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If you are quietly reading Positive Health now, taking your time, concentrating, absorbing its content, not just flicking through the pages, you are in some form of light trance state. Hypnosis is not a condition of oblivion or mental unresponsiveness, like sleep, but a state of mind where our normal awareness is reduced and attention is directed toward a specific mental idea, a problem, a physical stimulus, a fantasy – or an insight

Hypnosis can be seen as being on a scale of detachment from reality and on a scale of degrees of focus of attention or absorption.

Without our ability to focus in this way, we would never have evolved as we have. Indeed, new scientific discoveries see the trance state and dreaming, with which it is closely related, as playing a central role to the evolution of conscious life.

When we are wide awake our perceptions and responses are normally directed toward maintaining our orientation in what we regard as 'the real world'. And of course our everyday conscious awareness works within the constraints and demands of external reality. This after all is our main means of adaptation and survival.

But the more we move into a trance state, the more we pay less and less attention to external reality and make fewer efforts to monitor and interpret external events. Staying in touch with external events simply becomes less and less important or necessary to us. Or at least that's how it feels. When we finally give up the effort it takes to keep in touch, we enter a 'deeper' trance.

A typical move into trance is easily seen when you know what to look for. There is usually a slight pause in immediate activity, a facial expression of distraction and detachment, a peculiar glassiness of the eyes with a dilation of the pupils and failure to focus, a slowing down of heart rate and breathing, a condition of catalepsy, a fixity and narrowing of attention and an intentness of purpose.

The Symptomatic Trance

Some people live life continually in a trance. You can see this in the symptomatic trance of depressed people; they tend to shuffle slowly, become listless and disassociated. The term "symptomatic trance" refers to the circumstance of an individual's having generated a view of themselves and their life that leads to unwanted or unhealthy delusional experiences. Pompous megalomaniacs, for example, appear to be in the grip of such trances most of the time. Think of the religious leaders, political rulers and guru figures who occupy positions of unquestioned authority. Remember the old style communist leaders in the Kremlin and Peking whose vanity and pomposity convinced them that they were the centre around which the world circled. Because they were surrounded by sycophants their delusions were never challenged and their symptomatic trance was continually reinforced and maintained. Their movements and speech became slow, stiff and ponderous and the more they lost contact with the real world, the more unresponsive they became to external stimulus.

Symptomatic trances, however, are brought about by circumstances and the person themselves. By contrast, a good therapist would be working to break up the negative pattern of symptomatic trance states.

This happens when a patient is deliberately put into a trance by a hypnotherapist. The therapist's voice is focused on and becomes part of the trance experience as the patient's attention is turned inward and the outside world decreases in importance and is given less and less attention. Then awareness is increasingly directed toward internal events such as imagery, sensations, thoughts, etc. In other words, absorption with internal experiences is the main characteristic of the trance state. You become completely absorbed by particular internal events, with external events fading from conscious attention and losing significance entirely – unless the hypnotist directs the subject's highly focused attention to them.

The hypnotherapist becomes the only connection the subject has with the external world.

Trance is comparable in some degree to those common, spontaneous, limited restrictions of awareness seen in states of intense concentration, abstraction and reverie, or when we fail to see something obvious because we are expecting something quite different. In a deliberately guided trance, however, we begin to respond to internal realities we've become aware of. We naturally become less and less dependent upon the boundaries we set to deal with the external world. The way we normally provide meaning and structure to our lives in the world tends to be replaced by an internal definition of what is real.

The hypnotist can develop this internal mental construction with specific suggestions and metaphors. Then, what is real for the subject and what occurs within that reality is specified internally and not affected by external events or circumstances. It is as if hypnotised subjects enter a new world, one in which the ordinary rules of reality no longer apply but are replaced by internally based ones.

Hypnotised people can perceive their reality in a manner entirely foreign to actuality – but it's most real to them. This surrealistic contrast between the inner reality of the trance and the real world is what the stage hypnotist puts to good effect when he directs his subjects to believe and do the most outrageous things to entertain the audience.

Because the hypnotised subject's attention is focused inward, with virtually the only contact with external reality being an awareness of the hypnotist's voice, a great rapport is built up between the subject and the hypnotist. This tendency makes it easier to direct the subject's attention almost anywhere.

It is generally taught today that rapport is essential for successful use of hypnosis but there is evidence that hypnosis can be produced with or without the conscious co-operation of the subject. Schools of psychotherapy in central Asia, India and the Middle East have taught a variety of such techniques for over a thousand years.

The Trance State in Therapy

The ease with which we all go into trance, and the fact that this is not often recognised, has great relevance for all therapists, counsellors and anyone else trying to communicate with, or help, another person. This is because in the highly focused hypnotic state, we are highly suggestible.

This is important to understand because hypnosis is frequently induced all the time, not just in the controlled setting of a hypnotherapy session or on a stage for entertainment. It happens in the GPs surgery, in complementary health settings, in all forms of psychotherapy and in counselling. It happens at sporting events, religious ceremonies, musical occasions and when people are under stress at work. People are more suggestible when they're afraid or angry or in love or desperate – whenever the limbic system is aroused in fact. This is why people behave in quite unexpected ways, to them and the people who thought they knew them, when in emotionally aroused states.

In therapy, this responsiveness to the suggestions presented by the therapist is desirable to help the person to break free from the pattern of behaviour that is causing them distress – whether it's an anxiety condition, depression, phobia, habit of thought or an addictive behaviour. And, as well as being more responsive to ideas and able to accept suggestions more easily under hypnosis, we can also act on them more readily than in our ordinary state.

A good therapist recognises that the general tendency of hypnotic subjects to be passive and receptive is simply due to their suggestibility and is a direct result of the suggestions used by the therapist to induce hypnosis and not a function of the hypnotic state.

It is quite possible to induce far from passive hypnotic states – states of great mental and physical arousal – both in individuals and in groups. Hitler, for example learnt how to put large crowds into mass-hypnosis with a very simple technique so he could control, indoctrinate and orchestrate them. All kinds of mass delusions can be seen as due to hypnotic dissociation from reality.

A good therapist, however, is not trying to gain control over his subject but is using the subject's responsiveness to secure a spontaneous development of a pattern of helpful behaviour. The change in behaviour is merely initiated by the suggestions given.

When attention is highly focused and turned inward, we naturally become absorbed in this inner world. We begin to experience and respond exclusively to our brain's internal reality simulator. Our thoughts and images become so absorbing and convincing that they are subjectively indistinguishable from the experience of ordinary reality – just as in our dreams.

We respond as if this internal world were reality, ignoring for a while what we think of as the ordinary world. A memory, an imagined event, or a mere notion about what is happening can be experienced so vividly that it seems real. This natural ability is what is responsible for most hypnotic phenomena and is what the hypnotherapist is able to influence.

By carefully nurturing responsiveness and suggestibility the patient is guided in specific ways to create internal events which become "real" hypnotic experiences. Past events may be relived or current events understood and thought about in totally new ways. Almost any sensation or perception may be amplified, distorted, reduced, eliminated, or replaced by an awareness of new ones derived entirely from this internal reality simulator.

Can the Trance State be Harmful?

The use in this way of the natural patterns of memory, thought, and response to stimulate the experience of a different, hypnotic reality is characteristic of all effective hypnotherapeutic interventions. But it begs the question; what happens if the therapist intervening in the patient's life is not perceptive, skilled and knowledgeable? Can they do harm?

The answer is definitely yes.

Hypnotherapy gives you the opportunity to amplify and use resources within yourself which you would usually consider to be outside the realm of your "normal" consciousness. If you were lacking in confidence or self esteem, you could experience what it was like to speak in public with total confidence or be assertive in a positive way in a relationship. This breaks through the everyday trance experience that has held you back and enables you to develop more confidence as a permanent part of your personality.

These so-called "unconscious resources" are the main catalyst for therapeutic change in all forms of psychotherapy, even though many therapists are unaware that they are happening. The ability to make use of aspects of a patient's experience that he or she normally doesn't relate to in any meaningful way is one of the most significant reasons for integrating hypnosis into any therapeutic intervention.

Hypnosis is not a therapy in itself of course. It is the associations stimulated by the hypnotic experience that begin the therapeutic change in a person.

The success of any therapy mainly depends on the relationship and rapport between the therapist and the patient. Therefore, the quality of the client's relationship with a therapist using hypnosis is very important. If the therapist does not possess the basic skills and understanding that research shows are essential for competence, good outcomes are unlikely.

Using hypnosis involves a style of communication, a way of thinking about a therapeutic relationship, and a sensitivity to the client's specific way of being in the world. Hypnosis is a mechanism embedded within all psychotherapies if they are at all successful in being a catalyst for therapeutic change.

When therapy is not successful, or even is anti-therapeutic, hypnosis is also there as a factor in the failure. By that I mean 'wrong' aspects of the patient's experience are being hypnotically amplified or hurtful associations hypnotically established by unskilled therapists or counsellors.

The Trance State in Depression

For example, if a therapist is treating depression with a psychodynamic approach – which is where the patient is encouraged to search in their past for the 'cause' or the 'meaning' of the depression – you would find the depression getting worse. The last thing you should say to a depressed person is "...tell me about it..." because it just digs them even deeper into the depressive trance state. That is why psychodynamic approaches are contraindicated for depression and in America you can successfully be sued if you practise psychodynamic or hypno-analytical therapy with depressed people.

You can see why if you consider the following list of classical hypnotic phenomena which are the same psychological mechanisms with which we all create our private, subjective experience. Michael Yapko, one of the world's leading clinicians using hypnosis, describes this list as the "building blocks of experience – both positive and negative". And indeed they are the elements which, in various combinations, are the identifiable structures in all hypnotic experiences;

• Age regression (including hyperamnesia, where details of memory are enhanced, and revivification, where memory is relived as if the event was occurring for the first time in 'the here and now')
• Age progression
• Amnesia
• Analgesia
• Anaesthesia
• Catalepsy
• Dissociation
• Hallucinations (positive and negative)
• Ideodynamic responses
• Sensory alteration and
• Time distortion

Now compare how the same trance phenomena typically surface in depression and why psychodynamic approaches only maintain or deepen depression.

• Age regression – The depressed person mainly focuses on the past , recalling and re-experiencing past hurts, rejections, humiliations, etc. They use the past as their main reference for life decisions.
• Age progression. A depressed person will project past hurts into future contexts.
• Amnesia. A depressed person will forget past successes or positive feedback that they had had.
• Catalepsy. Depression is characterised by psychomotor retardation and rigid posturing.
• Dissociation. Whatever environment or context they are in they will tend to be miserable – even in happy social occasions like a party or a celebration. They selectively focus attention on negatives and dissociate from the present context, however good it might be, in favour of a past orientation. They also self-label 'parts' of themselves negatively ("I'm hopeless, I've got no sense of humour, I'm an angry person, I can't love anyone" etc.).
• Ideodynamic responses. Depressed people automatically have depressogenic thoughts, feelings, sensations and behaviours.
• Hallucinations. A depressed person will perceive rejection and negativity where none are present. Equally they are unable to see or hear positive feedback.
• Sensory alteration. Depressed people have an altered relationship to their body via physiological symptoms (somatisation). Their sensory awareness and sensory enjoyment are drastically reduced – they lose the capacity to enjoy good food for example, or physical closeness or sexual arousal.
• Time distortion. Depressed people also extend their experience of past and current discomfort and minimise their experience of future possibilities.

Patients' symptoms, for example, can be viewed as an unfortunate by-product of the same structures of hypnosis that might, in a different context, be therapeutic. This is "negative self-hypnosis" where self-hypnosis generates unwanted symptoms – the symptomatic trances – which are self-limiting and maintain self-destructive ways of responding to life and low rapport with other people creating the kinds of unsatisfying – even destructive – relationships so common among depressed people.

This negative trance binds them to a perception of reality that is rigidly adhered to, despite overwhelming, even pain-inducing, evidence that directly suggests to others that the person's view is in dire need of modification. The individual displays a markedly impaired ability to recognise and adapt to changing circumstances if they would require generating new or modified responses. Their behaviour is inappropriate and they don't recognise or respond meaningfully to the demands of the situations he or she faces. And this creates experiences that they then view as failure, rejection, humiliation, and so forth.

Symptomatic negative self-suggestion also rejects the self. This leads to a person failing to accept and use appropriately different parts of themselves. The symptomatic trance creates a dysfunctional dissociation within the person who labels a part (or parts) of themselves as negative and useless. Then the dysfunctional dissociation increases in direct proportion to the intensity of the attempts consciously made to "get rid of" such parts.

So hypnotic phenomena play an important part in instigating and maintaining depression and it's easy to see how doctors, therapists and counsellors who don't understand that can make matters worse for their patients.

Trance States in False Memory Syndrome

Another example of how harmful associations can be hypnotically developed is when a therapist or counsellor introduces the idea to someone that they might have been sexually abused as a child and forgotten it. In trance states they can come to believe it was so, without any evidence or without any previous indication, and that can do untold damage to families.

This topic has been given a lot of media attention in recent years after it was given the name 'false memory syndrome'. Much of the evolution of modern day psychotherapy has dwelt on the idea that you need to go back to a historical cause for distress and that that cause is very often hidden and if you rediscover it this will make you better.

Unfortunately this has proved to be a wrong idea. Indeed the closer therapists follow that approach the less likely are their patients to get better. Psychoanalysis, for example, is famous for not curing anybody.

Many of the problems with psychotherapy come about because of ignorance of how prone we all are to the effects of hypnosis. People will go into a trance if you just ask them to try to remember an event – we all have to go into a 'mini trance' to remember something – we focus our attention, eliminate distractions and begin to put our memory together again.

Doctors, therapists or counsellors who don't know this can do great harm to people. Memory is one of the brain's principle creative functions. When we remember we are retelling a story of the past.

And to go back and remember, you have to go inwards, and going inwards is one of the definitions of trance. It's inward attention and concentration – the opposite of conscious awareness of the outside world which requires a different part of the mind to be engaged. And, most significantly, the story always changes. The same person will not remember the same event again in exactly the same way. The story improves in the telling – or not – but it is always changing.

If you're asked to remember how you felt about something, that's trance inducing. If you ask someone to try and describe what a dream means for them, that's trance inducing. If you are asked, "how do you feel now?" that's trance inducing. So is being asked, "how did you feel then?"

There is also a big difference in asking someone "how did you feel about that?" and "What do you think about that?" because the questions access different parts of the brain. We have to go inwards into a trancy state to remember something. The problem is that, the more of a trancy state we are in, the more suggestible we are. And we are usually unaware of the trance in ourselves or that we are open to suggestion.

This means that all of us working with people in trouble need to be aware that our beliefs – whether we are doctors, therapists, counsellors – or anybody else questioning, talking to, or helping others, will to some extent automatically be affecting the other person's beliefs or behaviour. These beliefs are communicated by body language, facial expressions and tone of voice as well as just the spoken language.

So, the belief system a therapist or counsellor holds is a critical issue. Vicars are generating false memories of Satanic abuse in vulnerable people and others are doing the same with other forms of childhood abuse. It's so easily done when people are in trance and being spoken to by someone who has an agenda and is on the lookout for such abuse. And none of the people involved necessarily realise that hypnotic forces are at work. Just putting the idea in someone's head that they might have forgotten that they were sexually abused is enough to direct the creative mind to go on a search in that direction as it tries to find an explanation and a meaning for the distress it's suffering. A distressed person may then start to think that ... "perhaps something did happen ... perhaps I was ..."

So when a therapist, counsellor or doctor believes that large numbers of problems that people experience in their lives are due to people forgetting that they were sexually abused when they were children, they will contaminate the beliefs of vulnerable people who come to see them. And many of their patients will come to believe that they were so abused – even without corroborating evidence or any previous memory. That belief then becomes part of their reality. And, sadly, it is difficult, even in the face of evidence that undermines the belief, to withdraw commitment to that belief. (Research has shown that one in three people are incapable of abandoning established beliefs, however absurd.)

False beliefs are held with just as much conviction, passion and sincerity as 'true' ones. And we all know that sincere belief in something is no guarantee of truth. Enemies with entirely opposing points of view can be equally sincere in their belief that they are right!

The issue of false memories is complicated by the fact that some people do forget that they were abused. Forgetting unpleasant aspects of reality is, after all, how we keep ourselves sane. Real childhood abuse is bad enough but for therapists and counsellors to help create illusory memories of abuse is disastrous.

There are a host of myths and beliefs that influence therapy that are equally damaging. Many of these myths have been absorbed into our culture and are not often questioned. We tend to only notice obvious dubious beliefs like the idea that Satanic abuse is rampant, or that multi-personality disorders are common, or that abductions by aliens is an everyday affair. We also, however, need to be aware of the less obvious ones, those that are so deeply embedded in our culture we hardly notice them.

The power of expectation coupled with our suggestibility can take away our volition and so easily do harm – we all need to be more careful. Hypnosis is neutral. It can be used to help or destroy people.

The Therapeutic Trance State

You can now see why hypnosis is clearly identifiable as a significant element in any therapy once we learn to recognise the roles of suggestion, expectation, and influential communication in the therapeutic relationship.

The goal of any therapy is to influence the distressed person in such a way that they will discover new, more desirable ways of experiencing themselves. The therapeutic relationship is the vital context in which hypnosis and therapy occur; regardless of the preferred style of intervention the therapist uses.

Therapeutic trances may be temporary, short term experiences, such as occur in a therapy session, or they may be the more extensive, individually generated positive viewpoints of the self or life.

Regardless of their content or how long they last, therapeutic trances are beneficial to the individual. They enhance the quality of the person's self-image and experience of life. They help develop a meaningful and positive rapport between the individual and those close to them – family, friends and colleagues. They develop flexibility in the person so that they can adapt in a responsive and timely way to changing circumstances. They are appropriate to the context of their lives, intentions and desires. They strengthen the person's ability to recognise, accept and use more effectively the different parts of themselves. They allow for positive possibilities that motivate the individual to act in a responsible and goal-directed manner.

But we must never forget that trance is neutral and can just as easily trap and harm people as liberate them. Which is why the subject needs more attention..