Assessment, Screening, and Contraindications
What to assess
Before using hypnosis, screen for suitability and safety. Take a focused history: psychiatric diagnoses (psychosis, dissociative disorders, active substance misuse), trauma history, seizure disorder, significant cognitive impairment, and current medications. Assess motivation, expectancy, and the patient's own goals, since unrealistic expectations predict disappointment. Consider formal hypnotizability testing when the treatment plan depends on it (for example, hypnotic analgesia), but remember that clinical response often matters more than a score and that testing itself is an intervention that shapes expectancy.
Contraindications and cautions
Hypnosis is generally safe, but certain situations warrant caution or deferral: active psychosis or delirium, where altered experience may be disorganizing; dissociative identity presentations, where exploration of parts can destabilize without a structured plan; use of hypnosis to recover memories for legal purposes; and reliance on hypnosis in place of indicated medical evaluation. Seizure disorder is not an absolute bar, but induction should avoid prolonged visual fixation and the clinician should coordinate with medical care. Never delay urgent medical referral for a hypnotic trial.
Traps
Questions blur absolute contraindication with relative caution. Very few absolute contraindications exist; most items are about judgment, consent, and coordination with other care. Another trap is assuming a low hypnotizability score means a patient cannot benefit - skills-based and alert approaches often still help.
Rule of thumb
Screen with the question What could this intervention destabilize, and who else needs to know? Document the answer.
Worked example
A patient with epilepsy requests hypnosis for anxiety. Appropriate response: proceed with medical coordination, choose a low-arousal induction without intense eye fixation, monitor, and document the plan.