Atlas›Domain VI · Brief, integrative, trauma, hypnosis & coaching›Guide 094
Guide VI-094

Hypnotic ego-strengthening

John Heywood Hartland1965UK
A 25 · L 46 · M 2923 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: John Heywood Hartland's ego-strengthening procedure as he developed it from 1965 to 1971, reconstructed from Yeates' (2014) analysis and the Wikipedia account built on the primary texts. Contemporary additions are labelled separately: the ASCH Level 1 teaching (Thomson, 2026), McNeal and Frederick's (1993) "Inner Strength" procedure, and trauma-informed adaptations (Phillips, 2001; Harford, 2010). Hartland's own book chapter and his 1965 paper are not drawn on directly. The only full copy found online was an unauthorised upload of the copyrighted book, so it was not used [uncertain where wording or details of Hartland's originals matter].

Hypnotic ego-strengthening is a clinical-hypnosis procedure, not a separate therapy. Hartland, a British physician working at Hallam Hospital, published it in 1965 under the title "The value of 'ego-strengthening' procedures prior to direct symptom-removal under hypnosis" (American Journal of Clinical Hypnosis). He had found that direct suggestion to remove symptoms often failed. So he gave every patient, at every session and before any symptom work, the same graded sequence of general suggestions. These aimed to reduce tension, anxiety and apprehension and to restore confidence, energy, composure and self-reliance [source: Wikipedia, Hypnotic Ego-Strengthening Procedure; Yeates 2014].

The core idea of change is this. A patient who feels stronger, calmer and more capable no longer needs the symptom. Brown and Fromm later put it this way: once a patient feels strong enough, the symptom may become unnecessary. Ego-strengthening therefore prepares the ground for symptom-specific work, and Hartland reported that it was sometimes enough on its own. Hartland compared it to building up a patient's nutrition and rest before an operation [source: Wikipedia; Yeates 2014]. Modern teaching frames it as building expectancy, coping and self-efficacy, drawing on Bandura. In current practice it is placed in most hypnotic sessions [source: Thomson 2026, ASCH handout]. McNeal and Frederick called it the "bedrock" on which most other hypnoanalytic techniques rest [source: Wikipedia, citing McNeal & Frederick 1993].

Scope: this guide covers clinical hypnosis used by licensed health professionals within their competence. It is an adjunct, and it is not a stand-alone treatment for psychiatric or medical disorders [synthesis].

2. Framework

Hartland described no formal phases. The structure below is the course as reconstructed from his practice, followed by how the procedure fits into modern phase-oriented work.

A. Hartland's course (Hallam Hospital) [source: Wikipedia; Yeates 2014]

  • Phase 1: preparation, about 3–4 sessions.
    • Goals: assess hypnotic responsiveness, deal with the patient's concerns about hypnosis, and choose a suitable induction for this patient (Hartland used no standard induction).
    • Practice: rehearse inducing, deepening and dehypnotising several times, with suggestions that the patient will enter hypnosis more readily each time.
    • Ratification: give the patient experiences that convince them they were hypnotised and are a "good subject". The patient also gets used to the therapist's voice and style.
  • Phase 2: treatment sessions. Hartland's conventional course was about 20 half-hour sessions. Each session runs:
    1. Induction.
    2. Deepening.
    3. The ego-strengthening monologue, about 7–8 minutes.
    4. Symptom-specific suggestions, always last.
    5. Dehypnotising (re-alerting).
  • Criterion for moving from Phase 1 to Phase 2: the patient reliably enters and leaves hypnosis, their concerns have been answered, and they believe they respond well. Hartland set no numerical depth criterion in the sources [uncertain].
  • Ending: the sources give no termination criterion [uncertain]. Use the presenting goals and the patient's report of greater coping and self-reliance [synthesis].
  • Other schedules reported: Calnan (1977) gave ten psychiatric patients Hartland's monologue under hypnosis 12 times over six weeks [source: Wikipedia].

B. Placement within a session (modern ASCH teaching) [source: Thomson 2026]

  • Ego-strengthening can run through the whole session: begun during the induction, continued in the middle, and closing the session during re-orientation and reflection.
  • It is given in hetero-hypnosis (therapist-led) and practised by the client in self-hypnosis.

C. Placement in trauma treatment [source: Harford 2010; Phillips 2001]

  • In phase-oriented treatment of complex trauma, ego-strengthening belongs to Phase 1 (stabilisation): building self-regulation, affect regulation and positive resources before any memory processing.
  • A client who cannot attend to inner experience without becoming dysregulated needs prolonged stabilisation first. One case in Harford's series spent about four years in stabilisation.
  • The goal is to widen the window of tolerance until the client can keep a "dual focus": aware of the present and of the inner material at the same time.
  • Ego-strengthening itself contains no memory processing. When processing is later added, it follows that method's own readiness criteria [source: Harford 2010; synthesis].

D. Screening and contraindications

  • From the sources:
    • Assess hypnotic responsiveness and the patient's concerns about hypnosis before treatment [source: Yeates 2014].
    • Obtain informed consent for hypnosis [source: Harford 2010].
    • Contraindications for combined approaches are those of each approach on its own [source: Harford 2010].
    • Clients unable to attend inwardly without dysregulation need stabilisation first, for example skills-based work [source: Harford 2010].
    • Harford avoids hypnosis when the client is considering legal action against a perpetrator, because in some US jurisdictions hypnosis can affect the client's legal standing as a witness [source: Harford 2010].
    • Therapeutic suggestions given while a patient is still sceptical may fail and add to discouragement (Wolberg) [source: Wikipedia].
  • Added cautions [synthesis]:
    • Do not use formal trance with clients who have active psychosis or severe reality-testing problems.
    • With dissociative disorders, use it only within phase-oriented treatment, by clinicians trained in both hypnosis and dissociation.
    • With acute suicidality, do a standard risk assessment and safety plan first. Ego-strengthening never replaces them.
    • Do not use it while the client is intoxicated.
    • Physical symptoms need medical assessment before any symptom-directed suggestion.
    • Take extra care with clients for whom control or submission is a trauma theme. Hartland's authoritative style may echo the perpetrator for them, so use permissive wording.
    • Work only within your licence and training. Do not use stage-style or covert methods.

3. Guiding principles

  • Strength before symptom removal. Build general coping and confidence before targeting the symptom: put the ego-strengthening first in each session and the symptom suggestions last [source: Yeates 2014; Wikipedia].
  • Ego-strengthening at every session. Hartland repeated it each time, and ASCH teaches that it belongs in every hypnotic experience. In practice, end even problem-focused trance work with some strengthening [source: Wikipedia; Thomson 2026].
  • Sequence over exact words. Hartland held that the effect lay in a logical, step-by-step sequence of suggestions, each building on the last, and that his text was not meant to be read out unchanged. Keep the order of themes and write your own wording [source: Yeates 2014; Wikipedia].
  • Fit language to the person. Hartland said wording should be adapted to each patient's intelligence and education. Use the client's own vocabulary, goals and examples [source: Wikipedia].
  • No domination. Hartland avoided the word "must" so as not to seem domineering. Yeates adds that frequent "will" also sounds authoritarian. Prefer progressive or permissive phrasing such as "you're becoming…" or "you may notice…" [source: Yeates 2014].
  • Confident, direct delivery. Hartland used direct rather than indirect suggestion so as not to sound uncertain. Modern teaching uses both forms. Choose direct or indirect to suit the client, but deliver either with calm conviction [source: Yeates 2014; Thomson 2026].
  • Rhythm, repetition, pauses. Speak slowly and rhythmically, pause deliberately, stress key words, and say each idea in two or three ways to avoid monotony. Allow time for each suggestion to work, as one would for a medicine [source: Yeates 2014; Wikipedia].
  • Positive framing (Yeates' MORE test). Phrase suggestions as increases in what the client wants rather than decreases in what they fear: "more settled" rather than "less upset". Avoid "try", absolute words such as "exactly" and "everything", and talk of sleep [source: Yeates 2014].
  • Ratify the trance. Giving the client convincing experience that hypnosis is working raises expectancy and self-efficacy. Hammond stressed this. Point out each observable response to the client [source: Wikipedia, citing Hammond 1990; Yeates 2014].
  • Utilisation of strengths. Note strengths, past successes and goals at intake and build them into the trance [source: Thomson 2026].
  • Safety and alliance first. Rapport rests on safety, respect and the therapist's confident expectation ("Confidence is contagious", Lang & Laser, cited by Thomson) [source: Thomson 2026].
  • Ownership of trance. Frame the trance as the client's own skill and resources, so that practice makes the state easier to reach without the therapist [source: Thomson 2026].
  • Self-reliance as an aim. Hartland's later themes target independence and less dependence on others. Avoid encouraging dependence on the therapist or on recordings [source: Yeates 2014; synthesis on application].
  • Permissive, client-centred stance in trauma work. Treat responding as receptivity, not compliance; clients can reject suggestions that do not fit. Use non-suggestive questioning [source: Harford 2010].
  • Memory is not uncovered. Material recalled under hypnosis is one more source of data and is not more accurate than other memory. Never use ego-strengthening imagery or age regression to "recover" memories [source: Harford 2010; synthesis per brief].

4. Intervention inventory

Part A covers Hartland's procedure (items 1–8). Part B covers contemporary ego-strengthening techniques taught in clinical hypnosis (items 9–19). Part C covers trauma-informed adaptations (items 20–23). All example wording is my own and illustrative, not Hartland's text.

A1. Preparatory hypnotic training (Hartland)

  • Purpose: make the client a confident, practised responder before any therapeutic suggestion is given, and screen for suitability [source: Yeates 2014; Wikipedia].
  • When to use: the first 3–4 sessions of a Hartland-style course. A shortened form fits the start of any hypnosis course [synthesis].
  • Steps:
    1. Take a history and screen (Section 2D). Note the client's strengths and goals for later use [source: Thomson 2026].
    2. Ask what the client believes about hypnosis and correct misconceptions: control, sleep, being made to say things, "getting stuck" [source: Yeates 2014; specific misconceptions synthesis].
    3. Obtain informed consent. Cover what hypnosis is, what it is not, the client's control throughout, limits on memory accuracy and, where relevant, forensic implications [source: Harford 2010; synthesis on content].
    4. Try one or two inductions and keep the one that suits this client (A2).
    5. Practise the full cycle (induce, deepen, re-alert) several times within the session.
    6. Each time, suggest that the next entry into hypnosis will come more quickly and easily.
    7. Give ratifying experiences (A4).
  • Example language (illustrative): "Each time we practise, your mind learns the way in a little better. Next time you may find yourself settling more quickly, simply because you have done it before."
  • Watch for / working when: faster, smoother entry each time. Visible signs such as slowed breathing, facial relaxation and reduced movement. The client says they "did it" and expects to do it again. If the client stays tense or doubtful, keep training and do not move on to therapeutic suggestion (Wolberg's caution about scepticism) [source: Wikipedia].

A2. Individualised induction

  • Purpose: focus attention and establish hypnosis by a route that fits the person. Hartland had no standard induction [source: Yeates 2014; Wikipedia].
  • When to use: the start of every session.
  • Steps: the sources do not specify which inductions Hartland chose [uncertain]. A typical clinical structure [synthesis]:
    1. Comfortable seated position, feet flat, eyes open.
    2. Fixation on a point, or attention to the breath.
    3. Suggestions of growing heaviness or relaxation, paced to the client's out-breaths.
    4. Eye closure, either when the eyes tire or by choice.
    5. Progressive relaxation through the body.
  • Example language (illustrative): "Let your eyes rest on that spot… and as you breathe out, notice how the body begins to settle by itself… whenever your eyelids want to close, let them."
  • Watch for: discomfort with eye closure (offer eyes-open trance); breath-holding; signs of unease (A1, Section 5).

A3. Deepening

  • Purpose: increase absorption before the ego-strengthening monologue [source: Yeates 2014].
  • Steps: the sources do not name Hartland's deepeners [uncertain]. Common clinical forms [synthesis]:
    • Counting down, linked to the out-breath.
    • Imagery of going down stairs, steps or a path, unless descent imagery is aversive for this client.
    • Spreading relaxation from one body area to the next.
    • A fractionation cycle: briefly re-alert, then re-induce.
  • Example language (illustrative): "I'll count from five down to one, and with each number you can let yourself go a little further into comfort… five…"
  • Watch for: deeper is not required for ego-strengthening to work [synthesis]. Stop deepening at once if the client shows signs of distress or dissociation, such as frozen posture, flat affect or no response to a check-in (Section 5).

A4. Trance ratification

  • Purpose: convince the client that hypnosis is happening and that they are good at it, which builds expectancy and self-efficacy. Hartland used it in training, and Hammond stressed it as an ego-strengthening tool in its own right [source: Yeates 2014; Wikipedia citing Hammond 1990].
  • Steps:
    1. Give a simple suggestion with an observable effect, such as hand heaviness or lightness, or a sense of time passing differently.
    2. Comment on the response during or after trance.
    3. Credit the result to the client's own ability. [Specific ratifiers: synthesis]
  • Example language (illustrative): "You may have noticed your hand felt heavier than usual — that's your own mind responding. That same ability is what we'll use for the changes you want."
  • Watch for: never ratify something the client did not experience. Ask, don't tell. If nothing happened, normalise this and use an easier ratifier [synthesis].

A5. The ego-strengthening monologue (Hartland's sequence, paraphrased)

  • Purpose: improve the client's general state, reducing tension, apprehension, fatigue and preoccupation with self, and building composure, confidence and self-reliance, before symptom work [source: Wikipedia; Yeates 2014].
  • When to use: every treatment session, right after induction and deepening, for about 7–8 minutes. In 1965 the text was about 390 words; the 1971 final version was about 750 words [source: Wikipedia].
  • Steps (order of themes in Hartland's text, paraphrased from Yeates' line-by-line analysis):
    1. Framing. The client is deeply relaxed and receptive, and what is said will sink in deeply and last. Suggestions will gradually shape thinking, feeling and behaviour. Their effects continue after the session, at home and at work. What is described will happen, and the described feelings will be experienced. The changes continue day by day.
    2. Physical. Feeling physically stronger and fitter, more alert and energetic. Less easily tired or discouraged; Yeates recommends positive equivalents here (A8).
    3. Outward attention. Becoming absorbed in daily activities and surroundings rather than in oneself and one's difficulties.
    4. Nerves and mind. Steadier nerves; a calmer, clearer, more composed mind. Becoming less easily worried, agitated, fearful or upset.
    5. Cognition. Clearer thinking and easier concentration, giving full attention to tasks. Better memory, and seeing things in proportion without magnifying them.
    6. Emotional and physical calm. Feeling emotionally calmer and more settled, with mental and physical relaxation continuing.
    7. Confidence and independence. Confidence in one's own abilities without fear of failure. More independence and ability to stand up for oneself.
    8. Well-being. A greater sense of well-being, safety and security. Feeling happier, more contented and more optimistic.
    9. Self-reliance. Relying more on one's own efforts and judgement, with less need to depend on others.
    10. Transition. Move to symptom-specific suggestions (A6), then re-alert (A7). [source: Yeates 2014]
  • Delivery:
    • Slow, rhythmic, with pauses after each suggestion and key words stressed.
    • Each idea said in two or three different ways.
    • Direct statements, but never "must".
    • Adapted to the client's vocabulary and education. [source: Yeates 2014; Wikipedia]
  • Example language (illustrative, own wording for themes 2 and 7):
    • "Over the coming days you may find more energy available to you … more alertness … a body that feels more capable …"
    • "And alongside that, a growing trust in your own abilities … a quiet confidence that you can handle what each day brings … more and more ready to speak up for what you need."
  • Watch for / working when:
    • Between sessions the client reports feeling calmer, more energetic, less self-absorbed and more confident. Calnan's patients reported feeling more relaxed and self-confident, often in phrases that echoed the monologue without realising it [source: Wikipedia].
    • Theme 2 ("stronger, fitter") may be wrong for clients with chronic illness or disability. Theme 9 ("less dependence") may be wrong where dependence is realistic. Edit these themes [synthesis].
    • Do not read a published script verbatim; Hartland himself rejected that [source: Wikipedia].

A6. Symptom-specific suggestion after ego-strengthening

  • Purpose: address the presenting symptom once the client has been strengthened. This order was the original point of Hartland's procedure [source: Wikipedia; Yeates 2014].
  • Steps:
    1. After A5, give a few targeted suggestions tied to the agreed goal, such as calm in a feared situation or reduced urge.
    2. Keep them brief and positive.
    3. Link them to the strength just evoked. [Linking: synthesis]
  • Medical adjuncts: for physical symptoms, such as pain, IBS, surgery or dental anxiety, or smoking, use suggestion only as an adjunct within medical care and after medical assessment. Never present it as treating disease [synthesis per brief].
  • Example language (illustrative): "And with that steadier mind, when you next sit in the dentist's chair you may notice how much of this calm comes with you."
  • Watch for: symptom suggestions that run ahead of the client's confidence. If the client resists them, return to ego-strengthening alone for further sessions. Hartland reported many recovered with ego-strengthening alone [source: Wikipedia].

A7. Dehypnotising (re-alerting) and debrief

  • Purpose: return the client fully to ordinary alertness, with the benefits carried forward [source: Yeates 2014].
  • Steps:
    1. Give a post-hypnotic suggestion that the good feelings continue.
    2. Count up, for example from one to five, with suggestions of returning alertness and energy.
    3. Ask for eyes open.
    4. Check orientation: date, room, how the client feels.
    5. Debrief: what they noticed and what was helpful or unhelpful.
    6. Do not let the client drive while groggy. [Steps 2–6: synthesis]
  • Wording note: Yeates recommends saying "fully alert" rather than "wide awake", because hypnosis is not sleep [source: Yeates 2014].
  • Example language (illustrative): "In a moment I'll count from one to five, and by five you'll be fully alert, clear-headed, bringing back with you whatever feels useful … one …"
  • Watch for: residual drowsiness, headache or disorientation. Re-induce briefly and re-alert more slowly (Section 5).

A8. Revising the wording: Yeates' verbalisation check

  • Purpose: keep Hartland's strategy while removing wording that may work against it [source: Yeates 2014].
  • Steps (applied when drafting your own monologue):
    1. Remove sleep language ("asleep", "wide awake").
    2. Replace "unconscious mind" with plainer phrases about the deeper parts of the mind.
    3. Run each suggestion through the MORE test: keep it if it describes more of something wanted, and recast it if it describes less of something unwanted.
    4. Drop "try".
    5. Use "will" sparingly, with progressive forms instead.
    6. Avoid "exactly" and "everything". Specify the goal, not how the mind must achieve it.
    7. Check equivocal words such as "sensitive", "placid" and "give up".
    8. Keep the redundancy, pacing and optimism, in your own natural voice.
  • Example (illustrative): "You will be much less worried" becomes "You're becoming more and more settled."
  • Watch for: an artificial or "scripted" tone that the client notices. Rehearse the text aloud beforehand [synthesis].

B9. Planning by category: general, coping, self-efficacy (Brown & Fromm)

  • Purpose: move beyond one general monologue to targeted strengthening [source: Wikipedia, citing Brown & Fromm 1986].
  • The three categories:
    • General suggestions, of the Hartland type.
    • Specific suggestions that help the client discover and enhance coping strategies.
    • Specific suggestions that foster self-efficacy.
  • Steps [synthesis on application]:
    1. At case formulation, list the client's coping gaps and their self-efficacy beliefs about the target problem.
    2. In each session, open with brief general strengthening.
    3. Then add one coping-discovery suggestion and one self-efficacy suggestion tied to the current goal.
  • Example language (illustrative): "Your mind already knows ways of steadying itself … and as you rest here it can begin to find which of those ways fit this situation best."
  • Watch for: the client identifying coping options themselves, between sessions. That is evidence the coping-discovery suggestions are working [synthesis].

B10. Utilisation of the client's strengths and goals

  • Purpose: personalise the strengthening so it fits the client [source: Thomson 2026].
  • Steps:
    1. At intake, note concrete achievements, valued roles, skills, interests and goals.
    2. Choose two or three of them.
    3. Weave them into the trance in the client's own words.
    4. Suggest that the client may discover strengths they did not know they had. [source: Thomson 2026]
  • Example language (illustrative): "The same patience that got you through those years of night shifts is still there … available now … for this."
  • Watch for: choose strengths the client endorses, not ones you assume. Avoid achievements linked to shame or loss [synthesis].

B11. Revivification of past mastery (positive age regression)

  • Purpose: re-experience a real time of pride, success or competence, amplify the positive feeling, and carry it into the present [source: Thomson 2026].
  • When to use: with clients who can name at least one clearly positive memory. Avoid it early in treatment with complex-trauma clients, or use only a memory chosen and checked beforehand [synthesis].
  • Steps:
    1. Before trance, agree with the client on a specific memory of competence and check that it is free of painful associations [synthesis].
    2. In trance, invite them to return to it: where they are, what they see, hear and feel in the body.
    3. Amplify the positive feeling.
    4. Suggest that the feeling, and the knowledge "I can", come back with them.
    5. Optionally link it to an anchor (B17). [Steps 2–5: source: Thomson 2026; detail: synthesis]
  • Example language (illustrative): "Go back to that afternoon you crossed the finish line … notice where in your body that pride lives … let it grow a little stronger … that's yours to bring back."
  • Watch for: a positive memory can open onto a painful one, and the client may abreact. Have a stop signal agreed in advance and stabilise at once (Section 5). The aim is to re-experience a resource, not to explore the past. Do not probe for or interpret memories [synthesis].

B12. Reflection on mastery in trance

  • Purpose: in trance, review the client's overall record of coping. This builds a general sense of competence [source: Thomson 2026].
  • Steps [synthesis]:
    1. Invite the client to let several moments come to mind, without detail, in which they managed, adapted or got through.
    2. Suggest noticing the common thread running through them.
  • Example language (illustrative): "You don't need to go into any of them … just notice how many times you have found a way … and what that says about you."
  • Watch for: depressed clients may at first find no examples. Supply ones they gave you at intake (B10) [synthesis].

B13. Displacement or hypnoprojective imagery

  • Purpose: for clients who can't yet imagine themselves as strong, first watch someone else (or a figure) gaining the strength, then extend it to the self [source: Thomson 2026].
  • Steps:
    1. Invite the client to picture a person or figure facing a similar challenge.
    2. They watch that figure find calm or courage.
    3. Invite them to notice how it happens.
    4. Then suggest they step into, or borrow, that capacity. [Detail: synthesis]
  • Example language (illustrative): "Watch how that person handles it … what they do with their breathing, their shoulders … and when you're ready, see what it's like to try that on yourself."
  • Watch for: the client comparing themselves unfavourably with the figure. If so, slow down and emphasise learning rather than measuring up [synthesis].

B14. Metaphor and imagery of strength

  • Purpose: convey resilience indirectly, for example through a resilient tree [source: Thomson 2026].
  • Steps:
    1. Choose an image that fits the client's world.
    2. Describe it bending in the wind without breaking, with roots holding, recovering after storms.
    3. Allow the client to make their own connection, or offer one lightly. [Detail: synthesis]
  • Example language (illustrative): "… a tree that has stood through many winters … its branches move with the wind … and the roots go deeper than the storm can reach."
  • Watch for: imagery the client dislikes, so ask beforehand. Literal-minded clients may prefer direct suggestion [synthesis].

B15. Age progression to a successful future self

  • Purpose: build expectation by imagining a future in which the goal has been reached [source: Thomson 2026].
  • Steps:
    1. Set a realistic time frame.
    2. Have the client imagine a day in that future: what they are doing and how they feel.
    3. Ask the future self what helped them get there.
    4. Bring the answers back as next steps. [Steps 3–4: synthesis]
  • Example language (illustrative): "Imagine a morning six months from now … this is already easier … notice what you're doing differently … and what you'd want to tell yourself today."
  • Watch for: unrealistic or grandiose futures. Keep the future modest and specific [synthesis].

B16. Mental rehearsal of upcoming events

  • Purpose: rehearse a coming situation with competence and confidence [source: Thomson 2026]. Harford used imagery rehearsal of coping in the same way [source: Harford 2010].
  • Steps:
    1. Choose a specific upcoming event.
    2. In trance, rehearse it from start to finish, coping well.
    3. Include a minor difficulty and rehearse coping with it.
    4. End on success. [Steps 3–4: synthesis]
  • Example language (illustrative): "You arrive, you notice the flutter in your stomach, you let your breath lengthen … and you carry on."
  • Watch for: rising distress during the rehearsal. If it appears, pause, return to calm, and rehearse a smaller step [synthesis].

B17. Anchors, cue words and breath-linked suggestions

  • Purpose: link a calm or proud state to a portable cue the client can use outside the session [source: Thomson 2026].
  • Steps:
    1. At the peak of a resource state (from B11, B12 or the safe place), the client makes a small gesture, such as a fist or a finger-and-thumb circle, or says a word to themselves.
    2. Suggest that the cue will bring back the feeling.
    3. Rehearse it in trance, then test it after re-alerting.
    4. Optionally pair breathing with suggestion, breathing in confidence and out doubt. [source: Thomson 2026]
  • Example language (illustrative): "As that pride is strongest, gently press thumb and finger together … and whenever you do this, some of this feeling can return."
  • Watch for: if the cue is used in very distressing situations too early, it can weaken. Practise it first in mild situations [synthesis].

B18. Indirect suggestion and worthiness suggestions

  • Purpose: offer change as possibility rather than instruction. Suits clients who react against direct suggestion. Worthiness suggestions address the belief that one doesn't deserve rest or care [source: Thomson 2026].
  • Steps:
    1. Phrase change as curiosity: "you may notice…", "I wonder whether…".
    2. Include suggestions that the client deserves rest and time for themselves. [source: Thomson 2026]
  • Example language (illustrative): "I wonder when you'll first notice that you reacted more calmly than you expected … and you deserve this time simply to rest."
  • Watch for: clients with strong shame may reject worthiness suggestions. Start small, with permission to rest for a few minutes [synthesis].

B19. Ownership of trance, self-hypnosis and recordings

  • Purpose: transfer the skill to the client [source: Thomson 2026].
  • Steps:
    1. Frame the trance as the client's own achievement: they reached their own resources and can return there, more easily with practice [source: Thomson 2026].
    2. Teach a short self-hypnosis routine [synthesis]:
      • Sit comfortably and set a time limit.
      • Fix the gaze and take a few slow breaths.
      • Count down to deepen.
      • Use the anchor or safe place.
      • Give two or three ego-strengthening phrases in the client's own words.
      • Count up to re-alert.
    3. Suggest a regular practice slot, for example once a day [synthesis]. Hartland's sources describe no self-hypnosis or recordings; twice-daily self-practice belongs to Coué's method [source: Wikipedia].
    4. Recordings: an audio of the session, or the client's own recorded message to themselves. Thomson cites client-made video messages, credited to Tobi Goldfus [source: Thomson 2026].
  • Example language (illustrative): "You did this. I just gave directions. Each time you practise at home, finding your way here will become more familiar."
  • Watch for: practice routines that are too long. Recordings that the client can use only with the therapist's voice, which runs against the aim of self-reliance [synthesis].

C20. Inner Strength (McNeal & Frederick, 1993)

  • Purpose: contact an inner part of the self experienced as a lifelong source of survival and coping. Builds confidence, calm, optimism and a sense of having resources for one's goals [source: McNeal & Frederick script excerpt, ASCH resource].
  • When to use: after induction and deepening. Gather the client's goals beforehand so they can be named during the procedure [source: same]. Particularly suited to ego-state-informed and trauma stabilisation work [source: Wikipedia; Harford 2010].
  • Steps (structure paraphrased):
    1. Guide the client inward to a quiet, peaceful, central place within themselves.
    2. Invite them to become aware of a part called Inner Strength, framed as present since birth and as what helped them survive and overcome past obstacles.
    3. Leave its form open: let whatever images, feelings, thoughts or body sensations arise.
    4. Ask for an ideomotor "yes" finger signal when the experience feels clear and complete.
    5. Give suggestions of greater confidence, calm and optimism, and of having the resources to set and reach goals. Name the client's own goals here.
    6. Suggest the experience can be recalled at will.
    7. Teach a self-cue: briefly close the eyes, bring a hand to the forehead, evoke the image and remind oneself of one's resources.
    8. Suggest that the more often it is used, the more the client will come to trust their own intuition and feelings.
    9. Re-alert (not described in the excerpt; use A7). [source: McNeal & Frederick script excerpt]
  • Example language (illustrative): "Somewhere deep inside there is a part of you that has always been there … the part that got you through … you don't need to know what it looks like … just let it make itself known in its own way … and when you sense it, let your yes finger lift."
  • Watch for:
    • No finger signal. Allow more time, accept any partial sense, or switch to B11 [synthesis].
    • A frightening or critical figure appears instead. Thank it, let it step back, and return to the safe place. This may signal ego-state work that needs specialist training [synthesis].

C21. Safe or calm place imagery

  • Purpose: a stabilising resource and a retreat during distressing work. Harford notes it originated in clinical hypnosis and was later used in EMDR [source: Harford 2010].
  • Steps [synthesis]:
    1. Before trance, explore what "safe" or "calm" means to this client. The place may be real or imagined; avoid places linked to the abuser.
    2. In trance, build the place in every sense.
    3. Add a cue word.
    4. Suggest the client can return whenever they need.
    5. Practise going there and back several times.
  • Example language (illustrative): "Let a place come to mind where you can feel at ease … notice the light, the sounds, the temperature … and a word that belongs to this place."
  • Watch for: some trauma clients cannot feel safe anywhere. Use "calm", "comfortable" or "a little more settled", or an eyes-open sensory focus [synthesis].

C22. Inner helpers, ideal parent figures and the conflict-free image (trauma stabilisation)

  • Purpose: for adult survivors of childhood abuse, use hypnotic imagery to develop internal sources of support and positive self-experience [source: Harford 2010; Phillips 2001].
    • Harford describes developing inner helpers, inner advisors, inner strength and ideal parent figures.
    • He also describes re-parenting imagery, in which the adult self cares for a child self.
    • Positive emotions are amplified by suggestion and then carried into other contexts.
    • Phillips proposes building a "conflict-free image" from a positive sense of self the client has already actualised.
    • Post-hypnotic suggestion can support ego functioning. [source: Harford 2010, summarising Phillips 2001; Phillips' full paper not drawn on, uncertain on her procedural detail]
  • Steps:
    1. Confirm the client is in a stabilisation phase.
    2. In trance, invite a wise, kind or protective figure, or an ideal caregiver, to appear in a form that feels right to the client.
    3. Let the client experience being cared for, or have the adult self comfort the younger self.
    4. Amplify the positive feeling.
    5. Suggest the feeling is available in daily life. [Steps 1–5 synthesised from Harford's description]
  • Example language (illustrative): "Perhaps a figure who is entirely on your side can join you here … notice how they look at you … what it's like to be seen like that."
  • Watch for: grief at unmet needs, or intrusive memories. Keep the work in the present, use the safe place, and do not turn it into memory exploration [synthesis per brief]. Ego-state work with dissociative clients requires specialist training [synthesis].

C23. Split-screen imagery and widening the window of tolerance

  • Purpose: keep arousal tolerable and maintain a dual focus (present and inner material) when difficult material arises [source: Harford 2010].
  • Steps:
    1. Teach the client to hold a safe image on one side of an imagined screen whenever anything difficult appears on the other.
    2. If the dual focus is lost (flashback, pathological dissociation), switch to stabilisation strategies at once.
    3. Clinicians trained in EMDR may use slow tactile bilateral stimulation to strengthen hypnotic resource imagery or cue-word relaxation. Use this only within EMDR training. Harford notes his own approach to installing resources had no established protocol [source: Harford 2010].
  • Example language (illustrative): "Keep your calm place on the left of the screen … whatever shows on the right, you can glance back to the left any time."
  • Watch for: stop all processing if dual awareness is lost. This item is for stabilisation, not for processing trauma memories.

5. Handling problems

The sources say little about problem management. Most of the guidance below is my own synthesis and is marked; source-based points are cited.

  • Scepticism or low expectancy.
    • Wolberg warned that suggestions given to a sceptical patient may fail and deepen discouragement. Hartland spent 3–4 sessions on training and ratification before any therapeutic suggestion [source: Wikipedia; Yeates 2014].
    • Response: extend training (A1), use easy ratifiers (A4), explain the rationale, and set modest goals.
  • Low hypnotic responsiveness.
    • Response: ego-strengthening does not need deep trance. Use eyes-open relaxation, guided imagery or a naturalistic conversational style. Harford notes some clients prefer imagery or naturalistic approaches to formal hypnosis [source: Harford 2010].
    • Emphasise self-practice (B19) and frame progress as skill-learning [synthesis].
  • "It felt generic" or "it was patronising".
    • Hartland's monologue was standard for all patients. Contemporary teaching personalises it [source: Thomson 2026].
    • Response: rebuild the suggestions from the client's own words, strengths and goals (B10). Drop themes that don't fit, such as "physically stronger" for a client with a degenerative illness (A5).
    • Ask in the debrief which phrases landed and which jarred [synthesis].
  • Reactance to authority ('being told what to feel').
    • Avoid "must" and frequent "will" [source: Yeates 2014].
    • Response: switch to permissive and indirect forms (B18). Give the client choices within the trance, and remind them they can reject any suggestion. Treat the client's response as receptivity, not compliance [source: Harford 2010].
    • If a rupture follows a session, acknowledge it, ask what felt controlling, and agree changes to the wording [synthesis].
  • Overwhelm or abreaction during positive age regression or imagery.
    • Response: stop the suggestion. Speak in a calm, slightly louder voice and orient to the present: the room, the date, feet on the floor. Invite eyes open, or move to the safe place (C21) or split screen (C23).
    • Re-alert slowly and debrief.
    • Do not explore or interpret the memory under hypnosis, and do not suggest that it reveals hidden events. Note it, and plan whether and how it will be worked with in ordinary therapy, using a method with its own readiness criteria [synthesis per brief; Harford 2010 on returning to stabilisation].
    • Next session: choose resource memories more carefully in advance, and agree a stop signal such as a raised hand [synthesis].
  • Dissociation (blank, frozen, unresponsive, "far away").
    • Response: re-alert by grounding. Use the client's name and present-moment sensory cues: describe objects in the room, press the feet into the floor, hold something cold. Check orientation.
    • Shorten future trances and keep them lighter, with eyes-open options.
    • Assess for a dissociative disorder. Continue hypnosis only within phase-oriented treatment and your competence [synthesis; Harford 2010 on light trance and dual focus].
  • Difficulty re-alerting, grogginess, headache.
    • Response: re-induce briefly, suggest a comfortable return, and count up more slowly with suggestions of clear-headedness. Do not let the client leave or drive until fully oriented.
    • Check whether any suggestion left something unresolved, and remove or cancel suggestions that are no longer wanted [synthesis].
  • Worsening depression or emerging suicidality.
    • Response: ego-strengthening is not a treatment for suicidal risk. Carry out a standard risk assessment and collaborative safety plan, including lethal-means counselling (safe storage or removal). Refer or step up care as indicated.
    • Resume ego-strengthening only as one part of a broader plan. Avoid future-oriented imagery (B15) while hopelessness is high, if it highlights the gap from the present; use present-focused calm and mastery reflection (B12) instead [synthesis].
  • Non-adherence to self-hypnosis practice.
    • Response: shorten the routine to 2–5 minutes, link it to an existing habit, and offer a recording.
    • Problem-solve barriers, and review practice at the start of each session.
    • Frame missed practice as information rather than failure [synthesis].
  • Dependence on therapist or recording.
    • Hartland's own final themes aim at self-reliance and less dependence on others [source: Yeates 2014].
    • Response: move gradually from therapist-led to client-led trance. Have the client record their own suggestions (B19), and fade recordings [synthesis].
  • Client wants hypnosis to "fix" a medical problem.
    • Response: confirm medical assessment and ongoing care. Frame hypnosis as an adjunct for coping, comfort or anxiety. Do not suggest it treats disease [synthesis per brief].
  • Legal or forensic context.
    • Where legal action against a perpetrator is being considered, discuss the possible effects of hypnosis on testimony before any trance work. Consider non-hypnotic stabilisation instead [source: Harford 2010].
    • Document what was done and the wording used [synthesis].
  • Cultural or religious objections to hypnosis.
    • Response: explain the procedure plainly. Offer "focused relaxation" or "guided imagery" without a formal induction, and respect a refusal [synthesis].
  • Therapist over-reliance on a published script.
    • Hartland and Yeates both reject reading Hartland's text unchanged [source: Wikipedia; Yeates 2014].
    • Response: draft your own version in the theme order of A5, check it with A8, rehearse it aloud, and adapt it each session.

Sources

Sources

Further reading (not drawn on) [uncertain on details]

  • Hartland, J. (1965). The value of "ego-strengthening" procedures prior to direct symptom-removal under hypnosis. American Journal of Clinical Hypnosis, 8(2), 89–93.
  • Hartland, J. (1966; 2nd ed. 1971). Medical and Dental Hypnosis and Its Clinical Applications. London: Baillière Tindall. Later editions: Waxman (1989); Heap, M., & Aravind, K. K. (2001), Hartland's Medical and Dental Hypnosis (4th ed.), Churchill Livingstone. An archive.org copy appeared in search results; it is an unauthorised upload and was not used.
  • Brown, D. P., & Fromm, E. (1986). Hypnotherapy and Hypnoanalysis. Hillsdale, NJ: Erlbaum.
  • Hammond, D. C. (Ed.) (1990). Handbook of Hypnotic Suggestions and Metaphors. New York: Norton.
  • McNeal, S., & Frederick, C. (1993). Inner strength and other techniques for ego strengthening. American Journal of Clinical Hypnosis, 35(3), 170–178.
  • Frederick, C., & McNeal, S. (1999). Inner Strengths: Contemporary Psychotherapy and Hypnosis for Ego-Strengthening. Mahwah, NJ: Erlbaum.
  • Phillips, M. (2001). Potential contributions of hypnosis to ego-strengthening procedures in EMDR. American Journal of Clinical Hypnosis, 43(3–4), 247–262 (abstract record only).
  • Stanton, H. E. (1975, 1977, 1979, 1989): published adaptations of ego-strengthening ("ego-enhancement"). No procedure from them is given here [uncertain].
← Previous · VI-093Rapid Transformational TherapyNext · VI-095 →Ego state therapy