Mike Heap's Blog

Clinical Hypnosis: The Need for Clarity

Written on October 10, 2026

An agreed understanding of the defining characteristics of clinical hypnosis is lacking, as is a clear account of its underlying rationales.

Throughout this blog, I have insisted that crucial to an understanding of the phenomenon we call 'hypnosis' is the context in which it is taking place. In the context of academic research, most investigators appear to have an agreed understanding of what is meant by the term, enabling them to be confident that they are all investigating the same phenomenon.

Previously, I have provided a rough summary of this agreed understanding as follows: 'Hypnosis is an interaction between the hypnotist and subject or subjects in which the former repeats suggestions, ideas and imagined scenarios, to which, if they are sufficiently suggestible, the subjects respond in a manner they experience as realistic and effortless'.

When referring to hypnosis applied in the clinical context, I consider this agreed understanding to be at best insufficient. Indeed, in my experience clinical practitioners seem to have their own ideas of what hypnosis is, and these often differ from those of other practitioners. Moreover, the procedures they use which they refer to as 'hypnosis' may differ little from those of practitioners who do not claim to be using hypnosis. This makes formal research into clinical hypnosis problematical.

Now, reports of favourable outcomes of clinical trials into the efficacy of hypnosis for various disorders and conditions have not been lacking, although there are problems with such studies and what conclusions may be drawn from them; I shall not enumerate these here, with one exception. This is the persistent lack of any clear agreement concerning the defining characteristics of hypnosis when used in the clinical context, and the assumptions underlying its application as a therapeutic medium.

I believe that clinical hypnosis would be more favourably regarded by mainstream professions if practitioners agreed on a clear and explicit description of its defining attributes when it is used for clinical or therapeutic purposes. And since it is intended to promote significant and lasting changes of a psychological and physical nature, this 'agreed understanding' should include some explanation of the theoretical rationale that informs its application in the treatment of various disorders, conditions, and problems in life. While claims about the effectiveness of any treatment should have a strong evidence base, the same goes for the presumed mechanisms underlying its mode of action.

A while back, I came up with a short, loose description of what seems to me to be implicit in the clinical practitioner's use of hypnosis, including the assumptions on which its presumed clinical and therapeutic benefits are based:

A procedure whereby the clinician administers to the patient or client a series of suggestions of physical and mental relaxation and inner absorption. This results in a state of mind in which the recipients are more responsive to the clinician's therapeutic procedures and communications and there is enhanced access to their unconscious mind.

This 'state of mind' is referred to by some as the 'therapeutic trance', but its exact nature and attributes do not appear to have been elucidated in any objective way.

Well, I admit that this is at best just a start and more work needs to be done. It may merely provide a basis for further elaboration. But if it points in the right direction, then it immediately indicates the kinds of investigations, in addition to outcome studies, that are required to support the use of hypnosis in the clinic. For instance: What is the evidence for patients being 'more responsive to the clinician's therapeutic procedures and communications', or that 'there is enhanced access to their unconscious mind'.

I would add that we need to know more about which patients are likely to respond positively to hypnosis treatment and which patients are less likely to do so. Standard suggestibility scales, so useful in the laboratory, have generally fared poorly in the clinic as predictors of therapeutic outcome (i.e. as a means of assessing which patients are likely to be 'more responsive to the clinician's therapeutic procedures and communications').

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