• What is hypnosis?
• How will I know if I've been hypnotised?
• Will you take control of my mind?
• What will you be doing?
• What happens if I don't come out of hypnosis?
• Will I tell you all my secrets?

It is useful to explain that hypnosis can be considered as a form of relaxation where the mind is receptive to rational self-helping suggestions. Hypnosis will only occur if clients want it to happen. They will be in control and if they want to wake up they will be able to. They will not reveal any secrets if they do not want to.

At the preliminary induction stage, the client can be told that it is quite normal during hypnosis to feel tingling, warm or heavy feelings in their hands and limbs. It is recommended that the client either lies on a couch or is seated in a comfortable chair with a headrest. The room should be at a reasonable temperature as some clients feel cold during hypnosis (or relaxation). The counselling room preferably needs to be located in a quiet part of the building. It is usually more comfortable for clients if they remove their contact lenses or glasses.

The preliminary induction part of the hypnosis script is designed to encourage a state of hypnoidal relaxation. Whether a 'hypnoidal' state actually exists is debatable. However, this is not relevant as client expectation that hypnosis will prove helpful is probably the most important component in effective hypnosis (see Lazarus, 1973). In the script described, unlike the more traditional methods, the therapist does not 'will' the client to close his or her eyes as this may increase resistance and be counter productive in some cases.

Deepening
The deepening stage of hypnosis is designed to increase the depth of relaxation. The method described later in the hypnosis script uses a counting and breathing technique. This method can be used in most cases except where clients experience breathing difficulties, for example, smokers. In those cases or with clients who can easily visualise scenes, an imagery method may be preferable. If imagery deepening is selected then a particular suitable relaxing scene would need to be elicited from the client beforehand. Imagery that involves the client imagining going down something such as a hill, a lift, flight of stairs, a beach or a country lane is ideal. It is advisable to avoid imagery that may trigger anxiety as this will not help the relaxation process; for example, instructing a client who is phobic of lifts to imagine using a lift.

A typical imagery deepener is described below. It has been found helpful for the counsellor to gently emphasises the trigger words 'DOWN' and 'NOW' as this seems to induce a deeper state of relaxation in clients.

Optional imagery deepener (Palmer, 1993:28-31)
I want you now to imagine that you are at the top of the hill that you described to me earlier
Pause
Just look at the view. Notice the colours of the plants in the fields
Pause
As you look down the hill you can see the cows in the meadow at the bottom of the hill
Pause
You can feel the warmth of the sun on your face
Pause
In a few moments time
Pause
But not quite yet
Pause
You are going to take three steps DOWN the hill, one at a time
Pause
And by the time you take the third step you will be at the bottom of the hill in the meadow
Pause
And every time you take one step DOWN the hill you will feel more and more relaxed than you do NOW
Pause
In a few moments time, you are going to take your first step DOWN the hill, but not quite yet, and when you do, you are going to feel so very relaxed
Pause
Take your first step DOWN the hill NOW
Pause
NOW you are feeling more relaxed than you did a few seconds ago, a few minutes ago, a few hours ago, a few days ago, even a few weeks ago
Pause
NOW that you are one third of the way DOWN the hill, notice how your view has changed
Pause
Take your time and just look at the view that you know so well. And as you look around, notice how very relaxed you are now feeling
Pause
Can you see that you are now closer to the bottom of the hill. Your view of the meadow has improved
Pause
In a few moments time, I'm going to ask you to take your second step DOWN the hill, and when you take that step you are going to feel even more relaxed than you do NOW
Pause
Take your second step DOWN the hill NOW
Pause
NOW you feel even more relaxed than you did a few moments ago, a few minutes ago, much more relaxed than you did a few hours ago
Pause
Your view has altered again as you approach the bottom of the hill. The meadow looks much closer. If you look back up the hill, notice how far away the top of the hill now seems
Pause
Look in the fields at the plants and the cows. Notice the smells of the flowers in the hedgerow.
Pause
You are feeling so very relaxed now, it feels that you are really there in your favourite countryside walk
Pause
In a few moments time, but not quite yet, you take your last step DOWN the hill, and when you do, you will feel so very relaxed when you arrive in the meadow
Pause
Take your last step DOWN the hill NOW
Pause
NOW you are feeling so very, very relaxed. More relaxed than you felt a few moments ago, a few minutes ago, much more relaxed than you felt a few hours ago
(At this point, continue with the ego-strengthening script.)

Ego strengthening
This is the key part of the process where the therapist challenges the client's (previously assessed) irrational self-defeating beliefs and behaviours and inserts powerful rational self-helping statements (see Ellis et al., 1997). It is recommended that the coping statements are targeted directly at the client's irrational beliefs. The script can be altered to take into account any general condition from which the client may be suffering such as migraines etc. It is also useful to reiterate the positive effects of hypnosis outside the therapeutic hour (Palmer, 1993). This may have a beneficial post-hypnotic effect which is an important component of hypnosis.

Coping imagery can be included to help the client to deal with difficult situations such as giving presentations or dealing with phobias (Palmer and Dryden, 1995). Rational-emotive imagery can be used to demonstrate that clients can stand difficult situations and events and how to change unhealthy negative emotions to healthy negative emotions. Forward time projection imagery can be used to highlight that the client can stand current adverse situations and that seldom are events 'awful' indefinitely (Lazarus, 1984; Palmer and Dryden, 1995). However, it is important to select the appropriate imagery technique for a specific problem.

In the script, the 'pauses' help to underscore the ego-strengthening suggestions and enhance their effect (Palmer, 1993).

Symptom removal
The symptom removal stage is used if the client is experiencing difficulty dealing with a particular psychosomatic or physical symptom. If this stage is left out, then the termination script can be inserted at this point. Symptom removal is targeted at specific symptoms the client may be suffering from such as allergies, anxiety, asthma, habits (e.g. over eating, smoking), headaches, insomnia, migraine, pain, panic attacks, phobias, tics, skin disorders, and speech disorders etc. (Palmer, 1993). The script illustrated in the text may help with the alleviation of migraine and tension headaches. Hartland (1971) can be consulted for a wide range of symptom removal scripts.
When dealing with clients with so called symptoms of stress or physical pains it is important to ensure that the client does not have an underlying organic condition. An appropriate referral to a medical practitioner may be necessary.
Termination
The termination stage is the last part of the hypnosis procedure. If clients open their eyes before hypnosis script has been completed then they are asked to close their eyes and the termination stage is executed.

Debrief
It is useful to discover what the client thought and felt about the experience and to answer any queries that may have arisen during the session. If the client wants to receive hypnosis again in a later session then it is useful to ask whether he or she would like any part of the script altered.

HYPNOSIS SCRIPT

Preliminary induction (adapted Palmer, 1993:33-6)
Can you make yourself as comfortable as possible in your chair
Pause
And if you would just like to close your eyes
Pause
If you would like to listen to the noises outside the room
Pause
And now listen to the noises inside the room
Pause
These noises will come and go probably throughout this session and you can choose to let them just drift over your mind and choose to ignore them if you so wish
Pause
You will probably notice how these noises and the sound of my voice will become softer and louder and softer again during this session. This is quite normal and will indicate that you are in a state of hypnosis
Pause
Let your whole body go limp and slack
Pause
Now keeping your eyelids closed and without moving your head, I would like you to look upwards, keep your eyes closed, just look upwards
Pause
Notice the feeling of tiredness, sleepiness
Pause
And relaxation
Pause
In your eye muscles
Pause
And when your eyes feel so tired, so very, very, tired, just let your eyes drop back DOWN
Pause
Notice the feeling of tiredness, sleepiness and relaxation in your eyes
Pause
Let this travel DOWN your face to your jaw
Pause
Now just relax your jaw
Pause
If your teeth are clenched, then unclench them
Pause
Now relax your tongue. If it's touching the roof of your mouth then just let it fall down
Pause
Let the feeling of relaxation slowly travel up over your face to your forehead
Pause
To the top of your head
Pause
To the back of your head
Long pause
Then slowly DOWN through the neck muscles
Pause
and DOWN to your shoulders
Long pause
Now concentrate on relaxing your shoulders, just let them drop DOWN
Pause
Now let that feeling of relaxation in your shoulders slowly travel DOWN your right arm, DOWN through the muscles, DOWN through your elbow, DOWN through your waist, DOWN to your hand, right DOWN to your finger tips
Long pause
Now let that feeling of relaxation in your shoulders slowly travel DOWN your left arm, DOWN through the muscles, DOWN through your elbow, DOWN through your wrist, DOWN to your hand, right DOWN to your finger tips
Long pause
And let that feeling of relaxation in your shoulders slowly travel DOWN your chest right DOWN to your stomach
Pause
Notice that every time you breathe out, you feel more and more relaxed.
Pause
Let that feeling of relaxation and tiredness travel DOWN from your shoulders DOWN your back, right DOWN through your back muscles
Long pause
Right DOWN your right leg, DOWN through the muscles, DOWN through your knee, DOWN through your ankle
Pause
To your foot, right DOWN to your toes
Long pause
Let the feeling of relaxation and tiredness now travel DOWN your left leg
Pause
DOWN through the muscles, DOWN through your knee, DOWN through your ankle
Pause
To your foot, right DOWN to your toes
Long pause
I'll give you a few moments now
Pause
To allow you to concentrate on any part of your body that you would like to relax even further
15 second pause or longer if necessary

Deepening (adapted Palmer, 1993:36-8)
I want you now to concentrate on your breathing
Pause
Notice how every time you breathe out, you feel more, and more, relaxed
Pause
With each breath you take you feel so relaxed, so very, very relaxed
Pause
Breathe in slowly through your nose and slowly out through your mouth
Pause
With each breath you take
Pause
Every time you take a new breath of air
Pause
You are becoming more and more relaxed
Pause
Gradually you are drifting away as you become more, and more,
relaxed
Pause
On every out-breath you are becoming more, and more, sleepy
Pause
More and more deeply relaxed
Pause
Notice how, as you relax, you are breathing more, and more, slowly
Pause
And more, and more, steadily, as you become more, and more, deeply, very deeply, relaxed
Pause
You are drifting DOWN into a deep state of relaxation
Pause
Your whole body is becoming more, and more, relaxed, every time, you breathe out
Pause
I'm slowly going to count to five, and as I do, you will feel even more relaxed than you do now
Pause
One
Pause
NOW you are feeling more and more relaxed than you did a few minutes ago. More and more relaxed than you did a few seconds ago
Pause
Two
Pause
Notice how you are feeling so relaxed, that you are finding it so difficult to concentrate on my voice all the time
Pause
Three
Pause
NOW every time I say a number, every time you breathe out, you feel more and more deeply, very, very deeply relaxed. An overwhelming feeling of tiredness and relaxation is descending upon you as you listen to my voice
Pause
Four
You are feeling even more relaxed NOW than you did a few minutes, a few seconds ago. In a moment when I say the number five, but not quite yet, you are going to feel so very deeply relaxed...
Pause
Five
Pause
NOW you feel even more relaxed than you did a moment ago, more relaxed than a few seconds ago, much more relaxed than you did a few minutes ago, and very much more relaxed than you did a few hours ago.
Pause

Ego-strengthening (adapted Palmer, 1993: 38-41)
You are now so relaxed, so very relaxed, that you are becoming very aware of what I am saying to you
Pause
You are so aware that your mind is open to any positive suggestions I may make for your benefit
Pause
You are feeling so relaxed that when I make positive suggestions about your health, you will accept these suggestions, and gradually over a period of time you will feel better and better, even though you will not be here with me
Pause
My suggestions will just drift over your mind and you will be able to remember all the relevant ones that will influence your feelings
Pause
Your thoughts
Pause
And your behaviour
Pause
As you feel more and more deeply relaxed during this session, you will find new energy to help you cope with any problems you may have had recently
Pause
New energy to lessen any fatigue
Pause
New energy to help you concentrate on your goals
Pause
A new strength of mind and body to deal with internal and external pressures
Pause
Gradually, you will become absorbed in life again, looking forward to every day
Pause
An as every day goes by, you will become more relaxed, and much calmer than you have been for some time
Pause
And each day, you will feel far less tense, and far less concerned with unimportant matters
Pause
And as this happens, your confidence will grow as your old fears become a distant memory
Pause
Week by week, day by day, hour by hour, minute by minute, second by second, your independence will grow
Pause
Any anxiety or depression or guilt or stress will fade away as you learn to cope with life
(NB Target relevant emotion or physical state according to the client's presenting problem.)
Pause
You will be able to stand difficult situations much more easily
Pause
You will no longer hear yourself saying 'I can't stand it', but instead you will realistically say to yourself, 'It's unpleasant but I CAN STAND IT'
Pause
As you learn that you can stand situations, you will procrastinate less often and you will be able to start and continue your tasks more easily
Pause
You will question whether things are really awful. They may be bad but are they really awful?
Pause
As you realise that you can stand situations, and that things are seldom awful, you will be able to face your fears much more easily
Pause
If you fail at a task, you will not condemn yourself as a total failure or stupid
Pause
All it means is that you did not achieve your target
Pause
No more, no less
Pause
You will learn to accept yourself more for the person you are and not just for your achievements
Pause
Your internal demands, many of those unnecessary, inflexible musts and shoulds
Pause
Will change to preferences and coulds and subsequently your anxieties will lesson
(Target relevant emotion according to the client's presenting problem.)
Pause
Gradually, as time goes by, you will feel better and better and your life will improve
Pause
And your recent worries will be a thing of the past
Pause
And you will be able to put them behind you
Pause

An example of symptom removal (adapted Palmer, 1993: 42-3)
Day by day, week by week, month by month
Pause
As you become much more relaxed
Pause
And far less tense
Pause
Gradually, the tension in your shoulders
Pause
And in your neck will fade
Pause
You will stand and sit in a very relaxed manner
Pause
And as you do, you will feel so comfortable that any pain will become a distant memory
Pause
If you concentrate now on your face
Pause
On your head
Pause
And on your neck, notice how, as you relax even further
Pause
Gradually your head and face, are starting to feel warm
Pause
As this feeling of warmth increases, you are starting to feel even more relaxed than you did a few minutes ago
Pause
And day by day
Pause
As you feel less tense, in your body and mind, this state of relaxation will help to prevent headaches occurring
Pause
And as the pain is normally related to stress and tension
Pause
Day by day, as you become more relaxed
Pause
And less tense, the pain will diminish
Pause
And if you ever feel the headache returning
Pause
You will be able to sit down, relax your shoulders
Pause
Relax your neck muscles
Pause
Relax your face and head
Pause
And the pain will just drift away
Pause

Termination (adapted Palmer, 1993: 43-4)
In a few moments' time, but not quite yet, I am going to count to three, and when I do, you will open your eyes and wake up, and feel relaxed and refreshed
Pause
You will be able to remember or forget whatever you want to of this hypnosis session
And you will be in full control of your body and mind
Pause
And wake up today on (insert here: day, time, location)
Pause
As I count to three, you will wake up
(NB Counsellor starts to speak louder with each subsequent number)
Pause
One
Pause
TWO
Pause
THREE
Pause
Open your eyes in your own time

ANOTHER EXAMPLE OF AN EGO STRENGTHENING SCRIPT
It is recommended that the ego strengthening part of the script is adapted according to the problems that the client is suffering from. The following example is from a paper Ellis (1986) wrote about a female client with borderline personality disorder suffering from anxiety about anxiety and a range of other problems. Only a section is included just to illustrate how REBTers can be creative and strongly dispute irrational beliefs during hypnosis:

'Nothing will kill me. Anxiety won't kill me. Lack of sex won't kill me. There are lots of unpleasant things in the world that I don't like, but I can stand them, I don't have to get rid of them. If I'm anxious, I'm anxious - too damn bad! Because I control my emotional destiny - as long as I feel that I don't have to do anything, that I have to succeed at anything. That's what destroys me - the idea that I have to be sexy or I have to succeed at sex. Or that I have to get rid of my anxiety.' In your regular life, after listening to this tape regularly, you're going to think and to keep thinking these things. Whenever you're anxious, you'll look at what you're doing to make yourself anxious, and you'll give up your demands and your musts. You'll dispute your ideas that 'I must do well! I must get people to like me! They must not criticize me! It's terrible when they criticize me!' You'll keep asking yourself 'Why must I do well? Why do I have to be a great sex partner? It would be nice if people liked me, but they don't have to. I do not need their approval. If they criticize me, if they blame me, or they think I'm too sexy or too little sexy, too damn bad! I do not need their approval, I'd like it, but I don't need it. I'd also like to be unanxious, but there's no reason why I must be. Yes, there's no reason why I must be. It's just preferable. None of these things I fail at are going to kill me.'

'And when I die, as I eventually will, so I die! Death is not horrible, it's a state of no feeling. It's exactly the same state I was in before I was born. I won't feel anything So I certainly need not be afraid of that!'....

In commenting about whether hypnosis helped the client, Ellis stated that the client believed that she made greater progress using REBT hypnosis than she had previously made in REBT. Ellis also agreed with her findings (see Ellis, 1986).

Ellis has found that the depth of the trance achieved by his clients made little difference to the effectiveness of hypnosis. Therefore a deep trance state may be unnecessary and in some cases counterproductive if the client does not concentrate on the ego strengthening stage. It is recommended that clients record the hypnosis session and regularly listen to the tape at home. Ellis encourages clients to listen to the tapes on a daily basis for one or two months to enable the REBT messages to get through (Ellis, 1986; 1993). Ellis often only uses hypnosis for a single session. Wherever possible, Ellis prefers not use use hypnosis at all, but will use it with REBT if necessary. He stated in an interview: 'When people ask me for hypnosis I often talk them out of it. Why? Because they have usually read somewhere that it does magic and it will help them enormously with very little work on their part. I therefore try to help them see that this isn't so and try to get them to use REBT without hypnosis' (Dryden and Ellis, 1995:49).

INDICATIONS AND CONTRAINDICATIONS
Hypnosis is indicated for a wide range of unhealthy negative emotions, psychosomatic and stress-related disorders, including anger (damning), anxiety, asthma, allergies, behavioural problems (e.g. smoking, tics, over-eating and weight control), blushing, common and classic migraine, depression, guilt, hurt, hypertension, insomnia, irritable bowel syndrome, pain, phobias, physical tension, shame, skin disorders, (e.g. eczema), stress, speech disorders (e.g. stammering) and tension headache (see Hartland, 1971; Palmer, 1993; Palmer and Dryden, 1995).

Hypnosis has been used since the turn of the century, if not longer, for 'shell shock' or 'traumatic neurosis' (see Edgell, 1926; Pfister, 1917). These conditions are now commonly known as post traumatic stress disorder (PTSD). However, research indicates that hypnosis may not be the intervention of choice for PTSD as cognitive restructuring by itself or combined with exposure is more effective (see review in Penava et al., 1995). Interestingly, supportive therapy is the least effective intervention whereas brief psychodynamic therapy is on a par with hypnosis. More research is needed in this area because it is possible that if the hypnosis included imaginal exposure/implosion and REBT restructuring methods, then the technique would be more effective. A similar but less directive method has been discussed elsewhere (Moore, 1993).

Palmer and Dryden (1995) caution against using hypnosis if the client is under the influence of drugs or alcohol. Hypnosis is contraindicated in clients suffering from severe psychiatric disorders. It is not recommended for hysterical and conversion reaction symptoms unless the client is also receiving therapy to resolve any underlying conflicts. Palmer and Dryden also suggest that care needs to be taken when using hypnosis with clients who suffer from asthma, epilepsy or narcolepsy as hypnosis (or other forms of relaxation) may in rare cases exacerbate the condition.

CONCLUSION
Hypnosis as a therapeutic adjunct to REBT has been found beneficial for many individuals although it does suffer from some shortcomings (Ellis, 1986). Depending upon how it is applied, the key disadvantages are that hypnosis:

1) is not considered an elegant intervention from a REBT perspective
2) does not necessarily help clients to think for themselves
3) can encourage magical thinking
4) may reinforce low frustration tolerance (LFT) i.e. life should be easy, etc.
5) and may discourage hard work and practice.

Although one of the goals of therapy maybe to help clients shift from being LFTers to HFTers, in other words, to have a high frustration tolerance (HFT), if the only intervention applied is REBT hypnosis, then in my experience, clients may only become MFTers (moderate frustration tolerance). However, taking a pragmatic stance, as some clients find hypnosis advantageous and in certain circumstances it may reduce rates of attrition, then the technique may be worth using under appropriate supervision. Ellis and associates conclude (Ellis, 1997:97): Hypnosis is by no means an elegant therapy, but when combined with REBT it can significantly help clients who resist using REBT's cognitive, emotive and behavioural methods to become less distressed about the stressors in their lives'.

REFERENCES
Dryden, W. and Ellis, A. (1995) Dilemmas in giving warmth or love to clients. In S. Palmer, W. Dryden, A. Ellis and R. Yapp (eds), Rational Interviews. London: Centre for Rational Emotive Behaviour Therapy.
Edgell, B. (1926) Mental Life: An Introduction to Psychology. London: Methuen.
Ellis, A. (1986) Anxiety about anxiety: The use of hypnosis with rational-emotive therapy. In E. T. Dowd and J. M. Healy (eds), Case Studies in Hypnotherapy (pp. 3-11). New York: Guilford Press.
Ellis, A. (1993) Rational-emotive imagery and hypnosis. In J. W. Rhue, S. J. Lynn and I Kirsch (eds), Handbook of Clinical Hypnosis (pp. 173-86). Washington, DC: American Psychological Association.
Ellis, A., Gordon, J., Neenan, M. and Palmer, S. (1997) Stress Counselling: A Rational Emotive Behaviour Approach. London: Cassell.
Hartland, J. (1971) Medical and Dental Hypnosis and its clinical applications. London: Bailliere Tindall.
Lazarus, A. A. (1973) 'Hypnosis' as a facilitator in behavior therapy, International Journal of Clinical and Experimental Hypnosis, 21: 25-31.
Lazarus, A. A. (1984) In the Mind's Eye. New York: Guilford Press.
Moore, R. H. (1993) Traumatic Incident Reduction: A Cognitive-Emotive Treatment of Post-Traumatic Stress Disorder, in W. Dryden and L. K. Hill (eds), Innovations in Rational-Emotive Therapy. Newbury Park: Sage.
Palmer, S. (1993) Multimodal Techniques: Relaxation and Hypnosis. London: Centre for Stress Management.
Palmer, S. and Dryden, W. (1995) Counselling for Stress Problems. London: Sage.
Penava, S. J., Otto, M. W. and Pollack, M. H. (1995) An effect size analysis of treatment outcome studies for post-traumatic stress disorder, paper presented at the World Congress of Behavioural and Cognitive Therapies, July, Copenhagen.
Pfister, O. (1917) The Psychoanalytic Method. London: Kegan Paul.
Stephen Palmer is Director of the Centre for Rational Emotive Behaviour Therapy and Centre for Stress Management, London. He is a Fellow of the British Association for Counselling, an Associate Fellow of the British Psychological Society and the Albert Ellis Institute for Rational Emotive Behavior Therapy in New York and is a certified REBT supervisor. He is a member of the British Society of Experimental and Clinical Hypnosis. He was formerly Vice-chair of the Association of Rational Emotive Behaviour Therapists and recently became a Fellow of the Association.

Correspondence:
Centre for Rational Emotive Behaviour Therapy
156 Westcombe Hill
London
England
SE3 7DH
Copyright S. Palmer, 1997.