Clinical hypnotherapy

1. Introduction

Version followed: generic clinical hypnosis as defined by the Society of Psychological Hypnosis (APA Division 30) revised definition (Elkins et al., 2015) and as taught in the American Society of Clinical Hypnosis (ASCH) Level I curriculum and its Participant Resource Guide (ASCH-ERF, revised January 2019), supplemented by a BSCAH-trained clinician's published practice account (Booth, 2020). SCEH, BSCAH and ESH standards documents are not drawn on here [uncertain].

What it is. Clinical hypnotherapy is not a stand-alone school of therapy; it is the use of hypnosis, by a licensed health professional, inside a treatment the clinician is already competent to deliver. Division 30 defines hypnosis as a state of consciousness involving "focused attention and reduced peripheral awareness" with an enhanced capacity to respond to suggestion, and hypnotherapy as the use of hypnosis to treat a medical or psychological disorder or concern [source: ASCH, Keating slides quoting Division 30; Elkins et al., 2015 abstract]. The 2015 paper also defines hypnotic induction and hypnotizability; its full text is not drawn on, so those definitions are not reproduced here [uncertain]. The earlier (2005) Division 30 definition described the induction as an extended initial suggestion to use one's imagination, followed by suggestions for changes in experience, perception, sensation, emotion, thought or behaviour, and noted that people can learn self-hypnosis [source: Wikipedia summary of 2005 definition, secondary].

How change is thought to happen. Two phases: an induction that builds absorption, readiness to respond and (usually) relaxation, then suggestions that target perceptual, cognitive, emotional or ideomotor processes [source: Landry et al., 2018]. ASCH training frames hypnosis as a state of absorption linked to neuroplasticity and change and as a relational clinical skill [source: ISSTD page on ASCH training]. Change is consolidated by post-hypnotic suggestions and self-hypnosis practice that the client owns, with the overall aim of greater self-regulation and autonomy [source: ASCH Resource Guide; Keating slides]. Hypnotizability is a fairly stable trait, while attitudes and expectations are socially shaped and can be worked with [source: Landry et al., 2018].

Who may use it. ASCH training is restricted to people with a master's degree or higher in a health discipline and a state licence or certification (and RNs, graduate students and residents under conditions) [source: ISSTD/ASCH training page]. BSCAH offers accredited UK training for clinicians; non-clinical hypnosis practice has no regulated qualification [source: Booth, 2020]. Stage hypnosis is not a clinical method: it cannot provide adequate safeguards, and serious adverse reactions (including a first psychotic episode) have followed it [source: Gruzelier, 2000 record].

2. Framework

Clinical hypnosis has no fixed protocol length; sources describe a repeatable session structure nested inside the clinician's own treatment plan. [source: ASCH Level I curriculum; ASCH Resource Guide; Booth, 2020]

Phase A: Assessment and preparation (usually first 1 to 2 sessions, no formal hypnosis or a brief trial).

Goals: full clinical history and formulation; check that hypnosis fits the goal and the person; screen for contraindications; correct misconceptions; obtain informed consent; collect imagery material (interests, occupation, preferred places, preferred colours, stairs vs lift) [source: Booth, 2020; ASCH curriculum "Assessment and informed consent"].
Move on when: the problem is one you treat without hypnosis, no contraindication is present (or it has been managed), the client understands what hypnosis is and is not, and consents freely [synthesis, built on Booth 2020 and ASCH consent elements].

Phase B: The formal hypnotic encounter (repeated each session). ASCH teaches it as a sequence [source: ASCH curriculum "Anatomy of the hypnotic experience"; Resource Guide treatment-plan template]:

Rapport and attunement.
Induction (elicitation of trance).
Intensification (deepening).
Therapeutic work: ego strengthening, imagery, hypnotic phenomena, symptom-focused suggestions.
Post-hypnotic suggestions and cues for use in daily life.
Removal of any suggestions not meant to persist, then reorientation (re-alerting).
Processing the experience with the client (debrief).

Session length: one secondary source gives 30 to 60 minutes [source: Davis, 2024, secondary; uncertain].
Move on within the session when you see signs of absorption (ASCH teaches four physiological and four psychological signs; the specific lists were not in the opened outline [uncertain]) or the client reports it when asked.

Phase C: Self-hypnosis and consolidation (from the first or second hypnotic session onward). Teach a short self-induction and the cue(s) planted in session; give recordings if useful; ask for regular practice and as-needed use [source: Booth, 2020; ASCH curriculum "Self-hypnosis"].

Move on when the client can enter and leave hypnosis alone and reports using the cues in daily life [synthesis].

Phase D: Review and integration. Review progress, individualise inductions and imagery over later sessions, and fold hypnotic communication into the wider treatment (for anxiety: alongside CBT, biofeedback and psychoeducation) [source: Booth, 2020; ASCH Resource Guide anxiety plan]. Number of sessions: not specified by the sources [uncertain]; base it on the parent treatment and the client's response [synthesis].

Training ladder. ASCH Level I covers inductions (at least three), intensification (at least three strategies), reorientation and basic applications; Level II adds ideomotor signalling, an introduction to ego-state therapy, work with children, trauma, habits, anxiety and somatic problems including pain [source: ISSTD/ASCH training page]. Level II topics are not covered as full procedures here.

3. Guiding principles

Hypnosis is an adjunct within your competence. Use it only for problems you are trained to treat without it; sort uses you are ready for from those needing more training [source: ASCH curriculum Day 4; Booth, 2020].
Voluntary and client-controlled. Hypnosis needs a willing participant, cannot be used against someone's will, and the person can end trance at will [source: ASCH Resource Guide consent material]. Practical meaning: say so out loud before every first induction.
Never persuade. Offer it like any other option; a client may decline now and accept later [source: Booth, 2020].
Permissive over authoritarian. In most circumstances permissive wording is preferred [source: Keating, ASCH]. Practical meaning: "you may notice", "allow", "I wonder" rather than commands.
Individualise and utilise. Build suggestions from the client's own words, strengths, interests, goals and responses (Erickson's principle as taught by ASCH) [source: ASCH curriculum; Resource Guide].
Positive but honest language. Frame suggestions positively and avoid wording that undermines confidence, without promising outcomes [source: Booth, 2020; ASCH Resource Guide].
Ask, don't assume. If little change is visible, ask the client what they experienced [source: ASCH Resource Guide].
Pace, then lead. Match the client's breathing and rhythm before suggesting change [source: ASCH Resource Guide].
Build autonomy and self-regulation. The goal is the client becoming "a better boss" of brain and body (paediatric framing) [source: Keating, ASCH]. Practical meaning: every course ends with self-hypnosis skills.
Remove what should not persist. Take away temporary suggestions (heaviness, numbness, imagery) before reorienting [source: ASCH curriculum "importance of removing suggestions"].
Memory is fallible. Hypnosis does not make recall more accurate and can raise confidence in false memories; avoid leading questions and use regression and imagery with caution [source: ASCH curriculum; Leo et al., 2025]. Practical meaning: never use hypnosis to find out "what really happened".
Medical problems stay in medical care. Symptom work (pain, nausea, hot flushes) is offered alongside the medical team's treatment, after medical assessment, never instead of it [synthesis, consistent with Booth's palliative-care practice].
Disclose and monitor adverse effects. Unwanted effects are common but mostly brief; serious ones are rare and occur mainly in clinical and stage settings [source: Gruzelier, 2000 record]. Practical meaning: ask about after-effects at every next session.

4. Intervention inventory

All example wording below is my own illustrative paraphrase, not ASCH or founder scripts. Inductions named are those in the ASCH Level I curriculum and Resource Guide (breathing, eye fixation, eye roll, arm levitation and reverse levitation, sand bucket) plus those in Booth (2020).

4.1 Assessment and suitability screening

Purpose / when: before any hypnosis; decides whether, and how, to use it.
Steps: (1) Take a full clinical history and formulation as you would without hypnosis; focus on psychosocial situation, symptoms, priorities and previous treatments [source: Booth, 2020; ASCH curriculum "comprehensive case assessment"]. (2) Screen: current delusions or hallucinations and active drug or alcohol misuse are reasons not to proceed [source: Booth, 2020]; a history of psychosis is a strong caution, given published first-episode cases after hypnotherapy and stage hypnosis [source: Gruzelier record]; severe personality disorder and significant cognitive impairment are listed as cautions by a secondary source [source: Davis, 2024; uncertain]. Added cautions [synthesis]: severe or poorly understood dissociation (refer to or consult a clinician trained in dissociative disorders); untreated trauma when any regression or exploratory work is contemplated; seizure disorder (Gruzelier lists seizure among rare serious outcomes); acute suicidality (stabilise first); forensic involvement (see 4.3). (3) Note imagery material: hobbies, work, places, sensory preferences, colours for calm and for fear, stairs or lift [source: Booth, 2020]. (4) Check motivation and expectations.
Example language (illustrative): "Before we decide whether hypnosis would help, I'd like to understand what you're dealing with and what you've tried. Can you tell me about a place, real or imagined, where you feel at ease?"
Watch for: unusual beliefs about hypnosis (mind control, being "put under"), wish to recover memories, pressure from others to try it, or poor reality testing; any of these changes the plan.

4.2 Psychoeducation and correcting misconceptions

Purpose / when: first session; reduces fear and builds positive, realistic expectancy.
Steps: (1) Explain hypnosis in everyday terms, for example as the absorption of being lost in a book and not noticing someone come in [source: Booth, 2020, citing Friedrichsdorf & Kohen]. (2) Address control: hypnosis is not handing control to someone else; the client can stop at any time and will come out of trance even if the clinician does not bring them out [source: Booth, 2020; ASCH Resource Guide]. (3) Address common fears raised in ASCH teaching (mind control, being made to do embarrassing things) [source: Keating, ASCH]. (4) Contrast with stage hypnosis [synthesis]. (5) Explain that memories in hypnosis are not more accurate [source: ASCH curriculum; Leo et al., 2025]. (6) Give written information [source: Booth, 2020].
Example language (illustrative): "Hypnosis is a focused, absorbed kind of attention, a bit like being lost in a film. You stay aware, you can hear me, and you can open your eyes and stop whenever you like. I can't make you do anything you don't want to do."
Watch for: relief and curiosity (good); lingering fear of losing control (spend longer here, start with an eyes-open breathing exercise).

4.3 Informed consent

Purpose / when: before the first induction; record in notes.
Steps: Cover the elements ASCH consent material includes: participation is voluntary; the person can end trance at will; alternatives exist and they may decline; exploratory procedures may stir up emotional distress; in some jurisdictions recollections after hypnosis may make testimony inadmissible, and the only full protection is to avoid hypnosis [source: ASCH Resource Guide]. Add [synthesis]: that you will not try to uncover memories; how sessions may be recorded; that self-hypnosis practice is expected.
Example language (illustrative): "If there's any chance you'll give evidence in a court case about events in your life, hypnosis could affect that, so we should talk it through before going ahead."
Watch for: pending legal cases or police statements (consider deferring hypnosis or getting legal advice).

4.4 Rapport, attunement and pacing

Purpose / when: the opening of every formal encounter.
Steps: (1) Settle the environment: comfortable chair or couch, lower lights if possible, ask not to be disturbed, note the time [source: Booth, 2020]. (2) Observe the client's breathing and pace your words to the out-breath, pausing between breath cycles [source: ASCH Resource Guide]. (3) Use non-verbal cues: a long audible exhalation, a nod on the exhale, a gradually lowered voice; touch (such as a light hand on the shoulder) only with prior explicit permission [source: ASCH Resource Guide; permission rule is synthesis]. (4) Lead once matched.
Example language (illustrative): "Just notice your breathing as it is... and each time you breathe out, you can let a little more of the day go."
Watch for: breathing slowing in step with your voice.

4.5 Induction: focused (diaphragmatic) breathing

Purpose / when: a gentle first induction; suits anxious clients; doubles as a self-hypnosis skill.
Steps: (1) Ask the client to rest their palms on the belly and notice the breath low in the abdomen. (2) Pair words with breath: comfort and release on the out-breath. (3) Optionally add a two-part cue word split across in- and out-breath, and a counted rhythm with a longer out-breath than in-breath. (4) Frame the breath as something they can use any time. [source: ASCH Resource Guide, credited to L. Thomson]
Example language (illustrative): "Feel your hands rise as you breathe in... and settle as you breathe out. Let the out-breath be a little longer, as if the body is letting go of something it doesn't need."
Watch for: abdominal movement, muscle release on exhale; if the client feels short of breath, drop the counting.

4.6 Induction: eye fixation

Purpose / when: a classic, easy-to-follow induction.
Steps: (1) Client picks a spot to look at. (2) Suggest that the surrounding area may blur or seem to move and that absorption grows with each out-breath. (3) Suggest the eyes may close whenever they're ready. (4) Optionally suggest one part of the mind can listen while another drifts, then invite them to imagine a place. [source: ASCH Resource Guide, credited to D. Reid]
Example language (illustrative): "Keep your eyes on that spot... you might notice the edges softening... and your eyelids can close whenever they want to."
Watch for: steady gaze, blinking, eye closure; respond to whatever happens.

4.7 Induction: eye roll (rapid)

Purpose / when: quick elicitation once the client knows hypnosis; basis for brief self-hypnosis.
Steps: (1) Look upward. (2) Close the lids while holding a deep breath. (3) On a count of three, let the eyes relax, release the breath, and float into a comfortable inner space while the clinician's voice drops. (4) Mirror the breathing and pair it with calm and strength. [source: ASCH Resource Guide; ASCH curriculum]
Example language (illustrative): "Look up... close your eyes and take a deep breath and hold it... and on three, let the breath go and let yourself drift."
Watch for: eyelid flutter, breath release; avoid with eye conditions or discomfort [synthesis].

4.8 Induction: arm levitation and reverse levitation (ideomotor)

Purpose / when: demonstrates involuntary-feeling responses; builds expectancy and gives visible ratification.
Steps: (1) Both arms out in front. (2) Imagine a heavy book on one upturned palm and a helium balloon tied to the other wrist. (3) With permission, use light touch to signal direction (down for the book, up for the balloon). (4) Add a second, heavier book. (5) Let eyes close; the heavy arm drifts down, the balloon arm may stay up as the person goes inward. [source: ASCH Resource Guide, credited to L. Thomson; ASCH curriculum names arm levitation and reverse levitation]
Example language (illustrative): "Notice how the hand with the book wants to sink... while the other wrist feels the balloon tugging upward, all by itself."
Watch for: arm movement or report of heaviness or lightness; no movement does not mean no experience, so ask [source: ASCH Resource Guide]. Remove heaviness and lightness before re-alerting.

4.9 Induction: sand bucket (heavy arm)

Purpose / when: alternative ideomotor induction; good for visual and kinaesthetic clients.
Steps: (1) Arms out, eyes closed. (2) Imagine an empty pail hanging from one wrist. (3) Describe sand being shovelled in, with sound and growing weight; add wet sand. (4) Continue until the arm nears the lap; invite the other arm to relax too. (5) Dissolve the bucket and let tension drain out through the fingertips; breathe and rest. [source: ASCH Resource Guide, modified from a 2002 West Virginia University workshop]
Example language (illustrative): "Each scoop makes the pail a little heavier... and the arm can just follow that weight down, at its own pace."
Watch for: gradual descent; shoulder strain in people with musculoskeletal pain (let the arm rest at once) [synthesis].

4.10 Induction: colour breathing into a special place

Purpose / when: individualised induction in medical and palliative settings; good for anxiety and panic.
Steps: (1) Beforehand, collect the client's special place (real, remembered or imagined, with sensory details, who is there) and two colours, one for calm and one for fear or stress. (2) Breathe in the calm colour and out the fear colour while relaxation spreads through the body area by area. (3) Travel into the special place by stairs, lift or floating, as the client prefers. (4) Alternative rhythms: a swing, blowing bubbles, waves. (5) Adjust over later sessions. [source: Booth, 2020]
Example language (illustrative): "Breathe in your blue... and as you breathe out, let the grey drift away... and let that calm spread down through your shoulders and arms."
Watch for: the chosen place turning unpleasant (switch places or open eyes and talk; see section 5).

4.11 Intensification (deepening)

Purpose / when: after induction, to strengthen absorption before therapeutic suggestion.
Steps: Options in the sources: imagined descent by staircase, lift or floating [source: Booth, 2020; Landry et al., 2018]; repeated "deeper" suggestions with pauses [source: ASCH Resource Guide]; fractionation, named in ASCH teaching as a deepening method [source: ASCH curriculum]. Fractionation steps, as generally practised: briefly re-alert, then re-induce, repeating a few times, with each return suggested to go further [synthesis; ASCH's own steps not drawn on, uncertain]. Use counting with descent if the client likes it [synthesis].
Example language (illustrative): "As I count down from ten, you might imagine going down a gentle staircase, each step letting you settle a little further."
Watch for: slower breathing, stillness, facial smoothing; avoid stairs or lifts with a client who fears them (ask beforehand) [source: Booth asks preference; synthesis].

4.12 Ratification of trance

Purpose / when: throughout; confirms the experience to the client and builds expectancy.
Steps: Notice, comment on and use changes you observe (breathing, arm movement, stillness); connect suggestions to them with linking words such as "as", "when" and "and"; if little is visible, ask afterwards [source: ASCH Resource Guide]. Afterwards, time distortion reported by the client can be fed back as a sign of good absorption [source: Booth, 2020].
Example language (illustrative): "That's right... and as your breathing slows, you can notice how comfortable your hands feel."
Watch for: over-claiming; describe only what you saw.

4.13 Constructing therapeutic suggestions

Purpose / when: the core skill behind every suggestion in 4.14 to 4.21.
Steps: (1) Decide direct, indirect or mixed suggestion [source: ASCH curriculum; Resource Guide]. (2) Prefer permissive framing ("allow", "perhaps", "I wonder") [source: ASCH Resource Guide; Keating]. (3) Phrase positively, toward what the client wants [source: ASCH Resource Guide; Booth, 2020]. (4) Use the client's own words, goals and strengths (individualisation and utilisation) [source: ASCH]. (5) Use introductory words such as notice, allow, imagine, soon, and link suggestions to observed responses [source: ASCH Resource Guide]. (6) Shift toward dissociative language and a sense that responses happen by themselves; build anticipation; repeat key suggestions; reinforce with brief affirmations [source: ASCH Resource Guide]. (7) Adapt in real time to what the client does [source: ASCH Resource Guide]. Match style (authoritarian vs permissive) to the client [source: Landry et al., 2018, citing Yapko].
Example language (illustrative): direct: "Your shoulders are loosening now." Permissive: "I wonder which part of you will notice the comfort first."
Watch for: negative embedded wording ("don't feel anxious") and leading wording about the past; rephrase.

4.14 Ego strengthening

Purpose / when: in almost every session, after deepening; builds confidence, coping and a sense of mastery. ASCH teaches its definition, three types and three strategies, including simple person-specific suggestions [source: ASCH curriculum]; the three types were not named in the opened outline [uncertain].
Steps: (1) Draw on strengths and resources gathered in assessment. (2) Suggest the client has inner resources they may not have recognised, including the ability to steer thoughts, feelings and actions and to tolerate difficult people or situations. (3) Invite them to picture a future self using these resources. (4) Pace with pauses; individualise. [source: ASCH Resource Guide]
Example language (illustrative): "You've already come through a great deal... and the same strength that carried you then is available to you now, in ways you may only start to notice in the days ahead."
Watch for: generic praise the client rejects; anchor suggestions in real evidence from their life.

4.15 Special (safe) place as a resource

Purpose / when: stabilisation, anxiety, a base for other imagery; also the destination in 4.10.
Steps: (1) Use the client's chosen place with full sensory detail. (2) Let them explore it and notice calm. (3) Link the place to a cue (breath, word, gesture) for later use (see 4.21). [source: Booth, 2020; ASCH Resource Guide lists a place of calm and comfort as a treatment-plan anchor]
Example language (illustrative): "Notice what you can see there... the sounds... the temperature of the air... and let yourself just be there for a while."
Watch for: intrusions of distressing material; change the place or move to grounding.

4.16 Symptom-focused imagery (medical adjunct)

Purpose / when: pain, hot flushes, nausea, breathlessness or anxiety around procedures, offered alongside medical treatment after medical assessment, never as a replacement and never as a treatment for the disease itself [synthesis frame].
Steps: Use imagery chosen with the client: pain as a circuit with a gate or barrier that can be closed; cooling images such as a waterfall or ice for hot flushes [source: Booth, 2020]; a protective glove over a painful area, studied as a visual strategy for changing pain perception [source: Landry et al., 2018, citing Fardo et al., 2015]. Then link the image to a post-hypnotic cue (4.21).
Example language (illustrative): "Imagine the place where the pain signal travels... and somewhere along it there is a gate... and you can notice it beginning to close, just a little."
Watch for: any new, changed or worsening symptom: refer back to the medical team rather than suggesting it away [synthesis].

4.17 Control dial (thermostat) imagery

Purpose / when: gives a sense of control over pain, fear or nausea that can be used after the session.
Steps: Invite the client to find an internal control (a thermostat, dial or switch) linked to the symptom; rate it; turn it down slowly; rehearse using it after trance [source: Booth, 2020].
Example language (illustrative): "Find the dial for that feeling... notice what number it's on... and see if you can ease it down by one."
Watch for: if it won't move, accept any small shift and praise the effort.

4.18 Toolbox of resources

Purpose / when: coping preparation for difficult periods.
Steps: Invite the client to imagine a box or bag containing what they need to cope (qualities, memories, people, objects), choose items and practise reaching for them [source: Booth, 2020].
Example language (illustrative): "Imagine opening a box that holds everything you need for the week ahead... and notice what you find inside."
Watch for: an empty box; offer to fill it together from strengths discussed earlier.

4.19 Older, wiser self

Purpose / when: perspective and self-advice in decisions or distress.
Steps: Invite the client to meet an older, wiser version of themselves and ask for advice; the content can stay private [source: Booth, 2020].
Example language (illustrative): "Imagine meeting a version of yourself who is older and wiser... and you can ask what they'd like you to know. You don't need to tell me what they say."
Watch for: harsh or critical figures; redirect to a kind presence.

4.20 Future rehearsal and future pacing

Purpose / when: before feared events (procedures, chemotherapy, exams, phobic situations); consolidating gains.
Steps: (1) In hypnosis, the client rehearses the coming event step by step while using their calm cue. (2) Have them imagine a positive future self and practising skills between sessions; use phrases that link the response to "any time in the future" [source: Booth, 2020; ASCH Resource Guide].
Example language (illustrative): "Picture yourself arriving at the clinic next week... taking that slow breath... and noticing how much steadier you feel than you expected."
Watch for: rising distress during rehearsal: step back to an earlier point or the special place.

4.21 Post-hypnotic suggestions and cues (anchors)

Purpose / when: carries in-session responses into daily life.
Steps: (1) Choose a cue from everyday life or a deliberate signal (a breath, word or gesture). (2) In hypnosis, link the cue to the benefit. (3) Rehearse. (4) Check its use at next session. [source: Booth, 2020; ASCH Resource Guide; Leo et al., 2025 describe anchors]
Example language (illustrative): "From now on, whenever you switch on your computer, you can take a breath and remember how to turn that dial down."
Watch for: suggestions that could act at the wrong time (sleepiness while driving): limit cues to safe settings [synthesis].

4.22 Ideomotor signalling (advanced, ASCH Level II)

Purpose / when: ASCH teaches it as an exploratory strategy at Level II [source: ISSTD/ASCH training page]; Level I clinicians should not use it unsupervised. The detailed ASCH method is not drawn on here [uncertain].
Steps (general structure, synthesis): with consent, agree finger signals for yes, no and not ready to answer; ask simple questions about readiness, comfort and preferences; respect not-ready signals.
Example language (illustrative): "You might let one finger lift to mean yes."
Watch for: never use signals to confirm or discover past events; this risks building false memories [source: Leo et al., 2025; ASCH curriculum on memory fallibility].

4.23 Removing suggestions and reorientation (re-alerting)

Purpose / when: end of every hypnotic segment.
Steps: (1) Remove suggestions not meant to last (heaviness, lightness, numbness, imagery such as the bucket or books) [source: ASCH curriculum; Resource Guide]. (2) Restate the post-hypnotic cues that should stay. (3) Guide gradually back to the room, eyes opening when ready, feeling refreshed and alert; a count of three-two-one may be used [source: ASCH Resource Guide; Booth, 2020]. (4) ASCH teaches three reorientation methods; only the gradual and counted methods appear in the sources [uncertain].
Example language (illustrative): "In a moment I'll count from one to three... and you can bring back the calm, leaving the heaviness behind... eyes opening when you're ready, clear and awake."
Watch for: drowsiness, disorientation or headache: see section 5.

4.24 Processing the experience (debrief)

Purpose / when: immediately after reorientation, every session.
Steps: Ask what they experienced; ask rather than assume; note time distortion and other phenomena; check for any unpleasant effects; plan practice [source: ASCH Resource Guide; Booth, 2020; Davis 2024 lists a post-hypnotic discussion step, secondary].
Example language (illustrative): "What was that like for you? How long do you think we were working?"
Watch for: distress, confusion, or not being fully alert; do not let a client drive until fully alert [synthesis].

4.25 Teaching self-hypnosis and using recordings

Purpose / when: from early in treatment; makes gains portable and builds self-regulation.
Steps: (1) Explain the difference between self-hypnosis and clinician-led hypnosis [source: ASCH curriculum]. (2) Teach a short induction (breathing or eye roll) and a self-exit. (3) For intrusive symptoms such as hot flushes, teach a rapid version without a long induction [source: Booth, 2020]. (4) Ask for regular practice, like a prescribed treatment, plus as-needed use; a personalised recording (e.g. on their phone) can help; relatives may learn it too [source: Booth, 2020]. (5) Review at each session.
Example language (illustrative): "Each day, find five minutes: look up, breathe in and hold, then let go and go to your place. When you're ready, count yourself back from one to three."
Watch for: practice dropping off (see section 5); recordings played while driving (forbid) [synthesis].

4.26 Adapting for children

Purpose / when: paediatric practice by clinicians trained with children.
Steps: Use the child's interests and imagination; permissive language; frame the aim as the child becoming the boss of their brain and body; vary approach by age [source: Keating, ASCH; ASCH curriculum "Hypnosis with children"]. Detailed age-specific methods are [uncertain].
Example language (illustrative): "You get to be the boss of your body. Shall we find the switch for that tummy ache?"
Watch for: parental consent and child assent; keep eyes-open options.

4.27 Treatment planning and integration

Purpose / when: after assessment and periodically.
Steps: Write a plan specifying goals, chosen induction, intensification, therapeutic techniques (e.g. special place, ego strengthening, future self), post-hypnotic suggestions, reorientation, processing and homework; combine with other treatments (for anxiety: CBT, biofeedback, psychoeducation) [source: ASCH Resource Guide; ASCH curriculum Day 4]. Ego-state therapy and trauma applications belong to Level II and beyond and are not described here [source: ISSTD/ASCH page].
Example language (illustrative): "Here's our plan: we'll use breathing to settle, your beach to calm, and a cue you can use before meetings."
Watch for: hypnosis drifting into a substitute for the evidence-based core treatment [synthesis].

5. Handling problems

The sources name several of these problems (abreaction, adverse effects, memory risks, fear of losing control) but give few step-by-step responses; most responses below are my own synthesis and are marked.

"Nothing happened" / low visible response. Ask about the experience rather than assume none occurred [source: ASCH Resource Guide]. Hypnotizability varies and is fairly stable, while expectations can be shaped [source: Landry et al., 2018]. Response [synthesis]: switch to an induction that fits the client (ideomotor for kinaesthetic people, eyes-open breathing for people who dislike closing their eyes), lower the bar to "focused relaxation", and keep the useful parts (breathing, imagery, cues), which still work as relaxation and imagery skills.
Trying too hard or over-analysing. [synthesis] Use permissive wording and give the analytic mind a task ("part of you can listen while another part drifts", which ASCH eye-fixation material uses) [source for the split-attention idea: ASCH Resource Guide].
Fear of losing control. Repeat that the client is in charge and can stop any time; they will come out of trance on their own [source: Booth, 2020; ASCH Resource Guide]. [synthesis] Start eyes open, keep sessions short, let the client re-alert themselves to prove control.
Abreaction (sudden strong emotion) or flooding. ASCH Level I teaches abreaction and its therapeutic handling; the specific ASCH steps are not drawn on here [uncertain]. Exploratory procedures may cause emotional distress, which belongs in consent [source: ASCH Resource Guide]. Response [synthesis]: stay calm and slow; acknowledge the feeling; suggest distance ("watch it from further away") or move to the special place; if not settling within a minute or two, re-alert gently, ground (feet on floor, name objects in the room, slow breathing), and talk in the waking state. Do not push for more detail. Review the plan before the next session; strengthen stabilisation before any further work.
Spontaneous dissociation or trauma memories surfacing. Resurfacing of past trauma (usually with age regression) and spontaneous dissociative episodes are among rare serious outcomes [source: Gruzelier record]. Response [synthesis]: re-alert and ground as above; treat whatever surfaced as the client's present experience, not as a verified historical fact; do not use further hypnosis to clarify it; assess dissociation and trauma history, and refer or consult a trauma or dissociation specialist. Any later trauma processing should follow a trauma model with readiness criteria, stabilisation first and dosing within sessions, not generic hypnosis.
Requests to recover or check memories. Decline. Hypnosis and imagery can create pseudomemories and raise confidence in them; leading questions and long regression add risk [source: Leo et al., 2025; ASCH curriculum on fallibility of memory]. Recollections after hypnosis may affect courtroom testimony [source: ASCH Resource Guide]. [synthesis] Offer present-focused work instead, and document the conversation.
Psychotic symptoms or unusual experiences emerge. Stop hypnosis; assess mental state; arrange psychiatric review if needed; do not resume hypnosis without specialist input [synthesis, informed by Gruzelier's first-episode cases and Booth's exclusion of people with delusions or hallucinations].
Difficulty re-alerting, drowsiness, headache, dizziness. Unwanted effects are common but mostly short-lived; some (such as headache) arise from deactivation or anxiety [source: Gruzelier record]. Response [synthesis]: re-alert more slowly, re-induce briefly and reorient again with clear suggestions of alertness and removal of heaviness or numbness; check orientation; sit for a few minutes; no driving until fully alert; ask about after-effects next session and adjust (shorter, lighter sessions).
A lingering suggestion (heavy arm, numbness, sleepiness). [synthesis, based on ASCH principle of removing suggestions] Re-enter briefly, explicitly cancel it, then reorient.
Special place turns unpleasant. [synthesis] Offer a new place or an abstract calm image (colour, sound); or open eyes and choose together; avoid real places linked to loss.
Non-adherence to self-hypnosis. Booth frames practice like a prescribed treatment [source: Booth, 2020]. [synthesis] Shorten to one or two minutes, link to a daily routine, give a personalised recording, troubleshoot obstacles, and review practice at the start of each session.
Rupture: feeling manipulated, embarrassed or disappointed. [synthesis] Acknowledge, return control (client chooses induction, wording and whether to continue), revisit expectations, and offer to continue without formal hypnosis. Never persuade [source: Booth, 2020].
Boundaries and touch. Hypnosis has been linked to sexual misconduct prosecutions [source: Wikipedia, secondary]. [synthesis] Get explicit permission before any touch (several ASCH inductions use light touch), offer non-touch alternatives, consider recording sessions with consent or a chaperone, and never use hypnosis outside the clinical frame.
Medical symptoms and requests to replace treatment. [synthesis] If a client wants hypnosis instead of medical care, explain that it is an adjunct; obtain or confirm medical assessment before symptom work; refer back for any new or changing symptom.
Client in an active legal matter. Recollections after hypnosis may be ruled inadmissible in some jurisdictions [source: ASCH Resource Guide]. [synthesis] Defer hypnosis about relevant events or get advice before proceeding.
You reach the edge of your competence. ASCH asks trainees to identify which uses need more training [source: ASCH curriculum]. [synthesis] Seek supervision or ASCH/BSCAH-level further training; refer for ego-state, dissociation or trauma work.

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