Elman vs Erickson: two approaches to hypnosis

A major 2017 review of hypnotic induction methods concluded that researchers have found “few if any differences in responding across diverse hypnotic inductions” ( Lynn et al., 2017 ). That finding might surprise anyone who has watched the debate between Elman-style practitioners and Ericksonian hypnotherapists — two camps that often describe their methods as fundamentally different.

This article compares the two approaches side by side: philosophy, technique, evidence, and practical applications — so you can understand what actually distinguishes them and when each works best.

Elman vs Erickson: the overview

Who were Dave Elman and Milton Erickson?

Dave Elman (1900–1967) was an American radio host and entertainment hypnotist who spent the latter half of his career teaching hypnosis to physicians and dentists. He was not a medical professional, but his practical, no-nonsense approach earned him widespread influence in clinical hypnosis training. His 1964 book Hypnotherapy remains a primary reference for direct induction techniques and is still used in training programs worldwide. For a complete breakdown of his method, see our Dave Elman induction guide.

Milton H. Erickson (1901–1980) was an American psychiatrist widely regarded as the most influential figure in modern hypnotherapy. Erickson developed a fundamentally different approach — one that relied on indirect suggestion, therapeutic metaphor, and what he called “utilization,” the practice of incorporating whatever the client brings to the session (including resistance) into the therapeutic process. His methods shaped the development of several modern therapeutic approaches, including neuro-linguistic programming (NLP) and solution-focused brief therapy.

The two men were contemporaries but moved in different circles — Elman among dentists and physicians seeking a practical clinical tool, Erickson among psychiatrists and psychotherapists exploring the boundaries of therapeutic influence. Their contrasting philosophies continue to define a central divide in hypnotherapy practice today.

How the two approaches differ in practice

A session using the Elman method follows a predictable arc. The practitioner explains the process clearly, then guides the participant through a sequence of specific steps: deep breath and eye closure, eye relaxation and catalepsy test, spreading relaxation through the body, arm drop test, fractionation, and finally mental relaxation with the number elimination test. Each stage is verified before moving to the next. The entire induction typically takes three to five minutes. Once the participant reaches the desired depth, the practitioner delivers therapeutic suggestions directly — clear, specific, and often repeated for reinforcement.

An Ericksonian session looks quite different. There may be no obvious “induction” at all. The therapist might begin with a conversation about the client’s day, then gradually shift into a story or metaphor that mirrors the client’s situation. Suggestions are embedded within the narrative rather than delivered explicitly — a technique called indirect suggestion. The therapist observes the client’s responses closely, adjusting the approach in real time. There are no formal tests of depth; instead, the therapist reads behavioral cues: changes in breathing, muscle tone, eye movement, and responsiveness.

The contrast extends to what happens after induction. Elman-trained practitioners typically deliver suggestions in a straightforward manner: “Every time you feel the urge to smoke, you will feel calm and in control.” Ericksonian practitioners are more likely to use metaphor: “And you might notice, as you walk through that garden, that some of the old weeds have already begun to wither on their own.” Both approaches aim to bypass the critical faculty — they simply take different routes to get there.

Direct vs indirect suggestion — what the research says

The Elman vs Erickson debate often centers on whether direct or indirect suggestions produce better therapeutic outcomes. The research on this question is remarkably consistent: they don’t differ meaningfully.

A 1993 review of the best-controlled studies comparing direct and indirect suggestions found “no superiority of indirect over direct suggestions” — the two styles produced equivalent results when proper experimental controls were in place (Lynn et al., 1993). This finding has held up over three decades of subsequent research.

A comprehensive 2017 review reached the same conclusion from a broader angle, examining diverse hypnotic induction methods — not just suggestion styles but entire induction procedures. The authors found “few if any differences in responding across diverse hypnotic inductions,” concluding that the specific technique matters less than the therapeutic context, the practitioner-client relationship, and the client’s own characteristics (Lynn et al., 2017).

The most comprehensive evidence comes from a 2024 umbrella review covering 49 meta-analyses and 261 primary studies. The review found consistent therapeutic effects for hypnosis across conditions, with no significant differences between authoritarian (Elman-style) and permissive (Ericksonian) induction approaches (Rosendahl et al., 2024).

A separate review of what inductions accomplish at a neurophysiological level adds an important nuance: the primary function of any induction — whether Elman’s rapid procedure or Erickson’s conversational approach — is to establish a context for suggestion responsiveness. The method of getting there is less important than the fact that the context is established (Woody & Sadler, 2016).

When Elman’s approach works best

The Elman induction’s strengths are speed, structure, and verifiability. These make it particularly well-suited to specific clinical contexts.

In dentistry and medical procedures, time is limited and outcomes need to be measurable. A 2022 randomized controlled trial tested the Elman induction during wisdom tooth extraction and confirmed its clinical utility, while also finding that patient expectations significantly moderated outcomes — participants who expected hypnosis to work benefited most ( Egli et al., 2022 ).

The structured format also makes the Elman approach easier to teach and learn. Training programs frequently use it as the introductory technique because the fixed sequence and built-in verification points provide clear markers of progress for both student and supervisor. Practitioners who need a reliable, repeatable method — particularly those who use hypnosis as an adjunct to another primary specialty (dentistry, anesthesiology, physiotherapy) — often prefer the Elman approach because it integrates efficiently into existing clinical workflows.

The Elman method also works well with participants who prefer clear structure and transparent expectations. Some people find the ambiguity of indirect approaches unsettling — they want to know exactly what will happen and when. The Elman induction’s step-by-step format with explicit testing satisfies this preference and can help build trust quickly.

When Erickson’s approach works best

Ericksonian hypnotherapy excels in situations where flexibility and psychological depth matter more than speed.

For resistant or analytical clients — people who are skeptical of hypnosis, tend to overthink instructions, or find direct approaches uncomfortable — Erickson’s indirect method sidesteps the resistance rather than confronting it. Instead of telling someone to relax, the practitioner might describe a scene where relaxation happens naturally, allowing the client to experience the shift without feeling directed. This utilization principle — working with the client’s natural tendencies rather than against them — is Erickson’s most distinctive contribution to hypnotherapy.

A 2025 RCT comparing Ericksonian hypnotherapy to CBT for subclinical anxiety and depression found no significant difference in overall outcomes between the two approaches, but Ericksonian hypnotherapy produced faster anxiety reduction at the mid-intervention point ( Çınaroğlu et al., 2025 ). A systematic review and meta-analysis of Ericksonian hypnotherapy RCTs found comparable efficacy to active treatments including CBT and motivational interviewing across conditions ( Ericksonian MA, 2026 ).

Ericksonian methods are also well-suited to complex psychotherapeutic work — trauma processing, identity exploration, chronic conditions with psychological components — where the therapeutic relationship and the client’s own meaning-making are central to change. The open-ended, metaphorical nature of the approach allows clients to arrive at insights that feel self-generated rather than prescribed.

Can you combine both methods?

In modern practice, many hypnotherapists do not identify exclusively with either approach — they draw from both as the situation requires.

A common pattern is to use the Elman induction for its speed and reliability, then transition to Ericksonian techniques for the therapeutic portion of the session. This makes practical sense: the Elman procedure efficiently establishes the hypnotic state, while Ericksonian metaphor and indirect suggestion can be more effective for addressing complex psychological material once that state is achieved.

This integrative approach is consistent with the research. If inductions function primarily as a context-setting mechanism ( Woody & Sadler, 2016 ), and if direct and indirect suggestions produce equivalent outcomes ( Lynn et al., 1993 ), then a practitioner who can fluently move between styles has a broader toolkit without sacrificing efficacy.

The distinction between “Elman practitioner” and “Ericksonian practitioner” is therefore less a clinical boundary than a training tradition. A skilled clinical hypnotherapist adapts their approach to the client’s needs, preferences, and responses — using structure when it builds confidence, indirection when it bypasses resistance, and any combination that serves the therapeutic goal.

Which approach should you choose?

The most important takeaway from the research is that the specific induction method matters less than most people assume. A 2024 umbrella review covering 261 primary studies found consistent therapeutic outcomes regardless of whether authoritarian or permissive approaches were used ( Rosendahl et al., 2024 ). What matters more is the therapeutic relationship, the quality of the suggestions, and the individual’s own responsiveness.

If you are choosing a hypnotherapist, focus on their clinical credentials, experience with your specific concern, and your comfort with their personal style — not whether they identify as “Elman” or “Ericksonian.” A practitioner who rigidly adheres to one method regardless of context may be less effective than one who adapts their approach to your needs. For guidance on verifying practitioner credentials, see is hypnotherapy safe? For details on what a typical course of treatment looks like, see how many sessions you need.

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