Medical hypnosis and hypnoanalysis (Wolberg)

1. Introduction

Version followed: Lewis R. Wolberg, Hypnoanalysis (New York: Grune & Stratton 1945; London: Heinemann 1946; reissued 1964 and 2013) and Medical Hypnosis, Vol. 1 The Principles of Hypnotherapy and Vol. 2 The Practice of Hypnotherapy (Grune & Stratton 1948). Source status: the structure and the named techniques come from the publisher tables of contents and descriptions, library records and contemporary reviews; no legal full text of either book, or of The Technique of Psychotherapy, is publicly available (Wellcome holds print only; archive.org lends Vol. 1 only; the PEP-Web reviews are subscriber-only) [uncertain]. One point is sourced from a 1950s clinical report that applied his scheme: Wolberg's five-stage classification of trance depth (see A4). Wolberg's own induction methods, suggestibility tests, depth criteria and session schedule remain [uncertain]. No published step-by-step Wolberg protocol is available, so where this guide gives step-by-step procedure, it is a current clinical-hypnosis adaptation marked [synthesis], not Wolberg's own instructions. [source: Elsevier Hypnoanalysis TOC; WorldCat Vol. 2; Read Books Vol. 1 listing; Internet Archive Vol. 1 record; Wellcome catalogue; Creighton obstetric hypnosis report]

What it is. Wolberg (1905–1988) was a New York psychiatrist and psychoanalyst. In 1945 he founded the Postgraduate Center for Mental Health, and he advocated using hypnosis in psychiatric treatment [source: Wikipedia, Lewis Wolberg]. His approach is not a manualised therapy. It is a framework for using hypnosis inside a broader, psychoanalytically informed psychotherapy. It has three levels: (1) symptom removal by suggestion; (2) supportive and re-educative ("psychobiologic") therapy aided by hypnosis; and (3) hypnoanalysis, which uses trance to reach and work through unconscious conflict, resistance and transference [source: WorldCat Vol. 2 summary; Slater review].

How change happens (as the sources describe it). The hypnotic relationship is understood psychodynamically. The hypnotist is cast as an inner representative of the parent or superego, and this gives suggestion its force [source: Slater review]. At the symptom level, that rapport carries authoritative ("prestige") suggestion. At the analytic level, trance is used to speed access to material and to manage resistance. Suggestions are based on analytic interpretation, and hypnotic sessions are regulated, spaced and dosed [source: Glover 1946 review]. Insight is then interpreted and worked through [source: Elsevier TOC, ch. XX].

Caution for today's use. Wolberg's hypnoanalysis included a chapter on "the recall of buried memories" [source: Elsevier TOC, ch. XVII]. Current evidence is that hypnosis can alter memories and produce confident false memories: in two experiments by Orne's group, hypnosis added little to recall beyond more errors that subjects were confident were correct [source: Dinges, Orne et al., NCJRS abstract; Wikipedia, Hypnoanalysis, citing Kubie 1941]. This guide therefore never presents hypnosis as a way to recover accurate memories. Any material produced in trance is treated as the client's present experience, fantasy and meaning, not as historical fact [synthesis].

2. Framework

The three levels of hypnotherapy (Wolberg's own structure)

Volume 2 of Medical Hypnosis illustrates three approaches, each with a complete psychosomatic case record [source: WorldCat Vol. 2 summary]:

Symptom removal: authoritative ("prestige") suggestion aimed directly at the symptom. Wolberg's case was enuresis.
Psychobiologic therapy: hypnosis added to guidance, reassurance, persuasion and re-education. Wolberg's case was premature ejaculation. [uncertain] The label probably echoes Adolf Meyer's psychobiology; the link is unconfirmed.
Hypnoanalysis (re-education through insight): trance-assisted exploration and working through of conflict. Wolberg's case was severe persistent headache.

The Slater review lists the uses as symptom removal, non-analytic psychotherapy, reassurance, persuasion, and aiding progress in psychoanalysis [source: Slater review].

Phases (sequence follows the Vol. 1 chapter order; content is [synthesis])

Volume 1 runs through the nature of hypnosis, theories, the technique of hypnosis, susceptibility, suggestibility tests, depth of trance, and the first hypnotic session [source: Read Books Vol. 1 listing]. As a clinical sequence:

Assessment and medical clearance (1–2 sessions) [synthesis]
- Goal: formulate the problem, choose the level of therapy, and screen for contraindications.
- For any bodily symptom (headache, enuresis, sexual dysfunction, pain, GI symptoms), get medical assessment first. Hypnosis is an adjunct within medical care and never replaces it.
- Move on when there is a formulation, informed consent, no exclusion criteria, and medical causes have been addressed.
Preparation and suggestibility testing (part of 1 session) [source: Vol. 1 chapter titles; content synthesis]
- Goal: correct misconceptions, gauge responsiveness, and build rapport.
- Move on when the client understands what hypnosis is and is not, and agrees to proceed.
First hypnotic session and trance training (1–3 sessions) [source: Vol. 1 chapter titles; content synthesis]
- Goal: induction, deepening, assessing depth, re-alerting and debrief.
- Move on when the client enters and leaves trance comfortably and reports a tolerable experience.
Treatment proper at the chosen level [source: WorldCat Vol. 2; Glover review]
- Symptom-level work is typically brief. [uncertain] Wolberg's session counts are not given in the sources used; about 4–10 sessions is a [synthesis] estimate.
- Psychobiologic and hypnoanalytic work is longer, with hypnotic sessions interleaved with waking sessions. Glover credits Wolberg with a system for regulating, spacing and dosing hypnotic sessions [source: Glover 1946 review]. [uncertain] The actual schedule is not described here.
- Move from symptom-level to deeper levels only when a symptom keeps returning or is replaced by another, and the client wants exploratory work and is stable enough for it [synthesis].
Integration, self-hypnosis and termination (final 1–3 sessions) [synthesis]
- Goal: consolidate gains in the waking state, transfer skills (self-hypnosis), and plan for relapse.
- End when goals are met and the client can use self-regulation skills without the therapist.

Format: individual, typically 45–60-minute sessions with a waking discussion before and after any trance segment [synthesis]. Wolberg's case records are verbatim doctor–patient transcripts, which shows that dialogue and trance alternate within a session [source: Slater review; WorldCat Vol. 2].

Screening and contraindications

From sources:
- Hypnosis should be restricted to trained clinicians. Wolberg deplored public and stage displays and called for laws limiting hypnosis to the medical profession [source: Slater review].
- A secondary source says hypnosis is not recommended in psychosis, clinical depression or "hysterical disorders" because of a risk of agitation. It lists possible side effects: anxiety during induction, difficulty re-alerting, drowsiness, distress, headache, dizziness, false memories, and delayed reactions [source: Wikipedia, Hypnoanalysis; uncited there, so [uncertain]].
Note: Wolberg's own book-length case, Johan R., is described as a "schizophrenic personality" [source: Elsevier description]. Current practice would not use uncovering hypnoanalysis with a client at that level of fragility [synthesis].
Added exclusions or cautions [synthesis]:
- active psychosis or a history of psychotic decompensation
- dissociative identity disorder or severe dissociation, unless the clinician is trained in phased trauma treatment
- untreated PTSD or unstable trauma presentations (no uncovering or regression work; stabilisation first)
- acute suicidality or severe depression (do symptom-level work only after risk is assessed)
- marked paranoid traits or a fear of control
- bodily symptoms not yet medically assessed
- pending legal proceedings in which the client may testify (trance can contaminate memory and affect admissibility)
- clinician working outside their training and licence

3. Guiding principles

Hypnosis is an adjunct, not a therapy [source: Slater review]. Practical meaning: always know which psychotherapy the trance is serving.
Professional use only [source: Slater review]. Practical meaning: no demonstrations, entertainment or lay practice; work within your licence and training.
Match the level to the goal [source: WorldCat Vol. 2]. Practical meaning: decide whether you are removing a symptom, supporting and re-educating, or analysing, and don't drift between them unannounced.
The hypnotic relationship is a transference relationship [source: Slater review; Elsevier TOC ch. XVIII]. Practical meaning: expect compliance, dependency, idealisation or fear of the therapist, and discuss them.
Suggestions rest on understanding [source: Glover review]. Practical meaning: word suggestions from the case formulation, not from a generic script.
Dose the trance [source: Glover review]. Practical meaning: plan how much trance work each session holds and how sessions are spaced. Leave waking time to process.
Resistance is material, not an obstacle to override [source: Elsevier TOC ch. XIX; [synthesis] for practice]. Practical meaning: when a client won't go into trance or blocks, explore why rather than pushing harder.
Insight must be interpreted and used in waking life [source: Elsevier TOC ch. XX]. Practical meaning: anything that emerges in trance is discussed afterwards, at a pace the client can take in.
Conclusions are provisional [source: WorldCat Vol. 2, where the author says his conclusions will need revision]. Practical meaning: monitor effects and revise the plan.
Consent and control stay with the client [synthesis, current standard]. Practical meaning: explain every procedure beforehand; the client can stop at any time; no covert induction.
Trance products are not evidence [synthesis, from memory-contamination findings]. Practical meaning: never confirm, deny or build on "recovered" events. Work with meaning and feeling.
Medical symptoms need medical care first [synthesis]. Practical meaning: assessment comes before suggestion; hypnosis only alongside treatment.
Permissive wording is preferred today [synthesis]. Practical meaning: Wolberg's prestige suggestion was authoritative. Present-day clinicians usually soften it into collaborative, permission-giving language, which keeps the client in charge.

4. Intervention inventory

The intervention names and their place in the system come from Wolberg's tables of contents, the publisher descriptions and the 1946–49 reviews. None of these sources gives step-by-step procedure, so all steps and wording below are [synthesis] in line with current clinical-hypnosis practice, and all example language is illustrative, not Wolberg's. Items are grouped as A (foundations), B (hypnotherapy without uncovering) and C (hypnoanalysis).

A1. Pre-hypnotic interview, education and consent

Purpose: correct myths about hypnosis, establish motivation, screen for contraindications, and get informed consent. This is the opening of Wolberg's "first hypnotic session" sequence [source: Read Books Vol. 1 listing; content synthesis].
Steps:
1. Ask what the client has heard about hypnosis, including stage shows, fears of losing control and "truth serum" ideas.
2. Explain that hypnosis is focused attention plus heightened responsiveness, and that the client stays aware and can refuse any suggestion or stop.
3. Explain which level of work is planned and why.
4. Name the risks: temporary drowsiness, headache, strong emotion, and the chance that images or "memories" in trance feel real without being accurate.
5. Agree a stop signal.
6. Record consent.
Example language (illustrative):
- "You'll hear everything and you stay in charge. If you want to stop, just open your eyes or lift your hand."
- "Things that come up in trance can feel vivid. We'll treat them as meaningful, not as proof of what happened."
Watch for:
- wishes for magical cure, or for the therapist to take control
- fear of being made to reveal secrets
- legal motives, such as wanting to "remember" for a case. If so, decline uncovering work.

A2. Suggestibility (responsiveness) tests

Purpose: gauge responsiveness and give the client a safe first experience of suggestion. Medical Hypnosis Vol. 1 has a chapter on suggestibility tests [source: Read Books Vol. 1 listing]. [uncertain] Wolberg's specific tests are not described here.
Steps [synthesis]:
1. Use one or two simple waking ideomotor tasks, such as imagining the hands drawn together or one arm growing heavy, presented as a "warm-up" rather than a pass/fail test.
2. Note how much the client responds and how they feel about it.
3. Use the result to choose the induction style.
Example language (illustrative): "Just notice what your hands do as you imagine a gentle pull between them. Whatever happens is useful information."
Watch for: anxiety about failing (reframe: there is no failure), and over-compliance (deliberate movement to please).

A3. Induction

Purpose: establish trance. Vol. 1 has a chapter on "the technique of hypnosis" [source: Read Books Vol. 1 listing]. [uncertain] Wolberg's own induction methods are not described here; do not attribute any specific method to him.
Steps [synthesis; a standard eye-fixation/relaxation induction]:
1. Seat the client comfortably and ask them to fix their gaze on a point.
2. Suggest growing eyelid heaviness, paced to their blinking, and invite the eyes to close when ready.
3. Add progressive physical relaxation and slow breathing.
4. Use the client's own preferred imagery.
Example language (illustrative): "Let your eyes rest on that spot… as they get tired, they can close whenever they're ready, and your breathing can settle at its own pace."
Watch for:
- signs of trance: slowed breathing, reduced movement, facial smoothing, eyelid flutter
- distress, abreaction or a sense of losing control (pause and re-alert)

A4. Deepening and depth assessment

Purpose: deepen trance only as far as the task requires and estimate depth. Vol. 1 has a chapter on "the depth of trance" [source: Read Books Vol. 1 listing; iMusic Vol. 1 listing].
Wolberg's depth classification: five stages of susceptibility, namely waking, prehypnotic or hypnoidal, light trance, medium trance, and deep or somnambulistic trance. A Creighton University obstetric-hypnosis report (c. 1957) used "the generally accepted five divisions … as described by Wolberg", citing Medical Hypnosis Vol. 1 [source: Creighton report, p. 14]. [uncertain] Wolberg's observable criteria for each stage are not given here; do not attribute specific signs to him.
Steps [synthesis]:
1. Deepen with counting down, a descending staircase, or a calm place the client chooses.
2. Check depth with a simple ideomotor response, such as a finger signal or a felt heaviness in an arm, and note roughly which of the five stages fits (hypnoidal and light stages are enough for most work).
3. Accept light trance for symptom and supportive work. Deep (somnambulistic) trance is not required, and should not be sought for uncovering memories (see C8).
Example language (illustrative): "With each number I count from ten to one, you can let yourself drift a little further into comfort… and if you'd like to go deeper, let this finger lift."
Watch for: depth pursued for its own sake; spontaneous regression or dissociation (stop deepening, orient, re-alert).

A5. Re-alerting and debrief

Purpose: end the trance safely and process the experience [synthesis].
Steps:
1. Remove any suggestion not meant to persist, such as heaviness or numbness.
2. Count up with suggestions of alertness and well-being.
3. Check orientation (time, place).
4. Ask for the client's experience.
5. Do not let the client drive while drowsy.
Example language (illustrative): "As I count up to five you'll come back fully alert, clear-headed and comfortable, keeping whatever was useful."
Watch for: lingering drowsiness, headache, disorientation or upset. Re-induce briefly and re-alert more gradually, and stay until the client is oriented.

A6. Self-hypnosis training

Purpose: transfer skills and reduce dependence on the therapist. [uncertain] Not documented as a Wolberg technique in the sources used; included as a current [synthesis] standard.
Steps:
1. Teach a short self-induction: fixation, breath and a cue word.
2. Agree one or two personal suggestions drawn from the session.
3. Set a time limit and an exit count.
4. Plan daily practice of 5–15 minutes and review it each session.
Example language (illustrative): "Sit, breathe out slowly three times, say your cue word, give yourself your phrase, then count yourself back up from one to three."
Watch for: non-practice (see 5), use of self-hypnosis to avoid feelings, and intrusive imagery during practice (switch to grounding).

B1. Symptom removal by prestige (authoritative) suggestion

Purpose: relieve a circumscribed symptom directly, carried by the authority of the therapist relationship. Wolberg's illustrative case was enuresis [source: WorldCat Vol. 2; Slater review].
When: after medical assessment, for a recent, isolated, low-meaning symptom in a stable client. Not for symptoms that serve an important protective function [synthesis].
Steps [synthesis]:
1. Induction and light deepening (A3–A4).
2. Give a clear, specific, positively worded suggestion about the target behaviour, repeated in two or three phrasings.
3. Add a post-hypnotic cue linked to a daily routine.
4. Re-alert and debrief.
5. Repeat across sessions and track the symptom.
Example language (illustrative; enuresis-type target): "Each night your body will notice the signal of a full bladder and wake you in good time." Present-day permissive form: "…and you may be pleased to find your body learning to…"
Watch for:
- symptom return or a new symptom appearing (symptom substitution). If so, move to B3/C-level understanding.
- over-dependence on the therapist's authority. Build in self-hypnosis.

B2. Reassurance and persuasion under hypnosis

Purpose: strengthen confidence and correct mistaken beliefs, using the relaxed, receptive state as a supportive measure [source: Slater review lists reassurance and persuasion among uses].
Steps [synthesis]:
1. In the waking state, agree the realistic message, such as "palpitations in panic are not a heart attack".
2. In trance, restate it with calm imagery and ego-strengthening statements tied to the client's real abilities.
3. Debrief and link the message to homework.
Example language (illustrative): "You've already shown that you can handle this. Each time you remember that, the feeling can settle sooner."
Watch for: hollow reassurance that contradicts the client's experience, which loses credibility. Keep statements true and specific.

B3. Psychobiologic therapy with hypnosis (guidance and re-education)

Purpose: combine hypnosis with guidance, habit retraining and attitude change, without systematic uncovering. Wolberg's illustrative case was premature ejaculation [source: WorldCat Vol. 2].
Steps [synthesis]:
1. Do waking-state work first: psychoeducation, an agreed behavioural plan, and partner involvement where relevant.
2. In trance, rehearse the new behaviour in imagery with calm and mastery.
3. Give post-hypnotic cues for the real situation.
4. Review progress and adjust.
Example language (illustrative): "Picture yourself in that situation, breathing slowly, noticing early signals and choosing to pause, feeling steady and unhurried."
Watch for: medical contributors not assessed (refer); relationship conflict driving the symptom (shift towards couple work or C-level exploration).

B4. Hypnosis as an adjunct for psychosomatic and medical symptoms

Purpose: reduce the emotional and tension contributions to bodily symptoms. All three of Wolberg's Vol. 2 cases were psychosomatic: enuresis, premature ejaculation and headache [source: WorldCat Vol. 2]. Today's uses include procedural anxiety, pain, IBS, sleep and habit change [source: Wikipedia, Hypnoanalysis].
Steps [synthesis]:
1. Confirm a medical assessment, and liaise with the treating physician.
2. Agree that hypnosis is an add-on to medical treatment, not a replacement.
3. Use relaxation, comfort imagery and suggestions for coping (B1–B3).
4. Teach self-hypnosis (A6).
5. Never suggest away a symptom whose cause has not been assessed, such as new or changed headaches or pain.
6. Never present hypnosis as treating cancer or any other physical disease.
Example language (illustrative): "As the muscles of your neck and forehead soften, you can notice the discomfort becoming a little less important, while you keep following your doctor's plan."
Watch for: masking a symptom that needs medical review, and the client stopping medication. Re-refer if a symptom changes character.

C1. Structuring the hypnoanalytic course (regulating, spacing and dosing trance)

Purpose: combine psychoanalytic technique with hypnotic rapport for faster psychotherapy. Hypnotic sessions are regulated, spaced and dosed, which Glover called Wolberg's main technical advance [source: Glover 1946 review]. [uncertain] The actual schedule is not described here.
Steps [synthesis]:
1. Hold waking sessions on history, symptoms and current life problems.
2. Add a trance segment only for a defined purpose, such as exploring a feeling or a dream.
3. Keep trance segments short at first, and lengthen them only if the client integrates the material.
4. Follow each trance segment with waking discussion in the same session.
5. Insert purely waking sessions between trance sessions when material is intense.
Example language (illustrative): "Today let's use about ten minutes of trance to look at that tightness you mentioned, then talk about what came up."
Watch for: material arriving faster than the client can digest it, which shows as sleep disturbance, intrusive images or regression in functioning. If so, reduce the dose and return to stabilisation.

C2. Free association in trance

Purpose: loosen censorship so that thoughts, images and feelings linked to the conflict surface [source: Elsevier description names free association among the tools].
Steps [synthesis]:
1. Induce a light-to-medium trance.
2. Invite the client to report, aloud, whatever comes to mind about a named feeling or situation, without selecting.
3. Listen and reflect briefly, without leading questions.
4. Re-alert and explore the associations together in the waking state.
Example language (illustrative): "Just let whatever comes about that feeling come… words, pictures, sensations… and tell me about it as it comes."
Watch for:
- leading or suggestive questions such as "Did someone hurt you?". Never ask them.
- escalating distress (see 5)

C3. Hypnotically induced dreams

Purpose: use a suggested dream on a theme as projective material for understanding conflict [source: Elsevier description; Glover review list "dream induction"].
Steps [synthesis]:
1. In trance, suggest that the client may have a dream, now or that night, that helps them understand a named feeling or problem.
2. Ask them to describe it, or to record a night dream on waking.
3. In the waking state, work with its associations and meanings as you would with any dream.
Example language (illustrative): "In a moment you might have a dream, any kind of dream, that says something about that worry. When it's done, you can tell me about it."
Watch for: treating dream content as literal history (don't; dreams are symbolic); and frightening dreams. Ground the client, and offer a closing image of safety.

C4. Automatic writing

Purpose: let material the client cannot yet say aloud be expressed in writing during trance, then examined in the waking state [source: Elsevier description; Glover review].
Steps [synthesis]:
1. Agree beforehand what will happen to the writing (the client keeps it or decides about it).
2. In trance, suggest the hand may write freely about a topic.
3. Re-alert.
4. Let the client choose whether and when to read it.
5. Explore it as fantasy and meaning.
Example language (illustrative): "Your hand can write whatever it wants about that, and you can decide later whether to look at it."
Watch for: dissociative clients. Automatic writing can encourage dissociated functioning, so avoid it with them [synthesis]. Also watch for content taken as "hidden truth": reframe it as expression, not evidence.

C5. Hypnotic drawing

Purpose: nonverbal expression of feelings and conflicts in trance [source: Elsevier description lists hypnotic drawing].
Steps [synthesis]:
1. Provide paper and pens.
2. In light trance with eyes open, invite the client to draw whatever represents a feeling or situation.
3. Re-alert, then explore the drawing's colours, shapes and associations with the client as the expert on its meaning.
Example language (illustrative): "Let your hand draw how that feeling looks, without planning it."
Watch for: over-interpretation by the therapist. Let the client lead.

C6. Crystal and mirror gazing

Purpose: an imagery-projection method. The client gazes at a crystal or mirror in trance and reports the scenes or images they see, which are used as projective material [source: Elsevier description names crystal and mirror gazing]. [uncertain] Wolberg's procedure is not described here.
Today's equivalent [synthesis]: imagery on a mental "screen", with the client in control of a remote or a dimmer to distance the images.
Steps [synthesis]:
1. In trance, invite the client to imagine a screen and to let a picture form about a named feeling.
2. Ask them to describe it.
3. Let them shrink, dim or turn the image off at will.
4. Re-alert and explore the meaning.
Example language (illustrative): "On the screen, a picture may form about that feeling. You can make it smaller or turn it off any time."
Watch for: images being treated as factual scenes from the past (do not), and overwhelm (switch to safe-place imagery, then re-alert).

C7. Experimentally induced conflicts

Status: [uncertain] Glover lists "conflict" induction among Wolberg's devices and says it was not original to him [source: Glover 1946 review]. Its content is not described here. It belongs to a period tradition of suggesting a fictitious conflict in trance to study its effects.
Recommendation [synthesis]: do not use. Suggesting a made-up personal experience to a client implants a false memory-like belief. That is incompatible with current consent and memory-safety standards. No steps are given.

C8. "Recall of buried memories" and hypnotic regression

Status: one chapter of Hypnoanalysis (XVII) addresses "the recall of buried memories" [source: Elsevier TOC]. A related hypnoanalytic literature includes regression, the affect bridge (Watkins 1971) and Erickson and Kubie's protective suggestions with post-hypnotic amnesia [source: Wikipedia, Hypnoanalysis].
Recommendation [synthesis]: do not use hypnosis, regression or imagery to recover or verify memories. Kubie (1941) found that hypnosis can alter existing memories, and false memories are a listed side effect [source: Wikipedia, Hypnoanalysis]. Trance raises confidence without raising accuracy [source: Dinges, Orne et al., NCJRS abstract]. It can also contaminate testimony.
What to do instead [synthesis]:
- If trauma is suspected, use a phase-based trauma treatment: safety and stabilisation first, then a manualised memory-processing therapy in which the client is trained (for example trauma-focused CBT, prolonged exposure, cognitive processing therapy or EMDR), each with its own readiness criteria and in-session dosing.
- Hypnosis may be used only for stabilisation (calm place, ego-strengthening, grounding), not for uncovering.
If distressing memories surface spontaneously in trance [synthesis]:
1. Do not probe or ask for detail.
2. Acknowledge the feeling.
3. Offer distance ("you can watch from far away").
4. Ground and re-alert with an orientation check.
5. Debrief: what emerged is the client's experience now. Whether and how it happened is not something trance can settle.
6. Assess safety, and reduce or stop trance work until the client is stable.
Readiness criteria before any later memory processing, in whatever modality [synthesis]: stable living situation and no current abuse; no active suicidality or recent self-harm crisis; the client can use grounding to come back from distress; adequate support; and the client's informed choice.

C9. Working with transference under hypnosis

Purpose: recognise and use the client's feelings toward the hypnotist. These may be parental or authority feelings, such as compliance, longing, fear or anger [source: Elsevier TOC ch. XVIII; Slater review on the hypnotist as parent or superego figure]. Glover notes that Wolberg's method largely avoids transference, and leaves a transference neurosis essentially untouched if one develops [source: Glover 1946 review].
Steps [synthesis]:
1. Watch for shifts in trance responsiveness, such as sudden refusal or excessive eagerness, and treat them as signs of the relationship.
2. Name them gently in the waking state.
3. Link them to the client's patterns with other authority figures.
4. Keep the frame clear: no touch beyond what was agreed, no extra contact, documented sessions.
Example language (illustrative): "I noticed it was harder to settle today, right after we talked about your father's strictness. I wonder whether being guided by me stirs something similar."
Watch for:
- erotised or dependent transference. Maintain boundaries, and consider stopping trance work.
- a client who only improves "for" the therapist (fragile gains)

C10. Working with resistance

Purpose: understand blocks to trance or to material, rather than overpowering them [source: Elsevier TOC ch. XIX].
Steps [synthesis]:
1. When the client cannot enter trance, comes out spontaneously, goes blank or "forgets", stop pushing.
2. Ask what the client felt just before.
3. Explore fears, such as loss of control or what might emerge.
4. Offer a lighter, more permissive approach, or waking work.
5. Respect a no.
Example language (illustrative): "Something in you put the brakes on just then. That's worth listening to. What were you noticing?"
Watch for: confusing resistance with protective self-regulation in traumatised clients. The latter needs stabilisation, not interpretation.

C11. Interpretation and integration in the waking state

Purpose: make trance material usable in everyday life. Wolberg grounds suggestions in analytic interpretation and gives a chapter to hypnosis and interpretation [source: Glover review; Elsevier TOC ch. XX].
Steps [synthesis]:
1. After trance, ask the client what they make of what emerged.
2. Offer tentative interpretations linking feelings, symptoms and current relationships.
3. Translate insight into a concrete change to try before the next session.
4. Revisit it next time.
Example language (illustrative): "It seems that when you feel criticised, the headache steps in where anger might be. What would it be like to notice that this week?"
Watch for: intellectual agreement without change. Return to experience and behaviour.

C12. Patient journal between sessions

Purpose: keep track of daily experience, dreams and reactions during treatment. Hypnoanalysis reproduces the patient's own journal and daily experiences from the Johan R. case [source: Elsevier description].
Steps [synthesis]:
1. Invite brief daily notes on mood, symptom, dreams and reactions to sessions.
2. The client chooses what to bring.
3. Review selected entries at the start of each session.
Example language (illustrative): "A few lines a day is plenty. Just what you felt, any dreams, and anything from our sessions that stayed with you."
Watch for: journalling that becomes rumination or self-criticism. Shorten it, or add a 'what helped today' line.

5. Handling problems

The sources used name resistance and transference as central topics [source: Elsevier TOC ch. XVIII–XIX]. They also note Wolberg's opposition to non-medical and entertainment use [source: Slater review]. Glover warns that untrained therapists using these devices would be haphazard and unreliable [source: Glover 1946 review]. Everything else below is [synthesis].

Client cannot enter trance or responds weakly [synthesis]
- Normalise it: responsiveness varies, and light trance is enough for most work.
- Switch from a directive to a permissive induction, use the client's own imagery, or shorten the session.
- Explore fears (C10).
- If the client still doesn't respond, continue the same goals with waking techniques.
Fear of losing control [synthesis]
- Give the client control explicitly: a stop signal, eyes open, and self-hypnosis first, with the therapist only coaching.
Stuck: the symptom improves, then returns or is replaced by another [synthesis]
- Treat this as information that the symptom serves a function.
- Move from B1 to B3 or C-level understanding, and review life stressors and secondary gain without blame.
Resistance in hypnoanalysis (blanking, forgetting, coming out of trance) [source: Elsevier TOC ch. XIX names the topic; responses synthesis]
- Don't override it with stronger suggestion.
- Explore it in the waking state (C10). Reduce the trance dose.
Overwhelm, abreaction or dissociation in trance [synthesis]
1. Stop the exploratory suggestion.
2. Speak calmly and give present-time orientation: name, place, date, feet on the floor.
3. Use distancing ("see it far away, on a small screen") or switch to the safe place.
4. Re-alert gradually and check orientation.
5. Ground with the senses (name things you see and hear) and slow breathing.
6. Don't end the session until the client is oriented and settled.
7. Assess risk.
8. Revert to stabilisation-only work and review whether uncovering is appropriate at all.
Spontaneous "memories" or "recovered" abuse material [synthesis]
- Neither confirm nor dismiss it. Say that trance can't establish what happened.
- Focus on present safety and feelings.
- Document neutrally, and don't coach or reinforce details.
- Avoid further trance work on the theme.
- If the client is considering legal action, advise that trance work can affect their testimony and stop hypnosis on the topic.
- Follow mandatory reporting duties where current risk to others, such as children, is disclosed.
Difficulty re-alerting, or lingering drowsiness or headache [synthesis; side effects listed in Wikipedia, Hypnoanalysis]
- Re-induce briefly, remove any lingering suggestions, re-alert slowly with energising suggestions, and keep the client until fully alert.
- Advise against driving if the client remains drowsy.
Non-adherence with self-hypnosis or the journal [synthesis]
- Shorten the task to 2–5 minutes and tie it to an existing routine.
- Explore what gets in the way, such as boredom, intrusive feelings or doubt about effectiveness.
- Use a recording of the client's own agreed suggestions if that suits them.
Ruptures: feeling manipulated, criticised or "controlled" [synthesis]
- Acknowledge the client's experience and take your part in it.
- Revisit consent, adjust to more permissive language, and link the reaction to the transference only after it has been repaired (C9).
Excessive dependence or idealisation ("only you can fix me") [source: Slater review on the parental/superego role; response synthesis]
- Shift the work toward self-hypnosis and the client's own agency.
- Space out sessions, and plan termination explicitly.
Erotised transference or boundary pressure [synthesis]
- Keep the frame strict: no touch, a chaperone or recording if appropriate, and clear documentation.
- Discuss it in supervision. Stop trance work if it cannot be managed.
Medical symptom changes during treatment [synthesis]
- Pause symptom suggestions and refer back to the physician.
- Never use hypnosis to delay or replace medical treatment.
Client wants hypnosis to "find out what happened" [synthesis]
- Decline uncovering work.
- Explain the memory-contamination risk.
- Offer an evidence-based trauma pathway (C8) or a focus on current effects.
Clinician competence limits [source: Glover review warning; Slater review on professional restriction]
- Use only procedures you are trained and licensed for. Seek supervision from a clinical hypnosis society, such as one affiliated with ASCH, SCEH or ISH [synthesis].

Sources

Web sources:

Further web sources:

Books and papers cited:

Wolberg, L. R. (1945). Hypnoanalysis. New York: Grune & Stratton (London: Heinemann, 1946; 2nd ed. 1964; reissue 2013).
Wolberg, L. R. (1948). Medical Hypnosis, Vol. 1: The Principles of Hypnotherapy; Vol. 2: The Practice of Hypnotherapy. New York: Grune & Stratton.
Wolberg, L. R. (1954). The Technique of Psychotherapy. New York: Grune & Stratton.
Watkins, J. G. (1971). The affect bridge: a hypnoanalytic technique. International Journal of Clinical and Experimental Hypnosis, 19(1). Cited via Wikipedia [uncertain: secondary].
Kubie, L. S. (1941) and Erickson & Kubie (1941). Cited via Wikipedia [uncertain: secondary].

[uncertain] Wolberg's own induction wording, suggestibility tests, observable criteria for each of his five depth stages, session scheduling and the content of "conflict induction" are not described in this guide, because the books' full texts are not publicly available. The five-stage depth classification itself is sourced (A4).

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