For the Alliant International University course PSY 8500-53, Advanced Gay Men's Issues. Assignment, "Special Project," Summer 2019

1. SELF-HYPNOSIS
FOR GAY MEN
WITH LOW SELF-
ESTEEM
Nicholas van Bremen
Alliant International
University

2. PURPOSE
STATEMENT
The purpose of this presentation 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.
1. I describe the development of a negative self-concept
for gay men.
2. I postulate a conceptual framework of psychological
processes of gay men that provides a rational for the
implantation of a self-hypnosis intervention for gay
men.
3. I discuss self-hypnosis including a definition and
research that supports the intervention.
4. I describe how to implement self-hypnosis as a
supplemental intervention to treatment.
This presentation assumes gay men with low self-esteem have a
negative self-concept, i.e., limited self or worth and negative views
of the self. About 55% of gay men are estimated to have a
negative self-concept (Feinstein, Davila, & Yoneda, 2012), this
presentation addresses these gay men only,

3. GENDER-NONCONFORMITY
• Many gay men report feeling “different” from an early age, and report having
gender-nonconforming behavior during childhood(Landolt et al., 2004).
• Gender-nonconformity for boys is marked by an absence of masculine traits
and the presence of feminine traits.
• 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.
• Mother-son relationships have not been found to be affected by gender-
nonconformity.
• Gender-typical behaviors appear between ages two and four, a critical period
for attachment (Bowlby, 1969; Landolt et al., 2004).
• Gender-nonconforming boys are at a high risk of developing insecure
attachment due to their father-son relationship. Studies have showed that
there is a high rate of attachment avoidance in adult gay males (Landolt et al.,
2004).

4. GENDER-
NONCONFORMITY
• Gender-nonconformity also puts a strain
on peer relationships (Landolt et al., 2004).
• Interactions with peers are found to have
more impact on attachment style then
parent-child relationships (Grunebam &
Solomon, 1987).
• 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 gay men report chronic peer
victimization lasted many years, commonly
reporting the worst of it during middle
school.
Gender nonconformity, childhood rejection,
and adult attachment: a study of gay men
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.
Peer rejection also mediated the parent-child
relationship and adult attachment anxiety.

5. 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).

6. HOMOPHOBIC TEASING
• 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).

7. INTERNALIZED
HOMOPHOBIA
Internalized homophobia
has been significantly
related to (Rowen &
Malcolm, 2002).
• negative self-concepts
• lower levels of self-esteem
• negative beliefs about
physical appearance
• poor emotional stability
• symptoms of depression
• Social anxiety
• higher levels of sexual guilt
Anti-gay attitudes are widespread throughout
dominant culture 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.” (Grossman, Foss, &
D’Augelli, 2014; Meyer, 1995).

8. MINORITY STRESS
• In recognizing their 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.

9. SELF-
CONCEPT,
SELF-ESTEEM
AND GAY MEN
• The self-concept gives the brain instructions for how to interpret the
world. As the brain acquires information, it organizes the information
and makes decisions based on the self-concept. 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).

10. GAY MEN
SELF-CONCEPT
AND SELF-
ESTEEM
• The self-concept establishes expectations of the self, the
environment, and interactions with others. Expectations can be
understood as how the brain is programmed to prepare for
future experiences, as well as what is happening and experienced
moment-to-moment.
• All 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 situations and ourselves (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.”

11. SELF-
CONCEPT,
SELF-ESTEEM
AND GAY MEN
• 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.

12. HYPNOSIS, DEFINITION
• 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).

13. SELF-HYPNOSIS
• 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).

14. HYPNOSIS
FOR THE
SELF-
CONCEPT
• 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).

15. SELF-
HYPNOSIS
RESEARCH
• 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).
• 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).

16. HYPNOSIS
THE IMPORTANCE OF REPETITIONpatterned neural activity
Internalized beliefs, or programs, are the
result of patterned neural activity. Patterned
neural activity occurs from repeated
thoughts, observations, feelings, and actions,
and reactions become patterned. The more
we have a specific thought, the more likely
they are to be thought again. Patterned
neural activity develops neurological
pathways. The more beliefs are thought
about, the stronger the pathway becomes.
Our bodies are always seeking ways to
minimize energy costs. Incoming
information is processed along pathways
because this process saves more energy than
generating new pathways.
neuroplasticity
Self-hypnosis works because of
neuroplasticity. Neuroplasticity is the
ability of the brain to rewire, restructure,
and remold itself throughout the
lifespan, adapting for new information.
Repetition is necessary for the
suggestions received in the hypnotic
state in order to make them patterned.
The goal is to develop primed
neurological pathways that override
pathways of previous thoughts.

17. WINDOW OF
CONGRUENCE
Evidence shows positive affirmations can backfire, and lead people with low self-
esteem to feel worse about themselves. This occurs when the positive
affirmations are too positive. This is because the discrepancy between the self-
concept and the positive statement is too great (Fraser, 2012).
Positive affirmations can have harmful effects for the low self-esteemed person
(Fraser, 2012). In treatment, therapists who use positive statements that do not
resonate with the client can lead the client to lose faith in 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 go 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 clients and 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. This provides an opportunity for
the clinician and client to discuss what would be congruent, they can 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. 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 (Fraser, 2012).

18. CLINICAL
INTERVENTION
IMPLEMENTATION
• Clinicians do not need to be experienced hypnotists, nor do they need
training in hypnosis.
• This intervention is to supplement clinical treatment. It is not performed
during sessions and is not performed by the clinician. 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. They will need to write the
script following the instructions the therapist provides.
• 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. They will listen to their own guided self-
hypnosis recording, and follow its instructions.
• 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).
• Clients can play the recording at night while they sleep in addition to their
daily practice, there is less proof of efficacy with playing the recording while
sleeping.
• After they have practiced, clients will be able to easily enter the hypnotic state
and guide themselves without the recording (Amen, 2005).

19. CLINICAL
INTERVENTION
PROCEDURE
Training involves three stages:
1. Education
2. Demonstration
3. practice of self-directed skills.
• An initial training can be done during a session. In this session therapists can
provide clients with information on self-hypnosis and review how they will
prepare for it. Therapists can model what the guided self-hypnosis recording
will sound like, or they can have an example for the client to listen to.
• Therapists can ask the client to write a script for their self-hypnosis recording
for homework and to bring it to session the following week
• The next session, therapists 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.
• From this point forward, therapists can check in weekly about how their
practice is going, if they are consistent, and track any improvements the client
reports.

20. CLINICAL
INTERVENTION
CLINICIAN’S
TASKS
• Clinicians do not need to be experienced hypnotists, nor do they need training in
hypnosis.
• Suggest this as a supplemental intervention in addition to treatment, mostly
completed on the client’s own.
• Provide a rationale for the client, possibly information about the research and
populations that this treatment has shown to be effective with, and why they think it
will be useful for them.
• Use the three stages to guide training their client.
• Go over the four stages of self-hypnosis with the client, and how to do them.
• Provide a generic script the client can use as a guide to write their own script.
• Offer to help the client write the script and also help with the recording.
• Provide 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.
• Track the client’s diligence practicing the procedure. 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.
• 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.

21. CONCERNS
CONSIDERATIONS
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.

22. GUIDED SELF-HYPNOSIS STEPS
Step 1: Entering the hypnotic
Clients will enter by counting
slowly from 1 to 20, sending waves
of relaxation throughout the body,
and going to the client’s safe
place.
Following auto-suggestion, client’s
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.
The hypnotic state is very sensitive
and vulnerable to incoming
information. It is best to be openly
available only in safe, secure
environments, alone in a private
room is preferred.
Step 2: Positive
The goal of the second step is
to replace negative self-talk
with positive and
encouraging statements.
This step is most critical for
the success of the
intervention and for the client
to build a healthy self-esteem.
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.
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
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. Mental
imagery, or visualizations, are a form of
imagination.
Clients 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
Step 4: Dehypnotizing
It is important that whenever
possible, clients dehypnotize
themselves slowly because they are
coming out of a sensitive relaxed
state. 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.
Clients should know that no matter
how deep of hypnotized state they
enter, they will always be able to

23. QUESTIONS
What are the reasons self-hypnosis has been suggested for
use with gay men, do you think this will be effective, why or
why not?
Would you be willing to try this with a client? If yes, how do
you think you would go about doing so, what might you
do to adapt it for your clinical style? If not, what about this
does not work for you, what would you do differently?
What other interventions do you think would be effective
treatments for gay men’s self-concept and self-esteem?
Was there anything useful in this presentation, what is your
take away?

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