Hypnotherapy Technique or Profession?
This is a paper I co-wrote with my friend and colleague Fiona Biddle, enjoy
This paper 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 counselling 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 practise 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 labelling 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- ie 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 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.
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.
The authors hope to undertake further research in this area, and extend their studies to incorporate the efficacy of therapy. Any readers who have been involved in similar studies of have relevant data would be welcome to make contact.
Boyne, G (1989) Transforming Therapy Glendale, Westwood
Erickson, M & Rossi, E (1980) The Collected Paper of Milton H Erickson Vol 1 New York, Irvington
Hogan, K (2000) Hypnotherapy Handbook Eagan, Network 3000
Mills, S & Budd, J (2000) “University of Exeter Professional Organisation of Complementary and Alternative Medicine in the UK 2000: A report to the Department of Health” Exeter, Centre for Complementary Health Studies
Vontress, C (1988) Social Class Influences on Counselling Denver, Love
Waxman, D (Ed) (1989) Hartland’s Medical and Dental Hypnosis 3rd Edition London, Bailliere Tindall