By
Shaun Brookhouse
This article is derived from what seems to be the age old question as to whether hypnotherapy is technique or profession.
This controversy affects the acceptance of hypnotherapy conducted by
those without a formal qualification in another discipline, be it
medicine, psychology, counselling or psychotherapy.
The hypothesis
to be investigated was whether hypnotherapy has a theoretical basis
along similar lines to counseling and psychotherapy models in that
listening skills and the therapeutic alliance are utilised, either
implicitly or explicitly.
One difficulty in arguing that hypnotherapy is a profession is the lack of common standards of training.
Another difficulty is the lack of clinical training that generally
comes with medical or psychological training. A way to augment this
might be the incorporation of counselling skills in the clinical
practice of hypnotherapy. This could be achieved in either formal
qualification or informal experience. This study looked at how much
these factors already exist, and involved investigation, using
questionnaire and interview, of three different therapy groups;
qualified counsellors/psychotherapist who use hypnosis as an adjunct,
counsellors/psychotherapists who use hypnosis as their prime therapy,
and therapists with only hypnotherapy training.
Historically,
hypnotherapy as a discipline has been hard to define as it has been
claimed to be part of the medical, psychological, and complementary
therapy fields. Parts of its practise fit in to each of these fields,
but it does not fit entirely into any one of them.
Since 1954, the
British Medical Association has recognised hypnosis as a valuable
therapeutic modality, but many noted psychologists and psychiatrists
have taken the position of hypnotherapy being solely a technique.
(Waxman, 1989). Many also took the view that only physicians,
psychologists and dentists should be allowed to practise hypnosis in any
form (Erickson & Rossi, 1980).
In recent years, however, this
view has begun to be questioned. In the United States, the Department
of Labour gave an occupational designation of hypnotherapist (Boyne
1989). In the United Kingdom, with the advent of the popularity of
complementary therapies, hypnotherapy is recognised as one of the four
discrete disciplines that have been studied to determine clinical
efficacy (Mills & Budd, 2000).
The clinical application of
hypnosis, hypnotherapy, is a directed process used in order to effect
some form of behavioural change in a client. This change is achieved by
first eliciting information from the client, and then devising a way of
reflecting it back to the client in a way that the client will both
understand and act upon (Hogan, 2000).
Vontress (1988) gives us this definition of counselling:
Counselling is a psychological interaction involving two or more
individuals. One or more of the interactants is considered able to help
the other person(s) live and function more effectively at the time of
the involvement or in the future. Specifically, the goal of counselling
is to assist the recipients directly or indirectly in adjusting to or
otherwise negotiating environments that influence their own or someone
else's psychological well-being. (Vontress 1988 pg7)
There
seems to be little difference in the definitions given by Hogan and
Vontress. The obvious difference being that hypnotherapy uses hypnosis
as a vehicle for behavioural change. If this is the case, the primary
difference between counselling and hypnotherapy is the use that is made
of trance states. That is to say that hypnosis is the vehicle for the
counselling dynamic.
The Vontress definition does not analyse how the changes take place.
Knowledge of most of the main counselling models would suggest that the
use of skills, primarily creating the core conditions, or therapeutic
alliance, and active listening, are the basis of the process of change.
If this is taken as a given, it can then be asked whether these
conditions exist in the hypnotherapeutic relationship and affect the
outcome of therapy. This raises the question of the level of
understanding of this process amongst those practising hypnotherapy.
For
this study, a thorough review of literature relating to the theoretical
basis of hypnotherapy was undertaken, but few references could be found
which either confirm or deny the hypothesis that hypnotherapists
utilise the therapeutic alliance and listening skills, or that their
awareness, or not, of therapeutic process was relevant to their work as
therapists.
Many standard works on hypnotherapy refer to the need for rapport,
but often do not define this, or give details of how it can be obtained.
Many use the term hypnosis and almost ignore the "therapy" part, and
simply list tools or scripts, without explaining the reasons why these
are considered to "work".
The first part of the study was a
self-reporting questionnaire, sent to 300 hypnotherapists, 82 of whom
responded. This quantitative data gave information as to the
qualifications of the respondents, their self-reported knowledge and use
of counselling skills and the therapeutic alliance, and their primary
mode of therapy.
Counselling skills seem to play a significant
part in the professional practise of hypnotherapy. For the majority of
those questioned, 85.4%, counselling skills play a role in their
hypnotherapeutic practice. There was divergence in the replies of those
who do not use counselling skills in their practices. In reply to the
question as to what makes their work therapeutic most stated that
hypnosis gives direct access to the unconscious mind and therefore can
facilitate change, and so counselling is not necessary in this process.
Some cite evidence of hypnosis being therapeutic back to Milton Erickson
and as his work was therapeutic so was theirs. Erickson stated that
much of hypnosis is based on the development and maintenance of rapport
(Erickson & Rossi 1980). Most counselling training emphasises the
importance of rapport and considers rapport building (or the creation of
the core conditions) to be a counselling skill. It can be therefore
assumed that though these practitioners use counselling skills, they are
either unaware of this or unwilling to acknowledge it.
Despite
being qualified in other areas, the questionnaire uncovers an
interesting finding regarding how therapists identify themselves. If we
take the 25 respondents who do not claim to have any other formal
therapeutic qualifications away from these figures, this shows that 42
who hold other qualifications identify themselves as being primarily a
hypnotherapist. This is interesting from a labeling position, as
hypnotherapy has not always enjoyed favourable publicity and with many
leading figures who claim that hypnotherapy was not a therapy but a
series of techniques, still a majority of those questioned identify
themselves as hypnotherapists. These answers were used to formulate
interview questions that were then put to a subset of the previous
respondents. This subset included a male and a female therapist from
each of the three groups: qualified counsellors/psychotherapist who use
hypnosis as an adjunct, counsellors / psychotherapists who use hypnosis
as their prime therapy, and therapists with only hypnotherapy training.
The interview comprised 12 open questions designed to elicit information
as to whether and how the therapist used counselling skills and their
depth of understanding of the therapeutic alliance. Their answers were
judged by a panel of five senior practitioners and the author, all of
whom hold advanced degrees in counselling or psychotherapy.
The
data seems to indicate that though the understanding of what hypnosis is
remains fairly consistent through the three target groups, the depth of
knowledge seems greater in the qualified counsellor/psychotherapist
categories as opposed to those who have only a training in hypnotherapy
as their qualification. Additionally, the data indicates that the
qualified counsellors/psychotherapists have a greater understanding of
therapeutic process and how and why their form of treatment is
successful compared to those with only training in hypnotherapy.
This
study also finds that counselling skills appear to be used, at least to
some extent, within the practise of hypnotherapy whether the
practitioner realises this or not and so the importance of counselling
skills within the context of therapeutic process cannot be ignored.
It would be logical to infer that if these skills are being used,
then those that understand them- i.e. those with the qualifications in
these areas, will use them more effectively. It was beyond the scope of
this study to look at the efficacy of the practice of the different
types of therapist.
This conclusion has various implications for
individual therapists and the field as a whole. Therapists engaged in
the professional practice of hypnotherapy may need to give quantitative
data information as to the qualifications of the respondents, their
self-reported knowledge and use of counselling skills and the
therapeutic alliance, and their primary mode of therapy. These answers
were used to formulate interview questions that were then put to a
subset of the previous respondents. The whole field may be affected in
that professional societies may need to consider re-evaluating
membership criteria, and these factors need to be taken into
consideration during any process of statutory or voluntary regulation.
As
discussed earlier in this paper, the reason for conducting the research
was an interest in the question whether hypnotherapy is a profession or
a technique. The results of the study would support the idea that
hypnotherapy is a profession in its own right, not just a technique, and
has a basis consistent with the basis of counselling. The findings of
this report directly contradict Waxman's assertion, that the majority
of non-medically/psychologically qualified hypnotherapists hold no
formal therapeutic qualifications (Waxman 1989). It can be inferred by
the numbers of hypnotherapists who use counselling skills, that
counselling skills are a major component to the practice of
hypnotherapy. This implies that practitioners have either engaged in
independent study or studied for formal qualifications in counselling or
psychotherapy, which again goes some way to validate the importance of
counselling skills in the practice of hypnotherapy. Additionally, as
shown in this paper, there are practitioners who though are credentialed
in other mental health fields who identify themselves as
hypnotherapists as opposed to counsellors or psychotherapists. The
implications of this may be that as far as public is concerned the title
hypnotherapist is easier to recognise than the plethora of counselling
and psychotherapy titles currently in use. Alternatively, these
practitioners may not be interested in the biases of leading
practitioners and prefer to determine their own identity.
It is hoped that these conclusions will help to form a more general consensus as to what hypnotherapy is and to lead to an eventual unification of standards in hypnotherapy. This information could be useful to the future training of hypnotherapists
as far as exploring different models of therapy and the need for
accountability in the therapeutic relationship. Those who were qualified
in either psychotherapy or counselling also seemed to have a better
theoretical understanding of therapy as a concept and how hypnotherapy
fits into the hierarchy of therapies.