What Is Suggestion?

In the context of hypnotherapy, a suggestion is a communication – verbal or non-verbal – that is intended to influence a client’s thoughts, feelings, perceptions, or behaviour. Suggestions may be direct or indirect, simple or compound, and may target a broad range of outcomes from behavioural change and emotional regulation to perceptual shifts and physical relaxation.

The effectiveness of suggestion depends on several factors: the depth of the client’s hypnotic state, the degree of trust and rapport between practitioner and client, the plausibility of the suggestion relative to the client’s existing beliefs, and the skill with which the suggestion is framed and delivered. No single factor is decisive; suggestion works through the combination of all these elements.

Direct Suggestion

Direct suggestion presents the desired outcome straightforwardly and explicitly. For example, a direct suggestion for a client wishing to stop smoking might be: “From this moment forward, you are a non-smoker. You have no desire for cigarettes. You are free.” Direct suggestions work well when the client is highly motivated, responsive to hypnosis, and does not hold strong counter-beliefs that would cause their critical faculty to reject the suggestion.

Direct suggestion was the dominant approach in early hypnotherapy practice and remains effective with many clients. However, its limitations become apparent with clients who are sceptical, intellectually analytical, or who have strong unconscious investment in maintaining the presenting concern. For these clients, indirect approaches are often more effective.

Indirect Suggestion

Indirect suggestion communicates the desired outcome in a less explicit, more oblique manner. Rather than stating the desired change as a fact or command, indirect suggestion uses implication, story, metaphor, embedded commands, and open-ended language to engage the unconscious mind without triggering the critical faculty’s resistance.

Milton H. Erickson was the master of indirect suggestion and used it extensively in his clinical work. Erickson observed that the unconscious mind could extract and respond to suggestions embedded within seemingly unrelated stories or conversations, a technique he called “interspersal.” His characteristic sentence structures – long, rambling, and ambiguous – were deliberately designed to occupy the analytical conscious mind while the unconscious processed the therapeutic content.

An example of an embedded command within indirect suggestion might be: “Many people find that as they sit quietly and listen to the sound of my voice, they simply… relax deeply… without even trying.” The phrase “relax deeply” is an indirect command, delivered in a way that bypasses the critical faculty’s tendency to evaluate and potentially reject it.

Post-Hypnotic Suggestion

Post-hypnotic suggestions are suggestions delivered during hypnosis that are intended to influence the client’s thoughts, feelings, or behaviour after the session ends. They are a particularly important element of clinical hypnotherapy because they extend the therapeutic effect beyond the session room. A post-hypnotic suggestion might link a specific trigger (such as a stressful situation) to a desired response (such as taking a deep breath and feeling calm), creating a conditioned response that operates automatically in daily life.

For post-hypnotic suggestions to be effective, they should be plausible, specific, and consistent with the client’s goals. They should be offered in permissive rather than commanding language where possible, and they should be revisited and reinforced across the course of treatment.

Expectancy and Its Role in Therapeutic Outcome

Expectancy refers to the client’s anticipation of what will happen as a result of therapy. It is related to but distinct from the placebo effect – while the placebo effect involves the expectation of a specific treatment effect (such as pain reduction), therapeutic expectancy is a broader construct encompassing the client’s belief in the credibility of the therapy, their trust in the practitioner, and their general optimism about the possibility of change.

Research across psychotherapy broadly supports the view that expectancy is a significant determinant of outcome. Clients who believe therapy will help them tend to experience greater benefit than those who are sceptical, even when the same treatment is delivered. This does not mean that hypnotherapy is “just expectancy” – the specific mechanisms of hypnotic suggestion operate independently of expectancy – but it does mean that practitioners who attend to the client’s expectations and work to cultivate realistic optimism are likely to achieve better outcomes.

Practical applications of this include: providing clear information about how hypnotherapy works in the pre-induction phase, addressing and reframing negative expectations or misconceptions, using pre-talk effectively to build confidence in the process, and reviewing progress with the client regularly to reinforce evidence of positive change.

Ethical Considerations in Suggestion

The power of suggestion in hypnotherapy carries ethical responsibilities. Suggestions must always be in the client’s genuine interest and must not be used to create dependency on the practitioner, to implant false memories, or to influence the client’s beliefs or behaviour in ways that serve the practitioner’s rather than the client’s interests. The ethical use of suggestion is governed by the codes of conduct issued by professional bodies including the NCH and the CNHC, and is an important area of reflection in clinical supervision.