The Paradox of Induction

Foremost, I express my appreciation to Stephen Lankton, Editor-in-Chief of the American Journal of Clinical Hypnosis (AJCH) for inviting me to serve as guest editor for this special issue on induction. I also take this opportunity to express my appreciation to everyone who contributed to the special issue and worked with us under severe time constraints.

My interest in induction goes back to my training days when I took careful notes of all the clever words and phrases workshop leaders used in “inducing” hypnosis. Indeed, many of my fellow workshop participants did the same, and it is not uncommon to see workshop attendees looking for the precise magical combination of words to induce their clients into a trance to obtain involuntary responses.

An adage says “the pen is mightier than the sword,” despite the historic and current state of the world, which suggests otherwise. However, health care professionals engaged in the business of producing change recognize the importance of appropriately phrased messages to establish rapport and produce motivational sets and expectancies for their clients to help accept the idea of making efforts to change. We use words, phrases, and images to do the same prior to, during, and after a hypnotic stage of treatment to establish rapport and produce motivational sets and expectancies for our clients.

The use of the term “induction” to demark the preliminary steps to establish hypnosis makes intuitive sense; we as therapists recognize the need to warm up and ease clients into suggestions so that hypnotic responses occur. However, matters are not so simple—the two words “induction” and “trance” have been debated for years, both for their definitions and need. These terms are often taken for granted as relevant and important to hypnosis. For example, Lankton (2015) found the American Psychological Association (APA) Division 30’s definition of induction, “a procedure designed to induce hypnosis,” as “tautological” (p. 368). He further reflected, “Does induce mean ‘add to client’s experience’ or alter it, or deny it, (help) shift states, or does it not even involve the client’s experience at all?” (p. 368). Similarly, trance, often understood as a “special state,” is characterized by altered states of consciousness, attention, absorption, and suspension of critical thinking that facilitates the production of suggested responses involuntarily or sub- or un-consciously. A persistent issue is whether or not induction is a necessary and/or sufficient condition for trance states to occur. And, if we call the actions taken prior to establishing a trance state “induction,” then what are its requisite components?

In general, experimental evidence for the impact of induction on enhancing responsiveness to suggestions is weak. It appears that induction is neither necessary nor sufficient to enhance responsiveness to suggestions. It has been argued that induction does not produce a special state; rather, it helps create a positive set and expectancies to respond in particular ways (Barber & De Moor, 1972; Kirsch, 1985). The demand characteristics of being in a “hypnosis” session itself may suffice to produce a “hypnotic” response. While inductions are intended to make participants responsive to test suggestions, it may be argued that responding to suggestions themselves may have further inducing (deepening) or “de-inducing” properties via successful or failed responding. Further, the effects of induction are not uniform across types of individuals or types of suggestions. Indeed, items’ pass rates vary on standardized assessment instruments despite the use of inductions. Ordinarily, it is not easy to determine if responses are ‘hypnotic,” i.e., experienced classically as effortless and involuntary (Weitzenhoffer, 1974). This is because such reported subjective experiences might themselves be colored by demand characteristics and cultural expectations.

Inductions take many forms—they may involve asking participants to close their eyes, take deep breaths, relax (any number of scenarios are used), become more focused, let things happen, count (e.g., from 20 to 1) as a way of deepening, go up or down an escalator, experience feelings of being in a trance state, etc. Inductions even involve repetitive suggestion of the aforementioned sort. They may be long or short, tailored to individuals or even generally scripted, and with or without elaborate imagery.

Some investigators have argued that there are different types of trances (Barber, 1981) and different types of responders to hypnosis (Barber, 2000; Barrett, 1990, 1996; Forbes & Pekala, 1996; Terhune & Cardeña, 2010, this issue). What is interesting is that even when all participants receive the same induction, practitioners get different types of responders. These types of results suggest that no matter what one does, people respond according to their abilities and interpretations of the situation, induction instructions, and test or clinical suggestions. The results of induction seem to depend upon multiple factors: participants’ abilities, motivations, expectancies, and the therapists’ skills in establishing a relationship and conveying suggestions. Further, the various responder types (e.g., amnesia-prone, dissociaters, inward attention, or the relaxation types; Barber, 2000; Barrett, 1990, 1996; Forbes & Pekala, 1996; Terhune & Cardeña, 2010) are possibly not tidy, discrete categories. Identification of such putative types requires prior assessment and cumbersome scoring procedures; it is well documented that clinicians are reluctant to incorporate assessment procedures in their practice. The clinical use of such typologies must await further developments (Kumar, 2010).

We need more empirical research on induction including its value, its methodologies (direct, indirect, passive, active-alert, physical activity), and its role in achieving trance depth. What type of induction is helpful and when? How does one establish when an adequate trance depth has been achieved to produce the response that could be called truly hypnotic and therapeutic? Does it matter whether or not responses to suggestions fit the definition of the classic suggestion effect in order to be clinically effective? Is all communication basically hypnotic, particularly when the session is defined as hypnosis? In this special issue, we have internationally reputable scholars from Canada, England, Sweden, and the United States reflecting upon induction from different perspectives.

David Reid questions “the legitimacy of the term ‘hypnotic induction’ and its derivatives” and considers the possibility that such terms may inadvertently help perpetuate myths and misconceptions of hypnosis. He also examines the implications of the language of hypnosis, for example, “Can you really hypnotize someone?” “How can you tell if someone is in hypnosis? [italics in original]” He argues if the purpose of induction is to facilitate, elicit, or evoke a response, then the word induction (to cause) may not be quite the right word.

Erik Woody and Pamela Sadler consider why induction may or may not be a relevant topic. They argue that genuine hypnotic responding is not a result of imagination but is a result of change in the sense of agency, the classic suggestion effect; thus, they argue for separating the “hypnotic” response from other types of responses. They present a “work sample” perspective on induction as a procedure to set the initial stage or the context for the participant to know as to what skills and strategies are required to perform the “to be suggested” tasks. Their perspective includes Michael Nash’s notion of induction as a preamble, but it also includes everything that happens up to when the first test or clinical suggestion is given. They discuss possible ways induction can help hypnosis in terms of the cues they offer to how responses are to be enacted, the nature of interpersonal interactions to be expected, provide meta-suggestions, and allow for a clear transition for new behaviors to emerge.

Terhune and Cardeña lament the practice of induction is based on dated concepts and “uninformed by recent developments in theory and research.” They stress that “uncertainties abound” with respect to what constitutes an optimal induction, what are its essential elements, and its necessity. They examine research on suggestibility, spontaneous phenomenology, neuropsychology, and cognition and “call attention to the relatively impoverished state of knowledge” with respect to induction. They also discuss the notion of optimizing inductions for various types of suggestions and responders.

Stephen Lankton discusses Erickson’s non-authoritarian naturalistic induction in contrast to a ritualistic approach. Natural induction requires “Speaking the client’s own experiential language” (Erickson, 1958, as cited by Lankton, this issue), accepting the situation, and utilizing it to facilitate “reassociation of experiences.” It integrates induction and therapy. Erickson’s approach often involved storytelling, confusion techniques, encouraging dissociation between the unconscious and the conscious mind, and varying voice tones to reinforce the dissociation so as to discourage linear, conscious type thinking that contained learned experiences that served as source of resistance to suggestions for therapeutic experiences. Lankton provides the language for encouraging such dissociation (conscious/unconscious dissociation suggestion) and elaborates on his states of consciousness model and its usefulness in induction and therapy.

Richard Kluft argues that the process of induction may be “more complex and nuanced” than the way it is typically presented in workshop settings. He is concerned that induction is taught similarly to professionals from different disciplines, and that such oversimplification may produce failures for the clients and for the therapists who may, as a result, prematurely give up the practice of hypnosis. He calls for congruence between a therapist’s practice modality and the nature of induction used. He reflects on the important question, “When does a hypnotic induction actually begin?” He discusses the importance of expectancies, events prior to diagnosis (e.g., whether the patient had experienced trauma or not), therapeutic alliance and the real relationship, and elements of transference in creating induction strategies that may be more effective than the use of formulaic approaches.

Arreed Barabasz and Marianne Barabasz make a case for the use of induction. They differentiate between a simple response and a veracious hypnotic response and convey the idea that a response is not due to hypnosis if the participant is not hypnotized. They argue that merely generating expectancies is insufficient during an induction; rather, certain things need to be attended to in order to obtain a veridical hypnotic response. They identify three phases of induction and give specific suggestions on what to do (and what not do) during each phase.

Stephen Krystek and I present an experimental study that compared trance induction, task-motivational instruction, and a “cold-start” control group that was simply told “we will begin the hypnosis procedure now.” We found no significant differences among the three groups on the Barber’s Creative test of imagination and Fields Inventory Scale of Hypnotic Depth. Our findings are predictable from sociocultural perspectives of cultural expectancies.

Both academics and clinicians will find a plethora of useful materials in these articles. Hopefully, they will stimulate a broad discussion and research on this age-old concept of induction and its boundary conditions for appropriate use for subsequent issues of AJCH. Some might argue that the progress in hypnosis has been slow, but consider how long it took for an abacus to turn into an electronic computing device or a landline phone to turn into a wireless smart phone.