them turns the session into a demonstration (see 4.7).
  3. Optionally ask for an ideomotor signal, such as a finger lifting for "yes, comfortable".
  4. Go on to curative suggestion whatever the depth.
  5. If you are trained in a standardised hypnotic-responsiveness scale, you may use it at the first session. Do not reproduce its items for the client.
• Example language (illustrative): "However deeply or lightly you're resting is just right for what we're doing."
• Watch for: clients who judge themselves as "failing"; normalise light states. Spontaneous amnesia or very deep unresponsiveness (the somnambulistic degrees) calls for slow re-alerting and a full debrief (4.9) [synthesis].

4.6 Direct curative suggestion

• Purpose / when: the core therapeutic act. Once the patient was asleep or drowsy, Liébeault gave suggestions that denied the morbid symptom and supported the basic functions of health, such as sleep and digestion [source: Bramwell 1913]. Use it for functional symptoms, habits, sleep and anxiety, within your competence and after medical assessment [synthesis].
• Steps (wording principles are [synthesis]):
  1. Use only the target agreed before induction.
  2. State the change simply, concretely and affirmatively, for example that the pain is easing, sleep is coming more easily, appetite is returning.
  3. Add one or two supporting suggestions for general health: sleep, calm, digestion.
  4. Repeat each suggestion two or three times in the same monotone.
  5. Keep the suggestion phase short, a few minutes, in line with Liébeault's sessions of about ten minutes in total.
• Example language (illustrative): "From tonight, as you lie down, your body will remember this calm … sleep will come more easily … and as you sleep more easily, the tension in your stomach can ease … your digestion settling, comfortable."
• Watch for: suggestions that promise a cure of physical disease (never give these), or that conflict with the client's values. Effect shows as symptom change between sessions; track it with a simple daily rating [synthesis].

4.7 Running commentary and demystification during the session

• Purpose / when: Liébeault kept up a running commentary while working and kept the atmosphere quiet and ordinary, unlike the scenes at the Salpêtrière [source: Bramwell 1913]. Use it throughout, especially with anxious first-timers.
• Steps:
  1. Before and after the hypnotic segment, say briefly what you are about to do and what you just did.
  2. Keep the tone conversational outside the induction.
  3. Never stage phenomena (catalepsy, hallucinations, amnesia) to impress. The Nancy critique of Charcot holds that such phenomena follow the operator's expectations [source: Wikipedia, Nancy School; uncertain: secondary, unverified] [synthesis for the rule].
• Example language (illustrative): "In a moment I'll start the relaxation part, the same as last week, then a few statements about sleep, then I'll count you back up."
• Watch for: if the client becomes curious about "tests" of hypnosis, explain that they are not needed for treatment.

4.8 Post-hypnotic suggestion (open and agreed)

• Purpose / when: Bernheim reported subjects carrying out suggestions days later, often without remembering receiving them. He explained this as latent memories revived when the subject drifted back into a hypnotic state [source: Wikipedia, Nancy School; uncertain: secondary, unverified]. The clinical use is to carry the suggested change into daily life [synthesis].
• Steps [synthesis]:
  1. Agree the content and its trigger before induction, for example getting into bed, or the first sign of tension.
  2. During the suggestion phase, link the trigger to the desired response.
  3. After alerting, tell the client exactly what was suggested.
  4. Never suggest amnesia for the suggestion, and never give a suggestion the client has not agreed to.
• Example language (illustrative): "Each time you notice your shoulders tightening at your desk, that can be a signal to breathe out slowly and let them drop, just as they are now."
• Watch for: the trigger producing the response in the client's own report; any experience of acting "against my will" (stop and review).

4.9 Re-alerting and debrief

• Purpose / when: at the end of every hypnotic segment. Historically Liébeault sometimes left patients to wake by themselves: two girls he had put to sleep woke after about twenty and twenty-five minutes [source: Bramwell 1913]. In modern practice, re-alert actively and check orientation before the client leaves [synthesis].
• Steps [synthesis]:
  1. Announce the end.
  2. Count up slowly, suggesting returning energy, alertness and comfort.
  3. Reverse any heaviness you suggested.
  4. Ask the client to open their eyes, move and look around the room.
  5. Check orientation, drowsiness, headache or unease.
  6. Ask what they noticed and repeat the agreed post-session suggestion in waking form.
  7. Do not let a drowsy client drive.
• Example language (illustrative): "In a moment I'll count from one to five … with each number you become more alert … heaviness leaving the eyes and limbs … five, eyes open, wide awake and comfortable."
• Watch for: lingering drowsiness, disorientation, headache, or tearfulness. Repeat the alerting, ground the client (feet on the floor, naming objects in the room) and extend the debrief.

4.10 Waking suggestion and persuasion (suggestion without hypnosis)

• Purpose / when: Bernheim held that suggested effects can occur in the waking state without somnambulism, and that suggestible patients could be treated by straightforward persuasion [source: Wikipedia, Nancy School; uncertain: secondary, unverified]. His 1886 book has a chapter on suggestion in the waking state [source: Bernheim 1886 table of contents]; its procedure is not reproduced here [uncertain]. Use it when trance is declined, not needed, or as transfer to daily life.
• Steps [synthesis]:
  1. While the client is alert and attentive, give a clear, confident, specific statement of the expected change and its rationale.
  2. Ask the client to rehearse it in their own words.
  3. Link it to a concrete action.
• Example language (illustrative): "You've already slept better twice this week; your body is relearning this. Tonight, when you lie down, expect sleep to come; you don't have to force it."
• Watch for: suggestions that over-promise; credibility suffers if they fail. Keep claims modest and checkable.

4.11 Repetition across sessions

• Purpose / when: courses of treatment involved repeated sessions. The Nancy method as reported by Gerling recommends daily sessions, with response deepening and induction shortening over several days [source: Gerling 1909, ch. 6]. Bramwell's account of a sciatica treated for six months implies months of repeated suggestion in resistant cases [source: Bramwell 1913]. Total course length is not stated [uncertain].
• Steps [synthesis]:
  1. Repeat 4.3 (or 4.4 once the client is familiar with it), then 4.6, then 4.9. Historically sessions were daily; in outpatient practice today, weekly or twice weekly at the start is more usual.
  2. Keep the core suggestions the same, and add to them as progress is reported.
  3. Review the ratings every session.
  4. Space the sessions out once gains are stable.
• Watch for: plateaus (see 5).

4.12 Self-practice or autosuggestion between sessions [synthesis, lineage only]

• Purpose / when: the period sources do not describe Liébeault or Bernheim as teaching self-hypnosis [uncertain]. Coué's autosuggestion, the "second Nancy school", developed this direction [source: Wikipedia, Nancy School; uncertain: secondary, unverified]. Teach self-practice to support transfer and reduce dependence on the therapist.
• Steps [synthesis]:
  1. Teach a brief self-induction: fix the gaze on a point, think of rest, and let the eyelids grow heavy.
  2. The client repeats their agreed statement silently a few times.
  3. The client self-alerts with a count.
  4. Practise once in session, then daily for 5–10 minutes.
• Example language (illustrative): "At home, sit somewhere safe, rest your eyes on a spot, think 'rest' until your eyes want to close, repeat your sentence about sleep three times, then count yourself up to five."
• Watch for: never practising while driving or operating machinery; distress during practice (stop, and review in session).

4.13 Progress monitoring [synthesis]

• Purpose / when: every session. The Nancy group recorded outcomes for thousands of cases [source: Bramwell 1913]; modern practice needs individual tracking.
• Steps:
  1. Agree a simple daily 0–10 rating of the target symptom, or a frequency count.
  2. Review it at the start of each session.
  3. Document your formulation, consent and the content of the suggestions given.
• Watch for: no change after about 4 sessions means reconsider (section 5).

5. Handling problems

The period sources say little about problems. Bramwell notes that Liébeault found nervous and hysterical patients the most resistant, that outcomes varied widely, and that one practitioner could fail where another succeeded (the sciatica case) [source: Bramwell 1913]. Everything else below is my own guidance [synthesis].

• No eye closure, laughing, or "it isn't working" [synthesis]. Stop the induction and ask what the client noticed. The Nancy practice was not to persist: after about a minute without result the attempt was put off to the next day [source: Gerling 1909, ch. 6]. Normalise light responses: the Nancy view is that suggestibility varies in degree and that drowsiness is enough [source: Wikipedia; Bramwell 1913]. Offer eyes-closed rest from the start, or switch to waking suggestion (4.10). Do not escalate authority or insistence.
• Fear of losing control [synthesis]. Repeat the explanation from 4.1. Do a short trial of one or two minutes with an agreed stop signal, and let the client end it themselves to prove they can. Offer to say aloud every suggestion beforehand.
• Resistance to authoritative tone, or a rupture [synthesis]. The historical Nancy manner was directive. If the client feels talked down to or pushed, name it, apologise, rewrite the suggestions together in the client's own words, and switch to permissive phrasing ("you may notice…").
• Overwhelm, abreaction or sudden distress during the hypnotic segment [synthesis]. Stop the suggestions. Speak in a normal voice and say the client's name. Invite them to open their eyes, feel their feet on the floor and name things they see. Re-alert fully (4.9). Debrief, check safety, and do not go back to that material under hypnosis. If trauma material surfaced, reassess readiness and refer for trauma-focused treatment where indicated.
• Dissociation (blank stare, unresponsiveness, loss of time, depersonalisation) [synthesis]. Ground and re-alert as above, slowly. Check orientation to time and place, and do not let the client leave until they are oriented. Review screening; further hypnosis may be contraindicated.
• Slow or failed waking [synthesis]. Unlike Liébeault's practice of letting patients wake by themselves [source: Bramwell 1913], repeat the alerting count calmly with suggestions of energy, then ask the client to open their eyes and move. Stay with them until they are fully alert. Persistent difficulty means stopping hypnosis and reassessing.
• Headache, drowsiness or unease after the session [synthesis]. Usually brief. Repeat the alerting, reverse any heaviness suggestions, and allow time before leaving. Record it, and shorten the next hypnotic segment.
• Symptom unchanged after about 4 sessions [synthesis]. Re-examine the formulation: is the symptom maintained by avoidance, conflict, secondary gain or untreated disorder? Get medical review for bodily symptoms. Combine with or switch to an evidence-based treatment for the condition. Do not keep repeating the same suggestions indefinitely.
• Symptom shifts or new symptoms emerge [synthesis]. Explore what the original symptom did for the client, and treat the underlying problem with an appropriate psychotherapy rather than chasing each new symptom with suggestion.
• Non-adherence to self-practice [synthesis]. Shorten it to 3 minutes, tie it to an existing routine (bedtime), and record a personalised audio together. Ask what got in the way without judgment.
• Dependence on the therapist [synthesis]. Move early to self-practice (4.12) and waking suggestion (4.10), space sessions out, and frame gains as the client's own doing, in line with the Nancy principle that the key lies in the patient [source: Wikipedia; uncertain: secondary, unverified].
• Client wants hypnosis to recover memories or "find the cause" [synthesis]. Decline. Explain that hypnosis increases confidence without increasing accuracy, and can create convincing false memories. Treat memories as the client's experience, and use present-focused work only.
• Client wants to stop medical treatment, or expects a cure of physical disease [synthesis]. Decline that framing, state plainly that this is only an adjunct, and coordinate with the treating physician.
• Legal or forensic involvement [synthesis]. The Nancy group, notably the jurist Liégeois, studied suggestion in legal contexts [source: Wikipedia; uncertain: secondary, unverified]. Today, do not hypnotise a client who may testify about relevant events without specialist advice, because it can affect the admissibility of their evidence.
• Privacy [synthesis]. Liébeault treated patients in a shared room in front of others [source: Bramwell 1913]. Today always work one-to-one, or in a consented group format, never in front of others without consent.
• Requests for stage-type demonstrations or covert use [synthesis]. Refuse. Clinical use is consensual, transparent and goal-directed.

Sources

Web sources:

• Nancy School – Wikipedia: founders, dates, theory, works, influence (secondary).
• Bernheim, De la suggestion et de ses applications à la thérapeutique (1886): Source Library catalogue record with table of contents: chapter structure only.
• Bramwell, J. M., Hypnotism: Its History, Practice and Theory, 3rd ed. 1913 (partial text, Distant Reader / HathiTrust): eyewitness account of Liébeault's clinic and Bernheim's case figures.
• Sidis, B., The Psychology of Suggestion (1898), ch. VI: Bernheim's induction quoted from Suggestive Therapeutics.
• "Recent Literature" notice of Bernheim's Suggestive Therapeutics, 1890 (Zenodo): bibliographic details of the Herter translation.
• Sidis, B., The Psychology of Suggestion (1898), ch. VII: Bernheim's nine degrees and Liébeault's six degrees of hypnosis.
• Gerling, R., Der praktische Hypnotiseur (1909), ch. 6 "Die Methoden" (Projekt Gutenberg): Bernheim's and Liébeault's inductions, Liébeault's revised Nancy method, daily sessions (period secondary source).
• Gerling, R., Der praktische Hypnotiseur (1909), ch. 7 (Projekt Gutenberg): Liébeault's and Bernheim's degree scales.

Founders' books cited (their procedures are reported here through Sidis, Gerling and Bramwell) [uncertain]:

• Bernheim, H. (1886). De la suggestion et de ses applications à la thérapeutique. Paris: Doin. English: Suggestive Therapeutics: A Treatise on the Nature and Uses of Hypnotism, trans. C. A. Herter (1889). New York: Putnam. Public-domain scans: Wellcome Collection record; Wood Library-Museum record.
• Bernheim, H. (1891). Hypnotisme, suggestion, psychothérapie. Paris: Doin.
• Liébeault, A.-A. (1866). Du sommeil et des états analogues. Paris: Masson.
• Liébeault, A.-A. (1891). Thérapeutique suggestive. Paris: Doin.