Clinical Hypnotherapy & Hypnosis

VOLUME 38 NUMBER 2 Spring 2016 The Australian Journal of Clinical Hypnotherapy & Hypnosis

The Memory Wars: Notes from the Frontline and a History of the Holdouts Dr. Travis Gee

The Vivify Specific Induction: A Resource Therapy Action Dr. Gordon Emmerson

Eeny Meeny Miny Moe: Who Can Practice I Don’t Know? Dr. Leon W. Cowen

ISSN 0810-0713

Volume 38 Number 2 Spring 2016

Contents

The Australian Journal of

Clinical Hypnotherapy & Hypnosis An interdisciplinary journal dedicated to advancing the art, science and practice of hypnosis

The Australian Journal of

This publication has been adopted as the official journal of the Australian Society of Clinical Hypnotherapists www.asch.com.au

Clinical Hypnotherapy & Hypnosis

An interdisciplinary journal dedicated to advancing the art, science, and practice of hypnosis

Contents 1

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Editorial

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The Memory Wars: Notes from the Frontline and a History of the Holdouts

Eeny Meeny Miny Moe: Who Can Practice I Don’t Know? Dr. Leon W. Cowen

Dr. Travis Gee

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About the Contributors

The Vivify Specific Induction: A Resource Therapy Action

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Publication Standards

Dr. Gordon Emmerson

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Subscription Information

THE AUSTRALIAN JOURNAL OF CLINICAL HYPNOTHERAPY & HYPNOSIS Volume 38 Number 2 Spring 2016

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Eeny Meeny Miny Moe: Who Can Practice I Don’t Know? Dr. Leon W. Cowen, PhD (Clinical Hypnotherapy) AdvDipCH, MASCH, FAHA, MACA, MPACFA Academy of Applied Hypnosis, Hornsby, NSW, Australia University of Western Sydney, NSW, Australia

Abstract The Australian government is focussed on regulating health professionals (COAG, 2006). Government committees (AHMAC, 2011) have nominated clinical hypnotherapy as a modality which may or may not become part of this process. This paper asks: how can an emerging profession develop strategies to deal with unknown regulations that may or may not, directly or indirectly, impact its professional existence?

Introduction Over the last decade South Australia and Western Australia have removed legislative restrictions on the practice of clinical hypnotherapy (SASH, 2010; WAG, 2005). Is this the forerunner for national regulation? Currently the Australian government is working towards regulation of health professionals. This regulation may or may not involve clinical hypnotherapy, but our profession is mentioned in documents published by the Australian Health Ministers’ Advisory Council (AHMAC 2011). The clinical hypnotherapy profession is more than ever before in a state of change. Cohesion within the profession has seen the formation of a nationally based peak body—the Hypnotherapy Council of Australia (HCA), which is developing policies and procedures for the profession as a whole. With the formation of the HCA (HCA, 2012e), the profession is demonstrating a united approach to the resolution of professional issues which may impact future advancement (Kelly, 2012). It is unknown if regulation will even occur, and if it does, when and how it will occur. Preparedness may rely on reviewing what has happened to other complementary and mental health professions (NSWHD, 2002). Using this as a guide we can prepare our professional associations, teaching institutions and practitioners for this uncertain future. 26

In Australia there is an increasing trend to improve regulation to protect consumers from currently unregulated health practitioners (AHMAC, 2011). While there have been moves in the area of clinical hypnotherapy to remove legislative restrictions (Parliament of South Australia, 2009c), other Commonwealth authorities have undertaken work to establish a single national system (AHMAC, 2011) of registration and accreditation, as well as to pursue further reforms in mental health (COAG, 2011). This process commenced with the State and Territory regulation of thirteen professions and agreements to pursue further reforms in mental health (AHMAC, 2011). In light of the state deregulations, clinical hypnotherapy is now free to be practised anywhere in Australia. However, with mooted mental health industry reforms, we need to ask: what issues has the profession already addressed and what areas need further considerations to prepare for the proposed restructuring? The Australian Health Professional Regulatory Agency (AHPRA) is undertaking the regulation of the thirteen professions. The creation of AHPRA (COAG, 2008b) has established a national authority designed to regulate health professionals. In 2006 AHPRA recommended a single national registration, as well as a sole national board for health professional education (AHPRA, 2010). Part of the aim of a single national registration authority is to reduce red tape and promote more flexibility between health professionals working in different States and Territories (AHPRA, 2011a). Clinical hypnotherapy has its own new peak body. The membership base of The Hypnotherapy Council of Australia (HCA) includes clinical hypnotherapy associations, as well as teaching institutions. The mission statement states: “The HCA provides a cohesive identity for the diversity of hypnotherapy methodologies and promotes their professional and ethical practice for the benefit of the community” (HCA, 2012a). The role of the HCA is to unite, protect and guide the profession (Kelly, 2012) whilst working toward the ultimate goal of recognition and acceptance of clinical hypnotherapy at government, professional and community levels. To assist in these endeavours the HCA strives for consensus and seeks to provide guidelines for the profession (HCA, 2011). In the quest for recognition, clinical hypnotherapy has received some acknowledgements. The Australian Counselling Association (ACA) has developed a College of Counselling Hypnotherapy (ACA, 2009), and the Psychotherapists and Counsellors Federation of Australia (PACFA, 2011) has commenced forming its own College of Clinical Hypnotherapy (PACFA, 2016a). PACFA has also funded and published a literature review in which ten studies were reviewed on the application of hypnotherapy to chronic pain and anxiety (Davis, 2016). The presentation of this research was considered sufficiently important that it was accepted as a continuing professional development activity (PACFA, 2016b). The Australian Counselling Association published a similar literature review. The aim was of the review was to develop an up-to-date (within Australia 2002-2012 and internationally 20072012) literature review to outline the literature pertaining to the effectiveness of hypnotherapy (Cowen, 2016). The publishing of these reviews indicates that both THE AUSTRALIAN JOURNAL OF CLINICAL HYPNOTHERAPY & HYPNOSIS Volume 38 Number 2 Spring 2016

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Australian peak counselling and psychotherapy associations consider clinical hypnotherapy an important component of the Australian mental health sector. As clinical hypnotherapy takes its place within the Australian mental health sector it is expected to demonstrate professional standards. With the establishment of a clinical hypnotherapy peak body and the acknowledgment of the modality from national counselling and psychotherapy bodies the profession is advancing despite the fact that the training standards needed to enter the clinical hypnotherapy profession are yet to be established A review of Australian clinical hypnotherapy training would show it is comprised of government accredited and non-government accredited courses. Currently no Australian university provides a degree in clinical hypnotherapy. Vocational sector training equivalent to government accredited Training and Further Education (TAFE) Colleges have been developed, and provide qualifications under Australian Skills Quality Authority (ASQA). Government accredited courses have existed in Australia since 1998 (AAH, 1998). Non-government accredited training also exists. Government accredited and non-government accredited courses providing qualifications with the same nomenclature (such as Diploma or Advanced Diploma), and are a source of confusion for the profession (Gibson, 2012). The non-government accredited courses may or may not be at the same level of the government accredited training. The only conclusion that can be drawn is that the non-government accredited courses have not been assessed by the prevailing government regulator to determine their levels of training. In addition to these considerations is the fact that other health professionals also practice clinical hypnotherapy, and their training standards in this specialist modality may also be undetermined (Parliament of South Australia, 2009b). With training standards still being established and the evidence based research into clinical hypnotherapy efficacy, which forms the basis of many government considerations, being sparse (Parliament of South Australia, 2009a, 2009d) the government is determining whether or not regulatory measures are required.

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The five point plan (ACSQHC, 2012, p. 1) identifies areas of focus for all health professions. The five points are: 1. National standards 2. Formulate national accreditation schemes 3. National data set development 4. Publishing and reporting 5. Knowledge and leadership for safety and quality. To ensure the implementation of these goals the government requires a mechanism of reporting hence forming regulations and regulatory authorities. National regulations provide the government with substantial benefits. Apart from the public protection aspect these benefits include portability of qualifications so a practice can be established anywhere in Australia, uniformity of standards across the States and Territories, members of national registers adhering to the same standards, and less bureaucracy (AHPRA, 2010). Government funding is more easily accessed when all practitioners adhere to the same standards and quality assurance is high (AHMAC, 2011). On July 2010, ten health professions were regulated under the National Registration and Accreditation Scheme for the Health Professions. A supplementary list of nineteen unregistered classes of health practitioner (which included hypnotherapists) was identified and interested parties were invited to comment. There appears to be an anomaly in so far as whilst regulations are being implemented, restrictive legislation in South Australia (Parliament of South Australia, 2009c; SASH, 2010) and Western Australia (WAG, 2005) has been repealed. Governments have made no direct statements regarding the apparent anomaly, but the changes seem to reflect an intention to regulate health professions under Federal jurisdiction by a national registration scheme (AHMAC, 2011). This view is supported as the New South Wales (NSW) Health Care Complaints Commission released their Code of Conduct (NSWHCCC, 2012) which is under review by other States and Territories (AHMAC, 2011) and could lead to a nationally accepted code of conduct.

The Australian Health Workforce Ministerial Council (AHWMC) identified the need for national consultation to consider consumer protection for consumers who use unregistered health practitioners (AHMAC, 2011). The areas of primary concern were: sexual misconduct, non-proven cancer care, financially manipulative practitioners, conduct which placed the public at risk, and misleading and deceptive conduct (AHMAC, 2011). For government to protect the public some type of regulatory model is considered necessary (AHMAC, 2011).

Awareness of the move from State-based authorities to national authorities would seem to be our starting point in dealing with possible changes. To understand what the various government entities are and how they interact would make the task of dealing with the potential regulatory issues that could affect clinical hypnotherapy is, in my view, our first objective. We are fortunate that other professions such as counselling and psychotherapy (ACA, 2010; PACFA, 2004; Rogers, 2008) are also dealing with regulatory issues. Their experiences can inform our endeavours.

One aspect of consumer protection is quality assurance (ACSQHC, 2010). Quality frameworks as a mechanism for safety and quality of care provided in all healthcare settings are being promoted and endorsed by governments and adopted by professional health associations (Rogers, 2012) to address the growing requirements for profession driven, self determined quality assurance standards.

Changes can be made at the association level, the practitioner level, and at the trainer level. Each level has the ability to understand the requirements already in existence for other health professionals and reposition to meet the requirements. Associations can address the issues of best practice and quality assurance (ACSQHC, 2012) by initiating policies, undertaking research and encouraging practitioners to develop


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more relevant skills (such as research skills), achieve qualifications that have an established educational rigor such as government accredited qualifications which have recognition (Bupa, 2009; COAG, 2009) and presenters can hold professionally acknowledged credentials (not necessarily qualifications) in the industry, as well as training qualifications, which are currently the Certificate IV in Training and Assessment (TAE40110) (DEEWR., 2012). These actions increase the proficiencies of the individual practitioner, but how does the profession benefit overall? Benefits to the profession are achieved when the constituent parts of the profession (associations, teaching institutions and practitioners) make changes in line with the overall goals. With quality assurance (COAG, 2008b, 2009) and the subsequent regulation of health professionals, the clinical hypnotherapy profession as a whole may need to make some changes. The process of Voluntary Self Regulation (VSR) began as part of the Working Party and Development Committee from 2007-2011 (HCA, 2012e) and culminated with the commencement of the Hypnotherapy Council of Australia (HCA). The Hypnotherapy Council of Australia provides a cohesive identity for the profession of clinical hypnotherapy. It is comprised of professional associations and teaching institutions.

Other regulatory models used in Australia are co-regulation, which is an occupational regulatory system that brings together the best of self-regulation and statutory registration. In Government Monitored Self Regulation (GMSR), the ATMS model of coregulation, the occupation is controlled by the occupation, but has the support of the Government. In essence, co-regulation is a system whereby the Government provides the occupation with the legal authority to implement and monitor its own standards (Khoury, 2009, p.11; NSWHD, 2002).

The aim of the HCA National Board is to assist in developing the profession to ensure recognition at government and community levels (HCA, 2012e). Policies from governmental departments and agencies (ACSQHC, 2010; COAG, 2008b, 2009, 2011) are discussed within the HCA (HCA, 2011) and have the potential to become the base from which HCA policy is determined. Using this approach the HCA can prepare the clinical hypnotherapy profession for outcomes whether they arrive tomorrow, in ten years or never.

Negative Licensing Negative licensing would not restrict entry into clinical hypnotherapy. A set of objectives and standards is developed against which the practitioner would be independently assessed if a complaint should arise. This allows action to be taken against any practitioner who does not comply with required standards or code of practice. Negative licensing would also allow for penalties to be applied, ranging from warnings to court prosecution (AHMAC, 2011).

The potential outcomes of regulation are unknown. Currently, the only regulations directly impacting on clinical hypnotherapy are those from voluntary self regulation put forward by the HCA. The HCA provides guidelines (HCA–EP, 2012; HCA, 2012b, 2012c, 2012d), which can be accepted or not accepted by their member associations and training institutions individually or as a whole. The ramification of non-compliance with the HCA guidelines is removal from membership. In contrast, direct government regulations are not guidelines. Government regulations are legally enforceable and can involve prosecution (AHPRA, 2013).

Statutory Registration This regulatory method provides a statutory code of conduct for practitioners. This option would stipulate accepted professional standards of practice for all clinical hypnotherapists and would apply in all States and Territories (AHMAC, 2011).

Another example of a direct impact could involve a change of policy by professional indemnity insurance underwriters, which may alter clinician premiums; or private health insurers, which impacts clinical hypnotherapy directly by the inclusion or exclusion of hypnotherapy in health insurance policies. An example of an indirect impact could be a decision by the government to ensure that all health practitioners adhere to a specified code of conduct. The area of greatest speculation still remains whether any external regulation will occur.

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If additional regulation occurs in the health sector there is no guarantee that clinical hypnotherapy will be targeted even though it appears on the list of unregistered practitioners (AHMAC, 2011). There are various regulatory models and potentially differing opinions on which regulatory model is best for the clinical hypnotherapy profession. The model that has been chosen is Voluntary Self Regulation (Kelly, 2012). Self Regulation or Voluntary Self Regulation is outlined as: ...is in essence a self-imposed model of occupational regulation. Selfregulation typically involves a peak body or association with voluntary membership, supported by voluntary standards, recognised educational standards and an ethical code of conduct (Khoury, 2009, p.9).

Government Registration NSW has introduced a scheme to better regulate unregistered health practitioners. There are two main elements of the scheme: 1. A statutory code of conduct that sets standards that apply to all unregistered health practitioners (and registered health practitioners who provide health services that are unrelated to their registration), and 2. An avenue for dealing with complaints from consumers about practitioners who breach the code of conduct (AHMAC, 2011). Title Regulation Only Title regulation means that only registered practitioners who have demonstrated competency or who hold specified qualifications are able to use certain restricted titles. Title regulation is similar to co-regulation as it usually requires compulsory


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membership of a professional association. A government statutory board regulates the profession. Unregistered health care professionals and other people would not be permitted to use the techniques of the profession (NSWHD, 2002). Title and Practice Restriction This form of regulation involves title restriction, as outlined in ‘Title Regulation Only’, as well as the restriction of specified practices, which carry significant risks if performed by unqualified persons. It is possible that only the techniques which carry the risk would be restricted (NSWHD, 2002). The Current Climate To demonstrate the clinical hypnotherapy profession is dealing with government concerns of national standards, national accreditation schemes, national data set development, publishing and reporting, and knowledge and leadership for safety and quality (ACSQHC, 2012, p.1) would involve formulating a policy on national standards, quality assurance and public protection. The development of a policy to increase educational standards for practitioners and trainers, which conforms to those of other regulated health professionals, whilst providing a pathway for existing clinical hypnotherapists would be a challenge which our profession is very capable of rising to meet. The challenge of meeting professional concerns is being achieved in a variety of ways. Since 1998 clinical hypnotherapy has achieved four government accredited training providers with professional accreditations from professional associations such as the Royal Australian College of General Practitioners (RACGP, 2002), Australian Association of Social Workers (AASW, 2013), Counsellors and Psychotherapists Association (NSW) (CAPA, 2013a, 2013b) and the Australian-Traditional Medicine Society (ATMS, 2013). These acknowledgements demonstrate the capacity of the profession to meet professional standards. The academic development of the profession is also continuing with the admission of the author to PhD candidature in the School of Medicine at the University of Western Sydney. The formation of the HCA in 2011 (HCA, 2012e) is a foundational achievement as this newly formed peak body will address policy issues within clinical hypnotherapy. Such policies would include quality assurance, public safety, and a policy on research to demonstrate the efficacy of clinical hypnotherapy. As the HCA develops and evolves it would address the relevant professional issues. The profession would manage issues such as quality assurance, public safety and educational standards then automatically embrace those practitioners who were an asset to the profession and provide government with the evidence it requires to acknowledge the profession. Clinical hypnotherapy is currently establishing an evidence base. A recently published literature review outlined possible reasons for the paucity of evidence based research in clinical hypnotherapy (Cowen, 2016). One major contributing reason is the fact that clinical hypnotherapy training is only available in the vocational sector whilst research methodology and the research process are taught in the higher education

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sector. As most clinical hypnotherapists are not university graduates they do not have the training to conduct research which reduces available researchers. Research is being undertaken by medical practitioners, psychologists, dentists, nurses and other health professionals who use clinical hypnosis as an adjunct to their primary discipline. The conceptual differences between a health practitioner who uses hypnosis/hypnotherapy as an adjunct to an existing health practice, as opposed to clinical hypnotherapy being the primary modality, potentially skews research data. Government documents refer to evidence (COAG, 2006; NHMRC, 2009a, 2009b), which means research is required to be undertaken to establish the effectiveness of a particular treatment (ACSQHC, 2010). For example, government funded schemes (like WorkCover) seek reliability and validity to confirm the effectiveness of the mental health therapies they fund. WorkCover is a scheme which provides compensation for workers who are injured in the course of their employment (LAQ, 2012). WorkCover NSW outlined government expectations in its Psychological and Counselling Services Regulatory Framework (WorkCover NSW, 2009). The document clearly outlines evidence based practices as an item by which service will be assessed. A 2008 WorkCover survey revealed “psychological and counselling services are not routinely evidence based and focused on return to work” (WorkCover NSW, 2009, p.4). One common feature of WorkCover and other organisations who fund mental health therapies is to ensure that a procedure is effective. A foundation of this is a common feature in WorkCover regulatory frameworks being “promotion of evidence based practices and the promotion of measurable outcomes by service providers” (WorkCover NSW, 2009, p.5) For clinical hypnotherapy to receive access to government funded schemes it would be required to fulfil criteria expected of other WorkCover recognised providers. Criteria include the establishment of professional competence, ethical practice, holding professional indemnity insurance, and the delivery of evidence based focussed services (WorkCover NSW, 2009). For clinical hypnotherapy to be accepted as a reliable, validated and effective alternative to existing “best practice” methodologies, it would seem logical that clinical hypnotherapy would need to develop an evidence base. COAG provided a guide for ministerial councils which can serve as guidelines for clinical hypnotherapy to develop its own professional procedures (COAG, 2007). Ministerial councils commonly use these guidelines to form proposals which frequently have a regulatory impact. If regulation occurs (and there is no way of knowing when it will occur or even if it will occur) previous regulatory models can serve as a guide. In the current political environment both State and Federal authorities liaise with professions prior to introducing regulation (Kelly, 2012). Government liaison would mean there would be time to mobilise the profession. To do what, is the question? Do we lobby to maintain an unregulated profession which maintains standards established by one sector of the profession while another sector argues that hypnosis is an adjunct to a range of medical modalities (ASH, 2008)? In light of the existing trend towards the regulation THE AUSTRALIAN JOURNAL OF CLINICAL HYPNOTHERAPY & HYPNOSIS Volume 38 Number 2 Spring 2016

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of health professionals, the various government entities supporting regulation of mental health (AHMAC, 2010, 2011; AHPRA, 2011b; COAG, 2006, 2007, 2008a, 2008b, 2009, 2011; PoSA, 2009; Senate Community Affairs Committee Secretariat, 2008) can we wait until the bell has been rung? Do we have the time to answer the questions that will be asked before the toll of the bell fades? Eeny, meeny, miny, moe: who will practice I don’t know?

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Kelly, M. (2012). HCA – Update to the Profession – October 2012. Retrieved October 26, 2012, from Hypnotherapy Council of Australia: http://www.hypnotherapycouncilofaustralia.com/newsletter.htm

Rogers, S. (2012, Sept 19). ATMS – Framework Article from Sandi Rogers. ATMS Newsletter. SASH (2010). [Memo to All SASH Members].


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About the Contributors Senate Community Affairs Committee Secretariat. (2008). Towards recovery: mental health services in Australia. Canberra, ACT: Senate Printing Unit, Parliament House Australia. Retrieved from: http:// www.aph.gov.au/Senate/committee/clac_ctte/mental_health/report/report.pdf WAG. (2005). Psychologists Registration Act 2005. Perth, WA: Western Australian Government. Retrieved from: http://www.austlii.edu.au/au/legis/wa/num_act/pa200528o2005241/s2.html WorkCover NSW. (2009). Psychological Counselling Services Regulatory Framework Consultation Paper 5785. WorkCover NSW.

Dr. Leon W Cowen

Dr. Leon W Cowen has been a clinical hypnotherapist since 1974. As the Executive Director of the Academy of Applied Hypnosis he achieved the first Vocational Education Training (VET) accreditation for clinical hypnotherapy in 1998. Leon’s passion is focused on elevating clinical hypnotherapy to the same status as other recognised health professions. He has served the profession as an executive member of the Australian Society of Clinical Hypnotherapy (ASCH) and the Australian Hypnotherapists’ Association (AHA) and was the inaugural Chair of the Hypnotherapy Council of Australia’s Educational Advisory Body (HCA – EAB). Continuing his focus on clinical hypnotherapy standards and education, he was awarded a PhD from the School of Medicine, University of Western Sydney (UWS) for his thesis Developing Clinical Hypnotherapy Educational Guidelines Through Consensus. Over his 40 years (plus) professional career, Leon has been invited to present at various conferences, associations and universities. He provides submissions on clinical hypnotherapy issues to government, non-government agencies and health related organisations. He holds memberships and is a supervisor with several clinical hypnotherapy, counseling and psychotherapy associations. Currently, Leon is the Chair of Hypnotherapists Enhancing Life for People (HELP). HELP is a volunteer organisation that develops projects to assist the clinical hypnotherapy profession and raise the profile of clinical hypnotherapy within the community. The current project is to teach clinical hypnotherapists to write articles for professional (peer reviewed) journals. Academy of Applied Hypnosis Hornsby, NSW Australia Email: [email protected] Website: www.aah.edu.au

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