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Training, Supervision and Accreditation Standards

Introduction

The first efforts for establishing CBTHYPNOPSY’s training standards started in 2019. Various proposals and drafts were created and formed a good foundation for CBH-P Training across Europe and US.. However, it was only after the official format of the CBH-P’ therapeutic protocol was shaped up and the investigation of its therapeutic efficacy (in 2016) that allowed us to establish CBTHYPNOPSY. The school of Cognitive Behavior Therapy, together with schools of hypno-psychotherapy and hypnosis that also incorporate the psychological and psychotherapeutic element in their approach, continue to develop and elaborate IACBT’s training standards, making IACBT the leading Association on CBH-P training.

  1. Entry requirements

The regulations governing who can practice and/or be legally recognized as a hypnotherapist vary between European or International countries. In most countries the range of professional who can practice hypnotherapy, and be accredited as hypnotherapists is very broad and not particularly related to mental health services or any other psychological service.

All accredited therapists though recognized by national associations will be registered with a professional regulatory body.

However, given the fact that CBTHYPNOPSY’s main concern is to incorporate the element of psychology and psychotherapy in hypnotherapeutic practice and regulate a systematic, evidence-based approach, CBTHYPNOPSY restricts entry to specific professional groups such as: psychologists, psychiatrists, psychology counselors or any other profession related to the mental health field.

– Therapists being considered for accreditation will have sufficient experience in working in a therapeutic role with clients.

– Therapists will be using CBH-P in a systematic way as their main, or one of their main therapeutic models.

II. Length of training

  • The period of training will include basic professional and specialist training that prepares a person for work in CBH-P.
  • The competencies to become an effective Cognitive Behavioral Hypno-Psychotherapist are usually developed in two stages. Firstly, there are those competencies in generic therapeutic skills and the understanding of psychopathology that form part of a clinicians core professional training. Secondly, there is the development of knowledge about the CBT and the hypnotherapy models and specific competencies in psychotherapeutic skills that are usually developed as part of a professional qualification period of training that meets the CBTHYPNOPSY’s MinimumTraining Standards.
  • The minimum period of training recognized by CBTHYPNOPSY as sufficient to develop the Minimum Training Standards will not normally be less than 4 academic years, for both therapeutic modalities (i.e. CBT and hypnotherapy)

This is a minimum standard and does not preclude a national association requiring a longer period of time to attain the training standards recognized by its own requirements.

III. Theoretical and skills training & competences

  • The period of training (core professional training and specific post-qualification training) will include the acquisition of a critical understanding of the relevance of studies of human development, neurobiology of emotion, neuropsychology, psychopathology, social issues and evidence-based practice.
  • Specialist training may be in particular CBT model and any other model of hypnotherapy (e.g. Cognitive Behavior Hypnotherapy, Hypnoanalysis, Private Subconcious Mind Healing, Ego States Therapy, Guided Affective Imagery etc). However, all therapists will have covered a curriculum that will provide a broad-based understanding of the theoretical basis of cognitive behavioral hypnosis and its application across a range of problems.
  • Theoretical knowledge and skills will have been acquired through structured teaching and self-directed study.
  • The minimum number of hours study required for the CBTHYPNOPSY element of training is 450 hours of intensive theoretical and practical face to face training of which 200 should be provided directly by an accredited CBH-P trainer on a recognized course or an agreed program of study within the member association or country.
  • Skills training is an essential component of the acquisition of knowledge and experience and will predominantly be developed through supervised clinical practice, skills-based workshops, observation and clinical practice.

Skills training should be a significant part of a therapist’s total training program.

III.e

Therapists should achieve the skills to be able to understand and interpret research relevant to the outcome and effectiveness of hypnotherapy.

III.f

Acquired competences necessary to practice PHT will include:

III.f1

Ability to assess, understand and formulate a client’s problem(s) according to hypnotherapy model(s):

  • To demonstrate effective interviewing and listening skills using appropriate verbal and non-verbal communication.
  • To make use of appropriate assessment methods (questionnaires, rating scales, observational techniques) and understand their validity and reliability.
  • To understand the problem(s) presented in relation to hypnotherapy formulations.
  • To summarize, compare and contrast the psychological theoretical frameworks with different models of hypnotherapy to ensure that the appropriate model of intervention is applied.

III.f2

Ability to apply an appropriate range of PHT interventions:

  • To demonstrate a broad knowledge and skills in implementing a range of PHT interventions that is effective and evidence-based.
  • To be informed by and draw upon relevant information from the fields of psychology and other disciplines that have contributed to the knowledge base of PHT.
  • To have sufficient knowledge on normal and abnormal behaviour (e.g.,psychopathology), developmental and social contexts which are relevant to the area in which the practitioner works.
  • To work in a collaborative way with clients explaining at all points during therapy the relevance of the interventions used and seeking consent.
  • To make use of appropriate evaluation methods (questionnaires, interviews, observational techniques) to assess the impact of the interventions undertaken.

III.f3

To build, maintain and conclude a therapeutic working relationship

  • To set and maintain appropriate professional boundaries
  • To be able to effectively assess the risk of harm to patient, therapist or others
  • To be aware of and consider ethical and legal principles as applied to therapeutic relationships
  • To have an understanding of the impact that their own personal characteristics can have on their work, and to have the willingness and ability to change, making appropriate use of supervision and feedback

III.g

Possible methods to assess therapists’ competences include:

  • Direct observation of therapy sessions by a supervisor
  • Video recording of sessions
  • Audio recording of sessions
  • Rating scales on relevant competences
  • Discussion during supervision
  • Written and oral presentation of case reports
  • Peer review
  • Self-assessment
  • Training log-books
  • Papers accepted by scientific journals
  • Feedback from clients
  • Examination

III.h

Possible learning methods to acquire therapists’ competences include:

  • Theoretical lessons
  • Reading
  • E-learning
  • Supervised clinical practice
  • Peer group supervision
  • Supervision sessions
  • Observation and modelling
  • Discussion with other professionals
  • Attendance and presentations at conferences
  • Participation in skills training workshops
  • Research
  • Evidence-based reviews
  • Case presentations

III.i

Additional competences will be needed for practitioners undertaking supervision, training of other therapists and research.

Supervised clinical practice

  • Therapists will have conducted 200 hours of supervised assessment and therapy during training.
  • All therapists will have received supervision during the period of training for both assessment and therapy, carried out by a competent psychological CB hypno-psychotherapist.
  • Supervision will consist of regular feedback and discussion. Close supervision should be used as part of this process and might involve the use of live, audio or video materials.
  • A minimum of 8 clients will be treated during the period of training from assessment to completion or termination of treatment before a therapist is regarded as having completed their training. These cases will cover at least 3 types of problems and 3 cases will have been closely supervised as defined above.
  • Details of supervised clinical practice and case mix will be recorded in a training record.

Personal therapy

  • At least 20 hours of personal therapy or evidence of completed therapy is required.
  • All therapists must ensure that they can identify and manage appropriately their personal involvement in the process of PHT.

VI. Accreditation of Psychological Hypnotherapists

VI.a

Therapists who fulfill the Minimum Training Standards, maintain an agreed level of continuing professional development in hypnotherapy, receive regular clinical supervision.

VI.b

Therapists should demonstrate that they have reached a higher level of competence and expertise that enables them to provide supervision or training to others or be recognized as an advanced or senior practitioner in the area of hypnotherapy.

VI.c

Supervisors, advanced and senior practitioners will normally have 5 years of therapeutic practice  after meeting the minimum training standards and have received further training to equip them as trainers/supervisors.

VII. Assessing core training standards

VII.a

Therapists are expected to demonstrate an understanding of the theoretical aspects of PHT (e.g. Biothymics, Clinical Affectology, CBT hypnosis etc) and its application by the production of either a formal assessment essay, exam, or a relevant research dissertation or a research paper written as first author

VII.b

Supervised practice will be subjected to formal assessment with at least two case studies written up (2000-4000 words).

Supervision

Supervisors and senior practitioners will normally have 5 years of therapeutic practice after meeting the minimum training standards and have received further training to equip them as trainers/supervisors.

Recommended training

All PHT supervisors will have received basic training in PHT as specified in the HAPHT standards for the training and accreditation of PHT. The following form a number of recommendations for the training of PHT supervisors:

A.1

Specialized Supervision Training by University Courses or accredited training programs comprising the following components (see also below):

  • Supervision Theory
  • Personal Supervision
  • Continuing Professional Development (CPD) in hypnotherapy

A2.

Supervising at least two PHT treatments of two different PHT therapists under supervision of experienced PHT supervisor

A.3

Personal Supervision

A.4

 All accredited PHT supervisors must be recognized by General Hypnotherapy Register as advanced or senior practitioners

A.5

PHT supervisors will be using PHT therapy in a systematic way as their main or one of their main therapeutic models.

A.6

PHT supervisors will have appropriate training in PHT supervision

A.7

Acquired competences necessary to practice PHT supervision will include:

  • Contracting (e.g. between participants and institution, supervisor and supervisee, supervisee and client)
  • Goal setting (relevant questions in supervision)
  • Educating (supervision models)
  • Structure
  • Feedback between supervisor and supervisee, supervisee and client.
  • Evaluating PHT skills
  • Identification of core difficulties
  • Ability to indentify unconscious mechanisms that block therapy
  • Case formulation
  • Interview techniques
  • Using different models of PHT according to client’s needs
  • Appropriate goal setting
  • Unconscious communication skills
  • Ability to use language in an effective hypnotherapeutic way for the client’s benefit

Possible methods to assess supervisor’s competences include:

  • Direct observation of supervision sessions by a supervisor
  • Video recording of supervision sessions
  • Audio recording of supervision sessions
  • Rating scales on relevant competences
  • Discussion during supervision
  • Written and oral presentation of supervision reports
  • Peer review
  • Self-assessment
  • Supervision books
  • Papers accepted by scientific journals
  • Mutual feedback, between supervisor and supervisee

Possible learning methods to acquire supervisor’s competences include:

  • Theoretical lessons
  • Reading
  • E-learning
  • Supervised supervision practice
  • Peer-group supervision
  • Supervision sessions with a supervisor
  • Observation and modeling
  • Role play
  • Discussion with other professionals
  • Attendance and presentations at conferences
  • Participation in skills-training workshops
  • Research
  • Evidence-based reviews
  • Case presentations
  • Review of appraisals
  • Self–reflection
  • Mutual feedback

Code of ethics

The contents of this code are based upon a number of sources, including the codes and guidance of the Working Group for Hypnotherapy Regulation, UKCHO, NCH, BACP, BABCP, and UKCP, among others.

Score of this code

This Code encompasses the practice of hypnotherapy and psychotherapy, or similar practices conducted under a different name. All such practices are subsequently referred to generically under the heading of ‘Therapy’ and cognate terms such as ‘Therapist’ are employed in the same sense.

The Register for Evidence-Based Hypnotherapy & Psychotherapy™ is subsequently referred to below as ‘the Register.’

This Code governs the relationships between Therapist and clients; Therapist and other healthcare professionals; Therapist and their respective professional bodies.

The Code employs masculine pronouns in a gender-neutral sense, to designate both males and females.

All members of the Register are required to abide by the Code, without exception. The Governing Committee of the Register have the right to investigate and sanction members who fail to do so, including removing them from the Register.

1. Evidence-based practice

All Therapists undertake to:

  1. Adhere to the Code of Practice of the Register, including the requirements relating to evidence-based practice, consistent with their grade of registration.
  2.  Avoid any use of techniques or practices deemed inappropriate by the Committee, specifically,

2.1.  Past-life regression.

2.2.  Stage hypnosis for entertainment purposes.

2.3.  Exorcism or spirit release.

2. Professional conduct

All Therapists undertake to:

  1. Conduct themselves at all times in accord with their professional status and in such a way as neither undermines public confidence in the process or profession of hypnotherapy or psychotherapy nor brings the Register into disrepute.
  2. Therapists have an active duty to protect the public and the profession from unethical, unsafe or bad practice or behaviour. When offering criticisms or complaints about colleagues, Therapists should utilise appropriate channels such as the complaints procedures of relevant professional bodies, or, where appropriate, Trading Standards or other relevant bodies. Therapists offering criticisms outside of these channels have the duty to demonstrate that it is reasonable to do so. Therapists must use due care and diligence when offering criticisms and complaints to ensure that they are justified and can be substantiated.
  3. Respect the status of all other medical/healthcare professionals and the boundaries of their professional remit.
  4. Provide Therapy to clients solely within their sphere of competence, i.e., in those areas in which they are competent to do so and for which they carry relevant professional indemnity insurance.

“Competence” means adequate training, skills and experience but need not exclude treating a client for a condition which the Therapist has not treated before, provided that due diligence and professionalism is observed.

  1. Act in a non-biased, non-prejudicial manner towards all clients, providing those clients with an identical quality of service and treatment irrespective of the many differences which are to be found between clients, including but not restricted to: race, gender, sexual orientation, disability, etc.
  2. Disclose full details of all relevant memberships, training, experience, qualifications and appropriate avenues of complaint to clients, or other relevant professionals or organisations, upon request and only use those qualifications and memberships to which they have proof of entitlement, and to do so in a non-misleading manner. A client wishing to make a complaint must be advised to contact the Register accordingly, any such complaint will be dealt with according to the Register’s published complaints procedure.
  3. Explain fully to clients in advance of any treatment: the fee levels, precise terms of payment and any charges which might be imposed for non-attendance or cancelled appointments, and wherever relevant, confidentiality issues. This includes the limits of confidentiality and circumstances under which confidentiality may be broken.

“In advance of any treatment” means that not only should terms and conditions be set out in advance, but that they should be further clarified by the Therapist at the initial consultation when additional information about the client’s needs is obtained. If for therapeutic reasons, the Therapist wishes to modify treatment (e.g. to extend the treatment plan) then any effect this has on terms, conditions and pricing must be clearly explained to the client.

  1. Present all services and products in an unambiguous manner (to include any limitations and realistic outcomes of treatment) and ensure that the client retains complete control over the decision to purchase such services or products. N.B. guarantees of either a cure or a successful resolution of the problem/s presented shall not be offered. This does not affect the right of the Therapist to offer a guarantee, explicit or implicit, of the quality and professionalism of his service.

3. Welfare of clients

All Therapists shall undertake to:

  1. Work in ways that will promote client autonomy and well being and that maintain respect and dignity for the client
  2. Remain aware of their own limitations and wherever appropriate, be prepared to refer a client to another Therapist (regardless of discipline) who might be expected to offer suitable treatment.

N.B. The Therapist should give full consideration to the efficacy of treatment, including the manner in which their rapport with the client may affect such efficacy.  The Therapist has the right to refuse or terminate any treatment if it is a reasonable belief that it will not be, or continue to be, efficacious.  In refusing or terminating treatment due care must be given to fully explaining the rationale for refusal or termination to the client.

  1. Ensure that wherever a client is seeking assistance for the relief of symptoms of medical or psychiatric conditions, excluding those within the sphere of competence of the Therapist to treat, that unless they have already done so, the client is advised to contact a registered medical practitioner. N.B. Therapists should not attempt to offer clients a formal diagnosis of general medical or psychiatric conditions unless they have undergone relevant training in diagnostics and are suitably qualified to do so.
  2. Confirm that they will never knowingly offer advice to a client which either conflicts with or is contrary to that given by the client’s registered medical advisor/s. N.B. If the Therapist has doubts or concerns with regards to a client’s prescribed medication, they may always, with their client’s permission, contact the medical advisor personally or advise the client themselves to request a formal review of their medication from the medical advisor.
  3. Use due care and diligence to avoid the implantation or encouragement of any false memories in the client. Where memory recovery through regression, or similar techniques, is employed, to ensure at the earliest possible stage that the client is aware that experiences while in a suggestible state, or in a state of altered attention, are not necessarily accurate representations of the client’s past. To base their theory and practice with regard to recovered memories on current, credible, and mainstream scientific research on the psychology of memory.
  4. Ensure that their workplace and all facilities offered to both clients and their companions will be in every respect suitable and appropriate for the service provided. These shall include any consulting room used for the purpose of consultation and/or conducting therapy with any client, along with any reception or waiting areas associated with such rooms.
  5. Take all reasonable care to ensure the safety of the client and any person who may be accompanying them . To abide by Health & Safety law in the assessment and management of risks attached to their practices or place of work, in relation both to physical and also stress-related risks.
  6. Refrain from using their position of trust or confidence to:
  7. a) Violate the commonly understood professional boundaries appropriate to the Therapist/client relationship or exploit the client emotionally, sexually, financially, or in any other way whatsoever. Should either a sexual relationship, or a financial relationship other than for the payment of relevant products or services, or other inappropriate relationship develop between either Therapist and client or members of their respective immediate families, the Therapist must immediately cease to accept fees, terminate treatment (consistent with the rest of this Code) and refer the client to another suitable Therapist at the very earliest opportunity. N.B. Clarification on dilemmas experienced by Therapists in respect of the foregoing should be sought from their respective professional body.
  8. b) Touch the client in any way that may be open to misinterpretation. N.B. Before employing any techniques involving touch, both an explanation should be given and explicit permission received from the client.
  9. Not accept any inappropriate gifts, gratuities or favours from a client.
  10. Never protract treatment unnecessarily and to terminate treatment at the earliest moment consistent with the good care and well-being of the client.
  11. Maintain strict confidentiality within the client/Therapist relationship, always provided that such confidentiality is neither inconsistent with the Therapist’s own safety or that of the client, the client’s family members or other members of the public nor in contravention of any legal action (i.e. criminal, coroner or civil court cases where a court order is made demanding disclosure) or other legal requirement (e.g. Children’s Acts, Data Protection Act).

Where the Therapist is working as part of a larger team, for example within an institution or through a multidisciplinary or similar clinical approach, or where the client has been referred by a medical advisor or agency with conditions placed on the referral as to shared disclosure by the Therapist to the advisor or agency, then provided that it is clear that the client consents, confidential information may be shared by the Therapist with the team or referring advisor or agency.

  1. Ensure that client notes and records be kept secure and confidential and that the use of both manual and computer records remains within the terms of the Data Protection Act. N.B. Manual records should always be locked away when not in use and those held on computer should be password coded. The Therapist should provide, in advance, arrangements for the secure disposal of all client records in case of their permanent incapacity or death.
  2. Recognise that the maintenance of case notes should include personal details, history, diagnosis and/or identification of problem areas; programme of sessions as agreed between Therapist and client (if any), session progress notes and a copy of any contract.
  3. Obtain written permission from the client (or if appropriate the client’s parent/s or legal guardian/s) before either recording client sessions, discussing undisguised cases with any person whatsoever, or publishing cases (whether disguised or not) via any medium. N.B. “Recording” in this context means any method other than the usual taking of written case notes. “Undisguised” in this context means cases in which material has not been sufficiently altered in order to offer reasonable anonymity to all relevant parties. With particular reference to the use of CCTV equipment, all clients must be fully informed when such equipment is in operation and as above, written permission must be obtained prior to the commencement of any client session.
  4. Advise the client that disguised case studies may sometimes be utilised for the purposes of either their own Clinical Supervision or the Clinical Supervision and/or training of other Therapists, or for publication in suitable texts, and refrain from using such material should the respective client indicate that it should not be used for these purposes.

4. Clinical supervision & continuing professional development (CPD)

Therapists are expected to maintain or improve their level of skills and professional competence in accordance with the requirements laid down by the Register as appropriate to their registration grade.

  1. Clinical Supervision
  2. All practising members are required to maintain ongoing Clinical Supervision in accord with the Register’s Code of Practice.
  3. Clinical Supervision should be of a form suitable for the practice of hypnotherapy and psychotherapy, and should not consist merely in the presentation and discussion of case material, but should also contribute to professional development and improvement of the Therapist’s theoretical understanding and practical competence.
  4. Members are strongly encouraged to have a formal contract which specifies the terms, format, and scope of the Supervision arrangement, though this is not mandatory.
  5. Supervision should embrace reflective practice and continuing professional development, and may include practice and discussion of techniques, reviewing audio/visual material, discussion of theory, ethical dilemmas, and issues relating to the running of a clinical practice, as well as case material.
  6. Group Clinical Supervision is encouraged , where the Therapist and at least two other Therapists act as each other’s Clinical Supervisors, as a group. At least one member of the group should be of a suitably high level of qualification and experience and have been in full professional practice for at least two years. The Register strongly recommends that such groups are based upon a written contract or agreement which clearly specifies the roles and responsibilities of members, etc.
  7. Individual Clinical Supervision is acceptable , where one Therapist acts as Clinical Supervisor to the Therapist. The Clinical Supervisor in these circumstances must be of a suitably high level of qualification and experience, and have been in practice for at least two years. In addition, he must possess a suitable certification or qualification in the practice of supervision. The Clinical Supervisor should, where possible, be qualified in a similar mode of therapy. The Register also strongly recommends that an individual Clinical Supervisor should be a Senior Hypnotherapist or UKCP registered hypno-psychotherapist.
  8. Members in Clinical Supervision must retain appropriate records for a period of up to five years.
  9. Face-to-face Clinical Supervision is strongly recommended. However, in the case of illness, or other obstacles to meeting, other arrangements which take advantage of communication technology may be acceptable, e.g., internet, email, or telephone conferencing. It is recommended that at least 70% of the minimum number of Clinical Supervision hours should be conducted face-to-face, and ideally 100%. Where a Therapist does not have access to suitable Clinical Supervision within their geographical area, they may seek official permission from the Register to conduct Clinical Supervision primarily by communication technology, at a distance. In such cases, however, at least one face-to-face meeting per year should be arranged.

B. Continuing professional development (CPD)

  1. All grades except Associates and Students are required to engage in suitable CPD, and evidence may be audited by the Register, so appropriate records should be kept for a period of at least five years.
  2. Receipts for the purchase of suitable books, audio/visual training material, and other resources may be counted as equivalent to one credit each. Subscription to a suitable research journal may be counted as equivalent to five credits per annum. Each (seven hour) day of suitable classroom training may be counted as equivalent to five credits.
  3. CPD to the value of twenty credits per year must be undertaken by Therapists.
  4. Individual items of CPD submitted as evidence will be accepted only at the discretion of the Register and should be consistent with the evidence-based orientation of the Register. Other forms of CPD may be considered at the discretion of the Register.

5. Relationship with the register

All Therapists undertake to:

1 . Notify the Register, in writing, of any change in practice name, contact address, telephone number or email address at the earliest convenient moment.

  1. Inform the Register, in writing, of any alteration in circumstance which would affect their registration grade, status, or professional ability as Therapists .

3 . Inform the Register, in writing, of

  1. a) Any formal complaint (of which they are aware) made against them, made to them personally, or to any relevant organisation or body.
  2. b) Any disciplinary action taken against them by any professional body .
  3. c) Any criminal offence of which they have been convicted.

4 . Make available to the Register all relevant information requested as a result of investigation by any appointed Complaints and Disciplinary Officer, without hindrance (whether implied or actual) or unreasonable delay and comply fully with all requirements inherent within any Complaints and Disciplinary Procedure to which they subscribe

6. Advertising & professional qualifications

All Therapists undertake to:

1 . Ensure that all advertising, no matter in what form or medium it is placed, represents a truthful, honest and accurate picture of  themselves, their skill-base, qualifications and facilities and that any claims for the successful outcome of treatments (in whatever format) shall be based upon verifiable, fully documented evidence.

  1. Ensure that all advertising shall be accurate, truthful and that any claims made in advertising can be substantiated on request.
  2. Display only valid qualifications and certificates issued in respect of relevant training courses and events or certificates of registration, validation or accreditation as issued or awarded by relevant professional bodies.
  3. Make no claim that they hold specific qualifications unless such claim can be fully substantiated.

Notes for Guidance :

Title: "Dr"

Therapists should avoid the possibility of misleading the public by using the title “Dr” or “Doctor” in a manner which might be taken 9999333333333.

Therapists should, therefore, only use the title “Dr” if they are medically licensed in the UK or their title is both UK-issued and accredited and in a subject relevant to hypnotherapy or psychotherapy (e.g. counselling or psychology).  All Therapists using this title should explain in their advertising literature and to their clients, the nature and subject of the title and the awarding body, and non-medical “Drs” should declare that they are not medical practitioners in their advertising literature and to their clients.

Title: "Psychoanalyst"

This should only be used by suitably qualified members of the British Psychoanalytical Society (BPAS) or another member organisation of the International Psychoanalytical Association (IPA).

7. Treatment of minors, etc.

All Therapists undertake to:

1 . Obtain the written consent of an appropriate adult (i.e. parent, legal guardian or registered medical practitioner) before conducting treatment with clients who are either under the age of majority or are classified as persons with special needs, excepting where the Therapist has carried out an appropriate assessment for competency to consent to treatment, “Gillick Competency”, and is suitably qualified to do so.  N.B. Wherever possible and provided it is judged to be in the child’s best interests, it is advisable that an appropriate adult should be present during such sessions.

8. Research ethics

For all practical purposes, a “research participant” should be considered synonymous with a “client” and consequently, all relevant Clauses within the general Code of Ethics remain applicable.

Updated 31-May-08

Guidelines for evidence-based practice

CLINICAL HYPNOTHERAPY & HYPNO-PSYCHOTHERAPY

“I beg farther to remark, if my theory and pretensions, as to the nature, cause, and extent of the phenomena of [hypnotism] have none of the fascinations of the transcendental to captivate the lovers of the marvellous, the credulous and enthusiastic, which the pretensions and alleged occult agency of the mesmerists have, still I hope my views will not be the less acceptable to honest and sober-minded men, because they are all level to our comprehension, and reconcilable with well-known physiological and psychological principles.”

– James Braid, Hypnotic Therapeutics, 1853

This booklet is designed to explain the concept of evidence-based practice in relation to hypnotherapy and hypno-psychotherapy, and to provide guidelines for therapists seeking to adopt a more evidence-based approach.

What is Evidence-Based Practice?

By evidence we primarily mean information gained from credible scientific research studies, including clinical trials and experimental studies.  An influential definition was provided by Sackett et al. (2000): “Evidence-based practice is the integration of best research evidence with clinical expertise and patient values.”

A recent editorial in the British Medical Journal defined Evidence-Based practice as follows,

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.  The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

The team of authors add the following remarks regarding evidence-based practice in general medicine which, in our view, apply equally well to the practice of hypno-psychotherapy,

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.  Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.  Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.  (‘Evidence based medicine: what it is and what it isn’t’, Editorial, BMJ 1996; 312:71-72)

As the founder of Cognitive Therapy, Aaron Beck, argues, to a large extent scientific method can be seen as a refinement and extension of ordinary “common sense.”

In his approach to external problems, man is a practical scientist: He makes observations, sets up hypotheses, checks their validity, and eventually forms generalisations that will later serve as a guide for making rapid judgements of situations. […] Throughout his development, man repeatedly uses the prototype of the experimental method –without recognising it.  (Beck, 1976: 12)

Likewise, all therapists, necessarily, already formulate and check hypotheses in their own, individual clinical practice. Weitzenhoffer, one of the leading authorities on hypnotism, writes,

Why this emphasis upon a scientific approach?  It is because the scientific method, which in many instances, is just good plain common sense, has been found this far to be the best available method, certainly the most suitable, for the acquisition of useful, effective, knowledge. (Weitzenhoffer, 2000: 18)

The Evidence-Based philosophy merely encourages clinicians to reflect on this process and develop it to embrace more a sophisticated way of interpreting the data of their own experience and that of others.

Clinical practice is fundamentally the applied branch of the science of health.  In view of the success of the applied branches of other sciences, should we not seriously consider an applied branch for the science of health along the lines of the definitions just given?  Should that not then be what we as “clinicians” should practice?  Can any psychotherapist seriously consider carrying out her work without giving due consideration to those scientifically established facts that pertain to her practice?  (Weitzenhoffer, 2000: 19)

From the 1990s onward, “evidence-based” approaches to treatment have become increasingly popular.  Increasingly, this trend is extending to the practice of psychotherapy and hypnotherapy.  The official National Occupational Standards require hypnotherapists to be competent in designing treatment plans based upon ‘evidence from documented research and the success of the interventions concerned.’ (NOS, Element CH-H1.4).  The Standards also require hypnotherapists to know and understand ‘the information available on effective complementary healthcare and how to evaluate and use this information within [their] own practice.’ (NOS, Knowledge & Understanding, E2-3.)

Do Therapists Intuitively Know What Works?

Sometimes therapists object that they can tell what works and what doesn’t simply by observing their own experiences without looking at other people’s research.  Personal clinical experience is an essential factor in deciding how to help clients but there are other factors which need to be considered,

  1. Confirmation bias. There is a well-documented tendency for people to look for evidence to support their own presuppositions.  Therapists need to be careful to ask themselves whether they are interpreting evidence in the way other people would, or being selective in a way that merely confirms their own prejudices.

 

  1. Failure to follow-up. It is normal practice to measure the success of treatment after 6 weeks, 6 months, or even a year or more.  Therapists who base their judgement only on the feedback received from clients during sessions, and not on long-term measures, are very likely to statistically over-estimate the success of treatment as a result.

 

  1. Absence of real-world exposure. Some therapists carry out treatment without asking clients to test their improvement out in the real world, in vivo.  Clients may report feeling better in sessions but relapse when they encounter the situations which previously triggered their problem.  For example, a phobic might not know how much improvement they have made until they have tried to face their fears in reality, outside of the consulting room.

 

  1. Non-specific factors. Research consistently shows that many different forms of therapy have broadly similar success rates, despite using an enormous variety of theories and techniques.  The factors which psychological therapies have in common, their “non-specific” factors, are therefore likely to account for most of the perceived benefits of treatment.  For example, clients’ expectations about improvement, emotional support, therapist reassurance, etc., are such non-specific factors.  Therapists need to compare their success with a given technique against meaningful baseline figures, therefore, in order to know whether client improvement is due to the specific techniques used, or to non-specific elements in the therapeutic relationship.  Assuming that a technique “works” simply because a client gets better afterwards is known in philosophy of science as the post hoc ergo propter hocfallacy, from the fact that someone gets better after a therapy technique it does not follow that they got betterbecause of the therapy technique.

 

  1. Measurement bias. Certain ways of measuring client improvement may mislead therapists.  In particular, over-dependence upon a single measurement of client improvement, especially a single subjective measurement such as a SUD (subjective units of disturbance) scale, may create exaggerated estimates of client improvement.  In research, it is common practice to employ a battery of tests, e.g., validated questionnaires, physiological measures, and observation of behaviour change in order to arrive at a more reliable measurement of a treatment’s effects.

Evidence-based practice doesn’t mean ignoring your own personal observations, just being careful to interpret things as objectively as possible, and acknowledging what other people have found when they have carried out research in similar areas.

Recommendations for Evidence-Based Hypno-Psychotherapy

There are a number of recommendations that can be made to therapists seeking to adopt an Evidence-Based approach to their practice.

  1. Evidence-Based Theory. Aim to interpret the practice of therapy primarily in terms of credible, modern and mainstream scientific research, insofar as it is possible to do so, e.g., in the fields of health science, psychology and neurology.
  2. Occam’s Razor. Theories should be avoided, or at least questioned, which depend upon reference to pseudoscientific concepts or unnecessary/unverifiable hypotheses.  Psychotherapeutic theories, that is, should be consistent with the law of scientific parsimony, or “Occam’s Razor”, which states: “Entities are not to be multiplied without necessity.”  This principle requires that before new or controversial concepts are introduced it must first be confirmed that established ones are incapable of explaining the phenomena in question.  In developing 19th century hypnotism, James Braid applied Occam’s Razor by demonstrating that the new and controversial concept of “animal magnetism” was unnecessary to explain the therapeutic improvements and other effects observed.  Instead Braid demonstrated that “well-established” concepts like expectation, imagination, suggestion, attention, habit formation, etc., were sufficient to account for the observable phenomena produced.  Hence Braid wrote, ‘There is, therefore, both positive and negative proof in favour of my mental and suggestive theory, and in opposition to the magnetic, occult, or electric theories of the mesmerists and electro-biologists.  My theory, moreover, has this additional recommendation, that it is level to our comprehension, and adequate to account for all which is demonstrably true, without offering any violence to reason and common sense, or being at variance with generally admitted physiological and psychological principles.’  (Braid, 1851).

 

  1. Evidence-Based Practice. Utilise therapeutic techniques supported by a credible and comprehensive interpretation of relevant research in this area, insofar as it is reasonable and practicable to do so.  Eschew the use of techniques which have generally been shown to lack empirical support, or which research has suggested may be harmful, insofar as it is consistent with the well-being and best interests of the client, and other ethical considerations, to do so.

 

  1. Research Journals. Keep abreast of current research in your field by subscribing to one of the leading research journals, e.g., The International Journal for Clinical & Experimental Hypnosis (IJCEH).  These provide essential information on the latest research studies reviews with respect to the clinical practice of hypnotherapy.

 

  1. Clinical Textbooks. It is also important to study other contemporary sources of evidence-based theory and practice, such as books published recently, i.e., within the last ten years or so, and written by credible authors. Credible psychotherapy textbooks should be expected to reference a range of similar books and journal articles in their bibliography section, and this can be taken as a rough indication of the breadth and quality of research upon which they are based.  Well-established texts will often have gone through several editions, such as the current 4thedition of Hartland’s Medial & Dental Hypnosis by Heap & Aravind.  The best hypno-psychotherapy textbooks are often quite specialist hardback publications and may therefore be expensive.  Important textbooks are sometimes out of print, but most may be easily obtained from large online booksellers.

 

  1. Research Methods. Have at least a basic understanding of psychotherapy and medical research methods, sufficient to be able to interpret the meaning of articles in contemporary research journals.  An understanding of the research issues relating to psychotherapy and hypnotherapy will also help you to interpret the outcome of your own interventions.

 

  1. Clinical Supervision. Make use of formal clinical supervision to review your practice and discuss the outcomes in relation to research in the field.  For instance, supervision offers an ideal opportunity to discuss how research might guide clinical decisions you make with regard to the interventions used to help a specific client.

 

  1. Continual Professional Development (CPD). All hypnotherapists should attempt to maintain their appreciation of developments in the field through ongoing training and professional development.  This may consist of attending high-quality CPD training or professional conferences, etc.

Conclusion

Evidence-based practice is not meant to replace clinical skill and experience but to supplement and inform it.  The interests of the client are paramount.  Every client, however, has the right to expect a high standard of care from their therapist.  That includes the expectation that the therapist should be informed with regard to research in his field, and basing his actions upon a considered interpretation of credible scientific research. One need not kowtow blindly to “science.”  Still, we must recognise that there is an implicit contract between practitioners in psychology and psychiatry and the clients who seek their help.  This involves the assumption that the techniques of mental health specialists are based on scientific grounds. […] In this sense, it is a very profound responsibility of the clinical practitioner that he be in position to show some of the ties between what he practices and the background of formal theory that makes up the body of knowledge in his field.   (Singer, 1974: 5) Please contact the Register for Evidence-Based Hypnotherapy & Psychotherapy (REBHP) for further information or advice. References Beck, A.          (1976).  Cognitive Therapy & The Emotional Disorders. Braid, J.           (1851).  Electro-Biological Phenomena, etc. Braid, J.           (1853).  Hypnotic Therapeutics. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000).  Evidence based medicine: How to practice and teach EBM, 2nd edition. Singer, J.L.      (1974).  Imagery & Daydream Methods in Psychotherapy & Behaviour Modification. Weitzenhoffer, A.        (2000).  The Practice of Hypnotism. Back to Cbthypnopsy.