This article is derived from what seems to be the age old question as to whether hypnotherapy is technique or profession . This contravention affects the acceptance of hypnotherapy conducted by those without a formal qualification in another discipline, be it medicine, psychology, counseling 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 utilized, 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 counseling skills in the clinical practice of hypnotherapy. This could be accomplished 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 counsel / psychotherapist who use hypnosis as an adjunct, counselors / 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 practice 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 recognized 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 practice 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 Labor granted an occupational design of hypnotherapist (Boyne 1989). In the United Kingdom, with the advent of the popularity of complementary therapies, hypnotherapy is recognized as one of the four discrete disciplines that have been studied to determine clinical efficiency (Mills & Budd, 2000).
The clinical application of hypnosis, hypnotherapy, is a directed process used in order to effect some form of behavioral 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 counseling:
Counseling 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 counseling is to assist the respondents 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 behavioral change. If this is the case, the primary difference between counseling and hypnotherapy is the use that is made of trance states. That is to say that hypnosis is the vehicle for the counseling dynamic.
The Vontress definition does not analyze how the changes take place. The knowledge of most of the main counseling models would suggest that the use of skills, primatically creating the core conditions, or the 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 among those practicing hypnotherapy.
For this study, a thorough review of literature relating to the theoretic basis of hypnotherapy was undertaken, but few references could be found which either confirm or deny the hypothesis that hypnotherapists utilize the therapeutic alliance and listening skills, or that their awareness, or not, of the 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 which responded. This quantitative data wave information as to the qualifications of the respondents, their self-reported knowledge and use of counseling skills and the therapeutic alliance, and their primary mode of therapy.
Counseling skills seem to play a significant part in the professional practice of hypnotherapy. For the majority of those questioned, 85.4%, counseling skills play a role in their hypnotherapeutic practice. There was divergence in the responses of those who do not use counseling 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 counseling is not necessary in this process. Some cite evidence of hypnosis being therapeutic back to Milton Erickson and as his work was the therapeutic so was their. Erickson stated that much of hypnosis is based on the development and maintenance of rapport (Erickson & Rossi 1980). Most counseling training emphasizes the importance of rapport and considers rapport building (or the creation of the core conditions) to be a counseling skill. It can be there assumed that although these practitioners use counseling skills, they are either unaware of this or unwilling to acknowledge it.
Despite being qualified in other areas, the questionnaire uncovers an interesting finding concerning 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 favailability publicity and with many leading figures who claim that hypnotherapy was not a therapy but a series of techniques, still a major 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 responses. This subset included a male and a female therapist from each of the three groups: qualified counselors / 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 counseling 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 which held advanced degrees in counseling or psychotherapy.
The data appears to indicate that although the understanding of what hypnosis is remains fairly consistent through the three target groups, the depth of knowledge seems greater in the qualified counselor / psychotherapist categories as opposed to those who have only a training in hypnotherapy as their qualification. Additionally, the data indicates that the qualified counselors / psychotherapists have a greater understanding of the therapeutic process and how and because their form of treatment is successful compared to those with only training in hypnotherapy.
This study also finds that counseling skills appear to be used, at least to some extent, within the practice of hypnotherapy whatever the practitioner realizes this or not and so the importance of counseling skills within the context of the therapeutic process can not 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 efficiency 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 counseling 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 responses. 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 counseling. 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 counseling skills, that counseling 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 counseling or psychotherapy, which again goes some way to validate the importance of counseling skills in the practice of hypnotherapy. Further, as shown in this paper, there are practitioners who are credentialed in other mental health fields who identify themselves as hypnotherapists as opposed to counselors or psychotherapists. The implications of this may be that as far as public is concerned the title hypnotherapist is easier to recognize than the plethora of counseling and psychotherapy titles currently in use. Alternately, these practitioners may not be interested in the biases of leading practitioners and prefer to determine their own identity.
It is held 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 have been 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 counseling also seemed to have a better theoretic understanding of therapy as a concept and how hypnotherapy fits into the hierarchy of therapies.
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 Organization of Complementary and Alternative Medicine in the UK 2000: A report to the Department of Health” Exeter, Center for Complementary Health Studies
Vontress, C (1988) Social Class Influences on Counseling Denver, Love
Waxman, D (Ed) (1989) Hartland's Medical and Dental Hypnosis 3rd Edition London, Bailliere Tindall