HypnoTalks Questions & Answers with Axel Hombach & Dr John Butler – Episode 4

How important is the depth in working with hypnosis?

This is question that confuses many beginning hypnotists. To makes things even more confusing, different schools have different opinions about that.

However, are these founded on solid research?

In the forth episode Dr John Butler and I are going to discuss the question how important the so called depth in hypnosis really is for the outcome of the session. And Dr John Butler will also shed some light on what „depth“ really is.

So, around that depth many myths exist. Let’s hear Dr John Butler, and use what he is sharing with us already with our next client.

You may be surprised at the answer a clinical hypnotist and neurologist with nearly 40 years of experience gives.

Wie wichtig ist die Tiefe wenn wir mit Hypnose arbeiten?

Dies Frage stellen sich viele Hypnotiseure, besonders, wenn sie gerade ihre Karriere beginnen. Um es noch komplizierter zu machen, vermitteln verschiedene Schulen unterschiedliche Ansichten.

Doch gründen sich diese auch auf solider Forschung?

In der vierten Episode diskutieren Dr. John Butler und ich wie wichtig die Hypnosetiefe tatsächlich ist für das Ergebnis der Arbeit mit Hypnose. Außerdem wird Dr. John Butler etwas Licht darauf werfen, was oft als Hypnosetiefe bezeichnet wird.

Um die Hypnosetiefe ranken sich viele Mythen. Lassen Sie uns hören, was uns Dr. John Butler aus seinen 40 Jahren praktischer Erfahrung mit Hypnose und aus der Wissenschaft mitgibt.

Sie werden vielleicht überrascht über die Antwort sein, die ein klinischer Hypnotiseur und Neurologe mit rund 40 Jahren Erfahrung gibt.

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Axel Hombach

Welcome to the fourth episode of HypnoTalks Questions & Answers with Axel Hombach and Dr. John Butler. This time we are going to deal with a question of a colleague of how relevant the depth of hypnosis really is. Depending on which school you learnt at, there are various opinions and teachings about the relevance of the depth of hypnosis. And, I remember from my time when I started, how confused I was. Do I do it right? Is the client deep enough in hypnosis?

Now, I’m here on line with Dr. John Butler and we are going to tackle this question.

My name is Axel Hombach. I’m the leading hypnotist and head of the Hypnose Zentrum Köln. As I said, I’m currently online with Dr. John Butler of the HTI in London, which is the Hypnotherapy Training International, the leading school of hypnotherapy and hypnosis internationally.

Good morning John.

Dr. John Butler

Good morning Axel.

Axel Hombach

Now, our colleague, Marcus, asked that question in our open Transforming Therapy™ group on Facebook.

He asks:

Dear John,

how important is the depth in working with hypnosis? According to the myth, the deeper the better. And, does deeper also mean more relaxed?

John, when I read this question, there are actually several questions involved and we have to look at some points which are: What is depth of hypnosis? Can you measure it? Is it relevant for change work?

How would you suggest do we answer this question?

Dr. John Butler

Well Axel, it is indeed a complex question. And I think, the answer has to cover several aspects of the question. As you say, questions within the question. And so thank you Marcus. And, I will keep it as simple as I can, because if we take the scales that have been used to measure the depth of hypnosis, we could talk about that for a half an hour or more. And, so I’ll keep it as simple as I can. And, the answers are based on my own personal therapy experience, working with many clients, as well as looking at the work of other clinicians, and also looking at the research that exists, such as does exist in this field.

Now, on one level a very quick answer is, I would say, for most hypnotherapy problems the depth of the trance is not a major factor at all. It’s one of several factors. And, it is a relatively minor factor, compared to the other factors that determine therapeutic outcomes. Now, there are some issues, some problems in therapy, where it does have more relevance. But keeping it simple, if we look at the factors that determine therapeutic outcome first, the things that generate readiness for change and commitment to change, are really within the client. And the therapist, who is effective, understands about those and can tell to quite a level of accuracy where the client is on that continuum of getting ready for change, you know. No commitment to change to the other extreme, so to speak, really committed to change. Many therapists may assume the client is ready for change because they’re coming there. And so they work on that basis. But if they were more precise in their work, they would know that they’re really helping the client to get ready and make that commitment. And when that commitment is made, it’s often, that is where the change occurs. It’s almost like throwing a switch. And then it for many problems the change is actually already happening. It may take quite a while. A journey of change of reinforcement, of learning, of ups and downs. But making that decision to change, which means giving up alibis, which means giving up secondary gains. And often the client has had to have quite a level of suffering for them to say „I now need to make change“. So, all of those factors – and others – are very important to work with for generating therapeutic outcomes to stimulate change in the client, and the level of trance is a minor factor for most cases, for most problems.

Now, but back to the issue of depth itself it’s a fascinating topic in one way, because it’s long being noticed that people throughout a trance go through what we might call depth, which is a very crude term. You know, they seem to go into a more relaxed, more absorbed, more dissociated state. And we could argue, are other theorems better than depth? Because it’s a crude term like measuring the depth of water in the tank. You know, the hypnotic experiences is complex with factors such as absorption, passive concentration, alert concentration, and many stages that occur within the trance. Many phenomena that are occurring, increased selectivity, and so on, and increased use of the imagination, the increased emotional content at times, which will make for a much more, shall we say, better understanding of the trance if we were to investigate it, rather than just on one unitary measure like the so called depth of trance. So, with the client feeling that trance was very profound, „I really enjoyed it“, „I got a great sense of inner peace or happiness“.

So, we are very restricting ourselves when we say the depth of the trance. But, it’s been noted from the hypnotists of the 19th century and the Mesmerists that people went up and down in the level of trance, sometimes different between sessions and often noticing that some people went to certainly more intense, absorbed states of so-called trance. And now, there is a big debate about does trance exist, or is hypnosis primarily suggestibility or associate cognitive experience, involving suggestibility, imagination. But we’re not going to go into all of that at the moment. I would say, and by the way the discovery of the inner world through meditation, and if we go back thousands of years, even the Buddhist mapping the states of consciousness that are possible through techniques and methods like hypnosis, self hypnosis, meditation. It’s a very interesting area. But I would say, if we were interested in person development, self discovery, self realization, and that inner discovery well it’s interesting to consider the quality and depth of the trance and so on.

But if we take an average hypnotherapist working with a problem like the depth of trance in relation to smoking, many many studies have been done over the years which shows very little correlation. I have an old book I’m just looking at here on my shelves, Margaret Stager, clinical psychologist back in the 1950s, 1951, showing in her studies correlating depth of the trance, as best they could measure then, versus the outcome of therapy: Very weak correlation.

So, now, let’s take something like hypno-surgery, something I’ve become quite well-known for over the years. Would I want the person in a very profound, lovely state of relaxation and so-called trance? Yes! Because it would help them feel very detached, very calm, very able to ignore unpleasant noises in the background, and so it could have some value there. However, we all know that hypnotic analgesia can be achieved at very lighter level of trance for many people.

So, even when you look at the scales, which attempt to measure trance, and they run various tests for „can you imagine a fly crawling on your arm?“, „can you achieve an eye catalepsy? Or a hand moving up or down? Or hands moving apart?“ All of these tests are used to determine the level of susceptibility, which is really in this case the level of suggestibility – to use the old term – and really not measuring the level of trance itself, the level of the hypnotic experience. So that interesting issue about what the tests measure and whether you have to be at a certain level of trance to get a phenomenon like anesthesia, profound anesthesia. We know those scales are not that accurate. People sometimes experience interesting hypnotic phenomena at a so-called lighter level, but we are simply saying, „well he experienced that interesting phenomenon and therefore it means he’s at that level“. Even Dave Elman – one of the great masters, whose work we teach a great deal of, and who I’m the publisher for his audio and written materials – he said profound alagaësia is proof of a deeper level of trance. And yet in his own work he goes on to show how we can get substantial analgesia with waking hypnosis, without the trance so-called. And we know, I’ve known that people who just through suggestion could get a level of hypnotic anesthesia suitable for surgery. So there is a lot of complexity there it’s not a simple question to answer.

Now, the the old-fashioned term of depth was often, I think, associated with the idea of sleep and the person being kind of unconscious and then of course the subconscious was supposed to be open and like a passive vehicle for the suggestions. And I think that played into the idea of the power of the hypnotist. And so, if he was very deep he would automatically almost slavishly carry out those suggestions. And of course that view of the subconscious doesn’t really, doesn’t hold water. I don’t believe it’s true. It’s a mistaken view and it can become a great trap for therapists, too. Not only for their ego, but if the client says: „You know, I haven’t stopped smoking, I think the problem is you didn’t really get me deep, you didn’t really get me into hypnosis.“ And if the hypnotist falls into that trap he or she might say: „Well, it’s early days, if we do more practice with you, you’ll get deeper and then you’ll have deposited the result in therapy.“ Well, that’s very very misleading, very inaccurate. And now the onus, responsibility for therapeutic change is being put on the therapist. So, that’s a danger too.

So, we have to look at what is actually happening in hypnosis in more depth and that itself has caused a lot of confusion, conflict of theories, over the years. Again, we’re not going to into all of that. But I would say, of course people in hypnosis don’t lose awarenesses. Dave Elman said it’s increased 2,000 percent, he said. A 20-fold increase. They’re more sensitive, their minds are more acutely aware of things, they’ve greater selectivity, they may just switch off and ignore and they’re increased awareness because they just want to rest, they’re feeling tired. But all of those faculties that open up within the mind are available. And I think, depth of trance does not really capture such a multi-level, multi-dimensional experience of hypnosis. But, and I should say, in the studies – we’re not just talking of studies from 1950s – one of the people very involved in America with the psychology movement uses of hypnosis, Corydon Hammond, in his book and several writings of his, he touched on the subject and he decided from his review of other studies and his own observations, that as long as there was a moderate level of trance, the client was feeling reasonably relaxed, then their motivation, their rapport, the rapport with the therapist, their therapeutic relationship was, and other factors of course of commitment to change, were much much more important than the level of trance.

Now I’ve noticed with some clients over the years that having gone more fully into the trance with practice, certain phenomena may be more likely to occur. And we talk about pain control being one of them. But again, that’s not entirely dependent on the level of trance by any means but when the client feels „oh wow that was a good trance there“, it confirms for them that they’ve gone into hypnosis, which builds expectancy and motivation for change and confidence in the therapist and their abilities. So we can see that it’s a complex issue that people, clients and therapists, often oversimplify and misunderstand. And so it’s important that we as therapists are aware of the complexity of this issue and don’t fall into any of the therapeutic traps, where we are making a gross mistake such as „depth of trance is very influential in the therapeutic outcome“. As I’m saying from my experience and reading that’s not the case for most problems at all.

And all of the scales that have been done from Bernheim in the 19th century, and a big influence for a while in the 1950s was the Davis Husband Scale, the Stanford scales of hypnotic susceptibility, the Harvard group scale, all of these scales are measuring suggestibility. Responsiveness rather than depth of trance. There is only one that I know of that has been used, widely used, supposedly measuring level of trance and that was the LeCron Bordeaux scale, using an imaginary yardstick. it’s a very subjective way of trying to measure the trance experience, and even there we could question exactly what it’s measuring. Now, we might develop some better tests in the future and look at the neurology of it but I think there are dangers in this oversimplified view of the depth of the trance and its relation to therapy. And if a therapist says to a client „You are not very suggestible“, or „You can’t achieve a deep deep enough trance“ I think they are shortchanging that client. I think they’re not doing the best work and very much may be putting the blame either on the client or the client feels this therapist doesn’t know what they’re doing. And all of that is taking us away from the real, the important factors that determine the therapeutic outcome.

And I should say, Axel, that over the years, because I started getting very involved in this work back in my teenage years, and reading up on the subject, experimenting a little and I went along to different groups over the years, and I noticed some of the worst charlatans claimed, well, „we have the magic formula, the secret state, the deep level that we can take you to and that’s going to resolve your problems“. So that of course is gross charlatanism, because, in fact, in the cases that I was aware of they were the least qualified people at developing trance a deepening trance and understanding about trance but they were using it purely as a sales technique.

So in summary, I have to say while it had some relevance in therapy, it’s a complex issue its value in therapy. But the overwhelming evidence, unbiased evidence suggests very strongly that it is a very very minor factor for most therapeutic problems. Good therapists will understand how to develop a trance with a client, help them overcome their inhibitions, and not just say „you’re low hypnotizable“. A good therapist would be able to do all of that but they won’t get trapped into this idea that it depends on getting the person deep enough.

Axel Hombach

Okay John, because our time is already running out for today, for a 4th episode, thank you very much John, for your inside and your expertise on the depth of hypnosis, and how relevant it is.

To sum it up in two punchlines:

1st punch line would be: Deeper is not automatically more relaxed. Would you agree there.

Dr. John Butler

Yes that is it’s much more complex than that.

Axel Hombach


And the 2nd punch line I would say, from what you explained: For the result, for the outcome of the hypnosis sessions the depth of hypnosis itself is irrelevant. There are other factors a lot more relevant, as for example the hypnotist-client-relationship, which is also often referred to as the therapeutical relationship. Would that be summarized so correctly from your point of view?

Dr. John Butler

Absolutely. It is the fact, we can see it over and over again that for a therapeutic outcome the depth of the trance it’s very minor compared to those other factors and particularly the therapeutic relationship, with the rapport and the motivation of the client that is stimulated within the therapy session, often as they get ready for change.

Axel Hombach

Okay. So, the best advice would be:

„If you want to develop your skills and your abilities to generate results with your client, is, work on your traits, on your empathy, on your confrontiveness and what else is involved in that.“

Dr. John Butler

Absolutely. Work on yourself as a therapist and work on understanding how to motivate and stimulate the clients subconscious levels for therapeutic outcomes, for their goals.

Axel Hombach

Okay John. Before we now come to an end, any last words for today for our listeners?

Dr. John Butler

Well Axel, I would like to thank Marcus and thank everybody who is sending in questions. I’m looking forward to hearing about them and talking with you and with our listeners in these informal discussions, which are very interesting. And I’m really looking forward to continuing these discussions.

Axel Hombach

Please send us in more questions. Please join our open Transforming Therapy™ Facebook group, and bring us feedback, more questions. For today have a great day!

Goodbye for now.

John, it was a pleasure with you to do the next episode.

Dr. John Butler

Thank You Axel, my pleasure also

Axel Hombach

Have a good day. Goodbye for now.

Dr. John Butler

Bye for now.