Conversational and clinical hypnosis in complex trauma treatment

The Application of Clinical and Conversational Hypnosis in the Treatment of Complex Trauma

I. Introduction: The Challenge of Complex Trauma and the Potential of Hypnotherapy

Complex trauma, arising from prolonged and repeated interpersonal victimization, frequently with an onset in childhood, presents a formidable challenge to mental health.1 Its effects are pervasive, deeply impacting an individual's psychological, emotional, somatic, and relational functioning across the lifespan.1 The profound nature of these disturbances underscores the critical need for therapeutic interventions capable of addressing the deeply embedded sequelae. Hypnotherapy, encompassing both clinical hypnosis and conversational hypnosis, offers potential avenues for healing in this domain. Clinical hypnosis is generally understood as a clinician-guided approach that utilizes focused attention to help individuals access inner resources and facilitate therapeutic change.4 In contrast, conversational hypnosis, often associated with the pioneering work of Milton H. Erickson, employs more subtle, indirect methods of communication and suggestion to influence thoughts, feelings, and behaviors, frequently without a formal hypnotic induction.6 This report aims to provide an expert-level analysis of the application, efficacy, and ethical considerations of these hypnotic modalities in the treatment of complex trauma, drawing upon current research and professional understanding.

A notable consideration in applying hypnosis to trauma treatment is the role of dissociation. Clinical hypnosis itself involves focused attention and a degree of dissociation, wherein experiences can be separated into their component parts.4 Complex trauma, conversely, is often characterized by problematic, involuntary dissociative symptoms as a defense mechanism.1 This apparent paradox—using a state involving dissociation to treat a condition marked by pathological dissociation—suggests that the therapeutic utility may lie in the controlled, guided, and purposeful nature of hypnotic dissociation. This controlled state can potentially empower clients to gain mastery over their otherwise overwhelming and uncontrolled dissociative experiences. Clinical hypnosis might offer a structured pathway to access, process, and re-integrate dissociated material in a safe therapeutic environment. Conversational hypnosis, with its gentler, indirect approach, might circumvent entrenched dissociative defenses to establish a therapeutic connection and foster receptivity to change. This dynamic highlights the critical importance of highly skilled, trauma-informed therapists who possess a nuanced understanding of dissociation. Such therapists can carefully titrate hypnotic interventions, selecting appropriate types and depths of hypnotic engagement to prevent re-traumatization or the exacerbation of dissociative symptoms, thereby transforming a potential vulnerability into a therapeutic asset.

II. Understanding Complex Trauma

A. Defining Complex Trauma: Etiology, Core Characteristics, and Developmental Impact

Complex trauma typically arises from exposure to multiple, severe, and prolonged interpersonal traumatic events.1 These experiences often begin in childhood or adolescence, critical developmental periods, and frequently occur within relationships where an imbalance of power exists, such as with caregivers or other trusted figures, leading to profound relational betrayal.1 Common etiological factors include child abuse (physical, sexual, emotional), neglect, domestic violence, torture, sex trafficking, and prolonged exposure to war or community violence.1 Unlike single-incident trauma, which may have a clear beginning and end, complex trauma is characterized by its repetitive or ongoing nature, often in situations from which escape is difficult or impossible.1 This chronicity and the interpersonal context are central to its definition.

The core characteristics of complex trauma extend beyond those typically associated with Post-Traumatic Stress Disorder (PTSD). A key feature is its profound impact on development, particularly when the trauma occurs during childhood. Ongoing trauma can alter brain structure and functioning, disrupt the formation of secure attachment patterns, and interfere with the development of a cohesive sense of self and stable interpersonal relationships.1 Complex trauma often occurs in secrecy or is denied, leading to significant shame, isolation, and reluctance or inability to seek help.1 Survivors frequently experience pervasive feelings of helplessness and entrapment stemming from the inability to escape the traumatic environment.1

The developmental impact is multifaceted, leading to chronic difficulties in several domains:

●Emotional Dysregulation: Survivors often struggle with managing intense emotions, exhibiting heightened emotional reactivity, difficulty self-soothing, or, conversely, emotional numbing.1

●Disturbances in Self-Organization (DSO): This is a hallmark of complex trauma, encompassing a persistently negative self-concept (feelings of worthlessness, shame, guilt, being "broken" or "damaged"), identity confusion, and chronic difficulties in sustaining relationships and feeling close to others.1

●Dissociation: As a primary coping mechanism to survive overwhelming experiences, dissociation is common. This can manifest as amnesia for traumatic events, depersonalization, derealization, fragmentation of identity, and difficulties with concentration and feeling present in daily life.1

●Interpersonal Difficulties: Profound challenges with trust, intimacy, boundary setting, and a tendency towards re-victimization or isolation are frequent.1

●Somatic Complaints: Many survivors experience unexplained physical symptoms, chronic pain, or other stress-related medical conditions.1

●Behavioral Issues: Increased risk for self-harm, suicidal ideation and attempts, substance abuse as a form of self-medication, and engagement in high-risk behaviors are often observed.1

B. Diagnostic Considerations: CPTSD in ICD-11 vs. DSM-5 Approaches

The recognition of complex trauma's distinct features has led to evolving diagnostic conceptualizations. The International Classification of Diseases, 11th Revision (ICD-11), includes a diagnosis of Complex Posttraumatic Stress Disorder (CPTSD).2 To meet ICD-11 criteria for CPTSD, an individual must first meet all criteria for PTSD (re-experiencing the trauma in the here and now, avoidance of traumatic reminders, and a persistent sense of current threat). Additionally, there must be evidence of severe and persistent "Disturbances in Self-Organization" (DSO) across three domains: (1) problems in affect regulation (e.g., heightened emotional reactivity, explosive anger, reckless behavior, emotional numbing, dissociative states when under stress); (2) negative self-concept (e.g., persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event); and (3) disturbances in relationships (e.g., persistent difficulties in sustaining relationships and in feeling close to others).11 Notably, the ICD-11 definition of CPTSD focuses on this specific symptom profile rather than requiring a particular type of traumatic exposure, although prolonged, repeated interpersonal traumas are acknowledged as primary risk factors.11

In contrast, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), does not include CPTSD as a distinct diagnostic category.11 Instead, the DSM-5 criteria for PTSD were expanded to incorporate some symptoms often associated with complex trauma, such as negative alterations in cognitions and mood (which can include persistent negative beliefs about oneself, others, or the world; distorted blame of self or others; persistent negative emotional state; anhedonia; detachment) and marked alterations in arousal and reactivity (including reckless or self-destructive behavior).11 The DSM-5 also includes a dissociative subtype of PTSD for individuals who meet full PTSD criteria and also experience prominent symptoms of depersonalization or derealization.11 The rationale for the DSM-5 approach included the view that the definition of CPTSD was still evolving at the time of its revision, and there was a desire to maintain a broader, more clinically utilitarian definition of PTSD.11

To address the nuances of complex trauma beyond existing diagnostic frameworks, Professional Practice Guidelines (PPG) for working with adults with complex trauma histories have been developed through a collaboration between the American Psychological Association (APA) and the International Society for the Study of Trauma and Dissociation (ISSTD).2 These guidelines advocate for a dimensional and continuous model for understanding trauma complexity, moving away from a simple categorical distinction between "simple" and "complex" trauma. They emphasize the impact of traumatic life events that are (a) repetitive, (b) occur within significant interpersonal relationships, often involving betrayal, and (c) happen under conditions of coercive control, usually over extended periods.2

C. Differentiating Complex Trauma from Single-Incident PTSD

The distinction between complex trauma (or CPTSD) and single-incident PTSD is crucial for appropriate treatment planning. While both involve exposure to traumatic events and can share core PTSD symptoms, the "complexity" in complex trauma refers not merely to a greater quantity of trauma but to a qualitative difference in its nature and impact, particularly on self-identity and relational systems.1 This qualitative impact arises from the prolonged, repeated, and often interpersonal nature of the trauma, especially when it occurs during critical developmental periods and involves betrayal by trusted individuals. This leads to a more pervasive disruption of an individual's sense of self, their ability to regulate emotions, and their capacity for healthy relationships—aspects captured by the DSO criteria in the ICD-11 CPTSD diagnosis.11 Consequently, therapeutic interventions for complex trauma must extend beyond addressing traumatic memories and fear extinction; they need to encompass the repair of developmental deficits, the fostering of a stable sense of self, the enhancement of affect regulation capacities, and the facilitation of healthier interpersonal functioning. This often necessitates longer-term, phase-oriented treatment strategies.

The following table provides a comparative overview of key differentiating features:

Table 1: Defining Features of Complex Trauma vs. Single-Incident PTSD

Feature Single-Incident PTSD Complex Trauma/CPTSD

Nature of Traumatic Exposure Often a discrete, time-limited event 1 Repeated, prolonged, often interpersonal victimisation; inescapable 1

Onset of Trauma Can occur at any age; may be adult-onset without prior extensive trauma history Often begins in childhood or adolescence during key developmental periods 1

Relational Context of Trauma May or may not be interpersonal Typically interpersonal, often involving betrayal by trusted figures, caregivers, or those in power 1

Core Symptom Clusters (DSM/ICD) Re-experiencing, Avoidance, Negative Alterations in Cognitions & Mood, Arousal (DSM-5) 11 All PTSD symptoms plus Disturbances in Self-Organization (DSO): affect dysregulation, negative self-concept, relational difficulties (ICD-11) 10

Impact on Self-Concept Less pervasive impact on core identity; self-blame may be present Pervasive negative self-concept, chronic shame, guilt, feelings of worthlessness or being fundamentally "broken" 1

Impact on Affect Regulation Primarily fear-based dysregulation, hyperarousal Chronic and widespread difficulties with emotional dysregulation, including managing intense affect, emotional numbing, or dissociation under stress 1

Impact on Interpersonal Relationships Specific relational impacts related to the trauma, but not necessarily pervasive distrust from formative years Pervasive difficulties with trust, intimacy, boundaries, fear of abandonment, or reenactment of traumatic relationship patterns 1

Dissociation May be present (e.g., dissociative subtype in DSM-5) Often a prominent and chronic feature, used as a primary coping mechanism; may include identity alteration or significant amnesia 1

Typical Course Can remit spontaneously or respond to shorter-term, focused therapies Often chronic and persistent; typically requires longer-term, phase-oriented treatment 1

Common Comorbidities Anxiety disorders, depression, substance use Higher rates of dissociative disorders, personality disorders (especially Borderline Personality Disorder), eating disorders, substance use disorders, somatic symptom disorders 1

Key Treatment Focus Processing of the traumatic memory, fear extinction, cognitive restructuring related to the event Stabilization, safety, affect regulation skills, processing of multiple and layered traumas, relational repair, identity work, managing dissociation 2

III. Clinical Hypnosis: Foundations and Therapeutic Mechanisms

A. Core Principles of Clinical Hypnosis

Clinical hypnosis is a therapeutic modality employed by licensed and trained clinicians to address a variety of psychological and physical concerns.5 It is formally defined by organizations such as the American Psychological Association (Division 30) as "a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion".4 This state, often referred to as a hypnotic trance, is not sleep; rather, it is a natural, albeit altered, state of consciousness characterized by deep inner absorption and concentration, during which the client typically remains aware of their surroundings and the therapeutic process.5 Light to medium levels of trance are often sufficient for most clinical applications.5

Several core principles underpin the practice of clinical hypnosis:

1.Focused Attention (Selective Attention): A hallmark of hypnosis is the client's intense and absorbed focus on a particular internal or external stimulus, such as a thought, feeling, memory, image, sensation, or the clinician's words.4 This selective attention allows for a narrowing of the perceptual field, facilitating deeper engagement with therapeutic suggestions.

2.Reduced Peripheral Awareness: Concomitant with focused attention is a diminished awareness of extraneous stimuli or distractions.4 This reduction in peripheral awareness helps the client to become more receptive to the internal experiences and suggestions being explored in therapy.

3.Enhanced Suggestibility: While in a hypnotic trance, individuals may exhibit an increased openness to suggestions that are congruent with their therapeutic goals.5 It is crucial to understand that these suggestions are not commands but rather invitations for the client to experience their thoughts, feelings, or sensations in a new way.5 The therapist's words and demeanor play a significant role in how these suggestions are received and translated into therapeutic change.4

4.Dissociation: This is considered a defining characteristic of hypnosis.4 Dissociation in this context refers to the mental process of separating experiences into their component parts, allowing for a selective focus on one aspect over another. This is a naturally occurring phenomenon (e.g., "highway hypnosis," where one drives safely while lost in thought) that is harnessed therapeutically.4 Hypnotic dissociation can enable individuals to access abilities or achieve changes (such as analgesia or anxiety reduction) that they might not consciously know how to create.4

5.Accessing Subconscious Resources: During hypnosis, the typically active, critical faculty of the conscious mind tends to relax, allowing the subconscious mind to become more accessible.5 The subconscious is understood to hold a vast repository of memories, beliefs, learned behaviors, and untapped resources or skills.5 Hypnosis aims to leverage these subconscious capacities for therapeutic benefit.

6.Automaticity: One of the intriguing aspects of hypnosis is the phenomenon of automaticity, where positive therapeutic responses—such as alterations in mood, reductions in anxiety, or changes in perception—can occur without conscious effort or deliberation on the part of the client, seeming to "just happen".4

7.Role of Relaxation: While relaxation is often used to facilitate hypnotic induction and is beneficial for its anxiety-reducing effects, it is not a defining characteristic of hypnosis itself.4 Hypnotic phenomena can be elicited even when an individual is active and alert. However, in clinical settings, relaxation is frequently employed as a vehicle for hypnosis because it makes the acquisition of new skills and perspectives easier.4

These principles highlight that clinical hypnosis is not a passive state but an active process of experiential learning and change, guided by the therapist but ultimately driven by the client's own inherent capacities.

B. The Role of the Clinician and the Collaborative Nature of Clinical Hypnosis

The practice of clinical hypnosis is fundamentally a collaborative endeavor between the therapist and the client.4 The hypnotherapist acts as a facilitator or guide, inviting the client to explore different states of awareness and to experience their inner world in ways that can promote healing and growth.5 It is a process done with the client, not to them.4 Contrary to popular misconceptions, the client retains control throughout the session, cannot be made to do anything against their will or moral code, and is typically aware of what is happening.5

Effective therapeutic communication is central to clinical hypnosis. The therapist must skillfully use words, tone, and gestures to create a safe and receptive environment, tailoring suggestions to the client's specific needs and goals.4 Building strong rapport and managing client expectations are crucial initial steps; the hypnotic process often begins with instructions and suggestions designed to heighten positive expectancy, clarify roles, and help the client focus their attention.5 Indeed, rapport is considered a prerequisite for successful hypnosis.17

The ethical application of clinical hypnosis is paramount. The practitioner's intentions must be solely focused on the client's well-being, and fully informed consent is a non-negotiable aspect of the process.6 Hypnosis should never be used to manipulate, control, or harm an individual.6 Furthermore, clinical hypnosis should only be performed by licensed and appropriately trained healthcare professionals—such as mental health therapists, physicians, dentists, or master's level nurses—acting within the scope of their professional expertise and licensing laws.5 This typically involves postgraduate coursework, specialized training workshops, and often, ongoing consultation or supervision, particularly when working with complex conditions like trauma.2

The power of clinical hypnosis, therefore, resides not in some mystical ability of the therapist, but in their capacity to create a unique intra- and interpersonal context. Within this context, the client's natural cognitive processes, such as focused attention and the capacity for dissociation, are leveraged in a structured way. This allows the client's own mind to work more effectively towards achieving therapeutic goals, by temporarily shifting the usual modes of conscious processing and accessing deeper resources for change. This perspective demystifies hypnosis, framing it as a sophisticated psychological tool that underscores the client's active participation and inherent potential for healing, which is particularly empowering for survivors of trauma.

IV. Conversational Hypnosis: Principles and Ericksonian Approaches

A. Defining Conversational Hypnosis: Subtlety, Indirect Suggestion, and Rapport

Conversational hypnosis, also referred to as indirect or covert hypnosis, represents a distinct approach that utilizes the nuances of everyday language and interpersonal dynamics to guide an individual's thoughts, feelings, and behaviors.6 Unlike more formal hypnotic procedures, conversational hypnosis often occurs without a traditional induction ritual or the individual's explicit awareness that they are experiencing a hypnotic process.20 Its essence lies in communicating with the subconscious mind during what appears to be a normal, natural conversation.21

A primary characteristic of conversational hypnosis is its ability to bypass conscious resistance.6 The conscious mind often acts as a critical filter, evaluating and potentially rejecting direct suggestions. Conversational hypnosis employs subtle linguistic patterns and indirect communication strategies to circumvent this critical factor, thereby gaining more direct access to the subconscious mind, where beliefs, habits, and emotional responses are often rooted.7 This indirectness is a key differentiator from traditional hypnosis, which frequently relies on direct commands.7

Building rapport is fundamental to the successful application of conversational hypnosis.7 This involves creating a strong connection with the individual through active listening, demonstrating respect and empathy, and fostering an atmosphere of trust and safety.7 When rapport is established, the individual is more likely to feel open and receptive, facilitating their engagement with the subtle hypnotic processes embedded in the conversation.7

Conversational hypnosis can induce a naturalistic trance state, often with the individual's eyes open and in everyday settings.7 It leverages the mind's natural tendency to enter trance-like states, such as those experienced during daydreaming, deep absorption in a task, or when engrossed in a story.7 The conscious mind becomes less focused on external critique and more receptive to internal experiences and suggestions.7

B. The Milton Model and Ericksonian Hypnosis: Key Techniques

The development and popularization of conversational hypnosis are inextricably linked to the work of Milton H. Erickson, a highly influential psychiatrist and hypnotherapist.7 Erickson was renowned for his innovative and unconventional methods, particularly his mastery of indirect communication. He adeptly used his voice, carefully chosen words, storytelling, metaphors, and allegories to induce trance states and facilitate profound therapeutic change, often without the client's conscious awareness of the specific techniques being employed.7 A cornerstone of his approach was the individualization of therapy, adapting his techniques to the unique personality, experiences, and even resistances of each client.24 The "Milton Model," derived from Erickson's work, codifies many of these indirect language patterns.

Key techniques central to Ericksonian and conversational hypnosis include:

1.Indirect Suggestion: This involves phrasing suggestions in a way that avoids direct commands, thereby minimizing conscious resistance.6

○Embedded Commands: Therapeutic suggestions are skillfully woven into the fabric of ordinary sentences, often marked by subtle shifts in voice tone or pacing, so the subconscious mind registers them while the conscious mind may not.7 An example is, "As you listen to my voice, you can allow yourself to feel completely at ease".19

○Vague Language and Ambiguity: Using general or ambiguous terms allows clients to interpret the suggestions in a way that is most relevant to their own experiences and needs.7 This makes the suggestions feel more personal and less imposed.

○Presuppositions: These are statements that implicitly assume the truth of a particular idea or the inevitability of a desired outcome, without directly asserting it.19 For instance, asking, "What will be the first small sign that you are beginning to feel more confident?" presupposes that confidence will indeed increase.

2.Storytelling and Metaphor: Erickson was a master storyteller, using narratives, anecdotes, and metaphors as primary vehicles for therapeutic communication.7 Stories and metaphors engage the unconscious mind, allowing it to draw parallels to the client's own situation and discover new perspectives or solutions indirectly.21 A famous example is Erickson's use of a story about struggling tomato plants to help a patient suffering from severe trauma find a path to healing.24

3.Utilization: This core Ericksonian principle involves accepting and incorporating all aspects of the client's current experience—including their symptoms, beliefs, resistances, and behaviors—into the therapeutic strategy.19 Instead of confronting or trying to eliminate a "problem," the therapist finds ways to use it constructively to achieve therapeutic goals.24

4.Pacing and Leading: This technique involves first matching or "pacing" the client's current state (e.g., their language, mood, posture, breathing rate) to build rapport and create a sense of being understood.20 Once rapport is established, the therapist can then gently "lead" the client towards a more resourceful or desired state.20

5.Other Techniques: These include strategic alterations in voice tonality and pacing, the use of "never-ending sentences" to absorb attention, "mind-bending language" to create confusion and openness to new ideas, Dynamic Mental Imagery, leveraging symbolism, and offering choices or options to enhance cooperation.7

C. Comparison with Traditional/Clinical Hypnosis

While both clinical and conversational hypnosis aim to facilitate positive change by accessing subconscious processes, they differ in their typical methods and presentation:

●Directness of Approach: Traditional clinical hypnosis often employs direct suggestions and formal induction procedures, such as instructions for eye closure, progressive relaxation, or focusing on a specific point.7 Conversational hypnosis, in contrast, relies primarily on indirect, subtle suggestions embedded within natural dialogue.6

●Client Awareness of Hypnosis: In clinical hypnosis, the client usually explicitly consents to and is aware of undergoing a hypnotic procedure. In conversational hypnosis, the client may not be consciously aware that hypnotic techniques are being used; the process can feel like an ordinary, albeit deeply engaging, conversation.20

●Formality and Structure: Clinical hypnosis sessions often follow a more defined structure, including a formal induction, deepening techniques, therapeutic suggestions, and re-alerting. Conversational hypnosis is more fluid and less structured, adapting to the natural flow of the interaction.7

●Setting: Clinical hypnosis is typically conducted in a formal therapeutic setting, often with the client in a relaxed posture. Conversational hypnosis can be applied in a wider variety of settings, as it does not require a specialized environment.7

The non-authoritarian, client-responsive nature of Ericksonian conversational hypnosis makes it particularly well-suited for individuals who have experienced complex trauma. Survivors of such trauma often grapple with profound issues of trust, control, and agency due to past experiences of powerlessness and relational betrayal.1 Direct or overtly authoritative therapeutic approaches might inadvertently trigger defensiveness or re-enact past harmful dynamics. Conversational hypnosis, by prioritizing the therapeutic relationship, meeting the client "where they are" through utilization and pacing, and using their own internal framework and resources for change, can create a much safer and more empowering therapeutic environment.7 This approach respects the client's autonomy and can foster the deep sense of safety and collaboration essential for any effective trauma work. Consequently, conversational hypnosis may not only be a standalone therapeutic modality but can also serve as a vital precursor to, or an integrated component of, more structured trauma processing, by building the foundational trust and internal resources necessary for deeper healing. The therapeutic process in Ericksonian work begins with the initial interaction, as the very way of relating can be inherently healing.

V. Clinical Hypnosis in the Treatment of Complex Trauma

A. A Phased Approach: Stabilization, Trauma Processing, and Integration

The treatment of complex trauma using clinical hypnosis is most effectively conceptualized within a phased-oriented framework, a widely endorsed model for addressing the multifaceted nature of such profound psychological injury.14 Complex trauma often results in significant deficits in self-regulation, affect tolerance, interpersonal functioning, and a stable sense of self, making direct confrontation with traumatic memories potentially destabilizing or even re-traumatizing if adequate preparation and internal resources are not first established.2 The three commonly recognized phases are: (1) Stabilization and Skill Building, (2) Trauma Processing, and (3) Integration and Consolidation.

Phase 1: Stabilization and Skill Building

The primary goals of this initial phase are to establish safety, reduce overwhelming symptoms, improve affect regulation capacities, build coping skills, strengthen internal resources, and foster a strong, trusting therapeutic alliance. Hypnosis offers a range of techniques particularly well-suited for these objectives:

●Ego Strengthening: This involves hypnotic suggestions aimed at enhancing the client's sense of self-efficacy, competence, resilience, and overall ability to cope with distress.5 Suggestions may focus on self-acceptance, inner strength, and the ability to manage challenges. The work of McNeal and Frederick, as detailed in "Inner Strengths," provides contemporary psychodynamic and ego-state approaches to ego strengthening, including specific applications for posttraumatic and dissociative disorders, focusing on stabilization and the repair of developmental deficits.33

●Affect Regulation: Hypnosis can be instrumental in teaching clients to modulate intense emotions.

○Anchoring Resource States: This technique involves guiding the client to access a positive emotional state (e.g., calm, safety, confidence, competence) in hypnosis and then linking this state to a specific physical cue or anchor (e.g., touching a thumb and finger together).16 The client can later use this anchor to re-access the resourceful state when feeling overwhelmed.

○Safe Place Imagery: The client is guided to create or recall a detailed mental image of a place where they feel completely safe, peaceful, and secure.30 This internal sanctuary can be accessed during or between sessions for self-soothing and emotional containment.

○Relaxation Techniques: Hypnotically facilitated progressive muscle relaxation, guided imagery focusing on calming scenes, and suggestions for deep, diaphragmatic breathing can significantly reduce physiological arousal and anxiety.16

●Managing Dissociation: Given that dissociation is a core feature of complex trauma, hypnosis can be used to help clients gain a sense of control over their dissociative experiences rather than being overwhelmed by them.

○Hypnosis can provide a means of controlled access to dissociated memories or parts of the self, within a safe therapeutic container.36

○Techniques are employed to ground the client in the present moment and foster "dual awareness"—the capacity to be aware of a past memory or feeling while simultaneously remaining anchored in the safety of the present therapeutic environment.16

○Specialized approaches like Heart-Centered Hypnotherapy® aim to take clients back to the time of trauma to facilitate the assimilation and integration of split-off personality parts.8 Fraser's Dissociative Table technique, which utilizes hypnotic principles, offers a structured method for working with different ego states or parts.37

●Identifying Triggers: The focused and relaxed state of hypnosis can make it easier for clients to identify specific situations, sensations, or thoughts that trigger traumatic reactions or exacerbate symptoms, which may have previously gone unnoticed.16

●Self-Hypnosis Training: Teaching clients self-hypnosis techniques empowers them with tools for ongoing self-management of symptoms such as anxiety, pain, or intrusive thoughts, thereby enhancing their sense of agency.5

Phase 2: Trauma Processing

Once the client has achieved a degree of stabilization and developed adequate coping resources, the focus of therapy can shift towards the processing of traumatic memories. The goal is to access, work through, and reframe these memories and their associated emotions, cognitions, and bodily sensations in a safe, titrated, and integrated manner.

●Memory Regression/Access: Hypnosis can facilitate the recall of traumatic memories, sometimes with vivid sensory and emotional re-experiencing.16 This process requires careful pacing and therapist guidance to prevent overwhelm, often employing techniques that maintain dual awareness (awareness of the past event and present safety simultaneously).16 Spiegel emphasizes that hypnosis provides controlled access to dissociated traumatic memories, which is crucial for therapeutic work.36

●Reframing/Restructuring Memories: Once a traumatic memory is accessed, hypnosis can be used to modify the associated fear responses and maladaptive cognitions by introducing new perspectives, resources, or meanings.16 Examples include helping the client acknowledge that their original responses were adaptive at the time of the trauma but are no longer necessary, or guiding them to imagine their adult self providing protection and comfort to their child self during a past abusive event.16 This can neutralize the original trauma responses.

●Aversion Therapy (for Triggers): In some cases, clients can vividly imagine experiencing triggering stimuli while in a hypnotic trance and safely practice more adaptive and less distressing reactions.16 Repeated practice can decrease the severity of adverse reactions.

●Working with Abreaction: An abreaction involves the intense emotional reliving and discharge of a past traumatic experience.38 If an abreaction occurs spontaneously or is therapeutically evoked, it generally should be allowed to run its course to completion, as interrupting it can be counterproductive.38 This process requires skilled management by a trained therapist to ensure the client's safety, provide support, and facilitate therapeutic processing rather than mere re-traumatization.38 Post-abreaction, it is critical to help the client make sense of the experience and integrate any new insights or emotional shifts.38

●Imagery Rescripting (e.g., RECON Protocol): This involves using guided imagery in hypnosis to revisit a traumatic memory and then actively change or "rescript" aspects of the memory narrative to create a more adaptive outcome or incorporate new resources. A 5-step memory reconsolidation protocol (RECON) aims to clear trauma triggers and instill a more positive sense of self by reducing the distress and altering negative beliefs associated with the traumatic memory.41

Phase 3: Integration and Consolidation

The final phase of treatment focuses on consolidating the therapeutic gains, fostering a more coherent and integrated sense of self, improving interpersonal functioning, and orienting the client towards a more fulfilling future.

●Consolidating Gains: Hypnosis can be used to reinforce new, adaptive beliefs, emotional responses, and behaviors that have emerged during therapy.29

●Future Pacing/Age Progression: This involves guiding the client to mentally rehearse applying their new coping skills and perspectives to future challenging situations or to imagine themselves successfully achieving future goals and experiencing a more positive life.32

●Ego Parts Integration: For clients with significant dissociation or internal fragmentation, hypnotic techniques can facilitate communication, understanding, and collaboration among different ego states or "parts" of the self, with the aim of fostering greater internal harmony and allowing a more authentic, integrated self to emerge.42

●Reframing the Meaning of Trauma: Hypnosis can assist clients in integrating the traumatic experiences into their broader life narrative in a way that acknowledges the pain and loss but also emphasizes survival, resilience, and potential for post-traumatic growth.30 This helps to shift the trauma from being a defining aspect of their identity to an experience that has been processed and integrated.

B. Specific Techniques and Their Application

Delving deeper into specific techniques, Ego Strengthening procedures, as pioneered by Hartland and further developed by others like McNeal and Frederick, aim to build a client's internal locus of control, self-esteem, and coping capacities before direct trauma work is initiated.32 This might involve suggestions focusing on inherent strengths, past successes, resilience, and the ability to manage difficult feelings. For complex trauma survivors, whose sense of self is often deeply undermined, this foundational work is critical.

Safe Place Imagery is another cornerstone, particularly in the stabilization phase.30 The therapist guides the client to create a vivid, multi-sensory internal sanctuary. This is not just a relaxation exercise; it becomes a portable tool for self-regulation, a place the client can mentally retreat to when feeling overwhelmed by traumatic memories or intense emotions, both during and outside of therapy sessions.

Memory Reframing or Restructuring during the trauma processing phase is not about altering historical facts but about changing the emotional and cognitive meaning attached to the memory.16 For instance, a client who experienced childhood abuse might be guided in hypnosis to revisit a memory as their current adult self, able to offer protection, comfort, or validation to their child self. This "dual awareness" – experiencing the memory while simultaneously being grounded in present safety and adult resources – can powerfully shift the felt sense of the trauma from one of helplessness to one of agency and compassion.16

Anchoring Resource States provides clients with a quick and effective method for accessing positive emotional states on demand.16 Once a resourceful state like calm or confidence is fully experienced in hypnosis, it is associated with a discrete physical cue (e.g., a specific touch). Later, activating the anchor helps to re-elicit the desired state, providing an immediate tool for managing triggers or emotional dysregulation.

These techniques, among others, are not applied rigidly but are tailored to the individual client's needs, capacities, and the specific phase of therapy. The overarching principle is to use the focused state of hypnosis to empower clients with greater internal resources and the ability to process traumatic experiences in a way that leads to integration and healing.

C. Evidence of Efficacy: Research Findings and Case Studies

The efficacy of clinical hypnosis for trauma-related conditions, including PTSD, is supported by a growing body of research, though studies specifically targeting CPTSD as defined by ICD-11 are still emerging.

Meta-Analyses and Systematic Reviews:

Several meta-analyses have indicated the effectiveness of hypnotherapy for PTSD symptoms. A notable meta-analysis by O'Toole et al. (2016), encompassing six studies with 391 participants, found that hypnotherapy had a large and statistically significant positive effect on overall PTSD symptoms, as well as on specific symptom clusters of intrusion and avoidance.43 Another meta-analysis from 2022, also reviewing six studies, similarly concluded that hypnotherapy significantly reduced PTSD symptoms of intrusion and avoidance.35 While these reviews primarily focus on PTSD, their findings are relevant given the symptom overlap with CPTSD.

A systematic review and component network meta-analysis by Coventry et al. (2020) examined interventions for individuals exposed to complex traumatic events (e.g., veterans, survivors of childhood sexual abuse, domestic violence, refugees).44 This review found that psychological interventions, particularly phase-based approaches that include skills-based strategies alongside trauma-focused components, were promising for reducing PTSD symptoms, depression, and improving sleep, as well as addressing emotional dysregulation and interpersonal problems—all key features of complex trauma.44 Although hypnosis was not isolated as the sole intervention in many of the included studies, its principles are often integral to such phased, skills-based approaches.

A 2024 systematic review of meta-analyses (which included an update of Häuser et al.'s earlier work) reported robust evidence for hypnosis in managing pain and distress during medical procedures, and specifically referenced the meta-analyses by Rotaru & Rusu (2016) and O’Toole et al. (2016) regarding PTSD symptom reduction.46 An older meta-analysis by Flammer & Alladin 94 involving 57 studies indicated a medium overall effect size for hypnosis, which was larger for ICD-10 codable disorders.

Clinical Trials:

Specific clinical trials lend further support. A randomized, zolpidem-controlled clinical trial involving patients with chronic combat-related PTSD suffering from insomnia demonstrated that symptom-oriented hypnotherapy (twice-a-week sessions for two weeks) led to significant reductions in PTSD symptoms, an effect maintained at a one-month follow-up. The hypnotherapy group also showed improvements in intrusion, avoidance, and all assessed sleep variables compared to the medication group.47 Another study by Bryant et al. 67 found that civilian trauma survivors with acute stress disorder who received six sessions of CBT or CBT combined with hypnosis had significantly lower rates of PTSD at a 3-year follow-up compared to those who received supportive counseling.

Case Studies and Expert Opinion:

Case studies provide valuable insights into the application of hypnosis for complex trauma. Poon (2009) detailed a phased-oriented treatment using hypnotic techniques for four Chinese women survivors of complex trauma (childhood sexual abuse, rape, domestic violence). The treatment, which integrated hypnosis for grounding, stabilization, accessing traumatic memories, and consolidating gains, resulted in significant reductions in trauma symptoms, maintained at follow-up.29 Other case reports describe successful symptom resolution in combat veterans with PTSD using alert hypnosis 49 and significant improvements in an individual with childhood trauma following Root Cause and Parts Hypnotherapy, which included techniques like negativity clearing, safe age regression, ego parts integration, anger release, and forgiveness.42

Expert opinion pieces also affirm the utility of hypnosis. Gold and Quiñones (2020) argue compellingly for the applicability of hypnotically structured treatment to CPTSD, asserting that it is well-suited to address the major aspects of this syndrome, particularly given the role of dissociation.50 Spiegel and Cardena (1990) have long highlighted the value of hypnosis for providing controlled access to and facilitating positive restructuring of dissociated traumatic memories in PTSD treatment.36 Clinicians at centers like the Sheffield Wellness Centre note the effectiveness of hypnotherapy, including hypnoanalysis for accessing deeply buried memories, in alleviating symptoms of PTSD and CPTSD such as chronic pain, insomnia, flashbacks, and anxiety.51

While this evidence is promising, it is important to acknowledge that much of the robust research, particularly meta-analyses, has focused on PTSD rather than CPTSD defined by ICD-11 criteria. The evidence for hypnosis in CPTSD is often extrapolated from PTSD studies or derived from compelling case studies and strong theoretical arguments by experts in the field. The unique features of complex trauma, especially the Disturbances in Self-Organization (DSO) and profound developmental impacts, may require specific adaptations of hypnotic techniques and may yield different outcomes than those observed in general PTSD populations. Therefore, the efficacy of clinical hypnosis for the full spectrum of complex trauma likely hinges on its flexible and skillful application within a comprehensive, phase-oriented framework that specifically targets not only core PTSD symptoms but also these deeper disturbances in self and relational functioning. Techniques addressing ego strengthening, dissociation management, and relational repair become particularly salient. More research explicitly using CPTSD diagnostic criteria and evaluating hypnotic interventions tailored to its full symptom profile is needed.

Furthermore, the effectiveness of any hypnotic intervention for complex trauma is profoundly dependent on the therapist's ability to titrate exposure to traumatic material, skillfully manage dissociative phenomena, and meticulously tailor techniques to the individual client's stabilization needs, current coping capacities, and developmental deficits. Survivors of complex trauma are often highly vulnerable to dysregulation and fragmentation.1 Consequently, any direct or premature exploration of traumatic material without sufficient internal and external resources can be counterproductive or even harmful. Successful case studies consistently emphasize a phased approach, commencing with stabilization, grounding, ego-strengthening, and carefully paced memory work that respects the client's readiness.29 The literature underscores the necessity of managing overwhelm, dissociation, and potential abreactions with skill and sensitivity.16 Thus, the "art" of hypnotherapy for complex trauma lies less in the rote application of specific techniques and more in the therapist's capacity for careful titration, relational attunement, and resource-informed processing. This highlights the critical need for specialized training for therapists using hypnosis with this population, emphasizing not only hypnotic induction and suggestion but also comprehensive trauma theory, advanced dissociation management skills, and the principles of phased-oriented treatment.2

VI. Conversational Hypnosis in the Treatment of Complex Trauma

A. Therapeutic Applications: Building Rapport, Bypassing Resistance, Facilitating Change through Indirect Methods

Conversational hypnosis, particularly drawing from Ericksonian traditions, offers unique therapeutic applications that can be highly relevant in the treatment of complex trauma. Its subtle, indirect nature can be instrumental in engaging clients who might be resistant to more formal or direct therapeutic approaches.

One of the primary strengths of conversational hypnosis lies in its capacity for building rapport and trust.7 Through attentive listening, demonstrating respect, and conveying empathy—often nonverbally and through linguistic mirroring—the therapist can create a strong therapeutic alliance.7 This is especially crucial for complex trauma survivors, who frequently present with profound difficulties in trusting others due to histories of interpersonal betrayal.1 The "intrinsically maternal" quality sometimes ascribed to conversational hypnosis—a nurturing, supportive, and validating stance—can help foster an environment of safety and acceptance, which is a prerequisite for any trauma work.7

A key mechanism of conversational hypnosis is its ability to bypass conscious resistance.6 The conscious, critical mind of a trauma survivor may be hypervigilant and quick to reject direct suggestions or interventions that feel threatening or overwhelming. Conversational hypnosis uses subtle language patterns, storytelling, and metaphor to communicate more directly with the subconscious mind, where many trauma-related beliefs, emotional patterns, and defenses are held.7 This can be particularly useful when clients are wary of formal hypnosis or find direct confrontation of traumatic material too daunting.

Conversational hypnosis facilitates change indirectly through several core techniques:

●Stories and Metaphors: These are powerful tools for engaging the unconscious mind, allowing it to explore new perspectives, access resources, and find its own solutions without the need for direct commands or interpretations from the therapist.7 For complex trauma survivors, metaphors can provide a safe, symbolic way to process difficult experiences and reframe negative self-perceptions, thereby instilling hope and confidence.20

●Embedded Commands and Vague Language: Therapeutic suggestions can be subtly woven into the conversational fabric, guiding thoughts and feelings without overt direction.7 The use of vague or ambiguous language allows clients to fill in the details from their own experience, making the suggestions more personalized and resonant.19

●Offering Options: Presenting suggestions as choices or possibilities, rather than directives, respects the client's autonomy and can make them more receptive to new ideas.7 This is vital for survivors who have experienced a loss of control.

Furthermore, conversational techniques can be applied for emotional regulation and grounding, particularly in the initial stages of therapy or when a client becomes overwhelmed.54 The "conversational hypnosis grounding kit," which may include developing a "holding anchor" (a cue for comfort), a "special place" (a mental sanctuary), and identifying a "grounded person" (an internal or external figure representing stability), can help clients connect with and access states of calm and safety through guided conversation, even before formal case history taking or deeper trauma processing begins.54

B. Utilizing Ericksonian Principles with Complex Trauma Survivors

Milton Erickson's approach to hypnosis and psychotherapy provides a rich foundation for applying conversational techniques to complex trauma.7 His work emphasized tailoring therapy meticulously to the unique individual, skillfully utilizing their existing resources, beliefs, and even problematic behaviors (the principle of utilization), and communicating indirectly through nuanced language, stories, and metaphors.24

The principle of utilization is particularly relevant for complex trauma. Instead of viewing symptoms or resistances as obstacles to be overcome, an Ericksonian approach sees them as communications from the unconscious or as adaptive responses (however maladaptive they may now be) that once served a protective function.19 For instance, a survivor's dissociative tendencies, rather than being solely pathologized, might be acknowledged as a powerful survival skill that could, with guidance, be harnessed for controlled therapeutic exploration or for creating distance from overwhelming affect.

Erickson's mastery of storytelling for trauma is legendary. He demonstrated how carefully constructed narratives, often seemingly unrelated to the client's presenting problem, could bypass conscious defenses and facilitate profound healing in individuals with severe trauma, frequently without requiring them to directly relive or recount the traumatic events.24 Such stories can help organize fragmented memories, offer new perspectives, and allow the unconscious mind to process difficult material symbolically and at a safe distance.55

Erickson's approach was often solution-focused and resource-oriented, aiming to activate the client's innate capacities for healing, growth, and problem-solving.24 This aligns closely with the goals of complex trauma treatment, which include building internal resources, fostering resilience, and empowering survivors to move beyond a trauma-defined identity.52

C. Potential for Addressing Core Features of Complex Trauma

The principles and techniques of conversational hypnosis hold considerable potential for addressing the core sequelae of complex trauma:

●Relational Difficulties: The emphasis on deep rapport building, attunement, and validation within the conversational hypnotic interaction can itself serve as a corrective relational experience for survivors who have endured profound relational betrayals and attachment disruptions.7

●Shame and Negative Self-Perception: Deep-seated shame and negative self-beliefs are hallmarks of complex trauma. Indirect suggestions, positive reframing embedded in metaphors, and stories that highlight resilience can gently challenge these beliefs without the direct confrontation that might intensify shame or defensiveness.20

●Emotional Dysregulation: Conversational grounding techniques, the subtle evocation of calm states through language and imagery, and the teaching of self-soothing strategies can be integrated into the therapeutic dialogue to enhance emotional regulation capacities.54

●Avoidance: For clients who are highly avoidant of direct trauma work or even the idea of formal therapy, the subtle and naturalistic style of conversational hypnosis can provide a less threatening entry point into the therapeutic process.54

D. Current Evidence and Areas for Further Research

The evidence base for conversational hypnosis, particularly its application to complex trauma, is largely derived from the extensive case literature of Milton Erickson, along with more contemporary case studies and theoretical extrapolations by practitioners of Ericksonian hypnotherapy and Neuro-Linguistic Programming (NLP), which incorporates many Ericksonian principles.24 While this body of work is rich and compelling, offering many examples of successful outcomes, there is a notable scarcity of large-scale, randomized controlled trials (RCTs) specifically evaluating conversational hypnosis as a primary intervention for individuals formally diagnosed with CPTSD.

Conversational hypnosis is often viewed as a set of skills that can be integrated into broader psychotherapeutic approaches or used to prepare clients for more formal hypnotic work or other trauma-focused therapies.53 Its techniques can be seamlessly woven into psychotherapeutic conversations to enhance engagement, bypass resistance, and facilitate resource access.57

However, to establish its efficacy more definitively within the evidence-based practice landscape, particularly for a condition as severe and multifaceted as complex trauma, more systematic research is imperative. This would involve studies that:

●Clearly define and operationalize conversational hypnotic interventions for complex trauma.

●Utilize standardized diagnostic criteria for CPTSD.

●Employ rigorous research methodologies, including RCTs where feasible.

●Delineate the specific components of conversational hypnosis that are most effective for particular aspects of CPTSD (e.g., affect dysregulation, negative self-concept, relational difficulties).

●Explore its utility as both a standalone approach for certain clients/phases and as an adjunctive intervention. While reviews like Gold & Quiñones (2020) discuss the applicability of "hypnosis" broadly to CPTSD 50, the unique contributions and specific efficacy of conversational techniques within this broader category warrant more focused investigation.

The subtle, client-centered nature of conversational hypnosis makes it a particularly promising approach for establishing an initial therapeutic foothold with complex trauma survivors who may be highly defended, fragmented, or mistrustful. It can foster the essential safety and rapport needed before more direct or intensive trauma processing methods become feasible or advisable. By meeting clients where they are, utilizing their own language and worldview, and indirectly accessing internal resources through stories and metaphors, conversational hypnosis can gently awaken the client's inherent healing capacities.6 This makes it a valuable tool not only as an alternative to formal clinical hypnosis but also as a foundational skill set to prepare clients for, and enhance the effectiveness of, subsequent therapeutic work. The therapeutic impact may thus begin with the very first interaction, even before "hypnosis" is explicitly named or formally initiated.

Furthermore, the emphasis on storytelling and metaphor in conversational hypnosis aligns powerfully with narrative approaches to trauma healing.7 Complex trauma often shatters an individual's life story, leaving them with fragmented memories and a narrative dominated by pain, helplessness, and negative self-attributions.1 Both conversational hypnosis and narrative therapy aim to help individuals re-author these experiences, find new meanings, organize fragmented memories into a more coherent whole, and shift from a victim identity to one of survivorship, agency, and resilience.55 The indirect nature of Ericksonian storytelling allows the client's unconscious mind to make its own connections and derive personal meaning from the therapeutic narratives, a process that can be less threatening and more empowering than direct narrative retelling, especially in early stages of therapy. This suggests a natural synergy, where therapists can consciously craft therapeutic metaphors and stories that address core themes of complex trauma—such as powerlessness, betrayal, shame, and isolation—to promote integration and the construction of a more adaptive and hopeful self-narrative.

VII. Comparative Analysis: Clinical vs. Conversational Hypnosis for Complex Trauma

A. Strengths and Limitations of Each Approach

Both clinical and conversational hypnosis offer distinct advantages and potential limitations when applied to the treatment of complex trauma.

Clinical Hypnosis:

●Strengths:

○Provides structured techniques tailored for specific therapeutic goals, such as pain management, anxiety reduction, ego strengthening, and systematic trauma processing (e.g., memory regression, reframing).5

○Can facilitate the induction of deeper trance states, which may be beneficial for accessing profound subconscious material or enhancing certain hypnotic phenomena for particular individuals or tasks, although light to medium trance is often adequate for many clinical purposes.5

○Offers a clear and established framework for phased treatment (stabilization, processing, integration), which is crucial for the complexities of CPTSD.29

○Possesses a more developed research base regarding its efficacy for PTSD, providing a foundation for its application to complex trauma.35

●Limitations:

○The more formal and sometimes directive nature of clinical hypnosis might be perceived as intimidating or anxiety-provoking by some complex trauma survivors, potentially triggering issues related to control or compliance, given their past experiences.4

○Requires the client's explicit consent and willingness to engage in a formal hypnotic procedure, which may not always be forthcoming, especially in early stages of therapy or with highly mistrustful individuals.

Conversational Hypnosis:

●Strengths:

○Excels at building rapport, fostering trust, and creating a safe therapeutic alliance, which is paramount when working with survivors of complex trauma who often exhibit significant mistrust and relational difficulties.7

○Effectively bypasses conscious criticism and resistance, making it useful for addressing deeply ingrained negative beliefs, maladaptive patterns, and shame-based cognitions that are common in complex trauma.6

○Highly flexible and adaptable, allowing the therapist to tailor interventions to the individual client's unique presentation, language, and the emergent dynamics of the therapeutic dialogue.20

○Can be employed subtly without formal trance induction, making it accessible in various therapeutic contexts and for clients who may be hesitant about or fearful of the term "hypnosis".21

○Empowers clients by eliciting their own internal resources, solutions, and healing capacities through indirect means such as storytelling, metaphor, and utilization.24

●Limitations:

○Its less structured nature might be a drawback for therapists seeking clear, manualized protocols or for clients who require more overt guidance and structure to feel safe.

○The efficacy of conversational hypnosis can be highly dependent on the therapist's nuanced linguistic skills, keen observational abilities, creativity, and precise timing.27

○The research base specifically validating "conversational hypnosis" as a distinct modality for CPTSD outcomes is less developed than for clinical hypnosis, although Ericksonian principles are widely respected and integrated into many therapeutic approaches.24

○Due to its potentially covert nature, there are heightened ethical considerations to ensure it is used solely for the client's therapeutic benefit and not manipulatively, with transparency about the general approach being ideal.6

B. Considerations for Selecting or Integrating Approaches

The choice between, or the integration of, clinical and conversational hypnosis in the treatment of complex trauma should be guided by a careful assessment of the client's presentation, the specific therapeutic goals, the phase of therapy, and the therapist's own skills and training.

●Client Presentation:

○For clients exhibiting high levels of resistance, mistrust, or fear of formal therapeutic interventions, conversational hypnosis may be the preferred initial approach to gently build safety, establish rapport, and reduce defensiveness.7

○In cases of significant dissociation, identity fragmentation, or severe dysregulation, a structured clinical hypnosis approach within a carefully managed phased treatment model is often necessary. This would prioritize stabilization, ego-state work (e.g., utilizing techniques like Fraser's Dissociative Table 37), and explicit skill-building. Conversational grounding techniques are also invaluable here.54

○When the goal is to teach specific skills (e.g., pain management, sleep hygiene, self-soothing), clinical hypnosis offers targeted techniques and protocols.47

○Client preference and beliefs about hypnosis are also important. Some clients may feel more comfortable with a structured, clearly defined clinical hypnosis session, while others may respond better to the more naturalistic, embedded style of conversational hypnosis.

●Therapeutic Goals and Phase of Therapy:

○Early Phase (Stabilization, Rapport Building, Resource Installation): Conversational hypnosis can be highly effective for initial engagement, psychoeducation delivered through metaphor, eliciting internal resources, and strengthening the therapeutic alliance.54 Clinical hypnosis techniques such as safe place imagery, ego strengthening, and anchoring positive states are also central to this phase.30

○Middle Phase (Trauma Processing): Clinical hypnosis is often employed for more direct trauma work, including controlled memory access and regression, reframing traumatic narratives, and managing abreactions.16 Conversational elements, such as therapeutic metaphors and storytelling, can be skillfully integrated to support the processing, facilitate meaning-making, and maintain a sense of safety and collaboration.

○Late Phase (Integration, Consolidation, Future Orientation): Both approaches have a role. Clinical hypnosis can be used for consolidating therapeutic gains and for future pacing (mentally rehearsing future successes). Conversational hypnosis can help reinforce new, positive self-narratives and identity shifts as they are lived out in everyday contexts.

●Therapist Skill and Training: Both modalities require specialized training beyond general psychotherapy skills. Conversational hypnosis, in particular, may demand a high degree of linguistic subtlety, creativity, and the ability to improvise effectively based on the client's responses. Clinical hypnosis requires competence in formal induction techniques, ethical suggestion formulation, and managing various trance phenomena.

Ultimately, clinical and conversational hypnosis should not be viewed as mutually exclusive or rigidly separate entities. Instead, they can be conceptualized as existing on a continuum of hypnotic communication and intervention. Skilled and integrative therapists can draw techniques from both approaches, flexibly tailoring their interventions to meet the complex and often fluctuating needs of complex trauma survivors. For instance, a therapist might use conversational techniques to establish initial rapport and prime a client for hypnosis, then transition into more formal clinical hypnosis for specific interventions like memory reframing, and subsequently use conversational reinforcement to solidify gains. Alternatively, principles of clinical hypnosis, such as guiding focused attention towards an internal resource, can be woven into a primarily conversational therapeutic interaction. Training in both approaches provides therapists with a richer, more versatile toolkit. The emphasis should be on understanding and applying the underlying principles of hypnotic communication, therapeutic suggestion, rapport-building, and resource activation in a manner that is adaptable to the client's specific state, needs, and the current phase of their therapeutic journey.

The following table summarizes key hypnotic techniques applicable to complex trauma, noting their predominant style and primary therapeutic goal:

Table 2: Key Hypnotic Techniques for Complex Trauma (Clinical & Conversational)

Technique Predominant Style Brief Description Primary Therapeutic Goal in Complex Trauma Key Snippet Reference(s)

Ego Strengthening Clinical Suggestions to enhance self-efficacy, coping abilities, resilience, self-acceptance. Enhance overall coping capacity, sense of self-efficacy, internal stability prior to/during trauma work. 5

Safe Place Imagery Clinical Guided creation of a detailed internal sanctuary for safety and calm. Create internal safety, provide a tool for self-soothing and emotional containment. 30

Anchoring Resource States Clinical Linking a positive emotional/physical state (e.g., calm, strength) to a specific cue. Allow rapid access to positive states for affect regulation and managing triggers. 16

Memory Regression (Controlled) Clinical Facilitated recall of past experiences, often traumatic, with therapist guidance and safety measures. Access traumatic memories for processing within a therapeutic frame. 16

Memory Reframing/Rescripting Clinical Altering the emotional/cognitive meaning of a memory by introducing new perspectives or resources. Change the maladaptive impact of traumatic memories, reduce distress, instill empowerment. 16

Abreaction Management Clinical Guiding and containing intense emotional release during reliving of trauma. Safely facilitate the discharge and processing of overwhelming traumatic emotions. 38

Dissociative Table/Parts Work Clinical (Integrative) Using hypnotic visualization to facilitate communication and integration among dissociated parts of the self. Work with fragmented self-states, reduce internal conflict, foster integration in dissociative individuals. 33

Storytelling/Metaphor Conversational (Both) Using narratives and symbolic language to convey therapeutic ideas indirectly. Bypass conscious resistance, offer new perspectives, facilitate unconscious processing, reframe experiences. 7

Utilization Conversational (Both) Incorporating the client's existing behaviors, beliefs, symptoms, or resistances into the therapeutic strategy. Reduce resistance, leverage client's own framework for change, make therapy feel more natural and collaborative. 19

Indirect Suggestion/Embedded Commands Conversational (Both) Delivering suggestions subtly within conversational language. Communicate therapeutic ideas to the subconscious mind while minimizing conscious scrutiny or rejection. 6

Conversational Grounding Conversational Using dialogue to help client connect with present safety, internal resources, or comfortable feelings. Provide immediate affect regulation, stabilization, and coping skills, especially in early engagement or when overwhelmed. 54

VIII. Integrating Hypnotherapy with Other Trauma-Informed Modalities

A. Rationale for Integration

Complex trauma, with its pervasive impact on an individual's psychological, emotional, somatic, and relational functioning, often necessitates a multifaceted therapeutic approach.1 It is unlikely that any single therapeutic modality can comprehensively address all aspects of such deeply entrenched difficulties. Integrating hypnotherapy with other evidence-based and trauma-informed modalities can potentially enhance treatment outcomes by leveraging the unique strengths of each approach and creating synergistic effects.52 Hypnosis can serve as a powerful adjunctive tool, preparing clients for, deepening, or facilitating core processes within other therapeutic frameworks.35

B. Synergies with Eye Movement Desensitization and Reprocessing (EMDR)

EMDR and hypnosis share some common conceptual ground; both recognize the existence of special learning states conducive to change and aim to address the dissociation often associated with PTSD.60 Many interventions used within the EMDR protocol, such as the "float-back" technique for identifying earlier feeder memories, the "future template" for rehearsing adaptive responses, and various ego state interventions, have historical roots or strong parallels in hypnotherapy.60 Both modalities involve focused attention and the processing of traumatic memories to reduce their emotional charge.61

Hypnosis can be particularly valuable in the preparation phase (Phase 2) of EMDR, especially for complex trauma survivors who may present with limited internal resources or poor affect tolerance.60 Hypnotic techniques can be employed to develop and install essential resources such as a "safe place," nurturing figures, or feelings of inner strength and calm.60 This resourcing is critical for enabling clients to safely engage with traumatic material during EMDR's desensitization phase. If processing becomes overwhelming during EMDR, hypnotic techniques for affect regulation, grounding, and containment can be introduced to help the client return to their window of tolerance. Furthermore, for clients who struggle to access or target specific traumatic memories due to amnesia or fragmentation—common in complex trauma—hypnosis might offer a pathway to gently access this material in a more controlled manner, making it available for subsequent EMDR processing.

Despite these synergies, it is important to note distinctions: EMDR typically keeps clients fully alert and grounded in dual awareness (past memory, present safety) while using bilateral stimulation (eye movements, taps, or tones) as a core component of memory reprocessing.61 Clinical hypnosis more often involves a formally induced trance-like state and relies on therapeutic suggestion.61 EMDR follows a highly structured eight-phase protocol.61

C. Synergies with Somatic Experiencing (SE) and Other Somatic Therapies

Somatic therapies, including Somatic Experiencing, operate on the premise that trauma is not just a cognitive or emotional experience but is also profoundly held and imprinted in the body and nervous system.52 The goal of these approaches is to help individuals release stored traumatic energy, complete truncated defense responses, and restore nervous system regulation.64

Hypnosis can complement somatic approaches in several ways. It can enhance interoceptive awareness—the ability to sense and track internal bodily sensations—which is a core component of SE and other body-based therapies.65 Hypnotic suggestions focused on body scanning, noticing subtle shifts in sensation, or cultivating a sense of calm and safety can directly support nervous system regulation and the "felt sense" aspect of somatic processing.52

An integrated approach, sometimes termed "somatic hypnotherapy," explicitly combines these modalities.65 In this framework, hypnotic suggestions and guided imagery are used to help clients reframe limiting beliefs, access positive somatic resources (e.g., a felt sense of grounding or strength), and anchor new, adaptive patterns of thought, feeling, and behavior at a deep somatic level. Somatic techniques, such as focused body awareness exercises or gentle movement, can, in turn, enhance the efficacy of hypnotherapy by grounding clients in the present moment, increasing their receptivity to suggestion, and facilitating the release of trauma-related physical tension.65 Hypnosis may also facilitate access to implicit, non-verbal, somatic memories of trauma that are not easily reached through purely cognitive approaches.

D. Synergies with Cognitive Behavioral Therapy (CBT) and Trauma-Focused CBT (TF-CBT)

Hypnosis can significantly enhance several core components of CBT and TF-CBT when applied to complex trauma. For cognitive restructuring, the focused state of hypnosis can increase a client's receptivity to identifying, challenging, and modifying negative automatic thoughts, maladaptive schemas, and core beliefs that are often deeply entrenched as a result of trauma.35

In the context of exposure therapy, a key element of many CBT-based trauma treatments, hypnosis can be used to facilitate imaginal exposure in a more controlled, titrated, and potentially less overwhelming manner.66 By inducing a state of relaxation and focused attention, hypnosis can help reduce the anticipatory anxiety associated with confronting traumatic memories or feared situations, allowing the client to engage more fully in the exposure process.

Hypnotic mental rehearsal can also strengthen the acquisition, consolidation, and generalization of new coping skills taught in CBT, such as relaxation techniques, assertiveness skills, or problem-solving strategies. By vividly imagining themselves successfully applying these skills in various scenarios while in a hypnotic state, clients can build confidence and increase the likelihood of using these skills in real-life situations.

The formal integration of hypnosis with CBT, known as Cognitive Hypnotherapy, has demonstrated greater effectiveness than CBT alone in treating conditions like depression, anxiety, and hopelessness.35 Research by Bryant et al. also indicated that CBT combined with hypnosis was beneficial for individuals with acute stress disorder, leading to better long-term outcomes in preventing PTSD.67

E. Synergies with Dialectical Behavior Therapy (DBT)

DBT is an evidence-based treatment particularly effective for individuals with severe emotional dysregulation, a core feature of complex trauma and often associated with borderline personality disorder.68 DBT emphasizes skills training in four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.68

Hypnosis can complement and deepen these DBT skills. The focused attention cultivated in hypnosis is highly congruent with mindfulness practice, and hypnotic techniques can be used to enhance the client's ability to observe their internal experiences (thoughts, emotions, sensations) non-judgmentally and remain present-focused.68 For distress tolerance and emotion regulation, hypnotic interventions such as safe place imagery, anchoring resourceful states, and techniques for creating distance from or modulating the intensity of painful emotions can directly bolster the skills taught in DBT.68 For example, hypnotic suggestions can be used to strengthen a client's ability to use DBT's "TIP" skills (Temperature, Intense exercise, Paced breathing) or self-soothing strategies. Once a client has achieved sufficient stabilization and skill development through DBT's Stage 1 treatment, hypnosis could potentially be integrated into Stage 2, which focuses more directly on trauma processing, similar to its application in other phased trauma therapies.

F. Synergies with Internal Family Systems (IFS)

IFS therapy is a model that views the psyche as comprised of multiple "parts" or subpersonalities (e.g., Managers, Firefighters, Exiles) and a core "Self" that is inherently calm, compassionate, and wise.70 Healing in IFS involves helping clients understand and unburden their wounded "exiled" parts and fostering harmony among all parts under the leadership of the Self.70

There are natural parallels between IFS and hypnotic approaches that work with ego states or parts of the self, such as ego state therapy or Fraser's Dissociative Table technique.33 Hypnosis can be a powerful tool to facilitate communication with, and understanding of, these internal parts.70 It can help clients access and differentiate their parts, explore their positive intentions (even for seemingly maladaptive parts), and create internal dialogues. Hypnotic states may also help clients more readily access the qualities of the "Self"—calmness, curiosity, compassion—which are essential for healing internal conflicts and unburdening traumatized parts. Techniques for memory reframing and emotional release within hypnosis could directly support the IFS process of helping exiled parts release the extreme beliefs and emotions they carry as a result of past trauma.

It is important to note that IFS, while gaining popularity, is a relatively newer model, and like any integration, its combination with hypnosis should be approached thoughtfully and with a strong client-centered focus, being mindful of potential risks such as the creation of false memories if not handled skillfully.70

Across these various integrations, a common theme emerges: hypnosis often functions as a catalyst or enhancer for core therapeutic processes inherent in other modalities. By modulating arousal, facilitating access to subconscious material (memories, beliefs, emotions, somatic states), fostering resource states, and increasing receptivity to new learning and perspectives, hypnosis can create a more conducive internal environment for other therapeutic work to take place. This is particularly valuable for complex trauma survivors who may feel "stuck," overwhelmed, or unable to fully engage with standard therapeutic techniques. This suggests that training in hypnosis can be a valuable adjunct for therapists already skilled in other trauma modalities, enabling them to tailor and potentiate their existing interventions. The "active ingredients" of change may still reside within the primary modality (e.g., cognitive restructuring in CBT, bilateral stimulation in EMDR), with hypnosis serving to facilitate their more effective uptake and integration by the client.

IX. Ethical Considerations, Risks, and Limitations in Hypnotherapy for Complex Trauma

The application of hypnotherapy, whether clinical or conversational, to individuals with complex trauma necessitates a heightened awareness of ethical considerations, potential risks, and inherent limitations. The vulnerability of this population, often characterized by histories of betrayal, coercion, and profound disruptions in their sense of self and safety, demands utmost care and diligence from the therapist.

A. Informed Consent with Vulnerable Populations

Obtaining truly informed consent is a cornerstone of ethical practice, especially with complex trauma survivors.6 This involves more than a cursory explanation. Therapists must ensure:

●Clarity and Comprehensiveness: Clients must receive clear, understandable information about what hypnosis (both clinical and conversational approaches, if applicable) entails, its potential benefits for their specific situation, and any potential risks or side effects.6 This discussion should address common misconceptions, such as the myth of losing control or being made to do things against one's will.4

●Emphasis on Client Control and Autonomy: It should be explicitly stated that the client retains control throughout the hypnotic process, can choose to terminate the experience at any time, and will not be forced to say or do anything they do not wish to.4 This is vital for empowering survivors who have experienced profound powerlessness.

●Voluntariness: Consent must be given freely, without any form of pressure or coercion, stated or implied.18

●Ethics of Conversational Hypnosis: While the subtle nature of conversational hypnosis means the client might not always be aware of specific hypnotic techniques being used, ethical application demands that the therapist's intent is solely for the client's therapeutic benefit.6 Ideally, the client should have a general understanding of the therapist's communication style and approach, even if not every linguistic nuance is deconstructed. Transparency about the overall methods being employed fosters trust.

B. Managing Abreactions and Potential Destabilization

Complex trauma survivors are prone to intense emotional and physiological reactions when encountering trauma-related material.3

●Abreaction: This refers to the potent reliving of a traumatic experience, often accompanied by a strong discharge of associated emotions.38 While an abreaction can be therapeutically valuable if properly managed, it can also be overwhelming and frightening for both client and therapist.38

○Management: If an abreaction occurs, it should generally be allowed to proceed to completion rather than being prematurely terminated, as this can leave the client in a more vulnerable state or make the material harder to access later.38 The therapist must remain calm, provide consistent support, and maintain control of the therapeutic environment.38 Techniques such as "decentering" (labeling experiences as images, sensations, feelings while returning to a grounding focus like breath) can help manage overwhelm.39 Crucially, post-abreaction work is essential to help the client process the experience, integrate new insights, and re-stabilize before ending the session.38 Sending a client home in a highly vulnerable, dysregulated state post-abreaction is clinically irresponsible.38

○Risks: Unmanaged abreactions can be re-traumatizing. There is also a risk, particularly with inexperienced therapists, of the client becoming violent if strong transference reactions occur where the therapist is misidentified as a perpetrator from the past.38

●Destabilization: Given the inherent vulnerabilities in affect regulation and self-organization in complex trauma survivors 3, any hypnotic exploration of traumatic material must be carefully titrated. Premature or poorly managed exposure can lead to a worsening of symptoms, increased suicidality, engagement in self-destructive behaviors, or severe dissociative episodes.12 A trauma-informed approach, emphasizing thorough stabilization and resource-building before any direct trauma processing, is non-negotiable.40

C. The Risk of False Memories and Confabulation

The relationship between hypnosis and memory is complex and has been a source of considerable debate and concern, particularly in the context of trauma therapy.73

●Nature of Memory in Hypnosis: Research indicates that hypnosis does not necessarily enhance the accuracy of memory. While it may increase the quantity of reported details or the client's confidence in their memories, it does not guarantee veracity.73 All memory is reconstructive and fallible, susceptible to distortion and suggestion.73

●Suggestibility and Confabulation: The state of heightened suggestibility often associated with hypnosis can make individuals more vulnerable to incorporating cues from leading questions, therapist expectations (even if unconsciously conveyed), or external information into their recollections, potentially leading to the creation of confabulations or entirely false memories that feel subjectively real.73 Vividly imagining an event under hypnosis can sometimes lead to "imagination inflation," where the imagined scenario is later misremembered as an actual occurrence.73

●Hypnotic Regression: The use of hypnotic age regression to recover allegedly "repressed" memories of trauma is particularly controversial due to the high risk of iatrogenic memory distortion or fabrication, especially if the therapist actively pressures the client or presumes the existence of specific memories.74

●Professional Guidance (e.g., ISTSS): Organizations like the ISTSS advise caution when using hypnosis to access "unremembered" episodes of past abuse.14 While acknowledging that genuinely recovered memories of childhood trauma can be accurate, the ISTSS also emphasizes that there is no definitive clinical or laboratory procedure to verify the accuracy of individual memories. They stress that therapists must avoid exerting undue influence, neither pressuring clients to recover memories nor suppressing the recall process, and maintain a stance of neutrality regarding the veracity of such memories.75

●Clinical Implications: To mitigate these risks, therapists using hypnosis for trauma must:

○Be thoroughly educated about the science of memory, including its malleability and the potential for distortion.

○Employ non-leading, open-ended questioning techniques.

○Maintain strict neutrality regarding the historical accuracy of reported memories.

○Clearly communicate to clients the complexities of memory and the potential for hypnotic influence.

○Focus the therapeutic work on processing the emotional, cognitive, and somatic impact of remembered experiences and their current meaning for the client, rather than on definitively verifying historical details.

D. Contraindications for Hypnosis in Complex Trauma

While hypnosis can be beneficial for many, it is not suitable for everyone, and certain conditions are generally considered contraindications or require extreme caution, particularly in the context of complex trauma.

●Absolute Contraindications (General):

○Active Psychosis (e.g., Schizophrenia, other psychotic disorders): Hypnosis may exacerbate psychotic symptoms such as hallucinations or delusions due to its potential to blur reality testing and engage fantasy.77 There are rare reports of first-episode schizophrenia following hypnotherapy or stage hypnosis.80

○Certain Severe Personality Disorders (e.g., Antisocial Personality Disorder): There is a risk that hypnosis could disinhibit impulsive or aggressive behaviors, posing a danger to the therapist or others. Such individuals should only be treated by specialists in a team setting.78

○Ongoing, Unmanaged Substance Misuse: Active intoxication or severe withdrawal can interfere with the ability to engage meaningfully in hypnosis and may pose safety risks.77

●Relative Contraindications/Situations Requiring Extreme Caution in Complex Trauma:

○Extreme Instability or Acute Crisis: The client must possess a foundational level of emotional and situational stability before hypnotic exploration of trauma is undertaken. Crisis stabilization is the priority.

○Severe, Unmanaged Dissociative Symptoms without Specialized Therapist Training: If a therapist is not highly skilled in assessing and managing complex dissociative phenomena (e.g., rapid switching, severe depersonalization/derealization, uncontrolled abreactions), using hypnosis can risk further fragmentation or destabilization.

○Lack of Client Motivation, Trust, or Therapeutic Alliance: Hypnosis is a collaborative process. If the client is unwilling, highly suspicious, or if a secure therapeutic alliance has not been established, hypnosis is unlikely to be effective and could be counterproductive.4

○Client as a Witness in an Impending Legal Trial: Some jurisdictions advise against hypnotherapy for individuals who may be called to testify, due to concerns about potential memory contamination.79

●Conditions Not Necessarily Contraindicated (with appropriate training and care): PTSD itself responds well to appropriately administered trauma-focused hypnosis.78 Depression, even with suicidal ideation, can be addressed with hypnosis by experienced therapists, though caution is warranted.78 Epilepsy generally is not a contraindication, but specific precautions may be needed.78

E. Scope of Practice and Therapist Competency

The ethical and effective use of hypnosis for complex trauma is critically dependent on the therapist's training, skills, and adherence to professional boundaries.

●Professional Boundaries and Scope of Practice: Hypnosis should only be employed by licensed health or mental health professionals who have received appropriate, recognized training in clinical hypnosis and are practicing within the legally defined scope of their primary profession (e.g., psychology, medicine, social work, counseling).5

●Specialized Training for Complex Trauma and Hypnosis: Generic training in hypnosis is insufficient for working with the profound challenges of complex trauma. Therapists must possess specialized knowledge and skills in:

○The neurobiology, etiology, and developmental impact of complex trauma.

○The assessment and treatment of dissociative disorders and severe dissociative symptoms.

○Phase-oriented trauma treatment models (stabilization, processing, integration).

○Trauma-informed hypnotic techniques specifically adapted for safety, affect regulation, dissociation management, and titrated memory processing.2

○Training should ideally include both didactic instruction and extensive supervised clinical experience.40

●Ongoing Supervision and Consultation: Given the complexities and potential pitfalls of this work, ongoing clinical supervision or consultation with experts in both trauma/dissociation and hypnotherapy is strongly recommended, especially when managing difficult cases.2

The ethical application of hypnosis in the challenging domain of complex trauma ultimately hinges on a "trauma-informed hypnosis" paradigm. This means that hypnotic techniques are not applied in a vacuum but are secondary to, and meticulously guided by, a deep and comprehensive understanding of trauma dynamics, attachment theory, dissociation, neurobiology, and the core principles of phased-oriented treatment. The "how," "when," and "why" of using specific hypnotic interventions are often more critical than the techniques themselves. The inherent vulnerabilities of complex trauma survivors—such as fragmentation, suggestibility when distressed, and impaired reality testing under duress—can amplify the general risks associated with hypnosis, such as destabilization or memory distortion. Therefore, effective and ethical practice is not merely about being a competent hypnotist, but about being a competent and highly skilled trauma therapist who can judiciously, flexibly, and safely integrate hypnotic principles and techniques into a broader, individualized trauma treatment framework. This underscores the imperative for rigorous, specialized training standards that emphasize trauma-specific competencies alongside general hypnosis skills, moving towards what might be recognized as a specialization in trauma-informed hypnotherapy.

Similarly, the vigorous debate surrounding false memories and hypnosis, while highlighting critical risks, should not lead to an outright rejection of hypnosis as a potentially valuable tool in trauma therapy. Instead, it calls for the development and adherence to more rigorous ethical guidelines, comprehensive therapist training in memory science and non-suggestive interviewing, and a therapeutic focus that prioritizes the client's present-day healing, emotional processing, and meaning-making over the forensic validation of historical memories. When hypnosis is used in trauma recovery, its value may lie more in its capacity to help clients process the emotional, cognitive, and somatic charge of their experiences, reframe maladaptive meanings, build internal resources, and foster a more integrated sense of self, rather than in excavating "perfect" or irrefutably accurate historical truths. Informed consent procedures must explicitly address the complexities of memory and the potential influences of hypnosis, ensuring clients are aware that the goal is therapeutic integration and well-being, not necessarily historical reconstruction.

X. Professional Guidelines and Therapist Competency

The safe and effective application of hypnosis in the treatment of complex trauma is guided by principles and standards set forth by various professional organizations, alongside the imperative for specialized therapist training and competency.

A. Overview of Guidelines from Relevant Professional Bodies

Several key professional bodies offer guidelines relevant to the practice of hypnosis and the treatment of trauma, although highly specific, integrated guidelines for hypnosis in complex trauma are still an area for development.

●American Psychological Association (APA):

○Division 30 (Society of Psychological Hypnosis): This division is dedicated to the scientific study and ethical practice of hypnosis. It defines hypnosis as a state of consciousness involving focused attention, reduced peripheral awareness, and an enhanced capacity for response to suggestion.4 APA's official position, last revised in 2015, states that hypnosis should be employed by psychiatrists or other appropriately licensed and trained healthcare professionals, within the scope of their professional expertise, and in the context of a thorough medical and psychiatric evaluation consistent with the patient's treatment plan. It also emphasizes that hypnotic induction and termination should be clearly structured and consistent with evidence-based practice, and that training should be delivered by professionally credentialed individuals, optimally including both didactic education and supervised clinical contact.82 Division 30 promotes research, teaching, and the development of high standards for hypnotic practice.84

○APA Guidelines for Complex Trauma: Recognizing the unique needs of this population, the APA, in conjunction with the ISSTD, developed Professional Practice Guidelines (PPG) for Working with Adults with Complex Trauma Histories.2 These guidelines advocate for a dimensional understanding of trauma complexity and outline seven core principles of treatment, encapsulated by the mnemonic HISTORY: Humanistic, Integrative, Sequential, Timeline-focused, Outcomes-oriented, Relational, and Why (rationale-driven).2 While these PPGs do not explicitly detail specific hypnotic techniques, they strongly emphasize the need for specialized training for clinicians working with complex trauma and endorse an integrative approach to treatment, which could certainly include hypnotherapy as a component.2

●International Society for the Study of Trauma and Dissociation (ISSTD):

○As a co-developer of the APA PPG for complex trauma, the ISSTD is a leading organization in advancing the understanding and treatment of complex trauma and dissociative disorders.13

○The ISSTD publishes its own Guidelines for Treating Dissociative Identity Disorder (DID) in Adults (and similar guidelines for children), which are widely referenced as a foundational resource for working with highly dissociative clients.86 Given the high comorbidity of significant dissociation with complex trauma, these guidelines are highly relevant, although their specific recommendations regarding hypnosis are not detailed in the provided materials.

○ISSTD actively provides training opportunities, including courses and seminars on complex trauma, dissociation, and the ethical issues involved in treatment, such as working with dissociative parts and managing trauma enactments.85

○Historically, ISSTD conferences have addressed topics related to hypnosis. However, the organization has also navigated controversies concerning the use of hypnosis in memory recovery and past associations with fringe beliefs, leading to an ongoing emphasis on empirically based and clinically sound practices.86

●International Society for Traumatic Stress Studies (ISTSS):

○The ISTSS publishes influential treatment guidelines for PTSD and has also addressed Complex PTSD.14 Their approach to CPTSD typically involves a three-phase model: (1) safety, stabilization, and skills training; (2) processing and reappraisal of trauma memories; and (3) consolidation of gains and re-engagement with life.14

○Regarding hypnosis for PTSD, ISTSS guidelines acknowledge its potential use alongside other therapies but specifically advise caution with using hypnosis to access "unremembered" episodes of past abuse, due to concerns about memory accuracy.14

○The ISTSS has also produced a valuable document, "Childhood Trauma Remembered: A Report on the Current Scientific Knowledge Base and its Applications," which discusses the science of memory, the phenomenon of recovered memories, and provides guidelines for clinicians on how to handle such memories ethically, avoiding undue influence and respecting patient autonomy.75

●American Society of Clinical Hypnosis (ASCH) & Society for Clinical and Experimental Hypnosis (SCEH):

○These are premier organizations for professionals who use clinical hypnosis. ASCH, for example, offers a structured training program with different levels (Level 1, Level 2, Advanced Workshops) covering foundational principles, hypnotic induction and suggestion techniques, and applications for specific populations and complex clinical cases such as pain management and anxiety disorders.90 Level 1 training typically includes topics like establishing rapport, facilitating change, ego-strengthening, and basic inductions. Level 2 delves into more advanced techniques, including complex inductions and strategies for specific conditions.90

○Membership in and certification by organizations like ASCH or SCEH are often considered indicators of a practitioner's credentials and commitment to ethical, evidence-based practice.77

B. Essential Training and Competencies for Therapists

Effectively and ethically utilizing hypnosis in the treatment of complex trauma demands a sophisticated skill set that integrates core hypnotic competencies with specialized trauma-focused knowledge. Generic hypnosis training alone is insufficient. Essential competencies include:

●Core Hypnosis Skills: Proficiency in various hypnotic induction methods (both formal and conversational), the artful formulation and delivery of therapeutic suggestions (direct, indirect, permissive, metaphorical, post-hypnotic), techniques for deepening and managing trance phenomena, and ensuring safe and comfortable reorientation from the hypnotic state.41

●Comprehensive Understanding of Complex Trauma: In-depth knowledge of the etiology, neurobiology, and developmental impact of complex trauma, including its effects on attachment systems, identity formation, affect regulation, and interpersonal functioning. This includes familiarity with the diagnostic criteria and clinical presentation of CPTSD and associated conditions like dissociative disorders.2

●Assessment and Management of Dissociation: The ability to accurately assess for dissociative symptoms and disorders, understand the function of dissociation in trauma survivors, and skillfully manage dissociative phenomena during therapy. This includes knowing how to work constructively with dissociative parts or ego states and how to contain and process abreactions or flashbacks safely.12 Specialized training in approaches like ego state therapy or Fraser's Dissociative Table technique can be highly beneficial.33

●Implementation of Phased Treatment: The skill to apply hypnotic techniques systematically within a phase-oriented treatment model (stabilization, trauma processing, integration), carefully titrating interventions to the client's current level of stability, ego strength, and readiness for deeper work.14

●Affect Regulation Skills: Competence in teaching clients both hypnotic and non-hypnotic strategies for identifying, understanding, tolerating, and modulating intense emotions.30

●Rigorous Ethical Practice: A thorough grounding in ethical principles relevant to hypnotherapy and trauma treatment, including informed consent procedures specific to vulnerable populations, maintaining appropriate professional boundaries, ensuring confidentiality, understanding and navigating the complexities of scope of practice, and managing potential risks such as false memory implantation or client destabilization.6

●Skills in Integration: If applicable, the ability to thoughtfully and effectively integrate hypnotic techniques with other evidence-based trauma treatment modalities (e.g., EMDR, CBT, somatic therapies, DBT, IFS).35

●Cultural Competence and Humility: An awareness of how cultural factors, systemic oppression, and intersectionality can influence an individual's experience and expression of trauma, and the ability to adapt therapeutic approaches accordingly.2

●Therapist Self-Awareness and Countertransference Management: The capacity to recognize and ethically manage one's own emotional reactions (countertransference) when working with disturbing traumatic material and highly vulnerable clients.88

●Commitment to Ongoing Professional Development: A dedication to staying abreast of current research, best practices, and emerging techniques in both hypnotherapy and trauma treatment, including participation in ongoing supervision or consultation, especially when dealing with complex and challenging cases.2 Specialized training programs, such as those focused on "Trauma-Informed Hypnotherapy" 40 or comprehensive certificate courses 53, aim to provide clinicians with these necessary competencies.

While the existing guidelines from various professional bodies offer valuable frameworks for the general practice of hypnosis and for the treatment of complex trauma separately, there is a discernible gap regarding specific, integrated guidelines on the use of hypnosis for complex trauma. Clinicians currently need to synthesize information from multiple sources. The unique vulnerabilities and multifaceted presentation of CPTSD, combined with the specific potentials and risks inherent in hypnotic interventions, underscore the need for more consolidated practice standards. Such standards would ideally detail best practices for technique selection across different hypnotic modalities (clinical and conversational), appropriate sequencing within a phased treatment model, comprehensive risk management strategies (particularly concerning dissociation and memory), and clearly defined therapist competencies. The development or endorsement of such integrated guidelines by leading professional organizations would significantly enhance professional standards, ensure greater client safety, and promote more effective treatment outcomes for this challenging population.

XI. Conclusion and Future Directions

A. Summary of Key Findings

This report has undertaken a comprehensive analysis of the application of clinical hypnosis and conversational hypnosis in the treatment of complex trauma. Complex trauma, characterized by its origins in prolonged, repeated interpersonal victimization and its pervasive developmental impact, manifests in a wide array of debilitating symptoms, notably captured in the ICD-11 diagnosis of CPTSD through its core PTSD features and additional Disturbances in Self-Organization (DSO).

Clinical hypnosis, a clinician-guided modality utilizing focused attention, reduced peripheral awareness, and enhanced suggestibility, offers a structured, phased approach to treating complex trauma. Its techniques, such as ego strengthening, affect regulation strategies (e.g., safe place imagery, resource anchoring), controlled memory processing (e.g., regression, reframing, imagery rescripting), and methods for managing dissociation and abreaction, can be systematically applied to foster stabilization, facilitate the processing of traumatic experiences, and promote integration of therapeutic gains. The evidence base for clinical hypnosis in PTSD is considerable, with meta-analyses and clinical trials demonstrating its efficacy in reducing core symptoms. While direct large-scale research on CPTSD is still developing, compelling case studies and expert consensus support the adaptation of these phased, trauma-informed hypnotic approaches for the unique challenges of complex trauma.

Conversational hypnosis, rooted in the pioneering work of Milton H. Erickson, employs subtle, indirect linguistic strategies, storytelling, and metaphor to build rapport, bypass conscious resistance, and facilitate therapeutic change, often without formal hypnotic induction. Its strengths lie in its ability to create a safe and collaborative therapeutic environment, making it particularly valuable for initial engagement with highly defended or mistrustful complex trauma survivors. Ericksonian principles like utilization and pacing and leading, along with techniques such as the conversational grounding kit, can help mobilize internal resources, gently challenge maladaptive beliefs, and prepare clients for deeper therapeutic work. While the evidence for conversational hypnosis in complex trauma relies more heavily on Erickson's extensive case legacy, theoretical extrapolation, and contemporary case reports, its potential for fostering safety, agency, and narrative re-authoring is significant.

A comparative analysis reveals that clinical and conversational hypnosis are not mutually exclusive but can be viewed as complementary, existing on a continuum of hypnotic communication. Skilled therapists can integrate techniques from both modalities, tailoring their approach to the client's fluctuating needs, phase of therapy, and specific treatment goals. Furthermore, hypnosis, in its various forms, can be synergistically integrated with other established trauma-informed therapies such as EMDR, somatic therapies, CBT, DBT, and IFS, often acting as a catalyst to enhance client receptivity and deepen therapeutic processes.

Crucially, the ethical application of any form of hypnosis with complex trauma survivors demands a trauma-informed paradigm. This necessitates specialized therapist competency encompassing not only hypnotic techniques but also a profound understanding of trauma dynamics, dissociation, attachment theory, phased treatment principles, and rigorous risk management strategies, particularly concerning potential destabilization, abreaction, and the complexities of memory.

B. Recommendations for Clinical Practice

Based on the reviewed literature, the following recommendations are proposed for clinicians considering the use of hypnosis in the treatment of complex trauma:

1.Prioritize Comprehensive Assessment: Conduct a thorough assessment of the client's trauma history, dissociative features, current coping mechanisms, ego strength, and relational patterns before initiating any hypnotic interventions.

2.Adopt a Phased Treatment Approach: Strictly adhere to a phased model of therapy (stabilization, trauma processing, integration). Hypnotic techniques should be selected and sequenced according to the goals of each phase and the client's readiness.

3.Emphasize Stabilization and Resource Building: In the initial phase, utilize both clinical and conversational hypnotic techniques to establish safety, enhance affect regulation skills, build internal resources (e.g., ego strength, safe place, anchored states), and strengthen the therapeutic alliance.

4.Integrate Conversational Hypnosis Strategically: Employ conversational hypnosis techniques, particularly in early phases or with clients who are resistant, highly anxious, or mistrustful, to build rapport, provide psychoeducation through metaphor, and gently mobilize internal resources.

5.Apply Clinical Hypnosis Judiciously for Trauma Processing: When clients are sufficiently stabilized, use clinical hypnosis techniques for controlled and titrated processing of traumatic memories, ensuring careful management of dissociation and potential abreactions. Maintain a focus on dual awareness (present safety alongside past memory).

6.Uphold Rigorous Ethical Standards: Ensure fully informed consent, clearly explaining the nature of hypnosis, its potential benefits and risks, and the client's control over the process. Be particularly vigilant regarding the potential for memory distortion, avoiding leading questions and focusing on the therapeutic processing of experiences rather than forensic accuracy.

7.Seek Specialized Training and Supervision: Clinicians must obtain specialized training in both complex trauma treatment and trauma-informed hypnotherapy. Generic hypnosis training is insufficient. Ongoing supervision or consultation with experts in trauma, dissociation, and hypnosis is highly recommended, especially when working with complex cases.

8.Foster Client Agency and Collaboration: Consistently reinforce the collaborative nature of hypnosis, empowering clients and respecting their autonomy throughout the therapeutic process.

C. Identifying Gaps in Research and Suggesting Future Research Directions

While the existing body of knowledge provides a promising foundation, further research is needed to solidify the evidence base and refine the application of hypnosis for complex trauma. Future research should focus on:

1.CPTSD-Specific Efficacy Studies: Conducting more Randomized Controlled Trials (RCTs) that specifically evaluate the efficacy of both clinical and conversational hypnotic interventions for individuals meeting the formal diagnostic criteria for ICD-11 Complex PTSD.

2.Comparative Efficacy of Hypnotic Approaches: Investigating the relative effectiveness of different hypnotic techniques and styles (e.g., direct versus indirect suggestion, specific Ericksonian methods versus more structured clinical protocols) for various aspects of CPTSD, including DSO symptoms.

3.Mechanisms of Change: Exploring the underlying neurobiological, cognitive, and affective mechanisms through which hypnosis facilitates therapeutic change in complex trauma survivors.

4.Empirical Validation of Conversational Hypnosis: Moving beyond case studies and theoretical arguments to empirically validate the efficacy of specific conversational hypnotic techniques for complex trauma through methodologically sound research.

5.Development and Testing of Integrated Protocols: Designing and testing standardized protocols for the integration of hypnosis with other evidence-based trauma therapies (e.g., EMDR, somatic therapies, CBT, DBT) specifically for the CPTSD population.

6.Long-Term Outcomes and Follow-Up: Conducting studies with extended follow-up periods to assess the durability of therapeutic gains achieved through hypnotic interventions for complex trauma.

7.Nuances of Dissociation and Hypnosis: Further investigating the intricate interplay between therapeutic hypnotic dissociation and pathological dissociation in CPTSD, and establishing best practices for safely and effectively working with dissociative phenomena within a hypnotic framework.

8.Training, Competency, and Dissemination: Researching the most effective methods for training therapists in trauma-informed hypnosis and developing clear competency benchmarks to ensure safe and effective practice.

The future of hypnotherapy for complex trauma lies in the pursuit of rigorous, nuanced research that moves beyond generalizations from PTSD. This research must specifically address the unique features of CPTSD, particularly the Disturbances in Self-Organization, and validate the thoughtful integration of both clinical and conversational hypnotic approaches. Such endeavors, conducted within a robust ethical and competency framework, will not only enhance treatment efficacy but also further solidify the position of hypnosis as a valuable, evidence-based intervention for individuals recovering from some of the most challenging forms of psychological injury. This will enable the field to move from what is often perceived as a promising "art" to a more clearly defined "evidence-based science and art" in the service of complex trauma survivors.

Works cited

1.Fact Sheet I - Trauma and Complex Trauma: An Overview - ISSTD, accessed on June 5, 2025, https://www.isst-d.org/publications-resources/public-resources-home/fact-sheet-i-trauma-and-complex-trauma-an-overview/

2.New Professional Practice Guideline for Adults with Complex ..., accessed on June 5, 2025, https://www.ctipp.org/post/new-professional-practice-guideline-for-adults-with-complex-trauma-histories

3.Complex Trauma: Complex Reactions An Evolving and Complex Treatment Model - McGill University, accessed on June 5, 2025, https://www.mcgill.ca/crcf/files/crcf/courtois_keynote_presentation_0.pdf

4.Hypnosis - Dr. Michael Yapko, accessed on June 5, 2025, https://yapko.com/hypnosis/

5.Clinical Hypnosis - Behavioral Health Resources, LLC Behavioral ..., accessed on June 5, 2025, https://bhr-llc.com/clinical-hypnosis/

6.1 Conversational Hypnosis Mind Control Techniques (PDF), accessed on June 5, 2025, https://beta.mercycollege.edu/index.jsp/uploaded-files/4020083/1_Conversational_Hypnosis_Mind_Control_Techniques.pdf

7.The Art Of Conversational Hypnosis: Techniques And Principles ..., accessed on June 5, 2025, https://australianhypnosistrainingacademy.com.au/conversational-hypnosis-techniques-principles/

8.Dissociation: A New Teaching Reveals How Hypnotherapy Can Help, accessed on June 5, 2025, https://www.wellness-institute.org/blog/dissociation-a-new-teaching-reveals-how-hypnotherapy-can-help

9.Tracing the paths: a systematic review of mediators of ... - Frontiers, accessed on June 5, 2025, https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1331256/full

10.Complex PTSD - Post-traumatic stress disorder - NHS, accessed on June 5, 2025, https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/

11.Complex PTSD: History and Definitions - PTSD: National Center for ..., accessed on June 5, 2025, https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp

12.Treating Complex Trauma Survivors - Psychiatric Times, accessed on June 5, 2025, https://www.psychiatrictimes.com/view/treating-complex-trauma-survivors

13.New Resource: Guidelines for Working with Adults with Complex ..., accessed on June 5, 2025, https://www.complextrauma.org/guidelines_for_working_with_adults_with_complex_trauma_histories_released_by_the_american_psychological_association/

14.Treatments for PTSD, Complex PTSD, Trauma & Dissociative ..., accessed on June 5, 2025, https://traumadissociation.com/treatments

15.Learning the Fundamentals of Clinical Hypnosis for Pain Control – ABPP, accessed on June 5, 2025, https://abpp.org/newsletter-post/learning-the-fundamentals-of-clinical-hypnosis-for-pain-control/

16.Hypnosis for PTSD: How It Works, Effectiveness, & Examples - Choosing Therapy, accessed on June 5, 2025, https://www.choosingtherapy.com/hypnosis-for-ptsd/

17.What is the core component of hypnosis? - Quora, accessed on June 5, 2025, https://www.quora.com/What-is-the-core-component-of-hypnosis

18.The Ethical Considerations of Using Hypnosis and Hypnotherapy, accessed on June 5, 2025, https://www.davidbfisherhypnotherapy.com/the-ethical-considerations-of-using-hypnosis-and-hypnotherapy

19.Understanding Hypnotherapy, Conversational Hypnosis, and Hypnotic Language Patterns, accessed on June 5, 2025, https://emocare.co.in/understanding-hypnotherapy-conversational-hypnosis-and-hypnotic-language-patterns/

20.Conversational Hypnosis Hamilton | Moving Minds, accessed on June 5, 2025, https://movingmindshypnotherapy.com.au/conversational-hypnosis-hamilton/

21.Conversational Hypnosis Techniques and Principles Made Easy, accessed on June 5, 2025, https://mikemandelhypnosis.com/hypnosis-training/conversational-hypnosis-techniques/

22.CHP Conversational Hypnosis Practices - South African Institute of Hypnotism (SAIH), accessed on June 5, 2025, https://hypnotherapy.co.za/chp-conversational-hypnosis-practices/

23.Conversational Hypnotists Have These Skills | Skill Success Blog, accessed on June 5, 2025, https://blog.skillsuccess.com/conversational-hypnotists-have-these-skills/

24.The Genius of Milton H. Erickson: Transforming Hypnotherapy ..., accessed on June 5, 2025, https://www.nlpcourses.com/the-genius-of-milton-h-erickson-transforming-hypnotherapy/

25.Ericksonian Hypnotherapy: How Milton Erickson Revolutionized Modern Therapy - BetterHelp, accessed on June 5, 2025, https://www.betterhelp.com/advice/psychologists/how-milton-erickson-revolutionized-modern-therapy/

26.How Nurses Can Use Hypnosis In Practice, accessed on June 5, 2025, https://inursecoach.com/how-nurses-can-use-hypnosis-in-practice/

27.Ericksonian Hypnosis and Therapy Techniques - erickson, accessed on June 5, 2025, https://catalog.erickson-foundation.org/page/ericksonian-hypnosis-therapy-techniques

28.Unveiling the Subtle Art: How Psychologists Use Hypnosis Unknowingly, accessed on June 5, 2025, https://instituteofclinicalhypnosis.com/hypnosis/each-psychologist-uses-hypnosis-knowingly-or-unknowingly/

29.Hypnosis for Complex Trauma Survivors: Four Case Studies - Taylor & Francis Online: Peer-reviewed Journals, accessed on June 5, 2025, https://www.tandfonline.com/doi/abs/10.1080/00029157.2009.10401676

30.Hypnosis for Complex Trauma Survivors: Four Case Studies, accessed on June 5, 2025, https://www.tandfonline.com/doi/pdf/10.1080/00029157.2009.10401676

31.Using hypnosis with a battered woman with post-traumatic stress ..., accessed on June 5, 2025, https://www.researchgate.net/publication/287162957_Using_hypnosis_with_a_battered_woman_with_post-traumatic_stress_disorder

32.Hypnotic Ego-Strengthening Procedure - Wikipedia, accessed on June 5, 2025, https://en.wikipedia.org/wiki/Hypnotic_Ego-Strengthening_Procedure

33.Inner Strengths: Contemporary Psychotherapy and Hypnosis for Ego ..., accessed on June 5, 2025, https://www.routledge.com/Inner-Strengths-Contemporary-Psychotherapy-and-Hypnosis-for-Ego-Strengthening/McNeal/p/book/9781032580869

34.THE-USE-OF-HYPNOSIS-IN-THE-TREATMENT-OF-POST-TRAUMATIC-STRESS-DISORDER-IN-A-SURVIVOR-OF-MULTIPLE-CHILDHOOD-TRAUMA.pdf - BSCAH, accessed on June 5, 2025, https://bscah.co.uk/wp-content/uploads/2024/03/THE-USE-OF-HYPNOSIS-IN-THE-TREATMENT-OF-POST-TRAUMATIC-STRESS-DISORDER-IN-A-SURVIVOR-OF-MULTIPLE-CHILDHOOD-TRAUMA.pdf

35.Hypnotherapy For Trauma: How It Works and Its Effectiveness - Psych Central, accessed on June 5, 2025, https://psychcentral.com/health/hypnotherapy-trauma

36.New uses of hypnosis in the treatment of posttraumatic stress disorder, accessed on June 5, 2025, https://pubmed.ncbi.nlm.nih.gov/2211565/

37.How to Use Fraser's Dissociative Table Technique to Access and ..., accessed on June 5, 2025, https://connect.springerpub.com/highwire_display/entity_view/node/69850/full

38.Hypnotherapy skills and tips – Abreaction and Trauma | British ..., accessed on June 5, 2025, https://britishhypnosisresearch.com/hypnotherapy-skills-and-tips-abreaction-and-trauma/

39.Abreaction – Knowledge and References - Taylor & Francis, accessed on June 5, 2025, https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Psychiatry/Abreaction/

40.Trauma Informed Hypnotherapy Level 2: Techniques for Complex Trauma - CE-Classes.com, accessed on June 5, 2025, https://ce-classes.com/course-details/?numExamID=2614/trauma-informed-hypnotherapy-level-2-techniques-for-complex-trauma&t_code=664981d16e84a

41.Trauma Informed Hypnotherapy, accessed on June 5, 2025, https://www.traumainformedhypnosis.com/tih-level-one-course

42.Overcoming Childhood Trauma with Root Cause and Parts ..., accessed on June 5, 2025, https://www.sense-ability.co.uk/blog-article/2025/2/11/overcome-childhood-trauma-and-rebuilding-self-worth-with-root-cause-and-parts-hypnotherapy

43.A Meta-Analysis of Hypnotherapeutic Techniques in the Treatment of PTSD Symptoms, accessed on June 5, 2025, https://pubmed.ncbi.nlm.nih.gov/26855228/

44.Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis - PubMed Central, accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7446790/

45.Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis | PLOS Medicine, accessed on June 5, 2025, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003262

46.Meta-analytic evidence on the efficacy of hypnosis for mental and ..., accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10807512/

47.Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial - PubMed, accessed on June 5, 2025, https://pubmed.ncbi.nlm.nih.gov/18569138/

48.(PDF) Hypnosis for Complex Trauma Survivors: Four Case Studies - ResearchGate, accessed on June 5, 2025, https://www.researchgate.net/publication/24009460_Hypnosis_for_Complex_Trauma_Survivors_Four_Case_Studies

49.Whole Health – Clinical Hypnosis/Hypnotherapy - VA.gov, accessed on June 5, 2025, https://www.va.gov/wholehealth/professional-resources/clinician-tools/library-research-articles/Hypnotherapy.asp

50.Applicability of hypnosis to the treatment of Complex PTSD and ..., accessed on June 5, 2025, https://pubmed.ncbi.nlm.nih.gov/33118880/

51.PTSD and CPTSD: The Role of Hypnotherapy in Healing - Sheffield Wellness Centre, accessed on June 5, 2025, https://sheffieldwellnesscentre.co.uk/blog/hypnotherapy-for-ptsd-and-cptsd/

52.Can Hypnotherapy Help with PTSD or Complex Trauma? - Peter ..., accessed on June 5, 2025, https://ibhcounseling.com/hypnotherapy-ptsd-complex-trauma/

53.Hypnosis for Trauma & PTSD Certificate Course - PESI, accessed on June 5, 2025, https://www.pesi.com/sales/bh_c_001268_hypnosiscert_organic-32508

54.Hypnosis And Trauma » Hypnotherapy Training And Life Coaching ..., accessed on June 5, 2025, https://hypnosisacademy.ie/hypnosis-and-trauma/

55.Storytelling and Complex Trauma Healing: The Power of Narrative ..., accessed on June 5, 2025, https://www.healwithcfte.org/blog/storytelling-and-healing

56.Can Ericksonian Hypnosis Help for Trauma Treatment?, accessed on June 5, 2025, https://www.lisaslarsen.com/post/ericksonian-hypnosis-for-trauma-treatment

57.Hypnotherapy & Hypnoanalysis, accessed on June 5, 2025, https://www.morgan-ayrs.co.uk/phdi/p1.nsf/supppages/6799?opendocument&part=3

58.Healing Online: How I Use EMDR and Hypnosis in Virtual Therapy ..., accessed on June 5, 2025, https://www.alicebertoldo.com/blog/2515006_healing-online-how-i-use-emdr-and-hypnosis-in-virtual-therapy-sessions

59.Hypnosis and Hypnotherapy: A Guide to Ethical Practice, accessed on June 5, 2025, https://worksmarthypnosis.com/hypnosis-and-hypnotherapy-a-guide-to-ethical-practice/

60.Integrating Hypnosis, Somatic Psychology, and EMDR in the ..., accessed on June 5, 2025, https://www.12pointspsychology.com/professional-development-library/integrating-hypnosis-somatic-psychology-and-emdr-in-the-treatment-of-trauma

61.EMDR vs Hypnosis: A Guide to Choosing the Right Therapy - Hope For The Journey, accessed on June 5, 2025, https://hopeforthejourney.org/emdr-vs-hypnosis-a-guide-to-choosing-the-right-therapy/

62.Is EMDR a Form of Hypnosis? - AlphaMind Counseling Centers, accessed on June 5, 2025, https://alphamindcounselingcenters.com/is-emdr-a-form-of-hypnosis/

63.EMDR and the treatment of complex PTSD: A review | Request PDF - ResearchGate, accessed on June 5, 2025, https://www.researchgate.net/publication/233496682_EMDR_and_the_treatment_of_complex_PTSD_A_review

64.What is Complex PTSD and How Might Somatic Therapy Help? - Flourish Psychology, accessed on June 5, 2025, https://flourishpsychologynyc.com/what-is-complex-ptsd-and-how-might-somatic-therapy-help/

65.Exploring Somatic Therapy: Healing Through the Body-Mind ..., accessed on June 5, 2025, https://francescasciandra.com/blog/exploring-somatic-therapy-healing-through-the-body-mind-connection

66.Teaching Trauma-Focused Exposure Therapy for PTSD: Critical Clinical Lessons for Novice Exposure Therapists - PMC - PubMed Central, accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3188445/

67.Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up, accessed on June 5, 2025, https://pubmed.ncbi.nlm.nih.gov/16368074/

68.Dialectical Behavior Therapy in the Treatment of Trauma, accessed on June 5, 2025, https://www.wildflowerllc.com/dialectical-behavior-therapy-in-the-treatment-of-trauma/

69.DBT for Complex Trauma | Megan Quigley, LCSW, accessed on June 5, 2025, https://meganquigleylcsw.com/dbt-complex-trauma/

70.Your Guide to Internal Family Systems (IFS) Therapy - Healthline, accessed on June 5, 2025, https://www.healthline.com/health/mental-health/ifs-therapy

71.2-Day Intensive Workshop: Treating Complex Trauma with Internal Family Systems (IFS) Therapy - PESI, accessed on June 5, 2025, https://www.pesi.com/item/2day-intensive-workshop-treating-complex-trauma-internal-family-systems-ifs-therapy-68701

72.Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review - PMC, accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10845104/

73.The Dangers of Hypnosis and False Memories - Release Hypnosis, accessed on June 5, 2025, https://releasehypnosis.com.au/hypnosis-and-false-memories/

74.Remembering what did not happen: the role of hypnosis in memory ..., accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11832514/

75.Childhood Trauma Remembered Pamphlet Available – ISTSS ..., accessed on June 5, 2025, https://istss.org/childhood-trauma-remembered-pamphlet-available-istss/

76.Confabulation Cycle | Online Continuing Education CEUs for Counselor | Ethical Issues | PTSD - OnlineCEUCredit, accessed on June 5, 2025, https://www.onlineceucredit.com/ceus-online/ur-ethics-recall/trkUR02lo.html

77.Hypnosis: Risks, Side Effects, and Safety - WebMD, accessed on June 5, 2025, https://www.webmd.com/mental-health/hypnosis-risks-side-effects

78.Medical Issues and Hypno-psychotherapy - Hypnotherapy Manchester, accessed on June 5, 2025, https://hypnomanchester.co.uk/medical-issues-and-hypno-psychotherapy/

79.Hypnosis and hypnotherapy - Royal College of Psychiatrists, accessed on June 5, 2025, https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/hypnosis-and-hypnotherapy

80.bscah.co.uk, accessed on June 5, 2025, https://bscah.co.uk/wp-content/uploads/2024/03/MAIN-PAPER-UNWANTED-EFFECTS-OF-HYPNOSIS-A-REVIEW-OF-THE-EVIDENCE-AND-ITS-IMPLICATIONS.pdf

81.Hypnosis and the Counseling Profession, accessed on June 5, 2025, https://manifold.counseling.org/system/resource/2/5/d/25d5df5c-3916-41df-a5ff-10cdc3184473/attachment/fb74b42e8db81533617eca4cffe8f4af.pdf

82.APA Official Actions Position Statement on Hypnosis, accessed on June 5, 2025, https://www.psychiatry.org/getattachment/7f440154-4e79-41ad-85af-97b06beff7fc/Position-Hypnosis.pdf

83.The “New” APA Division 30 Definition of Hypnosis as a Step Backward - Scott Lilienfeld memorial site, accessed on June 5, 2025, https://scottlilienfeld.com/wp-content/uploads/2021/01/NewDefHypnoAJCH2015.pdf

84.Society of Psychological Hypnosis (Division 30), accessed on June 5, 2025, https://www.apa.org/about/division/div30

85.About ISSTD, accessed on June 5, 2025, https://www.isst-d.org/about-isstd/

86.International Society for the Study of Trauma and Dissociation - Wikipedia, accessed on June 5, 2025, https://en.wikipedia.org/wiki/International_Society_for_the_Study_of_Trauma_and_Dissociation

87.From Complex Trauma to Dissociative Disorders | Lovern 2025, accessed on June 5, 2025, https://cfas.isst-d.org/content/complex-trauma-dissociative-disorders-lovern-2025

88.Ethical Issues in the Treatment of Clients with Complex Trauma and ..., accessed on June 5, 2025, https://cfas.isst-d.org/content/ethical-issues-treatment-clients-complex-trauma-and-dissociation-2025-ethics-virtual-seminar

89.International Practice Guidelines | International Society for Traumatic Stress Studies, accessed on June 5, 2025, https://istss.org/clinical-resources/trauma-treatment/international-practice-guidelines/

90.ASCH Level 1 & Level 2 Workshop - American Society of Clinical Hypnosis (ASCH), accessed on June 5, 2025, https://asch.net/event/asch-level-1-level-2-workshop-8/

91.Dissociative Disorders: Causes, Symptoms, Types & Treatment - Cleveland Clinic, accessed on June 5, 2025, https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders

92.Dissociative Defense Mechanism: Causes and How to Cope - Healthline, accessed on June 5, 2025, https://www.healthline.com/health/mental-health/dissociative-defense-mechanism

93.Ethical aspects of research on psychological trauma - PMC, accessed on June 5, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3181588/

94.on the efficacy of hypnosis: a meta-analytic study - BSCAH, accessed on June 5, 2025, https://bscah.co.uk/wp-content/uploads/2024/03/ON-THE-EFFICACY-OF-HYPNOSIS-A-META-ANALYTIC-STUDY-204-part-2.pdf

Compiled by Gemini AI 05.06.2025

Qualification and Service provided

Stuart is a fully qualified and registered clinical hypnotherapist specialising in hypno-analysis, conversational hypnosis and cognitive behavioural hypnotherapy. He is fully registered and is listed on the Professional Standards Authority Accredited Register held by the CNHC under hypnotherapy (the official "right touch" regulation system in the UK). He is also qualified and accredited in a range of other therapies, and is a certified advanced clinical trauma specialist with multiple certifications, including in the specific use of hypnosis for trauma.  He is qualified to post graduate specialist levels in multiple of the other models mentioned for integration above including IFS-informed, Somatic, DBT, ACT, CBT. His therapy qualifications are underpinned with a MSc Psychology.

Stuart Practices online and in clinic in Edinburgh.