Solution-focused hypnotherapy

1. Introduction

Version followed: the UK Solution Focused Hypnotherapy (SFH) model credited to David Newton and taught by Clifton Practice Hypnotherapy Training (CPHT), as published by the Association for Solution Focused Hypnotherapy (AfSFH) and AfSFH practitioner material. Its solution-focused talking part is written up here from the SFBTA SFBT Treatment Manual for Working with Individuals, 3rd edition (2025), because that is the primary source for the questioning techniques SFH borrows. A separate, US lineage, Bill O'Hanlon and Michael Martin's Solution-Oriented Hypnosis: An Ericksonian Approach (Norton, 1992), is related but distinct; it is referenced, not followed. [source: AfSFH SFH page; NCH conference listing 2018; SFBTA manual 3rd ed.; SSW library record for O'Hanlon & Martin]

SFH is a brief talking therapy that combines solution-focused questioning with trance (hypnosis induced through guided relaxation). AfSFH credits three strands, which Newton combined into a structured framework in the early 1990s: Milton Erickson's client-centred use of anecdote and metaphor; the solution-focused questions (including the miracle question) developed by Steve de Shazer and Insoo Kim Berg; and a 'brain-based' psychoeducation in which clients are taught how the brain produces anxiety and how to change it. The therapist works on the client's goals and preferred future rather than on the history of the problem, and the method does not require exploring the past. NCH material describing Newton's presentation states that the therapist does not need to know what the problem is in detail. [source: AfSFH SFH page; NCH 2018 and CPD listings]

How change is said to happen (the model's own account, attributed, not established fact): anxiety, low mood and anger arise when stress accumulates (a metaphorical 'stress bucket') and control shifts from the calm, resourceful 'intellectual mind' to a fight-flight-freeze 'primitive mind'. Solution-focused conversation shifts attention to positive thoughts, positive interactions and positive activity. The model holds that this raises serotonin, while REM sleep and trance help 'empty the bucket'. Trance is described as a relaxed, problem-solving, daydream-like state in which the client reviews and rehearses what was discussed, and in which the client stays in control and decides which suggestions to accept. [source: AfSFH SFH page; Murton case study (AfSFH); Brzozowski practitioner page; Jamison (AfSFH blog)] Clinician note: the neurochemical explanations are the school's teaching simplifications. Present them to clients as a working metaphor, not as proven neuroscience. [synthesis]

Scope: this guide describes clinical use by a licensed psychotherapist who also holds hypnosis training within their competence. Stage hypnosis, covert induction and any technique designed to bypass consent are not part of this method and are excluded. SFH is not a memory-processing or trauma-exposure therapy, and it is never used to 'recover' memories. [synthesis, per brief]

2. Framework

SFH is a session-by-session format, not a phased protocol. It has two kinds of meeting: an initial consultation, then a run of treatment sessions with a repeating two-part structure.

Initial consultation (contents vary by practitioner) [source: AfSFH SFH page]

Consent form, terms and data handling, often sent beforehand.
Discussion of the issues, goals and 'best hopes'.
Contact details and relevant history and medical conditions.
Explanation of how the brain works, how emotions drive habits, and what trance is.
An indication of the likely number of sessions, which depends on circumstances (AfSFH gives no fixed number).
A guided-relaxation recording (download or CD) to listen to between sessions, usually nightly. [source: AfSFH SFH page; Murton case study]

Each treatment session [source: AfSFH SFH page; Murton case study]

Talking part: what has gone well and what changes the client has noticed since last time; a brain-related explanation relevant to the week; solution-focused questions (scaling, preferred future, next small step). AfSFH says CBT and NLP elements may be added 'as appropriate'; it does not specify them [uncertain].
Trance part: the client relaxes in a chair or on a couch, and the therapist guides them into a daydream-like trance to reflect on what was discussed. In the published case example this lasted about 10–20 minutes.
Measurement: rating scales and sometimes a galvanic skin response (GSR) finger monitor.

Session count and format. AfSFH gives no standard course length. The AfSFH online case example ran an initial consultation plus six weekly sessions over Zoom. Practitioner pages show short fixed courses for single habits (for example two longer sessions for smoking) and open-ended courses for anxiety [source: Murton case study; Brzozowski page]. The SFBT literature behind the questioning reports averages of roughly 3–6 sessions, with the client deciding when to stop [source: SFBTA manual 3rd ed.]. Exact CPHT course lengths are [uncertain].

Criteria for moving on and ending (SFH sources give none explicitly; SFBTA criteria applied) [source: SFBTA manual 3rd ed.]

From around session 2–3, ask what number on the progress scale would mean the client no longer needs to come. Many clients name about 7–8.
End when the client reaches their 'good enough' number and can describe how they will keep it there. Leave the door open for return sessions.
Move from consultation to treatment once consent is given, the client has a describable preferred future, and screening (section 4, intervention 1) shows no contraindication to trance. [synthesis]

3. Guiding principles

Future, not past. Talk is about the preferred future and what is already working. Practical meaning: when the client starts a problem history, acknowledge it briefly, then ask what they want instead. [source: AfSFH SFH page; NCH 2018 listing]
The client sets the goals. Goals should be specific, concrete and realistic. Practical meaning: write the goal in the client's own words and check it describes something they will be doing. [source: NCH 2018 listing; SFBTA manual]
No problem happens all the time. Exceptions exist. Practical meaning: ask about times the problem was absent or milder, and build on them. [source: NCH 2018 listing; SFBTA manual]
Small changes lead to bigger ones. Practical meaning: aim each week at one step up the scale, not at the full goal. [source: NCH 2018 listing; SFBTA manual]
Same process whatever the problem. De Shazer held that solution building is the same whatever problem the client brings. Practical meaning: the session template does not change with the diagnosis, but screening and referral decisions do. [source: NCH 2018 listing; synthesis for the screening caveat]
No need to revisit trauma. The client is not asked to go back over past trauma, or to go faster than they are comfortable with. Practical meaning: do not use regression or abreaction. If trauma symptoms dominate, refer for trauma-focused treatment. [source: NCH 2018 listing; synthesis for referral]
Educate the client about their brain. Clients learn a simple model of how anxiety builds and settles. Practical meaning: give a short, tailored explanation every session, framed as a metaphor. [source: AfSFH SFH page; Murton case study; synthesis for framing]
Positive focus. The model teaches that positive thoughts, positive interactions and positive activity reduce stress (the '3 Ps' as one trainee reports them). Practical meaning: each session's homework is one small, positive, doable action. [source: Jamison (AfSFH blog); Murton case study]
The client stays in control in trance. Trance is natural, and the client accepts only what they want. Practical meaning: use permissive wording, invite rather than command, and tell the client they can open their eyes and speak at any time. [source: AfSFH SFH page; synthesis for wording]
Listen, select and build; co-construct. The therapist picks up the client's solution words and builds questions from them. Practical meaning: reuse the client's exact phrases in your questions and in the trance. [source: SFBTA manual]
'Resistance' means the therapist has not yet found how to cooperate. Practical meaning: when a question lands badly, change your question, not the client. [source: SFBTA manual]
Utilisation (Ericksonian). Use what the client brings: their words, interests and experiences. Practical meaning: build trance imagery from the client's own calm places and successes. [source: AfSFH SFH page credits Erickson; O'Hanlon & Martin TOC lists utilisation; detail is synthesis]
Brevity. As few sessions as needed, decided with the client. [source: SFBTA manual]

4. Intervention inventory

The interventions follow session order: consultation tools (1–5), the talking part of each session (6–14), the trance part (15–22), then between-session and ending tools (23–26). Example language is illustrative throughout and not taken from any CPHT script.

1. Consent, screening and medical check (initial consultation)

Purpose / when: Before any trance work, to establish informed consent and rule out contraindications. AfSFH lists a consent form and the taking of relevant history and conditions [source: AfSFH SFH page]. AfSFH lists no contraindications, and its safety article is not drawn on here [uncertain].
Steps:
1. Give written information: what trance is and is not; that the client stays aware and in control; session format; data handling; and that SFH does not replace medical care.
2. Take a mental-health and medical history: diagnoses, current treatment and medication, GP details, previous therapy and how it went, and alcohol and drug use.
3. Screen for contraindications to trance. Gruzelier's review reports serious unwanted effects mainly in clinical and stage settings: psychotic episodes (including two first-episode schizophrenia cases), seizures, stupor, spontaneous dissociative episodes, and unbidden recall of trauma, often during age regression. High hypnotisability and intense involvement were facilitating factors. He supports screening vulnerable people [source: Gruzelier, Unwanted effects of hypnosis]. On that basis do not use trance with: current or past psychosis, or high risk of it; dissociative disorders or frequent dissociative episodes; poorly controlled epilepsy without medical advice; acute intoxication; acute suicidality (risk management first). Use extra care with untreated PTSD (no regression or memory work; refer for trauma-focused treatment) and with severe depression, personality disorder and bipolar disorder (only within your clinical competence, and liaise with the treating team). [synthesis, informed by Gruzelier]
4. Physical symptoms (IBS, chronic pain, migraine, sleep problems, habits involving eating or drinking, all of which AfSFH lists as presenting areas) need a medical assessment first. SFH is then offered only as an adjunct to medical care [source: AfSFH SFH page for the conditions; synthesis for the medical-assessment rule]. Never present SFH as treating physical disease.
5. Record consent, including consent to recordings and any GSR monitoring.
Example language (illustrative): "Before we use any relaxation or trance, I need to ask a few health questions, because there are some conditions where I'd suggest a different approach. Is that OK?"
Watch for: unusual experiences (voices, ideas of reference), losing time, 'spacing out', or a history of feeling worse after relaxation or meditation. Any of these is a reason to defer trance and rely on the talking techniques, or to refer. [synthesis]

2. Best hopes / goal setting (consultation, then reviewed weekly)

Purpose / when: First minutes of the consultation, to establish what the client wants instead of the problem. [source: AfSFH SFH page; SFBTA manual]
Steps:
1. Ask what their best hopes from the work are.
2. Move from what they don't want to what will be there instead.
3. Move from general to specific, and from feelings to observable behaviour.
4. Write the goal down in the client's words. In the AfSFH case, the stated aim was to be 'the best version of herself' and to enjoy life again; it was broken into concrete markers such as sleep, social contact and work confidence. [source: Murton case study]
Example language (illustrative): "What are your best hopes from coming here?" "If you weren't anxious, what would you be doing instead?" "How would you know, on an ordinary Tuesday, that things were better?"
Watch for: goals framed only as an absence ("not anxious"). Keep asking "what instead?" until you have something visible.

3. Brain explanation (psychoeducation)

Purpose / when: Once at the consultation, then a short tailored recap each session. It explains why the client feels as they do and why the homework and trance should help. [source: AfSFH SFH page; Jamison; Murton case study; Brzozowski]
Steps (content as the school's practitioners describe it):
1. Two 'minds': a calm, problem-solving intellectual part, and a primitive fight-flight-freeze part that takes over when stress is high. Resources in the intellectual part become 'temporarily off limits' during anxiety, depression or anger. [source: Brzozowski page]
2. Anxiety comes mainly from how we think about past, present and future events, illustrated with an anticipated job interview. [source: Murton case study]
3. The 'stress bucket': negative thinking and worry fill it, and when it overflows, symptoms or panic follow. Therapy reduces the inflow and adds ways to empty it. [source: Murton case study]
4. REM sleep is presented as a nightly way of processing the day and reducing anxiety. Disturbed sleep is linked to an overfull bucket. [source: Murton case study]
5. Positive thoughts, positive interactions and positive activity are presented as raising serotonin and lowering stress, and so are the weekly targets. [source: Murton case study; Jamison]
6. Trance is described as a relaxed, problem-solving state like daydreaming. [source: Murton case study; AfSFH page]
Example language (illustrative): "Think of stress as a bucket. Every worry, every 'what if', adds a bit. When it's full, the anxious, alarm-system part of the brain takes charge, and it's not good at thinking clearly. Our job is to slow what goes in and give you ways to empty it."
Watch for: clients who take the metaphor literally or who have been told, for example, that their depression is a 'chemical imbalance'. Present the model as a helpful simplification, and do not contradict medical advice on medication. [synthesis] Check understanding by asking the client to explain the bucket back in their own words. [synthesis]

4. Explaining trance and addressing myths

Purpose / when: Consultation, before the first trance. [source: AfSFH SFH page; Griffin practitioner page mentions addressing misconceptions]
Steps: Describe trance as a natural, focused, relaxed state. Explain that the client hears everything, cannot be made to do anything against their wishes, and can open their eyes or speak at any time. Ask about past experiences and fears of hypnosis (stage shows, films). [source: AfSFH SFH page; synthesis for steps]
Example language (illustrative): "It's much like the drifting feeling just before sleep, or being absorbed in a book. You'll be aware of my voice, and if anything doesn't feel right, just open your eyes and tell me."
Watch for: fear of losing control. Offer a shorter, eyes-open or lighter first trance. [synthesis]

5. Session count and expectations

Purpose / when: End of the consultation. [source: AfSFH SFH page]
Steps: Give an estimate tied to the goals, and agree to review at the scaling check-points. [source: AfSFH SFH page; synthesis]
Example language (illustrative): "Many people notice changes within a few sessions. We'll review together each week and stop when you're where you want to be."
Watch for: pressure to promise a fixed result. Make no guarantees. [synthesis]

6. 'What's been good?' / 'What's better?' opening (EARS)

Purpose / when: The opening of every treatment session. It directs attention to progress and gives the session content. [source: AfSFH SFH page; Murton case study; SFBTA manual for EARS]
Steps (SFBTA EARS sequence):
1. Elicit something better or positive from the week.
2. Amplify it: who, what, when and where; how they did it; who noticed.
3. Reinforce it: compliment the effort and the skill.
4. Start again: "What else?" Repeat several times.
Example language (illustrative): "So, what's been good this week?" "How did you manage to get out for that walk when you were tired?" "What else?"
Watch for: "Nothing" (see section 5). The case example shows clients increasingly bringing positives unprompted as therapy goes on. [source: Murton case study]

7. Pre-session change

Purpose / when: Start of the first treatment session. [source: SFBTA manual]
Steps: Ask whether anything has changed since booking. Build on any change the client wants with EARS.
Example language (illustrative): "Sometimes things shift a bit between booking and coming in. Have you noticed anything like that?"
Watch for: changes the client dismisses. Ask what they did to bring them about.

8. Scaling

Purpose / when: Every session, after the opening. It measures progress and sets the next step. [source: Murton case study; SFBTA manual]
Steps:
1. Ask the client to rate overall life happiness, or progress toward the goal, from 0 to 10. [source: Murton case study]
2. Ask what puts them at that number and not lower. [source: SFBTA manual]
3. Ask what one point higher would look like: what they would feel, do and see, and what others would notice. [source: Murton case study]
4. Optional session-end profile: the AfSFH case scored seven areas from 0 to 10 (positive thoughts, positive interactions, activity, confidence, use of strengths, achievements, overall happiness), giving a total out of 70 that was tracked weekly. This is that practitioner's tool, not a standard CPHT instrument [uncertain]. [source: Murton case study]
5. Optional scales for confidence or motivation. [source: SFBTA manual]
Example language (illustrative): "On a scale where 10 is life exactly as you'd like it and 0 is the worst it's been, where are you today?" "What's keeping you at a 5 and not a 4?" "What would a 6 look like on Monday morning?"
Watch for: steady movement up the scale; the client describing the next step in concrete terms. A stall over two or more sessions should prompt review (section 5).

9. Miracle question / preferred future

Purpose / when: Consultation or first treatment session (and repeated when goals drift). It builds a detailed picture of the preferred future that later becomes trance content. AfSFH credits de Shazer and Berg with the miracle question. The AfSFH case worked with the 'end destination' without naming the question [source: AfSFH SFH page; Murton case study]. The detail below follows the SFBTA manual.
Steps:
1. Set up the hypothetical: a miracle happens overnight while they sleep, the problem is resolved, but they don't know it happened.
2. Ask what they would notice first on waking.
3. Follow the day through hour by hour, asking for observable behaviour.
4. Add other people's views: who would notice, and what they would see.
5. Focus on first signs and small beginnings rather than the end state.
6. Check it is well formed: concrete, observable, situational, things present rather than absent, and including others' views. [source: SFBTA manual]
Example language (illustrative): "Suppose tonight, while you're asleep, something happens and the thing that brought you here is sorted. You don't know it's happened. What's the first small thing you'd notice tomorrow that tells you?" "What would your partner notice about you at breakfast?"
Watch for: rich, sensory detail. Gather it carefully, because you will reuse the client's own images in the trance (intervention 18). [synthesis]

10. Exceptions

Purpose / when: Whenever the client describes the problem. It finds times the problem was absent or milder, which shows the solution is already partly in their repertoire. [source: NCH 2018 listing; SFBTA manual]
Steps: Listen for 'except', 'sometimes' and 'better days'. Ask when it was a little better, what was different, and what they were doing. Amplify with EARS.
Example language (illustrative): "You said most evenings are bad. Tell me about one that was a bit easier. What was different?"
Watch for: the client recognising their own part in the better times, rather than putting it down to luck.

11. Relationship questions

Purpose / when: To get observable detail and other perspectives. Especially useful when the client struggles to describe themselves, and with clients who did not choose to come. [source: SFBTA manual]
Steps: Ask what a named other would notice, say, or rate on the scale.
Example language (illustrative): "What would your best friend say you've been doing that's helped?" "Where would your manager put you on that scale?"
Watch for: concrete behaviours that can become weekly steps.

12. Coping questions

Purpose / when: When the client is in crisis, overwhelmed, or reports that nothing is better. [source: SFBTA manual]
Steps: Acknowledge how hard things are. Ask how they have kept going and what has helped even a little. Build on that with EARS. Scale coping (0–10) and ask what one point higher would take.
Example language (illustrative): "That sounds really hard. How have you managed to keep going this week?"
Watch for: the client naming resources. If risk is present, follow intervention 1 and section 5 risk steps; do not move to trance.

13. Compliments

Purpose / when: Throughout. Compliments reinforce what the client is doing that works. [source: SFBTA manual]
Steps: The manual describes three types: direct compliments; indirect compliments (questions that presuppose competence, e.g. "How did you do that?"); and drawing out and endorsing the client's self-compliments.
Example language (illustrative): "It took real determination to go to that meeting feeling the way you did."
Watch for: compliments must be grounded in what the client actually reported, or they ring false. [synthesis]

14. Weekly small step (task)

Purpose / when: End of the talking part. It turns 'one point up' into one positive, achievable action for the week. [source: Murton case study; SFBTA manual]
Steps: Ask the client to choose one small step that fits the positive-thoughts / positive-interactions / positive-activity framework. In the AfSFH case these were restarting meditation, some 'me time', coffee with a friend, a lunch date, and a healthier-eating aim. Other SFBT options: 'pretend the miracle' on a chosen day, or notice what is working. [source: Murton case study; SFBTA manual]
Example language (illustrative): "Of the things we've talked about, what's one small thing you'd like to do this week that would show you're moving to a 6?"
Watch for: steps that are too big. Shrink them until the client is confident (8 or more out of 10) they will do them. [synthesis] For eating or exercise steps, keep them qualitative, with no weight, calorie or exercise targets. [per brief]

15. Trance preparation

Purpose / when: Second part of every session, after the talking part. [source: AfSFH SFH page]
Steps:
1. Confirm that today's state allows it: not intoxicated, not acutely distressed, no new symptoms since screening.
2. Invite the client to settle in a reclining chair or on a couch.
3. Agree a stop signal.
4. Remind them that they stay in control.
5. Summarise in a sentence what the trance will 'review'. [source: AfSFH page for chair or couch and client control; synthesis for the other steps]
Example language (illustrative): "Now you can just get comfortable. If at any point you want to stop, open your eyes or raise a hand. We'll let your mind go over what we've talked about."
Watch for: reluctance or apprehension. Keep trance shorter and lighter, or skip it that week. [synthesis]

16. Induction (guided relaxation)

Purpose / when: To move into a relaxed, focused, daydream-like state. AfSFH specifies induction through guided relaxation and visualisation. The specific CPHT induction scripts are not drawn on here [source: AfSFH SFH page; uncertain on exact technique].
Steps (generic relaxation induction, written as synthesis):
1. Eye closure, by invitation.
2. Slow breathing focus.
3. Progressive relaxation of body areas from head to feet, or the reverse.
4. A shift of attention to a pleasant, client-chosen calm scene.
5. Keep a slow, even pace and pause often.
Example language (illustrative): "Whenever you're ready, you might let your eyes close… and notice your breathing slowing all by itself… the muscles around your eyes softening… and that softness spreading down through your face and shoulders, at whatever pace suits you."
Watch for: slowed breathing, facial muscles relaxing, stillness, and swallowing reflex changes. Also watch for signs of distress (tensing, tears, rapid breathing, 'absent' look). If they appear, see intervention 21 and section 5. [synthesis]

17. Deepening

Purpose / when: After the induction, to deepen absorption. Not detailed in SFH sources [uncertain].
Steps (synthesis): counting down slowly, or imagery of descending (steps, a path), linked to further relaxation with each number.
Example language (illustrative): "In a moment I'll count from ten down to one, and with each number you can let yourself drift a little further into comfort, only as far as feels right."
Watch for: clients who dislike descending imagery (fear of heights, cellars). Swap it for floating or walking along a path. [synthesis]

18. Trance review of the session and preferred-future rehearsal (core therapeutic suggestion)

Purpose / when: The heart of the trance. The client reflects on what was discussed, and the mind is invited to 'explore and use' the ideas. AfSFH states this purpose; the exact suggestion content of CPHT trances is not drawn on here [source: AfSFH SFH page; uncertain on detail].
Steps (synthesis built on that stated purpose):
1. Briefly feed back, in the client's own words, this week's positives and exceptions.
2. Invite the client to imagine the next point up the scale and this week's small step already happening, with sensory detail from their miracle-question answers.
3. Add general calming and ego-strengthening ideas tied to the model: calm, clear thinking; sleeping well; noticing the good.
4. Use permissive phrasing ("you may notice", "perhaps").
5. Allow a period of quiet for the client's own processing.
Example language (illustrative): "And as you rest, your mind can go back over the good things from this week, the walk, the call with your sister… and perhaps you begin to picture yourself at that 6, getting up on Monday, noticing what's different, what you're doing, who notices…"
Watch for: reports afterwards of vivid, pleasant rehearsal and better sleep. Do not use direct suggestions that create amnesia, that direct the client to recall the past, or that contradict medical advice. [synthesis]

19. Metaphor and anecdote (Ericksonian element)

Purpose / when: Inside the trance (or in conversation), to carry a resource idea indirectly. AfSFH credits Erickson with the use of anecdotes and metaphors in SFH [source: AfSFH SFH page]. Specific CPHT metaphors are not drawn on here [uncertain].
Steps (synthesis): Choose a short story parallel to the client's goal: growth, learning a skill, a season changing. Draw it from the client's own interests where possible (utilisation). Tell it without explaining it.
Example language (illustrative): "You might remember learning to ride a bike… at first everything took effort, then one day your body simply knew how to balance."
Watch for: metaphors that accidentally echo distressing material. Check the client's associations in the debrief. [synthesis]

20. Permissive Ericksonian language patterns (optional, from the solution-oriented lineage)

Purpose / when: To keep suggestions collaborative and leave room for the client's own experience. O'Hanlon and Martin's book lists these elements of solution-oriented induction: utilisation, permission and validation, naturalistic evocation, presupposition, permissive language, splitting, interspersal, and confusion. The definitions below are general descriptions, not quotations of the authors. [source: SSW library record for O'Hanlon & Martin 1992; definitions synthesis, uncertain]
Steps (synthesis):
- Permission and inclusion: allow any response ("you might… or you might not…").
- Validation: accept whatever the client experiences as fine.
- Presupposition: speak as if change is coming ("when you notice…").
- Linking: connect something already happening to the desired response.
- Splitting: separate parts of experience ("part of you can rest while part of you listens").
- Interspersal: weave key words into a broader narrative.
- Avoid confusion techniques with anxious or dissociative clients, and do not use any pattern to override the client's stated wishes. [synthesis]
Example language (illustrative): "You don't need to try to relax; you can just notice whatever happens, and that's exactly right."
Watch for: a client who feels manipulated by indirect language. Be explicit about what you are doing. [synthesis]

21. Re-alerting

Purpose / when: End of every trance. Not detailed in the SFH sources; Gruzelier links some headaches and other unwanted effects to deactivation [source: Gruzelier; steps synthesis].
Steps (synthesis):
1. Signal that the trance is ending.
2. Count up slowly (for example one to five), with suggestions of returning alertness, comfort and clear-headedness.
3. Invite movement and stretching.
4. Have the client open their eyes, orient to the room, and sit up slowly.
5. Check they are fully alert before they leave or drive.
Example language (illustrative): "In a moment I'll count up from one to five, and by five you'll be fully alert, comfortable, clear-headed, bringing back whatever was useful."
Watch for: grogginess, headache, disorientation or lingering detachment. Repeat the re-alerting, ground the client (feet on the floor, name objects in the room, a sip of water), and do not let them leave until they are oriented. [synthesis]

22. Post-trance debrief

Purpose / when: Immediately after re-alerting. [synthesis; not described in SFH sources]
Steps: Ask how it was, what they noticed, and whether anything was uncomfortable. Note what to repeat or change next time. Remind them of this week's small step and the recording.
Example language (illustrative): "How was that for you? Anything you'd like more of, or less of, next time?"
Watch for: any unexpected emotion, memory or bodily sensation. Record it, explore it gently at the level of here-and-now coping, and revisit the screening decision. [synthesis]

23. Guided-relaxation recording (self-hypnosis practice)

Purpose / when: Given at the consultation for nightly listening between sessions. It is the client's self-hypnosis or relaxation practice. [source: AfSFH SFH page; Murton case study; Brzozowski; Griffin pages]
Steps: Give a general relaxation recording (practitioners describe roughly 30-minute versions) [source: Griffin page]. Advise listening in bed or somewhere safe, never while driving or operating machinery. Ask about use each session. [synthesis for the safety and review steps]
Example language (illustrative): "Listen to this each night as you go to sleep. It doesn't matter if you drift off before the end; it still helps."
Watch for: non-use (see section 5), or the client feeling worse after listening. Stop the recording and review screening. [synthesis]

24. Progress measurement (scales and GSR)

Purpose / when: Each session, to track change. [source: AfSFH SFH page; Murton case study]
Steps: Weekly 0–10 scaling (intervention 8). Optionally, with consent, a GSR finger monitor as a biofeedback display of stress arousal. How the GSR readings are used is not specified [uncertain]. You may add a validated outcome measure that you are licensed to use; this is synthesis, not an SFH requirement.
Example language (illustrative): "This little sensor just shows how your body's stress response changes as you relax. It's purely information for us both."
Watch for: discrepancies between self-rating and other indicators. Explore them with curiosity, not as proof either way. [synthesis]

25. Ending and relapse planning

Purpose / when: From session 2–3 onward, and at the final session. [source: SFBTA manual]
Steps:
1. Ask what number would be 'good enough' to stop.
2. When it is reached, ask how they will know they are staying there and what they will keep doing (the weekly steps that worked).
3. Agree what they would do if they slipped (return to the recording, the 3 Ps, a booster session).
4. Leave the door open. [source: SFBTA manual; synthesis for the relapse plan]
Example language (illustrative): "You've said 7 would be enough. What will you keep doing to stay at a 7 or above?"
Watch for: the client attributing change to their own actions (a good sign for maintenance). [synthesis]

26. Specific-issue courses and medical-adjunct use

Purpose / when: AfSFH lists habits (smoking, drinking, eating), IBS, chronic pain, insomnia, phobias, OCD and others as areas where SFH is offered [source: AfSFH SFH page]. Practitioners offer short fixed courses for single habits [source: Brzozowski page]. Course content for these is not drawn on here [uncertain].
Steps (synthesis): Use the same structure: goal and preferred future, scaling, small steps and trance rehearsal of the preferred future.
- For IBS and pain, work only after medical assessment and alongside the medical team. Tailor the trance imagery to comfort and coping. Never suggest stopping medical treatment or medication.
- For smoking, use it alongside standard cessation support.
- For eating, use qualitative goals only, and screen for eating disorders, which need specialist treatment.
- For OCD and phobias, SFH is not a substitute for exposure-based evidence-based treatment; offer that or refer.
Example language (illustrative): "This works alongside what your doctor is doing, not instead of it."
Watch for: new or changing physical symptoms. Refer back to the GP. [synthesis]

5. Handling problems

SFH sources say little about difficulties. Items tagged [source: SFBTA manual] come from the SFBT manual whose questioning SFH uses; everything else is [synthesis].

"Nothing is better" or "It's worse." Accept the client's view without arguing. Acknowledge how hard things have been. Ask how they coped, or what a close friend would say they have been doing to get through, then use EARS on whatever emerges. [source: SFBTA manual] Shorten the brain explanation that week. Keep the trance focused on rest and coping rather than progress. [synthesis]
"I don't know" or silence. Treat it as a sign you asked a hard question. Wait quietly, then, if needed, rephrase as a relationship question ("What would your sister guess?"). [source: SFBTA manual]
Stuck on the scale for 2–3 sessions. [synthesis]
- Check that the goal is still the client's own.
- Make the next step smaller.
- Re-ask the miracle question.
- Check recording use and sleep.
- Screen for an unrecognised condition (depression severity, substance use, trauma, medical cause).
- Consider whether a different, problem-specific evidence-based treatment (e.g. exposure for OCD or phobia, trauma-focused therapy for PTSD) should be offered or referred.
Client keeps returning to problem talk or the past. Listen briefly and empathically, then pick out solution fragments within it ("So on Tuesday it was a bit less… what helped?"). Some problem talk usefully contrasts with what the client wants. [source: SFBTA manual] If the past is pressing because of trauma symptoms, do not process it in trance; offer or refer for trauma-focused treatment. [synthesis]
Unrealistic or improbable goals. Stay curious. Ask what tells them it is possible, or what others would say about how likely it is, then explore the resources they can draw on. [source: SFBTA manual] Separate the goal from the first steps toward it. [synthesis]
Client sent by someone else (involuntary or 'visitor'). Learn the referral reason. Start from what the client wants and from their view, without challenge, and use relationship questions. [source: SFBTA manual] Do not do trance with a client who has not freely agreed to it. [synthesis]
Non-adherence to the weekly step or the recording. [synthesis]
- Do not criticise. Ask what got in the way, and what they did instead that was useful.
- Shrink the step, or let them choose a different one.
- For the recording, try a shorter track, a different time of day, or headphones.
- Respect a client who does not like recordings; the in-session trance still applies.
Overwhelm or abreaction in trance (sudden distress, tears, panic, intrusive memory). [synthesis, informed by Gruzelier's report that unbidden trauma recall and dissociative episodes occur]
1. Speak calmly and use their name.
2. Suggest the image fades and they come back to the room now.
3. Re-alert with a quick count-up and eyes open.
4. Ground them: feet on the floor, describe the room, slow breathing, a cold drink.
5. Do not explore or 'work through' the memory, and do not interpret it as historical fact.
6. When they are steady, debrief at the level of coping. Agree whether and how to continue, for example without trance, eyes open, or shorter trances.
7. Re-screen, and refer for trauma assessment if indicated.
Dissociation or difficulty re-alerting. [synthesis] Repeat the re-alerting in a firmer voice. Use sensory grounding and movement. Keep the client until fully oriented, and no driving until then. Record it. Stop trance work and reassess for a dissociative or psychotic process; liaise with their GP or psychiatrist where indicated. Gruzelier lists stupor, spontaneous dissociative episodes, seizures and first-episode psychosis among rare serious effects. [source: Gruzelier for the effects]
Headache, dizziness or grogginess after trance. Reassure, re-alert again, and offer water. Use a slower re-alerting next time and a shorter trance. If it is persistent or severe, seek medical advice. [synthesis; Gruzelier links headache to deactivation and anxiety]
Suicidal ideation or risk disclosed. [synthesis, standard practice]
- Pause the SFH format and complete a structured risk assessment.
- Agree a safety plan and lethal-means counselling (safe storage or removal), and involve crisis services and the GP as needed.
- Solution-focused coping and scaling questions can be used inside the assessment. The SFBTA manual shows asking with curiosity what tells the client their risk is low, and asking relationship questions [source: SFBTA manual]. These questions add to a standard risk assessment and never replace it.
- No trance until risk is managed.
Fear of losing control or of hypnosis. Re-explain trance (intervention 4). Offer eyes-open relaxation, a shorter first trance, or give the recording to try at home first. [synthesis]
Client sceptical of the brain model. Present it as a metaphor. Invite the client to test it against their week (does more positive activity fit with better days?), and drop the parts that don't land. [synthesis]
Ruptures (client feels pushed toward positivity or unheard). Name it and apologise. Spend more time acknowledging difficulty before solution questions, and ask what would make the sessions more useful. [synthesis] The SFBTA principle applies: adjust your approach to cooperate with the client. [source: SFBTA manual]
Physical symptoms change during the course (pain, bowel symptoms, headaches). Send the client back to the GP. Do not attribute new symptoms to stress without medical review. [synthesis]
Scope and competence. If the presentation needs a treatment you are not trained to give (eating disorder, psychosis, severe PTSD, substance dependence), refer. Supervision is recommended; AfSFH maintains a supervisor directory. [source: AfSFH supervisor directory listing seen in search; synthesis]

Sources

Sources:

Books and papers cited:

O'Hanlon, W. H., & Martin, M. (1992). Solution-Oriented Hypnosis: An Ericksonian Approach. New York: W. W. Norton. (Contents only seen.)
Gruzelier, J. Unwanted effects of hypnosis: a review of the evidence and its implications. Contemporary Hypnosis, 17(4), 163–193. [uncertain: the repository page gives 2006, but volume 17 suggests 2000]
SFBTA Research Committee (Beauchemin, De Jong, Eads, Franklin, González-Suitt, Guyton, Kim, Langer, Lee, Taylor Yates) (2025). Solution Focused Brief Therapy Treatment Manual for Working with Individuals, 3rd ed.

Not drawn on: the AfSFH safety article (afsfh.com/blog/SFHsafe/). CPHT training materials and any book by David Newton were not found in an open source. CPHT-specific induction scripts, session counts and contraindication policy are therefore marked [uncertain] above.

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