What if the client isn’t failing to engage with therapy?
What if the therapy is failing to adapt to the client?
Many therapeutic approaches use language that asks clients to “see”, “picture”, “visualise” or imagine an experience.
For people with aphantasia — weak or absent voluntary visual imagery — those instructions may not correspond to the way they think or experience their internal world.
My research into aphantasia and hypnosis explores what happens when therapeutic techniques and expectations are built around mental imagery that some people simply do not experience.
It began with a question that is deceptively simple:
Can you hypnotise someone who cannot visualise?
The findings suggest a more interesting question:
How can we adapt therapeutic approaches to the individual rather than expecting the individual to adapt to the technique?
Why hypnosis?
Hypnosis provides a particularly useful context in which to explore this question.
Hypnotic language and commonly used protocols can rely heavily on imagery and other things people with aphantasia often find challenging. Clients may be asked to visualise a scene, revisit an experience, imagine a future event or imagine ‘drifting out’ of their body.
For someone with aphantasia, instructions of this kind may be confusing, frustrating or simply impossible to follow in the way the practitioner intends.
As one participant in my research described:
“I’ve had the experience of getting really angry, so angry that people are asking me to see things... I’ve told them I’m not visual. And they still say ‘see’...”
This makes hypnosis an important lens through which to examine a wider issue:
What happens when therapeutic methods make assumptions about how a person thinks?
The research
My research explored aphantasic individuals’ experiences of hypnosis, the potential barriers created by commonly used hypnotic techniques and protocols, and ways in which hypnosis might be made more accessible to people who do not experience voluntary visual imagery.
Aphantasia and hypnosis:
(How) can you hypnotise if the subject cannot visualise?
The study
The qualitative research involved 24 participants with aphantasia, comprising 12 women and 12 men, aged 37–75 years (mean age 53).
It was conducted in two stages.
Stage 1
2021–22
n=24
Participants took part in focus groups and completed measures relating to imagery, including the VVIQ, Imagery Questionnaire and PSI-Q.
Stage 2
2022–23
n=17
Participants completed the SWASH (Sussex-Waterloo Scale of Hypnotizability) assessment and took part in four group hypnosis protocols, followed by participant feedback.
The data were examined using thematic analysis.
Ethical approval was granted by the University of Glasgow College of Social Sciences Research Ethics Committee (application 400210001).
Five barriers to experiencing hypnosis
The study identified five factors that could affect participants’ experiences of hypnosis.
1. Expectations
Participants could arrive with ideas about what hypnosis was supposed to feel like or what they were supposed to experience.
When their actual experience did not correspond with those expectations, this could itself become a barrier.
One participant explained:
“I haven’t found it very easy to be a hypnotic subject. I think I had an idea of what that meant. And because people were saying ‘visualise this, visualise that’ and I wasn’t, I think that got in my way quite a lot.”
The issue, therefore, may not simply be whether somebody can experience hypnosis, but whether their expectations allow them to recognise their own experience as hypnosis.
2. Analytical and literal processing
Highly analytical thinking and literal interpretation emerged as another potential barrier.
Some participants closely analysed instructions or interpreted the language used very literally. Rather than simply engaging with the experience, they might find themselves examining what was being asked, whether they were doing it correctly or what a particular instruction actually meant.
Detailed analysis or literal interpretation can hinder the experience of hypnosis.
3. Overly controlling the experience
Difficulty letting go or giving up control also emerged within participants’ accounts.
Monitoring what is happening — and continually evaluating whether the process is “working” — may interfere with deeper engagement.
This does not necessarily indicate an inability to experience hypnosis.
It raises questions about how expectations, trust, language and the therapeutic relationship interact with an individual’s cognitive style.
4. Visual language
For people who do not visualise, apparently ordinary therapeutic instructions can have a very different effect.
See.
Picture.
Visualise.
Imagine.
Visual language can create an immediate disconnect when the client interprets the instruction as requiring a mental picture that they cannot produce.
The important issue is not necessarily the word itself. People with aphantasia can, of course, understand concepts, think about places and events, remember experiences and anticipate the future.
The question is what the therapist means by the instruction and what the client understands they are being asked to do – and whether they think they can do it.
5. Commonly used techniques can be challenging
A number of popular hypnotic techniques rely explicitly or implicitly on mental imagery – or other mental processes many aphantasics find difficult if not impossible.
These include:
-
Guided visualisation
-
Regression — re-experiencing a past event or emotion
-
Future pacing — imagining future scenarios
-
“Dissociation” from the body
This does not necessarily mean that such therapeutic aims are inaccessible to everyone with aphantasia.
It does, however, raise an important clinical question:
Could the same therapeutic intention be approached in a way that better reflects how that individual actually thinks and experiences their internal world?
The implications go beyond hypnosis
Hypnosis is only one therapeutic context in which mental imagery is used.
A range of therapeutic approaches incorporate imagery-based exercises or language. If practitioners do not recognise that mental imagery varies considerably between individuals, we risk creating unnecessary barriers to effective therapy.
A client who struggles with an imagery-based intervention may be interpreted as resistant, disengaged or unable to perform the exercise correctly.
But another possibility deserves consideration:
The intervention may not be well matched to that person’s cognitive profile.
My research therefore raises broader questions about how therapeutic techniques are taught, communicated and adapted.
What can therapists do?
The findings point towards three useful principles for practice.
RECOGNISE
Ask about mental imagery. Don’t assume.
People may have very different internal experiences while using exactly the same words to describe them.
Understanding whether and how a client experiences imagery can help the practitioner interpret their responses more accurately.
UNDERSTAND
Explore the individual’s imagery & cognitive profile.
The absence of visual imagery does not tell us everything about how someone thinks.
Their experience may involve other sensory imagery, spatial awareness, conceptual thought, language, emotion, bodily sensation or other forms of internal representation.
The aim is not to put the client into another category.
It is to understand this individual.
ADAPT
Tailor language, techniques and pace to the person in front of you.
Where a technique depends on visual imagery, consider what the therapeutic aim of that technique actually is.
There may be another route to the same destination.
Questions this research raises
This work has generated further questions that extend beyond the original study.
How do different imagery & cognitive profiles influence response to various therapeutic approaches?
What role do expectations and the therapeutic relationship play?
How can we best adapt imagery-based techniques across different therapeutic modalities?
How can training better prepare therapists to work inclusively with aphantasic & neurodivergent clients?
These are questions that I hope to continue exploring through research, professional dialogue and collaboration with researchers, therapists and organisations.
Read the research
Publications
Aphantasia, just imagine... A blind mind! Hypnotherapy with nonvisualisersTrevena, P. (2024), in Jacquin, F. (ed.), The Exquisite Art of Hypnosis and Hypnotherapy. Beyond Techniques and Protocols. Jacquin Hypnosis Academy.
Mental Imagery and Hypnosis – New Frontiers of Knowledge
Trevena, P. (2024). Hypnotherapy Journal of National Council for Hypnotherapy, 1.
This professional journal article considers mental imagery and hypnosis in the context of emerging knowledge about aphantasia.
An accessible introduction to the research
Can Hypnosis Work on Those With Aphantasia?
In this article for the Aphantasia Network, I explore some of the questions that led to my research and consider what aphantasia may mean for the experience of hypnosis.
Listen & watch
I have discussed aphantasia, hypnosis, mental imagery and mental health across a range of podcasts, interviews and talks.
These conversations provide a more informal way to explore both the research and some of the wider questions surrounding aphantasia.
Topics include:
Aphantasia, visualisation and hypnosis
Aphantasia, hypnosis and mental health
Why aphantasia matters
Aphantasia and dreaming
Hypnosis in mental health
About Dr Paulina Trevena
Dr Paulina Trevena is an independent researcher, hypnotherapist and trainer whose work explores aphantasia, mental imagery and their implications for hypnosis and therapeutic practice.
Her work brings together academic research, clinical practice and lived experience of aphantasia.
Her current research examines how differences in imagery and cognitive processing may influence people's experiences of hypnosis, the barriers that can arise when therapeutic methods assume visual imagery, and how therapeutic practice might better accommodate cognitive difference.
Alongside her research and clinical work, Paulina speaks and provides professional training on aphantasia, hypnosis and the implications of mental imagery differences for therapeutic practice.
Speaking, training & collaboration
Bring this conversation into your organisation
Understanding aphantasia is about more than learning the definition of a relatively unfamiliar cognitive phenomenon.
It invites us to examine some of the assumptions embedded within therapeutic language and practice — including assumptions about how people remember, imagine, process information and experience their internal worlds.
I speak to professional, academic and public audiences about aphantasia, mental imagery, hypnosis and the implications of cognitive differences for therapy and mental health practice.
I also provide professional training for therapists and organisations interested in understanding aphantasia and exploring how therapeutic language, techniques and protocols can be made more responsive to individual cognitive differences.
I welcome enquiries from conference and event organisers seeking speakers, panellists and workshop facilitators; professional and healthcare organisations interested in training; and researchers, academics and practitioners interested in research partnerships and collaboration.
Interested in working together?
If you would like to invite me to speak at an event, deliver training within your organisation, contribute to a professional programme or discuss a potential research collaboration, I would be very happy to hear from you.
Dr Paulina Trevena
Independent researcher, hypnotherapist & trainer
Aphantasia World
