Essentials of Complementary and Alternative Medicine (June 1999)

Contraindications
The major contraindications to hypnosis are poor psychodiagnostic and psychotherapeutic skills of the therapist and, particularly, countertransference problems in the 
therapist. Everything that occurs in psychotherapy occurs with more rapid onset when hypnotherapy is used, and so the clinician should be skilled in psychotherapy 
(
1
). Also, high hypnotic ability poses a risk for appropriate physician-patient boundaries. The therapist should examine his or her motives for adding hypnosis to 
psychotherapy as well as the patient's motives for requesting hypnosis. Is the patient looking for a magical cure in which the patient is not an active participant? Is the 
patient looking for some fantasied or real history of abuse that legitimizes a passive victimlike role in psychotherapy and life? Is the patient's ego stable and integrated 
enough to do abreactive, regressive, or uncovering psychodynamic work? Certain diagnoses, such as borderline personality, major dissociative disorders, and 
paranoid reactions, require great clinical skill when hypnosis is used.
ORGANIZATION
Training and Quality Assurance
A therapist should not treat a patient with hypnosis for any condition for which the therapist would not treat that patient without hypnosis. For example, the pain of a 
brain tumor or fractured bone should not be treated exclusively with hypnotic analgesia. Hypnosis is simply an adjunct to the treatment process and is seldom a 
permanent treatment in and of itself. Hence, persons who are candidates to be trained to use hypnotic techniques in clinical practice must be licensed professionals in 
psychology, medicine, or other health-related professions. They should recognize the scope of their diagnostic competence. Psychologists should not treat brain 
tumors, and neurologists should not treat dissociative disorders. The American Society of Clinical Hypnosis, the Society for Clinical and Experimental Hypnosis, and 
the International Society of Hypnosis have established codes of ethics that define and limit the persons who can be taught hypnosis. The American Boards of 
Hypnosis identify clinicians with advanced competence in psychological (American Board of Psychological Hypnosis), medical (American Board of Medical Hypnosis), 
and dental (American Board of Dental Hypnosis) hypnosis. Information about board-certified clinicians can be secured by calling or writing to The American Society of 
Clinical Hypnosis in Des Plaines, Illinois (telephone: [phone]; 2200 E. Devon Avenue, Des Plaines, 60018).
Legislative bodies have not imposed a licensing structure on hypnosis and hypnotherapy as an adjunctive treatment modality restricted to health care providers. 
Individuals who are unlicensed and untrained in health care professions advertise hypnotherapy for many symptoms despite the fact that they are not licensed to 
diagnose and treat somatic or psychological disorders. In highly hypnotizable persons who are not correctly diagnosed, hypnosis can mask organic disease (e.g., pain 
of brain tumor) or a serious mental disorder (according to the  Diagnostic and Statistical Manual of Mental Disorders [DSM-IV]). Because hypnosis and hypnotherapy 
are not restricted by law, there is no effective way to censure or police unlicensed individuals other than through public education. For example, using people with 
high hypnotic ability and a history of trauma for entertainment is always hazardous, but there is currently no legislative restriction on irresponsible people to keep them 
from abusing others in this way.
Reimbursement Status
The use of hypnosis as an adjunct to medical, dental, and psychotherapy procedures is covered by many (but not all) insurance companies and is included in CPT 
diagnostic codes used in medicine and psychotherapy. Outside of this, hypnosis is generally not reimbursed.
PROSPECTS FOR THE FUTURE
It appears that one of the most promising applications of hypnosis is in the primary prevention of somatization disorders and stress-related diseases (
1
, 
14
, 
19
, 
25
, 
65
). This may involve 50% of all patients seen by primary care medicine (
122
). Somatization has been called “one of medicine's blind spots,” (
123
) and an editorial 
described it as medicine's “unsolved problem” (
124
). One of the most promising diagnostic and therapeutic applications of hypnosis is with psychophysiologic 
psychotherapy (
1
, 
3
, 
16
, 
19
, 
25
) for somatization disorders. As our understanding of the intricate connections between mind and body grows, hypnosis will likely play 
a key role in the treatment of disease and in improvement in quality of life. With its extensive theoretical, experimental, and empirical base, hypnosis is both a 
complement and an occasional alternative to conventional treatments. The role of hypnosis will also expand as new techniques for enhancing hypnotic ability in the 

general population are further developed.
C
HAPTER
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CHAPTER 26. B
EHAVIORAL
 M
EDICINE
Essentials of Complementary and Alternative Medicine