Mike Heap's Blog

Trance in the Clinical Context

Written on April 1, 2026

As stated in previous posts, at the heart of the traditional model of hypnosis was the belief that the induction of hypnosis resulted in the subject being in an altered state of consciousness, commonly referred to as a '(hypnotic) trance' and the subject's experiences and behaviour could be explained in terms of the nature of this trance state.

One of the assumed properties of the hypnotic trance was hyper-suggestibility, which was related to the 'depth' of the trance. However, as noted in previously, posts, the evidence suggests that any increase in a subject's responsiveness to suggestion is due to enhanced expectation and commitment on the subject's part conferred by the induction process.

The original concept of trance has not fared well in other ways. Additional alleged properties have included: hyper-obedience or automatism; amnesia for the trance experience; profound insensibility to pain; enhanced performance and the ability to perform superhuman or even supernatural feats; hypermnesia (the ability to remember accurate details of even remote events in one's life that one had forgotten); inability to lie; and extreme literalism. The processes underpinning these profound changes were thought to be the surrendering of conscious control of executive functions of the subject's brain to the hypnotist, and (see previous post) enhanced communication with the subject's unconscious mind.

It is generally acknowledged that in the main, these claims have not withstood experimental scrutiny. Consequently, this concept has lost much of its explanatory value when it comes to understanding hypnosis. Nevertheless, clinicians still find it pertinent and meaningful in their hypnotherapeutic work.

The subjective experience, or phenomenology, of hypnosis has been the focus of qualitative studies by several prominent researchers in the field. These reveal the multifaceted nature of the hypnotic experience and individual differences in the pattern and intensity of the various components, prominent amongst which are a narrowing of sensory awareness; absorption; profound mental and physical relaxation (during the induction, but not when arousal-increasing suggestions follow); detachment or dissociation; passivity-i.e. surrender of conscious control; and time dilation (significant underestimation of the duration of the hypnosis session).

Subjects vary in the intensity of the totality of their trance, many reporting that they simply felt very relaxed, while for others it is a novel and very unusual experience. The latter may feel somewhat confused and disoriented on alerting; they may report significant post-hypnotic amnesia for events that occurred during hypnosis and pronounced time condensation (believing, say, that a 45-minute session of hypnosis has lasted on 5 minutes or so). My impression, with some limited evidence from the literature, is that the last phenomenon occurs more often with stage hypnosis.

Returning to hyper-suggestibility, although subjects can be very surprised by their responsiveness to suggestions (e.g. during administration of a standard suggestibility scale) I am wary about including suggestibility amongst the ingredients of trance as it does not seem that high suggestibility and level of trance are necessarily related. In the clinical context, however, one very plausible claim (to which I would subscribe) is that hypnosis has the potential to promote a higher degree of rapport between clinician and patient than otherwise, and this in itself may render the latter more responsive to the clinician's therapeutic suggestions and other ministrations.

It remains, however, unclear-to me at least-if all the components listed above are purely 'hypnotic' manifestations. They may relate to other, more general aspects of the context and the subject's expectations and attributions. Some of them may also be characteristic of people's experience of procedures that are similar to hypnosis, such as relaxation training; various forms of meditation, including mindfulness; and autogenic training. The present discussion also links up with the outcomes of neuroscientific research into hypnosis, which I hope to cover in a later post.

I have mentioned above, and described in my previous post, the claim that trance facilitates communication with the subject's unconscious mind. Many therapists still make this claim, but I consider it to be baseless or at least highly questionable. It may be that during hypnosis, patients may sometimes be more ready to make personal disclosures than in a normal face-to-face interaction with their therapist, but that is a different matter. Likewise, there is no convincing evidence that during trance, patients may be enabled to remember repressed memories, notably of childhood trauma, including sexual abuse. This idea has resulted in many false accusations against parents by their grown-up children across the world, causing years of torment and distress for the families concerned.

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