What Happens in a Hypnotherapy Session? What to Expect

Author: Andreas Balasis, LCSW-QS, CHP

Reviewer:  Dr. Mary Perleoni, LMHC ✓

Someone comes in, predominantly the first session, it's a lot of information gathering, to get to know as much about them and their understanding of the problem at hand as I possibly can before I start to do a case formulation and conceptualize which concepts and which behaviors are going to be most applicable to the hypnotic process.

The way it goes is always going to be a pre-talk. And then there are different types of inductions, there are different types of deepeners, and there are different types of interventions when the hypnotic state is entered to reinforce different patterns of behavior, different bodily responses, and different belief systems. And then we bring them out of it and we do a debrief and we repeat the process.

What Happens in the First Hypnotherapy Session?

I want to get to know you first. Typically, any client, whether it's using hypnotherapy or if it's more cognitive behavioral, third wave cognitive behavioral, I love using ACT, acceptance and commitment therapy. It doesn't matter.

When someone comes in, I'll greet them warmly. I might have already had a consultation with them before. I'll go over the policies and procedures of the practice, the documents that they signed upon intake. I'll discuss briefly the limits of confidentiality.

I want to learn how they think about their lives and how they think about themselves and the language that they use to do that. So, of course, given the person's level of comfort and how quickly we're able to establish rapport with one another, I want to know about previous attempts to fix the problem.

I want to know about perceptions of mental health in general, perceptions of hypnotherapy going in, preconceptions, how they relate to the stigma surrounding it. And I want to do essentially a full biopsychosocial assessment. I want to know about health history, family mental health history. I want to know about their upbringing. I want to know about siblings, parents, extended family. I want to know about the presentation of the problem that they're coming in with, most specifically, and the language they use to describe it. I want to know what their day-to-day looks like and how they appraise their day-to-day.

If I ask people to describe themselves in the context of the problems that they're experiencing, I want to know if they view themselves in a way that speaks to a sense of agency or, oftentimes, a sense of hopelessness in the beginning.

A lot of people who come to hypnotherapy, at least in my experience thus far, it feels like a last resort. It's usually not their first experience trying to solve the problem at hand. So I want to validate that, because if this was easy, well, these problems wouldn't have been problems in the first place. They're patterns of behavior that are built up over time, and eventually they stack to a point where the demolition requires attention.

Why Does Rapport Matter in Hypnotherapy?

It's everything. I think in the therapy literature and research, the variable that most contributes to successful outcomes is the client-therapist relationship. People aren't going to open up to someone that they don't trust. It's just not how it works.

Oftentimes it's hard enough to think about the issues that bring people into my office, let alone talk about them to someone who is a relative stranger. So the rapport is quite literally the foundation. You don't have rapport, you're not going to accomplish anything.

Why Does a Hypnotherapist Ask How You Breathe?

First session, we might do a small type of induction, but really it'll be getting an understanding of connecting thoughts with physical experiences. I love asking people how they breathe. And I'll preface it with, this might sound like a silly question, but how do you breathe? And even the way that they respond gives me some insight as to how their mind works. Are they more analytical or are they more feeling-based?

The language that they use matters. Some people say, well, I understand conceptually, I'm supposed to breathe from my diaphragm. I want to fill up my lungs. That might lend itself to one type of hypnotizability demographic or style. Another person might say, I want to imagine a rush of air, or I want to feel deeply my lungs and body being energized. That might lend itself to a different type of style.

Oftentimes what people describe as taking a deep breath ends up being a shallow breath, which can contribute to many problems because the body is now sending signals that there's something wrong because we need a rapid uptake of oxygen. And now the mind is appraising for threats. Back to that salience network.

We'll look and see how they relate to the concept of relaxation. For some people, they truly desire relaxation. I want to feel calm. I want to feel in control. But there might not even be a frame of reference yet. So it's like saying I want to try a flavor of ice cream that hasn't been invented yet.

We need to create a frame of reference for what they desire. What does calm feel like? Well, if we don't know, because maybe we've lived our whole lives on edge, we try to construct what that state can be.

What Happens in the Second Hypnotherapy Session?

Session two, again, I want to know what was it like session one? What were some thoughts, judgments, feedback, anything that surprised you? Anything that, upon further reflection, you think could be helpful for me to know? Did the presenting problem occur in between sessions? Can we use that as a direct example? It really depends on the presenting issue.

That pre-talk means getting an understanding of the language that's going to be used in the hypnotic process and their perception of progress or lack thereof, or their perception of symptomology and order of operations for symptomology, a behavioral chain analysis, which is drawn from dialectical behavior therapy (DBT), to see how they understand cause and effect, because that's part of it.

What Does Hypnotic Induction Actually Look Like?

It's honing attention. The simplest way to put it is it's honing attention. That could be through specific focus on the sensation of each inhale and exhale. That could be the integration of, say, progressive muscle relaxation, so working through the body, adding tension and consciously relieving it.

There could be peaceful place inductions. Do they have any history with a place, a setting that they associate with safety, comfort, and peace? We could bring them to the specific details of that place. Imagine it using all five senses. And with that, what we're doing is we're honing where their attention lies.

And in doing so, it's reinforcing that they are in control. I can't put them in that place. They're choosing to do it.

Throughout the process, you're going to be essentially the one leading how we construct it. I see myself as the guide, but ultimately you're the one who decides where we go. You're not going to come out clucking like a chicken. You're not going to be doing a weird dance, making a fool of yourself in front of a crowd like these stage hypnotists do.

How Many Hypnotherapy Sessions Do You Need?

I don't know if it's responsible to give a universal appraisal of the amount of sessions. Something can click conceptually session one and you realize, wow, it's a lot easier for me to navigate what I'm experiencing. Sometimes it takes more. But there are way too many variables when it comes to a person's personality, a person's experiences, a person's expectations, to responsibly give a range.

Beyond that, oftentimes people want to continue because they uncover certain things, or they see how, this was my initial presenting concern, but now I've come to understand, well, this ties into something else. Or I see that there's effectiveness in looking at it in this area. So let's see if we can take a similar style, similar techniques, these similar mechanics and apply it to other areas of improvement.

Is It Normal to Feel Nervous Before Hypnotherapy?

I'd be more surprised and concerned if you told me you weren't nervous. Nervousness is the normal, appropriate response because you're anticipating a change. We're people, and by nature of being people, we are, call it wired, call it born, to seek comfort and seek consistency.

Even if the place that we are seemingly comfortable and consistent is actually not that comfortable and actually not that consistent, even a change for the better can represent a threat, can represent something that is worthy of being nervous of. And your body is going to respond accordingly.

But just the fact that you can notice and articulate nervousness tells me that we could better understand nervousness. And if we can better understand it, we can create what the inverse is. We can use hypnotherapy to do that, amongst other modalities too.

Meet Andreas Balasis

My name is Andreas Balasis. I'm a licensed clinical social worker in the state of Florida, and I've been intensively trained in mindfulness-based stress reduction through the Perelman School of Medicine at UPenn and in dialectical behavior therapy through the School of Social Policy and Practice at Penn.

I love to see the outcome of this process and everything that goes into it. It's fascinating.

If you're considering hypnotherapy and feeling a little nervous about that first appointment, reach out to IBWHC to set up a conversation with Andreas.