In the last blog, we talked about focus and suggestibility. This latest post builds on that by exploring the concept of expectancy.
What a client expects from a session will influence how responsive they are. And it works the other way too: the more responsive a client is, the higher their expectations of the experience are likely to be. In a hypnotherapy session if the client is aware they are directing their focus, they are in a different mental state and they are responsive to the hypnotherapist’s suggestions they will have heightened expectations for the success of the process.
How can we define expectancy
Expectancy is present throughout the hypnotherapy process.
A good starting point is whether the client believes they are hypnotisable. Studies show that individuals vary in their susceptibility to hypnosis, but most people are at least somewhat responsive. Many hypnotherapists use techniques to demonstrate that hypnosis is taking effect. One example is suggesting that the client’s arm is getting heavier. Another is asking them to imagine sucking on a lemon and then drawing attention to the watering of their mouth.
At the other end of the hypnotherapeutic intervention, there is evidence that post-hypnotic amnesia is heavily influenced by the client’s expectations. One study found that over three-quarters of clients who did not expect to remember the session did indeed forget it at a conscious level.
During the session, the therapist may introduce post-hypnotic suggestions. For instance, “Every time you see a cigarette, you’ll know you are a non-smoker,” or “When you notice pain, you’ll calmly reduce it by using your special technique.” Anchors are often introduced at this stage. A therapist might help a client achieve a calm state during hypnosis, and then invite them to clasp their hands together while focusing on that calm feeling. This creates an anchor. Later, the therapist might say, “Clasp your hands together and you will immediately become calm,” allowing the client to use this technique in everyday situations.
These are just a few examples of how expectancy can be harnessed to help clients in a hypnotherapy session.
How a hypnotherapist can use expectancy
A good therapist will work with expectations to reinforce a client’s confidence in the process of hypnotherapy. A client who expects therapy to work is far more likely to find that it does.
The hypnotic experience seems to amplify the power of expectancy. It taps into a common and natural human tendency to anticipate and work towards expected outcomes. There are two main types of expectancy: one directed outward, and one inward.
Stimulus expectancy is outward-facing. It is the belief that something will happen in the external world. For example, you see black clouds and expect thunder—so you run indoors. Expectancy, in this case, directly influences behaviour. But often people will expect something to happen in the outside world but take no action as they assess that they are not in control.
Response expectancy, on the other hand, is inward-facing and often more powerful. This is because people generally feel they have more control over their internal states than over external events. Sometimes this is described as a self-fulfilling prophecy, but that’s not entirely accurate. Just expecting a change does not guarantee it will occur—there may be many psychological blocks in the way. Much of the therapist’s work is aimed at identifying and overcoming these blocks.
Nevertheless, expectancy remains a valuable therapeutic tool. For instance, if a client expects their pain to lessen after a session, and it does, they are in a better position to maintain that improvement. And they will approach their next session with a confidence that it will be worthwhile.
So response expectancy, in particular, appears to be more effective in shaping future behaviour—because people feel more agency over their own responses than external events and may also be more motivated to change them.
To sum up, expectancy is a significant part of the therapeutic process, especially when used alongside other techniques. We must recognise its usefulness, but also be clear that it is not infallible, and it is certainly not the only factor at play.
For example, a study on Irritable Bowel Syndrome—an area where hypnotherapy is known to be effective—showed that expectancy appeared to play no role at all. In fact, more people who did not expect hypnotherapy to work had a successful outcome compared to those who did.
(See: PMID: 35198040)
In contrast, a study comparing hypnotherapy with cognitive-behavioural therapy for smoking cessation found that participants with higher expectations of success were more likely to quit successfully.
(See: DOI: 10.3389/fpsyg.2024.1330362)
More research is needed. It may be that expectancy plays a greater role in some conditions than others. For now, we can say that it is important—but it is not everything.
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I hope this overview has clarified some key ethical issues in psychological practice. Feel free to reach out with any questions or let me know if there are topics you’d like me to explore further.
Coming next
Information processing during hypnosis. We will look at how the brain processes information when in a hypnotic state. What this says about our cognitive processes, our brain waves and how our neural pathways are affected.