Hypnotic depth scales or scales of Hypnotisability are used to measure how deep a client is in trance.

There have been many studies into this over the years and I will highlight some of the different scales.

The Stanford Scale is numbered from 0 to 12, the higher the number, the deeper the level of Hypnosis.

0 Eye Closure (not scored)
1 Hand Lowering (right hand)
2 Moving Hands Apart
3 Mosquito Hallucination
4 Taste Hallucination
5 Arm Rigidity (right arm)
6 Dream
7 Age Regression (school)
8 Arm Immobilization
9 Anosmia to Ammonia
10 Hallucinated Voice
11 Negative Visual and Auditory Hallucination
12 Post-Hypnotic Amnesia

Subjects were given a hypnotic induction, followed by different hypnotic suggestions. For example, one suggestion asks you to imagine your hand is so heavy that you cannot hold it up. If you can hold up your hand, you fail that item. Most people are able to perform the first few items but not many people make it to the end of the test. According to the scales, the farther you get, the more susceptible you are to hypnosis.

Joseph Friedlander and Theodore Sarbin developed the below scale to measure susceptibility to hypnosis with items increasing in difficulty in order to yield a score. The higher the score, the more responsive one is to hypnosis.

Arons Depth Scale creator Harry Arons, some refer to this as the “6 stages of hypnosis” or “6 levels of hypnosis”

Stage 1: Hypnoidal - Hypnosis in this stage is very light. Many clients don’t feel or believe they are even hypnotized and feel completely awake and aware. There are two types of hypnoidal states, hypnopompic and hypnogogic. Hypnopompic is similar to the state you are just before waking up in the morning, that sort of half-aware, “twilight” state. Hypnogogic is like the state just before you fall asleep. A slow transition between wakefulness and sleep.

Stage 2 - In this state, the mind and body come more under the control of the subconscious. Larger muscle groups can be controlled and manipulated with phenomenon such as Arm Catalepsy becoming possible. In this state, your ability to discern reality from fiction becomes impaired.

Stage 3 - is characterized by “Aphasia”, a loss of ability to understand or express speech. Subjects will be able to remember a word, letter or number, but can be instructed to not be able to say it

Stage 4 - In this stage, subjects start to exhibit greater phenomena including the beginning of true amnesic stages. A subject at this stage will “forget” very personal and deeply embedded information such as their name, phone number, and address.

Stage 5- This is where true somnambulism begins. Somnambulism literally means “sleep walking”, but in this context it refers to an easily identifiable disconnect of the mind from both the body and the outside world.

Stage 6- Profound Somnambulism, Subjects can experience Negative Hallucinations where they don’t see or hear things that actually do exist.

So, why are these scales important in the Solution Focused Hypnotherapists practice? There is research that suggests that people’s response to hypnotic suggestions is almost as strong without an induction as it is with one. In other words, subjects respond to suggestions even without hypnotic inductions. Therefore, induction may not have a significant effect. This brings up an important question, if induction is not important, what are all the suggestibility scales actually measuring? We know that we all go into trance in our day to day lives naturally and we have the ability to process thoughts and suggestions in a day dreaming state, so why do we need our clients to reach the higher numbers on the scales? The answer is simple, in the main we don’t!

Another challenge with suggestibility testing is that it may interfere with hypnosis, if it leads people to believe they are not hypnotisable. If a patient is given a suggestibility test and they score low, this may lead them to believe that they will not benefit from hypnotic treatment. This idea may or may not exist, but the mere thought in the client’s mind that it may exist can cause it to exist as we know the mind doesn’t know the difference between what is real and what is not. This is the essence of hypnotherapy, expectation becoming reality as a result of the existence of the expectation.  Expectations matter, and if expectations of the effectiveness of hypnosis are questioned, that may lead to a lack of confidence in the hypnotic process.

Deeper levels of trance would be required if a patient was to have surgery under hypnosis. The University Hospital Centre at Liège in Belgium has reported more than 12,000 cases where hypnosis was used to treat pain since 1992. Enabling patients to have quicker recovery times without the after effects of general anaesthetic.

Hypnotic suggestibility testing is almost always used in hypnosis research. For our use, however, it is often ignored. As many therapists feel, it is not necessary for a client to be suggestible for hypnosis to be effective as a treatment method, as we only need a light trance for our clients to allow their conscious and subconscious minds to come together to find solutions.

Suggestibility tests are used to identify how susceptible a person is to Hypnosis. These tests are not generally used or needed in the Clinical setting as a light relaxed trance is considered enough for most clients to be open to suggestion and to allow the conscious and unconscious mind to work together to find solutions. As solution focused therapists, we would not encourage suggestibility tests as we would not want the client to think they have failed if the required response is not shown, they may well then believe they cannot be hypnotised and then resist therapy.

These tests can be sometimes used with children as an ice breaker or something they could be taught to try on their parents. A particular favourite, is to hold both arms out, one holding a brick and the other being held aloft with balloons, not many clients fail to show a response to this. But this should not be used, in my belief, as a measure, just a little fun to sometimes relax a child.

Suggestibility tests are often used by stage hypnotists to find the next star of their show, a series of tests would be carried out on the audience to weed out the more suggestable audience members to allow a good display of riding imaginary horses or eating raw onions.

We utilise trance in our process that is induced by a guided relaxation piece that allows the client to enter a state of tranquillity to focus the mind on what has been discussed in the session and to feel rested and calm when brought back to wakefulness. We do not need clients to be too deep into hypnosis to achieve our and their goals.

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Abreaction is the expression and consequent release of a previously repressed emotion, achieved through reliving the experience that caused it (typically through hypnosis or suggestion) this is not something that Solution Focused Therapists practice in, we do not focus on upsetting or painful moments from the past, we seek solutions to make tomorrow a better day.

From time to time, we have clients that may well experience an emotional response, which could lead to upset. In moments like this, we should show empathy and understanding. We need in these instances to work towards getting the client to move from the right pre frontal cortex to the positive left pre frontal cortex, to continue with the therapy process. Under no situations should trance be used if a client is upset as this would not provide the best therapeutic experience and may undo any works previously done. I recently had a client burst into tears during an initial consultation, as she finally understood why she was feeling like she did, this though was a release of emotion and not necessarily a negative release. On this occasion, humour was used to refocus the client, which led to a very productive session.

We can acknowledge upset, but we must remain focused in a caring way to get the client to stop shedding those tears that they will never have to shed again. By remaining calm and professional we should focus the client on positive thoughts to allow the negative emotions to subside.

What is Psychosis?

Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). 

There are two main symptoms, Hallucinations, where a person hears, sees and, in some cases, feels, smells or tastes things that do not exist outside their mind but can feel very real to the person affected by them; a common hallucination is hearing voices. And Delusions, where a person has strong beliefs that are not shared by others; a common delusion is someone believing there's a conspiracy to harm them. The combination of hallucinations and delusional thinking can cause severe distress and a change in behaviour. Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.

It's sometimes possible to identify the cause of psychosis as a specific mental health condition, schizophrenia, a condition that causes a range of psychological symptoms, including hallucinations and delusions, bipolar disorder, a mental health condition that affects mood, a person with bipolar disorder can have episodes of low mood and highs and Severe depression, some people with depression also have symptoms of psychosis when they're very depressed.

Psychosis can also be triggered. Trauma, Stress, anxiety, addictions and sometimes brain tumours can cause a psychotic episode. If we as Solution Focused Therapists witness a client who is experiencing a Psychotic episode, we should immediately seek assistance from the client’s medical practitioner.

If it is identified at the initial Consultation that a client is or has been diagnosed with a mental illness, whether currently taking medication or has previously taken it, then at these times we should contact their GP and our supervisor for advice. We should get clarification that what we can do for the client, will do no harm.

Talking therapies can help reduce anxiety levels in those who suffer, CBT is often prescribed alongside medications. If underlying anxiety can be reduced, this helps the medication be more effective in helping to prevent Psychotic episodes. Therefore, Solution Focused Hypnotherapy could assist in anxiety reduction and potentially reducing or stopping any addictions that the client may have.

I strongly believe that if the Solution Focused Hypnotherapist has even the slightest reservation regarding dealing with a client with a diagnosed Mental Illness, they should refer to a colleague with the experience to give the level of support the client needs. We should always work within our limits of experience to give the best possible care.

As a Solution Focused Hypnotherapist, it’s vital to understand and have a background knowledge of the differing approaches to therapy available today. Although I follow the SFH brief, there may be times when my methods would benefit from additional intervention, influenced by other forms of therapy.

It may be agreed with a client that a task is to be completed by the next session, this method is a favorite within CBT, where CBT would check that the task was completed, we would not mention it and allow the client to bring it up when we ask “what’s been good?” We discuss ways to make things better, we trust the clients to know how to solve their problems, but there may be times where we may indirectly suggest the better path to take. Tasks, goals and homework are set in CBT, elements we can choose to use if thought appropriate. A goal is key to any client and any therapist to allow us to work towards the clients’ best hopes

An area where we most definitely step outside of the usual SFH process is when it is evident that the clients progress would be encourage with the use of NLP. Rewind, Reframing and Swish are methods used very successfully when combined with SFH. In practice we may use the Swish method to allow clients to see their preferred outcome of a situation, or a preferred view of themselves. The joy with this method is that it can be done by the client whist at home at any time and doesn’t require Hypnosis. I have used this with clients who need help with weight loss and motivation at the gym. We use rewind to assist with Phobia and trauma. It is a non-threatening method which detaches the client from the emotional feelings attached to a memory or a trigger. I have used Rewind successfully on a number of Dog and spider phobia and most recently a fear of flying. We use reframe continually to allow clients to see things from a different perspective to the one that see now.

When discussing preferred futures with clients, we may from time to time think back and use the “My friend John” metaphor, used by Erickson, but as we don’t all have friends called John, we may suggest that “many clients have said that they have benefited from doing that” or using the powers of indirect suggestion to gently nudge the client in the right direction. 

We have to be continually looking to ensure we are providing the best level of support to our clients, they are all different, but our process is the same. So, careful use of language is vital to make the session unique to our individual. Some clients will not enjoy being told what to do, this is great if you have mastered indirect suggestion, some clients want to discuss the past, we do this, but it’s the positive past that we are interested in. Clients that want to give up smoking may feel they have a part of themselves that wants to keep smoking and dieters that want to subconsciously eat cake, we can help that using parts therapy. As long as the alternative methods we use are fundamentally positive, we should seek to use what ever we think is more appropriate.

Having the knowledge of many different aspects of other therapies, allows us to develop our techniques to allow choice as to the best possible solution for the client, which operating in the solution focused therapist brief. 

Therapy is therapy to many people. Understanding the different styles, what is available and what is appropriate for the patient can be a minefield. The NHS in the UK currently offers Seven types of talking therapy, Cognitive Behaviour therapy (CBT), Counselling, Behavioural activation, Interpersonal Therapy, Eye movement desensitisation and reprocessing, Mindfulness-based cognitive therapy and Psychodynamic psychotherapy (PP). All of which, in one way or another deal with depression, anxiety, panic disorders, phobias, obsessive compulsive disorder, post-traumatic stress disorder and bulimia etc. The lottery of different types of therapy for different problems, can be a difficult call for a GP, waiting times for referrals are currently running at 18 weeks and this is just to ascertain which of the seven is the best road to take, subject of course, to what specialists are available in the particular areas of the UK. Not great if your need is far greater than the waiting list.

We will compare below a selection of different therapy types, that deal with similar problems. These will be compared directly to the Solutions Focused Hypnotherapy (SFH) model and we will show how research has developed SFH it in the way it has.

Cognitive Behaviour therapy (CBT)

The aim of CBT is to explore change and how you think about your life.

Goals are set

Tasks are often used

Up to 20 sessions are often needed, sometimes longer.

Its highly structured to give consistency

Problems are broken down into parts and analysed.

It’s based on a theory, that thoughts, feelings, physical sensations and actions are all linked and that negative thoughts and feelings affect your mental wellbeing.

It’s recognised as a pragmatic therapy and doesn’t dwell on past problems, it’s very much in the now.

A very common therapy that is prescribed for most problems and extremely effective and is used to compliment medications also. It can be successful in a short period, but can take up a lot of the client’s time with extra work that could be asked for between sessions. It is focused solely on the client, rather than dealing with the wider issues going on in their lives.

Counselling

Counselling is a talking therapy

Problems are discussed in confidence with a counsellor

The expertise of the counsellor is vital to find solutions to offer to the clients.

Mainly used for depression, bereavement, anger, sexual orientation and to find reasons for the client’s unrest. It can be a long therapy. The client may have to discuss issues that they would rather forget and the past can be trawled over to find rational to why they are feeling that they are. But good for those that want to discuss and vent and to find those reasons.

Psychodynamic psychotherapy (PP)

This therapy looks at how childhood experiences and thoughts that the client is unaware of, effect feelings, relationships and behaviour.

The subconscious mind is assessed to provide reasoning for past problems that effect today.

Psychodynamic therapy focuses on the psychological roots of emotional suffering. Its hallmarks are self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient's life.

Hypnotherapy

Utilises guided relaxation to achieve a state of focused attention which enables the mind to find solutions

Used to treat conditions, such as anxiety, phobia, addictions, change habits, ease pain and increase confidence, to name a few.

Results are long lasting and success is usually in a short space of time.

Not currently prescribed on the NHS, but recognised by the British Medical Association as a valid medical treatment in 1955

Solution Focused Brief Therapy (SFBT)

Not currently prescribe on the NHS

Is future orientated to find solutions to problems

Is positive and builds on the strengths of the clients, with the understanding that they know what they need to do to move forward

Clients describe what they want, rather than what they do not want

The use of Scales is incorporated to monitor progress

It is goal directed

It finds exceptions to problems, investigating to find when the problem isn’t there

Does not rely on knowing what the problem is to be able to deal with it

Is structured and every problem, has the same process

Is a short therapy, 3-6 appointments us usually enough.

This method of therapy was devised to be brief and to allow clients to achieve their goals by positively questioning and encouraging success at every stage of the process. It relies on a team of people to watch the session with clients and is labour intensive, but has fast results.

What we have here is a SMALL selection of therapies available today and some of the similarities and differences, but not all. Before we compare this with the SFH model, let’s consider this - Knowledge is everything! having an understanding of how something works allows us to know when something isn’t working properly. Most appliances in the home come with operating instructions, so why don’t Humans?

Milton Erickson believed that everyone had sufficient wisdom and resourcefulness to be able to cope with life effectively, the subconscious part of the brain knew all the answers.

The cerebral cortex is a vast intellectual library, that is there for us all to access to find solutions. So how has Neuroscience influenced therapy? Well, there are too many contributors to mention, but let’s

consider a few, that have shaped the way that we work.

Jonathan Cohen, pioneered neuro-economics, he believed the forces that drive both rational and irrational forces are often at conflict with each other. He carried out a series of brain scans and identified that the more powerful the low roads activity (Amygdala), the less rational the reaction, the more active the high roads activity (prefrontal cortex) the more balanced the outcome. The low road was considered therefore a direct pathway designed to protect us without conscious thought.

Richard Davidson, proved that a positive state of mind can be trained, he carried out brain scans on monks who were thinking positively, then negatively and it showed that different parts of our minds are responsible for different feelings, so we can identify what part of the brain we are using and encourage positive thoughts.

John Ratey in his book, A users guide to the brain, saw the brain as an office, the Pre-frontal cortex was The Boss, who led the operation, the Amygdala was the Safety officer, always on the look out for danger and the Anterior cingulate was the Secretary, who let the boss know of any information he needed to know. In times of danger, the safety officer would take over instantly and the boss would be informed of his actions by the secretary, he could then make a rational decision about the situation, a great elaboration of Cohens discoveries. Ratey also proved we can alter the chemical balance in our brains in many ways to ensure we are “keeping the brain in balance to change your life”

Paul Elman discovered the Smile Advantage and discovered the brain is primed for positive feelings.

Marcus Raichle discovered that the brain showed large amounts of activity whilst resting or daydreaming and noticed that this activity stopped when the subject was given a task to complete. Asking the question, what was it doing during rest? the solution was reinforced by his colleague Gordon Shulman who saw on a sample of 134 brain scans that regardless of the task, areas of the brain that were active during rest, dimmed as soon as the subject was concentrating. They had discovered that the brain resorts to a default mode when unoccupied, which could be described as a trance like state and speculated that this may provide us with an inner rehearsal, considering future choices and outcomes.

Donald Hebb proved that neural networks were strengthened with repeated patterns of behaviour, by using rats to perform repeated tasks. Repetition strengthened areas in the brain, showing we can exercise our brains to and encourage growth.

Returning to the statement “knowledge is everything” why do most forms of therapy omit teaching the client how the mind works? We have years of scientific evidence to prove what is happening in our minds, surely an understanding of this is essential for our clients to be able to understand why they feel as they do.

Let’s finally look at Solution Focused Hypnotherapy and identify the similarities to other forms of Psychotherapy and the beneficial science-based additions that allow us to give a comprehensive service to our clients.

Solution Focused Hypnotherapy

A comprehensive presentation of the workings of the brain and mind is given to allow clients to see and understand how and why they are feeling like they do. Utilising research and scientific evidence from a multitude of professional bodies and researchers.

It is a talking Therapy (Counselling) (CBT) (SFBT) (PP) (Erickson)

Is future orientated, enabling the client to find solutions to problems (CBT) (SFBT)

It promotes positive change (CBT) (SFBT)

Its highly structured to give consistency (CBT) (SFBT)

It’s recognised as a pragmatic therapy and doesn’t dwell on past problems, it’s very much in the now. (CBT) (SFBT)

Is positive and builds on the strengths of the clients, with the understanding that they know what they need to do to move forward (CBT) (SFBT)

Clients describe what they want, rather than what they do not want (SFBT)

The use of Scales is incorporated to monitor progress (SFPT)

It is goal directed (CBT) (SFBT)

It finds exceptions to problems, investigating to find when the problem isn’t there (SFBT)

Does not rely on knowing what the problem is to be able to deal with it (SFBT)

Is structured and every problem, has the same process (SFBT)

Utilises guided relaxation to achieve a state of focused attention which enables the mind to find solutions (HYPNOTHERAPY) (Erickson)

Results are long lasting and success is usually in a short space of time (HYPNOTHERAPY)

Utilises repetition to build neural pathways in the brain (HEBB)

Puts the brain into a resting or trance state to activate the default mode and Inner rehearsal (Raichle/Shulman) (hypnotherapy) (Erickson)

As we can see, SFH is a combination of the best elements of many differing styles of therapy and its practice incorporates influences from esteemed therapists, scientists, researchers and the great Milton Erickson. Its solution focused approach allows clients to understand why they feel like they do and focusses on small positive changes to improve their mental health and wellbeing, allowing the mind to access its vast intellectual database to find solutions.  Such a collaboration of different therapies ensure that clients are given the best possible chance of living the lives that want to live, giving them the knowledge to make a change, because as we know, Knowledge is everything

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Solution Focused therapy is future orientate, designed to find solutions to problems. It builds on the strengths of the clients, with the understanding that they know what they need to do to move forward

Clients describe what they want, rather than what they do not want to allow themselves to see their preferred future. The use of Scales is incorporated to monitor progress, in the same way as in Solutions Focused Hypnotherapy. It finds exceptions to problems, investigating to find when the problem isn’t there and building on the strength of the client to seek what they did differently at the time. It Is structured and every problem, has the same process, tailored for the individual client, I follow a similar process, but combine it with Neuro science and Hypnotherapy.

Analytical or Jungian therapy is a theory that emphasises the importance of wholeness. It was derived from the work of psychiatrist Carl Jung. It is believed that the unconscious mind is the most important aspect of each individual and that making as much of the unconscious mind as possible can help with healing and the attainment of wholeness. Dreams are thought to be a part of the unconscious and that dreams show ideas, beliefs, and feelings of which individuals are not readily aware. Jungian psychotherapy aims to align conscious and unconscious thoughts. It examines the motivations that lie deep within the client’s psyche and underneath client’s conscious awareness. Jungian therapy draws on dream analysis, word associations and creative activities such as painting, drama, dance and music.