Self-hypnosis as a Clinical Intervention for Gay Men with Low Self-Esteem

Running head: SELF-HYPNOSIS FOR GAY MEN’S SELF-ESTEEM 11
Self-hypnosis as a Clinical Intervention for Gay Men with Low Self- Esteem
Nicholas van Bremen
Alliant International University

SELF-HYPNOSIS FOR GAY MEN’S SELF-ESTEEM 2
Self-hypnosis as a Clinical Intervention for Gay Men with Low Self- Esteem
Gay men are at serious risk for psychological disorders, intimate partner violence,
substance use, physical health conditions, poor interpersonal relationships, and decreased life
satisfaction (Gold et al., 2011; Miehls, 2015; Pachankis, 2015; Pachankis et al., 2015). These
stressors have been associated with low self-esteem (Meyer, 1995, 2003). Low self-esteem and
negative life events are often the result of a negative self-concept. Approximately 55% of gay
men are estimated to have a negative self-concept (Feinstein, Davila, & Yoneda, 2012). Self-
hypnosis is a mind-body exercise that has been found to develop a more positive self-concept
and increase self-esteem (Eason & Parris, 2018; Vos & Louw, 2009).
The purpose of this paper is to provide a rational for the use of self-hypnosis as a
supplemental intervention to clinical treatment for gay men with low self-esteem. First, I
describe the development of a negative self-concept for gay men. Second, I postulate the
psychological processes of gay men resulting in low self-esteem, providing a rational for the
implantation of a self-hypnosis intervention for gay men. Third, I discuss self-hypnosis
including a definition and research that supports the intervention. Last, I describe how to
implement self-hypnosis as a supplemental intervention to treatment.
Gay Men
Development of a Negative Self-concept
Gender-nonconformity. Many gay men report feeling “different” from an early age.
Many gay men report gender-nonconforming behavior in their childhood (Landolt et al., 2004).
Gender-nonconformity for boys is an absence of masculine traits and the presence of feminine
traits. The quintessential example of gender nonconformity is the boy who plays with dolls.

Gender-nonconformity is associated with poor father-son relationships (Landolt et al.,
2004). Fathers are found to have difficulty accepting their son as gender-nonconforming, and
tolerating gender-nonconforming behavior (D’Augelli, Grossman, & Starks, 2006; Landolt et al.,
2004). Fathers are also found to encourage gender-conforming behavior more than mothers. On
the other hand, mother-son relationships have not been found to be affected by gender-
nonconformity.
Gender-typical behaviors appear between ages two and four (Landolt et al., 2004). This
stage of development is critical for forming secure attachment (Bowlby, 1969). Gender-
nonconforming boys are at a high risk of developing insecure attachment due to their father-son
relationship. It can be posited that fathers who provide nurturing care for their sons until they
begin to show gender-nonconforming behaviors, and then withdraw their unconditional support,
will result in avoidant attachment style for the sons in adulthood. Studies have showed that there
is a high rate of attachment avoidance in adult gay males (Cook & Calebs, 2016; Landolt et al.,
2004).
Gender-nonconformity also puts a strain on the development of peer relationships
(Landolt et al., 2004). It is well known that children tease boys who have feminine traits or
interests. Research has found that 83% of gay men experience peer victimization in their youth,
including verbal, social, physical, and sexual abuse (D’Augelli, Grossman, & Starks, 2006).
Many of these gay men report chronic peer victimization to have lasted many years, most
commonly reporting the worst of it during middle school.
Interactions with peers are found to have more impact on attachment style then parent-
child relationships (Grunebam & Solomon, 1987). Landolt et al. (2004) studied relationships
between gender-nonconformity, rejection from parents and peers, and gay men’s adult

attachment style. The results found peer rejection to be a significantly stronger mediator
between gender-nonconformity and adult attachment anxiety than either rejection by the father
(and not the mother), or rejection from both parents (Landolt et al., 2004). Peer rejection also
mediated the parent-child relationship and adult attachment anxiety (Landolt et al., 2004).
Homophobic teasing. Boys commonly use homophobic name-calling to assert
dominance over other boys, rendering gender-nonconforming boys with an image of themselves
to feel powerless and socially insignificant (Miehls, 2017). Homophobic attitudes of students are
often influenced by faculty members, administrators, and other adults on school campuses (Bae-
Dimitriadis, Wozolek, Wootton, & Demlow, 2017; Espelage, Aragon, Birkett, & Koenig, 2008).
Homonegative expressions often go unchallenged by authority figures (Bae-Dimitriadis,
Wozolek, Wootton, & Demlow, 2017; Miehls, 2017). Gay youth report their self-esteem is
most effected by microaggressions commonly used in everyday social interactions, i.e., “That’s
so gay” (Bae-Dimitriadis, Wozolek, Wootton, & Demlow, 2017).
Homophobic teasing and name calling can have detrimental effects on quality of life in
adulthood (Birkett, Newcomb, & Mustanski, 2015; Miehls, 2017). As children play and interact,
they make appraisals of each other. They begin to develop a sense of self and self-esteem
through the appraisals of their peers (Grunebaum & Solomon, 1987). Evaluations made by peers
in middle childhood have a high risk of being internalized (Brooks, 1992). Boys who are abused
by their peers, e.g., teased, name-called, assaulted, develop their sense of self based on the
negative appraisals of their peers (Espelage, Aragon, Birkett, & Koenig, 2008).
Internalized homophobia. Anti-gay attitudes are widespread throughout dominant
culture are internalized as their identity, i.e., self-concept (Feinstein, Davila, & Yoneda, 2012;
Meyer, 2003). When boys develop have same-sex sexual attractions, typically during puberty,

they apply all homophobic statements made by their peers to their self-concept; they assume, “If
they were right about my being gay, all the mean things they said to me must be true too.”
(Greene & Britton, 2012; Grossman, Foss, & D’Augelli, 2014; Meyer, 1995).
Internalized homophobia has been significantly related to negative self-concepts, lower
levels of self-esteem, negative beliefs about physical appearance, poor emotional stability,
symptoms of depression, social anxiety, and higher levels of sexual guilt (Burns, Kamen,
Lehman, & Beach, 2012; Rowen & Malcolm, 2002). Recognizing same-sex sexual attractions, a
stigmatized identity emerges causing psychological distress (Meyer, 1995, 2003). Highly
stigmatized individuals often become hypervigilant, fearing constant threat to their safety
(Meyer, 1995).
The minority stress model has been used to examine the biopsychosocial effects of being
gay in a homophobic society. Minority stress suggests gay men’s experience of internalized
homophobia, perceived stigma, hypervigilance, prejudice, and discrimination has deleterious
effects on psychological and physical health of gay men (Meyer, 1995, 2003; Pachankis et al.,
2015). Minority stress has been associated with psychological disorders, intimate partner
violence, substance use, and low self-esteem. Minority stress has also been used to explain
syndemic effects on the prevalence of HIV and other health conditions commonly experienced
by gay men (Pachankis, 2015; Rendina, 2019).
Self-concept, Self-esteem, and Gay Men
Psychological Programing
The self-concept gives the brain instructions for how to interpret the world (Miller,
2013). As the brain acquires information, it organizes the information and makes decisions
based on the self-concept (Miller, 2013). In other words, the self-concept is how the brain is

programmed to understand the self, others, and their social position in their environment. The
self-concept of many gay men has been programed to view themselves based on the homophobic
teasing, name-calling, and rejection by their peers (Brown & Trevethan, 2010; Feinstein, Davila,
& Yoneda, 2012).
Many gay men have high levels of social anxiety (Burns, Kamen, Lehman, & Beach,
2012). They perceive others as a potential threat to their safety as many of their peers were "seen
as threats" during their childhood. Social situations are anxiety provoking because they fear
victimization at any given moment. Gay men may portray themselves publicly as confident, but
internally believe themselves to be worthless, unlovable, and deserving to be hurt (Downs,
2005). These internal beliefs often lead to intense feelings of shame, guilt, fear, anxiety, and
anger (Amen, 2013; Downs, 2005). Affective states influence an individual’s self-esteem
(Stafrace, 2004).
The self-concept establishes expectations of the self, the environment, and interactions
with others (Aronson, 2012). Expectations can be understood as how the brain is programmed to
prepare for future experiences, as well as what is happening and experienced with each arising
moment. Expectations can be non-conscious and conscious. Conscious thoughts are formulated
as narratives. Narratives use language to make sense of new experiences, remember old
experiences, and evaluate the self from moment-to-moment, i.e., self-esteem. Narratives include
self-talk, the constant ruminating thoughts about ourselves in various situations (Jemmer, 2009).
How we talk to ourselves about ourselves is incredibly important to the languaged
formation of our self-concept and self-esteem. Cognitive-behavioral theory has identified some
of the destructive ways people think about themselves, i.e., cognitive-distortions (Burns, 1989;
Jemmer, 2009). Gay men are vulnerable to cognitive distortions because of ongoing negative

attitudes toward sexual minorities in dominant culture (Feinstein, Davila, & Yoneda, 2012).
Jemmer (2009) poignantly stated, “If you are constantly sending yourself false negative
messages about yourself, then you will continue to perpetuate a negative outlook on reality while
believing your own erroneous thoughts.”
Once we have internalized a belief, if becomes programed (Aronson, 2012). Our brains
operate in ways to prove the beliefs the individual has about their self are true, self-fulfilling
prophecies (Amen, 2005; Aronson, 2012). The longer these beliefs continue, the more
experiences of self-fulfilling prophecies occur, providing evidence that the beliefs are true, and
the deeper these beliefs about the self become internalized. The reality is that beliefs about the
self are merely thoughts, and thoughts can be changed (Amen, 2005). If the gay man can
recognize that his self-beliefs are thoughts, his old thoughts can be replaced with new thoughts
that become positive beliefs about the self. The human mind gives the individual the power to
look at the beliefs, feelings, thoughts, and behaviors that run the individual’s life, and decides
what it wants to keep and what it wants to change. Hypnosis is a powerful tool that can assist in
changing the programing that runs our lives.
Self-hypnosis
Hypnosis can be defined as an open state of consciousness that involves focused attention
on internal experiences within the body and mind and an enhanced capacity for response to
suggestion (Elkins, Barabasz, Council, & Spiegel, 2015). The hypnotic state is an altered state of
consciousness, focused attention, and imaginative involvement, and deep relaxation, where
relevant suggestions can influence perception, memory, or mood improvement (Cieslak et al.,
2016; Elkins, 2014). In the state of deep relaxation, the subconscious is open to suggestions of
positive self-beliefs (Cieslak et al., 2016). To become more aware of experiencing what is

suggested and imagined, the hypnotic state may induce dissociation to detach from external
stimuli (Cieslak et al., 2016).
Self-hypnosis defined as self-induction into the hypnotic process produced by self-
generated suggestions (Eason & Parris, 2018). Eason and Parris (2018) conducted a meta-
analysis on the efficacy of self-hypnosis. Studies included in the meta-analysis were all
randomized controlled trials. Most studies included in the meta-analysis had a procedure
involving a three-stage training process: education, demonstration, and practice of self-directed
skills. The results found two sessions of self-hypnosis training may be as effective as eight
sessions of heterohypnosis treatment. In their discussion, they reported on results from other
studies not included in the meta-analysis, suggesting that self-hypnosis can be successful for
populations that heterohypnosis has not been effective (Eason & Parris, 2018).
Self-hypnosis has been shown to increase an individual’s self-esteem (Cieslak et al.,
2016; Eason & Parris, 2018; Vos & Louw, 2009). Because individuals can use self-hypnosis in a
variety of circumstances and situations, it has the benefit of enhancing their sense of autonomy
(Cieslak et al., 2016). Self-hypnosis has also been found to have additional benefits, including
validation of coping abilities and enhanced self-efficacy (Eason & Parris, 2018).
A study with HIV-positive men indicated self-hypnosis showed statistical significance on
the reduction of stress, with implications toward maintaining good health (Taylor, 1995).
Numerous studies have also shown self-hypnosis to improve the self-concept for individuals
experiencing symptoms of depression (Aldahadha, 2018; Dobbin, Maxwell, & Elton, 2009).
Participants of a study on women with low levels of body-image, self-esteem, and sexual self-
image reported they felt better about their bodies and began feeling relaxed during sexual
activity, the majority were able to enjoy their sexual encounters (Cieslak et al., 2016).

Hypnosis is a powerful tool for improving an individual’s self-concept and self-esteem
(Amen, 2013). Hypnosis is used by many sport psychologists for motivation, reduction of
anxiety and relaxation, and to improve the athlete's self-concept (Savoy & Beitel, 1997; Wang et
al., 2003). Hypnosis improves self-blame, negative thoughts and self-esteem with individuals
who had a negative self-concept (Feist, 1989). A cognitive experiential approach to hypnosis has
been shown to enhance self-image and decrease anxiety for individuals with anxiety disorders
(Boutin, 1990; Grant, 1983; Kroener-Herwig & Denecke, 2002; Sapp, 1992, 1996; Stanton,
1988). Research has also shown hypnosis to have significant positive results on the academic
self-concept of students with lower academic performance (Cooper 1990; Kass and Fish 1991;
Ritzman 1994).
Clinical Application
Intervention
This intervention is to supplement clinical treatment. It is not performed during sessions
and is not performed by the clinician. Clinicians do not need to be experienced hypnotists, nor
do they need training in hypnosis. It is left up to the client to implement a practice of self-
hypnosis as many times per week as they can, seven days a week is preferred for maximum
results.
This self-hypnosis intervention requires clients to make their own guided self-hypnosis
recording, about 15 to 30 minutes long. Following the instructions the therapist provides, they
will write their own script to make it personal to their needs. It is important for clients to make
their own recording. Studies have shown guided self-hypnosis using the individual’s own voice
have better results (Amen, 2005; Cieslak et al., 2016).

To perform their regular self-hypnosis practice, they will need to sit or lie down in a
quiet, safe and secure location, preferably a private room, for approximately 20 to 45 minutes.
When they are ready to begin, they will listen to their own guided self-hypnosis recording and
follow its instructions. The client needs to know that the hypnotic state is very sensitive, open
and vulnerable to incoming information. When letting one’s guard down and making them self
openly available to suggestions, they need to be in a safe and protected environment.
To increase the effects, clients can play the recording at night while they sleep in
addition to their daily practice. It is not advised that they only listen to the recording when they
are sleeping, there is less proof of efficacy with playing the recording while sleeping though
some have found it to be effective.
This practice takes repetition. The client needs to be told upfront that they will likely not
be able to achieve the hypnotic state the first few times they practice. They need to be
encouraged not to give up after a few tries. The more the client practices, the easier and faster it
will be for them to enter this state. After they have been practicing regularly, clients will be able
to easily enter the hypnotic state and guide themselves without the recording (Amen, 2005).
Training
Training involves three stages: education, demonstration, and practice of self-directed
skills. An initial training can be done in session to education the client. In this session the
therapist can provide the client with information on self-hypnosis and review how they will
prepare for it. To demonstrate, the therapist can briefly model what the guided self-hypnosis
recording will sound like, or they can provide an example for the client to listen to. For
homework, the therapist can ask the client to write the script for their self-hypnosis recording,
and to bring it to the following session.

The next session, the therapist can review the client’s script and check in about any
questions they have about recording the guided self-hypnosis, or how and when they will be
making their first few attempts to practice self-hypnosis. From this point forward, it is the
client’s responsibility to incorporate the intervention into their daily life. The therapist can check
in weekly about how their practice is going, if they are consistent with their practice, and track
any improvements the client reports.
Importance of repetition. Internalized beliefs, or programs, are the result of patterned
neural activity. Patterned neural activity occurs from repeated thoughts, observations, feelings,
and actions, and reactions. The more we have specific thoughts, observations, feelings, actions,
and reactions, the more likely they are to happen again. This process is called long-term
potentiation, these neurons are primed to be used again.
Patterned neural activity develops neurological pathways. The more beliefs are thought
about, the stronger the pathway becomes. Our brains are always seeking ways to minimize
energy costs. Incoming information is processed along pathways because this process costs less
energy than generating a new pathway.
For a gay man with habitual negative self-talk, the reoccurring negative thoughts are
fallow primed neurological pathways in part because they use less energy than new positive
thoughts. With each negative thought, they re-prime themselves for the negative thought to
happen again. This cycle perpetuates itself until some form of second order change creates a
new pathway for new beliefs.
Self-hypnosis works because of neuroplasticity. Neuroplasticity is the ability of the brain
to rewire, restructure, remold itself, and adapt to new information throughout the lifespan.
Repetition is necessary for the suggestions received in the hypnotic state to become patterned

neuronal activity. The goal is to develop primed neurological pathways that override pathways
of previous negative thoughts, and eventually to restructure the brain to be programmed for
positive beliefs about the self, empowered expectations, and successful behaviors.
Window of congruence. This practice uses positive affirmations. Evidence shows
positive affirmations can backfire, and lead people with low self-esteem to feel worse about
themselves. It occurs when the positive affirmations are too positive. This is because the
discrepancy between the self-concept and the positive statement is too great.
Positive affirmations can have harmful effects for the low self-esteemed person. In
treatment, therapists who use positive statements that do not resonate with the client can lead the
client to distrust the clinician which would render treatment ineffective. It can also lead the
client to believe all psychotherapy is ineffective, and no longer seek treatment or support which
can eventually lead to any number of detrimental outcomes.
Using the concept of the “window of tolerance,” by Dan Siegel (1999), we can use what
I’ll call the window of congruence. The window of congruence provides a gauge for how a
positive statement can be while staying congruent with the client’s self-concept. Therapists
aiming to increase the self-esteem of their clients need to use positive statements that stay within
the clients' window of congruence, once outside the window, the statement no longer holds true
for the client, and can become subjectively more harmful.
The window of congruence provides a visual guide and language for practitioners and
clients to talk about positive statements and self-concept. Once a statement is made by a
therapist, they can ask the client to assess if the statement is within their window, “Can you take
that in?” or, “Does that resonate?” or, “Do you see that about yourself?” This provides an
opportunity for the clinician and client to discuss what would be congruent. The window

metaphor can also be used to challenge old beliefs with new information and integrate the new
information to the client’s self-concept.
Research shows positive statements work best in small steps that gradually become more
positive over time (Fraser, 2012). As discussed, it is crucial that positive statements stay
congruent with the client’s self-concept, in other words, the client has to believe these self-
statements to be true. Using the window of congruence, the therapist can determine the steps
that build to developing higher self-esteem.
Tasks of the clinician. Clinicians do not need to be experienced hypnotists, nor do they
need training in hypnosis (Amen, 2005). The therapist can suggest this as a supplemental
intervention in addition to treatment, mostly completed on the client’s own. They can support
their suggestion by providing a rationale for the intervention, with information about the research
and populations that this treatment has shown to be effective with, and why they think it will be
useful for the client.
Clinicians can use the three stages as a guide to provide a simple training the client.
It would be helpful for the clinician to go over the four stages of self-hypnosis with the client,
who each one is done, and their benefits. Therapists can provide a generic script the client can
use as a guide to write their own script. They may want to offer help to the client with writing
the script and also help with the recording. It might also benefit the client if the therapist
provided an example of an audio recording that the client can hear so they know what their
recording should sound like, in terms of tone and pacing.
Once the client is ready to start, the clinician can track the client’s diligence with
implementing this into their life, where or not they have started, and how regularly they are
practicing. They can also track any improvements of the client’s self-esteem over time.

It is important to emphasize that the client perform the procedure at least once a day.
Consistency with the procedure is key. Therapists need to remind clients that change will not
happen overnight, reprogramming their brains takes some time. This is a process that takes effort
and diligence on their behalf. If they keep it up, this method has been shown to be very
effective.
Steps of Guided Self-hypnosis
The guided self-hypnosis itself has four steps: 1) entering the hypnotic state, 2) positive
affirmations, 3) visualizing success, 4) leaving the state of deep relaxation and returning to a
wakeful state of consciousness. This has been adapted from Miller’s chapter which appears in
Amen’s (2013) book on healing attention deficit disorder. Miller is world-renowned for his
expertise of hypnosis, cognitive reprogramming, meditation, and achievement (Amen, 2013).
Step 1: Entering the hypnotic state. Clients will enter the hypnotic state by counting
slowly from 1 to twenty. Next, they will be guided through several deep breaths, sending waves
of relaxation throughout the body. Then they will be asked to visualize a safe haven that they
can return to in their mind at any time during the practice. During this step, clients will learn
how to separate themselves from stressors of the environment for the duration of the practice.
They will let go of mental and physical tension and focus on the present moment and the internal
experience of inner peace, stillness, and physical relaxation.
Step 2: Positive affirmations. The goal of the second step is to replace negative self-
talk with positive and encouraging statements. In this step, negative beliefs are replaced with
positive ones, e.g., create confidence in attributes where the client feels insecure, increase self-
advocacy and empowerment where the client feels helplessness and doubt.

This step is most critical for the client to build a healthy self-esteem. It may be useful for
clinicians to work with their client to write this step to make sure the statements are within the
client’s window of congruence. To achieve the greatest results, as client’s self-concept becomes
more positive, they should make new recordings with positive statements that at the top edge of
the window of congruence. The top of their window would be what Vygotsky would refer to as
the zone of proximal development (McLeod, 2012).
Step 3: Visualizing success. The outcome of this stage is to develop the belief deep
within that success is possible. Imagination is one of the most powerful tools for learning
(Miller, 2013). Mental imagery, or visualizations, are a form of imagination that the client will
be using in this stage.
The client will be asked to visualize a challenging situation that might occur in the future.
For gay men, a useful situation might be rejection, either from a romantic interest or employer.
It is helpful for the situation to be similar to one that has happened in the past, when they reacted
inappropriately.
In the client’s imagined situation in the future, they imagine themselves as if they are
actually there. They visualize the behavior they would use if they truly believed the positive
affirmations from step two were true. They visualize their response as having the most
successful behavior they can imagine. This step serves as a post-hypnotic suggestion deep in
their mind (Miller, 2013).
Step 4: Dehypnotizing. To return to a normal wakeful state, the client slowly counts
backwards from twenty to one. It is important that whenever possible, clients dehypnotize
themselves slowly because they are coming out of a sensitive relaxed state (Miller, 2013). In the

hypnotic state, the client’s guard has been dropped. It is best to return to a normal waking state
gradually in order to put the proper protectors back on and function smoothly.
If they have returned too quickly, they may feel groggy or anxious. This is because they
have not finished turning their protectors back on. If this happens, they can sit or lie down and
slowly go through the dehypnotization process again. The client should know that no matter
how deep of hypnotized state they enter, they will always be able to come out of this state
quickly, faster than if they were sleeping, should an emergency or urgent situation arise while
they are in their self-hypnotic practice.
Concerns, considerations, and contraindications
The biggest concern is for clients to schedule to do it. Many have difficulty finding 15 to
30 minutes a day to set aside for themselves, particularly people with low self-esteem because:
one, they do not feel they are worth taking the time to do something good for themselves; two,
they do not feel they are worth improving; three, they will put their needs aside for someone else;
four, they are as bad as they believe themselves to be and that is permanent and not possible to
change.
Clinicians need to make sure that positive statements in their self-hypnosis audio-
recording stay within the window of congruence to ensure the least risk of harm. To achieve
greatest improvements, as client’s self-concept improves, they should make new recordings to
push the boundary of their most current self-concept and window of congruence.
As with any internal process, e.g., mindfulness, meditation, trauma survivors may be
triggered by processes that heighten awareness to internal sensations (Treleaven, 2018). Gay
men are living in a context of oppression and systemic trauma, historical trauma, and often
endure symptoms of insidious trauma. These symptoms may become activated when they

practice self-hypnosis. Common reactions may be dissociation, restricted breathing, images of
traumatic memories, and undesired somatic sensations. This needs to be discussed with gay
clients before they begin. Clinicians may seek consultation from trauma experts to support their
clients who experience and negative reactions. Research shows that mind-body exercises such as
self-hypnosis are beneficial to trauma survivors and do not need to be avoided, but engaging
clients in what to be aware of before they practice will help them make informed choices should
any negative reactions occur (Treleaven, 2018).
Conclusion
Gay men frequently suffer from negative self-concept and low self-esteem as a result of
childhood rejection and homophobic teasing. Internalized homophobia persists in the context of
a society with prevalent homonegative attitudes. Minority stressors affect their physical and
psychological health. Improving the self-concept of gay men experiencing the effects of
minority stress can have profound positive results on the satisfaction of their lives. Self-hypnosis
is an intervention that research suggests can improve their self-concept and self-esteem, and well
as have many other benefits, such as relaxation, reduction of stress, pain reduction, increased
sense of autonomy, motivation, interpersonal skills, self-confidence, and more.
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